gynecology world, and i'm committed to do it until the time when sexual and reproductive health, quality services are available to each girl and to each woman and their rights is protected, respects, and fulfilled. i thank you. [ applause ] >> wow, thank you so much. our next fellow is a doctor who is a research associate with the university of michigan school of public health. you can see him wearing michigan apparel every single minute of the day. right now it's closest to his ankles, he is sporting some

michigan socks. most other times it's more at eye level. he says i blink three times when i feel a sense of danger, and i strongly believe that it keeps me and my family safe. i remember this as if it was yesterday. i walked about a mile to fetch drinking water. at the time i was asked what i would be when i grew up. without thinking, i said i would be a medical doctor. and i knew that i was a kid from a poor neighborhood, and that dream was real to me. my dad taught me to believe in myself, and i believed they could conquer any obstacle for my dream to make the world a better place.

as i travelled 12 hours on a bus, within weeks it became real. my dream died and it became real. headaches, fevers, but i went to class. at any cost i want today be in medical school. but i died. i was in a coma for two weeks. when i came back to life, i lost my hearing to complications of meningitis. meningitis is common in northern nigeria. this climate zone extends from the shores of senegal to the east, going over west africa.

in this region every year thousands of young adults get ill with meningitis. 10% of them die. i'm one of the few that survived. and for that anyone, i was lucky. i had never been to the north of my country, but when i travelled, it was unusual and the climate changed. i wondered if it extended to the south of our country, is that why i got meningitis? now i dream. i dream again of things to stop

this from happening. because i have returned to medical school, i became a physician, and i'm now a researcher. in reality it still goes on. this year i will speak. nigeria is battling the worst outbreak of meningitis this year. like i said, i dream. i now walk at the intersection because i always wonder what is the connection between climate change and human health. and my work is now very fulfilling. that's why i dream. i dream of a day when tapping our resources does not hurt human health. i dream of a day when everyone has access to health. in my country, poverty, lack of

education, lack of -- and we know that extremism has impeded good health care. but i still dream. and i know that this dream will come true. thank you. [ applause ] next up, the executive director of psi haiti. i like that she says, i like to sing in the shower but make up songs with the statistics that i have to remember before making a presentation or speech. thankfully she was just belting out whatever song she wanted for this. because there are no statistics involved. [ applause ] >> i always knew i wanted to

change the world. i wanted to change my country. haiti. i knew i wanted to have an impact on haiti. here i am doing it every single day in and out. i was working with youth. i was working with women. and hiv prevention and family planning. i was going all over around the country talking to them, reaching them, providing services and activities. i would actually change their lives and have an impact and help them change their behaviors. the more i started working, the more i started having responsibilities, the more i became frustrated. because with responsibility i started to understand the bureaucracy around our work. i started to understand the donors and their priorities and priorities that did not always meet the priorities of the people. i started to see programs that had a huge impact on the population and these programs closing and not able to continue because of lack of funding.

and worst of all, i started to see my people, the ones we wanted to help, sitting around and waiting for ngos, waiting for the international communities to come and help them. i was mad. my optimism was diminishing. i was actually asking myself, is this the life i want to have. do i want to continue doing this work. is it worth it? then, on january 12, 2010, the unbelievable happened in my country. i was at home with my husband and my children. and the ground started to shake beneath us. we had no idea what was going on. we were not prepared for this. we had not talked about that. i was scared. we were -- it was unbelievable. the four of us were fine, but what about my friends. what about my family. what about my city? at that time, all we could hear were the screams.

all you could see was the smoke coming from the city. i felt powerless. here i was, wanting to change my country, and i couldn't do anything. my government was on the floor. i felt i was shaken to my core. the next morning, at sun rise, we woke up go see what was going on, to go find my family, to go see the city. as i drove, i was speechless. there are no words to describe what i was seeing. the city was destroyed. there was so much fear, so much pain, so much suffering. we had no idea how we would stand up, rise and be able to continue as a country. then, in the middle of all this, i saw something unbelievable, i saw something unexpected. i saw courage in people's eyes. i saw a man pick up rocks to clear rubble of a house where a stranger was stranded. i saw a baker open up his store

to give bread to people who have been there all night long. i saw people with their own personal problems be there to help others. i want haitians wanting to be there for each other and be a solution instead of having to wait for the international community to come do the work. i saw that light in their eyes. i saw that possibility, that possibility that together we could come as one to be able to help each other. in the middle of the chaos, i was asking, did i want to take my children and leave the country, leave the disaster, because there was no way this could get better. there was no way haiti could stand up again. my answer was no. because i saw that light in their eyes. that light that shows me that we

as a people can come together and make this country better. thank you. [ applause ] >> thank you, anick. our next fellow and next speaker is mary anika sando. dr. mary sando. she is a health specialist with unicef. and if you're impressed by that, you will be more impressed to know that she loves to sing and she can do a mean imitation of celine dion. mary. [ applause ] >> the happiest day of my life was in 2009 and 2010. when i gave birth to my two

children at a hospital. but as much as i felt the joy and dignity of having survived two safe deliveries, i could not forget that five years earlier, i was not the woman opt stretcher, but the woman in a white coat trying to save the life of a woman on a stretcher. but i failed. we all failed. anna was walking into the labor room when i was walking as an intern in that hospital. she was in a very weak state. her eyes were barely open. she was very pale. her gown was stained with blood. so my team and i quickly gathered around her, taking her vitals and blood, for we knew

she needed emergency blood transfusion. but in the span of like 30 minutes, anna began having difficulty in breathing. we did everything we could to save her. but all our efforts were in with vein. i remember looking at anna lying in a pool of blood and i felt very -- from us not being able to save her. she was only 26 years old. even though i didn't know her, i knew she must have had a whole life ahead of her. how could she have just died like that? so later on, i had the courage and go out of the labor room to meet her husband. and i still recall that very painful moment of having had to inform him of the unfortunate passing of his wife of just one year.

it was so difficult because their baby girl died just a few hours earlier in child birth. so later on as i gathered the medical records to certify anna's death, i realized that she was anemic from the time she was pregnant, from the begin to the end. and her anemia made it very difficult for her to survive following the severe bleeding she suffered after her birth, after the birth of her child. and so, despite all our efforts, anna became one among many tanzanian women who suffer due to severe bleeding after birth, that must succumb. seeing anna and so many women after that die because of maternal complications, was and

continues to be, very heart breaking. and so, even today, 24 women die each day in my country because of maternal complications. and we know now that more than 90% of these deaths can be prevented using very simple interventions, such as making sure women get to clinic early and any danger signs are identified and managed. but also using simple medication such as injecting women immediately after delivery to prevent them from the possibility of bleeding like anna suffering. but also simple medications, that would be able to prevent and manage women who may get complications following high blood pressure induced by their pregnancy. controlling infections after birth. and also improving emergency of care. so we know these interventions

work. they have been proven to work. so as a doctor, and a mother myself, i chose to make a difference, because it was the life of all these women and the death of one that inspire me do my work. today, anna would have been ten years older. and her daughter would have been ten years. so i do my work for them. thank you. [ applause ] >> that one really hit me. i gave birth seven months ago, and i was severely anemic throughout my pregnancy. so it just feels so recent, so relevant. and mary's work is so important. thank you, mary. next up we have a bit of a shift. this fella is a doctor, but not like the other doctors you've

just heard. he is co-founder of biosense technologies. and he is just a fountain of ideas. he came up to me a couple of minutes before we started, and he said, i have an idea. i thought, uh-oh, it is about the presentation and we are getting ready to go on, and he said, there should be a reef and it could happen between me and this other fellow. >> and i thought, this is myshkin, he has these ideas. you are lucky to hear from this infectious energetic human being. he was named after a character in a novel. and he is very glad nobody in primary school was into russian literature. here is myshkin. >> myshkin is -- [ inaudible ]

so i'm one of those guys who just loves technology. you know, the latest gadget. i have to look at it, how it works. i'm one of those guys. so in -- no, the people like me, i create marketing and marketing people, marketers, as incarnation of evil. and that is my picture. say the word. scare. big inventions. big ideas. so in 2006, i was very happy to get a chance to work for nokia in india. that was like a big thing for me. and nokia was really big in india at the time. 7 out of 10 phones were a nokia phone. so i had like hundreds of ideas buzzing. we can do this.

the phone can have this. and this button here and have this and that and this and that. and he sort of poured it out to my boss who listened patiently. and thought yeah, okay. then he said, myshkin, this time, the mobile phone business is not about mobile phones. i didn't quite get it. i was a young kid who liked technology and all that. slowly i started to understand. but it hit home to me once. i was in a shopping mall in south delhi, negotiating a contract, and i went out of his office. i was walking through the mall. and a nice big mall. very plush. i could see different brands. see big holdings. i could see people walking fast. getting into the shops.

glass. it was wonderful. and finally, i started getting it. everything moving in slow motion. like the matrix. i could see how it worked. i could see that it was not about technology. it was about the phones and washing machines. it was not about any of that at all. i could see that, patterns and kids running around and parents are looking in and they could see what was happening. and i could see their eyes light up. and i realized that they are not buying what is in the box. they are buying a new life. they are buying an idea, a hope. that their life will be better. different. that's what marketing has done to them. and this is not necessarily a bad thing. in india, this is changing the face of india. so i walk out of the mall -- i still love technology, but something inside me change. i started thinking, what if we could use this idea, this hope, this marketing.

and apply it to other stuff. sanitation, water, energy. what if we do that. so a few years later, i happened to be working with a team of doctors. we had a big idea. a big technology idea. that we could use mobile phones and electronic devices to take scans where scans do not exist. so i eventually built a platform on android, that could do imaging for urine and blood strips. it could diagnose diabetes and other complications at less than 10 cents per test. we found the company. we took it to -- my doctor friends were like, let's get funding and suddenly, i realize that's the mall scene. we will push this technology to people, let's build it together. so we essentially allowed local

enterprise, we worked with local enterprises, we worked with people. so i realized it was not a big save the world idea, it was a small part after user story. so with this "matrix" scene, i get it -- i get young people with big ideas. myshkin, there is this thing to build. i just need $1 million to prove it. i put on my best keanu reeves face and say, no. let me show you. thanks. [ applause ]

>> thank you, keanu. wonderful talk. thank you so much. our next fellow and speaker is an amazing person. he is the founder of -- co-founder of amani global works. the proud parent of four children. and he is also a coral director. but jacques also made a lasting mark in my heart when from literally the other side of the world he recited almost verbatim an article that courtney and i had written focused on dignify and design. since that time, every time we interact, jacques and i talk about the word dignity and what it means us to.

it is with no greater pleasure than right now, that i get to introduce, my very special friend, jacques. >> when we hear about -- in the news, it is all about genocide. women being raped. wars. and what about this tiny island? where i am from. of 250,000 people. that is building health care system, and driven by forgotten modernized people we call pygmies. nine years ago, my wife, a nurse, and i couldn't stand by while many people were dying from primitive diseases. we couldn't stand by while girl be married just to be taken away

from the family and given to men so they could be fed. we couldn't stand by. we couldn't just sit in new york and enjoy good life. we decided to go back. and the best way we thought to change and bring our contribution to this community was by building a -- we believe that by building that would provide many jobs to people. we believe that if people have job, they could take care of their families. three years later while exploring possibilities and to build -- we stumbled into a tiny village. we just learned that two children have died. and i asked why they died.

women, who by the way, told me she was invited in 1961 to my mom's wedding, told me, what do you mean? no one will look at us. no one will touch us. i couldn't believe that in 20th century, pygmies were still -- this still exist in the eyes of other people. in fact, pygmies believe they are not human. and other members of the community believe pygmies are not human. they are not seen, they are not heard. then i asked what they thought about this -- one said, we love the idea, but what if you built a dispensary for us. will we be treated like other human beings? like human being? i was shocked. it became clear to me that it is not what they want. it is not what they thought was good for them. it is what they believe is good

for them. they made it clear. the weaker the -- i talk to communities and made it clear that they were the only people who would have to be in their -- while they didn't have money, we decided that they had to use whatever they had. so we built the first clinic. and for the first time, the humans and nonhumans work together to build the first clinic. after we succeeded, we commit -- we commit to expand the clinic. i believe in a dignifying design. i believe that if we build in the community, a beautiful building that is part of the community, that give them hope

and believe in themselves. but we didn't have much land because the powerful land owners around was planted sugarcane and as some of us know, sugarcane plantation can be prime more mosquito that transmit malaria. so people leave, suffer from malaria. we did everything we could but could not take it away. we threaten to shut down clinic, we solved the problem. then one morning, i was waken up by a group of pygmies which said we just finished the job. and the clinic is safe. they are not seen. they are not heard. they can't be because they don't exist. they don't pay taxes.

so who have been looked down, they brought this beautiful idea of building a clinic and i'm happy to note in august, a beautiful hut with running water, air condition on one kilometer radius. [ applause ] it is this determination. this courage. this belief this they also deserve being part of the community that wakes me up every morning and goes to see them. and that why i do what i do. thank you. [ applause ] >> our next speaker is a very gentle soul.

i had the pleasure of working with him on his writing over the last year and i've just been repeatedly touched by how gentle and insightful he is. he also likes to share really gross-out medical stories with me that freak me out. but most of the time, he's very gentle. he's a clinical direct over gunadarma university hospital. and his interesting fact, you can tell by now, we asked all of them one interesting fact, broke my heart. it is that he loves walking in the rain. so here he is. >> so, do you know this? we humans are in a battle with life. so here is the story. i was called on a medical

mission in 300 miles away where there is a holy school that accommodates deacons and search scholars. it is also home for poor. people rarely change clothes and are constantly having body lice. when my medical team arrived there, we were recognizing what was going on. many people were sick and they were along the church corridor. it was not an epidemic. it was an epidemic of born -- one of the priests told us, this is all the result of body lice infestation. we just spray lady -- body lice.

we try to kill them on daily basis. we spray holy water on them. but they continue killing us. how could this small creature could cause this much trouble, should be a question that -- this tiny hitch hikers live with humans for millennia. and in spite of all efforts to get rid of them, they went along the ride when humans conquered the globe. they migrate with humans. when humans evolve and lost their fur and start with clothes and preventing lice infestation, lice lost their wings. they flattened and adopt their new environment.

actually, lice tend to outsmart humans, their only host. so this live human interaction interweave with the germs, they can transmit. lice could cause itching and annoyance. but the germs they carry could cause -- that is what exactly happened in the church. an epidemic of a fever. the outbreak, louse born fever, is not known in any part of the

world except in the high land and in parts of sudan. so with increasing migration, it is likely that the lice could reemerge and do be the next emerging infection. and it is becoming more conducive to lice but not for humans, as you know. so we should treat lice harder than ever. otherwise it will continue killing us. thank you. >> that man's smile and gleaming teeth juxtapose with that and we

will see. our next speaker is a managing director of fine doctors nigeria. we first met a couple of years ago, she tried convince meg that lots of doctors are also helicopter pilots. i didn't think so. as you might notice when she steps up on stage and she is much taller than i would ever be comfortable walking on, safe walking on, ola reports that she loves shopping. ola. >> meet mr. mystifa. he is 70 years old and the ceo of a multinational company and

he's also a billionaire. now, meet his girlfriend. she's 22 years old. she's broke as hell. and she's been dating him for the past six months. mr. mystifa, as you may have guessed, is her sugar daddy. and the bases of their sugar daddy relationship is, he takes responsibility for giving her various favors, money and gifts in exchange for, whatever he wants. you see, he dictates what she is getting. and he dictates what he wants. and she simply obeys. now, the weirdest thing i think about their relationship is that mr. mystifa has a lost

experience in business and economics and markets and could very, very easily empower candy to be a business person just like him. but instead, he keeps her on a sort of leash. giving her just enough to keep her happy. but never enough to prevent her from running back to him. i think there is a similar dynamic between the west and africa. every year there are policies and clinical protocols and best practices. copied and pasted directly and awkwardly into africa. often expensive, which makes them unsustainable. and inappropriate. and very, very little given to the concept of reverse

innovation. this is the ability of african entrepreneurs ourselves to develop solutions in not only our health care problems, but health care problems across the globe. in lots of parts of africa, we transact in shorts in marketplaces using our mobile phones. we have mobile wallets. and i can go up to a person selling meat or bread or rice in the rural market in the middle of nowhere and pay her with my mobile phone. here in aspen, i can't even buy a louis vuitton handbag with mobile money. that means that in this small area of mobile technology, we have actually managed to leapfrog over the west and start using technology that has not

been adopted here before. and i believe that if we can succeed in leapfrogging in this single area of mobile technology, then we can leapfrog in health care as well. i'm the founder and ceo the of west africa's -- every year we have rescues with planes and helicopters and our team of doctors. now, our service runs, what's cheaper and what's leaner, than our western counterparts. we've today think outside the box a lot when it came to medical equipment. when it came to keeping our operating costs low. and we operate primarily in nigeria. so we have quite dangerous terrain sometimes to recover and rescue people from. now i really believe african entrepreneurs in the next few years can join the league of

general electric and metronic and oxy log to deliver the next generation of health care solutions and not just be recipients of aid or owners of trade. i also hear development community executives facing like, i have to put on my american accent now, okay. we're not the kind of organization that just gives them fish. we teach them how to fish. we teach them how to fish. but my question to that, is what if i don't like fish. what if i want steak? the truth is that sugar daddy relationships like this one are unsustainable and rarely stand

the test of time. the relationship that is equal is what stands a fighting chance. thank you. [ cheers and applause ] >> all right. between louis vuitton and steak, we know what kind of lady this one is. all right. next up, we have jane otai. someone who i just have profound respect for. the kind of work she does. she is going to talk about it. we were on a panel earlier, and i'm just continually touched by the sort of direct service work that jane does and how she always centered those people, which she will of course do again today for you. she is senior program adviser at

topego, which is related to johns hopkins. she loves cooking but has a hard time following western recipes because she can't find the ingredients in kenya. here she is. jane. i sleep very light. i will be able to tell you what keeps me awake. i work in nairobi. and in this community, there are about 60% of the population of nairobi and women and girls in this community have various information about health, generally, and especially family planning. so these are the women i interact with every week and everyday. and i think about it in my sleep. and when illiterate women, i have to think about how i bring the message to them.

in one of these meetings, i met kedra. kedra is a 26-year-old lady. but when you look at kedra, you would think she was 40 because she is worn out. her health is very poor. and when she sneaks into one of these young mothers clubs, she comes with her little baby, actually 4 years old, but when you look at him you think he is 2 years because of malnutrition. so it hits me that many women hear about health issues, family planning on regular television. but they need to interact with other women in order to really have information about family planning. and for this reason we have young mothers clubs set up where

we meet weekly with these women to talk about issues of health, child care, issues of family planning, issues of marital relationships. and we talk to them every week and this message slowly comes down. but i found that there is a way that they can communicate with them and these are my tools. i use sticks with these women. and in these meetings we divide the women into like four groups and some groups have seven children, others five, three and two. and for those women who have many children, soon they run out of the steaks. because they are not able to provide the food, clothing, education for their children, and they soon realize that oh, with many children i actually cannot provide everything. so we ask, what are some of the coping mechanisms if you are not

able to provide for the education, what do you do? these are real choices for these women. many of them say, you know, we give the younger children food and the older children go without food. or we take the boys to school and the girls remain home because we cannot take all the children to school. and for those who have run out, they say, well, in my family we have ten children and i decided to go into prostitution to support our home. so finally, they realize what there is a relationship between having many children and whether you can be able to provide for these children. using these steaks. sew i ask again, what have we -- so i asked again, what have we learned in the few weeks that we have been together. kedra puts of her hand and said she want to contribute. okay, tell us. she said, you know, i have had 11 children in my life. i got married when i was 13 years old.

and over time, i give birth to many children. and i continued giving birth because they were dying. seven of them, seven, i have put in the ground. i have buried seven of my children. i only have four children remaining. and it is because i did not have family planning. nobody told me about it. but over the weeks, i have learned about family planning and actually i have an implant here, i have an implant. and it can protect me for five years. and i'm telling other women about family planning now. so i realize that actually this program is making an impact on the women that we talk to. they are able now to remain -- relate family planning, survival and provision to their families and children. so that what i do and it keeps me awake every night. thank you. [ applause ]

>> thank you, jane. amazing. so powerful to see jane up on the opening stage yesterday. so our last speaker, our last fellow to present to you tonight, is an amazing, amazing person. he is the founder of the consultancy, he submitted to us that he loves apple product. all right. i heard there is much more to this amazingly courageous person, and you're about to meet him right now. >> when i was growing up, i wanted to be either a lawyer or an actor.

so in 1999, when i got admission into the university to study theater art, it was a dream come true. three months into my admission, i met ebram. ebram was everything i wanted to be. intelligent, with a wicked sense of humor. with my feeding allowance, this was a good relationship between ebram and i that he had such an impactive influence on my life. so it was after my first year holiday, when i went back to school, i got a call, ebram would like to see me. he is in the hospital. i rushed to see him.

and the moment i walked into the ward, i saw my best friend. lying there on the bed. i could see his ribs through his skin. those cancer all over his skin. his skin was dark. his eyes was big and popping out of his skull. he was lying on there. his hand were withered. skin wrinkled. i couldn't help myself, i broke down. and then, he turned around and looked at me and he said, come over here, bitch. even at this particular time, he still had a sense of humor. i walked up to him and he stretch out his very weak hand and he held me and he said, i've got aids.

and i've only got a few days to live. and i would like to talk to you. and he looked right into my eyes and through me and he said, bisi, of all my friend, you are the only one that can get the message across to every other friend about hiv. and i want you to promise me that you will do this. i was young. i had no idea what he wanted me to do. in my frustration, i started looking for an answer. then i came across an organization in nigeria calls alliance right. working with gay men at that time in the area of hiv. i volunteered for them. and few months into volunteering, i was given the opportunity to become the program director. that came with a responsibility of lobbying nigerian government to start an hiv friend walk that

would include men who have sex with men, and drug users.

in nigeria has to stop. that 17% of hiv-positive gay men

living in nigeria would not have access to treatment. in my frustration, the picture came back to me and then i realized that no matter what happens, i have to keep his memories alive because this there is to much work to be again [ -r . and live coverage today across the c-span networks. at noon eastern on c-span2 the cato institute looks at presidential's constitutional authority to use military force against isis without congressional approval. at 1:00 eastern on c-span, a panel discussion examining the political debate about the legal approval process at the keystone

xl pipeline hosted by the wilson center. and c-span's campaign 2014 coverage continues tonight here on c-span3 with the governor's debate in massachusetts. five candidates battling for the open seat, including martha coakley, republican politician and businessman charlie baker and independent candidates evan fallchuck, and scott lively. live coverage gets under way at 7:00 eastern. again, we'll have that here on c-span3. also live tonight at 7:00 eastern on c-span, a west virginia senate debate between congressman shelly moore capito and natalie tennant as they fight for open seat by retiring jay rockefeller. here are some television ads being released by the candidates in the ads. >> obamacare we're losing our choice of doctors. a higher deductible.

a higher premium. that inhibits our choice and those are thing s west virginias hold dear. >> shelley moore capito -- >> health insurance will be more expensive, more costly for small businesses. this administration has put a big damper on our way of live. and our love of freedom. >> i'm shelley moore capito and i approve this message. when she was a week old our daughter had open heart surgery that saved her life. friends, family and folks all across west virginia prayed with us, the insurance company called her a preexisting condition. i know health care reform wasn't done right. there's a lot i'll do to make it better for west virginia but i'll never go back to the day of letting insurance companies deny insurance coverage to our children. sad to say we're now seeing

politics at its worst. my opponent is attacking my personal integrity and my family with athds that are blatantly false. i'm disappointed but not surprised because she's shown from the start that she'll say and do anything. misleading voters on purpose just to get elected is not a west virginia vow. and i'm going to fight just as hard for my family as i have for all of west virginia's families. i'm shelley moore capito and i approve this message. >> i'm natalie tennant and i approve this message. >> what do we really know about shelley moore capito? on the financial services committee she helps bankers get rich. in return, they've given her nearly $2 million. but there's more. while west virginians were losing their jobs and savings to wall street, she gave her husband, a wall street banker, insider tips and they made more than $100,000. congresswoman capito keeps getting richer and west

virginians pay the price. >> we'll have live debates in that west virginia race at 7:00 eastern on c-span. on c-span2 virginia's debate between mark warner and former rnc chair ed gillespie. next a conversation about vaccinations and why measles and mumps that were largely eradicated in the u.s. a generation ago are reappearing. a panel of doctors and others participated in this 90-minute discussion. welcome to the national press club and journalism institute. a special welcome to the vast audience viewing us today via c-span. i am myron belkin, president of

the press club. hosting this briefing with the pbs show nova and tangled bank studios with be co-producer of the upcoming show on vaccines. no question from maine to ohio to california, there have been many outbreaks of preventable diseases that many in my generation thought were no longer a threat. measles, mumps, whooping cough and even polio. and on a personal note, i was a foreign correspondent for the associated press for 40 years. when i'm asked, what was the most important story i ever covered, i respond that it was covering the eradication of smallpox in ipd yeah. when i went out with a group of world health organization epidemiologists, to talk about report on how they isolated areas with smallpox to ensure that everyone was vaccinated. and those vaccines in behar

helped make the world smallpox free a few years later and that is why it is essential not to forget the role of vaccines. no question, this issue of vaccines is being talked about by news media around the united states and the world. and i'm pleased that today we will be hearing from a distinguished panel, including journalists on the front lines covering this issue. persons like joe lawlor, health and human services reporter, of the portland press herald maine sunday telegram 37 the return of preventable diseases and risks of opting out, nova, the premiere pbs show on science, health, education and more. i want to welcome paula offit, executive producer here in the audience, and julia court, senior producer, who are based at wgbh in boston, one of the pbs flagship stations.

our moderator today is michael ros rosenfeld, the head of tangle bank studios here in washington. the term tangle bank was inspired by the origin of charles darwin and his tangle hypothesis. named after darwin's colorful description after complicated ecosystem. so we look to you, julia and michael, and other experts on the panel to help us understand the complicated ecosystem of vaccines. thank you so much again for having this important discussion, this very important discussion, at the national press club under the auspices of its journalism institute. i'm very pleased to turn over the floor to julia koord. >> thank you, myron. and thank you to the national press club institute for hosting this briefing and thank you all for coming this morning. we're here to talk about reporting on vaccinations and outbreaks of vaccine preventable

diseases. and to share some insights we've gained while preparing our upcoming program vaccines calling the shot. vaccination is really a perfect topic for nova to cover because our primary mission is improving the public's understanding of science through accurate and engaging journalism. and, in fact, today nova and pbs are among a small handful of places one can find good science journalism on television. and still the need for science journalism has never been greater. science and technology is joined in so many public policy issues today. like vaccination, it's crucial that people not only get the facts, but get clear, accessible explanations, analysis of the facts so they can make informed decisions. yet, providing these can be really challenging for journalists, especially on subjects like vaccines. because not only is the science very complicated, but we're

presenting this to readers, viewers, our audience, who are not just engaging with the facts but are engaging with powerful emotions, like fear, mistrust. so, this is a challenge our producer, our whole editorial team faced putting together this program as we aim to provide solid scientific understanding in a field that's full of misinformation and misconception, to an audience that includes parents who are confused. who have a lot of questions, but are trying very hard to do the right thing for their children. paula, senior executive producer of nova, who is here today, and i, were very fortunate to be working with an extremely talented team of veteran scientist journalist, including sonia pemberton, producer, director and writer, and michael rosenfeld who took on this very difficult and complicated but

extraordinarily important topic. we hope today's discussion is helpful to you as you report on vaccines and outbreaks and wrest wrestle with some of the issues we've been wrestling with. so now i'd like to turn things over to michael rosenfeld, head of television an film at tangled bank and executive producer of vaccines calling the shots. >> thank you, julia, for that kind introduction. and thank you, myron, for the opportunity to participate in this briefing. good morning, everyone. thanks so much for coming. the subject of vaccinations is on the minds of many americans right now as we send our kids back to school at a time when vaccine preventable outbreaks are making headlines around the country. the cdc puts the numbers in perspective. measles was declared eradicated in this country in the year 2000. but there have been almost 600 cases so far this year. that's the highest level in the u.s. in almost two decades. pertussis or whooping cough is also a problem. 2012 was an especially bad year with nearly 50,000 cases and 20

deaths in the u.s. and this year the state of california declared a pertussis epidemic. these are diseases that vaccines can and do prevent so the numbers will make anyone, but especially a journalist, wonder what's going on. at tangle bank studios, our mission is to shed light on public health so the story of vaccines in the context of these outbreaks was irresistible to us. we have been fortunate to partner with pbs and nova to explore some of these issues. the result, as you've heard, is the new documentary "vaccines:calling the shots" which airs next week on nova at 10 p.m. eastern. we hope audiences will understand the science behind the issues. at the same time we know this a story that will continue to unfold over the coming weeks and months and years. i think it's safe to say that journalists will have their work cut out for them as they cover

the return of vaccine-preventable diseases which can't be fully explored from any single beat. this is not just a science story, it is a public health story, a medicine story, economics and policy, psychology and history as well. our panelists today reflect that. you have their bios, so i won't repeat that information but i would like to add a few things about them. as you'll see when you watch the film, paul offit, to my left, cares passionately about public health. not that he was a leader in the rotavirus vaccine which saves hundreds of thousands of lives around the world. he also is on the front line of pediatric medicine at the children's hospital of philadelphia. from public speaking to writing books, paul has a lot to say about the role of vaccines and the return of vaccine-preventable diseases. the way to make a smart film is to immerse yourself in the topic.

and sonya pemberton, next to paul, really goes deep. when i first discussed this film with her years ago, i was impressed by how much she knew about vaccines. and, in fact, sonya has spent the last 4 1/2 years immersing herself in this topic. with the detail understanding of the subject, sonya has given a lot of thought to how this story should be told. her goal, which we shared, was to craft a film that would bring clarity to a very complicated science. and also be accessible to the general public and to parents who, as julia said, have a lot of conflicting thoughts and emotions about vaccination. brian zikmund-fisher grabbles with one of the hardest subjects to study and communicate risk and as someone who studies how people make decisions at university of michigan, adept at explaining tough concepts like immunity and relative risk. and those subjects are especially important for vaccine -- for the vaccine conversation because how you see

risk can have a big impact on whether you vaccinate your kids, on schedule, delay some shots or even skip their vaccinations entirely. and finally, i'm pleased to joe lawler to the panel, covering the health beat for the portland press herald in maine. he has written front page stories calling attention to the rise in vaccine exemption rates as well as potential legislative responses. his coverage has generated lots of discussion on the web, which tells you something about the appetite for good reporting on this subject. so, that's the panel. i'm now going to ask each of the panelists to speak for roughly five minutes about the subject of vaccines from their particular vantage point, and then we'll open the floor to questions. paul? >> okay. if we could start, actually, there's a two-minute clip about herd immunity that's going to

lead into my five minutes. so, roll it. >> the 2013 measles outbreak in new york hit hard and fast. but remained within the brooklyn area. why didn't it spread to the other 8 million people in the city? the virus was in circulation, even though it often wasn't obvious. and it was being carried by people who often had no idea they were infected. ♪ but the vast majority of people who came into contact with the virus had protection. they were vaccinated. >> there's two things that matter for whether or not i'm

going to get sick. one is, if i bump into somebody who has the disease, am i protected against it or not? but the other piece, and the more important piece, is the chance i will bump into somebody in the first place who has this disease. and you can think of this as the sort of concentric circles of people. and the less the disease exists in my circle or the next circle or the next circle, the safer i am. >> it's known as herd immunity and it protects everyone. including young babies and people who can't be vaccinated for medical reasons. and in new york, it works. >> if we didn't have the high vaccination levels that we do, you know, in new york city, and even in this community, i can promise you, we would have had hundreds if not thousands of cases.

>> but this protection is fragile. for highly infectious diseases like measles, we need 95% of the community vaccinated for herd immunity to hold. if the rate drops, even just a few percent, herd immunity can collapse. >> so, we live in a country of about 300 million people. among that 300 million, there are 500,000 people who can't be vaccinated. they can't be vaccinated because they're getting chemotherapy for their cancer, can't be vaccinated because of immune suppressive therapy or because they are too young. they depend on those around them to protect them and when herd immunity starts to break down, what you see is exactly what you are seeing now. which is the most contagious diseases come back first. for example, among the most contagious diseases are measles, mumps and whooping cough. now, as michael said to

introduce this, look at the current measles epidemic. i think is instructive. the current epidemic has about 600 cases. that's about the biggest epidemic we've seen since two decades ago, since the mid-1990s. 600 cases. now, if you look at this, how it happened, the way it happened is generally citizens from this country travel to areas where measles is endemic. meaning it occurs generally year-round. for example, the philippines. the philippines last year 31,000 cases of measles and 42 deaths from measles. a traveler generally unvaccinated goes the philippines, catches measles, comes back and spreads it for the most important among a group of unvaccinated children. the roon those children are unvaccinated are because the parents chose not to vaccinate them. now, although it is the biggest epidemic we've seen in two decades, i mean, it's worthwhile looking at what this disease was before we had a measles vaccine,

which the first measles vaccine was introduced in 1963 before the first measles vaccine, every year there were 3 to 4 million cases of measles. there were 48,000 hospitalizations and 500 deaths. everybody saw measles. i mean, meese manies was a scourge. today although there are 600 cases, i would bet few people, if anyone in this room, has actually seen a case of measles. in fact, when measles -- when a suspicion of meelss case comes into our hospital, a child who has fever, rash and a question of measles, they generally bring old people, like me, down into the emergency department to see whether or not it really is a measles case because people don't remember what measles looks like. for example, when a recent larry king live show, jenny mccarthy, who is my personal go-to person on health care advice, i don't know if she's yours, but she said -- when addressing the issue of whether the mmr vak soon could cause autism, she said, i'll quote, as she does so

eloquently, i'll take the freaking measles every time. what that tells you is that not only has she never seen measles, she doesn't know how sick it can make you, she forgot measles. we have forgotten what measles looks like, which is remarkable. i remember when i was an attending at children's hospital in philadelphia in 1991, we were in the midst of a massive measles epidemic. it centered on two fundamentalist churches in our city. now, this is 1991. this is 30 years into the development of the measles vaccine. we had 1400 cases of measles and nine deaths. we had five deaths in a continue-day period in february of 1991. i mean, our city was in a panic. and so, there certainly are those of us who understand the power of measles. for example, about 50% of children with meelss will have an abnormal chest x-ray. which is to say they'll have radiographic evidence of pneumonia if not clinical pneumonia. i like to think what we

experienced in 1991 in philadelphia is a lesson from the past and not a prologue to the future. thanks. >> sonya? >> hi. i'm sonya pemberton. i'm a flick maker and a science journalist. and like many people in this room, i see myself as conduit between the public and the science. i initially started thinking about this film way back in 2009, actually, after i made a different film called "catching cancer" and that was about how viruses can trigger cancers. how, in a funny way, that's good news. because if you can find a virus causing cancer, there is a way find a vaccine to stop it. the film went to air. and then i received a rather large proportion of nasty mail. and what many people might call hate mail and abuse.

i was actually shocked. because i spent most of my life growing up in a medical family. i make medical-based films. i originally started to study medicine. you know, this is my area. i was surprised. and so i decided that i wanted to understand why people could be so upset and so angry about vaccines that they would take the time to write me these letters. so i began a process, really, of 4 1/2 years of digging really deep. i really wanted to understand why people would be really frightened of vaccines, because for me this was alien. i saw it as a life-saving medicine, so i just didn't understand it. so, i had to really confront my own bias, my own pro-vaccination stance and try and understand what it felt like to be someone who was fearful of vaccines. and that is what led to the film. i thought today what i would try to contributed is five things i have learned talking to people with hesitancy about vaccines

and communicating vaccination issues. so, from one journalist to many others, here are my five tips at the moment. first of all, never forget that vaccination is a good news story. we get so used to hearing the pitched as an us versus them debate, argument and fight. around 1% of people in this country don't vaccinate at all. it's a really small number. so, can we all just get a grip, to start off with. about 90% on average vaccinate most of the time, or all of the time, on the schedule. and it's around about 10% of people who might skip or delay some of the shots at the time. that group is important. because as paul said, this can affect herd community. it's not an insignificant number. it's an important number. but i think it's really important that we all put it in context that it is the norm to vaccinate and we should reinforce good behavior, in a

sense, you know, positive stuff. so that was one of the first lessons i learned. to think about this as good news story, not a bad news story. the second and really important thing is that people who have concerns around vaccines are not necessarily anti-vaccine. in fact, the number of people that came forward to me, and i'm talking about hundreds of people that i've spoken to over the years, said, i'm nervous about vaccines. i have concerns about vaccines. i'm scared this vaccine or that vaccine. once i was open to having the conversation with them and didn't shut them down with my kind of personal bias about, you should just have a vaccine because it's good for you, when i stopped and actually listened to them, i would discover most of them were not against vaccines. they just wanted to ask questions. i think we forget that because the groups that are strongly against vaccines are so vocal, that we can lose sight of this very large group of people who just have concerns. we did the first national survey

of attitudes to vaccinations in our country, australia, and discovered around 53% of parents have some concerns around vaccines. now the vast majority, 47%, go on to fully vaccinate anyway. what was interesting, they had enough concerns to make them question. i felt like the least i could do as a filmmaker is try to speak with to those parent. and to do that respectfully and acknowledging people are not necessarily outright refusing, they're just simply concerned. also, the i think the think we need to remember is internet has changed the vaccination landscape. it's a force to be reckoned with. as we all know. people go to dr. google for all sorts of things, including vaccine information. so, trying to counter that with some calm, sensible and hopefully, impartial in a sense, in a sense we're just looking at

the science and trying to follow what the science has to say. i think that's vitally important. my third point, it's okay to talk about concerns and fear. you don't need to be frightened of allowing people or encourage people to talk about their concerns. in fact, as brian will attest, many, many studies that will show, actually acknowledging fear helps people deal with fear. that's how we all process it. when you don't talk about things or try to push them away or don't allow people to talk about this sort of thing, then i think we make the problem worse. so, for me, one of the goals of the film was to help reduce fear, so in order to do that, we took the very brave step to actually acknowledge fear and let people in the film talk about their fears and concerns. and i think that is the fundamental point of difference of this film and hopefully the reason why it will speak to many people. the fourth thing i wanted to add was, there are a spectrum -- there is a spectrum of views

around vaccines. it is not a debate. it is not us versus them. that's shorthanded. that's lazy. that's not the way we should be thinking about this. there are people that -- with a spectrum of views around vaccines. one interesting study i like to think of came out of australia originally was a spectrum of five groups. there's the unquestioning acceptor. the questioning acceptor. the hesitant. the delayer or cherry-picker and the outright refuser. now, this is just one way of grouping people, but i found it useful to try and think of where people sit on this spectrum and remembering the outright refuser is around about 1%. so, and there's a very big group in the middle. and trying to speak to that group and not -- and treat them with respect and listen to what they have to say was really, really important. and, again, it's worth remembering, the vast majority do choose to vaccinate. so, enenforcing that. finally, number five, it's something that paul offit says very eloquently in the film.

he says, we're all in this together. and whenever i struggled with people hitting me with their opinions about vaccines or their fears around vaccines or saying things i knew were scientifically inaccurate, hi to find a place in myself where i could listen to them and think, look, we're all in this together. we're all united by the need and the desire to try and protect the ones we love. all of us, no matter what your position. if you come from that position, then i think we can find a basis with which we can have a good conversation. the australian broadcast last year of the original version, many, many, many parents, hundreds of parents came forward to say the film helped. it opened a new conversation. that allowed those that just had questions to come forward and speak. there was very sane and nice conversation on the internet for about a week, which was really good fun. and people said, please and thank you and would you mind answering this question and it

was all terribly polite for a little while. that was wonderful to see. and the people who would normal kind of hit hard had to be quiet because the people who had just hesitancy and questions came forward. and also what was interesting that came out of it was the australian immunization specialists have started training pediatricians in how to speak to vaccine-hesitant parents so they can be equipped with the skills to have these conversations. finally, i want to say that i think i'm really optimistic that there is a way to have this conversation. and that we can all do it. and we can all help the situation and help people to talk to one another. and i hope you find the film interesting in that regard. thanks. >> thank you, sonya. so, for a perspective on risk and where that fits into this story, brian. >> thank you, all. i'm a decision psychologist. my academic field is trying to think about how people gather information, make sense of data, make sense of risk. and in many ways, we ask parents

to go through a journey much like the one seasonya has gone through to think about what they need to figure out about vaccines, what they need to feel about vaccines and ultimately what they need to do about vaccines. i would like to start with rolling a second clip from the nova episode and then i'll talk about the implications of it. >> she wants to vaccinate her two children but she's chosen not to follow the recommended vaccine schedule. >> so, the plan is to be fully vaccinated as soon as possible, but we're doing one vaccine at a time. i don't know if that's the right way. >> i don't know where we came up with that. >> she has a 4-year-old and is expecting another child soon. she delayed vaccinating her oldest until she was 3. >> i was concerned that her immune system couldn't handle it.

we just waited. >> my son and hers, they're not vaccinated yet. my older ones don't have boosters. >> marianna has four children. she vaccinated at first, but then one child had a seizure. >> so, i'm just really worried about reactions. and i am worried about the diseases, so kind of confused, really. >> in america children must be vaccinated before they start kindergarten but the required shots vary from state to state. most allow for exemptions based on personal or religious beliefs. here in california almost 3% of children are exempt and in some schools it's more than 30%. >> i have a lot of friends who don't vaccinate at all. if you say vaccine around them, they look at you like you are -- well, you know, like you were poisoning your child. on the other hand, you have parents, they can't even understand why this is even a question. >> nobody is willing to really

have a conversation with you and discuss what's a severe reaction, is it okay to have a seizure. i would really like to know what the real risks are. >> one of the things you'll notice in that clip, there's a lot of discussion of risk and not a whole lot of discussion of benefit. that's the first thing i want to highlight in the conversation. dr. offit is right. we are facing a point in time in which the benefits of vaccines are just much harder for parents to understand, precisely because it is not part of their experience. 70 years ago every parent, every grandparent knew personally cases of the kinds of dieses we now prevent with vaccines. you didn't have to sell vaccines to them. they wanted vaccines because

they didn't want their children to grow up in a world in which those diseases are the threat that they are. today as dr. offit pointed out, they don't know that that. they don't know it in the intuitive sense. i can have the word measles is circulating but unless i have the experience of knowing someone with the disease, it doesn't have the same impact. our risk perceptions are fundamentally as much about experience and emotion as about thoughts and facts. so, the challenge we all face is how do we help people understand the threat of vaccine-preventible diseases in a world in which their narrow circle, the people around them, are not likely to include someone who has been affected by polio or measles or whooping cough. of course, the challenge here is that in the modern world, we are -- our society is mobile. the person who is standing behind me in starbucks could have been in russia, could have been in india, could have been in africa yesterday.

we do not know what that person is bringing with them. and precisely because of the mobility of modern society, the intuitive understanding of, are the people around me sick? if not, maybe i'm safe, no longer is an accurate representation of the risk we potentially face. and so somehow we have to have the conversation on a public level to help people recognize, to tell this possibility story and help them understand that it's that benefit of vaccines that we need to get back in touch with. now, we do need to talk about safety. and we do need to talk about the questions that parents have. gabrielle in the film ends, you know, that little clip there with two sentences that i want to highlight. she askses, you know, what's a severe reaction? is it okay to have a seizure? i want to point out two things about that. the first is this, she knows

that vaccines are not perfect. she knows that she has to at least think about the possibility of a reaction. that is true. vaccines are not perfect. she wants more information. and as a result, the simple statement of vaccines are safe is not going to feel satisfying to her. from a public health standpoint, vaccines are one of the safest things medicine has to offer. that is part of the reason why we offer it to people. because we know at a population level, the benefits vastly outweigh the risks. on a personal level, that's different. so, the challenge is, we have to acknowledge the complicated story in order to gain the trust of parents, like gabrielle. if we simply say, vaccines are safe, why should we trust that? we have to be willing to go a little deeper.

now, when she asks, is it okay to have a seizure, what she's really asking is, is it okay that this thing i hear that has benefits also has risks? how am i supposed to as a parent put my child at risk? and so the last thing i want to talk about is the parental experience of risk. parents always want to do what's right for their children. and to keep children safe. but part of us always knows that risk is everywhere. i'm a parent. my daughter just turned 16. and i handed her the keys to the car. unquestionably the most dangerous, ricky thing i will ever expose her to. and i did it anyway. because i knew the benefits to her, to her development, were worth putting her at risk. now, that doesn't mean i ignore risk. right? we want to be safe. give her a safe car. make sure she trains, she learns how to drive well, et cetera. just like it is appropriate for

parents to say, how can we minimize risk in the context of vaccination? but we also have to engage with the point that part of what being a parent is, is sometimes is dealing with risk because risk is everywhere. vaccines are incredibly safe. most children who are vaccinated have the most trivial of symptoms, if anything. but severe reactions do very occasionally occur. those tend to be very temporary. but they can be scary. and so there's a duality of risk i need to end with. at a population level, public health can say, look, this is a one in a million risk, we don't need to worry about it if it has huge benefits that outweigh the risk. from a policy standpoint, that's all right. have i no problem with that. from a parental standpoint, parents don't care about

probability. parents care about possibility. it's possible their child might have something scary happen to them. they're going to worry about that. we have to acknowledge that reality in order to be heard by them and in order to be trusted by them. the conversation of vaccines for me is one of respecting the emotions of parents and helping them realize, yes, this may not be the easiest thing to do to watch your child get a shot, but it may well be the thing you need to do for all the benefits it will provide. >> thank you, brian. for a perspective from a journalist who has been actively covering this story, joe lawler. >> thank you for having me here. i guess i first wanted to point out that the folks on this panel here are all -- have lived or studied this issue for their entire careers, many years, and, you know, myself i started looking into this in july.

but i dare say, you know, many journalists will be approaching this like myself from completely an outside perspective or learning things on the fly. you know, i'm the health reporter at the press herald in portland, maine, but i've only been the health reporter for a year. i would say, you know, there would be a lot of general assignment reporters or city hall type reporters who may end up covering these kinds of stories based upon the dwindling resources in the media, unfortunately, in this day and age. and the other thing i wanted to -- i want to talk a little about how i came upon this story. you know, it's really not a very obvious story. there was a -- in 2012 there was a pertussis-whooping cough

outbreak in maine. so, i started at the newspaper last year and i wrote about a straight story about how, oh, there was this outbreak and isn't that -- shouldn't we be somewhat concerned and then just moved on. and then this year it was pointed out to me that maine had one of the highest voluntary opt-out rates for parents choosing not to vaccinate their children. the opt-out rate for children entering kindergarten, and the opt-out rate is 3.9%. you know, as a journalist, when you see a number like that, you're like, is that really that bad? but as the excellent documentary points out so well is even with small numbers of people opting out, herd immunity, what protects all of us, breaks down even at 95% or less vaccination

coverage, depending upon the disease. so, you know, the more i looked into this story, the more i realized this could be a pretty big deal. i mean, it would be better to write about it before than after. if there was some -- a tremendous, terrible outbreak like what happened in philadelphia in 1991, i mean, that would be a tragedy. i thought it would be better to write about this before. so, anyway, we spent a lot of time. the thing that struck me about this topic, unlike a lot of things, if -- say 5% or so% of the population believes something that's not true, for the most part that doesn't affect me, affect us. you know, if you're at your family reunion and your second cousin talks about area 51 or the aliens in roswell, you might

just nod your head and move on to the next conversation and it doesn't really affect you. 5% of the population believes that, so be it. but with vaccines, in order for them to work properly, you really need everybody buying in, or almost everybody buying in. so, you know, that really struck me. so, we did a pretty comprehensive story about this. you know, talking to all different types of parties including somebody who had contracted polio as a child and people -- we got the side of the people who were -- didn't believe in vaccinations. we also made the decision that for this particular story, you know, and as the documentary points out very well, the science is settled. there is no debate amongst scientists whether vaccines work. and there's no proof -- it's been debunked about the

connection between autism -- there is no connection between autism and vaccines. so, while -- when approaching this story, have you to look at it like, okay, these people have concerns but it's not a scientific debate. they're having a debate, which they believe to be scientific, but it's not scientific. so, you can't do the whole, you know, well, this side believes this and this side believes this and let the readers decide. it's not that kind of story. you are doing a disservice to the readers if you approach it like that because the science, as i said, is settled. so, anyway, we put the story together. the reaction to it -- even though i was researching this topic for a month and got a sense of how much depth and breadth there is to this topic, it's really dwaish if you read about it, it's really quite amazing.

but reaction to the story still floored me because we had over 600 comments on our website. for us, that's probably ten times the normal amount of comments we would receive on a story. and, you know, i was really interested in what types of people were commenting on the story. it was fascinating. it wasn't just the 1% sonya was talking about. the virulent, anti-vaccination people who were commenting. there was a lot of people who, i believe, were just misinformed. they weren't militant about it but they were just misinformed and didn't believe that that -- they felt like the cdc was hiding something maybe or just -- the scientists were covering up information.

and then there was a healthy debate and a lot of people who were patiently debunking the claims people were making, which i felt was a good service. so, you know, we're going to continue following this story very closely. we did some follow-up stories and there's more to come. i think there's a big topic. this is a huge topic. and the point i want to make, there's also an element of -- it's not just a science story but also a political story in a way because this gets to the issue of u should the government be telling me what to do? should the government be forcing me to have sack seens? there's a clear correlation between states that are -- for instance, washington state used to be one of the highest -- had one of the highest opt-out rates of children entering kindergarten in the country and they made it harder -- they

didn't make it impossible but they made it harder for parents to opt out. and then upon doing that, within just a couple years, they've seen a reduction in the percentage of people opting out and also a corresponding reduction in outbreaks. this is not an easy -- in maine just last year, they -- it made it through the house, a bill that would have -- i don't want to get into too much detail but an anti-vaccination bill. but it passed the house. it was killed in the senate but passed the house. our legislators were playing pro-vaccinations were playing defense, in a way. in vermont, the governor of vermont has gone on the record saying he believes parents should have a choice and it should not make it harder to opt out. vermont has one of the highest rates of children -- of parents opting out of the vaccine.

i suppose if you don't really think about it in detail and really get into the heart of why vaccinations work, it does sound logical. the government should not force me to do something. but, you know, this is one of those cases where the 5% to 10% of the people, you know, it really does matter. so, thanks a lot. >> thanks, everyone. i think that probably gave you all a good sense of the complexity of this subject. also, of how personal it is for people. both parents and doctors on the front lines who care most about protecting their parents through vaccination. so with that i'm going to turn this over to all of you for questions. there are microphones available that will be coming around in the aisles. if you -- if you wouldn't mind

just telling us your name and your affiliation. thanks so much. yeah, right up here. >> is it on? this is penny starr with cns news. some of the people -- i mentioned to sonya before this event, you mentioned the internet and there are sites people i know go to called the informed parent. one of the main things they do is use cdc stats to make their arguments, anti-vaccine arguments. i wondered if you could address that issue as to -- in other words, is the government doing enough to actually communicate with parents about the benefits or the risks. >> paul, do you want to take that? >> thank you. >> so, for example, if you look at the impact of vaccines on

diseases like diptheria, measles, and you go back far enough, like the late 1800s, early 1900s, can you see the incidence of measles or mumps or german measles or tetanus decline before vaccines were introduced. when vaccines were introduced -- that's because we changed things like sanitation in in country, hygiene in the home, that had an impact on these diseases. purifying the drinking water had an impact on diseases. if you look at introduction of vaccines, the slope of that curve dramatically declines. there's a dramatic reduction because of the introduction of vaccines. that particular cdc statistic will be used by those who oppose vaccines to say, see, we didn't need vaccines because the rate was going down anyway. it's these diseases would still exist if we didn't have vak seens. when the soviet union was dissolving, the -- and there was tremendous social upheaval,

diptheria vaccination declined in a series of countries that didn't see much diptheria and then it dramatically rose. an introduction of the vaccine and the rate dropped again. the same thing can be said with japan and pertussis vaccines. we do these experiments over and over again. there's no reason to believe anything other than what the data show. don't use them when the disease goes up. use them and the disease goes down. that's one example. in terms of how the cdc or others try to communicate that, i think a lot of groups, american academy of pediatrics, there was a vaccination education of children's hospital, the autism science foundation, a lot of groups out there that really try to communicate good science to the public. i think they do it compellingly and cogently and passionately. and i think it's made a difference. i really do. i think if you look at the way this story is covered now, as compared to 15 years ago, it's much better. are there going to be those

groups who consistently hold onto the notion that vaccines are doing more harm than good? yes. i don't think they're ever going to go away completely. but i think we are making a difference because i think a lot of people are trying to communicate good science to the public. >> brian, do you have thoughts on this from a science communication point of view? >> i think the one thing i would add to this, to acknowledge the character of the internet and the role it plays in the discussion of vaccines, the internet is not just making information more available to people. it's enabling us to share stories, share individual cases. the cases someone wants to share are the cases that have emotional power. if you believe, rightly or wrongly, if you believe your child was harmed by a vaccine, that's the kind of story we want to share. that's the kind of story other people want to share. the stories that don't get shared as much is the story that's the most common story. i got my child vaccinated. it hurt a little bit.

it didn't bother them that much. nothing happened. he doesn't get sick. this is boring. but it is the fundamental story of vaccines. it is the story that is the most common story of vaccines. precisely because in a web 2.0 environment, the shared content comes from users. what we tend to see when we go looking is a disproportionate share of the people who want to share information. that's not a fair -- it's not even close to a proportionate representation of the lived experience of vaccines. and so that's the challenge we face. how do we help people understand that what gets shared is not a fair representation. it's the people who want to be sharing their story and give voice to the other story. the story of the mother chose child is in a classroom where there's measles. what is she feeling at the

moment she realized, yes, she did vaccinate? does that make her feel safe? that emotion is also important here. it's much harder to find. somehow i wish we could make that story more common. >> so, there's -- you're probably going to talk about what i was going to suggest. there's a story in the film that really gets to this, which is the luke philbichlt n story -- >> yeah. i was going to say this issue of telling a boring story is interesting. one of the scientists i first approached very early on said, if you're going to make a film about this, point a camera at an ordinary family, eating dinner, watching television and run it for an hour. i went, what? he said, that's the truth. nobody's getting sick. nothing is happening. they're going about their lives. they're not thinking about disease. they're not worrying about disease. they're not taking temperatures. he said, that's the story of vaccinations. i said, yeah sure, i can't turn that into an hour of television. it is the challenge as communicators how we tell the

story effectively and actively. we took a bit of a gamble in this film. i say a gamble because it was scary and genuinely scary to tell a story of -- a classic story you see on the internet of my child was a health y beautiful, fabulous little baby and 6 months of age, everything was fine. hours after the vaccine, everything went terribly wrong. can you find those stories on the internet. i chased a lot of those stories. i tried to talk to a lot of parents. it was very hard to verify those stories. i found one family prepared to speak. hi their medical records and they were ready to be filmed. they're in the film. it's a very interesting story because their child, yes, 17 hours after vaccines, at 6 months of age, started to have seizures. and those seizures were ongoing and devastating and resulted in this child having brain damage over time. so, for the first year of that child's life, they believed it

was the vaccines. but then testing was done and science was done and they discovered their child had a form of epilepsy. a form of epilepsy triggered by a fever often. not always, but triggered by a fever. in this kind of epilepsy, the first ever seizure usually curse around 6 months of age. another little girl we filmed, she got flu, she's 6 months, luke's best friend, she also has it and she got it from having a fever in flu. the vaccines were not a cause. they were the trigger. like bouncing on the trampoline is a trigger, or getting hot or getting upset is a trigger because he has epilepsy. it was an extraordinary journey they went on because they truly believed vaccines did it to their child. putting it in the film was a way

to explore those stories, story of some child getting sick. putting a face to it and putting science to it. and one thing i did want to say, if we can try to tell the stories where nothing goes wrong, it's really helpful pipts really, really helpful. because it is the norm for all of us and we don't question it because we're all living in this lovely, relatively safe world. so i think we have an obligation to try to share that safe story as much as we can. >> just briefly, to follow up on one thing that sonya said in sort of the relationship between causal and temporal associationings. my wife is a private practicing pediatrici pediatrician. she came into the office on a weekend day. helping the nurse give vaccines. there was a 4-month-old sitting on her mother's lap along the wall. while my wife was drawing one of the vaccines into the syringe, the 4-month-old went on to have a seizure and ended up having

epilepsy. if she had given the vaccine five minutes later, you know, i'm stupid, my child is fine, she gets a vaccine five minutes later, she has a seizure, now epilepsy and the vaccine didn't do it? i think you're always going against, as brian points to, the power of the emotional anecdote as compared to the power of statistics, which i think is a hard fight. >> if i can make one quick point. i think also a lot of the fears and opposition koms about, at least in maine, and probably some other places, oregon might be another good example, of, you know, people take a movement. for example, the organic food, natural movement, which it's good to eat your vegetables and thing things that come out of the ground rather than processed food. but for whatever reason, i believe vaccines and maybe other

forms of western medicine have been labeled as being artificial, therefore, bad for you. and so, you i'm sure people could talk about why that's not true. but i believe that sentiment is out there. there's trace amounts of things like formaldehyde, but people see that and they get scared. that was the bill that was introduced in the main legislature that passed the house, got killed in the senate, was to inform parents of every ingredient that was in each vaccine without any context behind it. a scare tactic. but i just wanted to point that out. >> a quick point. i think it's formaldehyde is natural. vaccines are natural. they're derived from products of nature, from parts of viruses or bacteria. for

formaldehyde, we have been making it since we crawled out of the ocean. the quantity we have in our bodies is greater than what's in the vaccine. pen and teller did something once. they were able to get about 300 people in california -- california maybe doesn't count. they were able to get 300 people in california to sign a position to ban a hydrogen and oxygen -- water, by giving its chemical name. they never lied. which was a great part of the video. they say it's in our tears, our streams and it's -- we have to get rid of this. that works. chemical names always sound bad. >> context is everything. >> i have to say that one of the things we have in the film is we show that vaccines go back at least 1,000 years. and it was a traditional form of therapy that people used to do. we explained where that comes

from and why that -- i found that astounding. i didn't know that. if you are into things that have traditional focus, i think that's interesting. but i also think there's a false -- another false polarity here that if you are into organic food and all this sort of stuff that you don't vaccinate. that's an artificial divide. it doesn't really exist. we shouldn't buy into that. there's a marvellous group in australia, a group of alternative moms who are alternative in every way, shape and form. they have put up billboards saying i do yoga, i meditate, i immunize. they have all these posters that basically say, you don't have to be either or. that's not the conversation. we're artificially making that a divide. >> hang on. the mike is coming.

>> related to this discussion you just had, do you see any correlation between the fears of genetically modify ied organism and food with some of the engineered m eed molicuecules yn vaccines? >> i think that's a great point. yes is the answer. you know, it's just the -- so, for example, the hpv vaccine is made using dna technology. it's the best of -- these are

great vaccines. you take a single protein from the virus. you basically use, in this case a yeast cell to serve as a factory to make that protein. then you purify the protein. it's 100% purely one single surface protein. it can't possibly reproduce itself. it's not the virus. it's just the one part of the virus. it's the important part, because it induced protection. what could be better? you are right. it's genetic engineering -- interestingly, genetically -- foods are genetically modified all the time, just in the wild. in the wild. and what you want to do is you want to be able to create a situation where you are going to -- get the most benefit and the least harm. that's true with vaccines. when they describe viruses, they use the following terms. they use the term vaccine virus. for the natural virus, they don't say natural virus. they say wild-type virus.

what it says is that in the wild, it could do anything. wild-type viruses reproduce themselves thousands of times or tens of thousands of times in your body. a vaccine virus usually reproduces itself fewer than 20 times. it reduces an immune response. you want us to be able to tame nature. this notion that it's man against nature and nature is all good, i don't know what planet people are living on. mother nature can kill you. you want to make sure that that doesn't happen. >> one over here. >> good morning. i want to first thank you. i'm also a pediatric nurse practitioner. i wanted to ask particularly sonya, you were commenting about the response you had to your film. i want to know what works as we move forward. how do we make -- how do we get to a place where we reinforce

positive behavior or a way to get -- move forward from this? my hopes with this is we can jump start getting more children vaccinated and healthy. could you comment on that and kind of give us positive stories as you move forward after your film? >> yeah. look, i wish i had the absolute answer to that, of course. i think through our film being released, the australian version being released last year and now the american version is next week, but the australian version told us a few things. that was, there were many, many, many more people wanting to talk about this than the broadcaster realized. it broke records in our country. we had 1 million facebook posts. we had -- i can't remember now. it was over 100,000 downloads, which is enormous in our

country. we didn't -- no one anticipated the level of response. people want to know about this. people want to talk about this. secondly, that opening the conversation to say it's all right to have concerns made a difference. it was the point of difference. we were not going to tell you what to do, necessarily. but we were going to invite the conversation to begin. now, that can sound like a trite statement, but it wasn't. it was very genuine. it was difficult because people came to you with stories that are difficult to hear, personally if they have scientifically not sound. it's hard not to jump down people's throats and say, that's nonsense and leave it at that. you had to really engage. we found having a lot of good material, having good people on call who could answer complex questions. i'm not a medical doctor. i'm not qualified to answer the really complicated questions. don't try and speak beyond your area of expertise was really important.

we found that, sure, we got hit by a lot of the negative stuff. and that was a bit depressing, because -- after a few days, what happened was there was so much spamming going on that it stopped the conversation. people dumping anti-vaccine into the mix. they were miscalculating. that was depressing, because you had to go, do we have to block you? do we have to stop that? we tried to keep it open for as long as we could. i guess the only really strong thing i would say is that the people are interested, that the conversation is worth having, open it up, let it run, try not to control it too much in the sense if there's nutters coming into the place, you have to be careful. most people just wanted to have the conversation and provide

them with good information. >> i would also like to add, i think there's important parallels in the vaccine context to the conversations that have been going on now for a decade or more in terms of patient role in medical decision making. we no longer exist in a society in which the physician says, we're going to do this, we're going to do surgery and you have no choice. that evolution has been important. and the challenge is, how do we inform -- patients aren't medical experts. they need enough information to get the gist of the tradeoffs that are faced to understand the ways that their values enter into this. but also the ways in which they need to respect the science, they need to respect the data and understand when their doctor is saying, this is really a good choice. why their doctor is saying that.

that it's not because somebody said so. there is, in fact, a reason behind that. to respect the fact they might want to know what that reason is because they are going to nod their head and say, yes, this is a good idea. engaging at that level, recognizing that if we're going to give parents autonomy to make choices, we need to give them the empowerment, the information, but also the emotional empowerment to face that process and to be a parter in in that. most patients when faced with difficult treatment decisions like what breast cancer surgery to have, they're not saying, i know everything. they are coming in with questions in mind. they're coming in knowing that they are not an expert and wanting help to figure it out. if we take that perspective here, we open the door for people to say, here is how much i want to know, or here is what the pieces that i don't understand. and then to engage with them on that and to help them move forward. >> i wanted to