g ahead. many say in order for children to benefit, it will be up to political leaders to cap up. >> and a reminder there's more news on the website. hello, i'm ray suarez, if you're an american of a certain age you remember when people routinely got measles. i had it in elementary school in the 1960s. did you? fast-forward to 2000. infectious disease specialists pronounced measles effectively eradicated in the united states. suddenly it's bringing illness and maybe death to americans. why? health officials are concerned it's because a growing number of parents are choosing not to have their children vaccinated.

look at the numbers from the centers for disease control. last month 180 cases were reported. 42 tracked to an exposure at disneyland in california in december. if you look at the data from the last five years, it's a growing problem. in 2010 less than 100 people got the measles, a normal year since near eradication in 2000. last year there were 644 cases. measles, immunity and debate over vaccinations in the 21st century, we are here in our new time, in our new home - it's "inside story". in the battery of vaccinations a child gets before

starting school is the mmr, the measles, mumps, rubella. in almost every state in the union parents can, for personal, religious or medical reasons object to the vaccination requirement for entering school, and the percentage of american schoolkids declined. in marin county california, a higher personnel of parents than any other state asked for exemptions, where 6-year-old rhett is a student. he battled leukaemia and with the climbing number of measles cases in california, his family is concerned and trying to protect him. rhett can't get the measles vaccine because leukaemia has weakened his immune system. carl is rhett's father and joins us from san francisco. welcome to the programme. has the large number of exemptions in marin county made the act of going to school for

your child risky? >> thank you for inviting me to your show. first of all, we knew there was a risk sending our child to school, not just to get the measles, but any ill possess. it is lower now because he's finished his chemotherapy. the real risk is not just for our second, but the other kids that are not immunized there too. that is the constep of the immunity. based on science, which is logically explained, and reliable immunization. if we don't get the number of immunization up, the risk is higher. we are at that point now where everybody is at risk. >> what are you asking the school system in marin to do. what can they do to accommodate your forwards and understand your case? >> so we have asked the school

to help us solve for heard immunity. what can we do as a community to get more people to immunize their children. we know that it goes beyond the school. it's in the libraries, the grocery scores, planes, everywhere. we suggested if they banned children who are not immunized by reason of personal choice, not medical, personal choice. if those students were banned from school, we believe more parents would immunize their children. and then the hurt immunity level would rise. question. >> would that involve changing the law in california. the way it's constituted, it's my understanding that it's six to get an exemption. >> so. first of all the law was changed in january. you can't sign a paper saying i want to be exempt because of perm choice.

the law says you have to have the personal choice exemption validated by a medical doctor, a paediatrician, for example. that's a step taken this year. yes, the law will have to be change the further to enable strict rules, so that kids who are by personal choice not immunized can't go to school. we asked the superintendent of schools to align with others, and make that ask of the public health officials, and our state government. to force that change. >> does this set up a head-on collision of rights. i mean, you have certain desires, you want to protect your child. many of the parents choosing not to have their kids vaccinated believe they are protecting their children as well. >> and i respect their - that they want to protect their children. i respect their personnel

beliefs. what i do not expect is their choice to not immunize their child when it can have an effect on other children, meaning if their child gets the measles, and passes it to another child at school or irp in the community, their joys has caused harm in our greater community. it's not unlike second hand smoke and the rules around peanut butter. we have a rule - do not send peanut butter to school or send your kids to school with peanut butter because others have allergies. for some reason, the law is protecting people who have exemp shons for measles. >> if your view is accepted by the county school system, there could be a result that kids that

come to school and don't have a vaccination record could be barred from class, told "you're not welcome." >> they can choose to go to a different school. i'm suggesting the public school system can be - can take a position to help educate, like we education our chairman. we educate on the real science. we'll never get 100%. partly because of medical exemptions, like my child. it's important to find a vehicle to get everyone to immunize their children. using the public school system, especially coming into kindergarten, i believe it's the best time to do that. today? >> he's doing great. thanks for asking. as a matter of fact his immune system is building up nicely, we are confident he'll be immunized soon. i feel

that this goes beyond rhett, it's other kids facing life-threatening illnesses that can be impacted if this spreads. not to mention the parents. sorry, one last thing. if there is an outbreak in our school, our son has to stay home for 21 days. that's tough on a family with two working parents, to be told you have to stay home with your kid for 21 days. >> not to mention it injures the learning process. being out of school for three weeks, you miss a lot. >> we know what that is like, he missed a lot when he was sick. >> thank you for joining us on . >> thank you for having me much. >> when we come back, with more of the programme after a short break, we'll have more on the spike in measles cases and the cost benefit questions vaccinations raise for individuals and the ethical exchanges for whole societies. stay with us, it's "inside

story".

welcome back to "inside story", i'm luis suarez, we are looking at the soaring -- i'm ray suarez, we are looking the at soaring number of measles in america, more than a decade after it was considered eradicated. new jersey governor chris christie was touring a vaccine research and production center in britain as part of a trade mission. he was asked about measles cases and vaccines, he pointed out he and his wife had their children vaccinated and said:

chris christie was trying tohread the needle as a republican with national aspirations and a state government with oversight responsibilities, he spent the next day walking back the statement a measles vaccination endorsement. and stated: joining us for the rest of the programme, a paediatrician in washington d.c. and a doctor from baltimore city health commissioner. does a statement hike governor chris christie help you as a municipal health official?

>> politicians should base what they say on science and fact and evidence, not on what is appealing to individuals at any given time. we know vaccinations are the biggest sus cess, that they have saved thousands of lives. it used to be every school a child would get measle, and hundreds of children died every year. many thousands suffered damage, like brain damage, hearing and vision loss. to get to that point, to a point now where back in the year 2000 measles was considered eliminated. that is a big success story. tragedy. >> does having any doubt undermine the whole eddy fizz of using vaccines as a public health measure.

>> i'm okay with parents asking questions. i don't see it as a problem for physicians to answer the questions of sceptics. i believe we should be transparent, it's worth it for parents to understand the risks and bent fits in either choice, to fact sinuate or not. the more that -- vaccinate or not. the more we allow parents to run the risk of letting children be exposed to preventible diseases like measle, the more we are health. >> has the age of the internet ushered in a distrust of authority so you and your white coat with your stetho scope around the neck are not as readily believed by parents would feel there's another source of information. >> i feel the internet made it possible for people feeling antiestablishment to feel validated. i don't know whether it's

necessarily that physicians should be threatened by the internet's offering of the information. we should look at ourselves as earning our patient's trust. maining and answering their questions with the best evidence and guiding them towards a decision that is in their children's best heath. >> some of this is binary. you have people saying you ought to do this. this is medically recommended and people free to say "i'm not going to do it." . >> we somehow not allow people to make decisions an cafeteria-style choice. the problem with the internet is people are hearing this from all facts. >> dr jenny mccarthy. >> that's right, the

epidemiologist amongst all of us. that's not fact. when people are choosing different things, that is not good med skin p sin. there should be -- medicine. there things where it's a decision that doesn't just affect your family, but everyone around you as well. in the case of vaccinations it's good for your child. we know we need community, 95% or so of the community to be immunized against the disease in order for everyone to be affected. now we see what happens when 95% is not immunized and outbreaks are happening. >> as we heard in the first part of the programme. california tightened up its process. some for gaining on exemption. if you want to not get the child vaccinated, it's not as easy as it once was. if

i want to start at baltimore schools, do i need a full card of vaccinations. >> we do. this is why we have a vaccination rate of 99% in public schools. this is also why in baltimore state we have not had a case of measles in over a decade. that is something we should be proud of in the city. we are protecting and safeguarding the health and well being of all the children, not just the individual who makes a decision to not vaccinate, but we are protecting the health of all of our kids. >> is the disneyland case almost like having an extra arrow in your quiver. people are reading about it, thinking "gee, i've been to disneyland", they identify with the experience "i could get sick because there are unvaccinated people here." >> absolutely, it's a teaching

moment for public health, medicine and parents. a fact about the disneyland outbreak that concerns me, six infants caught the measles from the outbreak under the age of one, which was the first age at which we can give the measles, mumps, rubella, they were depending on their herd, the rest of the community, to keep them protected until they are old enough to get vaccinated for the disease themselves. the children are depending on the rest of us to do our part, keep up community immunity. i feel it's a valuable experience because they were not anticipating going to the happiest place on earth. that is not what they wanted for their family whatsoever. the more that families are looking at these are not just personal risks or choices, but that we are building a community health

experience, that we are building community immunity together. i feel that is a valuable outbreak. >> and it's a reminder of how contagious measles can be. these are not necessarily people who have coughed or sneezed or touched each other or been in physical contact with each other at all. >> absolutely. that is the thing that is scary about the measles virus itself. it is extremely hardy, 90% contagious. exist in there for hours after a person coughs or sneezes, can live on the surface. so this is not really something that we are able to look at and readily identify that oh, this is a sick person, i need to maintain my distance or put on a mask or gloves. it's in the environment. it's in the surfaces that we are supposed to share with each

other, like a cafeteria. disneyland or shop or store. we should be able to do these things without feeling we are risking our health. >> as long as everywhere has their shots, they can do still ahead - how to talk to families who vaccinations vaccinations. it's not enough to tell them that they are wrong. do health officials see that they have a problem. how do you turn them around and get the numbers headed in the other direction. stay with us.

you're watching "inside story" on al jazeera america i'm swore ray suarez. wednesday on "america tonight" michael oku will report from marin county on the measles story, and dig into why so many

parents in an affluent, highly educated area are choosing not to vaccinate their children and what that means for others at risk. that's wednesday. paediatrician, host of "doctor america youtube show" is with me, along with dr lena wen, baltimore city health commissioner. dr wen, you have the force of law, the authority of government of baltimore, but you would like to win the argument, bringing parents along, rather than order them to vaccinate. how do you win the argument. >> it's about science, evidence, and iltraiting about what's when kids are not operating. in the 1930s, they had an outbreak of measles, and there were thousands stricken ill. many permanently disabled, and many who died as well. and illustrating what happens

when people are not vaccinated, and illustrating what happens when people are vaccinated. telling stories, using science is a way to win the hearts and the minds. >> i'm touched that you are concerned about me. i'm listening to you. i've read about mercury, autism and kid who get sick after getting vaccines. i'll choose not to do it. >> i'm a doctor at heart as well. i agree with my colleague that ultimately it is about a doctor, patient relationship and understanding the reasons behind why someone is making a certain choice. nearly all the time after speaking with someone we'll be able to change their minds because we'll see that and perhaps what they got was evidence came from a different source not validated, and see that they heard an anecdotal story. ultimately it is about having a trusted relationship.

whether with your doctor or your practitioner or public health commissioner. it's something that we have to get over misinformation. >> we heard dr wen use an example of an epidemic in the 1930s in baltimore. >> is part of the problem, part of what makes it hard that vaccine succeeded too well. it's hard to illustrate the downside of wide-spread illness when people don't have it in their own experience. >> yes. i wonder whether we are punished for our success. whether there's a bird in the bear by not witnessing your neighbour or the kid down the street put through the trials and tribulations - are they going to make a comeback, suffer consequences. the kid down the street is not as far away as we think they are. there were 145,000 deaths among children worldwide from the measles. they didn't happen necessarily in the united states, but

happened overseas. and these days with how mobile our communities are, it's not hard to imagine that that could be the next-door neighbour, the child down the street. furthermore, we have the children in our midst who are unable to get vaccinated. we know children struggling with leukaemia. i have been at the bedside of patients. these are patients in our communities, in our schools, they are in our neighbourhoods, and if not. we don't necessarily think about the children that could be dying from measle, we could see these very living, real children who could not be contracting something as presentable as measles because of misinformation on the internet. these are fellow americans, we have it within our reach to protect them from something as preventible as measles or whooping cough or rubella. >> some doctors suggested

running rough shod over the religious exemption because so much is at stake. in the ohio case, a missionary came back from asia, not having been vaccinated. was carrying measles, gave it to a religious community that doesn't believe in vaccinations, ohio. >> on our mind, baltimore is not an island. a week ago we had a suspected case of mooseles -- measles. it turned out not to be measles. we went through the process of contract tracing, and given how contagious it is. we wanted to take every precaution and treated the case like suspected measles, it was a wake-up call that even though we haven't had a case in 10 years, that it is not an island. we have people travelling all the time. that's it.

we have children who cannot be immunized. week. >> we have to do our best. >> we are at a point where they are right around the 91, 92% mark. are you worried that we'll have, at some point in the near problem? >> i'm worried about that, because it doesn't take much for the viruses to get a foothold. it doesn't sound that strong. maybe 16%. that's all the opportunity some germs need to start trouble, to start, to cause problems for people that never had the choice about whether they wanted the disease this their community. >> have you seen an active case of measles.

>> i have not personally and i hope i do not see one. >> that is reflective in itself. you are not 22. you are a fully fledged professional adult and have never seen measles. >> my md is a little over 10 years old. the only way i have known about it is people who have trained me. i've been trained by physicians that lived through the '30s, and '40s, they were the first responders to the outbreaks in their communities. to listen to their stories, experiences, to see how their hearts were broken by families devastated by diseases that they never got to have that choice. that is something that stays with me if i have not seen the case myself. >> doctor, great to have you with us. thank you for joining us on this edition of "inside story". get in touch on facebook, follow us on twitter and watch us next time.

in washington, i'm ray suarez. >> we're following a funeral cortege procession through the outskirts of baltimore... kyndal staten was shot dead at his home in northeast baltimore. he was 27. today his family and friends are burying him.