The issue also affects the country’s fastest-growing Charedi community in Prestwich, Manchester.
The World Health Organisation (WHO) has held discussions with communal leaders from the north-east London suburb, home to Europe’s largest strictly Orthodox community, because of “persistent outbreaks of vaccine preventable diseases (VPDs)”. The organisation has decided to intervene via its Tailoring Immunisation Programme (TIP), which was designed to identify susceptible populations.
Low uptake levels threaten to “jeopardise disease elimination”, according to WHO, which is why medical experts are working with community leaders — many of whom are calling for action now.
Chief among those is Stamford Hill GP, Dr Joseph Spitzer, himself an Orthodox Jew. More than 80 per cent of his patients in Cranwich Road Surgery are Charedi.
“Parents who don’t immunise their children are totally irresponsible, for their own children and other people’s,” he said.
For diseases to be wiped out, communities must have “herd immunity”, whereby well above 90 per cent of people are immunised. When that is not reached, as in Stamford Hill, where the percentage is well below 80 per cent, there is the risk of an epidemic, particularly among the elderly, young children and pregnant women.
Evidence provided by City and Hackney Public Health Team revealed that uptake of the 5-in-1 vaccine (combating diphtheria, tetanus, whooping cough, polio and Hib), which should be delivered in early infancy, was around 30 per cent lower in concentrated Charedi areas than in the rest of the borough of Hackney. In Stamford Hill, the uptake in 2015-16 was 64 per cent, compared with 90 to 95 per cent elsewhere in the borough.
Rates for the MMR vaccination in the same area for the same period were 76 per cent, while the uptake across Hackney was 85 to 89 per cent. This is significantly better than previously, but is “slowly and steadily declining”, a council spokeswoman said.
When Rachel Fein’s daughter was four months old, she contracted measles at the creche at Yesodey Hatorah Senior Girls School, where Mrs Fein is deputy head.
“She was too young to have the MMR so when she was exposed to measles she developed it with complications,” said Mrs Fein. “Thankfully there were no long-term effects, but she was admitted to hospital with a high fever, lethargy, a rash and dehydration.”
Children are no longer accepted in the creche without vaccinations, unless there are specific medical reasons.
Dr Spitzer said that reasons for the drop in vaccination rates are “hard to define”.
“A lot is based on ignorance and myth. Parents aren’t desperately well informed because they don’t follow secular media,” he explained. “Sometimes they say the rebbe told them not to immunise, but when I speak to the rebbes they vehemently deny it. There’s a certain laissez-faire attitude due to people no longer knowing what these diseases are. Immunisation is a victim of its own success.”
Babies should be vaccinated from eight weeks onwards, but that advice often falls on deaf ears.
“Occasionally we have outbreaks of measles, rubella and mumps which are entirely preventable,” Dr Spitzer said.
The Cranwich Road Surgery is among three in the area to employ a Charedi nurse to boost take-up. Naomi Freeman was previously funded by Hackney Public Health to do just that across the borough and was highly successful. However, she was recently made redundant due to budget cuts.
“I got rates up from 54 to 87 per cent [within the community],” said Mrs Freeman, who was taken on by Dr Spitzer last month. At that time, immunisations at Cranwich Road were just 50 per cent.
“Health visitors would be told that Pesach is coming up and they can’t immunise for six weeks,” Mrs Freeman added. “The health visitors took that at face value, but I say ‘put your kugel in the oven and come to me’.”
Excuses for not seeking vaccinations are numerous, according to Mrs Freeman, who says the risk is heightened by overcrowding and the high proportion of pregnant women and young children in the community.
But there are real pressures which deter parents. She explained: “Most mothers don’t drive and every week there’s Shabbos to prepare for. They are so overloaded so often they can’t face having a child that’s going to be unwell for several days. But the side-effects are so minute in comparison to getting the actual illnesses.” She continued: “I had someone who never immunised because family members said it was too dangerous. Would you ask your cleaner for medical advice? Of course not. So why go to family when doctors and nurses want the best for your children?”
She cited a recent example of a child from another Charedi community who had three limbs amputated after contracting meningitis. “Maybe the mother forgot her appointment or didn’t want her child to cry for a few days. Would you want that guilt?”
Rabbis are vital to reverse the trend, she believes and somebody playing his part is Rabbi Avrohom Pinter, chairman of the Orthodox Jewish Health Forum.
He said: “People don’t take immunisation seriously because they’ve seen those illnesses and think ‘it isn’t that terrible’. They don’t realise that it could kill somebody else. We have a responsibility to others as well as to ourselves.”
Rabbi Pinter believes the inaction is partly due to enduring fears about MMR, sparked by former doctor Andrew Wakefield who was discredited over claims the vaccine caused autism. He said: “Some people say ‘it’s in God’s hands and I’m not going to take that risk’. That view has no basis in Yiddishkeit.”
Rabbi Pinter is critical of the NHS’s decision to axe Mrs Freeman’s role, but commends her continuing involvement. “Somebody outside the community may accept some of the excuses out of political correctness, but she understands the issues,” he said.
The importance of vaccinations within the community was emphasised by Professor David Katz, an immunopathologist who is chairman of the Jewish Medical Association (UK).
He said: “All communities need to be engaged with immunisation. The Stamford Hill Jewish community is not unique, but they may need more encouragement, and a different, sensitive approach from healthcare workers.
“It is very unfortunate that previous efforts to support high rates of immunisation in that community seem to have been disrupted due to changes in service funding and provision. Doctors have already seen serious complications, requiring hospital admission.
“The good work done in this community in the past must not be dissipated.”
The issue also affects the Charedi community in Prestwich, Manchester. According to Dr David Hibbert, a local GP who is strictly Orthodox, it is a problem he has repeatedly encountered in his 30-year career. “I’m sat here at my desk with a load of immunisation refusers that I need to chase up,” he said. “On the whole these people blame anecdotal stories of this person who had a reaction or that person who fell ill, or they are just mistrustful of the whole system.
“If the government was really interested in raising rates they would just insist that no child could go to school without immunisations, like they do in France.”
Dr Hibbert acknowledged that some people are simply “overwhelmed” by the pressures of large families which is why his practice periodically organises home visits to immunise children.
Two years ago a report into the health of the Salford Jewish community’s health revealed that uptake was a problem among Charedim in the area.
The report showed that just over half of people (58 per cent) were totally happy about immunising their child, while the remainder were either unhappy about it or unsure. It concluded that a “new, hard-hitting marketing campaign on immunisation” was needed.
Dr Marc Herscovitz, a GP working with the Charedi community in Gateshead, painted a rosier picture. He said: “Rates of immunisation here are within the expected norms, with local rabbis supporting vaccinations.”
According to Shlomi Isaacson, of the Jewish Council of Gateshead, the local Labriut Healthy Living Centre has worked closely with Charedi families and with GPs’ surgeries to boost numbers being vaccinated and there are currently few concerns about take-up.
Low take-up rates are not uncommon within Charedi communities elsewhere in the world. As a result, there have been reports of several epidemics of preventable diseases in recent years, including measles outbreaks in Brooklyn in 2013.
