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Vaccine Nation

When my father was 7, he contracted polio. In a few days he lost all feeling in his legs. He was confined to bed for six months. His second grade teacher came to visit, bringing a record of Eine Kleine Nachtmusik and a hardcover of “Alice in Wonderland.” (Thus began a love of great music and psychedelic literature that would last the rest of his life.) He took apart radios and clocks and put them back together. He underwent agonizing physical therapy. He fantasized about hanging out with FDR, taking the therapeutic waters and getting massages in Warm Springs, Ga. Eventually he learned to walk again, lurching around in metal braces and on old-school crutches. One foot remained gnarled, lumpy and uneven; one leg was withered. Despite repeat surgeries, he walked with a pronounced limp for the rest of his life.

And he was one of the lucky ones; he lived. In the epidemic’s worst year, 1952, there were 58,000 cases of polio reported in America — 21,269 children were left with mild to disabling paralysis; 3,145 died. After the Salk vaccine became available in 1955 and the Sabin vaccine debuted in 1962, the incidence of polio plummeted. Childhood immunization has been credited with preventing 450,000 yearly cases of polio worldwide.

Another vaccine that’s saved thousands of lives is the one for bacterial meningitis, an illness that has been described as the only disease that can kill a healthy young adult in 24 hours. Before the vaccine debuted in the United States in 1987, one in 200 kids under the age of 5 contracted the disease every year; 600 died. In fiction, the disease killed John Henry in Carson McCullers’s “The Member of the Wedding.” In a scene that haunted my childhood, his death took 10 days and two brutal pages. “John Henry had been screaming for three days and his eyeballs were walled up in a corner stuck and blind. He lay there finally with his head drawn back in a buckled way, and he had lost the strength to scream.” Today, though, the incidence of this disease has declined by 98%. It seems a relic of literature, as irrelevant as measles. Actually, I’d always thought measles were a minor annoyance, like chicken pox. I had no idea they could lead to pneumonia, diarrhea, brain inflammation and death. But how was I to know? Thanks to a vaccine, it was declared eliminated from the U.S. in 2000, before either of my kids was born.

Today, though, more parents are opting out of childhood vaccinations. They feel that the shots are no longer necessary, that they traumatize children, that they cause illness, and most commonly, that they cause autism. Thousands of anecdotal reports and dozens of poorly designed studies link autism to vaccines, but there has been only one seemingly credible study, published in the British medical journal The Lancet in 1998, that found a link. As it turned out, the study had major methodological flaws. Of the 12 children in the study, some turned out to have had developmental disorders before they were vaccinated and most were clients of a lawyer who was preparing to sue vaccine manufacturers. Oops. The Lancet retracted the study in 2004, and 10 of its 12 co-authors disavowed it.

Still, the notion that vaccines cause autism persists. And today, 48 states allow parents to opt out of childhood immunizations. Every state except Mississippi and West Virginia permits parents to say no on religious grounds, and 18 states let them say no for “personal or conscientiously held” beliefs. Most of these opt-out laws were passed in the last few years…and wouldn’t you know it, disease rates that had fallen for years are climbing again.

In 2005, a 17-year-old girl carried measles back from a visit to Romania, spreading it to 34 people, most of whom were unvaccinated. More than 100 Orthodox Jews, most of them small children, in a heavily-unvaccinated community in Manchester, England, were also recently diagnosed with measles. The Centers for Disease Control and Prevention also described a 2004-05 outbreak of whooping cough among 345 unvaccinated Amish. But it’s not just the unvaccinated who are at risk; the more unvaccinated people there are, the more everyone is at risk.

Jewish communities have long struggled with issues of personal freedom and collective responsibility. In December 2005, the Conservative movement’s Committee on Jewish Law and Standards held an unusual open meeting to consider a question posed by a Solomon Schechter Day School principal: Was the school obliged to accept children who were unvaccinated? The children’s parents had said their decision not to vaccinate was a “religious” one. Rabbi Joseph Prouser of the Little Neck Jewish Center in Queens, wrote the teshuvah; the committee debated and then unanimously accepted it. His view: If a child does not have a serious medical condition that would make being vaccinated risky, he or she must be vaccinated to go to Schechter.

Prouser told me, “My thought process was that the best medicine and science available to us indicates that required immunizations are safe and effective, and unvaccinated students present a danger not only to themselves but to those around them, even students who’ve already been vaccinated, because the efficacy of a vaccine varies from patient to patient, and any reduction in the threshold of immunity in the community can spark an epidemic.”

His teshuvah makes for fascinating reading. Prouser draws a parallel between vaccination and the biblically mandated building of a parapet on every home. The parapet is intended to prevent people from falling off your roof. “Construction of a parapet on a dangerous roof is an undertaking that necessarily involves a measure of risk,” he writes. “The parapet is thus a particularly apt paradigm for immunization, a protective measure deemed obligatory despite a statistical risk incurred in the process.” Prouser also discusses Maimonides’s list of 24 transgressions that are to be met with bans of excommunication. Among them: “One who has something harmful on his property, for example a vicious dog or an unsafe ladder, we place him under a ban until he removes the hazard.” Hey, hippie parents, your unvaccinated kid is a potentially lethal pit bull of germs!

Prouser also explores the history of compulsory vaccination in the United States. In a 1905 case, Jacobson v. Massachusetts, Mr. Jacobson refused to comply with a Cambridge city ordinance requiring residents to be vaccinated against smallpox. He was fined five dollars. Why? The Supreme Court declared, “The spectacle would be presented of the welfare and safety of an entire population being subordinated to the notions of a single individual who chooses to remain a part of that population.” (Much like parents who count on other families’ vaccinating their children to confer immunity on their own.)

The teshuvah shows that Jews have been backing vaccination for centuries. Rabbi Nachman of Bratzlav (1772-1811) said, “One must vaccinate every baby against smallpox before the age of three months, for if he does not do so, he is like one who sheds blood. And even if one lives far from the city, one must travel there even if the season is very cold…” (Ach, it’s cold! Let the baby get smallpox!) Prouser dryly notes that this ringing endorsement of immunization comes from someone who was generally not a fan of physicians. He quotes Rabbi Nachman as having said, “It was difficult for the Angel of Death to kill everybody in the whole world, so he appointed doctors to assist him.” Ha, ha, Rabbi Nachman!

Prouser also shares a story of primitive immunization strategy from Rabbi Shalom Buzagli, a Moroccan-born member of London’s Ashkenazi Bet Din in the 18th century. “Buzagli reported that a child who had survived smallpox and was in the final stages of recovery would be given a handful of raisins to hold until they were warmed by his hand,” writes Prouser. “The raisins would be given to a healthy child to eat, producing the same effect as variolation: mild infection resulting in immunity.”

Yes, I have had my children vaccinated. (Come here, honey, eat these raisins!) At the risk of sounding like Tom Cruise, I did the research; I learned the history. (Anyone who doesn’t is glib and deserves to get their couch jumped on.) I was comfortable with the level of risk involved. Ordinarily my parenting philosophy is not to judge (no one whose 2-year-old still drinks from bottles at naptime and whose 5-year-old just ate four hockey-puck-sized slabs of Hebrew National salami right before bedtime is in much of a position to throw stones) but in this case, your right to swing your fist ends where it meets my face, and your right not to vaccinate your child should end where your front door meets the rest of the world. If parents remembered how bad these diseases actually were, they wouldn’t be so anti-vaccine; it reminds me of the way 20-somethings tend to be more anti-choice than 50-somethings — the latter actually remember back-alley abortions.

All our children deserve the best chance at lifelong health. As for the brand-new vaccine that guards against the virus that causes cervical cancer…well, it’s new. I’m still researching. I need a little time before I start screaming at Matt Lauer. But if you check back with me in four years, I suspect I’ll be for it.

In the days after this piece was published, several readers pointed out that I neglected to discuss thimerosal, a preservative that was once used in many childhood vaccines. Thimerosol contains mercury, which the Food and Drug Administration acknowledged could theoretically cause “neurodevelopmental disorders,” but not autism. In any case, pediatric vaccines were reformulated between ‘99 and ‘01 to eliminate thimerosol. There was no drop in the number of kids with autism and similar disorders, as one might expect if thimerosol were indeed the culprit.

Write to Marjorie at [email protected].


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