country. there is no doubt that challenges remain with regards to immunization rates to american families brought access to no cost of vaccines is clearly a key factor in maintaining and improving our vaccination rates. in my home state of washington, we have a universal childhood vaccine program which provides recommended vaccines for all children but another number of important federal programs that ensure access to free vaccines in our country. can you describe cdc's effort to ensure all americans to have access to the vaccines they need without cost sharing including vaccines children program? and particularly why that is so important. ..

those illnesses in the last 20 years since a $1.4 trillion. the cdc supports the states in a discretionary immunization program to bridge the gaps that are not addressed through the program. in particular supporting the public health infrastructure for immunization so state and local health department said immunization programs that work with clinicians in those areas they don't just investigate outbreaks like the measles outbreak but they work day in

and day out supporting provider education in dealing with vaccine shortages and distributing vaccine so they get to the providers offices. washington has a fantastic program. >> thank you. for me and a lot of my colleagues disease prevention was a key priority when the affordable care act, i am proud of the fact they have to cover recommended vaccines with cross sharing. health insurance coverage is increasing can you tell me what cdc is doing to help to build insurance -- >> the affordable care act means more people have insurance and that is excellent for vaccines because the acl requires insurers provide all recommended vaccines with no deductibles when given but network provider. the cdc has been supporting 35 states to set up building

practices so leading issue is people need to get vaccinated in a public health clinic, that health clinic will build the insurer, we are trying to make sure the scarce federal dollars for the the insurers to pay their way. >> in the home state vaccination worldwide, the gates foundation, and the reality is we are incredibly lucky to have people who have witnessed death by disease like measles or polio or whooping cough. i know you have worked with these issues across the globe. can you tell us what you perceive are the key challenges to achieving optimal immunization rates as opposed to developing countries? >> we are fortunate to have a

strong health system and access to vaccines. in many countries even with the lines that provide vaccines for free for the poorest countries the infrastructure is very weak so strengthening health systems overseas so they can deliver vaccine is vitally important. there are a number of public/private partnerships helping in that arena and i want to mention the measles rebel initiative, responsible for billion children getting measles vaccine through campaigns and other areas and about 15 million children have been prevented from buying from measles in the last 15 years through the measles rubella initiative working with governments around the world. >> public health infrastructure we have here is critical for issues like this. >> if everything the american were insured we need public health to make sure we are addressing the needs of the communities. >> thank you. >> we will now move to a five

minute round of questions. senator collins, senator mikulski and senator warren, the ones who just arrived at 11:00, we will move to the second panel even if we haven't finished the senators's questions. that will take 15 minutes and we will pick up where we left off with the senators who are next in line. >> dr. schuchat, the president's budget request includes a $15 million cut to the centers for disease control and prevention section 317 immunization program. you just responded to a question from senator murray about the importance of state and local health infrastructure. more than just paying for that section 317 immunization program

supports our reach, awareness, surveillance efforts by state and local public health agencies. it is puzzling to me that the administration would propose to cut this program when we are in the midst of a measles outbreak when you would think you want increased public outrage awareness and surveillance. you just talked about the importance of the state and local rules. could you explain to us why this cat has been proposed? >> public health infrastructure at state, local and federal level is vitally important to protecting americans. these threats like measles are an airplane ride away. reduction in resources requested through the president's budget will be accounted for through

reduction in vaccine purchase and the idea is that instead of paying for vaccines for insured people unhealthy apartments will build -- build the insurers to pay their way but absolutely protecting the public health infrastructure at the state and local level is critically important that the communication out reach and provider work that we do. >> it seems to me this is exactly the wrong time for us to be reducing funding in this area given the importance you just outlined. historically access to health care and the cost of vaccines, the major barriers to achieving high vaccination rates but increasingly it is clear that other factors have come to bear as we are seeing declining vaccination rates in some extremely wealthy areas of the

country. and recently compared unfavorably vaccination rates from wealthy areas of los angeles the south sudan. how should public health strategy change to reach those parents. and avoid the costs of the vaccines that have ample access to health care certainly better than those in the south sudan. >> 25 years ago we were dealing with the problem of children not having access to vaccines and what we see more and more these days is parents opting out of the system and not wanting kids to be vaccinated. and every one wants them to be

healthy. and for a number of parents especially in these communities opting out is common, they really don't realize these are still around and as we are seeing this year when measles virus comes into a community those communities where lots of people are vaccinated at higher risk. i hope parents in the communities are recognizing the threat is actually real. another factor is misinformation and in today's world is easy to get information of all types. much of it isn't very good. we at the cdc try to have the best information possible available land to make sure people see the sources of information and really check the facts themselves. clinician groups research suggests parents want to hear about these things from their own doctor who knows they're unique circumstances. a lot of the attitudes out there

may be from complacency, that these are not visible but this year the disease is getting more visible. >> i think the study that played a huge role unfortunately lot of people mistakenly believe there is a link to autism and and where the family has been discredited. thank you, mr. chairman. >> senator collins, thank you. senator mikulski. >> my question is fairly identical to senator collins's question $50 million in the grant program, to take care of the uninsured, the outrage and education. you are saying that reduction of

$50 million has no impact on those services related to vaccine safety out reach education? >> i can say those reductions have no impact. what i tried to say is the way that i would address those changes would have discretionary vaccine purchases and try to increase the building of insurance. and the public health infrastructure fee protected. >> this is the same way and particularly issues related to our education the gentlelady from maine, this is not an appropriation theory this is a valid area of inquiry and bipartisan cooperation. science and misinformation, the cdc tracks the correlation

between vaccine compliance, and mississippi 100% up what is the autism rate in mississippi? >> i don't have that information but there are number of ways to understand trends in nazism, and a number of different studied designs discredited any link. >> the solution to misinformation is more information. at science and evidence based. my question is to you track the correlation? >> we track the trends in us is a man the trends in vaccination around the country. the trends in vaccination, almost everybody is getting vaccinated with most of the vaccines stage by stage there

are differences in part to give vaccines. mississippi has -- does not allow personal exemptions for belief and many people feel the only exemptions that ought to be a lot of medical ones. some children can't get vaccines. >> not trying to get into it. there are high rates of compliance. how does that correlate? >> correlation between vaccine, uptick and autism. >> you had the epidemiology to support that which goes exactly to reach education. and efforts in the area of autism we have been very focused on issues related to alzheimer's and others but it is an epidemic in our country. and fathers to protect their children.

they need good information in real science. families facing these challenges they need to have answers and we should take a look on a bipartisan basis but i want to look at immigrant children and their vaccination and this can get controversial but what are the outreach efforts and how do we deal with this? 60,000 children came to america last year, many of them are in their and hopefully they are in sunshine, going to schools and so on. as cdc an effort with states with high rates of new immigrants both legal and not be aware of the immunization of children are addressed because there is this attitude they shouldn't be in schools or get the public health infrastructure. my home town of america central american kids are going to

school side-by-side with gentry kids. so how do we ensure the needs of those children are addressed and therefore the needs of american children to being protected are also addressed? >> they don't respect borders and it is important for individuals to be vaccinated for their own health but also to protect the people around them so state and local health departments work hard to make sure people are immunize regardless of their country of origin. is important in an era where measles has been eliminated from north and south america for us to continue to make sure there is strong immunization and other parts of the world where measles is still circulating. preventing preventable diseases it is important to make sure people have access to vaccines regardless where they are from. thank you. >> thank you, senator mikulski

the senator can city. >> those folks infected in the california epidemic how many were native-born americans and how many immigrated here? >> i don't have that information but what i can say is most of the importations that we have of measles each year are americans traveling abroad. >> when you say an american, u.s. born american we have heard a lot about how families from the wealthy communities, and where we see in these cases my residency in los angeles. and their contracting this. >> years ago we had a lot of

importations in latin america. the americas took on the elimination of measles. and have great success. >> time is limited. if someone is coming from the philippines, what is the requirement now? >> there is a requirement from documentation of vaccination against vaccine preventable diseases and children of vaccines make sure the refugees for instance would have access. >> that is for children, by definition less than 18. with an adult immigrates from a country like the philippines? >> that is not the case but most of the spread, most of the risk, if you survive to adulthood in most countries you have been

exposed to measles. >> of those adults going to the philippines and coming back, they are the ones bringing the cases. if there is any travel advisory if you go to the philippines to get immunized is there any effort in the philippines, you mentioned how the americans but up their immunization efforts, what about the philippines. >> there are efforts philippines suffered that horrible hurricane and weather problems much of their immunization infrastructure was destroyed, they had a really bad measles outbreak in response and cdc and others helped respond to help them work on their immunization campaign. the biggest outbreak we had last year from measles was a couple of mesh adults who travel to the philippines had never been vaccinated and brought the barseback to ohio. it turned out the on amish

community stepped up to be vaccinated. it is as newer communities where parents are opting out that we are worried about. >> the immunization records, wind -- my church went to a mission conference in the philippines. is he required to show his vaccination record to go? >> he wasn't but we hope we are reaching him throughout reject it. we are concerned with the ohio outbreak we haven't reached those travelers. they should have been immunized and they were misdiagnosed. >> seems like an easy thing to do if you apply for a visa to bonino saying you are traveling to a place with endemic measles. >> there are a lot of electronics that alert you. with our alert they're not 100% in terms of people following

them. >> when we approved a visa, there should be some process by which somebody is traveling to and endemic country and remind them of their risk. >> we could look into that. >> what about immunization rates? have the resource stayed the same? >> they have reason for the new vaccines and stable for the others and we tracked closely the percentage of children who receive no vaccines at all. >> wondering about senator murray's statement that of affordable care act improve immunization rates but the chip program and vaccine for children program, i have done a lot of immunization work on children that cost enough in a barrier for immunization for some time because of public health. do you accept that? >> it is adults where vaccination rates are very low and we have some lagging coverage in teenagers

particularly -- >> require hepatitis b coverage. >> they coverage through age 18. the aca would cover vaccination of an adult with hepatitis b if they were in recommended -- >> if they are at risk. it is important for the record for childhood immunization, but affordable care act has not hurt but it has not augmented that much was previously there. >> the vaccines for children program has been -- >> but not the aca. i yield back. >> senator warren. >> went up polio and measles vaccine became available for the first time to make sure their kids would be protected they lived in a world of infectious diseases that destroyed children's futures and they desperately wanted to leave that world behind the these vaccines, the memory of these diseases has

faded and the importance of vaccination has become less obvious. the pure research center report found 80% of baby boomers and seniors believe vaccines should be mandatory. only 59% of people under 30 hold that believe. now measles is back. you are the top immunization official in the united states. i want to walk through the science with this on you. is there any scientific evidence that vaccines cause autism? >> no. >> is there any scientific evidence that vaccines caused profound mental disorders? >> no but some of the diseases we vaccinate against can. >> the diseases can but not the vaccines. is there any scientific evidence that vaccines have contributed to the rise in allergies or autoimmune disorders among kids? >> no. >> are there additives or preservatives in vaccines that

can be toxic to kids? >> not in the amounts of vaccines. >> is there any scientific evidence that giving kids their vaccines further apart or spacing them differently is healthier for kids? >> no. increases the risk period. >> it adds to the danger. is there any scientific evidence kids can develop immunity to these diseases on their own simply by eating nutritious foods or being active? >> no. >> how to the risks of a child responding negatively to a vexation -- vaccination compare with skipping vaccinations at risk exposure to the deadly disease? >> vaccines are safe and highly effective and it is important for parents to know the best way to protect their kids. >> every parent wants to protect their children, parents should know all of the credible scientific evidence suggests

that modern vaccines are safe, modern vaccines are affected and modern vaccines are our best chance of protecting our children from diseases that can kill some. is that right? >> that is right. >> thank you, mr. chairman. >> thank you, senator warren. senator robert. >> thank you, i appreciate you holding this hearing. in kansas we had 19 cases of vaccine preventable diseases last year the most prevalent was measles. we have not had any new measles cases reported yet this year. public health workers are concerned, parents are concerned. the problem is our immunization rates are down. for the 2013 year through the 2014 year the percentage of young people who receive necessary vaccinations is below 90. that is not good.

for the record i had measles and chicken pox and mumps and everything else that people had back in the day. what i am asking if i can get to it here very quickly, if immunization rates continue to decline what advice do you give youngsters parent to rely on others in the community to jews vaccination and help protect their own? >> the lower the rates of the more your children are at risk so you want to be making sure your own children are vaccinated but also have those around them. and they have leukemia for instance, live virus vaccines, and the community level of vaccinations. >> the reason parents don't vaccinate, they fear side effects, religious or philosophical objections and there's a whole bunch of paragraphs in the background of

information on which states are easier to get religious exemption in which easier to get a philosophical objection, a simple letter assigned by a doctor. how often, however, the mistrust of recommended vaccine schedule, how often would you say the vaccine schedule is too rigorous, what reassurances will you provide parents on this concern? >> many parents do mention the number of shots children get an average together visit as something that concerns them. and at the times they are recommended because of the way they work and the disease risk, our advisory committee on immunization practices reviews the science of the vaccines and diseases and update the schedule every year based on the best information available so i strongly recommend parents get their children vaccinated on time and according to the

schedule. >> in answer to the chairman's question which really nailed the issue right off the bat, there is the major danish study published in 2002, 540,000 children showed there was no relationship to vaccination, any kind of problem with autism, institute of medicine did the same, there have been the centers for disease control, or economic groups. all these examinations point to the same conclusion that the body of evidence that was established a long time ago. this is a state issue. that seems to be the problem cdc is trying to convince every

state, mississippi if aught finds leads at the bottom not at the bottom but fairly close to. very concerned about it but at least the media today realizes one study which is totally discredited, there should be a strong statement by everybody involved that they should go ahead and cause vaccinations, and thank you for your leadership. >> thank you, senator roberts. when i go to senator bob one of want to mention we will excuse dr. schuchat and paul the second panel. any senator who hasn't had a chance to ask the question will be the first one up.

senator baldwin. >> i think the ranking member for holding this hearing. our vaccination program has reduced human suffering by preventing or reducing the outbreak of preventable diseases, and thanks to national policies, the affordable care act, millions of families have access to free immunization and it is why i am concerned about the recent measles outbreak or the surgeon misinformation exacerbated by the me the and national figures. this information is surrounding vaccine safety. to prevent future outbreaks it is vital to invest in our nation's vaccine production

capacity, support cutting edge science and enhance public education surrounding vaccine safety. i have a number of questions especially around our production. over 20 years ago partially in response to a measles outbreak congress recognized the critically important roles of vaccines by passing and creating less cdc vaccine for children program which provides recommended pediatric vaccines to low-income children. the cdc maintains a stockpile for pediatric vaccines, so could you tell us the current state of our national pediatric vaccine stockpile and is the measles vaccine included in that supply? can you elaborate on the role of the stockpile in addressing outbreaks as well as house cdc works to maintain it?

>> the vaccine for children program includes a stockpile that is approximately 50%, enough vaccine for 50% of the pediatric population to be vaccinated for a year. so we currently have over 3 million doses of eminem are vaccine. the stockpile has been used for epic response a used for vaccine shortages and even with a robust vaccine manufacturing industry there are many vaccines where only one two produce them and when there are interruptions of supply, a stockpile to make sure there's not an introduction in use. >> i want to explore further this issue of production and interruptions both with disease

prevent double diseases that are prevented by vaccines or the influence of vaccines or 100% match in a prevalent season. two issues, three issues domestic manufacturers versus overseas manufacturing an epidemic that has been a long issue and the includes domestic production, anything you can elaborate on would be helpful. secondly production is still slow based on chicken eggs and there have been many efforts to transitioned to a production on the influenza vaccine. where are we on that? feared the with regard to diseases that are preventable by vaccines, we had drug

manufacturing that decided to exit at a arianna and often times heard from front-line pediatricians who cite we don't have enough in our clinic and we have people coming in and can't meet the demand. is there better notice given to the cdc, do we have more safeguards in place to make sure we don't have an alarming shortage? >> we have a wake-up call ten years ago in october of 2004 where overnight half of the expected influenza vaccine supply wasn't coming through. that was prompted an enormous amount of re-evaluation on different parts of government we are in better shape now. that year we eventually had 58 million doses of flu vaccine. we have 150 million doses of flu vaccine that have been

distributed, multiple new manufacturers or additional manufacturers producing for the market and a number of formulations besides a debased that are approved by the fda and being used. the influenza vaccines are included among the seasonal flu vaccine supply and looking towards the future there's a lot of enthusiasm across the government and across academia around investments towards universal influenza vaccine that might give us a broader and better logger lasting protection than the annual flu vaccines we use today. in terms of communication with the industry. >> i want to get senator franken in before we leave. thank you, senator franken. >> thank you for that.

i am thinking that maybe this outbreak in measles is a wake-up call. as sarah warren said a lot of baby boomers and some of us in some dissenters that are older have measles and maybe this is time for people, educated people who wear forgoing this for their children, understand things like herd immunity you get a critical mass of people not getting immunized, you have outbreaks like this. and the financial process, 2005 article that attempts to

quantify the economic impact on health infrastructure, researchers estimate one case of measles costs the federal state and local health departments for the $140,000. just one case. you talked about the return on investment of these immunizations and it is one of the most obviously cost-effective also prevent a lot of suffering. we live in a global world and want to ask you about that investment, with global public health and what the importance of that is. in terms of our investment on this in africa and other places can you respond to that?

>> measles has been eliminated from the americas circulated around the world with 20 million cases a year. in some of the cases that had major outbreaks it is investing in their health infrastructure and supporting their ability to have strong immunizations systems that will protect americans and strengthen their health so we came to the partners in the eradication initiative and the measles rubella initiative and in ways to protect children everywhere with vaccines that are saved and affective. it strengthens community protection at home and is the right thing to do. >> in particular highly contagious and you are one play right away for an american getting effective -- speaking of

which, he's ups on the horizon what made be the next measles, what are we looking for in the near future? >> with infectious diseases you have to be ready for the idea the microbes are changing faster the and we are. we dealt with virus 68 problem, a severe respiratory illness in children that we really hadn't seen the last two years we are dealing with the middle east respiratory syndrome a new virus that was dealing with about in the middle east. >> the mirrors. >> we believe think it is critical to be strengthening public health infrastructure and capacity for global health for countries around the world's

those that we don't see them get as bad as we got that could jump on it right away and we don't see importations of mayors of but we recognize this overseas and battling them seriously. >> that is why the cdc, i want to thank you for your service to this nation and the world. thank you, mr. chairman. >> maybe i missed heard something. the state department website said u.s. immigration law requires immigrant visa applicants to obtain certain vaccinations prior to issuance of immigrant visas so an adult immigrant to the united states to obtain a visa is required to obtain certain vaccinations. >> i can double check. >> reading of the state department website i didn't

want to leave the impression or different impression if different question wasn't true. >> thank you for your time. there are some who didn't have time to ask questions but we want to invite the second panel to come up now. i will now move ahead and introduce the second panel to save time. we will hear from dr. kelley moore, dr. more is director of limitation program at the tennessee department of health and is responsible for promoting proper use of recommended vaccines and overseeing the response to outbreaks of vaccine with preventable disease. she has earned a graduate medical degree from vanderbilt, masters of public health from harvard school of public health and i am completely objective

with the department of public health, one of the finest in the country. dr. mark slater the professor of clinical pediatrics and pediatric infectious disease specialists at the university of california san diego and reading children's hospital in san diego, also on medical director san diego emigration partnership involved in a variety of immunization practices projects. dr. tim jacks is the father of two children who were exposed to measles in arizona. he is and every child by two immunization champion. every child by 2 is non-profit dedicated to increase vaccination rates, to tell their story. let's begin with you and the three of you could summarize your comments in five minute we

would appreciate it and senators, continued questioning. >> thank you, chairman alexander and senator murray put the benefits of immunization and inviting me to testify about the public health perspective on vaccine preventable disease. most people are unaware, with a strong history of the immunization a single case of measles required major public-health response. i would like to acknowledge the first lady chris e for their commitment to immunization as an essential step in promoting and protecting the health and prosperity of tennessee. you could say tennessee has a culture of immunization. for the past two influenza season as the majority of tennessee age 6 months and the perceived a flu vaccine. in 2013, 95% of kindergartners, doses of eminem are, one of 100 claimed religious exemption and

just over 1 in a thousand were exempted by dr. for medical reasons. the federal vaccines for jill and program remove barriers to access for eligible children since 1994. states on line immunization informations systems supported by section 317, insures authorized users such as clinics and schools have access to immunization records to see what vaccine the child may need to verify they are protected. we have high immunization rates for teens and adults that prevent diseases like meningitis, cancer, pneumonia, and shingles. and the clinical and pharmacy colleagues address misinformation and concerns about safety health benefits and affordability. to improve access our department is using federal prevention and public health funds to help local public health clinics that come in a good -- network

providers so we can provide recommended vaccines to their beneficiaries with no out-of-pocket costs. when it comes to disease outbreaks, public health goes into one case of measles. i visibly recall each of the nine cases tennessee has had in the decade i directed our immunization program and the recent experience is a good example. on a friday afternoon last april, a doctor called his regional health office about an adult with uncertain immunization history with overseas travel in the e r with classic symptoms of measles. the diagnosis was not in question. a game plan was developed in a call with state immunization program to identify those who may have been exposed in the four days the unsuspecting patient was highly infectious. 124 people were identified. the m m r vaccine could protect the most recently exposed

susceptible contacts if public health finds them quickly enough. 25 contract with and in the meaning of vaccinated on saturday. others were killed what the jewish symptoms developed. among the 124 contacts just three cases among other adults developed. for them the same isolation contact ramifications process was practiced but faster. no additional cases occurred. total of 106 contracts were evaluated. td a for the media statewide to educate the public in prepared clinicians' through state health alerts with the educational webinar. and consultation and specialized testing helped us optimize our outbreak management tactics. a great deal of credit goes to the hard work of public health at all levels. this results, however, could only be achieved in a high percentage of the population which was already in use in. the imported case landed among

those who were not immunized and susceptible, would have been a different outcome. conference and sustained commitment immunization and strong public health infrastructure in section 317 funding will continue to equip us to meet the educational and operational challenges of keeping individuals and communities healthy and safe through of affordable, accessible and affective immunization services. thank you for the opportunity to testify here today. i've provided a more detailed written testimony for the record and glad to answer your questions. >> thank you, dr. moore. doctors lawyer. >> thank you very much for holding this hearing on the unimportant topic, the re-emergence of vaccine preventable disease and what we can do to prevent further outbreaks. china pediatric infectious disease specialist at the university of california san diego, and i am also a member of

this committee and infectious disease of the of the american academy of pediatrics and by testimony today has strong endorsement of aarp. vaccine that one of the greatest public health achievements as has beened that out by several of the senators. prior to the introduction of vaccines children suffered regularly from serious illnesses like measles, diphtheria, polio, even bacterial meningitis. the development and widespread use of vaccines lead to a reduction or eradication of these once common childhood illnesses. because of the success of vaccines i have never seen a case of polio, did the real or tetanus in my 30 years of practice in pediatric infectious disease. in a teaching session i held last week with 20 p.m. residents in training i asked if any of them had seen measles. none of them have. but as we have seen from our current measles outbreak and continued outbreaks of whooping cough around the country we are

witnessing a re-emergence of vaccine preventable diseases in the united states. unfortunately my residents are going to get a chance to see the measles. pediatricians are concerned the re-emergence of disease is a signal that bigger outbreaks are yet to come. most of the cases in the current measles outbreak are from california, 13 from my own community. with outbreaks like this increasing in frequency and size, this measles outbreak like all other measles outbreaks are occurring because we have too many intentionally and immunize children in the united states and it illustrates the problem created by an immunized population is this simple trips to disneyland has led to what multistate outbreak of measles involving 100 people. measles is one of the few infectious diseases that literally flies through the air. it is completely predictable that such outbreaks will occur again if immunization rates stay where they are or get worse.

most parents choose to vaccinate their children but there are pockets of and in humanize children around the country. in san diego we have 1500 kindergarten students who are not fully immunized and that number is increasing steadily over the last decade. the current measles outbreak reminds us of an important fact of infectious diseases. when one person is infected all around them people they don't know. and to the child's and immunized however well-meaning. the decision affects us all. an excellent job controlling the current measles outbreak, when too many people to make the decision not to vaccinate their children, outbreaks will no longer be controlled. why is this happening? all parents want what is best for their children but many parents are choosing to not have their children immunized because they have received inaccurate

information about the risks and benefits of vaccines and the diseases they prevent. i have held a number of forums in san diego county meeting with vaccine has and parents to hear their concerns. based on what i have heard in these discussions i conclude that the internet can be a dangerous place for parents looking for information about vaccines. the internet is replete with anecdotes and misinformation that that leads parents to think vaccines have caused harm. what is overlooked by parents is the fact that just because an adverse health out, occurs in the time after a vaccine doesn't need the vaccine caused the problem. take science to prove or disprove a link between two events and parents are not hearing the science. the vaccine schedule recommended by cdc and a pea was developed with strong scientific standards and was proven to be safe and effective. for every vaccine the risk from

the disease outweighs any risk from the vaccine. in my opinion the best way to decrease the number of families refusing to vaccinate their children is to improve communication of vaccine safety and effectiveness, increase science literacy of the population, limit the philosophical exemptions from school entry requirements for vaccination and continue to carefully monitor the safety of all vaccines we use. taking these steps can ultimately help reduce the number of children who choose not to vaccinate their children. the re-emergence of vaccine preventable diseases is alarming and must be confronted if we are going to prevent further outbreaks like the one we are experiencing. i look forward to your questions. >> thank you dr. jacks. >> senator alexander senator murray, an esteemed members of congress, my name is tim jacks i am a board certified pediatrician and i am on the front lines of this vaccination

issue. ideally recommend vaccinations to my patients and address concerns about immunization. lately i have been addressing many questions over the on going measles outbreak. i am not here as a medical professional. i am here as a father. three weeks ago my infant son and daughter madeline who is battling leukemia were exposed to measles. since her diagnoses with leukemia six months ago our home life has revolved around my daughter maggie's care. she has been admitted to the hospital six times and spent nearly a month there. she is on a regimented schedule of treatments and takes medication three times a day, up to six medications at a time. we have weekly visits to an outpatient clinic where she has procedures, but were gone and she gets her chemotherapy infusions. at one such clinic visit my

children were exposed to measles. we were informed of this exposure and instructed to return for shots of the measles antibodies which we did. these antibodies are not perfect protection but in the case of my children the only thing we can do to prevent them from actually coming down with measles. right now my two children are at home under quarantine. while we are awaiting the three weeks to see if they developed measles or if they exit quarantine without any symptoms i typed and entry into maggie's blog and this is something to update family and friends to her treatment progress to let people know how she is doing. typically i get a hundred people reading this book. it has gone viral.

and the unvaccinated child, in this blog, hopefully educated some people as to why my children and many other children like them are at risk. eli, i can-month-old son has received all of his immunizations on schedule but is too young to receive his first dose and my daughter maggie who was also previously fully immunized is at extra risk because of her weakened immune system, due to leukemia and her treatments. the blog went viral. in over two weeks it received over 1.3 million shares on facebook and has been read calloused times. i have been contacted and interviewed by cnn, fox news and many other local and national media outlets. i have taken these opportunities to share our story and hopefully raise awareness to this issue. my hope is we can prevent some

families from going through the same thing we have gone through the last three weeks. i hope we can prevent more families from getting measles altogether. prevention is simple vaccinate. as immunization rates drop, herd immunity starts to breakdown. this herd immunity is the only thing protecting my two young children from being exposed to measles or whatever the next outbreak is. i urge a strong unified, bipartisan voice supporting the scientific evidence that vaccines are safe and save lives. we need a consistent message from the presidency to capitol hill to our local state legislators, schools and even day cares. i urge congress to take actions supporting programs and infrastructure already in place to get these vaccines to those that need them most and contain outbreaks such as we are seeing

today. i will care for my family. i will work to promote health among my patients and through partnership with organizations like every child by two and arizona partnership for immunization, i will advocate for timely vaccinations for children. thank you for your commitment to this issue. we can stop the spread of vaccine preventable diseases and protect the innocent. we can protect our children. we can protect my children. thank you. >> thank you, dr. jacks for your personal story and thank you, doctor sawyer and dr. moore and now we go to the senators who have not had a chance to ask questions, beginning with senator casey. >> thank you very much. i appreciate this hearing. we think the witnesses for bring to this hearing room your experience your knowledge, your significant time you have

dedicated your lives on these issues and dr. jacks, we grow grateful you are bringing your personal story. these issues are difficult enough but never more so when you have a loved one, in your case a daughter subject your efforts. i referred to a why question, why this failure to vaccinate has become so significant? maybe the question we are all asking. maybe i better question to ask is what can we do to push back against it? we are doing that today and obviously each of your testimony have referred to that. i want to get to the ground level work that has to get done. and maybe some members of the

panel do. what happens in our schools, in communities and pediatricians, you mentioned the fact that in all your years, being exposed to this in a direct way. to ask specific questions about pediatrics, there has to be pediatric training, there was a change in the training that they have to vaccinate? >> that is an excellent question. there are efforts from the american academy of pediatrics and in my case locally, immunization three or four years ago, i added a section of that curriculum to teach residents and training how to communicate

about vaccine safety and address concerns of these parents in an open on confrontational way. to educate our families and give good accurate information. there is information circulating, we get on the internets and take it to heart. to raise the science literacy from the united states than as a tall task. we will never win this battle. >> i want -- on page 40, you talked about the second full paragraph. in tennessee and quoting, in tennessee local school nurses and coordinated school health directors are among our most important champions of immunization. tell us about that the importance of that. as much as we have an obligation

in washington to get a message out to get a policy right a lot of the best work will be done in those settings. >> that is true. i can't speak highly enough about local and nurses, school nurses and school administrators who work with families because these parents often hesitate to vaccinate their children out of fear. they want to do what is best for their child, bells go off when they hear scary things about vaccines and is hard to not ring that bell. ..

i know in the debate about how to respond to the ebola crisis, among the best pieces of advice we all got here was local validaters are a lot better than validaters outside of a local area. i won't say washington by thinking of what i'm talking about. thank you for your work and i'm grateful you're here today. >> thank you, senator casey. senator murphy. >> thank you for this thing. thank u. all of you, to tell your story. i wanted to talk for just a minute, ask a few questions about the nuts and bolts of how exemptions work. because we've seen a pretty rapid rise in exemptions, in my state for instance, which has fairly loose rules regarding getting exemptions. a feature we share with

california, frankly. we've seen just in the last three years the number of people who are applying and getting religious exemptions has doubled, just in three years. and so i heard in your testimony, doctor sawyer come your proposing eliminating the philosophical objection to kenya just big for a minute on why you've made that proposal? >> i made the proposal because as you pointed out i live in california, where up until last year a note to exempt your child from school vaccinations, you simply flipped over paper and signed it that you had a philosophical objection, not a religious exemption not a medical reason your child couldn't be vaccinated. you just don't believe in vaccines. just as you mention in your statement, we have seen a steady rise in those exemptions in california over the last decade. there are very few religions that specifically advised their followers to not vaccinate.

it's the philosophical exemption that is causing the problem and i think it's driven by misinformation. so i am certainly in favor of eliminating such philosophical exemptions. a state senator in california just introduced a bill last week to do just that, and i'm going to be supporting that effort in california. >> let me suggest an alternative to the elimination of the exemption. as you mention all you need to do in a state like california or connecticut is simply sign a piece of paper. you get no information about the consequences of not getting a vaccination. yet the studies are pretty clear that more information that you get, the less likely it is that people take the exemption. and, in fact the less likely to have outbreaks. this is a stunning one from 2006. in states that have higher bars were exemptions, they were 50% less likely to have whooping cough outbreaks. and you can recite other literature that says the same

thing. dr. sawyer, but happy to get comes from the rest of the planet, let's say we just raise the bar for a philosophical objection and we said for instance, that we have to consult with your physician first order you have to review information on -- about the risks of not getting your kids vaccinated. do you think that that would be helpful if we weren't successful in eliminating the exception? i will be glad to hear others. >> we have just done that in california. last year passed a law that requires parents to exempt their child, have a form signed by health care provider at least have been educated. that led to about a 1% drop in the rate of exemptions in california as a whole but it is still at 2.5 3.5% in different commute is in california. we will see next to whether the form continues to drop the rate. my concern is with seeing the benefit of a 100 we will go back

to a steady, gradual increase in exemptions, whether people stick to philosophical ones with their doctors, the information, or whether as they start exercise religious exemptions that they didn't before. >> just quick comments. >> tennessee is one of the past winter to states that does not have a philosophical exception has no intention of developing one. >> only one -- only 20 states have them spit creek, only about 29 or so including tennessee. i think we have to decide as a community to want to attack the most vulnerable among us or do we want to provide choices and options for protectioprotectio n? we can't do both at the same time with a disease as contagious as measles. we are prepared to accept the consequences of outbreaks like this and personal choice is perfectly fine but if you want to protect the vulnerable then immunization needs to take place to do that. it's the best way to do it. >> thank you, mr. chairman.

my office is looking at some legislation, proposed legislation that would provide some incentives for states to increase the information that they are giving to parents. not mrs. addicted what exemptions are used, but to admit that is a national health priority it probably makes sense to make sure that the best information is given a. the irony is if you're getting a medical exception to have to have a note signed by doctor. but if you're using a philosophical exemption or religious exemption, often all you have to do is sign the back of that for but it seems like at the very least we should try to marry those two standards together. thank you, mr. chairman. >> senator bennet. >> thank you, mr. chairman. thank you very much to you and the ranking member for holding this hearing. it strikes me listen to the testimony that we have been victimized by two things. one, a generation that has not experienced these diseases because of vaccines and have lost sight of what they look

like. and interestingly, dr. sawyer's point, the unedited content on the internet, more affluent families i guess are reading. i wonder dr. sawyer, and then ask the other panelists, 11 also say, dr. jacks, thank you for your testimony. i hope maggie is getting a chance to watch you or maybe doing something something more interesting ago but they get for being a. dr. sawyer, could you use this opportunity to tell us what the biggest falsehoods are that are being trafficked on the internet and what the answers to those falsehoods are? if the other panelists would like to join that would be great as well. >> as has been mentioned several times today, autism remains one of the major concerns of parents, even though as dr. schuchat put up the sides has discredited any association between the two. what you get beyond that, the next thing you hear is that we are overwhelming children's immune system with too many vaccines to send. the whole philosophy of the

immunization schedule is to protect children as soon as we can for as many things as we can. so delay in vaccines is really counterintuitive to the whole purpose of the vaccination program. if we were overwhelming children's immune system i am an infectious disease doctor. those kids would be getting unusual infections because their immune system was overwhelmed but we don't see that that too much for months six months when we give we team vaccinations. the last major theme hear about are the ingredients in vaccines and the concern that perhaps some of them are toxic. once again that's been discredited, looked at very carefully. fda approved of these vaccines in large part based on their safety record. >> dr. moore stick with i will add to dr. sawyer's excellent list that i agree with, the flu vaccine causes the flu. i hear that every over and over from a educated folks, and that is certainly one we work to counteract because of the benefits of flu vaccine. so that's a common one.

and then hpv vaccine might cause promiscuity but we do that from time to time as well. >> just to be clear to anybody listen to this, these are all things that are demonstrably incorrect. dr. jacks i wonder, you are a pediatrician. do you have advice to pediatricians across the country about how to handle the conversation that they have with parents about vaccines? >> yes with regard to families, questions or concerns but it is addressing the questions and concerns. you know, back in the day physicians could take somewhat of an authoritative stand it is a great deal of respect. nowadays is really more of a working with families to come to the conclusion of what's best for their children.

whether its immunizations or whether not we want to treat an ear infection. and so as a pediatrician my goal is number one, develop relationship with my families so that we do have that rapport. and then for me to make my recommendation and address their concerns specifically. >> to give anything, dr. sawyer you would add you train pediatricians? this question of whether there are things that pediatricians can do? >> right. so the curriculum i mentioned we develop locally in san diego as well as the academies curriculum basically takes people through the appropriate way to listen attentively to people's issues and be respectful and addressing them, but to continue to convey the signs in the most clear way one can. so that families can reach the right conclusion. >> thank you. thank you, mr. chairman.

i surprised the chairman because i was finished early. >> forty-three seconds. >> i will never get that time back. >> we will put it in the bank. >> i will take that. >> we have done and i'm sure all of us would probably like to ask have a second round of questions. dr. moore, i believe you said that the case be measles from tennessee was in memphis right? >> it was actually an adult in west tennessee. >> and you described you moved in quickly and the number of people that just the one case that you didn't touch with was how many? >> 124 that he would come in contact with that one case during the '40s before they were diagnosed. >> this isn't it with the vaccination rate for measles is what? >> very good. i don't have the specific number for the region but it was clear because 124 people were exposed and only three people got sick that it was very high speed as dr. sawyer was talking, i was

thinking about the phrase going viral and then dr. jacks used a. i think modern this generation understand the idea of going viral. you are talking about measles flying through the air to that's unlike ebola, a complete panic actually last fall when, when we spent $5 billion, changed of the hospitals procedures dominated was going on, although public health departments. and that could only be caught by an exchange of bodily fluids. this flies through the air. this goes a viral. this is a disease that goes vital. we senators in a bipartisan way to understand the problem of dealing with highly educated people who get bad information on the internet. that happens to us every day. we do with that. we know what it is but let's go back to the going viral. what if this person in west tennessee who dr. moore acted on

quickly and what if that person had been discovered in a part of los angeles where the immunization rate is 60-70% instead of 90 or 95%? describe the number of people and the multiplying of people that would have to be contacted to make certain that the disease didn't spread. >> i can share the experience we had in san diego in 2008, which was our last outbreak. we had 12 cases, and over 800 people were exposed to those 12. so it quickly goes up exponentially. the number of people you have to track. analyst public health is their to track those people and keep them poor indeed it could easily just get completely out of control. >> so you at 800 people, but each of them might have infected someone else right? >> exactly. in that outbreak with close to 100 people were courting for three weeks just to prevent the

next way. we were all crossing our fingers with this design a break that maybe we are near the end. i noticed the case never went up by 20 just this last week so i'm not sure we're done with us yet. >> when using flies through the air, we have an example of going viral and modern parlance i suppose. dr. jacks, this may not be an exact comparison but people asking why i continue to play the piano when is young, and i remember responding, i didn't remember my mother giving me a choice about it. i guess i had a choice. we are not talking about taking choices away today from parents, but we are talking about a conversation between a pediatrician and a parent. that probably wouldn't start by without, i mean, even in the state of parents who deal differently that my generation of parents, let's say how

strongly do you recommend to your parents that they vaccinate their children? i suppose the most persuasive thing you can do is tell them the story of their own children. but do you just make a neutral observation about it or do you come to conclusion and say i think you should do it speak was i definitely come to the conclusion of recommending that we do vaccinate. i oftentimes don't approach it quite that way because i want to get their thoughts and opinions and their fears first because so i can address those. i talk to families from a couple that is still project that hasn't had their first child in do that first visit after they are born, to the routine visits when we went to vaccination. and every visit, whether they are 100% getting vaccinated or whether they are still trying to decide i'm talking answering

questions and urging them to make good, informed decisions. and my understudy my opinion is that yes vaccines are absolutely one of the best things they can do to protect their young child. >> i am out of time but i assume, i assume that i know in our state years ago my wife led an effort to establish a medical home for every child about to be born, prenatal health care. i assume anything in prenatal health care that allows a parent to know more about the value of vaccinations before the child is born is a very effective way to keep the vaccination rate high. senator murray. >> thank you, mr. chairman. dr. moore, i wanted to ask you about this because i'm interested in learning more about what can be done to increase uptake of the hpv vaccine. we are really fortunate to have a vaccine today that can prevent most forms of cervical cancer, which i'm sure you know is the

second leading cause of cancer death among women in the united states, about 12,000 women get cervical cancer every year. about 4000 are expected to die from it. we know that those are deaths that can now be prevented. i wanted to ask you what can state and local health departments do to more effectively promote hpv vaccine? >> that's a wonderful question and certainly we know that a lot of young women and men are not being protected against this virus yet who could be. in tennessee our emission rates are about one in three, and would like it to be much higher. we are working collaboratively with cancer advocates because they have wonderful experience raising awareness about breast exams and pap smears and we are collaborating together to try to help families understand that this new vaccine is a cancer prevention tool that can help reduce the risk of an abnormal pap smear for a young lady later in life. we are also trying to make sure people understand this vaccine

is safe. it lasts, and it is very, very effective. and we bundle it with other routine vaccines so is given at the same time for protection middle schools, the first meningitis shot and it is a part of the reading preteen immunization bundle. so we're trying to help people understand that there's nothing exceptional about this except that it is phenomenal cancer prevention at an incredibly exciting to have a tool in her hand at the last generation didn't have to protect women and men from cancer for the lifetime. >> well, thank you. appreciate that. i also want to make of that in my home state we have an incredible public-private partnership that's called -- at a time when the state had the highest vaccine exemption rate in the country. our state health department came together with some key health promoting organizations including group health foundations within reach, and the seattle children's hospital to create this really innovative

partnership which addresses vaccine hesitancy through work with parents and our health care providers alike. it has support from the gates foundation, which is helpful, and engagement of a lot of partners. but vacs-northwest is doing some really amazing work which i should mention also has been rigorously evaluated with the intent of sharing a lot of lessons that dealing with other states. i wanted to ask you dr. moore, how can working with private and nonprofit partners help health departments in their efforts of vaccine? >> thank you. health department of a major role in promoting immunization. we long ago starred next up being the medical home. they go to the own private doctors for immunizations now which of providing the best holistic care for upbringing of the child. but we partner with these organizations in order to help support them in doing the right thing. because what i find in clinical practice, pediatricians are currently busy with everything they have to do and it helps

them if there is a group in public health focused on promoting just the musicians where we can provide them support like our immunization information system that makes their jobs easier. and so our role when it comes into doing site visits, about quality of their immunization care through site visits we do in their offices educational programs that we provide promotional material, we help give them the resources they need for the private sector to do the best possible job for the patients. because they are primarily the ones taxing our children. so this partnership has been wonderful. i'm all about relationships and these relationships have been great at developing strong collaborations and bolstering immunization in tennessee certainly. >> thank you. and dr. jacks thanks for being here today. i appreciate your willingness to come. since you started speaking out about her own family situation have you been surprised to know how many people don't know that

some people cannot be vaccinated? >> surprisingly no actually. there's been a lot of support a lot of positive feedback certainly a small amount of negative feedback from certain populations but it seems like the knowledge is there. i just don't think it's in the public conscience when they are making the decision to vaccinate or not vaccinate and that's why i'm doing this. i want to raise awareness of the issue so it can be part of the discussion. >> okay, i appreciate that. i just want to ask you as a pediatrician, what do you think are the key barriers to vaccine uptake? >> largely education and the misinformation that is out there. >> thanks. thanks, mr. chairman. >> senator cassidy. >> first elected request unanimous consent into the record a statement from the march of dimes. >> will be done. >> thank you. obviously with declining

resources on the federal level. i see that the administration is cutting the 317 money, dr. moore, that you referenced. but i will also don't begin as a fellow who used to work in a public hospital system that as a pediatrician get a lot of immunization work. there's always a great concern about immunization. so sometimes i would see people, to speak to our pediatricians about immunization and it was like call the new council. these folks cared about it. jackson sawyer care about ashley. so can we use our 317 money more effectively? let me ask, and ask this not to challenge but to suggest. when i look at that map of california, you can isolate those communities which are not immunizing. we opt to pay jacks to come in and speak to those families so that they know if they have a domestic it is helping them in the home and if they're wealthy they may, whose child was unvaccinated and recently came from another country their

children are at risk. dr. jacks, to do that very effectively. i guess and going to ask him are we still using our 317 money in a paradigm of 20 years ago before we had immunization registry that could pin point where we had pockets of the i'm immunized? and before we realize many people are basing their decision based on emotion not upon their physician's recommendation? sensible question 317 is a 20 years ago or are they adapting to our ability to use the data to pin point where we need an intervention? >> thank you for that question. i can say under dr. dr. schuchat solution is the three something program is adapted to focus on where we are today with our immunization programs. 317 funding that we have is going to support our immunization information system that provides this image in clinical decision support for clinicians who need to keep up

with the complex current immunization schedule to provide optimal care. it can provide that support. it makes it easy to issue an immunization certificate. we are using those funds to provide education not only for clinicians and large conference settings but also want him on education. we will send a public health immunization expert into a clinic to spend half the day with -- >> those clinicians, again they don't need a half a day. they just need to have posted online their clinics results compared to other clinics. the natural competition is going to drive the. we know that from infectious disease rates. if you post an immunization rate and their liking, they will come up. i suspect if he did that for an elementary school we are going to post the rate of the children immunized here, enter but beware because over 50% are not immunized. do you fall what i am saying? is the petri dish for meals. dr. sawyer?

>> first of like to agree with your very last comment about posting these rates for schools. because we want parents to be informed about vaccines in general but we should also want them to be informed about the environment that they're putting their children. there's no doubt that a school 40 or 50% of a given us join as where the next outbreaks are going to occur because once they get going -- >> is there a push to do so? there should be something we should be letting parents know as much as possible about both because of it the pediatrics article that staff provided. is a pediatrician pushes immunization, she is more likely to convince to vaccinate then issues a passive okay that's fine, i will sign the note. to what degree are we posting individual clinics and/or individual schools? seems like we should be doing that in santa monica. >> the rates of school vaccination our public information. they are posted on the state website budget to go look for them rather than putting right in the face of of the. as he walked in on the first day

of school might be more effective. >> dr. jacks any comments? okay. well, i will use back my 43 seconds. thank you. >> this time the bank is getting full. senator franken. >> i don't think i'm going to take very long. appreciate all your testimony and all your answers to the questions. i just have ma it may be too early to know the answer to this and all your on the front lines of this obviously and dr. jacks, your story, you are hearing a lot. what is the public reaction to this in the last week or so? because hopefully we are disseminating some information here, and the news has been, and what do you sense has been the reaction to the outbreak and to

all the public information all the discussion on the news, et cetera? what has been the reaction from those parents who waved the immunization for the child? is this being helpful? is this a learning moment for america? >> i was absolutely. i have certainly heard stores local pediatricians have been trying to convince families for years to immunize and when this measles outbreak happened there walk in the door wanting to be immunized. i think the publicity is are important to raise awareness about the fact that these diseases are still out there, and i think again the senators for organizing this hearing can do that. >> yes. i've had great experience getting a lot of good questions from the media and from families particularly focus on our immunization exemption which

is low but not only the wealthiest county in tennessee has almost four times as high and exemption rate as the county next door davidson county from metro nashville among kindergarten student but i think the continental detention hopefully even though our exemption rates don't compared to california and some other places, it's making people realize that the consequences of their choices. >> dr. jacks? >> i would just echo what they are saying. there's definitely been a lot of good awareness about the issue a lot of families have coming to get immunized both against measles as well as other immunizations. i just had a family this last week that the parents were kind of split on do we vaccinate, do we not. i remember them and they came and they got all their vaccinations. >> you know, this article from years ago i think probably did

a lot of damage in this and we've seen not exploited, maybe growth in autism, at least in the diagnosis of it, whether it's a genuine increase or just better diagnosis. and parents and it is a devastating thing autism. and so i know that that fear resonated with people. so i think that again that this is maybe a wakeup moment, a learning moment. and i hope that it is. i want to thank you for being here today. i want to thank the chairman for calling this hearing. thank you.

>> i give you one minute 16, but i am the end anyway. >> just a couple minutes left industry. you can see it in its entirety on c-span.org. the u.s. senate is about to gavel in. members will start the day with a general speech. no legislative work has been announced after the. it will be looking to hear from mitch mcconnell on the send direction today. the armed service committee unanimously approved ashton carter's nomination for defense secretary yesterday. that could come up today. live now. the chaplain: let us pray. eternal spirit, the giver of every good and perfect gift, we are sinful people seeking salvation. we are lost people seeking direction. we are doubting people seeking faith.

teach us, o god, the way of salvation. show us the path to meaningful life. reveal to us the steps of faith. today use the members of this body as instruments of your glory. quicken their hearts and purify their minds. broaden their concerns and strengthen their commitments. show them duties left undone. remind them of promises unkept. reveal to them tasks unattended. lord lead them to a deeper experience with you. and, lord, please comfort the

loved ones of kayla jean mueller mueller. wree pray in your merciful name. amen. the president pro tempore: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god indivisible, with liberty and justice for all. mr. mcconnell: mr. president? the president pro tempore: the majority leader. mr. mcconnell: i move to proceed to h.r. 240. the president pro tempore: the clerk will report. the clerk: motion to proceed to calendar number 5 h.r. 240,

aen act making a eption pros for the department of homeland security for the fiscal year ending september 30, 2015, and for other purposes. mr. mcconnell: mr. president? the president pro tempore: the majority leader. mr. mcconnell: last night i joined members of both parties to recognize the latest bipartisan achievement for the american people. the clay hunt act which will provide important support to our nation's veterans passed the house and senate with overwhelming bipartisan support. it's on its way to president obama's desk right now and i'm confident he'll sign it. and today the house of representatives is expected to pass yet another bipartisan bill for him to sign, the keystone jobs bill. it is just common sense. that's why this bipartisan legislation that already passed the senate with support from both parties. that's why labor parties support it. that's why the american people support it.

americans know that construction of this infrastructure project would pouch billions that the -- pump billions that the economy and support thousands of good jobs. they also know that america could achieve this with, as the president's own state department has indicated minimal environmental impact. so americans are urging president obama not to i want fear with the review process for political reasons any longer. americans are urging the president to finally heed scientific conclusions his own state department already reached. let american workers build this infrastructure project. sign this jobs and infrastructure bill. now, powerful special interests may be demanding that the president veto keystone jobs, but we hope he won't. if the president did ultimately bow to these special interest demands, that's a discussion we can have then. but either way americans should know this: the new congress won't stop pursuing good ideas.

this new majority is committed to refocusing washington on the concerns of the middle class and the passage of bipartisan bills like clay hunt and keystone jobs shows we're doing just that. now, on a ditch different matter, mr. president, democrats are blocking homeland security funding in order to defend executive overreach the president has said himself on many many occasions he didn't have. as i indicated yesterday, this is the reason the senate can't move forward so it needs to come to the end. here is the simplest and most obvious way it can: many democrats previously indicated opposition to the kinds of overreach described by president obama himself as unwise and unfair. so all they have to do is back these words up with some action. if democrats claim to be against overreach and claim to be for funding the critical activities of the department of homeland

security then there's no reason for them to continue their party's filibuster. so vote with us to allow the senate to actually debate homeland security funding insteaded. we've already offered a fair and open debate that would allow for amendments from both parties. if the bill needs to be amended that's when it could be, when we actually got on the bill and offered amendments. so this is about democrats being confronted with a choice: filibuster funding for homeland security to protect overreach president obama himself referred to as -- quote -- "ignoring the law" -- end quote -- or allow the senate to debate and vote on the very funding they want. thorpg we received the president's proposed authorization for the use of military force against isil and its affiliates. it was clear from the outset that a successful military campaign to defeat isil would

require a multiyear effort. so it's certainly in order for congress to debate an authorization like this. and because congress must meet its responsibility to decide whether our military should use force, the senate will review the president's request thought thoughtfully. individual senators and committees of jurisdiction will review it carefully and they'll listen closely to the advice of military commanders as they consider the best strategy for defeating isil. because this issue we demands such serious consideration i want our members to have an early opportunity to discuss the president's request. that's why later today our conference the republican conference will meet for a discussion led by senators corker and mccain. mr. president, i yield the floor. mr. durbin: mr. president? the presiding officer: the assistant democrat leader. mr. durbin: mr. president i'm standing in today for the democratic leader, senator reid, who is absent for a medical

procedure. and he was with us yesterday and will be returning after the break. we wish him a speedy recovery. he's gone through quite a bit with the accident that he endured on january 1. we wish him the very best and a quick recovery. mr. president, we're going to have a chance to do something this week that's important: to fund the department of homeland security. this was a department created after 9/11 for obvious purposes. we never want america to be vulnerable again to that type of extremist terrorist attack and all the death and destruction it brought with it. and so on a bipartisan basis we created this department. 22 different agencies were merged into one so we would have a common effort to keep america safe and secure and the department of homeland security has done a great job. secretary jeh johnson is currently the leader of that agency. he is an extraordinarily gifted and talented man.

and he is doing his best to keep america safe. we should do everything we can to keep it safe, too. and that means that the senate and the house of representatives need to do their job when it comes to the department of homeland security. you see mr. president as fen -- as everyone knows when we talked about funding the agencies of government this last december after the election, there was only one agency -- one department -- which the republicans singled out and said, we will not properly fund this one department. what was it? the department of homeland security. i don't understand this. if that department has the singular responsibility of keeping america safe, why would we risk the security and safety of america by not properly funding the department of homeland security? the house republicans insisted on that position and senate republicans backed them up. why would they jeopardize america's security over the funding of this department? so the republicans could engage

in a political debate over president obama's immigration policy. it's an important debate. it's a worthy debate. there's no reason why we shouldn't engage in this debate. but why would the republicans insist that this debate be at the expense of funding the department of homeland security? it doesn't make any sense. in fact, we are running a great risk by what we call continuing resolutions instead of regular budgetary appropriations for this department. secretary johnson has talked to us about what's going to happen if we don't properly fund the department of homeland security. there are grantings that are given through that department to fire departments and police departments across america to train their personnel to upgrade their equipment, to be ready, god forbid, for the next challenge that faces america. and yet the republicans insist on stopping that grant making to

the local police departments in your community and mine and the fire departments so they can engage in a debate with the president over immigration. what is it about the president's immigration policy that infuriates the republicans? could it be that the president has said he wants to prioritize deportations in america so that we, in fact, are going to deport those who are the most dangerous in the united states? i hope that's not it. because the president's position is something most americans would endorse hartley endorse. could it be that they object to the president's proposal that those who are here undocumented, parents of american citizens and parents of legal residents that those who were here undocumented step forward pay their taxes submit themselves to a criminal background check in order to have a two-year temporary work

permit? i doubt many americans would disagree with that. it would mean that these tax-paying workers would be checked and if there's any problem, deported. the republicans want to stop that. they disagree with the president's executive order. i think we ought to have that debate but not at the expense of funding the department of homeland security. but that's their position. so in 16 days the department of homeland security runs out of money. the department entrusted with keeping america safe from terrorism runs out of money. what are we going to do about it? well there's something very easy that we can turn to. it's on the senate calendar of business. it's on every desk here, available to every senator. s. 272 a bill introduced by senators shaheen and mikulski to make the appropriations for the department of homeland security, to give them the budget they need to protect america. it takes out all this -- the

immigration riders insisted on by the house and takes us down to the basics. are we going to fund this department? well the republican majority leader has insisted that he will stand in the way of funding this department unless we can get into this political debate about immigration. i think that's shortsighted. senator reid came to the floor a few days ago and said, we are prepared to engage in this debate on i am immigration not at the expense of homeland security. we have had three votes mr. president, on the floor of the senate, and this effort by the republicans has fallen woefully short in every single vote to receive the 60 votes necessary. so why does the majority leader insist on this -- sticking with this approach? it's hard to explain. it could be that within his own caucus -- and maybe he personally -- thinks that the efforts of the president to protect certain people from

deportation are just plain wrong. one of thosests is -- one of those efforts is one that i heartily support myself. it is called daca. did a withdiddaca was an executive order issued by the president in 2010 -- i'll double-check on this date -- and in that executive order, the president said that those who were eligible under the dream act would be given protection from deportation. the dream act was a piece of legislation i introduced 14 years ago which said, if you were brought to america as an infant a toddler a small child and you stayed in america had no serious criminal issue finished high school, and you were prepared to enlist in the military or go on to college you would get a path to legalization. that's what the dream act said. it's never become law. but these young people -- we estimate 2 million nationwide -- are left in limbo. they came to america brought to

america at an early age grew up in america went to american schools, pledged allegiance to our american flag, sang our national anthem, and believed they were americans and then they were told, sorry but you don't have the necessary documentation. you're not l legally here. they are left in limbo. president obama said on a two-year basis we will protect these young people from deportation. they'll have a background check they'll pay their fees and on a two-year basis they can live in america without fear of deportation, work in america or go to school in america. those are the dreamers. that is the daca provision which the republicans are opposing in the house of representatives. it is the provision which the majority leader insists that we vote on before we can fund the department of homeland security. i think it's instructive to introduce these dreamers to

members of the senate who may not know who they are. and i want to introduce two of them today. nelson and john madeleno. nelson is on the left in suit, john on the right in his graduation gown. they were brought to the united states from venezuela when nelson was 11 and john 9 years old. they were honor students at lakeside high school in atlanta georgia. john was in the air honor society in his junior rotc. nelson and john went to the institute of technology one of the most selective engineering schools in america. in 2012 nelson graduated from georgia with honors with a major in computer engineering. president obama established the daca program shortly after nelson graduated from georgia tech. thanks to daca, nelson has been working since 2012 as a computer engineer for a foreign tune 500

semiconductor corporation. john also received daca in 2012 while he was still a student at georgia tech. he then worked for two years as a researcher in biomedical engineering at a lab at georgia tech. researching glaucoma, one of the leading causes of blindness. in 2014, john graduated from georgia tech with a major in chemical and biomedical engineering with the highest honors. he's now working as a process engineer with a fortunate -- fortune 500 company. nelson wrote me a letter. "to me daca means the opportunity to live my dreams and contribute to society in a ways i couldn't imagine. daca means one of my life's goals -- owning my own company -- could be a possibility in the future. daca means a chance. daca means the american dream." his brother john wrote here's what he said, "i consider myself to be an american and to be someone who loves and

wholeheartedly dedicates themselves to the development of this country. from age nine, i have made the united states my home and it's made me the man i am today. i proudly call myself an american." when you hear the stories of these two young men who attended college and finished without any government assistance or loans who worked hard to get their degrees in challenging fields like computer engineering who went to one of the best schools in america who now have talents and skills that create opportunities not only for discovery but for innovation and entrepreneurship i wonder what are the republicans thinking when they say these two individuals don't belong in america. they need to be deported. they need to be sent back to venezuela, a country that neither of them really knows.

is that the answer to america's future to export the knowest talented minds? the hardest-working individuals? the major achievements made in their lives are to be ignored. i don't think so. i think americans by and large believe in fairness. fairness says we will not hold the children of the parents who are responsible for wrongdoing responsible themselves. if you're pulled over for speeding you may get a ticket. it would be fundamentally unfair to give one to the child sitting in the car seat in the car. they weren't driving. these kids weren't driving either. their parents drove to america came to america without any permission from the children. they set up a life here and they made a good life here. now do you want to penalize these children because their parents came to america? it doesn't make sense. and frankly it doesn't represent what this country is

all about. we are a nation of immigrants and the immigrants who come here make a difference. they bring not only a determination for a better life, but they're risk takers. they leave it all behind, wherever they were, to come to america and risk it all in the hopes that they'll have a better life and even more importantly their children will. that's who we are. that's what america is all about and has been from the beginning of time. and why would we turn our backs on that heritage? why would we ignore the opportunity these young people bring? well that's the republican position, at least the one stated by the house of representatives. it's been summarily rejected now three different times on the floor of the senate, and yet the majority leader comes to us today and says he may do it again. it's not fair to the department of homeland security. it's not fair to john and nelson. it's not fair to this country. let's do the right thing. let's fund the department of homeland security before we leave for any recess. let's get it done so that that

department can protect america. the majority leader talked about what we've achieved here: the keystone canadian pipeline act which was the highest priority of the senate republicans. trans-canada a canadian corporation, would be able to transport oil from canada to a refinery in texas and then export it from the united states. the benefits of construction, of course and 35 permanent jobs at the pipeline, of course. but in the end the refined oil coming in from canada will not benefit the american economy. we had an amendment on the floor which addressed that very issue and every single republican said we will not vote to keep that refined oil product in america. we also suggested if you're going to build a pipeline in america, use american steel. put american workers to work at the steel mills to make the steel that's necessary to build the pipeline, and that too was rejected by the republicans. they said no, insisting on

american steel won't be part of this so-called pipeline jobs project. well, i think there are better ways to get the economy moving forward and to create more jobs. one ofone of them is infrastructure and i'm sure we'll debate it at a later time. the other thing introduced was the clay hunt bill, related to veteran suicide. and it passed overwhelmingly, to no one's surprise. why was this bill held up in the previous congress? there was an objection to bringing the bill to the floor by a republican senator by a republican senator. so there was no obstruction to passing this bill on the democratic side, and i'm glad it passed. i know the president is about to sign it. the other thing i'd like to mention is that's unfortunate that we are leaving this week on a recess for the president's day week we're leaving at a time when loretta lynch's nomination to be attorney general of the

united states is still pending. she has now been pending i understand longer than any nominee for attorney general in history. i went through the hearing with her and there was no opposition. none. they asked the witnesses who were brought in if any one of them objected to her being attorney general. not one raised his hand. there were no objections. there is no objection to this woman serving our nation. she's been the u.s. attorney for the eastern district of new york. she's done an amazing job. why are they holding her up? what's the purpose in this? we should pass and approve her nomination before we leave this week. mr. president, i is it the following statement -- i ask the following statement i'm about to make be placed in a separate part of the record. the presiding officer: without objection. mr. durbin: thank you. next thursday president obama is going to declare the pullman district on the south side of

chicago a national monument. this is the first time a unit of the national park service will be established in chicago. this designation is the result of a collaborative effort by the businesses residents and organizations of the pullman area in chicago to restore and preserve this unique community. the people who are part of the pullman legacy helped shape america as we know it. the pullman neighborhood includes almost 90% of the original buildings that the railcar magnet george pullman built a century ago for its factory town to build railroad cars. it was the birthplace of the nation's first black labor union, the brotherhood of sleeping carporters. pullman workers fought for fair labor conditions in the late 19th century and the pullman porters help advance the civil rights movement. during the depression in the 1890's the pullman industry was the catalyst for the first industry wide strike in the united states that helped to lead to labor day as a national holiday. the pullman porters are credited with creating the american

middle class. i've introduced legislation with my colleague senator kirk and congresswoman kelly to make this site a national historic monument. anthony beale of the ninth ward worked hard to garner support for the recognition of pullman. many others have advance this had proposal. david dogue president of chicago neighborhood initiative, lynn mcclure with the national parks conservation association and many others who drew attention to the historical significance of this neighborhood. the pullman national monument will be an important addition to the current national park system. it highlights stories from communities that are rarely represented by other national parks. the park's urban location on chicago's south side makes it easily accessible to millions of people by public transportation, again, setting pullman apart from other national parks. the national park service is associated with national ran wonders like geysers and forests.

urban national parks are few and far between. with this designation the pullman neighborhood is joining the ranks of the national mall and the statue of liberty as national parks accessible in urban areas. the monument also will provide an opportunity for tourism and job creation much-needed in this community. it's only right that pullman be preserved and honored as part of our national park system. i commend the president for his decision to showcase the prominence and legacy of pullman in our nation's history. mr. president, i yield the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call: