A highly contagious disease was sweeping across the United States. Thousands of children were sick and some were dying. In the midst of this outbreak, health officials did something that experts say had never been done before and hasn't been done since: They forced parents to vaccinate their children.
It sounds like something that would have happened 100 years ago. But this was 1991 — and the disease was measles.
Dr. Robert Ross was deputy health commissioner of the hardest-hit city, Philadelphia, where the outbreak was centered in the Faith Tabernacle Congregation in the northern part of town.
"This church community did not believe in either immunizations or medical care," says Ross, who is now the president of the California Endowment, a private health foundation.
The church ran a school with about 1,000 kids. Ross says that none had been vaccinated. One day, his office got a phone call from a grandparent, saying that a lot of children at the school were sick. They had developed rashes from head to toe and fevers — telltale signs of measles.
Ross and his colleagues approached the church and pleaded with the pastor to allow health officials to examine and immunize the children. But the pastor refused. So Ross and his colleagues went door to door, to church members' homes.
He says that most of the parents were pleasant and cooperative and allowed health officials to enter their homes. Many of the children they saw had measles. Ross says the majority were doing fine, but some were very sick, including an 8-year-old girl.
"[She] was lying on the couch in front of the television, ashen and pale, and with a very rapid respiratory rate. I felt that she may die within hours if we didn't get her to treatment," Ross says.
He went to the family's living room to call a judge, who was on call and ready to issue a court order, requiring any gravely ill children to be taken to a hospital. But as Ross held the phone, the girl's grandmother grabbed his arm and tried to prevent him from dialing.
"She began lecturing me about believing in the power of the Lord," Ross says. "It was a viscerally disturbing episode that left me quite shaken."
Ross eventually reached the judge, and the girl was taken to a local hospital. She survived.
But across the city, hundreds more were sick. So Ross and his colleagues did something unprecedented: They got a court order to force parents at Faith Tabernacle to have their children vaccinated.
Ross says it was the right thing to do, because it was in the best interest of the children. But it was deeply traumatizing to the parents.
"I recall we lined the children up and gave the immunizations, and many of the parents were actually weeping," he says.
The court order had taken a few weeks. By the time the vaccines were administered, the measles outbreak was subsiding in Philadelphia. Only nine children from the church were ultimately vaccinated, and Ross says the intervention probably didn't affect the spread of the disease.
In the end, nine kids across Philadelphia died, including six from Faith Tabernacle. The church is still operating the school today but declined to comment.
Some experts say it's rather surprising that the parents were forced to have their children vaccinated.
"There was a law that protected these church members' right to refuse vaccination on religious ground," says Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia.
But the U.S. Supreme Court had ruled years earlier that parents cannot deny lifesaving medical treatments to their children for religious reasons. That ruling set a precedent that made it difficult for Faith Tabernacle to find legal representation.
"Even the American Civil Liberties Union, which was perfectly willing to represent an unpopular cause, declined to take the case, because they felt that it was not [the parents'] right to martyr their children to their beliefs," Offit says.
So the question now is this: If there were a similar outbreak today, could the courts force parents to vaccinate their children?
Offit says it's possible. "Were things ever to get as bad, even approaching as bad as things were in Philadelphia in 1991, yes, there are certainly legal remedies to make sure that we can compel parents to protect their children," he says.
Ross, who led the fight against measles in Philadelphia, says health officials must go to great lengths to educate parents about the importance of vaccines. He believes courts should only intervene when parents are clearly putting their children's lives at risk.
"It should be 'break glass in case of emergency,' " he says.
STEVE INSKEEP, HOST:
The number of measles cases this year is now over 140. That's according to new numbers out this week from the Centers for Disease Control. The rising number of measles cases has reignited debate about the anti-vaccination movement. Turns out, there was a time when the government forced children to get the measles vaccine during an outbreak far worse than what we're seeing now. NPR's Anders Kelto has a little history.
ANDERS KELTO, BYLINE: This was 1991.
(SOUNDBITE OF NEWSCAST)
UNIDENTIFIED NEWSCASTER: In Philadelphia, an outbreak of measles has killed six children.
KELTO: It was the worst measles outbreak in the U.S. in decades. Dr. Robert Ross was the deputy health commissioner of Philadelphia at the time. He says the disease was centered around the Faith Tabernacle Congregation.
ROBERT ROSS: This church community did not believe in either immunizations or medical care.
KELTO: The church had a school with about a thousand kids. None were vaccinated. And then one day, Ross' office got an anonymous call, saying that a lot of children at the school were sick. They had rashes and fevers. So Ross and his colleagues approached the church...
ROSS: And pleaded with the pastor to allow us to examine and immunize the children.
KELTO: But the pastor refused. So Ross and his colleagues went door-to-door to church members' homes. A lot of the children they saw there had measles. The majority were doing fine. But some were very sick. Ross remembers one girl in particular.
ROSS: Was a little girl, about 8 years old, who was lying on the couch in front of the television, ashen and pale and with a very rapid respiratory rate. I felt that she would - she may die within hours if we didn't get her to treatment.
KELTO: So he went to the family's living room to call a judge. He wanted a court order to get the girl to a hospital.
ROSS: And the grandmother was trying to hold my arm from dialing the phone and began lecturing me about believing in the power of the Lord. It was a viscerally disturbing episode that left me quite shaken.
KELTO: The girl was taken to a hospital and survived. But hundreds more kids were sick across Philadelphia. So Ross and his colleagues did something unprecedented. They got a court order forcing parents at the church to get their children vaccinated.
ROSS: I recall we lined the children up and gave the immunizations. And many of the parents were actually weeping.
KELTO: The court order had taken a while, and by the time these vaccines were given, the measles outbreak was subsiding. Only nine children from the church were vaccinated. And Ross says it probably didn't have an effect on the spread of the disease. In the end, nine kids across the city died, including six from the church. Faith Tabernacle is still operating the school. They declined to comment. Dr. Paul Offit has written extensively about vaccines and the law. He's at the Philadelphia Children's Hospital. He says in some ways, it's surprising that the kids in Philadelphia were forced to get vaccinated...
PAUL OFFIT: Because there was a law that, frankly, protected these church members' right to refuse vaccination on religious grounds.
KELTO: But the U.S. Supreme Court had ruled many years earlier that parents can't deny life-saving medical treatments to their children for religious reasons. Faith Tabernacle and another church had trouble getting legal representation, even from the one organization that everyone thought would defend them...
OFFIT: The Pennsylvania chapter of the American Civil Liberties Union refused to represent these churches because they felt that it was not their right to martyr their children to their beliefs.
KELTO: So the question now is this. If there were a similar outbreak today, could the courts force parents to vaccinate? Offit says it's possible.
OFFIT: Were things ever to get even approaching as bad as things were in Philadelphia in 1991, yes. There are certainly legal remedies to make sure that we can compel parents to protect their children.
KELTO: Dr. Robert Ross, who led the fight against measles in Philadelphia, says court-ordered vaccinations should only happen in a true emergency. The best way to prevent a child from getting sick, he says, is to educate the parents.
ROSS: But if it's clear that the only way to protect the child is to engage the courts, then do so.
KELTO: Anders Kelto, NPR News. Transcript provided by NPR, Copyright NPR.