At the urging of 28 area physicians, Pittsburgh’s three Jewish day schools have all enacted vaccination policies stricter than those mandated by the state.

Community Day School, Hillel Academy and Yeshiva Schools now do not recognize the right to an exemption from immunization based on religious or philosophical grounds.

The new standards were set forth in a letter from the physicians to area Jewish schools last spring. They proposed that vaccination — with certain medical exceptions — should be mandated by Jewish schools as “an active step toward ... fulfilling the mitzvah to preserve health.”

While many herald the policy as being in accord with Jewish law and principles, others see it as infringing on individual freedoms, and valuing the welfare of the many over the rights of the few.

In Pennsylvania, children are required by law to follow a prescribed schedule of vaccinations before they are admitted to public or private school. Parents may claim exemption from that requirement on religious grounds, on the basis of a strong moral or ethical conviction, or if they provide a physician’s written statement that immunization may be detrimental to their children’s health.

The stricter policies now in effect at the day schools, as well as Beth Shalom and Rodef Shalom preschools, prohibit a religious or philosophical exemption to vaccination. In addition, these schools will only accept a medical exemption signed by a state-licensed primary health care provider, rather than just any physician chosen by the family.

The Jewish Community Center of Greater Pittsburgh’s Early Childhood Development Center still recognizes Pennsylvania’s religious exemption to vaccination, said Kelly Gable-LaBelle, division director of Early Childhood Services.

Drs. Jonathan Weinkle and Deborah Gilboa, both of the Squirrel Hill Health Center, spearheaded the movement to increase vaccination in the Squirrel Hill Jewish community last spring, following an outbreak of measles in western Pennsylvania.

“Vaccination is without question one of the two best things that have happened to public health in the last 100 years,” Weinkle said. “The other being [closed] sewers.”

The letter notes that current immunization guidelines are developed by a standing committee of the Centers for Disease Control, in collaboration with the American Academies of Pediatrics and Family Practice, and “represent the combined expertise of our nation’s leading epidemiologists, infectious disease specialists, and primary care physicians, and are designed to maximize immunity to vaccine-preventable disease at the earliest possible age, with the least burden on families and the maximum amount of safety.”

“Given the strength of this recommendation,” the letter continues, “it should be incumbent upon every Jewish individual to follow these recommendations unless the individual’s physician specifically advises them not to because of a direct risk to their own health.”

Weinkle said the Center embarked on a campaign to increase vaccination in Jewish schools because studies show that when schools insist on vaccination, more people communitywide vaccinate as well.

“We had patients saying they did not want to vaccinate, and it offended me both medically and Jewishly,” Weinkle said. “There is no official Jewish objection to vaccination. Actually, it is quite the opposite; it should be obligatory.”

Rabbi Scott Aaron, community scholar at the Agency for Jewish Learning, agrees.

“In general, Jewish law holds that saving life through proven medical means is a commandment,” Aaron said. “Immunizations have, by and large, been shown, in general, to be proven medical techniques to accomplish this goal of life-saving. As long as there is no individual risk from vaccination to the recipient — or the vaccine is an unproven treatment — as long as that’s the case, then Jewish law mandates vaccination. Accordingly, Jewish law would then support vaccination policies in Jewish schools in general.”

Susan Friedberg Kalson, CEO of the Squirrel Hill Health Center added “a rationale for a religious exemption in Jewish schools does not make sense.”

While Community Day School and Hillel Academy have always required vaccinations as a prerequisite to admittance into school, Yeshiva Schools changed its policy as a result of the campaign last spring.

“Since the request was made [to not recognize a religious exemption to immunization], we don’t accept new families in Yeshiva without a medical reason to not vaccinate,” said Rabbi Yisroel Rosenfeld, dean of the school.

Although Yeshiva will not accept new families without proof of vaccination, there are three or four families already in the school whose children are not immunized.

“For the families who have been here all along, we are not going to send them out,” Rosenfeld said. “We try to encourage them to vaccinate, but we don’t turn out children that have been here already.”

In discussions Yeshiva officials had with the Board of Health, “We decided that if there is an outbreak of a disease, at that point, we would ask all nonvaccinated children to stay home,” Rosenfeld added.

Weinkle says that having unvaccinated children at school can pose a serious health risk to others.

Those whose health is put at risk by exposure to nonvaccinated people include transplant recipients, who cannot receive vaccinations that contain live viruses, Weinkle explained. Also at risk is the 1 to 2 percent of the population that is vaccinated, but somehow does not become immune to certain diseases, and babies and young children who have not yet been vaccinated.

“In modern medicine, vaccination is one of the safest and most effective interventions that we’ve developed,” said Dr. Jim Lando, public health physician with the Allegheny County Health Department.

Yet advocates for individuals choosing to avoid any risks associated with vaccination see the elimination of a religious or philosophical exemption as an infringement on the rights of the individual.

Barbara Loe Fisher is co-founder of the National Vaccine Information Center, an organization that supports the right of consumers to “make educated, voluntary health care choices,” according to its Web site.

According to Loe Fisher, the federal vaccine injury compensation program, established by the National Childhood Vaccine Injury Act of 1986, has paid more than $2 billion to families of children who have been injured or died as a result of vaccination.

“Vaccination should not be separated out from the informed consent paradigm,” she said.

Since the establishment of the CDC and American Academy of Pediatrics recommendations regarding vaccination requirements, Loe Fisher continued, families seeking medical exemption from vaccination have found it rough going.

Because it’s hard for a family to find a physician to provide a medical exemption, Loe Fisher said, many must rely on the religious or philosophical exemption, available in almost all states, to avoid vaccination.

She is not in favor of a private school refusing to accept those exemptions which are provided for by state law.

“It is questionable for a school to narrow those exemptions and not allow a parent who believes a child is at risk to take an exemption,” Loe Fisher said.

“This issue about vaccinations raises some very interesting issues in Jewish culture,” said Peter H. Meyers, professor of clinical law at the George Washington University Law School. Meyers, who is Jewish, directs the vaccine injury clinic at GWU Law School, and teaches courses on vaccination law and illegal drugs.

“It is the classic distinction between the rights of an individual and the right of the state or the government,” he said.

“The theory of vaccination is you take some small risk for yourself, but we ask everyone to run that small risk to protect society in general.”

Under American law, he said, “there is a right of individual autonomy; the government can’t force you to do some things.

There is support in Jewish law for a medical waiver, Meyers continued. “We’re not going to sacrifice people if we know they’re going to die for the greater good. This is not American or Jewish law. The state is not supreme.”

The religious exemption poses a different set of issues, Meyers said. Even if it could be argued that there is no basis in Judaism for a religious exemption, it does not necessarily imply that a Jewish family should be prohibited from claiming a religious exemption based on personal beliefs.

“Where do you draw the line?” Meyers asked. “To have a religious exemption, do you have to have it as a core part of your religion, or can it be your personal philosophy? What if you have just a strong philosophical or religious belief? Some states say a mere moral objection is enough.”

Meyers does not believe that Jewish law would limit the protection given to conscientious objectors to only those whose formal religions promoted such objections. Likewise, he doubts Judaism would limit a moral objection to vaccination to those whose religion required abstinence from immunization.

“We respect the freedom of consciousness in America,” he said.

(Toby Tabachnick can be reached at tobyt@thejewishchronicle.net or 412-687-1263.)