reported an infringement of their intellectual rights. thus they've got to pay the price. they've got to have the burden on them. we're going to put the burden on them. for saying somebody just stole my property. we're increasing the burden on them. if they do that from then on they have a whole new obligation, a bureaucratic obligation. in addition the patent holder gains a new bureaucratic fee, not just bureaucratic requirements but a fee and forced to pay recordkeeping fees to maintain current records at the patent office. more fees, more bureaucratic requirements. these are minor inconveniences to multinational corporations. these people with hundreds if not thousands of employees, it's not going to cost them anything. in fact, when they go to court, they have a whole stable of attorneys, won't take them much money there either. so these multinational corporations are -- this isn't even an inveebs.

but for the -- an inconvenience. but for the little guy these new requirements are killers. they don't have the $100,000 they can drop into this, keeping better books over here or getting hold of all these people or exposing anybody who has invested in their patent. . this also enables nested shell companies, which have few assets, but can infringe on patents while the inventor is unable to sue their customers. who are free to continue infringing. so they set up -- we'll just do all of our business with this technology through that company, so if we get sued, they can't get at us. no way. the first court case they are going to -- we're going to shield these big guys who are stealing. this process could keep an infringing process in place for a decade or more while the

inventer is trying to find ways of getting -- inventor is trying to find ways of stopping that infringement. this authorizes the patent office director to create a patent troll database and create a strategy to teach small business how to defend themselves against patent trolls. we are encouraging the director of the patent office to create an enemy's list of a strategy guide for people who are infringing on other people's patent rights. that's what we're talking about. they want to -- they're trying to basically vilify a group of people who are involved in a perfectly legal and moral economic activity, helping out small business guys, buying small patent owners' rights to their patents if they can't enforce it themselves. are going into -- or going into partnership with them. no, now we're going to have a list of these people who are going to be on an enemy's list by -- and that's mandated by

the patent office according to this legislation. so we're encouraging this enemy's list strategy. instead of just, ok, if there's a frivolous lawsuit, let's make it easier for someone to defend themselves in court. the ultimate results of this legislation will be increased patent infringement. you got that? this legislation, h.r. 9, will increase the amount of theft in our society. reduced legal remedies, we have basically reduced the legal remedies for the victim. for those who have been infringed. we've redulesed the investment in small business. why are people going to invest in a small -- in a new patent if they think it can be infringed upon and this guy isn't going to get his money back? so we've dramatically hurt the amount of money that's going to be invested in the new technology, in the brilliant ideas that come out from our students from university. you know, they come out they have great ideas. we want them to go into small business follow their dream. oh, no. this would make it almost

impossible for people like that, our young people and small businessmen, people with a dream. the irreparticle -- the irreharpanel -- irreparable damage, all these people will be hurt. our colleges and universities they know that if this bill, if this passes, this bill passes, the one that was going through the senate passed, there would be a dramatic reduction in the value of all the patents that they hold and that's major, major asset by our universities. each one of these so-called reforms is detrimental to the patent owners. especially damaging to individual small inventors. every provision bolsters the patent thieves, the infringer, at the expense of the legal owner. let's talk about -- no. let's not talk about that. let's talk about patent trolls how evil they are. troll's a bad word. everything they're proposing in the name of stopping the

trolls, using that as cover, hurts the little guy and helps these big guys who are financing this campaign to undermine our patent system. this approach assists thieves because they are powerful corporations versus little guys whose only hope is that america -- only hope for the little guy has always been that america stands for the god-given rights and that those rights are protected by our government. recognized and protected by -- as it was in the constitution. to all people rich and poor their rights are protected in this country and we are not about and we should not be about to let big corporate interests step on the little guy. the guy who owns a piece of property and a big corporation wants to build a road across it, to build a whatever it is on the other side, an oil rig or whatever it is, they have to pay that man's price because he owns that property. and in this case we're talking only about an ownership for 17 years granted, to somebody who has actually come up with

something of great value to our people. no. we need to make sure that we remain the country where we protect everybody's rights and that the big guys can't get away with stepping on the little guys. the rights of ownership are the same as all of our other rights. speech religion, assembly. and this has been what we're seeing now in the last couple of years, a blatant power grab by the big guys to diminish the rights of the little guy. when the bill -- when the bill identical to this one was previously submitted, opposition emerged to it as people figured out what i'm telling you. what i'm saying tonight. people heard the debate over here, they mobilized and we found out, when they found out what was about to be foisted on them, speaking in loud voices, here's some of the people who opposed or expressed major concerns over that act out of a bill that was identical to h.r. 9, which is now perched and ready to be shoved through congress. the association of american

universities american council on education, association of american medical colleges, association of public and land grant universities, association of university technology managers, council of american government relations, eagle forum, club for growth, american business association, american bar association patent office professional association traditional conference committee on rules and practices and procedures, american intellectual property association intellectual property owners association, national association of patent practitioners, national venture capital association and also the biotech industry organization pharmaceutical research and manufacturers of america, phrma innovative alliance, coalition for the 21st century patent reform institute of electrical and electronics engineers. let's just note, all of these were opposed, are very concerned about that act because it creates more paperwork for everybody, increases the cost for anybody

who wants to defense their rights -- defend their rights, forces patent holders who file claims of infringement to maintain new bureaucratic reporting and to pay new record keeping costs, just complicates their lives and their expenses. eliminates the independent judicial review of patent applicants striking section 145 and 35. this is very important in order to keep patent -- the patent office honest. there should be an independent judicial review. that's what they tried to foist off on us last time. dramatically and it dramatically increases the financial risk for anybody filing an infringement suit. we need to make sure that our country stays true to the american people. what will give us security for our people. we need to be on the cutting edge of technology. we need to be ahead of our potential enemies. we can't defend our country man

for man. we've got to have the best equipment and technology that comes from creating -- creative thinking of our people. we need to make sure that our working people are producing more wealth with every hour of work they do. thus we can afford to provide the services and the standard of living for ordinary people. if we actually just every time there's a new idea that we permit that to be stolen by multinational corporations, that's not going to improve the well-being of our people. we've seen this going on so far . this is not the first time. this is just the last 25 years of onslaught and what we have now on h.r. 9 is just latest salvo into the effort to destroy the patent office. or the patent system that we've got. but this happened a long time ago. we've had to reaffirm the rights of the little guy over and again. does anyone ever -- there's a statue in our congress, in our capitol here, to phylo

farnsworth. he was the inventor of the picture tube for the television. he was a farmer and an engineer in utah. not many resources at all. but he figured out something, the r.c.a., one of the biggest corporations in the country at the time, was trying to find. how do you create a picture tube? well, he wrote them, said i found the secret. and they sent their top engineer over and he actually showed them what he had done and they said, we're going to get back to you and work with you as your partner. you know what they did? they -- he could never get a hold of them again. one of the richest and most powerful men in the united states set out to steal the rights for the patent for the picture tube from this lone american, this guy who had a

small farm in utah. and phylo didn't give up. he led a struggle for 20 years to get his rights to own that technology. that intellectual property. and when he was fighting this huge corporate interest that was trying to squish him like a bug, he stood up there and he couldn't have to do alone. -- have stood alone. people invested in his lawsuit. people invested with him so that justice would come and inventors in the united states would know that when they invent something, they have a right and the american people will stick by them. in the end, the supreme court made the decision and they decided with the little guy. they decided with phylo. what a great affirmation of our country. and there's a statue today of farnsworth in the capitol. the man who advanced communications in our country. you'll never find a statue of david or any of these big

moguls who tried to squish him. these multinational corporations, let's remember, the heart of america, patriotism, let's be loyal to our regular people. they will be loyal to us. that's what this american revolution was all about. i ask for my colleagues to join me in opposing h.r. 9 and i invite people to talk about it and to talk to their congressmen and their senators and to make sure that they don't come in here for a vote not knowing how important this vote is on h.r. 9. with that i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the chair will recognize a motion to adjourn. mr. rohrabacher: i do here now move that the house adjourn. the speaker pro tempore: the question is on the motion to adjourn. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the motion is agreed to. accordingly, pursuant to house

resolution 99 the house stands adjourned until 10:00 a.m. tomorrow morning for morning hour debate. as a further mark of respect to the member memory of the late honorable alan nunnelee.

>> watch house floor coverage right here on c-span starting at noon tomorrow. coming up, the senate health committee examines the rise of unvaccinated children in the current measles outbreak. the senate finance committee hears from former senators on the 1986 tax deal. congressman luke messer of indiana talks about the president's request to lose -- use military force against isis. according to the cdc, 121 cases of measles have been reported in 17 states and the district of columbia. tuesday, the director of the cdc's national center for immunization and respiratory diseases testify on capitol hill about the outbreak.

the hearing is about two hours. >> the senate committee will please come to order. we are holding a hearing about the reemergence of vaccine is in double diseases. we will have an opening statement and introduce our panel of witnesses. after testimony senators will have five minutes of questions. we have two panels today. two hours for the hearing. we will about noon.

last september, this committee held a hearing about the ebola virus. a brave physician who worked in liberia and contracted ebola. there was and is no cure. there was and is no vaccine. this produced a near panic in the united states. it changed procedures in nearly every hospital and clinic. one chattanooga public health officer saying it is ebola all the time every day.

measles is too sick and up to 4 million americans each year. many believed it was an unpreventable childhood illness. introduction of a vaccine in 1963 changed everything. measles was declared eliminated. absence of continuous disease transmission for more than 12 months. from 2001-2012, the median number of cases reported in all of our country was about 60. today is february 10, 2015 and the 41st day of the year and already we have seen more cases of measles than we would in a typical year.

one measles outbreak in illinois has affected at least five babies, all less than one-year-old. infants and individuals who are immune all compromised are traditionally predicted by what is called herd immunity. when more than nine out of 10 people are vaccinated so they don't get sick. that keeps the babies from getting sick. that herd immunity is incredibly important. measles can cause life-threatening complications in children. eyewitnesses will talk about what is causing this outbreak and why some parents are choosing not to vaccinate their children. measles is only one example. this hearing which was planned before the measles outbreak

reminds us of the importance of vaccines. an analysis of immunization rates across 13 states -- small private academies in new york city to large public elementary schools outside of boston and native american reservation schools in idaho where vaccination rates have dropped -- sometimes under 50%. california is one of the 20 states that allows parents to claim personal belief exemptions. some areas of los angeles, 60% of parents have filed a personal belief exemption and those elementary schools vaccination rates are as low as those in chad or south sudan. the purpose of this hearing is to examine what is standing between healthy children and deadly diseases.

it ought to be vaccinations but too many parents are turning away from sound science is this -- vaccines save lives. they saved the lives of people vaccinated, protect the lives of the vulnerable around them like infants and those who are ill. vaccines and save lives. they protect us from the ravages of awful diseases like polio which invades the nervous system and can cause paralysis. i can remember how parents were frightened by the prospect of polio for their child. i had classmates who lived in iron lungs. or will bring coffee is another example which causes they can mucus to acutely in the airwaves. -- whipping cough. or a bacterial infection that affects the mucous membranes of your nose and throat and can

damage your heart, kidney and nervous system. vaccines save lives. they take deadly come awful, ravaging diseases from our history. it is troubling to hear that before we have even reached valentine's day this year, 121 americans are sick with measles, a disease a limited 15 years ago. a growing number of parents are not following the recommendations of doctors and public health professionals who have been making this recommendations for decades. at a time when we are standing on the cusp of medical breakthroughs never imagined cutting edge personalized medicine tailored to an individual's genome, we find ourselves retreading old ground. i turned to senator murray for her opening statement. >> thanks to all of our witnesses for coming to share your expertise with us today. keeping our families healthy cannot be more important so i'm glad to have the opportunity to

hear from all of you about the threat back seen preventable diseases and still pose in the united states. there is no question we have come a long way when it comes to what was once widespread and extremely dangerous. vaccines are one of our country's greatest public health successes. we know how to prevent illnesses that struck so many children as recently as a generation or two ago. but recent news about the measles outbreak in many states made clear that vaccine preventable diseases are still a threat. we can't afford to become complacent about protecting the progress we have made. children across the country needed to be vaccinated. we need to be vigilant about breaking down any barriers that families may face when it comes

to accessing certain vaccines and we need to which were that in any cases where take-up rates are low, we are spreading awareness so more people can be protected. the hpv vaccine is a great example. it prevents life-threatening cancers, including cervical cancer, which impacts thousands of lives in the united states each year. cdc reports that take-up rates for the vaccine are still on acceptably low, meaning people continue to be exposed to deeply harmful illnesses that could have been prevented. i know several of our witnesses have done a lot of work on this issue. i will have questions about what we can do to encourage broader use of vaccines. i'm looking forward to an update about the recent measles outbreak and the work the cdc is

doing to continue to encourage vaccines. i'm eager to hear from dr. kelly more about the role of states and preventing and responding to outbreaks. i know dr. sawyer will be able to provide valuable insight into ongoing nationwide efforts to increase immunization rates and keep children and families healthy. i want to thank all of our witnesses for the important work you are doing and taking the time to be here with us today. >> thank you for working together so we jointly invited the witnesses today. each witness will have up to five minutes. if you will summarize your views and five minutes so senator scott a chance to give their questions -- so senators have a chance to ask their questions. we will have to end the first panel at 11:00. i hope all of us can get questions them to the first

panel. the director of national center for immunization and respiratory diseases of the sinners for disease control -- centers for disease control and prevention. she has worked at cdc since 1998 on immunization, respiratory and other infectious diseases. she is a rear admiral in the public health service commissioned corps and was named assistant surgeon general of the united states public health service in 2006. welcome. >> good morning, mr. chairman and members of the committee. thank you for the opportunity to speak with you today. our nation's immunization system is strong, protecting the health of americans, saving lives and money. this year's outbreak of measles demonstrates how interconnected we are. many threads are just an airplane right away. despite high national

immunization coverage against measles, last year, we had more cases of measles in the u.s. then we have had since 1994. since jin reversed, we have already had more measles cases this year than we have had in most full years since 2000. -- since january 1. 121 people from 17 states have been reported to have measles. most are linked to an ongoing outbreak that originated at disney parks in california during december. most cases were not vaccinated or did not know if they had been vaccinated. recent patients with measles have exposed others in a variety of settings, including a schools, child care, emergency departments, outpatient clinics and airplanes. these episodes require a rapid response coordinated across

local, state and federal jurisdictions. the backbone for such a response comes from the public health immunization infrastructure. the systems and people that protect our communities from vaccine preventable diseases. today, we are talking about measles but we could just as easily be talking about a resurgence of will bring cough meningitis on college -- whooping cough. we need a stronger musician system -- immunization system that takes care of prevention and ensures the quality of practice -- ready to launch mass vaccinations for the next pandemic. whether a vaccine is given in a private doctor's office or any community clinic, the public health system plays a critical role in making sure vaccinations are to double -- accessible, safe and effective. and that are immunization policies are based on a strong scientific foundation continually reviewed.

our priorities are maintaining a strong program including presuming -- preserving core health infrastructure at the state and federal levels . responding to outbreaks another urgent vaccine needs. coverage for many childhood vaccines is above 90%. reported cases for most vaccine preventable diseases are done by more than 90%. most parents are vaccinating their children with most of the recommended vaccines. less than 1% others have received no vaccines at all. immunizations continue to be one of the most cost-effective health interventions.

the past 20 years of u.s. childhood immunization has prevented over 300 million illnesses, 732,000 deaths and resulted in $1.4 trillion in cost. in many ways -- in cost savings. we are a victim of our own success. fewer and fewer doctors are urging parents -- because of our success, parents may wonder if vaccines are necessary and may worry that the risks may outweigh the benefits of protecting their families from vaccine preventable diseases. the increase in measles cases can be seen as a wake-up call. measles is very contagious. in the 1980's and early 1990's, measles outbreaks uncovered systemic problems with poor

children having access to vaccines. it is an indicator of how globally in -- interconnected we are. measles uncovers those people in areas in the west that are opting out of immunization. we have indications that some of those unvaccinated micro-communities may be large -- getting larger. our system has risen to challenges in the past and cdc will work with partners to keep measles from regaining a foothold in our country and. we can keep these numbers down keep measles from returning and threatening the health of our community's and sustain the enormous benefits that are immunization partnership has achieved. >> about tenures ago, a group of us went to south africa

and we found the president of south africa had rejected the science on hiv-aids and decided it was not caused by a virus and that in the cure was a elimination of poverty, setting back south africa for years in terms of its ability to deal with hiv-aids. today, there is information that is on the internet, which is where we were told the president found his information some years ago, that says there was a study in 1998 by andrew wakefield alleging a connection between measles, mumps and rubella vaccines and autism. let's say you were a position or pediatrician and a parent comes

in and says i have been on the internet and i am concerned because i found that, according to this medical journal, there is a relationship between this measles and mumps vaccine and the possibility of my child being autistic. what would you say to that parent? >> autism is a terrible condition. that paper you are mentioning has been totally discredited. it was found to be fraudulent and is not the case. there have been dozens of studies of vaccines -- they do not cause autism. they are highly effective and safe and/or a good way to protect your children from vaccine preventable diseases.

guest: when you say totally discredited, what do you mean by that? >> information was found to be fraudulent by a british investigator. there have been dozens of studies that were better to understand whether there is a link between vaccines and autism. it was a natural question some parents had because of the onset age for autism. those studies have been incredibly reassuring. when i talk to the parents, i explain that as a physician and a public health expert, i can tell you that vaccines are very safe and effective. while autism is a terrible condition, vaccines do not cause autism. >> that article was just flat wrong? >> that's right. >> numerous studies have shown that was wrong. what happened to the author of the article? >> he lost his medical license because of the fraudulent behavior. >> we have been talking about a variety of vaccines. it struck me as we were so worried about ebola last fall that many of the public health people would point out to me

from tennessee that we had the flu season coming up -- how many americans die each year from the flu? >> flu is very variable. it can be between 3000 and a good year to 50,000 men superior. -- 3000 in a good year to 50,000 in a severe ear. -- severe year. we do recommend everybody six months and over get a flu vaccine every year. >> measles is not just a runny nose.

it is a serious disease. what would you say to a parent who comes in and says i will opt not to get the measles vaccine? what are the risks of that? how many children who contract the measles die? >> before there was the measles vaccine, 400-500 children in this country died. the risk of dying is much higher in countries that are poor where malnutrition is a problem. we have about hundred 50,000 deaths from measles around the world each year. it used to be millions and that is an improvement because of high uptake of measles vaccines. >> if your child contracted measles in the united states the chances of death would be about one and 1000? >> that's right. there are other problems with measles. even a mild case of measles is a scary thing for a parent. when i had measles, she was scared to take my temperature because i looked so horrible. she was worried it was not coming down.

it can be pretty scary for parents, even the mild cases. there are other complications besides death. children can get pneumonia or dehydration or in a logic problem -- neurologic problem. >> thank you. >> thank you so much for being here and for all the work you do to protect our families and children across the country. there is no doubt the challenges remain with regards to immunization rates. broad access to no-cost vaccines is clearly a key factor in maintaining and improving our vaccination rates. we have a universal childhood vaccine program in washington which provides recommended vaccines for all children. there are a number of important federal programs that ensure access to free vaccines. can you describe cdc plus effort

to ensure all americans do have access to the vaccines they need without cost sharing? why that is so important. >> the cdc administers the vaccines for children program. we celebrated 20 years of that program. it has been extraordinarily effective. provides free vaccines to children who were uninsured and medicaid eligible. it provides vaccines for almost 50% of children in the united states. this program has greatly overcome racial, ethnic and financial barriers to vaccination. we see much higher coverage now in the era of the program. we think it has saved over 300 million illnesses and saved $1.4 trillion. cdc supports the state discretionary immunization programs to bridge the gaps that are not addressed through the

program. supporting the public health infrastructure for immunization so state and local health departments that work with the clinicians in those areas don't just investigate outbreaks like measles but work day in and day out and support provider education and dealing with vaccine shortages and distribute in vaccines -- distributing vaccines. your state has a fantastic program. >> thank you. for me and a lot of my colleagues, disease prevention was a key priority when we wrote the affordable care act. health plans now have to cover recommended vaccines without cautionary -- can you tell me what cdc is doing to help health departments build insurance providers? to cover individuals >> the affordable care act means more people have insurance and

more insurance is excellent for vaccines because it requires insurers provide all recommended vaccines with no co-pays or deductibles. cdc has been supporting 35 states to set up billing practices so that ensure people need to get vaccinated, that health clinic will be able to bill the insurer and recoup the money. the federal dollars go to protect infrastructure and the insurers pay their way. >> good. i am really proud of the number of organizations in my home

state where they are global leaders in providing vaccinations worldwide. we are incredibly lucky to have people who have witnessed death by disease -- you have worked with these issues across the globe. can you tell us what you perceive are the key challenges to achieving optimal immunization rates here? >> we are so fortunate to have a strong health system and access to vaccines. many countries, even with an alliance that provides vaccines for free, the infrastructure is very weak. strengthening health systems overseas so they can deliver vaccines is vitally important. there are a number of public-private partnerships that have been helping in that arena. the measles rubella initiative were responsible for more than a billion children getting measles

vaccines through campaigns and other areas and we think about 15 million children have been prevented from dying from measles in the last 15 years through the initiative. >> the public health infrastructure we have here is critical for issues like this. >> absolutely. even if every single american were insured, we still need public health to make sure we are addressing the needs of communities. >> thank you. we will now move to five-minute rounds of questions. senator collins, senator mikulski -- for those who have just arrived, we will move to the second panel. we will pick right up where we left off with the senators who are next in line. >> thank you, mr. chairman. the president's budget request includes a $50 million cut to the centers for disease control and prevention section 317 immunization program. you just responded to a question from senator murray about the importance of the state and local public health infrastructure. more than just paying for vaccines, section 317 supports

outreach awareness surveillance efforts by the state and local public health agencies. it is puzzling to me that the administration would propose to cut this program when we are in the midst of a measles outbreak. when you would think that you would want increased public outreach, awareness and surveillance. you have just talked about the importance of the state and local roles. could you explain to us why this cut has been proposed? >> the public health infrastructure at the state, local and federal level is vitally important to protecting americans.

these threats are an airplane ride away. reduction in resources requested through the president's budget will be accounted for through a reduction in vaccine purchase. instead of paying for vaccines for insured people, the health department will be able to build the insurers so they will pay their way. protecting the public health infrastructure at the state and the level is critically important, as is the communication outreach and the provider work we do. >> it seems to me this is exactly the wrong time for us to be reducing funding in this area given the importance you just outlined. historically, access to health care and the cost of vaccines

has been the major barriers to achieving high vaccination rates. increasingly, it is clear that other factors have come to bear as we are seeing declining vaccination rates in some extremely wealthy areas of our country. there was a recent article in the atlantic magazine that recently compared unfavorably the vaccination rates in wealthy areas of los angeles to the higher rates in the south sudan. how should our public health strategy change to reach those parents? you would not think that would be the areas -- they can obviously afford the cost of the vaccines and have ample access to health care. certainly better than those in south sudan. >> 25 years ago, we were dealing with the problem of children not having access to vaccines. what we are seeing more and more these days as parents opting out of the system.

i like to start with the premise that every parent wants their child to be healthy and safe and that is number one. for a number of parents, especially in some of these communities were opting out is common, they don't realize the diseases are still around. when measles virus comes into a community, they are at higher risk. i hope parents in those communities are recognizing that the threat is real. another factor is misinformation. it is really easy to get information of all types. much of it is not very good. we try to have the best information possible available to make sure people see the sources of the information and can check the facts themselves. we work closely with clinician groups. what our research suggests is that parents want to hear about these things from their own doctors who know them and their family. a lot of the attitudes out there might be from complacency that these diseases have not been visible. this year, the disease is getting more visible. >> thank you.

i think the study also played a huge role, unfortunately. a lot of people still mistakenly believe there is a link to autism and are unaware that that study has been thoroughly discredited. >> thank you. senator mikulski? >> on the reduction of $50 million in the 317 great program , which is to take care of the uninsured and vaccine safety outreach and education.

you are saying that that reduction of $50 million will have no impact on those services related to vaccine safety outreach and education? >> i can't say those reductions will have no impact. what i tried to say is the way we would address those changes would be to reduce the discretionary vaccine purchase and try to increase the billing of insurance. it is vital infrastructure be protected. >> we feel the same way. the issues related to outreach and education -- this is not an appropriations hearing.

when we do deliver, this is a valid area of inquiry and bipartisan cooperation. this takes me to science and misinformation. does cdc track the correlation between vaccine compliance and raise in autism? mississippi which has a 100 percent compliance rate, what is the autism rate in mississippi? >> i don't have that information. there are a number of ways we have tried to understand trends in autism and vexing exposures. a number of different study designs have discredited any links. >> i believe the solution to misinformation is more information. and that it besides an

evidence-based. my question is, do you track that? do you track the correlation? >> we track the trends going on in autism and the trends going on in vaccination around the country. the trends in vaccination are that almost everybody is getting vaccinated with most of the vaccines state-by-state, there are differences in particular vaccines. mississippi has a -- does not allow personal believe exemption. many people feel the only exemptions that ought to be allowed our medical once. >> i'm not here trying to get into it. i'm trying to get into the epidemiology. where there are high rates of compliance, how does that correlate? >> there is not a correlation between vaccine uptake and the autism. >> you have the epidemiology to support that? >> is. -- yes. >> i think the committee ought

to think about our efforts in the area of autism. we have been very focused on alzheimer's and others. it really is an epidemic. mothers will do anything to protect their children. they need good information, real science and for families facing these challenges, they need to have answers. i want to shift gears to immigrant children. their backs nations. -- vaccinations. what are the outreach efforts and how do we deal with this? 60,000 children came to america last year.

many of them are in maryland. hopefully they are in the sunshine, going to schools and so on. in states where there are high rates of new immigrants, where the immunizations of children are addressed -- there is this whole attitude that they should not get our public health infrastructure. this is what we are talking about. central american kids are going to schools side-by-side with the gentry kids. how do we ensure those children are addressed and therefore the needs of american children are also addressed? >> vaccine preventable diseases do not respect borders. it is important for individuals to be vaccinated for their own health and to protect those around them. it is very important in an arrow were measles has been eliminated from north and south america for us to continue to make sure that there are strong immunization efforts another parts of the world. -- in other parts of the world. it is important to make sure people have access to vaccines regardless of where they are from.

>> senator cassidy? >> of those folks infected in the california epidemic, how many were native born americans and how many have immigrated here? >> i don't have that information. most of the importations we have of measles each year are in the americans traveling abroad. american-born. >> we have heard a lot about how the families from the wealthy committees of santa monica and los angeles are not vaccinating their children. is that where we are seeing these cases?

i did my residency in los angeles. a lot of the immigrants may have fallen between the cracks. do we have any sense of who is contracting this? >> for the measles outbreak, we are seeing spread in some of the wealthier communities. years ago, we had a lot of importations of measles from latin america. the americas took on the elimination of measles and did major campaigns around all of the countries and had great success. >> when someone immigrates, what is their requirements in terms of immunizations? >> there is a requirement for documentation of the vaccination against the vaccine preventable diseases. the program makes sure that refugees would have access. >> that is poor children, by definition less than 18.

what if an adult immigrates from the philippines? >> that is not the case there. most of the spread is coming from -- most of the risk is in children. if you survive to adulthood, you have already been exposed to the measles. >> those adults going to the philippines and coming back, is there any travel advisory -- any effort in the philippines? you mentioned how the americans have popped up their efforts. >> there are efforts there. the philippines and suffered that horrible hurricane. much of their immunization infrastructure was destroyed. they have had a bad measles outbreak. cdc another is have helped respond.

the biggest outbreak we had last year was in a couple on the show adults who traveled to the philippines who had never been vaccinated and brought the virus back to ohio. the image community stepped up to be vaccinated. that was a large community. in the u.s., most communities have high immunization rates. it is these newer committees where parents are opting out that we are quite worried >> we need and immunization record to travel overseas. was he required to show his vaccination record to go? >> he was not. we hope that we are reaching him through our outreach efforts. we were concerned that with the ohio outbreak, we had not reached the travelers. they were misdiagnosed. >> that can be an easy thing to do. to put in a note saying you are

traveling to a place with endemic measles. >> there are a lot of electronic prompt that it will alert you. >> is that something that when we approve a visa -- there should be some process by which somebody is traveling to and endemic country, we would remind them of their risk. what about immunization rates since 2009? >> they have risen for some of the newer vaccines and are stable for the others. we tracked closely the percent of children who receive no vaccines at all by h2. -- age two. >> you seem to concur that the affordable care act may have improved immunization rates. the vaccines for children program -- that cost has not been a barrier for immunization of children for some time.

would you accept that? >> its adults were the rates are low. we have some lacking coverage and teenagers. it covers through age 18. the aca would cover vaccination of the nettle with hepatitis b if they were in a recommended -- >> if they were at risk. i think it is important for the record that the portable care act is -- affordable care act has not hurt but not augmented. >> it has been a wonderful -- >> we need to keep moving. senator warren? >> when the vaccine became available for the first time

parents lined up to make sure their kids would be protected. they lived in a world of infectious diseases that destroy children's futures and they desperately wanted to leave that world behind. these vaccines worked so well, the memory of these diseases has faded. last month, the depew center found that while 80% of seniors believe it vaccines should be mandatory, only 59% of people under 30 hold that belief. now, measles is back. you are the top immunization official in the united states. i want to walk through the science on this with you. is there any scientific evidence that vaccines cause autism? >> no. >> is there any scientific evidence that vaccines cause profound mental disorders? >> no, but some of the diseases we vaccinate against can.

>> the diseases can, but not the vaccines. is there any scientific evidence that vaccines contribute to the rise in allergies in kids? >> no. >> other additives that can be toxic to kids? >> no. >> is there any scientific evidence that giving kids vaccines further apart is healthier for kids? >> it increases the risk. >> it adds to the danger. is there any scientific evidence that kids can develop immunity to these diseases on their own simply by eating nutritious foods or being active? >> no. >> how do the risks of a child responding negatively to a vaccination compare with the risks of skipping vaccination and risking exposure to a deadly disease?

>> vaccines are safe and highly effective and it's important for parents to know they are the best way to protect their kids. >> said parents should know that all of the credible scientific evidence suggests that modern vaccines are safe, modern vaccines are effective, and modern vaccines or our best chance of protecting our children from diseases that can kill them. is that right? >> that is right. >> thank you. thank you, senator. >> thank you. senator roberts. >> thank you, mr. chairman. i appreciate your holding this hearing. in kansas, we had 19 cases of preventable diseases, and the most was measles greed we have not had any new measles cases reported this year.

public health care workers are concerned, and the problem is our immunization rates are down. for the 2013 year until the 2014 school year, the percentage of those receiving this is not good. for the record, i had measles. chickenpox and that that people had back in the day. if i can get to you very quickly. if immunization rates continue to decline, what advice do you give to the youngsters and parents you have to choose the vaccination to help protect their own? >> the lower the rates are, the more your children are at risk so we want to make sure your own children are vaccinated.

some kids cannot get vaccines, because they have leukemia, for example. they cannot have live viral vaccines, so our next is the community vaccine. >> you highlighted some of the reasons, fear of side effects religious, or philosophical objections, and there are a whole bunch of paragraphs here in the background information which is states it is easier which are easier to get a philosophical objection, a simple letter signed by a doctor. how often, however about the mistrust of recommended vaccine schedule, how often would you say it is the latter that the vaccine schedule is too rigorous, and what assurances can you provide to parents on this concern? >> many parents do mention the number of shots they get at a particular visit as something that concerns them. we like to let people know that the vaccines are recommended at the times they are recommended

because of the way they work and because of the disease risk, so our advisory committee practices and reviews the sciences and updates the schedule every year based on the best information available, so we 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 of list in 2002. 540,000 children showed definitely there was no relationship between mmr i.e. measles vaccination, and any kind of problem with autism, and the institute of medicine report in 2004 did the same. along the way, there have been studies from the national institute of health, centers for disease control, and hundreds of

academic groups. all of these 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 they can to try to convince every state. we are at the bottom. or not at the bottom, very close to it area and i am very concerned about it, but at least the media, i think, today at least realizes that one study which was totally discredited there should be a very strong statement by everybody involved that 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 will now go to senator baldwin. i want to mention again to the senators that at 11:00, we are going to excuse dr. schuchat and caught a second panel, but anyone who has not been able to ask a question will be the first one up. senator baldwin? >> thank you, mr. chairman, and i also want to thank you for holding this hearing. it has reduced human suffering and saved lives by preventing and reducing the outbreak of preventable diseases, and thanks to national policy, including the affordable care act now millions of families have access to free immunizations. and it is why i am so concerned as i know many of my colleagues are, about the recent measles outbreak and the surge in misinformation, exacerbated by the media and even some national

figures, and this is information that is surrounding vaccine safety. to prevent against future outbreaks, i think it is vital that we continue to invest in our nation's vaccine production capacity, support cutting-edge science, and enhance the accreditation 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 role of vaccines by passing and creating the cdc vaccine for children program, which provides recommended pediatric vaccines to low income children. the cdc also maintains a stockpile for pediatric vaccines, so, dr., could you

tell us the current state of our national pediatric vaccine stockpile, and is the measles vaccine included in that supply and can you elaborate on the role of the stockpile in addressing outbreaks, as well as how cdc works to maintain it? >> yes. be vaccines for children program includes a stockpile that is approximately 50% -- enough vaccine for 50% of the pediatric population to be vaccinated for one year, so we currently have over 3 million doses of mmr vaccine. the stockpile has been used for outbreak response and also for shortages, and even with our robust vaccine industry, there are many vaccines where there are only one or two manufacturers who produce them, and when there is a destruction

in supply, we will have to go to our stockpile to make sure there is no disruption in use, so it really has been a safety net for vaccine security. >> i want to explore a little further this issue of production , both with disease preventable diseases that are prevented by vaccines, but also with the influenza vaccine. where they might not be 100% match to the strain in a given flu season. two issues. well, three issues. the mistake manufacturer versus overseas manufacture, in the case of an epidemic that is particularly lethal. it has been a long issue, anna and at her stand we have improved domestic production. anything you can't 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 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 oftentimes, with little notice to the medical profession. i have heard from frontline pediatricians who say we don't have enough in our clinic, and he cannot meet the demand. is there better notice given to the cdc? do we have more safeguards in place to make sure we don't have an alarming shortage? >> yes. we had a big wake-up call about 10 years ago in october 2004, where overnight, half of the expected influenza vaccine

supply wasn't coming through and that really prompted an enormous amount of reevaluation on the different parts of government. we are in much better shape now. that year, we eventually had about 58 million doses of flu vaccine. this year, we have nearly 150 million doses 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 others come besides those that are egg-based that are being used, so the influenza vaccines are included among this year's seasonal flu vaccine supply, and looking towards the future, there is a lot of enthusiasm across the government and across academia around investments towards a universal influenza vaccine that might give us broader and better and longer lasting protection than the annual flu vaccines that we use today, so there is a lot of

progress in the past decade. there is more work to be done. in terms of the communication with the industry -- >> i would like to get senator franken in, before you leave. if it is all right. thank you, senator baldwin. senator franken. >> thank you. i am thinking that maybe this outbreak in measles is a bit of a wake-up call, as senator warren said. you know, a lot of baby boomers and some of us, 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

that they understand things like herd immunity, and if you have a mass of people not getting vaccinated, you have outbreaks like this, and the financial costs. there was a 2005 nih article that attempted to quantify the economic impact on health infrastructure. they estimated that one case of measles costs the federal state, and local health departments more than $140,000 to respond to just one case, and you talked about the return on investment of all of these immunizations, and i think it is one of the -- it is obviously cost effective also prevents a lot of suffering. we live in a global world, and i just want to ask you about that

investments 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? >> yes. measles has been eliminated from the americas but it is still circulating around the world with about 20 million cases per year, and in some of the countries that have had major outbreaks, it is 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 are really keen to be partners in the polio eradication initiative and the measles rubella eradication and how we can protect children everywhere with vaccines that are safe and effective. it really strengthens our community protection here at home, and it is really the right

thing to do overseas, as well. >> because measles, in particular is highly contagious, and you are one plane ride away from 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 -- what else are we looking from -- four in the near future? >> possibly. >> with infectious diseases, you really have to be ready for the idea that the microbes are changing faster than we are as people, this past year we dealt with the enterovirus, a severe respiratory illness that we have not really seen in children. and then we were dealing with

the middle east respiratory syndrome, a new virus that was causing very severe disease in the middle east and with some travelers returning from there two cases in the u.s., so we really think it is critical to be strengthening public health infrastructure and capacity for global health security in countries around the world so that we do not let an epidemic like ebola get as bad as it got. we can jump on it right away. we will not see importations, but we recognize this overseas and help the countries that are battling them deal with them swiftly. >> and that is why the cdc is so important. i really want to thank you for your service to this nation and to the world. thank you, dr.. thank you, mr. chairman. >> thank you senator franken. dr., maybe i'd miss heard something. the state department website said u.s. immigration law

requires visa applicants to obtain certain vaccinations prior to entrance with an immigrant visa, so an adult immigrant to the united states who obtained a visa is required to obtain certain vaccinations correct? >> yes, i can double check. >> i did not want to leave a different impression that was not true. >> thank you. >> dr. schuchat. thank you so much for your time. there have been a couple of senators who have not had time to ask questions, but hoping they will understand we want to invite the second panel to come up now, and they will be the first ones up after the next 15 minutes of testimony. i was now move ahead and introduce the second panel to save time, if i may. first, we will hear from dr. kelly moore. dr. moore is the director of immunization at the tennessee department of health and she is responsible for promoting proper use of recommended vaccines as

well as overseeing the response to outbreaks of vaccine preventable diseases. she has her undergraduate medical degree from vanderbilt and a masters in public health from the harvard school of public health, and i am completely objective, but the tennessee department of public health is one of the finest in the country. dr. sawyer, pediatric disease specialist from the university of california at san diego. and the children's hospital in san diego. he is also the ethical director at the san diego immunization partnership and involved in a variety of immunization practices projects. dr. tim jacks is a pediatrician and the father of two young children who were recently exposed to measles in arizona. he is in 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 and caring for the two children. i am grateful he could be here to tell their story. dr. moore, let's begin with you. if the three of you could summarize your comments in five minutes, we would appreciate it. 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 the preventable diseases. 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 would like to begin by recognizing first lady christie haslam and bill haslam for the commitment to immunization as an essential step in promoting and protecting the health of

tennesseans. you can say tennessee has a culture of immunization. for the past two influenza seasons, the majority of tennesseans, aged six months and up, received a flu vaccine. in 2013, 95% of kindergartners were immunized with all required vaccines including both of mmr. the federal vaccine for children program has removed barriers to access for eligible children since 1994. our state's online immunization information systems supported by section 317 federal funds, ensures 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 are protected. we have more work to do with vaccinations for teens and adults that prevent seasons such as meningitis, cancer, and

shingles. public health colleague to address misinformation and concerns about safety, l benefits, and affordability. to improve access, our department is using 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-pocket costs. when it comes to disease outbreaks, he realized how much public health work goes into one case of measles. i vividly recall each of the nine cases tennessee has had in the decade i have 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 in recent overseas travel who was in the er with classic systems of measles.

the diagnosis was not in question. a game plan was quickly developed, following the state immunization program to identify those who may have been exposed in the four days he was in. 124 people were identified. the mmr vaccine could protect the most recently exposed in -- if public health could find them quickly enough. those with uncertainty immunity were vaccinated on others were saturday. counseled in symptoms developed. among the 124 contacts just , three cases among other adults developed. for these, the same isolation contact tracing and notification process was practiced, but faster. no additional cases occurred. in total, 406 were evaluated. pbh works with the media statewide to educate the public and prepared clinicians through state health alerts and an educational webinar. cdc measles experts provided consultation and specialized testing that helped us optimize

our outbreak tactics. a great deal of credit in the story goes to the hard work of public health at all levels. this result however, it could have only been achieved in a community where the high percentage of the population was already immune or there would have been a very different outcome. congress' sustained commitment through the program and 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 have provided a more detailed testimony for the record and glad to answer your questions. thanks. >> thank you, dr. moore.

dr. sawyer? >> thank you very much for holding this hearing on a very important topic during the reemergence of vaccine preventable disease and what we can do together to prevent further outbreaks. as you have heard, i'm a pediatric infectious disease specialist at the university of california san diego and with the children's hospital in san diego. i am also a member of the committee of infectious diseases of the american academy of pediatrics. my testimony today has a strong endorsement of aap. vaccines are one of the greatest health achievements, which has been pointed out by the dr. and senators. prior, children suffered regularly from serious illnesses, like measles, polio diphtheria, and, in fact even , bacterial meningitis. the development and widespread use of vaccines has led to a reduction or ratification 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 diseases. in the teaching session i held last week with 20 pediatric residents in training, i asked if any of them had the measles. none of them had. however, as we have seen from the current measles outbreak and continued outbreaks of whooping cough or pertussis around the country, we are witnessing a reemergence of vaccine preventable diseases 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 the current measles outbreak are from california. and 13 are from my own community. 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 with 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 staying where they are or get worse. while most parents do choose to vaccinate their children, there are pockets of unimmunized children all over the country. in san diego, we have 1500 kindergarten students that are not immunized. that number has been increasing steadily. over the last decade. 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 and people they do not even know, become infected. the decision of a parent to leave their child unimmunized however well-meaning, is a decision that affects us all.

although our public health community has done an excellent job of controlling the current measles outbreak, too many people make a decision not to vaccinate their children, outbreaks will no longer be controlled. why is this happening? all parents want what is best for their children, but many parents are choosing to not have their children immunized amongst having received inaccurate information about the risks, benefits, 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. 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 it is overlooked by parents is the fact that just because an outcome occurs in the time after vaccine, it does not mean 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 vaccination schedule recommended by the cdc and aap has been developed with a strong scientific standards and has been proven to be safe and effective. in every case, for every vaccine, the risk from the disease outweighs any risk from the vaccine. in my opinion, the best way to decrease the number of families refusing to vaccinate their children is to improve communication about vaccine safety and effectiveness. to increase the science literacy of our population, to limit the philosophical exemptions from school entry requirements on vaccinations, and to continue to carefully monitor the safety of all the vaccines we use. taking these steps can ultimately help reduce the number of parents who choose not to vaccinate their children. the reemergence of vaccine-preventable diseases is alarming and must be confronted if we are going to prevent further outbreaks like the one we are 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 am a board certified pediatrician and i am on the front line of this vaccination issue. i daily recommended vaccinations to my patients and address concerns and questions they have regarding immunizations. lately, i have also been addressing many questions on the ongoing measles outbreak. but i am not here today as a medical professional. i am here today is a father. three weeks ago, my infant son and daughter madeline, who is battling leukemia, were exposed to measles. since her diagnoses with leukemia six months ago, our home life has revolved around my daughter maggie's care. she has been admitted to the hospital six times and spent nearly one month there. she is on a very regimented

schedule of treatments and she takes medication three times a day, up to six medications at a time. we have weekly visits to an outpatient clinic where she has procedures. she has blood work drawn, and she gets chemotherapy infusions. at one visit my children were exposed to measles. we were informed of the 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 into her treatment progress and just to let people know how she is doing. typically, i get 100 people needless to say, it has gone viral. the title of this blog entry was "to the parents of the unimmunized child who exposed my family to measles." in this blog, i vented my frustration and anger at the situation and i explained and hopefully educated people as to why my children and many other children like them are at risk. eli, my 10 month old son, has received all of his immunizations on schedule but he's too young to receive his first dose of mmr. my daughter, 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 numerous times. i have been contacted for interviews on local and national media outlets. i have taken these opportunities to share our story and hopefully raise awareness to the issue. my hope is that we can prevent families from going through the same thing we have gone through these last weeks. we also hope we can prevent more families from getting measles altogether. prevention is simple, vaccinate. as immunization rates drop, and the community starts to break down, that is the only thing protecting my two young children from being exposed to measles or whatever the next outbreak is. i urged a strong, unified, bipartisan voice supporting the scientific evidence that immunizations are safe and that they save lives. we need a consistent message

from the presidency to capital and down to local state legislators, schools, and even thinkers. i urge congress to take actions recording programs and infrastructure already in place to get these vaccines to those that need the most and contain outbreaks such as we are seeing today. i will care for my family and i will work to promote health among my patients. and through partnership with immunizations, like every child by two and the arizona partnership for immunization, i will advocate for timely vaccinations for children. thank you for your commitment to the issue. with your help, we can stop the spread of vaccine preventable diseases and protect the innocent. we can protect our children. we can protect my children. thank you. >> thank you, dr. jacks for your personal story and thank you dr. sawyer and dr. moore. i will go to the people who have not had a chance to ask

questions and begin with senator casey. >> thank you very much. we would like to thank the witnesses for bringing to this table and hearing room your experience, knowledge, significant time that you have dedicated your lives to on these issues. dr. jacks, we are especially grateful for bringing your story. especially when you have a loved one, in your case your daughter, is the subject of your own efforts. we are grateful for you bringing that to us. i am tempted to ask, but i would just refer to it, about the why question and why the failure to vaccinate has become significant? that may be the question that we are all asking. i guess maybe a better question

to ask is, what we can do to push back against it? we are doing that today and i see each of your testimonies have referred to that. i want to see some of the ground-level work that has to get done day in and day out about which i do not know much and maybe some members of the panel do. what happens in our schools, communities, and even in the offices of pediatricians? dr. sawyer, you mentioned that you had never been exposed to this in a direct way as a practitioner. i wanted to ask you specifically about pediatrics. do you think we are reaching a point where there 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 a good question and there are efforts underway from the american academy of pediatrics. in my case, i have a curriculum for residents about immunization. three years or four years ago, i added a whole section to teach residents and training on how to communicate about vaccine safety and address the concerns of these parents in an open nonconfrontational way, with the hope that if we can educate our families and give them good and accurate information, they will make the right decision. the problem is that there is so much inaccurate information circulating that a highly educated family who read something on the internet and takes it to heart before they really critically look at the source of that information. that is what we need to try and address. i mentioned in my statement, to raise the science literacy in the united states. that is a tall task, but we need it. >> i would like to refer to your testimony on page three, you

talk about in the second full paragraph, in tennessee, local school nurses and coordinated school health directors are among our most important champions of immunization. can you tell us about the importance of that? as much as we have an obligation in washington to get a message out and get policy right, a lot of the best work will be done in those settings. >> that is true. i cannot speak highly enough of our local public health nurses school nurses, school administrators at work with families. truly, these parents often have the hesitation of physicians out of fear. they want to do the best for their children and bells go off with these very things about vaccines and it is hard to un-ring that bell. when i talked to local public health nurses, they care so deeply about these families that they work with, and a lot of this can be overcome with

credible information from trusted sources and good relationships. that is what these folks provide. i am always a phone call away when they have a question on a technical thing. i can help them with that, but they are the ones with relationships with families to help them overcome fears. i think our immunization rates are testimony to that ability for them to work through this with families. >> i appreciate that. i will wrap up. just one statement. i know that in the debate on how to respond to the public crisis, among the best pieces of advice we all got here was local valuators are a lot better than valuators outside of the local area. i don't want to say washington but i think you know what i am talking about. thank you for your work and i'm grateful you are here today. >> thank you, senator casey. senator murphy, especially dr. jacks for taking the time to tell your story. i want to ask a few questions

about the nuts and bolts of how exemptions work. we have seen a pretty rapid rise in exemptions, in my state for instance, we have fairly loose rules in getting exemptions. a feature we share with california, frankly. we have seen in the last three years, a number of people who are applying and getting religious exemptions doubled. just in three years. you are proposing eliminating the philosophical objection. can you speak for one minute on why you made a proposal? >> i made the proposal because as you pointed 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 and signed it that you had a philosophical objection.

not a religious exemption, not a medical reason your child cannot be vaccinated, but just that you do not believe in vaccines. just as you mentioned in your statement, we have seen a steady rise in those exemptions over the last few decades. there are very few religions that specifically advised their followers to not vaccinate. it is the philosophical exemption that is causing the problem. i think it is driven by misinformation, so i certainly am in favor of eliminating such philosophical exemptions. the state senator in california just introduced a bill last week to do just that and i am certainly going to be supporting the effort in california. >> levy suggests an alternative to the elimination of the exemption, as you mentioned, all you want do in a state like california or connecticut is sign a piece of paper and you get no information on the consequences of not getting a vaccination. if the studies are pretty clear

that more information you give the less likely it is that people take the exemption. if that, the less likely you will have outbreaks. this is a stunning one from 2006, in states that have higher bars for exemption, they were 50% less likely to have whooping cough outbreaks. let's say we just raise the bar for a philosophical objection and we said for instance, you have to consult with your physician first or you have to review information on 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 asked dr. sawyer, but i will be glad to hear others. >> i will speak first because we have a form that says they need to sign that they have been

educated. that led to about a 1% drop in the rate of california, but it is still at 2.5% to 3.5% in communities in california. we will see whether that form continues to drop the rate, but my concern is that we have seen the benefit of a one-time drop and we will go back to the study and gradual increase in exemptions whether people stick to philosophical ones or as they start to exercise religious exemptions that they did not before. >> tennessee is one of the vast majority of states that does not have a philosophical exemption and has no intention of developing one. >> only 20 states have them. >> correct. about 29 or so only have no philosophical, including tennessee. 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 with the disease as contagious as measles. prepared to accept the consequences of offerings like this and personal choice is fine, but if we want to protect the vulnerable, like dr. jacks' children, then immunization needs to take place and it is the best way to do it. >> my office is looking at some legislation -- proposed legislation that would provide incentives for states to increase the information that they are giving to parents. not necessarily dictating what exemptions are used, but to admit that as a national health priority, it probably makes sense to make sure that the best information is given out. the irony is, if you are getting a medical exemption, you have to have a note signed by a doctor. if you are using a philosophical exemption or religious exemption, often all you have to do is sign the back of the form. it seems at the very least we should try to marry those two standards together.

>> senator bennett. >> thank you, mr. chairman. thank you for holding this hearing. it strikes me listening to the testimony that we have been victimized by two things. one, a generation that has not experienced these diseases because of vaccines and they have lost sight of what they look like. and interestingly, dr. sawyer's point, the unedited content on the internet they are reading. i wonder, dr. sawyer, and i hope maggie is getting a chance to watch you. thank you for being here. dr. sawyer, could you use this opportunity to tell us what are the biggest falses that are being trafficked on the internet and what are the answers? if the other panelists would like to join in, that would be great. >> as it has been mentioned,

autism remains one of the major concerns to parents even though dr. schuchat has pointed out that there is not a lot of credibility between the two. 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 really counterintuitive to the whole purpose of the vaccination program. if we were overwhelming children's immune systems, i am an infectious disease doctor, we do not see that into two months, four months, or six months when we give routine vaccinations. the last major thing you hear about are the ingredients in vaccines and the concern that perhaps some of them are toxic. once again, that has been discredited and looked at very carefully. the fda approves of these

vaccines. >> i will add to dr. sawyer's excellent list that i agree with. the vaccine causes the flu. i'd hear that every year over and over from well-educated folks and that is certainly one we work to counteract of the benefits of the flu vaccine. the hpv vaccine, may cause promiscuity. we hear that from time to time as well. that is what people are concerned about hpv given to preteens. >> just to be clear to everybody listening, these are demonstrably incorrect. >> i wonder, you are a pediatrician, do you have advice to pediatricians across the country on how to handle the conversation that they have with parents about vaccines? >> yeah, with regard to families that have questions and concerns, it is really just

that. it is addressing their concerns and questions. you know, back in the day, physicians could take somewhat of an authoritative stance and there was a great deal of respect. nowadays, it is more of a working with families to come to a conclusion on what is best for their children. whether it be immunizations or whether or not we want to treat an ear infection. i would like to make my recommendations and address their concerns specifically. >> do you have anything to add dr. sawyer? >> this question on whether there are things pediatricians can do? >> right. >> the curriculum i develop basically takes people through the appropriate way to listen attentively to people issues and

be respectful and addressing them, but to continue to convey the science in the most clear way one can, so families can reach the right conclusion. >> thank you, mr. chairman. >> thank you. i finished early. that is 43 seconds. i will never get that time back. >> we will put it in the bank. we have time, and i am sure all of us would probably like to ask or have a second round of questions, dr. moore, i believe you said the case of measles from tennessee was in memphis? >> it was actually an adult in west tennessee. >> you describe you moved in quickly and the number of people in that one case that you have to be in touch with have to be how many? >> people i come in contact with

them. i do not have a specific number for that region, but it was clear because 124 people were exposed and only three people got sick that it was very high. >> as dr. sawyer was talking earlier, i was thinking about the phrase, going viral. and then dr. jacks used it. this generation understands the idea of going viral. you are talking about measles flying through the air. that is unlike ebola that threw the country into a panic last fall, that could only be caught by an exchange of bodily fluids. this flies through the air and goes viral. this is a disease that goes viral. we senators, in a bipartisan way, understand the problem of dealing with highly educated people who get that information on the internet. that happens to us every day. we deal with that and we know

what it is. let's go back to the going viral. what if this person in west tennessee, who dr. moore acted on quickly, what if that person had been discovered in a part of los angeles where the immunization rate is 60% or 70% instead of 90% or 95%? describe the number of people and the multiplying of people that would have to be contacted to make certain that the disease did not spread. >> i can share the experience we had in san diego in 2008, which was our last outbreak. we had 12 cases and over a hundred people were exposed to

those 12. it quickly goes up exponentially. the number of people you want to track, and unless public health is there to track those people and keep them quarantined, it could easily get completely out of control. >> so you had 800 people, but each of them might have infected someone else, right? >> exactly. in that outbreak, we had close to 800 people quarantined for three weeks to prevent that next wave. we were all crossing our fingers with this disneyland outbreak that maybe we are near the end. i noticed that the case number went up by 20 just this past week, so i am not sure we are done with this just yet. >> moneys a flight to the air, we have an example of going viral in modern i suppose. dr. jacks, this might not be an exact comparison, people asked me why continue to play the piano when i was young and i remember responding that i did not remember my mother giving me a choice, but i guess i had a choice. we are not talking about taking

choices away today from parents, but we are talking about a conversation between a pediatrician and a parent. that probably would not start -- even in this day of parents who feel differently than 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 than you can do is tell them the story of your own children. 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 definitely come to a conclusion of recommending that we do vaccinate. i often times do not approach it quite that way because i want to get their thoughts, opinions and fears first, so i can address those. i have heard from a couple that is still pregnant and has not

had their first child yet to the routine thing -- visits where we would do a vaccine. every visit, whether they are getting vaccinated or whether they are still trying to decide, i am talking and answering questions and urging them to make good informed decisions. my understanding, opinion, is that, yes, vaccines are one of the best things they can do to protect their young child. >> i am out of time, but i assume -- my wife led an effort to try to establish prenatal health care and trying to let parents know about vaccines before the child is born is a good way to keep the vaccination rate high. >> dr. moore, i'm interested in learning more about the increase of the uptake of the hpv vaccine.

we are very fortunate to have a vaccine today that can prevent most forms of cervical cancer, which i am sure you know is the second leading cause of cancer death among women in the united states. about 12,000 women get cervical cancer every year. about 4000 are expected to die from it. we know that those are deaths that now can be prevented. i would like to ask you what can state and local health departments do to effectively promote hpv vaccine? >> that is a wonderful question and we certainly know that a lot of young women and men are not protected against this virus yet who could be. in tennessee, our immunization rates are about one in three and we would like it to be much higher. we are working collaboratively with cancer advocates because they have wonderful experience raising awareness about breast exams, pap smears, and we are collaborating together to try

and help families understand that this new vaccine is a cancer prevention tool that can help reduce the risk of an abnormal pap smears for a young lady later in life. we are also trying to make sure people understand the vaccine is safe, it lasts, and it is very very effective. we bundle with other routine vaccines. so what is given at the same time as other vaccines, the first meningitis shot, and it is part of the routine pre-immunization bundle. we are trying to help people understand that there is nothing exceptional about this except that it is phenomenal cancer prevention and incredibly exciting to have its will in our hands when the last generation did not have to protect women and men from cancer for their lifetime. >> thank you, i appreciate that. i would also like to mention in my home state we have an

incredible public and private partnership called vac northwest. at my time when they had the highest vaccination rate in the country, our state health department came together with key health promoting organizations, within reach, and seattle children hospital, to create an innovative partnership which addresses a vaccine hesitancy to work with parents and health care providers alike. it has support from the gate s foundation which was helpful and engagement of a lot of partners. vac northwest has been doing amazing work and has been evaluated with the intent of sharing a lot of lessons that they are learning with other states. i wanted to ask you, dr. moore how can working with private and nonprofit partners help the efforts? >> health departments have a major role in promoting immunization. long ago we started -- they go to their own private doctors for

immunizations now to provide holistic care about praying for their child, but we partner with these organizations in order to help support them in doing the right thing. pediatricians are incredibly busy with everything they have to do and it really helps them if there is a group in public health focused on promoting immunizations where we can provide them support like our immunization information system that makes their job easier. our role but it comes into doing site visits about quality of immunization care, site visits that we do in their offices, educational programs that we provide, promotional material, we help give them the resources they need for the private sector to do the best possible job for the patients because they are primarily the ones vaccinating our children. this partnership has been wonderful. i am all about relationships and

these relationships have been great at developing immunizations. >> thank you. and dr. jacks, i appreciate your willingness to come. since you started speaking about your own family's situation, are you surprised to know how many people know that some people cannot be vaccinated? >> surprisingly no, actually. there has been a lot of positive feedback, certainly a small amount of negative feedback from certain populations, but it seems like the knowledge is there. i just do not think it is in the public conscience when they are making the decision to vaccinate or not vaccinate. that is why i am doing this. i want to raise awareness of the issue so we can be part of the discussion. >> i appreciate that. i just wanted to ask you as a pediatrician, what do you think are the key areas to vaccine uptake?

>> largely education and the misinformation that is out there. >> thank you. >> thank you, senator murray. senator cassidy. >> i would like to question anonymous consent to enter a statement to the record. thank you. obviously, we have declining resources on the federal level. i see that the administration is cutting the 317 money, dr. moore, that you had reference. i also will note as a fellow who used to work in a public hospital system that there is always a great concern about immunization. sometimes i would see people come to speak to our pediatrician about immunization and it was like a call to newcastle. these folks cared about it. jacks and sawyer care about it passionately. can we use our 317 money more effectively? i ask this not to challenge but to suggest.

when i look at that map of california, you can isolate those communities which are not immunizing. if you want to pay jacks to come in and speak to those families whose child was unvaccinated and recently came from another country, their child is at risk. i guess i will ask, are we still using our 317 money in a paradigm of 20 years ago before we had immunization registries that could pinpoint where we had pockets of the unimmunized? and before we realize that many people are basing their decisions based upon a motion, not upon the physicians' recommendations? simple question, 317, are our programs adapting? >> thank you for that question. i can say under dr. schuchat's leadership that we are focused on where we are with our immunization program. the 317 funding that we have is going to support our information system that provides clinical

position support for clinicians who need to keep up with the complex current immunization schedule to provide optimal care. it can provide that support. it makes it easy to issue immunization certificates. we are also using those funds to provide education not only for clinicians in large conference settings, it also one-on-one education. we will send a public health immunization expert into a clinic to spend half a day. >> those clinicians, again, they do not need to have it and they just need to have posted online their clinic's results compared to other clinic's, and natural competition will drive it and we know that from infectious disease rates.