Measles Vaccination Is a ‘Religious Obligation’.

Measles is back. The US, which declared the disease eliminated in 2000, has had over 981 cases confirmed in 26 states this year, including two cases in Massachusetts.

Like the majority of states, the Commonwealth has a religious exemption for schoolchildren immunization requirements. (Massachusetts is not among the 15 states that allow exemptions for “personal or moral beliefs.”) That may soon change. At the beginning of June, Massachusetts State Representative Andy Vargas filed HD 4284, a bill that would leave only a medical exemption.

Michael Grodin says that is a good idea: “Religious and philosophical exemptions to the vaccine should not be allowed.” He is a professor in the Center for Health Law, Ethics & Human Rights at the School of Public Health, a professor of psychiatry and of family medicine at the School of Medicine, and a psychiatrist at Boston Medical Center.

Although growing anti-vaccination sentiment is mostly based on debunked claims about vaccines causing autism, religious exemptions have come into the spotlight with the current measles outbreak, which has been most pronounced in Ultra-Orthodox Jewish communities in New York State (which eliminated its religious exemption this month). But Grodin, who is also core faculty of Judaic Studies and a member of the Division of Religious Studies of the College of Arts & Sciences, says that Judaism and the rest of the world’s major religions overwhelmingly support vaccination. “I would argue, and most rabbis would argue, that it’s not only acceptable to get the measles vaccine, but a religious obligation,” he says.

Grodin spoke with SPH about where religious doctrine comes down on vaccination, what makes the measles vaccine especially vital, and the new Department of Health and Human Services (HHS) rule allowing healthcare workers to refuse care based on moral and religious beliefs.

Why do you consider the measles vaccine a particularly unambiguous necessity?

Measles is the perfect storm of all of the reasons that everyone needs to have vaccinations. We could have a different discussion if it was not as contagious of a disease, if it was not as serious of a disease, if it was very difficult to diagnose the disease, if it did not have a particular pattern of infectivity, if there was not a vaccine or if the vaccine had serious side effects. But this is the perfect combination of everything which says that parents, I would argue, must vaccinate their kids unless there is some medical reason not to.

The idea that the vaccine can cause autism has been debunked many times. There is just no evidence that there is any connection, and besides, you are weighing it against the life-threatening aspect of measles for children. When I was in training 40 years ago, we used to see kids die from measles. They would develop serious pulmonary disease and pneumonia, and brain swelling which could lead to death or lead to significant neurological problems. It is a very serious disease.

Why is it important to set up requirements that children get vaccinated?

Herd immunity. If you get the vaccination rate above 95 percent or so, the virus does not stay around. That can and has been achieved. In Massachusetts, before kids go to school, something like 93 percent are vaccinated.

You have to get the measles, mumps, and rubella vaccine between one year of age and up to 15 months for your first dose. Babies who are too young to be vaccinated and who do not get the maternal antibody are a vulnerable population. It is very risky for those children in particular if there is a virus around.

All 50 states allow medical exemption for vaccinations, and that is quite justifiable. You would not want to vaccinate children who have an immunodeficiency or a chronic disease that is going to put them at serious risk if they get the vaccine. That also means that you don’t want them being exposed to the disease. You want to have a high vaccination rate because of the people who cannot get vaccinated. You want to protect them.

States have the authority to render their police powers to protect the health, safety, and welfare of their residents—we know that you can quarantine people who have been exposed, and isolate people who actively have the disease. That is the responsibility of the state, and so the state has the authority to require evidence of vaccination before a child enters public school. If the family refuses to vaccinate, homeschooling may be necessary.

Why do you disagree with having a religious exemption for this vaccine?

What it means to be under religious exemption is not exactly clear. The quote is, `sincere religious belief,’ whatever that means.

There may be fringe groups within religions that say this, that, and the other, but no major religion has objections to vaccinations in their doctrine, nor would you expect them to. Religions are generally into protecting life and preventing disease.

In terms of Jewish law, all the chief rabbis and all the major rabbis have said that not only is it acceptable to get a vaccination, but it is mandatory—assuming you are not putting your own life at risk. You are protecting life. Life is sacred. Life is of infinite value. You are created in the image of God, and you need to get vaccinated because you need to protect God’s gift.

What about Christian Scientists?

There is a recent official statement of the Christian Science Church, which says,

`For more than a century, our denomination has counseled respect for public health authorities and conscientious obedience to the laws of the land, including those requiring vaccination…. Most of our church members normally rely on prayer for healing… So we’ve appreciated the vaccination exemption and sought to use it conscientiously and responsibly, when it has been granted. On the other hand, our practice isn’t a dogmatic thing. Church members are free to make their own choice on all life-decisions, in obedience to the law, including whether or not to vaccinate their children. These aren’t decisions imposed by their church.’

That is their religion. But this has always been a problem for Christian Science.

There was a very famous case, the Twitchell case in 1993, which I was involved in. A child was sick. The parents were Christian Scientists, and they took their child to a faith healer. The child got very sick and eventually died. The parents went on trial for manslaughter. The question was, do they have a duty to take their child to seek medical care? The answer is they probably did. Maybe they can go to the faith healer initially, but at some point, they should have realized that the child needed medical care. It’s a child welfare issue.

Why is religious exemption a child welfare issue?

The First Amendment doesn’t protect you from protecting your kids.

Children can’t consent. Parents are supposed to speak in the best interest of their child. You can martyr yourself, but you can’t martyr your children. No religion requires you to martyr your children.

Jehovah’s Witnesses refuse blood. We have had cases at the hospital which I have been involved with where parents refused to transfuse their children. We get a court order and transfuse their kids. That does not mean it is not a serious decision that has enormous implications.

How can public health practitioners interact with religion without running into issues of paternalism?

I would argue that engaging with religious groups is necessary if one is going to bring about successful public health policies. If you can understand religion and its traditions, you may come to understand why your public health program is failing.

What are your thoughts on the new HHS “conscience and religious freedom” rule?

The problem with conscientious objection by clinicians is that you are licensed by the state and you serve a public function. It is not your right to have a medical license. It is your privilege. At some point there is negligence, and then you get your license revoked.

If you do not believe in abortion, you do not want to go work in an abortion clinic. But you have to do an emergency pregnancy termination in the emergency room independent of your beliefs. That is why you have an emergency room. If you have a walk-in clinic, do not put up a sign that says `Emergency.’

In Massachusetts, licensed physicians actually have a legal obligation to stop on the road if somebody is injured and needs help. That does not mean you have to know how to do anything except call 911 and let the EMTs take over. You have an obligation as a medical professional to do your due diligence and do the best you can.

If you are in private practice you can choose your patients outside of an emergency situation. But at some point there is malpractice. If you are a white supremacist, we do not let you practice. You cannot discriminate against suspect classes: race, gender, sexual orientation, etc.

The bottom line is that nobody should be harmed. Your beliefs are one thing, but when you act on your beliefs, it is a different story.

—Michelle Samuels