From smallpox to polio, we have learned that vaccines save lives. The troubling number of parents are not vaccinating their children. Last september, this Committee Held a hearing about the ebola virus. A brave and physician who worked in liberia and contracted people a and a brave father contracted people a e 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. Every member one chattanooga Public Health officer saying it is all people up all the time every day 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 20012012, 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 oneyearold. 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 dont get sick. That keeps the babies from getting sick. That herd immunity is incredibly important. Measles can cause lifethreatening cup locations in children. 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 humans asian rates across 13 states 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. 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 valentines 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 individuals genome, we find ourselves retreading old ground. I turned to senator murray for her opening statement. Guest thanks to all of our witnesses for coming to share your expertise with us today. Keeping our families healthy cannot be more important so im 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 countrys 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 cant 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 takeup rates are low, we are spreading awareness so more people can be protected. The hpv vaccine is a great example. It prevents lifethreatening cancers, including Cervical Cancer, which impacts thousands of lives in the United States each year. Cdc reports that takeup 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. Im looking forward to an update about the recent Measles Outbreak and the work the cdc is doing to continue to encourage vaccines. Im 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. Guest thank 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. She has worked at cdc since 1998 on immunization, respiratory and other Infectious Diseases. She is a rear admiral in the Public HealthService Commissioned Corps and was named assistant Surgeon General of the United StatesPublic 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 nations immunization system is strong, protecting the health of americans, saving lives and money. This years outbreak of measles demonstrates how interconnected we are. Many threads are just an airplane right away. Despite High NationalImmunization 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 Doctors 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 maintainin. Responding to outbreaks another virgi 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 costeffective 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 wakeup call. Measles is very contagious. In the 1980s and early 1990s, 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 microcommunities 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 communitys and sustain the enormous benefits that are Immunization Partnership has achieved. Guest about 10 years about tenures ago, a group of us went to south africa and we found the president of south africa had rejected the science on hivaids 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 hivaids. 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. Lets 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 . Thats 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, 400500 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 . Thats 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 nocost 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 dont 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 copays 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 publicprivate partnerships that have been helping in that arena.