Israeli epidemiologists and other public health experts are wringing their hands in fury and disappointment over more-extreme ultra-Orthodox (haredi) and even some secular women who are refusing to vaccinate their toddlers or get vaccinated during pregnancy against potentially deadly pediatric diseases.

Two Jerusalem infants have died in recent weeks from whooping cough (Bordetella pertussis ), a disease that should have disappeared long ago but has returned in the last two years or so.
A seven-week-old girl was admitted a week ago to Jerusalem’s Shaare Zedek Medical Center (SZMC) with severe brain seizures caused by meningitis because the haredi mother refused to be vaccinated against pertussis during her pregnancy. Adults infected with pertussis cough violently for about three months but survive.

Infants, however, can develop complications including mini-strokes, pneumonia, slowed or stopped breathing, dehydration or weight loss due to feeding difficulties, seizures, and even brain damage.

Such pediatric diseases shouldn’t exist anymore. It’s as if we’ve returned to 1860 when Louisa May Alcott’s novel Little Women told of the death of one daughter from contagious scarlet fever.

CHILDREN STROLL in Jerusalem’s ultra-Orthodox Mea She’arim neighborhood. (credit: YONATAN SINDEL/POOL)
CHILDREN STROLL in Jerusalem’s ultra-Orthodox Mea She’arim neighborhood. (credit: YONATAN SINDEL/POOL)

“The newborn on our ward will probably survive but she is at high risk of serious damage for the rest of her life and could end up at public expense in the department of very damaged, ventilated children at Herzog Memorial Center,” bemoaned Prof. Yechiel Schlesinger, director of the SZMC’s Wilf Children’s Hospital and an expert in infectious diseases.

In an interview with The Jerusalem Post, he explained that “infants can’t themselves be vaccinated against pertussis during their first few months of life, but when their pregnant mothers get a shot in their third trimester, their antibodies against the disease are created passively.”

Half a century ago, said Schlesinger, “the pertussis vaccine caused some complications, but more recently, a better, a-cellular vaccine replaced it, and a decade ago, it was decided that pregnant women should be advised to get the shot.

Vaccines still have a bad reputation among some haredi groups

The problem is that the vaccine still has a bad reputation among some haredi groups in various ultra-Orthodox neighborhoods, settlements and cities who have an ideological suspicion against vaccines – including that against COVID-19, especially after they were told by ignorant rabbis and even some doctors that it was dangerous and was promoted only to benefit pharmaceutical companies that produced them.”
Pregnant women in the community go to obstetricians and tipat halav (baby) clinics doctors for screening and testing, but even though the professionals speak out in favor of vaccination, they are often ignored, he added. Fewer shots given against diphtheria and tetanus for babies have also been recorded.
“Vaccine refusal exists among various haredi communities in the US, but it seems to me to be much less significant there, as they are more exposed to medical facts there. There is also a very small group of secular yuppies in moshavim in the Jerusalem area who also oppose vaccinations in principle,” Schlesinger noted.
Arab Israelis – including large Bedouin families – are much more compliant about taking their infants and toddlers for vaccinations in clinics and of pregnant women getting the pertussis shot. “They usually don’t believe in nonsense such as conspiracy theories about pharmaceutical companies,” said the SZMC pediatrician. “They have other problems such as multi-resistant pathogens, excessive use of antibiotics, and diabetes. They usually do what their doctors tell them.”

A RECENT REPORT by the European Union stated that “populations that come from lower socio-economic backgrounds or migrant communities or belong to cultural or religious minorities usually achieve substantially lower vaccine uptake compared to the general population.

There are some underserved populations, however, that manage to achieve vaccine coverage similar or higher than the general population. The Arab minority in Israel is one such example.”

The report continued that Arabs, about 36% of whom live below the poverty line compared to 18% of the Jewish population, live mostly in Israel’s social and geographic periphery and make up 21% of the Israeli population.

“However, despite poorer health outcomes on many levels, including lower life expectancy rates and higher infant mortality among the Arab population, Arab children achieve higher coverage for routine vaccines than the general Jewish population. For example, in 2018, by the 13th month of their life, 82% of Arab children compared to 61% of Jewish children had received the first dose of the mumps, measles, and rubella (MMR) vaccine. In addition, the consent rate to the human papillomavirus (HPV) vaccine was 98.8% among Arab mothers compared to 54.3% among Jewish mothers.”

The general level of public health in Israel is relatively high because of devoted care by the four public health funds, Schlesinger continued, but “it is declining, partly due to the reduction in public funding for preventing diseases,” he said.
Only recently was an amount of NIS 750 million approved for coalition needs, while nothing was left for public health. Now, the government has decided to make across-the-board state cuts that will harm the health system.

Dr. Ze’ev Feldman, chairman of the State Doctors Organization in the Israel Medical Association, told the Knesset Health Committee last week that “cutting the healthcare system during a war causes serious harm to the security of the country, and those who support such a cut endanger the lives of Israeli citizens and IDF soldiers. The healthcare system and especially prevention services need an additional budget and certainly not a cut!”

PROF. NADAV DAVIDOWITCH, a leading epidemiologist, dean of the School of Public Health at Ben-Gurion University’s Faculty of Health Sciences in Beersheba, and principal researcher and chair of the Taub Center for Social Policy Studies’ Health Policy Program, is also very worried about the vaccine-refusal phenomenon. “It’s not new, but it’s more serious than before,” he told The Post.

“We have known for many years that vaccination rates in the haredi community are lower than in the rest of the population – especially after the fourth, fifth, sixth, and beyond child is born – but not all haredim are the same. Not all oppose vaccinations.”
Forty years ago, when a woman delivered her first baby, a public-health nurse made a surprise visit to her home to see how she was managing and if she needed any help or advice. Today, such a service is non-existent.
Davidowitch urged that public health activities be boosted, but unfortunately, they are weakened. A recent Taub Center report blamed the state’s privatization of tipat halav centers a few decades ago to save money for the decline and lack of uniform funding and professionalism of the clinics around the country.
The Israel Cancer Association (ICA) funds mobile mammography vans that travel around the country to provide free breast exams. But there are no such mobile facilities to bring public-health nurses to haredi communities so women without private transportation and those caring for many young children can take them for shots.
Some haredi rabbis speak out on behalf of vaccinations, but others  ignore the issue or join the conspiracy theories and spread fake news. The Health Ministry should actively try to persuade the rabbis to encourage vaccination. This reporter personally suggested over a decade ago to then-health minister Ya’acov Litzman that lectures on a wide variety of public health issues – from smoking and diet to vaccinations and accident prevention – be provided by public health experts at ritual baths while women wait for their turn, but he ignored the idea completely.
“The COVID-19 pandemic created a greater lack of faith in pediatric vaccinations among the haredi community,” said Davidowitch. If measles-vaccine compliance falls below the 95% mark, there is no effective herd immunity to protect those who are not vaccinated. We need real-time data, town-by-town, block-by-block, to know which families are getting vaccinations and which are not. Many families also don’t go for vaccines on time. There are more ultra-Orthodox women in public health professions who should be utilized to spread the word on the subject.”