introspection. i'm del walters for al jazeera. for more go to www.aljazeera.com. >> it's been 300 years how jener figured out how to oh smal stop small pox. this is "inside story."

hello, i'm ray suarez. polio, small pox, measles, dip they're i can't, whooping cough. they were scourges to the population bringing death to generations of human beings. one by one their burden has been lifted from humanity, certainly the developed world through the use of vaccines. small pox has been irradicated. and now these diseases are rar rarely seen among american kids. but these diseases have been allowed to gain a foot hold. outbreaks would we would be seen once again in metropolitan areas because not everyone is

vaccinated. disease and vaccines on this "inside story." people close to ohio state university in the midst of mums outbreaks. young children are most at risk. >> parents will take kids to the mall, and they'll be exposed to germs that they won't normally see. >> there was a small outbreak. in 62009 there were 4,000 cases. but since the vaccination introduction mumps have dropped. measles cases are also on the rise. 53 people in ten states have been infected with the disease this year. the measles were under

eradication in the united states a decade ago. there were 189 cases in 2014, a huge jump from 2012, which saw only 55 cases. >> measles, you could have an incubation period from the time you're exposed anywhere from 10 to 21 days. you become infectious before rash onset. >> measles are contagious and can live in the air two hours after the infected person has left the area. last month in new york some 20 cases of measles were reported in upper manhattan in the bronx. the state health commissioner said it may have gained speed in hospitals. >> even though we have high vaccination rates overall there are pockets

of people that is infectious. >> health conscious parents who don't see vaccine as natural or healthy. or parents fearing vaccinations are linked to autism based on a 15-year-old report that has since been debunked. some high profile celebrities have questioned it's use. jenny mccarthy links her son's autism to his vaccinations. she said he has since been cured

through gluten-free diet and alternative medicines. people often feel that they are protected from diseases through herd community. if others are vaccinated then their own children won't catch it. it requires a 80% to 90% vaccination rate which some communities in the u.s. are struggling to achieve. nearly half of american toddlers born between 2004 and 2008 were not up-to-date on their shots for undane reasons like work schedules, transportation problems and insurance woes. >> what really worries us is that measles can be deadly. up to 30% of people who get measles could have some complication. >> if measles complications were to stop worldwide the "world health organization" warns

people would die every year from a preventable disease. >> just this week the colorado hospital of representatives passed a bill to make it harder for parents to voluntarily opt out of vaccinations. if they don't want to vaccination viccinizethen they will have too through vaccination education. in our washington studio, barbara lowe fisher. and in baltimore daniel salmon , doctor, let me start with you, are most american kids getting their required vaccinations before they start school?

>> yes, they are, ray, and that's very fortunate. they're getting their vaccinations. they're listen ing to their pediatrician and family doctors, but as your piece said increasingly there are parents who are not knowledgeable about vaccines, skeptical about vaccines, spreading out the immunizations, keeping more of their children susceptible for longer periods of time, and that has people like me fretting and worried about that. for the children's sake. >> daniel, do we know what fraction of children that is, does it vary from immunization to immunization? >> well, the fast majority of parents get their children vaccinated. 2% of children nationally don't get vaccinated by those numbers are deceiving. as you pointed out there are communities where much higher rates of parents refuse vaccines.

and those communities are at increased risks of outbreaks of disease. >> well, when we say increased risk is there kind of a rule of them that we know if a certain percentage of kids are not getting immunization you're in trouble, otherwise not? >> yes, unfortunately, it's a little more complicated than that. generally we want to see 90% to 95% of people vaccinated. but we saw, for example n california which was seeing major outbreaks of pe pertussis, there were higher rates of parents refusing vaccines, they were also part of that pertussis outbreak. >> barbara lowe fisher, one pediatrician wrote plea he thinks it's his single most important job as a pediatrician to get people vaccinated. how is it at the same time there

are all these doubts? are they well-founded? >> well, that's an interesting statement by that pediatrician. i know when i was growing up in the 1950s, and by the way we were talking earlier i had measles, i had rubella, chickenpox, i had all of the children in my generation did. that the pediatrician would say that that is his single most important job is to get his children in his practice vaccinated. his single most important job is to help those children stay healthy. there are children who are not candidates for vaccinations, and there are children who have having reaction to vaccination. that's why you have parents asking today. it's a profound experience when you take your child into a pediatrician, and you follow the orders that have pediatrician, and you get your child vaccinated, and you watch your child regress physically,

emotionally, and that child becomes a different child because they had a severe reaction to vaccine. families talk to each other. this personal experience is shared because we have three times vaccinationed recommended by the cdc than when my children were being vaccinated in the 70s and 80s. >> doctor, i admit when i look at the chart today, i have kids in their mid 20's, there are many more vaccinations than there were on the recommended list, and they come close together, and it's changed radically since my kids were kids, is that fair? >> it's fair and it's wonderful, isn't it. we're giving more vaccines, and preventing more diseases. back in the day when ms. fisher and i were young and there were measles about, 400 children in the united states died of measles each year. that number is now zero. we could go through that litany

for each of the vaccine-preventable diseases. the fact that modern designs has provided the means to prevent so much illness to make childhood safer is miraculous, and we're the envy of the world in the implementation of our childhood immunization program. >> it's one thing to have seven vaccines. the core vaccines in the 70s and 80s, we now have vaccination convenients on the recommended and mandated schedule that do not fit the same category as those seven diseases. we have diseases, like diarrhea, infant diarrhea, it's a problem in the third world but not here. hepatitis-b is mainly an adult disease and it's give to newborns at bit. people are asking questions because the kinds of vaccines are not like polio and small pox. this discussion that is being

held is needed in our society because we cannot continue to assume that more vaccines are going to increase our health when we're seeing one in six children today who is learning disabled. one in nine has asthma. one in 50 is diagnosed with autism. w we need to do the science and find out if the scheduled is contributing to the increase of chronic disease and disability. that's what we need to ask of science. >> we'll deal with these after the break. but before the break, barbara lowe fisher just put out there the hepatitis-a and b and noted they're rare in children. why are they on the required schedule for infant vaccination? diseases that are not very common in children? >> you have to get into the

individual disease, and i would agree with ms. fisher more discussion and dialogue is important, but i would also point out that those chronic diseases that she's talked about have not been found to be caused by vaccines. some of the vaccines we use today are not as serious like polio, but other new vaccines newer vaccines like influenza type b is a very serious disease. one needs to look at not necessarily small pox or polio as the only model of disease we want to prevent. >> how does disease like hepatitis-b which is rare in the population in general, but certainly among children get on the required rota for infant vaccination. >> if you look at hepatitis-b, a fair amount of transmission was occurrinoccurring from the mom o didn't know that she had

hepatitis-b, gave bit to the baby who was infected and then 20 years later whether or not woo come down with cirrhosis of the liver. the transmission of that virus was occurring at birth. the hepatitis-b at birth prevents the mother from transmitting the virus to her child. >> we'll take a short break. when we come back we'll talk more about the cost-benefit analysis about the small number of children who have debilitat debilitating side effects versus the needs of the much larger

>> welcome back to inside story. i'm ray suarez on this edition of the program we're talking about vaccination and the return of diseases like measles that had nearly been irradicated. in the united states children are vaccinated against 14

different pathogens and get 24 immunizations by their second birth and five injections during a single doctor visit. those numbers reflect the recommended immunization record. should parents be able to opt out of it? >> it should be the principle and practice of modern medicine. informed consent means you have the right to be fully informed about the benefits and risk of the vaccine. yes, i believe there should be freedom of choice regard to rack shaq vaccination in the united stat states. >> part of the problem may be

exposure in kindergarten. >> you have the right and the freedom to do that. if you looked at medical literature, you do not believe that your child is a candidate for vaccination because you believe your child may be at risk of having a reaction, you must have the freedom to protect the child's health. medicine of 2012 and '13 acknowledge that there is gaps in knowledge of who is at high risk for suffering a bad reaction. the same is true in the inning of who is at highest risk of suffering from an infectious disease. we've got to do better science. that is the message, informed consent and better science. >> doctor, is it possible to know if some children will have bad reaction, whether it might

be better to space them out differently, to give them in different sequence, any that have. >> the childhood immunization schedule has been studied very thoroughly. we've convinced 80,000 pediatricians and family doctors, the "world health organization," so this is something that parents should have a great deal of comfort in. now, there are some children who are immino-crow miced, take medicines such that they can't take their vaccines. for these reasons they should not receive the vaccines. we protect them by protecting the healthy children around them so that the viruses and bad bacteria can't find those children. we have a responsibility not only to our children, but to all of our brothers and sisters who live in our neighborhood. we work on this together as a community, and we should take great pride that we can protect

those children today by protecting ourselves. >> barbara lowe fisher, is that a compelling argument, that part of what you're doing is not only protecting the people in your small family but people of your whole community? >> a mother's first duty as a mother is to nurture her child and protect the health of her child so that child can become a productive member of society. if we all protect our own children in the best way that we can, that by extension will protect the community. we cannot say that herd community is more important than the health of an individual child. >> daniel salmon. exceptions vary from state to state, by design should they be hard to get? >> every state has their own laws for school entry and exemptions from those laws. they do vary between states

because the laws are the state's rights. it should be fairly difficult to get. i do agree with ms. fisher that parents should have ultimate decision to vaccinate or not vaccinate their children in most cases unless there is a terrible outbreak of a disease and the state needs to step in. but if a child is going to choose not to vaccinate and take an exemption, i think it should not be easy to do so. i think they should go through the effort as it would take to get vaccinated. >> you heard ms. fisher speak up to informed consent. if you did a counseling session and you decided no, do you part company at that point? you made your best case and the parents say no, i don't think it's for me, and you just leave it there? >> well, i do agree with ms. fisher at least in most cases the parents should ultimately be able to decide what vaccines their children get, but often that educational

counseling doesn't occur or meet the needs of the parents. so it's very hard for them to find good, accurate information that addresses their needs. >> we're going to take a short break. when we return we'll talk about the campaign that comes from some parts to keep kids from becoming vaccinated at least when it comes from different so many money stories sound complicated. but don't worry. i'm here to take the fear out of finance. every night on my show i break down the confusing financial speak and make it real.

>> according to an institute of medicine study commissioned by the government, 90% of children have been immunized with most recommended vaccines by the time they enter kindergartenned. we're discussing vaccines, parents' concerns about safety and the decision not to vaccine and concerns for public health. >> in our washington, d.c.

studio barbara low fisher president of the vaccine information center, and from baltimore, maryland, daniel salmon from vaccine safety. dr. salmon let me begin with you. do you think the skepticism that exists about vaccination comes from the rising tide of skepticism of authority that you see in many parts of our lives. religious authority, education, media, the judicial system, there is a lot of doubt in public institutions that used to be pretty unquestionably trusted. is this part of the same thing? >> yeah, i think that's part of what is going on. it's not the fuel picture. it's true that the government strongly supports vaccines and they do so because of the tremendous vicinity tha benefite

population. likewise, large corporations and companies that make drugs and vaccines are also not doing as well as they might in terms of public confidence. back when these diseases were prevalent they were also feared. if you look at polio and you speak to my grandparents' generation. they didn't go to movie theaters and swimming pools because they were terrified of polio. the vaccines developed were not funded by the government. they were funded by dimes put in cans by the average person to develop a vaccine. the vaccines developed were developed by people who became national heroes. not sports stars but scientists who developed vaccines. when there was a lot of disease people were afraid of those diseases. today largely because of vaccines we don't see these diseases. however, people are afraid of other diseases, many of which

ms. fisher mentions mention like autism . there are many who struggle with a an autistic child, and that fear often contributes . >> we're not as afraid because we're not as sick. >> again, you have to make a distinction between diseases. polio and small pox are very different from some of the other diseases that we're vaccinating for today. the question is really today a lot about the numbers of vaccines, and the numbers of vaccines that are given on one

day and how early they're being given, and the lack, again, the institute of medicine has pointed out we need to fill in the gaps in the science. it's not settled. science evolves. it is not static, and we have to do a better job of finding out just how many children are regressing an vaccination from chronic and poor health. there has to be a balance between preventing infectious disease and chronic disease. it's about health and not just government policy without exception. >> there is a distinction between chickenpox, which is uncomfortable and inconvenient, and polio, which is life changing, isn't that a fair point. >> you have to understand that there are children who are going to get serious complication was all the illnesses we've been talking about today, including chickenpox. so the impact of the vaccines is to eliminate those

hospitalizations and deaths that occur from all of the diseases that we have been talking about. and i think it's a natural thing to think that we can continue to prevent more diseases as we develop more vaccines. we ought to celebrate that. think about it, measles, as i said before, we used to have 400 children in the united states on an annual basis die of measles. there is no evidence that measles vaccines or others that mentioned today. that science is really quite secure. >> that's all that we have time for on this edition of the fire. to my guests, thanks for a good discussion. that brings us to the end of this edition of "inside story."

from washington, i'm ray suarez. . >> welcome to al jazeera america. i'm del walters. these are the stories that we're following for you. some people said they hit snags as they try to beat the deadline for the affordable care act. crimea making it clear that the country won't back away from its decision. and how climate change could drastically change our world.