 Okay, moving along our next speaker. You've seen him on the Colbert report. We were just talking about that, you know, that's funny talking about using humor as a delivery system for information and I realized probably 90% of the history and philosophy and I don't know even religion that I know I learned from money python like you know the Philosophers playing soccer You ever seen that that that little clip, you know where where like Confucius is the referee and stuff It's like I realized wow that why did that stick with me when I was 11 or 12 years old? So it's it's really it's really interesting that you can communicate sort of information through humor in a light way that is often We'll stay with the person much longer Stephen Colbert and John Stewart are great examples of that Stephen Colbert especially because he is so ironically funny Speaking of Colbert our next guest has been on Colbert. It was awesome It's so it's so nice to see one of us doing good work in that kind of a medium So it's Paul off it. He's he's been on Colbert his talk is the 1991 Philadelphia measles epidemic Lessons from the past and here's the limerick the cheese steak the Phillies the mall Ben Franklin and Independence Hall Philadelphia's got great things and a lot. Let's not mention the outbreak at all Please welcome Paul off it So as of July 3rd of this year the Centers for Disease Control and Prevention reported that there were 545 measles cases. That's more than anything we've had in 20 years The reason that there is that there is this huge outbreak is because people are choosing not to vaccinate their children more than 90% Of those who've gotten measles are children and they are they are unvaccinated But it's their parents made that choice and the reason that the parents made that choice is because they don't remember what measles Looks like or what measles can do But I remember I mean I lived through a Philadelphia measles epidemic that showed me exactly what measles could do and that's what I want to talk about today It started on April 20th 1989 at the spectrum After returning from a trip to Spain a teenager with a blotchy rash attends an REM concert a couple of weeks later Several other teenagers got sick measles at this point had entered our city Now on on May 21st this headline appeared in the Philadelphia Inquirer Its title suggests that measles is no big deal But in fact measles was a big deal the vaccine was first introduced in the United States in 1963 prior to the vaccine every year measles caused about three million cases 48,000 hospitalizations and 500 deaths almost everyone was infected by 15 years of age when you died You died typically of pneumonia encephalitis, which is inflammation of the brain or dehydration Now the measles vaccine worked by 1978 only 27,000 cases were reported and the CDC was optimistic that measles could be eliminated From the US so they launched something called the measles elimination program with a goal to eliminate measles by 1982 in 1983 only 1500 cases reported but in 1989 measles came back When June 2nd of 1990 this headline appeared in the Philadelphia Inquirer and it was it was Discussing what had been recent trends as of May 19th 1990 There were 35 deaths for measles reported in the US and there were had been 41 measles deaths already reported for all of 1989 even though you're only halfway through 1989 so the CDC reacted and what they did was they they Recommended a second dose of vaccine so which gave children for the most part a second chance to get a first dose And it also increased the efficacy for those who got two doses from 95 percent to 99 point five percent But in in the case of Philadelphia it didn't matter by November 29th 1990 There were 96 children who've been infected with measles by December 7th that number increased to 124 and by December 31st It increased to 258 in December of 1990 an 18-month-old boy died from measles pneumonia That was the first measles death in our city in 20 years When January 16th of 1990 on the north Philadelphia baby died of measles It was the second death and also occurred like the first in an unimmunized child The Philadelphia Health Commissioner recommended that the first dose of measles vaccine should now be given at six months of age Figuring that that would be a time at which the the Transplantal immunity from the mother would have faded enough so that at least you could have an effective vaccine Seven weeks after that the city health officials did something that has never been done before and never been done since I'll get to that The Philadelphia Health Commissioner was dr. Robert Ross He on January 16th received an anonymous phone call from a woman whose daughter belonged to the faith Tabernacle Church in north Philadelphia The woman warned Ross that church members don't believe in medical care No one had died yet said Ross But for the first time we worried that we might not hear about a case of measles until a church member calls the police or calls The coroner to pick up the body Now in the faith Tabernacle Church the doctrine of the members believe that the Bible is opposed to all means of healing Apart from God's way if I go to God and ask him to heal my body said church member Gordon corn I can't go to a doctor for medicine. You either trust God or you trust man The church school contained hundreds of children none of whom were immunized That's that's a sign it actually exists outside the faith Tabernacle Church, which is alive and well in the city of Philadelphia today On February 11th. This headline appeared in the Philadelphia inquires two more children died On February the 7th days before that headline Karen still a nine-year-old girl is pronounced dead for measles on February 10th Monica Johnson a classmate is also pronounced dead Monic is one of 11 children in the home all of whom are unimmunized Monica's father is a teacher at the school I feel very confident in my belief in that way that I've raised my child He says Monica is something that God has given us and now it's taken away After Karen stills death Ross meets with the Reverend Charles Reiner who was a pastor of faith Tabernacle He was soft-spoken the consummate gentleman says Ross, but he drove me nuts We told him we needed to vaccinate everyone in the school, but he said the families wouldn't let us do it On February 12th this headline appeared in the inquire now as we're starting to try and get into the area of these these into the Homes of the children who who are part of this this church Ross obtained this is Philadelphia This is one of several steps that was taken by the Philadelphia courts The first is Ross obtains a court order to visit the families who refused to let him touch their children All you can do is look through the doorway and try and determine whether or not The children are severely dehydrated or whether they have pneumonia Most of the families had six eight ten or twelve kids because they didn't believe in birth control says Ross There were many there were also a lot of kids who were physically or mentally Disabled because they all had in-house deliveries. Even if the kids were born breached. They didn't do a C-section It was like the old days Ross found the children appeared well these kids had a rash They were lying in bed, but they were alert conversant and well hydrated He said but he pleads with the parents to please let him know if any of their children gets sicker On February 15th the next child died On the or the headline said the next child died that had reported to death It occurred the day before police were called to the home of Lynette Milne's who is pronounced dead Milne's doesn't attend the Faith Tabernacle Church But her sister does Lynette's seven brothers and sisters are also all unimmunized quote when another kid turned up the morgue I checked my list and realized she was on it said Ross. I had just called the mother and she told me her kids were fine She lied to me Ross refers the case to district attorney Ron Castile who considers filing criminal charges, but demures Unfortunately when the parent is willing to risk the death of their children because of religious belief says Castile It's unlikely that the threat of prosecution will in any way act as a deterrent Then Ross takes the next step Realizing that the information he's getting is inaccurate from the parents He gets a court order to physically examine children and he had list enlist residents at our hospital I was at the hospital at the time children's hospital Philadelphia and St. Christopher's children hospital Which are the two major hospitals in the city to go door-to-door and go into those homes and into the rooms and examine the children Quote it was one of the more inspiring moments in my 30 years in health care says Ross These are busy people on call every third night yet. They were happy to do it On February 15th this headline appeared in the Daily News In the early morning of February 15th Nancy Evans a 15 year old from North Central Philadelphia dies from measles Nancy doesn't belong to the Faith Tabernacle Church rather. She belongs to the 1st century Gospel Church Another large faith healing group in this in our city Also on February 15th Tina Louise Johnson who was the 13 year old sister of Monica Johnson who had previously died dies on the day of Monica's funeral neither Nancy Evans nor Tina Louise Johnson were taken to a doctor when their illness is worsened Five children have now died in ten days. I don't know if I can put this in perspective. This is 1991 this is about 30 years into development of a measles vaccine and although Medicine has its limits. I mean there is much that we don't know and much that we can't do This was one thing we can do we can prevent measles We have had a had a measles vaccine at this point for 28 years And yet these parents chose not to use that vaccine thus putting their children at risk and and ultimately killing them Philadelphia is now in the midst of the worst epidemic in the United States Of interest in the US about one in a thousand infected children will die from measles That was true in the pre-vaccine era is about a point one percent in some developing world countries that that Mortality rate can reach as high as one in three hundred, but in Philadelphia in night in February of 1991 Four of a hundred and fifty children with measles who attend the Faith Tabernacle Church are dead That is a mortality rate of one in thirty five So the CDC sent a team to investigate the team was headed by Bill Atkinson Atkinson and his group were concerned that there was something unique about the Philadelphia measles strain Perhaps it was more virulent and that that's what was going on But they found that the the deaths had nothing to do with the circulating strain and everything to do with the parents Children were dying not because they weren't getting intravenous not not Children were dying because they aren't getting intravenous fluids for their severe dehydration or oxygen for their pneumonia antibiotics for the bacterial super infection on top of their viral pneumonia in February 18th 1991 This headline appeared in the Philadelphia inquire when finally Charles Reinhardt spoke out The devil has tried to put fear in people's hearts. He said Job was robbed of everything he had as he went through the trial. He learned from it There is no fear when you can see God on your side Reinhardt sees these deaths of children in his church as a test of His faith a test. He has every intention of passing. It's drawing us all together. He says Now we go to the third step in the Philadelphia courts Which is Ross asks the mayor who was Wilson good at the time to obtain a court order to hospitalize children who are critically ill With the telephone a number of judge in hand residents Meaning residents of the the hospital interns and residents to Children's Hospital Philadelphia and St. Chris's Examine children from the Faith Tabernacle Church quote It was like entering a time warp said Mark Jaffe who headed the St. Chris's team with the exception of the fact that they stay at home and watch their children die from measles They seem like wonderful people When February 18th this headline appears in the Philadelphia inquire Daniel Kern a four-year-old developed me developed measles pneumonia a healthcare worker insists on admitting the child to the hospital the parents Politely but firmly refused Ross calls city solicitor Sharice Lilly who calls family court judge Edward Summers Who gets an emergency order to hospitalize the boy a second child One-year-old girl named Bianca Carpina is also hospitalized against her parents will The Philadelphia measles epidemic is now at its peak at Children's Hospital Philadelphia We were admitting eight and we had seen 82 children our emergency department in 28 have been hospitalized at St. Chris's 250 children are seen in the emergency department and three are being hospitalized every week Ross and his team have visited 80 families and 500 children but predicts correctly There will be more measles deaths in the city of Philadelphia On February 21st this headline appeared in the Daily News Philadelphia is now a fear destination to nearby schools to cancel trips to the city It's the city prints 50,000 educational pamphlets and is vaccinating hundreds of school children every week Pennsylvania sends a hundred thousand dollars in federal funds to help on February 27th 1991 Mayor Wilson Goods asked the city solicitor's office to obtain an order to forcibly Vaccinate children now I should put this in some perspective There's a distinction between a legal distinction between mandatory vaccination and compulsory vaccination with mandatory Vaccination you are asked to vaccinate your child if you don't you will pay some sort of price a societal price You won't be able to get to go to the school You'll you want to go to you may not be able to work in the hospital You want to work in that's the price compulsory vaccination is you bring a child in pin them down and vaccinate them against their parents Will it's something that has never happened in this country in a hundred years, but happened that one February in Philadelphia 1991 now now the question was was this Constitutional was it constitutional to compel vaccination in the case of an outbreak like this one now according to the Supreme Court's interpretation of the Constitution States are Permitted through their police power to compel vaccination of their citizens it really centered that case Centered on a Lutheran minister named Henning Jacobson who during a smallpox epidemic in Cambridge, Massachusetts Refused vaccination his key and in addition he refused to pay the five dollar fine It came with that refusal that he believed that that that God would protect him and that he did not need the smallpox vaccine That case worked its way up from district courts to the state Supreme Court and ultimately up to the United States Supreme Court We're Chief Justice John Marshall Harlan writing for the majority wrote the following The Liberty secured by the Constitution of the United States does not import an absolute right to be wholly freed from restraint There are manifold restraints to which every person is necessarily subject for the common good Society based on the rule that each one is a law unto himself would soon be confronted with anarchy and disorder So at this point this this headline appeared in the Philadelphia Inquirer that the Philadelphia was now Philadelphia was now going to obtain a court order to forcibly vaccinate children against their parents will now the the the the parents of the of the Faith Tabernacle Church along with the church Pastor Charles Reinhardt sought out the help of the the Pennsylvania chapter of the American Civil Liberties Union believing that they would represent them now remember at this point Although it is not your constitutional right to To avoid vaccines to choose not to get vaccines a state can decide That that that state is now going to allow a religious exemption to vaccination In fact, there are 41 states in the United States that now frankly allow Religious exemptions to vaccination Nevada's one of them Pennsylvania's one of them So it was it seemed like a slam dunk that the American Civil Liberties Union who is certainly willing to represent Unpopular causes would be willing to take the side of the parents here I mean it in Pennsylvania in 1991 we had had a law in the books allowing religious exemptions of vaccination for more than 10 years This is just to make the point that the ACLU is willing to represent unpopular causes They represented the neo-Nazis in their March in Skokie, Illinois in 1977 Skokie is a town which had a number of Jewish people including Holocaust survivors that lived there and in fact They ultimately prompted this This headline in the onion which said ACLU defends neo-Nazis right to burn down ACLU headquarters I've never saw that but Interestingly on March 2nd 1991 this headline appeared in the Philadelphia inquire as the ACLU declined to help the parents in this measles case Which frankly was a surprise to all of us There is certainly a free exercise of religious claim by parents said Deborah Levy of the Philadelphia chapter of the ACLU But there is also a competing claim that parents don't have the right to martyr their children I don't think we've walked away from our principles here When March 2nd 1991 this headline appears as the judge permitted the city to vaccinate Objectors now the Jerome Balter was a lawyer for the parents of the Faith Tabernacle Church and he protested that decision Quote their healing is dependent on their faith. He says they believe that's the right thing to do for their children But the judge rejected that and ruled in favor of the city So Balter took his case then to the Pennsylvania the Commonwealth of Pennsylvania Superior Court of Appeals The State Superior Court judge was Vincent Cirillo who heard that appeal now while Balter represented the parents It was actually Sean Lacey that rep was the public defender representing the children at one point during the meeting the hearing Cirillo noticed a pained expression on Lacey's face and asked are you ill? Lacey had just been handed a note concerning a 20 month old boy named Jones Jones who were members of the Faith Tabernacle Church and That precipitated what was this headline on March 9th The boy had had a measles encephalitis from which he ultimately succumbed At this point now that that next child had died Balter argued that parents are now willing to allow sick children to be admitted to the hospital But they still refuse to be vaccinated He's implying that treatment is as good as prevention a statement that has clearly been contradicted by events of the previous month When March 9th, this headline appeared in the Daily News and on June the 7th this headline appeared You know, I should make a point here actually while I can Measles is a is a winter and spring disease that measles is gone by April or May We are still seeing cases in July in this country and the reason is is that that? The source of measles is coming from other countries. So in other words the Philippines is the main source Philippines is in a major epidemic. They had they had 32,000 cases of measles last year and 41 deaths from measles last year And so what will happen and this is true in that Ohio part of this epidemic the current epidemic where there's been more than 150 cases Amish person goes to unvaccinated goes to the Philippines comes back comes into an unvaccinated Community and spreads the disease now now in the Philippines measles is endemic year-round So I think that's why we're continuing to see cases even into the summer months Which is was never seen even in the in the pre-vaccine era because we're bringing it in from other countries But remember we live in a sea of measles I mean there are 20 million cases of measles every year in the world and 122,000 deaths every year in the world and you know it's a global travels common The difference sorry the difference between then and now is that the for the what's happened is you know We had say and by 2000 we really eliminated endemic measles from the United States But what's happened over the last say 15 years is there's been a gradual decline in in measles immunization rates So as there's been a decline in herd immunity and when there's a decline in herd immunity The first thing you see come back are the most contagious diseases And that's exactly what you're seeing now measles mumps Hooping cough to some extent bacterial meningitis You would have to have a further erosion in herd immunity to start to see diseases like polio Deferia come back those are more emotional diseases And I think if they did come back you would it would have an even greater effect in the current outbreaks, but that's that's the way it works So as I said typically means this is from Robert Levinson who was director of disease control in Philadelphia Typically measles a disease of the late winter and early spring when the warm weather Comes the cases disappear Reiner has a different interpretation of what's happening at this point focusing on the children in his church Who had survived the infection without medical care. He said we believe God has provided his faithfulness The the CDC's report actually came out in in in late In 1993 it was filed on December 3rd 1992, but what they found was that among church members There were 486 people who were infected and six killed among non-church members 938 people were infected in three killed. That's one city in one winter Period all nine deaths were in children the attack rate in church members was about a thousand fold greater Than in the surrounding community and you know, I think just as a side I mean when Jenny McCarthy who's my personal go-to person for health care advice She may not be yours, but you know when she gets on On larry king live and says or an opress and says as she does so eloquently I'll take the freaking measles every time as if the choice is between getting an mmr vaccine and thus risking autism or getting measles That's not the choice mmr vaccine doesn't cause autism, but What that tells you is is the success of the vaccine You know that it's not just that we've largely eliminated measles. We've largely eliminated the memory of measles I mean those of us who live through this philadelphia outbreak saw what measles can do We had several children in our hospital who died of measles. I'm not sure they would have died today I mean today we have advances in ICU Care that include things like oscillators and heart lung machines that we didn't have then But you know to watch a child come in and over a five or seven day period die of measles stays with you And when when when mccarthy says that that on the on on national television It it just reminds me of how how much we don't remember what this virus could do But this hopefully will Will educate people certainly this event educated me about what this virus could do I'm into the cdc in 2000 looked at sort of immunization rates in in 2013 have found that that About 30,000 children whose parents had chosen not to vaccinate them for religious reasons given under reporting I think the insular nature of some of these faith healing groups I think the number is probably far greater than that and and just as i'll leave you with this last note and us save time You know I would argue that although i'm not a particularly religious person I would argue that if religious or religious at all But I think that if religion teaches us anything it teaches us to care about our children to care about our neighbors to care about Our families I did the notion of a religious exemption to vaccination to me is a contradiction in terms It seems to me that it is a profoundly unreligious act I mean in addition there are religious exemptions to child abuse neglect laws if it's child abuse and neglect I just think that's not religion So i'll close you close with why do we allow such a profoundly unreligious act to be performed in the name of religion? Thanks for your attention