Dr. Marc Siegel on measles and the controversy shaking Rockland County

Rockland County, New York is a beautiful suburb of New York City on the west side of the Hudson River. A pastoral place, it is currently the center of a raging controversy between the anti-vaccination community, the Orthodox Jewish community, and public health.

On the surface the conflict would appear to be an issue between the rights of the individual versus the rights of the community, where close to 170 new measles cases have occurred in mostly unvaccinated children. But the problem goes deeper and is really about the necessity for public health paradigms to supervene an individual’s rights to place others knowingly at risk.

Almost two weeks ago, County Executive Ed Day issued a public ban for all those under the age of 18 who haven’t been vaccinated against measles. He was right, and the ban was mostly a warning - the intention was not to put anyone in jail. At first, more than 500 additional vaccines were given, but then on April 5, State Judge Rolf Thorsen ruled that unvaccinated minors could return to schools, churches, synagogues and shopping centers.

DR. MARC SIEGEL: MEASLES – AND VACCINE NON-COMPLIANCE – MEETS PUBLIC HEALTH

I believe this was wrong, that the county executive had every right to issue the 30-day ban. Consider that according to the National Conference of State Legislatures, “Public health quarantine and isolation are legal authorities that may be, but rarely are, implemented to prevent the spread of communicable diseases. Isolation may be used for ill people, to protect the public by preventing exposure to infected people. Quarantine may be used to restrict the movement of well people who may have been exposed to a communicable disease until it can be determined if they are ill, for example, people who have a communicable disease but do not know it, or may have the disease because of close contact with ill people but do not show symptoms.”

The threat to others was significant not because of the sheer number of cases but because measles has a high infectivity rate of over 90 percent in unvaccinated individuals. It also can lead to serious complications including pneumonia (1/20), brain swelling or death (1-2/1000).

As a practicing Jew, I can tell you there is also nothing in Orthodox Jewish teaching against vaccines. In fact, the Torah (old Testament) favors public health. The anti-vaccine movement in the area is led by a propaganda group, PEACH, Parents Educating and Advocating for Children’s Health (a title which is the exact opposite of what they are doing) - which is spreading untruths to the community including the myth that vaccines cause autism. Luckily, a group of Orthodox Jewish nurses are countering this propaganda.

The county is currently working on legislation banning non-medical exemptions to end the gridlock. The problem with that solution is that there will still be many who will simply be non-compliant and refuse to get vaccinated.

There need to be consequences, and as long as the numbers continue to climb, I believe that extending the ban is warranted. Consider that two doses of the vaccine are 97 percent effective. Since MMR is a live virus vaccine, pregnant women, infants, chronically ill, and those who are immune-compromised cannot take it. Currently, only 72 percent of minors in Rockland County have received the MMR vaccine. But compliance needs to be over 90 percent (90 to 95 percent) in order to properly protect the community and the U.S. from measles regaining a foothold here.

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Measles, which once killed millions, still kills more than 100,000 per year around the world. MMR vaccine is a life saver, and the last measles death in the U.S. was in 2015, with none in the 12 years prior to that. We certainly don’t need anymore.

Now that’s public health 101.

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