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Op-Ed: Be’itta achishena – non-action and action when delay is deadly | Dr. Naor Bar-Zeev [UPDATED – The Doctor responds]

Whenever, as a pediatrician I see a sick child, and after I have gone thoroughly through the history of the presenting problem, the past medical history, have insight into the family and child’s life circumstances, and have physically examined the child – at that moment I always stop and ask myself, “What have I not thought of? What have I not even considered?” And most importantly of all I always ask myself, “What if I am wrong?” The more confident I feel about a diagnosis, the more I listen out for the kol demama daka of self doubt.

The child in front of me at that moment has infinite importance. I know the parents love the child more than anything, but for that moment I feel like it is only me who is responsible for that child. As if the weight of her or his creation by the Almighty has been placed upon me. Heánochi harisi es kol haám haze? im anochi yeliditihu? Moshe rabbeinu asks, and the implication is of course the affirmative. Yes, Moshe must feel like he is the oimen of the people. They are his responsibility.

I am often busy. I always have competing priorities. Sometimes I have two very sick children simultaneously needing my attention. But I never leave a child’s presence without thinking, “what have I not considered?” Taking leave of this child is akin to leaving penei hashekhina that is present in that child kivyachol. And when I stand before a child I have to remember before Whom it is that I am really standing.

This immense responsibility has led me to think about how to protect children from ever coming to need my clinical care in the first place. How can I prevent illness and lo aleinu death? What are its primordial causes? Is it poverty? Is it lack of access to care? Is it health systems structures and their political underpinning? Is it war? Is it fear? Is it reduced literacy? Is it economics? I have published research in these areas. I studied epidemiology and public health for these reasons. During my PhD years I realized that the science itself needed to be critiqued and to be understood me’achorei hapargod (behind the veil/curtain) as it were, so I went and studied more and became an accredited statistician and Fellow of the Royal Statistical Society, and am statistical editor of a journal on infectious disease epidemiology. I review science and critique science, and sometimes politely reject science that I think is not up to scratch. We owe our children at the very least to be as intellectually rigorous and honest as possible.

I have worked with pharmaceutical companies also. I have made the nature of these relationships public. The expectation that vaccinologists or epidemiologists avoid any contact with vaccine manufacturers is as unsafe as saying that car safety analysts should have no contact with the car industry. There must be a conversation, and these companies must be financially responsible and support independent research. This is neither bribery, nor corruption nor conspiracy. It is an ethical duty. Indeed the public must have access to these relationships so it can judge their validity for itself, and whether such relationships have been corrupted. If at this point you want to stop reading what I have to say, I understand.

Now I am very far from being an example of someone learned in Torah scholarship, nor am I in any way an example of fine middos. Even the suggestion is ludicrous. And here’s the proof. A Jew must distance himself very far from anger. One must try to avoid anger which is the source of many bad middos and aveiros rachmana litzlan. But I feel really angry. And I am here expressing this anger publicly.

A few nights ago, there was an assault on the Jewish community. People were bussed in to hear a series of talks in Rockland County, that were publicized very widely in print and social media. From reports of persons attending, the things that were said at that meeting were disgraceful. Falsehoods and lies, and libels at other ethnic or social groups that are cringe-worthy at least, and incitement at worst. Even the anti-vaccine speakers who believe in their own views should be ashamed to be associated with libelous slander.

Moreover, the claims made at that meeting were a violence to your children. Meetings like this are an absolute blow to the Jewish community. They target specifically the fabric of care and trust. They prey on people’s beautiful and dedicated and unwavering love for their children to put those very children at risk. If we continue to have more measles cases, then there will be measles deaths. Yes, I am using scare tactics here, and do you know why? Because I am scared! Because I can see the inevitable truth unfold, that measles disease carries a mortality price, as we have seen in Eretz Yisroel and as we are seeing in many other countries now around the world, who have even higher mortality rates.

I hope that I am wrong. I hope there are no deaths, so someone can then point an accusatory finger at me and say I was using scare tactics. That I said children will die and they did not. Good, may it be so. Let me be accused of emotional manipulation. I feel emotional, and I am trying to convince you, to manipulate you, but with openness and truthfulness.

I have attended meetings at the World Health Organization where people who have dedicated their lives to giving access to life-saving vaccines just look at me incredulously and ask, “How can this be, Naor? How can it be the Jewish people are allowing this to happen?” There is no antisemitism there whatsoever. There is deep concern, and an acknowledgement not only of our Torah, but of our sense of mutual responsibility.

It sounds shocking because it IS shocking.

How can we be letting falsehoods circulate, colorful brochures by unstated authors and unknown funders, that are full of lies. Meetings espousing lies, organized by fake communal organizations with free buses targeting the frum community. Who is behind this? This is an attack on all of us, do you not see it? If at this point I have alienated you and you feel that I am patronizing and you want to stop reading what I have to say, I understand.

Second only to my respect for the child I am attending to, is my respect for that child’s parents. Parents are not stupid. Parents are not callous. Parents’ love for their children is boundless, (which is why kibbud av vaéim ein la shi’ur), it is the closest analogy we have in life for the Endless Light of the Creator yisboroch. If I have ahovo for the child before me, I have yir’a before the immeasurable love that her or his parents have. It is my absolute duty to explain to parents to the very best of my ability my understanding of their child’s medical condition, the risks and benefits of every course of action. To support them, and to respect them, to listen to them and to share with them. But it is my duty to respect the child most of all. If at very rare times this means speaking sharply or pointedly to parents, then I will do so, out of my respect for them. They want what I want – the best for their child.

When Yehuda approached the vizier of all Egypt to save Binyomin, he was, Rashi says, ready to attack the man he didn’t know was Yosef. His love for Binyomin strengthened him to take on the greatest empire there has ever been. And at that moment – ve’lo yachol Yosef le’his’apek! Yosef could no longer contain himself. He cried and revealed himself to his awe-struck brothers. Ani yosef! Ha’od avi chai? This was the same Yosef who a lifetime ago had said “es achai anochi mevakesh. hagida na li, eifo hem ro’im?

Dear reader, dear dear parent, do you not see the connection? Ha’od avi chai is another expression for es achai anochi mevakesh! Yosef never thought about himself. That baál hakhalomos halaze, that young boy who was mesalsel (twirling) with his hair – was misunderstood. The only thing he ever wanted was “anochi achalkel eschem ve’es tap’chem“. The writer of these words is seeking out the ear, the heart and the mind of his fellow parents. Please, I beseech you, where are you pastured? How can I reach you. Your child is, boruch Hashem alive and I hope well. Together let us keep her that way. Lets us together protect him from the vicious illness that is spreading and the vile words that are fuelling it. If you are worried or uncertain about vaccination, and have decided to withhold or not do it just yet until you are convinced – stop. Ask yourself – what if I am wrong?

Have an open mind, be skeptical, be thoughtful. But learn to trust people whose whole purpose of being is to protect your child. Know what you don’t know. Understand the immense complexity in the immunology and in the epidemiology. Understand that someone’s personal experience, tragic though it might be, real though it might be, is by itself insufficient evidence of the truth. Understand that a claim is not the same as a fact. Understand that even a valid question is not an answer. Learn and understand the history of vaccine preventable disease, and the toll it took on communities. Understand that great halakhic minds have almost universally stated that you are mechuyav to vaccinate your child. If this is the halakha, and by the almost unanimous majority, then the Almighty requires it. How can you stand brazenly against it? The Jewish people are well-trained at waiting – ki mechakim anachnu lach! We are experts at the shev ve’al taase. But you should think as if every moment that you do not vaccinate your child, every moment that your child remains at risk, you are being mevatel a mitzvas assé.

As a vaccinologist and as a clinical trialist I also ask myself that question – what if I am wrong? In all my work safety is an inherent part of what I look for in every research study I conduct. I have stopped research studies when concerns have arisen, and only allowed them to recommence after thorough audit and investigation have been reassuring. I am required to and do report every possible adverse event, even if on the surface it seems unrelated to the study. There are studies I have developed and never conducted, because I am worried about certain aspects of safety.

As a doctor and as an epidemiologist, I am forever grateful to the kudsha berich hu, shechalak mechochmaso lebasar va’dam – that we have through arduous and rigorous scientific efforts been able to reduce child mortality globally. That the single greatest mechanism for that was through vaccination. That I am driven to reduce the injustice that I see when women walk a full day through unsealed roads, with their child on their back, to reach a clinic where they wait for hours to receive a vaccine, only to be told it is not available. Or a child who dies in my care because the life-saving drug that they ought to receive has run out.

As a husband and as a father, I know that I will do whatever it takes to protect my children, and so I will vaccinate them. And I also know you will do the same for your children. Please don’t delay.

Hakaton yihye la’elef vehatzair legoy atzum, ani Hashem be’itta achishena (Yeshayah 60:22)

Dr Naor Bar-Zeev is Deputy Director of the International Vaccine Access Center and an Associate Professor of International Health and Vaccine Sciences at the Johns Hopkins Bloomberg School of Public Health.

———————————————–

UPDATE – Friday 8:45 AM:

The following are responses to some questions readers had:

Dear Rs,

The National Vaccine Injury Compensation Program is explained here: https://www.hrsa.gov/vaccine-compensation/index.html

Regarding alum, I will address you as I would any professional colleague of mine. The lay summary is at the end.

Alum (aluminum) adjuvants have been used since around 1927. Alum can, uncommonly, cause local reaction in the skin. (I have seen this once in my career, not that that means anything regarding frequency of this event). The MMR vaccine does not contain alum.

I am not an expert in aluminum biochemistry. But here is my assessment of what is known about this issue.

Aluminum is an abundant element in the environment and is ingested ordinarily. Admittedly it is not normally injected. Quite recently there have been a number of publications on this topic that are breaking new ground. Some are favourable and some express concerns about aluminum compounds as adjuvants. Such concern is welcome and important, and is part of critical appraisal of course. There are secondary voices who read this literature and present it for more than what it is. I think this is occurring on both sides. I guess that is to be expected with any topic that generates strong opinions. This is not necessarily bad, but can have bad consequences. Mostly people overvalue the validity of small studies or exploratory studies, because they match their hypotheses. It is important to remember that hypotheses can never be proven. We can never be definitively right about any issue, we can only be definitively wrong, and the best we can hope for is to be possibly right until proven otherwise. So a dose of humble pie would be good for everyone. A few recent papers in biochemistry journals but not in clinical medical journals expressed concerns about the validity of published studies. A reasonable recent review that seems appropriately understated is Principi N et al, Vaccine 2018;36:5825.

From my reading (and my expertise is not in this area) there may be some evidence of genetic predisposition HLA-DRB1*01 to inflammatory disorder that may be triggered by aluminum, I don’t myself know the population prevalence of this HLA type. But I still interpret all this with caution. See Israeli E et al Clin Rev Allerg Immunol 2011;41:163. Taken further in Gherardi RK et al, Lupus 2012; 21:184, and argued against in Ameratunga R et al. J Allergy Clin Immunol Pract. 2017;5(6):1551.

Mechanisms of action for harm by aluminum compounds may be easy to postulate, but demonstrating that they are actually causal of disease is likely to be very difficult. To explain further – exploratory mechanistic studies with low statistical power are likely to be many. Post-hoc data driven analyses are likely to occur and putative mechanisms will found, but the bias and false discovery rate inherent in such studies is likely to be high.

Demonstrating definitively that these mechanisms do not cause harm will be difficult because of the broad range and looseness of case definitions. What we define as a case of something is likely to be difficult to agree upon. (see the issues with the so-called Morgellon’s disease which is quackery, though similar debates once occurred with what are now accepted as real syndromes like Chronic Fatigue) Once a case definition is determined, ideally also agreed upon with broad consensus, and used, then a-priori well designed studies will be needed. Initially these are likely to be case control studies. In such studies, cumulative exposure to aluminum compounds will need to be estimated in retrospect, which is a problem, unless there is some way of measuring accurately total body exposure over time, perhaps there is a way to do this but I am not a biochemist or pharmacologist. Then understanding the population incidence of the outcome in question will also need to be undertaken. This is because even if the case control study implies a higher odds ratio of exposure among cases than among controls, and even if in rare outcomes we assume the odds ratio approximates the relative risk, this in no way means a high absolute risk. I might be a million times more likely to be eaten by a shark at the beach than at the shopping mall, but that does not mean that going to the beach is dangerous. Retrospective cohort studies will be done (See Glanz JM et al Vaccine 2015;33:6736) but are subject to confounding. Prospective studies will be massive and likely not very feasible, and also subject to confounding. Head to head trials of vaccines with and without adjuvant unlikely to be able to be powered for actual clinical safety endpoints.

It is impossible to prove something is always safe. In fact inherently that can never be a true statement. Vaccines are always potentially unsafe. But the absolute magnitude of such risk is likely to be very very very low. Identifying even a plethora of possible biological mechanisms for risk does not mean they are a definitive cause of actual clinical harm. But the absolute risk of disease that arises from vaccine hesitancy is high.

It is important that as our tools for identifying pharmacokinetics and biochemical pathways improves, that we continue to seek possible mechanisms for harm, and for cure. But that is just a very early first step. There will always be residual uncertainty. The quest for certainty is common among the lay population (I get lots of emails throwing around the phrase “100% sure”), but it will never be fulfilled. What we need is more nuanced understanding that in the face of ever present uncertainty we must make good judgements. I am not aware of any evidence of harm from aluminum that outweighs the benefit of vaccination.

So in summary:

Alum in vaccines is safe.

MMR vaccine does not contain alum.

The risk from not vaccinating is real and increasing every day because of more and more cases of measles.

The benefits of vaccination far far far outweigh the unproven theoretical risks of alum.

Given the evidence to date it is unwise to avoid vaccination because of concerns regarding alum adjuvants.

———————–

Dear Deb,

The long and difficult process of getting a vaccine licensed for use is set up so as to protect the public from harm.

If the guarantee of safety of a vaccine depended on the ability to sue a company that would be terrible, because then harm would need to occur before somebody sued and the problem got dealt with. Whether it is justifiable to exempt manufacturers from liability in case of harm is a valid social and ethical debate. But vaccine safety should not depend on either side in that debate.

The use of a comparator in a clinical trial is vitally important. Depending on the study design, sometimes that comparator should be a placebo. At other times it should be everything in a vaccine formulation expect the immunogen (I have explained this to “Deb” previously in Lakewood scoop). During phase 1 and 2 trials placebos are often used. Sometimes also in some phase 3 trials. Sometimes it is unethical to use a placebo since this would prevent a person in the trial receiving a licensed vaccine. (This answer also applies to Wise grandmother’s question). In the case of very rare adverse events, clinical trials are unlikely to be large enough to detect this. But other kinds of largescale epidemiological studies can. Such studies have time and again showed that vaccination is safe with respect to the outcomes tested for in those studies).

Large scale observational studies comparing persons choosing to vaccinate with those that choose to not vaccinate are possible under certain specific circumstances (see for example Bar-Zeev N & King C et al Lancet Global Health 2018 Sep;6(9):e1036-e1044). But in many cases such studies are subject to substantial bias since they lack randomization.

Vaccine Trials are registered in advance of being conducted (for example clinicaltrials.gov) and independently peer reviewed and ethically approved before they can commence. They cannot start if they “make no sense” as you put it.

Your claim that everyone is unique as an individual is undoubtedly true on a moral level. However it is also true that we all work biologically in much the same way. There is a great deal of ongoing research examining immunological mechanisms among special groups, like the very young, the very old, and so on, and understanding in what ways they differ. The idea of “personalized medicine” based on very individual genetic variants is fashionable. But even so, we are all biologically alike. It must be so for the survival of our species. Again, this is a biological requirement (what the Rambam might refer to as hashgachas ha-min). Though on a moral, emotional, intellectual, spiritual level, HKB”H could distinguish one drop from another in Egypt. The Almighty yisboroch also calls each and every star by its own name (moné mispar lakochavim lechulam sheimos yikra). But from the immunological perspective, biologically – we all work in the same way. Though almost miraculously our immune memory tailors itself individually to what we have experienced over our lifetime. And that is the very basis of vaccination.

———————–

Dear keepyourcool,

Regarding the liberal lefty CIA… with a name like mine I would have hoped you would think I was a Mossad agent, not the CIA. But how shall I put it? kede’amri inshi: I could tell you but then I’d have to …

Please sshhh!! I won’t tell if you won’t.   😉

———————–

Dear Totty,

The MMR and MMRV vaccines are very safe and effective. Giving it in a combined way provides high community coverage and maximises simultaneous responses to live vaccines.

———————–

Dear wise grandmother,

Your questions are good, but based on partial understanding of epidemiological principles, I say so respectfully.

———————–

Dear yossi,

Your pediatrician is mistaken. Or at the very least s/he is not optimizing population protection, nor individual protection using that approach.

———————–

Dear Samu,

Your sevara of “lehisropos velo lehazik” does not seem to have bothered dozens of great poskim who have all ruled that vaccination is obligatory.

Though you are quite correct that the first rule of medicine since Galen (much admired by the Rambam) is “Primum non nocere” First, do no harm. It is THE guiding principle of vaccine development and evaluation.

———————–

Dear “Truth be told says”,

Vioxx is not a vaccine.

There are examples of vaccine that have been withdrawn from market also. I have discussed these in previous responses in the Lakewood Scoop. If a vaccine causes harm it gets withdrawn. Whether this is always justified is an important ethical debate. But that is beyond the scope of this response.

———————–

Dear everyone else,

If I have not responded to your comment please do not be offended, nor assume that my shetika is a hodaá, nor think that I have no answer. I have a chavrusa to catch!

This is a really really important issue. Lives of our children are at genuine risk. That risk grows the more cases of measles occur. This outbreak is not going away any time soon. This is a disaster, considering that measles was eliminated in the United States. Vaccinating your children is the best way to protect him and her and to protect others who are too young to be vaccinated, or who are vulnerable for other reasons.

Better a 1000 fines of $1000, and better schools being closed and better strife in the community, and school exclusion and frustration and consternation – better all that than one precious child being lost.

Please do the right thing!

I will keep speaking out – makin oto ad sheyomar rotze ani.

We do not allow hate speech in our community. We do not allow someone to yell out “fire” in a crowded hall. We should not tolerate communal gatherings that spout lies and misinformation that leads to caring parents being afraid to vaccinate. Freedom of speech is not unlimited. Not when it will lead to disease and lo aleinu death.

Go vaccinate your children.

Good health and good wisdom to everyone,

Naor

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There are 45 Comments to "Op-Ed: Be’itta achishena – non-action and action when delay is deadly | Dr. Naor Bar-Zeev [UPDATED – The Doctor responds]"

  • Rs says:

    Thank you for your genuine concern . Please explain the four billion dollars that have been paid to vaccine damaged individuals . Please explain what went wrong with Holly of Holly’sllaw who died from the Mmr .
    Please explain dr. schoenfelds research showing the role of aluminum in autoimmune diseases .

    • Dov says:

      re. vaccine payments – there’s a recent article in the Atlantic that explains the history in-depth. Shouldn’t be too hard to find it though (if you actually want an answer to your question).
      re. aluminum – I don’t have the data in front of me right now, but there’s much higher levels of aluminum in other things we consume/take into our bodies compared to vaccines

  • Deb says:

    Dr Naor,
    You are a brilliant and thought out doctor. You are have the best intentions. If you come out with a vaccine and supervise the safety studies i will allow my child to get that vaccine because you are ehrlich and only want the best for all children. You have pure intentions.
    Unfortunately not all of pharma share your integrity.
    How can you trust the safety and mandantory vaccine policies on a product that has no liability, has never been tested against a saline placebo and has paid out 4 billion in vaccine damages in the usa
    please dont use the ethical argument to answer this.
    Saline placebos should be used when a new vaccine comes out.
    Before they put hpv or prevnar or hib on the market they could have used a saline placebo to test safety.

    The insurance companies have health records of fully vaccinated and fully unvaccinated kids. Why dont they study all aspects of health in their group and prove you right?
    There are millions in the usa that dont vaccinate, its not just a small group of frum jews.
    Why dont they do real studies showing safety and not convoluted ones like one group is fully vaccinated and the other group is vaccinated but without the mmr shot?
    Or mothers who got dtap in preg and mothers who didnt and then when baby is born both groups fully vaxxed and then compare autism rates in the two groups.
    These studies make no sense
    It doesnt show safety of vaccines at all!!
    Finally, every child is different
    Inside and out
    Everyone’s body reacts differently to medication and to vaccines
    It should never be a one size fits all
    If the medical community would be more transparent and open about this and not deny vaccine injury, more people would vaccinate.

  • justme says:

    thank you Dr Bar-zeev! Beautifully put!
    May your heartfelt words reach the hearts they are aimed!!

  • Avraham says:

    Thank you Doctor.
    This is a real good Op-Ed.

  • keepyourcool says:

    How do we trust big institutions? Especially with liberals in charge?
    UN is total failure!
    IRS, FBI, CIA, DOJ etc. were all compromised during Obama presidency!
    Why is CDC & WHO any different?

  • Totty says:

    I fully trust you and my childrens’ doctors which is why I vaccinate, but why isn’t there a response to some of the other side’s claims—the ones which seem legitimate? Such as why there can’t be vaccines for measles, mumps, and rubella separately but not all at once? I will continue to listen to the advice of doctors and most of Daas Torah in this regard but I am still curious as to the response to these suggestions.

    • Einer Aza says:

      Every single time the antis make an assertion, it gets shot down. There is no proof that separating the vaccines is beneficial, yet there is proof that it is harmful. People get busy and they don’t come to the doctor in time.
      Now that you know, realize that the antis won’t change their tune. They will repeat every debunked assertion, such as ‘unavoidably unsafe’ until simple people suspect there may be something to their words.

      They are unscrupulously dangerous.

      • nyj says:

        It may overwhelm the young child’s immune system. People would be MORE likely to go get the vaccines if they wouldn’t have to give so many at once.

  • Are You says:

    Deb,
    Vaccines are not Drugs
    They are just dead or weakened diseases injected to stimulate the immune response.
    With all due respect you are not even on the right boat.

    • Deb says:

      not sure what your point is at all.
      go read the ingredients in any vaccine.
      it contains alot more than a weakened virus / dead virus / live virus (chicken pox and mmr)

  • wise grandmother says:

    The only way you will be able to convince the anti-vaxxers is when there is a study of fully vaccinated children versus fully un-vaccinated children and compare their overall health. Take couple of thousand of each and prove that thery have the same amount of autism, the same amount of ADD/ADHD, the same amount of allergies, the same amount of diabetes, etc… Give me a good reason why this hasn’t been done.

    • Einer Aza says:

      A layman can ask all kinds of questions, but he may not understand the answers. Statistics are tricky things, they take much study and understanding to appreciate. For you to use your layman’s question to prove anything is frivolous, it is not the correct way to reach a decision.

      Here is one possible answer:
      Because there are too many variables. Overall health is an ambiguous term and affected by too many things. How can they survey people without controlling their enviroment?

      And the truth is, even if they conducted this survey, the anti-vaxxers would not back down. As history has shown us, they continue to make assertions long after they have been debunked.

    • nyj says:

      exactly!! There is no good reason why this hasn’t been done.

    • w22 says:

      There is a lot of things that have a roll on health; income, what part of the city you live in, what your skin hue is, how many kids do you have ect. In 2008 the anti-vax raised money to do a 5 year study that will take into account all these things. If you know were to find the study please let me know

  • yossi says:

    Dr , My pediatrician is for vaccinations but very opposed to the way that many locally give them five at a time, some without even verifying that the child is fully healthy, and also to very young. He says that this can overwhelm the immune system and the body won’t be able to deal with this toxicity. Yet I do see many pediatricians that dole these out in seemingly ridiculous amounts all at once. I was interested in your opinion on this matter.

  • Wow says:

    Wow. What a beautifully written, intelligent, heartfelt letter. Divrei chachamim bnachas nishmaim. May you be able to continue your integral work on behalf of the klal bnachas!

  • Lakewood Vaxxer says:

    Wise Grandmother, you have only to go to the local cemetary and see the graves of the young children (babies-5 years) from the 1800-1900’s to know that vaccines work.

  • justme says:

    Totty,
    The antivaxx world has had their questions answered legitimately, time and again. They refuse to internalize any of the anwers. They refuse to be reasonable. As Rabbi Dr. Akiva Tatz said, “You cannot reason with someone that is not being reasonable.” He is so right!
    I personally have had many people come and ask me questions. I gave them long explanation to what they were questioning, and they understood and accepted the answer. But then a week later I would hear them ask it again. The antivaxx leaders have been utilizing cult-like techniques to convince their followers in a way that you cannot reason with them, just like you cannot convince a Lev Tahor member that they’re lifestyle is not al pi Torah.
    There have been countless safety studies done on vaccines. There have been many studies done comparing vaccinated and unvaccinated children. The outcome has been that vaccines do not increase the risk of autism, sids, automimmune diseases, allergies, etc. I will not start quoting them. For those that REALLY know how to research, they are not hard to find. Those that do no know how to research, and do not know how to decipher medical jargon, should start learning how to do so, BEFORE making these big decisions.
    Yes, vaccines come with risks. But small risks. Very small compared to the risk of doing otherwise.
    The antivaxx world insists that measles is a mild childhood illness that is beneficial for a child to contract. That is true, in most cases. But too often, it is not. As one antivaxx mother just said yesterday ” My kids have the measles. I come from an antivaxx family, and so does my husband. So I purposely exposed my children to the measles, as I was told it’s so healthy! But had I known how sick they would become I never would have let this happen! The people that I always listened to have lied to me about this, and now I feel lost. If I vaccinate my children out families will be mad at us forever. But how can I let this happen again???”
    There have been tens of children hospitalized throughout this outbreak. Many in the ICU, and many on ventilators and more. But the families work hard to keep it a secret. They refuse to let anyone talk about it, and don’t even tell their siblings and closest friends.
    There is a woman in Israel in a coma from the measles. A frum Yungerman in his 30’s, that has been perfectly healthy before, now paralyzed waist down from the measles. A baby of a few months old in Brooklyn that had encephalitis. Parents were given notice on 2 seperate days that the baby will probably not survive the night. B”H the baby survived. How much damage was done? That they do not know as of yet. These are all stories which I confirmed to be true. I’m sure there are more.
    We must stay strong, educate those that are willing to hear.
    May Hashem watch over all Yiddishe Kinderlach!!

  • moishe kahan says:

    Will you please compare the vaccinated vs non vaxed in your own practice , their overall health , as we well as how much they contribute to your wealth

    • Naor Bar-Zeev says:

      Dear Moishe,
      In my own practice I have seen unvaccinated children hospitalised and die from vaccine preventable infectious diseases.
      I am funded through my university salary.
      The clinical work I do is pro bono. I make exactly zero dollars for my clinical work.
      kol tuv
      Naor

  • Don't Know Everything says:

    This article is amazing!
    The main point I think we should focus on is the fact that we do not know everything. Statistics is a very complex subject that the average person cannot grasp entirely.
    We therefore have a chiyuv to do Hishtadlus and listen to the Doctor who we use. Not trusting a doctor in taking vaccinations is as if one has a heart attack and tells the doctor how to perform the surgery.
    “Nitan r’shus lrofei lhisrapai”

  • samu says:

    #14

    lhisropos vlo lhazik

  • Truth be told says:

    Can you please explain how a company like Merck that continued to produce Vioxx for several years after they already knew there were problems with it and that it was killing tens of thousands of people is allowed to manufacture vaccines and not even have any liability for them?

    They were successfully sued for the Vioxx debacle yet they are the only manufacturer of the MMR and we are supposed to trust them? No one went to jail for that, just business as usual for them.

  • nyj says:

    problem is that there is no choice in vaccines. The govt. mandates to give all of them or nothing. Do you actually mean that If I delay in giving my 12 hour old baby the hepatitis vaccine, when his mother never had and does not have hepatitis, I am being mevateil a mitzvas asei??? I don’t think any posek will agree with that.

  • Naor Bar-Zeev says:

    Mazel tov!
    Let us hope for your wonderful baby’s sake that the people around you have not delayed vaccinating against measles, since your baby is unable to receive that vaccine for many more months to come. And if they are delaying then yes they are being mevatel their obligation klapei shmaya and klapei your baby.
    bivracha
    Naor Bar-Zeev

    • nyj says:

      My baby is much more than 12 hours old!! but I will take your mazel Tov wishes anyway!! Thank you. (I was just using the word My as an example, I meant A baby)

      So are you saying that only if people delay the measles vaccine they are obligated klapei shamaya, but no other vaccine ?

      But a problem is that there is no measles vaccine, it is only MMR. Do you think that as a vaccinologist you would be able to convince the drug company to produce separate vaccines for measles, mumps and rubella?
      Also, it seems that you did not mean that the hepatitis vaccine must be given to such a young baby, especially if his mother does not have and never had hepatitis. But do you think the people around the baby should be getting the hepatitis vaccine on the day that the baby is born?

  • Why says:

    Please explain why you give the hep b shot (hep b is an std) to day old infants from frum families.

    • w22 says:

      Because alot of people have baby “nurses” that come from who knows where

      • come on says:

        That’s not a good reason. Do you know how hep b is transmitted? through blood (or std). These foreigners may be nurses or not but are they giving blood or hurting the babies to the extent that their blood has access to the baby’s blood?
        Secondly, most ppl. know when their in the hospital after their baby is born whether they will be having one of these “nurses” in their home. So what about all those who don’t use their services?

  • Seeker says:

    Dr. Bar Zeev, it is heartwarming to see your genuine concern for your patients’ well being. You speak passionately about vaccines preventing disease, but you did not mention how you educate your patients on proper nutrition; poor eating habits directly affect immune response, emotional health, behavioral health, etc. Do you warn the schools about the dangers of candy and soda? Do you teach your patients how childhood obesity is far more harmful than a virus? Do you advise your patients how to boost their immune system so that their amazingly designed bodies can optimally fight all these diseases?

  • nuj says:

    Dr Naor,

    I’ve never met a vaccinologist. Exactly what does a vaccinologist do? It would be very helpful if you would cite some of the studies on vaccine safety that you have done. I would love to read them. thanks!

    Also, it seems that you work as a pediatrician in third world countries, where the mothers must carry their babies on their backs on unpaved roads to go to the doctor to get their vaccines, which are not available. I don’t think that happens in industrialized countries.

    I think a much better way to improve public health is to first get clean water, adequate food and better living conditions for the people living in the country where you practice medicine.

    • Naor Bar-Zeev says:

      The tragedy is that where vaccines are difficult to access people really make such a struggle to try to get them. While in countries that are wealthy, and people are educated, countries that have benefited most from vaccination – it is in those countries that vaccine uptake rates are dropping.
      “vayishman yeshurun vayiv’at”

  • yottle says:

    executive summary:
    “aluminum is safe”
    Here he takes us all as fools.
    in the clinical trials of Gardasil, 2.3% of the group that received only AAHS (the alum adjuvant) developed auto-immune conditions within 6 months, while ZERO from the saline placebo group.
    But than again,, maybe Merck’s is some fringe group.

    • Naor Bar-Zeev says:

      Dear Yottle,
      Respect is earned by respecting others, not by name calling. I take nobody to be a fool. Quite the contrary, anti-vaccine campaigners are sophisticated and malicious. They should be held fully responsible and culpable for the harm their words cause. If as a result of a false and misleading post like yours, even one parent hesitates to give their child MMR – that will be your responsibility, and may the Almighty hold you more accountable than you hold yourself to be.

      I have given a very thorough evaluation of the mechanistic literature that could remotely raise concerns about alum. Regarding your mention of HPV vaccine see the very large and reassuring studies by Willame C et al Human Vaccines & Immunotherapeutics 2016;12:2862 and Lin L et al Pediatric Infectious Diseases Journal 2018;37:e93 and Lehtinen M et al Human Vaccines 7 Immunotherapeutics 2016;12:3177. This is not a comprehensive list.

      Regardless, this is all a distraction designed to attack parents’ confidence in vaccines. MMR contains no alum adjuvant. For the parent worried about MMR, do not be swayed by yottle’s comment. Make the right decision for your child. Vaccinate them.

      Naor

      • only you can do the name calling? says:

        you’re integrity is questionable when you say in one sentence that respecting others is earned not by name calling and then proceed to call people that are concerned with the safety of vaccines after having witnessed vaccine injuries anti-vaccine campaigners. Most of the people in the group that you refer to as “anti-vaccine” are actually “ex-vacciners” we followed your advice and vaccinated our children and now are left holding the bag with vaccine injured children. Vaccine injury is real. Vaccines are not safe and effective for everyone. therefore to promote a narrative that I must sacrifice my child for the greater good run completely opposed to what Yiddeshkeit stands for. As parents we were given the responsibility to care for our children and do what is the right thing for our child, not follow what everyone else is doing merely because everyone else is doing it. No tow people have the same epigenetics and therefore each medical procedure must be customized for the patient in question.

        the real name calling was “malicious” what scientific proof do you have that there is anyone on the side of vaccine education is malicious. stop saying things without having scientific evidence to back it up.

  • Dc says:

    Thank you Dr. your sincere interest in public health . You still didn’t explain why bilions of dollars have been awarded in vaccine court to people suffering damage from vaccines . Can vaccines be made safer ?
    Most docs won’t admit this fact and that’s why there is skepticism. They will keep parroting “ safe and effective “ but not much else .

  • wise grandmother says:

    re: population studies for vaccines.
    I checked out the reference you gave of a population study comparing vaccinated children to children who chose not to vaccinate. The study you cited in Lancet by Bar-Zeev – that’s you! – studies children in the sub Sahara region. It only studies one vaccine: Rotovirus.. One would expect that the results in the US, where clear water and good hygiene are prevalent, would be different.
    I know you replied to me that i have only a partial understanding of epidemiology, but a reasonable person should be able to explain to reasonable person why it would be too difficult to compare large populations of vaccinated versus unvaccinated children in the US. There is a growing grassroots movement all across the USA of parents who don’t vaccinate their children. So it shouldn’t be hard to do multiple studies in multiple states, correcting for factors like diet and pre-existing conditions. These studies are done all the time for diet, exercise, smoking, etc… Parents are waiting for these studies to be done in the USA – not the sub Saharan desert..

  • keepyourcool says:

    Dr. Naor,

    You did not answer my question!

    How do you trust big institutions run by Liberals?

    UN – passes countless resolutions condemning Israel for violation of Human rights, yet almost nothing on PA, Syria, Iran and other Arab counties that oppress and kill their citizens on regular bases!!!

    IRS – under Obama illegally denied non-profit status to “Tea Party” organizations for political reasons and no one was held accountable!

    DOJ – under Obama ran operation called “fast and furious” that put assault weapons into the hands of Mexican cartels, causing countless death in Mexico and US and no one was held accountable. Obama DOJ targeted Trump complain for political reasons creating “Russia Gate” now known as “Spy Gate” and we see how hard it is to get to any accountability from government employees.

    FISA – under Obama allowed surveillance on Trump election complain braking all the rules and no one was held accountable yet!

    CIA – under G. W. Bush issued fake WMD assessment causing second Iraq war, costing USA $5 trillions. Under Obama spreading misinformation about Russian election interferance to implicate President Trump and no one was held accountable yet!

    FBI – under Obama clearing and defending Hillary Clinton and implicating President Trump of collusion with Russia, and after 2.5 years only few people are being held accountable so far.

    CDC – is just huge and powerful government agency accountable to congress that is at best “sleeping at the wheel” or paid off to look the other way. When you have Big Pharma insiders in charge of government regulatory agency what do you think happens??? You can’t compare that to auto industry!!!

    WHO – was established by same diplomats who established corrupt UN and that’s enough of a reason not to trust it!

    We have major health issues in our community like behavioral and mental issues, allergies and other chronic illnesses, causes of which are being swept under the carpet. Instead we are busy with 100% vaccination effort!

  • Shmeel says:

    To keepyourcool – Stop with the Conspiracy Theories!

  • Seeker says:

    W22:If your baby nurse is sharing needles with your infant then you have a much bigger problem than hep b. (Hepatitis b is NOT transmitted through saliva; it is a std.)

  • Am I Immune? says:

    I wonder if Dr. Bar Zeev could answer this question. When it is said that vaccines are 95/97% effective does that mean that is the case for each person who gets it or does that mean that for that percentage they are completely immune whereas the rest are not immune at all. Because of the recent outbreak I went to check my titers. The results were that I was immune. My understanding was that even if I would be exposed I am 100% immune. Is that true? If so that is pretty cool that they wear off after nearly three decades!

  • mazel says:

    Dr., if all of us are biologically the same, then why do many people who are vaccinated not become immune (based on my studies, the number is greater than the 3% published by the CDC), and many people do become immune?

  • Yikes! says:

    MMR and other vaccines were analyzed to see if they contain glyphosate, a cancer-causing product that is used to kill weeds. And sure enough some vaccines did contain it, with MMR having the most amount! More info can be found at “Glyphosate found in major childhood vaccines” and “Weeding out vaccine toxins: MMR, Glyphosate and the health of a generation.”

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