NEW YORK — A quick fix to New York City’s measles outbreak is proving elusive, and the reasons are as much political as they are medical.
A powerful voting bloc, the ultra-Orthodox community has managed to carve out what is arguably a separate system of city services with their own ambulances, school buses and police. They run their own private schools for which they receive city, state and federal funds.
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That insularity coupled with measles outbreaks in Europe and Israel — two popular destinations for Hasidic Jews — made it only a matter of time before the virus spread out of control.
And New York City Mayor Bill de Blasio, who represented parts of the community as a City Council member, has been as accommodating as anyone to the Orthodox community, if not more so.
But de Blasio, who has been criticized by some as having been slow to respond to the outbreak, is now ordering mandatory vaccinations in some Brooklyn neighborhoods, a move that’s drawn criticism from community leaders and elected officials as potential government overreach. And he’s walking a political tightrope between a community he’s long-supported — and that has supported him with votes and campaign donations — and managing a burgeoning public health crisis.
“The mayor should have gone out sooner and gave the push to say, ‘people should be vaccinated‘ without coming out and saying we’re going to do penalties and to strong arm anyone,” City Council Member Chaim Deutsch told POLITICO in an interview. “You need be diplomatic in the way you come out. You can’t come out with force all of a sudden. You need to come out and say, ‘Listen, we need you to work with us. This is an epidemic now in the city, and it’s getting worse and worse.‘”
The city’s current measles outbreak, which began in October, has led to 329 infections confirmed by the city health department since October. That figure includes 44 new cases since last week. Twenty-five people have been hospitalized, six in the intensive care unit.
For years, the ultra-Orthodox Jewish community in Brooklyn, now at the heart of the worst measles epidemic in a generation, has suffered smaller outbreaks of vaccine-preventable diseases: chicken pox in 2016, pertussis in 2015, measles in 2013. In each case, the city health department dutifully recommended vaccination, and for the most part, people have listened. In New York city’s public schools, 99 percent of students are vaccinated, and 0.25 percent have religious exemptions. Among yeshivas — private schools that serve Orthodox students — across the city, 98 percent of students are vaccinated, and just 2 percent have religious exemptions.
But in Williamsburg, Brooklyn, home to a large ultra-Orthodox community, the rate of religious exemptions stands at close to 5 percent. In some ultra-liberal pockets of Brooklyn and in some ultra-Orthodox communities, the rates of religious exemptions have been growing rapidly since the turn of the century.
“We actually have some schools in Williamsburg where 20 percent of the children are known to have religious exemptions,” Health Commissioner Oxiris Barbot said on WNYC’s “The Brian Lehrer Show” last week. “I go back to the issue that there is nothing in Talmudic law that really prohibits vaccinations.”
Health department officials have long tried to stress the importance of vaccinations, working with physicians and rabbis. But they’ve seen their efforts stymied by a slew of misinformation that people hear and see from friends and family they hold in higher esteem than medical professionals.
At several of the schools and day care centers city health officials identified as sites of measles outbreaks in Brooklyn, the rate of religious exemptions from vaccination have steadily increased over the past six years, according to data available from the state health department. (Data for the sixth site identified by the city, Simche Kinder, was not available on the state’s website).
Anti-vaccine sentiment isn’t unique to the Orthodox community, but no community has a relationship with the city of New York quite like the Orthodox Jews, and political leaders’ history of both conflict and acquiescence is almost certainly playing into the current predicament.
“Our missed opportunity is not being louder earlier about the anti-vax sentiment,” infectious disease physician and the deputy health commissioner for disease control, Dr. Demetre Daskalakis, told POLITICO, speaking about the current measles outbreak.
“There is only so much our outreach and education can do when we don’t have trusted voices in the community to say that these anti-vax people are deleterious and harming the health of your kids,” Daskalakis said.
For almost the entirety of de Blasio’s tenure, Orthodox yeshivas were allowed to flout state educational guidelines with little to no interference from the city. When the city did crack down, some yeshivas simply refused to comply.
When he ran for mayor, de Blasio promised to do away with Mayor Michael Bloomberg’s restrictive policy on the practice of metzitzah b’peh, a form of ritual circumcision in which the mohel sucks blood from a newly circumcised baby’s genitals, which had led to multiple cases of children contracting herpes. De Blasio negotiated a toothless deal, relying essentially on self-reporting to stem the spread of herpes among Orthodox children. Six new cases of neonatal herpes resulting from metzitzah b’peh occurred since the deal was brokered.
This measles outbreak is fundamentally different from those cases in part because much of the ultra-Orthodox community’s leadership is at this point actively trying to get people to vaccinate their children.
“The Department of Health, the mayor mentioned that that they’re working with us very closely,” said David Niederman, head of the United Jewish Organizations of Williamsburg and an important liaison to the city’s Jewish community.
Niederman told POLITICO that he and other community leaders have been working “very intensively” with the city for a few months, and he feels confident there is progress. “The publicity of us — the rabbinical leadership and lay leadership— telling people that you have to, by Jewish law you have to vaccinate — That is going to have the effect on those last few holdouts to basically fall in line.”
Last week, “Der Yid,“ a newspaper published by the Satmars, a sect of Orthodox Jews, took the extraordinary step of publishing a newspaper editorial in English calling on people to vaccinate their children.
Still, despite the 30,000 robocalls and hundreds of fliers from the city, urging, cajoling and threatening parents to vaccinate their children or face fines — the distrust of government and concern that vaccines do more harm than good is forming a significant roadblock to city officials’ efforts to slow the outbreak’s progress.
But elected officials and health experts said while they thought the mayor may have been slow to forcefully condemn the anti-vaccination movement, they didn’t believe it was because of political pressure against vaccinations coming from the leadership of the Ultra-Orthodox community.
“Should he have done a quarantine earlier … Is it about doing the wrong thing?” said Democratic political consultant Hank Sheinkopf. “No he did the right thing in this case. Could he have been more forceful? Maybe.”
City Council Member Mark Levine said it wasn’t fair to compare the issue of vaccinations to “other challenging political issues in the ultra-Orthodox community, in part because so many prominent ultra-Orthodox leaders in Brooklyn and elsewhere have spoken out in favor of vaccination.”
“I think the anti-vaxxers in the Orthodox community represent a fringe element,” Levine said. “They’re circulating materials that are meant to tug at the emotional heartstrings of parents, that martial pseudo-science, that even invoke religious concerns, but those concerns have been roundly rejected by an array of prominent Rabbinic authorities who not only describe vaccines as being acceptable but even mandatory. I don’t think this falls in the category of other more controversial health and other issues related to the Orthodox community because of the support of so many prominent leaders.”