Tzali Freedman, 55, isn’t sure if he ever physically crossed paths with a visitor to his community of Oak Park, Mich., who was infected with the measles. But with a disease a virulent as this one, it didn’t matter, as he became one of the 704 people in 22 states nationwide who has contracted the measles since the start of 2019.

“I was shocked—like what, how can that be? I’m a fully immunized guy. I had no clue I was not vaccinated,” he says, explaining that he heard that a person with the measles had visited his synagogue, but Freedman didn’t think it would affect him. “If I had known my vaccine was garbage, I would have gotten a new vaccination.”

For more than a week, Freedman barely ate. He lost eight pounds, had vision impairment as the disease caused the outer layer of his cornea to blister, and was anguished at the thought he might have infected his family or other community members. Stuck in bed as the disease took its toll, he began emailing everyone he knew urging them to get the MMR (Measles, Mumps and Rubella) vaccine.

“I went crazy with fear that this information is not being shared. I was very traumatized by the whole thing, and I started sending out emails to contacts across the country. I was crying; I thought the whole community was going to get it,” he said.

Speaking during a media teleconference on April 29 that was posted online, Centers for Disease Control and Prevention vaccine director Dr. Nancy Messonnier said: “Most adults are protected against measles; that’s what the science says, including people who were born before measles vaccine was recommended and even people who only got a single dose of measles. We really are focused on adults who are at higher risk and those who are traveling internationally, university students and adults specifically living in these communities that are having outbreaks.”

Poster advocating vaccination for measles. Credit: New York State Senate.

Currently, those communities are primarily Orthodox Jewish enclaves in Brooklyn, N.Y., and suburban Rockland County in suburban New York. In Brooklyn, as of April 29, 423 people, among them 270 of them children ages 4 and younger, have gotten the measles; while in Rockland County, 41 percent of the 206 people with the measles are under the age of 4. (An unrelated measles outbreak in Washington state has been declared over.)

Messonnier said that the outbreaks in New York are the “largest and longest-lasting” since the measles was eliminated in 2000. “The longer these outbreaks continue the greater, the chance that measles will again get a foothold in the United States.”

The CDC believes the rise of the measles is being fueled by an under-vaccinated community and “misinformation spreading in some counties about the safety and effectiveness of the MMR vaccine.  Sadly, these communities are being targeted with inaccurate and misleading information about vaccines.”

‘How can we be protected’?

While much of the recent news has focused on the Orthodox community, previous outbreaks have impacted other geographic areas. An outbreak in 2017 was linked to Somali-Americans in Minnesota with a low vaccination rate, and a 2013 outbreak was spurred by unvaccinated members of the Amish community in Ohio.

“The anti-vaccine movement is not just in the Chassidic environment, there are other groups who are skeptical of the risk-benefit of vaccines,” says Dr. Shmuel Shoham, associate professor of medicine at Johns Hopkins University School of Medicine and associate director of the university’s transplant and oncology infectious disease program. “It’s my opinion that they are wrong—that the benefits of the vaccine to the individual, community and country, as a whole, outweighs the risk.”

Shoham says his patients—primarily cancer and transplant patients—are particularly vulnerable to any illness because their immune systems are compromised. “They are calling and asking, ‘What can we do? How can we be protected?’ ”

Because the early symptoms of the measles are not unique (fevers, coughs, even a rash, etc.), it may not be the first thing people consider when their children suffer from an illness. And by the time they are actually diagnosed with the measles, says the doctor, “they’ve spread the disease all around.”

“The measles virus is very good at being passed from person to person. You don’t need a big slug or particle, which you get because the person is coughing. And it does tend to stick to surfaces in the environment that the next person can touch and become infected,” says Shoham. “If you are a non-immune person—either you’re immune-suppressed or you haven’t been vaccinated—and you are in a room with a person who has the measles or in a room that was within the last two hours previously occupied by someone with the measles,” you can get the measles.

Nevertheless, some anti-vaxxers, as they are called, are standing their ground. As one Twitter user with the name “flatbushantivaxxer”wrote: “Vaccines kill and maim and the risk outweighs the benefit in a first world country and maybe even in a third world country. No vaxxed fully unvaxxed study ever done on all health outcomes and mortality. Who paid for the organized doctors’ campaign?

Communal members say that “flatbushantivaxxer” and others like them are a tiny minority, and when most people learn the facts about the vaccines they are choosing to get vaccinated.

‘Part of the mitzvah of maintaining health’

In the Detroit area, where Freedman and 42 others—more than half of them adults—were stricken with the disease, health officials mobilized quickly to offer vaccines in various sites, including at local synagogues.

By mid-April, Leigh-Anne Stafford, health officer for Oakland County Health Division in Michigan, and her department had conducted eight vaccine clinics in partnership with Young Israel of Oak Park and have given 1,141 vaccines at that location over the last few weeks.

“Our main message is to get vaccinated if you are unvaccinated, unsure of your vaccination status or unsure of your immunity to measles,” she said. “If you do not have two documented doses of the measles (MMR) vaccine, talk to your health-care provider or visit the Health Division to get the recommended two doses.”

Similarly, since October, the New York City Department of Health has administered more than 21,280 doses of the MMR vaccine to people who are under 19 years old in the Williamsburg and Borough Park sections of Brooklyn.

Knowing that a small group still refuses to be vaccinated, the city’s health commissioner has ordered all residents living and/or working in these same areas to be vaccinated or risk a $1,000 fine. And on Tuesday, the city hosted a telephone-based town hall so people could call in and get their questions about the measles and vaccines answered by medical professionals.

Malky Ackerman, a nurse at a Jewish school in Brooklyn, has been dealing with the outbreak since it began last year. When it started, she says about 20 kids out of the 1,000 students who attend the school were not vaccinated. After New York City mandated that children be vaccinated or they would not be allowed into school, the number of unvaccinated children shrank to just a handful, and those children are no longer in school.

Many synagogues are also making clear that their doors are closed to those members of the community who do not vaccinate their children.

“The medical consensus, which halachah [Jewish law] demands that we follow, unambiguously supports the safety and efficacy of vaccines as a first-line defense against measles,” Rabbi Efrem Goldberg, the religious leader at Boca Raton Synagogue in Florida, wrote in a message to his community. “The gedolei ha-Poskim have ruled that vaccinations are halachically mandated as part of the mitzvah of protecting and maintaining our own health. Those who choose not to vaccinate must realize that their decision is not only personal, but it affects the rest of the community as well.

“A shul is a public space in which people are invited come to connect with Hashem and with community,” he went on to say. “But it is also a private space in which we can and must make rules to insure and enforce the safety and security of all.”

As for Freedman, who is now on the road to recovery—fortunately, no one else in his family got the measles—he is doing his part to encourage others to get vaccinated. At the behest of a rabbi in Baltimore, he recorded a video recounting his experiences to encourage people in the Orthodox Jewish community there to come out for a vaccination drive.

His story, as predicted, went viral. Now he hopes even more people will listen.