As Bracha Poliakoff, a 32-year-old mother of three, walked into Bnai Jacob Shaarei Zion synagogue in December, she passed several security officers and Baltimore police. The meeting’s subject — the importance of measles vaccines — had become a contentious one in her community.
Before she sat, an “anti-vaxxer” handed her a leaflet warning that vaccine ingredients were toxic and her cellphone buzzed with a robocall disparaging the doctor speaking that night.
Poliakoff dismissed the messages as “scare tactics.”
Following measles outbreaks around the country, some in other Orthodox Jewish communities, the meeting at the Park Heights Avenue synagogue was among a number of efforts by Baltimore’s Orthodox Jewish leadership over the past five years to mitigate the influence of a small but loud minority of vaccination opponents.
Maryland has had five cases since April 5. The first four were in Orthodox Jewish families in the Pikesville area, according to Rabbi Ariel Sadwin, who was among several rabbis and doctors working with the government to mobilize vaccination efforts. Sadwin said the patients were children under 4 who were too young to get the full vaccination and all are doing much better with symptoms largely subsided.
A fifth case was announced Friday. The Maryland Health Department has confirmed all five cases were in the northwest Baltimore area.
With measles cases spreading in recent months in New York, New Jersey and Israel, places many Baltimore families visit during Passover, rabbis, medical professionals and community leaders had kicked preventative measures into high gear.
Their actions have resulted in more than 1,500 people getting vaccinations and booster shots at city and county clinics and doctors’ offices.
Maryland is among 23 states with measles cases, according to the U.S. Centers for Disease Control and Prevention. The 839 U.S. cases reported this year through May 10 are the most since 1994 (and since measles was “eliminated” in 2000).
When cases began emerging in Baltimore’s Orthodox Jewish community in April, Poliakoff rushed her 18-month-old to get his second measles shot ahead of schedule.
“People are nervous about what’s happening in other communities,” she said.
Measles is spread through coughing, sneezing and mouth secretions, and the virus can remain in the air for up to two hours. Someone is contagious for four days before the telltale rash appears, until four days after it begins.
The incubation period spans seven to 21 days, according to Fran Phillips, Maryland’s deputy secretary for public health services.
Maryland’s first four cases were reported from April 5 to 19, the first night of Passover.
Phillips said many family have connections to the New York City area and had traveled there in recent weekends.
“There aren’t a lot of cases [in Maryland], but this time next week we may be having a different conversation,” Phillips said in the middle of the Passover holiday. “There is no other way than vaccination to be safe.”
Last week, the Baltimore City Health Department offered its second measles vaccination clinic at a Northwest Baltimore synagogue. Wendy Drazin, 54, was getting a booster shot.
Vaccination is the “responsible” thing “to protect other people so they don’t get sick,” she said. She was concerned about babies too young to get vaccinated and about anti-Semitism stoked in reaction to measles cases in the community.
While Drazin knew families who didn’t get immunized, she said, “There are plenty of anti-vaxxers everywhere, not just in the Jewish Orthodox community.”
Resistance to vaccination has cropped up among some Christian and Muslim groups, as well as in secular society.
Vaccination rates among kindergartners remain high across the country, according to the CDC. In the 2017-2018 school year, the rate in Maryland was 98.6%. Only Mississippi’s rate was higher.
The rate in the state, however, has dropped from a high of 99.4% in 2014-2015.
Celebrities have long fueled anti-vaccine sentiment. They include Robert F. Kennedy Jr., Jenny McCarthy and President Donald Trump, who reversed course in April and told reporters, “The vaccinations are so important. … They have to get their shots.”
Moshe Hauer, the rabbi of the Bnai congregation, organized the meeting Poliakoff attended, after cases emerged in New York and Israel. He invited Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.
But before participants sat, they were greeted by Ruth Goetz, a grandmother who is a member of the invited Orthodox Jewish community and is a District 2 representative for Baltimore County’s Republican Central Committee. She handed out leaflets printed from an anti-vaccine website.
“I don’t believe in forcing people to vaccinate,” Goetz told The Baltimore Sun. She is not a fan of Offit’s, but said she hadn’t organized the robocall undermining him.
A well-known anti-vaxx doctor from out of state also had posted on social media the announcement for the Baltimore discussion — with Adolf Hitler’s image superimposed over Offit’s. Thus the security presence.
Like many anti-vaxxers, Goetz questions the motivations behind pharmaceutical companies, doctors and vaccine mandates from government and school officials.
And she did not appreciate a letter sent by Orthodox leadership in the wake of the first measles case, which recommended that unvaccinated people “avoid public places and group settings of all kinds, as their presence poses a serious risk to the community at large.”
“That’s crazy,” she said. “That’s a lot of pressure on people.”
Goetz said a handful of friends refuse vaccinations, but the messages that they can be a threat have caused them to go “underground.”
“There is a huge divide in the community,” Goetz said.
However, leadership insists that there is not a divide.
"The leaders of our community, including rabbis and school officials, have had zero tolerance for those who refuse to vaccinate,” Sadwin said.
Hauer said anti-vaccine messages have “made our job painfully difficult” and said opponents have been misled to believe vaccines are dangerous.
“As a result, in a desire to protect children, they are making a decision that is the opposite,” Hauer said.
Hauer has helped organize countermessages, including a video recorded by a 55-year-old Detroit man who contracted measles this spring.
Poliakoff’s sister, Adena Friedman Cohen, is involved in a vaccine task force through the Orthodox Jewish Nurses Association. Members have been holding meetings with mothers and produced a booklet about vaccines.
“We do believe that education is important, and we want people to understand and feel good about [vaccinations],” Cohen said. “Forcing people to vaccinate is a last resort.”
Cohen is up against organizations such as PEACH, an anti-vaccination group formally known as Parents Teaching and Advocating for Children’s Health. Cohen said she found one of the group’s pamphlets left at her door disturbing.
“I’m a medical professional,” she said. “I know it’s not true, but it’s so convincing.” She said the group’s literature misquoted studies and shared scary stories of children dying.
Dr. Scott Krugman, vice chair of pediatrics at Sinai Hospital, said PEACH has caused damage in other communities, but he and several others didn’t think it had made significant inroads in Baltimore.
“PEACH is simply giving parents access to information so they can make informed decisions,” said Jennifer Margulis, an author and parent volunteering with PEACH. “There's a tremendous amount of peer-reviewed science showing that the current vaccination schedule may not be in the best interests of children’s health.”
As with every vaccine, side effects are possible from the measles-mumps-rubella, or MMR, vaccine. But medical studies have found the vaccine to be highly safe and effective, and far safer than getting measles.
Poliakoff said she believes Baltimore’s Orthodox Jewish community has stayed relatively resistant to misinformation because it is medically oriented.
Rabbi Shmuel Kaplan, director of the Chabad-Lubavitch group of Maryland, explained that one element in Jewish religious law is to question whether something is positive or effective.
“We have a rule: Don’t do it you until know something is effective. Do no damage,” Kaplan said. “I think this is the underlying thing. If some believe there is something that could be wrong with vaccines, why do it? So they push it off.”
But he said most people trust doctors and estimates that only 2% to 3% of the community is not vaccinated.
Kaplan and Hauer said the Baltimore rabbis have been vocal and “shoulder to shoulder” that you have to trust doctors and get vaccinated.
Passover ended the night of April 27. Last week, LifeBridge Health, which primarily serves the northwest Baltimore region and includes Sinai, lifted its ban on youth visitors under the age of 14, which it imposed after several cases of measles. It explained that it ended the policy because it had been more than 14 days since the last confirmed case and there was no evidence of further transmission in the area.
Krugman helped the Orthodox Jewish community organize its immunization efforts.
“We’re hoping by mid-May, we will see that this is a great proactive thing we did and that we spared any further cases,” Krugman said.
Then came news of the fifth case, announced Friday.