How Philadelphia Mandated Vaccinations In 1991

NPR's Sacha Pfeiffer speaks with Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, about the last time the U.S. mandated measles vaccinations.

SACHA PFEIFFER, HOST:

Mandatory measles vaccinations have been ordered for people living in parts of Brooklyn, N.Y. That's the order of New York City Mayor Bill de Blasio. And it was prompted by a measles outbreak in some ultra-Orthodox Jewish communities there. Vaccination rates are low in those communities, and an anti-vaccination movement is spreading there. Requiring vaccines is a rare public health move, but there is a precedent. During a 1991 outbreak in Philadelphia, city officials mandated vaccinations for children against their parents' will. Dr. Paul Offit treated children during that outbreak. He's director of the Vaccine Education Center at Children's Hospital of Philadelphia. And he joins us to talk about the experience.

Dr. Offit, welcome.

PAUL OFFIT: Thank you.

PFEIFFER: In New York, Mayor de Blasio has said anyone who doesn't comply will be fined. But he hasn't said that people will be forced to get an injection or take a pill. In Philadelphia, was anyone actually forced to be vaccinated?

OFFIT: Yes. There's a distinction between mandatory vaccination and compulsory vaccination. What de Blasio is asking for is mandatory vaccination, which is to say, get a vaccine. If you don't get it, then you'll pay some sort of societal price. You may have to pay a fine or something like that. Here in Philadelphia, we had compulsory vaccination, which is to say, your child got a vaccine whether you wanted your child to get a vaccine or not. It was a court order.

PFEIFFER: And how did Philadelphia get to that point?

OFFIT: Well, we - in that several-month period in early 1991, we had 1,400 cases of measles and nine deaths. It was a major epidemic. I mean, parents were scared to death in this city. The city became a feared destination. It was a nightmare.

PFEIFFER: You were treating children who came to the hospital with measles. What condition were those kids in?

OFFIT: Well, typically, when you're hospitalized with measles it's because you have severe pneumonia caused by the virus or you have a bacterial superinfection that was set up by the virus when it infected your lungs or you have severe dehydration. Those were generally the reasons children came into the hospital.

PFEIFFER: So they were - they - these kids were in tough shape.

OFFIT: Yes. And this was at the point where, actually, they were compelled to come in. This epidemic centered on two fundamentalist churches - Faith Tabernacle and First Century Gospel, which were faith-healing churches. So it wasn't just that they didn't immunize. They also didn't choose medical care. And so they often let their children get very sick before, frankly, they were compelled by law to bring them to the hospital.

PFEIFFER: What did their parents tell you about why they hadn't vaccinated their children?

OFFIT: They were profoundly of the belief that Jesus would protect their children. And they said Jesus was our doctor.

PFEIFFER: And did they also believe that vaccines could cause their kids harm? Were they skeptical about them in other ways?

OFFIT: I think they were just skeptical of modern medicine, period. They saw modern medicine as an act of man. They saw Jesus as someone who could protect their child, independent of whether or not man intervened.

PFEIFFER: In Philadelphia, when those mandatory vaccines were ordered, were there any legal challenges to them?

OFFIT: Yes. The pastor of the Faith Tabernacle Church actually did challenge that because, frankly, what he was doing was perfectly legal. We had had a religious exemption to vaccinations on the book for 10 years. There was nothing he was doing that was illegal. And so he asked the American Civil Liberties Union to represent him, but the ACLU was unwilling to take the case. They said, basically, while they believe that you are at liberty to martyr yourself to your religion, you're not at liberty to martyr your child to your religion. So they didn't take the case.

PFEIFFER: Given the fears that many people out there have about vaccines, do you have any qualms or concerns about mandatory vaccinations?

OFFIT: No. I think that were those fears well-founded, sure, I could understand it. I mean, if vaccines cause what they fear vaccines cause, like chronic diseases like autism or diabetes or multiple sclerosis or attention deficit disorder or hyperactivity disorder, sure. But vaccines don't cause that, so they're making bad decisions based on bad information that's putting their children and other children at risk. I mean, at some point, somebody has to stand up for these children.

PFEIFFER: To take us back to present day, is there anything you think was learned from the Philadelphia experience that could be applied to New York City today?

OFFIT: Only just how bad it can get. I guess I just think we invariably fail to learn from history, which is why, occasionally, we're condemned to repeat it. I mean, do we really need to learn that measles is a potentially fatal infection? Do we need to learn that? Before there was a measles vaccine, 500 people died every year in this country, and most of them were children. Forty-eight thousand people were hospitalized. Do we really need to keep learning that lesson? You know, we eliminated measles from this country in the year 2000. And I think not only did we largely eliminate that virus, I think we eliminated the memory of that virus. People don't remember how sick it could make you. And that's why, I think, they can be so cavalier about these kinds of choices.

PFEIFFER: Dr. Paul Offit is director of the Vaccine Education Center at Children's Hospital of Philadelphia. And he treated children during a measles outbreak in Philly in 1991. Dr. Offit, thanks for talking with us.

OFFIT: Thank you.

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