REPLY: COVID-19 Vaccines, Halakha, and Medicine
To the Editor:
We thank R. Rafi Eis for his very thorough reading of our article, “Halakha Approaches the COVID-19 Vaccine.” He writes that “Our current knowledge of the COVID vaccine would seem to require an update to the essay.” We agree and appreciate his giving us the opportunity to do so.
[Read Rafi Eis’ Letter to the Editor here.]
“Halakha Approaches the COVID-19 Vaccine” appeared in TraditionOnline on October 20, 2020, nearly one month before Pfizer announced that its vaccine trial had met its primary efficacy endpoints, nearly two months before the UK or the FDA granted it emergency use authorization, and before it first became available to the public. The article appeared several weeks before poskim weighed in on the permissibility or obligation of taking the vaccine, and 10 months before the FDA gave it full approval. Our article offered a theoretical analysis of how halakha might approach a COVID-19 vaccine if and when it should become available, based on the limited available medical data regarding a potential vaccine’s efficacy and the existing halakhic literature about the obligation to vaccinate in general and, more specifically, during an epidemic. So what has happened since the publication of our article? Where did it leave off and what is the current medical and halakhic reality?
Soon after the publication of our article, as governments made the vaccine available to the general public, poskim and religious institutions from across the Jewish world issued statements endorsing, if not obligating, vaccination. In Israel these included Rabbis Chaim Kanievsky, Yisrael Meir Lau, Gershon Edelstein, Yitzchak Yosef, Asher Weiss, Shlomo Amar, Yitzchak Yishayahu Weiss, the Gerrer and Boyan Rebbes, as well as the Moetzet Gedolei HaTorah, among others. (A complete list can be found in Menashe David Sasson, HaHisunim be-Halakha, 347-359.) The Orthodox Union, under the guidance of Rabbis Mordechai Willig and Hershel Schachter, and with the support of R. Dovid Cohen, classified vaccination as a fulfillment of “the Torah obligation to preserve our lives and the lives of others requires us to vaccinate for COVID-19 as soon as a vaccine becomes available.” Virtually no recognized posek prohibited vaccination. Their strong encouragement paid off, and Jews of all stripes got vaccinated, to their benefit and that of those around them.
As of March 2023, 5.55 billion people, or 72% of the world’s population, had received the COVID vaccine. COVID-19 vaccines saved nearly 20 million lives in the first year that they were available. In the US, through November 2022, COVID-19 vaccines prevented more than 18.5 million hospitalizations and 3.2 million deaths, and saved the country $1.15 trillion. Scientists estimate that “Without vaccination the U.S. would have experienced 1.5 times more infections, 3.8 times more hospitalizations, and 4.1 times more deaths.”However, preventing the acute phase of COVID-19 does not tell the whole story or capture the full efficacy or impact of the vaccine. Each case of COVID carries a risk of long COVID, which can severely interfere with quality of life; vaccination cut the risk of long COVID by as much as 50%. Many of the infections that the vaccine prevented would have been re-infections, which carry a higher risk of death than do initial infections.
The impact of the vaccine is even more remarkable given the challenges of the multiple variants that have arisen since the initial strain, especially Omicron for which the vaccine provided broader and more durable protection against severe outcomes such as hospitalization and death. The reported “mild” nature of Omicron is due in large part to vaccine protection. The CDC continues to recommend the vaccine for all individuals regardless of age, and so do poskim.
Regarding the Swedish model, touted by Eis, which relied on the development of immunity through infection alone, many scientists debate its merit. An independent review of Sweden’s policies has revealed that the government suppressed scientific information, and that “During 2020, Sweden had a ten times higher COVID-19 death rate compared with neighbouring Norway… The Swedish response to this pandemic was unique and characterized by a morally, ethically, and scientifically questionable laissez-faire approach.” The details of Swedish policies are horrifying. The authors report that the Swedish government deliberately used children to spread COVID-19 and denied care to the elderly and those suffering from other conditions. “Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives” (see especially Supplementary Materials 6). Swedes suffered gravely from these policies, with a death rate between February 2020 and March 2022 of 1,790 per million, worse than that of Germany (1,539), Canada (984), and Japan (220). Sweden ultimately did vaccinate its population. As of April 2022, 87.1% of Swedes 12 years and older had received at least one dose.
Regarding R. Eis’ assertion that in October 2020 the medical community did not consider COVID life-threatening for healthy people below age 40: Only two months later, Dr. Rochelle Walensky, soon to become the director of the CDC, reported in a New York Times op-ed column that deaths from COVID-19 had surpassed those from opioid overdose in this age group. As of June 14, 2023, 6,965 Americans between the ages of 18 and 29, and 19,735 individuals between the ages of 30 and 39 had died from COVID-19. Of the 127 million Americans who have had COVID-19, 26% of those between the ages of 25 and 39 developed long COVID. In 8% of these cases, the long COVID was severe. Furthermore, arguing that those under 50 do not require vaccination fails to recognize the importance of vaccination not only to prevent infection for oneself but to protect others in fulfillment of lo ta’amod al dam re’ekha.
In its conclusion, “Halakha Approaches the COVID-19 Vaccine” states:
We hope that a safe and effective vaccine will be developed and disseminated in the very near future. It is our best hope to alleviate the worldwide suffering and to arrest the horrific death toll brought about by the COVID-19 pandemic. When it does arrive, we feel that it is morally obligatory and halakhically mandated that people accept the vaccine.
When we wrote these words, we never anticipated the overwhelming endorsement of the vaccine by the medical community, government and government agencies, and poskim that followed, nor the miraculous effects of the vaccine in turning the tide of the pandemic.
Our hope was that the article would prompt a discussion in the Orthodox world regarding how halakha conceptualizes vaccination. That it continues to draw interest nearly three years later indicates that we achieved our objective. Indeed, a great deal has transpired since October 20, 2020, and we have much to celebrate and for which to thank God. Our poskim followed science and courageously adhered to the most current medical recommendations. Their almost universal endorsement of the vaccine is both refreshing and meaningful, and it saved countless lives. Knowing this, we are grateful that our rabbinic and halakhic leadership got it right.
Sharon Galper Grossman, MD, MPH & Rabbi Shamai Grossman, MD, MS