Feb 09 2010

Religion, Assimilation, Vaccination

Published by at 3:25 pm under Bioethics,Public Health

Posted by: John Culhane on Tuesday, February 9th, 2010

According to this story, an outbreak of mumps has occurred in counties just north of New York City, mostly in Orthodox (or Hasidic) Jewish communities, where parents routinely seek religious exemptions to vaccination requirements for their children. In total, about 1,000 kids (mostly adolescents) have been afflicted.

When I was a kid, we all came down with mumps, and more: measles, chicken pox, and so-called “German measles” (rubella) were the most common. Mostly, these were cause for missing a week or so of school, but nothing more. Yet all of these diseases are properly seen as deadly threats to the public’s health. Measles, which is particularly likely to spike in a population where a significant number go unvaccinated, routinely killed many hundreds of kids each year in the U.S. alone, caused about double that number of permanent brain injuries, and cost the health insurance system dearly through the many thousands of hospitalizations. Mumps, in addition to the quasi-endearing chipmunk cheeks we all had, was most often associated with deafness as a complication.

The outbreak sits at the confluence of two infuriating obstacles to vaccination: bad science and over-deference to religion. Apparently, the outbreak in the U.S. was an unwanted import from the U.K., where a mumps outbreak had spread to some 4,000 people. Vaccination exemptions are frighteningly common there, mostly because of a thoroughly refuted study that purported to show a link between vaccinations and autism. Indeed, the prominent British medical journal that had published the study, the Lancet, last week retracted it after a British medical panel concluded that the lead author had been unethical and had conflicts of interest. And a flood of other studies since that one had already disproven its autism-vaccination link.

Once mumps made its way into the U.S., the congregation Orthodox and Hasidic Jews proved fertile ground for its spread. One locus was an area within Rockland County, New York, where a large, insular community of Hasidic Jews lives. I grew up in Rockland (in a nearby town), and know the community. On a Saturday, we’d drive past the synagogue-going residents — all on foot, the men in simple black garb with a defining hairstyle, the women in long dresses with head covering. Quite an insular community, and one in which, (credible) rumor had it, the families didn’t pay property taxes on their homes (each being considered a holy place). So there’s one exception from general laws that they enjoyed.

I didn’t know until recently of this other exemption for vaccinations, and I don’t support either carve-out. (In my view, no church should be exempt from paying property tax in the first place. There’s another whole post there, but I digress.) Respecting religion doesn’t require subjecting the public to needless risk. Quite the contrary: Religion is honored when we find and protect a proper, separate space for it. But personal or congregational religious expressions should end where the interest of the general public — a secular interest — is imperilled. Thus, it’s hard to justify a ban on the burka in public spaces (compare, say, driving, if evidence showed that the compromise to peripheral vision was significant), but equally hard to justify allowing the adherents of any religious group to forego vaccination. It’s easy to forget the public health success story of vaccinations. This recent story on those confronting new challenges from polio, many decades after they were first afflicted, should be reminder enough — but probably won’t be.

What’s the public health threat if everyone else is vaccinated? First, there’s the threat to the unvaccinated children themselves. The state has an interest in them, too, and at least one state supreme court has held that this interest makes unconstitutional any non-medical exemption. Beyond that, the vaccinations are themselves not completely effective. Thus, even the vaccinated kids can come down with the illness in question; and some of them will if a sufficient number in the population is not vaccinated. So it’s not “just” a question of getting to decide what to do about your own child’s health, an issue that the state has an interest in anyway.

When they first enacted religious exemptions to vaccination requirements decades ago, states did do under duress: Congress tied recognition of such exemptions to federal funding. It’s time to wake up and repeal these laws before we undo this great public health accomplishment.

 

Opinions expressed in this blog are not necessarily those of Widener University or its School of Law.

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