Many of us have seen a powerful sign of hope in the arrival of the first COVID-19 vaccines, but not all of us. Some are not so excited – for various reasons, a very valid one of which is concerned about the side effects of the vaccine, particularly if they interact with existing conditions. However, Jewish law, clarified in a responsa from the Central Conference of American Rabbis in 1998, has much to say about the public health issues at play in vaccines, particularly how in this case protecting oneself is protecting many others at the same time.
On December 18, 2020, Rabbi Rachel Gurevitz of Congregation B’nai Shalom in Westborough, MA, a Scientists in Synagogues congregation from 2016-2017, presented an overview of Jewish law and values on vaccinations in her sermon at the end of the week that Covid-19 vaccines began to be delivered to frontline healthcare workers. She was joined by congregation members Dr. Elyssa Pellish, who had received her first dose as an Emergency dept. doctor the previous day. Also joining them was Dr. Andrea Ciaranello, Epidemiologist and Infectious Diseases doctor at Mass General. Dr. Ciaranello has also served on the congregation’s COVID-19 Task force, in addition to advising on several other groups serving local communities.[Read More]
Rachel Gurevitz: We’re going to take a moment of reflection tonight now on something that, of course, is incredibly timely, with all that has been in the news in this past week. I’m really delighted that we have two doctors who are members of our congregation who are with us this evening, so I want to invite Dr. Pellish to come on, and I’m gonna add you to my spotlight screen here. And I know we have Dr. Ciaranello – Andrea is also with us this evening, and we’ll call on her in a little while. But it was a somewhat spontaneous request, and I’m so pleased, Elyssa, that you were able to join us this evening for Shabbat.
Elyssa and her family have been in these last months among the many families who have celebrated a bar mitzvah in the midst of this pandemic, and so have been very much part of everything that we have been dealing with as a congregation. But [Elyssa] is also a doctor who spends some of her time in the emergency room. And as I have a chance to see so much of what’s going on in the lives of our members through the blessings of social media, I was really pleased to see that she was among probably the first group of doctors who, when the vaccine arrived in Massachusetts, was able to begin that process.
So I’m going to invite you to unmute there, Elyssa. Before we do that, I want to do a moment of blessing, and I want to share some thoughts and then engage in some conversation with you and with Andrea a little bit this evening. But can I just ask – I don’t want to feel too much like, you know, the TV reporter with the microphone up, but can you give us some sense of what the energy in the atmosphere was amongst you and your colleagues when this started to unroll this week, and the vaccine arrived?
Elyssa Pellish: Honestly, it was amazing and inspiring to be there today, watching everyone get vaccinated. Almost everyone that I know, that I work with, is, you know, signing up to get the vaccine. And I think what was so amazing today was that it’s not just the doctors that are getting it, it was the entire staff at the hospital. So it was the custodial staff, the nurses, the respiratory therapists, the secretaries, everyone who is there in the hospital risking their lives on a daily basis. And it was just, it really – people were in tears as they came in to get the vaccine. It was amazing. I’ve never seen anything like it before.
Rachel Gurevitz: Well, I can only imagine, because of all of that pent-up angst and just emotional drain of these 10-11 incredibly long months, and how incredibly intense and painful that has been so many times in those hospital wards.
Elyssa Pellish: So I think finally people are seeing a little shimmer of light at the end of this long dark tunnel.
Rachel Gurevitz: Right. So a number of my colleagues were discussing over the last couple of days, you know, “Is there a Jewish blessing?” Is there, like – what should we say for getting the vaccine? And people had different ideas. Some people were trying to be creative and write something new, but I feel that we have a blessing in our tradition for when we arrive at a significant moment, a new experience, something that we want to just pause and take in as being a moment worthy of deep, deep appreciation. And that’s the Shehecheyanu blessing, that gives thanks to God, who has given us life, who has sustained us – those of us who are able to say this blessing are present and have been sustained – and who have reached this very moment. This is the kind of the moment that we just want to acknowledge and take in. So I invite you to join with me and others who may not have received a vaccine yet, but who just want to take in that moment, that energy of the fact that this week, vaccines began to arrive and are starting to roll out, first of all, for our healthcare workers, and soon in many other parts of the community.
And we know it’s going to take a number of months before it gets to us all, but I want to take this moment to take that Shehecheyanu blessing.
Baruch atah, Adonai Eloheinu, Melech haolam, shehecheyanu, v’kiy’manu, v’higiyanu laz’man hazeh. Amen.
And so many blessings to you, Elyssa, and to so many of our healthcare workers – as you said, not just our doctors, our nurses, but so many who are going into the hospital each and every day, in so many different departments, who have been risking their lives to be of service to others. Just, there’s an enormous well of gratitude. And I know it doesn’t always feel like that when we look at what’s going on in the larger community, but for us certainly, we feel it.
I’m gonna take the spotlight off you for a moment, but don’t go away, I would like very much to invite you and Andrea – I know Andrea is with us as well, Dr. Chiaranello, who is an infectious disease and epidemiologist expert at Mass General. She has been a member of our COVID task force for the congregation, one of a couple of doctors who have been providing us with really invaluable guidance so that we can try and make as safe decisions as we can for our congregation – such enormous gratitude there. But I want to just offer my reflections tonight as a rabbi for a few minutes, and then come back to Elyssa and Andrea, just to get their response and additional thoughts.
So I guess this is the moment. It’s so interesting that this was the week that people started to receive the vaccine. I have to ask the question: did we witness a Hanukkah miracle in our own days? You know, that’s one of the blessings that’s traditionally added to the prayers of Hanukkah – “Just as they experience miracles then, so may we experience miracles in our time.” And we’ve had one vaccine roll out, it looks like another one is imminent, and they’ve already started to arrive.
And next, after our health workers, we have first responders, who are going to be receiving this vaccine in the coming weeks. It’s going to come to nursing homes and other senior facilities. And, I think, based on what I’ve been hearing, that the hope is that there will be enough production to have provided access to most of us to getting this vaccine by July.
But let’s take stock of the moment we’re in. We have over 310,000 who have died from COVID-19 in under a year in this country alone, and we’re seeing, based on where we are in the current surge, projections of the possibility of crossing the 400,000 line by the end of the first week of January, unless we can do something to change the direction of this surge. So it’s so important to repeat and reinforce what you will have heard every medical expert on every reputable news channel say: the arrival of vaccines is wonderful news, but we must still today hold back from risky behaviors, to not go unmasked anywhere in indoor public places or outdoor places where others are walking. Do not bring multiple households together, during this holiday season or at any other time while COVID numbers right now are this high. And please, don’t take any unnecessary risks, because the stakes are just too high.
And I really do appreciate, as I’ve been listening to the media, so many medical experts that they bring on to be explicitly responding to those who have expressed some skepticism or anxiety about the vaccines. And I’m equally anxious, myself, about some of the polling that has been produced, because it right now, at this moment, indicates that there are too many people who seem to be leery of taking up the vaccine, and if we don’t hit critical mass, then the normal that we hope is now visible in our future, even if it’s still a number of months off, is going to continue to elude us as a nation.
And I’m hopeful that these indicators will change over the coming months, but as a faith leader, I feel obligated to share and reinforce the importance of getting vaccinated. And I don’t expect to be among those with early access to it, but I will certainly be quick to take up the opportunity when it does become available to me, which is probably not going to be until the spring of next year.
But whenever I choose to make such a clear statement about a current issue, I always want to bring you Jewish wisdom from across the centuries to see how it guides our thinking about the issues. What do our sets rabbis of centuries ago know of vaccines, you might be wondering? Well, of course they could not imagine where medical science would take us, but they did lay down strong ethical foundations that continue to provide strong logic that guides us now. And in a Halachic question that was posed by a Reform congregation to our movement’s response committee on the issue of compulsory vaccinations back in 1998, we can find a lot of the primary sources from Jewish wisdom, and some good logic that was part of the response back then that I think guides us today. So first I think it’s worth saying that Jewish law today regards the practice of medicine as a mitzvah, a religious obligation. It is an aspect of pikuach nefesh, the preservation of human life, which takes precedence over virtually every other requirement in the torah.
And that was a position that evolved over a number of centuries that were reflective of ideas over those centuries. So in the early times of rabbis, in the Talmud, the first, the second century, they still saw healing as a gift from God, but as science was further understood and medical experts started to be part of our evolution as human beings, by the time the primary code of law in Jewish tradition that’s used across the board, the Shulchan Arukh arrives in the late 1400s, this position about the practice of medicine being a mitzvah is strongly asserted.
And as this responsa is citing a number of Halachic sources, including those that were in the centuries following the Shulchan Arukh, they share a couple of key points. And I’m excerpting from a much longer piece, just to give you a sense of what some of these teachings say. Here’s one: “Should an expert or competent physician (in Hebrew, rofe uman or rofe baki) prescribe a remedy for a patient with a serious illness, the patient must accept the remedy, even if its preparation and application would normally violate the prohibitions of Shabbat or the Holy Days. One who refuses this treatment on the grounds that he or she would prefer to observe the laws of Shabbat is described in the Halachic text – very technical term here – as a chasid shoteh, a pious fool. It is not an act of piety. And the tradition says that they should be compelled to do what the physicians prescribe. We are required, the authorities tell us, to accept what is defined as proven remedies, because they fall under the category of pikuach nefesh, saving of life. And we do not have a right to refuse this. What if God has given skill and science the ability to provide something that saves life? We are told that we do not have a right to then refuse that.
But on the other hand, we’re not required to accept medical treatments that are unproven or of dubious therapeutic value. So therefore the key question is: “Do immunizations qualify as a refuah bedukah, as proven remedies? Do they offer a reasonably certain prospect of successful treatment, in this case, the prevention of dangerous diseases, or are there therapeutic benefits, dubious at best? And no medical therapy can be entirely free of risk, but do vaccines pose a level of danger that would outweigh their benefits?” That’s the core question in Jewish tradition.
And the responsa then returns to facts that have been gathered through medical research and epidemiology in order to answer this question that it’s just posed. So a little bit of review of history that it provides, which is all sourced through medical research:
“Not so long ago, infectious disease was counted as the most serious threat to human life. Its effect upon children was devastating. Of every 1,000 children born in 1900, 160 would die of an infectious disease before the age of five. And today, by contrast, parents in the developing world no longer fear these diseases. And this welcome change, surely one of the great success stories of the 20th century, is largely due to vaccines, which are among the most effective means of preventing disease, disability and death.
The ultimate goal of immunization is the eradication of disease, and the model for this eradication is the experience that was had with smallpox. This once-deadly killer was eliminated in the world in 1980 through a combination of a worldwide campaign of immunization, surveillance and adequate public health control measures […] Before the 1960s, well over 500,000 cases of measles occurred each year in the United States, and 1 out of every 15 children who contracted the disease during the large epidemic died from it. Today, the incidence of measles has been reduced by 99%. Worldwide, it’s estimated that at current levels of immunization, 3.2 million deaths from measles and 450,000 cases of paralytic polio are prevented each year, and another 1.2 million measles deaths and 12,000 cases of paralytic polio might be prevented if full immunization could be achieved.”
This was back in 1998. I know there’s been enormous work since then, I think, on polio in particular, and I’ll turn to our medical experts on that shortly.
“During a rubella epidemic, 1964-65, 20,000 infants born to mothers infected during pregnancy suffered from blindness, heart disease and mental retardation. Today, thanks to nearly universal use of an effective vaccine, the rubella virus poses virtually no threat to the children of expectant mothers.”
So then the responsa, after sharing some of this information and other examples, returns to the question as to whether or not we are in a position to say a vaccine is to be regarded as a proven remedy, and therefore in Jewish tradition would be obligatory. And we measure risks against benefits, and when we do this with respect to vaccines, we find that the risks that they pose are far outweighed by the prospect of infection, morbidity and mortality from the diseases that they are intended to prevent.
And all of this leads to the conclusion, in this responsa and across the board in Jewish tradition, that immunization qualifies as refuah bedukhah, a medical therapy of proven effect, and as such, Jewish tradition would define immunization as part of the mitzvah of healing, and would recognize it as a required measure. The responsa then goes on to add something which I think is very important, particularly in this moment, as to why social education and social pressure must be exerted to get people to receive vaccines. It cannot be left to “Just do what you want,” because the responsa says:
“Immunization is a matter of social ethics and responsibility as well. Scientists recognize that protection of individuals from serious diseases depends not only on their own immunization, but on the immunization of others in the community. Vaccines are not 100% effective,” (although these new ones are incredibly effective, based on what we know so far). “Even in a fully immunized population, the vaccine will not succeed in conferring immunity upon every single person.”
Immunization, therefore, is not purely a private matter, but one of social ethics. Our decision to vaccinate or not to vaccinate directly affects the lives and health of our neighbors. Now, as a rabbi, I’m not competent to render judgments where there’s any kind of scientific controversy, but what we see when it comes to vaccinations is that the overwhelming view of scientists is in agreement as to the need and the importance and the safety of vaccines. And we rely on the overwhelming view of scientists, as rabbis, when we’re making statements like this, not because scientists are immune to error, but because today’s science is a discipline that’s got such a rigorous methodology that leads to the recognition and correction of mistakes. There’s so much testing, there’s so much scrutiny and peer review, that questions concerning the safety of any vaccine are vigorously examined by the medical community. And so we can have a lot of faith and trust in our medical experts.
That our movement has thought about these questions in decades past, and has drawn upon centuries of Jewish wisdom, but has also applied it to the pressing needs of our time, I think provides us with an incredible resource. We can bring our faith and Jewish ethics together in harmony, together with the best of medical science, to guide us forward. And that’s what I want to advocate that we do. So I said to Elyssa, at the end of presenting this information tonight, in my drash, I wanted to turn to her, and I want to turn to Andrea, and do what I’m going to call a Rachel Maddow moment, when she says “Did I get anything wrong? Did I miss anything? Is there anything here that you would like to further add or reinforce?”
So I’m going to add Elyssa back here on screen, and Andrea, if you’re able to unmute – I don’t know if you’re in a place to be on camera, but if not, we would love very much to have your expertise to add to the conversation this evening as well.
Elyssa Pellish: I’ll just say, no, I think you got everything right. I’m really impressed. That was – I’m impressed with the Jewish religion and how focused they are on science. And I think doing what is the right thing to do, the right thing for the community as a whole, you know, I think sure, there are some unknowns with this vaccine – it’s an MRNA vaccine, we’ve never had this type before – but we have scientists who have been studying this type of technology for a long time, it’s not a new technology, and it’s just come around so quickly, because by pairing the government and the private sector together, they have basically taken away the risk that these private drug companies had. And the disease is so prevalent, the incidence is so high, that they were able to get thousands of people into these Phase 3 studies very quickly, so it has come a lot quicker than any other vaccine. I think the polio vaccine was the quickest before this, and that was four years. But the incidence of this virus is so high that they were able to do it that quickly.
So I’m sure there are some unknowns, there always are, but the unknowns with COVID are extremely high. The disease is – we just don’t know much about this disease at all. And the fact that you can be asymptomatic, or you can die from respiratory distress when you’re young and healthy, it’s just – I don’t want to take that risk, and I don’t want to take the risk of being what we call in medicine the “long-haulers,” or those that have symptoms for months still, with shortness of breath, with a fast heart rate, severe fatigue. I don’t think anyone would want that. So the tiny risk associated with a vaccine – give that to me any day over any of these other symptoms. So that’s kind of what I thought when thinking about whether or not to get this vaccine.
Thank you – Andrea.
Andrea Ciaranello: Yeah, thank you for asking me on. I’m sorry I’m not in a place with video, I’m just leaving the hospital. So I think you did a beautiful job. That was like a stellar review of the literature worthy of – any medical student would be proud. And I think you’ve got it all right, and I think Elyssa really did hit on the the sort of balance of risks and benefits. The long-term and short-term sort of complications from the illness itself are certainly worse than the risks of the vaccine.
I think it is important for people to know that there are some side effects. You know, a fairly substantial minority of patients, in the vaccine trials, had a reaction to it – it was usually something really mild, like a sore arm, a fever, feeling kind of crummy for a day or two. It’s more after the second dose than the first, in the vaccines that have two shots required. So you know, people should be aware that that will happen, that’s normal, it means your body’s making a robust response immunologically to the vaccine.
Elyssa Pellish: I will say, I have not had one side effect.
Andrea Ciaranello: The primary side effect I have observed in my colleagues has been joy and hope. So yes, exactly, I’m excited. Mine is tomorrow, 10:30 AM. I’ll keep you posted, I’m really excited, but I would encourage people to get the vaccine when your turn comes up, just as you said, not only to protect yourself and to prevent those things that Elyssa described, but just also to do our part to keep from passing it to others, to end this pandemic, you know, a little bit sooner with every vaccine that’s given. And I hope really much for the day when we can all have it.
I think one of the things that we feel badly about, getting it early on, is just the issues of equity and access to the vaccine. You know, of course we’re grateful to be in this first wave, but just so aware of how many people aren’t able to access it yet, not only in the US, but you know, my physician colleagues in South Africa, for example, are just saying, you know, “We’re loving your selfies, but also, no idea when we’re going to get it here.” So, happy to have the government reinvigorating its commitment to science, and also to participating in the global community related to vaccines and science. I think it will be a really bright spot in the light of this winter as well.
Rachel Gurevitz: Thank you, I’m glad you’re getting your first dose tomorrow. And thank you for raising the question of equity. I think that, aside from waiting for our turn and doing our part, the other piece of this is that there will be opportunities, I think, to advocate and to ask of our administration down the line to, you know, to take the privilege that we have as a country, and to advocate in ways and to send resources through the World Health Organization or others, because this really is a global pandemic, and there won’t be a “normal” until the world has access. And clearly, you’re absolutely right, you mentioned South Africa, I mentioned it earlier during our Zoom oneg, that one of my rabbinic colleagues says she doesn’t expect to see sight of this vaccine for perhaps another 18 months, as a rabbi in South Africa. So yeah, very different situation.
Andrea, we have been so incredibly grateful to be guided by your gentle hand and expertise. And I know you haven’t just done this for our congregation, but for so many other communities, for school districts and for all that you do. And Dr. Pellish, just more strength to you, and to so many of members of our community who are working on the front lines in a lot of different ways. We have a number of congregants who have been working in the emergency rooms, working as nurses, working in hospice, and dealing with this every single day since March. And it’s incredible work. And I know that it’s going to be ongoing for a while, but we hope that there’s eventually a massage and a bubble bath and something in your future when we might be able to breathe a little bit of a sigh of relief together.
Andrea Ciaranello: Yeah, and maybe a hug.
Elyssa Pellish: Amen to that, yeah.[/Read]