Each update in the nationwide surge of measles cases takes Dr. Paul Offit back to the battlefield that was Children’s Hospital of Philadelphia during a regional outbreak that began in 1990. By the time it ended the following year, more than 1,400 city and suburban residents had contracted the disease, and nine children were dead.
Then an attending physician at the University City hospital supervising the care of young measles patients, Offit “saw how bad it could get," he recalled. “It was harrowing, like a war zone.”
Back then, the outbreak was centered on Faith Tabernacle Church in North Philadelphia as well as the offshoot First Century Gospel Church in the city’s Juniata section. Both congregations believed that the Bible opposes all means of healing apart from "God’s way.” Hundreds of children in the church school had not been immunized, and six of them died. Within those congregations alone, 486 people were infected.
Nationwide, in the current scourge, 764 cases have been reported this year through May 3, according to the Centers for Disease Control and Prevention. Pennsylvania has five of them, all in Allegheny County; New Jersey officials have confirmed 14.
Some of the highest numbers have come from New York, Detroit, and Baltimore, in particular from several Ultra-Orthodox Jewish communities.
Although the “vast majority of Jews, including those who are Ultra-Orthodox, have their children vaccinated,” there are some outliers who refrain out of fear and misinformation, said Rabbi Joshua Waxman, president of the Board of Rabbis of Greater Philadelphia.
For the most part, the Philadelphia area’s Orthodox communities support immunization, said Rabbi Albert Gabbai of Congregation Mikveh Israel in Society Hill. Judaism teaches that “when one life is lost, it’s like a part of God is lost,” he said. “It is an obligation to do everything we can do to preserve life. If a vaccination has been scientifically proven to preserve life, then it is an obligation to preserve one’s life.”
New York, with the highest tally of cases, has more insular enclaves of Jews than Philadelphia. Anti-vaccination activists often target such small communities, whose religious views or cultural isolation make them vulnerable to claims disproved by medical science and rebutted by faith leaders, said Offit, now the director of the Vaccine Education Center at CHOP and author of several books on the subject, including Bad Faith: When Religious Belief Undermines Modern Medicine.
In most states, Pennsylvania and New Jersey among them, residents are allowed to opt out of immunization because of religious beliefs, said Rita Swan, a former Christian Scientist who advocates on behalf of children’s right to medical care. Nonetheless, she said, courts have repeatedly ruled that parents do not have a constitutional right to deprive their child of immunization and that states have the authority to compel it in the interest of public welfare.
Families from a variety of religious traditions decide not to immunize their children despite repeated assurances from faith leaders that God won’t object. They disagree, or they may be confused about the theology, said Rene Najera of Hanover, Pa., an associate scientist at Johns Hopkins University who edits the History of Vaccines website for the College of Physicians in Philadelphia.
Like some Ultra-Orthodox Jewish parents, they become targets of the anti-vaccination movement. Waxman cited a measles outbreak in 2017 in the Somali American community in Minnesota.
In 2014, the Amish community in Ohio was hit by 383 cases of measles, mostly among unvaccinated families.
The Amish have no religious objection to vaccination, but the community’s cultural understanding of what it means to be healthy contributes to some families’ decisions not to immunize, said Steven Nolt, professor of history and Anabaptist studies at Elizabethtown College in Lancaster County.
The Amish view health as “Can I do my job? Can I get up in the morning and work?” Nolt said. With that perspective, preventive medicine may take a back seat. Amish people also value tradition, so if immunization wasn’t a priority for parents or grandparents, “that may trump the authority of modern medicine or the claims of science,” he said.
In a 1994 outbreak of measles among Christian Scientists in Missouri and Illinois, 190 people contracted the disease. None had been vaccinated.
Most Christian Scientists “normally rely on prayer for healing,” according to a statement on the denomination’s website, but members are free to make their own choices about vaccinations.
“Christian Scientists report suspected communicable disease, obey quarantines, and strive to cooperate with measures considered necessary by public health officials. We see this as a matter of basic Golden Rule ethics and New Testament love,” the statement reads.
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For some, including Jews and Muslims who advocate maintaining the body’s purity, vaccinations that use gelatin derived from pigs may be problematic. Both traditions prohibit eating pork.
But the vaccines made from porcine gelatin go through such an extensive transformation that the process may remove the impurities, said Katherine Klima of Cherry Hill, a nurse-midwife and Islamic ethicist.
“The majority opinion is that it would be better if the companies that make the vaccines would use something else, but since they don’t, we need to use the vaccine because, clearly, its benefit is greater than any potential harm,” said Klima, a former director of nursing at the National Guard Hospital in Medina, Saudi Arabia.
In Catholicism, some believers objected to immunization starting in the 1960s, when researchers developed vaccines by using tissue from fetuses that didn’t survive because of abnormality, illness, or elective abortion, said Najera, the Johns Hopkins scientist.
In 2005, however, the Vatican released “Moral Reflections on Vaccines Prepared From Cells Derived From Aborted Human Fetuses,” stating that immunization protects children, serves the common good, and should not be rejected. The cells used now are many generations removed from fetal tissue, Najera said.
Yet within every religion are groups that do not agree with its leaders’ pronouncements, he added. “We are trying to inform the public that at the high levels of major religions, there is no objection to vaccines. Hopefully, we will change some minds.”