The orthodox Jewish community in New York is fighting measles outbreaks. The deniers of vaccines are to blame.

Anti-vaccine officials have persuaded parents in New York to refuse vaccines for their children, causing two of the largest measles outbreaks in the state's recent history, according to local health authorities.

On Thursday, 17 people in the Williamsburg and Borough Park neighborhoods of New York City were confirmed by measles, as well as 53 people in neighboring Rockland County, for a total of 70 cases. Other cases are currently under investigation and their number is expected to increase.

What is remarkable here is that all cases occur among unvaccinated or under-vaccinated orthodox Jews, mostly children, whose parents have been the targets of anti-vaccine propagandists – some of whom are community members – according to the city's health department.

The Brooklyn group called PEACH – or Teaching and Advocating Parents for Children's Health – spreads misinformation about vaccine safety, citing rabbis as authorities, through a hotline and magazines. Brooklyn Orthodox Rabbi William Handler also proclaimed the well-dissociated link between the measles-mumps-rubella (MMR) vaccine and autism. Parents who "appease the gods of vaccination" engage in "child sacrifice," he told Vox.

In recent days, I have discussed the epidemic with orthodox Jews in New York and their concerns about the vaccine. And I learned that a minority were suspicious of vaccines – for reasons that have nothing to do with religious doctrine.

However, the fact that some Orthodox Jews live outside the mainstream, avoid technology and hold the rabbinic opinion in high esteem can make them particularly vulnerable to anti-vaxxers.

"As a religious Jew, you also get used to having a minority point of view," said Alexander Rapaport, CEO of the Masbia Soup Kitchen Network in Brooklyn, and a public face of the Hasidic community. "So, if something is not common, that does not stop you from believing it."

He also explained that some orthodox Jews in Brooklyn go to school together, worship together, live and travel together. This means that some unvaccinated people living nearby can be dangerous. But it also means that to advance public health messages, additional efforts are needed. "We see the government investing a lot in public health awareness," said Rapaport. "But it never affects Yiddish speakers or people who do not have a TV."

The story of New York is familiar: other closely united communities, such as the Somali-US-Somali community and the Amish of Ohio, have recently been affected by measles outbreaks caused by the refusal of vaccination. This latest epidemic is a reminder of how vulnerable island groups can be vulnerable to anti-cancer drugs and the unique challenges that public health advocates face in countering their messages in these communities.

Measles was eliminated in the United States in 2000, but outbreak-related epidemics have increased in island communities.

The measles virus is really scary: it's one of the most infectious diseases known to man. A person with measles can cough in a room, leave and, if you are not vaccinated, hours later, you could catch the virus by the droplets in the air that they left behind. . No other virus can do it.

So, if you are not vaccinated, it is extremely easy to get measles. In an unvaccinated population, a person with measles can infect 12 to 18 others. This is much higher than other viruses like Ebola, HIV or Sars.

In 2000, because of widespread vaccination, the virus was declared eliminated in the United States: enough people were immunized so that outbreaks were rare and deaths from measles were barely heard.

But for any vaccine to be effective, it takes a certain percentage of people in a population to be immunized. This is called "collective immunity" and means that diseases can not spread very easily in populations. With the MMR vaccine, 95% of people need to be vaccinated. Thus, only a few people who refuse vaccines can be dangerous.

Javier Zarracina / Vox

Since 2000, we have been seeing epidemics every year in populations where the rate of adoption of vaccines is lower, totaling between 37 and 667 cases. The virus usually spreads when unvaccinated travelers visit places where measles is widely spread and bring it back to other unvaccinated or under-vaccinated people in a close-knit community where some parents have decided not to use the vaccine. vaccine for their children.

This has happened in two of the largest measles outbreaks in the United States since the elimination of the disease. In 2014, measles spread among unvaccinated Amish in Ohio after a missionary brought back the Philippines virus. And in 2017, a traveler triggered an outbreak in an unaccompanied Somali-American community in Minnesota.

In New York, the current outbreaks also come from travelers who have recently visited Israel, where a massive measles outbreak is currently underway. The travelers returned to the United States and spread it among unvaccinated or under-vaccinated New Yorkers.

But this is not an isolated incident. The Orthodox Jewish community has already faced many epidemics of vaccine-preventable diseases in recent years, including whooping cough and mumps. Not later than in 2013, another measles outbreak involving 58 cases has become the city's largest since 1992, nearly a decade before the elimination of measles, and its cost of $ 400,000 to contain the city.

The reason parents do not vaccinate in New York

Most of the people I have talked to in this story have not worried about vaccine safety and have happily vaccinated their families. The majority opinion is also that there is no religious reason to avoid vaccines.

"From a religious point of view, people have to vaccinate," said Rabbi David Niederman, executive director and president of the Jewish Unified Organizations of Williamsburg. Instead, people have a duty to protect their families and the most vulnerable in their communities. "All that causes harm – you have to do everything you can to [avoid] this."

However, anti-vaccine activists use rabbinical authority and the argument that we must avoid harming to convey false information.

Consider the story of Rachel *, an Orthodox Jew in Brooklyn. When her eldest was 18 months old, she brought her baby to the doctor for the MMR vaccine. Shortly after, the girl had a fever that climbed to 106 and eventually had to be hospitalized.

"The doctor said there was no correlation with the vaccine," recalls the mother of seven, aged 11 months to 15 years. But Rachel was skeptical. After that, she noticed that her daughter was getting sick all the time. "Ear infections, viruses. I lived with the doctor. She thought vaccines could be the cause.

So, she read the shots in PEACH's pamphlets, she watched the anti-vaccine documentary Vaxxedand spoke to his neighbors about his orthodox Jewish community in Brooklyn.

"Rabbis who do not think vaccines are the way to keep a low profile," she said, "but I could name a few."

She read and heard about things that concerned her. The ingredients contained in the vaccines did not seem healthy and safe, and she heard rumors that children with autistic children would be affected immediately. (For the record, data on thousands of people over the last 50 years have shown that vaccines are extremely safe and effective.)

Thus, over the years, Rachel has vaccinated her children "less and less". His two youngest are not immune at all.

Nowadays, between taking her children to school and changing diapers, the housewife is hosting a library in her home, where parents can borrow books on vaccines and discuss what they have read. The library includes books on and against vaccination. "People can read and decide for themselves."

Her library is announced in anti-vaccine materials that are spreading in Rachel's community, and is now part of the vaccine-resistant minority – a vaccine that has helped trigger two of the largest measles outbreaks in recent US history.

"It was very difficult to dissuade parents"

PEACH

Some of Rachel's concerns are reflected in the Vaccine Safety Manual, which was written in Brooklyn by a group called PEACH – or Parent Education and Advocacy for Children's Health. (The group declined to be interviewed for this story.) The book carries the slogan: "You can still vaccinate later. You can never dump the skin, "pages of false information about vaccines, including the well-dissociated link of autism, as well as rabbi advice on" biblical command "to avoid endangering life or health of people – including the danger of vaccines.

Rabbi William Handler is another source of erroneous information about vaccines. He also argues that vaccines are at the root of autism and sharing with parents. "I'm telling parents that public health authorities like [the Centers for Disease Control and Prevention] are not interested in individual children, "he said. The best way to avoid potential damage is to avoid getting vaccinated, he advises. "[Parents] do not want to play Russian roulette with their children. It's like a child sacrifice.

Although large-scale studies involving thousands of participants in several countries have failed to establish a link between MMR vaccine and mental development disorder, it is the view of autism that the Department of New York's health is big news.

"Unfortunately, the question of whether there is any connection has really been lost and [because of] misinformation and it has been very difficult to dissuade parents, "Vox Jane Zucker, deputy commissioner of the Immunization Office in New York, told Vox. "We hear that they want to wait for the child to be bigger to know that they are not autistic, then have him vaccinated."

The challenge of fighting anti-vaccine rhetoric in remote communities

New York State does not allow parents to refuse vaccines for philosophical reasons, although parents can obtain exemptions for health and religious reasons. Once the children have reached school, they must submit evidence that their children have been vaccinated, unless waived.

According to Zucker, vaccination levels in New York Jewish schools seem average, although religious schools enjoy more religious exemptions than non-religious schools. And before children go to school, there is a problem in Williamsburg: the vaccination coverage rate is one of the lowest in the city among young children aged 19 to 35 months.

Zucker was not surprised that children affected by measles in this outbreak are still too young to go to school. According to the city's health department, the cases of measles in Williamsburg and Borough Park involved only young children between the ages of seven months and four years. (Rockland refused to provide details about the people affected, citing confidentiality issues.)

This means that there is a cohort of children for whom national immunization laws are not applicable and vulnerable to vaccine-preventable diseases.

"Once kids get to school, we know we are well vaccinated," Zucker said. "It's late, though, and that's what's linked to this epidemic."

Reaching reluctant parents for vaccination is not easy, however. The Department of Public Health sent out notifications to schools and hospitals hosting a large Jewish Orthodox population, carried out awareness-raising activities, placed advertisements and distributed posters in Yiddish and English orthodox newspapers.

Public health officials must intervene before epidemics begin

But they must do more, said community leaders, and intervene before the outbreak of epidemics.

"We have a language barrier, a cultural barrier," said Rabbi Avi Greenstein, executive director of the Jewish community's Boro Park Council, in one of the affected areas, "and it makes sense that the Department of Health [our community]. "

Post-epidemics, posters on the importance of public health vaccines will appear in community centers and bodegas in the area, said Alexander Rapaport, CEO of Masbia Soup Kitchen. But, "The posters of the city are reactionary," he added, and efforts to inform people before the epidemics are still insufficient.

Javier Zarracina / Vox

According to the latest data from the New York City Department of Health, the use of MMR vaccine has increased dramatically among children in Williamsburg since the beginning of the epidemic.

So maybe it's an opportunity to change people's point of view. "It is becoming increasingly clear that people take the position [not to vaccinate]they are an irresponsible person, an irresponsible parent, "Greenstein reiterated. "It's the challenge for the community."

* We did not use Rachel's real name because she was worried about privacy and her negative reactions.