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tv   Senate Health Committee Hearing on Vaccines and Outbreaks  CSPAN  March 5, 2019 10:02am-11:53am EST

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>> the senate committee on health education, labor, and pension will stick -- will please come to order. senator murray and i will each
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have an opening statement and we will introduce the witnesses and after their testimony, senators will have five minutes each of questions. it wasn't long ago when i was a boy that i remember the terror in the hearts of parents that their children might contract polio. i had classmates who lived in iron longs. the majority leader of the united states senate, mitch mcconnell, contracted polio when he was very young. a poignant story about his mother who didn't know what to do but she took him to warm springs because that's where president roosevelt went. of time, long period she massaged his like several hours per day which is hard to imagine if you remember toddlers. able to walk is today. thousands of others are not so lucky. the introduction of a vaccine in 1955, polio was eliminated in the united states
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in 1979 and in every country in the world except three, polio is just one of the diseases we have a radical the united states thanks to vaccines. before the vaccine for measles was developed, up to 4 million americans each year contracted the highly contagious airborne virus. in 2000, the centers for disease declarednd prevention measles eliminated from the united states. in the 19 80's, smallpox was declared eradicated from the world i the cdc and the world health organization. these stories of polio and measles and smallpox are a remarkable demonstration of what modern medicine can accomplish in the lives of millions of people in our country and the world. four years ago, this committee held a hearing on vaccines. that was following the 2014 outbreak of measles. it was the worst outbreak since
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the disease was declared eliminated in 2000. even though 91% of americans had been vaccinated for measles in 2017, according to the cdc, we continue to see outbreaks of this preventable disease because there are pockets in the united states that have low vaccination rates. 300 73ar, there were cases of measles, the second highest number since 2000 and so for this year, 159 cases reported. in outbreaks are confirmed washington state, new york, texas, and illinois. we know some americans are hesitant about vaccines. today, i want to stress the importance of vaccines. not only has the fda found them to be safe but vaccines save lives. cleans have been so successful that until recently, americans have lived without fear of getting measles, polio, or rubella.
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we have made significant strides in improving vaccination rates. about 44% of americans had received vaccines for seven preventable diseases, all of which i will try to pronounce. get their area, tetanus, pertussis, polio, measles, rum -- mumps and rubella, influenza, chickenpox. over 70% of americans are vaccinated against all seven of these diseases. scenes protect not only those who have been backside but the larger community. this is called herd immunity. some young people cannot be vaccinated because they are too young or have a weak immune system because of a genetic disorder or they are taking medicine that compromises their immune system like cancer treatment. vaccines protect those who cannot be vaccinated by preventing the spread of disease. low immunization rates can communitiesherd
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immunity. while the overall vaccination rate nationwide is high enough h to create thiserd immunity, certain areas, the pockets of the country where vaccination rates are low, are vulnerable to outbreaks. is a lot of misleading and incorrect information about vaccines that circulates online throughout social media. here is what i'd like for parents in tennessee to know, parents in washington, parents in texas, everywhere in the country. vaccines are approved by the fda. the meet the fda's gold standard of safety and the advisory committee on immunization practices makes recommendations on the use of vaccines in our child andd annual adult vaccine schedules. this advisory committee is made up of medical doctors and public health professionals for medical schools, hospitals, professional medical organizations around the country.
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they are among the best or country has to offer and they have dedicated their lives to helping others. these recommendations are reviewed and approved by the cdc director and are available on the cdc website. there's nothing secret about any of this science. countless studies have shown back scenes are safe. claims vaccines are not safe and are preying on the unfounded fears and struggles of parents and they are creating a public health hazard that's entirely preventable. is it important for those who have questions for those who to speak with a rep. hill: help -- a rep. ribble: health provider. just because you find it on the internet doesn't mean it's true. vaccines save lives of those who received vaccines in the lives of those too young or vulnerable to be immunized. before i turn this over to senator murray, want to add that the national child vaccine injury act of 1986 required the
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department of health and human services to submit a report to congress within two years after the legislation was signed into law. the health committee has received two reports from the department submitted to congress 1989.8 and july, i ask consent that the reports be submitted to the committee records of a can be more accessible to the public. senator murray -- >> think it very much. as states grapple with measles outbreaks, this issue cannot be more timely. i remember in 2001 measles was officially eliminated from the united states and what welcome news that was for families across this country. , years of the efforts efforts that actually led to that victory. he for the vaccine was available, measles outbreaks used to spread through communities like wildfire. if you were old enough to drive, odds are you already had measles. today, vaccines that protect against measles have been in use
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for over 50 years. like other vaccines, we know the vaccine is safe, effective and save lives. that is why today, generation of students are starting college almost none of whom had to worry about a measles outbreak at school. it also means a generation of new parents may not appreciate just of dangerous measles is. of thethe introduction measles vaccine and widespread vaccination, millions of people caught measles annually, meaning thousands were hospitalized, hundreds of people died, mostly children under five years old. measles is not just deadly, it's also one of the worlds most contagious diseases. it is easily transmitted through coughing and sneezing. it can linger in the air and on infected surfaces for two hours. it is already contagious four infected person develops a rash and another four days after. nine out of 10 unvaccinated people exposed to measles catch
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it. that's why the measles vaccine is so important in providing protection. experts say in order to establish herd immunity against measles, to prevent an outbreak from occurring within a community, at least 95% of people should be vaccination. meeting that threshold is crucial to protect people who are unable to get vaccinated, infants, those with medical conditions. unfortunately, while the national vaccination rate remains high, and communities across the country, we are falling behind. vaccine coverage rates are declining in certain areas contributing to the rise in preventable outbreaks. county, washington were public health officials continue to respond to a measles outbreak. immunization rate among children in that community is less than 70%, far below what is needed to keep families safe. the result is a true public health emergency.
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over 70 confirmed cases and counting. the majority of cases have affected children under 10 years old who are unvaccinated. -- isase is not a concern not just a consent for family members were worried about their will of the ones who are seriously sick, it is a threat modeighbors and communities struggling to get an incredibly contagious disease under control. it's a terror for parents with newborns who cannot yet get vaccinated and a strain on our public health system as hundreds of staff in washington state are pulled from critical public health roles to respond to this crisis. the centers for disease control and prevention stretches to support the response to outbreaks in washington and several other states. measles is not the only disease that deserves our attention amidst slipping vaccination rates. diseases like the chairman mentioned, mumps, pertussis, or whooping cough are cause for
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concern. these out rights are a clear sign we have had to do more to address vaccine hesitancy and make sure parents have the fact they need to understand the science. sex scenes are safe and effective and life-saving. parents across the country want to do what is best for their families to keep them safe which is why they need to be armed with the knowledge about the importance of vaccination and why we need research and vaccination communication to help us better educate people to address vaccine hesitancy and build vaccine confidence. the role to understand social media and online misinformation play in spreading dangerous rumors and falsehoods. we need to better prepare the full spectrum of health care providers who are often the professionals people trust most to counter vaccine hesitancy and promote vaccination. important not only for parents but also expectant parents who may already be deciding whether or not they plan to vaccinate and for promoting adult vaccines
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and encouraging people to protect themselves and others throughout their lives. i look forward today to hearing dr.weisma about hown washington state is working to get parents reliable information about the importance of vaccination and all of our witnesses here today about how the federal government and partners can promote vaccines and prevent the spread of misinformation. fightingare now multiple measles outbreaks, it's important we also educate people hpv vaccine role in preventing sexually transmitted diseases and lowering cancer risk, the flu vaccine on the heels of one of the most deadly flu seasons in years, the whooping cough vaccine especially for those around infants who are particularly susceptible to the disease and the value of other recommended vaccines. we also need to make sure we are approaching the public health challenges like this from a global perspective. we know diseases are not stopped at borders or walls or bands.
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by doctors andd nurses and vaccines and public health awareness. they are stopped by strong investments in public health systems here at home and abroad. they say amounts of prevention is worth a pound of cure. that's certainly the case here. is about mmr vaccine $20. meanwhile, washington state has spent over $1 million already addressing the current measles outbreak. investing in prevention is not just more effective at keeping our families and communities healthy, it is more affordable as well. the vaccines for children program is another great example of this. over 25 years and it's helped low income families get shots at no cost and has saved $1.6 trillion, prevented 380 million illnesses, and saved 860,000 lives. that's more people that live in seattle. i hope we can work together in a bipartisan way to build on programs like this with strong steps to help address public yet,h crises and that are
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to prevent them from happening the first place. i'm glad to have this opportunity to learn more about how we can do that and consider how to make sure people across the country understand that user safe and effective to keep their families and community healthy. would ask a, i letter from the national association of county and city health officials be submitted for the record. it speaks of the important role of our local health departments across the country in responding to vaccine preventable disease outbreaks and other emergency health crises. >> so ordered, thank you, senator murray. i will now introduce our witnesses. each one of you will have up to five minutes for questions and answers. i will ask the senators to keep the questions and answers within the five minutes so everyone can have a chance to purchase a paid. -- to participate. senator murray will introduce the first witness. >> from my home state of washington, i am pleased to introduce dr. john huisman - we
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isman who was appointed the secretary of health and 2013. he has a 22 year career working to keep our families and communities healthy. throughout his career, he has worked at four different health departments including clark county public health in vancouver which is the current frontline of our measles outbreak in our state and i know some of my colleagues on the committee will appreciate learning that before you came to my state to work in our public health system, you got your education in there is receiving your bachelors degree in wisconsin, your masters in connecticut, and your phd in north carolina. i'm glad we have you now in washington state working to help keep our families safe and healthy and respond to public health threats as we currently are and i appreciate you coming out. >> thank you, senator murray. senator isakson, will you introduce the second witness? >> i am pleased to introduce to the committee and everyone here omar. dr. zod
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we are delighted to have you here today as an expert on the subject we are discussing. he is a professor of global health and professor of epidemiology and pediatrics at emory university, school of public out the medicine. he also works in the emory vaccine center making him a well-qualified witness for today's hearing. his research includes studies in the united states and internationally, clinical and to estimate the efficacy of influenza, polio, measles and other vaccines. he has published a proximally review andand peer has served on several advisory committees including the u.s. national vaccine advisory committee. 150as also mentored over clinical members and other graduate students playing a important role in ensuring the pipeline of qualified scientists as well espoused in the united
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states america. here fornd we are what your expertise. we appreciate your testimony, go emory. >> thank you, senator isakson. we will hear from dr. jonathan the cutler's, the chair of pediatrics at the university of tennessee health science center and serves as pediatrician in chief at the remarkable labo onner children's hospital in memphis and received his degree and completed his residency at the university of alabama at birmingham. in 1999, he was named a saint jude's scholar and the physician scientist of oman program and joined the saint jude faculty in the department of infectious diseases where he spent 13 years managing a translational research lab studying influence of viruses and bacterial pneumonia. in 2012, he joined la bonner and has published more than 150 peer
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review articles. john boyle is president and ceo of the immune deficiency group in maryland that meets the needs theeople with immunodeficiency disease. prior to joining the foundation come he worked with the children's national medical center in a platelet disorder association. he received his bachelor science from boston university, a master and nonprofit management from notre dame of maryland university and finally, we welcome ethan landenberger. atcurrently a student norwalk high school in norwalk, ohio. he is here to share his experience seeking out information about vaccines and making decisions about whether or not to become vaccinated. welcome again to all of our witnesses. dr.wuiesman.ith chairman alexander and ranking member murray and
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established members of the committee, thank you for the opportunity to discuss public health work and protecting people from vaccine preventable diseases. vaccines are safe, effective and the best protection we have against serious preventable diseases like measles. vaccinating children in the united states has saved millions of lives, increased expectancy, and saved our society trillions of dollars. my mission as washington secretary of health is to protect and promote the health of all its people and ensure our public policy is based on test available science. i want to speak directly to the parents who have children with serious health issues and who have been attending our hearings in washington state and are watching this hearing today. i see your pain and your desire for answers to your children's health issues. your mission to protect and promote the health of your children is one we share. while the science is clear that vaccines do not cause autism, we need to better understand its causes. theeed to develop together
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affected families, scientists, and public health officials, research agendas to get the answers we need. state territorial and tribal and local public health agencies are on the front lines. in washington state, we provide all recommended vaccines without charge to all children under the age of 19. we provide an electronic immunization information system for health care providers to dose schedules, provide reminders when patients are overdue, and measure immunization rates. we help parents make informed decisions by summing them the information they need to keep children healthy and publish plain talk about childhood immunization. nurses byschool giving them access to the electronic immunization records. as of yesterday, washington state's measles outbreak had 71 cases plus four cases associated with our outbreak in oregon and one in georgia. containing a measles outbreak takes a whole community response led by governmental public
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health. the moment they suspected cases reported, disease investigators interview that person to determine when they were infectious, who they were in close contact with, and what public spaces they visited. and helpinfectious, officer orders them to isolate themselves so they don't infect others, notifies the public about the public places they were in when they were infected and sets up a call center to handle questions. we also reach out to individuals who were in close contact with the patient. if they are unvaccinated and without symptoms, we ask them to quarantine themselves within 21 days which is how long it can take to develop symptoms and we want to them so we quickly note they develop -- and we monitor them quickly note how they develop symptoms. we obtain samples to test for measles and if they have it, we start the investigation process all over again. this is a staff and time intensive activity and its highly disruptive to people's lives.
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responding to this preventable outbreak has cost over $1 million and require the work of more than 200 individuals. what do we need the federal government? first, we need sustained, predictable and increased federal funding. congress must prioritize public health and support the prevention of public health funding. we're currently reacting to crises rather than working to prevent them. the association of state and territorial health officials and over 80 organizations are asking by to raise the cdc's budget 22% by fy 22. this will immediately bolster prevention services, save lives and reduce health care costs. second come our response to this outbreak has been benefited greatly from the and him at an all hazards preparedness act so thank you. public health emergency preparedness agreement authorized by this body are currently funding for hundred million dollars a low funding levels. more robust funding is needed and i strongly urge you to reauthorize papra because many
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authorizations expired 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 parents with immunization information nor maintain our electronic immunization systems. fourth, we need federal leadership for a national taxing campaign, spearheaded by cdc in partnership with states that counters the anti-vaccine messages similar to the successful truth tobacco campaign. we have lost much ground. urgent action is necessary. everyone has a right to live in a community free of vaccine diseases.e to make this a reality, we must continue to invest in and strengthen our public health system, thank you. >> thank you, dr. wiesman. dr. omer. >> thanks for the opportunity for me to talk about vaccines in this forum.
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elimination of pandemic measles transmission from the u.s. 2000 is a significant health problem. most of the cases have occurred through u.s. travelers going outside and bringing it back. recent measles outbreak of been contained, frequency and size of these outbreaks have it in alarming to those of us who follow these trends. the rest of this testimony will be focused on answering some of the salient questions that have been coming out. the first question is -- why haven't we seen a national level outbreak in the u.s.? we cannot take this for granted. similar develop and status like germany, france, and italy more recently have had national level outbreaks. it is not a coincidence that we have not seen similar outbreaks and there are several reasons. loves --all, our law our laws work by changing the balance. in most states, they were by changing the balance of
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convenience for vaccination compared to non-vaccination by having physician counseling or by having parents go through a video that talks about vaccines and the benefits of vaccines, etc.. the third thing in our country, medical society is like the ,merican academy of pediatrics it's been very prominent in vaccine advocacy and it is important because it's based on the fact that physicians are the most trusted source of vaccine information. we have talked about the role measles has played in an vaccine refusal has played in these outbreaks and i will just give a few numbers. more than half of the cases since the elimination have been on vaccinating and approximately 70% of them are unvaccinated due to refusal or on medical exemptions. there is a contribution of vaccine refusal in our epidemiology of measles.
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vaccine mandates have them effective tool in changing the balance of convenience that i was talking about. that is a state-level issue. i will focus on some of the things the federal government can do. i have provided more details in my written testimony. there are a few things the federal government can do. first, consider making vaccine counseling reimbursable. i have worked on vaccine research in multiple countries and multiple states in the u.s. there are many local factors that are specific but there is -- constant -- vaccine health care providers specifically physicians are the most trusted source of vaccine thoseation even amongst who are a little skeptical of vaccines. we need to use that tool more effectively. on the practical side, physicians do not have the time
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to properly counsel patience using evidence-based approaches. all of the reason the part of the reason is the fact that this is not reimbursable. physicians lose money on this kind of important public health education. investuntry, we should in high-quality vaccine acceptance and communication research. i often say that if you don't accept half-baked vaccine development science and we don't -- there is an evaluation of the science from trials and a six sciences but we should not be accepting of half-baked vaccine can indication and behavioral science. nih cancer prevention initiatives are a gold standard for these kind of interventions and evidence-based communication strategies. d, the national institute for
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national institute for infections and allergies have had very effective intervention development in the area of hiv-aids behavior. we have that precedent in this country many to invest in actual research. ,efore we develop evidence while this is going on, there is an existing blueprint of interventions that the advisory committee put together. unfortunately, not all of it is interventions have been at the monta but it's ready to be implemented. cdc plays an important role in fighting these fires, working with states and local health departments which is unique so we need to support their efforts and continue to prioritize vaccine safety research. fornt to thank you bipartisan and consistent support for vaccines because that matters.
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that shows that there is broad societal support for vaccines and those of us who work to protect children from these infectious diseases really appreciate that. >> thank you, dr.. thank you.rs, , i'm the chair of pediatrics at the university of tennessee and the in shape.an as someone who devoted his career to the child health sphere, i truly believe there is no more precious resource than our children. they should be protected by all means available to us. they really are the future of this nation. the childhood vaccination program of united states has proven to be one of the most powerful public health achievements in our history. in the first half of the 20th century, there were more than one million infections and more than 10,000 deaths every year in this country from diseases which are now preventable by childhood vaccines. measles alone caused more than half a million illnesses every year.
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measles is a highly contagious viral respiratory disease characterized by fever, cough, sore throat, and a rash. it is a very dangerous disease. about one and 1000 infected persons develop encephalitis come an infection of the brain. one and 1000 the severe pneumonia and half of those with the severe complications die. there is no specific treatment for measles. vaccination is the only means of preventing these outcomes. with the introduction of a safe and effective vaccine for measles in 1963 and improved public health effort, nearly every child received it and new cases of measles arising in the united states were illuminated by the year 2000. unfortunately, the issues of vaccine opposition and vaccine hesitancy or noun peering our ability to effectively insure coverage aided by state laws that make it easier to avoid vaccination. the last decade has brought numerous outbreaks to the united states and putting several ongoing at present. these outbreaks are strongly linked to vaccine refusal and in
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particular, to clustering unvaccinated individuals in specific communities or regions. this is not limited to the united states. countries worldwide are dealing with similar outbreaks. as an example for the committee, there were zero cases of measles in brazil in 2017 but more than 10,000 cases occurred countrywide in 2018 when travelers brought measles into the country. the vaccine against measles is safe and effective. one does provides complete protection and about -- in about 93% of individuals in a second dose raises that level to 92 -- 297%. about one in 10 children make screens fever from 1-2 days after vaccination and one in 3000 or one in 4000 have a simple seizure associated with no lasting effects. allergic reactions are rare and typically very mild. when compared to the outcomes of the disease itself, it's easy to
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see why doctors and public health officials universally recommend on time and complete vaccinations. thaksin refusal is high and getting worse in many states. this was complicated by the right of state policies regarding exemption for vaccination in the methods of counseling. the rate of parents claiming nonmedical exemptions is about allowmes highe that philosophical objections. media drives a new phenomenon distinct from vaccine opposition stuff when parents get much of their information about health care issues such as vaccines from the internet or from social media platforms, reading uninformed opinions and the absence of accurate information can lead to understandable concerning confusion in parents. they may be hesitant to give their children vaccinations without being provided with more information.
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the role of the pediatrician is important with these families. we must do a better job of connecticut at many levels but particularly at the point of contact at the well-child visit when vaccination should take place. about half of the time, when counsel to properly, parents with vaccine hesitancy will agree to have their children vaccinated on time. the other half, little seems to the solution must happen in policy or broader education efforts. i would like to thank the committee for addressing this important issue. vaccine refusal is one of the growing public health threats of our time. if we continue to allow nonmedical exemptions to vaccinations, the rates of the vaccine will continue to fall with more outbreaks undoubtedly following. as a leader at a children's hospital, have a unique perspective. children's hospitals are regional and sometimes national resources. our hospital sits in the corner of tennessee next to arkansas and mississippi. these are three states that have very different policies for granting exemptions to vaccines which creates tremendous problems and a threat to the children we serve many of whom
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are too young to be vaccinated or our compromise and are prone to severe severe -- severe diseases. protecthe committee to children as they grow up and become the next generation, thank you. >> thank you, mr. boyle, welcome . rankingman alexander, number murray and members of the committee -- thank you for inviting me here to testify on communityance of herd for vaccine preventable diseases. i am john boyle and i'm the president and ceo of the immune deficiency foundation, a not-for-profit organization that represents people with primary immunodeficiency diseases. group ofeases are a more than 350 rare and chronic disorders which parts of the body in the system are either missing or functioning improperly. there's an estimated 250,000 people diagnosed with pi in the
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u.s. alone which is one in 1200 of your constituents. these assortments are caused by genetic defects and are not contagious. there is a variety between the different forms of pi but one thing unites all or all of them, we are immunocompromised it means we're vulnerable to common viruses and bacteria. i have a form of pi. i was diagnosed with it when i was six months old when a respiratory infection nearly killed me. in short, i don't produce antibodies but i'm able to be here with you today because i receive weekly infusions of antibodies from other people -- throughead plasma a blood plasma. this gives me back some of what i'm missing but i'm still susceptible to infections. because i was diagnosed early and i receiveig therapy, my health is better than -- better than most others but a simple cold can wreak havoc. we are incredibly vulnerable to commit a cool illnesses.
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-- two communicable illnesses. this is truly a life-and-death matter. i think all of you probably remembered david vetter known as the boy in the plastic double who was born with severe combined immunodeficiency. children diagnosed with scid, manyr others face challenges every day and exposing these children to something as severe as measles could be life-threatening. parents in committees were vaccine uses being questioned our afraid to send their children outside. they are afraid because they know the history, the science, and the math. they know the stakes. if people stop vaccinating, the safety net of community immunity will fall and their children will be among the first casualties. this does not just affect children, it affects adults, too. there is no newborn screening
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but most members of arc minute ago years and decades with serious and recurring infections without knowing they have a compromised immune system. i'm concerned for the health of the segment of our community, the undiagnosed. if community immunity fails, they don't even know they need to take precautions. those of us in know we have pi do what we can to avoid exposure to infections but the undiagnosed lack this basic knowledge and are more at risk. the reason all of us are so dependent on community immunity is that vaccines do not work with most of us who have forms of pi. our systems either don't remember the pathogens or we physically cannot create the antibodies. a further complication is that there are some vaccines that are dangerous to us, live vaccines. those in the field of immunology have studied this issue thoroughly to produce evidence-based guidelines to best safeguard those of us with pi. an article i shared with
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committee discusses the issues surrounding which vaccines are either indicated or not but it also addresses the growing neglect of societal adherence to routine vaccinations, what we are talking about today. it states how important it is for family members and those around patience to receive all available standard immunizations in order to protect the family member who has pi. life along with the lives of hundreds of thousands of others who are immunocompromised depend on community immunity. we depend on vaccines. i understand the concern that come aw parents have particular given the misinformation on social media, but that fear cannot override the fact. history has shown us the vaccine works. signs is shown as the vaccines are necessary. mathematics is shown as the odds
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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 plates from the past. we will settle first and more but the loss of community immunity is a threat to all of us. we need to band together to , combathe myths misinformation campaigns come and help ensure that measles and other vaccine preventable diseases are once again put in her place, in history books and not in our communities, thank you. >> thank you, mr. boyle. lindenberger, welcome. >> thank you. the opportunity to speak today. senior in high school and my mother is an anti-vax advocate saying vaccines cause despitend brain damage the fact such opinions have been
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debunked in recent times. in my entire life, gone without numerous vaccines against measles, chickenpox or polio. 2018, i studied on my vaccinations despite my mother's approval leading to a story and i'm happy for that. to understand why have come here and what i want to talk about, have to share some details about my home life and upbringing. i grew up understanding my mother's beliefs that vaccines are dangerous. concerns andce her these believes were met with strong criticism. over the course of my life, seeds of doubt were planted and there was\my mother would receive but that did not lead anywhere. to understand as i post high school and began to critically think for myself, saw the information in defense of vaccines outweigh the concerns heavily. i began leading debate clubs in
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my school and pursuing this and i realized one certain quality to debates when it comes to the controversial discussion which is that there seems to always be two sides to a discussion. there always seems to be a counterclaim or rebuttal and always something to strike back debate.terms of this may seem true in all essences but it's not true for the vaccine debate and i approach my mother with this concern, that she was incorrect. times,ached her numerous trying to explain that vaccines are safe and i should be vaccinated. approached her with articles from the cdc exquisitely claiming that ideas that vaccines cause autism and are extremely dangerous consequences, they were incorrect. mother with my information from the cdc that claims that vaccines do not cause autism and she responded that that's what they want you to think. skepticism were taking the forefront in terms of information.
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conversations like these reaffirmed the evidence that the defense of vaccines was at least much greater than the deeply rooted misinformation my mother interacted with and that's what i want to focus on today. to combat preventable disease is at theinformation forefront. my mother would turn to anti-vaccine groups online and in social media who came to her defense rather than health officials and credible sources. this may seem to be dangerous the vaccinations but she loved her children and were concerned. this information bread and this is not necessarily justifiable. it was with respect and love that i disagreed with my mother. with the information she provided, i continue to try to explain that it was misinformed. these are ideas that vaccines cause autism and brain damage
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and the measles outbreak is no concern to society and america were ideas that were pushed by the sources she would go to. individuals and organizations that spread this it, they instill fear into their public for their own gain knowing the information is correct. for my mother, my -- her love and thection was pushed sources that spread misinformation should be the primary concern of the american people. more things can be done, almost 80% turn to the internet for health related questions. i further explained more statistics in my written testimony. i would like to walk away with today and finalize -- my mother would turn to illegitimate sources that did not have peer-reviewed information and i saw the claims
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for myself were not accurate and because of that and because of my health care professionals, i was able to speak with an information provided to me, was able to make clear, concise, and the scientific decision. approaching this issue with the concern of education and addressing misinformation properly and cause change as it did for me. although the debate around vaccines is not centered on information and concern for health and safety, this is why education is important and why misinformation is so dangerous. thank you. >> thank you. thank you for coming from ohio to let us hear what you have to say. now we will begin five-minute rounds of questions. we have many senators interested and i would ask the senators to keep the combination of questions and answers within five minutes. rs, you are a pediatrician in chief at one of our country's leading children's hospitals. your business is to talk every day during your career with lots
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of parents about the children. what do you say to parents who come to you in memphis and says i have heard on the internet or that vaccines cause autism? i don't want my child to be vaccinated. what do you say to that parent? >> when we look at this is that parents have a very complex set of issues they are concerned about. that's one of them but there are many others they think about and they bring to us. it's not one issue we have to talk about. >> i want to focus on autism. why do they say that to you? >> this was raised about 20 years ago when there was a fraudulent paper published linking vaccines to autism. that paper was published in the united kingdom. >> it was a respected journal? >> yes, it was a physician who
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published it and he was unfortunately a by a set of attorneys more than 400,000 pounds to falsify information because they were suing the government of england against vaccines. be wrong andd to was retracted and he lost his medical license. >> what's in the journal do about it? >> the journal retracted the paper and said it was no longer valid. there been other papers or journals that agreed with that position? not that agree with that position but there have been numerous scientific research done in the interim that of shown the opposite that vaccines are not lengthen the institute of medicine in the united states , her highest authority on these issues, has declared that it's a closed issue. as you talk with parents, is that persuasive with a mother who is concerned about her child and who has heard that vaccines cause autism? rapport withs a the physician and initial respect for the opinion of the parent and for the physician,
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you can say things like that and say the evidence is clear, you should do this and they will trust that information. >> in your opinion, there is no evidence,reputable that vaccines cause autism? there is absolutely no evidence at this time the vaccines cause autism. omer, do you agree with that? >> absolutely. >> do you agree with that? >> i do. >> what about state exemptions? you are a state public health officer and is a former governor, i have a bias toward washington not telling states what to do on [laughter] not washington, d.c. telling states what to do. senator murray is correcting me. have about do you
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state exemptions and the effect on the concern we see today with pockets of measles across the country? thes we heard earlier, choice to make exemptions more difficult to get to be as burdensome is not getting the vaccine is incredibly important. we have twon state, bills right now that are looking to remove the personal exemptions from vaccines for school entry and for childcare entry. i think that's 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 record so we don't even know if they are vaccinated or would like exemptions and we have to tackle that problem as well. it's really a resource issue for schools and public health. i will stay within my time,
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senator murray. >> thank you very much. i appreciate everything your state and local colleagues are doing on the frontlines lines of this measles outbreak in washington state. your confirming a managing the cases, tracing potential contacts, examining exposure sites, there's a lot going on but it's hard to imagine how much worse is outbreak would be if not for all the tireless work of some of some a public health officials on the ground. we're hope we are not -- 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 public/private partnership vax northwest and your communication with parents has helped in building confidence. >> yes, we believe the child profile mailings that go out to parents to kids up to age six, s in timeut at point
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appropriate to development the child and are important as a trusted source of information not just on vaccines but childhood development. it's that relationship we build with parents through that mailing but i think is incredibly important. when i go out to the public and see a new, often asked them if they get this mailing from the health department. they say we love it and it's great information. i think that trusted source is important. the public-private partnership we have with vax northwest is a research initiative to try to best understand how we address vaccine hesitancy. there have been two studies done, one looking at health care providers and how to best train them around medication with their patients .unfortunately, that work did not make a difference in terms of addressing vaccine hesitancy or necessarily health aroundoviders efficacy feeling confident in those
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conversations. the other piece was one with parents, parents who are interested in vaccine advocacy, training them on how to have conversations with parents, how to share information at pta meetings, etc. that found that it increased parents'knowledge of vaccine and reduce their hesitancy. omer, we needdr, to keep each other safe and your research on vaccine hesitancy is critical. parents are some making decisions about whether or not to vaccinate before they even have their child. what are the implications of some of these early decisions and what have you learned about the key factors that lead some parents to hesitate to vaccinate? >> thank you for the question. you rightly point out that a lot of the evidence suggests many parents are making the decisions
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on vaccines before the baby is born. born, it'saby is like a fast-moving train and parents go through an extended jet lag. before that, there is a lot of discussion happening. there are several reasons for this. the first one is that vaccines are a victim of their own success. of vaccines preventable diseases go down, because of vaccines, successive cohorts of parents see and hear about real or perceived adverse events and not the disease. there is that mental calculus that changes. there are several interactions with several local factors. in the u.s. for example, due to that, we have a change in the disease rate which is a good thing. we have less appreciation of vaccine susceptibility and .in that ontest, focusing not just
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childhood but before the baby is born, we are working on a randomized controlled trial in collaboration with the university of colorado and johns hopkins. due to investment due to funding from the national institute of allergy and infectious diseases. we are looking at bringing together the best evidence and packaging it and seeing if it has an impact, not just maternal vaccinations but this intervention being performed in pregnancy leading to childhood vaccination rates increase. the initial results from them are promising but to come back to the idea that we need to continue to invest in the best science or vaccine behavior and communication as we do for vaccine safety and vaccine efficacy. >> thank you very much. >> thank you, senator murray. senator isakson? >> thank you all for your testimony. mr. lyndonberger, what year in
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school are you? >> i'm a senior in high school. >> when did you start researching vaccinations? mother would vocalize her views on vaccines throughout my entire life. it was a progression to start to see evidence as i would see suppose, try and counterclaim with her. this see she would have backlash that she shared information. on facebook she would share a video and people would say it's incorrect. intrigued mehat that people would disagree with my mom so i looked into it over the years. does your mother get most of her information online? >> either through facebook or sites that use the social media platforms. >> where you get most of your information? ,> not facebook, from the cdc
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information from organizations like the institute of medicine. i try my best to look at accredited sources. >> i would love to be at thanksgiving dinner at your house. [laughter] it would be a heck of a discussion. dr. omer thank you for your work at emory and they do an incredible job. other any things on the horizon that would join this group of people that you might want to immunize for later on? >> there are several exciting development in one of the big caps and vaccine has been the fact that there is the gap between when the baby is born and when we start vaccinating. that's due to immunological reasons and one of the more exciting developments in this area is the area of maternal immunization revaccinated -- where you vaccinate mom to protect notch as the mother but the baby as well. there are vaccines against the
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virus.tory sensitive vaccines are being developed like a vaccine that is being developed against b streptococcus so there are several on the horizons, the field is expanding. do those-- vaccinations take place in the mother before the baby is delivered? during the course of gestation? first was called mothers gift and i think it's an appropriate name for this kind of strategy where maternal antibodies protect the baby. >> i've been to africa with the cdc in number of times and seen your organization's work. i don't know of any organization that does more for health care in our country than cdc. how much do you use them as a resource in your work at emory? >> cdc is a national treasure. the firefighting function they
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perform with the state and local health department is somewhat unique. the european cdc is relatively new and has a narrow mandate. 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. i'm not trying to put down any other countries are health agencies but because they are trying their best but the kind of investment that has gone into building this cooperative framework of the cdc being the premier technical public health agency but working closely with state and local health departments has served as well including this area. >> i don't think you're putting them down at all. we are lucky to have the cdc in the u.s. but the world considers it their health center and they are doing a better job incubating cdc and other countries to replicate what they do in countries more developed and populated. they are a great resource.
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i thank all of you for being here today. don't forget about thanksgiving dinner. [laughter] senator baldwin. >> thank you, in 2015, this committee held a similar hearing to discuss the resurgence of vaccine preventable diseases and response to a multistate measles outbreak. our nation possible vaccination program has saved lives by perfecting and reducing the outbreak of vaccine preventable , which isike measles one of the most effective vaccines. so, i am troubled that we are over another preventable outbreak in several states that have similarly been exacerbated by a search -- ofrch -- surge misinformation about vaccine safety.
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education surrounding vaccine safety, younger children and those with compromised immune systems have a higher risk of measles complications. dth of misinformation online about the science behind those scenes, dr. wiseman, dr. do state health departments play in arming community leaders like school withials and providers accurate information, scientific resources on vaccine safety? what can welow on, do to prevent another outbreak in the future? for that question, yes.
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states and local health departments really are the leaders in communities around these health strategies to engage communities around vaccine information. to provide health education, they work with the school systems and health care providers to make sure that they have the information that they need. it really takes a sort of coordinated effort. honestly, that system is crumbling. the sort of resources that are going into prevention in our state, local, tribal, territorial health agencies has been decreasing. and we are really not up to the task. for example, i had a call with cdc a number of months ago. we do this every few weeks and talkingon the call about a hepatitis a outbreak occurring throughout the country communities. they are encouraging us to do proactive vaccination campaigns with homeless and injection drug users, which is where this is being seen.
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have the resources. i asked my staff at the plan would look like. it would probably cost us $5 million. i don't have those resources. i don't have the staff there. it's very concerning to me. i forgot your second question. >> how can congress help. >> so i answered it right there. including research around how is it we communicate with folks about vaccines and have a national campaign. we really need to get on this. >> to add to that, in addition to research and investment in hike wally research, i think the makings can work on vaccine counseling reimbursable. at the front lines these conversations happening every day, take the blueprint that i
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mentioned that is already there that was developed by the national vaccine advisory committee that has a specific space to have that kind of limitation out there. that shouldn't be taken for granted. the last thing in this stream of specific things is prioritizing vaccine safety enterprises that we have, not just a template of this country, but everywhere else as well. having a robust vaccine safety not only a tool to retain confidence in vaccines, but it's just the right thing to do. then this these are specific things that the congress can do. >> i only have a few moments left. maybe if we run out of time, you can submit information for the record. i follow of course some of the
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invent spence -- advancements that happen in my state and the interesting things that are happening. since 2007 a company called flu generation in madison wisconsin is working on a better 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 throughout the world. and i think that there is more that we can do to support the development of better vaccines to protect individuals from an illness that results in literally thousands of deaths each year. mr. boyle, can you describe why it is important for congress to this medicalupport research that advances the development of more effective vaccines for common illnesses like the flu? specifically for vulnerable populations? >> sure, let me try.
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challengesof the that i see, even when i think about my colleagues and friends who sometimes struggle with whether to get the flu vaccine is basic issues of fears of things like needles. they don't want to get a shot. they are scared of that. for that reason i know that things like the flumist and others are attractive. the problem is within our asmunity, a live virus, such has been used in the past, is a problem, so we are a bit torn and in that we want something to be easy and efficacious, something it will be widely adopted, but at the same time we have to be concerned about those who are undiagnosed. so, there is a bit of a balance there. investigation to technologiese new
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would be phenomenal. at the same time, it would have to work with the cdc and others in order to balance out the needs of those who are actually going to be affected by that negatively. but we are all in it together, so the continuing conversation important andn is our community and other immunocompromised communities would be delighted to be part of those conversations. >> dr. paul? you.ank thank you for your testimony. through much of modern history, science and freedom have lived in relative harmony. traditionally as medical discoveries came about, like vaccines,nd polio antiseptics, antibiotics, results were so overwhelming that overtime the vast majority of the public accepted these advances voluntarily. in fact innovations like smallpox had to overcome initially great public prejudice. learned about the
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middle eastern technique from , his pastor, cotton mathers. his first patient was actually his son, incredibly brave choice. the consensus of the medical community was opposed to him at the time. 50the doctor learned, one of of those inoculated would die from the vaccine. yet the death rate from smallpox was 50%. not mandatent did the vaccine, but within two generations it was accepted enough that george washington insisted that martha b inoculated before visiting him in the military cams. today though instead of persuasion, many governments have taken to mandating a whole host of act scenes, including those for nonlethal diseases. sometimes these vaccine mandates have run amok, as when the government mandated a rotavirus xe and that was later recalled because it was call it -- causing intestinal blockage in
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children. i'm not a fan of government code version, yet given the choice i do believe that the benefits of most vaccines outweigh the risk. yet it is wrong to say that there are no risks to vaccines. even the government admits that children are sometimes injured by vaccines. since 1980 84 million dollars has been paid out by the vaccine injury compensation program. despite the government admitting to and paying $4 billion for vaccine injuries, 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 informed consent is not required. proponents of mandatory government evacuation -- vaccination are you the parents that refuse to vaccinate risk spreading these diseases to immunocompromised communities. this doesn't 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 the next we will
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be mandating flu vaccines? between 12000 and 56,000 56,000s -- 12,000 to people die from affluent america. i would guess that those who want to be mandating measles would be after the flu next. yet the current science only allows for educated guessing when it comes to the flu vaccine . each year before the flu strain is known, scientists put their best guess into that year's vaccine. some years it is completely wrong. we vaccinate for the wrong strain of flu vaccine. get five states already mandate flu vaccines. is it really appropriate to mandate a vaccine that more nate's fornot back the wrong flu strain? as we contemplate forcing parents to choose this or that the xe in, it's important to remember that force is not consistent with the american story, nor with the liberty that our forefathers saw when they came to america.
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i don't think you have to have one or the other, though. -- i'm not here to say don't vaccinate your kids. for myself and my children i believe in the benefits of vaccines greatly outweighing the risks, but i still don't favor giving up on liberty for a false sense of security. thank you. [clapping] >> do you yield back? senator warren? >> thank you, mr. chairman. we have heard today about how important vaccines are in presenting and controlling many diseases. i want to zero in on one that we are battling right now in massachusetts. since last april, 318 outbreak associated cases of acute hepatitis a virus have been reported in the commonwealth of massachusetts. hepatitis a is a contagious liverthat causes
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infection, older children and adults that require -- acquire flu,irus can experience incredibly unpleasant symptoms, fever, nausea, and in rare cases the virus can even lead to death. in massachusetts four people have already died since the outbreak began. now, we didn't used to have a hepatitis a vaccine at all. but in 19 95 and 96, the fda two hepatitis a vaccines. and soon after, cdc recommended vaccination for certain populations, including routine accident and nations of children living in areas with elevated rates of the virus. study infectious diseases, what impacted the introduction of the hepatitis a vaccine on the national rates of the virus? >> thank you very much, senator warren.
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hepatitis a can be a severe disease. in particular for high risk roots. the vaccine of the 1990's is very safe and very effective. we have seen a tremendous decrease with a 50 fold decrease nationally. outbreaks, with public health work to do as illustrated by a current outbreak. >> that's the question i want to ask. the vaccine rates are way down. we have a vaccine preventable virus here. why are we seeing so many hepatitis a cases emerging now? >> we are seeing the vaccine administered in childhood, only been around for about 20 years, so if you are 21 or older, you probably haven't had it. it is recommended that high risk groups, like recreational drug users, part of the problem in massachusetts, be vaccinated.
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efforts to find the high risks are well, giving them the vaccines would help prevent these in the future. >> we have been battling the opioid crisis for years. hepatitis a is another place where we need to fight on this. but we are learning from this, just this past october, the same cdc committee says recommendations in the 1990's helped the rates of the virus declined sharply. adding people experiencing homelessness to the list of those recommended. i see that you are all nodding. right? in massachusetts the public health workers, the community health centers, and jails have sprung into action to try to get the vaccine to those risk.e most at dr. weissman, as secretary of the washington state department of health, you oversee the public health response. what can we be doing to ensure that local health officials have
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the resources they need to be able to do their work? >> really, part of this is making sure that the prevention public health fund is funded and theook at the funding for cdc. we have been asking the state territorial health officials in local public health for increasing the cdc budget 22% by fiscal year 22. we are talking money now. we are talking money. whether it's a situation like hepatitis a in massachusetts or a measles outbreak in washington state, how'd to the presented costs of a vaccine program compare with the containment and treatment costs of an outbreak? forn general we know that every dollar spent on vaccines you save about 10. it's definitely a cost-effective prevention. >> the more that we do on the
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front end to make sure that everyone gets access to the vaccines, the less we will see individuals contracting hepatitis a, measles, whooping cough, all of the other vaccine preventable diseases. this administration has repeatedly sought to cut prevention and public health support key immunization programs and they have continued their efforts to weaken the medicaid program that covers all the recommended vaccines for children and for many adults as well. that most of my colleagues are on the same page about the importance of vaccines. let's make sure we are also on the same page about the importance of public health funding so that people can get access to those public health fundings. thank you. senator roberts? >> thank you, mr. chairman. to go a little cross current, here.
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state that the importance of vaccines in infants and 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 vaccines from mental -- vaccines, like mental diseases. we have a few octogenarians in the senate that get vaccinated. especially with flu. your reference to this topic on the effect of a heard it immunity syndrome -- herd immunity syndrome, particular settings in which adults and seniors are more susceptible to the diseases of they are not vaccinated, i would like to figure out -- we can look for ways that federal programs can help by removing
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barriers to services like vaccines and providing the right incentives for people to use them. barriers exist? where do we need more education for seniors to overcome these challenges? i'm going to give you a personal illustration. a young lady, in her 80's, but she was young. [laughter] she made sure that all six of her children got flu shots. and in turn, all of their grandchildren. and then yet, she got the flu in kansas this time around. bad. bad, just a very bad flu season. for some reason, she didn't get a flu shot. who hasshe is, a mother told her kids, get vaccinated, and they sure have.
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and then in her own situation, she didn't get a flu shot. along with her husband. we lost both. the sniffles became the flu, the , we get intorious pneumonia and all sorts of other problems. go into what to kind of treatment they received. but they were important folks and pillars of their community. i sometimes think that the octogenarian caucus, well, in the senate we are known as potted plants. omer, you have written about vaccine confidence and i'm interested in how this applies to adults in recent years. we have seen outbreaks of vaccine preventable diseases.
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the cdc also noted a drop in the immunization rate from hospitalization deaths in the last flu season. i don't get it, i don't understand why in a. of your life when you would be obviously saying that i need the flu shot, in response to why you didn't do it, i just didn't get around to it. i don't know if anyone would like to offer any opinions. we are talking about young people all the time, but there are those who still contribute to this society even though there is no bargraph after 84 anything. who are just out there. anybody want to comment? >> thank you, senator. narrated isat you not unique unfortunately in this country and around the world. are one of the highest risk groups for complications on influenza. the vaccines are slightly less effective in the elderly, but the reason that we need more of them to be vaccinated.
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this is one of the gaps i was talking about where we don't severaldence for groups, including the elderly. this is not a group that is actively opposed to vaccines. they have the concept. what infectious diseases can do. but at that time, when a lot of the discussion has revolved around childhood vaccines, we need an evidence-based strategy to communicate not just to the elderly, but also to their health systems, their providers who deal with the utterly don't have unfortunately the muscle memory to talk about vaccines. to make it a part of their routine clinical practices. but there is a lot to be done and thank you for highlighting that issue. >> mr. chairman, my time has expired. i want you to know that we did myself, this, dr., before the committee hearing, but you certainly hit the nail on the head.
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i think it is an issue that we overlook. thank you. >> thank you. senator kaine? >> thank you to the witnesses, this has been a fascinating topic. noticed another study coming out in the last one of four hours, a study dealing with a very significant longitudinal study with a big chunk of children in denmark that also again demonstrates no link and the mmr vaccine and autism. it's a timely day to have this hearing. i want to ask a question, begin with a question about vaccination shortages, which is a former governor worries me a lot. in the supply chain that can lead to shortages in these medications, 2017, outbreaks of hepatitis a led to constraints on that vaccine. many constituents have contacted my office about their inability to access the shingles vaccine.
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so, last year i joined a bipartisan group with members of this committee, urging commissioner gottlieb to put together a task force on the shortage of drug vaccines. look forward to reading that report and i think it may be on the verge of being published. the committee has completed the work and it is close to publication and it may be working committee consideration when it's done. what more can you -- i will describe -- send this specifically to the doctors -- what more can we do at the federal level to make sure there is an adequate supply of vaccines? start out and turn it to my colleague. one thing that we need to continue to do is figuring out new technologies for producing vaccines. we sort of use technology that is a long and labor us process. we have to move towards new cell-baseds around
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or competent vaccines so that we can produce them more quickly. it is a problem with the vaccine shortages. >> one of my mentors has set a is --mes that a vaccine is 100% safe and 0% effective in a file. developing a vaccine is not sufficient. we need to have a stable supply of vaccines. that requires, a, federalized thinking and response from regulation to working with, you know, our research entities with a robust pipeline of new vaccines. there are multiple approaches. bodies through multiple and abilities, what it does is create an intellectual marketplace of ideas. there's more than one strategy that we are focusing on at the science level.
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ofhave more likelihood products that compete with each other and give us more options in the country. working with manufacturers, ensuring that we understand a stable manufacturing pipeline. the third thing is, you know, sometimes in certain dynamics one policy intervention is florida, which invests in preparedness intervention. for example, some flu vaccines that would be required in a todemic, it is for us sustain the pipeline through interventions and investments that are a bit more direct, that sort of straddled the divide. so, it will require a nationwide national response, not just a federal response for states and other partners as well. >> thank you for that.
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dr., be quick, i have another question. >> three quick issues. one is that these are for-profit companies creating these axes. having a federal by that gives will makeassurance he them produce more, helping the vaccine shortages. second, we have a problem not so much with shortage but with distribution and a logistics effort. we can do better with that at the local level, making sure that every physician practice or hospital has that. third is reinforcing the importance of the national stockpile that keeps these vaccines and reserve where we might need them. last half minute mr. lindberg, i want to compliment you. in virginia one of the things that he said that is still so powerful is progress in government and all else the pens on the broadest possible diffusion of knowledge to the general population. he believes that the diffusion of knowledge, giving people knowledge will enable them to make the right decisions.
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now, fake knowledge, misinformation, intentionally misleading information can also be disseminated and in this social media age, with the internet, the competition between the true, the valid, the fake and the dangerous, even the manipulated, by people who want to do us harm, is difficult. i think it's interesting that probably both your mother and you reached your conclusions because you had an internet and tools to do your own research. and so the difference between your mother and you, using some of the same tools and reaching different conclusions, but i applaud your critical thinking skills and willingness to share your story. >> thank you. i don't want to go over time, but to comment on that very quickly, part of the issue is being able to inform people about how to find good information. with my mother it wasn't that she didn't have the information, but that she was manipulated into disbelieving it, that the cdc was made out to be a fraudulent group pushing out
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vaccines for its own reasons. i wanted to comment on that. >> my turn? let me give some color to what senator paul said. you may or may not know my position. there are those who have not been vaccinated that required transportation and who are, who ended up with terrible diseases. for whatever reason they didn't understand vaccination was important. it's important to point out that even if flu shots are not completely effective, they do mitigate. so, there is a cross benefit that will decrease severity, number one. number two, hospitals commonly require employees to be immunized because they understand that herd immunity is important and if the nurses adn't immunize, she could be typhoid mary, if you will, bringing diseases to those who
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are immunocompromised, as mr. boyle points out. with regards to the inquiry, that is a statute requiring that information statements the given . that is a federal requirement. and in the name of liberty we should therefore rely upon states and localities to make a further requirement, but they do typically require informed consent. that is important to know not to be misled regarding that. secondly, i think next we should point out that in terms of requirements, the requirements are that you cannot enter school unless you are vaccinated. if you are such a believer in liberty that you do not wish to be vaccinated, there should be a consequence and that should be that you cannot infect other people. mr. boyle, if your child is born with immunodeficiency and someone comes to your school who is not vaccinated and the lack of herd immunity means that your child, who, no fault of their own, cannot be immune, is a victimless crime that somebody
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doesn't get vaccinated and your child dies? my gosh, you are the guy who,senting those people for whatever reason, the vaccine doesn't work and they are particularly susceptible. i remember a particularly tragic case for about six years ago of a child who was immunocompromised, on steroids, chemotherapy for cancer, and someone brought measles to the school. i think i remember that child died. do i remember that correctly? brexit we are talking the same child, yes, died a number of years later from a follow-up reaction. child parent had the vaccinated, but now she's on cancer chemotherapy and she's immunocompromised and in school, thinking that she can be a normal child, even though she's on cancer chemotherapy. the because someone else has made a decision not to vaccinate their child, her child dies. now if you believe in liberty, that's fine, don't get immunized, but i don't think you
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need to necessarily expose others to the disease. dr. mccullough, tell me, you are in a state where you mentioned a practice or you have people from three different states. hats off to mississippi, they always have the highest immunization rate. you didn't elaborate. what are the differences between the patients in these states in terms of ok, mississippi is always immunized, you imply maybe tennessee and arkansas are not. >> mississippi doesn't allow nonmedical exemptions and they have a nearly 100% rate of immunization at school. they pay a lot of attention to it. exemptionsreligious but not philosophical exemptions. in tennessee we have a 90% vaccination rate and can garden entry, but we have seen the rate undermedical exemptions religion triple in the last 10 years. you can predict where that is going. arkansas on the other hand allows for religious and philosophical exemptions, 94% below the level.
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>> wendy you see the most xe and presentable disease -- preventable diseases? >> it's all rare. tennessee we get about one per year a measles case, always imported from outside the united states. >> we have adequate herd immunity that would protect, even if people are coming in with other diseases? >> the problem is, as you have seen in california, oregon, and washington, there are pockets where it is low. it could happen in tennessee next week, plenty of communities are below that level. >> so obviously we have a bunch of docs, people who, i can't help but notice that your beard is not as heavy as other peoples. so this is not total -- you don't have to be an md, phd, or masters of public health to understand these issues, correct? >> correct. >> you just need to bring a critical faculty to it and
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understand that it's not just the individual affected, but the individual they go to school with, correct? >> as i said before, my decision was based on other people as well. my family physician encourage me to get vaccinated. my school deemed to me as a health threat. that pushed me to look further into getting my vaccines despite my mother's beliefs. >> i will nonetheless defer to myself, but i'm out of time, as the chair. thank you very much. thank you for caring for the people you went to school with as much is you cared for yourself. i yield my time. senator? >> thank you both for having this hearing. thank you all for being here. good fortune of having a grandfather who was a pediatrician who practiced medicine from 1921 until about 1985. my childhood was filled of his
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accounts of the changes that he saw on the medical landscape over the course of his career. i still remember him describing what it was like to see someone suffer from lockjaw, which is tetanus. the jaw locks, the swallowing stops, the muscle spasm, the breathing stops. he talked about what a difference it made when the tetanus vaccine became available . i remember my mother, who had three children. youngest born in 1960, remarking during my childhood that now there was a vaccine against rubella, german measles, pregnant women didn't have to worry nearly as much about going out of their house during pregnancy. accidentally contracting german measles that could be so damaging to the fetus. i think it is incumbent on all of us to remember these stories. pointer of you made the
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that without this experience of what these diseases actually do , we have gotten less vigilant as a society about the importance of this. about the importance of vaccinations. withi wanted to follow-up importance of helping pregnant women get vaccinated. the unitedt in states almost all vaccines are administered to visit -- infants once they are two months old. for the first two months of their lives infants rely on the antibodies of their mothers, the ones that moms you -- have that prevent them from viruses like the flu. these are not necessarily the new ones that you are working on, they are critical for pregnant women and babies. we know that they face a greater risk of problems due to premature birth delivery, hospitalization, and death.
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astonishingly, only about half of the women receive the flu vaccine during pregnancy. with infant mortality rates reaching startling numbers in the united states in recent years, it's critical we take basic steps to help women and babies during pregnancy and childbirth. what is the leading cause for the low number of vaccinated women? what can we do moving forward to help improve these numbers? >> there are several causes. there are very few women outright oppose the vaccines. there is this huge group that is sensitive. in terms of how to intervene, pregnancy is physiological.
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things like standing waters, concepts to nudge the practice into vaccinating. working on supply-side issues, physician communications and persuading pregnant women. baby,is this focus on the a focus on other universal things, the mothers are both motivated to protect the baby and scared to harm the baby. as we generate safety evidence, we need to find allusions to this as well. thenybe what i will do with my limited time is ask the practitioner, i'm
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curious about how you go about communicating with parents who are having vaccination hesitancy. among those who choose not to vaccinate their children, what's the most common reason? doing forward, what can we to help make sure that parents are educated about the importance? >> 10 years ago it was one common reason, the fear of autism. right now there is a real polyglot of reasons. all sorts of different minor concerns that come up here the most important thing for a .ediatrician to do is listen respect the concerns, they are different for every person. really individualized the education you are going to give. we need to have an individualized message. the patient and physician. >> and best practices i would expect about how to do this.
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>> absolutely. >> thank you very much. thank you, mr. chair. ?> senator smith >> thank you, mr. chair, thank you all for being here. i really appreciate it. in 2017 my home state of minnesota experienced the largest measles outbreak we have seen since 1990. between march and august of that year we had 75 cases of measles. 21 related hospitalizations. our state department of health, which really is a model for department of health stepped in and did a remarkable job working with children, hospitals, hennepin county, a whole range of other partners. dr., i know you have been dealing with this in washington. can you just summarize for us to be a partner as you
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deal with these outbreaks? all, they have lent their technical experts around is incredibly important. we need to be looked at how it is the a to the cdc director, as we said last week. getting to the people around vaccines and not science on the shelf. we need to have national campaigns based on evidence that we developed, evidence on how to .est communicate it is a response effort that happens at the local level. we need to remember that, which means we have got to find -- fund local health departments actively so that they have the
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staff to respond. frankly also to prevent these. working with pockets of that haves in advance pockets of unvaccinated. >> in minnesota, when we saw the measles outbreak, there were some communities disproportionately affected. in order to communicate and here well the concerns and issues from these communities, it was important that we had culturally competent and specific kinds of outreach. can you talk about what you have seen that are good models and the area? >> a good models are the folks on your staff who are actually culturally diverse and who know these communities inside and out as being really important. we have to have employees who reflect the face of the communities. that's a challenge for us and we are not there. and then i think it's really the community development outreach where we are building those relationships with informal leaders in the communities,
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whether they be church leaders, elders and tribal communities, whatever. trusted folks there that people listen to, engaging them in health promotion work. >> thank you. what anyone else like to comment on that specific question on how we can have culturally connected outreach in this area? a specific add example that stood out for many of us, that community was targeted for misinformation. there were several visits with folks who were not enthusiastic about vaccines. so, the response is also an example of how to engage communities. the difference is not just around the health department but the partners that came together and worked with the communities itself, to pick up the rates of vaccination. they have the tools that are evidence-based. one is that you have a disease savings-based approach and you don't just talk about the back scenes, but you talk about the
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disease itself. that's what it's all about. >> did you want to add to this? >> that way of talking about a diverse group of people, addressing specific communities, one, i would stress the biased level at least, for young people moving into adulthood, on the medical level is very important. once you become of age, for me, most of my friends didn't understand that they could get vaccinated despite their parents wishes. still that push of extending to young people that these are especially important. >> thank you, mr. boyle. >> to add onto that, as we talk about the cultural issues here, one of the things i have found, while i love what the cdc and others have provided, one of the other pieces of the communication that are missing are stories. there's precious little that connects a person if they are not swayed by facts to the needs. is receivingaunt
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chemotherapy and is immunocompromised, tired back to the personal in their community. as they said, i have not seen to theseas we talked campaigns, that's another layer to add in to everything that needs to happen. >> thank you. >> senator casey? >> thank you, mr. chairman. dr. cassidy, ranking member murray, thank you for presiding over this hearing. it's an important set of issues. i want to start with mr. lindenberg are. --n i was a senior in haste a senior in high school? i would like to think that at that age i could do would you have done. the answer is probably no. some members of the community -- committee could have made it, but i'm not one of them. i know how difficult this would be no matter your age or station
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in life. it's a difficult topic and you also have a personal story to tell that is difficult. you can tell it in private, let alone in a public setting. third, you have done something that we don't often do in washington. this is a town where people are pretty good at demonizing and dividing. we are real experts at being categorical. to be veryen able clear about where you stand and what you believe and bear witness to the truth without being categorical. without demonizing. that is not only help you for this topic, but instructive to the rest of us here. both parties in both houses, i hope evil are listening. if you could share additional ideas that you developed because of the experience you had as to how to effectively reach out to
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parents and address their concerns so that they are confident in the advice of their and don't hesitate to have children immunized. that question,r actually. there's an important distinction to make between the information provided, as we discussed earlier, where people don't resonate with data and there were better stories. you have seen a lot from the vaccine communities, what they built through parents is on a that speaksal level volumes to people because for my family and my mom, reaffirming that the position was correct, she knows people and has seen stories. we don't know a lot of the factors involved. i have seen that a large portion of what we have been seeing to address your question, even miraculously, the stories of people suffering, stories of
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these diseases that are preventable ravaging countries is extremely important. the side effects and complications opposed, even when talking about measles there is a huge misinformed belief around the anti-vaccine community, but measles is one of the biggest killers of young infants. you see virtually 80% of measles death in certain statistics are from children five and under. when you convince parents not only that information is incorrect, but that the children are at risk, that's a much more substantial way to cause children to change their minds. >> that's helpful. i appreciate your testimony. i will ask one more, dr., i want to get to the issue of prevention. we repeat over and over again that that is the best cure. we know that vaccines provide the best type of prevention not only for the individual, but for
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the population by way of herd immunity, as we have heard today. for you though is can you describe based on your own experience, your own work, the -- both in terms of your research and inpatient care, what are some of the both symptoms and outcomes of both typical maxine preventable diseases for children and adults? a wide spectrum depending on the disease you are talking about. these are obviously diseases that cause severe disease and death or they would not have been targeted longer ago for elimination. i think that one of the things that as physicians and providers that we don't realize really how bad it was, i trained at a time when meningitis was a scourge. every kid had chickenpox. i remember seen three or four
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kids per night coming in almost comatose and with brain damage, some of them dying. that vaccine came in when i was in my pediatric residency in the disease disappeared overnight. trainees now don't see that and don't understand just how bad these diseases are. >> because of advancements. >> absolutely. and thecation piece ability to spread that message, having these vaccines. that's my scenes is important. >> on what to think everyone for being here. >> ranking member, thank you. additional submit information that time if they would like. thank you for being here. the committee stands adjourned. [clapping] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national
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cable satellite corp. 2019]
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>> and as they hearing wraps up, members will begin debate today on bills dealing with radioactive waste, including waste from radiation bills. and energy efficiency in schools. as we wait for the house to gavel in, take a look at some of today's. -- today's "washington journal." joseph antos from the american enterprise institute who serves as a policy scholar and joining us as well is adam gaffney from the group physicians for a national health program.

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