Measles is back. Last year, about 650 cases were reported in the United States — the largest outbreak in almost 20 years. This year, more than a hundred have already been reported.
Parents have chosen not to vaccinate their children because they can; 19 states have philosophical exemptions to vaccination, and 47 have religious exemptions. The other reason is that parents are not scared of the disease. But I’m scared. I lived through the 1991 Philadelphia measles epidemic.
Between October 1990 and June 1991, more than 1,400 people living in Philadelphia were infected with measles, and nine children died. The epidemic started when, after returning from a trip to Spain, a teenager with a blotchy rash attended a rock concert at the Spectrum. By Nov. 29, 96 schoolchildren had been stricken with the illness; a week later, it was 124; by the end of December, the number had risen to 258, and the first child had died. The Centers for Disease Control and Prevention sent a team to determine whether the strain of measles was particularly virulent. It wasn’t. Investigators found that the deaths had nothing to do with the strain that was circulating and everything to do with the parents.
Two fundamentalist Christian churches — Faith Tabernacle Congregation and First Century Gospel Church — were at the heart of the outbreak. Children had not been vaccinated, and when they became ill, their parents prayed instead of taking them to the hospital to receive the intravenous fluids or oxygen that could have saved their lives of those with the worst cases. “If I go to God and ask him to heal my body,” said a church member, Gordon Korn, “I can’t go to a doctor for medicine. You either trust God or you trust man.”
Public health officials turned to the courts to intervene. First, they got a court order to examine the churches’ children in their homes, then to admit children to the hospital for medical care. Finally, they did something that had never been done before or since: They got a court order to vaccinate children against their parents’ will. Children were briefly made wards of the state, vaccinated and returned to their parents. At the time, a religious exemption to vaccination had been on the books in Pennsylvania for about a decade.
To prevent doctors from violating his church’s beliefs against vaccination, the pastor of the Faith Tabernacle Church asked the American Civil Liberties Union to represent him. It refused. “There is certainly a free exercise of religion claim by the parents,” said Deborah Levy, of the Philadelphia chapter of the A.C.L.U., “but there is also a competing claim that parents don’t have the right to martyr their children.”
When spring came and the epidemic faded, C.D.C. officials published the results of their investigation. Over a third of those infected — 486 of 1,424 — belonged to one of those two churches, as did six of the nine dead children.
At the Children’s Hospital of Philadelphia, we saw more than 200 children in our emergency department and admitted about 40. Children would come in, covered in rashes, squinting in the bright light (a side effect caused by eye irritation), struggling to breathe and often extremely dehydrated. It was like being in a war zone. When I asked their parents why they had done what they had done, they all had the same answer: “Jesus was my doctor.”
It seems to me that if religion teaches us anything, it’s to care about our children, to keep them safe. Independent of whether one believes in Jesus, or that the four Gospels are an accurate account of what he said and did, you have to be impressed by the figure described. At the time of Jesus, around 4 B.C. to 30 A.D., child abuse was the “crying vice” of the Roman Empire. Infanticide and abandonment were common. Children were property, no different from slaves. But Jesus stood up for children. In Matthew 25:40, he said, “Verily, I say unto you, Inasmuch as ye have done it unto one of the least of my brethren ye have done it unto me” — a quote that could be emblazoned onto the entranceway of every children’s hospital in the world.
Constantine, the first Christian emperor of Rome, passed laws protecting children from abuse and poverty. Christian monasteries became prototypes for modern-day hospitals. And missionaries brought medicine to the four corners of the earth in Jesus’ name.
So why didn’t representatives from other churches or other religions stand up for the children suffering from measles in Philadelphia? The reason is obvious. No one likes to tell someone else how to practice their faith. It’s an understandable instinct — to a point. And that point was reached in Philadelphia in 1991.
In the wake of the current epidemic, several states have proposed legislation modifying or eliminating philosophical exemptions to vaccination. No lawmaker, however, dares to touch religious exemptions. It’s political dynamite. But with an estimated 30,000 children in the United States unvaccinated for religious reasons, that is a dangerous mistake.
Parents shouldn’t be allowed to martyr their children — or in this case, those with whom their children have come in contact. Religious exemptions to vaccination are a contradiction in terms. In the good name of all religions, they should be eliminated.
Paul A. Offit, a pediatrician specializing in infectious diseases at the Children’s Hospital of Philadelphia, is the author of Bad Faith: When Religious Belief Undermines Modern Medicine.