For certain Christians, the decision of whether to vaccinate comes down to the origins of the vaccines themselves. Some pro-life parents cite a moral disgust and a deep lament over the use of 58-year-old aborted fetal cell lines in development for several recommended immunizations, including MMR (measles, mumps, and rubella) and chickenpox.

“The use of fetal cells in vaccine study and creation is one of the primary reasons we do not vaccinate,” said Mandy Reynvaan, a mother of five in Oregon, where a measles outbreak has flared over the past few months. “The methods used to obtain these cells are horrifying.”

This week, Reynvaan traveled to the state capital to lobby against a bill that threatens to remove a parent’s right to refuse vaccinations for school-age children unless there is a medical reason. If passed, Oregon will be the fourth state to remove non-medical exemptions.

Furthermore, Reynvaan, who teaches fourth grade, is concerned that the state is not far off from mandating all teachers be vaccinated, which would put her job at risk. She and her husband have filed philosophical exemptions to vaccines for each of their children.

The bill making its way through the state legislature comes in response to 14 measles cases in Oregon and 73 in neighboring Washington state, which Tuesday passed a bill to the governor’s desk that would limit personal and philosophical exemptions for the MMR vaccine (but not religious exemptions).

Across the country, there have been over 600 cases in 22 states, spurring several state proposals that, in an effort to protect against the spread of disease, would restrict parental rights and religious freedoms for families who skip immunizations due to their faith convictions. Measles has seen a 30 percent increase globally, something the World Health Organization (WHO) attributes to vaccine hesitancy in countries that had practically eliminated the disease.

Christians who refuse to vaccinate are part of a larger trend, as younger parents in general are more likely than previous generations to believe the benefits don’t outweigh the risk. Only 78 percent of 30- to 49-year-olds support an MMR vaccine requirement for school children, compared to 90 percent of those over 65, according to a 2017 Pew study.

While many evangelicals—both in favor of vaccines and against—see their faith as compatible with science, the questions they raise over immunizations coincide with some distrust around the medical industry and human authority.

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Overall, American confidence in the medical community has fallen from 60 percent to 37 percent since the ’70s. Fewer than half of adults don’t believe scientists fully understand the MMR, according to the General Social Survey, despite the scientific consensus in favor of vaccines. Those who put their trust in the Holy Spirit and Scripture may be wary of embracing secular authority and expertise, BioLogos has noted, which could influence how they view scientific findings on topics like vaccine safety. Pew Research found that white evangelical Protestants are more likely than other Christians and Americans in general to favor allowing parents to decide what to do about childhood vaccines.

The abortion that started it all

The fetal cells that disturb parents like the Reynvaans actually originate from material procured from two abortions that took place in the 1960s, an era when measles was so common it often went unreported. There were roughly a half million reported cases in the US from 1956–1960. While about 450 of those people died, there were many more severe complications from measles, including 150,000 with respiratory complications, 4,000 cases of encephalitis, and thousands hospitalized each year. Doctors were eager to develop an effective vaccine.

For immunizations to work, they require the virus to be hosted in a living cell. Cell biologist Leonard Hayflick, working at the Wistar Institute in Philadelphia, reasoned that fetal cells would be protected from outside pathogens and the “cleanest” type to use in vaccines. He partnered with a Swedish scientist to procure the fetal tissue from an elective abortion in a country where it was legal.

In the recent book, The Vaccine Race, journalist Meredith Wadman describes the patient, “Mrs. X,” who requested an abortion due to her “run-down husband,” an alcoholic who was rarely around to help with the young children they already had. Days after her abortion in June 1962, Hayflick had the fetal lung cells he needed for testing.

Hayflick previously discovered that as cells divided and grew into subsequent generations they lost the youthfulness of the original cells. (This was contrary to popular scientific thought at the time. The discovery is now named after him.) So he grew the cells, dividing them just eight times, and froze enough in storage. Vaccine-makers still use the cell lines called WI-38 today.

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These fetal cells from the “Mrs. X” abortion were used to grow weakened or inactive viruses in the development of two vaccines: the rubella vaccine (the R in the MMR vaccine) and one version of rabies vaccine and are used around the world. Around the same time, the British Medical Council in the UK also produced vaccines from fetal lung cells. Using cells procured through an abortion in 1966, a culture called MRC-5, they created vaccines for hepatitis A, chickenpox, and shingles. A polio vaccine was also made and used in other countries but not the US. Researchers did experiment with other fetal tissue samples in their development, but the human fetal cells in current vaccines all stem from these two abortions.

Just one bottle of cells from Hayflick, Wadman writes, “would produce 87,000 times more vaccine than is made by a typical vaccine-making company, setting out today to make one year’s worth of a typical childhood vaccine that it will ship to more than forty countries.”

An ethical dilemma

Pro-life proponents of immunization point out that vaccines no longer rely on abortion to provide further fetal cells—and that the initial two abortions were not conducted to supply vaccine makers with fetal tissue in the first place. Such circumstances would be immoral—an argument on the Southern Baptist Convention’s Ethics and Religious Liberty Commission (ERLC) blog.

The Catholic Church also concluded, in a 2005 statement, that those who receive vaccines are not culpable in the original abortions. Focus on the Family’s Physicians Resource Council, which last updated a statement in 2015, suggests that Christians have the moral freedom to receive vaccines, though it also respects those Christians who come to a different conclusion after consideration and prayer.

National Institute of Health director Francis Collins suggests comparing it to organ donation after a child was shot. “There was a terrible, evil loss of life of that child and yet I think we would all say that if the parents decided and they wanted something good to come of this and gave their consent, that’s a noble and honorable action,” he said. “Does that translate into a parent, after going through a pregnancy termination, deciding that they would like the fetal tissue to actually help somebody?” ERLC makes a similar comparison to organ donation not condoning murder.

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Consent poses another ethical dilemma. The tissue from “Mrs. X” dates back to an era when scientists often failed to secure permission from donors or their families to use the cells. Think too of Henrietta Lacks, the African American cancer victim whose cells were secretly used in decades of research. Researchers today are expected to obtain informed consent.

“It is easy to condemn out of hand the scientists who conducted these experiments on the most voiceless and powerless among us. And their actions were in many cases horrifying and inexcusable,” Wadman wrote, noting the “deep moral abhorrence” abortion opponents and other vaccine skeptics may feel. “But it is more instructive—and perhaps more likely to prevent similar betrayals in the future—to try to understand why they did what they did.”

Concerns over reactions

One Louisiana mom described feeling shocked and betrayed when she found out that vaccine development used aborted fetal cell lines. It only led to growing mistrust of her pediatrician. “I trusted my doctor to be honest with me,” she said. “I desperately wanted to do right by my children.”

Concerned about vaccine reactions, she looked up her kids’ medical history to discover her firstborn had been vaccinated for hepatitis B without her knowledge after she had a C-section, deepening a sense of betrayal.

Like many parents with similar worries, she turned to the WHO, Centers for Disease Control (CDC), books, and medical journals to research vaccines, but her doctor balked at her efforts, telling her “not become a quack like all the other parents, and just vaccinate my children.”

Reynvaan’s hesitation over vaccines dates back to a seizure and 105-degree fever she experienced after her own 18-month immunizations, given according to CDC recommendations. The event landed her in the hospital, and though her pediatrician at the time didn’t see the episode as a vaccine reaction, her mother grew wary and proceeded with a less-rigorous vaccine schedule, declining recommended boosters. This was prior to the Vaccine Adverse Event Reporting System (VAERS), which launched in 1990 for parents and medical professionals to log reactions to immunizations.

There are roughly 30,000 reactions reported to VAERS each year, and roughly 85–90 percent of them are considered “mild side effects,” such as a fever, arm soreness, or crying and mild irritability. Reactions are more common for the DTaP, where roughly 50 percent of patients run a low-grade fever (under 100.4 degrees), according to the WHO. VAERS also collects reports of adverse events, such as anaphylactic shock, which occurs in about one in a million doses.

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The latest research agenda set forth by a CDC committee in 2011 reviewed the relationship between immunizations and autoimmune diseases, saying that so far a connection has not been clear. Nevertheless, it suggested more research on the genetic variability of human immune responses with the aim of reducing severe reactions to vaccines.

As an adult, Reynvaan has suffered autoimmune issues she attributes to her childhood vaccines and wants to avoid her children experiencing the same. “We are not close minded. We believe our Christian beliefs and science are not diametrically opposed, but instead, work together,” the Oregon mother told CT, describing years of research and mounting concerns over pharmaceutical companies’ liabilities for adverse reactions. “At the end of the day, our desire is to raise healthy children.”

A Christian response

Vaccine opponents know the negative stereotype that surrounds them, especially as outbreaks threaten to spread once-eradicated diseases and put vulnerable populations at risk. Crystal Kupper, a mom and journalist in Oregon, said she had once “mocked those who did not vaccinate as uneducated conspiracy theorists.” Even though she is enthusiastically in favor of vaccines, she gained a new respect for the so-called anti-vaccine crowd through a MOPS (Mothers of Preschoolers) group.

“These women were some of the most educated … articulate, well-researched, giving, generous, selfless, Christlike people I have ever had the pleasure of meeting,” she said. “And ever since, it pains me to see how many of my Christian friends openly mock those who don’t vaccinate as not only stupid but selfish and unbiblical. I often think of Ephesians 4:29: ‘Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen.’”

She put her journalistic skills to use in researching medical journals to understand her friends’ position and even interviewed people who don’t vaccinate for her own reporting. She too was shocked over the use of aborted fetal cell lines. Whatever your viewpoint, she feels Christians can find common ground with fellow believers who are trying their best to raise their children and who ultimately put their trust in God for their children’s health and safety.

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But Christian convictions have also spurred a vocal minority to do more. A group in Oregon wrote the state legislature to explain their position against vaccines and their hope to “avoid creating an incentive to develop similar cell lines in the future.” Even if they decline vaccines developed from aborted fetal cell lines, parents could still have their kids receive 9 out of 14 childhood immunizations recommended by the CDC, including the flu shot as well as DTaP and related Tdap, which cover tetanus, diphtheria, and whooping cough.

Even though the measles vaccine doesn’t use fetal cell lines, measles, mumps, and rubella vaccines are no longer available separately, so the combined MMR vaccine—which contains fetal cell lines in the rubella vaccine—is required to combat the current measles outbreak.

Collins explained that separating the MMR again would require regulatory oversight, which would be costly, therefore, likely not a priority for manufacturers. (Merck stopped producing the individual vaccines in 2009.)

Vaccine researchers today have many more options than those who developed major vaccine breakthroughs in the ’60s, said David Prentice, a cell biologist and research director of the Lozier Institute, a pro-life policy organization. “The vast majority of vaccines nowadays never see any of those old fetal cell lines,” he said. “They’re grown in monkey cells or other types of human cells or stem cell types.”

There is a subset of the Christian opposition to vaccines that also takes issue with certain animal cells used in medical research, citing concerns over Levitical guidelines on animals and blood products, as well as some that challenge vaccines for sexually transmitted viruses such as the human papillomavirus (HPV) and hepatitis B. But many concerned about the fetal cells would prefer to see animal cells used.

“The use of human fetal cells in vaccine creation isn’t necessary,” Reynvaan said. “Animal cells can be used and are used in many current vaccines.”

Japanese companies produce rubella and hepatitis A vaccines that do not use fetal cell lines, instead using animal cell lines, but they are unavailable in the United States.

The new Ebola vaccine, which uses a monkey cell line, is shown to be 97.5 percent effective in protecting against the current outbreak in Congo. And while the older shingles vaccine was cultured in an old aborted fetal cell line, a new one called Shingrix, cultured in a Chinese hamster cell line, is more effective.

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Opponents to vaccine mandates would like to see lawmakers offer more flexibility for religious exemptions for school children. One mother described how, in South Carolina, where her stepchildren were born, parents either opt in to all vaccines or no vaccines. Meanwhile, New Mexico allows more of a pick-and-choose approach on its form, meaning parents can select the vaccines from which they are requesting an exemption. While these solutions wouldn’t entice everyone, they might change some parents’ minds. Furthermore, even Washington’s recently passed bill addresses only the MMR.

Yet even if lawmakers and non-vaccinating religious parents could find a compromise, the reality is the issue is multi-faceted for many, with some still left asking questions about safety, particularly on the relationship between vaccines and autoimmune diseases. It is estimated 3 to 5 percent of the population suffers from an autoimmune disease.

“I totally understand people’s hesitancies about that,” said Prentice. “There haven’t been any scientific studies to nail it down, yay or nay. … It’s incumbent on drug manufacturers … to adhere to the strictest standards and eliminate any potential source of a biological problem.”

For some Christians, understanding the impact a whole community can have on health influences their personal choices—meaning they vaccinate to benefit their neighbors because it improves herd immunity. Therefore, Collins suggested that those of us who can should vaccinate to protect those with immune deficiencies and cancers.

But meanwhile, a lot of trust will have to be rebuilt for those who fear they or their children are at risk for adverse effects. Reynvaan is unsure that the pharmaceutical industry can be trusted. In her personal research, she characterized her findings as full of “corruption, falsified reports, and incomplete science on the part of the pro-vaccine community.”

Rebecca Randall is the science editor for Christianity Today.