Just Remove this Death from Me: Rabbinic Responses to Vaccination

Consistently enthusiastic rabbinic support for immunization preceded even the 1796 introduction of Edward Jenner’s pioneering smallpox vaccine. Rabbi Abraham Nanzig published a treatise (London, 1785) endorsing variolation against smallpox, providing a theological framework for his approbation:

“In God’s compassion for His creatures, He has withdrawn His hand from this dreaded disease somewhat, granting skill and understanding to talented physicians of our time, who have developed an effective, nearly risk-free treatment.”

Nanzig explains that his rabbinic methodology synthesizes Yediat Hachacham V-beqiat Harofeh – “the knowledge of the Sage and the expertise of the physician.” The typeface in the Hebrew original is configured to illustrate that this phrase forms an acrostic of the Tetragrammaton (YHVH) – boldly asserting the sanctity of the author’s task, the godliness of medical science, and the Providential nature of advances in immunization against infectious disease. Nanzig approvingly cites the earlier practice of the Jewish community of Fez. A young smallpox survivor, in the final stages of recovery, would be given a handful of raisins to hold until they were warmed in his hand. The raisins were fed to a healthy child, with the same effect as variolation: mild infection resulting in immunity.

Later rabbinic authorities hailed Jenner as a “Righteous Gentile” for his lifesaving work (the same title bestowed upon rescuers of imperiled Holocaust era Jews). Even Rabbi Nachman of Bratzlav (1772-1811), famously suspicious of “modern” medicine and its practitioners, insisted: “We must be exceedingly careful about the health of our children… and in no way lax in this matter… One must vaccinate every baby against smallpox… Those who do not do so are like shedders of blood.” Bratzlav devotees today extend their master’s counsel to “immunizations against all kinds of serious illnesses, like paralytic poliomyelitis (God save us!),” etc. Rabbi Hershel Schachter of Yeshiva University wrote that “where vaccines are mandated by the state,” the Jewish religious obligation to observe the law of the land is dispositive. In 1995, Rabbi Shlomo Zalman Auerbach, dean of Orthodox Israeli rabbinic decisors, ruled that it is even permissible to set aside the restrictions of the Sabbath in order to be immunized, should foregoing the Sabbath opportunity create a potentially life-threatening delay.

None of these rabbinic authorities denied the risks inherent in vaccination. Estimating the 1785 rate of infection attending variolation at one in a thousand, Nanzig concluded, “For such a negligible risk, we do not reject so great a benefit.” The polio vaccine, even 60 years ago, carried a mortality rate of one in a million: one thousand times safer than Nanzig’s estimate. Even such heightened safety is now considered unacceptable: the oral polio vaccine is widely rejected in the United States due to the one in 2.4 million likelihood of contracting polio therefrom. Other standard vaccines are analogously safe, rendering the Jewish religious obligation to vaccinate exponentially more manifest today than in the eighteenth century!

Contemporary rabbinic authorities have established this religious obligation as carrying scriptural authority – citing no fewer than five affirmative Commandments and three Biblical prohibitions:

• “Do not stand idly by the blood of your neighbor” (Leviticus 19:16).
• “Love your neighbor as yourself” (Leviticus 19:18).
• “Take utmost care and watch yourselves scrupulously” (Deuteronomy 4:9).
• “Be particularly careful of your well-being” (Deuteronomy 4:15).
• “Restore it to him” (The duty to restore lost property, expanded to include personal  health – Deuteronomy 22:2).
• “Do not remain indifferent” (Deuteronomy 22:3).
• “Make a parapet for your roof” (The obligation to remove hazards to public health and safety from one’s domain – Deuteronomy 22:8).
• “Do not bring blood upon your house” (Deuteronomy 22:8).

Jews have an unambiguous religious obligation to be immunized (and to immunize their children) against infectious disease. Which vaccines are included under this rubric may be determined by standard pediatric practice and state requirements for admission to public school.  “The law of the land is the Law.”  Failure to immunize is a serious, compound violation of Jewish Law.

The recent opposition of “ultra-Orthodox” Jews to vaccination, and the resultant lethal outbreak of measles in those communities, evinces isolationist disdain for secular society and civil law. It is an aberration in Jewish history, representing a grievous departure from normative Jewish practice and morality… the putative “traditionalism” of the transgressors notwithstanding. Contemporary outbreaks are, ironically, a consequence of the success of the very vaccines being neglected. Never having witnessed the devastating effects of polio or measles or smallpox, parents have become complacent. The morbid fear that impelled earlier generations gratefully to vaccinate their children (and themselves) is less palpable today… precisely because vaccines have worked so well!

In addition to running afoul of the Torah’s explicit Commandments, Jewish anti-vaxxers subvert four defining fundaments of Jewish religious life and national identity:  

1. The best science available properly drives (and in no way conflicts with) Jewish faith (Maimonides, Guide for the Perplexed 2:25).
2. Safeguarding health and life is a cardinal value, taking precedence over virtually all other religious obligations.
3. Jewish Law affirms that “the law of the land is the Law.” Jews are subject to civil authority.
4. The self-stigmatizing scandal of immunological recalcitrance and contagion among Jews is inconsistent with our founding, covenantal mission to “be a blessing” and an object of blessing by “all the families of the Earth” (Genesis 12:2-3).

The Prophet Amos issued an indictment of just such a pattern of social and spiritual subversions: “For three transgressions of Judah, for four, I will not withhold judgement: because they have spurned the Teaching of the Lord and have not obeyed His Laws. They are beguiled by delusions” (1:4).

Rabbi David Tzvi Hoffman is revered for harmonizing the respective demands of modernity and traditional Jewish piety at the dawn of the twentieth century. Regarding a controversial pediatric surgical procedure (Frankfort, 1926), he ruled: “The opinion of the father and mother has no effect one way or the other… We do not find anywhere in the Torah the right of parents to endanger the lives of their children by preventing the doctor from treating them.” Or as Pharaoh, besieged by a plague he could have prevented, said in a rare moment of moral clarity:  “Just remove this death from me” (Exodus 10:17).