When United Torah Judaism inked its coalition agreement with Likud on April 29, party members triumphantly hailed the reversal of a slew of legislative measures implemented by arch-nemesis Yair Lapid, including an increase in monthly child allowances — but it came with one caveat.

Under the terms of the coalition deal, which appointed party member Yaakov Litzman deputy health minister, “the National Insurance law will be amended, such that child allowances will not be given in cases where a parent refuses to vaccinate their child.”

That condition — which did not specify which vaccines would be included — revives a six-year-old debate on the legality of linking welfare benefits to vaccinations. It also comes on the heels of a quiet climb in the number of parents opting out of some or all vaccinations, primarily from within some segments of the ultra-Orthodox community as well as Bedouin families in southern Israel with limited access to medical treatment (another group is found among upper-to-middle class Israelis, based on ideological grounds).

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The Haredim and Bedouin, among those most resistant to inoculations, are also among Israel’s most impoverished and have the largest families, so they are ultimately the most dependent on the monthly allowances. Hinging benefits on vaccinations, then, puts them in a tight spot.

While the legal measure would not be unprecedented globally (Australia has conditioned benefits on vaccines beginning in 2016), some Israeli rights groups are fuming at the decision, accusing the government of discriminating against its weakest populations amid deepening poverty rates, and penalizing children for their parents’ decisions. They argue as well that the legislation simply won’t change the minds of those staunchly against vaccinations, known as “anti-vaxxers.”

Resuscitating an old battle

The debate dates back to 2009, when an amendment cutting a percentage of the child allowances for the unvaccinated was approved – also, coincidentally, as part of a coalition agreement. The revision, which was scheduled to go into effect by December 2010, was delayed after rights groups argued that Bedouin in the Negev had limited access to healthcare. The High Court upheld the government decision, rejecting petitions by rights groups and maintaining in its ruling that conditioning allowances on vaccines was “moderate” and “not an expression of trampling on rights but rather of the government’s commitment to the welfare of children in Israel, a commitment whose importance cannot be emphasized enough.”

While the High Court appeared to resolve the dispute by 2013, then-health minister Yael German later torpedoed it unilaterally, saying it was “not just.”

With the UTJ coalition agreement containing a more strongly worded formulation than before, the original petitioners slammed the reemergence of the welfare-allowances link this week.

“This is a serious act, even worse than the previous attempt in 2010 to harm the allowances. Then, a reduction of the allowance was being discussed… now this refers to canceling the entire allowance,” lamented Yitzchak Kadman, director of the Israel National Council for the Child, in an email.

Terming the move “draconian, unprecedented and dangerous,” Kadman noted that child benefits, while paid to the parents, were designated for the children. While affirming the importance of vaccinations, Kadman said that since there was no legal obligation to vaccinate one’s children, it should not carry a legal penalty.

“The State of Israel never set a requirement to vaccinate, but it doesn’t hesitate to hit the pocketbooks of families with children who didn’t fulfill an obligation that was never set.”

Sawsan Zaher, an attorney representing Adalah, the legal center for Arab minority rights in Israel, said in a statement that “if the amendment is implemented, this would be another punitive measure against children in the unrecognized Bedouin villages who, on the one hand, the government refuses to make preventative healthcare accessible, and on the other hand, punishes them by taking away their allowances if they aren’t vaccinated.”

Similarly, Mor Sagmon of the Association for Information on Vaccines called the move a dangerous precedent that will enable the reduction of child allowances based on the whims of the Finance Ministry or other stakeholders in the future. “Perhaps tomorrow they will reduce it for those who don’t fly a flag on Independence Day or those who smoke?” Sagmon said.

The three organizations, the original petitioners to the High Court on the subject, said they would weigh legal action again if the government follows through on the coalition promise.

The rise of the anti-vaccination movement

While Israel still enjoys vaccination rates that top 90 percent, the past few years have seen a surreptitious uptick in the number of parents opting out. Unlike the US, though, Israel has seen little vocal protest or discussion and minimal media coverage or grassroots activism.

In his 2014 report, State Comptroller Yosef Shapira warned of a “great danger” of outbreak among populations where vaccination rates dipped below the national average (90%-97%).

“Although this is a relatively high rate, this fact shows that tens of thousands of children in Israel either have not received some or all vaccinations,” he wrote. “There are populations, for example residents of Haredi neighborhoods in Jerusalem and the Bedouin in the Negev, where the vaccination rates are lower than the national average, and there is a great danger of outbreak of disease (some of which could be contagious) among them.”

The report followed a 2007 outbreak of measles that were carried by a British tourist attending an ultra-Orthodox wedding in Beit Shemesh and subsequently spread through its many non-vaccinated attendees. By the end of the year, over 1,400 cases were recorded nationwide.

In Haredi circles, most vaccines are generally encouraged by the Ashkenazic rabbinic leadership, with some exceptions (for example, the swine flu vaccination was reportedly considered “not worth the risk” by Rabbi Aharon Leib Shteinman while the polio vaccine during the 2013 outbreak was promoted, the Kikar HaShabat website reported.)

A Health Ministry report from 2012 found that in the primarily ultra-Orthodox city of Bnei Brak, the unvaccinated rate climbed as high as 18 percent, according to Kikar HaShabat.

A 2011 report carried out by Haifa University concluded the opposition to vaccinations is “a trend rapidly gaining traction in the past years.” Along with the ultra-Orthodox groups and Bedouin, the study noted, it was also popular among middle-to-upper class Israelis who refrained from the inoculation for “ideological” reasons and gleaned most of the information that drove them to refrain from vaccinations from websites and TV. A 2013 study similarly noted an increase among Israel’s highly educated.

With regard to the seemingly disparate groups and the varied reasons for sidestepping vaccines, Sagmon maintained that “most” parents who refrain from vaccinating their children make an “informed decision” on the risks and “they are not going to change their decision because of child allowances.”

Kadman, more cautiously, distinguishes between the Haredi and Bedouin unvaccinated and the “relatively small number” of anti-vaxxers on principle.

“The reduction of child allowances would needlessly harm the poor families and weak populations that are occasionally excluded from health services,” he said. “In contrast, with regard to the groups abstaining from vaccinations on ideological grounds (a relatively small number), the fine will have no benefit since they will not forsake their beliefs for the cut to the child allowances, which is peanuts.”

The various studies and the comptroller largely agreed that the trend was on the rise, but noted that precise figures on the number of unvaccinated are not available, in part due to professional incompetence by the Health Ministry to effectively gather the data. The Health Ministry is still in the process of compiling a national vaccination database, and the implementation of the ambitious legislation may be impossible until the system identifying Israel’s unvaccinated is completed.

A statement from the ministry said that it was in the process of gathering data from its offices around the country and from the Leumit healthcare system. The other health care services will “join soon,” it said.

Until then, the stealthily swelling population of anti-vaxxers and non-vaxxers will likely continue to exist under the radar, regardless of the legislation, undisturbed.