ArticlePDF AvailableLiterature Review

What the World's religions teach, applied to vaccines and immune globulins

Authors:

Abstract

For millennia, humans have sought and found purpose, solace, values, understanding, and fellowship in religious practices. Buddhist nuns performed variolation against smallpox over 1000 years ago. Since Jenner developed vaccination against smallpox in 1796, some people have objected to and declined vaccination, citing various religious reasons. This paper reviews the scriptural, canonical basis for such interpretations, as well as passages that support immunization. Populous faith traditions are considered, including Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam. Subjects of concern such as blood components, pharmaceutical excipients of porcine or bovine origin, rubella strain RA 27/3, and cell-culture media with remote fetal origins are evaluated against the religious concerns identified.
Vaccine
31 (2013) 2011–
2023
Contents
lists
available
at
SciVerse
ScienceDirect
Vaccine
jou
rn
al
h
om
epa
ge:
www.elsevier.com/locate/vaccine
Review
What
the
World’s
religions
teach,
applied
to
vaccines
and
immune
globulins
John
D.
Grabenstein,1
Merck
Vaccines,
770
Sumneytown
Pike,
WP97-B364,
West
Point,
PA
19426,
USA
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
20
October
2012
Received
in
revised
form
21
December
2012
Accepted
7
February
2013
Available online 26 February 2013
Keywords:
Religion
Beliefs
Vaccines
Antibodies
Immune
globulins
a
b
s
t
r
a
c
t
For
millennia,
humans
have
sought
and
found
purpose,
solace,
values,
understanding,
and
fellowship
in
religious
practices.
Buddhist
nuns
performed
variolation
against
smallpox
over
1000
years
ago.
Since
Jenner
developed
vaccination
against
smallpox
in
1796,
some
people
have
objected
to
and
declined
vaccination,
citing
various
religious
reasons.
This
paper
reviews
the
scriptural,
canonical
basis
for
such
interpretations,
as
well
as
passages
that
support
immunization.
Populous
faith
traditions
are
considered,
including
Hinduism,
Buddhism,
Jainism,
Judaism,
Christianity,
and
Islam.
Subjects
of
concern
such
as
blood
components,
pharmaceutical
excipients
of
porcine
or
bovine
origin,
rubella
strain
RA
27/3,
and
cell-culture
media
with
remote
fetal
origins
are
evaluated
against
the
religious
concerns
identified.
The
review
identified
more
than
60
reports
or
evaluations
of
vaccine-preventable
infectious-disease
outbreaks
that
occurred
within
religious
communities
or
that
spread
from
them
to
broader
communities.
In
multiple
cases,
ostensibly
religious
reasons
to
decline
immunization
actually
reflected
concerns
about
vaccine
safety
or
personal
beliefs
among
a
social
network
of
people
organized
around
a
faith
community,
rather
than
theologically
based
objections
per
se.
Themes
favoring
vaccine
acceptance
included
transfor-
mation
of
vaccine
excipients
from
their
starting
material,
extensive
dilution
of
components
of
concern,
the
medicinal
purpose
of
immunization
(in
contrast
to
diet),
and
lack
of
alternatives.
Other
important
features
included
imperatives
to
preserve
health
and
duty
to
community
(e.g.,
parent
to
child,
among
neighbors).
Concern
that
‘the
body
is
a
temple
not
to
be
defiled’
is
contrasted
with
other
teaching
and
quality-control
requirements
in
manufacturing
vaccines
and
immune
globulins.
Health
professionals
who
counsel
hesitant
patients
or
parents
can
ask
about
the
basis
for
concern
and
how
the
individual
applies
religious
understanding
to
decision-making
about
medical
products,
explain
facts
about
content
and
processes,
and
suggest
further
dialog
with
informed
religious
leaders.
Key
considerations
for
observant
believers
for
each
populous
religion
are
described.
© 2013 Elsevier Ltd. All rights reserved.
Contents
1.
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Methods
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Results
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.2013
3.1.
Populous
religious
groups
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.2013
3.1.1.
Hinduism
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.2013
3.1.2.
Buddhism
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.2013
3.1.3.
Jainism
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3.1.4.
Judaism
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.2014
3.1.5.
Christianity
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3.1.6.
Islam
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.2016
3.2.
Vaccine
components
and
processes
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.2017
3.2.1.
Bacteria,
viruses,
cell
substrates
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.2017
3.2.2.
WI-38
and
MRC-5
cell
lines
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.2017
Tel.:
+1
215
652
6695;
fax:
+1
215
652
8833.
E-mail
address:
john
grabenstein@merck.com
1JDG
is
an
employee
of
Merck
&
Co.,
Inc.,
Whitehouse
Station,
NJ.
This
work
represents
the
author’s
opinions
and
not
those
of
Merck
&
Co.
The
author
has
been
a
practicing
Roman
Catholic
his
entire
life,
and
has
explored
religious
aspects
of
immunization
since
the
1990s.
0264-410X/$
see
front
matter ©
2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.vaccine.2013.02.026
2012 J.D.
Grabenstein
/
Vaccine
31 (2013) 2011–
2023
3.2.3.
Rubella
virus
strain
RA
27/3
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.2017
3.2.4.
Porcine
excipients
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.2018
3.2.5.
Bovine
excipients
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.2018
3.2.6.
Misunderstandings
of
vaccine
production
or
content
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.2018
3.2.7.
Pathogen
route
of
exposure.
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.2018
4.
Discussion
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.2019
5.
Personal
note
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.2020
Acknowledgements
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.2020
Appendix
A.
Supplementary
data.
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.2020
References
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.
.2020
1.
Background
People
conducting
immunization
programs
may
encounter
individuals
who
hesitate,
question,
or
decline
some
or
all
vac-
cines
or
immune
globulins
based
on
religious
beliefs
or
related
cultural
reasons.
Such
matters
are
intensely
personal
and
may
be
disconcerting
for
health
professionals
not
comfortable
dis-
cussing
religious
issues
or
who
usually
make
immunization
decisions
based
on
matters
more
closely
aligned
to
quantitative
sciences.
The
word
religion
derives
from
the
Latin
religio
or
religionem,
describing
respect
for
the
sacred
or
reverence
for
God
or
gods
[1,2].
Multiple
definitions
of
religion
have
been
proposed,
but
religions
are
fundamentally
sets
of
beliefs
about
God
or
spirituality
held
by
groups
of
people.
Like
all
groups,
religious
groups
develop
their
own
systems
of
culture.
And
yet,
as
we
will
see,
behaviors
of
like-
minded
individuals
are
not
necessarily
related
to
the
theological
basis
of
their
religions.
“Religious”
differs
from
“theological,”
in
part,
as
social
differs
from
scholarly.
Religious
concerns
about
immunization
have
a
long
history,
reaching
back
to
those
who
rejected
Edward
Jenner’s
1796
mode
of
smallpox
vaccination
as
contrary
to
God’s
will
[3].
In
the
United
Kingdom,
the
Anti-Vaccination
League
formed
in
1853
in
Lon-
don
to
oppose
compulsory
vaccination
acts
[3–6].
Similar
events
occurred
in
the
Netherlands
and
elsewhere
[6].
In
the
United
States,
several
Boston
clergymen
and
devout
physicians
formed
the
Anti-
vaccination
Society
in
1879
[3,4,6–8].
In
contemporary
cases,
such
objections
involve
blood
products,
porcine
or
bovine
pharmaceuti-
cal
excipients,
or
the
remote
fetal
origins
of
cell-culture
media
and
rubella
strain
RA
27/3.
In
contrast,
it
is
also
worth
remembering
that
some
of
the
earliest
descriptions
of
variolation
to
prevent
smallpox
involved
the
proponency
of
Buddhist
religious
women
[9].
Individual
rights
are
deeply
embedded
in
many
cultures.
With
contagious
diseases,
though,
vaccine
and
immune
globulin
deci-
sions
may
affect
more
than
an
individual’s
health.
This
occurs
if
a
parent
chooses
to
withhold
immunization
from
a
child
or
where
vaccine-exempting
people
increase
the
infectious
risk
of
their
neighbors.
Numerous
examples
of
vaccine-preventable
outbreaks
among
religious
schools,
congregations,
and
communities
illustrate
how
clusters
of
vulnerable
people
can
enable
epidemics,
even
spreading
beyond
those
foci
to
neighboring,
well-immunized
communities
[12–15].
Published
examples
include
diphtheria
[16,17],
Haemophilus
influenzae
type
b
[18,19],
hepatitis
A
[20,21],
measles
[22–51],
mumps
[52–55],
pertussis
[19,33,50,51,56,57],
poliomyelitis
[19,33,45,58–70],
and
rubella
[45,71–80,82].
Tetanus
cases
have
also
resulted
[50,51,83].
These
infections
occurred
in
multiple
countries
(including
transmission
across
borders
and
oceans)
and
among
a
range
of
cultural
traditions
and
socioeco-
nomic
situations,
leading
directly
to
hospitalizations,
disabilities,
and
deaths.
In
several
analyses,
the
risk
of
measles
or
pertussis
was
6–35
times
higher
among
people
claiming
exemption
to
immu-
nization,
compared
with
the
general
population
[32,33,84].
This
elevated
risk
applies
regardless
of
the
faith
tradition
involved.
The
infectious
risk
has
nothing
to
do
with
religious
denomination
or
righteousness
of
the
objection.
To
paraphrase
the
Book
of
Genesis
(chapter
4,
verse
9),
vaccine
recipients
are
their
brother’s
keepers,
as
contributors
to
herd
protection.
This
review
is
intended
to
provide
a
factual
and
contextual
basis
for
discussions
about
religious
concerns
about
vaccines
and
immune
globulins,
as
well
as
the
role
of
religion
in
promoting
immunization.
The
perspective
taken
here
is
that
of
religious
insti-
tutions
and
authorities,
as
they
would
teach
their
doctrines
to
believers.
It
is
important
to
note
that
there
may
be
differences
between
what
individual
believers
profess
and
what
their
canon-
ical
texts
teach.
Indeed,
different
sects
within
a
faith
tradition
can
interpret
the
same
scriptural
passages
differently.
Vaccines
did
not
exist
when
the
Torah,
Bible,
Qur’¯
an,
or
major
Sanskrit
texts
were
originally
written.
Subsequent
interpretations
are
fundamental
to
how
contemporary
believers
approach
immunization.
This
review
is
not
intended
to
criticize
or
argue
against
any
religious
beliefs,
but
rather
to
objectively
describe
the
basis
from
which
the
beliefs
arise,
as
well
as
various
religious
positions
that
may
enable
or
even
expect
immunization
to
be
conducted.
The
goal
is
a
clearer
understanding
of
the
nature
of
some
motivations
for
or
objections
to
immunization,
how
broadly
or
narrowly
the
objections
tend
to
be
applied,
and
to
help
dispel
misunderstanding.
Philosophical
objections
to
immunization
are
beyond
the
scope
of
this
article.
Respectful
consideration
of
religious
beliefs
within
a
clinical
set-
ting
is
important
because
medicine
and
religion
come
together
to
frame
and
enlighten
choices
made
by
patients
as
well
as
health
pro-
fessionals
[4,45,68,85,86].
Scientists
and
clinicians
confront
moral
and
ethical
choices
daily
and
often
observe
a
religious
faith
that
helps
guide
their
own
personal
conduct.
Indeed,
the
religious
beliefs
of
countless
historical
and
contemporary
researchers
and
clinicians
have
been
a
source
of
motivation
to
help
relieve
human
suffering
by
means
of
immunization.
2.
Methods
To
identify
professional
and
lay
documents
related
to
the
acceptability
or
unacceptability
of
vaccines
and
immune
globu-
lins
based
on
religious
beliefs,
PubMed
and
Google
databases
were
searched
using
the
search
terms
[outbreak
and
religion],
[vaccine
and
religion],
and
[vaccine
and
“name
of
specific
religious
group”],
specifying
each
of
the
world’s
religions
estimated
to
have
at
least
5
million
adherents:
Bahá’í
Faith,
Buddhism,
Christianity,
Confu-
cianism,
Daoism,
Hinduism,
Islam,
Jainism,
Judaism,
Shinto,
and
Sikhism.
Also
searched
were
populous
denominations
within
the
Christian
tradition:
Roman
Catholicism,
Eastern
Orthodox
and
Ori-
ental
Orthodox
Churches,
Amish,
Anglican,
Baptist,
Church
of
Christ
(Scientist),
Church
of
Jesus
Christ
of
Latter-day
Saints
(including
“Mormon”),
Congregational,
Dutch
Reformed
Congregations,
Epis-
copalian,
Jehovah’s
Witnesses,
Lutheran,
Methodist,
Pentecostal,
Presbyterian,
and
Seventh-Day
Adventist.
J.D.
Grabenstein
/
Vaccine
31 (2013) 2011–
2023 2013
Table
1
Notable
scriptural
passages.
1A.
Hindu
Texts:
Bhagavad
G¯
ıt¯
a
3.14.
Shikshapatri ´
sloka
16
and
31
1B.
Sayings
of
the
Buddha:
Sermon
at
Benares.
Dhammapada
X:130
and
XV:204.
S¯
ama˜
n˜
naphala-sutta.
Sig¯
alov¯
ada-sutta,
Advice
to
Sig¯
ala.
Bodhicharyavatara
of
Santideva
III
1C.
Hebrew
Bible:
Genesis
4:9,
Leviticus
11:7–8,
11:10–11,
19:16,
and
19:19,
Deuteronomy
4:9,
14:7–8,
22:1–4,
and
22:8,
and
Proverbs
23:12–13
1D.
Christian
New
Testament:Passages
cited
to
support
immunization:
Mark
7:18–23,
Luke
10:33–35,
Luke
14:1–6,
1
Corinthians
10:24,
2
Timothy
1:14,
James
2:8,
and
3
John
1:2.
Passages
cited
in
declining
immunization:
Matthew
10:7–8
and
15:13,
Mark
2:17
[Note
similarities
with
Luke
5:30–31
and
Matthew
9:10–12]
and
5:34,
and
1
Corinthians
3:16–17;
6:19–20.
Consider
also
(C),
with
regard
to
Old
Testament
1E.
Jehovah’s
Witnesses:
Genesis
9:3–4,
Leviticus
17:10–14,
and
Acts
of
the
Apostles
15:28–29
1F.
Qur’¯
an:
2:173,
5:3,
5:4,
16:81,
16:116,
30:30.
Full
text
of
these
passages
appears
in
the
Supplemental
material.
These
selected
scriptural
passages
should
be
interpreted
in
context
with
text
pre-
ceding
and
following
them.
All
documents
identified
via
PubMed
were
assessed.
For
the
Google
searches,
at
least
the
top
50
entries
for
each
individual
search
were
evaluated,
more
when
the
search
results
delivered
rel-
evant
documents.
After
each
search,
reference
lists
were
scanned
to
identify
other
relevant
documents.
Religious
reference
books
were
consulted
[1,2],
as
well
as
key
scriptural
texts
(e.g.,
Hebrew
Bible,
Christian
New
Testament,
Qur’¯
an,
Table
1).
3.
Results
3.1.
Populous
religious
groups
Discussion
of
the
major
religious
groups
appears
below,
sequenced
by
the
founding
dates
of
these
traditions.
The
Chris-
tian
denominations
are
listed
alphabetically.
This
review
did
not
identify
any
canonical
doctrine
that
has
led
to
religious
objection
to
vaccines
or
immune
globulins
for
Bahá’í
Faith,
Confucianism,
Daoism,
Shinto,
or
Sikhism.
Most
ostensible
objections
to
immunization
attributable
to
reli-
gious
belief
fell
into
three
categories:
(a)
violation
of
prohibitions
against
taking
life,
(b)
violation
of
dietary
laws,
or
(c)
interference
with
natural
order
by
not
letting
events
take
their
course.
Each
is
addressed
further
below.
3.1.1.
Hinduism
Various
denominations
of
Hinduism
share
a
fundamental
set
of
common
beliefs,
but
philosophies
and
practices
vary
across
dif-
ferent
Hindu
denominations.
With
no
single
founder,
Hinduism
considers
itself
Sanatan
Dharma
(the
Eternal
Tradition)
and
traces
its
roots
to
the
revelations
in
the
Vedic
sacred
texts
of
ancient
India
(at
least
1500
years
before
our
common
era
(BCE)
to
500
BCE)
[1,2].
There
are
four
major
branches
of
Hinduism:
Shaiva,
Vaishnava,
Shakta,
and
Smarta.
The
Vedic
sacred
texts
were
transmitted
orally
for
many
centuries
before
being
committed
to
writing
[1,2,87].
Important
Hindu
texts
include
the
Shrutis
and
the
Smritis
(e.g.,
Vedas,
Mah¯
abh¯
arata,
R¯
am¯
ayana,
Bhagavad
G¯
ıt¯
a).
In
Hinduism,
the
ethics
and
metaphorical
meanings
of
the
texts,
as
revealed
by
spir-
itually
elevated
gurus,
may
often
be
emphasized
more
than
literal
interpretations.
Vaccination
is
widely
accepted
in
predominantly
Hindu
countries.
Hindus
advocate
non-violence
(ahimsa)
and
respect
for
life,
because
divinity
is
believed
to
permeate
all
beings,
including
plants
and
non-human
animals
[1,2,87,88].
The
degree
to
which
Hindu
believers
apply
the
principle
of
non-violence
varies.
Hindu
scrip-
tures
support
the
use
of
violence
in
self-defense
and
do
not
equate
ahimsa
with
pacifism
[88].
Some
reason
that
even
vegetation
must
submit
for
human
survival
and
that
humans
unknowingly
destroy
life
forms
on
a
regular
basis
through
daily
activities,
as
Mohandas
Gandhi
acknowledged
(Table
1A).
Some
Hindus
embrace
vegetarianism
to
respect
higher
forms
of
life
(Table
1A);
some
eat
meat
only
on
certain
days.
Food
habits
vary
across
communities
and
regions.
Observant
Hindus
who
do
eat
meat
often
abstain
from
beef.
The
cow
in
Hindu
society
is
tradi-
tionally
identified
as
a
caretaking
and
maternal
figure.
Verses
of
the
Rig-Veda
refer
to
the
cow
as
devi
(goddess),
but
Hindus
do
not
wor-
ship
cows,
but
rather
venerate
(deeply
respect)
them.
This
review
did
not
identify
contemporary
Hindu
concerns
with
trace
bovine
components
of
some
vaccines.
3.1.2.
Buddhism
Buddhism
involves
traditions,
beliefs,
and
practices
based
on
teachings
attributed
to
Siddhartha
Gautama,
commonly
known
as
the
Buddha
(awakened
or
enlightened
one).
The
Buddha
taught
in
the
eastern
part
of
what
is
now
India
between
the
6th
and
4th
cen-
turies
BCE,
perhaps
563–483
BCE.
He
is
recognized
by
Buddhists
as
an
enlightened
teacher
who
shared
his
insights
(Table
1B)
to
help
end
ignorance,
craving,
and
suffering,
and
attain
Nirvana
(Nibb¯
ana,
freedom
from
suffering)
[1,2,89–91].
Major
Buddhist
sects
include
Theravada,
Mahayana,
Vajrayana,
and
Zen.
Buddhism
has
no
central
text
commonly
referred
to
by
each
tradition,
nor
a
central
author-
ity
empowered
to
pronounce
on
doctrine
or
ethics.
Vaccination
is
widely
accepted
in
predominantly
Buddhist
countries.
A
key
precept
within
Buddhism
generally
prohibits
killing,
either
humans
or
animals
[1,2,92,93].
Some
canonical
passages
seem
to
accept
meat
consumption,
whereas
certain
Mahayana
sutras
(texts)
denounce
eating
meat
[94].
In
the
modern
Buddhist
world,
attitudes
toward
vegetarianism
vary
by
location.
This
review
did
not
identify
contemporary
Buddhist
concerns
with
trace
bovine
components
of
some
vaccines.
Buddhism
does
not
oppose
treatment
of
an
existing
illness
by
use
of
non-animal
derived
medicines,
because
treatment
is
an
act
of
mercy
[95–98].
Antibiotics
kill
microorganisms,
yet
antibi-
otics
are
accepted
because
they
help
people
get
closer
to
reaching
Enlightenment.
Serious
diseases
separate
the
body
from
the
mind.
Preventing
disease
means
preventing
disharmony
within
the
body.
The
Nepalese
Lama
Zöpa
Rinpoche
describes
a
prayer
of
the
Heal-
ing
Buddha,
to
prevent
diseases
not
yet
experienced
[99].
He
also
describes
Logyönma
(or
Loma
Gyönma),
“a
female
healing
bud-
dha
in
leaf-wearing
aspect,”
known
as
an
opponent
to
epidemic
diseases
[99,100].
The
first
written
account
of
variolation
describes
a
Buddhist
nun
(bhikkhuni)
practicing
around
1022–1063
CE
[9].
She
ground
scabs
taken
from
a
person
infected
with
smallpox
(variola)
into
a
powder,
and
then
blew
it
into
the
nostrils
of
a
non-immune
per-
son
to
induce
immunity.
Continuing
this
tradition,
the
14th
Dalai
Lama
participated
in
poliovirus
immunization
programs
personally
[101].
3.1.3.
Jainism
Jainism
arose
in
India
between
the
9th
and
6th
centuries
BCE,
based
on
the
teachings
of
Nataputta
Vardhamana
(also
called
Mahavira),
who
prescribed
a
path
of
non-violence
toward
all
liv-
ing
beings
[2,88,102,103].
Their
scriptures
are
known
as
the
Jaina
Sutras.
In
the
practice
of
ahimsa,
expectations
are
less
strict
for
lay
persons
than
for
monastics.
Jains
recognize
a
hierarchy
of
life
forms,
such
that
mobile
beings
are
accorded
more
protection
than
immobile
ones
[2].
Jains
are
vegetarians
or
vegans
[2,102].
They
avoid
eating
root
vegetables
in
general,
as
cutting
the
root
from
a
plant
kills
it,
unlike
other
parts
of
the
plant
(e.g.,
leaves,
fruits,
seeds).
Although
Jains
acknowledge
that
plants
must
be
destroyed
for
the
sake
of
food,
they
accept
such
violence
only
inasmuch
as
it
is
indispensable
for
human
survival
[2,88,102].
2014 J.D.
Grabenstein
/
Vaccine
31 (2013) 2011–
2023
Jains
may
drink
boiled
water,
cook
food,
use
paper
or
soap,
and
take
necessary
antibiotics,
but
perhaps
with
some
regret.
When
considering
vaccination,
Jains
may
benefit
from
an
explanation
of
the
seriousness
of
the
diseases
to
be
prevented,
to
explain
the
ratio-
nale
for
killing
microorganisms
in
the
course
of
vaccine
production
[103,104].
Jains
agree
with
Hindus
that
violence
in
self-defense
can
be
justified
[88,102].
Jains
filter
water,
to
remove
any
small
insects
that
may
be
present.
Observant
Jains
drink
primarily
water
that
has
been
fil-
tered
and
boiled.
Boiling
kills
the
multitude
of
tiny
beings
in
the
water,
but
this
is
considered
preferable
to
allowing
the
beings
to
reproduce
in
the
water
and
later
die,
which
would
result
in
a
greater
number
of
deaths.
As
one
Jain
writer
explained:
.
.
.
we
should
not
cause
violence
to
creatures;
but
we
cannot
live
without
water;
so
minimizing
sins,
we
should
use
water.
.
.
.
Meaningless
use
is
improper”
[104].
3.1.4.
Judaism
Judaism
is
based
on
the
relationship
between
God
and
the
children
of
Israel.
Judaism
considers
itself
the
religion
of
Jacob
(alternately
Yisrael
or
Israel),
grandson
of
Abraham
and
father
of
Judah
[1,2].
Major
Western
branches
or
denominations
include
Orthodox,
Conservative,
Reform,
and
Reconstructionist.
The
first
five
books
(Torah)
of
the
Hebrew
Bible
date
to
around
1200
BCE,
with
an
evolution
of
ancient
Judaism
that
reached
its
present
form
around
450
BCE.
The
documentary
basis
of
Judaic
teaching
is
the
Hebrew
Bible
(Tanakh
or
Miqra),
expounded
in
later
texts
such
as
the
Talmud
and
the
Shulchan
Aruch
[1,2].
Judaism
traditionally
expects
certain
actions
of
its
believers
to
maintain
health.
Pikuakh
nefesh,
acting
to
save
one’s
own
or
another’s
life,
is
a
primary
value,
a
positive
commandment
(mitz-
vah
aseh)
[105–115].
Judaic
principles
emphasize
the
community
benefits
of
disease
prevention
in
a
manner
superior
to
individual
preference,
based
on
scriptures
such
as
Leviticus
19:16
(Table
1C)
that
counsel
not
to
stand
idly
by
while
a
neighbor
is
in
trouble.
Jewish
scholars
applied
this
directive
to
encourage
smallpox
vacci-
nation
in
previous
eras.
Rabbi
and
physician
Mosheh
ben
Maimon
(also
called
Maimonides
or
Rambam)
expounded:
“Anyone
who
is
able
to
save
a
life,
but
fails
to
do
so,
violates
‘You
shall
not
stand
idly
by
the
blood
of
your
neighbor”’
[105,108,109].
Indeed,
in
settings
where
vaccination
services
were
intermittently
available,
several
scholars
stated
it
is
permissible
to
set
aside
Sabbath
restrictions
on
activity
to
allow
vaccination
[105,106,109,110,112,113,115].
Simi-
larly,
there
are
exemptions
from
fasting
if
one
is
ill.
Parental
responsibilities
are
detailed
in
a
number
of
Jewish
texts
[105,107,111],
based
in
Proverbs
23:12–13
(Table
1C).
The
Talmud
has
long
encouraged
parents
to
teach
their
children
to
swim,
as
a
means
of
preventing
drowning
in
some
unknown,
but
foreseeable
scenario.
Scholars
have
taken
this
as
a
metaphor
for
vaccination
against
a
future
infection
[105,107,108].
Maimonides
wrote
about
prevention:
“One
must
avoid
those
things
which
have
a
deleterious
effect
on
the
body,
and
accustom
oneself
to
things
which
heal
and
fortify
it”
[105].
Another
metaphor
related
to
community
responsibility
is
ele-
vated
to
the
status
of
a
paradigm:
the
admonition
to
erect
a
railing
around
one’s
roof,
when
it
was
often
used
as
a
porch,
to
prevent
harm
to
others
who
may
later
walk
there
from
an
anticipatable
hazard
(Deuteronomy
22:8,
Table
1C)
[105,106,108,109,111,115].
This
paradigm
has
been
applied
as
a
proactive
call
for
communal
protection:
vaccinating
oneself
and
one’s
family
to
reduce
the
risk
of
transmission
of
infectious
diseases
to
neighbors
and
bystanders.
Within
halacha
(Jewish
law),
the
kashrut
is
the
collection
of
Jewish
dietary
laws,
followed
more
closely
by
branches
such
as
Orthodox
than
by
other
branches.
Food
considered
fit
for
consump-
tion
is
termed
“kosher”
in
English,
with
most
dietary
laws
derived
from
the
Books
of
Leviticus
and
Deuteronomy
(Table
1C).
Among
these
dietary
laws
are
prohibitions
on
consuming
ani-
mals
considered
impure
(e.g.,
pork,
shellfish).
Products
of
impure
or
improperly
slaughtered
animals
are
also
non-kosher
(treif).
Ani-
mal
gelatin,
for
example,
may
be
avoided
as
food;
nonetheless,
kosher
gelatin
(from
cows
or
fish
prepared
to
be
kosher)
may
be
an
alternative
food.
In
distinction
to
dietary
laws,
Jewish
medical
issues
are
judged
based
on
concepts
of
medical
law
contained
in
halachic
codes.
The
propriety
of
using
vaccines
or
immune
globulins
within
Judaism
would
be
evaluated
from
a
therapeutic
or
disease-prevention
per-
spective.
Multiple
Jewish
authorities
agree
that
limitations
on
medications
with
porcine
components
are
only
an
issue
with
oral
administration
(for
those
who
observe
kosher
rules),
not
prod-
ucts
given
by
injection
[86,105].
Thus,
the
teachings
to
avoid
pork
products
do
not
apply
to
injectable
medications,
in
contrast
to
food-
stuffs.
Permissibility
of
oral
administration
of
medications
with
non-
kosher
ingredients,
if
necessary
to
preserve
life,
is
provided
in
the
Talmud
[105].
In
the
case
of
oral
medications,
the
transformation
(ponim
chadashos)
of
“primary”
pork
components
into
processed
materials
would
make
them
more
acceptable.
Oral
medication
con-
taining
small
amounts
of
material
derived
from
non-kosher
animals
devoid
of
its
taste
could
be
kosher
under
some
circumstances.
According
to
a
principle
known
as
bitul
b‘shishim,
a
small
amount
of
non-kosher
food
mixed
with
a
much
greater
quantity
of
kosher
food
may
be
acceptable
if
the
non-kosher
item
loses
its
taste
or
is
diluted
beyond
a
1:60
ratio
[116].
Additional
conditions
(e.g.,
inten-
tion,
gentile
source)
need
to
be
considered
before
this
ruling
can
be
made.
Rabbi
Abraham
Nanzig,
writing
in
London
in
1785
in
the
era
of
smallpox
outbreaks,
described
the
halachic
basis
for
exposing
a
child
to
variola
virus
(variolation)
to
induce
immunity
against
smallpox:
“One
who
undergoes
this
treatment
while
still
healthy,
God
will
not
consider
it
a
sin.
Rather,
it
is
an
act
of
eager
religious
devotion,
and
reflects
the
Commandment
to
‘be
particularly
careful
of
your
well-being”’
(Deuteronomy
4:15,
Table
1C)
[105,115].
In
the
1850s,
distinguished
Rabbi
Yisroel
Lipshutz
described
Edward
Jen-
ner
as
a
“righteous
gentile,”
for
his
efforts
in
developing
smallpox
vaccination
[105,109].
Jewish
communities
(often
ultraorthodox,
those
who
adhere
meticulously
to
Jewish
law
and
tend
to
be
more
isolated
from
others)
in
several
countries
have
experienced
measles
and
mumps
outbreaks
associated
with
declining
vaccination
[37,41,43,46,47,52,55,111].