NVAC Meeting: June 4, 2019: State Legislation Panel
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NVAC Meeting: June 4, 2019: State Legislation Panel


>>WELCOME BACK TO OUR FIRST DAY
OF THE NATIONAL VACCINE ADVISORY COMMITTEE MEETING.
OUR NEXT PANEL WILL BE FOCUSED ON INCREASING VACCINATION
COVERAGE THROUGH IMMUNIZATION LEGISLATION.
SCHOOL IMMUNIZATION REQUIREMENTS ARE STATE REGULATE TO AID IN LOW
RATES OF VACCINE AVOIDABLE DISEASE.
IN THIS SESSION WE’LL SEE HOW HESITANCY HOT SPOTS AND RISE AND
NON-MEDICAL VACCINES THREE STATES WILL PROVIDE THEIR
EXPERIENCES WITH IMMUNIZATION REQUIREMENTS AS WELL.
WE’LL BEGIN THIS PRESENTATION WITH A SHORT INTRODUCTION OF THE
PANEL BY DR. BECKHAM FOLLOWED BY A PRESENTATION ON THE PHONE BY
DR. SAAD OMER, WILLIAM CHAIR GLOBAL HEALTH AND PROFESSOR IN
HEALTH EPIDEMIOLOGY AND PEDIATRICS IN THE SCHOOL OF
PUBLIC HEALTH AND SCHOOL OF MEDICINE AT EMORY UNIVERSITY.
HE’S ALSO A FACULTY MEMBER OF THE EMORY VACCINATION, VACCINE
CENTER. IN JANUARY 2019 YALE NAMED HIM
THE INAUGURAL DIRECTOR FOR YALE INSTITUTE FOR GLOBAL HEALTH
EFFECTIVE JULY 1, TO 19. HE SERVED PREVIOUSLY AS NVAC
MEMBER. HEEL PROVIDE AN UPDATE OF
EVIDENCE RELATED TO VACCINE MANDATES.
HE WILL BE FOLLOWED BY DR. PETER HOTEZ, DEAN OF NATIONAL SCHOOL
OF TROPICAL MEDICINE AND PEDIATRICS MICROBIOLOGY BAILOR
COLLEGE OF MEDICINE, ALSO DIRECTOR OF THE TEXAS CHILDREN
CENTER FOR VACCINE DEVELOPMENT AND THE EXTHE TECHS CHILDREN’S
HOSPITAL ENDOWED CHAIR OF TROPICAL PEDIATRICS. DR. HOTEZ WILL PRESENT ON HIS
WORK ON NON-MEDICAL VACCINE EXEMPTION HOT SPOTS.
HE’LL BE FOLLOWED BY BECKY SHIPP, DIRECTOR OF THE
MISSISSIPPI STATE DEPARTMENT OF HEALTH IMMUNIZATION PROGRAM.
MISSISSIPPI BENEFITS FROM ONE OF THE HIGHEST IMMUNIZATION RATES
IN THE NATION AMONG CHILDREN ENROLLED IN KINDERGARTEN.
DR. RICHARD PAN, CALIFORNIA STATE SENATOR, PEDIATRICIAN AND
FORMER UC DAVIS EDUCATOR WHO WILL DISCUSS HIS EXPERIENCE WITH
VACCINE RELATED LEGISLATION IN CALIFORNIA, AND FINALLY NOT
LEAST, DR. JOHN DOUG ALSO, EXECUTIVE DIRECTOR OF THE
TRICOUNTY HEALTH DEPARTMENT, THE TRICOUNTY HEALTH DEPARTMENT
SERVES 1.5 MILLION PEOPLE NAY DAMS COUNTIES IN COLORADO AND
HE’LL DISCUSS EFFORTS TO ENCOURAGE VACCINES FOR THIS
YEAR. THANK YOU FOR YOUR TIME.
DR. BECKHAM, I’LL LET YOU START THE PANEL.>>THANK YOU.
HAPPY TO BE BACK. I WANTED TO OPEN THIS SESSION
THIS AFTERNOON AND TALK BRIEFLY, STATE AND LOCAL VACCINATION
REQUIREMENTSES FOR DAY SCHOOL AND SCHOOL ENTRY ARE SO VERY
IMPORTANT AND IMPORTANT TOOLS FOR MAINTAINING A HIGH
VACCINATION COVERAGE RATE, AND IN TURN LOWER RATES OF VACCINE
PREVENTABLE DISEASE. STUDIES HAVE SHOWN EXEMPTIONS
CLUSTER GEOGRAPHICALLY, AND THAT MANY NATION SCHOOL SYSTEMS DON’T
HAVE ACT QUAD RESOURCES TO PERFORM NECESSARY AUDITS OF
PROVISIONALLY ENROLLED STUDENTS, IN BOTH SITUATIONS PUT
COMMUNITIES AT GREATER RISK FOR OUTBREAKS.
RECOGNIZING THE IMPORTANCE OF THIS ISSUE FOR MAINTAINING HIGH
VACCINATION RATES. THIS PANEL AS DR. HOPKINS
MENTIONED WILL FOCUS ON RESEARCH TRENDS AND RESEARCH STATE
REGULATION POLICY AND EXPERIENCE AT THREE DIFFERENT STATES,
MISSISSIPPI, CALIFORNIA, COLORADO
AND I JUST WANTED TO BE VERY CLEAR, THAT IMMUNIZATION
REQUIREMENTS IN THE UNITED STATES ARE STATE REGULATED,
HOWEVER, THE REQUIREMENTS IN THE PERSONNEL RESPONSIBLE FOR MAKING
THESE DECISIONS LOOK VERY DIFFERENT STATE BY STATE.
AND THIS SESSION WE’RE GOING TO SEEK TO BUILD AN UNDERSTANDING
OF CURRENT TRENDS AND RESEARCH AND STATE IMMUNIZATION POLICY AS
WELL AS CHALLENGES AND OPPORTUNITIES THAT STATE SPACE
IN THIS AREA. SO NOW I’LL TURN IT OVER TO
DR. PETER HOTEZ. THANK YOU.>>DR. U LMER WILL PRESENT ON
THE PHONE FIRST. , DR. OMER.>>I GUESS, (INDISCERNIBLE)
GREETINGS FROM GENEVA, MY PRIVILEGE TO PRESENT TO NVAC, I
WILL BE TALKING ABOUT VACCINE MANDATES PROVIDING AN OVERVIEW
OF EVIDENCE. NEXT SLIDE.
SO I DON’T HAVE ANY CONFLICT. THE FIRST SLIDE WE LOOK AT A FEW
YEARS AGO IN 2016, WE LOOK AT REASONS FOR NON-MEDICAL
NON-VACCINATION AMONG U.S. CASES AND WE FOUND THAT APPROXIMATELY
70% OF THOSE WHO WERE, OF CASES FOR VANNING MAKES WERE
UNVACCINATED FOR REASONS OR VACCINE REFUSAL.
EVEN IF WE ADDED CHILDREN WHO ARE TOO YOUNG TO BE VACCINATED
OR OTHERWISE INELIGIBLE TO RECEIVE A VACCINE, BUT
NON-MEDICAL EXEMPTION COMPRISE OF 43% OF CASES.
THIS TREND EVEN SINCE THEN CONTINUED AND WE ARE SEEING
UNPUBLISHED STATE AT SIMILAR NUMBERS.
NEXT SLIDE. IN THAT ANALYSIS WE CREATED A
CUMULATIVE EPIDEMIC CURVE WHERE WE ADDED THE OUTBREAK WHERE
THESE CURVES WERE AVAILABLE INTO A SINGLE CURVE AND STRATIFIED
THEM BY VACCINATED AND UNVACCINATED AND WE FOUND THAT
MOST OF THE DATA CLUSTERED IN THE FIRST FOUR WEEKS OF
OUTBREAKS AFTER THAT IT WAS SPARSE DATA BUT WHERE THE DATA
WERE ROBUST IS FIRST FOUR WEEKS THOSE WHO WERE UNVACCINATED AND
I HAVE SHOWN EARLIER THE REASONS FOR NON-VACCINATION NON-MEDICAL
EXEMPTIONS WERE MAJOR REASON FOR NON-VACCINATION, CONTRIBUTED
MORE TO THE EARLY PARTS OF THESE OUTBREAKS.
SO PROVIDING SOME EVIDENCE THAT THOSE WHO ARE UNVACCINATED DUE
TO NON-MEDICAL EXEMPTIONS PROVIDE THAT CRITICAL MASS OF
SUSCEPTIBLES THAT CAN START AND CONTRIBUTE TO THESE OUTBREAKS.
WE ALSO DID ANOTHER ANALYSIS THAT CAME OUT WITH
DR. (INAUDIBLE) AND WE LOOKED AT THE TOTAL SUSCEPTIBLES IN THE
POPULATION. SO VACCINE COVERAGE IS A SNATCH
SHOP IN AN AGE GROUP AND OFTEN IS USED TO LOOK AT POPULATION
VULNERABILITIES WHICH IS NOT REALLY MEANT FOR, IT’S A
PROGRAMMATIC INDICATOR SAYING HOW MUCH, HOW WELL YOU ARE DOING
IN THE, I’M ON SLIDE 5. SO WHY, HOW WE ARE DOING AS A
PROGRAM IN A GIVEN YEAR. HOWEVER, A SLIGHTLY DIFFERENT
WAY OF LOOKING AT THE POPULATION SUSCEPTIBLE TO ADD PEOPLE THAT
ARE ALREADY IN THE SYSTEM WHO ARE UNVACCINATED IN PREVIOUS
YEARS AND THOSE WHO ARE TOO LONG TO BE VACCINATED, WHEN WE DID
THIS ANALYSIS WE FOUND SOMETHING CONCERNING, SUBSTANTIALLY HIGH
PROPORTION OF OBVIOUSLY, IT’S NOT CLOSE TO A MAJORITY BUT
UNREASONABLY HIGH, APPROXIMATELY 12.5% OF U.S. CHILDREN OR TWO
TEAMS WERE VULNERABLE TO MEASLES BECAUSE OF THESE REASONS.
AND WE WERE IN DIFFERENT AGE GROUPS WE WERE APPROACHING THE
HEARD IMMUNITY THRESHOLD IN SEVERAL PARTS OF THE U.S. WHAT
YOU SEE WHEN YOU, THAT HAPPENS, IS YOU SEE INCREASE NUMBERS AND
MORE FREQUENT OUTBREAKS OF MEASLES.
THIS IS WHAT WE SAID EXACTLY WHEN WE PUBLISHED THIS IN 2016.
WE ALSO LOOKED AT AGAIN WITH DR. BERNARCHEK IN A DIFFERENT
SCENARIO, WHAT WE FOUND WHEN WE LOOK AT HOW MUCH IS MEASLES
BEING BROUGHT IN BY THOSE WHO ARE TRAVELING FROM THE U.S. AND
COMING BACK VERSUS THOSE WHO ARE UNAUTHORIZED IMMIGRANTS.
A LOT OF DEBATES, THERE’S A LITTLE MISCONCEPTION.
WE LOOK AT TOP COUNTRIES WHO WERE FOR THE SOURCES OF
UNDOCUMENTED IMMIGRANTS AND WHERE U.S. RESIDENTS TRAVELED
TO, TURNS OUT MOST OF THE PLACES OR MOST OF THE U.S. VISITORS
COME FROM PLACES WHERE THE MEASLES INCIDENCE IS LOWER THAN
THE U.S. AND WHERE THE VACCINE COVERAGE IS HIGHER THAN THE U.S.
BECAUSE VERY VACCINATION RATE. ON THE OTHER HAND IN THE U.S.
VISITORS GO ARE REASON WHERE THE VACCINE COVERAGE IS MORE AND THE
MEASLES RATES ARE HIGHER. IN FACT WE ESTIMATED THAT YOU
ARE MORE, YOU ARE APPROXIMATELY 10 TIMES MORE LIKELY TO HAVE A
U.S. VISITOR IMPORTING A MEASLES CASE THAN UNAUTHORIZED IMMIGRANT
BRINGING THAT CASE. SO SOME CONTEXT IN THESE KINDS
OF DEBATES, ET CETERA. SO MANDATES FAIR REASONABLY
WELL, EVEN WHEN WE COMPARE THEM TO OTHER INTERVENTIONS.
THIS COMPREHENSIVE APPROXIMATELY 20,000 WORD REVIEW, DONE BY SOME
OF THE BEST PEOPLE IN THE FIELD, FIGURED OUT AND COMPARED SEVERAL
INTERVENTIONS TO INCREASE COVERAGE VACCINATION COVERAGE,
THEY FOUND INCLUDING INTERVENTIONS SUCH AS
PREVENTATIVE HEALTH COMMUNICATION, ON SITE
VACCINATION. DEFAULT AND INCENTIVES FAIRED
WELL BUT ANOTHER INTERVENTION WAS RIGHT UP THERE WITH THESE
INTERVENTIONS THAT SHOWED PROMISE AND HAD POTENTIAL FOR
AND EVIDENCE OF IMPACT WHICH WAS VACCINE REQUIREMENT OR MANDATES.
SO IN THE U.S. JUST TO PROVIDE AN OVERVIEW, THESE ARE STATED
REQUIREMENTS AND MANDATES AS SAID BASED ON STATE LAW,
THEREFORE THERE’S A LOT OF VARIABILITY IN THEM.
I’M ON SLIDE 8. THEY PLAY A MAJOR ROLE IN LOWER
RATES OF VACCINE PREVENTABLE DISEASE.
THEY ALLOW THREE TYPES OF EXEMPTIONS, MEDICAL OR
PHILOSOPHICAL INTERVENTIONS. SLIDE NINE.
AND SO VACCINE EXEMPTIONS ARE CATEGORIZED NON-MEDICALX,
RELIGIOUS OR RELIGIOUS AND MYS SOFTCAL, SO THE WAY WE ASSESS
LAWS IS NOT WHETHER IT SAYS RELIGIOUS VERSUS PHILOSOPHICAL,
NOT JUST TEXT BUT SOMETIMES WRITTEN AS RELIGIOUS EXEMPTION
AND BUT IT IS WRITTEN BROADLY DE FACTO PHILOSOPHICAL EXEMPTION.
SO SLIDE 10 NOW. ANOTHER WAY OF LOOKING AT IT HOW
EASY IT IS TO OBTAIN EXEMPTION. A BALANCE OF CONVENIENCE SLIDES
FOR EXEMPTION. I WILL PRESENT DATA FROM THERE.
WE UPDATED A CDC INDEX CLASSIFIED EASE OF OBTAINING
EXEMPTION OR ADMINISTRATIVE OBTAINING EXEMPTION AND
CATEGORIZE THEM INTO EASY, MEDIUM AND DIFFICULT.
FIRST OFF WE FOUND WAY BACK THAT SLIDE 11 WE FOUND EXEMPTION
POLICIES WERE ASSOCIATED WITH INCIDENCE WHEN WE AGGRESSIVELY
FOR BASELINE FACTORS IN THE STATE.
IF YOU WERE IN A STATE THAT HAD EASY EXEMPTION, THE INCIDENCE
WAS APPROXIMATELY 50% HIGHER COMPARED TO A DIFFICULT
EXEMPTION POLICY STATE. SLIDE 11.
SLIDE 126789 WHEN YOU LOCK IN EARLY 2000, THE RATES OF VACCINE
EXEMPTION WERE KIND OF GOING UP BUT NOT THAT TO UNDERSTAND WAS
NOT THAT CLEAR. WE FOUND WHEN WE CATEGORIZE
STATES BY PERSONAL EXEMPTION VERSUS RELIGIOUS ONLY IT WAS
STATES THAT HAD EXEMPTIONS WHERE THESE RATES ARE GOING UP.
SLIDE 14. AT DIFFERENT PERHAPS BETTER WAY
OF CATEGORIZING THE STATES IS EASY, IMMEDIATE JUDGE VERSUS
DIFFICULT EXEMPTION POLICY AND AT THAT TIME EASY EXEMPTION
POLICIES STATES WERE THE ONES RESPONSIBLE FOR INCREASE OF
NON-MEDICAL EXEMPTION RATES. WHEN WE LOOK IN 2012 WE FOUND
WILD PHILOSOPHICAL EXEMPTIONS HAD
HOWEVER THE ONLY STATES PROTECTED FROM THIS TREND WAS
DIFFICULT EXEMPTION POLICY STATE.
SLIDE 17. SO BACCHANAL 2000 CLUSTERING OF
VACCINE REFUSAL, WE SHOW FOR THE FIRST TIME THAT VACCINE REFUSAL
CLUSTERS ARE FROM MICHIGAN AND WE AND OTHERS HAVE BEEN
REPLICATED IN CALIFORNIA AND NICE HERE MORE NATIONALLY AS
WELL, OVER ALL PHENOMENON USING DIFFERENT APPROACHES, SO BACK IN
2008 WE FOUND THAT THERE WAS CLUSTERING EFFECTS EVER OF OF OF
VACCINE REFUSAL BUT OVERLAP IN CLUSTERING OF, THE REASON WE USE
PERTUSSIS IS IN THE POST ELIMINATION ERA THAT GAVE A
MODEL FOR THAT WAS MORE PREVALENT THAN MEASLES SO WE
LOOK AT IT MORE MICRO LEVEL. THIS IS DECLARED VACCINE REFUSAL
IS ASSOCIATED WITH EPIDEMIOLOGY BUT THAT’S NOT EXCLUSIVE REASON,
WE KNOW PANT OTHER REASONS FOR PRODUCTIVE EPIDEMIOLOGY IN THE
US. WE FOUND IF YOU WERE IF YOU FOUND CENSUS THAT WAS IN AN
EXEMPTION CLUSTER WAS THREE TIMES MORE LIKELY OR HAVE THREE
TIMES HIGHER ODDS OF BEING IN A PERTUSSIS CLUSTER AS WELL
COMPARED TO CLUSTER THAT WAS OUTSIDE AN EXEMPTION CLUSTER.
SO NEXT SLIDE. WE ALSO HAD A NATURAL EXPERIMENT
OR FEW NATURAL EXPERIMENTS WASHINGTON STATE INTRODUCED A
LAW THAT ADDED EDUCATIONAL COUNSELING AND FINE FORM FROM A
LICENSED PROVIDER FOR WASHINGTON, IN ORDER TO OBTAIN
NON-MEDICAL EXEMPTION. NEXT, THE LAW WENT INTO EFFECT
JULY 22, 2011, AND NEXT SLIDE. SHOWS THE IMPACT OF THE CHANGE
IN WASHINGTON EXEMPTION POLICY. SO THERE WAS A TREND LINE OBVIOUSLY SOME VARIABILITY
AROUND THAT TREND LINE. BUT WHAT HE SAW RIGHT AFTER THE
INTRODUCTION OF THIS LAW, BOOM, THERE WAS REDUCTION WHICH WAS
APPROXIMATELY 40% REDUCTION, OVER 40% REDUCTION IN RELATIVE
SENSE, RATES OR EXEMPTION VACCINE REFUSAL RATES.
THE FIRST FOUR YEARS THE RATES WERE CONSISTENT.
SO THEY ADDED A PHYSICIAN COUNSELING REQUIREMENT.
NEXT SLIDE. THINK ABOUT THE FACT THAT AS WE
SUGGESTED, AS I MENTION, THERE IS SUBSTANTIAL HETEROGENEITY AND
CLUSTERING IN TERMS OF VACCINE EXEMPTION, VACCINE REFUSAL RATES
AND THAT WAS TRUE IN WASHINGTON, WE HAD KNOWN FOR AGES, IN THIS
SLIDE AS I SHOW RATES WERE 1.2% COMPARED TO, COUNTY ONE IN FOUR
CHILD WAS EXEMPT FOR ONE VACCINE OR ANOTHER.
EVEN WAY BACK IN EARLY 2000. A SO WE LOOK AT IMPACT OF
WASHINGTON LAW CLUSTERING VACCINE EXEMPTION AND WE FOUND
THAT INITIALLY STARTING FROM 1998 THERE WAS AN INCREASE IN
CLUSTERING OF THESE HOT SPOTS BUT IN 2011 NOT ONLY THE OVERALL
RATE WENT DOWN BUT CLUSTERING WENT DOWN.
HOWEVER THERE WERE A FEW CLUSTERS OF NON-MEDICAL
EXEMPTION AND ESPECIALLY THE ONES TOWARDS THE SOUTH IS WHERE
WE ARE SEEING A LOT OF OUTBREAKS RIGHT NOW.
LESSON IS NOT ONLY LOOK AT OVERALL RATES BUT LOCAL
HETEROGENEITY. GOING TO SLIDE 22, DATA CAME OUT
PUBLISHED IN PEDIATRICS A FEW DAYS AGO, LESS THAN AN WEEK AGO
I RECALL, WHERE WE EVALUATED IMPACT OF CALIFORNIA ELIMINATION
ACTUALLY THREE POLICIES THAT WERE IMPLEMENTED IN QUICK
SUCCESS, AND IMPACT ON DIFFERENT OUTCOMES RELATED TO THE NON-, UP
TO DATE VACCINATION STATUS. SO THE FIRST, THE TOP LAYER IS
CONDITIONAL ENTRANCE, KIDS WHO WERE ALLOWED TO ENTER SCHOOL ON
THE PROMISE THEY’LL GET VACCINATED AND A FEW YEARS AGO A
LOT OF, SOME PARENTS AND SOME SCHOOLS MISUSED OR DID NOT STICK
TO THE SPIRIT OF THIS REQUIREMENT OR EVEN THE LETTER
THEN OVERVIEW WITH THE KIDS WHO ARE NOT VACCINATED AND DON’T DO
CATEGORIES VACCINATION STATUS IS NOT DOCUMENTED TO BE COMPLETE.
THE NEXT CATEGORY IS MANDATES NOT APPLICABLE LARGE SUPPLY
(INAUDIBLE) I’LL. BACK TO INTERVENTIONS IN A
SECOND N FOR EXAMPLE HOME SCHOOLER OTHER PROGRAMS WITH ANY
PROBLEM APPLICABLE AND MEDICAL EXEMPTION THEN IN PURPLE
EXEMPTION. THE EXEMPTIONS WERE, A PHYSICIAN
COUNSELING, THE REQUIREMENT, THAT (INDISCERNIBLE) HAD IMPACT
A LITTLE BIT ONLY A LITTLE BIT OF IMPACT ON CLUSTERING.
THEN THE CONDITIONAL ENTRANCE, CONDITIONAL PROGRAM SCHOOL
PROVIDED MATERIAL AND EDUCATION ON HOW TO IMPLEMENT THE ENTRANCE
MORE DRASTICALLY AND MDM 77 WHICH HAD PROVISION OF
ELIMINATING ALL PB 8 EXEMPTION, WHAT IT DID WAS AFTER THESE
THREE THINGS, THERE WAS AN OVERALL INCREASE IN IMMUNIZATION
RATES. THERE WAS INCREASE, DECREASE IN
MULTIPLE VACCINATIONS BUT WHEN IT CAME TO PBE, IT WAS THE
MAGNITUDE OF SOME OF THE OTHER THINGS LIKE MEDICAL EXEMPTIONS
LIKE NOT APPLICABLE OVERVIEW BUT IN A WAYS REPLACING THE
MAGNITUDE FOR THAT SPECIFIC CATEGORY.
SO IT DID HAVE IMPACT, NEXT SLIDE, THESE IMPACTS, THIS WAS
ON SLIDE 33 I SHOW SOME OLDER DATA WAS IN H LINE WITH WHAT WE
OBSERVED PREVIOUSLY AT THE NATIONAL LEVEL WHEN WE LOOK AT
THE RATES OF MEDICAL EXEMPTION IN SOME STATES THAT HAD
DIFFICULT MEDIUM VERSUS EASY NON-MEDICAL EXEMPTIONS.
WHAT HE FOUND WAS STATES DIFFICULT ON MEDIUM NON-MEDICAL
EXCEPTIONS HAD RELATIVE WILL I HIGH RATES OF MEDICAL
EXEMPTIONS. AND WANTED FULL REPLACEMENT,
DIDN’T COME CLOSE TO THAT, AT THAT TIME, BUT WE DID FIND THAT
IF YOU MADE A NON-MEDICAL EXEMPTION SOME PARENTS WITH
THEIR PROVIDERS SEEK MEDICAL EXEMPTION IN A LITTLE MORE
FREQUENCY. THE NEXT SLIDE IS 24.
WHAT WE SAW THAT’S SPECIALLY 2016, 2017 ERA, THE CLUSTERING,
EVEN IF YOU LOOK AT THE THREE ARROWS THAT I DISCUSSED, AREAS I
DISCUSSED, INITIAL REMOVAL, INITIAL ADDITION OF PHYSICIAN
REQUIREMENTS EDUCATION, SCHOOLS, ET CETERA, OTHER MEASURES TO
REDUCE CONDITIONAL ENTRANCE BUT ELIMINATION OF NON-MEDICAL
EXEMPTION, WHEN YOU SEE THE LAST ERA AFTER ALL, THREE WERE IN
EFFECT, THERE’S REMARKABLE REDUCTION IN CLUSTERING OF
VACCINE REFUSAL. THIS WORK WAS DONE BY
COLLABORATORS SPECIFICALLY (INAUDIBLE) AND AND THIS WORK
SHOWED THE SEVEN CALIFORNIA CLUSTERS WERE VIRTUALLY
ELIMINATED THROUGH THESE THREE INTERVENTIONS.
THERE’S ANOTHER PIECE OF DATA THAT I WANT TO SHARE WE VALUE
WAITED DIFFERENT APPROACHES MODELED USING WASHINGTON DATA,
WHAT WOULD HAPPEN AND HOW EARLY WOULD YOU HAVE UP TO DATE RATES
FOR ALL VACCINES VERSUS POPULATION LEVEL AND WE FOUND
THAT IF YOU HAVE EVEN THE BEST INTERVENTIONS, IMPLEMENTED AND
SO FAR HAVE BEEN IMPLEMENTED AT KINDERGARTEN LEVEL THERE ARE A
LOT OF KIDS IN THE COHORT THERE FROM PREVIOUS YEARS, SHOWED
EARLIER ON THE REFLECTION IF YOU LOOK AT ONE YEAR, KINDERGARTEN
RATES IS REFLECTION OF ONE YEAR DATA.
AND WE SAID THAT IF, UNLESS YOU HAVE APPROXIMATE PROGRAM FOR
PREVIOUS YEARS CATCH UP PROGRAM, IT WILL TAKE AROUND 6, 7 YEARS
TO START SEEING ACTUAL IMPACT ON DISEASE VULNERABILITY.
SO NEXT SLIDE. WHAT DO WE DO, THERE’S
DISCUSSION OF NON-MEDICAL EXEMPTIONS ELIMINATING THOSE BUT
SHORT OF THAT AND THEN THE A LOT OF DATA IN, TO CONSIDER OTHER
OPTIONS WHAT STATES CAN DO IN ADDITION OR INSTEAD OF THAT
DEPENDING ON QUALITY CASE YOU CHOOSE, IS THE FIRST THING IS
FIND A FORM THAT DISCUSSES RISK OF VACCINATION, IN PERSON
COUNSELING WITH PHYSICIAN, REVIEW, LETTER ELABORATING THE
REASON THE CHILD SHOULD BE EXEMPT.
OBTAIN FORM BY SPECIFICALLY REQUESTING STATE AND LOCAL
(INAUDIBLE) DOWNLOADING ONLINE. YOU GO ON LINE, YOU PRINT A
FORM, CHECK OFF THE BOX AND GIVE IT TO, YOU HAND IT TO THE SCHOOL
IF PARENT WAS KEEPING CHILD VACCINATE AND PROTECTING THEIR
OWN CHILD BUT CONTRIBUTING TO COMMUNITY, HAS TO GO TO
APPROXIMATELY FIVE OR SO VISITS BUT EVEN IN THE FIRST YEAR TO
KEEP THE TIME VACCINATING PROTECTING OTHERS SHOULD BE SOME
COMPARISON IN TERMS OF EASE OF OBTAINING EXEMPTION VERSUS
VANNING MAKES. THE LAST, VACCINATION.
THE LAST IS ANNUAL RENEWAL. KEEPING CHILDREN VACCINATE IS AN
ANNUAL PROCESS, ONGOING PROCESS, IT’S REASONABLE TO SAY THOSE WHO
CHOOSE EXEMPT GO THROUGH SOME OF THESE REQUIREMENTS.
IT ALSO HAS IMPLICATION IN TERMS OF HAVING REASONABLE RATES OF
NON-MEDICAL EXEMPTION. SO I WANT TO ACKNOWLEDGE SEVERAL
COLLABORATORS MY TEAM, VALERIE, FALLS WITH A COLLABORATOR,
(INDISCERNIBLE) A LOT OF THIS WORK AND I WANT TO ACKNOWLEDGE
EXTERNAL COLLABORATORS LIKE, AND SOME OF THE OTHERS THAT I HAVE
HAD A PRIVILEGE OF WORKING ON ON SOME OF THESE DATA.
I’LL STOP HERE.>>DR. HOTEZ.>>THANK YOU SO MUCH.
I’LL GO TO THE NEXT SLIDE HERE. SO DR. OMER’S PRESENTATION
REALLY ELOQUENTLY SUMMARIZED THE IMPACT PUBLIC HEALTH IMPACT OF
CLOSING NON-MEDICAL EXEMPTIONS TALK ABILITY WHAT WE HAVE BEEN
DOING IN STATE OF TEXAS AND BRANCHING OUT NATIONALLY.
I COME AT THIS FROM A VERY UNUSUAL POINT OF VIEW.
I’M NOT FORMALLY TRAINED IN VACCINE POLICY OR ADVOCACY.
I’M A LABORATORY INVESTIGATOR M.D. Ph.D. LABORATORY
INVESTIGATOR TRAINED IN PEDIATRICS WHO DEVELOPS VACCINES
FOR POVERTY RELATED NEGLECTED DISEASES BUT ON THE LEFT THERE I
ALSO HAVE FOUR ADULT KIDS INCLUDING RACHEL WHO IS 26 WHO
HAS AUTISM AND A NUMBER OF SEVERE INTELLECTUAL DISABILITIES.
AND SO AS YOU CAN IMAGINE JUST BY HAVING, COMBINING THOSE TWO
FEATURES PUTS ME IN A VERY INTERESTING POSITION WHEN
LOOKING AT THIS RISE IN TIDE ASSOCIATED WITH THE ANTI-VACCINE
MOVEMENT. THE VACCINES THAT WE DEVELOP ARE
ONLY FOR POVERTY RELATED DISEASES.
WE HAVE A VACCINE FOR SCHISTOSOMIASIS IN PHASE 2
CLINICAL TRIALS, THAT IS TAKING PLACE WITH THE HOOK 1 VACCINE.
YOU CAN SEE ON THE MAP THERE, THESE ARE INDEED DISEASES, THESE
ARE VACCINES THAT TARGET DISEASES OF THE POOREST OF THE
POOR PARTS OF AFRICA, POOREST PARTS OF SOUTHEAST ASIA AND, SO
WE HAVE A MULTI-VALENT VACCINE WE’RE ADVANCING.
WE DO A FAIR BIT OF CAPACITY, DEVELOPMENT FOR VACCINES BECAUSE
WE ARE A NON-PROFIT WE TEACH OTHER COUNTRIES HOW TO DO WHAT
WE ARE DOING WHICH IS EARLY TO MID STAGE VACCINE DEVELOPMENT.
I HAD TOOK ON THIS DEVELOPMENT CAPACITY ROLE WHEN I SERVED THE
STATE DEPARTMENT IN THE WHITE HOUSE AS SCIENCE ENVOY, WE
FOCUSED OUR ACTIVITIES IN THE MIDDLE EAST AND NORTH AFRICA,
FOR A VACCINE DEVELOPMENT CAPACITY BUILDING BECAUSE THERE
REALLY IS NONE. SO DISEASES THAT WE ARE SEEING
THE RISE OUT OF THE ISIS OCCUPIED AREAS IN SYRIA AND IRAQ
AND NOW IN YES MEN, THERE IS A DISFIGURING DISEASE, NOBODY IS
MAKING THAT VACCINE SO NOW WE ARE PARTNERING WITH COUNTRIES IN
THE MIDDLE EAST AND NORTH AFRICA FOR THAT PURPOSE.
MY ENTRY INTO THE WORLD OF VACCINE HESITANCY STARTED WHEN
WE MOVE TO TEXAS. BELIEVED OUR GROUP FROM GEORGE
WASHINGTON UNIVERSITY IN 2011 TO TEXAS CHILDREN’S HOSPITAL AND
BAILOR COLLEGE OF MEDICINE TO START A SCHOOL OF TROPICAL
MEDICINE, TO BUILD ON THE RESOURCES OF THE TEXAS MEDICAL
CENTER TO CREATE THE TEXAS CHILDREN’S HOSPITAL CENTER FOR
VACCINE DEVELOPMENT IN ORDER TO EXPAND YOUR PORTFOLIO.
AND WHILE WORKING IN TEXAS, I BECAME AWARE OF THIS.
WHICH IS THIS DRAMATIC INCREASE IN THE NUMBER OF KIDS NOT
GETTING VACCINATE IN H STATE OF TEXAS.
THE MOST RECENT NUMBERS A FEW WEEKS AGO INDICATE MORE THAN
60,000 KIDS ARE NOT GETTING VACCINES IN STATE OF TEXAS SO I
THINK PROBABLY TEXAS HAS THE MOST NUMBER OF KIDS NOT GETTING
THEIR VACCINES. THAT WAS INCREDIBLY ALARMING TO
ME. AND ESPECIALLY WHEN YOU LOOK AT
THE RATE OF THAT INCREASE. BY THE WAY, THESE ARE THE KIDS
WE KNOW ABOUT. BECAUSE TURNS OUT THAT IN THE
STATE OF TEXAS WE HAVE OVER 320,000 HOME SCHOOL KIDS IN THE
STATE OF TEXAS. ANYBODY WANT TO GUESS PERCENTAGE
OF HOME SCHOOL KIDS NOT GETTING THEIR VACCINES IN THE STATE OF
TEXAS? ANYONE WANT TO THROW OUT A
NUMBER? 10% IS?
30%? THE ANSWER IS DRUM ROLL.
WE DON’T KNOW, THEY’RE HOME SCHOOLED.
SO PROBABLY THERE’S PROBABLY BETWEEN 60,000 HOME SCHOOL WE
PROBABLY HAVE OVER 100,000 KIDS NOT GETTING VACCINATE IN THE
STATE OF TEXAS. I BECAME VERY CONCERNED ABOUT
THIS AND BEGAN WRITING AND SPEAKING ABOUT THE DANGERS THIS
POSES TO THE STATE OF TEXAS, PARTICULARLY WITH MEASLES.
I FOCUSED ON MEASLES MORE THAN THE OTHERS BECAUSE AS WE ALL
KNOW ONCE VACCINE COVERAGE DECLINES, MEASLES HAS THE
HIGHEST REPRODUCTIVE NUMBER OF ALL VACCINE PREVENTABLE
DISEASES. AND IS MOST LIKELY THE FIRST ONE
TO RETURN. BUT IT WASN’T JUST MEASLES, WE
HAD A NUMBER OF DEATHS FROM UNVACCINATED KIDS WHO DIED FROM
INFLUENZA, DESPITE RECOMMENDATIONS.
AND WE HAVE A THIRD PROBLEM OF THE HPV VACCINE, WE HAVE ONE OF
THE LOWEST UPTAKE OF THE HIV VACCINE AMONG TEENAGE GIRLS IN
THE COUNTRY. LOOKS LIKE BETWEEN MMR, FLU
VACCINE HPV VACCINE, THESE ARE THE BATTLEGROUND VACCINES IN THE
STATE OF TEXAS. THIS IS WHERE KIDS ARE NOT
GETTING VACCINATED. I’M NOT TOO FOCUSED ON THE
PANHANDLE COUNTIES BECAUSE THE POPULATION THERE IS SO SMALL.
YOU CAN SEE AUSTIN IS BECOMING A DANGEROUS SITUATION IN THE
AUSTIN, TEXAS AREAS AND KNOT TEXAS TOWNS LIKE PLAY KNOW AND
DEN TON AN FORT WORTH, I BECAME VERY CONCERNED THAT WE ARE GOING
TO SEE MEASLES AND OTHER THINGS. IT’S HAPPENING BECAUSE WE HAVE A
AGGRESSIVE ANTI-VACCINE LOBBY IN THE STATE OF TECHS TECHS.
WHAT’S STARTED IN 2015 THE ANTI- THE GROUP ORGANIZED AROUND A
POLITICAL ACTION COMMITTEE CALLED TEXAS FOR VACCINE CHOICE
WHICH RAISES MONEY AND LOBBIES THE STATE LEGISLATURE TO MAKES
IT EASIER TO EXEMPT THE KIDS IN THE STATE OF TEXAS OUT OF
VACCINES AND SOME WAYS HARDER AND HARDER TO VACCINATE THEM.
SO ON SAAD OMER’S LIST TEXAS IS ONE OF THOSE WHERE IT IS QUITE S
I TO OPT OUT. THIS IS HAPPENING THROUGH A
DELIBERATE POLITICAL MOVEMENT NOW IN THE STATE OF TEXAS.
THESE ARE WHAT THE TEXAS TRIBUNE REPORTS ON SOME SCHOOLS, WE
CANNOT GET SPECIFIC INFORMATION ABOUT INDIVIDUAL PUBLIC SCHOOLS
IN THE STATE OF TEXAS BECAUSE THE ANTI-VACCINE LOBBY IS
BLOCKED. ANY TRANSPARENCY ABOUT THAT
INFORMATION, IF YOU ARE A PARENT AND WANT TO SEND YOU KID TO
PUBLIC SCHOOL YOU CANNOT FIND OUT PERCENTAGE OF KIDS NOT
GETTING VACCINATED IN YOUR SCHOOL BUT TEXAS TRIBUNE IS ABLE
TO GET INFORMATION IN PRIVATE SCHOOLS AND YOU CAN SEE THE
VACCINE EXEMPTION RATE, MY OPINION THESE SCHOOLS I’M LISTED
HERE ARE UNSAFE SCHOOLS FOR CHILDREN.
SO MANY KIDS ARE NOT GETTING VACCINATED.
SO I STARTED TO WRITE AND SPEAK ABOUT THIS ISSUE.
BUT THEN I ALSO BECAME CURIOUS TO SEE IS THIS PURELY TEXAS
PHENOMENON OR MORE GENERALIZABLE IN THE UNITED STATES.
AGAIN LABORATORY INVESTIGATORS WE WEREN’T FUNDED TO DO THIS BUT
WORKING WITH A MEDICAL STUDENT AT BAYLOR, JACQUELINE O LIVE
WITH TWO FACULTY MEMBERS, (INDISCERNIBLE) WHO ARE
EPIDEMIOLOGISTS WHO ARE WORKING ON PARACYTIC DISEASES.
WE WROTE AND GOT INFORMATION FROM STATE HEALTH DEPARTMENTS
AND COLLECTED AS MUCH PUBLICLY AVAILABLE INFORMATION AS WE CAN.
WE FOCUSED IN PART INSPIRED BY WHAT SAAD OMER WAS FINDING ON
THE STATE THAT ALLOW THE 18 STATES NON-MEDICAL EXEMPTIONS
FOR REASONS OF PERSONAL OR PHILOSOPHICAL BELIEF.
WE ARE ABLE TO COLLECT INFORMATION ON 14 OF 18 STATES.
THESE ARE THE RISE IN THE 18 STATES, YOU CAN SEE THAT THE
NUMBER OF MMEs, THESE ARE, THE INFORMATION WAS ONLY AVAILABLE
FOR KINDERGARTNERS IS GENERALLY ON THE WAY UP FOR MOST STATES
BUT THEN WHEN WE LOOKED A MAP OF THE UNITED STATES BASED ON 14 OF
18 STATES WE PUBLISH THIS IN THE PUBLIC LIBRARY OF SCIENCE UNTIL
LAST YEAR, THIS IS WHAT WE FOUND.
AS BAD AS TEXAS WAS, IT WAS BY NO MEANS THE WORST.
YOU CAN SEE THAT ARIZONA IS A TRAIN WRECK, UTAH IS A TRAIN
WRECK. IDAHO IS A DISASTER.
WASHINGTON, STATE OF OREGON, NOT MUCH BETTER.
THEN YOU HAVE POCKETS IN WISCONSIN AND MAINE.
OUR OVERALL IMPRESSION IS THAT THERE IS A BIGGER PROBLEM IN THE
WESTERN STATES THAN THE EASTERN STATES.
WE DON’T QUITE UNDERSTAND WHY. SO A LOT OF WHAT WE WERE DOING
IS MORE HYPOTHESIS GENERATING THAN HYPOTHESIS TESTING.
THIS IS LOOKING AT THE PERCENTAGE OF KIDS NOT GETTING
VACCINATED AND IF YOU LOOK AT IDE EYE FOR INSTANCE, IT LOOKS
AWFUL, IDAHO IT LOOKS AWFUL BUT MANY COUNTIES ARE RURAL COUNTIES
WITH SMALL NUMBERS BUT WE ALSO WANT TO GET A SENSE OF IS BIG
URBAN AREAS IN THE UNITED STATES.
WHAT WE DID WAS TO LOOK AT THE DATA DIFFERENT WAY IN TOTAL
NUMBER OF EXEMPTIONS IN ORDER TO GENERATE HEAT MAP OF THE URBAN
AREAS WHERE KIDS ARE NOT GETTING VACCINATED.
THIS IS WHAT IT LOOKED LIKE. AGAIN, TEND TO BE MORE WEST THAN
EAST. OVERALL WE IDENTIFIED 15 URBAN
COUNTIES WHERE LARGE NUMBERS OF KIDS ARE NOT GETTING VACCINATED.
THAT, YOU SEE THERE’S NOTHING IN IDAHO.
BECAUSE THEY’RE VERY SMALL NUMBERS OF INDIVIDUALS IN EACH
COUNTY BUT WHEN YOU LOOK AT THE BIG URBAN AREAS, SEATTLE,
SPOKANE, PORTLAND, OREGON, SALT LAKE CITY.
PHOENIX. SOME OF THOSE TEXAS COUNTIES
INCLUDING TRAVIS, WHICH IS AUSTIN, COLLIN COUNTY WHICH IS
DENTON. UP IN THE DETRIAL AREA.
SO WE WITHOUT ABOUT THESE 15 URBAN HOT SPOT AREAS AND
PREDICTED THESE ARE AREAS WE THINK, IS LIKELY AND NOW IN 2019
IN OUR AMERICAN MEASLES EPIDEMIC WE HAVE MEASLES IN SEVEN OF 15
COUNTIES SO WE WOUND UP MAKING A GOOD MEASLES PREDICTION MAP.
THE ONE BIG ONE WE MISSED WAS THE ONE IN NEW YORK BECAUSE
THAT’S NOT A STATE THAT ALLOWS NON-MEDICAL EXEMPTIONS FOR
REASONS OF PERSONAL OR PHILOSOPHICAL BELIEF.
AT THAT TIME WHEN WE RATE THIS WE THOUGHT RELIGIOUS EXEMPTIONS
WERE NOT AS CRITICAL AS PHILOSOPHICAL AND PERSONAL
BELIEF EXEMPTIONS. AND SAAD OMER’S DATA BEARS THAT
OUT BUT WHAT WE ARE SEEING OF COURSE IN THE STATE OF NEW YORK
IS VERY MUCH THE SITUATION WE SAW EARLIER IN MINUTE, RESEMBLES
WHAT WE SAW IN MINNESOTA WHERE THERE WAS DELIBERATE TREPIDATION
LEADERS OF THE ANTI-VACCINE MOVEMENT EXHIBITED PREDATORY
BEHAVIOR SWOOPED IN, DESCENDED ON THE SOMALI IMMIGRANT
POPULATION TO DECLINE THE MEASLES COVERAGE AND NOW WE SEE
IN THE ORTHODOX COMMUNITY IN NEW YORK SO THIS THERE’S NO WAY TO
PREDICT IN TERMS OF MAP. HAVING SAID THAT, THIS ALSO
LOOKS AT, SHOWS A ROUGH CORRELATION BETWEEN THE DECLINE
IN THE INCREASE IN NON-MEDICAL EXEMPTIONS AND LOWERING OF
MEASLES, MUMPS RUBELLA MOWNIZATION RATES BUT NOT AS
WHAT SAAD OMER DID. RECENTLY MY COLLEAGUE AT
UNIVERSITY OF TEXAS AUSTIN, PROFESSOR SARCAR HAS TAKEN OUR
VERSION 1.0 AND EXPANDED AND IMPROVED ON IT BY NOT ONLY
LOOKING AT THE NON-MEDICAL EXEMPTIONS FOR REASONS OF
PERSONAL PHILOSOPHICAL BELIEF BUT ALL COUNTIES IN THE UNITED
STATES IN TERMS OF EXEMPTIONS BUT IN A CLEVER ADDITION WHAT HE
DID WAS TO LOOK AT AIRLINE HUB TRANSPORTATION.
KNOWING THAT SO MANY OF THE, WHAT IS IGNITING MEASLES IN THE
UNITED STATES IS IMPORTATION FROM ASIAN COUNTRIES BUT
ESPECIALLY FROM EUROPE RIGHT NOW BECAUSE EUROPE HAD 80,000
MEASLES CASES LAST YEAR. I THINK THAT WAS A VERY CLEVER
IDEA BECAUSE IT PROVIDES A LITTLE MORE NUANCE BUT YOU CAN
SEE THE SAME COUNTIES WERE IDENTIFIED BUT SOME NEW ONES POP
UP IN FLORIDA, AND IT BRINGS OUT THE ONES IN NEW YORK AS WELL.
SO THOSE ARE THE MAJOR POINTS I WANTED TO MAKE.
REALLY STRUGGLING TO COMBAT THIS VERY ACTIVE ANTI-VACCINE
MOVEMENT IN THE STATE OF TEXAS WE ARE A BIT OUTGUNNED IN THE
STATE OF TEXAS. ONE OF THE THINGS WE TRY TO DO
IS NOT ONLY POINT OUT HOW PROVIDE THE EVIDENCE SHOWING NO
LINK BETWEEN VACCINES AND AUTISM, WE SUMMARIZE NOW LOTS OF
INFORMATION THAT LINK IT IS MMR VACCINES TO AUTISM AS WAS
ORIGINALLY ALLEGED, THEN THE THIMEROSAL PRESERVATIVE THAT
USED TO BE IN VACCINES, SPACING VACCINES TOO CLOSE TOGETHER, NOW
IT’S ALUMINUM SO THE ANTI-VACCINE LOBBY PLAYS THIS
GAME OF VACCINE WHACK A MOLE, KNOCK ONE DOWN THE OTHER POPS UP
SO WE ALSO DO WITH RACHEL THERE SHOWING THE CHANGES IN BRAINS OF
AUTISM ARE HAPPENING IN EARLY FETAL DEVELOPMENT SO IT’S PAPERS
LIKE THIS SO THE BROAD INSTITUTE HARVARD MIT HAS NOW IDENTIFIED
MORE THAN 99 GENES LINKED TO AUTISM ALL THEM INVOLVED IN
EARLY FETAL BRAIN DEVELOPMENT HAPPENING IN EARLY ON IN
PREGNANCY T. WHAT WE NOW DO WHOLE EXOME SEQUENCING WE DO
THIS WITH RACHEL AND MY WIFE ANN AND I AND ABLE TO IDENTIFY ONE
OF THOSE GENES WHICH IS INVOLVED IN A NEURONAL CYTOSKELETON GENE
INVOLVED IN NEURONAL CONNECTIONS SO 25% OF THE 99 GENES IN THE
ORAL CYTOSKELETON, THAT MAKES SENSE WHEN YOU THINK ABOUT THE
NATURAL HISTORY OF AUTISM. SO I’LL STOP THERE.
THIS IS THE NEW BOOK I HAVE WRITTEN WHICH YOU CAN IMAGINE
GENERATING A LOT OF INTEREST. IT’S GOT THE VERY STRAIGHT
FORWARD VACCINES DO NOT CAUSE RACHEL’S AUTISM, WHICH LAYS OUT
IN A STRAIGHT FORWARD MANNER THE EVIDENCE SHOWING THERE’S NO LINK
BETWEEN VACCINE AND AUTISM. BUT ALSO MASSIVE EVIDENCE ABOUT
WHAT AUTISM IS TO PROVIDE THAT COUNTER NARRATIVE HOW IT BEGINS
IN EARLY FETAL BRAIN DEVELOPMENT AND THE CHALLENGES OF RACHEL AND
MY WIFE ANN AND I FACE IN TERMS OF RACHEL GAINING EMPLOYMENT
WITH INTELLECTUAL DISABILITIES ADS WELL AS MENTAL HEALTH
COUNSELING AND ALL THE OTHER STRUGGLES THAT AUTISM FAMILIES
HAVE. THAT’S A VERY BRIEF OVERVIEW,
HAPPY TO MOVE ON TO THE NEXT SPEAKER.
THANK YOU. [APPLAUSE]>>MS. SHIPP, PLEASE.>>I’M GLAD TO BE WITH EVERYONE
TODAY. TODAY WE’RE GOING TO GO OVER
SOME MISSISSIPPI LEGISLATION ON OUR IMMUNIZATION COMPLIANCE.
OUR ACTUAL IMMUNIZATION REQUIREMENTS REGARDING SCHOOL
AND LICENSED CHILD CARE FACILITIES.
HOW WE REGULATE THIS LEGISLATION AND THEN ACTUALLY SHOWING YOU
WHAT OUR VACCINATION COVERAGE RATES ARE COMPARING OUR REQUIRED
VACCINES WITH OUR RECOMMENDED VACCINES.
THEN ALSO TALKING ABOUT SOME SUCCESSFUL PARTNERSHIPS THAT WE
HAVE REALLY NEEDED TO BE SUCCESSFUL IN OUR STATE.
OUR MISSISSIPPI CODE THAT WE HAVE, OUR LAW IS 41-23-37.
IN THIS LAW IT STIPULATE THAT OUR STATE HEALTH OFFICER IS THE
ONE TO DETERMINE IMMUNIZATION PRACTICES FOR THE BEST
PREVENTION OF, FOR PREVENTING VACCINE PREVENTABLE DISEASES.
OUR LAW ALSO GOES INTO DEFINING WHAT A SCHOOL IS AND SO THAT IS
SET AS PUBLIC, PRIVATE OR KINDERGARTEN.
BUT ALSO TO ENSURE THAT WE DON’T MISS ANYTHING, IT ALSO SPECIFIES
SIMILAR TYPES OF FACILITY INTENDED FOR THE INSTRUCTION OF
CHILDREN. THE ONLY TYPE OF SCHOOLING THAT
DOES NOT FALL UNDER THIS LAW THE EXCEPTION IS LEGITIMATE HOME
INSTRUCTION PROGRAMS, THOSE ARE ACTUALLY DEFINED WITHIN ANOTHER
LAW IN MISSISSIPPI. SO OUR CERTIFICATE OF
VACCINATION IN THE LAW, GOES ON TO STATE THAT OUR CERTIFICATE OF
VACCINATION MAY ONLY BE ISSUED ON FORMS THAT ARE SPECIFY BY THE
MISSISSIPPI STATE BOARD OF HEALTH AND THAT OUR ONLY
EXEMPTIONS IN MISSISSIPPI ARE FOR MEDICAL PURPOSES AND THOSE
MAY ONLY BE APPLIED FOR BY A DULY LICENSED PHYSICIAN ON
BEHALF OF A CHILD. THEN OUR LAW ALSO INCLUDES THAT
THE, THAT ALL SCHOOLS BOTH PUBLIC AND PRIVATE ARE REQUIRED
TO REPORT IMMUNIZATION COMPLIANCE STATUS OF ALL
ENROLLED CHILDREN IN OCTOBER AND DECEMBER EACH YEAR TO THE STATE
DEPARTMENT OF HEALTH. SO THE VACCINES WE REQUIRE IN
MISSISSIPPI FOR K-4 THROUGH 12th GRADE ARE YOUR DTAP,
POLIO, HEPATITIS B, MMR, VARICELLA AND OUR MOST RECENT IS
TDEP FOR 7TH GRADE ENTRY, THAT WAS INTRODUCED IN 2012.
OUR LICENSED CHILD CARE FACILITY REQUIREMENTS ARE VERY SIMILAR
EXCEPT HIS PNEUMOCOCCAL WERE ADDED IN EARLY 2000s.
SO THIS IS ACTUALLY HOW MISSISSIPPI REGULATE COMPLIANCE.
WE UTILIZE CERTIFICATE OF IMMUNIZATION COMPLIANCE FORM
WHICH EVERYONE IN THE STATE OF MISSISSIPPI LOVINGLY REFERS TO
AS FAMILIAR AS THE FORM 121. SO THIS IS REQUIRED FOR
ATTENDANCE TO ANY SCHOOL, K-4 THROUGH 12th GRADE, ANY HIGH
SENTENCED CHILD CARE FACILITY. THESE FORMS ARE REQUIRED TO BE
ON SITE AT ALL TIMES FOR ALL CHILDREN.
THE FORM IN AND OF ITSELF IS AVAILABLE TO ALL MEDICAL
PROVIDERS FOR ISSUANCE OUT OF OUR MISSISSIPPI IMMUNIZATION
REGISTRY, THE GRAY PORTIONS YOU SEE ON THIS FORM ARE ACTUALLY
PRE-POPULATED WITHIN OUR MISSISSIPPI REGISTRY AND
ACCESSIBLE TO THE MEDICAL PROFESSIONALS TO BE ABLE TO
PRINT OUT. THIS IS THE BOTTOM PART OF THE
FORM. THIS IS THE PART WHERE MEDICAL
PROFESSIONALS ARE ABLE TO VALUE DADE COMPLIANCE AND DENOTES
WRITE LEVEL OF COMPLIANCE THERE IS, WHATEVER THE CHILD IS S
COMPLIANT OR COMPLETE FOR K 4 THROUGH 6 GRADE OR COMPLETE FOR
7TH GRADE AND OLDER. THESE SIGNED BY MEDICAL
PROFESSIONAL. SO THAT CAN INCLUDE PRESCRIBING
PROVIDERS. OUR PHARMACISTS OR OUR LICENSED
NURSES IN THE STATE OF MISSISSIPPI.
NOW IN ORDER FOR A CHILD TO RECEIVE A MEDICAL EXEMPTION FROM
THAT SCENE IN THE STATE OF MISSISSIPPI, IT IS REQUIRED THAT
A PHYSICIAN WHO IS LICENSED IN THE STATE OF MISSISSIPPI
COMPLETES THIS MEDICAL EXEMPTION REQUEST FORM.
KNOWN AS FORM 139. SO BASICALLY THE TOP OF THIS
FORM, I HAVE IT UP HERE FOR YOU TO LOOK AT, IT HAS THE CHILD
BASIC INFORMATION, THESE FORMS MAYBE SUBMITTED BY THE CHILD
PEDIATRICIAN FAMILY PHYSICIAN OR INTERNIST LICENSED IN
MISSISSIPPI. CHILD OUT OF STATE TERTIARY CARE
PHYSICIAN IF WE RECEIVE ONE OF THOSE ON THE CHILD THAT RESIDES
INSIDE OF MISSISSIPPI THOSE ARE REVIEWED ON A CASE-BY-CASE
BASIS. EACH VACCINE REQUIRES
DOCUMENTATION OF EXEMPTION STATUS.
WHETHER THAT’S GOING TO BE PERMANENT, TEMPORARY WHICH IS
GOING TO REQUIRE AN EXPIRATION DATE OR NO EXEMPTION AT ALL.
SO THE BOTTOM PART OF THIS FORM REQUIRES DOCUMENTATION REQUIRED
OF THE REQUESTING PHYSICIAN. SO THAT PHYSICIAN IS GOING TO
HAVE TO STATE THE REASON FOR MEDICAL EXEMPTION, THEIR
PERSONAL CONTACT INFORMATION FOR THEIR CLINIC, THEN THEY’RE GOING
TO HAVE TO INCLUDE AND SIGN A DECLARATIVE STATEMENT TO
VALIDATE THEIR DECISION FOR THAT VACCINE EXEMPTION REQUEST.
AND THEN ALSO ENSURE APPROPRIATE EDUCATION PROVIDED TO THE PARENT
OR GUARDIAN. EXCUSE ME.
THEY ALSO HAVE TO INCLUDE THEIR MISSISSIPPI MEDICAL LICENSE
NUMBER AND MPI NUMBER. THESE NUMBER ARE RECEIVED A THE
CENTRALIZED MISSISSIPPI STATE DEPARTMENT OF HEALTH CENTRAL
OFFICE, THEY ARE ONLY REVIEWED BY OUR STATE EPIDEMIOLOGIST OR
DEPUTY STATE EPIDEMIOLOGIST. NOW, EITHER ONE OF THESE
PHYSICIANS DO NOT VALIDATE THESE MEDICAL EXEMPTIONS.
THEY SIMPLY MAKE CERTAIN THAT ALL REQUIRED DOCUMENTATION HAS
BEEN COMPLETED. ONE THAT HAS BEEN ESTABLISHED,
THEN THEY WILL ISSUE A FORM 122, MISSISSIPPI MEDICAL CERTIFICATE
OF EXEMPTION. THESE ARE ACCEPTED IN BOTH
SCHOOLS, PUBLIC AND PRIVATE, AS WELL AS LICENSED CHILD CARE
FACILITIES. AND OFTEN TIMES SCHOOLS AND
CHILD CARE FACILITIES ARE UNFAMILIAR WITH WHAT THIS FORM
LOOKS LIKE, THEY WILL CALL TO VERIFY WITH US THAT THIS IS AN
ACTUAL TRUE MEDICAL EXEMPTION FORMS THEY ARE ALLOWED TO
ACCEPT. THE ORIGINALS ARE FILED WITH US
AT OUR CENTRALIZED MSDH OFFICE BECAUSE DURING A THREAT OF A
VACCINE PREVENTABLE DISEASE OCCURRING IN THIS COMMUNITY, THE
CHILD MAY BE EXCLUDED FROM THE SCHOOL OR LICENSED CHILD CARE
FACILITY PER MSDH GUIDANCE. PART OF THAT VALIDATION PROCESS
WHEN THE REQUESTING PHYSICIAN APPLIES FOR AN EXEMPTION, THAT
IS ALSO PART OF THE EDUCATION THEY HAVE TO PROVIDE TO THE
PARENT. SO WHAT THIS IS HERE IS THIS IS
INFORMATION ON HOW MANY CHILDREN IN THE STATE OF MISSISSIPPI,
KINDERGARTEN THROUGH 12th GRADE HAVE A COMPLETE
CERTIFICATE OF IMMUNIZATION OF COMPLIANCE BY OUR GEOGRAPHIC
REGION. YOU CAN SEE FOR A TOTAL FOR
WHOLE STATE IT’S 99.7%, WHICH IS WONDERFUL.
NOW, THIS YOU CAN SEE ARE OUR KINDERGARTNERS.
SO THIS IS OUR MOST RECENT SET OF KINKED GARNERS, THIS IS OUR
2018, 20, KINDERGARTNERS. OUR 2018, 19 SCHOOL YEAR AND THE
NUMBERS ARE STARTING TO LOOK LOWER WHEN YOU CONTRAST THAT TO
THE 99.7% FOR THE STATE FOR KINDERGARTEN THROUGH 12 GRADE
AND LOOK AT 99.2% FOR THE WHOLE STATE WHEN YOU LOOK AT JUST
KINDERGARTNERS. SO THIS IS ACTUALLY BEEN OUR
RISE IN MEDICAL EXEMPTIONS OVER THE PAST SEVERAL YEARS, SO SOME
DIFFERENT PROCESS CHANGES OCCURRED IN 2015, 2016 WHERE WE
BEGAN CENTRALIZING THE PROCESS, AND THEN IN 2016, 2017 SCHOOL
YEAR OUR STATE EPIDEMIOLOGISTS DO NOT VALIDATE THOSE MEDICAL
EXEMPTIONS THEY SIMPLY ENSURE THAT WE HAVE ALL REQUIRED
DOCUMENTATION AND YOU CAN SEE THE CLIMB IN THAT.
THIS SHOWS A LARGE DIFFERENCE BETWEEN IMMUNIZATIONS REQUIRED
IN MISSISSIPPI VERSUS IMMUNIZATIONS RECOMMENDED.
SO EVERYTHING IN GREEN IS REQUIRED.
YOU CAN SEE WE EASILY STAY, THIS IS NIS CHILD FOR 19 TO 35
MONTHS. YOU CAN SEE WE STAY IN THE
’80s AND ’90s FOR REQUIRED VACCINATIONS.
LOOK HOW LOW WE DROP ON ROTAVIRUS, AND HEPATITIS A WHICH
IS AT 49.8%. THIS GIVES YOU A DIRECT
CORRELATION BETWEEN VACCINES THAT ARE RECOMMENDED, VERSUS
VACCINES THAT ARE REQUIRED. AND THE DISPARITY IN THOSE
PERCENTAGES. FROM THIS IS OUR NIS TEAM
VACCINATION COVERAGE RATE AND SO IN THE 2012, 13 SCHOOL SEASON
THAT’S WHEN TDEP FOR 7TH GRADE ENTRY BECAME A REQUIREMENT IN
MISSISSIPPI. SO YOU’LL NOTICE IN 2012 OUR
TDEP IMMUNIZATION RATE JUMPED UP TO 53.5%.
YOU CAN SEE THE CONSECUTIVE INCLINE EACH YEAR WHEREAS NOW WE
ARE UP TO 92.4%. OUR MMR REMAINS STEADY,
VARICELLA HAS BEEN INCREASING OVER THE YEARS.
OUR ONE DOSE VARICELLA WAS A REQUIREMENT IN 2002, AND THEN
OUR TWO DOSE VARICELLA REQUIREMENT, BECAME A
REQUIREMENT IN 2008. SO IT TAKES TIME WHEN LOOKING AT
13 TO 17-YEAR-OLDS TO BE ABLE TO SEE THE INCREASE IN DIFFERENCE
IN OUR IMMUNIZATION COVERAGE RATES BUT WE EVENTUALLY GET
THERE, IT JUST TAKES TIME WHEN YOU ARE LOOKING AT OLDER
CHILDREN, AS FAR AS TEAMS. AND THEN OUR HEPATITIS B IS A
REQUIREMENT SINCE 1999. WE HOLD STEADY WITH THAT.
WHEN YOU LOOK AT MENINGOCOCCAL AND HPV RECOMMENDED VACCINES,
THOSE VACCINATION COVERAGE RATES ARE MUCH LOWER THAN THE
REQUIRED. SOME OF THE SUCCESSFUL
PARTNERSHIPS WE CAN ATTRIBUTE THIS TO REGARDING VACCINE ACCESS
AND COMPLIANCE VALIDATION, OUR STATEWIDE MEDICAL PROFESSIONALS
ARE JUST FABULOUS IN FINDING ALL THOSE 121 FORMS MAKING SURE TO
ADMINISTER THE VACCINE ACROSS THE STATE.
THE MISSISSIPPI DEPARTMENT OF EDUCATION AND OUR MSDH LICENSURE
DIVISION WORKED TIRELESSLY WITH US TO MAKE SURE THAT THEY
MAINTAIN COMPLIANCE ASSURANCE THROUGH AUDIT PROCESSES.
SO THAT’S AN INTEGRAL PIECE OF THIS.
I CAN’T SAY ENOUGH GOOD THINGS ABOUT OUR MISSISSIPPI CHAPTER OF
AAP, MISSISSIPPI PUBLIC HEALTH ASSOCIATION WHO GO TO GREAT
EFFORTS TO ADVOCATE ON OUR BEHALF IN THIS.
FROM THANK YOU SO MUCH. I APPRECIATE THIS OPPORTUNITY.>>DR. PAN.>>GOOD MORNING.
MY NAME IS DR. RICHARD PAN, I’M A PEDIATRICIAN AND STATE SENATOR
REPRESENTING THE SACRAMENTO REGION IN THE STATE OF
CALIFORNIA TO GIVE YOU A LITTLE BACKGROUND ON MYSELF, ACTUALLY I
CAME TO CALIFORNIA AFTER I FINISHED MY TRAINING, ACTUALLY
UP IN BOSTON. I WAS A RESIDENT IN MASS GENERAL
PEDIATRICS LIKE DR. HOTEZ, SOMETHING IN THE WATER THERE.
WHEN I WAS IN MEDICAL SCHOOL, I WAS, MEDICAL SCHOOL AT THE
UNIVERSITY OF PITTSBURG, I DID THE STINT AS CO-STEP OFFICER
OVER IN PHILADELPHIA, IN 1991, AND MOST PEOPLE THINK ABOUT THE
GULF WAR GOING ON THERE BUT THE VACCINE ADVISORY COMMITTEE LARGE
MEASLES OUTBREAK GOING ON IN PHILADELPHIA AND I DIDN’T KNOW
DR. OF FETE AT THE TIME BUT, OFFIT AT THE TIME BUT I WAS A
OFFICER WORKING IN CLINIC IN PHILADELPHIA AND SAW MY FIRST
CASE OF MEASLES. THAT WAS A OUTBREAK THAT
AFFECTED OVER 900 PEOPLE GOT INFECTED, NINE CHILDREN DIED.
WHEN I WAS IN MEDICAL SCHOOL THEY SAID YOU WON’T SEE A
MEASLES UNLESS OVERSEAS. I GOT TO SEE MEASLES FIRSTHAND.
AFTER I FINISHED MY TRAINING, I WENT TO UNIVERSITY OF CALIFORNIA
DAVIS TO BE FACULTY MEMBER, MY MAIN INTEREST WAS ACTUALLY ON
ISSUES ON SOCIAL DETERMINANTS OF HEALTH, I WAS TRAINING DOCTORS
HOW TO BE INVOLVED IN THE COMMUNITY, LOOKING AT HOW DO
VARIOUS SOCIAL DETERMINANTS OF HEALTH AFFECT THE HEALTH OF
CHILDREN. I WAS RECOGNIZED BY MEDICAL
BOARD OF CALIFORNIA, PHYSICIAN HUMANITARIAN OF THE YEAR BECAUSE
MY WORK IN THAT AREA SORT OF DONE LOCAL COMMISSIONS TO AGAIN
ADDRESS SOME OF THOSE ISSUES. BUT ALWAYS VACCINATION WAS IN
THE BACK OF MY MIND, MY EXPERIENCE IN FILL TELL FEEIA,
MY, PHILADELPHIA, MEDICAL TRAINING, NOTED THAT AS LEADER
IN OUR LOCAL AMERICAN ACADEMY OF PEDIATRICS CHAPTER IN DISTRICT
IN CALIFORNIA, THE PERSONAL BELIEF EXEMPTIONS ARE RISING.
I RAN FOR THE CALIFORNIA STATE LEGISLATURE IN 2010 AND MY
ELECTION MAINLY LOOKING AT AGAIN THE ISSUES AFFECTING CHILDREN
RELATED TO THE GREAT RECESSION. THAT’S WHY I RAN.
SIMULTANEOUSLY WE EXPERIENCED PERTUSSIS OUTBREAK AT THE TIME.
THERE WERE TEN INFANTS WHO DIED OVER 800 INFANTS HOSPITALIZED.
9,000 INFECTIONS. THE CALIFORNIA LEGISLATURE THAT
WAS BEFORE I WAS THERE. ACTUALLY ADDED THE TDAP
RECOMMENDATION FOR 7TH GRADE IN RESPONSE TO THAT OUTBREAK.
AFTER I GOT ELECT TO THE LEGISLATURE I KNEW THAT WE NEED
TO DO SOMETHING ABOUT THE RISE IN OUR PERSONAL BELIEF
EXEMPTIONS, I SHOULD MENTION THAT CALIFORNIA AT THAT TIME ONE
COULD ARGUE PERHAPS ONE OF THE MOST LAX STATES IN THE COUNTRY.
BASICALLY YOU DON’T WANT YOUR CHILD VACCINATED YOU SIMPLY
SIGNED THE STATEMENT, THAT WAS IT YOU WERE DONE.
NOTHING ELSE YOU NEEDED TO DO. SOME PEOPLE TALKED TO ME SAID WE
NEED TO DO WHAT THE STATE OF WASHINGTON DID.
STATE OF WASHINGTON JUST PASSED LEGISLATION SAYING YOU NEED TO
TALK TO A LICENSED HEALTHCARE PROFESSIONAL TO GET A PERSONAL
BELIEF EXEMPTION SO I AUTHORED, I KNOW NINE, YOU SEE I AUTHORED
THREE BILLS ON VACCINES, AB 2109, SB 277 WE I LIMBNATES
NON-PERSONAL BELIEF EXEMPTIONS AND I’M CURRENTLY AUTHORING AND
GOING THROUGH LEGISLATURE SV 276 TO ADDRESS MEDICAL EXEMPTIONS.
NOW, SO IN TERMS OF THAT PARTICULAR BILL, WE GOT IT
THROUGH AND DR. OMER TALKED THE RESULTS OF THAT PARTICULAR BILL
BUT I WANT TO TALK ABOUT THIS JOURNEY FROM THE LAX STATE IN
THE COUNTRY TO A STATE WHERE WE ARE TRYING TO RESTORE COMMUNITY
IMMUNITY. PART OF REASON I HAVE ALL THE
SOCIAL MEDIA STUFF ON THE BOTTOM OF THE SLIDE IS TO REMIND ALL OF
US THAT PART OF THE BATTLE WE ARE WAGING IN TERMS OF VACCINE
COMPETENCE IS IN SOCIAL MEDIA. IT’S ALLOWED PEOPLE WHO DO NOT
SUPPORT VACCINES LEADERS OF THE ANTI-VAX MOVEMENT TO REACH OUT
AND CONNECT THE PEOPLE, TO BRING THEM, DRAW THEM INTO ECHO
CHAMBERS WHERE THEY EXCLUDE SCIENCE INFORMATION.
IF YOU TRIED GOING IN THERE, YOU POST ANYTHING THAT IS NOT
ACCURATE, THAT’S WHAT VACCINES YOU ARE KICKED OUT.
SO THEY SHIELD, THEY DEFINITELY TRY TO PUT WALLS AROUND IT.
NOT ONLY THAT, THEY USE THAT AS A FORM OF ORGANIZATION TO
INTIMIDATE AND HARASS ANYONE WHO POSTS PRO VACCINE NOT JUST
PROSCIENCE INFORMATION, PARENTS WHO SIMPLY TALK ABOUT THEIR
CHILD WHO DIED OF VACCINE PREVENTABLE DISEASE, WILL GET
ATTACKED ON SOCIAL MEDIA BY THESE PEOPLE.
THINK ABOUT IT, A PARENT WHO IS NOW SUFFERING THE LOSS OF THEIR
CHILD, FROM FLU, OR FROM OTHER SOME OTHER VACCINE PREVENTABLE
DISEASE GETS ATTACKED. PHYSICIANS WHO SIMPLY POST WE
ARE PROVYING VACCINATIONS FOR HPV FOR CHILDREN IN OUR
PRACTICE. GET ATTACKED.
AND THEN WHAT HAPPENS THEY GANG UP AND DOWN RATE THEM ON YELP
AND OTHER THINGS TO ATTACK THE PRACTICE’ REPUTATION.
CERTAINLY, THE ELECTED OFFICIAL WE GET ATTACKED FOR LOTS OF
THINGS BUT CERTAINLY NOT JUST ISSUE OF SPREADING
MISINFORMATION, IT’S ALSO ABOUT ATTACKING ANYONE WHO SPREADS
ACCURATE INFORMATION. SUPPRESSING THOSE VOICES.
I THINK WE HAVE TO THINK ABOUT THAT.
BECAUSE WE OFTEN TALK ABOUT WE NEED TO EDUCATE PEOPLE.
IT’S NOT JUST WE’RE TRYING TO COME TEND WITH VACCINE
MISINFORMATION BUT WITH PEOPLE WHO TRY TO SUPPRESS ANYONE WHO
TRIES TO EXPRESS SUPPORT. THAT BECOMES ADDITIONAL
CHALLENGE. SOME PEOPLE ASK, WHAT DID WE
LEARN? WHEN I DID AV 12009 I SAID OKAY
WE GOT LAYERS SO I SAID OF COURSE HERE IS THE SCIENCE.
WE KNOW THE SCIENCE. WE SAY WE HAD, WE NEED TO
PERSONAL BELIEF EXEMPTION RATES HIGH, STATE OF WASHINGTON DID
SOMETHING, THEY DROPPED THEIR PERSONAL BELIEF EXEMPTION RATE,
WE NEED TO TRY TO PROTECT OUR KIDS, SO OF COURSE WE GET
DOCTORS, PEDIATRICIANS AND DOCTORS SAYING THIS IS
IMPORTANT. WE GET SCIENTISTS THAT SAY
THEY’RE IMPORTANT. THEN THE OPPOSITION BRINGS
PARENTS WHO SAY MY CHILD IS VACCINE INJURED.
AND SO WHILE I HAVE I WAS SUCCESSFUL IN PASSING THAT BILL
I RECOGNIZE WE CANNOT BE SUCCESSFUL IN COMMUNICATING
UNLESS WE ORGANIZE THE PRO-SCIENCE PARENTS.
THEY ARE THE MAJORITY. THEY ARE OUT THERE.
EVERY POLL SHOWS THAT VAST MAJORITY, 80 PLUS PERCENT OF
PARENTS WANT CHILDREN TO BE VACCINATED AND BE REQUIRED TO BE
VACCINATED FOR SCHOOL BUT NO ONE IS ORGANIZING THEM.
NO ONE IS PUTTING IT TOGETHER. SO THE ANTI-VACCINE GROUPS BY
THE WAY THEY SPENT AT LEAST HALF A MILLION DOLLARS OPPOSING SB 2
7, HIRED TOP LOBBYISTS, THE ONES WILLING TO TAKE THEIR MONEY.
SO WHO IS LOBBYING FOR VACCINES? WE KIND OF HOPE MEDICAL
ASSOCIATION PUTS THEM, THEY’LL DO THAT, ET CETERA BUT THAT’S
WHAT WE ARE UP AGAINST, DR. OTEZ, HOTEZ TALKED ABOUT THE
ANTI-VACCINE LOBBY IN TEXAS. THEY WAGE CAMPAIGNS, HIRE
LOBBYISTS AND TALKING TO LOBBYING, MOST WILL ACCEPT THEIR
MONEY BUT THEY PAY TOP DOLLAR, THEY ARE WILLING TO PAY TOP
DOLLAR. SO SOMEONE NEEDS TO ORGANIZE PRO
VACCINE,, THAT’S WHAT WE DID WITH 277, WE CANNOT JUST HAVE
SCIENTISTS AND DOCTORS GO AND SAY THIS IS THE RIGHT THING TO
DO, HERE IS THE EVIDENCE. WE HAVE TO ORGANIZE THE
PRO-SCIENCE PARENTS TO SAY WE DEMAND THAT LEGISLATORS DO THEIR
JOB AND PROTECT THE PUBLIC THAT’S OUR JOB.
GOVERNMENT JOB TO PROTECT THE PUBLIC.
WE NEED YOU TO PROTECT THE PUBLIC.
WE CANNOT HAVE SCHOOLS WHERE RATES IMMUNIZATION RATES BELOW
10%. BELOW 90% OR 95%, THAT’S NOT
SAFE. THERE ARE CHILDREN, THE ONES WHO
NEED MEDICAL EXEMPTION NEED THE REST OF THEM TO BE, EVERYONE
ELSE TO BE VACCINATED. OTHERWISE IT’S NOT SAFE.
WE HAVE PARENTS OF CHILDREN TRANSPLANTS TESTIFY ABOUT I’M
WORRIED ABOUT MY CHILD BEING GOING TO SCHOOL.
BECAUSE IMMUNIZATION RATES. WE HAVE TO ORGANIZE PARENTS.
WE ORGANIZE PARENTS, VACCINATE CALIFORNIA.
PARENTS CAME TOGETHER. THEY NOT ONLY SPOKE AT THE BILL
IN THE STATE HOUSE, THEY LOBBIED THE SCHOOL DISTRICTS AND TOLD
THEM TO ADOPT RESOLUTION TO SUPPORT.
THEY WENT TO COUNTY AND SUPERVISORS.
THEY WENT TO TALK TO THEIR CITY COUNCILS.
THEY COMMUNICATED WITH EACH OTHER.
THEY TALKED TO THE MEDIA. BY THE WAY, WHAT YOU DON’T WANT
IS YOU DON’T WANT MEDIA SITUATION WHERE YOU HAVE A
DOCTOR BASICALLY TELLING A PARENT WHO SAYS THEIR CHILD IS
VACCINE INJURED THAT THEY’RE WRONG.
THAT MAYBE TRUE, BUT OFTEN IS TRUE, BUT THAT DOESN’T PLAY
WELL. SO IT’S VERY IMPORTANT WE HAVE
TO ORGANIZE PARENTS. PARENTS HAVE TO BE STANDING UP,
THEY HAVE TO BE THE FACE, STAND UP TO BE THE FACE OF THE
PRO-SCIENCE MOVEMENT AND VACCINE COMPETENCE.
SO THIS IS OUR COALITION WE PUT TOGETHER FOR SB 277.
AND I WOULD MAKE NOTE ONLY A PORTION OF THESE ARE HEALTH,
PUBLIC HEALTH GROUPS. YOU HAVE TO BUILD BROAD
COALITIONS. WE HAVE IN ADDITION TO THE
HEALTH GROUPS, WE ALSO HAVE CHILDREN ADVOCACY GROUPS, THEY
DON’T JUST ADVOCATE FOR VACCINES OR HELP LIKE CHILDREN NOW,
CHILDREN’S DEFENSE FUND, WE HAVE WE HAVE THE EDUCATION PEOPLE, IT
IS A SCHOOL REQUIREMENT, THE COUNCIL HAS SCHOOL EMPLOYEE
ASSOCIATION SAYING WE WANT THIS BILL.
WE HAD CITIES AND COUNTIES, COUNTY HEALTH DEPARTMENTS BARE
THE COST. WE HAD BUSINESS GROUPS,
BUSINESSES GET DISRUPTED WHEN THERE’S CUT BREAKS.
WE HAVE TO BUILD BROAD COALITIONS, NOT SIMPLY PUB LOOK
HEALTH. WE HAVE TO BUILD BROAD
COALITIONS OF PEOPLE SAYING WE NEED TO ACT.
WE NEED TO PROTECT THE PUBLIC. WE NEED TO KEEP EVERYONE SAFE.
THIS WAS THE RALLY FOR 277 WE WERE GOING TO ASK GOVERNOR BROWN
TO SIGN THE BILL, HE SIGNED IT EARLIER THAT MORNING SO IT WAS
MORE A VICTORY CELEBRATION BUT YOU CAN SEE WE HAD A WIDE
VARIETY OF PEOPLE WHO CAME TOGETHER TO MAKE IT HAPPEN.
SO WE HAVE PARENTS AND OTHER MEMBERS OF THE COALITION AS WELL
AS OF COURSE PHYSICIANS AND SO FORTH.
HERE WE WERE IN ELEMENTARY SCHOOL BECAUSE IT IS ABOUT
KEEPING PEOPLE SAFE. I WILL MAKE A REMARK TOO BECAUSE
I’M A PHYSICIAN, I’M A PUBLIC HEALTH PERSON, I HAVE A MASTERS
IN PUBLIC HEALTH, I’M A PEDIATRICIAN.
WHETHER ENWE TALK TO THE PUBLIC, THIS IS NOT PUBLIC HEALTH, I
VALUE PUBLIC HEALTH HIGHLY, EVERYONE HERE DOES.
IT’S ABOUT PUBLIC SAFETY. PUBLIC SAFETY.
THE PUBLIC CARES ABOUT PUBLIC SAFETY EVEN MORE.
THIS IS ABOUT PUBLIC SAFETY, YOU DIE OF A GERM, YOU DIE OF
PREVENTABLE DISEASE YOU ARE JUST AS IF YOU HAD DIED IF SOMEONE
MURDERED YOU WITH A GUN OR STABBED AND KILLS YOU.
PEOPLE NEED TO KNOW THAT. THIS IS A PUBLIC SAFETY ISSUE.
WE ARE TRYING TO KEEP KIDS AND OTHERS SAFE.
EVERYBODY NOT JUST, EVERYBODY DESERVES THAT PROTECTION.
I ALSO MAKE MENTION THAT PEOPLE TALK ABOUT RIFE AND FREEDOM,
EVERYONE HAS THE RIGHT TO BE ABLE TO GO ABOUT THEIR COMMUNITY
NOT HAVING TO BE THREATENED BY A PREVENTIBLE DISEASE AND FREEDOM
IS ABOUT THE FREEDOM TO GO ABOUT YOUR COMMUNITY BEING THREATENED
BY A COMMUNICABLE DISEASE AS WELCH THE OPPOSITION TALKS ABOUT
WE’RE ABOUT CHOICE RIGHTS AND FREEDOM, WE CANNOT LET THEM TAKE
THAT LANGUAGE. WE ARE ABOUT CHOICE AND RIGHT
AND FREEDOM. THEY ARE TAKING AWAY OUR
FREEDOM. THERE’S ARTICLES HOW FAMILIES
WHO HAVE CANCER AND AFRAID TO GO OUTSIDE, THAT’S NOT FREEDOM.
YOU CHOSE TO LAY THERE FREEDOM. THE CHILD WITH TRANSPLANT WHOSE
NOTHER SAID I CAN’T GO TO SCHOOL BECAUSE ANOTHER FAMILY DECIDED
NO T TO VACCINATE CHILDREN AND THAT FAMILY MEMBER HAS
CHICKENPOX WHICH WILL KILL MY CHILD, MY SCHOOL TOLD MY CHILD
DON’T GO TO SCHOOL, THAT CHILD LOST THEIR RIGHT TO GO TO
SCHOOL. THEY LOST THEIR FREEDOM TO TWO
TO SCHOOL. THAT’S WHAT WE SHOULD CARE
ABOUT. ONE OF THE THINGS I ALSO WANT TO
TOUCH ON IS THAT AS WE DO LEGISLATION, I THINK THE ONE OF
THE THINGS WE ARE VERY EXCITED ABOUT IS WE GENERALLY GOT VERY
POSITIVE SUPPORT FROM THE PRESS AND SO FORTH FOR ARTICLES BUT
ONE OF THE CHALLENGES WE HAVE AS WELL, I KNOW THIS SOUNDS SUBTLE
BUT IT’S IMPORTANT, IS THAT, WHEN ARTICLES COME OUT, WE’LL
HAVE AN ARTICLE THAT SAYS WHY IT’S IMPORTANT TO VACCINATE AND
SUPPORT THE LEGISLATION, SO FORTH, BUT THE PICTURE WILL BE A
SCREAMING CHILD WITH A BIG NEEDLE BEING STUCK OR THEY LIKE
TO HAVE LOTS OF PICTURES OF THE PROTESTERS, THE ONES WHO OPPOSE.
SO THIS IS SOMEWHAT UNIQUE, THIS WAS IN THE LA TIMES.
THERE’S A LINE OF PEOPLE SUPPORTING THIS.
THERE ARE MORE PEOPLE WHO SUPPORT THE VACCINATION THAN
PEOPLE WHO OPPOSE. EVERY POLL SHOWS THAT THAT NEEDS
TO BE ON EVERY NEWSPAPER. WHEN THE NEWSPAPER SHOWS ARTICLE
ABOUT LEGISLATION REGARDING VANNING MAKES THEY NEED TO SHOW
PEOPLE WHO SUPPORT BECAUSE THERE ARE MORE OF THEM, NOT A CROWD OF
PEOPLE WEARING THINGS DON’T TAKE MY CHOICE FROM MY CHILD.
THOUGH THE ARTICLE IS GREAT, THE IMAGE IS WRONG, HEADLINE IS
OFTEN WRONG. WE NEED TO INSIST THAT THEY USE
THE APPROPRIATE PICTURES. ONE THING WE SHOULD INVEST IN IS
STOCK PHOTOS TO USE. SOMEBODY GO WE DON’T HAVE THE
PHOTOS THAT’S NOT A BIG THING TO DO.
WE HAVE TO CHANGE NARRATIVE, WE HAVE TO CHANGE, BECAUSE THAT’S
WHAT THE FACTS ARE. WE HAVE TO HAVE THINGS TO
REFLECT FACTS. I NO YOU SAW THE SLIDE DR. OMER.
PERSONAL BLEACH EXEMPTIONS 2109 T DROP AFTER WE PASS 277.
I WOULD ALSO MAKE NOTE THAT PART OF THE EFFECT ALSO IS THAT I
WOULD, IS THAT OF COURSE WHEN WE HAD THE MEASLES OUTBREAK THAT
LED TO SB 277, THE AWARENESS WITH ALL THE NEWS REPORTING
AROUND THE PASSAGE OF IT AND THE MEASLES OUTBREAK ALSO I’M SURE
HAD AN IMPACT ON PEOPLE GETTING VACCINATED.
SO THAT WAS IN PART PUBLIC HEALTH, RECOGNIZING WITH THE
MEASLES OUTBREAK WE NEED TO DO MORE AND SEE LEGISLATION GOING
THROUGH SO I DON’T WANT TO TAKE CREDIT FROM THE HARD WORK FROM
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH AND COUNTY HEALTH
OFFICER AND SCHOOL NURSES AND EMPLOYEES THEY WORK VERY HARD TO
MAKE THAT HAPPEN. BUT ALSO THE GREATER PUBLIC
AWARENESS THAT CAME FROM TVING NEWS COVERAGE AS WELL WE CAN’T
ALWAYS COUNT ON THAT, SO NOW WITH MEDICAL EXEMPTIONS FROM THE
STATE OF MISSISSIPPI WE SEE THIS AS WELL, BE SURE THAT WE HAVE
THE STEP UP MEDICAL EXEMPTION. THAT’S WHY I’M DOING SB 276-6789
WE HAVE, SO WHAT HAPPENS TO THE OPPOSITION WE BRING PEOPLE AND
MAKE A LOT OF NOISE. I MENTION THE PEDIATRICIAN I
LEARNED A LOT ABOUT VACCINATIONS AND IMMUNOLOGY AND PREVENTABLE
DISEASES BUT WHAT I DIDN’T LEARN WAS THE MYTHOLOGY AND PLAYING
GOT YOU ALL THE TIME. SOME SENSE WE HAVE TO EDUCATE
PEOPLE ABOUT THAT BECAUSE WHEN YOU ARE IN THE PUBLIC SPHERE, I
WANT TO SAY I KNOW YOU HAD PREVIOUS CONVERSATION, WE HAVE
TO THINK ABOUT THE CONVERSATIONS TO HAVE AND THE POLITICAL ARENA
ARE SOMEWHAT DIFFERENT THAN CONVERSATIONS IN THE DOCTOR’S
OFFICE TO TALK TO A VACCINE HESITANT PARENT WHO MADE THE
DECISION TO SHOW UP TO YOUR OFFICE.
THEY MEANT THEY WERE SLIGHTLY MOTIVATED TO HEAR WHAT YOU HAD
TO SAY. IT BECOMES DIFFERENT IN HEARING
ROOM WHERE THE OPPOSITION NO HOLDS BARRED, NOT INTERESTING IN
CHANGING YOUR, AND TRYING TO BE COOPERATIVE.
SO IT IS A DIFFERENT CONVERSATION THAT HAS.
THE OTHER THING TO MAKE NOTE IS THAT SOMETHING I CAN SAY
ANECDOTALLY BUT TO KEEP IN MIND, SO WHAT I WAS TOLD IS THAT
BEFORE SB 277 AND THE AMERICAN ACADEMY OF PEDIATRICS DID A
SURVEY PEDIATRICIANS HOW MUCH TIME THEY SPENT TALKING TO
FAMILY ABOUT VACCINATION. MOST TIME SUCCESSFUL AND WE GET
PEOPLE TO VACCINATE BUT COST OF VACCINE HESITANCY, THE COST OF
UNCERTAINTY THE ANTI-VAXERS ARE GENERATING THOUGH WE STILL GET
THE VAST MAJORITY OF PEOPLE TO VACCINATE CHILDREN, I THINK THEY
WERE ESTIMATING LIKE 15, 20 MINUTES OF CONVERSATION ABOUT
VACCINES. THAT IS ALMOST THE ENTIRE VISIT SO NOT TALKING THE
OTHER ISSUES TO SHARE ABOUT KIDS.
WE ARE SPENDING TIME TALKING ABOUT VACCINES.
I HAVE BEEN TOLL NUMEROUS TIMES, THOUGH SOMEONE NEEDS TO DO THE
STUDY, IN CALIFORNIA THAT CONVERSATION IS THREE MINUTES.
REQUIRED FOR SCHOOL, MY KIDS VACCINATED.
NOW WE CAN START TALKING NUTRITION, WE CAN TALK ABOUT HOW
YOU DO IN SCHOOL, SO FORTH. THAT GOES BEYOND VACCINE BUT WE
NEED TO THINK ABOUT IT SO WHEN WE TALK ABOUT HOW TO DEAL WITH
VACCINE HESITANCY, I I HAVE SEEN, THERE’S PROGRAMS SAYING
YOU CAN TAKE AN ANTI-VAX PARENT AND SPEND EIGHT HOURS WITH
DOCTOR AND CHANGE THEIR MIND, THAT’S WONDERFUL BUT VERY
EXPENSIVE, EIGHT HOURS OF PHYSICIAN TIME TO CONVINCE
SOMEONE. WE HAVE TO KEEP PEOPLE FROM
GETTING TO THAT PLACE IN THE FIRST PLACE.
WE HAVE POLICY THINGS WE SHOULD DO AND SETTING SOCIAL NORMS, WE
HAVE TO THINK WHAT WE’RE GOING TO DO ABOUT SOCIAL MEDIA AND NOT
THE INFORMATION AND THE SUPPRESSION OF ACCURATE
INFORMATION. IN SOCIAL MEDIAND OTHER VENUES
AND THINK ABOUT ALSO HOW WE WORK WITH MAINSTREAM MEDIA TO BE SURE
WHEN THEY WRITE GREAT ARTICLES WE HAVE TO BE SURE THE WHOLE
PACKAGE COMES TOGETHER. I’M IN POLITICS NOW NOT JUST
MEDICINE. THE WHOLE PACKAGE HAS TO COME
TOGETHER TO SEND THE RIGHT MESSAGE.
WE MANAGE TO GET PEOPLE TO UNDERSTAND THE ISSUE OF FALSE
EQUIVALENCY. NOW WE CAN MOVE BEYOND THAT
BEING SURE IMAGES AND SO FORTH ACCURATELY REFLECT THE FACT THEY
ARE WRITING ABOUT. WITH THAT I’LL PASS TO THE NEXT
SPEAKER AND LOOK FORWARD TO ANSWERING YOUR QUESTIONS LATER
ON. THANK YOU. [APPLAUSE]>>OUR FINAL SPEAKER ON THE
PANEL IS DR. JOHN DOUG ALSO. , DOUGLAS.>>GOOD AFTERNOON, EVERYBODY.
I’M NOT SURE I GAVE MY TALK THE RIGHT TITLE. IT SHOULD HAVE BEEN VIEWS FROM
AN EASY EXEMPTION STATE FOLLOWING PROGRESS IN PLACES
LIKE CALIFORNIA, MISSISSIPPI, OR MAYBE IT WHY COLORADO WANTS TO
BE LIKE CALIFORNIA AND MISSISSIPPI.
I’M GOING TO GIVE YOU A SNAP SHOT OF WHAT’S HAPPENING IN AN
EASY EXEMPTION STATE OVER THE PAST TEN YEARS OR SO.
WE HAVEN’T GOT IT FIGURED OUT BY ANY MEANS, WHAT GALVANIZED OUR
ACTION IS LAST SURVEY THAT SHOWED COLORADO RANKED 49th
OF THE 49 REPORTING STATES AMONG KINDERGARTNERS VACCINATED WITH
MMR. WE HAVE NOT YET HAD AN OUTBREAK
THIS YEAR BUT WE ARE SITTING POISED A LITTLE BIT LIKE PETER
LOOKING AT HOT SPOTS AROUND THE COUNTRY FOR SUCH A THING TO
HAPPEN. I WANT TO GIVE YOU HISTORIC
PERSPECTIVE, COLORADO FIRST PASSED REQUIRED IMMUNIZATION
LAWS IN 1978. FROM THE OUTSET WE INCLUDE
MEDICAL PERSONAL RELIGIOUS EXEMPTIONS SO WE HAVE BEEN
LIVING WITH WHAT ONE MIGHT CONSIDER TO BE A MISTAKE, A
FACT, A REALITY FOR THE LAST FOUR DECADES.
WE INITIATED OUR IMMUNIZATION INFORMATION SYSTEM IN 2007.
WE TOYED WITH DIFFERENT WAYS OF ADDRESSING THE PERSONAL
EXEMPTION RATE BUT DIDN’T REALLY HAMMER IT, HARD IS THE WRONG
ADJECTIVE BUT HAMMER UNTIL DESIRABLE UNTIL 2014 WHEN WE
PASSED HOUSE BILL 1288 REQUIRING ALL SKOALS AND LICENSED CHILD
CARE FACILITIES TO REPORT ANNUAL IMMUNIZATION AND EXEMPTION RATES
WITH EXEMPTIONS REQUIRED TO BE FILED EVERY YEAR FOR SCHOOLS.
NOW, FILING EXEMPTIONS IN COLORADO IS A WHOLE LOT EASIER
THAN IN A PLACE LIKE MISSISSIPPI.
I COULDN’T KEEP UP WITH HOW MANY FORMS YOU GUYS HAVE.
WE DON’T HAVE FORMS. YOU CAN FILE AN EXEMPTION TO
COLORADO NOW ON THE BACK OF A NAPKIN.
SO IS IT’S AN EXTRAORDINARILY EASY PROCESS TO IMPLEMENT AND
WAS POINTED OUT, A LOT EASIER IN COLORADO TO GET AN EXEMPTION
THAN IT IS TO GET YOUR KID IMMUNIZED.
THAT’S BEEN A REALITY OF OUR SITUATION AS WE MOVED FORWARD.
THESE ARE TREND DATA FOR UP TO DATE VACCINES ON THE LEFT SIDE.
SLIDE. THIS IS PROBABLY HARD TO READ
BUT THERE WERE SOME LAND MARKS ALONG THE WAY.
IN THE MID 1990s THE THREAT OF SCHOOL EXPULSION, IF, EXPULSION
WAS REMOVED, THAT WAS RESPONSIBLE FOR THE DIP IN ’94
TO ’95. WE HAD FIVE TO EIGHT YEARS OF
DIFFICULTY WITH FERPA, THE ACT THAT COVERS SCHOOL INFORMATION,
LOTS OF CONFUSION COLORADO AS TO WHETHER SCHOOL RECORDS COULD BE
TRANSFERRED TO THE IMMUNIZATION REGISTRY AND VICE VERSA.
THAT FINALLY GOT CORRECTED. THINGS SMOOTHED OUT A LITTLE BIT
AND IN 2014 WE PASSED THAT EXPANDED IMMUNIZATION AND
EXEMPTION REPORTING. AS YOU CAN SEE ON THE RIGHT SIDE
OF THE GRAPH, EXEMPTIONS VARIED SOMEWHAT SIMILARLY OVER THAT
PERIOD OF TIME. SINCE WE PASSED OUR 2014 BILL,
FAR SHORT OF WHAT DR. PAN TALKED ABOUT IN CALIFORNIA WE HAVE THE
ABILITY THE LOOK AT DATA BY SCHOOLS, AND THIS IS AN EXAMPLE
OF WHAT WE CAN PULL OFF THE STATE SYSTEM NOW, ON THE LEFT
SIDE ARE THE AVERAGE UP TO DATE RATES, THESE ARE ALL SCHOOLS,
ALL VACCINES SO IT’S PRETTY IMPRECISE, IT’S THE UBER VIEW OF
VACCINES AT SCHOOL LEVEL AND IF ONE DRILLS DOWN ON THIS, ONE SEE
MORRIS AND MORE DOTS, GREEN IS GOOD, HIGHER THAN 95%, RED IS
BAD, LOWER THAN 90, YELLOW IS IN BETWEEN.
THEN WE HAVE SOME THAT AREN’T REPORTING.
ON THE RIGHT SIDE, WE SHOW AVERAGE EXEMPTION RATES, PINK
LOWER THAN TWO AND A HALF, YELL HOE BETWEEN TWO AND A HALF AND
FIVE AND RED HIGHER THAN 5%, BLUE NOT REPORTING.
ONE CAN DRILL DOWN ON THIS. AS WE DO IN THE DENVER METRO
AREA WHICH IS WHERE MY THREE COUNTY HEALTH DEPARTMENT IS.
WE ARE NOT DOING SO BAD WHEN ONE LOOKS AT AVERAGE UP TO DATE
RATES, MORE GREEN THOUGH AS PETER POINTED OUT IN HIS
PRESENTATION, WE HAVE PLACES IN COLORADO LIKE BOULDER WHICH IS
THE UPPER LEFT QUADRANT, ONE SEES MORE RED IN TERMS OF
IMMUNIZATION RATES. IF WE DRILL DOWN EVEN FURTHER,
YOU DON’T RECOGNIZE THE GEOGRAPHY HERE UNLESS YOU ARE
FROM THE DENVER METRO AREA, WE ARE COVERING THE THREE COUNTIES
MY REPRESENTS. EVEN IN A PLACE THAT LOOKS GREEN
FROM THE 50,000-FOOT PERSPECTIVE, ONE SEES POCKETS OF
SCHOOLS WHERE WE HAVE LOWER IMMUNIZATION RATES.
THIS IS GOING BACK LOOKING AT MMR COVERAGE, APOLOGIES I HAVE
REVERSED THE HEADINGS ON THESE SLIDES, THE LEFT PART SHOULD BE
MMR EXEMPTIONS AND THE RIGHT PART OUGHT TO BE MMR COVERAGE.
ONE SEES A LITTLE BIT LIKE THE STORY THAT WAS MENTIONED
EARLIER, THAT IN THE WESTERN PART OF OUR STATE WE HAVE A
WHOLE LOT LOWER RATES COVERAGE AND A LOT HIGHER RATES
EXEMPTION, IT IS NOT CLEAR WHETHER THIS HAS TO DO WITH
RUGGED FRONTIER MENTALITY PERSONAL BELIEFS, OR WHETHER
THIS TO DO WITH CONVENIENCE EXEMPTIONS, IT IS EASIER IF I
WORK TWO JOBS. I DON’T WANT A FUSSY BABY TO
KEEP ME FROM GOING TO WORK TO SIGN THE FORM I’M TAKING THE
EXEMPTION. WE HAVE BEEN STRUGGLING TO
UNDERSTAND AGAIN THAT FAIRNESS ISSUE.
FINALLY WE CAN DRILL DOWN IN A LOCAL AREA FOR MMR VACCINATION
RATES, ONE SEES AGAIN QUITE THE SAME DISTRIBUTION I SHOWED
EARLIER. WE HAVE BEEN ABLE TO USE THIS
DATA TO PROVIDE IMMUNIZATION FACT SHEETS FOR SPECIFIC
SCHOOLS. THE POINT MADE EARLIER TEXAS YOU
DON’T KNOW WHAT THE SCHOOL LOOKS LIKE YOU ARE TAKING YOUR KID TO,
WE ARE TAKING AND GIVING TO DIFFERENT SCHOOLS, SUGGESTING
THEY MAKE THEM AVAILABLE TO PARENTS.
WE DID THE SAME BY LEGISLATIVE DISTRICTS TRYING TO PERSUADE
LEGISLATORS OR AT LEAST EDUCATE LEGISLATORS WHAT’S HAPPENING IN
THEIR DISTRICTS IN TERMS OF IMMUNIZATION COVERAGE.
FAST FORWARD TO 2019. WE HAVE CONFLUENCE OF THE
DOCUMENTATION COLORADO IS LAST IN COUNTRY IN TERMS OF MMR
KINDERGARTEN COVERAGE RATES AND ISSUE WE HAVE THE WORST OUTBREAK
OF MEASLES IN 30 YEARS, THE DATA ARE A LITTLE OUT OF DATE.
WE ATTACK THIS PROBLEM WITH A NEW BILL, COLORADO 19-1312.
A MUCH MORE MODEST ATTEMPT TO ADDRESS EXEMPTIONS THAN YOU
HEARD IN OTHER STATES. THE REQUIRED THE HEALTH
DEPARTMENT TO DEVELOP A STANDARDIZED FORM AND SUBMISSION
PROCESS TO CLAIM EXEMPTIONS, IT REQUIRE THE STATE TO DEVELOP
EDUCATION MATERIALS AND DISTRIBUTED.
AND TO DEVELOP AND DELIVER FOR THE LEGISLATURE AN ANNUAL BOARD
ON EXEMPTIONS. THE STATE BOARD OF HEALTH WAS
REQUIRED TO DEVELOP RULES, ADOPTING MEDICAL EXEMPTIONS
RECOMMENDS FROM THE ACIP. THIS WAS A SPECIFIC ATTEMPT TO
AVOID WHAT WE HEARD CALIFORNIA WAS UNDERGOING, WHICH WAS BROAD
INTERPRETATION CAN YOU QUALIFY FOR MEDICAL EXEMPTION, WE
ADOPTED RULES, THEY WERE REQUIRED TO ADOPT RULES
REQUIRING HEP A ROTAVIRUS AND MENINGOCOCCAL AS WELL.
HPV WAS PROPOSED BEING INCLUDED, THESE BECAME QUITE
CONTROVERSIAL, INFLUENZA BECAUSE IT’S AN ANNUAL IMMUNIZATION AND
HPV BECAUSE OF POLITICAL BAGGAGE, THOSE WERE WITHDRAWN.
EXEMPTIONS WERE ALLOWED TO BE SUBMITTED MEDICALLY BY
PHYSICIANS, PAs AND NURSE PRACTITIONERS, PERSONAL AND
RELIGIOUS EXEMPTIONS, AND THIS IS PROBABLY THE MAJOR TWIST OF
THE BILL, REQUIRED THE PARENTS TO COMPLETE A FORM TO BE
PROVIDED AND TURNED IN BY HAND TO STATE OR LOCAL HEALTH
DEPARTMENT. THIS WHILE SEEN BY THE PARENTAL
COMMUNITY WHO DID NOT WANT TO HAVE THEIR KIDS BE VACCINATED
WAS SEEN AS A BUMP IN THE ROAD. THIS WAS A PROMOTED AS A
FAIRNESS STEP. IT WAS CLEARLY STILL GOING TO BE
HARDER FOR PARENTS TO GET THEIR KIDS IMMUNIZED BY PARENTS
PREFERRING AN EXEMPTION WOULD BE REQUIRED TO GO IN PERSON TO
STATE OR LOCAL HEALTH DEPARTMENT.
FINALLY, IMMUNIZATIONS ARE REQUIRED TO BE ENTERED INTO THE
REGISTRY AND NOW EXEMPTIONS WERE GOING TO BE REQUIRED TO BE
ENTERED AS WELL. ONCE AGAIN, LOTS OF MEDIA
ATTENTION TO THIS. WE HAD THE OPPORTUNITY OF A
NATIONWIDE MEASLES OUTBREAK TO REFLECT ON, MUCH OF THE MEDIA
WAS COVERAGE SOME OF, MORE PEOPLE LINED UP TO PREVENT
DISEASE QUICKRY BECAME CONTROVERSIAL.
IT WAS REACTION TO THE DEGREE OF DIFFICULTY FOLLOWING EXCEPTION
IT IS MEASURE PUT IN PLACE TO CREATE FAIRNESS CREATED PUSH
BACK. THERE WAS A LOT OF RESISTANCE IN
USE OF ACIP LANGUAGE REGARDING MEDICAL EXEMPTIONS, WE HAD MUCH
TESTIMONY BY VARIETY OF PARENTS AND HEALTHCARE PROVIDERS WHO
SAID IN MY CASE, I HAD AN OLDER SIBLING WHO HAD SPEECH
DIFFICULTIES AFTER A VACCINE, THAT OUGHT TO CREATE THE
OPPORTUNITY FOR MEDICAL EXEMPTION FOR THE REST OF MY
CHILDREN. THERE WAS ACTUALLY INDIVIDUAL
PUSH BACK ABOUT EACH ADDED VACCINE.
ONE OF THE MAJOR TALKING POINTS WAS THE COLLUSION OF PUBLIC
HEALTH WITH BIG PHARMA, AN EXAMPLE OF GOVERNMENT WORKING TO
HEALTH PROFITS OF BIG PHARMA. GENERAL CONCERNS NOT JUST ABOUT
THE BILL WERE VACCINE SIDE EFFECTS, THE SORTS WE HEARD
ABOUT, WE HEARD ABOUT AUTISM. NOT HEARD IN COLORADO BEFORE BUT
AN IMPORTANT TALKING POINT IS THE MONTHS VACCINES WAS
ORIGINALLY DERIVED FROM ABORTED FETAL TISSUE.
FOR OUR RELIGIOUS COMMUNITY THIS BECAME AN ISSUE THAT BECAME
PROMINENT IN THE CONCERN. THERE WERE ISSUES ABOUT
PERCEIVED CONFIDENTIALITY OF THE IMMUNIZATION REGISTRY.
AND AS WELL AS THE SUSPICION OF THE PROFIT ENTERPRISE OF THE BIG
PHARMACEUTICAL INDUSTRY COLLUDING WITH THE GOVERNMENT.
FINALLY WHAT WAS THE BIGGEST SURPRISE OF ALL WAS THE
CONFLUENCE OF THE VACCINE HESITANCY OPPOSITION WITH
PARENTAL RIGHTS. PARENTAL RIGHTS HAS BEEN AN
ISSUE IN A NUMBER OF STATES ACROSS THE COUNTRY.
THE NOTION IS THAT BIG GOVERNMENT IS GETTING IN THE WAY
OF PARENTS RAISING THEIR CHILDREN.
WE HAD A SEX EDUCATION BILL IN COLORADO ABOUT A MONTH AND A
HALF BEFORE THE IMMUNIZATION EXEMPTION BILL WAS INTRODUCED.
THAT BECAME THE MAJOR TALKING POINT OF TRYING TO CREATE A
COMPREHENSIVE BILL IN COLORADO AND A VERY QUICKLY BECAME AN
ADOPTED TALKING POINT OF WHAT TURNED INTO ALMOST COMPLETELY
PARTY LINE OPPOSITION WHERE WE HAD SUPPORT BY THE PREDOMINANTLY
DEMOCRATIC LEGISLATORS BUT ALMOST COMPLETE OPPOSITION TO
THE BILL BY REPUBLICAN LEGISLATORS.
REALLY AS SEEN THROUGH THE PARENTAL RIGHTS LENS.
WE HAD ONE MORE ANGLE IN IT. COLORADO HAD A BLUE WAVE
ELECTION LAST FALL. BOTH LEGISLATIVE BODIES ARE IN
DEMOCRATIC HANDS, OUR GOVERNOR REMAINED DEMOCRATIC BUT WE
CHANGED GOVERNORS, THE NEW ONE TURNED OUT TO HAVE STRONGER
VIEWS ON PERSONAL LIBERTIES THAN OUR PREVIOUS GOVERNOR.
AND ACTUALLY CAME OUT WITH SOME SURPRISING COMMENTS ABOUT HIS
UNWILLINGNESS TO SIGN AND SUPPORT A BILL THAT WOULD REDUCE
PARENTAL ABILITY TO DETERMINE VACCINATIONS FOR CHILDREN.
EVEN THREATENING THE ORIGINAL VERSION OF THE BILL.
THIS REMAINED AN IMPORTANT ISSUE BECAUSE WHILE THIS GOVERNOR,
GOVERNOR POLL HAS TAKEN A NUMBER OF REALLY VERY PROGRESSIVE STEPS
FREE FOLD KINDERGARTEN, CLIMATE CHANGE REGULATION, IN THIS
PARTICULAR STANCE WE HAVE RUN INTO LESS COOPERATIVE PUBLIC
HEALTH COOPERATION. THE FINAL UPSHOT WAS THE
LEGISLATIVE SESSION WHICH ENDED UP BEING ENTIRELY, OR OVERALL
QUITE PRODUCTIVE, NUMBER OF VERY IMPORTANT BILLS PASS, RAN INTO A
PROBLEM WITH TIME AT THE END OF THE SESSION.
THE IMMUNIZATION BILL PASSED OUR HOUSE.
BUT LEADERSHIP IN SENATE HAD TO DETERMINE SIMPLY NOT ENOUGH TIME
TO GET IT THROUGH. SO NO BILL PASSED, LOTS OF
ENERGY, LOTS OF PUBLICITY, AND FRANKLY LOTS OF NOW
CONSIDERATION TO WHAT APPROPRIATE NEXT STEPS OUGHT TO
BE. I’LL SAY A COUPLE OF LESSONS
THAT CAME OUT OF THIS SESSION WERE THAT THE BILL BECAME MORE
POLITICIZED THAN MOST THOUGHT. THE PARENTAL RIGHTS ISSUE BECAME
A LARGER FACTOR TO TRY TO ADDRESS.
THE NOTION THAT SO FEW WHO WERE ARGUING AGAINST IMMUNIZATION FOR
THEIR CHILDREN HAD ANY HISTORIC OR PERSONAL EXPERIENCE WITH
VACCINE PREVENTABLE DISEASE, I THINK WAS A MAJOR ISSUE, AS IT
IS IN MOST PLACES WHERE THE RESISTANCE TO VACCINES COME UP.
BUT THE LAST THING I POINT OUT IS ONE MADE EARLIER.
WE WHITE COATED HEALTH WORKERS SHOW UP, WE HAD VERY FEW PRO-VAX
PARENTS SHOW UP. POLLS SHOW ABOUT 92% OF FOLKS IN
COLORADO WANT VACCINES TO BE REQUIRED FOR SCHOOL ENTRY.
WE KNEW WE HAD PUBLIC OPINION ON OUR SIDE.
BUT AS A PUBLIC HEALTH COMMUNITY, WE DID NOT GET
PRO-VAX PARENTS MOBILIZED. I THINK IF WE HAD ANY LESSONS
GOING FORWARD, IT’S LOOKING AT MOMS WHO WANT THEIR KIDS TO BE
VACCINATED, OR GRANDMOTHERS WHO KNOW VACCINE PREVENTABLE
DISEASES WHO WANT THEIR GRANDCHILDREN TO GET VACCINATED.
SO DR. PAN, WE ARE LOOKING TO CONTINUE LEARNING FROM
CALIFORNIA, WE ARE GOING TO LEARN FROM MISSISSIPPI.
AND BE WAITING FOR NEXT YEAR. THANK YOU. [APPLAUSE]>>LIKE TO THANK ALL THE MEMBERS
OF OUR PANEL, JUST TO LET THOSE IN THE COMMITTEE KNOW WE HAVE
TIME FOR A FEW COMMENTS OR QUESTIONS BUT AT 3:50 ADMIRAL
GIROIR WILL INTRODUCE SECRETARY AZAR WHO WILL SPEAK TO US AT
3:52. SO MEMBERS WANT ANY QUESTIONS OR
COMMENTS OF THIS EXCELLENT PANEL?
REBECCA, YOU HAD THE FASTEST HANDS.>>COOL. I WANT TO SAY THANK YOU FOR THE
WIDE RANGE OF PERSPECTIVES THAT Y’ALL JUST DEMONSTRATED.
I FORTUNATELY AND UNFORTUNATELY LIVE IN ONE OF THOSE WESTERN
STATES THAT’S RED IN A HOT SPOT BUT I’M CURIOUS IF Y’ALL HAVE
DRILLED DOWN IN ANY OF THE STUDIES THAT YOU HAVE DONE TO
DETERMINE WHAT THE RATE IS OF CONVENIENCE EXEMPTION VERSUS
THOSE THAT TRULY BELIEVE THEY DON’T WANT THEIR KIDS
VACCINATED?>>WHEN WE DID 2109, IN
CALIFORNIA, AND ALSO WE SAW THIS THE IN STATE OF WHAT WAXER WE
SAW ROUGHLY 20% DROP IN PERSONAL BELIEF EXEMPTION RATE IN
CALIFORNIA. APPROXIMATELY THE SAME IN
WASHINGTON. WE THINK MOST FOLKS ARE PEOPLE
WHAT HAPPENS BEFORE YOU SAID YOU NEED AN EXEMPTION, WHAT HAPPENS
IS THEY SHOPE UP TO SCHOOL, NOT VACCINATED, NOT OPPOSED TO
VACCINES, BUT PARENTS, I WASN’T HAD A CHANCE TO GET TO THE
DOCTOR, ET CETERA. THE SCHOOL SAYS SIGN THIS, START
SCHOOL, WHETHER THEY DO OR NOT IS NO STORY, WHEN THOSE LAWS
PASS, THEY HAD TO GO TO THE DOCTOR ANYWAY, TO GET COUNSELING
AND SINCE THEY WERE THERE THEY GOT THE SHOTS.
SO I’M NOT SAYING THAT REFLECTS ALL OF THEM BUT I THINK THERE
WAS A BIT OF, THE TASK WE THINK THAT THAT DROP WAS, THE PEOPLE
WHO PARTICULARLY WANTED VACCINES.
WHEN WE TALK WHO IS HARD CORE ANTI-VAX, THIS IS THOSE BY THE
WAY HOME SCHOOL, IF YOU DON’T TRUST THE GOVERNMENT ABOUT
VACCINES, WHY ARE YOU TRUSTING YOUR GOVERNMENT TO TEACH YOUR KIDS.
WHAT HAPPENS IS WE SEE PEOPLE SHOW UP TESTIFYING AGAINST OUR
VACCINE BILL AND THEY TALK ABOUT HOME SCHOOL, THE BILL ACTUALLY
DOESN’T AFFECT YOU BECAUSE WE SUPPOSEDLY SAY YOU DON’T NEED TO
VACCINATE YOUR CHILD IF YOU HOME SCHOOL.
SO ONE OF THE BIG OPPOSITION TO HOME SCHOOL PARENTS EXCEPT FOR
THE FACT IT DOESN’T AFFECT THEM. SO THEY’RE THERE BECAUSE THEY
HAVE BEEN UP AND PART OF THE OVERALL ANTI-VAX MOVEMENT.>>WE DON’T HAVE DATA THOUGH
IT’S A FANTASTIC QUESTION ANECDOTALLY OUR SCHOOL NURSES
WHO ARE THE ONES DEALING WITH BRINGING IN EXEMPTION FORMS SAY
IT’S A BIG ISSUE IN URBAN AREAS AND WE THINK IN MORE SPARSELY
POPULATED PARTS OF THE STATE WHERE DISTANCE IS FOR
TRANSPORTATION, TIME TO GET APPOINTMENT, ET CETERA, IT’S
PROBABLY BIGGER BUT THAT’S ANECDOTAL.>>WE ALSO NEED TO WORK ON
IMPROVE ACCESS. AFTER THE LARGE OUTBREAKS WE HAD
IN THE EARLY ’90s, WE MADE VACCINE FOR CHILDREN, WE,
THERE’S OTHER STEPS TAKEN, BUT WE DO NEED TO THINK ABOUT ACCESS
TO VACCINES. CALIFORNIA AFTER WE PASS 277
SCHOOL DISTRICTS HELD VACCINATION EVENTS AT THE SCHOOL
PRIOR TO ENROLLMENT, THEY SET UP OPPORTUNITIES, THE CHILD SHOWED
UP WITHOUT VACCINES AS LONG AS PARENTS SAID YES THEY CAN GET
THE CHILD VACCINATEED THAT DAY, SET UP CLINIC OR ARRANGE AND GET
THEM VACCINATE TO START SCHOOL THAT AFTERNOON.
SO WE NEED TO THINK ABOUT THOSE OPPORTUNITIES FOR PARENTS TO
REALLY THE BARRIER IS NOT, BECAUSE ATTITUDES FOR VACCINE,
MORE BECAUSE ABILITY TO GET THEM.>>IF I MAY ADD SOMETHING TO THE
CONVERSATION. CAN EVERYONE HEAR ME?>>GO AHEAD SAAD.>>I THINK IT’S REASONABLE THE
LOOK AT, LIKE MANY OTHER BEHAVIORS, LIKE OTHER PATHWAYS
TO OUTCOMES AND BIOMEDICINE, LET ALONE BEHAVIORS, IT’S BETTER TO
LOOK AT MULTI-MODAL CAUSES SO IT’S RARE THAT WE HAVE ONE
REASON FOR PEOPLE NOT TO DO IT. NOT TO DO SOMETHING.
PART OF THE REASON WITHIN A SINGLE HUMAN, COULD BE
CONVENIENCE, COULD BE ATTITUDE. COULD BE ACCESS.
AS WELL. SO I WOULD URGE FOLKS TO LOOK AT
IT AS AS A MULTI-MODAL PHENOMENON, EVEN WITHIN AN
INDIVIDUAL PARENT. THESE, THE CONTRIBUTIONS
UNFORTUNATELY MAKES IT HARDER TO STUDY T GOES UP AND DOWN.
SO A REASONABLE WAY TO LOOK AT IT, IS THROUGH THE PREVENTABLE
FACTION APPROACH, IE OR ADAPTATION OF THAT APPROACH,
WHICH DR. PAN ALLUDED TO TO SEE WHAT FRACTION CAN BE IMPACTED BY
A GIVEN INTERVENTION. THAT DOESN’T NECESSARILY MEAN
SPECIFIC FACTION WILL CONTRIBUTE FOR THAT PERSON IN TERMS OF
THEIR REASONS FOR NOT GETTING VACCINE OR GETTING THEIR CHILD
VACCINATED. A LITTLE BIT OF NOTE OF CAUTION.
TO ADD TO THAT, WE NEED ONGOING GOOD SCIENCE, IT MAY HAVE BEEN
MENTIONED EARLY ON AS WELL, THIS IS WE DON’T ACCEPT SUBSTANDARD
SCIENCE IN VACCINE DEVELOPMENT WE SHOULD DEMAND GOOD QUALITY
SCIENCE IN VACCINE ACCEPTANCE AND COMMUNICATION.>>THANK YOU FOR THE
PRESENTATION, IT WAS GREAT. MY QUESTION IS FOR DR. PAN.
ONE AND OTHERS TO FOLLOW-UP, ONE TO MOBILIZE PRO-VACCINE PARENTS
IN CALIFORNIA, IS THERE A WAY TO REPLICATE THAT IN EVERY STATE OR
LOOK TO ALREADY EXISTING ADVOCACY ORGANIZATIONS AND
PROVIDE MORE SUPPORT? WE HAD VACCINE IN COLORADO WOULD
YOU THINK YOU MAY HAVE BEEN MORE SUCCESSFUL?>>VACCINATE CALIFORNIA CAME
ABOUT WHAT HAPPENED WAS WHEN THE MEASLES OUTBREAK BEGAN IN DISNEY
LAND, IT HAPPENED DECEMBER 2014, WE STARTED GETTING PHONE CALLS
FROM PARENTS WHO SAID TO THE VARIOUS LEGISLATORS, WHAT ARE WE
GOING TO DO ABOUT THIS? WE NEED SOMETHING TO DO ABOUT
IT. WE STARTED TO REALIZE WHAT WE
NEED TO DO IS GET THEIR NAME AND NUMBER AND CONNECT THEM WITH
EACH OTHER. AND SAY OKAY, WELL, YOU ARE
CONCERNED ABOUT IT. CAN I SHARE YOUR NAME WITH OTHER
PEOPLE WHO ARE? THEN WE FOUND THEM SOME FUNDING
FOR THEM TO BE ABLE TO DO SOME ACTIVITY TOGETHER, TO HELP
ORGANIZE. SO THAT’S HOW VACCINATE
CALIFORNIA CAME TOGETHER. WE RECOGNIZED WE NEED TO, HOW DO
WE SUPPORT AND PRO-VACCINE, I DON’T WANT TO SAY PRO-VACCINE,
THEY ARE VACCINES WE DON’T ADVOCATE FOR HERE BECAUSE
SCIENCE DOESN’T SAY WE NEED TO HAVE THEM HERE.
IT’S PRO-SCIENCE. PRO-SCIENCE, PRO-HEALTH,
PRO-PUBLIC SAFETY PARENTS WHO SAY I WANT MY KIDS TO BE SAFE AT
SCHOOL, I WANT OTHER PEOPLE’S KIDS TO BE SAFE AT SCHOOL.
WE SHOULD HAVE POLICIES TO KEEP PEOPLE SAFE IN COMMUNITIES AND
SCHOOLS AND WE NEED TO CONNECT THEM TOGETHER AND HELP ORGANIZE.
THAT’S WHAT WE DID. SO WE CONNECTED THEM, WE HAD
THEM CONNECT WITH EACH OTHER, WE ALSO, POLITICS, WE USED
POLITICAL PEOPLE TO GIVE ADVICE. HOW TO ORGANIZE CAMPAIGNS.
THESE ARE SOME OF THE THINGS YOU DO.
SO HOW DO I LOBBY MY CITY COUNCIL?
HERE IS ADVISE HOW YOU DO THAT. SO FORTH.
SO WE PROVIDE, FOUND PEOPLE TO GIVE TECHNICAL ASSISTANCE.
SO FORTH. SO THAT’S HOW, AND DOING THAT.
SO THAT’S WHAT WE NEED TO DO, PROVIDE, CONNECT PEOPLE
TOGETHER, PROVIDE RESOURCES, AND FRANKLY THAT’S WHAT THE OTHER
SIDE DOES AS WELL.>>I CERTAINLY AGREE WITH THAT
BUT I WOULD SAY THE ONE THING WE HAVEN’T TALKED ABOUT THIS
MORNING OR TODAY VERY MUCH IS THE FACT THAT THE ANTI-VACCINE
MOVEMENT HAS CHANGED JUST IN THE LAST COUPLE OF YEARS.
THEY NOW DOMINATE THE INTERNET, NEW NUMBERS SAY THERE EAST AT
LEAST 480 ANTI-VACCINE WEBSITES ON THE INTERNET, THEY FIGURED
NICELY HOW TO AMPLIFY THEIR MESSAGE ON FACEBOOK AND OTHER
FORMS OF SOCIAL MEDIA. SO UNLESS WE START TAKING DOWN
THE ANTI-VACCINE, ON FACEBOOK, AS I SAID SITTING NEXT TO PAUL EARLIER, THESE ARE A MESSAGE IN
A BOTTLE IN THE ATLANTIC OCEAN, IT’S SO DOMINANT RIGHT NOW.
FOR INSTANCE ON FACEBOOK THE GOOD NEWS IS MY BOOK VACCINES
DID NOT CAUSE RACHEL’S AUTISM IS ONE OF THE HIGHEST RANKED
PRO-VACCINE BOOKS ON AMAZON, BAD NEWS IS IT’S RANKED 25 BECAUSE
THERE’S 24 PHONY ANTI-VACCINE BOOKS OUT THERE BEING
AGGRESSIVELY PROMOTED ON AMAZON. SO UNLESS WE FIGURE HOW TO
DISMANTLE THIS MEDIA EMPIRE, NOT ALL OUR MESSAGES, ALL OF OUR
ACTIVITIES ARE STILL GOING TO FALL SHORT I’M AFRAID.>>
>>I WOULDN’T DISCOUNT WHAT PETER SAID.
IF WE HAD LARGER TURN OUT OF PRO-VAX EXPERIENCE IT WOULD HAVE
HELPED LEGISLATIVELY. IN 2014 WHEN WHEN THE WEAKER
BILL WAS PASSED WE HAD SEVEN FOLKS THAT TURNED OUT FOR THE
TESTIMONY AND SUPPORTED THE BILL, 50 AGAINST IT.
THAT TURNED OUT TO BE A SOMEWHAT CATALYZING MOMENT.
POLITICALLY IN COLORADO BECAUSE THIS TIME WHEN THE BILL CAME UP
WE HAD 500 FOLKS TURN OUT AGAINST THE BILL AND THE
TESTIMONY WENT UNTIL FOUR IN THE MORNING.
WE INCREASE THE PRO-VAX PEOPLE BY THE SAME NUMBER, THEY’RE
ALMOST ALL HEALTHCARE PROFESSIONALS.
ONE POINT MADE BY THE BILL SPONSOR IS A LARGE PROPORTION OF
THE OF THE PARENTS WHO TURN OUT AGAINST THE BILL WAS POINTED
OUT, HOME SCHOOL THEIR KIDS. THEY HAD GREATER SCHEDULING FLEX
IT WILL IN THE LEGISLATURE AT FOUR IN THE MORNING, THEN THE
PRO-VAX PARENTS FOR THE IDEA OF TRYING TO FIND GRANDMOTHER’S
THAT MIGHT BE RETIRED WHO HAD GRANDKIDS, MIGHT BE AT LEAST IN
A PLACE WE HAVE WORKING PARENTS SIMPLY CAN’T GET OUT, ONE WAY OF
INCREASING THAT VOICE.>>ONE THING I WANT TO CLARIFY,
WE DID NOT ATTEMPT TO AND DID NOT SEEK DESIRABLE TO OUT SCREEN
OUTSHOUT THE OPPOSITION. I THINK ACTUALLY THERE’S, THEIR
VOCIFEROUSNESS, THE IDEA NOT THE MATCH THEM IN THAT OR TRY TO, I
DON’T THINK IT’S AN EFFECTIVE STRATEGY.
THEY WANT TO BE THE WAY THEY ARE, AND SO FORTH, LET THEM BE
THAT WAY. WE DON’T NEED TO OUTPOM THEM BUT
WE NEED TO BETTER ORGANIZE THEM TO, IT’S A CAMPAIGN.
WE TALK POLICY, IN POLITICS IT’S CAMPAIGNING YOU CAMPAIGN THE GET
PEOPLE ELECTED, YOU CAMPAIGN TO GET POLL IS IS PASSED.
WE NEED EFFECTIVE CAMPAIGNERS SO WHAT WE NEED TO DO IS WE NEED TO
GET CONNECT PRO-VACCINE, PRO-SCIENCE, THE PRO-SCIENCE
PARENTS TOGETHER, ORGANIZE THEM AND THEN MOBILIZE THEM, DOESN’T
MEAN YOU TRY THE TURN OUT 500 FOR A HEARING, THAT’S NOT THE
IMPORTANT THING, THEY ARE NOW TALKING, THEY ARE BEING IN THE
MEDIA. SO, THEY ARE COMING BEFORE THE
LOCAL GOVERNMENT, THEY ARE TALKING TO NEIGHBORS, HOLDING
EVENTS AND SO FORTH. I THINK THE OTHER PART OF THE
CHALLENGE, IS REFERENCED BY DR. HOTEZ, I MADE MENTION WHAT I
EARLIER PRESENTED IS IN SOME OF THE SPACES LIKE SOCIAL MEDIA BUT
ALSO PHYSICALLY, IS THAT THE OPPOSITION DOES NOT SHY FROM
BULLYING INTIMIDATION AS WELL. SO THEY’RE NO JUST PUSHING THEIR VIEWS THEY ARE SUPPRESSING OTHER
PEOPLE’S VIEWS. PEDIATRICIAN SAYS HEY I HAVE HPV
VACCINE, MY PATIENTS HERE THEY ARE, THEY WILL ATTACK THAT
PERSON. THE FAMILY MEMBER WHO IS NOT TRY
FOG PROMOTE VACCINE SAYING MY CHILD DIED OF FLU GETS ATTACKED.
OFTEN TIMES FAMILY TAKES DOWN THE PAGE OR THE POST.
THAT’S WHAT WE ARE UP AGAINST. WE HAVE TO TAKE, MAKE A POLICY
THAT ADDRESS THIS TYPE OF ACTIVITY AS WELL.
THIS KIND OF BULLYING AND INTIMIDATION SHOULD HAVE NO
PLACE IN PUBLIC DISCOURSE. IT’S BIGGER THAN THIS.
GROUP VACCINES UNFORTUNATELY VACCINES IS ONE PLACE THIS IS
PLAYING OUT.>>THANK YOU FOR A SPECTACULAR
PANEL. THANK TO THE COMMITTEE FOR YOUR
INTEREST, LET’S HAVE A ROUND OF APPLAUSE. [APPLAUSE]>>WE’RE GOING TO START OUR NEXT
PANEL PRESENTATION PROMPTLY AT THREE O’CLOCK SO IF YOU NEED TO
STAND AND STRETCH WE’LL JUMP
BACK IN QUICKLY.

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