have learned because there's just really no set curriculum that can be guaranteed. [ applause ]. >> today the civic club of cleveland, we have enjoyed a friday forrum from anne neal. thank you, ms. neal, for your informative remarks. thank you, ladies and gentlemen. this forrum is now adjourned. [ applause ]. [ bell rings ] on the next washington journal, we'll discuss the latest news from ferguson, missouri, and about the resignation of defense secretary chuck hagel. our guests include andrew tilghman. and later, bill shore will be here to talk about hunger in america. our show is live at 7:00 a.m. eastern/4:00 a.m. pacific on c-span. looking ahead to tuesday night, we'll have a look at one community in america is handling the recent influx of young, undocumented immigrants. you'll hear from republican mayor jude it kennedy who describes efforts to provide undocumented children with education and health services. then on c-span2 at 8:00 p.m., a sis dis cushion on cronyism and government. steve simpson shares his thoughts from the hungry minds speaker series. and on c-span, interviews with retiring members of congress. will feature iowa democratic senator, tom har kin and howard coble. it's part of our week-long series. here are a few of the comments we recently received from our viewers. >> i just have to tell you that to see these people in person, to hear them, have the panel discussion or congressional hearing, it is so important to understand the context and to listen to the statement in its entirety. >> i have been watching book tv for a few years and i think book tv is the greatest program on tv. i just really like, you know, how these authors pick the times not only to present some gist of what they write, but the moderator always does a great job of stimulating the conversation. yeah. it's what i look forward to on the weekends for me, to watch as much as i can. >> i watch c-span all the time when i'm home. it's the only station i have on most of the time. i think it's absolutely excellent. i watched all of the debates around the country. thank you for the book talks and for the history. i like all of it. and i am thankful that it's there and i use it in my classroom. i teach at a community college in kentucky. thank you very much. >> and continue to let us know what you think about the programs you're watching. call us at 202-626-3400. e-mail us at comments at c-span.org. or send us a tweet at #cspancomments. like us on facebook, follow us on twitter. the national press club's journalism institute hosted a discussion on vaccine safety. experts explained why diseases like measles or mumps which has largely been eliminated generations ago are now making a comeback. this is an hour and a half. welcome back to the national press club and its journalism institute and a special welcome to the vast audience viewing us today via c-span. i am myron belkind, the president of the press club and we are pleased to be hosting this briefing with the pbs show, nova and tangle bank studios, the coproducer on the upcoming show on vaccines. no question, from maine to ohio to california, there have been many outbreaks of preventable diseases that many in my generation thought were no longer a threat. measles, mumps, whooping cough and even polio. on a personal note, i was a foreign corespondent for the associated press for 40 years, when i am asked, what was the most important story i ever covered -- i respond, that it was covering the eradication of smallpox in india. when i went without a group of world health organization epideemologyists to remote eastern india to report on how they isolated areas of smallpox to ensure that everyone was vak indicated. and those vaccines in india helped make the world smallpox free a few years later. and that is why it is essential not to forget the role of vaccines. no question, this issue of vaccines is being talked about by news media around the united states and the world. and i am pleased that today we will be hearing from a distinguished panel, including journalists who are on the front lines covering this issue, persons like joe lawlor, the health and human services reporter of the portland press harold main sunday telegram. who to better examine the science behind vaccination, the risk of opting out than nova, the premiere pbs show on science, health, education, and more. i want to welcome paula offit. the executive producer here in the audience and julia kourtd, the senior producer who are based at wgbh in boston, one of the pbs flagship stations. and our moderator today is michael rosenfeld. i gather the term tankle bank was inspired by charles darwins on the origin of species and his tangle bank hypothesis. so we look to you, julia, michael and other experts on the panel to help us better understand the complicated echo systems of vaccines. thank you so much, again, for having this important discussion, this very important discussion at the national press club under the os miss sis of its journalism institute. i'm pleased to turn over the floor to julia court. >> thank you, myron. and thank you to the press club institute for hosting this briefing and thank you all for coming this morning. we're here to talk about reporting on vaccination and outbreaks of vaccine-preventable diseases and to share some insights we've gained while preparing our upcoming program "vaccines calling the shots." vaccination is a perfect topic for nova to cover because our primary mission is improving the public's understanding of science through accurate and engaging journalism. in fact, today nova and pbs are among a very small handful of places one can find good science journalism on television. and still, the need for science journalism has never been greater. science and technology is involved in so many public policy issues today. like vaccination, it's crucial that people not only get the facts but get clear accessible explanations and sis of the facts so they can make informed decisions. yet, providing these can be really challenging for journalists, especially on subjects like vaccines because not only is the science very complicated but we're presenting this to readers, viewers, our audience who are not just engaging with the facts but are engaging with powerful emotions, like fear, mistrust. so this is a challenge our producer, our whole editorial team faced putting together this program as we aim to provide solid, scientific understanding in a field that's full of misinformation and misconception to an audience that includes parents who are confused who have a lot of questions but are trying very hard to do the right thing for their children. paula, senior executive producer of nova who is here today and i were very fortunate to be working with an extremely talented team of veteran science journalists including sonya pemberton and michael rosenfeld, who took on this really difficult and complicated but extraordinarily important topic. so, we hope today's discussion is helpful to you as you report on vaccines and on these outbreaks and wrestle with some of the issues that we've been wrestling with. so, now i would like to turn things over to michael rosenfeld, head of television and film at tangled bank and executive producer of "vaccines calling the shots". >> thank you, julia, for that kind introduction and thank you, myron for the opportunity to pash tis pate in this briefing. good morning, everyone. thanks so much for coming. the subject of vaccination is on the minds of many americans right now as we send our kids back to school at a time when vaccine-preventable outbreaks are making headlines around the country. the cdc puts the numbers in perspective. measles was declared eradicated in this country in the year 2000, but there's been almost 600 cases so far this year. that's the highest level in the u.s. in almost two decades. pertussis or whooping cough is also a problem. 2012 was an especially bad year with nearly 50,000 cases and 20 deaths in the u.s. and this year the state of california declared a pertussis epidemic. these are diseases that vaccines can and do prevent, so the numbers would make anyone but especially a journalist wonder what's going on. at tangle bank studios our mission is to shed light on complex topics so the story of vaccines in the context of these outbreaks was irry cystable to us. we've been fortunate to partner with nova and pbs to explore some of these issues. the as a result is a new documentary "vaccines calling the shots" which airs at september 10th at 9:00 p.m. eastern. we hope the film will help the audience understand the science on these issues. at the same time, we know that this is a story that will continue to unfold over the coming weeks and months and years. i think it's safe to say that journalists will have their work cut out for therm as they cover the return of vaccine-preventable disease which is can't be fully explored from any single beat. this is not just a science story, it's a public health story, a medicine story, it's economics and policy, psychology and history as well. our panelists today reflect that breadth. you have their bios, so i won't repeat that information, but i would like to add a few things about them. as you see when you watch the film, paula offit to my left cares passionately about public health. he was a leader in the row toe virus vaccine that saved hundreds of thousands of lives around the world. he has extensive years of experience on the front line of pediatric medicine at children's hospital. paul has a lot to say about the role of vaccines and the return of vaccine-preventable diseases. the way to make a smart film is to immerse yourself in the topic and sonya pemberton, next to paul, really goes deep. when i first discussed this film with her several years ago, i was impressed by how much she already knew about vaccines and sonya has spent the last four and a half years immersing ners this topic. in addition of acquiring a detailed understanding of the topic, she given a lot of thought on how this story should be told. her goal was to craft a film to bring claire toy a very complicated science and be accessible to the general public and to parents who as julia said have a lot of conflicts thoughts and emotions about vaccination. brian zikmund-fisher grapples with one of the hardest things to communicate, risk. he studies how people make decisions at the university of michigan, he is great at explaining tough concepts. those subjects are especially important for vaccine conversation because how you see risk can have a big impact on whether you vaccinate your kids on schedule, delay some shots or skip their vaccination entirely. finally, i'm pleased to welcome joe lawlor to the panel. journalist covering the health beat for the portland press harold in maine. joe has first-hand experience covering vaccination. he has called attention to the rise in vaccine exemption rates and potential legislative responses. he has generated lots of discussion on the web. so that's the panel. i'm now going to ask each of the panelists to speak for roughly five minutes about the subject of vaccines from their particular vantage point and then we'll open the floor to questions. paul? >> okay. if we could start actually there's two-minute clip about heard immunity that will lead into my five minute miss sminut. so roll it. >> the 2013 measles outbreak in new york hit hard and fast, but remained within the brooklyn area. ♪ why didn't it spread to the other 8 million people in the city? ♪ the virus was in circulation, even though it often wasn't obvious. and it was being carried by people who often had no idea they were infected. ♪ but the vast majority of people who came into contact with the virus had protection. they were vaccinated. ♪ >> there's two things that matter for whether or not i'm going to get sick. one is, if i bump into somebody who has the disease, am i protected against it or not? but the other piece and the more important piece is the chance i will bump into somebody in the first place who has this disease. and you can think of this as these sort of concentric circles of people and the less the disease exists in my circle or the next circle or the next circle, the safer i am. ♪ >> it's known as herd immunity. and it protects everyone, including young babies and people who can't be vaccinated for medical reasons. and in new york, it worked. >> if we didn't have the high vaccination levels that we do, you know, in new york city and even in this community, i can promise you we would have had hundreds if not thousands of cases. >> but this protection is fragile. for highly-infectious diseases like measles, we need 95% of the community vaccinated for herd community to hold. if the rate drops, even just a few percent, herd immunity can collapse. >> so, we live in a country of about 300 million people. in that -- among that 300 million, there are 500,000 people who can't be vaccinated. they can't be vaccinated because they're getting chemo therapy for their cancers or getting immune suppressive therapy for their chronic disease or can't be vak nated because they're too young. they depend on those around them to protect them. when herd immunity starts to break down, what you see is exactly what you're seeing now, which is the most contagious diseases come back first. and for example, among the most contagious diseases are measles, bumps and whooping cough. now, as michael said to introduce this, look at the current measles epidemic. i think it's instructive. the current measles epidemic has 060 cases. that's the biggest epidemic we seen since the mid 1990s. 600 cases. now, if you look at this sort of how that happened, the way that it's happened is that generally citizens from this country travel to areas where measles is endemic. meaning it occurring generally year round. for example, the philippines. in the philippines last year there were 31,000 cases of measles and 42 deaths from measles. a traveler goes to the philippines, catches measles and comes back and spreads it for the most part among a group of unvaccinated children. the reason those children are unvaccinated is because the parents had chosen not to vaccinate them. now, although it is the biggest epidemic we've seen in two decades, i mean, it's worthwhile looking at what this -- this disease was before we had a measles vaccine when the first measles vaccine was introduced in 1963. before the first measles vaccine, every year there were 3 to 4 million cases of measles. 48,000 hospitalizations and 500 deaths. everybody saw measles. i mean, measles was a scourge. today all though there are 600 cases, i would bet few people if anyone in this room has actually seen a case of measles. in fact, when measles -- when suspicion of measles case comes into our hospital, a child who has fever, rash and there's a question of measles, they generally bring old people like me down into the emergency department to see whether or not it really is a measles case because people don't remember what measles looks like. for example, when a recent larry king live show, generalmy mccarthy, who is my personal go-to person for health care advice, i don't know if she's yours. she said, when asked -- when sort of addressing the issue of whether the combination of measles, mumps, mmr could cause autism, she said and i will quote, i'll take the freaken measles every time. what that tells you is that not only has she hasn't seen measles, she doesn't appreciate how sick it can make you but she has no recollection of measles. we've forgotten what measles looks like which is remarkable. i remember when i was a attending at children's hospital of philadelphia in 1991, we were in the midst of a massive measles epidemic. it centered on two fundamentalist churches in our city. this was 1991. this is 30 years into the development of a measles vaccine. we had nine deaths. five deaths in a ten-day period in february of 1991. i mean, our city was in a panic. and so, there's certainly those of us who understand the power of measles. for example, about 50% of children with measles will have an abnormal chest x-ray. so i would like to think that what we experienced in 1991 in philadelphia is a lesson from the past and not a prologue to the future. thanks. >> sonya? >> hi. i'm sonya pemberton. i'm a film maker and a science journalist. and like many people in this room, i see myself as a conduit between the experts and the public. translating science for the public is kind of what i do and what i focus on. i'm initially started thinking about this film way back in 2009 actually after i made a different film called catching cancer. that was about how viruses can trigger cancers and how in a funny way that's good news because if you can find a virus causing a cancer then you have a chance of creating a vaccine to stop it. and the film went to air and it got lots of nice reviews and things happened, but then i received a rather large proportion of nasty mail and what many people might call hate mail and abuse. i was actually shocked because i spent most of my life growing up in a medical family. i make medical-based films. i started to study medicine. this was my area. i was surprised. so i decided that i wanted to understand why people could be so upset and so angry about vaccines that they would take the time to write me these letters. so i began a process really four and a half years of digging really deep. i really wanted to understand why people would be really frightened of vaccines. for me, this was alien. i saw it as a life-saving medicine. i didn't understand it. so, i had to really confront my own bias, my own pro-vaccination stance and try to understand what it felt like to be someone who was fearful of vaccines. and that is what led to the film. i thought today what i would try to contribute was five things i have learned about talking to people with hesitancy around vaccines and about communicating vaccination issues. so, from one journalist to many others, here are my five tips at the moment. first of all, never forget that vaccination is a good news story. we get so used to hearing it pitched as an us versus them debate and argument and fight. less than one -- around about 1% of people in this country don't vak nate at all. it's a really small number. can we all just get a grip to start off with? 90% on average vaccinate most of the time or all of the time on the schedule. it's around about -- depends on where you are -- 10% might skip or delay a shot. that group is important. this can affect herd immunity. it's not an ig significant number. it's an important number. but it's really important that we all put it in context that it is the norm to vaccinate and we could re-enforce good behavior in a sense, positive stuff. that was one of the first lessons i learned to think about this as a good news story, not a bad news story. the second and really important thing is that people who have concerns around vaccines are not necessarily anti-vaccine. the number of people who came toward to me -- i'm talking about hundreds of people that i've spoken around the year, i have concerns about vaccines. i'm scared of this or that vaccine. once i was open to having a conversation with them and didn't shut them down with my kind of personal bias about you should just have a vaccine because it's good for you, when i stopped and actually listened to them, i would discover that most of them were not against vaccines. they just wanted to ask questions. and i think we forget that because the group that are strongly against vaccines are so vocal that we can lose sight of this very large group of people who just have concerns. we did the first national survey vaccines in our country n australia and discovered around -- exactly 53% of the parents have some concerns around vaccines. now, the vast majority, 47% go on to fully vaccinate any way. but what was interesting is they had enough concerns to make them question. and i thought the most useful thing i could do as a film maker was try to speak to those parents. so the film in nova is trying to speak to parents who have vaccine concerns and to do that respectfully and acknowledging that people are not necessarily outright refusals, they're simply concerned. and also i think the thing that we need to remember is that the internet has changed the vaccination landscape and it's a force to be reckoned with and people go to dr. google for all sorts of things, including vaccination. so try to counter that with some calm, sensible and hopefully impartial in a sense in the sense that we're just looking at the science and trying to follow what the science has to say. i think that's vitally important. my third point is it's okay to talk about concerns and fear. you don't need to be frightened of allowing people or encouraging people to talk about their concerns. in fact, as brian can atist, there's many, many studies that show acknowledging fear helps people deal with fear. that's how we all process it. when you don't talk about things or try to push them away or don't allow people to talk about this sort of thing, then i think we make the problem worse. so, for me, one of the goals of the film was to help reduce fear. so in order to do that, we took a very brave step to actually acknowledge fear and let people in the film talk about their fears and concerns. and i think that is the fundamental point of difference of this film and hopefully the reason why it will speak to many people. the fourth thing i wanted to add was there are a spectrum of views around vaccines. it is not a debate. and it is not us versus them. that's shore handed, that's lazy, that's not the way we should be thinking about this. there are people with a spectrum of views around vaccines. one really interesting study that i like to think of and it came out of australia originally was a spectrum of five groups. there's the unquestioning accepter, the questioning accepter, the hesitant, the delayer or cherry picker and the outright refuser. now, this is just one way of grouping people. but i found it useful. to try and think of where people sit on this spectrum and remembering the outright refuser is around 1%. so, and there's a very big group in the middle and trying to speak to that group and not -- treat them with respect and listen to what they have to say was really, really important. and again, it's worth remembering the vast majority do choose to vaccinate so re-enforcing that. and finally, number five, it's something that paul offit says very eloquently in the film, and he says, we're all in this together. and when ever i struggled with people hitting me with their opinions about vaccines or their fears around vaccines or saying things that i knew were scientific inaccurate, i had to find a place in myself where i could listen to them and think, look, we're all in this together. we're all united by the need and the desire to try to protect the ones we love, all of us, no matter what your position. and if you come from that position, then i think we can find a basis at which we can have a good conversation. the australian broadcast last year or the original version many, many, many parents, hundreds of parents came forward to say that the film helped, that it opened a new conversation, that allowed those that just had questions to come forward and speak. there was very sane and nice conversation on the internet for about a week, which was really good fun. and people said please and thank you and would you mind answering this question and it was all terribly polite for a little while and that was wonderful to see. the people who would normally have to hit hard had to be quiet because the people who had hesitancy and questions came forward. and also, what was really interesting that came out of it was the australian immuniization specialists started training pediatricians in how to speak to vaccine hesitant parents so they can be equipped with the skills to have these conversations. so, finally, i want to say that i think i'm really optimistic that there is a way to have this conversation and that we can all do it and we can all help the situation and help people to talk to one another and i hope you find the film interesting in that regard. thanks. >> thank you, sonya. so for a perspective on risk and where that fits into this story, brian? >> thank you all. i'm a decision psychologist. my academic field is trying to think about how people gather information, make sense of data, make sense of risk. and in many ways, we ask parents to go through journey much like the one that sonya have gone through to gather information and figure out how -- what they need to think about vaccines what they need to feel about vaccines, and then ultimately what they need to do about vaccines. and so i would like to start with rolling a second clip from the nova episode and then i'll talk about the implications of it. >> wants to vak nate her two children, but she's chosen not to follow the recommended vaccine schedule. >> so the plan is to be fully vaccinated as soon as possible but we're doing one vaccine at a time. i don't know if that's the right way. you know -- >> i don't know where i came up with that? >> yeah, i don't know. >> this woman has a 4-year-old and is expecting another child soon. she delayed vaccinating her oldest until she was 3. >> i was concerned that her immune system couldn't handle it. we just waited. >> my son and her -- they're not vaccinated yet and my older ones don't have boosters. >> mariana has four children. she vaccinated first but then one child had a seizure. >> just really worried about reactions. and i am worried about the diseases, so kind of confused really. >> in america, children must be vaccinated before they start kindergarten, but the required shots vary from state to state and most allow for exemptions based on personal or religious beliefs. here in california, almost 3% of children are exempt and in some schools it's more than 30%. >> i have a lot of friends that don't vaccinate at all. if you say vaccine around them, they look at you like you are -- well, you know, like you are poisoning your child. >> on the other hand, you have parents that they can't even understand why this is even a question. >> nobody is willing to really have a conversation with you and discuss what's a severe reaction, is it okay to have a seizure? i would really like to know what the real risks are. >> so, one of the things that you'll notice in that clip is that there's a lot of discussion of risk and not a whole lot of discussion about benefit. and that's the first thing i want to highlight in the conversation, which is that dr. offit is right. we are facing a point in time in which the benefits of vaccines are just much harder for parents to understand, precisely because it is not part of their experience. 70 years ago every parent, every grandparent, knew personally cases of the kinds of diseases that we now prevent with vaccines. you didn't have to sell vaccines to them. they wanted vaccines because they didn't want to have their children grow up in a world in which those diseases were the threat that they were. today, as dr. offit pointed out, people don't know that. they don't know it in that intuitive sense. i can have the words that measles is circulating, but unless i have the experience of knowing someone with the disease, it doesn't have the same impact. our risk perceptions are fundamentally as much about experience and emotion as they are about thoughts and facts. and so the challenge that we all face is how do we help people understand the threat of vaccine-preventable diseases in a world in which their narrow circle, the people close around them, are not, in fact, likely to include somebody who is affected by whooping cough, polio or measles. but, of course, the challenge here is that in the modern world we are -- our society is mobile, right? the person who is standing behind me in starbucks could have been in russia, could have been in india, could have been in africa yesterday. we do not know what that person is bringing with them. and precisely because of the mobility of modern society, the intuitive understanding of the people around me sick? well, if not, then maybe i'm safe, no longer is an accurate representation of the risk we potentially face. and so somehow we have to have the conversation on a public level to help people recognize, to tell this possibility story and help them understand that it's that benefit of vaccines that we need to get back in touch with. now, we do need to talk about safety and we do need to talk about the questions that parents have. right, gabrielle in the film ends that little clip there with two sentences that i want to highlight. she asks, you know, what's a severe reaction? is it okay to have a seizure? i want to point out two things about that. the first is this -- she knows that vaccines are not perfect. she knows that she has to at least think about the possibility of a reaction. and that is true. vaccines are not perfect. she wants more information. and as a result, the simple statement of vaccines are safe is not going to feel satisfying to her. from a public health standpoint, vaccines are one of the safest things that medicine has to offer and that's part of the reason why we offer it to people because we know at a population level the benefits vastly outweigh the risks. but on a personal level, that's different. and so, the challenge is we have to acknowledge the complicated story in order to gain the trust of parents like gabrielle. if we simply say, vaccines are safe, why should she trust that? she knows it's more complicated. we have to be willing to go a little bit deeper. now, when she asks, is it okay to have a seizure? what she's really asking is, is it okay that this thing that i hear has benefits, also has risk? how am i supposed to, as a parent, put my child at risk? and so the last thing i want to talk about is the parental experience of risk. parents always want to do what's right for their children and to keep children safe. but part of us always knows that risk is everywhere. i'm a parent. my daughter just turned 16 and i handed her the keys to the car. unquestionably, the most dangerous risky thing i will ever expose her to. and i did it any way because i knew that the benefits to her, to her development were worth putting her at risk. now, that doesn't mean i ignore risk, right? we want to be safe. i give her a safe car. make sure she trains, she learns how to drive well, et cetera. just like it is appropriate for parents to say, how can we minimize risk in the context of vaccination? but we also have to engage with a point that part of what being a parent is sometimes dealing with risk because risk is everywhere. and, you know, vaccines are incredibly safe. most children who are vaccinate have had the most trivial symptoms if anything. but severe reactions do occasionally occur. those tend to be very temperature rare but they can be scary. there's a duality of risk that i need to end with. at a population level, public health can say, look, this is a one in a million risk, we don't need to worry about it if it has huge benefits. it will outweigh whatever the risks are. from a society standpoint, from a policy standpoint, that's all right. i have no problem with that. as a parental standpoint, parents don't care about probability, they care about possibility. and it's possible that their child might have something scary happen to them, they're going to worry about that. we have to acknowledge that reality in order to be heard by them and to be trusted by them. so, the conversation of vaccines for me is one of respecting the emotions of parents and helping them realize that, yes, this may not be the easiest thing to do to watch your child get a shot. but it may well be the thing that you need to do for all the benefits that it will provide. >> thank you, brian. so now for a perspective from a journalist who has been actively covering this story, joe lawlor. >> hi. thank you for having me here. i guess i just first wanted to point out that the folks on this panel here are all -- have lived or studied this issue for their entire careers, many years, and, you know, myself, i started looking into this in july. you know, but i dare say, you know, many journalists will be approaching this like myself from completely an outside perspective or learning things on the fly. you know, i'm the health reporter at the press herald in portland, maine. i've only been the health reporter for a year. i would say, you know, there would be a lot of general assignment reporters or city hall-type reporters who may end up covering these kinds of stories based upon, you know the dwindling resources in the media unfortunately in this day and age. and the other thing i wanted to -- so i want to talk a little bit about how i came upon this story and, you know, it's really not a very obvious story. in 2012, there was a pertussis whooping cough outbreak in maine. and so, you know, i started at the newspaper last year. so i wrote about just kind of a straight story about, oh, there was this outbreak and isn't that -- shouldn't besomewhat concerned and then just kind of moved on. but then this year it was pointed out to me that maine had one of the highest voluntary opt out rates for parents choosing not to vaccinate their children. the opt-out rate -- this is for children entering kindergarten. the opt-out rate is 3.9%. as a journalist, when you see a number like that, you're like, is that really that bad? but as the documentary, the excellent documentary points out so well, is even with small numbers, people opting out, herd immunity, what protects all of us, breaks down even at 95% or less vaccination coverage depending upon the disease. so, the more i looked into this story, the more i realized this is really could be a pretty big deal. i mean, it would be better to write about it before than after. if there was some really tremendous, terrible outbreak like what happened in philadelphia in 1991, i mean that would be a tragedy. i thought it would be better to write about this before. so, any way, spent a lot of time -- so the other thing that really struck me about this topic, unlike a lot of things, if people -- say 5 or 10% of the population believes something that's not true, for the most part that doesn't affect me, down, affect us. so if you're at your family reunion and your second cousin talks about area 51 or the aliens in roswell, you know, you might just kind of nod your head and move on to the next conversation and it doesn't really affect you. 5% of the population believes that, so be it. but with vaccines, in order for them to work properly, you really need everybody buying in or almost everybody buying in. and so, you know, that really struck me. so, we did a pretty comprehensive story about this. you know, talking to all different types of parties, including somebody who had contracted polio as a child and people -- we got the side of the people who were -- didn't believe in vaccination. but i do have to say, we also made the decision that for this particular story, you know, and as a documentary points out very well, the science is settled. there is no debate amongst scientists, whether vaccines work and there's no proof -- it's been debungt about the connection between autism -- there is no connection between autisms and vaccines. so, from -- when approaching this story, you have to look at it like, okay, these people have concerns but it's not a scientific debate. they're having a debate which they believe to be scientific but it's not scientific. so you can't do the whole, you know, well, this side believes this and this side believes this and let the readers decide. it's really not that kind of story. you really, i believe, are doing a disservice to the readers if you approach it like that because the science, as i said, is settled. so any way, so we put the story together and it ran and the reaction to it was really -- even though i had been researching this topic for about a month and kind of got a sense of how much depth and breadth there is to this topic, it's really -- if you read about it, it's really quite amazing. but the reaction to the story still floored me because we had over 600 comments on our website and, for us, that's probably 10 times the normal amount of comments that we would receive on a story. and, you know, i was really interested in what types of people were commenting on the story. you know, it was fascinating. it wasn't just the 1% that sonya was talking about, the veer lant, absolute anti-vaccination people who were commenting. there was a lot of people who i believe were just misinformed, who were -- you know, they weren't militant about it but they were just misinformed and didn't believe that they felt like the cdc was hiding something maybe or that there was just the scientists were covering up information. but -- and then there was a healthy debate and a lot of people who were patiently debunking the claims that people were making, which i thought was a good service. so, you know, we're going to continue following this story very closely. we did some followup stories and there's more to come. i think there's a big topic -- this is a huge topic. and the other -- the point i want to make is that there's also an element of -- it's not just a science story but it's also a political story in a way because this gets to the issue of should the government be telling me what to do? should the government be forcing me to have vaccines? and there's a clear correlation between states that are -- for instance, washington state used to be one of the highest -- had one of the highest opt-out rates of children entering kindergarten in the country. and they made it harder -- they didn't make it impossible, but they made it harder for parents to opt out. and then upon doing that, within just a couple years they've seen a reduction in the percentage of people opting out and also a corresponding reduction in outbreaks. but this is not an easy -- you know, in maine, just last year, they -- it made it through the house a bill that would have i don't want to get into too much detail here, but it was an anti-vaccination bill and it passed the house and it was killed in the senate but it passed the house so our legislatures were playing pro vaccination legislatures were playing defense in a way. in vermont, they just -- the governor of vermont, you know, has gone on the record to say that he believes parents should have a choice and it should not make it harder to opt out. vermont has one of the highest rates of children -- of parents opting out of the vaccine. and so, you know, i suppose if you don't really think about it in detail and really get into the heart of why vaccinations work, it does sound logical that government should not force me to do something. but, you know, this is one of those cases where the 5 to 10% of the people, you know, it really does matter. so, thanks a lot. >> thanks, everyone. i think that probably gave you all a good sense of the complexity of this subject and also of how personal it is for people, both parents and doctors on the front lines who care most about protecting their parents through vaccination. so, with that i'm going to turn this over to all of you for questions. there are microphones available that will be coming around in the aisles. and if you wouldn't mind just telling us your name and your affiliation. thanks so much. yeah. right up here. >> hi. is it on? >> yes. >> this is penny star with cns news. some of the people i had mentioned to sonya before this event that there are -- you mentioned the internet and there are sites that people i know go to it's called the informed parent. one of the main things they do is use cdc stats to make their arguments, anti-vaccine arguments. i wondered if you could address that issue as to -- in other words, is the government doing enough to actually communicate with parents about the benefits or the risks. >> paul, do you want to take that? >> thank you. so, for example, if you look at the impact of vaccines on diseases like the theory of measles, et cetera, and you go back far enough, late 1800s and late 1900s you can actually see the measles or bumps or diphtheria decline even before vaccines were introduced. when vaccines were introduced -- that's because we changed things like sanitation in this country, hygiene in the home, that had an impact on these diseases, obviously purifying the drinking water had an impact on reduction in diseases. you see that there's a dramatic reduction because of the introduction of vaccines. that particular cdc statistic will be used by those who oppose vaccines, saying, see, we didn't need vaccines because the rate was going down any way. but certainly these diseases would still exist if we didn't have vaccines. and we have abundant evidence of that. for example, when the soviet union was dissolving, and there was tremendous upheaval, the incident of diphtheria declined in a series of countries that didn't really see much diphtheria and then it rose. we saw 50,000 and then there was the introduction of diphtheria vaccine and then the rate dropped again. the same thing can be said with japan and the pertussis. there's no reason to believe anything other than what the data show which is that vaccines clearly make a difference. don't use them, and the disease goes up. use them and the disease goes down. so that's one example. in terms of how the cdc or others try and communicate that, i think a lot of groups, the american academy of pediatrics, there was a vaccine education children's hospital of philadelphia, every child by 2, there's a lot of groups out there that really try to communicate good science to the public. i think they do it compellingly and passionately and i think it's made a difference. if you look at the way this story is covered now as compared to 15 years ago, it's much better. will there be those groups who consistently hold on to the notion that vaccines are doing more harm than good? yes. i don't think they're ever going to go away completely. i think we're making a difference. lot of people are trying to communicate good science to the public. >> brian, do you have thoughts on this one about science communication point of view? >> the one thing i would add to this is to acknowledge the character of the internet and the role it plays in the discussion of vaccines. right? the internet is not just making information more easily available to people. it's enabling us to share stories, to share individual cases. of course, the cases that someone wants to share are the cases that have emotional power, right? if you believe rightly or wrongly, if you believe your child was harmed by a vaccine, that's the kind of story we want to share. that's the kind of story others share. the store rirs that don't get shared as much is the story that's the most common story. i went. i got my child vaccinated. i hurt a little bit. it didn't bother them that much. nothing happened. he doesn't get sick. this is boring. but it is the fundamental story of vaccines. it is the story that's the most common story of vaccines. and precisely because in a web 2.0 environment, the shared content comes from users, what we tend to see when we go looking is a disproportionate share of the people who want to share information. and that's not a fair representation -- it's not even close to a proportionate representation of the lived experience of vaccines. and so that's the challenge we face is how do we help people understand that what gets shared is not a fair representation. it's the people who want to be sharing their story. and to give voice to the other story. right? the story of the mother whose child is in a classroom where there is measles and what is she feeling at the moment she realized, yes, she did vaccinate and does that make vaccinate and did that make her feel safe? that emotion is also important here, but it's hard to find, and somehow i wish we would be able to make that story more common. >> you're probably going to talk about what i was going to suggest. there is a story in the film that really gets to this, which is the pervae story. >> this issue of telling the boring story is really interesting. one of the scientists i talked to early on said, sonia, if you're going to make a story about this, just point the camera at a normal family eating dinner and run it for an hour. and i went, what? he said, because nobody is getting sick. they're eating dinner and going on about their lives. they're not getting sick, they're not taking temperatures. that's the story of vaccination. i'm going, sure, i can't turn that into an hour of television. it is interesting how we as communicators tell the story effectively and accurately. we took a bit of a gamble in this film, and i say gamble because it was definitely story to tell a classic story that you see on the internet of my child was a healthy, beautiful, fabulous little baby, and six months of age, everything was fine, and hours after the vaccine, everything went terribly wrong. you can find those stories on the internet. i chased a lot of those stories. i tried to talk to a lot of parents. it was very hard to verify those stories. but i found one family who were willing to speak, i had their medical records and they were in the film. they were a very interesting story because their child, 17 hours after vaccines at six months of age, started to have seizures, and those seizures were ongoing and devastating and resulted in this child having brain damage over time. and for the first year of that child's life, they believed it was the vaccines. but then testing was done and they found that their child had a form of epilepsy triggered by a fever. and in this kind of epilepsy, jarvais syndrome, the seizures start at six months of age. the little girl in the interview that wasn't in the film, hers was caused by the flu. she was six months, she was luke's little friend, actually, she got it from the flu and he got it from a spike in fever from the vaccines. the vaccines were not a cause. the vaccines were a trigger, like jumping on the trampoline is now a trigger for him or getting upset is a trigger for him, because he has epilepsy. but it was a journey his parents went on because they truly believed the vaccines had caused this to their child. so it is usually the story of some child getting sick and trying to put a face to it and put science to it. one thing i did want to say is that if we can try and tell the stories where nothing goes wrong, it's really helpful. it's really, really helpful, because it is the norm for all of us and we don't question it because we're living in this wonderful, relatively safe world. so i think we have an obligation to try and share that safe story as much as we can. >> just briefly, to follow up on one thing that sonia said in terms of sort of the relationship between causal and temporal associations, my wife is a private, practicing pediatrician, and she came in the office on a weekend and she was helping the nurse give vaccines. there was a four-month-old sitting on her mother's lap along the wall, and while my wife was drawing one of the vaccines into the syringe, the four-month-old had a seizure, and then went on to have a permanent seizure disorder epilepsy. if she had given that vaccine five minutes earlier, i think there was no statistical data in the world that would have convinced her anything but the vaccine caused it. my child comes in here, she's fine sherks ge fine, she gets the vaccine, five minutes later she has epilepsy and the vaccine didn't do it? so i think you have the emotion of the verdict rather than the statistics, which is a hard fight. >> if i can make one quick point, i think also a lot of the fears and opposition comes about, at least in maine and probably some other places. oregon might be another good example of people taking a movement, for instance, like the organic food, natural movement, which it's good to eat your vegetables and things that come out of the ground or other processed food, but then for whatever reason, i believe vaccines and maybe other forms of western medicine have been labeled as being artificial, and, therefore, bad for you. and so, you know, i'm sure people could talk about why that's not true, but i believe that sentiment is out there, and there's trace amounts of things like formaldehyde that would absolutely not make you sick, but people see that and they get scared, and that was actually the bill that was introduced in the main legislature last year that passed the house, got killed in the senate and was just informing parents of every single ingredient that was in each vaccine without any context behind it. a scare tactic, essentially. but yeah, i just wanted to point that out. >> just a quick point. formaldehyde is natural. vk seasons a vaccines are natural. they're derooiived from parts o nature. we've been making formaldehyde ever since we crawled out of the ocean and went to land. what goes into your bodies is r rhythmically coming out of your bodies. they were able to get 3,000 people in california. hydroxy monoxide, they were able to get people to take because they never lied. they said it's in our tears, it's in our streams and we've got to get rid of this. and that worked. so chemical names always sound bad. >> context is everything. >> i want to say that one of the things we have in the film is we show vaccines go back at least a thousand years, and it was a traditional form of therapy that people used to do, and we explain where that comes from. i found that astounding. i didn't know that. if you're into things that have traditional focus on things, i think that's interesting. but i also think there is a false -- again, another false positi polarity here that if you are into organic food and all this other stuff, you don't vaccinate. it's an artificial divide. it doesn't really exist and we shouldn't buy into that. there is a group in australia called immunize, and they put signs around saying, i do yoga, i meditate, i eat organic foods. they have posters that basically say you don't have to be either or. that's not the conversation. we're artificially making that a divide. >> i'm alan kotok with science and enterprise. related to this discussion we just had, do you see any correlation between the fears of genetically modified -- genetically modified organisms in food with some of the engineered molecules you find in vaccines? >> i think that's a great point. yes is the answer. you know, it's just -- so, for example, the human papilloma virus vaccine and the hepatitis b vaccine are both used using common technology. i think these are great vaccines for that reason. you take a single protein from the virus. you basically use the yeast cell to serve as a factory to make that protein, then you purify that protein. it's basically 100% purely o one-surface protein. it can't possibly reproduce itself. it's that one part of the virus, and it's the important part. what could be better? you're right, it's genetic engineering. first of all, foods are genetically modified all the time, they're just genetically modified in the wild. what you want to do, you want to be able to create a situation where you're going to get the most benefit and the least harm. and that's true with vaccines. they use the term vaccine virus. for the natural virus, they actually don't say natural virus, they say wild type virus. what it says is that in the wild, it could do anything. wild type virus has reproduced themselves thousands of times or sometimes tens of thousands of times in your body. a vaccine virus usually reproduces itself 20 times. that's what you want. you want us to be able to tame nature. this sort of notion that it's man against nature and nature is all good, i don't know what planet people are living on, because mother nature can kill you. you want to make sure that doesn't happen. >> other questions? there's one over here. >> good morning. my name is ann graham and i'm a state legislator from the state of maine. and i want to first thank you. i'm also a pediatric nurse practitioner. and i wanted to ask, particularly, to sonia. you were talking about the response you had to your film. i want to know what works as we move forward. how do we make -- how do we get to a place where we reinforce positive behavior or a way to get -- move forward from this? my hopes with this is we can jump-start getting more children vaccinated and healthy. could you comment on that and kind of give us some positive stories as you moved forward after your film? >> yeah. look, i wish i had the absolute answer to that, of course, but i think through our film being released, the australian version being released last year, and obviously the american version is next week. but the australian version told us a few things, and that was there were many, many more people wanting to talk about this than the broadcaster realized. we had 1 million facebook posts. we had -- i can't remember now -- it was over 100,000 downloads, which in our country is enormous. we have it free on the internet. no one anticipated the level of response. so firstly, people want to know about this, people want to talk about this. secondly, opening the conversation to say it's all right to have concerns made a difference. and it was the point of differen difference, that we were not going to tell you what to do, necessarily, but we were going to invite the conversation to begin. now, that can sound like a trite statement, but it wasn't. it was very genuine. it was difficult because people came to you with stories that are difficult to hear, especially if they're scientifically not sound, you know. it's very hard not to jump down people's throats and say that's nonsense and leave it at that. you had to actually really engage. we found having a lot of good materials, having good people on call who could answer complex questions. i'm not a medical doctor, i'm not qualified to answer the really complicated questions, so don't try and speak beyond your area of expertise was really important. and we found that, sure, we got hit by a lot of the negative stuff, and that was a bit depressing because after a few days, what happened was there was so much spamming going on, it stopped the real conversation. by spamming, people just kept dropping inaccurate information into the mix. they were actually calculating, which was interesting. that was depressing because you have to go, oh, do we have to block you, do we have to stop that? we tried not to. we tried to keep it open for as long as we could. so i guess the only really strong thing i would say is that people are interested, the conversation is worth having. let it run. try not to control it too much in the sense if there is absolute nonsense coming into the place, you have to be careful about that, but most people just wanted to have a conversation and provide them with good information. >> i would also like to add, i think there is some important parallels in the vaccine context to the conversations that have been going on now for a decade or more in terms of patient role in medical decision making that we no longer exist in a society in which the physician is paternalistic and says, we're going to do this, we're going to do surgery and you have no choice. and that evolution has been important. and the challenge is, how do we inform patients -- patients aren't medical experts. they need enough information to get the gist of the tradeoffs that are faced to understand the ways their values enter into this, but also the ways in which they need to respect the science, the way they need to respect the data and understand when their doctor is saying, this is really a good choice, why their doctor is saying that. that it's not just because somebody said so, that there is, in fact, a reason behind that. and to respect the fact that they might want to know, at least in some form, what that reason is before they nod their head and say, yes, this is a good idea. so engaging at that level, recognizing if we're going to give parents autonomy to make choices, we also need to give them the empowerment, the information, but also the emotional empowerment to face that process and to be a partner in that. most patients, when faced with difficult treatment decisions like what breast cancer surgery to have, they're not saying, i know everything. they're coming in with questions in mind. they're coming in knowing they're not an expert and wanting help to figure it out. i think if we take that perspective here, we open the door for people to say, here's how much i want to know, or here's the pieces i don't understand. and then to engage with them on that and to help them move forward. >> i want to say something super quick. we were also really surprised and astounded by the amount of reaction that we got to the story, but upon reflecting about it a little bit, it does make some sense, because while maybe only 5% or so on the top end don't vaccinate their children prior to kindergarten, there is some evidence out there that shows a lot of people are delaying vaccines, spacing them out because of fears, and i think we've all run into people or many people have run into people who have at least heard from somebody who is concerned about safety of vaccines, and so i think it's a topic that many people are very interested in. >> just following up on something brian said, this isn't going to be terribly popular, but this is sort of my point of view on this. it's, what does it really mean to be informed? we say we want to inform parents about vaccines. let's take the chicken pox vaccine. if somebody comes into your office and says, i've done my research and i've chosen not to get the chicken pox vaccine, then they haven't done the research. because if you do your research, you'll get it every time. what does doing research really mean? what parents mean is they've read opinions about the vaccine on the internet. but to really do research for that, what you need to do is you need to read the several hundred articles that have been written about that vaccine. you need to understand how that vaccine was made, what the difference is between that virus or wall type viruses. to do that you need some background level in virology, epidemiology. i think a few doctors have that. what we do is rely on a panel of experts like those who advise the cdc or those that advise the aap to at least collectively after that expertise and then advise as to whether or not that vaccine should be given and when and why. but that's extremely hard -- i'll say it another way. that's an impossible message to sell in the 21st century. that just doesn't work. brian is right, at some level people have to know they're being informed to some extent, but what informed means, i guess, is a tough one. >> i think it's important to clarify. we talk about paternalism in the early days years ago in medicine. paternalism meant, you will have surgery. i think we also need to acknowledge in today's world that even if we don't do that, medical professionals, public health professionals do have a responsibility to help guide someone through the process of thinking about something. it's not just, okay, it's your choice, go away, you're on your own. no, no, that's not sufficient. we do have a responsibility as people who are experts in the science or experts in the context to say, this is what you need to pay attention to. this is the piece that you may not yet understand. if you want to go back and read it, you have that right, but we can't just throw information at parents and expect they have the skills to make sense of it all. we need to draw upon our own knowledge and our own expertise to guide them through that process, even if ultimately we were going to turn around and say, yes, you have the choice at the end to decide what you're going to do. it's not just a choice to, you know, read whatever you want and think that that is a full understanding. our understanding, our expertise, is part of that and we need to share that. >> i would also say one thing that gets forgotten is doing nothing is also a choice. so the choice not to vaccinate is a choice to do nothing. and it has its own risks. so i think one of the messages i thought people don't often get is that doing nothing is also a risky choice. and the other thing i found interesting that, by and large, one thing parents often didn't understand is if your child gets one of these diseases, for the most part there is no cure. there are treatments, and lots of interventions we can do today, but there is no cure. so some parents would say to me, oh, if my child gets measles, i'll just take them in and get the vaccine then. so there are some basic sort of things we have to deal with. but also that one medicine -- i met one family from switzerland whose 17-year-old daughter got measles, and unfortunately, they didn't agree to be in the film. it was too raw for them. but they were quite a wealthy family in switzerland, and their daughter got severe measles. long story short, she was taken to one of the most fancy hospitals in europe, and she died at 17 from measles in 2011. and there is nothing this family could do to save her, nothing. the best medical technology in the world in one of the best swiss hospitals in the world couldn't save this 17-year-old girl. now, that's a message people don't get. it's very unlikely to get that severe measles, we know that, but it can happen. >> i have to say, though, that that understanding is something that is clearly driving the medical professionals you meet in this film, and paul actually speaks about it very eloquently in the film regarding the 1991 episode of philadelphia. i think we have time for two more questions. is there another question in the room? >> do you see any difference in perception between adult vaccines and children's vaccines is this do you run into the same problem with shingles or influenza? >> i think as a general rule, pediatricians at family practice are much better about making vaccines part of their routine care. adult -- physicians that take care of adults are less good at that. certainly immunization rates in influenza have gotten much better over time. i think the physicians who take care of adults have gotten better than that. there is a new anticoccal vaccination for adults over 65 and we have a single vaccine recommended for all adults over 60, but as a general rule, the uptake around adults is pretty woeful. so we're not that good about immunizing adults than we are children. for whatever reason, we're less passionate about it. >> i do think it's a fundamental problem, precisely because for an adult vaccine, you're doing it to yourself, right? if you hear information about risks, you're taking it on for yourself. we all protect our children more than we protect ourselves. and that's part of the reality here, is that we will look at our children as vulnerable, as people who need special protection for very good and appropriate reasons. but that means that information about potential concerns about vaccines, about even just the simple side effects of, your arm is going to hurt, has a different meaning with our little infant than it does with ourselves. that makes the conversation more difficult when the tradeoff between benefits and risks has to come to the surface. >> question back there. >> hi, i'm linda cramer jenning with glamour magazine. the reaction always focuses on mothers. what do fathers think about the vaccine? >> i admit, i don't know a whole lot of data information on the gender you're talking about. we know that for child medical decision in general, it is more often the mother who is involved, but that is to some deegan issue of availability, of generations, and i do believe that's evolving over time as more fathers become the primary caregiver of their children. the generational issues are important. the generational issues are extremely important for many reasons. the experience issue in terms of what have parents actually seen in their lived experience, but also in terms of the way in which parchts parents gather information. my generation uses the internet differently than my daughter's generation does. that's the part that we have to respect, that the conversation today is different than the conversation was 25 years ago, and it's going to be different in 20 years. because each generation gathers information in different ways, stories circulate in different ways, and we have to respect that we have to move the conversation along with the technology and the process. >> i always like to say as an aside from a personal experience, my wife has the say over what vaccines they get, but i'm the one that has to take them in, and i would describe my youngest son as being vaccine hesitant because they tried to give him a shot, and he ran into the parking lot and i had to chase him down. a little more seriously, i just want to say from a generational standpoint, those 50 and older is really unquestioning. you know, they lived or it was close enough to their generation that they saw the effects of measles and polio, et cetera, and also, the whole thing about history, you're condemned to repeat it if you don't remember. if you look back at the media coverage from the time of, say, jonah salk, he was a conquering hero, really. it was an ann arbor, michigan where they made the announcement, and there was a famous quote from him, you know, edward armorall, would you patent the vaccine, would you patent the son? it was viewed as heroic from people that i've interviewed. i also just want to say really quickly that i had never seen a modern video of a child with pertussis in the mental ability. it really hits home. >> back to the gender differences, my experience was it didn't impact in a negative way. when the human papilloma virus vaccine first came out in 2006, i actually spoke at my daughter's high school. she was in eighth grade at the time, so it was the most harrowing talk i've ever given. i also talked to a group of senior girls at an all-girls school. i asked them who had gotten vaccines. about half of them raised their hands, which is better than today, but i asked the other half, how come you didn't get them, and they said, my father didn't want me to get them. probably because this would likely increase the possibility of sexual activity. when tmy daughter turned 18 yeas old, i told her she could date who she wanted when she wanted, she just had to wait until i was dead. >> can we go until 11:00? that reminds me of something that i actually wanted to ask sonia, because you made this film initially for the australian market. and then we brought you over here and you essentially remade it for the united states. i guess i want to ask you, what did you discover getting to come here and cover the story in the american context about what's different? which stories, perhaps, were more important and less important elsewhere? >> well, the australian version was designed also for the european market, so it covered a lot of stories in europe and britain and ukraine and india, and it had a very different kind of slant. so the view that we took in the original was to keep it very global even though there was about 30% australian stories, but to keep it very focused on which disease spreads. the american context for me has been quite different, because in australia, a vaccination is not mandatory. you can choose to vaccinate. as we put it, we have the carrot, not the stick. so you get the trial benefits and so forth and you can get child baby bonuses and things if you have your child fully vaccinated. in our country, our vaccination rate is sitting about 93%, so it's higher than here. so there were different issues. what i learned about the american situation was that it's more passionately debated, i think, here. it's more divisive in some ways. i think the issues -- in our country the issues of the measles, mumps, rubella, that doesn't really warrant big discussion because most parents have made the decision that's been put to bed. we have to explore that in more detail for the american audience because that's still a live subject here. hpv, the uptake in our country is quite high. 80%, i think it is. what is it here? >> hpv? >> hpv. >> hpv for girls that have completed the series is 38%, for boys it's 14%. so it's woeful. >> so in australia, for girls it's around 80%. it's much higher. i think the distrust of authority is greater here in some ways, and this ability that you can trust your own opinions and your own research is more dominating in terms of a psychology here. so that's all been interesting to explore that. at the same time, all the moms in the film have been great and very giving. we didn't want to ridicule you, we just wanted to show your story. you were so frightened and forthcoming. i'm not sure we would have gotten quite the same thing in australia. i think most importantly, though, is we can't forget beyond the sort of emotional issues and the scientific issues, there are also the issues of convenience and the realities of how easy it is for parents to get vaccines or not. medical coverage in our country is free, so we have a whole different kind of set of issues. it doesn't cost you anything to go and have a vaccine. so we've got completely different kind of forces at play. i do think somebody in europe once said to me, there are the three c's of vaccination. and it was confidence, complacency and convenience. and the issues that kind of shape whether people are going to vaccinate. confidence in your vaccine or confidence in the information that you have, complacency, if you're very complacent about the disease and you don't think it's a threat, and convenience. if your social system, your government, your medical systems is set up in a way that makes it easy for you to go and have your children vaccinated, then all those things influence whether or not you will. it's not enough just to blame things on parents. there are systems in place that also inform that. does that answer your question? big question, that one. >> we'll have to wrap up after one more question. >> one more question. it's really quite self-serving on my part. i fully intend on bringing legislation in our next legislative session to help encourage vaccination rates. i understand, particularly, michael, you had mentioned that nova will have some pieces around what states have done as far as legislation. if you could speak to that or if joe has a sense of that, i would appreciate it. >> sure. well, the broadcast goes out, you know, in a week on the 10th. there are extensive details on the nova website, and they include articles on a range of topics including the legislative framework. there are infographics being done, so there is really an extensive effort to kind of keep the story going and great resources for parents and others who are interested. >> one of the things that i would encourage people to do is if you're interested in this subject, we'll put members of your family or community who are nervous about vaccines to spread the word. i think it would be really useful to have people use their own networks to sort of have that conversation during this time. because there's a window where you can certainly talk about things that perhaps you usually sidestep. i guess one of the things i was really surprised by is the fact that in one of the families, there are a few people in the family that are reluctant to vaccinate, but people just avoid the issue and don't talk about it. here comes a window to talk about it, so if you can use your networks, that would be really terrific. >> in the very few minutes we have left, let me just ask the panelists if they have any concluding thoughts or things that you would just like to add before we have to