but what i'm asking, if i can get to it here very quickly, if immunization rates continue to decline, what advice do you give to these youngsters' parents who have to rely on others in their community to choose vaccination to help protect their own? >> the lower the rates are the more your children are at risk. so you want to be making sure your own children are vaccinated, but also it's important to have those around them vaccinated. some kids can't get vaccines because they have leukemia, for instance they can't get live viral vaccines, so our best protection is that community-level of vaccination. >> well, you highlight the three reasons parents don't vaccinate, the fear of side effects, religious or philosophical okays, and there's a whole bunch of paragraphs in the background information on which states are easier to get a religious exemption and which are easier to get a philosophical

objection, a simple letter signed by a. doctor can. how often however about the mistrust of -- how often would you say it's the latter that the vaccine schedule is too rigorous, and what reassurances could you provide to parents on this concern? >> many parents do mention the number of shots children get at a particular visit as something that concerns them. we like to let people know that vaccines are recommended at the time they're recommended because of the way they work and because of the disease risk. so our advisory committee reviews the science of the vaccines and diseases and updates the schedule every year based on the best information available. so we, you know 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

was a major danish study published in 2002. 540,000 children showed definitely there was no relationship between mmr somebody ie, measles advantage she nation -- and -- vaccination and any kind of problem with autism. an institute of medicine report many 2004 did the same. -- in 2004 did same. along the way there's been studies from the national institutes of health centers for disease control. all of these examinations point to the same conclusion, the body of evidence was firmly established a long time ago. however, this is a state issue. and that seems to be the problem. cdc is doing the very best that you can to try to convince every state. mississippi leads, we're at the bottom. not at the bottom but, you know, fairly close to it. i'm very concerned about it. but at least the media i think

today realizes one study that was totally discredited that there should be a very strong statement by everybody involved that they should, they should go ahead and get these vaccinations. so i strongly recommend that, and i thank you for your leadership. >> thank you, senator roberts. we'll now go to senator baldwin, and i want to mention again to the senators at 11 we're going to excuse dr. schuchat and call the second panel for 15 minutes. but then any senator who hasn't had a chance to ask a question will be the first one, first one up. senator baldwin. >> thank you, mr. chairman. i also want to thank ranking member for holding this hearing. our nation's vaccine program has

greatly redawessed human suffering -- reduced human suffering and saved lives by preventing and reducing the outbreak of preventable diseases. and thanks to national policies including the affordable care act, now millions of families have access to free immunizations. and it's why i'm so concerned as i know many of my colleagues are, about the recent measles outbreak and the surge in misinformation whats orer baited by the media -- exacerbated by the media and even some national figures. and this is information, of course surrounding vaccine safety. to prevent against future outbreaks, i think it's vital that we continue to investigation in our nation's vaccine production capacity support cutting edge science anden hasn't public education -- and enhance public education surrounding vaccine safety. so 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 the cdc's vaccine for children program which provides recommended pediatric vaccines to low income children. the cdc also maintains a stockpile for pediatric vaccines. so dr. schuchat, could you tell us the current state of our national pediatric vaccine stockpile, and is the measles vaccine included in that supply? and you elaborate on the role of this stockpile in addressing outbreaks as well as how cdc works to maintain it? >> yeah. the vaccines for children program includes a stockpile that is approximately 50% of --

enough vaccine for 50% of the pediatric population to be vaccinated for a year. so we currently have over three million doses of mmr vaccine. the vaccine stockpile has been used both for outbreak response, but it's also been used for vaccine shortages. and even with our robust vaccine manufacturing industry, there are many vaccines where there's only one or two manufacturers that produce them. and when there are interruptions in supply, we'll have to go to our stockpile to make sure that there's not an interpretation in use. -- interruption in use. so it's really been a critical safety net for the vaccine security. >> i want to explore a little further this issue of production and interruptions in production both with disease-preventable diseases that are prevented by vaccines but also, you know, with the inflew wednesday sa

vaccine where there may not be 100% match to the strain that's prevalent in a given flu season. two issues. one is -- well, three issues. domestic manufacture versus overseas manufacture in case of an epidemic that's particularly lethal has been a long issue. and i understand we've improved domestic production. anything you can e wrap rate -- elaborate on that would be helpful. secondly production is usually still slow and based on chicken eggs. and there have been many efforts to transition to a cell-based production in the influenza vaccine. where are we on that? and thirdly, with regard to diseases that are preventable by vaccine, we have had drug manufacturers who have decided to exit that area. and and oftentimeses with

little -- often times with little notice to the medical profession. i've heard from front line pediatricians who say we don't have enough in our clinic, and we have people coming in, and we can't meet the demand. is there better notice given to the cdc? do we have more safeguards in place to make sure that we don't have an alarming shortaging? >> -- shortage? >> yeah. we had a big wake-up call about p ten years ago in october 2004 where overnight half of the expected influenza vaccine supply wasn't coming through. and that was, really prompted an enormous amount of reevaluation on the different parts of government. we're in much better shape now. that year we eventually had about 58 million doses of flu vaccine. this year we have nearly 150 million dose of flu vaccine that have been distributed. there are multiple new manufacturers or additional manufacturers producing for the u.s. market, and we also have a number of formulations besides

the egg-based that have been approved by the fda and are being used. so cell-based and recombinant-based influenza vaccines are included among this year's seasonal flu vaccine supply. and looking towards the future, there's a lot of enthusiasm across the government and across academia around investments towards a universal influenza vaccine that might give us broader and better longer-lasting protection than the annual flu vaccines that we use today. so there's a lot of progress in the past decade. there's more work to be done. in terms of the communication with the industry -- >> dr. schuchat i'd like to try to get senator franken in before you leave, if we may. so if it's all right -- thank you, senator baldwin. senator franken. >> thank you, mr. chairman, for that. you know i'm thinking that maybe this outbreak in measles is a bit of a wake-up call.

as senator warren said, there are, you know, a lot of baby boomers and some of us, and some of the senators who are older had measles and remember it. and maybe this is a really good time for people -- especially some educated people who were forgoing this for their children -- to understand things like herd immunity that you get a critical mass of people not getting immunized, you have outbreaks like this. and what the costs are just like the financial costs, there was a 2005 nih article that attempted to quantify the economic impact on health infrastructure, and researchers estimated that one case of measles costs the federal, state and local health

departments more than there are 140,000 -- $140,000 to respond to just one case. and this, you talked about the return on investment of all, of these immunizations and i think it's one of the most -- it's obviously, cost effective. it also prevents a lot of suffering. we live in a global world, and be i just want to ask you about that investment that we put into global public health and what the importance of that is. so in terms of our investing in this in africa and other places can you respond to that? >> yeah. measles, um, has been eliminated from the americas but it's still circulating around world with about 20 million cases a year. and in system of the

countries -- in some of the countries that have had major outbreaks, it's really investing in their health infrastructure and supporting their ability to have strong immunization systems that will protect americans as well as strengthen their health. so we're really keen to be partners in the polio eradication initiative and the measles/rubella initiative, in the gabby alliance and in ways we can help protect children everywhere with vaccines that are safe and effective. it strengthens our community's protection here at home, and it's really the right thing to do overseas as well. >> because measles in particular is highly contagious, and you're one plane ride away from another, for an american getting infected. speaking of which, what other infectious diseases may be on the horizon? what might be the next measles?

and what might come from abroad like meres or what else are we looking for in the near future or possibly? possibly? >> yeah. with infectious diseases, you really have to be ready for the idea that the microbes are changing faster than we are as people. and so, you know, this past year we dealt with the d-68 problem a severe respiratory illness illness in children. the last two years we've been dealing with a new virus that was causing very severe disease in the middle east and in some travelers returning from there with two cases here in the u.s -- >> that's mrs? >> yeah. we really think it's critical to be strengthening health infrastructure and whatty for health security in countries around the world to we don't let an epidemic like ebola get as bad as it got.

we recognize diseases overseas and help the countries that are battling them deal with them swiftly. >> and that's why the cdc is so important. i really want to thank you for your service to this nation and to the world. thank you, doctor. thank you, mr. chairman. >> thank you, senator franken. dr. schuchat, just to -- maybe i misheard something. the state department web site says that 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 who obtains a visa is required to obtain certain vaccinations, correction? >> yeah. i think that's right. we can double check -- >> yeah. i'm reading off the state department web site. i didn't want to leave the impression that -- i didn't want to leave a different impression if a different impression was untrue. >> thank you. >> dr. i schuchat, thank you so

much for your time. there are a couple of senators who haven't had a chance to ask questions, but i hope they will understand that we want to invite the second, the second panel to come up now, and they will be the first ones up after the next 15 minutes of testimony. i'll now move ahead and introduce the second possible to save -- second panel to save time, if i may. first, we'll hear from dr. kelly moore. dr. moore is director of immunization program at the tennessee d. of health. in this role, she's responsible for promoting proper use of recommended vaccines as well as overseeing the response to outbreaks of vaccine-preventable disease. she has her undergraduate medical degrees from vanderbilt, a masters of public health from harvard school of public health and i'm completely objective, but the tennessee department of public health is one with of the finest in the country. dr. mark sawyer is professor of

clinical pediatrics and a pediatric infectious disease specialist at university of california san diego and grady children's hospital in san diego. he's also the medical director at san diego immunization partnership and involved in a variety of immunization practices projects. dr. tim jacks is a pediatrician and the father of two children who recently were exposed to measles in arizona. he's an every child by two immunization champion, every child by two is a nonprofit dedicated to increasing vaccination rates among children. his wife is in arizona caring for their two children. i'm grateful he could be here to tell their story. dr. moore, let's begin with you, and if the three of you could summarize your comments in five minutes, we'd appreciate it, and then the senators will continue questioning. >> thank you chairman alexander

and senator murray, for holding this hearing on the benefits of immunization and for inviting me here to testify about public health perspective on vaccine-preventable disease. most people are unaware that even in a state with a strong history of immunization, a single case of measles requires a major public health response. i'd like to begin by acknowledging governor bill haslam and first lady chrissy haslam for their commitment to immunization as an essential step in promoting and protecting the health and prosperity of tennesseans. you could say tennessee has a culture of immunization. for the past two influenza seasons, the majority of tennesseans age six months and up received a flu vaccine. in 2013 95% of kindergarteners were immunized with all required vaccines including both doses of mmr. just 1 out of 100 claimed a religious exemption, and just over 1 in 1000 were exempted by a doctor for medical reasons. the federal vaccines for children program has removed

barriers to access for eligible children since 1994. our state's online immunization information system, supported by section 317 federal funds, insures that authorized users such as clinics and schools have access to immunization records to see what vaccines a child may need or to verify that they're protected. we have more work to do to reach high immunization rates with vaccines designed for teens and adults that prevent diseases such as meningitis, cancer pneumonia and shingles. public health partners with our clinical and pharmacy colleagues to address misinformation and concerns about safety, health benefits and affordability. to improve access, our department is using federal presense and public health -- prevention and public health funds to help clinics become in-network providers for commercial insurance plans so we can provide recommended vaccines to their beneficiaries with no out-of the pocket costs.

when it comes to disease outbreaks, few realize how much public work goes into one case of measles. i vividly recall each of the nine cases tennessee has had in the decade i've directed our immunization program. our most recent experience is a good example. on a friday afternoon last april, a doctor called his regional public health office about an adult with an uncertain immunization history and recent overseas travel who was in the e.r. with classic symptom ises of measles. the diagnosis was not in question. a game plan was quickly developed in a call with the 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 mmr vaccine could protect the most recently exposed susceptible contacts if local public health could find them quickly enough. 25 contacts with uncertain immunity were vaccinated on saturday. others were counseled about what

to do if symptoms developed. among the 124 contacts just three cases among other adults developed. if or these, the same isolation contact tracing and notification process was practiced but faster. no additional cases occurred n. total, 406 contacts were evaluated. tdh worked with the media statewide to educate the public and prepared clinicians through state health alerts and aningsal webinar. cdc measles' experts provided consultation and specialized testing that helped us optimize our tactics. a great deal of credit in this story goes to the hard work of public health at all levels. this result, however could only have been achieved in a community where a very high percentage of the population was already immune. had this imported case landed among those who were unimmunized and susceptible, there would have been a very different outcome. congress' sustained commitment

to immunization and a strong public health infrastructure through the vfc program 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 affordable accessible and effective immunization services. thank you for the opportunity to testify here today. i've provided a more detailed written testimony for the record, and i'm glad to answer your questions. thanks. >> thank you dr. moore. dr. sawyer. >> chairman alexander and ranking member murray thanks very much for holding this hearing on a very important topic, the reemergence of vaccine-preventable disease and what we can do together to prevent further outbreaks. as you've heard, i'm a pediatric infectious disease specialist at the university of california san diego and grady children's hospital in san diego. i'm also a member of the american academy of pediatrics, and my testimony today has the

strong endorsement of aap. vaccines are one of the greatest public health achievements as has been pointed out by dr. schuchat and several of the senators. prior to the introduction children suffered regularly from serious illnesses like measles diphtheria polio even bacterial meningitis. the development and widespread use of vaccines has led 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, diphtheria or tetanus in my 30 years of practice in pediatric infectious disease. in a teaching session i held last week with 20 pediatric residents in training, i asked them if any of them had seen the measles. none of them had. however, as we have seen from our current measles outbreak and continued outbreaks of pertussis or whooping cough around the country, we are witnessing a reemergence of vaccine-preventable ill 'ems here in the united states. unfortunately, my residents are

going to get a chance to see the measles. pediatricians are concerned that the reemergence of disease is a signal that bigger outbreaks are yet to come. most of the cases in this current measles outbreak are from california and 13 are from my own community. but outbreaks like this are increasing in frequency and size. this measles outbreak like all other measles outbreaks are occurring because we have too many intentionally unimmunized children in the united states and it illustrates the problem created by unimmunized populations. a simple trip to disneyland has led to a multistate outbreak of measles involving more than 100 people. measles is one of the very few infectious diseases that literally flies through the air. so it is completely predictable that such outbreaks will occur again if immunization rates stay where they are or get worse. while most parents do choose to vaccinate their chirp, there are pockets of unimmunized chirp all over the country.

in san diego we have 1500 kindergarten students who are not fully immunized. the current measles outbreak reminds us of an important fact about infectious diseases, they are a shared public health problem. when one person is infected people around them, people they don't even know become infected. the decision of a parent to leave their child unimknewized however well meaning is a decision that affects us all. although our public health community has done an excellent job of controlling this current measles outbreak, when too many people 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 the 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-hesitant parents to hear their concerns. based on what aye heard in these discussions -- i've 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 leads parents to think that vaccines have caused harm. what is overlooked by parents is the fact that just because an adverse health outcome occurs in the time after a vaccine doesn't mean that the vaccine caused the problem. it takes science to prove or disprove a linkage between two events, and our parents are not hearing the science. the vaccine schedule recommended by cdc and aap has been developed with strong scientific standards and has been proven to be both safe and effective. in every case for every vaccine, the risk from the disease outweigh withs any risk from the -- outweighs any risk from the vaccine. in my opinion, way to decrease

is to improve communication about vaccine safety and effectiveness, to increase the science literacy of our population, to limit the philosophical exemptions from school entry requirements for vaccination and to continue to carefully monitor the safety of all of the vaccines we use. taking these steps can ultimately help reduce the number of children who choose not to advantage city nail their children -- vaccinate their children. this must be confronted if we are going to prevent further outbreaks like the one we're currently experiencing. thank you for allowing me to testify, and i look forward to your questions. >> thank you, dr. sawyer. dr. jacks. >> senator alexander senator murray esteemed members of congress, my name is tim jacks, i'm a board-certified pediatrician, and i'm on the front line of this vaccination issue. i daily recommend vaccinations to my patients and address concerns and questions they have regarding immunizations.

lately, i've also been addressing many questions over the ongoing measles outbreak. but i am not here today as a medical professional. i'm here today as a father. three weeks ago my infant son and daughter, madeleine -- 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's been admitted to the hospital six times and spent nearly a month there. she's on a very regimented schedule of treatment and she takes medications three times a day, up to six medications at a time. we have weekly visits to an outpatient clinic where she has procedures she has bloodwork drawn, and she gets her chemotherapy infusions. at one such clinic visit, my children were exposed to the measles. we were informed of this exposure and instructed to return for shots of the measles

antibodies, which we did. now, 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 waiting the three weeks to see if they develop measles or if they exit quarantine without any symptoms, i typed an entry into maggie's blog. and this blog is something i use to update family and friends to her treatment progress and just to let people know how she's doing. typically, i get a hundred people reading this blog. needless to say, it has gone viral. the title of this blog entry was "to the parents of the unvaccinated child who exposed my family to measles." in this blog evented my frustrations, my anger at the situation, and i explained --

and hopefully educated some people -- as to why my children and many other children like them are at risk. ely, my ten-month-old son has received all of his immunizations on schedule but is too young to receive his first dose of mmr. and my daughter can, maggie, who was also previously fully immunized is at extra risk right now because of her weakened immune system due to her leukemia, as well as her treatment. the blog went viral. in over two weeks, it received over 1.3 million shares on facebook and has been read countless 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 that we can prevent some families from going through the same thing that we've gone through these last three weeks. ..

there is congress to take actions pouring the programs and infrastructure already in place to get these vaccines to those in need them the most and contain outbreaks. i we will care for my family to work to promote health among my patients and

through partnership with organizations like every child by two and the arizona partnership for immunization i we will advocate for timely vaccinations for children. thank you for your commitment. with your help we can stop the spread of vaccine preventable diseases or protect of protect the innocent, protect our children we will protect my children. thank you. >> thank you for your personal story and thank you. now you. now we will go to the senators who have not yet had a chance to ask questions. we begin with senator casey. >> mr. chairman, thank you very much. much. we want to thank the witnesses for bringing to this hearing room today your experience, knowledge significant time that you have dedicated your lives on

these issues. they are especially grateful you are bringing your own personal story. these issues are difficult enough but ever more so when you have a loved one in your case a daughter that is the subject of your own efforts. we are grateful for you bringing that to us. i am tempted to ask but i won't. why this failure to vaccinate becomes so significant. that may be the question that we are all asking. but i guess a a better question to ask is what can we do to push back against it. there doing that today. i i wanted to get to some of the ground-level work that has to get done day in and day out. what happens in our schools,

communities, and the office of pediatricians? you mentioned talking about the fact that you in all your years had never been exposed to this in a direct way as a practitioner. i wanted to ask you specific questions about pediatrics. do you think think we are reaching the.where they're has to be pediatric training that speaks to this? in other words a change in the training that reflects the reluctance that some parents have to vaccinate. >> i think that is an excellent question and they're are there efforts underway from the american academy of pediatrics nationally and in my case locally have a curriculum about immunization. i had a whole section of the curriculum to teach residents and training about how to communicate about vaccine safety and address

the concerns with the hope that they will make the right decision. the problem is they're is so much inaccurate information circulating highly educated people get on the internet and take it to heart before they look at the source of the information. that is what we need to address. without without that we we will never win this battle. >> thank you. referring to your testimony on page three you talk about in the 2nd full paragraph in tennessee -- and i'm quoting from a local school nurses and coordinated school health directors are among our most important shepherding -- champions. you tell us about that and the importance of that. as much as we have an obligation to get the

message out a lot of the best work we will be done in those settings. >> that is true. i cannot speak highly enough of our local public health nurses at school nurses and school administrators because truly these parents often hesitate to vaccinate they're children out of fear. they want to do what is best for there child. bells go off off when they here scary things about vaccines, and it is hard to unring. the people best equipped to do that other people they trust and are in close relationships with. public health nurses care so deeply about these families they work with, and a lot of this can be overcome with credit to have credible information from trusted sources and good relationships. i am always a phone call away. i can help them, but they are the ones with the relationships to help them overcome these fears and i think our immunization rates

are a testimony to that ability for them to work through this with families. >> i appreciate that. i we will wrap up with one statement. in the debate about how to respond to the ebola cursus among the best pieces of advice we all got was local validator's are a lot better than validator's outside of a local area. i won't say washington, but you know what i'm talking about. about. thankful for your work and grateful you are here today. >> thank you. >> thank you you very much mr. chairman and ranking member for this hearing. thank you for taking the time to tell your story. i want to talk for just a minute and ask you a few questions about the nuts and bolts of how exemptions work because we have 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.

just in the last three years we have seen the number of people applying and getting religious exemptions has doubled. just in three years. and so i heard in your testimony that you are actually proposing eliminating the philosophical objection. can you speak for a minute a minute on why you have made that proposal? >> because, as you.out, i live in california where up until last year in order to exempt your child from school vaccinations you simply flipped over a paper at the school registration and signed it and that you had a philosophical objection. you just don't believe in vaccines. just as you mentioned we have seen a steady rise in is exemptions over the last decade. there are very few religions that specifically advise there followers to nonvaccinated. the philosophical exemption is causing the problem and i think it is driven by misinformation.

i i am in favor of eliminating such philosophical exemptions. a bill was introduced to do just that and i we will support that effort. >> let me suggest an alternative to the elimination of the exemption as you mentioned, all you need do is simply sign a peace of paper. you actually get know information about the consequences of not getting vaccination. yet the studies are clear that the more information that you give the less likely it is people will take the exemption and the less likely it is you will have outbreaks. in states that have higher bars for exemption they were 50 percent less likely to have whooping cough outbreaks and you can recite other.

i am happy to get comments from the rest of the panel. let's say we raise the bar for philosophical objection and said, for instance, you have to consult with your physician 1st or review information about the risks of not getting your kids vaccinated. do you think that that would be helpful if we were not successful in eliminating the exemption? >> i we will respond 1st because we have just done that in california, passed a law that requires a parent to exempt there child, have form signed by a healthcare provider that at least they have been educated which led to a 1% drop in the rate of exemptions in california has all but it is still a two and a half to three and a half percent in different communities in california. we we will see whether that continues to drop the rate.

we have seen the benefit of a one-time drop that will go back to the steady, gradual increase in exemptions whether people stick to philosophical ones or whether they start to exercise religious exemptions that they did not before. >> a quick comment. >> senator, tennessee is one of the vast majority of states that does not have a philosophical exemption. >> only 20 states have the. >> correct. including tennessee. and i think that we have to decide as a community, do we want to protect the most vulnerable among us or do we want to provide choices and options for protection? we cannot do both at the same time. if we are prepared to accept the consequences of outbreaks like this than personal choice is perfectly fine. if we want to protect the vulnerable than immunization must take place.

>> thank you, mr. chairman. my office is looking at some legislation proposed legislation that would provide incentives for states to increase the information they are giving to parents not necessarily dictating what exemptions are used but to admit that as a national health priority it makes sense the best information is giving out. if you are giving a medical exemption you have to have a note signed by a doctor. if your using a philosophical or religious exemption often all you have to do is sign the back of that form. at the very least we should try to marry those two standards. >> thank you, senator murphy. senator bennett. >> thank you for holding this hearing. it strikes me 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 the unedited

content on the internet that people more affluent families are reading. i wonder and i asked the other panelists and thank you for your testimony. thank you for being here. 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 join in, that would be great as well. >> as has been mentioned, autism mentioned, autism remains one of the major concerns of parents even though the science is completely discrediting any association between the two. once you get beyond that the next thing you hear is we are overwhelming the children's immune system. the whole philosophy of the immunization schedule is to

protect children as soon as we can for as many things as we can. delaying vaccines is counterintuitive. if we were overwhelming children's immune system -- i am an infectious disease doctor. those kids would would be getting unusual infections, but we don't see that. the last major thing that you here about are the ingredients in vaccine and the concern that some of them are toxic. once again that has been discredited. the fda approves these vaccines in large part based upon their safety record. >> i we will add that i agree that the flu vaccine causes the flu. i hear that every year over and over and is one that we work to counteract because of the benefits. that is a common one.

hpv vaccine might cause promiscuity. we here that from time to time as well. >> and just to be clear these are things that are scientifically, demonstrably incorrect. i wonder your opinion do you have advice for pediatricians across the country about how to handle the conversation that they have with parents about vaccines? >> yes. with yes. with regard to families that do have questions and concerns it is just that addressing questions and concerns. back in the day positions could take somewhat of an authoritative stance and there was a great deal of respect. nowadays it is moreover working working with families to come to a conclusion of what is best

whether it's immunization or whether or not we want to treat an ear infection. as a pediatrician, my goal is to number one develop relationships with my family's so that we have ever poor and then for me to make my recommendations and address there concerns specifically. >> you train pediatricians. this question of whether they're are things that pediatricians can do. >> the curriculum i curriculum, i mentioned we have developed locally as well as the academy curriculum basically takes people through the ability to listen attentively and to continue to convey the science in the most clear way that one can so that families reach the right conclusion. >> thank you. thank you mr. chairman. mr. chairman. i surprised the chairman because i was finished early

i we will never get that time back. >> we we will put it in the bank. >> we have time and i'm sure all of us would like to have a 2nd round of questions. i believe you said the case for measles was in memphis. >> and west in west tennessee. >> and you described you moving quickly. the number of people was how many? >> 124. >> and this is an area where the vaccination rate is what? >> very good. i we will have a specific number, but it it was clear because 124 people were exposed and three people got sick. >> i was thinking about the phrase going viral.

this generation understands the idea of going viral they complete panic last fall we spend $5 billion changed every hospitals procedure, dominated what was going on in that can only be caught by an exchange of bodily fluids. this flies through the air goes viral. we senators understand the problem of dealing with highly educated people who get that information on the internet. we deal with that. let's go back. this person in west tennessee what if that

person had been discovered in los angeles where the immunization rate is 60 or 70 percent? described the number of people and the multiplying of people that would have to be contacted to make certain that the disease did not spread. >> i can share the experience in san diego in 2,008 which was our last outbreak. over 12 cases and 800 people. it goes up exponentially. unless public unless public health is they're to track people and keep the quarantined it could easily get completely out of hand. >> 800 people but then each of them might have infected someone else. >> exactly. and in that outbreak we had close to 100

100 people quarantined for three weeks to prevent the next wave and are crossing our fingers with this disneyland outbreak. i no is the case number went up by 20 just this last week. >> when you say flies through the air we have an example of going viral in modern parlance, but doctor jacks, this may not be an exact comparison. people ask me why i continue to play the piano when i was young. i do not remember my mother giving me a choice about it. i guess i had a choice. we're not talking about taking choices away today but we are talking about the conversation between a pediatrician in the parent that probably would not start without -- even in this day of parents who deal differently in 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 your own children, but do you just make a neutral observation about it or do you come to a conclusion and say i think you should do it? >> i i come to a conclusion of recommending that we do vaccinate. i often times do not approach it quite that way because i want i want to get there thoughts and opinions and fears 1st so that i can address those but i talked to families from a a couple that is still pregnant that has not had they're 1st child in to that 1st visit after they are born to the routine visits where we would do vaccinations and every visit whether they are hundred percent getting vaccinated or whether they are still trying to decide i am talking answering

questions, urging them to make good informed decisions and my understanding my opinion is that i salute the vaccines are one of the best things that they can do. >> i am out of time. i assume that my wife led an effort to establish a medical home for every child is about to be born. i assume that allows a parent to know more is an effective way to keep the vaccination rate. sen. murray. >> thank you, mr. chairman. i wanted to ask you about this because i am especially interested in learning more about what can be done to increase uptake of the hpv vaccine. we are fortunate to have a vaccine that can prevent most forms of cervical cancer which i am sure you no is the 2nd leading cause of cancer death among women in the united states.

about 4,000 are expected to die and we know that those are deaths that can be prevented. i want to ask you for what can state and local health department due to more effectively promote the hpv vaccine? >> that is a wonderful question and we know that a lot of young women and men are not protected yet who could be. in tennessee immunization is at one that one in three and we would like it to be 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 help families understand this knew vaccine is a cancer prevention tool that can help reduce the risk of an abnormal pap smear for your lady later in life and we are trying to make sure that people understand the vaccine is safe lasts, and

is very very effective and we bundle it with other routine vaccines so that it is given at the same time as the pertussis protection in the 1st meningitis shot and is part of the routine bundle. we are trying to help people understand that they're is nothing exceptional about this except that it is phenomenal cancer prevention and incredibly exciting to have a tool in our hands the last generation did not have to protect women and men from cancer. >> thank you. appreciate that. in my home my home state we have an incredible public-private partnership of the ask northwest at a time when my state had the highest vaccine exemption rate in the country, our state health department came together with key health promoting organizations including group health foundation to create this really innovative partnership which addresses

vaccine hesitancy through work with parents and our healthcare providers alike. it has supports from the gates foundation's and the engagement of many partners but we're doing amazing work which i should mention is being rigorously evaluated with the intent of sharing lessons learned. i want to ask you, how can working with private and nonprofit partners help health departments in there efforts with vaccines? >> thank you. health departments of a major role in promoting immunization. we long ago stopped being a medical home for most children. we partner with these organizations in order to help support them in doing the right thing. what thing. what i find in clinical practice, pediatricians are incredibly busy and it helps if they're is a group focused on promoting just

the immunization. we can provide them support that makes their jobs easier and so all when it comes to doing site visits about quality of immunization care site visits that we do in the office educational programs 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 vaccinating children. this has been wonderful and i am all about relationships these relationships have been great. >> thank you. thank you for being hear today. i appreciate your willingness to come. since you started speaking out about your family situation, have you been surprised to know how many people don't know that some people cannot be vaccinated?

>> surprisingly now actually there has been a lot of good support. it seems like the knowledge is they're it is just not in the public conscience when they are making the decision to vaccinate or not vaccinate. vaccinate. that is why i'm doing this. i want to raise awareness of that issue. >> i i appreciate that and wanted to ask you is a pediatrician what do you think are the key varick -- barriers to vaccine uptake? >> largely education and the misinformation that is out they're. >> thank you. >> first i would like to request unanimous consent to enter into the record a statement for the march of dimes. >> will be done. thank you. obviously we have declining resources on the federal

level. the administration is cutting the 317 money that you referenced, doctor moore i we will note as a fellow that used to work in the public hospital system, a pediatrician, a lot of pediatric immunization work and there is a great concern. sometimes i would see people come to speak to pediatricians but immunization and it was like newcastle. these folks cared. jackson sawyer care. care. can we use the 317 money more effectively? i asked is not a challenge but to suggest, when i look at the map of california, you can isolate those communities which are not immunizing. we ought to pay jacks to come in and speak to those families so that they know they have a domestic that is helping them in there home's child was unvaccinated and recently came from another country, they're children are at risk.

he could do that effectively i we will ask are we still using our 317 money in the paradigm of 20 years ago? before we realize many people are basing there decisions on emotions not upon their physician recommendation. simple question, 317 program rooted in 20 years ago or are they adapting to our ability to use data to pinpoint where we need intervention? >> thank you for that question. the program is definitely focused on where we are today with our immunization programs. the funding we have is going to support our immunization information program that provides clinical decision support for clinicians and need who need to keep up with the

complex trend immunization schedule. we also are using funds to provide education not only for clinicians and large conference settings but one-on-one education. we will send an expert into a clinic to spend half a day >> they don't need a half a day. they just just need to have it posted online. compared compared to other clinics the natural competition is going to drive it. we no that from infection disease rates. they're going to come up. i suspect if you did that for an elementary school we will post the rate of the children immunized enter but beware because over 50 percent are not immunized a petri dish for measles. your comments? >> i would like to agree

with your last comment about posting rates. we want parents to be informed about the environment that they are putting there children in, and there is know doubt the school of 40 or 40 or 50 percent immunized is where the next outbreaks we will occur. >> is they're a push to do so? we should be letting parents no. i read the pediatrics article. if a pediatrician pushes immunization she is more likely to convince to vaccinate them if she is passive. to what degree are we posting individual clinics and/or individual schools? >> i can certainly comment for california. the rates of public information posted on the state website but you must go look for them rather than putting them in the face of the parent as they walk in. >> your comments?

i will yield back. >> this time bank is getting full. >> i don't think i we will take on. i appreciate your testimony in your answers to the questions. i i just have -- and it may be too early to know the answer. all of you are on the front lines obviously. your story you are hearing a lot. what is the public reaction to this? because hopefully they are disseminating information and the news has been what do you sense has been the

reaction to the outbreak and to all of the public information, all of the discussion on the news? what has been the reaction from those parents who waved the immunization? is this being helpful? >> i would say absolutely. i have heard stories from pediatricians who have been trying to convince families to immunize. i think the publicity is important to raise awareness about the fact that these diseases are still out they're, and i think the senators parley have done that. >> i have had great experience getting a lot of good questions from the media and families particularly focused on immunization exemptions

which are low but notably the wealthiest county has almost four times assign exemption rate as the county next door for metro nashville, kindergarten students. that caught everyone's attention. hopefully even though our exemption rate compared to california and other places is making people realize the consequences of there choices. >> dr. >> i would echo what they are saying.

did a lot of damage. and we have seen a -- not an explosion but a growth in autism at least in the diagnosis of it whether it is the genuine increase were just better diagnosis. and it is a devastating -- it is a devastating thing, autism. so i so i no that that fear resonated.

>> thank you, sen. >> i. >> i just want to thank all of our witnesses today for being hear and for all the work your doing to help keep people safe. i particularly want to thank our chairman for holding this hearing at such an important time. >> i think sen. murray for her work and her staff's. this has been helpful, and not just to us but to anyone who has been listening. we are so proud of our public health department not just on this but on the quick reaction to the fungal meningitis episode where your organization save saved lots of lives. thank you for your in your

field feel that your testimony. the hope we have is the message goes viral and that it goes fast. i have a a hard time keeping my old governor had off and it makes me think of the importance of our state organizations. the medical associations work through there legislatures and associations and are in touch with parents everyday. we would like to take some steps to solve all these problems. the truth is most of that reaction has to be with those closest to the parents. i think the idea of a medical home for every child is probably the surest and best way to approach this be

his parents are talking to pediatricians and we will make sure the children were vaccinated. >> i have some closing remarks i am supposed to make. the hearing record we will remain open for ten days. the next hearing we will occur tomorrow at 930 and look at the issue of ambush elections. elections. thank you for being hear and the committee stands adjourned. >> this week three nights of tech >> $40,000 a $40,000 a year it should be a bentley. for that privilege of leasing that car he gets to be impoverished. >> here from insiders at

facebook, paypal at sea and more. >> israel probably the top high-tech company in the world puts digital 1st for gdp growth, job creation minorities, arabs, orthodox views movement. >> starting tonight at 7:00 p.m. eastern. >> this week book tv and american history tvr in prime time. teewun book tv c-span2 book tv features programs on topics like:

will

joining us. guest: thank you for having me. host: to start off, could you give your sense of a little bit of the history of black colleges and universities, and what their le was whethey wfirst >> could you give your sense of a little bit of a history of black colleges and universities and what there role was goes well back into the 1800s. as these schools were formed a given opportunity in the country in a segregation of education system and receive an opportunity for higher education. it was founded in 1867. it was necessary as we had a segregated system. over time, right now when you look at the other country, about