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The Wate ecimation Tightrop aside while your fllow's blood is shed (Ceviticus, 1916). The: Talmud (Sanhedrin 73a) teaches that this requires one to expend effort fand money, if necessary to save a person in dan ger. One may logically extend this tothe prever- fon of sickness. One way of accomplishing this Involves the use of vaccinations, particularly dur Jing an epidemic [1], Te question that might arise ‘sshow farms person go tosaveanather? Can fone risk his ow life? The obligation to save Someone may be restricted toa situation where the sins more likely to occur then the los [2 Does this concern apply to vaccinations? Fuher it ‘would appear that immunization is part of + Biblical-directed preventive health program. The Code of Jewish Law (Shuchan Aruch, Yorok Deh 16) cts the responsibility one has to take actions toprevent disease. ‘The text presents a scenario in ‘which town is stricken with plague ad theve= dents are urged to avoid contacting it In adai- tion there i discussion about one who sucvived Aaplague That person isnot commanded o lave Ins twin ifthe same plague stikes again, ashe is assumed to now have immnity to the plague From these sources, vacination may be conside ‘re part of ones obligation in guarding his, and Ins community’, health (1), ‘This surely would be applicable during the spread of smallpox. Smallpox isa serious, possibly fatal, disease caused by a contagious Sus. ‘Death con occur in up to 30% of ense> Many survivors have permanent scars snd some sre left blind [3]. The causative agent, a varcla Wirus, isa member ofthe pox family. “Although the smallpox virus surfaced among the human population thousands of years ago, as recently as 1967 it allied between ten and fifteen milion people, causing an estimated fwo milion deaths This disease was not confined to one o Wo coun tres, butt affected people in forty-three counties T: Bible commands, "You shall not stand SS [4m 1980 the World Health Organization (WHO) declared the eradication of smallpox, which was arguably one of the greatest cco plishments of the Twentieth century. For a dis fase to be eradicated, certain conditions must be ret The vaccine must be: (1) A stable vaccine, Gefined as 2 vaccine not requiring reeigeration tnd, therefore, suitable in Third-Woeld countries ‘where reigeration may not he possible. A freeze ried vaccine was develope that only required rehydration before usage. (2) An ecient vaccine. ‘The smallpox veccine was administered with _mult-prong syringe (bifurcated needle) that drew blood. This ensure injection ofthe vaccine using Jess of the vaccine material [4]. (3) Easily portable. Traveling by foot to administer the vac Eine, it was brooght t ifficul, hard-toseach areas. ( Nov-zocnostc, meaning that theres no Snlmal reservoir forthe viras, As the virus did fot infect animals, when there sere no more Jhaman hosts for the virus to sfect, it had ao an smal reservoir in which to hide, “The WHO was able t develop a vaccine ‘that it these criteria, thus leading to the eradica Hon of smallpox over twenty yeats ago, Now the vias ean aly be found in the laboratories of Center for Disease Control (CDC) in Atlanta, GA, ‘and in similar laboratories in Sera, Rusia So ie there anything to worry about?” Is it at all significant f the vrs il exit in some freezer of 4 laboratory somewhere? Since the scare with Anthrax and September 1th. 200 many scientists Ihave been thinking about what would happen if sucha sample fll into the hands of terrorists. ‘The fear of bioterorsm is curnently a major concer. In the United Stats no one has been ‘vaccinated for smallpox since 1972 and in the rest fof the world since 1977. Thus, exposure to the virus would besevere, To prepare forthe pos sibility of bio-terrrism and to supplement the existing stockpile of smallpox vaccine, since 2 2001 the United States has purchased smallpox ‘vaccines from Great Britain, Due to the presence of potential risks, people aze hesitant t6 receive the vaccine. The ‘aetine in widespread use Was derived from the viral strain called "vaccinia," which is genetically distinct from varila and cowpox. Just. as award Jenner, wo synthesized the fist vaccine using cowpox virus, did, current vaccinators ‘chose the vaccinis stain because it provided Immunity with fewer and less severe side-effects [a]. The majority of adverse side-effects resulting from te smallpox vaccine are not life threatening snd subyide wethoue treatment (1). Sueh side fects include redness and soreness at the injec tion site, enlargement and soreness of glands located inthe armpits, and alow fever Previously, howeves, one of every 1000 people vaccinated forthe fist time experienced adverse side-effects that were serious although rot lle threatening, and_requited medical attention. Such reactions included « vaccinia eash, an out break of sores intially limited to fone area but that eventaally Spread 19 other areas ofthe body throught the blood, and some times to other people through “Jewish Law elfect outweighed the risk of acquiring the Smallpox virus ‘As pat of the United State’ bio-terorism readiness program, hear-elated complications due fo the smallpox vaccine have been noted [Although the symptoms are usally mild,» few ‘deaths have resulted. "Therefore, the CDC recom tended that those individuals with tee out of Fue ofthe heart disease factors should not be wae- ‘inated. These heart disease factors ae: high cho- lesterol, high blood pressure, diabetes, cigarette smoking, and family history of heart disease ‘Ao, the American Heart Assocation suggested ‘that those Vaccinated be cognizant of any sym toms of heartrcated problems, including chest pin or discomfort, shortness of breath, palpits: tons, ankle sweling, and/or fatigue [SL Inthe face of possible bio-terrorist attack swith the smallpox vias asthe weapon which isk {5 grater, the vis or the vaccine? Some Jews ‘oppose Vaccination because ofthe command in the ‘ible, “Walk simply before the Led your Ga ‘whichis interpreted to mean, ‘alk with Him in simplicity ‘and anticipate His support, and Sonot delve into the ture,” In hhalachs Gewish Law), there i contact. More seriously, rub: would not the concept of shea ol tas bing the eyes can lead to blind (le, sit and do not act) versus ress, though washing one’s put anyone “ase” (ie, action). Usually, ands after touching the vacce | j when both the outeomes ofthe ration site can prevent such out- In-unmecessary | scion and the inaction have sig- comes, In addition, toxic oF danger.” nificant negative results, we tend llergic rashes can occur albeit rel, n response tothe vaccine Tn the past, potential lfe-veat- ening cases affected 14-52 people per ne milion vaccinated. Upon experiencing a liethreatening reaction, immediate medical attention was needed. One condition, termed a. progressive ‘accinia, was manifested as a continuous skin Infection, causing tissue destruction and frequent Iy leading to death. Postvaccinal encephalitis, or inflammation of the brain, was another ife-theat- ening reaction. ast reports have shown that bout 1'or 2 people, gut of one milion people vaccinated, died as a result of the vaccination Farthermore, specific sub-populations (eg, the elderly) may be at a heightened risk [3], Although the odds of developing a serious Iealth hazard are rather small in 1972 the Urited States stopped administering. the smallpox vaccine because the sk of an adverse health to select the inaction. This rationalization is comprehensi- ble when the risks are equal However ifthe risk asccated with the disse is ‘greater than the isk ofthe vacinalion, the maaseh fe the more frequent choice. Rabbi Yisroel Lipshute, the Tires Vise, ruled in the 18th cen- tury thal the smallpox vaccine was permitted, rogardlss of therisk of ying. This ruling wasset forth when contagious diseases, suchas smallpox, ‘were common. His deision was applicable when smallpox was still a murderous disease and the ‘reat ofthe disease outweighed the ek of the vaccination. What about our curentsitaton, ‘when people area lessor equal rik of ying from ‘the disease as they ae from the immunization [I]? ‘Ged does not want people to put them selves in unnecessary danger Ths can be seen in the Bible (Deuteronomy 415) and the Book of Prophets (Joshua 2811) where it is wnitten: oe, ll Vinishmartom ood Voofitoscichen” (You shall really beware for your souls), The Foer Firing, a commentatr onthe Book of Props, says that this command was stated when the ‘Children of srsel weve passing the nex (darges) fo that they should beware of [9]. We see rm heze that Jewish Lave would! not pat anyone in unnecessary danger Therefore, any actions neces sary fo reduce the risks connected with vacin tion would be required, Furthermore, once the danger of disease fast a sufficetly low level, the risk of vaccination may be too high. Yet we still mast be cognizant of the risk ofthe re-eme tence of smallpox which may jushiy a renewed policy of vaccination. An example of risk asese- ment con be seen n connection with poliomyelitis ‘The United States switched from the ora Sabin vaccine (hich used a live bu atenaated viru), to the safer but less effective Salk vaccine (hich used an inactive virus). Apparently, the healthrsk From the oral vaceine was equivalent 10 the rk of sequiring poliomyelitis (1. ack mutations ofthe attenuated virus, which have the potontel to ‘use diease, contributed to the risk ofthe ora ‘osine and demanded that itbe replaced with the ‘vaccine with the inactive virus 6) (One is essentially making a rsk-benefit sssessment when deciding whether or not @ be ‘Vaccinated. It necessary to compare the inc ‘dence an seriousness of the disease with the dan~ jets associated with the vaccination. OF course the ideal vaccine would totally protect witout adverse side-effects. Unfortunately, the idea is often very unlikely ond difficul, if not spose, to achive. larger risk is acepted with thevac- ination when the clisease iscangerous. This isk- benefit analysis was applied to the smallpox voe~ ‘de when the risk of acquiring the disease was ‘very serious [1], This assessment may be srilar to the analysis made by someone who sees hi fel- low in danger and wants to save hr, “The decision to receive the smallpox ae- ‘ine isdlifcut to make sole the risk ofthe dis- fase is currenly unknown, The side-effect rom ‘the immunization, accepted when the diseasewas widespread, are being reexamined [1], We ktow from studying the history ofthe American Inclans that the introduction of anew ox as in our case, tradicated dseate can have destructive capabil: ties. The Europeans transmitted microbial and ral diseases, inelding smallpox, to the Native ‘Americans wh had not been previously exposed and had no prior immunity,” The results were devastating [6). Today, people weigh the nsk of = bi-trrrist lack again the risk of vaccination. Without more information from the government ‘hough, we are not able to make a proper risk-ben fit aeseament [1 Since presently there is no credible expec: tation of 2 smallpox outbreak, the United States foverament is not recommending immunization Of the general public. Widespread vaccination ‘woulel not be the preferable course of ction at this time, especially due # the fact that protection from the disease can be achieved soon after expo- sure tothe virus. In spite ofthis the government is recommending vaccination of the healthcare first responders, Undoubtedly this sa prevents tive measure [I], This isnot the first time such 3 precautionary measure has been implemented. ‘American and Beis troops were vaccinated prior to the Gull War as part of the preparntion for Operation Desert Storm [8 Tseae als tok this precautionary step, in 2002, when it was feared that Saddam Hussein ‘would unleash a biological attack using the small ox vias. In response to that possibilty, 1.500 Dealth workers were vacelnated withthe smallpox vaccine. Their concer for bioterrorism lesd them to include soldiers and other emergeney- ‘sponding personnel in receiving the vaccination (7). In subsequent years, the Israeli goverrunent has immunized approximately 40,000 people specifically those at the greatest sk of contacting Smallpox if i were to be wed as a biological ‘weapon I} “This isthe situation as it currently exists People cancersed with the hlachic implications of ‘heir actions mast be aware of world events and of scientiie/medial information, and need to com Sul Jewish Law /Rabbinie Sourees for guidance ‘May we never face such an epidemic in which we hhave to implement these difficult decisions. = LEYNA PRESSMAN ic senior Stor Calle for Women majoring in ilagy se Aaknowiedgement] {would lke t thank De Babich and Rabbi Richmond for reviewing ths article. I would also like to ‘express my immeasurable gratitude to my parents for their constant help and corns sport. IIAsHFoTora p/h on / Society Work edence/The Ee. of Slip Immunization Ep towed Janay 1, 20, [asst 1 097) il expesentaon om hana in fw La I A Scenes an or Render ow dows the Torah Undead and Mat the Challenges of Slee? An Artiopology of ‘Apponche and Views Soplr and Kosch, fa} NCSYPablstony Nav York NY Pp 10¢ 12 Dfthe Patent Eduton inatate inc ht /wenlmhgoe/ felines /ttrale/ Sralpox/ 01. eve January 1,300) Entie 180) Sco The One Fare Threat of Smallpox Aan Monthly Ps New sean [SlAmerian Hear. hip://wwwamescanearorg/preenerhimlenier-O016875(reieved Sour 200 Teall, K-(98i. Vin Hunting: AIDS, Cancer and the Human Reroviws Story of Sic Dacor HarpesColins Puen, Unie Sac [Newsmax tel Pepating for Worst. Sep with Smaljpox Vaccacatons. Brenan, P tp wowace ahve ae/2000/17/ 0 ah eed anny 27,208). [seaward 0). Te nbc Enemy A Natu story of Vises, Oxo iver ess, Engng