Transcripts For CSPAN Childhood Vaccination 20150214

Introduce our panel of witnesses. After that, senators will each have five minutes of questions. We have two panelists today. In two hours for the hearing we will end about noon. We will have an hour for each panel and i will and the first panel at 11 00. From smallpox to polio, we have learned that vaccines save lives. Yet, a troubling number of parents are not vaccinating their children. Last september, this Committee Held a hearing about the ebola virus. Our witnesses included a brave and physician who worked in liberia and contracted people a and contracted ebola. There was and is no cure. There was and is no vaccine. This produced a near panic in the United States. It changed procedures in nearly every hospital and clinic. I remember one chattanooga Public Health officer saying it is ebola all the time, every day. In response, congress appropriated more than 5 billion to fight the spread of the virus. The impact of efforts is that the number of people a cases are declining. At the same time, here in the United States, we are experiencing a large outbreak of a disease for which we do have a back scene. Measles used to second up to second sicken up to 4 million americans each year. Many believed it was an unpreventable childhood illness. Introduction of a vaccine in 1963 changed everything. Measles was declared eliminated. Absence of continuous disease transmission for more than 12 months. From 20012012, the median number of cases reported in all of our country was about 60. Today is february 10, 2015 and the 41st day of the year and already we have seen more cases of measles than we would in a typical year. One Measles Outbreak in illinois a suburb about half hour from chicago, has affected at least five babies, all less than oneyearold. Infants and individuals who are immuno compromised are traditionally predicted by what is called herd immunity. Meaning that when more than nine out of 10 people are vaccinated so they dont get sick. That keeps the babies from getting sick. That herd immunity is incredibly important. Measles can cause lifethreatening complications in children. Such as pneumonia or swelling of the brain. Our eyewitnesses will talk about what is causing this outbreak and why some parents are choosing not to vaccinate their children. Measles is only one example. This hearing which was planned before the Measles Outbreak reminds us of the importance of vaccines. An analysis of immunization rates across 13 states performed by u. S. To usa today found the problem. Schools ranging from small private american reservation schools in idaho where vaccination rates have dropped precipitously low sometimes , under 50 . California is one of the 20 states that allows parents to claim personal belief exemptions from vaccination requirements. In some areas of los angeles 60 of parents have filed a personal belief exemption and those Elementary Schools vaccination rates are as low as those in chad or south sudan. The purpose of this hearing is to examine what is standing between healthy children and deadly diseases. It ought to be vaccinations. But too many parents are turning away from sound science. Sound science says vaccines save lives. They save the lives of people vaccinated, protect the lives of the vulnerable around them like infants and those who are ill. Vaccines save lives. They protect us from the ravages of awful diseases like polio which invades the nervous system , and can cause paralysis. I can remember how parents were frightened by the prospect of polio for their child. I had classmates who lived in iron lungs. Or whooping cough, is another example which causes they can causes it just to build up acutely in airways. Or a bacterial infection that affects the mucous membranes of your nose and throat and can damage your heart, kidney and nervous system. Vaccines save lives. They take deadly, awful ravaging diseases from our history. It is troubling to hear that before we have even reached valentines day this year, 121 americans are sick with measles, a disease eliminated in the United States 15 years ago. It is troubling that a growing number of parents are not following the recommendations of doctors and Public Health professionals who have been making this recommendations for those medical recommendations for decades. At a time when we are standing on the cusp of medical breakthroughs never imagined cutting edge personalized medicine tailored to an individuals genome, we find ourselves retreading old ground. I turn to senator murray for her opening statement. Thanks to all of our witnesses for coming to share your expertise with us today. Keeping our families healthy cannot be more important so im glad to have the opportunity to hear from all of you about the threat vaccine preventable diseases still pose in the United States. There is no question we have come a long way when it comes to what was once widespread and extremely dangerous illnesses. Vaccines are one of our countrys greatest Public Health successes. Thanks to them we know how to , prevent illnesses that struck so many children as recently as a generation or two ago. But recent news about the Measles Outbreak in many states made clear that vaccine preventable diseases are still a threat. And that we cant afford to become complacent about protecting the progress we have made. Bottom line, this needs that children across the country needed to be vaccinated. We need to be vigilant about breaking down any barriers that families may face when it comes to accessing certain vaccines and we need to which were that need to ensure that that in any cases where takeup rates are low, we are spreading awareness so more people can be protected. The hpv vaccine is a great example. It prevents lifethreatening cancers, including Cervical Cancer, which impacts thousands of lives in the United States each year. Despite that, cdc reports that takeup rates for the vaccine are still unacceptably low meaning people continue to be exposed to deeply harmful illnesses that could have been prevented. I know several of our witnesses have done a lot of work on this issue. I will have questions about what we can do to encourage broader use of vaccines. Im looking forward to an update about the recent Measles Outbreak and the work the cdc is doing to continue to encourage vaccines. Im eager to hear from dr. Kelly more about the role of states in preventing and responding to outbreaks. I know dr. Sawyer will be able to provide valuable insight into ongoing nationwide efforts to increase immunization rates and keep children and families healthy. So, i want to thank all of our witnesses for the important work you are doing and taking the time to be here with us today. Think very much, mr. Chairman. Thank you very much senator, and thank you for working together so we jointly invited the witnesses today. Each witness will have up to five minutes. If you will summarize your views in five minutes so senators have a chance to ask their questions. Then i will that will take an hour i said before some of the senators came in, well have to and the first time at 11 00 comes that we can get the second panel that will go on until 12 00. She has worked at cdc since 1998 on immunization, respiratory and other Infectious Diseases. She is a rear admiral in the Public Health Service Commissioned Corps and was named assistant Surgeon General of the United States Public Health service in 2006. Welcome. Good morning, mr. Chairman and members of the committee. Thank you for the opportunity to speak with you today. Our nations immunization system is strong, protecting the health of americans, saving lives and money. But this years outbreak of measles demonstrates how interconnected we are. Many threats are just in airplane ride away. Despite High National Immunization Coverage against measles, last year, we had more cases of measles in the u. S. Then we have had since 1994. Since generate first, we have already had more measles cases this year than we have had in most full years since 2000. From january to february 6 this year, 121 people from 17 states have been reported to have measles. Most are linked to an ongoing outbreak that originated at disney parks in california during december. Most cases were not vaccinated or did not know if they had been vaccinated. Recent patients with measles have exposed others in a variety of settings, including a at schools, child care emergency departments, Outpatient Clinics and airplanes. These episodes require a Rapid Response coordinated across local, state and federal jurisdictions. The backbone for such a response comes from the Public Health immunization infrastructure. The systems and people that protect our communities from vaccine preventable diseases. Today, we are talking about measles but we could just as easily be talking about a resurgence of the whooping cough, or a sorted shortage of a deck seen. We need a stronger immunization system that takes care of prevention and ensures the quality of clinical practice but is also robust enough to response to emergencies and his ready to launch mass vaccinations for the next pandemic. Whether a vaccine is given in a private Doctors Office or any community clinic, the Public Health system plays a Critical Role in making sure vaccinations are accessible, safe, and effective. And used in the best way to protect our americans. And that are immunization policies are based on a strong Scientific Foundation continually reviewed. Our priorities are maintaining a Strong Program including preserving core Health Infrastructure at the state and federal levels maintainin. Responding to outbreaks another and other insurgent vaccine needs. Coverage for many childhood vaccines is above 90 . And reported cases for most vaccine preventable diseases are down by more than 90 . Most parents are vaccinating their children with most of the recommended vaccines. Less than 1 of toddlers have received no vaccines at all. Immunizations continue to be one of the most costeffective health interventions. For each dollar invested, there are 10 of societal savings and three dollars of direct medical savings. The past 20 years of u. S. Childhood immunization has prevented over 300 million illnesses, 732,000 deaths and resulted in 1. 4 trillion in costs. In many ways, though, in cost savings. We are a victim of our own success. Fewer and fewer doctors are urging parents because of our success, parents may wonder if vaccines are necessary and may worry that the risks may outweigh the benefits of protecting their families from vaccine preventable diseases. The increase in measles cases should be seen as a wakeup call. Measles is very contagious. And quickly uncovers pockets of under vaccinations. In the 1980s and early 1990s, Measles Outbreaks uncovered systemic problems with poor children having access to vaccines. Relating to the creation of the vaccines for Children Program. Today, measles in the u. S. Is an indicator of how globally interconnected we are. When we see outbreaks with importations measles uncovers , those people in areas in the west that are opting out of immunization. We have indications that some of those unvaccinated microcommunities may be getting larger. Are immunization system has risen to challenges in the past and cdc will work with partners to keep measles from regaining a foothold in our country and. Working together we can keep , these numbers down, keep measles from returning and threatening the health of our communitys and sustain the enormous benefits that are Immunization Partnership has achieved. Thank you. About 10 years ago, he led a group of us to south africa and there we found maybe it was 12 years ago and there he found the president of south africa had rejected the science on hivaids and decided it was not caused by a virus and that the cure was a elimination of poverty, setting back south africa for years in terms of its ability to deal with hivaids. Now today, there is information that is on the internet, which is where we were told the president found his information some years ago, that says there was a study in 1998 by Andrew Wakefield alleging a connection between measles, mumps and rubella vaccines and autism. Lets say you were a physician or pediatrician and a parent comes in and says i have been on the internet and i am concerned because i found that, according to this medical journal, there is a relationship between this measles and mumps vaccine and the possibility of my child being autistic. What would you say to that parent . Autism is a terrible condition. That paper you are mentioning has been totally discredited. It was found to be fraudulent and is not the case. There have been dozens of studies of vaccines. And the question of fact question of vaccines they do not , cause autism. They are highly effective and safe and or a good way to and are a good way to protect your children from vaccine preventable diseases. When you say totally discredited, what do you mean by that . Information was found to be fraudulent by a british investigator. Some of the information was not correct in terms of the notes that were submitted. There have been dozens of studies that were better to understand whether there is a link between vaccines and autism. It was a natural question some parents had because of the onset age for autism. But those studies have been incredibly reassuring. When i talk to the parents, i explain that as a physician and a Public Health expert, i can tell you that vaccines are very safe and effective. While autism is a terrible condition, vaccines do not cause autism. , so you woul he would say that that article was just flat wrong . Thats right. Numerous studies have shown that was wrong. What happened to the author of the article . He lost his medical license because of the fraudulent behavior. We have been talking about a variety of vaccines. It struck me as we were so worried about ebola last fall that many of the Public Health people would point out to me from tennessee that we had the flu season coming up how Many Americans die each year from the flu . Flu is very variable. It can be between 3000 in a good year to 50,000 in a severe year. This is a quite severe year for flu. So 3000 to 50,000 could die. Is a vaccine for flu . That is right. Right now, about 46 of americans get a flu vaccine each year. We would like that to be much higher. So we do recommend everybody six months and over get a flu vaccine every year. Lets go back to the measles for a minute. Measles is not just a runny nose. It is a serious disease. What would you say to a parent who comes in and says i will opt not to get the measles vaccine . What are the risks of that . How many children who contract the measles die . Before there was the measles vaccine, 400500 children in this country died. The risk of dying is much higher in countries that are poor where malnutrition is a problem. We have about 150,000 thats deaths from measles around the world each year. It used to be millions and that is an improvement because of high uptake of measles vaccines. If your child contracted measles in the United States the chances of death would be about one and 1000 . Thats right. But remember, there are other problems with measles. Even a mild case of measles is a scary thing for a parent. When i had measles, she was scared to take my temperature because i looked so horrible. It has been so high. She was worried it was not coming down. It can be pretty scary for parents, even the mild cases. There are other complications besides death. Children can get pneumonia or dehydration or also get a neurologic problem. Thank you. Thank you so much for being here and for all the work you do to protect our families and children across the country. There is no doubt the challenges remain with regards to immunization rates. Broad access to nocost vaccines is clearly a key factor in maintaining and improving our vaccination rates. In my home state of washington, we have a universal Childhood Vaccine Program in washington which provides recommended vaccines for all children. But i know there are a number of important federal programs that ensure access to free vaccines. Can you describe the cdc effort to ensure all americans do have access to the vaccines they need without cost sharing . And particularly why that is so important. The cdc administers the vaccines for Children Program. We celebrated 20 years of that program. It has been extraordinarily effective. It provides free vaccines to children who were uninsured and medicaid eligible. To find financially Vulnerable Children in the country. It provides vaccines for almost 50 of children in the United States. This program has greatly overcome racial, ethnic and financial barriers to vaccination. We see much higher coverage now in the era of the program. As i mentioned, we think it has saved over 300 million illnesses and saved 1. 4 trillion. Cdc supports the state discretionary Immunization Programs to bridge the gaps that are not addressed through the program. In particular, supporting the Public Health infrastructure for immunization so state and local Health Departments that work with the clinicians in those areas dont just investigate outbreaks like measles but work day in and day out and support in supporting provider education and dealing with vaccine shortages and distribute in vaccines distributing vaccines. Your state has a fantastic program. Thank you. For me and a lot of my colleagues, disease prevention was a key priority when we wrote the Affordable Care act. Im very proud of the fact that health plans now have to cover recommended vaccines without cautionary. As health and Health Insurance coverage is not increasing, now increasing can you tell me what cdc is , doing to help Health Departments build insurance providers . To cover individuals the Affordable Care act means more people have insurance and more insurance is excellent for vaccines because it requires insurers provide all recommended vaccines with no copays or deductibles. Cdc has been supporting 35 states to set up billing practices so that ensure people so that if the insured people need to get vaccinated, that Health Clinic will be able to bill the insurer and recoup the money. We are making sure the federal dollars go to protect infrastructure and the insurers pay their way. Good. And i just want to mention i am , really proud of the number of organizations in my home state where they are Global Leaders in providing vaccinations worldwide. We have the gates foundation. And the reality is, we are incredibly lucky to have people who have witnessed death by disease like polio or whopping cough. I know you have worked with these issues across the globe. Can you tell us what you perceive are the key challenges to achieving optimal immunization rates here . We are so fortunate to have a strong Health System and access to vaccines. In many countries, even with an alliance that provides vaccines for free, the infrastructure is very weak. Strengthening Health Systems overseas so they can deliver vaccines is vitally important. There are a number of publicprivate partnerships that have been helping in that arena. I just want to mention the Measles Rubella Initiative were responsible for more than a billion children getting measles vaccines through campaigns and other areas and we think about 15 million children have been prevented from dying from measles in the last 15 years through the initiative. The Public Health infrastructure we have here is critical for issues like this. Absolutely. Even if every single american were insured, we still need Public Health to make sure we are addressing the needs of communities. Thank you. We will now move to fiveminute rounds of questions. Senator collins, senator mikulski for those who have just arrived, we will move to the second panel. Even if we havent finished the senators questions. That will take 15 minutes. Then we will pick right up where we left off with the senators who are next in line. Senator call it. Thank you, mr. Chairman. The president s budget request includes a 50 million cut to the centers for Disease Control and prevention section 317 Immunization Program. You just responded to a question from senator murray about the importance of the state and local Public Health infrastructure. More than just paying for vaccines, section 317 supports outreach awareness surveillance efforts by the state and local Public Health agencies. It is puzzling to me that the administration would propose to cut this program when we are in the midst of a Measles Outbreak. When you would think that you would want increased public outreach, awareness and surveillance. You have just talked about the importance of the state and local roles. Could you explain to us why this cut has been proposed . The Public Health infrastructure at the state, local and federal level is vitally important to protecting americans. As i mentioned earlier, these threats are an airplane ride away. The reduction in resources requested through the president s budget will be accounted for through a reduction in vaccine purchase. Instead of paying for vaccines for insured people, the Health Department will be able to build to bill the insurers so they will pay their way. Protecting the Public Health infrastructure at the state and the level is critically important, as is the communication outreach and the provider work we do. It seems to me this is exactly the wrong time for us to be reducing funding in this area given the importance you just outlined. Historically, access to health care and the cost of vaccines had been the Major Barriers to achieving high vaccination rates. But increasingly, it is clear that other factors have come to bear as we are seeing declining vaccination rates in some extremely wealthy areas of our country. For example, there was a recent article in the atlantic magazine that recently compared unfavorably, the vaccination rates in wealthy areas of los angeles to the higher rates in the south sudan. How should our Public Health Strategy Change to reach those parents . You would not think that would be the areas they can obviously afford the cost of the vaccines and have ample access to health care. Certainly better than those in south sudan. Yes, 25 years ago, we were dealing with the problem of children not having access to vaccines. What we are seeing more and more these days is parents opting out of the system. I like to start with the premise that every parent wants their child to be healthy and safe and that is number one. I think that for a number of parents, especially in some of these communities were opting where opting out is common they dont realize the diseases are still around. When measles virus comes into a community, they are at higher risk. I hope parents in those communities are recognizing that the threat is real. Another factor is misinformation. Of course, in todays world, it is really easy to get information of all types. Much of it is not very good. We try to have the best information possible available to make sure people see the sources of the information and can check the facts themselves. We work closely with clinician groups. What our Research Suggests is that parents want to hear about these things from their own doctors who know them and their family. So, i think a lot of the attitudes out there might be from complacency that these diseases have not been visible. Unfortunately, this year, the disease is getting more visible. Thank you. I think the study also played a huge role, unfortunately. I think that a lot of people still mistakenly believe there is a link to autism and are unaware that that study has been thoroughly discredited. Thank you. Thank you senator. Thank you. My question was going to be fairly similar to the other question. On the reduction of 50 million in the 317 great program, which is to take care of the uninsured and vaccine safety outreach and education. Now, you are saying that that reduction of 50 million will have no impact on those Services Related to vaccine safety outreach and education . No, i cant say those reductions will have no impact. What i tried to say is the way we would address those changes would be to reduce the discretionary vaccine purchase and try to increase the billing of insurance. It is of course vital that the infrastructure be protected. We feel the same way. The issues related to outreach and education this is not an appropriations hearing. When we do deliver, this is a valid area of inquiry and bipartisan cooperation. This takes me to science and misinformation. Does cdc track the correlation between vaccine compliance and rates of autism . Specifically, mississippi which has a 100 percent compliance rate, what is the autism rate in mississippi . I dont have that information. But there are a number of ways we have tried to understand trends in autism and vexing vaccine exposures. A number of different study designs have discredited any links. I believe the solution to misinformation is more information. And that it be science and evidencebased. My question is, do you track that . Do you track the correlation . We track the trends going on in autism and the trends going on in vaccination around the country. The trends in vaccination are that almost everybody is getting vaccinated with most of the vaccines statebystate, there are differences in particular vaccines. Mississippi has a does not allow personal believe exemption. And many people feel the only exemptions that ought to be allowed our medical once. Certificate get vaccines because of not trying to get into it. What im trying to get into the into is the epidemiology. Where there are high rates of compliance, how does that correlate . There is not a correlation between vaccine uptake and the autism. You have the epidemiology to support that . Yes. I think the committee ought to think about our efforts in the area of autism. I know we have been very focused on alzheimers and others. But it really is an epidemic. Mothers will do anything to protect their children. They need good information, real science and for families facing these challenges, they need to have answers. It is another area i think we should take a look at on a bipartisan basis. But i want to shift gears to immigrant children. And their vaccinations. I know this can get controversial, but what are the outreach efforts and how do we deal with this . For example, 60,000 children came to america last year. Many of them are in maryland. Hopefully they are in the sunshine, going to schools and so on. But, has the cdc in states where there are high rates of new immigrants, where the immunizations of children are addressed because there is this whole attitude that they should not be in our schools, they shouldnt get our Public Health infrastructure. This is what we are talking about. Central American Kids are going to schools sidebyside with the gentry kids. How do we ensure those children are addressed and therefore the needs of American Children are also addressed . Vaccine preventable diseases do not respect borders. It is important for individuals to be vaccinated for their own health, but also to protect those around them. We have worked there had to make sure that they are immunized. It is very important in an arrow an era where measles has been eliminated from north and south america for us to continue to make sure that there are strong immunization efforts in other parts of the world. For vaccine preventable diseases, it is important to make sure people have access to vaccines regardless of where they are from. Thank you. Thank you. Senator cassidy . Tell me. Of those folks infected in the california epidemic, how many were native born americans and how many have immigrated here . I dont have that information. But what i can say is that most of the importations we have of measles each year are in the americans traveling abroad. When you say an american, though, americanborn. Uk so we have heard a lot about how the families from the wealthy committees of santa monica and los angeles are not vaccinating their children. Is that where we are seeing these cases . I did my residency in los angeles. There are a lot of the a lot of immigrants, and a lot of the immigrants may have fallen between the cracks. Do we have any sense of who is contracting this . For the Measles Outbreak, we are seeing spread in some of the wealthier communities. Years ago, we had a lot of importations of measles from latin america. But the americas took on the elimination of measles and did major campaigns around all of the countries and had great success. Im side. When someone immigrates, what is their requirements in terms of immunizations . There is a requirement for documentation of the vaccination against the vaccine preventable diseases. For children, the Program Makes sure that refugees would have access. That is poor children, by definition less than 18. What if an adult immigrates from the philippines . That is not the case there. Most of the spread is coming from most of the risk is in children. If you survive to adulthood, you have already been exposed to the measles. So, of those adults going to the philippines and coming back, is there any travel advisory is there any effort in the philippines . You mentioned how the americans have bucked up their efforts. There are efforts there. The philippines had suffered that horrible hurricane. Much of their immunization infrastructure was destroyed. They have had a bad Measles Outbreak. Cdc and others have responded to help them work on their immunization campaigns. You know, the biggest outbreak we had last year was in a couple amish adults who traveled to the philippines who had never been vaccinated and brought the virus back to ohio. The homage Amish Community stepped up to be vaccinated. That was a large community. In the u. S. , most communities have high immunization rates. It is these newer committees where parents are opting out that we are quite worried about. Was he required to show his facts his vaccination record to go . He was not. But we hope that we are reaching him through our outreach efforts. We were concerned that with the ohio outbreak, we had not reached the travelers. In fact they were misdiagnosed. , that can be an easy thing to do. If you apply for a visa, to put in a note saying you are traveling to a place with endemic measles. There are a lot of electronic prompts that it will alert you. But they are not 100 in terms of people following them. Is that something that when we approve a visa there should be some process by which somebody is traveling to and an endemic country, we would remind them of their risk. I deftly think we could look into that. What about immunization rates since 2009 . They have risen for some of the newer vaccines and are stable for the others. We tracked closely the percent of children who receive no vaccines at all by age two. I wondering about senator murrays statement. You seem to concur that the Affordable Care act may have improved immunization rates. The vaccines for Children Program that cost has not been a barrier for immunization of children for some time. Again, because of the program as well as the Public Health. Would you accept that . For adults, the rates are low. We have some lacking coverage in teenagers. It covers through age 18. And the aca will not either . Clacks the aca would cover vaccination of the nettle with hepatitis b if they were in a recommended if they were at risk. I think it is important for the record that the Affordable Care act has not hurt but not augmented. The vaccines for Children Program has had huge we need to keep moving. I yield back. Rex thank you. Senator warren . Thank you. When the vaccine became available for the first time parents lined up to make sure their kids would be protected. They lived in a world of Infectious Diseases that destroy childrens futures and they desperately wanted to leave that world behind. These vaccines worked so well, the memory of these diseases has faded. And the importance of vaccinations has become less obvious. Last month, the depew center found that while 80 of seniors believe vaccines should be mandatory, only 59 of people under 30 hold that belief. Now, measles is back. You are the top immunization official in the United States. I want to walk through the science on this with you. Is there any Scientific Evidence that vaccines cause autism . No. Is there any Scientific Evidence that vaccines cause profound mental disorders . No, but some of the diseases we vaccinate against can. The diseases can, but not the vaccines. Is there any Scientific Evidence that vaccines contribute to the rise in allergies in kids . No. Are there additives that can be toxic to kids . No. Not in the amounts. Is there any Scientific Evidence that giving kids vaccines further apart is healthier for kids . No, it actually increases the risk. It adds to the danger. Is there any Scientific Evidence that kids can develop immunity to these diseases on their own simply by eating nutritious foods or being active . No. How do the risks of a child responding negatively to a vaccination compare with the risks of skipping vaccination and risking exposure to a deadly disease . Vaccines are safe and highly effective and its important for parents to know they are the best way to protect their kids. Every parent wants to protect their children. Parents should know that all of the credible Scientific Evidence suggests that modern vaccines are safe, effective and are our best chance of protecting our children from diseases that can kill them. Is that right . Yes. Thank you. Senator roberts . Thank you, mr. Chairman. I appreciate you holding this hearing. In kansas, we had 19 cases of vaccine preventable diseases last year. The most prevalent was measles. We have not any new measles cases reported yet this year. Our Public Health workers are concerned and parents are concerned and im concerned. The problem is our immunization rates are down. For the 20132014 school year, the percentage of youngsters has fallen below 90 i had measles and chickenpox and mumps and Everything Else that people had back in the day. What i am asking, if i can get to it quickly if immunization rates continued to decline, what advice do you give to these youngsters parents . The lower the rates are, the more your children are at risk. You want to be making sure your own children are vaccinated. Its important to have those around them vaccinated. Some kids cannot get vaccines because they have leukemia. Our best protection is that Community Level of vaccination. You highlight three reasons parents dont vaccinate. Fear of side effects, religious or philosophical objections. There is information on which states are easier to get a religious exemption or philosophical objection. A simple letter signed by a doctor. How often would you say the mistrust of the vaccine schedule , how often would you say it is too rigorous . What reassurances can you provide parents on this concern . Many parents mention the number of shots that children get at a particular visit as something that concerns them. The vaccines are recommended at the time they are recommended because of the way they work and the disease risk. Our Advisory Committee reviews the science of the vaccines and diseases and updates the schedule every year based on the best information available. I strongly recommend parents get their children vaccinated on time and according to the schedule. An answer to the chairmans question which nailed the issue right off the bat, there was a major danish study published in 2002, 540,000 children showed there was no relationship between mmr vaccination and any kind of problem with autism. The institute of medicine report in 2004 did the same there have been studies from the National Institute for health, centers for Disease Control and hundreds of other reliable academic groups. They all point to the same conclusion. The body of evidence was firmly established a long time ago. However this is a state issue. , that seems to be the problem. Cdc is doing their best to try to convince every state mississippi leads. We are at the bottom. Not the bottom, but fairly close. Im very concerned about it. At least the media realizes that one study which was totally discredited there should be a strong statement by everybody involved that they should go ahead and get these vaccinations. I strongly recommend that and i thank you for your leadership. Thank you, senator roberts. I want to mention again to the senators, at 11 00, we will call the second panel for 15 minutes. Any senator who has not had a chance to ask a question will be the first one. I want to thank the Ranking Member for holding this hearing. Our nations Vaccine Program has greatly reduced human suffering and saved lives by preventing and reducing the outbreak of preventable diseases. Thanks to National Policy , including the Affordable Care act commit millions of families have access to free immunization. Im concerned about the recent Measles Outbreak and the surge in misinformation, exacerbated by the media and national figures. This information is surrounding vaccine safety. To prevent against future outbreaks, it is vital that we continue to invest in our nations vaccine production capacity. Support cutting edge science and enhance Public Education surrounding vaccine safety. I have a number of questions especially around our production. Over 20 years ago, partially in response to a Measles Outbreak congress recognized the critically important roles of the vaccines by passing and creating the cdcs vaccine for Children Program. Which provides recommended pediatric vaccines to low income children. The cdc maintains a stockpile for pediatric vaccines. Could you tell us the current state of our National Pediatric vaccine stockpile. Is the measles vaccine included in that supply . Can you elaborate on the role of the stockpile in addressing outbreaks and how cdc works to maintain it . The vaccines for Children Program includes a stockpile that is approximately 50 , enough vaccine for 50 of the pediatric population to be vaccinated for one year. We currently have over 3 million doses of mmr vaccine. The vaccine stockpile has been used for outbreak response and vaccine shortages. Even with a robust vaccine manufacturing industry, many vaccines only have one or two manufacturers producing them. And when there are interruptions in that supply, we have to go to our stockpile to make sure there is not an interruption in use. It has been a critical safety net for the vaccine security. I want to explore a little further the issue of production and interruptions in production. With diseases that are preventable by vaccines and the influenza vaccines where they may not be 100 matched to the strain. Two issues three issues. Domestic manufacturers versus overseas manufacturers. With improved domestic production, everything you can elaborate on that would be helpful. Secondly, production is usually still slow and based on chicken eggs. There have been where are we on that . With regard to diseases that are preventable by a vaccine, we have had drug manufacturers who decided to exit that area. Often times with the old notice little notice to the medical profession. I have heard. Trish and say we dont have , enough in our clinic and we cant meet the demand. Do we have more safeguards in place to make sure that we dont have an alarming shortage . We had a big wakeup call about 10 years ago in october of 2004 where come overnight, half of the expected influenza vaccine supply was not coming through. That has prompted an enormous amount of evaluation. We are in much better shape now. That year we eventually had 58 , million doses of flu vaccine. This year, we have nearly 150 million doses distributed. There are multiple new manufacturers for the u. S. Market. We have a number of formulations besides the eggbased that are being used. Cellbased influenza vaccines are included among this years seasonal flu vaccine supply. Looking towards the future there is a lot of enthusiasm across academia and the government about investments towards a universal influenza vaccine that might give us broader and better protection than the annual flu vaccines we use today. There is a lot of progress. There is more work to be done. In terms of the communication with the industry i would like to try to get senator franken in. Thank you, mr. Chairman. Im thinking that maybe this outbreak is a bit of a wakeup call. As senator warren said, a lot of baby boomers and some of us who are older had measles and remember it. Maybe this is a good time for people, especially some educated people who were forgoing this for their children, to understand things like herd immunity. You get a Critical Mass of people not getting immunized you have outbreaks like this. What the cost are, like the financial costs there was a 2005 , nih article that attended to quantify the Economic Impact on Health Infrastructure and researchers estimated one case of measles costs the federal state and local Health Departments more than one of 140,000 to respond to just one case. You talk about the return on investment for all of these immunizations. It is one of the most it is obviously Cost Effective and prevents a lot of suffering. We live in a global world. I just wanted to ask you about that investment that we put into global Public Health. What the importance of that is. In terms of our investing in this in africa and other places. Can you respond to that . Measles has been eliminated from the americas but is still circulating around the world with 20 million cases a year. In some of the countries that have had major outbreaks, it is investing in their Health Infrastructure and supporting their ability to have strong immunization systems that will protect americans as well as strengthen their health. We are keen to be partners in the polio eradication initiative. In ways we can help protect children everywhere with vaccines that are safe and effective, and strengthens our Community Protection at home. This measles is highly contagious. You are one plane ride away from an american getting infected. Speaking of which, what other Infectious Diseases may be on the horizon . What may be the next measles . What else are we looking for in the near future . Possibly . With Infectious Diseases you really have to be ready for the idea that the microbes are changing faster than we are as people. We dealt with the interovirus. A new virus causing very severe disease in the middle east. Travelers returning from there. We really think it is critical to be strengthening Public Health infrastructure and capacity for Global Health security in countries around the world so that we dont let an epidemic like ebola that the disease is overseas and help the country deal with them is swiftly. That is why the cdc is so important. I really want to thank you for your service to this nation and to the world. Thank you, doctor. Thank you, mr. Chairman. Dr. Schuchat, maybe i misheard something. It says it requires visa applicants to obtain certain vaccinations prior to entrance with an immigrant visa, so an adult immigrant to the United States who obtained a visa is required to obtain certain act certain vaccinations, is that correct . Yes, i can double check. I did not want to leave a different impression that was not true. Thank you, dr. Schuchat. There are a couple senators that were enabled to ask their questions i hope they will understand. We will now invite the second panel to come up now and they will be the first ones after the next 15 minutes of testimony. I will now move ahead and introduced the second panel to save time, if i make. First we will hear from dr. Kelly moore. Dr. Moore is the director of immunization at the Tennessee Department of health and she is responsible for promoting proper use of recommended vaccines as well as overseeing the response to outbreaks of vaccines preventable diseases. She has her undergraduate medical degrees from vanderbilt and masters of Public Health from Harvard School of Public Health. I am completely objective, but the Tennessee Department is one of the finest. Dr. Mark sawyer is pediatric disease specialist from the university of california at san diego. He is also the medical director at san diego Immunization Partnership and involved in a variety of immunization practices and projects. Dr. Tim jackson is a pediatrician and the father of two hundred children who were recently exposed to measles in arizona. He is an every child by two immunization champion. Every child by two is a nonprofit dedicated to increasing vaccination rates among children. His wife is in arizona and caring for the two children. I am grateful he could be here to tell their story. Dr. Moore, lets begin with you. If the three of you could summarize your comments in five minutes we would appreciate it. The senators will continue questioning. Thank you, chairman alexander. Thank you for holding the hearing for vaccine preventable diseases. Most people are unaware that even in a state with a strong history of aiming his nation, a single case of diesels requires major Public Health response. I would like to begin by Technology First Lady Christie haslam and bill haslam for the commitment to immunization as an essential step in promoting and protecting the health of tennesseans. You can say tennessee has a culture of immunization. For the past two and of influenza seasons, the majority of tennesseans aged six months and up received a flu vaccine. In 2013, 95 of kindergartners were immunized with all required vaccines including both doses of mri. The federal vaccine for Children Program has removed barriers to access for eligible children since 1994. Our states online immunization Information Systems supported by section 317 federal funds, insurers authorized users such as clinics and schools have access to immunization records to see what vaccines a child may need or to verify that they are protected. We have more work to do to read reach high immunization rates with vaccines designed for teens and adults that prevent diseases such as meningitis, cancer pneumonia, and shingles. Public Health Partners with our clinical and pharmaceutical colleagues will address the information and concerns about Health Benefits and affordability. To improve access, our department is using federal prevention and health funds to help public local Health Clinics. So we can provide recommended vaccines to their beneficiaries with no outofpocket costs. When it comes to disease outbreak, if you realize how much help public work goes into one case of noodles, i vividly recall each of the nine case of measles, i vividly recall each of the nine i directed. Our most recent experience is a good example. On a friday afternoon last april, a doctor called his regional Public Health office about an adult with an uncertain immunization history in recent overseas travel who was in the er with classic systems of measles. A game plan was quickly developed following the state Immunization Program to identify those who may have been exposed. The mrr vaccine could protect the most recently exposed is Global Public can help find them quickly enough. Others were counseled in symptoms developed. Among the 124 contacts just , three cases among other adults developed. For these, the same isolation Contact Tracing and notification process was practice, but faster. No additional cases occurred. In total, 406 contents were contacts were evaluated. Pbh works with the media statewide to educate the public and prepared clinicians through state Health Alerts and an educational webinar. Cdc measles experts provided consultation and specialized testing that helped us optimize our outbreak tactics. A great deal of credit in the story goes to the hard work of Public Health at all levels. This result, however, it could have only been achieved in a community where it a very High Percentage of the population was already vaccinated. There would have been a very different outcome. Congresssustained commitment through the program and section 317 funding will continue to equip us to meet the educational and operational challenges of keeping individuals and communities healthy and safe through affordable, accessible and effective immunization services. Thank you for the opportunity to testify here today. I have provided a more detailed testimony for the record and glad to answer your questions. Dr. Sawyer . Thank you very much for holding this hearing on a very important topic during the the reemergence of vaccine preventable disease and what we can do together to prevent further outbreaks. As you heard im a pediatric , Infectious Disease specialist at the university of california san diego. I am also a member of the committee of Infectious Diseases of the American Academy of pediatrics during why testimony today has a strong endorsement of aap. Vaccines are one of the greatest health achievements. Prior, children suffered regularly from serious illnesses like measles. Polio, and even bacterial meningitis. The development and widespread use of vaccines has led to a resurrection or eradication of these once common childhood illnesses. Because of the success of vaccines, i have never seen a case of polio, or tetanus in my 30 years of practice in pediatric Infectious Diseases. In the teaching session i held last week with 20 pediatric residents and training, i asked if any of them has the measles. None of them had. However, as we have seen from the current Measles Outbreak and continued outbreaks of whooping cough around the country, we are witnessing a reemergence of vaccine preventable diseases in the United States. Unfortunately, my residents are going to get a chance to see the measles. Pediatricians are concerned that the reemergence of disease is a signal that bigger outbreaks are yet to come. Most of the cases in the current Measles Outbreak are from california. 13 are from my own community. Outbreaks like this are increasing in frequency and size. This Measles Outbreak, like all other Measles Outbreaks, are occurring because we have too many intentionally done immunized on immunized children in the United States and illustrates the problem right on immunized populations. Measles is one of the very few Infectious Diseases that literally flies through the air. It is completely predictable that such outbreaks immunization rates staying where they are or get worse. While most parents do choose to vaccinate their children, there are pockets of on immunized children all over the country. In san diego, we have 1500 kindergarten students that are not immunized. That number has been increasing steadily. The current Measles Outbreak reminds us of an important fact that they are a shared Public Health problem. When one person is infected, people around them and people they do not even know become infected. The decision of a parent to leave their children unimmunized, however wellmeaning, is a decision that affects us all. Although our Public Health community has done an excellent job controlling the current Measles Outbreak, too many people make a decision not to and will make it last longer. Many parents are choosing to not have their children immunized as they have received inaccurate information about the risks, benefits, and the diseases they prevent. I have held a number of forums in san diego meeting with parents to hear their concerns. The internet is replete with anecdotes and misinformation that leads parents to think that vaccines have caused harm. It is overlooked by parents that the fact that just because an outcome occurs in the time after vaccine, it does not mean the vaccine caused the problem. It takes science to prove or disprove a linkage between two events, and our parents are not hearing the science. The vaccine schedule has been developed with a strong scientific standards and has been proven to be safe and effective. In every case, for every vaccine, the risk from the disease outweighs any risk from the vaccine. In my opinion, the best way to decrease the number of families refusing to vaccinate their children is to improve communication on vaccine safety and effectiveness. To increase the science literacy of our population, to limit the philosophical exemptions from school entry requirements on vaccinations, and to continue to monitor the safety of all the vaccines we use. Taking these steps can ultimately help reduce the number of parents who choose not to vaccinate their children. It is alarming and must be confronted if we are going to prevent further outbreaks like the one we are currently experiencing. Thank you for allowing me to testify and i look forward to your questions. Dr. Tim jacks. Esteemed members of congress, my name is tim jacks. I am a boardcertified pediatrician and i am on the front line of this vaccine issue. I daily recommended vaccinations to my patients and addressed concerns they had regarding immunizations. Lately, i have also been addressing many questions on the ongoing Measles Outbreak. I am not here today as a medical professional. I am here today is a father. Three weeks ago, my infant son and daughter, who is battling leukemia, were exposed to measles. Since her diagnoses with leukemia six months ago, our home life has revolved around my daughter, maggies care. She has been admitted to the hospital six times and spent nearly one month there. She is on a regimented schedule of treatments and she takes medication three times a day, up to six medications at a time. We have weekly visits to an Outpatient Clinic where she has her procedures, bloodwork drawn, and at one visit my children were exposed to measles. We were informed of the exposure and instructed to return for shots of the antibodies, which we did. Now, these antibodies are not perfect protection, but in the case of my children, the only thing we can do to prevent them from actually coming down with measles. Right now, my two children are at home under quarantine. While we are waiting the three weeks to see if they develop measles or if they exit quarantine without any symptoms, i typed it entry into maggies blog. The blog is something i used to update family and friends into her treatment progress and to let people know how she is doing. Typically, i get 100 people reading this blog. Needless to say, it has gone viral. The title of this blog entry was to the parents of the unimmunized child to expose my family to measles. In this blog, i vented my frustration and anger at the situation and i explained and hopefully educated people as to why my children and many other children like them are at risk. Eli, my 10 month old son has received all of his immunizations on schedule but is too young to receive his first dose of mrr. My daughter, maggie, who was also previously fully immunized is that extra risk right now because of her weakened immune system due to her leukemia as well as her treatment. The blog was vital. In over two weeks, it received over 1. 3 million shares on facebook and has been read numerous times. I have been contacted for interviews on local and National Media outlets. I have taken these opportunities to share our story and hopefully raise awareness to the issue. My hope is that we can prevent families from going through the same thing we have got their these last weeks. We also hope we can prevent more families from getting measles altogether. Prevention is simple, vaccinate. As a unionization rates drop and the Community Starts to break down and that is the only thing protecting my to do to Young Children from being exposed to measles or whatever the next outbreak is high urged a strong, unified, bipartisan voice supporting the Scientific Evidence that breastfeeding are safe and that they save lives in we need a consistent message from the presidency to capital and down to local state legislators, schools, and even thinkers. I urge congress to take actions recording programs and infrastructure already in place to get these vaccines to those that need the most and contain outbreaks such as we are seeing today. I will care for my family and i will work to promote health among my patients. And through partnership with immunizations like every child by two and the Arizona Partnership for immunization, i will advocate for timely vaccinations for children. Thank you for your commitment to the issue. With your help, we can stop the spread of vaccine preventable diseases and protect the innocent. We can protect our children. We can protect my children. Thank you. Thank you, dr. Jacks for your personal story and thank you dr. Sawyer and dr. Moore. We will go now to the people who have not had a chance to ask questions and begin with senator casey. Thank you very much. We would like to thank the witnesses for bringing to this table and hearing room your experience, knowledge, significant time that you have dedicated your lives to on these issues. Dr. Jacks, we are a especially grateful for bringing your story. These issues are difficult enough, but ever more so when you have a loved one, in your case or daughter, is the subject of your own efforts. We are grateful for your bringing that to us. I am tempted to ask, but i would just refer to it, kind about why question and why the failure to vaccinate as becomes a significant. That may be the question that we are all asking. I guess maybe a better question to ask is what we can do to push back against it. We are doing that today and i see each of your testimonies have referred to that. I want to see some of the groundlevel work that has to get done day in and day out about which i do not know much and maybe some members of panel do. What happens in our schools, communities, and even in the offices of pediatricians. Dr. Seiter, you mentioned you were dr. Sawyer, you mentioned that you had never been exposed to this in a direct way as a practitioner. I wanted to ask you specifically is about pediatrics. Do you think we are reaching a point where there has to be pediatric training that speaks to this . In other words, a change in the training that reflects the reluctance that some parents have to vaccinate . I think that is a question and there are efforts underway from the American Army academy of pediatrics. In my case, i have a curriculum for residents about vaccination immunization. Three years or four years ago i added a whole section to teach residents and training on how to communicate about vaccine safety and address the concerns of these parents in an open nonconfrontational way, with the hope that if we can educate our families and give them good and accurate information, they will make the right decision. The problem is that there are so much inaccurate information circulating that a highly educated family who read something on the internet and takes it to heart before they really critically look at the source of that information. That is what we need to try and address. I mentioned in my statement, to raise the science literacy in the United States. That is a tall task, but we needed. I would like to refer to your testimony on page three, you talk about in the second full paragraph, in tennessee local School Nurses and coordinated School Health directors are among our most important champions of immunization. Can you tell us about the importance of that . As much as we have an obligation in washington to get a message out and get policy right, a lot of the best work will be done in those settings. That is true. I cannot speak highly enough of our local Public Health nurses School Nurses, School Administrators at work with families. Truly, these parents often have the hesitation of back physicians out of fear. They want to do the best for their children and bells go off with a heres very things about vaccines and it is hard to unring that bell. When i talked to local Public Health nurses, they care so deeply about these families that they work with and a lot of this can be overcome with credible information from trusted sources and good relationships. That is what these folks provide. I am always a phone call away when they have a question on a technical thing. I can help them with that, but they are the ones with relationships with families to help them overcome fears. I think our immunization rates are testimony to that ability for them to work through this with families. I appreciate that. I will wrap up. Just one statement. I know that in the debate on how to respond to the public crisis, among the best pieces of advice we all got here was local validators are a lot better than validators outside of the local area. I dont want to see washington but i think you know what i am talking about. Thank you for your work and im grateful you are here today. Thank you, senator casey. Senator murphy, especially dr. Jacks for taking the time to tell your story. I want to ask a few questions about the nuts and bolts of how exemptions work. We have seen a pretty rapid rise in exemptions, in my state for instance, we have fairly loose rules in getting exemptions. A feature we share with california, frankly. We have seen in the last three years, a number of people who are applying and getting religious exemptions doubled. Just in three years. You are proposing eliminating the philosophical objection. Can you speak for one minute on why you made a proposal . I made the proposal because as you pointed out, i live in california where up until last year, in order to exempt your child from School Vaccinations you simply slipped over a paper and signed it that you had a philosophical objection. Not a religious exemption, not a medical reason your child cannot be vaccinated, but just that you do not believe in vaccines. Just as you mentioned in your stay, we have seen a steady rise in those exemptions over the last few decades. There are very few religions that specifically advised their followers to not vaccinate. It is the philosophical exemption that is causing the problem. I think it is driven by misinformation, so i certainly am in favor of eliminating such philosophical exemptions. The state senator in california just introduced a bill last week to do just that and i am certainly going to be supporting the effort in california. Let me suggest an alternative to the elimination of the exemption, as you mentioned, all you want do in a state like california or connecticut is sign a piece of paper and you get no information on the consequences of not getting a vaccination. If the studies are pretty clear that more information you give the less likely it is that people take the exemption. If that, the less likely you will have outbreaks. This is a stunning one from 2006, in states that have higher bars for exemption, they were 50 less likely to have whooping cough outbreaks. Lets say we just raise the bar for a philosophical objection and we said for instance, you have to consult with your physician first or you have to review information on the risks of not getting your kids vaccinated. Do you think that that would be helpful if we were not successful in eliminating the the exemption . I will speak first because we have a form that says they need to sign that they have been educated. That led to about a 1 drop in the rate of california, but it is still at 2. 5 to 3. 5 and communities in california. We will see whether that form continues to drop the rate, but my concern is that we have seen the benefit of a onetime drop and we will go back to the study and gradual increase in exemptions whether people stick to philosophical ones or as they start to exercise religious exemptions that they did not before. Tennessee is one of the vast majority of states that does not have a philosophical exemption and has no intention of developing one. Only 20 states have them. Correct. About 29 or so only have no philosophical, including tennessee. Do we want to protect the most vulnerable among us or do we want to provide choices and options for protection . We cannot do both at the same time with the disease as contagious as measles. If we are prepared to accept the consequences of offerings like this and personal choice is fine, but if we want to protect the vulnerable like dr. Jacks children, then immunization needs to take place and it is the best way to do it. My office is looking at some proposed legislation that would provide incentives for states to increase the information that they are giving to parents. Not necessarily dictating what exemptions are used, but to admit that as a National Health priority, it probably makes sense to make sure that the best information is given out. The irony is, if you are getting a medical exemption, you have to have a note signed by a doctor. If you are using a philosophical exemption or religious exemption, often on you have to do is sign the back of the form. It seems at the very least we should try to marry does to standards together. Senator bennett. Thank you, mr. Chairman. Thank you for holding this hearing. It strikes me listening to the testimony that we have been victimized by two things. One, a generation that has not experienced these diseases because of vaccines and they have lost sight of what they look like. And interestingly, dr. Sawyers point, the unedited content on the internet are reading. I wonder, dr. Sawyer, and i hope maggie is getting a chance to watch you. Thank you for being here. Dr. Sawyer, could you use this opportunity to tell us what are the biggest falsehoods being trafficked on the internet and what are the answers. If the other panelists would like to join in, that would be great. As it has been mentioned, autism remains one of the Major Concerns to parents even though dr. Schuchat has pointed out that there is not a lot of credibility between the two. The whole philosophy of the immunization schedule is to protect children as soon as we can for as many things as we can. Delaying vaccines is really counterintuitive to the whole purpose of the vaccination program. If we were overwhelming childrens immune systems, i am an Infectious Disease doctor, we do not see that into debt months, four months, or six months when we give routine vaccinations. The last major thing you hear about are the ingredients in vaccines and the concern that perhaps some of them are toxic. Once again, that has been discredited and looked at very carefully. The fda approves these vaccines. I will add to dr. Sawyers excellent list that i agree with. The vaccine causes the flu. Id hear that every year over and over from welleducated folks and that is certainly one week work to counteract acres of the benefits of the flu vaccine. The hpv vaccine, my cost might cause promiscuity. We hear that from time to time as well. That is what people concerned about hpv given to preteens. Just to be clear to everybody listening, these are scientifically demonstrably incorrect. I wonder, you are a pediatrician, do you have advice to pediatricians across the country on how to handle the conversation that they have with parents about vaccines . Yeah, with regard to families that have questions and concerns, it is really just that. It is addressing their concerns and questions. You know, back in the day physicians could take somewhat of an authoritative stance and there was a great deal of respect. Nowadays, it is more of a working with families to come to a conclusion on what is best for their children. Whether it be immunizations or whether or not we want to treat an ear infection. As a pediatrician, my goal is to establish a relationship with families and for me to make my recommendations and address their concerns specifically. Do you have anything to add dr. Sawyer . Their curriculum the curriculum i develop basically takes people through the appropriate way to listen attentively to people issues and be respectful and addressing them, but to continue to convey the science in the most clear way one can. So families can reach the right conclusion. Thank you, mr. Chairman. Thank you. I finished early. That is 43 seconds. I will never get that time back. We will put it in the bank. We have time, and i am sure all of us would probably like to ask or have a second round of questions. Dr. Moore, i believe you said the case in measles from tennessee was in memphis . It was actually adult in west tennessee. You describe you moved in quickly and the number of people in that one case that you have to be in touch one with have to be how many . 124 that came in contact. I do not have a specific number for that region, but it was clear because 124 people were exposed and only three people got sick that it was very high. As dr. Sawyer was talking earlier, i was thinking about the phrase going viral. And then dr. Jacks used it. This generation understands the idea of going viral. You are talking about measles flying through the air. That is unlike ebola that threw the country into a panic last fall. When we spent five million dollars, change procedures, and Public Health departments. That could only be caught by an exchange of bodily fluids. This flies through the air and goes viral. This is a disease that goes viral. We senators in a bipartisan way understand the problem of dealing with highly educated people who get Bad Information on the internet. That happens to us every day. We deal with that and we know what it is. Lets go back to the going viral. What if this person in west tennessee, who dr. Moore acted on quickly, what if that person had been discovered in a part of los angeles where the immunization rate is 60 or 70 instead of 90 or 95 . Describe the number of people and the multiplying of people that would have to be contacted to make certain that the disease did not spread. I can share the experience we had in san diego in 2008, which was our last outbreak during we had 12 cases and over a hundred people were exposed to those 12. It quickly goes up exponentially. The number of people you want to track, and unless Public Health is there to track those people and keep them quarantined, it could easily get completely out of control. So you had 800 people, but each of them might have infected someone else, right . Exactly. In that outbreak, we had close to 800 people quarantined for three weeks to prevent that next wave. We were all crossing our fingers with this disneyland outbreak that maybe we are near the end. I noticed that the case number went up by 20 just this past week, so i am not sure we are done with this just yet. Moneys a flight to the air, we have an example of going viral in modern i suppose. Dr. Jacks, this might not be an exact comparison, people asked me why continue to play the piano when i was done and i remember responding that i did not remember my mother giving me a choice, but i guess i had a choice. We are not talking about taking choices away today from parents, but we are talking about a conversation between a pediatrician and a parent. That probably would not start even in this day of parents who feel differently than my generation of parents, lets say, how strongly do you recommend to your parents that they vaccinate their children . I suppose the most persuasive than you can do is tell them the story of your own children. Do you just make a neutral observation about it or do you come to a conclusion and say, i think you should do it . I definitely come to a conclusion of recommending that we do vaccinate. I often times do not approach it quite that way because i won to get their thoughts, opinions and fierce burst. So i can address those fears first. So i can address those. I have heard from a couple that is still pregnant and has not had their first child yet to the routine thing visits where we would do a vaccine. Every visit, whether they are getting vaccinated or whether they are still trying to decide, i am talking and answering questions and urging them to make good informed decisions. My understanding, opinion, is that yes, vaccines are one of the best things they can do to protect their young child. I am not a time, but i assume i am out of time, but i assume my wife led an effort to try to establish Prenatal Health care and trying to let parents know about vaccines before the child is born is a good way to keep the vaccination rate hike. Hi. Gh. Dr. Moore, im interested in learning more about the increase of the uptake of the hpv vaccine. We are very fortunate to have a vaccine today that can prevent most forms of Cervical Cancer, which i am sure you know is the second leading cause of cancer death among women in the United States. About 12,000 women get Cervical Cancer every year. About 4000 are expected to die from it. We know that those are death that not cap that now can be prevented. I like to ask you what can state and local Health Departments due to effectively promote hpv vaccine . That is a wonderful question and we certainly know that a lot of young women and men are not protected against this virus yet who could be. In tennessee, are immunization rates are about one in three and we would like it to be much higher. We are working collaboratively with cancer advocates because they have wonderful experience raising awareness about breast exams, pap smears, and we are collaborating together to try and help families understand that this new vaccine is a Cancer Prevention tool that can help reduce the risk of an abnormal pap smear for a young lady later in life. We are also trying to make sure people understand the vaccine is safe, it last, and it is very, very effective. We bundle with other routine vaccines. So what is given at the same time as other vaccines, the first meningitis shot, and it is part of the routine preimmunization bundle. We are trying to help people understand that there is nothing exceptional about this except that it is phenomenal Cancer Prevention and incredibly exciting to have its will in our hands about the last generation to not have to protect women and men from cancer for their lifetime. Thank you, i appreciate that. I would also like to mention in my home state we have an incredible public and private partnership called vac northwest. At my time when they had the highest vaccination rate in the country, our state Health Department came together with key Health Promoting organizations, within reach, and seattle children hospital, to create an Innovative Partnership which addresses a Vaccine Hesitancy to work with parents and Health Care Providers alike. It has support from the Gate Foundation which was helpful and engagement of a lot of partners. Vac northwest has been doing amazing work and has been evaluated with the intent of sharing a lot of lessons that they are learning with other states. I wanted to ask you, dr. Moore, how can working with private and nonprofit partners help the efforts . Health departments have a major role in promoting immunization. Long ago we started they go to their own private doctors for immunizations now to provide Holistic Care about praying for their child, but we partner with these organizations in order to help support them in doing the right thing. Pediatricians are incredibly busy with everything they have to do and it really helps them if there is a group in Public Health focused on promoting immunizations where we can provide them support like our immunization Information System that makes their job easier. Our role, when it comes to doing site visits about quality of immunization care, site visits that we do in their offices, Educational Programs that we provide, promotional material, we help give them the resources they need for the private sector to do the best possible job for the patients because they are primarily the ones vaccinating our children. This partnership has been wonderful. I am all about relationships and these relationships have been great at developing immunizations. Thank you. Dr. Jacks, i appreciate your willingness to come. Since you started speaking about your own families situation are you surprised to know how many people know that some people cannot be vaccinated . Surprisingly, no actually. There has been a lot of positive feedback, certainly a small amount of negative feedback from certain populations, but it seems like the knowledge is there. I just do not think it is in the public conscience when they are making the decision to vaccinate or not vaccinate. That is why i am doing this. I want to raise awareness of the issue so we can be part of the discussion. I appreciate that. I just wanted to ask you as a pediatrician, what do you think are the key areas to vaccine uptake . Largely education and the misinformation that is out there. Thank you. Thank you, senator murray. Senator cassidy. I would like to question anonymous consent to enter a statement to the record. Thank you. Obviously, we have declining resources on the federal level. I see that the administration is cutting the 317 money, dr. Moore, that you had reference. I also will note as a fellow youths fellow who used to work in a Public Hospital system that there is always a great concern about immunization. Sometimes i would see people come to speak to our pediatrician about immunization and it was like a call to newcastle. These folks cared about it. Jacks and sawyer care about it passionately. Can we use our 317 money more effectively . I asked us not to challenge but to suggest. When i look at that map of california, you can isolate those communities which are not immunizing. If you want to pay jacks to come in and speak to those families whose child was unvaccinated and recently came from another country, their child is at risk. I guess i will ask, are we still using our 317 money in a paradigm of 20 years ago before the dust before we had immunization registries that could pinpoint where we had pockets of the unimmunized . And before we realize that many people are basing their decisions based upon a motion, not upon the physicians recommendations . Simple question, 317, are our programs adapting . Thank you for that question. I can say under dr. Schuchats leadership that we are focused on where we are with our Immunization Program. The 317 funding that we have is going to support our Information System that provides clinical Decision Support for clinicians who need to keep up with the complex current immunization schedule to provide optimal care. It can provide that support. It makes it easy to issue immunization certificates. We are also using those funds to provide education not only for clinicians in large conference settings, it also oneonone education. We will send a Public Health immunization expert into a clinic to spend half a day. Those clinicians, again, they do not need to have a day. They just need to have posted online their clinics results compared to other clinics, and natural competition will drive it and we know that from Infectious Disease rates. If you post an immunization rate and they are lacking, they will come up. I suspect if you did that for Elementary Schools, we are going to post the rate of the children immunized here, so what are your comments on that . First, i would like to agree with your last comment about posting rates for schools. We want parents to be informed about vaccines in general and we should also want them to be informed in the environment they are putting their children in. There is no doubt that is going that a school with 40 or 50 of any unimmunized children is where the next outbreak will be. Is there a push to do so . We should be letting parents know as much as possible about both because i read the pediatrics article that staff provided. If a pediatrician pushes immunization, she is more likely to convince someone to vaccinate them if she is passive, thats ok, i will sign a no. Te. To what degree are we posting individual clinics or to individual schools . It seems like you should be doing that in santa monica. The rates for School Vaccination are Public School information and posted on the states website. You have to go look for them instead of putting them in front of the face of a parent, which might be more effective. Any comments . Well, i will yield back my 43 seconds. This time bank is getting full. I will not get take very long. I appreciate your testimony and answers to the questions. It may be too early to know the answer to this, all of you are on the front line obviously, your hearing a lot. What is the public reaction to this in the last week or so . Because hopefully we are disseminating some information here and the news has been. What do you sense has been the reaction to the outbreak and to all the public information, all the discussion on the news etc. . What has been the reaction from those parents who waived the immunization for the child . Is this being helpful, a learning moment for america . I would say absolutely. I have heard stories from pediatricians that have tried to convince parents for years, and when the Measles Outbreak happened, they were walking in the door wanting to be immunized. I think the publicity is important to raise awareness about the fact that these diseases are still out there and i think the senators who are organizing this hearing can do that. I have had great experience , getting a lot of good questions from the media and family, particularly focused on our immunization exemption which is low, but notably the most wealthy county in tennessee has almost four times as high an exemption rate as the county next door, davidson county, among kindergarten students. I think that caught everyones attention and hopefully, even though our exemption rates do not compare to california and some other places, it is making people realize that these are the consequences of their choices. Dr. Jacks . I would just echo what they are saying. There has been a lot of good awareness and a lot of families have come in to get immunized, both against the measles as well as other immunizations. I just had a family this last week that the parents were kind of split on should we vaccinate, do we not . I remember them and they came in and got all their vaccinations. This article from years ago i think probably did a lot of damage in this. We have seen not an explosion, well, maybe, in autism, at least in the diagnosis of it. Whether it is a genuine increase or just better diagnosis. It is devastating thing, autism. I know that that fear resonated with people, so i think that this is maybe a wakeup moment learning moment, and i hope it is. And i want to thank you for being here today. I want to thank the chairman calling this hearing. Thank you. I will give you one minute and 16. But i am the end, anyway. Senator murray, do you have Closing Remarks . I would just like to thank our witnesses and for being here and doing all the work to help keep people safe from vaccines and preventable diseases very i particularly want to thank our chairman, senator alexander, for holding this hearing. Thank you. I thank senator murray for her work and her staff putting together an Extraordinary Group of witnesses today. This has been very, very helpful. Not just to us but to anyone who has been listening. Dr. Moore, again, we are so proud of our Public Health department in tennessee. I think back, not just on this, but on the Quick Reaction to the fungal meningitis episode where your organization saved lots of lives. Dr. Sawyer and dr. Jacks, thank you for your leadership in your field and your testimony. I think the hope we have is that dr. Jacks message goes more viral than the measles does and that it goes fast. I have a hard time keeping our old my old governor hat off and it makes me think of the importance of our state organizations. Cdc really works through the states. The medical associations work through their legislatures and associations and they are in touch with parents every day. We would like to take some step to solve all of this problem but the truth is, in my view most of that reaction has to be with those who were closest to the parents and who sees them regularly. I think the idea of a medical home for every child is about to who is about to be born is probably the surest and best way for states to approach this because parents are talking to their pediatricians and they are going to make sure their children are vaccinated. I have some Closing Remarks i am supposed to make. The hearing record will remain open for 10 days. Members may submit Additional Information and questions for the record within that time. The next hearing will occur tomorrow at 9 30 to look at the issue of ambush elections. Thank you for being here today. The committee will stand adjourned. The Political Landscape has changed with the congress. Not only are there 43 new publicans and 15 new democrats. There are also more women in congress. Including the first africanamerican republican in the house. Keep track of the members of congress. The page has Voting Results and statistics. New congress best access on cspan, cspan2, cspan radio, and cspan. Org. Late yesterday chris murphy and ben cardin introduced legislation that would repeal the 2001 authorization for the use of military force, the rest known as au mf. Chris murphy in the article on your screen. The authorization was approved by congress in response to that september 11 attacks giving bush the authority to act against those responsible. This legislation would terminate that authorization in the next three years and clarify that congress did not intend or authorize a perpetual war by passing the measure. President obama has been using it to justify the current u. S. Military campaign against isis. This week, he formally delivered a new request for authorization something the house and senate are expected to consider over the next several weeks. The house this week passed a bill authorizing construction of the keystone xl