tv Senate Health Committee Hearing on Vaccines and Outbreaks CSPAN March 8, 2019 6:10pm-8:02pm EST
the doctors now know they have developed for the first time a vaccine which will provide safe protection against the measles. >> sunday night at 8 pm eastern on the presidency with the university of virginia professor william hitchcock on the age of eisenhower >> dwight eisenhower was the most popular, respected and admired man of that period, 1945-61. he served as president and had massive approval from the public winning two landslide elections. the average approval rating while he was president for eight years was 65% and that was the average. the next president that comes closest to that was bill clinton at 55% and after that ronald reagan at 83%. they are way back in the rearview mirror. watch american tv this
weekend on c-span 3. the senate health committee heard from the 18- year-old that got vaccinated against his parents wishes and they are looking into the vaccine safety and what to do about preventable outbreaks. this hearing is one hour, 50 minutes. the senate committee on health educat it is the senate committee on health, education, labor and pensions. come to order. we will have an opening statement and then introduce the witnesses. after the witnesses testimony senators have each five minutes of questions. it was not long ago when i was a boy that i remember the terror in the hearts of parents that their children could contract polio. i had classmates that lived in iron lungs. the majority of the leaders of the u.s. senate, mitch
mcconnell, he contracted polo when he was very young. he has a poignant story about his mother that did not know what to do but took him to the warm springs where roosevelt went. it was a long period of time that she would massage his legs several hours a day and that's hard to imagine if you remember toddlers. that is why he is able to walk today. thousands of others were not so lucky. following the introduction of the vaccine, in 1955 the polio was eliminated and since then from every country in the world except for three. polio is only one deceive we have eradicated in the u.s. thanks to the vaccine. before the vaccine for measles was developed, up to 4 million americans each year contracted the highly contagious, airborne virus. in 2000 these centers for
disease control and prevention, the cdc declared the measles eliminated in the u.s. in the 1980s smallpox was eradicated by the world by the cdc and world health organization. these diseases and polio in small parts are the remarkable demonstration of what modern medicine can accomplish in the lives of millions of people in our country and in the world. four years ago this committee held a hearing on vaccines following the 2014 outbreak of measles, the worst outbreak since the disease was declared eliminated in 2000. 91% of americans have been vaccinated for measles in 2017. according to the cdc, we continue to see outbreaks of this preventable disease due to the pockets in the united states that have low
vaccination rates. last year there were 372 cases of measles, the second highest number since 2000 and this your 159 cases reported with outbreaks in washington state, new york, texas and illinois. we note some americans are hesitant about the vaccines. today i want to stress the importance of vaccines. not only has the fda found them to be safe but the vaccines save lives. vaccines have been so successful that until recently americans have lived without fear of getting the measles, polio or rubella. we have made significant strides in improving the vaccination rates. in 2009 44% received vaccines for the seven preventable diseases, diphtheria, tetanus, pertussis, polio, measles, mumps and rebello, influenza type b, chickenpox and numa
cocoa according to the cdc. today over 70% are vaccinated against all seven of these diseases. vaccines protect not only those vaccinated but the larger community, and that is called the herd community. some cannot be vaccinated because they are too young, have a weak immune system or genetic disorder or they get compromised immune systems like from cancer treatment. we can vaccinate those that can be vaccinated and prevent the spread of the disease but the low immunization can destroy the herd community but the vaccination could be high enough to create the herd community and in pockets of the country where they are vulnerable to the outbreaks. there is misleading and incorrect information about vaccine circulating online and throughout social media.
what i would like the parents in tennessee to know, parents in washington, texas and all over the country that vaccines are approved by the fda. they meet the fda gold standard of safety. they make recommendations on the use of the vaccines in our country with the annual child and adult vaccine schedules. the advisory committee is made up of medical doctors, public health officials from medical schools, hospitals and medical organizations from around the country. they are among the best the country has to offer and dedicated their lives to helping others. these recommendations are approved and seen by the cdc director and available on the cdc website. there is nothing secret about the sites with countless studies showing that vaccines are safe. there is fraudsters claiming
that they are not safe, preying on the founding peers and struggles of parents to create the public health hazard that is entirely preventable. it is important for those that have questions about vaccines and especially parents to speak with a reputable health provider. as with many topics, just because you found it on the internet does not mean that it is true. the science is sound that vaccines save lives and those that receive the vaccines and those too young or rollable to be immunized. before i turn this over to senator murray, the national child vaccine injury act requires the department of health and human services to submit the report to congress within two years after the legislation was signed into law. the health committee has received two reports from the department, may 4, 1988 and july 21, 1989. we consent that the reports be submitted to the committee record to be more accessible to
the public senator murray. >> thank you, mr. chairman. this issue could not be more timely. i remember in 2000 when the measles was officially eliminated from the u.s. and it was welcome news for the families across the country. i remember the years of efforts that led to that victory. before the vaccine was available, the measles outbreaks which spread through the communities like wild fire and if you were old enough to drive odds were that you already had the measles. we have vaccines that protect against the measles and use for years and we know the vaccine is safe, effective and that it saves lives. this is why, today, a generation of students are starting college and almost none that have to worry about the measles outbreak at school. it is a new generation and new parents may not appreciate how dangerous the measles is.
before the introduction of the vaccine and widespread vaccination millions caught the measles annually with thousands hospitalized with hundreds dying, mostly children under five years old. measles is not only deadly but one of the most contagious diseases easily transmitted through coughing and sneezing. it can linger in the air and on infected surfaces for up to two hours and contagious four days before the infected person develops a rash and four days after. 9 out of 10 unvaccinated people exposed to the measles catch it which is why the measles vaccine is so important in providing protection. experts say in order to establish herd immunity against the measles and prevent the outbreak from occurring within the community, 95% of the people should be vaccinated. meeting the threshold is
crucial to protect people unable to get vaccinated like infants or those with certain medical conditions. unfortunately while the national vaccination rate is high in communities across the country, we are falling behind. the vaccine coverage rates are declining in certain areas contributing to the rise in preventable outbreaks like in washington where public health officials continue to respond to the measles outbreak. immunization rates among children in the community is less than 70%, far below what is needed to keep the families safe. the result is a true public health emergency with over 70 confirmed cases and counting. the majority affect the children under the age of 10 that are vaccinated. each case is not just a concern for the family members that have worried about their loved ones that are seriously sick but it is a threat to the neighbors and community struggling to get this
incredibly contagious disease under control. it is a terror for parents with newborns that cannot get get vaccinated, and a strain on the public health system with hundreds of staff being pulled from rural public health areas to respond to the crisis. the disease for the center of control prevention is responding to the outbreak in washington and other states. it is not only measles that is among the slipping vaccination rates. it is the mumps, pertussis or whooping cough that are also cause for concern. we must do more to address the vaccine hesitancy and make sure that parents have the facts they need to understand the science that the vaccines are safe, and lifesaving. parents across the country want to do best for their families to keep them safe which is why they need to be armed with the knowledge of the importance of
vaccinations. we need research in vaccine communication tools and education to have people better addressed in vaccine hesitancy and to build confidence. there's online misinformation spreading dangerous rumors and falsehood. we to better prepare healthcare providers that are often the professionals that people trust most to counter the vaccine hesitancy and mumps vaccination. this not only important for parents but expecting parents that may decide whether or not they plan to vaccinate, and to promote adult vaccinations and encourage people to protect themselves and others throughout their lives. i look forward to hearing to the doctor about how washington state is working to give parents reliable information and the importance of vaccination and from all of the witnesses here today about how the federal government and their partners can promote vaccines and prevent the spread of misinformation.
where fighting multiple measles outbreaks and we must educate people on the lowering cancer risk and the flu vaccine on the hills of one of the deadliest flu seasons in years and the whooping cough vaccine. that is especially those that are particularly susceptible to the disease and the value of recommended vaccines. we need to make sure that we are approaching the public health challenges like this from a global perspective. we know diseases are not stopped by the borders, walls and stopped by doctors, nurses and vaccines along with public health awareness. it is strong investment in the public health system at home and abroad. they say the outs of prevention is worth a pound of cure and that is the case here. the dose of mmr vaccines is
about $20. they are addressing the current measles outbreak and it will be more effective at keeping our families and community healthy but affordable as well. the vaccine for the children's program is another great example. for over 25 years they've helped kids at low income families get shots at no cost and saving $1.6 trillion preventing 380 million illnesses and saving 863,000 lives. that is more people than live in seattle. hope we can work together in a bipartisan way to build on programs like this to help address the public health crises and to prevent them from happening in the first place. i'm glad to have the opportunity to learn more on how to do that and to consider how people across the country understand how vaccines are safe and effective to keep the families and communities healthy. esther chairman, i would ask the letter from the national association of county and city
health officials be submitted to the record. it speaks to the local health departments across the country and responding to the vaccines and preventable outbreaks. >> so ordered, and thank you, senator murray. we introduced the witnesses and each one of you have up to five minutes for questions and answers. i will ask the senators to try to quit the questions and answers within the five minute time limit so everyone has a chance to participate. senator murray will introduce the first question. >> i am pleased to introduce doctor weekman, and his service is the latest in the 22 year career working to keep families and communities healthy. throughout his career is worked at four different health departments, and the public health of vancouver, the front line of the community outbreak in our state and i know some of the colleagues on our committee
will appreciate learning that you got your education in their state receiving her bachelor's degree in wisconsin with your masters in connecticut, and phd in north carolina. i'm glad we have you now in washington state working to keep our family safe and to help us with this threat. i appreciate you coming out here from washington. >> thank you, senator murray >> senator isaacson if you will introduce our second witness. >> i am pleased to introduce dr. old mayor. i want to make sure we get that right. we are delighted to have him here today as an expert on the subject we are discussing and the professor of global health and epidemiology and pediatrics and school of public health in medicine. the doctor works in the him red
seen center making him a well- qualified witness for the hearing today with this research including studies in the u.s. and internationally and estimating the efficacy of influenza, polio, measles and other vaccinations. dr. omer has published approximately 1500 papers in peer-reviewed and is on several respected advisory committees and panels including the u.s. vaccine and advisory committee. he has mentored over 100 faculty members and phd along with other graduates playing an important role to make sure the pipeline of qualified scientists is well stocked in america. thank you for being here today, dr. omer. we appreciate your testimony. go emirate >> thank you senator isaac son. we will hear from the doctor, chairing the department pediatrics at the university of tennessee health and science center and serves as
pediatrician and she at the children's hospital in memphis. he received his medical degree and completed internship and residency at the university of alabama at birmingham in 1999, named the st.judes scholar in the science development program and join the st. jude faculty in the department of infectious diseases and spent 13 years managing the transitional research lab studying influenza virus and the study of bacterial pneumonia. his published over 150 peerreview articles. fourth, john boyd hill is the president and ceo of the immune deficiency foundation in maryland focusing on meeting the needs of the people with primary immune oh efficiency diseases. prior to joining the foundation he worked for the children's national medical center on disorders and support associations. he received his bachelor of
science from the boston university and a master of nonprofit management from notre dame of maryland university and finally we welcome ethan landenberger, currently a student at norwalk high school in norwalk, ohio. he is sharing his experience seeking out information about vaccines in making decisions on whether or not to become vaccinated. welcome to all of our witnesses. let's begin with dr. wiesman . >> chairman alexander and ranking murray and thank you for working to work with people on vaccine-preventable diseases. >> vaccines are safe and work against the best protection we have immunizing against serious diseases like measles. it saves millions of lives,
increases expectancy and saves society trillions of dollars. my mission at the washington secretary of health is to promote the health of all people and ensure public health is based on the best available science. i want to speak directly to parents that have children with serious health issues and attending the hearings in washington state that are watching this hearing today. i see your pain and desire for answers to your children's health issues. your mission to protect and promote the health of your children is one that we share. while the site is clear that vaccines do not cause autism we need to better understand the causes and to develop together the affected family, scientists and public health officials research agendas to get the answers that we need. the state territorial, tribal and local public health agencies are on the front line. in washington state would provide all recommended vaccines without charge to all children under the age of 19. we provide electronic immunization system for
healthcare providers to track schedules, provide reminders when patients are overdue and measure immunization rates. we help parents make informed decisions by sending them the information they need to keep the children healthy and we published plain talk about childhood immunization. we as cisco nurses by giving them access to the electronic immunization records. the washington measles outbreak as of yesterday had 71 cases and associated with an outbreak in oregon and georgia. this takes a community response led by the governmental public health. the moment the suspected case is reported the disease investigators interview the person to determine when they were infectious who they were in close contact with and what public spaces they visited. it still infected they order them to isolate themselves so that they don't infect others and notify the public about the community public places they
were in when they were infectious and they set up a call center to handle the questions. we reach out to individuals in close contact with the patient and if they are unvaccinated and without symptoms we asked them to quarantine themselves for up to 21 days, how long it takes to develop symptoms. we monitor them to see if they developed the measles and if they show symptoms we get them to the healthcare provider and obtain samples to find out if they have the measles. if they have the measles we start the process all over again. it is staff intensive, highly disruptive for people's lives and this preventable outbreak has cost over $1 million and requires the work of over 200 individuals. first from the federal government we need sustained, predictable and increased federal funding. congress must prioritize public health and support the prevention and the public health fund. we are reacting to the crises instead of working to prevent
them. the state territorial health officials in over 80 organizations are asking you to raise the tdc budget by fy 22 which could bolster and save lives and reduce healthcare costs. our response to the outbreak has benefited greatly from the pandemic and healthcare act and thank you. the prepared programs authorized by the law are currently funded $400 million below the funding levels in 2000. more robust funding is needed and i strongly urge you to quickly reauthorize with many authorizations expiring last year. the 317 immunization program has been flat funded for 10 years without increased funding we cannot afford to develop new ways to reach the parents with immunization information nor maintain the electronic immunization systems. fourth, we need federal leadership for the national vaccine campaign spearheaded by
the cdc in partnership with the states to counter the anti- vaccine messages similar to the true tobacco prevention campaign. we have lost much ground in urgent action is necessary. everyone has a right to live in the community free of vaccine- preventable diseases. to make this a reality we must continue to invest in and strengthen our public health care system. thank you. >> thank you, dr. wiesman . dr. omer. >> thank you for the opportunity to talk about vaccines in this form. the measles transmission from the u.s. in 2000 has been a significant public health success. most of these cases have occurred u.s. travelers going outside and bring it back. the recent outbreaks have been contained but the frequency and size of the outbreaks is particularly alarming for both of us that are following this
trend. the rest of the testimony will focus on answering the daily questions that are coming up and the first question is why have we not seen a national level outbreak in the u.s.? we cannot take this for granted and we have similar development status like germany, france and italy, specifically recently have had national level outbreaks. it is not a coincidence that we have not seen similar outbreaks and there are several reasons for it. first of all, our laws mandate and they work by changing the balance for most states and they work by the community vaccination compared to non- vaccination by having physician counseling or by having parents go through a video that talks about the vaccines and the benefits of vaccines, etc. the third thing is that in our country the medical societies like the american academy of
pediatrics and the infectious diseases society of america that have been promising in vaccine advocacy. it is important and based on the fact that physicians have the most trusted source of vaccine information. also we talked about the roles we have played in the vaccines refusals lately and these outbreaks. a few numbers, more than half of these cases since the elimination have been unvaccinated in approximately with 70% refusal or nonmedical exemptions. there is a contribution of vaccine refusal in the immunology of the measles. the vaccine mandates have been an effective tool in changing the balance of convenience that i was talking about but that is at the state level issue. i will focus on some of the things the federal government can do and in my original testimony i provide more details on that issue.
i'm happy to answer questions. there are a few things the federal government can do. consider making vaccine counseling reimbursable. i've worked on vaccine research in multiple countries and in multiple states in the u.s. there are many local factors that are specific. there is one constant in that healthcare providers and specifically physicians the most trusted source on vaccination even among those that are little bit skeptical of vaccines. we need to use this tool more effectively. on the practical side physicians did not have the time to properly counsel patients using the evidence- based approaches. part of the reason, not all of the reason, is the fact that it is not reimbursable. for the physicians, they lose money on this important public health information. as a country, the second point is to invest in the high quality vaccine acceptance and
communications research. i often say that if you don't accept the vaccine development sites, and we don't. the idea goes through the evaluation of the signs with trials, etc. we should not be accepting of the vaccine communications on behavioral sites appear for example, we have the prevention initiatives on hiv and a gold standard for these interventions and evidence- based medication strategies. the national institute for immunology -- sorry, national institute for infectious and allergies has had a very effective intervention development in the area of hiv- aids behavior. we have that precedent in this company and we need to invest in that national research. while developing evidence there is an existing blueprint of
interventions that the national vaccine advisory committee put together but unfortunately not all of its prevention and recommendations have been implemented. it is ready to be implemented. the cdc plays an important role in fighting these fires and working with the state and local health apartment. it is unique in the development world and we need to support the mission. we should continue to prioritize the backs in isolation research. i want to thank you for your persistent support of vaccines because it matters. it shows there is a broad cycle of support for vaccines. those of us that work to protect children from these infectious diseases really appreciate that. >> thank you, dr. omer. >> welcome to dr. mccullers. >> good morning and i and i am the chair at le bonheur's
children's hospital in memphis. as someone that has devoted his career to the child health spirit i believe there's no more precious resource in our children that should be protected by all means available to us because they really are the future of the nation. the childhood vaccination program in the u.s. is truly one of the most powerful public achievements in our history. in the first half of the 20 century there were over 1 million infections with over 10,000 deaths every year in this country from diseases that are now preventable by childhood vaccines. the ellis's cost over a half million of illnesses every year and that is a highly contagious respiratory disease characterized by fever, cough, sore throat and rash. it is very dangerous. one out of 1000 persons will develop encephalitis, and affection of the brain and developing pneumonia with half of those with severe complications that will die.
there is no treatment for measles so vaccination is the only means to prevent the outcome. with the introduction of the safe vaccine in 1953 with improved public health efforts to see that nearly every child received it and new cases were entirely eliminated by 2000. unfortunately the vaccine opposition and hesitancy are appearing our ability to effectively ensure coverage aided by the state laws to make it easier to avoid vaccination. the last decade has brought numerous outbreaks in the u.s. including several ongoing and present, strongly linked to the vaccine refusal and in particular to the clustering of unvaccinated individuals in specific communities or regions. the problem is not limited to the u.s. with countries worldwide dealing with similar outbreaks. in this committee we showed zero cases of measles and brazil in 2017 with over 10,000 occurring countrywide in 2018
when effective travelers brought the measles into the country. the vaccination is safe and effective with one dose dividing complete protection in 93% of individuals and the second dose raises that protection level up to 97%. very few side effects occur. 1 out of 10 will experience fever for a few days after vaccination with 1 out of 3000 to 4000 having a simple seizure associated with fever, and no lasting affects. it is usually rare and mild. when compared to the outcome of the disease itself it is easy to see why doctors and public health officials universally recommend on time and complete vaccinations. vaccination refusal is getting higher in every state and complicated by the variety of state policies regarding exemption of vaccination, counseling on vaccines. the rate of parents claiming nonmedical extension is about 2 1/2 times higher in states that
allow religious and philosophical objections. the evidence showing multiple pathways worsening the problem. social media is now driving it, and vaccine hesitancy as it is termed. parents get much of the information about healthcare issues such as vaccines from the internet, social media platforms like twitter and facebook. reading uninformed opinions and inaccurate information can lead to understandable concerning confusion and the parents. they may be has done it to get their children vaccinated without getting provided more information. the role of the pediatrician is very important with these families and we must do a better job communicating at many levels and particularly the point of contact when the vaccination should be taking place. half the time when counsel appropriately those parents hesitating will agree to have the children vaccinated on time. we have to have a solution earlier either in the form of policy or broader educational
efforts. in closing i want to thank the committee for addressing this important issue. vaccine refusal is one of the growing health threats of our time. if we continue to allow nonmedical vaccination more outbreaks will can -- undoubtably follow. the children's hospital are regional and national resources and the bonners children's hospital sits in the corner of tennessee next arkansas and mississippi. these three states have very different policies for granting exemption for the vaccines which is a tremendous problem for us, a threat to the children we serve which are many too young to be vaccinated and prone to more diseases. i urge the committee to consider solutions to harmonize public health policies and protect children as they grow up to become the next generation. thank you. >> thank you, dr. mccullers.
welcome to dr. boyle. >> thank you for inviting me to testify on the importance of herd immunity , vaccine- preventable diseases. my name is john boyd hill, president and ceo of immune and efficiency foundation and would represent people with primary inefficient diseases or pi. we have a group of three and 50 rare and chronic disorders in which parts of the body immune system are missing or functioning improperly. there is an estimated 250,000 people diagnosed with pi in the u.s. alone, one out of 1200 of your constituents. this disorder is caused by a genetic defect and not contagious. there is a variety of different forms of pi but we are all in you owe compromised and i have a form of pi x la and was
diagnosed when i was six months old when the respiratory infection nearly killed me. in short i do not produce antibodies but i'm able to be here with you today because i receive weekly infusions of antibodies from other people through blood plasma people. the infusions give me back some of what i'm missing but i'm still susceptible to infections. because i was diagnosed early and receive the id therapy my health is better than most of us but a simple cold can wreaked havoc with me and other members of our community that are incredibly vulnerable to communicable illnesses. for some members the infection is truly a life-and-death matter. i think you remember david better, the boy in the plastic bubble that was born with a severe combined immune deficiency. children diagnosed with skid, x la or any other form of pi face multiple challenges with several
everyday pathogens. exposing them to something as severe as measles can be life- threatening. parents and communities were vaccine use is bringing questions are afraid to send their children outside. they are afraid because they know the history, the science and the math. they note the states. people stop vaccinating the safety net of community immunity will dissolve and their children will be among the first casualties. of course this does not only affect children but adults as well. the newborn screening for skid most members of the community go years or decades with serious and recurring infections without knowing they have the compromised immune system. i am particularly concerned with the health of this segment of the community, the undiagnosed. if immunity fails they don't know they have to take precautions. those of us that no we have pi do what we can to avoid exposure to infections but the
undiagnosed and lack of basic knowledge are more at risk. the reason that all of us are so dependent on the community and pi immunity is that vaccines don't work with most of us that have forms of pi. our systems don't remember the pathogens or cannot create the anybody's. the further complication is that some vaccines are actually dangerous to us. as a result those in the field of immunology have studied the issue thoroughly to produce evidence-based guidelines to better safeguard us with pi. the article i shared with the committee discusses issues surrounding which vaccines are indicated or not and addresses the growing neglect of the societal adherence to routine vaccinations. that is what we are here talking about today. it states how important it is for family members and those around patient immune deficiencies can receive immunizations in order to protect the family member that has pi.
in closing let me say this, my life along with the lives of hundreds of thousands of others that are immuno compromised depend on community immunity. we depend on vaccines. i understand the concern that some of the new parents have, particularly given the misinformation on social media. at that. cannot override the facts. history has shown us that vaccines work. science has shown us that vaccines are necessary. mathematics has shown us that the odds of children having a healthy life are magnitudes greater if they have had their vaccines. the current decline in vaccine usage is literally bringing back places in the past for those immune compromised will suffer first and more the loss of community immunity that is a threat to all of us. we need to banded together to dispel the myth, compact
misinformation campaigns and ensure that measles and other vaccine-preventable diseases are once again put in their places, in the history books and not in the communities. thank you. welcome. >> thank you chairman and distinguished committee members for the opportunity to speak today. good morning everyone i am a [ indiscernible - low volume ] and my mother is an anti-back advocate believing that they cause autism and brain damage and do not benefit the health v of society. my entire life i went without numerous vaccines against diseases such as measles, chickenpox and polio. in december 2018 i began catching up on my immunizations despite my mother's disapproval. eventually [ inaudible ] so
thank you. to understand why i have come here and what i really want to talk about i have to share details about my home life and upbringing. i grew up understanding my mother's belief that vaccines are dangerous and she was openly about these views. both online and in person she would voice her concerns and her beliefs were met with strong criticism. over my life veseeds were plant of doubt because of the backlash my mother would receive but over time [ indiscernible - low volume ]. is important to understand as i approached high school and began to critically think for myself i saw the information of the positives outweigh the negative. i began pursuing and i realized one certain quality to debate when it comes to the controversial discussions which is that there seems to always be two sides to a discussion and a counterclaim or rebuttal and always something to strike back with in terms of debate. in all instances this is not true for the vaccine debate and
i approached my mother with this concern. i approached her numerous times trying to explain that vaccinese are safe. by a pressure even with articles from the cdc explaining ideas that vaccines cause autism and extremely dangerous consequences [ indiscernible - low volume ]. in one instance i approached my mother with information that claimed vaccines do not cause autism and she said that is what they want you to think. skepticism and worry were taken to the forefront in terms of the information. conversations like these reaffirm that evidence of in defense of invaccines was at least on an anecdotal level much greater than the information my mother interacted with and that mais what i want to focus on today. to combat preventable disease outbreaks information is in my mind the forefront of this matter. my mother would say anti- vaccine groups online and
social media looking for evidence of defense rather than health officials. this may seem to be in malice because of the dangers that not vaccinating imposes but this is not the case. my mother loved her children and she was concerned. this information misinformation spreads and that is not necessarily justifiable. it was with respect and love that i disagreed with my mother and with the information she provided i continued to explain it was misinformed these ideas that vaccines cause brain damage and autism and a measles outbreak [ indiscernible - low volume ] were ideas that were pushed by these resources that she would go to. for certain individuals and organizations that spread this misinformation it instills fear in the public knowing their information is incorrect. my mother was used to push an
agenda to create a false distress and the sources which spread the information should be [ indiscernible - low volume ]. almost 80% of people turn to the internet for health related questions. i further explained more evidence in my written testimony. it turns out what i would like to walk away with today and i will finalize with this although my mother turned to sources that did not have peer evidence or information lti saw the evidence and claims for myself were not accurate and because of that and because of my healthcare professionals i was able to speak with and the information provided to me i was able to make a clear scientific decision. approaching this issue with the concern of education and addressing this information properly can cause change as it did for me. although the debate around vaccines does not necessarily center on information this is why education is important
thank you. >> thank you mr. ethan lindenberger and from coming from ohio to let us hear what you have to say. now we will begin a five-minute round of questions. there are many senators and i would ask that you keep the combination questions and answers within five minutes. you are a pediatrician and chief at one of our country's leading children's hospitals so your business is everyday during your career with lots of parents about their children. what do you say to parents or to a parent that comes to you in memphis and says, i have heard on the internet or i have read that vaccines cause autism and i don't want my child to be vaccinated?
what do you say to that parent? >> what we finally looked at is that parents have a very complex set of issues that they are concerned about. there are a anlot of other thin that they think about and bring to us. it is not just one issue we have to talk about.:i want to focus on autism, what if they said that to you? >> this was a concern raised about 20 years ago when there was a fraudulent paper published linking the vaccines to autism -- published in the united kingdom -- respected journalist that correct? it was a physician that published it and he was unfortunately paid more than 400,000 pounds to falsify information because they were suing the government of england against vaccines. this was found to be wrong and it was retracted and he lost his medical license. >> what did the journal do about it? >> the journal retracted the paper and said it is no longer
valid. >> have you read other journals that have agreed with that position? >> there have not been that agreed with that position. there have been numerous scientific research done in the interim that have shown the opposite that these vaccines are not linked and the institute of medicine in the united states are high of authority on these issues and declared they are saying it is a close issue now. >> is that persuasive with a mother who is concerned about her child and has heard that vaccines cause autism? >> i think if there is a rapport with the physician and a mutual respect for the opinion of the parent and also for the physician, you can say things like that and say the evidence is clear, i believe you should do this and they will trust that information. >> in your opinion there is no evidence reputable evidence that vaccines cause autism? >> there is absolutely no evidence that vaccines cause autism. >> you agree with that?
>> absolutely. >> do you agree with that? >> i do. >> do you agree with that? >> i do. >> mr. ethan lindenberger? >> what about state exemptions, you are a state public health officer and as a governor i have a bias towards washington not telling states what to do -- with washington dc not telling states what to do i am being corrected here. what advice do you have about state exemptions and the effect on the concern we see today and pockets of measles across the country? >> i think as we heard earlier the choice to sort of make exemptions more difficult is as burdensome as not getting the vaccine in it is incredibly important. in washington state as you know
we have two bills right now that are looking to remove the personal exemption from vaccines for school entry and for child care entry. i think that is one of the tools we have and that we should be using for this. i will also say in washington state another problem we have is that about 8% of our kids are out of compliance with school records. we don't even know if they are vaccinated or would like exemptions and we have to tackle that problem as well which really is a resource issue for schools and public health. >> i will stay within my time senator murray. >> thank you. i appreciate everything you and your state and local colleagues are doing on the front line of this measles outbreak in washington state. confirming
and managing the cases, tracing potential contact, identifying exposures sites, crafting community messages, there is a lot going on but it is really scary to imagine how much worse this outbreak would be if not for all of the tireless work of so many public health officials on the ground. we all hope we are able to not just respond to outbreaks but also focus on preventing them in the first place. i want to ask you how have initiatives like the private public partnership and your department's proactive communication with parents of young children helped to build confidence? >> yes we do believe the child profile mailings that go out to parents of kids up to age 6 they go out at points in time which are appropriate to the development of the child. they are incredibly important and it is a trusted source of information not just on vaccines but on childhood development and it is that relationship that we build with parents through that mailing that i think is incredibly important. when i go out to the public and i tisee a new parent i will oft ask them if they get this
mailing from the health department and they say we love it and it is great information. i think that trusted sources really important. the public-private partnership that we have sewith northwest i actually a research initiative to best understand how we address vaccine hesitancy. there have been two studies done, one looking at healthcare providers on how to best train them around communication with their patients, unfortunately that work did not find that it made a difference in terms of addressing vaccine hesitancy nor necessarily healthcare providers efficacy around feeling confident in those conversations. the other piece was one with parents and parents who were interested in vaccine efficacy training them on how to have conversations with parents, how to share information at pta meetings etc. and that did find an increased parent knowledge of vaccines and reduced their hesitancy. >> thank you.
as vaccination rates in some areas drop below levels we need to keep each other safe. your research on vaccine hesitancy and likewise is really critical and we know some parents are making decisions about whether or not to vaccinate before the even have their child. what are the implications of some of these early decisions and what have you learned about the key factors that some parents are hesitant to vaccinate? >> thank you for the question and you are right to point out that a lot of this evidence and parents are making decisions around vaccines before the baby is born. after the baby is born it is like a fast-moving train that the parents go through this extended jet lag. before that there is a lot of discussion happening etc. and there are several reasons for this. the first one is the big picture which is that vaccines are the victim of their own
success. as the rates go down because of vaccines cohorts and parents see and hear about real or perceived adverse events not the disease. what happens is that that mental calculus changes and then there are several local factors. in the u.s. for example we have that have changed the disease rate which is a good thing. we have less appreciation of vaccine susceptibility -- and so in that context focusing on not just childhood but before the baby is born we are working for example our group is doing in collaboration with the university of colorado and john hopkins where and due to funding from the national institute on infectious diseases, we are looking at bringing together the best evidence and packaging it and seeing if that has an impact
not just on maternal vaccinations but this intervention being performed in pregnancy leading to childhood vaccination rates increase. the initial results are promising but to come back to the idea that we need to continue to invest in the best science for vaccine behavior and communications as we do for vaccine safety and efficacy. >> thank you. >> thank you. >> thank you all for your testimony, [ indiscernible - low volume ] ni >> i am a senior in high school. >> when did you start doing investigation and research on vaccinations? >> my mother would verbalize her views on vaccines throughout my entire life and i started to see evidence as i would unsee people i suppose trying to counterclaim with her
and argue online. i would see that she would have this backlash and she was share information and she was sure a video people would say it is false. it intrigued me that people disagreed and i started studying it over years. >> did your mother get most of her information online? >> from what she presented yes either through facebook or sites that use the social media flop platforms. >> where do you get your information? >> not from facebook. from the cdc and world health public association and also cited information from those organizations like the institute of medicine. i tried to also look at accredited sources. >> i would orlove to be a guest at thanksgiving dinner at your house. that would be a heck of a discussion right there. thank you for being here today. what currently is on the
horizon that would join this group of people that we might want to immunize for later on? >> there are several exciting developments and one of the big gaps has been the fact that there is a gap of availability when the baby is born when you start vaccinating. that is due to and one of the more exciting developments in this area is the area of maternal immunization where you vaccinate mom and i have the privilege of being involved in some of those trials to protect not just the mother but the baby as well. there are vaccines against the biggest cause of viral pneumonia in the world on the horizon and a variety of vaccines being developed. there is a vaccine that is being sdeveloped against group streptococcus and several vaccines and the field is expanding. >> are this vaccinations taking
place before the baby is delivered? >> yes. >> so it is transferred during gestation? >> yes. our first trial i think is is an appropriate name for this kind of where antibodies protect the baby. >> i have been to africa with the cdc and i've seen your work and you are always working the field. i don't know of any organization that does more for healthcare in our country than the cdc does. how much do you use cdc for research? >> a lot. the cdc is a national treasure and the function i spoke about it performs with the state and local health departments is somewhat unique. for example it has a very narrow mandate and people who have looked at the effectiveness of national public health agencies in europe have clearly come out with the understanding that our cdc is very strong and i am not trying to put down any other
countries because they are trying their best but the kind of investments that have gone into building this corporative framework of the cdc being the premier technical public agency but working closely with the state department has served as well including in this area. >> [ indiscernible - low volume ] worlds healthcare center and we are lucky to have it in the united states but the world [ indiscernible - low volume ] cdc is doing a better job incubating and now to replicate what they do in countries that are more developed so they are a great resource. i think all of you for being here today. don't forget to invite me to dinner one day i can meet with your mom. >> thank you. in 2015 this committee held a similar hearing to discuss the resurgence of vaccine preventable diseases in response to a multistate
measles outbreak. our nation's vaccination program has saved lives by preventing and reducing the outbreak of vaccine preventable diseases like measles which has one of the most effective vaccines. i am troubled that we are here again ilfacing another preventable outbreak in several states that has similarly been exacerbated by a surge of misinformation surrounding vaccine safety. i believe we must do a better job to prioritize investments in public education surrounding vaccine safety. younger children and those with compromised immune systems have a higher risk of measles complications and with the spread of misinformation rising in the media and online about the science behind vaccines dr.
john wiesman and saad omer what role do state health departments play in arming community leaders like school officials and providers with accurate information and scientific resources on vaccine afety? as a follow on what congress can do to improve the public health education so we don't see another preventable outbreak in the future? >> thank you for that question. yes states and local health departments really are the leaders and communities around t these health strategies to engage their communities aroundn vaccine information. they help provide health education, they work with the school systems, they work with healthcare providers to make sure this providers have the information they need and it really takes this sort of coordinated efforts. systems crumbling
and the resources going into prevention in our state, local tribal and territorial health agencies has been decreasing. we are really not up to the task. for example i had a call with the cdc a number of months ago and we do this every two weeks and cdc was on the call, talking about a hepatitis a outbreak happening throughout the country in many communities. they are encouraging us to do proactive vaccination campaigns with homeless and injection drug users which is where this is being seen. i don't have the resources and i asked my staff, what would a plan look like and it will probably cost us $5 million. i don't have those resources or the, that is very concerning >> how can congress help?
>> the research around how is it we communicate with folks about vaccines and then have a national campaign, we really need to get on this. >> >> investment in high-quality research i rthink congress can work on vaccine counseling so that is a specific tool that physicians can use at the frontlines of these conversations happening every day the blueprint is already there that was developed by the vaccine advisory committee that has very specific science-based recommendations to have that kind of implementation and continue to support the cdc's mission of controlling these outbreaks better should not be taken for granted.
having a robust vaccine safety program is not only a tool to maintain confidence in vaccines but it is the right thing to do. >> thank you. i only have a few seconds left and i will ask a question and if we run out of time we could submit information for the record. i followed a course things that happen in my state and some of the interesting things that are happening. since 2007 a company called in madison wisconsin has been working to develop a more effective flu vaccine based on technology that was discovered and invented at the university of wisconsin. as we have heard today highly effective vaccines have played a critical role in advancing
public health around the world and i think there is more we can do to develop and support the development of better vaccines to protect individuals from illness that results in thousands of deaths each year. can you describe why it is important for congress to continue to support this medical research that advances the development of more effective vaccines for common illnesses like the flu? specifically for the vulnerable population. >> sure let me try. the one of the challenges that i see even thinking about my colleagues and friends who sometimes struggle with whether to get the flu vaccine is the issue of fears of things like needles, they don't want to get a shot. they are scared of that. for that reason i know things
like the flu mist and others are attractive but the problem is within our community the live virus that has been used in the past is a problem. we are a little bit torn in that we want something to be easy idand something that will widely adopted but at the same time you have to be concerned about those who are undiagnosed. there is a little bit of a balance there and further investigation to help understand what new technologies can be made to reduce the burden of getting a vaccine be it for the flu or something working medical would be phenomenal. at the same time we will have to work with the cdc and others in order hto balance out the needs of those who were actually going to be affected by that negatively. we are all orin it together so this continued conversation is important and our community and other compromised communities i think would be delighted to be
a part of these conversations. >> thank you. >> thank you for your testimony. for much of modern history science and freedom have lived in relative harmony. traditionally as discoveries came about like smallpox or polio vaccine and sepsis or antibiotics the results were so overwhelming that over time the vast majority of the public excepted these advances voluntarily. in fact innovations like the smallpox vaccine had to overcome rate public prejudice. the doctor learned about the middle eastern technique from his servant for a famous pastor cotton mathers. his first patient was his son an incredibly brave choice. the consensus of the medical community was entirely posed at the time. the vaccine was a live vaccine and as he learned about one in 50 of those inoculated would die from the vaccine. yet the death rate from
smallpox was approximately 50%. the government did not mandate the ghvaccine though but within two generations it was accepted enough that george washington insisted be vaccinated before visiting him in the military camps. today that includes vaccines for nonlethal diseases. sometimes these vaccine mandates run amok when the government mandated a rotavirus vaccine that was later recalled because it was causing intestinal blockage in children. i am not a fan of government coercion yet given the choice i do believe the benefits of most vaccines outweigh the risks. is it wrong to say there are no risks to vaccines, even the government admits children are sometimes injured by vaccines. since 1988 over $4 billion has been paid out from the vaccine injury compensation program. despite the government admitting to paying that money
no informed consent is used or required when you vaccinate your child. this may be the only medical procedure in today's medical world where an informed consent is not required. proponents of mandatory government vaccination argue parents who refuse to vaccinate their children risk spreading these diseases to the immunocompromised community. there does not seem to be enough evidence of this happening to be reported as a statistic, but it could happen. if the fear of this is valid are we to find that next we will be mandating for vaccines? between 12 and 56,000 people die from the flu or are said to die from the flu in america and it is estimated to be a few hundred from measles if the current science only allows for educated guessing when it comes to the flu vaccine each year before that year's vaccine or strain is known scientists put
their best guess into that years vaccine and some years it is wrong. we vaccinate for the wrong strand or strain of flu vaccines is it really appropriate to mandate a vaccine that more often than not vaccinate for the wrong flu strain? i think it is important to remember forces not consistent with the american story nor is it consistent with the liberty our forefathers sought when they came to america. i'm not saying don't vaccinate your kids. if this hearing is for persuasion i am all for it. i believe the benefits outweigh the risks but i still do not favor giving up on liberty for a false sense of security.
thank you. >> thank you mr. chairman. we have heard today about how important vaccines are representing and controlling preventing and controlling many diseases and i want to zero in on what we are battling now in massachusetts. since last april 318 outbreak cases of acute hepatitis a virus have been reported in the commonwealth of massachusetts. it is a contagious virus that causes infection in older children and adults and they g can experience unpleasant symptoms like fever and nausea and in rare cases it can lead to death in massachusetts four people have already died since the outbreak began. we did not used to have a hepatitits a vaccine at all but in 1995 through 1996 the
fda approved two hepatitits a vaccines . soon after the cdc recommended vaccination for certain populations including routine vaccinations of children living in areas with elevated rates of the virus. you study infectious diseases, what impact did the reduction of the hepatitits a vaccine have on the national rates of the virus? >> thank you senator warren. hepatitits a can be a serious disease in high risk groups particularly. the vaccine that came out in the light late 90s is extremely successful and we have seen a tremendous decrease in the rate of the disease. we have seen more than a 50 fold decrease nationally over those years, primarily eliminating a lot of the disease in children but there is still a lot of public health
work to do as you see illustrated. >> we now have a vaccine preventable virus here why don't we see so many cases emerging now? >> the vaccines are administered in childhood and it has only been around 20 years. if you are older you probably haven't had it. it is recommended that high risk groups like recreational drug users which is part of the problem in massachusetts get vaccinated. we have not gotten to all of those groups yet. efforts to find the high risk individuals which are well defined and get them the vaccine would prevent these out in the future. >> this is part of what is happening in massachusetts. we have been battling the opioid crisis for years and hepatitits a is just another place we need to fight on this. we are learning from this, just this past october at the same cdc committee says recommendations in the 1990s
helped erase the decline sharply and added persons experiencing homelessness on the list of those recommended to get hepatitits a vaccines. i see you nodding. in massachusetts our public health workers at community health centers and our jails have sprung into action to try to get pthe vaccine to those w are most at risk. dr. john wiesman as secretary of the washington state department of help you oversee your states public health response . ubwhat can we be doi to ensure local public health officials have the resources they need to be able to do their work? >> thank you. part of this is making sure the prevention in public health funds is funded and that we look at the funding to cdc. we have been asking health officials and local public health for increasing the cdc
budget 22% by fiscal year 22. >> so we are talking money now? and whether it is a situation like hepatitits a outbreak in massachusetts or the measles outbreak in washington state, how do the preventive costs of a vaccine program compare to the containment and treatment costs of an outbreak? >> in general we know preventative dollars spent on vaccines you save about so it is a cost-effective intervention. >> good. so the more we do on the front end to ensure everyone gets access to the vaccines the less we will see individuals contracting hepatitis a, measles, whooping cough and all of the other vaccine presentable diseases preventable diseases. this administration has sought to cut the prevention and d public health fund which supports key immunization programs and they have continued for efforts to weaken the wmedicaid program which
covers vaccines for children and for many adults as well. i am glad most of my colleagues are on the same page about the importance of vaccines. now let's make sure we are all on the same page about the importance of public health funding so people get access to those vaccines. thank you. >> thank you mr. chairman. i am going to go a little cross current here and i want to state that the importance of vaccines and in young people cannot be overstated. i understand that. i want to talk about the seniors who are also at increased risk of experiencing serious and life-threatening effects of vaccine preventable diseases. we have quite a few in the
senate get vaccinated more so for the flu. you touched on this with your reference to this topic on the effect of a immunity syndrome which i appreciate particular settings in which adults and seniors are more susceptible to infectious diseases if they are not vaccinated. i like to figure out if we can look for ways that the federal program will help by removing barriers to services like vaccines and providing the right incentives for people to use them. what procedural barriers exist getting seniors proper access to vaccines? do we need more education for seniors to overcome these challenges? i will give you a personal illustration. a young lady in her 80s but she was young she made sure all six
of her children got flu shots and in turn all of their grandchildren and i was a bunch of folks. yet she got the flu in kansas and this time around it was bad. it was a really bad flu season and for some reason she did not get a flu shot so here she is, a mother who has told her kids get vaccinated and they have, then in her own situation she didn't get a flu shot along with her husband. we lost both. the sniffles became the flu and the flu became serious and then we get into pneumonia and then we get into all sorts of other problems and i am not going to
go into what kind of treatment they received. they were very important folks and they were pillars of their community and they were still very active, i sometimes think [ indiscernible - low volume ] in the senate all of those potted plants also known as chairman [ indiscernible - low volume ] around here. dr. saad omer you have written about vexing confidence and i'm interested in how this applies to adults in recent years where we have seen outbreaks of preventable diseases and the cdc also noted a drop in immunization rates contributing to the rise in hospitalization and death us during the last few season flu season. i don't get it. i don't understand why in a period of your life when you say i need the flu shot and then respond why you didn't do it say i just didn't get around to it. maybe you would like to offer some opinions but there are
people who still contribute to this even though there is no bargraph after 80 four anything just out there. anyone want to comment? >> thank you senator. the story is not unique unfortunately in this country. the elderly are one of the highest risk groups for complications after influenza. the vaccines are slightly less effective with the elderly but that is the reason we need more of them to be vaccinated. this is one of the gaps i was talking about that we don't have evidence based to communicate with several groups including the fda. this cis not a group that is actively opposed to vaccines. they have the concept of vaccines and they have seen what infectious diseases can do but at that time when a lot of the discussion has resolved around childhood vaccines we
need evidence-based strategies to communicate to not just the elderly but also to the health systems, the providers who deal with the elderly don't have the memory to talk about vaccines and to make it part of their routine clinical practices. there is a lot to be done and thank you for highlighting that issue. >> mai tai mr. chairman has expired. i want you to know that you did not .plan this before the committee hearing but he certainly hit the nail on the head and i think this is an issue we overlook. thank you. >> thank you mr. chair and thank you to the witnesses. this has been a fascinating topic. i noticed yet another study that came out in the past 24 hours, a study dealing with the very significant longitudinal study of a big chunk of children in denmark that also
again demonstrates no link between the vaccine and autism so it is a timely day to have this hearing. i want to ask a question and begin with a question about vaccination shortages which is a former governor that worries me a lot. the problems in the supply chain that could lead to shortages outbreaks of hepatitits a increased demand and restrained the supplies of the vaccine. many constituents have contacted my office about their inability to access the shingles vaccine. last year i joined a bipartisan group with members of this committee in a letter to the commission the urgent commissioner urging him to develop a report on the shortage of drug vaccines. i look forward to reading that report and i think it may be on the ioverge of being published and i think it is close to
publication. it might be worthy of some committee consideration when it is done. what more can we do at the federal level to make sure there is an adequate supply of m vaccines? >> just llstart out and then i will turn it to my colleague. we need to continue investing in vaccine research and figuring out new technologies for producing vaccines. that way it is a labor's process and we need to move toward new technologies i think around vaccines so that we can produce them more quickly and ensure the safety and it is a problem with the vaccine shortages. >> what if i a mentor had said a few times a vaccine remains in a file and was hundred % safe but 0% effective?
we need to have a stable supply of vaccine and [ inaudible ] thinking and response from regulation to working with our research entities to say there is a robust line of new vaccines and there are multiple approaches what it does is it creates an intellectual marketplace of ideas so there is more than one strategy that we are focusing on and we have more likelihood of having multiple products that with each other and sort of give us sumore options in the country. we are showing there is a and the third thing is sometimes especially in pandemics policy prevention is part of
preparedness and for example some flu vaccines that would be required in a pandemic their interest is to ensure a stable intervention and investments which are a little more direct emerging in routine vaccinations. >> it eswould require a nationa response not just a federal response. >> thank you for that. >> you need to be quick because i have one more question. >> quickly then three quick issues and one is that these are for-profit companies that create the vaccines so having a federal that gives them surety will make them produce more which will help the vaccine shortages. the second is we really have a problem not so much with a shortage of distribution when it comes thto logistics and we could do better at that at the
local level making sure every position practice physician practice hehas that. we are als teaching national stockpile which keeps these in reserve when we might need them. >> thank you i just want to compliment you we revere jefferson and virginia and one of the things he said which is so powerful is progress in government and all else depends upon the broadest of knowledge to the general population. he believes the diffusion of knowledge and giving people knowledge will enable them to make the right decision. misinformation and intentionallm misleading information can also be disseminated and in this social media age with the internet the competition between the true and valid, fake and dangerous, even the manipulated by people who want to do us harm is difficult but i think it is interesting that both your mother and you probably reached your
conclusions because you had an internet and tools to do your own research. so the difference between your mother and you are using some of the same tools and reaching different conclusions but you've applied your critical thinking skills and her willingness to share your story and i think you. >> just to comment on that quickly, i think part of the issue is being able to how to find this information because it wasn't that my mother could have the information that she was manipulated into believing it. it was made out that the cdc was a fraudulent group but that is not the case. the evidence proposed is genuine and so i just want to comment on that. >> let me give some color to what senator paul said. you may or may not know the position i have seen people that have not been vaccinated who required liver transplantation because they were not and ended up with
terrible diseases because for no other reason they just did not understand vaccination a was it important. even if flu shots are not completely effective they do mitigate and so there is a cross benefit that will decrease with severity and hospitals commonly require their employees to be immunized because they understand immunity is important and if a nurses aide is not immunized she could be a typhoid mary if you will bringing disease to those who are immunocompromised. in regards to the federal government there is a statute requiring vaccine information statements should be given, that is a federal requirement and in the name of liberty we should allow states and ur localities to make a further requirement so that is important to know not to be misled regarding that.
secondly i think pwe should point out that in terms of requirements it is that you cannot enter school unless you are vaccinated. if you are such a believer in liberty that you hedo not wish be vaccinated then there should be consequences and that is you cannot infect other people. if your child is born with an immunodeficiency an someone comes to your school that is not vaccinated, the lack of argumentative means your child, who no fault of their own, cannot be immune. is that a victimless crime that someone does not get vaccinated and your child dies? my gosh you are the guy who is representing those people who for whatever reason the vaccine doesn't work and they are particularly susceptible. i remember a tragic case in washington state six years ago of a child who was compromised and on steroids taking chemotherapy for cancer and someone brought ndmeasles to th school. i think i remember that child
died. do i remember that correctly? >> if we are talking about the same child yes he died a number of years later from a follow-up reaction. >> so the parent has had the child vaccinated but now she is on cancer chemotherapy and she is immunocompromised and she is thinking she can be a normal child but because someone else has made a decision not to vaccinate their child her child dies. if you believe in liberty don't get immunized but i don't believe you need to necessarily expose others to the disease. you are in a state you mentioned of practice where you have people from three different states and hats off to mississippi they always have the highest immunization rate. you did not elaborate what are the differences between the patient's between the three different states in terms of
immunization? >> mississippi does not allow any nonmedical exemptions and they have nearly a 100% rate of immunization at school. tennessee is in the middle allowing religious exemptions but not philosophical exemptions . in tennessee we have a 97% vaccination rate at kindergarten entry but we have seen the rate of nonmedical exemptions under the religious exemption triple in the past 10 years so you can predict where that is going. arkansas allows both religious and philosophical exemptions at a rate of about 94% below the level. >> [ indiscernible - low volume ] >> all of these are rare and we see them from all over the states. tennessee we get about one measles case per year always from outside the united states imported. >> so the immunity would still protect even if people are
bringing in other diseases? >> at this point as you have seen in california and oregon and washington is that there are pockets where it can grow any could easily happen in tennessee next week. there are plenty of communities below that level and we could see an outbreak. >> obviously we have a bunch of people and i noticed your beard is not as heavy as other people's. this is not you don't have to be a md or phd or master in public help to understand these issues correct? >> correct. you just need to bring a critical faculty to it and understand it is not just the individual effected but it is the individual or person at the school correct? >> as i stated before my decision to get vaccinated was for the safety of my health and those of others. i approached my physician and r she encouraged me to get vaccinated. i was told i could not attend school without my vaccinations so that for me also pushed me to look further into getting my vaccines done because i thought
the threat being imposed. >> i am out of time although i am the chair i will defer myself and i think you very much. i yield. thank you mr. chair and ranking member for having this hearing. thank you all for being here. i had the great good fortune of having a grandfather who was a pediatrician and he practiced medicine from 1921 until 1985. my childhood was filled with his accounts of the changes he saw on the medical landscape over the course of his career. b i still remember him describing what it was like to see someone suffer from lockjaw which is tetanus, the jaw locks up, the swallowing stops, the breathing stops, the muscle spasms and his talking about what a difference it made when the vaccine became available.
i remember my mother who had three children, the youngest born in 1960 remarking during my childhood that now that there was a vaccine against rubella the german measles pregnant women did not have to worry nearly as much about going out of their house during pregnant the accidentally contracting german measles which could be so damaging to the fetus. i think it is incumbent on all of us to remember these stories because a number of you have made the point that without this experience of what these actually do and mean, we have gotten vigilant about the importance of this and the importance of vaccinations. dr. saad omer i wanted to follow up with you, you spoke about the importance of what they are doing on helping pregnant women niget vaccinated
we know in the united states almost all vaccines are administered to infants once they are two months old, for the first two months infants rely on the antibodies of their mothers and the moms transfer those to protect them from preventable diseases or viruses like the flu. we know vaccines like the flu vaccine are currently available and are critical for pregnant women and their babies. we know these populations are at a risk of complications due to the flu including premature birth deliveries, hospitalization or death. astonishingly only about half of women received the flu vaccine during pregnancy. with infant mortality rates reaching startling numbers in the united states in recent years it is critical we take basic steps to protect women and babies during pregnancy and childbirth. what do you think is the leading cause of the low number of vaccinated pregnant women
and what can we do moving forward to improve these numbers and keep mothers and babies safe? >> there are several causes and only a few women are opposed to vaccines. there is this huge group and that is the opportunity to persuade and educate and have these meaningful conversations. in terms of how we intervene we propose a model which is practice provider and patient. we cater to the pregnant women because it is a very physiological state to be in and we advocate for evaluating strategies and there is emerging evidence mpthere is to the strategy to do things like standing orders which [ inaudible ] much of the practice into vaccinating. working on the supply side issues and physician
communication and persuading [ indiscernible - low volume ] specific reasons on the baby and with found this is another thing that mothers are both motivated to protect the baby and scared to harm the baby. as we generate safety evidence we need to find better ways and evidence-based ways to communicate to pregnant women. >> thank you. maybe with my limited time is i will also ask dr. jonathan mccullers as a practitioner i am curious about how you go about communicating with parents who are having vaccination hesitancy, among parents who choose not to vaccinate what is their most common reason and what can we do to help ensure parents are
educated about the importance of vaccinations? >> 10 years ago there was one common reason that was the fear of autism and right now there is really a polygon of reasons with all sorts of different minor concerns that come up. the most important thing for a pediatrician or family practitioner to do is listen and understand, respect what the concerns are because they are different for every person and then individualize how you will approach it and what education you will give. there are a lot of concerns floating around and we need to have this individualized message. >> and the sharing of best practices i would expect among professionals about how to do this? >> yes directed at their particular concern. >> thank you. >> thank you mr. chair and ranking member murray and for all of you being here. in 2017 my home state of minnesota experienced the largest measles outbreak we have seen since 1990 and
between march and august of that year we had 75 cases of measles and 21 related hospitalizations and our state department of health which is really aa model for great departments of health stepped in and did a really remarkable job working with children's hospital and a whole range of other partners. the reason i know you have been dealing with this in washington and some of my colleagues have gotten at this but could you just summarize for us how best the federal government can be a good partner as state department are dealing with these outbreaks? >> first of all i would say the cdc is amazing. they have lent us their technical experts around measles and have sent people out to our state in part based on our request so that is incredibly important. i think again we need to be
looking at how is it we get to the cdc director and get to thev hearts and minds of people around vaccines and to not put science on the shelf. we need to have this national conversation and national campaign based on evidence and that we develop the evidence on how to best communicate. it is a response effort and it happens at the local level. we need to remember that we need to find our local health departments adequately so they have the staff resources to respond and also to prevent disease. we need to work with communities and advance this. . >> biscuits to another question related. in minnesota when we saw the measles outbreak we saw some communities that were disproportionately affected. in order to communicate and hear well the concerns and the issues of these communities it was important to have culturally
competent issues in the community is, it was important that we had culturally content specific kinds of outreach. can you talk about mwhat you have seen that are good models in that area. >> it is having folks on the staff that are culturally diverse and who know the communities inside and out. we have to have employees that reflect the face of the community. that is a challenge for a lot of us and we are not there. i think it is the community development outreach work. building relationships with informal leaders and communities. whether they are church leaders, elders, tribal communities or whatever. the trusted folks there that people listen to. and engage them in health promotion work. >> what anyone else like to comment on the question of how we can have culturally connected outreach in this area? >> if i may add, the example
stood out for many of us. the community was targeted for misinformation. there were several visits by folks that were not enthusiastic about vaccines. so the response is also an example of how to engage communities. the children's hospital. not just the health department but other partners coming together to work with iothe community itself and pick up the rates of vaccination. they have the tools that are evidence-based. one of the tools is that you have this disease based approach. you don't just talk about the vaccine but you talk about the disease itself because that is what it is all about. >> i would add that when you are talking about a diverse group of people addressing specific communities, one thing i would address on an unbiased level is that for oyoung peopl especially moving into adulthood with decisions on a medical level, it is important. when you become of age, at
least for me, most of my friends did not understand that they could get vaccinated against apparent's wishes. and living on your own and that push of explaining to young people that vaccines are especially important. >> just to add to that, as we are talking about the cultural issues, one of the things that i found -- i love with the cdc and others provide -- one of the pieces of communication we are missing are thstories. there is little that connects the person. if they are not swayed by facts, to the needs. if someone's aunt is receiving chemotherapy and is compromised, tying it back to the personal in their community i think is a peace i have not seen much. as we talk about these campaigns and the needed next steps, it is another layer to add into everything else that needs to happen. >> senator casey.
>> thank you mr. chairman. i want to thank you and doctor cassidy for presiding over this hearing. it is an important set of issues. i want to start with mr. landenberger. i would like to be able to believe that -- you are a senior in high school now, i would like to believe at that age, i could do what you have done today. i think the answer is probably no. there are probably some members of the community that could have but i'm not one of them. and second i wanted to say that i know how difficult this would be, no matter what age or what station in life. it is a difficult topic and you have a personal story to tell which is difficult to tell and private, let alone in a public setting. thirdly, you have done something we don't often do in washington. this is a town where people are pretty good at demonizing and
dividing. we are really experts at being categorical. someone that disagrees with us is always bad. you have been able to be very h clear about where you stand and what you believe and bear witness to the truth without being categorical and demonizing. that is not only helpful for this topic but it is instructive for the rest of us here, and both parties in both houses and i hope people are listening. i wanted to ask you, if you could share additional ideas -- about the experiences you have had, as to how to effectively reach out to parents and address their concerns so that they are confident in the advice -- the advice of their doctors and don't hesitate to have their children immunized. >> thank you for that question. there is an important distinction made between the information provided -- as we discussed earlier, where people don't resonate well with
information and data numbers. you see with a lot of the anti- vaccine communities, a large portion of the foundation that they build to tcommunicate wit parents is on a very anecdotal level sharing stories and experiences. and that speaks volumes to people because even for my family, my mom could reaffirm that her position was correct because she knows people and she has seen stories. we don't know a lot of factors involved. even though i could say that, it doesn't resonate. so to address your question more accurately, the stories of people suffering from preventable diseases and the stories of preventable diseases ravaging countries and nations is extremely important. the side effects and complications imposed. people talking about measles, there is a huge misinformation that it is not a dangerous disease. measles is one of the biggest killers of young infants because of the dangers it poses
to young children. you see upwards of 80% of measles death are from children five and under. when you convince parents that their children are at risk, that is a more substantial way to cause people to change their minds. >> that is helpful and i appreciate your testimony. i know we are low on time. i will ask one more. i wanted to get to the issue of prevention which we repeat over and over again as the best care. we know that vaccines provide the best type of prevention not only for the individual but for the population by way of immunity as we have heard so often today. my question for you though is, can you describe, based on your own experience, work and research -- both, in terms of your experience in research an of patient care, what are some of the symptoms and the
outcomes of typical vaccine preventable diseases for children and adults? >> there is a wide spectrum depending which disease you are talking about. these are diseases that cause severe disease and death or they would not have been targeted 50 years ago and longer for elimination. one of the things that, as physicians and as providers that we don't realize, is how bad it was. i trained at a time when meningitis -- was discouraged. every kid with baron cella got chickenpox -- chickenpox. i remember working in the emergency department with kids coming in with brain damage and some dying. the vaccine came in when i was in my pediatric residency and disappeared overnight. trainees now don't see that and they don't understand just how bad these vaccine preventable diseases are because they have never experienced it. i think
that is the education piece. and the ability to really spread the mission that this really is good that they are eliminating and that we have these vaccines. >> thank you for being here. >> thank you thfor participating. the hearing record will remain open for 10 days. numbers may submit additional information for the record during that time if they would like. thank you for being here. the committee stands adjourned.
service. that is saturday at 10:00 p.m. eastern on american history tv's "real america" on c-span three. . >> tonight on c-span three, a senate armed services committee hearing on military housing. and then a house hearing on recent outbreaks of measles in the u.s. and a state of the state address from florida governor ron desantis and ohio governor mike dewine. >> the senate armed services committee held a hearing with the secretaries of the army, navy and air force as well as the military branch about housing conditions on military bases. members ask the officials about reported cases of lead paint, mold and vermin and housing for service members and their families across the country. this hearing is two and half hours.