What’s really behind the measles outbreak in NY Jewish communities?

Officials blame vaccination rates, but large families, dense neighborhoods, a high rate of social interaction and a tendency to travel all facilitate the disease’s spread

A sign warns people of measles in the ultra-Orthodox Jewish community in Williamsburg on April 10, 2019 in New York City. (Spencer Platt/Getty Images/AFP)
A sign warns people of measles in the ultra-Orthodox Jewish community in Williamsburg on April 10, 2019 in New York City. (Spencer Platt/Getty Images/AFP)

JTA — New York City’s info page on an ongoing measles outbreak could not be clearer: “Most of these cases have involved members of the Orthodox Jewish community,” it reads.

But less clear is the cause of the outbreaks in heavily Jewish neighborhoods of Brooklyn and Rockland County. Officials said low immunization rates in these communities were to blame, and have tried to force residents to vaccinate.

Jewish organizations like Agudath Israel of America acknowledged that there are pockets of resistance to vaccination in those communities. But they said overall vaccination rates for ultra-Orthodox Jews are in line with the general population and vaccination was the “clear societal norm” in the community.

State statistics showed, however, that Rockland County’s immunization rates were significantly below the 96 percent goal set by the state Health Department. And more than 20 Jewish schools in Rockland County and Brooklyn had more than 10% of kids claiming a religious exemption from vaccination.

This picture from April 5, 2019, shows a nurse preparing the measles, mumps and rubella vaccine at the Rockland County Health Department in Haverstraw, Rockland County, New York. (Johannes Eisele/AFP)

To be sure, a low vaccination rate isn’t the only issue at play. A Rockland County official told the Jewish Telegraphic Agency that other factors have contributed to the disease’s spread among ultra-Orthodox Jews. They tend to live in close quarters with large families, and have a high rate of interpersonal interaction — for example, men gather for prayer at synagogue three times a day. The official said ultra-Orthodox Jews tend to travel overseas more often that other residents, which could bring measles cases from Israel or Ukraine, where cases have been reported.

That argument was echoed by Dr. Daniel Berman, who specializes in infectious disease, and Prof. Awi Federgruen of the Columbia University business school, who is active in efforts to encourage immunization. According to their analysis of public data, published in the New York Daily News, ultra-Orthodox schools in Brooklyn had an unweighted average vaccination rate of 96%. That’s higher than the 95% vaccination rate experts recommend in order for a community to be collectively immune from the disease.

“If you’re dealing with a community or area where there’s very intense and frequent interactions between individuals, there’s going to be much more of a force to propagate the epidemic,” Federgruen said. “And in Orthodox Jewish communities there are two factors: They live in areas with very high densities in population, and their lifestyle, the way they conduct themselves, people are interacting with each other physically in many ways.”

New York City declared a public health emergency in April, and required people in four heavily Jewish Brooklyn ZIP codes to vaccinate. In March, Rockland County, home to the largely ultra-Orthodox community of Monsey, declared a state of emergency and barred unvaccinated kids from public spaces. The order was later rescinded.

A sign warns people of measles in the ultra-Orthodox Jewish community in Williamsburg on April 10, 2019 in New York City. (Spencer Platt/Getty Images/AFP)

At the time of the order, less than 73% of Rockland County was vaccinated. Owing to a series of free vaccination clinics, that rate has since crept up to around 77%, according to New York State data.

New York City has also shut down one ultra-Orthodox school for not providing immunization records to the state.

And some individual schools in Brooklyn and Rockland have low vaccination rates. According to data from the State Department of Education, more than 30 ultra-Orthodox schools in Rockland had immunization rates lower than 90% last year. In Brooklyn, the number was more than 20.

But Federgruen said that school data, for better or worse, may not tell the whole story. According to local data, only 21% of cases in New York City, and 30% in Rockland, come from school-age kids. A large number also come from kids ages 1 to 4, who may be in preschool or day care.

A bill in the State Assembly seeks to outlaw any exemption to vaccines aside from one mandated by a doctor — in other words, no religious exemptions. The legislation, introduced in April, was spearheaded by two Jewish lawmakers.

Assemblyman Jeffrey Dinowitz, who represents part of the Bronx, said the current law is unclear as to whether schools are generally required to accept religious exemptions. For example, the New York State Department of Education recently forced the Shulamith School for Girls in Cedarhurst, New York to accept a student’s religious exemption from vaccination, according to the Five Towns Jewish Times. The school sought to block the student, saying that, contrary to the exemption, Jewish law requires vaccination.

Measles cases have been clustered in parts of Rockland County, NY, that include New Square, an all-Hasidic village. (Uriel Heilman)

Dinowitz told the Jewish Telegraphic Agency that he’s pushing to outlaw those and other non-medical exemptions because unvaccinated kids could put those who are immuno-compromised at risk.

“If someone has a legitimate medical reason to not get vaccinated, those people are exposed in a very significant way when there’s an outbreak,” Dinowitz said. “I would never tell people how to practice their religion. It’s about health. It’s not about religion.”

A handful of rabbis, activist parents and vocal outsiders have been spreading anti-vaccination messages among ultra-Orthodox Jews in public events, conference calls and social media. The organized ultra-Orthodox community, however, is supporting the effort to vaccinate. Agudath Israel of America has urged the community to vaccinate and cautioned against anti-Semitism due to the outbreak.

“[C]ountless rabbinical figures and leaders, including leading rabbis in the Agudath Israel movement and doctors serving these communities, have repeatedly encouraged vaccination in the strongest possible terms,” reads an April statement by the group.

The official in Rockland, speaking on background per local government policy, said that officials met with 100 ultra-Orthodox community leaders in October to try to stem the outbreak.

“If people think this is some kind of Jewish problem, it’s not,” Dinowitz said. “Leaders in the Orthodox community are advising people to get vaccinated because they understand that this can save lives.”

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