ideas festival. hosted by atlantic and aspen institute. we'll show you as much as we can until the program on the press club on vaccinations gets underway at 9:30 a.m. eastern. . . >> for those of you who are watching out in the lobby, these next sessions will be great. the man who's keeping us safe in town, bill bratton, and our

editor-in-chief, james bennet. >> thank you, commissioner, for being with us today. [applause] i thought i'd open with a familiar, oft-repeated statistic that i thought i should repeat again. you'll correct me if i have it wrong. in 1990, there were 2,245 homicide in the city of new york, which i think was the record mark. and last year there were 333 homicides in the city of new york. though the population had grown by a million people in the meantime, and there are however many millions more visitors to the city every year. i can remember what the social implications of that statistic were for neighborhoods across the city in the early '90s, and the transformation is nothing short of astonishing. you arrived in new york to lead the transit police this 1990. -- in 1990. and while there are no doubt

many factors that explain the decrease, the source of strategies and tactics you put in place from aggressively implementing the broken windows philosophy to pursuing data-driven methods of policing are widely credited with this transformation. so you're the guy to ask, i think, about what's next. and i've heard you talk a lot in the last couple of years about predictive policing. and i thought we might start there with what does that actually mean? >> okay. predictive policing is the evolution we're now going through in policing. the period of time we're in right now is called the information intelligence era that we have learned the importance of gathering as much information as possible and as quickly as possible, making intelligence out of it. in policing that was the com stat system we put in place in 1994. that was the engine that really

drove the crime declines that allowed us to move from the all-time murder high in the city to, last year, the all-time low. good news is so far this year we have 18 fewer murders than we had same time last year. to the good news is that crime can continue to go down. the challenge to do that is to find ways to, in fact, do it. and predictive policing, i think, is going to be one of those tools. with the huge amounts of information that we can gather, with algorithms that have now been developed and are being continually improved upon, we have the ability within a geographic area to predict with some certainty within a certain time frame that a crime will likely be committed there unless we put that by putting a police officer there. cops on the dots. same thing as we did in the 1990s. >> it does sound a little bit like "minority report." you're not identifying the criminals in advance though,

you're identifying the likelihood of a crime being committed? can you give a concrete example? >> actually, in some respects you are identify aing the criminal because the algorithm also takes into account who's live anything that area, who's been arrested, who just got out of jail, the patterns and trends of crime that are being reported matching up against who does that type of crime. so the minority report you referred to is the tom cruise movie in the late 1990s that looked so futuristic, and now everyone in the audience with your iphone can do exactly what tom cruise was doing that seemed so futuristic as recently as ten years ago. this is the reality of policing, and as we go forward into the 21st century, it's going to become much more common place. the idea of using technology, using big data, using all of the new ways of collaborating with each other to effectively keep crime low, and most importantly,

prevent it from occurring in the first place. >> so what, in the future, can we as citizens expect our public spaces to feel like? i mean, there are now 6 or 7,000 cameras in the streets of new york. do you imagine more in public spaces, the use of drones and so forth be as has been pecklated a lot lately -- speculated a lot lately? >> >> we had 7.5 million people in 1990, we now have, we believe, 8.5 million, probably more, and with the 56 million tourists, that number is growing. we're going to live in a densely crowded city where public spaces will, in fact, be more crowded. from the police perspective, one of the things we'll attempt to do is to try to continually improve our ability to police those public spaces. my principled successor, commissioner kelly, post-9/11 implemented the program called domain awareness initially in

the wall street area and growing up to 59th street in manhattan and now moving north. that eventually will be throughout the city, and that's the camera systems. currently 7,000 cameras, private sector, police cameras that are all interconnected so that we have the ability to very closely monitor -- particularly in manhattan -- public space. we also have license plate scanning capabilities that in the future it will be impossible to come into the city of new york and not have your license plate scanned in some fashion at ez-pass or some location where that number is being recorded. all of this is constitutionally-protected activity, the if you will. it has been deemed by the supreme court to be lawful to, in fact, do it, and quite frank with you, it's one of the ways that we, in fact, will keep you increasingly safe. that in exchange for giving up some degree of privacy that we will be able to, one, prevent crime which is more important

than solving it after the fact. there's not one of you that doesn't want, that wants to be the victim of a crime. every morning at my 9:00 crime briefings and my 8:30 terrorism briefing technology and big data is an essential part of just about every crime i look at in that briefing in the morning. >> you have pulled back from one of your predecessor's policies. you've disbanded the so-called demographics unit that was monitoring muslim communities very closely, keeping files on people, listening in on conversations in restaurants and so forth. do you think that we either in the city or, and/or nationally, i guess, did lose our balance a little bit in the struggle against terrorist threats in recent years? >> no, not really. the entity you're referring to had other names, called the them graphic name -- demographic name, i think, was most commonly

used. at its peak, numbered about 15 officers. when i arrived in january as new commissioner, the unit was down to, i think, three officers, so it effectively had been disbanded prior to my arrival and the remaining three officers out of 1,000, by the way. to read some of the tabloids, you'd think armageddon had arrived on january 1st. we have over a thousand officers in the city of new york that spend their time on counterterrorism activities. so the removal of the last three officers from a function that had, basically, over the last several years ceased to occur, it was not going to diminish in any significant way our capabilities. and it was also, i point out, its function was not just to effectively try to learn more about the muslim community. with any community that the department did not have a sense of or idea of, we are incredibly mixed society t in new york

city, 200 some odd different population groups here. and from a policing standpoint, the more you know about those various communities, the better off we'll be able to police them, to develop collaborations with them so if there is an issue happening in their native country that we need to be aware of because it might generate concerns here. we do need to be aware of those commitments, but i don't think we need -- of those communities, but i think we can do it through census tracking, through many other methods. >> are some of the methods of the unit still part of the practice of the rest of the force? >> well, certainly we have community service officers in each of our 77 precincts, and their role is to intimately understand what communities exist, that their role is to go out proactively, introduce themselves, understand issues in those communities, ways that we, the police, can understand them, interact better with them and protect them better. so that's what i'm talking

about. and i've got hundreds of community service officers that are doing a lot of the same work that this entity was doing. we're doing it in a much more collaborative manner, much more trust-building manner than the idea that somehow or another we were spying on a particular community. >> if i could ask you the balance question from the other direction. i wonder do you worry, do you think that the public we are -- as 9/11 recedes a bit -- are becoming less, less concerned than we should be about terrorist threats? is this -- i don't want to presume that anything keeps you up at night, but is that what does keep you up at night mostly in this job? >> in this city the concerns about terrorism, i don't believe, have diminished. it's every day in the newspapers, we'll have the event on the 15th of this month, the

opening of the 9/11 memorial museum. and then in october we'll open the new world trade center. so inasmuch as that's where 9/11 occurred here, it's constantly in our memory and constantly in our day-to-day lives. throughout the rest of america, i think there's been a significant dropoff. i really had to fight in los angeles the seven years i was there, 2002-2009, to get resources to build up a counterterrorism capability. again, each though los angeles has been the subject of several plots, it had not -- it had experienced two airport-related incidents, but nothing on the scale of new york. so america's second largest city, 9/11, the network of it, had faded very quickly. it certainly has not, i don't believe, faded in this city. and certainly for the new york city police department, we'll be in this for the rest of our existence as anybody who lives in new york, your children,

their children, the issue of terrorism is going to remain a fact of life here. >> let me ask you about another controversial practice of stop and frisk or stop, question and frisk. you made clear that it's an essential part of the tool kit, that you can't really police without it. but you're reforming it here. so what is a reformed version of stop and frisk look like? >> i actually think the term "reform" might be the inappropriate term. what we are doing, we are modifying it. stop, question, frisk is a constitutionally-protected activity, terry v. ohio, supreme court of 1968, that outlined the parameters within which police would have to operate. that you have to police constitutionally, respectfully, consistently. you can't police different in a poor neighborhood than a rich neighborhood. the issue of stop, question, frisk is that a police officer has to have reasonable suspicion

, and reasonable suspicion is less than probable cause. it's a lesser proof, if you will. but it has to be something that he or she can articulate as to a belief that a person or persons has, is or is about to commit a crime. and they have to be able to articulate why they feel that. that then entitles them to stop a person, it entitles them to question a person, and if the officer fears for his or her safety or fears that the persons they're interacting with might be a risk to the safety of the public, that they might be carrying a weapon, the officer can then frisk that person. it's a basic tool of american policing. it's something that you could not function effectively without. myself and mayor de blasio, that really felt that over the last several years in new york city -- i shouldn't say the last several years, several years ago that the practice had grown too large for the extent of the problem it was addressing. 6-700,000 stop, questions and

frisks documented. while crime was going down dramatically. and that was the mayor's police professional, that belief was certainly different than the former mayor, mayor bloomberg, and the former police commissioner, commissioner kelly. although over the period 2012-2013 the numbers of stop, question and frisk had declined dramatically from a peak of about 6-700,000 down to sever hundred thousand. -- several hundred thousand. meantime, crime, with fewer stops, continued to go down. and so far this year we do probably anywhere from 50-100 stops a day, down from the peak of several thousand a day. crime continues to go down. so my belief is that we were doing too much of it. the cops who are asked to do it believed they were doing too much of it. the unions that represent them believed they were doing too much of it. similar to you going to a doctor for cancer, he's going to treat

you with radiation, chemo, surgery. and you want it to be appropriate to the extent of your disease. and after you're feeling better, you don't want him to keep giving you more radiation, more chemo or more surgery if, in fact, the disease is being dealt with appropriately. so i liken stop, question and frisk in new york that the patient was getting better. crime was down dramatically. but particularly in minority communities, more and more medicine was being applied, and the patient was not feeling better about what the doctor thought was an improved condition. so in any event, the issue has now been, i believe, diffused because we're still practicing it, and we'll continue to practice it, and at the same time crime is continuing to still go down. and hopefully, relationships between the police and particularly in the minority communities that experience still as much of the remaining crime, that those relationships will have an ability to be

improved upon. >> but are the actual tactics changing, the actual exchange between the police officer and the person on the street? i mean, i would imagine even if the volume comes down, that minority communities will still find themselves, people within those communities disproportionately targeted. challenge that premise if i have it wrong, please. if that's the case, how do you avoid having the same kind of friction? >> first off, you're not targeting them. the unfortunate reality that a number of the precincts around the city that there is more criminal-type activity that's irrefutable. you have more shootings, you have more crime. and so we tend to have more police in those neighborhoods, so you're going to have with proactive policing more stops. but the challenge is to do them constitutionally always. you cannot break the law to enforce it. you have to have reasonable suspicion that you can articulate.

you want to do it to the best of your ability respectfully, and you want to do it consistently, that i don't stop you and treat you differently as a white person than if i was dealing with a black person up in harlem. that there has to be a consistency, the way we do it. and in all instances, you have to be able to articulate what the reasonable suspicion was. so effectively, we're constantly trying to improve our training, improve our supervision, and i think that's an area that with the increased focus we're putting on that will also help to reduce some of the tension that existed over the last several years in some of the more severely-stressed commitments because of their crime problem -- communities because of their crime problem and the fact that police had to be more active in those communities. >> all right. our shot clock is down to about one minute in this, so i'd love just as maybe to hand it over to them, i'd love to hear your thoughts on what meaningful gun control might actually look like in a country where there are 350 million guns said to be in

circulation. that seems as big or bigger an obstacle than the second amendment to gun control. i wonder what you think. >> well, first off, i think the term "gun control," it's over. we lost control. [laughter] 350 million guns -- [applause] let's face it. largely because of the lack of political leadership, and all credit to mark and gabby for their leadership on the issue. what we're dealing with really is gun reform, trying to find new ways to deal with the issue of gun violence. one of the ways we certainly can do that is through policing. those who would use guns, being very aggressive in finding them, arresting them and working with the courts where that use of the firearm results in grievous injury, put them away. that the idea police exist to control behavior, but to do it lawfully, to do it respectfully. and in dealing with crime and

particularly gun crime, the idea is that the better focused we are on those who are committing the violence -- which, fortunately, are still a relatively small number in our society -- the better we're able to identify them and get at them, the better for all of us. the good news is we're getting better at that all the time as reflected by, in this city at least in the insanity that is america, in this city we're still leading the country in our gun reduction incidents and violence. >> thank you very much, commissioner. >> thank you. appreciate it. [applause] >> thanks again to commissioner bill bratton. thanks for all you do. for my boss, james bennet. pretty good job. [laughter] you know, i think that the way that james bennet and bill bratton just left their conversation, talking about the 350 million guns in the united states, is the perfect pivot point into an important

discussion. for nearly 15 years, gabby giffords has been in public service. she was the youngest woman ever elected to the arizona state senate. she represented her community in the arizona legislature from 2000 to 2005 and then in the united states congress from 2006-2012. and she was consistently ranked as one of the nation's most centrist members of congress. in 2007 gabby married mark kelly, a naval aviator who flew 39 combat missions in operation desert storm and was a nasa astronaut. mark flew his first of four missions in 2001 aboard space shuttle endeavour, the same shuttle he commanded on his final flight in may 2011. he's also commanded the space shuttle discovery and is only one of two individuals to have visited the international space station on four different occasions. after representative giffords was wounded in 2007, she and mark have been become known

around the world. we're grateful to them for joining us today for a conversation with hannah rosen about their lives before and after the shooting and hear views on responsible gun ownership in the 21st century. i have one other thing to add, and i just want to say that this is a bit of the fun element to it. i'm a fan of bono be, i went to his concerts, and the thing that both enlightened and yet now, you know, mark has just deflated me. bono be would, from his concerts -- remember when he was speaking to gabby from up in space and we all thought that was live? none theless, it was taped, but it was a magical moment between mark and gabby giffords. taped or not taped, it was astounding. hanna, the floor is yours. >> thank you. [applause] >> thank you.

>> and that's before we started. [laughter] so i'm going to start out with a few simple questions to get us going, get to know gabby a little bit better. are you a morning person or a night owl? >> a night owl. [laughter] >> cat person or a dog person? >> a dog person. >> houston or tucson? >> tucson is my home. >> houston's okay too. >> oh, pretty good. >> you don't want to put down anybody. >> no. especially texas. >> especially texas, exactly. although you seem tough. [laughter] >> coffee or tea? >> sugar's -- sugar -- >> coffee or tea? >> tea. >> tea with what? >> sugars. two sugars. >> two sures. that's a hot of sugar.

>> so from the very beginning, you and gabby have made the stages of her recovery public, videos in the hospital, speaking like this. why did you do it that way? >> you know, it's interesting, when gabby first got to the rehab hospital which is in houston, texas, about two weeks after she was injured, a friend of mine said, hey, i want to help, i want to do something for you, you know, what can i do? and i didn't really have anything for him. and then he mentioned, he said, so are you going to record any of this, all her therapy? and i said, well, i never really thought about it, why don't you just go grab a camera. so it wasn't actually something that was really planned, it just happened. and then got her therapists, whenever gabby was in a room doing therapy, they would set up the camera and turn it on, and it wasn't until later that we, you know, when gabby did her first interview with diane sawyer on abc did they ask was there anything out there, and we actually wound up having a lot of stuff. but it was kind of a

happenstance. >> but a lot of people would have said no, i think. >> you know -- >> i don't want anyone to see me like this. >> yeah. well, you know, gabby had to give permission for anything that was put out there about her, and, you know, as we travel around the country -- and we still find this -- that her recovery and what she went through has been very inspirational for a lot of other people that have had their own medical issues and injuries. and so it seemed like, it seemed like the right thing to do, you know? that it would, you know, motivate others in their own therapy. >> yeah. didn't you visit the boston bomber people too? >> yes. >> right? and didn't you visit them in the hospital? >> in the hospital. >> yeah. at the rehab hospital, i think it's called spaulding up there in boston. we were actually in boss to on the b a couple of days ago, but this was just about a year ago, and we, you know, we visited with a lot of these folks that are now, you know, multiple

amputees. and, you know, just saw what they were going through. and i think, you know, they draw a little strength -- >> yeah. >> -- from gabby, from her own recovery. >> and have you been involved in the therapy and the recovery at all? >> not really. [laughter] >> i did in the beginning. actually, we -- you know, now we're both really, really busy. in the beginning i used to be involved in the physical and occupational stuff. you know, babs by's at the point now where it's pretty much her and the therapist. >> what are you doing now? >> well, all kinds of stuff. i've got a bunch of things i'm involved with. i think we'll get to some of that. >> and, gabby, do you feel like you are going back to the old gabby or creating a new gabby in this process? >> better. stronger. tougher. >> uh-huh. >> good stuff. >> yeah. the new gabby giffords. >> the new gabby giffords be. >> new gabby giffords. >> okay. and how do you maintain a positive outlook?

how do you do that? >> i want to make the world a better place. >> uh-huh. >> yes. yes. yes. >> because i always see you smiling when i see you. mark, you once told a story about gabby's recovery that included a ring, that was a story about a ring. can you tell us that story? >> well, yes. actually, this ring. when dan by was in a coma in the hospital in tucson just days after she was injured, you know, you don't know what's -- and the doctors don't even know what amount of brain activity is going on when somebody's in a coma, and one of the first things we saw when we knew that gabby giffords was still in there somewhere was while she was unconscious. but, you know, at some level she was still thinking and able to pay attention. with her eyes closed and still out of it, she pulled off my

ring. >> the one on your finninger? >> yes. pulled it off and started flipping it through the fingers of her left hand. >> while in a coma? >> yes. so she wasn't actually in a coma. >> and that's something she used to do? >> yeah. usually sitting at a restaurant at din err she'd often pull it you have and do the same thing. >> that's amazing. and you don't remember? >> not really. >> right. gabby, is it true that in the early phases of your recovery you just said the word chicken? >> chicken, chicken, chicken. [laughter] chicken, chicken, chicken. >> that was it. >> chicken, chicken, chicken, chicken -- >> for a long period of time. >> a long time, chicken, chicken, chicken. [laughter] >> has anyone explained why? >> yes. and we knew that even before she started saying anything. the speech therapy said with a heft side traumatic brain -- left side traumatic brain injury that people often do what's

called per receive rate on a single word, and she picked the word -- >> chicken. >> chicken. [laughter] which is much better than many other options. [laughter] could have been a lot worse. [laughter] >> you didn't feel she was talking about your bravery or anything like that. [laughter] >> i don't know. [laughter] >> gabby, what can you do now that you could not do two years ago? >> drive a car. >> wow. okay. >> yeah. which is pretty, pretty amazing, i think. a few months ago we were at the formula one track in austin, texas, the new, you know, circuits of the americas. so this is a new f1 race here in the united states, and it wasn't during the race, but we were there on a separate day with a guy, good friend of ours who built the track. and i said to gabby after we drove around a couple times, i said, so are you ready to drive? well, the last time she drove a car was to the safeway where she was shot. and she said she wanted to to give it a try, and she jumped in

the passenger seat, and i said, okay, left foot. because her right would not work with the brake and the left hand, and the third time around the track she was going 110. [laughter] and you only went off the track once. [laughter] >> there are videos of these guys skydiving from after the accident, so you'd be amazed what gabby can do. what's the toughest challenge now? >> aphasia. i don't like it at all. >> that's the, the aphasia is, you know, the speech issue that she has from her brain injury. >> yes. >> but for gabby, the more difficult part is the transmission. >> yes. not the other -- >> meaning saying the word, finding the the right words? right. but is, so is it true you asked to relearn spanish then? >> si. por favor.

[laughter] >> that's amazing. >> once a week, right? >> once a week. >> once a week gabby has a spanish instructor that comes over. i try to not be there because she knows i took five years of spanish in high school, and this woman completely abuses me at the kitchen table. [laughter] but it's great for gabby because she used to give speeches in spanish and do interviews in spanish. >> oh, okay. >> and do radio ads for her campaigns in spanish. >> okay. so that's why spanish. >> well -- >> a reminder, you can see all of this at c-span.org. we'll leave this and take you live to the national press club in washington for a discussion on vaccine use in the u.s. a panel looks at measles, whooping cough and other infectious diseases that are making comebacks. live here on c-span2. >> of the upcoming show on vaccines. ..

they went out with a group of who epidemiologists, they isolated areas with small pox to ensure that everyone was vaccinated. those vaccines indeed help make the world smallpox free a few years later. not to forget the role of vaccines. no questions this issue of vaccines is being talked about by news media around the united

states and the world's and i am pleased we will be hearing with the distinguished panel including journalists in the front lines covering this issue, persons like joe lauter of the portland press herald maine sunday telegram. and who to better examine the science behind vaccinations than the return of preventable death diseases and the -- the premier pbs show on science, health, education and more. i want to welcome paula apso, a executive producer in the audience and julia court, senior producer, w gb h in boston, one of the pbs flagship stations and our moderator today is michael rosenfelt, the head of terry noe bank studios, it was inspired by charles darwin's on the origin of species and his table the

bank hypothesis named after darwin's colorful description of a complicated ecosystem so we look to you, julia and michael and other experts on the panel to help us better understand the complicated ecosystems of vaccines. thank you again for having this important discussion, this very important discussion at the national press club under the auspices of its journalism institute. i am pleased to turn the floor over to juliet court. >> thank you, thank you to the national press club journalism institute for hosting this breeding and thank you for coming for this morning. we are here to talk about reporting on vaccinations and outbreaks of vaccine preventable diseases and to share some insights we have gained while preparing 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. today "nova" and pbs are small handful of places one can find good science journalism on television. the need for science journalism has never been greater. science and technology is involved in so many public policy issues today like vaccination. is crucial that people not only get the facts but get clear, accessible explanations, analysis 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 are presenting this to readers, viewers, our audience, who are not just engaging with the fact 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 is full of misinformation and misconception to an audience that includes parents who are confused and have a lot of questions but are trying very hard to do the right thing for their children. paula, a senior executive producer of "nova" and i were very fortunate to be working with an extremely talented team of veteran science jealous including the producer/director and writer and michael rosenfeld who took on this difficult and complicated but extraordinarily important topic. we hope today's discussion is helpful to you as you report on vaccines and these outbreaks and wrestle with the issues we have been wrestling with. now i would like to turn things over to michael rosenfeld,

executive producer of vaccines calling the shots. >> thank you, julia, for that introduction and thank you, myron, for the opportunity to participate in this briefing. thanks for coming. the subject of vaccination is on the minds of many americans as we send our kids back-to-school at a time when vaccine preventable outbreaks are making headlines around the country. the cdc puts numbers in perspective. measles was declared eradicated in this country in the year 2000 but there are 600 cases of far this year, the highest level in the u.s. in almost two decades. whooping cough is also a problem. 2012 was an especially bad year with 50,000 cases and 20 deaths in the u.s. and this year the state of california declared it an epidemic. these are diseases vaccines can and do prevent. the numbers would make anyone,

but especially a journalist, wonder what is going on. our mission is to shed light on complex topics and public health so the story of vaccines in the context of these outbreaks was irresistible to us. we have been fortunate to partner with pbs and "nova" to explore these issues. the result is a new documentary, vaccines calling the shots which airs on "nova" september 10th at 9:00 p.m. eastern. i would hope the film will help audiences understand the science behind these issues and invite a thoughtful dialogue. at the same time we know this is a story that will continue to unfold over the coming weeks and months and years. safe to say journalists will have their work cut out for them as they cover the return of vaccine preventable diseases which can't be fully explored from any single piece. this is not just a science story but a public health story, medicine story, economics and policy, psychology and history as well.

our panelists today reflect that. you have there bios align won't repeat that information but i would like to add a few things about them. when you watch the film, you will see all to my left, cares passionately about public health. it is not just the he was a leader in the development of the rotavirus vaccine which saves hundreds of thousands of lives around world but has extensive experience from his years on the front line of pediatric medicine at the children's hospital of philadelphia. from public speaking to writing books he 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. sonya pemberton goes deep. when i first discussed this film with her i was impressed by how much she already knew about vaccines and in fact she has spent the past four years

immersing herself in this topic. in addition to acquiring detailed understanding of the subject sonya has done a lot of thought to how the story should be told. herbal which we shared was to craft a film that would bring clarity to complicated science and be accessible to the general public and to parents who as julius said have a lot of conflicting thoughts and emotions about vaccination. it is one of the hardest subjects to study and communicate, risk. as someone who study how people make decisions at the university of michigan, is adept at explaining tough concepts like immunity and relative risk. those subjects are especially important for vaccine conversations because how you see risk can have a big impact on whether you vaccinate your kids on schedule, delay some shots or even skip their vaccinations entirely. finally i am pleased to welcome joe lauter to the panel.

he covers the portland press herald in maine. joe had experience covering vaccinations. he has written front page stories calling attention to the rise in vaccine exemption rates as well as potential legislative responses. this has covered lots of discussion on the web, which tells you about the appetite for good reporting on this subject. that is the panel. i am not going to ask each of the panelists to speak for roughly five minutes about the subject of vaccines from their particular vantage point and we will open the floor to questions. paul? >> if we could start, there's a two minute clip about herd immunity that will lead into my five minute so roll it. [silence] >> the 2013 measles outbreak in

new york is hard and fast but remains in other areas. 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 are two things that matter for whether or not i am going to get sick. one is the 5 bump into somebody who has the disease, and i protected against it? the other piece, for more

important piece, is the chance i will bump into somebody in the first place who has this disease. you can think of this as 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 is known as herd immunity and it protects everyone, including young babies and people who can't be vaccinated for medical reasons. in new york, it works. >> if we didn't have the hy vaccination levels that we'd do in new york city and even in this community, i can promise you we would have had hundreds if not thousands of cases. >> the protection is fragile. the highly infectious diseases like measles, we need 95% of the community vaccinated for herd immunity to hold.

if the rate drops even a few percentage, herd immunity can collapse. >> so we live in a country of 300 million people. of months -- there are 500,000 people who can't be vaccinated because they are getting chemotherapy for their cancers, they can't the vaccinated because of immune suppressant therapy for chronic diseases or because they are too young. they depend on those around them to protect them and when herd immunity starts to break down what you see is exactly what you are seeing now which is the most contagious diseases come back first. among the most contagious diseases are measles, mumps and whooping cough. as michael said, to introduce this, look at the current measles epidemic. it is instructive. the current measles epidemic has 600 cases, the biggest epidemic we have seen since two decades ago, the mid-1990s.

600 cases. if you look at this, how that happens, the way it happened is generally citizens from this country travel to areas where measles is endemic, it occurs generally year round so for example the philippines. in the philippines last year there were 31,000 cases of measles and 42 deaths from measles so the travel goes to the philippines, catches measles and comes back and spreads it for the most part among the group of unvaccinated children. the reason those children are unvaccinated is because parents had chosen not to vaccinate them. although it is the biggest epidemic we have seen in two decades it is worthwhile looking at what this disease was before we had a measles vaccine which the first measles vaccine was introduced in 1963. before the first measles vaccine every year there were 3 to 4 million cases of measles, 38,000 hospitalizations and 500 deaths. everybody saw measles.

measles was a surge. today although there are 600 cases i would that few people if anyone in this room has ever seen a case of measles and in fact when measles, a suspicion of measles case comes into a hospital, fever, rash and the question of measles they bring old people like me into the emergency department to see if it is a measles case because people don't remember what measles looks like. for example on a recent larry king live show jenny mccarthy, my personal goal to person for health care advice, don't know if she's yours, she said when asked -- addressing whether the combination of measles, mumps or rubella could cause autism she said, quote, i will take the measles every time. what that tells you is not only has she never seen measles, she doesn't appreciate how sick measles can make you but has no recollection of measles. we have forgotten what measles

looks like which is remarkable because i remember when i was attending children's hospital in philadelphia in 1991, we were in the midst of a massive measles epidemic. it centered on two fundamental restrictions in our cities, 30 years into the development of the measles vaccine we have 1400 cases of measles and nine death, five deaths in a ten they period 1991. the city was in a panic. there certainly were those of us who understood the power of measles. for example 50% of children with measles have an abnormal chest x-ray which is to say they have radio graphic evidence of pneumonia if not clinical pneumonia. what we experienced in 1991 in philadelphia is a lesson from the past and not a prologue to the future. >> i am sonya pemberton, a

filmmaker and science journalist and like many people in this room i see myself as a conduit with the public. translating signs for the public is what i do. i started thinking about this from way back in 2009 after i made a different phone call catching cancer and that was how viruses can trigger cancers and how in a funny way that is good news because if you find a virus causing cancer, you create a vaccine. the film got lots of nice reviews but i received a rather large proportion of nasty mail, what people might call hate mail and abuse and i was shocked because i spent the rest of my life growing up in a medical family, i started to study medicine, this is my area. i was surprised. i decided i wanted to understand

why people could be so upset and so a green about vaccines food they would take time to write me is these letters of began a process of 4.5 years. i wanted to understand why people would be really frightened of vaccines because to me this was a limb. i saw it as a life-saving medicines i didn't understand it. i had to confront my own bias, my own pro vaccination stand and try to understand what it felt like to be someone fearful of vaccines and that is what led to the film. i thought today trying to contribute five things i learned about talking to people with hesitancy of vaccines and communicating vaccination issues so from one journalist to many others -- first of all, vaccination is the good news story.

we get so used to hearing it, debate and arguments, less than 1% of people in this country don't vaccinate at all. it is a really small number. can we just get a grip? 90% on average vaccinate most of the time or all of the time, on schedule. it is -- depends where you are -- 10% of people who skip or delay some shots sometimes. that group is important because this can affect herd immunity. it is not an insignificant number. it is an important number but it is important that we all put it in context that it is the norm and we should reinforce good behavior, so that was one of the first lessons i learned. to think of this as a good news story, not a bad news story. the second and really important thing, people who have concerns

about vaccines are not necessarily anti vaccines. the number, hundreds of people i have spoken to over the years that i am nervous about vaccines, i have concerns, i am scared of this vaccine, once i was open to having a conversation and didn't shut them down with my personal bias, when i stopped, i would discover most of them were not against vaccines but wanted to ask questions, but because the group that are strongly against vaccines that we could lose sight of a large group of people, we did the first national survey in australia and 53% of parents, some concerns around vaccines. the vast majority, a fully

vaccinated any way. what was interesting is they had enough concerns to ask questions and the most useful thing, speak to those parents so it is actually about trying to speak to parents who have vaccine concerns and to do that respectfully and acknowledging people are not necessarily our right refusing to be concerned. also the thing we need to remember is the internet has changed the vaccination landscape. it is a force to be reckoned with as we all know. people go to google for all sorts of things including vaccine information's of trying to counter that with some calm, sensible and hopefully impartial, looking at the science and trying to follow what the science has to say is vitally important. my third point is it is 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 attest there are many studies that show acknowledging fear helps people to deal with fear. that is how we all process it. when you don't talk about things or push them away or don't allow people to talk about them, we make the problem worse. for me one of the goals of the film was to help reduce fear. we took the brave step to acknowledge fear and let people in the film talk about fears and concerns and that is the fundamental point of difference this film and hopefully will speak to many people. the fourth thing i wanted to add is there is a spectrum of views around vaccines. it is not the debate. it is not us versus them. that is not the way we should be thinking about this. there are people with a spectrum around vaccines. one interesting study i like to

think of and came out of australia of a originally was a spectrum of five groups, the unquestioning acceptance, the questioning acceptor, the hesitant, the deal mayor or cherry picker and out right refuse her. these ear one way of grouping people but i found it useful to think of where people sit on this spectrum and remembering the out right refuser is 1%. this is a big group in the middle and trying to speak to that group and treat them with respect and listen to what they had to say was really important. it is worth remembering, the vast majority do choose to vaccinate so reenforcing that, finally, number 5, something paul offit says eloquently in the film, we are all in this together. whenever i struggled with people hitting me with their opinions about vaccines or their fears around vaccines are saying things i knew were

scientifically inaccurate i had to find a place in myself where i could listen to them and think we are all in this together, we are all united by the need and desire to try to protect the ones we love, all of us, no matter your position and if you come from that position we can find a basis where we could have a good conversation. the broadcast last year of the original version, many many came forward to say the film helped with a new conversations that allowed those who just had questions to come forward and speak. very sane and nice conversation and the internet for about a week and people said please and thank you and would you mind answering this question it was terribly polite and that was wonderful to see and people who would normally hit hard had to be quiet because people with hesitancy and questions came forward and also what was really

interesting that came out of it was the australian immunization specialists started training pediatricians in how to speak directly to hasn't parents so they could be equipped with skills to have these conversations. finally, i am really optimistic that there is a way to have this conversation and we can all do it and we can all help the situation and help talked to one another and i hope you find it interesting in that regard. >> for a perspective on risk and how that fits into the story, thank you all. have a psychologist. my academic field is thinking about how people gather information, make sense of data, make sense of risk. in many ways we ask parents to go through a journey much like the one sonya has gone through, to gather information and figure out what they need to think about vaccines, what they need to feel about vaccines and

ultimately what they need to do about vaccines. i would like to start with a second clip from the "nova" episode and talk about the implications of it. >> she has chosen not to follow the recommended vaccines schedule. >> the plan is to be fully vaccinated as soon as possible, we doing one vaccine at a time. i don't know if that is the right way. i don't know. >> she has a 4-year-old and is expecting another child. she delayed vaccinating her oldest until she was free. >> i was concerned. my son and -- they are not vaccinated. >> she has four children and vaccinated at first but then one

child had a seizure. >> it is really worrying. i am worried about the diseases. >> in america children must be vaccinated before they start kindergarten but the required shots very from state to state and most allow for exemptions based on personal or religious beliefs. here in california over 3% of children are exempt and in some schools it is more than 30%. >> a lot of risk. if you save vaccine around them they look at you like you are poisoning your child. on the other hand if you are a parent that they can't even understand why this is even a question. >> no one is willing to have a conversation with you and discuss what are the severe reactions, is it ok to have a seizure, would really like to know what the risks are.

>> one of the things you will notice in that clip is there is a lot of discussion of risk and not a lot of discussion of benefit. that is the first thing i want to highlight in the conversation which is 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 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 where the threat that they were. today, as dr. offit pointed out people don't know that. they don't have the 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 experiencing the motion has thoughts and fact so the challenge 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 someone who had been affected by polio or measles or whooping cough. the challenge is in the modern world our society is mobile. the person standing behind me in starbucks could have been in russia, india, 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, are the people around me sick?

if not then maybe i am safe, no longer is an accurate representation of the risk we potentially face. so somehow we have to have a conversation on a public level to help people recognize, to tell this possibility story and tell some understand that it is that benefit of vaccines we need to get back in touch with. ..

>> we have to acknowledge the complicated story in order to gain the trust. if we say vaccines are safe why should she trust that? when she asks is it okay to have a seizure? she is really asking is it okay this thing i hear has benefits has risks as well. how am i supposed to, as a

parent, put my child at risk. the last thing i want to talk about is the parental experience of risk. parents want to do what is right for their children and keep them safe. but part of us know risk is everywhere. i am a parent. my daughter just turned 16 and i handed her the keys to the car. unquestionable the most dangerous, risky think i will ever expose her to. and i did it anyway because i knew the benefits to her development were worth putting her at risk. that doesn't mean i don't want to be safe. i gave her a safe car and she trained. just like it is appropriate to say how can we minimize risk in the context of vaccines. but part of what is being a parent is sometimes dealing with

risk because risk is everywhere. and you know vaccines are incrediblely safe. most children who are vaccinated have little if anything happen. but severe reactions do occur and they can be temporary but they are scary. at a population level, public health can say this is a one in a million risk and we don't need to worry about it if it has huge benefits it will outweigh the negatives. from a society standpoint i have no problem with that. but from a parental standpoint parents care about probability. and if it is possible they will worry about it. we have to acknowledge that in order to be heard and trusted by

them. the conversation of vaccines is one of respecting the emotions of parents and helping them realize this may not be there easiest thing to do: watch your child get a shot. but it maybe what you need to provide. >> thank you, brian. now for a journalist who has been covering the story. >> thank you for having me. i wanted to point out the folks on the panel lived and studied this issue for their entire careers, many years, and you know, myself i started looking into this in july. and you know i dare say many journalist will be approaching this like myself from, you know, completely outside perspective

or learning things on the fly. i am the health reporter at the press herald in portland, maine. but i have only been the health reporter for a year. i would say dlz there is a lot of general assignment reporters that might cover the stories due to the dwindling resources in the media. i want to talk about how i came upon this story. it is not a very obvious story, really. in 2012, there was a whooping cough outbreak in maine. i started at the newspaper last year and wrote about how there is an outbreak and you know shouldn't we be somewhat

concerned and 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. it is 3.9% for the opt-out rate. as a journalist when you see that number you say is that really that bad? but as the move oh points out herd immunity breaks down at 95% or less vaccine coverage depending on the disease. the more i looked into this story the more i realized this could be a pretty big deal. it would be better to write

about it before than after. if there was a tremendous terrible outbreak of what happened in philadelphia in 1991 that would be tragedy so i thought it would be better to write about it before. i guess the other thing that struck me about this topic is that unlike a lot of things, you know, if people -- say 5-10 percent of the population believes something that is not true, for the most part it doesn't affect me or us. if you are at your family reunion and your second cousin talks about area 51 you might nod your head and move on to the next conversation. if 5% of the population believes that so be it. but with vaccines in order for them to work properly you need everybody buying in or almost

everybody buying in. so that really struck me. so we did a pretty comprehensive study about this and talking to all different types of parties including someone who contacted polio as a child and got the side of people that didn't believe in vaccinations. but the science is settled for this story. there is no debate amongst scientist rather vaccines work. and there is no proof or it has been debunked about the connection between autism and vaccines. there is no connection between the two. when approaching this story you have to look at it like okay. these people have concerns but

it isn't a scientific debate. they are having a debate, which they believe to be scientific, but it isn't scientific. so you can't do the whole well this side beliefs this and this side beliefs this and let the readers decide. it isn't that kind of story. you are doing a disservice to the readers if you approach it like that because the science is settled as i said. so anyway, we put the story together and you know it ran and the reaction to it was really, even though i have been researching this topic for about a month and got a sense of how much depth and breadth there is to this topping, it is really -- if you read about it it is quite amazing. but the reaction to the story floored me. we had 600 comments on our website and for us that is probably ten times the normal

amount of comments we would see on a story. i was interest in what types of people were commenting on the story. was fascinating. it wasn't just the 1% that sonya was talking about it. the absolute anti-vaccination people who were commenting. there were a lot of people, who i believe, were misinformed and were not militant about it but just misinformed and didn't believe -- they fleet like the cdc was hiding something or just the scientist were covering up information. 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 we are going to continue following this story closely.

we did follow-up stories and there is more to come. this is a huge topic. and the point i want to make is there is an element of not just being a science story but a political story in a way. this gets to the issue of should the government be telling me what to do. should the government pea forcing me to have vaccines? washington state had one of the highest opt-out rates of children entering kindergarten in the country. and they made it harder for parents to opt out and upon doing that within a couple years they have seen a reduction in the percentage of people opting out and corresponding reduction

in outbreaks. but in maine, just last year, it made it through the house, a bill that would have -- i don't want to get into too much detail -- but it was an ant anti-vaccine bill. in vermont, the governor of vermont went on the record saying he believes parents should have a choice and not make it harder to opt out and vermont has one of the highest rates of children ofting out of vaccines. so you have don't think about it in detail and get into the heart of why vaccines work it sounds

logical: the government shouldn't force be to do something. but this is a case are 5-10 percent of the people really does matter >> thanks a lot. thanks, everyone. i think that gave you all a sense of the complexity of this subject and how personal it is for parents and doctors on the frontline who care most about protecting their patients through vaccination. with that, i will turn it over to question and there are microphones available. tell us your name and aff affiliation if you don't mind. >> hi, is it on? this is penny star with cns news. some of the people i mentioned

to sonya before this event that there are, you mentioned the internet, and there are sites tat people i know go to called the informedparent and they use cdc stats to make their anti-vaccine arguments and i wonder if you could address that issue. in other words, is the government doing enough to communicate with parents about the benefits or the risks? >> paul, do you want to take that? >> thank you. for example, if you look at the impact of vaccines on diseases like measles and you go back far enough. you can go back to the late 1800s you can see the instances of measles or mumps decline before vaccines were introduced

and that is because we changed things like sanitation and that had an impact on the diseases. obviously purifying the water had an impact. but the slope of the curve dramatically declines when you look at the introduction of the vaccine. that will be looked to say see we didn't need it because the rate was going down anyway. but these diseases would still exist without vaccines. there was social upheaval and the instance of diptheria declined in the cities that did want see much and then it rose. there was an introduction of the vaccine and the rate dropped

again. so we do these experiences over and over again and there is no reason to believe anything other than what the data shows. that is one example. in terms of how the cdc and others try to communicate i think a lot of groups like the american academy of pediatrics and other groups out there try to communicate good science to the public and they do it compellingly and passionately. i think it has made a difference. if you look at the way the story is covered now compared to 15 years ago it is much better. are there groups that hold to the to the notion that vaccines do more harm than good? yes. but i think we are making a difference because people are trying to get good science to

the public. >> 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 vaccine. the internet isn't just making information more easily available to people. it is enabling us to share stories and individual cases and the cases that someone wants to share are the cases that have emotional power. if you believe, rightly or wrongly, your child was harmed by a vaccine that is the story we want to share. the stories that don't get shared as much is the most common story. i went and got my child vaccinated, it hurt a little, it didn't bother them, nothing happened, he doesn't get sick, this is boring. but it is the fundamental story of vaccines. the most common story of vaccines.

and precisely because in a web 2.0 environment the shared content comes from users and what we tend to see when we go look is a disporportianate amount. and that is the challenge. what is shared isn't a fair reputation and to give voice to the other story. the story of the mother whose child is in a classroom where there is measles and what is she feeling at the moment she realizes yes, she did vaccinate and she is feeling safe. that emotion is important but it is harder to find. >> there is a story in the film

that gets to this which is the story -- >> i was going to say this issue about telling the boring story is interesting. one of the scientist i first approached earlier on said sonya if you are going to make a movie about this point it at a regular family eating dinner and run it for an hour. that is the truth. people are not getting sick. they are not thinking or worrying about disease. that is the story of vaccination he said. and i said i cannot turn that into an hour of television. but it is a challenge of how to tell a story effectively and accurately. so we took a gamble with this film. it was scary, genuinely scary, to tell a story that you see on the internet of my child was a

healthy, beautiful, fabulous baby at six months and hours after the vaccine everything went terribly wrong. you can find those stories on the internet. i chased a lot and tried to talk to a lot of parents and it was hard to verify them. i had a family who was prepared to speak and i had their medical records. their child, 17 hours after the vaccines at six months started to have seizures and they were ongoing and devastating and resulted in the 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 science was done and they discovered their child had a form of epilepsy that is

triggered by a fever. and the first ever seizure occurs around six months of age. and for another girl we interviewed but wasn't in the film hers was caused by the film at six months. she got it from her first fever from the flu and he got it from a spike in fever after the vaccine. the vaccines were not a cause but a trigger. like bouncing on the trampoline was or getting hot. it was an extroidinary journey. putting that in the film was trying to explore the internet stories. the story of a child getting sick and putting a face and science to it. one thing i did want to say is that if we can try to tell the stories where nothing goes wrong it is really helpful.

it is really, really helpful. it is the norm for all of us. we don't question it because we are living in this relatively safe world. so we have an obligation to try to share the safe stories. >> and just briefly to follow-up on something sonya said the relationship because causal and temporal causation. my wife is a practicing practition and came into the nurse and there was a 4 month old sitting along the wall with its mother. the four month old went on to a seizure while she was drawing the vaccine. if she had given that vaccines five minutes earlier i don't think there was any data that would convince her that anything else caused it. you think i am stupid? she gets the vaccine and five

minutes later she is having seizures and epilepsy? so you are going through the power of the emotions pervus the power of the statistics -- versus -- >> if i could make one quick point. i think the fears and opposition comes about, at least in maine and oregon might be another good example, of people taking a movement, for instance like the organic food/natural movement which you know it is good to eat vegetables and things tat come out of the ground rather than processed food, but for whatever reasons vaccines and other forms of western medicine have been labelled as being artificial and therefore bad for you. so, you know, i am sure people could talk about why that is not

true. but i believe that sentiment is out there and there is trace amounts of things like formaldehyde that would absolutely not make you sick but people see that and get scared and that was the bill that was introdu introduces that passed the house and killed in the senate was to inform parents of every ingredient in the vaccine without any context behind it. a scare tactic. >> formaldehyde is natural. viruses are derived from parts of nature. we have been making formaldehyde since crawling out of the ocean on to land and the quantity we have in our bodies is more than any you will ever get in a

vaccine. but it is the wording. pen and teller were able to get 300 people in california, california maybe doesn't count, but sign a petition to ban dry hydydro hydroxy and they never lied. they said it is in our tears and streams and we have to get rid of this. and that worked. chemical names always sound bad. >> context is everything. >> one of the things we have in the film is we show vaccines go back at least a thousand years. it was a traditional form of therapy and i found that astounding. so things with traditional focus show this is interesting.

but there is another false polarity that if you are in a organic food that you don't vaccinate and that is an artificial divide. it doesn't exist and we should not buy into that. there is a marvelous group in australia called i immuneinize and they are alternative moms and have build boards saying i meditate, eat organic foods and vaccinate. you don't have to be either or. we are making that a divide. >> hang on. the mike is coming. >> i am alan cotalk with the science enterprise. related to this discussion you just had do you see any correlation between the fears of

genetically modified organisms in food with some of the engineered molecules you find in vaccines? >> i think that is a great point. yes, is the answer. for example, the hpv vaccine and hepatitis b vaccine are both made using technology where you take a single protein from the virus and you basically use in this case the yeast cell to serve as a little factory to make that protein and then you purify that protein making a

hundred percent purely one surface protein. it isn't the virus. just that one part and the important part. what could be better? but you are right. it is genetic engineering. foods are genetically modified of the time in the wild. but you want to create a situation where you are going to get the most benefit and the least harm and that is true with vaccines. vaccine virus is the term they use but for natural virus they say wild type virus. that is a better term. what it says is in the wild it could do anything. wild type viruses reproduce themselves thousands of times or tens of thousands of times.

a vaccine virus only about 20 times. you want us to tame nature. this notion of 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. >> good morning. i am ann gram. i wanted to ask sonya particularly and you were commenting about the response to your film. i want to know what works as we move forward. how do we get to a place where we reinforce positive behavior or a way to move forward from this? my hopes is we can jump start getting more children vaccinated and healthy.

can you comment on that and give us positive stories as you move forward after your film. >> yeah, look, i wish i had absolute answer to that, of course, but i think through our film being released last year and obviously now the american version is last week but the australia version told us there were many more people wanted to talk about this than the broadcaster realized. it breck broadcaster records, we had one million facebook posts and over a hundred thousand downloads which in our country is enormous because it is free on the internet. no one anticipated the level of response. so people want to know and talk about this. and opening the conversation to say it is okay to have concerns

made the difference and that was the point of difference where we were not going to tell you what to do but invite the conversation to begin. that was very genuine and people came to you with stories that were difficult to hear especially if they are not scientifically not sound and it is hard not to jump down people's throat and say that is non-sense and leave it at that. we find having good material and people on call who could answer compplex questions. i am not a medical doctor and not qualified to answer complicated question. so don't speak beyond your area of expertise was important. we found we got hit by a lot of negative stuff and it was a bit depressing because after a few

days what happened was there was so much spaming going on it stopped the real conversation and by spaming i mean people dumping endless anti-vaccine messages in the mix. and the people vaccine hesitant were miscalculating and that was interesting. it was depressing because it was like do we have to block you or stop that? we tried not to. we tried to keep it open as long as we could vment so the only strong thing i would say is that people are in tterested, the conversation is worth having, open it up and try not to control it. most people just wanted to have the conversation and provide them with good information. >> so i would also like to add i think there is important parallels in the vaccine context to the conversations 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 says we are going to do this and do surgery and you have no choice. and that evolution has been important. and the challenge is how do we inform patients -- patients are not 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 and the ways in which they need to respect the science and data and understand when their doctor is saying this is really a good choice why their doctor is saying that. that it isn't just because somebody said so. that there is in fact a reason behind that and respect the fact they might want to know in some form what the reason is before they nod their head and say yes, this is a good idea.

engaging at that level and recognizing if we are giving parents the availability to make choices they need the empowerment, information and emotional empowerment to face the process and be a partner. most patients when faced with difficult treatments like what breast cancer surnlry to have they are not coming in saying i know everything, they are coming in knowing they are not an expert and need help figuring it out. and when open the door for them to say this is what i understand and don't understand and help them with this. >> we were astounded by they action be got to the story. while 5% don't vaccinate before

kindergarten there is evidence that people are delaying vaccines and spacing them out because of fears and i think we have run into people or many have run into people who have at least heard from somebody who is concerned about the safety of vaccines and so i think it is a topic that many people are very interested in. >> just following up with something brian said, what does it mean to be informed? we say we want to inform parents about vaccines but let's take the chicken pox vaccine. if someone comes into your office and says i have done my research and i have chosen not to get the chicken pox vaccine then they have not done the research. because if you do the research you will get it every time.

the parent means they have read people's opinion about it on the internet. to really do research for that what you need to do is read the several hundred articles that have been written about the vaccine and understand how that vaccine is made, what are sort of the differences between that virus and the wild type virus and the safety and ethicacy and to do that you need a background in statistics or virology. and what we really do is rely on panels of experts like those that advise the cdc or aap to collectively have that expertise and advise when and why that vaccine should be given. but that is an impossible

message to sell in the 21st century. people have to have a sense they are being informed to some extent but what inform means is a tough one. >> can i respond to that? i think it is important to clarify. we talk about paternalism and that means you will have surgery. we need to acknowledge in today's world medical professionals have a responsibility to help guide someone through the process of thinking about this. it isn't just your choice go away. that is not sufficient. we have a responsibility as people who are experts in the science and context to say this is what you need to pay attention to. if you want to go back and read

it you have that right. but we cannot just throw information at parents and expect they have the skills to make sense of it. we need to guide on our own knowledge to guide them through. it isn't just a choice to read whatever you want and think that is a full understanding. we are understanding our expertise is part of the puzzle and we need to share that. >> and doing nothing is a choice. the choice not to vaccinate is a choice to-do something and has its own risk. the other thing i found interesting was by and large one thing parents didn't understand is if your child gets one of

these diseases for the post part there is no cure. treatments and interventions we can do. so parents could say if my child gets measles i will take them in and get it then. doesn't work like that. i met one family from switzerland whose 17-year-old daughter got measles and they didn't agree to be in the film but they were a wealthy family in switzerland and long story short she was taken to the fanciest hospital in europe and she died from the measles in 2011 and there was nothing the family could do to save her. the best medical technology in the world in one of the best hospitals in the world couldn't save this 17-year-old girl. that is a message people don't get. it is unlikely to get that

severe measles. we know that. but it can happen. >> i have to say that understanding is something that is driving the medical professionals you meet in the film and paul speaks about itinl the film regarding the philadelphia incident. i think we have time for two more questions. is there another one? >> do you see any difference in perception between adult vacc e vaccines and children's vaccines? do you run into the same problem with shingles or the flu vaccine? >> i think as a general rule,

pediatricians and family practitioners are better at making vaccines part of their routine care. adult physicians are less good at that. certainly immunization rates for the flu are better over time. i think the practitioners taking care of adults have gotten better. as a general rule the uptake among adults is woe full. i don't think we are good about immune nizeing adults. >> i think it as a different problem because for an adult vaccine you are doing it to yourself. if you hear information about risk you are taking it on for

yourself. we all proteblth our children more than we -- protect -- protect ourselves. and that is part of the reality. children are looked at as people that need special protection. and information about potential concerns about vaccines and simple side-effects of your harm is going to hurt has a different meaning when you talk about our infant versus ourselves. and that makes the conversation more difficult when the tradeoff between benefits and risks has to come to the surface. >> question back there? >> i am linda cramer with glamour magazine. and all of the story telling focuses on mothers. what does the research show about the father's input and

have you noticed any generational trends? millennial parents more or less likely? >> so i admit i don't know lot of da of data on the gender topic. i know it is often the mother more involved but that is an issue of availability for generation and i do believe that is evolving over time. the generational issues are important for many reasonsism the experience issue in terms of what have parents actually seen in their lived experience and in terms of the way in which

parents gth gather information. we have to respect this conversation is different today than it was 25 years ago and different in 20 years. each new generation gathers information in different way. and we have to move the conversation along with the technology and the process. >> i would like to say, aside prom personal experience, my wife decides when and where the shots to take but i am the one to bring them in so she doesn't have to see them suffer. and i would describe my youngest son as being vaccine hesitant was they tried to give him a shot and he ran out and i had to

chase him down. 50 and older group is unquestioning this. they lived or it was close enough they saw affects of measles and polio. and the whole thing with history you are condemned to repeat if you don't remember it. if you look back at the media coverage sock was a hero. there was a famous quote from him. will you patent the vaccine? would you patent the sun was this response. it was viewed as heroic from people i interviewed. and i want to say i had never seen a modern video of a child with whooping cuff and seeing

that in the movie hit home. >> one thing to get back to your question about gender differences, my experience was it impacted in a negative way. when the hpv vaccine came out i spoke at my daughter's high school at the time and i spoke to a group of senior girls and asked how many had gotten the hpv vaccine, half raised their hand and the other half when asked why you didn't get it and they said their father didn't want it because they thought it would increase the chance of having sex. >> can we go to 11:00?

>> okay. so that reminds me of something i wanted to ask sonya because you made the film initially for the australian market and we brought you over and you essentially remade it for the united states. what did you discover when you came and covered the story in the american context about what is different and which stories were more important in the united states and perhaps less important elsewhere? >> well the australian version was designed for the european market so it covered a lot of stories in europe and we filled in butan, ukraine, and india. and the view that we took in the original was to keep it very global even though there was about 30% australian stories but keep it globally focused.

the american context has been different. in australia, vaccination is not mandatory. we have the carrot not the stick. you can get child baby bonuses if the child is fully vaccinated. and the rate is around 93% so it is higher than here. so there are different issues. what i learn about the american situation was that it is more passionate debated here. it is more divisive hair here. i think the issues in our country, the issue of autism and mmr is over and doesn't warrant discussion because most parents put that to bed but that is still a live subject here.

hpv, the uptake is high, 80% in our country and here -- hpv for girls who have completed the series is 38% and boys it is 14%. >> in australia it is around 80% from memory so it is much higher. yeah, the are different forces that play. i think the distrust of authority is greater here in some ways and this idea that you can trust your own opinions and your own research is more dominant in terms of psychology here. that has been interesting to explore that. at the same time the vaccine hesitant moms appearing in the film were brave, great and giving. i said we will not ridicule you. we just want to show your story and they were frank and

forthcoming and i am grateful to them. i am not sure we would get the same thing in australia. i think most importantly, though, is we cannot forget that beyond the emotional issues and the scientific issues 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. doesn't cost you anything to go have a vaccine. so we have different forces at play. i do think as somebody in europe said there are the three c's of vaccination. confidence, complacency, and convenience. and the issues that shape whether or not people will vaccinate. confidence in your vaccine or information that you have. complacency if you are complacent about the disease and

don't think it as a threat will have an influence. and convenience. if your social and medical system is setup in a way that makes it easy to get your child vaccinated all of those influence they will. it isn't enough to blame the parents. there are systems in place that inform that. does that answer your question? >> one more question and we will have to wrap up. >> one more question. i intend on bringing legislation to help encourage immunization rates and i understand particularly michael had mentioned that nova will have some pieces around on what other states have done for

legislation. if you could speak to that i would appreciate it. >> the broadcast goes out you know in a week on the 10th. but in addition there are extensive materials on the nova website. and they include articles on a range of topics including the legislative framework. there are infographics being done and an extensive effort to keep the story going and create resources for parents and others who are interested. >> one of the things i would encourage people to do is if you are interested in this subject or have members of your family or community who are nervous around vaccines to spread the world because i think it would be useful to have people to use their own networks to have that conversation during this time because there is a window where you can suddenly tack about

things that perhaps you usually side step. i guess one of the things i was surprised by was the fact that in a lot of families there are 1-2 that would be unsure about vaccinating but people will not just talk about it. so if you can use the windows to open it up that would be terrific. >> in the last few minutes let's ask the panelist if they have concluding thoughts or things you would like to add before we have to wrap up? last words? >> i will say i think a choice to not get a vaccine is not a risk-free choice. i think the time is coming where we need to explain ourselves better. for my parent's generation, vaccines were not something you had to convince people about or

in my generation. but the younger generation didn't grow up with this and you need to explain what it means to not get the vaccine. and we have to realize this isn't something that sells itself any more. i think we have to make it clear why it is so important to do this. we have to be patient about making a clear. it was frustrating when people don't see this thing that is so obvious to us. but we have to be patient. >> very short one. if someone comes up to me and says i don't believe in vaccines instead of jumping become and saying it isn't about faith it is about science i now ask why. and it opens a whole different conversation so i would encourage people to ask why if you hear that. >> i think my last message is we tend to focus in health education about providing facts. but in my line of work context is everything. we need to help parents, we need

to help the policy discussions understand the context of vaccination. and the context just reminded us that helping people to imagine how life without vaccines will be different than life as it is now with vaccines and the vack nation rates we have. 70-80 years ago parents said no son, you cannot go to the pool because of the epidemic. in the united states we don't say that because vaccines accomplished the goal of making them rare. but if we move forward without the rates we are opening the door back into a life where parents have to fear and think about these questions in their daily lives. and it is that choice we need to

remind people of as we consider and weigh the puck picture. >> i was going to reiterate what can be done. there have been state partners in washington state and california and others that simply make it more difficult to opt out. it isn't only a matter of making it more difficult to opt out. but in most ways if you want to opt out you have to sign a form and then have a conversation with a medical professional and then they say sign it after you have the conversation and just that extra step is very helpful because hopefully people are becoming convinced with that extra conversation or maybe just the extra hoop to jump through makes it they would rather go ahead and get the shots. so that does seem like it is

working in some states according to early returns so that is all i have to say. thank you. >> i would like to thank you all for coming. and thank the panelist for an interesting discussion and nova for embracing the film. and the national co-press journal for co-sponsors this. you will be able to see a web cast of this on the website in the next few days and you can follow the conversation on twitter with the #vaccinesnova. thank you so much for coming. [applause]

>> you can see all of this event on our website. a federal appeals court is looking at the legality of the

subsidies tide to the health care law. they will reconsider the case with the full roster of judges participating. 4.7 million americans have received subsidies run by the federal government. that rehearing set according to the "washington journal" for december 17th. we will be back at the national press club later this afternoon. at 1 o'clock back at the press club to hear on issues that the left and right can agree on. ...