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Must Healthcare Workers Get the COVID-19 Vaccine?

Shevat 5781 | January 2021
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Many countries have begun to offer the much-anticipated COVID-19 vaccine. However, 20% of physicians and more than 40% of nurses say that they will refuse or defer vaccination. This decision is particularly dangerous, as many healthcare workers cannot work remotely to minimize their risk of infection. They have higher infection rates than the general population and can spread infection to patients with weakened immune systems. Does halakha require healthcare workers to take the COVID-19 vaccine?  Is their obligation greater than that of the general population?

The Obligation to Receive the COVID-19 Vaccine: The General Population[1]

Halakha might obligate COVID-19 vaccination for everyone, to reduce the risk of infection and to build herd immunity. Perhaps the most compelling reason to vaccinate is altruism. Sanhedrin 73a derives the obligation to protect others from danger from the mitzvah, lo ta’amod al dam re’echa, do not stand idly by. But does this obligate a person to put himself in danger in order to rescue someone else?  Does it require us to receive a new vaccine with no long-term safety data?     Beit Yosef Choshen Mishpat 427 cites Talmud Yerushalmi Terumot Chapter 8, which obligates someone to place himself in possible danger to save someone else from definite danger. However, Shulchan Aruch Choshen Mishpat 426 omits this ruling. Based on Radbaz 3:627 (53) and Radbaz 5 Lilshonot ha-Rambam 1:582 (218)), poskim rule that where there is a minimal risk to the rescuer and great benefit to the person in danger, one must rescue.

The results of the COVID-19 vaccination trials, which included over 70,000 participants, confirm that the vaccine has an efficacy of 95% and no serious adverse effects. It is possible that the vaccine could cause rare side effects (with a frequency of 1 in 100,000 or 1 in 1,000,000) or long-term side effects. But long-term side effects of vaccines are exceedingly rare and scientists believe that long-term adverse effects of the COVID-19 vaccine will be extraordinarily uncommon, comparable to the minimal risk for which Radbaz obligated the rescuer to rescue.  Poskim caution against overestimating the risks of danger.[2]  Because routine vaccinations protect others from becoming infected, with minimal risk to the vaccinated person, virtually all poskim permit vaccination and many even obligate it. Some use harsh language to describe those who refuse vaccination especially during a pandemic, classifying them as shofech damim, rodef, and rotzeach b’gramma (indirect murderer).

 Several poskim have weighed in on the vaccine. While some have denounced it, the Orthodox Union and the Rabbinical Council of America, with the endorsement of Rav Mordechai Willig and Rav Hershel Schachter, consider COVID-19 vaccination a biblical obligation and exhort the public to vaccinate at the first available opportunity.[3]  Rav Chaim Kanievsky has stated that one must vaccinate. Rav Asher Weiss strongly encourages vaccination. Regarding vaccination on Shabbat, Rav Weiss suggests leniency for healthcare workers, a high-risk population that could spread the disease to patients suffering life-threatening illnesses.[4]

Although these rulings do not specifically discuss the unique situation of healthcare workers, poskim who do not obligate COVID-19 vaccination might do so for healthcare workers, while those poskim who obligate vaccination might find it even more incumbent on this population.  There are several reasons for this:

Verapo Yerape: Physicians’ Obligation to Heal

Physicians have a unique obligation to heal based on the Biblical sources v’hashevota lo and lo ta’amod al dam re’echa.[5]

Rambam Perush Mishnayot Nedarim 4:4 derives the physician’s obligation to heal from v’hashevota lo – to heal his body. Torah Temima Devarim 22, Comment 8 explains that Rambam does not cite verapo yerape as the source of this obligation because this verse merely grants the physician permission to heal, while v’hashevota lo obligates him.

Shulchan Aruch Yore Deah 336 rules:

The Torah has granted the physician permission to heal, and it is a religious duty that comes under the rule of saving an endangered life. If he withholds [treatment] he is regarded as one who sheds blood.

Taz asks, if the physician is obligated to heal, why must the Torah grant him permission? He answers that true healing must come from the heavens but since man is not worthy of this he must achieve healing through the ways of the world. Once this has become the method of healing, the physician is obligated to heal. Tzitz Eliezer Ramat Rachel 21 extends the obligation to heal to non-life-threatening situations. The duty to heal obligates the physician to take all necessary steps to protect the health of his patients.

The Obligations of the Hippocratic Oath

Rav Yuval Cherlow suggests that the Hippocratic oath, which entitles the physician to the benefits of his profession, also obligates him to incur its risks.[6]

The Obligation to Treat Infectious Diseases

Tzitz Eliezer explains that while one may not place one’s self in possible life-threatening danger to save someone, a physician who risks infection by treating a contagious patient fulfills a great religious duty.[7]  Shevet HaLevi 8:251 similarly obligates a physician to care for a patient with a dangerous infectious disease, citing Rabbi Akiva Eiger, who instructed people to tend to the sick during the cholera epidemic.   Preventing the spread of COVID-19 to patients is part of the physician’s obligation to treat infectious diseases.

Additional considerations intensify the obligation of healthcare workers to receive the vaccine

Incurring Risk in Daily Activities

Rav Yitzchak Zilberstein argues that someone who would incur risk for himself, must incur similar risk to rescue someone else. He applies this criterion to a pregnant doctor whose patient has German measles, which can lead to miscarriage and birth defects. He rules that she has no obligation to care for him because no amount of money could entice a pregnant woman to expose herself to this infection. However, if she would consider abortion, an indication that she would accept danger for her own personal benefit, she might be obligated to assume a comparable risk to save others and to treat the patient.  Similarly, halackha might obligate healthcare workers who accept the risks of flu vaccination to receive the COVID-19 vaccine.[8]

Special Allowance for Occupational Risks

Halakha allows occupational risks. Bava Metizia 112a rules that one must pay a worker in a timely fashion because he risked death for his wages. Rashi suggests that one may endanger himself for employment. Noda B’Yehuda Tinyina Yore Deah 10 permits hunting, a dangerous activity, only for employment. Iggerot Moshe Chosen Mishpat 1:104 allows one to be a professional athlete though this occupation has risk. Similarly, Tzitz Eliezer 8:15, Kuntres Refua B;Shabbat 5:9 argues that if a physician’s position requires him to place himself at risk, he may do so. The special dispensation permitting occupationally risky behaviors applies to all healthcare workers, not just physicians, and allows them to receive a potentially dangerous vaccine if required for employment.

The Obligation to Save the Community

Yam Shel Shlomo Baba Kamma 6:26 suggests that during a plague one should escape the endemic area, but someone who has the ability to save the tzibbur must remain to help despite the risk. In the midst of the COVID-19 pandemic, healthcare workers have the unique ability to help the tzibbur by performing their jobs and by getting vaccinated to reduce the risks of infecting their patients.

Healthcare workers as Soldiers

Regarding the obligation to save others from danger, Rav Weiss compares the physician to a soldier at war.[9]  He cites Chatam Sofer Choshen Mishpat 44 and Orach Chaim 208 that during war there are different laws of pikuach nefesh. These apply not only to soldiers but also to anyone who satisfies a vital communal need, such as police officers, fire fighters, and guards, who are obligated to endanger their lives to save others. He argues that occasionally nations need war and without sacrifice of life, the war cannot be won. Those who work to heal the sick are permitted to risk danger to save others. In this war on COVID-19, healthcare workers function as soldiers whom we expect to incur personal risk to save the community.

As democratic countries prioritize distribution of the COVID-19 vaccine, several halakhic principles create a unique duty for healthcare workers to receive it at the first opportunity.  These include their obligation to make the same sacrifices for others that they would for themselves, the special allowance for occupational risk, and the obligation to save the community during a pandemic. For physicians, the obligation to treat, and by extension prevent, infectious disease, the obligation to heal, and the responsibilities inherent to the Hippocratic oath create a further obligation to receive the COVID-19 vaccine.

 

[1] For a full discussion of this topic, please see my article in Tradition Online, https://traditiononline.org/halakha-approaches-the-covid-19-vaccine/#easy-footnote-bottom-18-13392

[2] Aruch Hashulchan Choshen Mishpat 321:8, Pitchei Teshuva Choshen Mishpat 426, Mishna Brura 329:19

[3] https://rabbis.org/wp-content/uploads/2020/12/Guidance-re-Vaccines.pdf

[4] file:///C:/Users/sharon%20galper/Downloads/%D7%9E%D7%A7%D7%A5%20-%20%D7%94%D7%97%D7%99%D7%A1%D7%95%D7%9F%20%D7%9C%D7%A7%D7%95%D7%A8%D7%95%D7%A0%D7%94%20%D7%91%D7%94%D7%9C%D7%9B%D7%94.pdf

[5] Sanhedrin 73a

[6] https://ethics.tzohar.org.il/%d7%94%d7%90%d7%9d-%d7%a8%d7%95%d7%a4%d7%90-%d7%a6%d7%a8%d7%99%d7%9a-%d7%9c%d7%94%d7%a1%d7%aa%d7%9b%d7%9f-%d7%9b%d7%93%d7%99-%d7%9c%d7%98%d7%a4%d7%9c-%d7%91%d7%97%d7%95%d7%9c%d7%94/

[7] Jewish Medical Law: A Concise Response; Compiled and Edited by Avraham Steinberg, M.D. Translated by David Simons M.D.; Beit Shammai Publications, 1989, Part 10, Chapter 11

[8] https://www.medethics.org.il/wp-content/uploads/2020/05/%D7%9E%D7%90-1-%D7%94%D7%9C%D7%9B%D7%94-%D7%9C%D7%9E%D7%A2%D7%A9%D7%94.pdf

[9] Minchat Asher 3:122.

Dr. Sharon Galper Grossman

a radiation oncologist and former faculty member of Harvard Medical School where she also obtained a Masters in Public Health. Her current interests are in Women’s Health and Halakha, specifically issues related to preventing women’s cancers. She has recently published “The Angelina Jolie Effect in Jewish Law: Prophylactic Mastectomy and Oophorectomy in BRCA Carriers” in the Rambam Medical Journal. “Resolving the Debate Over Human Papilloma Virus (HPV) Vaccination for Cancer Prevention in the Religious World” has been accepted for publication in Tradition.