It is somewhat surreal that in 2019, it is necessary to write an article explaining to people why a vaccine that prevents cancer is a great thing. It is also a sign of the strange times in which we live that we have measles, mumps, and whooping cough outbreaks occurring nationally, as well as a case of tetanus in an unvaccinated 6- year old child that led to a 57-day hospitalization. Following a measles outbreak at Disneyland in 2015, the state of California mandated vaccines be required for school attendance, eliminating “personal belief exemptions.” Our great state of Texas, however, still allows people to “conscientiously” exempt themselves from the requirement with a waiver from the state.
I would like to point out that there is nothing “conscientious” about refusing vaccines. The word, conscientious, means “guided by our conscience to do what is right.” If we, especially as Jews, are committed to doing the right thing for ourselves, our children, and society, immunization is crucial. Not every vaccine is 100% effective for every person, but herd immunity, when most of the population has been fully vaccinated, helps protect those few of us who may not mount a good response to a particular vaccine or who have not yet been vaccinated. When we stop vaccinating our children, we are reducing herd immunity and making it more likely that epidemics will continue to occur, as they have started to do in the last few years. We are also seriously endangering those with the lowest immunity among us who are not be able to be immunized due to cancer or other immunodeficiencies. How can we call such actions conscientious?
It is sad to contemplate how many children have been harmed in the decades since Andrew Wakefield, formerly a British gastroenterologist, wrote his disgraceful, fraudulent article, which was published in Lancet in 1998. Lancet was a previously highly reputed British medical journal (with a now well-deserved reputation for anti-Semitism), and it was difficult then to understand why a poorly done study with so little power involving only 12 children, was published to begin with. It took 12 years for Lancet to finally retract the article after discovering evidence that Wakefield made up the data while working for lawyers who were suing the vaccine companies. His medical license was revoked in Britain, and although he cannot practice in the U.S. either, he makes his home in Austin where he continues to influence parents not to vaccinate. These parents, unfortunately, are the same people for whom medical evidence is immaterial to swaying their opinions.
Unfortunately for the poor parents grasping for any reason why their child had autism, the idea that a vaccine could be to blame took hold. In the years since the study was published, there have been numerous studies costing millions of dollars trying to see if the Wakefield study was real. Time and again, they have concluded that there is no link between vaccines and autism. The newest study was just published and involved more than 650,000 children over a 10-year span. In an article about the study, it is mentioned that there were 206 cases of measles in the U.S. just in January and February of 2019, which is higher than the total number of cases in all of 2017. It also mentioned an outbreak in an Orthodox community in New York City that started with a child who contracted measles while in Israel. It is truly a chilul Hashem that this is the type of publicity that Orthodox Jews are generating. The diseases which are making a comeback now due to parental refusal to vaccinate had been largely eradicated from the US before vaccine refusal started to become commonplace.
I want to give one anecdote to relate how very effective the early and timely administration of vaccines can be. There is a bacterium called Haemophilus influenza B, known as Hib, which was the leading cause of meningitis in children in the 80s. Children, who were previously healthy, could fall ill and die or be permanently disabled from this disease very quickly. Before I started medical school, nearly all pediatricians had seen patients die of this disease. The first vaccine that came out for Hib was in 1985, targeting two year-olds. It had almost no effect on morbidity and mortality of the disease because most of the affected children were under two. Two years later, a vaccine came out starting at two months of age. The vaccine started to be given commonly the year I started medical school. I have never seen a case of the disease, which many of my colleagues just two or more years older had seen frequently. This example shows why early immunization is so important. For more excellent information about vaccines and why vaccine refusal is such a bad idea, I heartily recommend two books by Dr. Paul Offit of Children’s Hospital of Philadelphia: Autism’s False Prophets and Deadly Choices.
We have a moral obligation to take care of our health. In an article which explores some of the halachic origins of this obligation, Yosef ben Shlomo Hacohen and Richard H. Schwartz, Ph.D., quote from Exodus (Beshalach 15:26) shortly after the splitting of the Red Sea and just after the people complained about the water being bitter, and Hashem told Moshe to throw wood into the waters and then they became sweet. In the next pasuk, Hashem says:
אם שמוע תשמע לקול ה אלוהך והישר בעיניו תעשה והאזנת למצותיו ושמרת כל חקיו כל המחלה אשר שמתי במצרים לא אשים עליך כי אני ה רפאך.
“If you will listen to the voice of your God and do what is upright in his eyes and keep his commandments and all his statutes, all the maladies that I put on the Egyptians, I will not inflict on you. I am Hashem your Healer.”
In the same article, the authors also discuss the words of the Rambam (Rabbeinu Moshe ben Maimon), who in addition to being a prolific Torah scholar and author of Mishneh Torah and Guide for the Perplexed, was also the personal physician of the Sultan in Egypt. The Sultan once asked him, “How do I know that you are an expert physician, since during the period that you have been here, I have never been ill, and you have not had the opportunity to test your skills?” Maimonides replied by giving the credit to Hashem as the Great and Faithful Physician but also added that just as God promised his people that because he is their healer, he will protect them from all the diseases of Egypt, the best test of the personal physician’s skill is the ability to prevent illness. Were the Rambam alive today to witness the frequent vaccine refusal amongst our people, I have no doubt that he would condemn such practice sharply.
Finally, I return to the original premise of this article, which is the importance of administering the HPV vaccine (Gardasil 9) which prevents nine human papillomavirus subtypes associated with cervical cancer, cancers of the head and neck, anal cancer, and genital warts. Gardasil should be given in two doses between the ages of 9 and 15, optimally 6-12 months between doses. If initiated after 15, three doses are required. The vaccine seems to be most immunogenic and effective in younger ages (part of why two doses suffices at a younger age, but requiring three after age 15). The vaccine cannot treat HPV disease, so once someone is infected with an HPV subtype, there is less chance of adequate prevention from subsequent cancers.
While religious Jews can argue that their children should not be at risk for these diseases, and I certainly hope they are correct, I also think we should prevent cancer whenever we have the chance. While the rates of cervical cancer are lower in Orthodox communities, they are not zero. We continue to screen for this cancer as part of women’s health, and screening programs have resulted in early detection and treatment of cervical cancer. As we are not God, we can never know for sure what the future holds for any individual; what solitary lapse in judgement a person might have or the experiences one’s bashert might have had in a past life before becoming baal teshuva. Not everything that happens in a person’s life is even voluntary. If a violent act befalls one of our children, God forbid, should the suffering of that person be compounded by also getting cancer when we could have prevented it? As Jewish parents, it is our obligation to do whatever we reasonably can do to keep our children physically, mentally, and spiritually healthy. Making sure they have the HPV vaccine series as well as the other recommended vaccines is a part of our parental (and halachic) obligations.
Michelle Kravitz is a pediatrician with Forest Lane Pediatrics and is also the current Chair of Pediatrics at Medical City Dallas. She is a graduate of Johns Hopkins University and Uniformed Services University of the Health Sciences School of Medicine. She is married to Brian Kravitz, a fellow USUHS graduate and a pediatric anesthesiologist at Children’s Health, and they have three adult children. She and Brian are members of Shaare Tefilla. Dr. Kravitz thanks Ilana Pister, MD, a pediatrician involved in community medicine in Brooklyn, NY, for her excellent editorial assistance.