Israeli Minister Mulls Mandatory Inoculations in School System

Conditioning acceptance into school on inoculation would require changing the current law ■ Parents who 'choose not to have their children given recommended shots' make 'risk of infection higher,' Yaakov Litzman writes

A child getting an inoculation for the flu in the city of Lod.
\ Ilan Assayag

Deputy Health Minister Yaakov Litzman is looking into whether inoculations can be made mandatory in the school system, in response to a request form the Israel Pediatric Association.

In a letter to Health Ministry Director General Moshe Bar Siman Tov, Litzman asked whether such a condition can be implemented in cooperation with the pediatric association, the Education Ministry and parents’ organizations.

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According to the plan, Litzman wrote, “non-inoculated children will be required to have all their inoculations [referring to those recommended by the Health Ministry], or bring a letter from an authorized physician explaining why the child is not inoculated.”

Litzman also asked the director general to check whether inoculations should be given in kindergarten rather than waiting until children start elementary school.

“Inoculations are the cornerstone of prevention of dangerous infectious diseases and they have decisive importance in the health of children and the public in general,” Litzman wrote. He notes that inoculations given in Israel are safe and efficacious, and that non-inoculated children pose a risk to others, which increases when they go to school.

“Inoculation rates in Israel are high compared to other countries, but in recent years some parents are choosing not to have their children given the recommended shots.” There are still areas where inoculation rates are low and infections break out as a result, he wrote, adding: “We are aware that in some settlements in Samaria and in a number of places in Pardes Hanna-Karkur and Zichron Yaakov the inoculation rate is low and the risk of infection is higher.”

The deputy health minister wrote: “We are aware of the difficulty of a directive like this but we think that individual freedom ends if it hurts others, and we have cases where a non-inoculated population caused diseases like measles, chicken pox and others – in babies who have not reached inoculation age. “

Litzman’s letter was sent following a request from the pediatric association last week. In a letter they sent to the ministers of health, of education and of labor, social affairs and social services, the heads of the Israel Pediatric Association, Prof. Shai Ashkenazi and Dr. Tzahi Grossman, called for the universal adoption of an initiative introduced recently in a private preschool network in the Tel Aviv suburb of Ramat Hasharon. The letter was also sent to the Union of Local Authorities in Israel.

Opinions are divided over the initiative, which is called Hagan Hamehusan (“the vaccinated preschool“) between those who regard inoculations as part of society’s mutual obligations to public health, and those who see it as an infringement on personal autonomy. The Health Ministry does not currently have the authority to impose this obligation. Clause 19 in the Public Health Law allows fines and even imprisonment to be imposed on those who refuse inoculations under extreme circumstances, but it has only been invoked twice. To condition entry to schools on mandatory immunization would require changing the existing law.

The healthcare system has long been concerned over the herd effect in refusing inoculation- a trend on the rise in some countries- for diseases like measles, whooping cough and others. Healthcare officials say that the trend of opposition in recent years to immunization in Israel is due to decreasing belief in the need for immunization because the risk is perceived as less tangible, and a greater desire for individual autonomy.

Despite attention in social media, opposition does not yet seem to have had a real effect on inoculation rates. A few weeks ago, a World Health Organization report on inoculation rates stated that in recent years, the inoculation rate in Israel is among the highest in the world. The data show that the inoculation rate has been stable over the years and in some cases has even risen; for example, there has been an uptick in inoculations against whooping cough, tetanus, diphtheria, polio and Haemophilus influenza, a serious bacterial infection.

According to the report, in 2017, 98 percent of toddlers in Israel received their first vaccination against measles and 96 percent received the second.

The data also indicates that almost everyone in Israel believes in the efficacy and safety of inoculations and their function in public health.

The actual number of non-inoculated children in Israel is between 3,000 to 4,000 non-inoculated or partially inoculated out of 180,000 babies born each year. Out of a total of 2.9 million children, age 0–17, the figure is a few tens of thousands.