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The Manual Behind the Mandates

An Essay on Paul Offit’s Bad Faith

Lies are Unbekoming | July 14, 2026

In June and October 1998, Paul Offit sat on the CDC’s Advisory Committee on Immunization Practices and voted twice in favor of Wyeth-Lederle’s RotaShield rotavirus vaccine: on June 25 to recommend it for routine childhood use, and on October 22 to add it to the federal Vaccines for Children Program.¹ Offit’s own rotavirus vaccine, developed at the Children’s Hospital of Philadelphia in partnership with Merck, was under development at the time. On October 22, 1999, exactly a year after his second vote, ACIP rescinded the RotaShield recommendation after CDC identified an elevated rate of intussusception in vaccinated infants. Intussusception is a bowel condition in which one segment of intestine telescopes into another and cuts off its own blood supply; without emergency intervention, it kills. The surveillance data at the point of withdrawal included hospitalizations and infant deaths. Offit abstained from the withdrawal vote.² Seven years later, Merck’s RotaTeq, which Offit co-invented, received ACIP recommendation for the same schedule slot. The patent sale netted him at least six million dollars by his own account, with other public estimates running higher.³

In June 2000, the United States House Committee on Government Reform published Conflicts of Interest in Vaccine Policy Making. The report named Offit specifically. It concluded that “conflict of interest rules employed by the FDA and the CDC have been weak, enforcement has been lax, and committee members with substantial ties to pharmaceutical companies have been given waivers to participate in committee proceedings.”⁴

In March 2015, Basic Books published Offit’s Bad Faith: When Religious Belief Undermines Modern Medicine. The book accuses religious parents of moral failure. It calls for the elimination of religious exemption from vaccination law. It endorses criminal prosecution of parents who withhold pharmaceutical products from their children on religious grounds, including, under the Oregon sentencing guidelines Offit presents as a model, terms of up to twenty-five years in prison.⁵

Offit is the Maurice R. Hilleman Professor of Vaccinology at the University of Pennsylvania and directs the Vaccine Education Center at the Children’s Hospital of Philadelphia. He has written five previous books along the same lines, including Deadly Choices: How the Anti-Vaccine Movement Threatens Us All and Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. His public role for two decades has been to defend the schedule and to condemn parents who decline it. Book after book, he plays the doctor calmly explaining what the parents are getting wrong.

Bad Faith extends the position into religion. It was published five years before COVID. Its recommendations were substantially enacted between 2015 and 2022. Read now, it functions less as ethical inquiry than as a legislative operations manual whose program was executed.

The Method

The book opens with cases designed to overwhelm objection. A Wisconsin pastor performs an exorcism on an eight-year-old boy with autism and asphyxiates him under his own body weight.⁶ An ultra-Orthodox mohel in Brooklyn performs metzitzah b’peh, sucking blood from a circumcision wound with his mouth; eleven infants develop what medicine identifies as neonatal herpes, two die, and two suffer permanent brain damage.⁷ At a Texas ministry associated with televangelist Kenneth Copeland, sixteen people including a four-month-old become ill in what Offit calls a measles outbreak connected to a daycare center on church property.⁸ In Ireland, a Hindu woman named Savita Halappanavar dies after a Catholic hospital refuses to remove her miscarrying fetus while a heartbeat is still detectable; the coroner attributes her death to septicemia.⁹

None of these cases involves ordinary religious exemption from vaccination. What they share, at the level Offit uses them, is that religious belief was present at the scene of a death. What they do not share is the specific practice the book has been marshalled to condemn.

That is the book’s central rhetorical move. It builds a moral gradient from ritual mutilation and life-refusal to any parental decision that rejects a pharmaceutical recommendation on religious grounds. The gradient does not require the cases to be comparable. It requires only that the reader carry the emotional freight of the extreme cases into the ordinary one.

The move is announced on page xiii. Offit writes, in his own voice, that he began the book expecting to arrive where Dawkins and Hitchens arrived, at the conclusion that religion is illogical and potentially harmful, but instead found himself moved by the Old and New Testaments. “The reader will be surprised to learn that the hero of this book isn’t science or medicine or doctors; it’s religion.”¹⁰

The concession does specific work. It reassures the religious reader that the book is not hostile to their tradition, and it disarms the skeptical reader who has watched vaccine industry figures dismiss religious objections as backward. Once both are quieted, the book proceeds to recommendations that religious readers, warned properly, would reject on sight.

Rita Swan is the emotional engine of the book. Offit opens with her and closes with her. To understand what he does with her, it helps to see her before he found her.

She was raised in Christian Science. In 1977, her fifteen-month-old son Matthew died after his parents, following church teaching, refused medical care for what was diagnosed as bacterial meningitis.¹¹ A year after his death, still a Christian Scientist, she went to the medical library at Wayne State University in Detroit. She had heard about another Christian Science child, a boy named Danny, whose meningitis had reportedly resolved without medical treatment; she wanted to understand why God had saved Danny and not Matthew. She read the textbooks. Danny had one kind of meningitis, viral, which typically resolves on its own. Matthew had another, bacterial, which does not. Antibiotics would have saved him. She sat on the floor of the library stacks and read the paragraph over and over. In her own words: “I did not have to be afraid that Matthew had died because we were not right with God. I knew that I wasn’t giving up a magical, supernatural protection or any kind of protection from evil because Christian Science had no power. It hadn’t healed anything.”¹²

That is the moment before Rita Swan became a public figure. She left the church, founded an organization called Children’s Healthcare Is a Legal Duty, and dedicated her life to eliminating religious exemption from child abuse and neglect law. Everything after sits downstream of that library floor. What Offit builds on top of it in Bad Faith is a criminal-law regime under which the state prosecutes not only parents like Rita Swan’s former self, but parents who bear no resemblance to Rita Swan’s former self at all.

Swan’s grief is real. Her son died. Her devotion to what she now believes is real. None of that is at issue. What is at issue is the strategic use to which her narrative has been put. Offit takes a mother whose child died in 1977 after her family refused emergency medical treatment for a present, acute illness, and uses her story to justify the elimination, in the 2010s, of the religious right to decline pharmaceutical injection of a healthy child. The two positions are not the same. Nothing in Matthew Swan’s death establishes what the parents of a healthy two-month-old should be permitted to decide about a hepatitis B injection.

The emotional weight travels regardless. That is the point of putting Rita Swan on the first page and the last page of the book.

Once the extreme cases have done their work, the ordinary case follows. Offit writes: “On any given day in America, tens of thousands of children whose parents have chosen not to vaccinate them for religious reasons can be found in daycare centers, schools, playgrounds, and churches across the country.”¹³ The sentence sits between the paragraphs about the Copeland church and the paragraphs about the woman dying at St. Joseph’s in Phoenix. By the time the reader arrives at unvaccinated children in daycare centers, the frame is set. They are on a moral continuum with mohels who kill babies and hospitals that let mothers die.

The frame does specific violence to the categories. A parent who declines a rubella vaccine on religious grounds is not the parent who prays over a bowel-obstructed child until he dies. Collapsing the two into one policy target requires an argument. Offit does not make the argument. He performs the collapse rhetorically and moves on.

Standing Up

Chapter 12 is called “Standing Up.” It is the book’s operations manual.

The model case is Oregon. Between 1999 and 2011, Rita Swan and Oregon prosecutor Terry Gustafson worked to strip religious exemption from Oregon’s criminal code. In 1999, Representative Bruce Starr introduced a bill repealing all religious exemptions to child abuse and neglect statutes. The Christian Science Church lobbied against it. The legislature compromised, repealing five of the exemptions.¹⁴ Twelve years later, after further deaths among children in the Followers of Christ church, Swan and her husband moved from Iowa to Oregon and lived in Salem for four months lobbying for full repeal. This time the Christian Science Church withdrew opposition. Governor Kitzhaber signed the bill. Religious exemption in Oregon was eliminated.¹⁵

Offit reports these events approvingly. He notes that under Oregon’s mandatory sentencing guidelines, parents convicted of religiously motivated child abuse or neglect could face up to twenty-five years in prison.¹⁶ He offers this as a template.

The Schaible case is the chapter’s central prosecution. Herbert and Catherine Schaible, members of the First-Century Gospel Church in northeast Philadelphia, lost their two-year-old son Kent in 2009 after choosing prayer instead of medical care; the coroner ruled the death due to bacterial pneumonia. The Schaibles were convicted of manslaughter and sentenced to ten years’ probation, with an order to seek medical care for their remaining seven children. In 2013, while under probation, their seven-month-old son Brandon died of the same condition. The Schaibles were charged with third-degree murder and sentenced to three and a half to seven years in prison. Their remaining children were removed to foster care.¹⁷

Offit reports the case as vindication of the prosecutorial approach. What the chapter does not report is the distinction between the Schaible position and the position of the parent who declines a hepatitis B or MMR injection for a healthy child. The Schaibles refused antibiotics for their acutely ill children. The parent refusing MMR is refusing pharmaceutical injection of a well child in the absence of any acute illness. One is refusal of treatment for present illness; the other is refusal of a product administered to a healthy body. Arguing for equivalent prosecution requires arguing for equivalence between the two positions. The chapter does not attempt the argument. It stacks the cases.

The children whose deaths Offit catalogues are real. Kent and Brandon Schaible are dead; more than eighty children lie in the Followers of Christ cemetery in Oregon; Matthew Swan was fifteen months old when he died in 1977. None of that is at issue here. What is at issue is the argumentative bridge: whether the deaths of children whose parents refused treatment for acute illness license the criminalization of parents who decline pharmaceutical products intended for a healthy body. Offit says yes. The book’s structural task is to make that inferential leap feel intuitive rather than argued.

In 2012, the American Academy of Pediatrics awarded Rita Swan the President’s Certificate for Outstanding Service. Robert W. Block, then AAP president, presented her with a plaque at the national meeting.¹⁸ The award marks a specific institutional turn. The largest pediatric medical body in the United States awarded its highest honor to a lay activist whose organizational mission is the elimination of religious exemption. Since then, the AAP has campaigned publicly for the removal of non-medical exemptions from state vaccine mandates.

The concession on page xiii is at this point difficult to sustain. The book that opens with “the hero of this book isn’t science or medicine or doctors; it’s religion” also contains, one hundred and eighty pages later, the sentence: “the American public’s instinctive tolerance for religion often exceeds reason.”¹⁹ Both sentences are Offit. Both are Bad Faith. The hero of page xiii and the tolerance-that-exceeds-reason of page 193 are the same subject in the same book. The concession was a hospitality. Chapter 12 is what waits behind it.

Offit’s resolution is to distinguish between religion properly understood, which is charity, and religion improperly performed, which is medical neglect. Charity is what he defends. Anything else is subject to statute. The distinction is convenient. It is also a claim no religious tradition would recognize as an outside authority’s to draw. Offit is not a theologian. He is a pediatrician with a financial stake in vaccine uptake and an institutional platform at the largest children’s hospital in the country. The book adjudicates which religious practices are protected and which are prosecutable. Parents disagree at their statutory peril.

From Print to Statute

Bad Faith was published in March 2015. Three months later, on June 30, 2015, California Governor Jerry Brown signed SB277, eliminating both religious and personal-belief exemptions from the state’s school vaccination requirements. California became the third state, after Mississippi and West Virginia, to permit only medical exemption.²⁰ The bill had been introduced in February 2015, roughly the same month Basic Books shipped Offit’s manuscript. Public advocacy for the bill drew heavily on the framing Offit had spent the previous decade establishing. Four years later, in 2019, California passed SB276, restricting the medical exemptions that had replaced the eliminated religious ones. What began as a policy conversation about religious refusal ended as a near-total mandate.

In June 2019, New York eliminated religious exemption by legislative vote. The bill passed in response to what the state described as measles outbreaks in Rockland County and Brooklyn, communities with large Orthodox Jewish populations. Governor Andrew Cuomo signed the bill the same day it passed both chambers.²¹ Maine passed LD 798 in May 2019, eliminating religious and philosophical exemption; the law survived a March 2020 ballot referendum challenge.²² Connecticut eliminated religious exemption in April 2021.²³ Mississippi, which had never permitted religious exemption to school vaccination, was ordered by a federal court in 2023 to allow one under Bosarge v. Edney.²⁴

The COVID-era mandates of 2021 and 2022 extended the framework beyond state school law. Federal contractors, healthcare workers at facilities receiving federal funding, and workers at companies with more than one hundred employees faced injection requirements as conditions of employment. Military personnel faced separate mandates. Religious exemption processes existed on paper. Employers rejected them at scale, and litigation over denied exemptions moved through the federal courts for the next several years.²⁵

Family court applied the framework to custody. In October 2017, Oakland County Judge Karen McDonald sentenced Rebecca Bredow of Ferndale, Michigan to seven days in jail for contempt of court after she refused to vaccinate her nine-year-old son under a court-approved parenting agreement. Her ex-husband was granted temporary custody. Bredow’s son received four vaccinations while she was behind bars. She then lost primary custody permanently. Three months later, in a separate Michigan custody dispute, attorney Aaron Siri deposed Stanley Plotkin, Offit’s mentor and vaccine industry co-strategist. Plotkin had been recruited as expert witness for the father seeking to vaccinate his ten-year-old daughter over the mother’s religious objection. The nine-hour deposition on January 11, 2018 ended with Plotkin recusing himself the following day. The father nevertheless prevailed at trial.²⁶ Similar custody rulings have moved through American family courts since. The framework Offit established in Bad Faith, that religious or personal objection to vaccination is a category on which the state may act against the parent, is the framework these courts now apply.

Under the Siri deposition, Plotkin stated the position openly. Asked whether he believed anyone could have a valid religious objection to vaccination, Plotkin answered no. Asked whether he took issue with religious beliefs, yes. Asked whether he stood by his written statement that “vaccination is always under attack by religious zealots who believe that the will of God includes death and disease,” he answered “I absolutely do.”²⁷ The deposition is the sworn version of what Bad Faith had put in more polished prose three years earlier.

In 2014, forty-eight American states recognized either religious or philosophical exemption to school vaccination. Between 2015 and 2022, four eliminated non-medical exemption: California, New York, Maine, and Connecticut. They joined Mississippi and West Virginia as the states permitting only medical exemption. The injection mandate regime extended in parallel into employment, healthcare, military service, and family law. Whether the reader considers this a public health achievement or a civil liberties collapse, the trajectory is documented. The book’s program was substantially enacted.

The framework has not gone unopposed. Aaron Siri and the firm of Siri & Glimstad have led the litigation counterattack, exposing Stanley Plotkin under deposition in 2018 and pressing federal court challenges to the COVID-era mandates. Robert F. Kennedy Jr.’s Children’s Health Defense has funded much of the legal and public education work. Bosarge v. Edney, the April 2023 federal ruling that ordered Mississippi to allow religious exemption to childhood vaccination, is one visible product of that pushback. In January 2025, West Virginia Governor Patrick Morrisey issued an executive order directing state health officials to implement a religious exemption process; the resulting conflict between the governor’s office, the state Board of Education, and the state courts is now before the West Virginia Supreme Court. The framework Bad Faith helped establish is now being tested in the same courts that first applied it.

The Document Exists

The record is a public one. In 1998, Paul Offit voted twice at ACIP to add a rotavirus vaccine to the childhood schedule. That vaccine was withdrawn a year later after CDC identified elevated intussusception risk and infant deaths. In 2006, his own rotavirus vaccine was added to the schedule under a subsequent ACIP recommendation. Merck paid him at least six million dollars for the patent, by his own admission, with other public estimates running higher. In 2000, the House Committee on Government Reform named him in a report on conflicts of interest at the CDC. In 2015, he published a book that opens by calling religion “the hero” and closes by endorsing prison terms of up to twenty-five years for parents who cite religion in declining pharmaceutical products for their children.

Between 2015 and 2022, states passed the laws the book recommended. California, New York, Maine, and Connecticut eliminated religious exemption from school vaccination. Federal COVID-era mandates conditioned employment, healthcare, and military service on injection. Family courts began ordering vaccination over parental objection and jailing mothers who refused. In 2014, forty-eight American states recognized non-medical exemption to childhood vaccination. By the end of 2022, forty-four did. Litigation and executive action since have partly reversed the direction of travel, and the story is not settled.

There is a version of this story a defender of the book would tell. In that version, the American vaccine mandate regime built between 2015 and 2022 is a public health triumph, and Bad Faith is the ethical volume that helped make it possible. In that version, Rita Swan on the floor of the Wayne State library reading about her son’s death is the founder of a movement to protect children, and Kent Schaible, Brandon Schaible, and the eighty-plus children in the Followers of Christ cemetery are the reason the state was right to act. That version exists. It is the version Bad Faith itself tells.

The other version is that the author of Bad Faith is a pediatrician who voted rotavirus vaccines onto the CDC schedule while his own rotavirus vaccine was in development at Merck, abstained from the vote to withdraw the failed predecessor after infants died, and sold his own version to Merck for at least six million dollars. In that version, the book that calls religion “the hero” is written by a man the House of Representatives named in a conflict-of-interest report fifteen years earlier, and its policy recommendations, enacted in state after state and then extended into COVID-era employment law, functioned to remove the last legal ground from which parents could decline the products his own industry manufactures. In that version, the mother on the library floor was leveraged into a criminal-law regime she never asked for.

The reader can pick the version. Both start from the same documents. The book calls itself an inquiry into religious belief. The record of what it did calls it something else. Everything is documented: Chapter 12 in the book, Offit’s financial history in the 2000 House committee report, the Schaible convictions in Pennsylvania court records, the state exemption repeals in state statute, the Plotkin deposition in sworn testimony. The elements exist for anyone to verify.

The document exists and says what it says.

How to Explain It to a Six-Year-Old

Imagine there is a kid at school named Paul who sells cookies at lunch. He has been selling them for a long time and he is rich now.

One day Paul writes a big book. In the book he says that any kid who doesn’t buy his cookies at lunch is being mean, and that the teachers should send those kids to the principal, and that the principal should punish their parents.

The teachers read Paul’s book. Some of them agree. Soon there is a new rule at school: if you don’t buy Paul’s cookies at lunch, you get sent to the principal’s office.

But some kids have real reasons for not buying cookies. Some are allergic. Some don’t have any money. Some of their families believe cookies are wrong. Some kids just don’t want cookies today. The rule doesn’t care. If you don’t buy them, you are in trouble.

Meanwhile, Paul is still selling cookies. He is still getting rich. He never mentioned in his book that he was the one selling them.

That is the story of Bad Faith. Paul Offit is a doctor who made millions of dollars from a vaccine he invented. He wrote a book saying that religious parents who don’t want vaccines for their children should go to prison. Between 2015 and 2022, several American states passed laws matching what his book said. The vaccines his industry sells are now required in more places than they used to be. The parents who don’t want them have fewer places left to say no.

Paul’s book called religion “the hero.” It wasn’t.

References

¹ Offit’s ACIP tenure (October 1998 to June 2003) and the specific rotavirus votes (June 25, 1998; October 22, 1998; October 22, 1999) are documented in United States House of Representatives, Committee on Government Reform, Conflicts of Interest in Vaccine Policy Making, Majority Staff Report, June 15, 2000 (Section V, Advisory Committee on Immunization Practices, Exhibits 38-41 pertaining to Dr. Offit specifically). See also Handley, J.B., How to End the Autism Epidemic (Chelsea Green Publishing, 2018), Chapter 4, “The Reward Is Never Financial”; and Olmsted, Dan, and Mark Blaxill, “Voting Himself Rich,” Age of Autism, December 2009.

² Centers for Disease Control and Prevention, “Withdrawal of Rotavirus Vaccine Recommendation,” Morbidity and Mortality Weekly Report 48(43), November 5, 1999. RotaShield post-licensure surveillance findings, including hospitalizations for intussusception and deaths, are documented in CDC MMWR reports from October and November 1999. Offit’s abstention from the withdrawal vote is reported by Olmsted and Blaxill, op. cit., and by Handley, op. cit.

³ Handley, op. cit., quoting Offit’s own email correspondence acknowledging the six-million-dollar figure, and noting that “other public estimates have been far higher.” Handley’s citation is to Offit-David Brown correspondence, August 18, 2009.

⁴ United States House of Representatives, Committee on Government Reform, Conflicts of Interest in Vaccine Policy Making, June 15, 2000. Available via the Children’s Health Defense archive at childrenshealthdefense.org.

⁵ Offit, Paul A., Bad Faith: When Religious Belief Undermines Modern Medicine (Basic Books, 2015). ISBN 978-0-465-04061-2. Endorsement of Oregon’s mandatory sentencing appears in Chapter 12.

⁶ Bad Faith, Introduction, pp. ix-x. Terrance Cottrell Jr., killed August 22, 2003.

⁷ Bad Faith, Introduction, p. xi. See also New York City Department of Health and Mental Hygiene, “Notes from the Field: Neonatal Herpes Simplex Virus Infection Following Jewish Ritual Circumcisions,” MMWR 61, 2012.

⁸ Bad Faith, Introduction, pp. xi-xii. The Tarrant County outbreak, August 2013, was traced to Eagle Mountain International Church.

⁹ Bad Faith, Chapter 6, “Dialogue of the Deaf,” pp. 82-85. Halappanavar died October 28, 2012, at University Hospital Galway.

¹⁰ Bad Faith, Introduction, p. xiii.

¹¹ Bad Faith, Chapter 1, “The Very Worst Thing,” pp. 1-18. Matthew Swan died July 1977.

¹² Bad Faith, Chapter 12, “Standing Up,” pp. 177-178. Rita Swan’s account of the Wayne State University medical library and her decision to leave Christian Science.

¹³ Bad Faith, Introduction, p. xii.

¹⁴ Bad Faith, Chapter 12, pp. 184-186. The 1999 Oregon legislative fight and Bruce Starr’s HB 2494.

¹⁵ Bad Faith, Chapter 12, pp. 186-187. Oregon House Bill 2721 (2011).

¹⁶ Bad Faith, Chapter 12, p. 186.

¹⁷ Bad Faith, Chapter 12, pp. 187-191. See also Commonwealth v. Schaible, Pennsylvania Court of Common Pleas, Philadelphia County. Herbert and Catherine Schaible entered no-contest pleas to third-degree murder on November 14, 2013, and were sentenced February 19, 2014.

¹⁸ Bad Faith, Epilogue, p. 195. American Academy of Pediatrics announcement of the 2012 President’s Certificate for Outstanding Service.

¹⁹ Bad Faith, Chapter 12, p. 193. The full sentence in context reads: “the American public’s instinctive tolerance for religion often exceeds reason—in this case, resulting in a misguided respect for a belief that violates one of the most fundamental teachings of all religions: protecting the vulnerable.”

²⁰ California Senate Bill 277 (Pan/Allen), signed by Governor Jerry Brown on June 30, 2015. Codified at California Health and Safety Code § 120325. California Senate Bill 276 (Pan), restricting medical exemptions, was signed September 9, 2019.

²¹ New York Senate Bill S2994A / Assembly Bill A2371A, signed by Governor Andrew Cuomo on June 13, 2019, repealing New York Public Health Law § 2164(9).

²² Maine LD 798, signed by Governor Janet Mills, May 24, 2019. Upheld in a March 3, 2020 statewide referendum by a vote of 73 to 27 percent.

²³ Connecticut House Bill 6423, signed by Governor Ned Lamont on April 28, 2021, repealing the state’s religious exemption to school vaccination requirements.

²⁴ Bosarge v. Edney, U.S. District Court for the Southern District of Mississippi, 2023, ordering the state to allow religious exemption to childhood vaccination requirements.

²⁵ Federal COVID-19 vaccination mandate litigation includes NFIB v. OSHA, 595 U.S. 109 (January 13, 2022) (staying the OSHA Emergency Temporary Standard for large employers); Biden v. Missouri, 595 U.S. 87 (January 13, 2022) (allowing the CMS healthcare worker mandate to take effect); and numerous federal cases involving denied religious exemption accommodations.

²⁶ Rebecca Bredow’s jailing and custody loss are documented in contemporaneous news reports from October 2017 (Oakland County Circuit Court, Judge Karen McDonald presiding; Detroit Free Press, CBS News, Washington Post reporting). The separate Michigan custody case in which Stanley Plotkin was deposed by Aaron Siri (January 11, 2018) is described in Handley, J.B., How to End the Autism Epidemic, Chapter 4. The deposition ran approximately nine hours.

²⁷ Deposition of Stanley Plotkin, taken by Aaron Siri, January 11, 2018. Transcript publicly available via the Informed Consent Action Network. The exchange on religious objection to vaccination appears at approximately pp. 42-46 of the deposition.

July 16, 2026 Posted by aletho | Book Review, Corruption | COVID-19 Vaccine, Human rights, United States | Comments Off on The Manual Behind the Mandates