[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
CONFRONTING A GROWING PUBLIC HEALTH THREAT: MEASLES OUTBREAKS IN THE
U.S.
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
FEBRUARY 27, 2019
__________
Serial No. 116-9
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
36-524 PDF WASHINGTON : 2020
COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois GREG WALDEN, Oregon
ANNA G. ESHOO, California Ranking Member
ELIOT L. ENGEL, New York FRED UPTON, Michigan
DIANA DeGETTE, Colorado JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland PETE OLSON, Texas
JERRY McNERNEY, California DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice BILL JOHNSON, Ohio
Chair BILLY LONG, Missouri
DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon BILL FLORES, Texas
JOSEPH P. KENNEDY III, SUSAN W. BROOKS, Indiana
Massachusetts MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California RICHARD HUDSON, North Carolina
RAUL RUIZ, California TIM WALBERG, Michigan
SCOTT H. PETERS, California EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
------
Professional Staff
JEFFREY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
MIKE BLOOMQUIST, Minority Staff Director
Subcommittee on Oversight and Investigations
DIANA DeGETTE, Colorado
Chair
JAN SCHAKOWSKY, Illinois BRETT GUTHRIE, Kentucky
JOSEPH P. KENNEDY III, Ranking Member
Massachusetts, Vice Chair MICHAEL C. BURGESS, Texas
RAUL RUIZ, California DAVID B. McKINLEY, West Virginia
ANN M. KUSTER, New Hampshire H. MORGAN GRIFFITH, Virginia
KATHY CASTOR, Florida SUSAN W. BROOKS, Indiana
JOHN P. SARBANES, Maryland MARKWAYNE MULLIN, Oklahoma
PAUL TONKO, New York JEFF DUNCAN, South Carolina
YVETTE D. CLARKE, New York GREG WALDEN, Oregon (ex officio)
SCOTT H. PETERS, California
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
----------
Page
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 1
Prepared statement........................................... 3
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 4
Prepared statement........................................... 6
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 7
Prepared statement........................................... 8
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, opening statement...................................... 9
Prepared statement........................................... 11
Hon. Michael C. Burgess, a Representative in Congress from the
State of Texas, prepared statement............................. 12
Hon. Kathy Castor, a Representative in Congress from the State of
Florida, prepared statement.................................... 55
Witnesses
Nancy Messonnier, M.D., Director, National Center for
Immunization and Respiratory Disease, Centers for Disease
Control and Prevention, Department of Health and Human Services 13
Prepared statement........................................... 16
Answers to submitted questions............................... 61
Anthony S. Fauci, M.D., Director, National Institute of Allergy
and Infectious Diseases, National Institutes of Health,
Department of Health and Human Services........................ 26
Prepared statement........................................... 28
Answers to submitted questions............................... 75
Submitted Material
Article of February 5, 2019, ``Collapse Of Health System Sends
Venezuelans Fleeing To Brazil For Basic Meds,'' by Jason
Beaubien, NPR, submitted by Mr. Duncan......................... 56
Letter of February 26, 2019, from Peter Hotez, M.D., to Mr.
Burgess, submitted by Mr. Burgess.............................. 59
CONFRONTING A GROWING PUBLIC HEALTH THREAT: MEASLES OUTBREAKS IN THE
U.S.
----------
WEDNESDAY, FEBRUARY 27, 2019
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:01 a.m., in
the John D. Dingell Room 2123, Rayburn House Office Building,
Hon. Diana DeGette (chair of the subcommittee) presiding.
Members present: Representatives DeGette, Schakowsky, Ruiz,
Kuster, Castor, Tonko, Pallone (ex officio), Guthrie
(subcommittee ranking member), Burgess, McKinley, Griffith,
Brooks, Mullin, Duncan, and Walden (ex officio).
Staff present: Kevin Barstow, Chief Oversight Counsel;
Billy Benjamin, Systems Administrator; Jesseca Boyer,
Professional Staff Member; Jeff Carroll, Staff Director;
Waverly Gordon, Deputy Chief Counsel; Tiffany Guarascio, Deputy
Staff Director; Judy Harvey, Counsel; Chris Knauer, Oversight
Staff Director; Jourdan Lewis, Policy Analyst; Kaitlyn Peel,
Digital Director; Andrew Souvall, Director of Communications,
Outreach, and Member Services; C. J. Young, Press Secretary;
Jen Barblan, Minority Chief Counsel, Oversight and
Investigations; Mike Bloomquist, Minority Staff Director;
Jordan Davis, Minority Senior Advisor; Margaret Tucker Fogarty,
Minority Staff Assistant; Ryan Long, Minority Deputy Staff
Director; Kristen Shatynski, Minority Professional Staff
Member, Health; Alan Slobodin, Minority Chief Investigative
Counsel, Oversight and Investigations.
Ms. DeGette. The Subcommittee on Oversight and
Investigations will now come to order.
Today, the subcommittee is holding a hearing entitled
``Confronting a Growing Public Health Threat: Measles Outbreaks
in the U.S.''
The purpose of today's hearing is to examine the public
health surveillance and infrastructure response to the current
measles outbreaks in the United States.
The Chair now recognizes herself for the purposes of an
opening statement.
OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Today, we will examine a serious public health emergency
that is threatening communities across the country. Since the
start of this year alone, more than 159 people across 10 States
have been infected by measles.
This is a highly contagious and potentially deadly disease
that was once declared eliminated here in the United States,
thanks to the development of a successful preventative vaccine.
Yet, despite the previous success, as we sit here today, we
have communities across the country scrambling to protect their
residents and we have parents who are reading daily headlines
about an outbreak, worried how they are going to protect their
children and their families.
If there was ever one topic that should transcend politics
or party lines, this should be it. On behalf of the American
people, it is this committee's job to ensure that our public
health agencies are doing everything they can to prevent the
spread of this disease.
And I can tell you, right now, this committee has serious
concerns about how our Nation's public health system is
responding to the current outbreak. What we accomplished less
than 20 years ago in eliminating this disease was truly amazing
and we want to know exactly can what this administration is
doing to once again stop the spread of this highly contagious
disease.
We also want to know how we got ourselves back into this
situation and what our agencies are doing to prevent another
outbreak, such as this one, from happening again.
Before the measles vaccine was developed in 1963, there
were half a million cases of the measles being reported every
year to the CDC. Forty-eight thousand people a year were being
sent to the hospital and, as a result, as many as 500 people a
year died.
It wasn't until the development of the measles, mumps, and
rubella vaccine--known as the MMR vaccine--that we, as a
country, were able to stop this horrific illness.
But despite that success, here we are again, as I said,
less than 20 years later, dealing with the fear associated with
yet another outbreak of the disease.
As of now, there have been 127 reported cases of the
measles in 10 States, including in my home State of Colorado.
In fact, in my district last month, the Denver Public Health
Department was forced to issue a measles exposure warning when
an adult acquired the measles after traveling internationally.
Now, that seems to be isolated, but the recent outbreaks
are a real cause for national concern. The national measles
vaccination rate of children between 19 and 35 months old is
currently at 91 percent.
That may seem high to some, but given the highly contagious
nature of measles, it is well below the 95 percent vaccination
rate that is required to protect communities and give it what
is known as ``herd immunity.''
This so-called ``herd immunity'' is particularly vital to
protecting those who cannot be, or are not yet, vaccinated
against the measles, such as infants or those with prior
medical conditions who are at a higher risk of suffering severe
complications from the vaccine.
As our public health agencies have repeatedly emphasized,
reaching that 95 percent vaccination rate is critical to
preventing outbreaks such as the one we are experiencing today.
While the overall national rate of MMR vaccinations is
currently at 91 percent, the rate in some communities is much
lower. Some are as low as 77 percent. In fact, Colorado has one
of the lowest rates of kindergartners vaccinated for MMR in the
country, well below the rate necessary to protect vulnerable
children from this potentially deadly disease.
Outbreaks, like the one we are seeing with measles, remind
us of just how interconnected our communities are. They remind
us of how the decisions of one community can directly affect
other communities across the country and we have--as a nation,
to stop the spread of deadly diseases, we have to address the
root cause of the problem and we have to identify concrete
steps.
We have to provide parents and community leaders with real
science-based information, not only about how vaccines are
safe, but why they are so important. We need to support
additional research into vaccine safety to further increase
consumer confidence in these vaccines.
And we need to strengthen our public health infrastructure
at all levels of our Government to better prepare for and
respond to these outbreaks.
We have to work together to protect the most vulnerable
among us and we have got to ensure that an outbreak of measles
once again becomes a rarity in this country.
I want to thank our witnesses, Dr. Messonnier, who is here
on behalf of the Centers for Disease Control and Prevention,
who is on the front lines of preventing this, and, of course,
Dr. Anthony Fauci from the National Institutes of Health, no
stranger to this committee on a variety of issues, who is here
to talk about his in-depth knowledge of the vaccines and how we
can prevent these diseases from spreading in the U.S.
Thank you both for being here, and I am now happy to
recognize the ranking member of the subcommittee, Mr. Guthrie,
for 5 minutes for his opening statement.
[The prepared statement of Ms. DeGette follows:]
Prepared statement of Hon. Diana DeGette
Today, we will examine a serious public health emergency
that's threatening communities across the country.
Since the start of this year alone, more than 159 people
across 10 States have been infected by measles.
This is a highly contagious and potentially deadly disease
that was once declared eliminated here in the United States--
thanks to the development of a successful preventive vaccine.
Yet, despite that previous success, as we sit here today,
we have communities across the country scrambling to protect
their residents--and we have parents, who are reading daily
headlines about an outbreak, worried about how they are going
to protect their children and their families.
If there was ever one topic that should transcend politics
or party lines, this should be it.
On behalf of the American people, it is this committee's
job to ensure that our public health agencies are doing
everything they can to prevent the spread of this disease.
And I can tell you, right now, this committee has serious
concerns about how our Nation's public health system is
responding to this current outbreak.
What we accomplished less than 20 years ago--in eliminating
this disease--was truly amazing.
And we want to know exactly what this administration is
doing to once again stop the spread of this highly contagious
disease.
We also want to know how we got ourselves back into this
situation and what our agencies are doing to prevent another
outbreak, such as this one, from happening again.
Before the measles vaccine was developed in 1963, there
were half a million cases of the measles being reported every
year to the CDC. 48,000 people a year were being sent to the
hospital and, as a result, as many as 500 people a year died as
a result.
It wasn't until the development of the measles, mumps, and
rubella vaccine--known as the MMR vaccine--that we, as a
country, were able to stop this horrific illness.
But despite that success, here we are again--as I said,
less than 20 years later--dealing with the fear associated with
yet another outbreak of this disease.
As of now, there have been 159 reported cases of the
measles in 10 States, including in my home State of Colorado.
In fact, in my district last month, the Denver Public
Health Department was forced to issue a measles exposure
warning when an adult acquired the measles after traveling
internationally.
Now, that seems to be isolated, but these recent outbreaks
are cause for real national concern.
The national measles vaccination rate of children between
19 and 35 months old is currently at 91 percent.
That may seem high to some, but given the highly contagious
nature of measles, it's well below the 95 percent vaccination
rate that's required to protect communities and give it what is
known as ``herd immunity.''
This so-called ``herd immunity'' is particularly vital to
protecting those who cannot be, or are not yet, vaccinated
against the measles--such as infants or those with prior
medical conditions who are at a higher risk of suffering severe
complications from the vaccine.
As our public health agencies have repeatedly emphasized,
reaching that 95 percent vaccination rate is critical to
preventing outbreaks such as the one we are experiencing today.
While the overall national rate of MMR vaccinations is
currently at 91 percent, the rate in some communities is much
lower--some are as low as 77 percent.
In fact, my State of Colorado has one of the lowest rates
of kindergartners vaccinated for MMR in the country--well below
the rate necessary to protect vulnerable children and people
from this potentially deadly disease.
Outbreaks, such as the one we are seeing today with
measles, remind us of just how interconnected our communities
are.
They remind us how the decisions of one community can
directly affect other communities across the Nation.
We, as a nation--to stop the spread of these deadly
diseases--have to address the root cause of the problem. And we
have to identify concrete steps.
We have to provide parents and community leaders with the
real, science-based information--not only about how vaccines
are safe, but why they are so important.
We need to support additional research into vaccine safety,
to further increase consumer-confidence in these vaccines.
And we need to strengthen our public health infrastructure
at all levels of our Government to better prepare for, and
respond to, these outbreaks.
We have to work together to protect the most vulnerable
among us, and we have to find ways to ensure that an outbreak
of measles once again becomes a rarity in this country.
I want to thank our witnesses who are here to testify
today.
Dr. Nancy Messonnier, who is here on behalf of the Centers
for Disease Control and Prevention, and is on the frontline of
preventing this.
And Dr. Anthony Fauci from the National Institutes of
Health--who is no stranger to this committee--is here to talk
about his in-depth knowledge of the vaccines and how we can
prevent these diseases from spreading in the U.S.
Thank you both for being here.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Mr. Guthrie. Thank you, Chair DeGette, for holding this
important and timely hearing, and this is an area of bipartisan
interest. Measles is an extremely contagious virus. It can
cause significant respiratory symptoms, fever, and rash.
In some cases, the consequences can be severe. One in 20
children with measles develops pneumonia. One in a thousand
children develop brain swelling that can cause brain damage.
One or two in a thousand children who contract measles will
die.
Fortunately, measles was declared eliminated in the United
States in 2000 because the Nation had gone more than 12 months
without any contagious disease transmission. Public health
experts believe this progress was achieved because of the very
safe combination of measles-mumps-rubella--or MMR--vaccine,
very high vaccination rates and a strong public health system
to detect and respond to outbreaks.
However, elimination does not mean the disease was
completely eradicated. The disease remains in many parts of the
world. There are about 20 million cases worldwide each year.
Measles returns to the U.S. when the infected travelers
bring the disease back to parts of the country where some
parents have chosen not to vaccinate their children. Because
measles is so contagious, it is estimated 93 to 95 percent of
people in a locality need to be vaccinated to achieve
population immunity.
This level of population immunity provided by very high
vaccination rates prevents outbreaks and sustained transmission
of measles. According to CDC tracking, while national
vaccination rates remain high, estimated MMR vaccination rates
among 13-to-17-year-old teenagers can vary widely, ranging from
77.8 percent to 97.9 percent across States and local counties
in the United States.
We currently have multiple measles outbreaks in the United
States. As of February 21st, 2019, the CDC reported that there
are 159 confirmed cases of measles this year in 10 States.
My home State of Kentucky was recently added to the list.
Unfortunately, this current outbreak is continuing a recent
trend. An average of 63 measles cases were reported to CDC from
2000 to 2007.
However, from 2011 to 2017, the annual average of reported
cases increased to 217. The CDC told the committee staff that
in the last 5 years there have been 26 measles outbreaks
involving five or more people. Seventy-five percent of those
cases spread in the local close-knit communities with groups of
unvaccinated people.
These outbreaks are tragic, since they were completely
avoidable. Every State except three have enacted religious
exemptions for parents who wish not to vaccinate their
children. There are 17 States that allow a personal or
philosophical exemption, which means that most people can opt
out for any reason.
For example, in Washington State, just 0.3 percent of
Washington's families with kindergartners use a religious
exemption while 3.7 percent of families use a personal
exemption and 0.8 percent use a medical exemption.
Vaccine exemptions have increased in the past 3 years to a
median 2.2 percent of kindergartners among all States. With
recent links to pockets of undervaccination, some State
legislators are looking to tighten or eliminate certain types
of exemptions that allow parents to not have their children
immunized.
After the Disneyland-linked outbreak of measles in 2014,
the State of California ended a religious and personal
exemption for vaccines. The Washington legislature is working
on legislation that substantially narrows the exemptions for
vaccination that would eliminate the personal or philosophical
exemption while tightening the religious exemption.
In recent weeks, State legislators in New Jersey, New York,
Iowa, Maine, and Vermont have proposed eliminating religious
exemptions for vaccines. However, last week the Arizona House
Health and Human Service Committee approved three bills to
expand exemptions for mandatory vaccinations.
Given the concerns raised by the measles outbreak in
various parts of the Nation and recent State legislative
activity, it is appropriate to have this hearing to provide
greater discussion and examination at a national level.
I welcome our two expert witnesses, Dr. Messonnier of the
CDC and Dr. Anthony Fauci of the National Institute of Allergy
and Infectious Diseases.
I look forward to your testimony, and I yield back my time.
[The prepared statement of Mr. Guthrie follows:]
Prepared statement of Hon. Brett Guthrie
Thank you, Chair DeGette, for holding this important and
timely hearing. This is an area of bipartisan interest.
Measles is an extremely contagious virus. It can cause
significant respiratory symptoms, fever, and rash. In some
cases, the consequences can be severe. One in 20 children with
measles develops pneumonia, and one in 1,000 children? develop
brain swelling that can cause brain damage. One or two in 1,000
children who contract measles will die.
Fortunately, measles was declared eliminated in the United
States in 2000 because the Nation had gone more than 12 months
without any continuous disease transmission. Public health
experts believe this progress was achieved because of a very
safe combination measles-mumps-rubella--or MMR--vaccine, very
high vaccination rates, and a strong public health system to
detect and respond to outbreaks.
However, elimination does not mean the disease was
completely eradicated. The disease remains in many parts of the
world. There are about 20 million cases worldwide each year.
Measles returns to the U.S. when infected travelers bring the
disease back to parts of the country where some parents have
chosen not to vaccinate their children. Because measles is so
contagious, it is estimated 93 to 95 percent of people in a
locality need to be vaccinated to achieve population immunity.
This level of population immunity--provided by very high
vaccination rates--prevents outbreaks and sustained
transmission of measles. According to CDC tracking, while
national vaccination rates remain high, estimated MMR
vaccination coverage among 13-to-17-year-old teenagers, can
vary widely, ranging from 77.8 percent to 97.9 percent across
States and local counties in the United States.
We currently have multiple measles outbreaks in the United
States. As of February 21, 2019, the CDC reported that there
are 159 confirmed cases of measles this year in 10 States. My
home State of Kentucky was recently added to this list.
Unfortunately, this current outbreak is continuing a recent
trend. An average of 63 measles cases were reported to CDC from
2000 to 2007. However, from 2011 to 2017, the annual average of
reported cases increased to 217. The CDC told the committee
staff that in the last 5 years there have been 26 measles
outbreaks involving five or more people. Seventy-five percent
of those cases spread in local close-knit communities with
groups of unvaccinated people. These outbreaks are tragic since
they are completely avoidable.
Every State, except three, have enacted religious
exemptions for parents who wish not to vaccinate their
children. There are 17 States that allow a personal or
philosophical exemption, which means that most people can opt
out for any reason. For example, in Washington State, just 0.3
percent of Washington's families with kindergartners used a
religious exemption, while 3.7 percent of families used a
personal exemption and 0.8 percent used a medical exemption.
Vaccine exemptions have increased in the past 3 years to a
median 2.2 percent of kindergartners among all States.
With recent outbreaks linked to pockets of
undervaccination, some State legislatures are looking to
tighten or eliminate certain types of exemptions that allow
parents to not have their children immunized. After the
Disneyland-linked outbreak of measles in 2014, the State of
California ended religious and personal exemptions for
vaccines. The Washington legislature is working on legislation
that substantially narrows the exemptions for vaccination that
would eliminate the personal or philosophical exemption while
tightening the religious exemption. In recent weeks, State
legislators in New Jersey, New York, Iowa, Maine, and Vermont
have proposed eliminating religious exemptions for vaccines.
However, last week, the Arizona House Health and Human Services
Committee approved three bills to expand exemptions for
mandatory vaccinations.
Given the concerns raised by the measles outbreak in
various parts of the Nation and recent State legislative
activity, it is appropriate to have this hearing to provide
greater discussion and examination at a national level.
I welcome our two expert witnesses, Dr. Nancy Messonnier of
the CDC, and Dr. Anthony Fauci of the National Institute of
Allergy and Infectious Diseases. I look forward to your
testimony, and I yield back.
Ms. DeGette. The gentleman yields back.
The Chair now recognizes the chairman of the full
committee, Mr. Pallone, for 5 minutes for an opening statement.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Madam Chair.
This committee has a long history of addressing public
health concerns and infectious disease crises. Today, we are
here to discuss the troubling increase in the number of measles
cases here in the United States.
This issue hits close to home for me. Just this past
December, 33 cases of measles were confirmed in Ocean and
Passaic Counties in my home State of New Jersey. And Madam
Chair, my written statement actually says that, fortunately,
the outbreak in New Jersey is now over.
But the reality is I have to change my written statement
because I was reading through my press clips this morning and
this was front the Bergen Record, which is a publication--a
daily newspaper in the northern part of the State--and it says,
I quote, ``Confirmed cases of measles exposure reported in
Bergen County. A New Jersey man who has been diagnosed with
measles may have exposed people in Bergen County to the disease
earlier this month, particularly at two locations in Hillsdale,
State health officials said. Exposures would have occurred
between February 17th and Monday,''--this past Monday--``a
spokeswoman for the State health department said.''
So it isn't true that the outbreak is over in New Jersey.
This is--these are--this is a case now in a county where
measles had been previously reported.
So as of this morning, there have been--and that doesn't
count this--there have been 159 measles cases reported across
the Nation already this year, and there are now six outbreaks
of three or more cases in four States. Not only are we seeing a
troubling increase in cases, but the number of outbreaks also
continues to grow, and it is deeply disturbing.
The reemergence of this highly contagious vaccine-
preventable disease poses a threat beyond the pockets of
communities in which it arises. It is particularly dangerous to
infants, children under the age of 5, those who are pregnant,
and people with compromised immune systems.
All these people are at higher risk of severe complications
from measles. But what is particularly disconcerting is that
this is a public health problem for which science has already
provided a solution: a safe and effective vaccine. There is
overwhelming confidence among researchers, public health
officials, and parents in the MMR vaccine.
Yet vaccine hesitancy and, to a lesser degree, vaccine
access concerns are behind the growing number of measles cases
in the United States since 2010.
I know that we will discuss both of these issues and hear
from our experts as to the Federal Government's responsibility
in addressing both. But I would also like to hear from
witnesses about one particular area of great concern to me, and
that is the proliferation of disinformation about the safety
and efficacy of the MMR vaccine.
I am deeply troubled by the role digital media plays in
perpetuating myths and fears regarding measles. It is
undermining the facts on how to safely and effectively prevent
measles and other vaccine-preventable diseases.
For example, recent media reports found that users on
YouTube and Facebook are steered towards antivaccination
content due to the platform's algorithms.
Both companies have said they are taking steps to address
the promotion of conspiracy theories, but we must keep our eye
on where this misinformation will pop up next, particularly
when we know there is a preponderance of evidence that the MMR
vaccine is safe and effective and that there are numerous
measures in place to continue to monitor and assess its safety
and the safety of other vaccines.
I am deeply troubled that parents are being inundated with
distortions and misinformation campaigns when they are going
online to try to make informed decisions about their child's
health.
And I look forward to hearing from Dr. Messonnier--if I am
pronouncing it right--and Dr. Fauci about what is driving the
recent measles outbreak. I would also like to know what efforts
are underway by the CDC and NIH to address this growing public
health threat and where they still need additional support.
So, hopefully, this will be a hearing where we try to get
to the bottom of what is actually happening out there, and
thank you for our witnesses.
Thank you, Madam Chair. This is a very important hearing.
Thank you.
[The prepared statement of Mr. Pallone follows:]
Prepared statement of Hon. Frank Pallone, Jr.
This committee has a long history of addressing public
health concerns and infectious disease crises. Today, we are
here to discuss the troubling increase in the number of measles
cases here in the United States.
This issue hits close to home for me. Just this past
December, 33 cases of measles were confirmed in Ocean and
Passaic counties of my home State of New Jersey.
Fortunately, the outbreak in New Jersey is now over, but as
of this morning, there have been 159 measles cases reported
across the Nation already this year. And there are now six
outbreaks--of three or more cases--in four States. Not only are
we seeing a troubling increase in cases, but the number of
outbreaks also continues to grow. This is all deeply
disturbing.
The reemergence of this highly contagious
vaccinepreventable disease poses a threat beyond the pockets of
communities in which it arises.
It is particularly dangerous to infants, children under the
age of 5, those who are pregnant, and people with compromised
immune systems. All of these people are at higher risk of
severe complications from the measles.
What is particularly disconcerting, is that this is a
public health problem for which science has already provided a
solution: a safe and effective vaccine. There is overwhelming
confidence among researchers, public health officials, and
parents in the MMR vaccine.
Yet vaccine hesitancy, and, to a lesser degree, vaccine
access concerns are behind the growing number of measles cases
in the U.S. since 2010.
I know that we will discuss both of these issues and hear
from our experts as to the Federal Government's responsibility
in addressing both.
I'd also like to hear from our witnesses about one
particular area of great concern to me, and that is the
proliferation of disinformation about the safety and efficacy
of the MMR vaccine.
I am deeply troubled by the role digital media plays in
perpetuating myths and fears regarding measles. It is
undermining the facts on how to safely and effectively prevent
measles and other vaccine-preventable diseases.
For example, recent media reports found that users on
YouTube and Facebook are steered toward antivaccination content
due to the platform's algorithms.
Both companies have said they are taking steps to address
the promotion of conspiracy theories, but we must keep our eye
on where the misinformation will pop up next.
Particularly when we know there is a preponderance of
evidence that the MMR vaccine is safe and effective. And, that
there are measures in place to continue to monitor and assess
its safety and the safety of other vaccines.
I am deeply troubled that parents are being inundated with
distortions and misinformation campaigns when they are going
online to try to make informed decisions about their child's
health.
I look forward to hearing from Dr. Messonnier and Dr. Fauci
about what's driving the recent measles outbreaks. I'd also
like to know what efforts are underway by the CDC and NIH to
address this growing public health threat, and where they still
need additional support.
Thank you, and I yield back.
Ms. DeGette. The gentleman yields back.
The Chair now recognizes the ranking member of the full
committee, Mr. Walden, for 5 minutes for the purposes of an
opening statement.
OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OREGON
Mr. Walden. Good morning, Madam Chair. Thank you for
holding this hearing.
The reemergence of vaccine-preventable diseases including
measles coincided with the undervaccination as a major public
health concern. World Health Organization last month called
vaccine hesitancy one of the 10 biggest threats to global
health, noting the shocking 30 percent increase in measles
cases worldwide last year.
In 2000, measles was considered to have been eliminated in
the United States. Last year, the U.S. had its second most
cases since 2000. The current measles outbreak showcases the
problem of undervaccination.
It is a problem that hits close to home for me since 65
measles cases in the outbreak have mainly occurred in Clark
County, Washington, a suburb of Portland, Oregon, with four in
Multnomah County, Oregon, for a total of 69 confirmed measles
cases.
Measles exposure even reached my district with an infected
person from Clark County visiting a trampoline park in Bend,
Oregon. While there have been no confirmed cases resulting from
that particular exposure, this highlights the reach of the
measles outbreak.
Unfortunately, the case information suggests the region
near Portland has been an area of undervaccination. Most of
these cases involve people who are not vaccinated and most of
those infected were children between the ages of one and ten.
County public health officials are confronted with
directing hundreds of susceptible families who have been
exposed to the virus at more than three dozen locations
including a Portland Trailblazers basketball game, schools,
churches, and stores such as Costco and Walmart.
There are important reasons for getting the measles
vaccine. Measles is a highly contagious infectious disease that
spreads through coughing and sneezing. Health officials say the
virus is so contagious that if an unvaccinated person walks
through a room after someone with measles has left, there is a
90 percent chance that an unvaccinated person will get that
disease.
This can be a very serious disease. Measles infection
typically causes a high fever and rash. About one of four
people who gets measles will be hospitalized.
Infection can lead to ear infections, hearing loss and, in
rare cases, brain swelling and even death. Measles vaccine is
highly effective and may be one of the most effective vaccines
around.
Two doses are about 97 percent effective and since the
introduction of the combination MMR vaccine there has been a 99
percent reduction in the number of measles cases compared to
the prevaccine era.
It not only protects you, but others as well, particularly
vulnerable infants who cannot be vaccinated. This year can help
provide important information--this hearing--I am sorry--can
help provide important information to address questions for
some people about the safety of the vaccine as well as
heightened awareness about the effectiveness of the vaccine and
the importance of getting vaccinated.
If we don't reverse the downward trend of vaccination we
risk bringing back measles in full force.
So I welcome both of our witnesses today to provide their
expertise about the disease of measles and insights into the
facts and value of measles vaccine.
Dr. Nancy Messonnier, thank you for your service and your
leadership in various senior capacities at the Centers for
Disease Control and Prevention.
Dr. Anthony Fauci, the director of National Institutes of
Health Institute of Allergy and Infectious Diseases--sir, you
need no introduction, having testified probably hundreds of
times before our committee.
However, on this occasion, I think you should be
recognized, sir, for more than 50 years of public service,
including your 35th anniversary year as director of the
National Institute of Allergy and Infectious Diseases and for
your achievements.
[Applause.]
You have made substantial contributions to HIV/AIDS
research. You have helped develop therapies for formerly fatal
diseases. With many honors, you have been awarded the Lasker
Award and the Presidential Medal of Freedom.
Chair DeGette, I really think we need to congratulate him.
So we look forward to your testimony and to learning more in
this committee about what we should do, going forward.
[The prepared statement of Mr. Walden follows:]
Prepared statement of Hon. Greg Walden
Chair DeGette, thank you for holding this hearing. The
reemergence of vaccine-preventable diseases, including measles,
coinciding with undervaccination is a major public health
concern. The World Health Organization last month called
``vaccine hesitancy'' one of the 10 biggest threats to global
health, noting the shocking 30 percent increase in measles
cases worldwide last year. In 2000, measles was considered to
have been eliminated in the United States. But last year, the
U.S. had its second-most cases since 2000.
The current measles outbreak showcases the problem of
undervaccination.
It's a problem that hits close to home for me since 65
measles cases in this outbreak have mainly occurred in Clark
County, Washington (a suburb of Portland, Oregon), with four in
Multnomah County, Oregon, for a total of 69 confirmed cases of
measles. The measles exposure even reached my district, with an
infected person from Clark County visiting a trampoline park in
Bend, Oregon. Though there have been no confirmed cases
resulting from that particular exposure, this highlights the
reach of the measles outbreak.
Unfortunately, the case information suggests the region
near Portland has been an area of undervaccination. Most of
these cases involved people who were not vaccinated, and most
of those infected were children between the ages of one and 10.
County public health officials are confronted with
directing hundreds of susceptible families who have been
exposed to the virus at more than three dozen locations,
including a Portland Trailblazers basketball game, schools,
churches, and stores such as Costco and Walmart.
There are important reasons for getting the measles
vaccine. Measles is a highly contagious, infectious disease
that spreads through coughing and sneezing. Health officials
say the virus is so contagious that if an unvaccinated person
walks through a room after someone with measles has left, there
is a 90 percent chance that an unvaccinated person will get the
disease. This can be a very serious disease. Measles infection
typically causes a high fever and rash, and about one of four
people who gets measles will be hospitalized. The infection can
lead to ear infections, hearing loss, and in rarer cases, brain
swelling and death.
The measles vaccine is highly effective, and maybe one of
the most effective vaccines around. Two doses are about 97
percent effective. Since the introduction of the combination
MMR vaccine, there has been a 99 percent reduction in the
number of measles cases, compared to the prevaccine era. It not
only protects you, but others as well, particularly vulnerable
infants who cannot be vaccinated. This hearing can help provide
important information to address questions for some people
about the safety of the vaccine, as well heighten awareness
about the effectiveness of the vaccine and the importance of
getting vaccinated. If we don't reverse the downward trend of
vaccination, we risk bringing back measles in full force.
I welcome both of our witnesses to provide their expertise
about the disease of measles, and insights into the facts and
value of the measles vaccine. Dr. Nancy Messonnier, thank you
for your service and your leadership in various senior
positions at the Centers for Disease Control and Prevention.
Dr. Anthony Fauci, the Director of the National Institutes of
Health Institute of Allergy and Infectious Diseases, you need
no introduction, having testified probably hundreds of times
before this committee. However, on this occasion I think you
should be recognized, sir, for your more than 50 years of
public service, including your 35th anniversary year as
Director of the National Institute of Allergy and Infectious
Diseases, and your achievements. You have made substantial
contributions to HIV/AIDS research, and you have developed
therapies for formerly fatal diseases. Among many honors, you
have been awarded the Lasker Award, and the Presidential Medal
of Freedom. Chair DeGette, I think he deserves a bipartisan
round of applause and our appreciation.
We look forward to your testimony, and to learning how our
committee can help support your efforts to protect public
health.
Mr. Walden. With that, I will yield the balance of my time
to Dr. Burgess.
Mr. Burgess. I thank the chairman for the recognition. In
full disclosure, I am a measles survivor. I was of an age where
the measles vaccine was not available.
Even though I was very young when that happened, I still
remember the clinical course with the measles of hard shaking
chills, the muscle pain, and, of course, the rash that is
pathognomonic of measles.
I will tell you that we forget about some of the
complications of measles. I took the liberty of printing out a
couple of pages from Harrison's Principles of Internal
Medicine.
Let me just run through some of the highlights: laryngitis,
croup, bronchitis, otitis media, ear infections, pneumonia both
viral and secondary bacterial, fever, headache, drowsiness,
coma, seizures. Ten percent of patients who have measles
encephalitis do not survive. Transverse myelitis following
measles has been reported, similar to polio. Gastrointestinal
complications, hepatitis, appendicitis, ileocolitis, mesenteric
adenitis.
Other rare complications include myocarditis,
glumerulonephritis, pulmonary nephritis, post-infection
thrombocytopenia purpura. It is a serious illness. It is
entirely vaccine preventable. I am grateful we are having the
hearing today. I yield back.
[The prepared statement of Mr. Burgess follows:]
Prepared statement of Hon. Michael C. Burgess
Thank you, Mr. Walden. This is an incredibly important
hearing to hold as we are seeing measles outbreaks in different
areas throughout the country. While the largest outbreaks have
been in Oregon and Washington State, as of February 14th there
are eight total confirmed cases in Texas in 2019, including one
in my district in Denton. According to the Centers for Disease
Control and Prevention, reported measles incidence decreased 87
percent from 2000 to 2016, and the annual estimated measles
deaths decreased 84 percent. What these statistics show us is
that the vaccination program was safe and effective.
It is frustrating to see a measles resurgence nearly 20
years after measles was declared eliminated from the United
States. I look forward to hearing from Dr. Fauci and Dr.
Messonnier about how NIH and CDC have worked and will continue
to work to protect our Nation's public health and prevent
further spread of this terrible disease.
Ms. DeGette. I thank the gentleman for yielding and, Mr.
Walden, I really thank you for recognizing Dr. Fauci. He really
is a true treasure, and we are always happy to see him.
I am going to ask unanimous consent that Members' written
opening statements be made part of the record.
Without objection, so ordered.
I also ask unanimous consent that Energy and Commerce
members not on the Subcommittee on Oversight and Investigations
be permitted to participate in today's hearing.
Without objection, so ordered.
I would now like to introduce our witnesses, who have
already been introduced by a number of opening statements.
Dr. Nancy Messonnier, who is with the National Center for
Immunization and Respiratory Diseases at the CDC, and Dr.
Anthony Fauci, the director of the National Institute for
Allergy and Infectious Diseases at the National Institutes of
Health.
Both of you are aware, I know, that the committee is
holding an investigative hearing and, as such, has had the
practice of taking testimony under oath.
So either of you have any objections to taking your
testimony under oath?
Let the record reflect the witnesses have responded no. The
Chair then advises you that under the rules of the House and
the rules of the committee you are entitled to be accompanied
by counsel. Do you desire to be accompanied by counsel today?
Let the record reflect the witnesses have answered no. If
you would then, please rise and raise your right hand so you
may be sworn in.
[Witnesses sworn.]
You may be seated. Let the record reflect that the
witnesses have responded affirmatively, and you are now under
oath and subject to the penalties set forth in Title 18 Section
1001 of the U.S. Code.
And the Chair will now recognize our witnesses for a 5-
minute summary of their written statements. As both of you
know, there is a microphone and a series of lights in front of
you.
The light turns yellow when you have a minute left, and it
turns red to indicate that your time has come to an end.
So, Dr. Messonnier, I recognize you for your opening
statement. Thank you.
STATEMENTS OF NANCY MESSONNIER, M.D., DIRECTOR, NATIONAL CENTER
FOR IMMUNIZATION AND RESPIRATORY DISEASE, CENTERS FOR DISEASE
CONTROL AND PREVENTION, DEPARTMENT OF HEALTH AND HUMAN
SERVICES; ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE
OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL INSTITUTES OF
HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES
STATEMENT OF NANCY MESSONNIER
Dr. Messonnier. Thank you.
Good morning, Chair DeGette, Ranking Member Guthrie, and
members of the committee. I am Dr. Nancy Messonnier. I am the
director of the National Center for Immunization and
Respiratory Diseases at CDC.
Thank you for the opportunity to speak with you today.
Outbreaks of measles have, once again, been prominent in the
headlines. From January 1st to February 21st, 159 cases of
measles have been confirmed in 10 States, including California,
Colorado, Connecticut, Georgia, Illinois, Kentucky, New York,
Oregon, Texas, and Washington.
In 2018, 372 people with measles were reported from 25
States and the District of Columbia. Most cases have been
unvaccinated. Measles outbreaks have been and continue to be a
constant threat to the health of the American people.
While measles has been eliminated in the U.S. since 2000,
measles is circulating in many parts of the world and
importations remain a challenge.
Unvaccinated U.S. residents traveling abroad are at risk
for measles and returning unvaccinated U.S. residents and
foreign visitors to the U.S. may develop measles and expose
their families and communities.
Nationally, we enjoy high measles vaccination coverage.
However, there are pockets of people who are vaccine hesitant,
who delay or even refuse to vaccinate themselves and their
children.
Outbreaks of measles occur when measles gets into these
communities of unvaccinated people. Those choosing not to
vaccinate tend to live near each other. Some of these are what
we call close-knit communities, people who share common
religious beliefs or racial ethnic background. Others are
people who have strong personal belief against vaccination.
In the past 5 years, there have been 26 measles outbreaks
of more than five cases. Twelve of these were in close-knit
communities including outbreaks in a Somali community in
Minnesota in 2017 and orthodox Jewish communities in New York
City and New York State in 2018.
These 12 outbreaks account for 75 percent of cases over the
past 5 years. Vaccine hesitancy is the result of a
misunderstanding of the risk and seriousness of disease
combined with misinformation regarding the safety and
effectiveness of vaccines.
However, the specific issues fueling hesitancy varies by
community. Because vaccine hesitancy remains a highly localized
issue, the strategy to address these issues need to be local
with support from CDC. Strong immunization programs at the
State and local levels are critical to understanding the
specific issues and empowering local action.
CDC also works to support State and local public health
efforts through research to understand these reasons and
develop targeted strategies to address hesitancy.
In addition, a rapid response coordinated across local,
State, and Federal jurisdictions is critical to control of
outbreaks. The public health immunization infrastructure, the
systems, and people is the backbone for such a response.
Front line public health workers and clinicians across the
country are following up on people potentially exposed to
measles and recent outbreaks.
A critical component of our immunization infrastructure is
the Vaccines for Children program. Enacted in 1994 in response
to a large measles outbreak, VFC is celebrating its 25
anniversary.
Because of VFC, we have seen significant decreases in the
disparities in vaccination coverage that previously existed. I
would like to acknowledge and thank Congress for the leadership
they have shown in supporting VFC and providing us this
national treasure.
Our investments in the immunization program have been of
great benefit to our children, our communities, and our
country. Immunization continues to be one of the most cost-
effective public health interventions.
Each dollar invested in the childhood immunization program
earn $10 of societal savings and $3 in direct medical savings.
Immunizing our children is the social norm with only 1 percent
of children receiving no vaccines. Not only that, most parents
continue to have confidence in the safety and effectiveness of
vaccines.
In many ways, however, we are a victim of our own success.
Because of our success, fewer and fewer doctors and parents
have witnessed the serious and sometimes life-threatening
consequences of vaccine-preventable diseases, or VPDs.
Because of our success, we live in a time when outbreaks of
VPDs make headlines and are not just seen as a routine and
sometimes tragic part of childhood.
Because of our success, parents may wonder if vaccines are
really necessary and they may believe that the risk of
vaccinating infants or temporary discomfort a vaccine may cause
outweighs the benefits of protecting them from VPDs.
Our immunization system has risen to challenges in the
past. CDC is committed to keeping measles and other VPDs from
regaining a foothold in our country.
Even very large outbreaks start with a single case. Working
together, we can keep these numbers down, keep measles from
returning and threatening the health of our communities, and
sustain the enormous health and societal benefits that our
immunization partnership has achieved.
Thank you.
[The prepared statement of Dr. Messonnier follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you, Doctor.
Dr. Fauci, you are now recognized for 5 minutes.
STATEMENT OF ANTHONY S. FAUCI
Dr. Fauci. Thank you very much, Chairman DeGette, Ranking
Member Guthrie, members of the committee. Thank you for giving
me the opportunity to talk to you for a few minutes about the
continued reemergence of vaccine-preventable disease, measles.
As shown on this slide and as mentioned by several of you
already, measles virus is one of the most contagious viruses
that we know among the pathogens that confront mankind--as
mentioned, that if an individual gets into a room with someone
who has measles and that person is coughing and sneezing,
there's about a 90 percent chance that that person---that is
very unlike other diseases like influenza and other respiratory
diseases when the hit rate, although it is high, is nothing
approaching 90 percent.
Also, we know a lot about the virus. It has been very well
sequenced. That is important, because we can tell when the
virus is reintroduced into our country from where it comes,
such as the Israel insertion into the--into the Brooklyn among
the Hasidic Jews. We knew that it had come from an individual
from Israel.
Importantly is the potential for eradication because a
similar virus among animals was eradicated. I consider it
really an irony that you have one of the most contagious
viruses known to man juxtaposed against one of the most
effective vaccines that we have and yet we don't do and have
not done what could be done, namely, completely eliminate and
eradicate this virus.
You heard some of the--oops, I better go back one. Oops, it
is just--it has got a life of its own. Go back a few. There you
go.
As was mentioned, prior to the vaccine era there were about
3 million deaths each year. The decrease was dramatic. There
were 21 million lives that were saved from vaccines between the
year 2000 and 2017.
But, as shown on the last bullet on this slide, there are
110,000 deaths still today in the world, which means there is
the danger of the reinsertion of measles from other countries
and if we are not protected.
Again, prevaccine measles in the United States 3 to 4
million measles case and, as was mentioned by several of you,
48,000 hospitalizations. Like Dr. Burgess, I remember very
clearly the year that I got infected with measles. It was very
uncomfortable and it was very scary because at that year I went
back and looked at the statistics. There were 900,000 to a
million cases in the United States that year.
But look what the vaccine done. This is a very dramatic
slide. As shown, it dramatically decreased it to the point of
the year 2000 when we essentially eliminated.
But let us take a look at some of the things that I
mentioned about the disease itself. Fever, cough, rash, as was
mentioned by Dr. Burgess--again, contagious from four days
before the rash to four days after. So people are spreading
measles before they really know that they actually have
measles.
We have a group of individuals who are particularly at risk
for complications--infants and children, pregnant women,
immunocompromised, and even adults. If you are not protected
and you get infected, adults have a high incidence of
complications.
We have heard about the complications. They are not
trivial. One out of ten with ear infections, which could lead
to deafness; pneumonia in one out of 20 cases; encephalitis one
in a thousand; a very rare occurrence called subacute
sclerosing panencephalitis, which I will mention in a moment.
I don't want to scare the audience here but this is an x-
ray of a child who was infected, developed pneumonia with
bacterial complications. That x-ray, if it were normal, should
look all dark where the lungs are. The light is what we call
whiting out of the lungs, which very often leads to death.
As I mentioned, subacute sclerosing panencephalitis is very
rare, but it should be mentioned 7 to 10 years after an
individual develops measles they can have a very devastating
neurological syndrome--no known cure and is vaccine
preventable.
This is what it looks like. The brain on the right side has
a lot of dark spaces where. That is where brain tissue should
be. That is what happens when the brain gets damaged.
And so this is the statistics that Dr. Messonnier and
several of you mentioned about what is going on right now. This
slide is really unacceptable. This is a totally vaccine-
preventable disease and when we see these kind of blips, this
is not something to be taken lightly.
So what we all should strive for that measles in the United
States we need to get to zero.
Thank you.
[The prepared statement of Dr. Fauci follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you, Dr. Fauci.
It is now time for Members to have the opportunity to ask
questions. I will recognize myself for 5 minutes.
Since we first announced we would be holding this hearing
almost two weeks ago, more than 58 additional measles cases and
an additional outbreak have been reported. Parents around the
country are seeing headlines about these outbreaks.
As, Dr. Fauci, you mentioned, it is so rare now that it
actually does make headlines. But there is also a lot of noise
out there on measles and vaccines and I think sometimes because
we eliminated measles for a while parents now are unclear about
how best to protect their children and families.
Both of our witnesses are the two--two of the top public
health officials in the country. And so I would like to ask
each one of you what is the most important piece of advice you
would give to parents around the country on how they can best
protect their children and families from measles.
Dr. Messonnier?
Dr. Messonnier. Taking care of your health, eating well,
exercising, getting enough sleep--those are all parts of a
healthy lifestyle.
But the only way to protect against measles is to get
vaccinated. It is a safe and effective vaccine, and parents
should go ahead and get vaccinated.
If they have questions, they should talk to their doctor.
Their doctor can provide them more information about measles,
answer their questions, and reassure them to then go ahead and
get vaccinated.
Ms. DeGette. Dr. Fauci, do you have anything to add?
Dr. Fauci. Yes. I think it is important to point out,
obviously, ditto what everything that Dr. Messonnier said. But
we should look upon it in two approaches. One, it is for the
safety of your own child and the other is a responsibility to
the community, because in your opening statement, Congressman
DeGette, you mentioned this issue of herd immunity and we all
have a responsibility to be part of that umbrella of herd
immunity. And once it goes down below a certain percentage,
then you have danger to the entire society.
And something that is not fully appreciated is that we
vaccinate children first time at 11 to 12 months, and then the
boost at 4 to 6 years. Those infants are vulnerable to measles
if they get exposed.
So it is our responsibility to protect them and the only
way you can protect those who are not old enough to yet get
vaccinated or the immunosuppressed is to be part of that herd
immunity.
Ms. DeGette. Right. Now, Dr. Messonnier, you talked about
the risks and benefits, and we have heard a lot from both of
you about the benefits.
What are the risks of the--and maybe, Dr. Fauci, you want
to add into this, too--what are the risks inherent in the
vaccine itself? I think that might be one reason why some
parents are choosing not to vaccinate their children as they
believe that the risks with the vaccine outweigh the benefits.
Dr. Messonnier. I think you are exactly right and I think
in the setting of not a lot of measles cases around parents
weigh in their mind the risks and benefit and think they
shouldn't vaccinate.
The truth is this is an incredibly safe vaccine. We have a
host of experience with it. The vaccine has been used for a
really long time.
We, in the United States, enjoy one of the most robust
systems to monitor the safety of vaccines and that is why we
can say with confidence that this is a safe vaccine. The most
common side effects are a sore arm, which goes away pretty
quickly.
Ms. DeGette. And where can parents go to get factual
information about vaccines?
Dr. Messonnier. Yes, thank you. That is a really important
question. As a parent myself I understand that there is lots of
information out there and it is really hard to sort through it
all and make sure that you are getting the correct choices for
your children.
CDC works really hard to make sure that we put out
scientifically credible information. That is one of our core
missions. But we also provide that information to health care
providers.
Parents say that the person they trust most to help them
make health care decisions is still their health care provider
and that is also true of patients that are hesitant to
vaccinate.
So parents should talk to their health care provider. They
can help them sort through the sea of information out there to
what is scientifically correct.
Ms. DeGette. Dr. Fauci, do you have a sense of what parents
can do to get accurate information about the risks and
benefits?
Dr. Fauci. Yes. I mean, I want to echo what Dr. Messonnier
said. The CDC website is just really a cornucopia of important
information. It is easily accessible. You go to cdc.gov. It
says Search. Put measles in and all the things you really want
to know about it are right there with references.
Ms. DeGette. Great. OK. Thank you very much, both of you,
for being with us today and clearing up some of these myths.
I am now happy to recognize the ranking member, Mr.
Guthrie, for purposes for asking questions for 5 minutes.
Mr. Guthrie. Thank you very much, and again, thanks for the
witnesses for being here. And this is important and I think
every parent, regardless of what decisions they made on--want
to make the best decision for their child. That is what
people--and so we want to make sure the best information, the
accurate information, so they can make the best decision for
the child.
This is particularly pertinent to me. One of my great
friends growing up--I was born in 1964. He was born just a few
months before me in 1963 and his mom had rubella. He was born
without a hand--essentially, without a hand. And so I have
always thought of measles and how devastating it can be.
As a matter of fact, you can see him play baseball. He
could throw the ball, have his glove on his hand, put his hand
in and just amazing how he adapted to it. But it was something.
So I remember later in life when I was a little older my
mom telling how the--because she was six or seven months
pregnant with me when he--when he was born and just the terror
that went through our community and with women that were
pregnant with their children at that time.
So it has always been--so I just want to ask some questions
and try to get information out, moving forward, and for both of
you to answer. In your opinion as physicians and leaders in
Federal public health agencies, should parents of unvaccinated
children be more fearful of measles or the measles vaccine?
Dr. Fauci. To me, it is a no doubt. That is really a no-
brainer. Clearly, if you look, and as I try to describe in my
opening statement, the potential complications and even if you
don't have complications, just the discomfort associated with
the illness of measles far, far outweighs, as Dr. Messonnier
said, of a very, very safe vaccine.
So, to me, there is no doubt. I am a parent. I have three
daughters. They were all vaccinated and the thing that I
worried about was them, if I did not vaccinate them, getting
measles if it came into the community. That would scare me, not
the vaccine.
Mr. Guthrie. Thank you.
Dr. Messonnier. One thing I will add is that in the current
outbreak in Clark County, Washington State, we have seen a huge
upsurge in acceptance of vaccine and use of vaccine in the
community.
When faced with the real threat of measles, people--parents
weigh that same equation and realize it is better to vaccinate.
What we need to do is get those messages to parents before the
measles outbreak hits.
Vaccine is incredibly safe. Measles remains a risk
throughout the country. Yes, it is a no-brainer.
Mr. Guthrie. And your children are vaccinated?
Dr. Messonnier. Of course my children were vaccinated.
Mr. Guthrie. So for both of you, again, how many doses of
MMR vaccine have been given in the U.S.? Millions or----
Dr. Messonnier. I mean, millions of doses of MMR vaccine
are given every year.
Mr. Guthrie. And after more than 55 years of experience and
hundreds of millions of doses, we estimate, what is the safety
record of MMR vaccine?
Dr. Messonnier. You are right. Millions of doses in the
U.S., not to count also the multimillion of doses given
globally, all tell us for certain that the safety record is
good. It is an incredibly safe vaccine. Parents should be
reassured that we know this vaccine is safe because of all this
experience.
Mr. Guthrie. Dr. Fauci?
Dr. Fauci. Also, I think it is important about how some
people can get confused because when you're in a certain area
of childhood--so vaccines are recommended at around one year--
11 to 12 months--and then the boost at 4 to 6 years.
During that period of time of childhood a lot of things
happen to children. They get a lot of different diseases.
Sometimes bad things happen. And if you were to look at that
you can make an association and say, well, maybe that's due to
the vaccine.
But a number of studies over many, many years have shown
the disassociation of that and, as Dr. Messonnier said, that
when you go back and look at the strict safety of the vaccine
it is extraordinarily safe.
Mr. Guthrie. I want to look at some of the concerns. I have
heard some parents claim that measles vaccine can cause brain
inflammation--encephalitis. Is that true? Is that true?
Dr. Fauci. Brain inflation encephalitis?
Mr. Guthrie. Encephalitis. Can measles vaccine cause
encephalitis--the vaccine?
Dr. Fauci. The vaccine, no.
Mr. Guthrie. There are no cases----
[Disturbance in hearing room.]
Dr. Messonnier. There is no----
Dr. Fauci. Rare.
Ms. DeGette. The Chair will remind all persons in the
audience that manifestation of approval or disapproval of the
proceedings is in violation of the rules of the House and its
committees.
The gentleman may proceed.
Dr. Messonnier. In healthy children MMR vaccine does not
cause brain swelling or encephalitis.
Mr. Guthrie. So if a child wasn't healthy when they are
vaccinated would----
Dr. Messonnier. So there are rare instances of children
with certain very specific underlying problems with their
immune system and who the vaccine is contraindicated. One of
the reasons it is contraindicated is in that very specific
group of children there is a rare risk of brain swelling.
Mr. Guthrie. Would a parent know if their child was in that
category before they are----
Dr. Messonnier. Certainly, and that is why a parent should
talk to their doctor.
Mr. Guthrie. OK. And then one more, because I had a couple
of seconds with the questions. So another thing, that the
people can self-medicate with Vitamin A to prevent measles and
not do the vaccine. What is the validity of that, in your
opinion?
Dr. Fauci. Well, the history of Vitamin A and measles goes
back to some very important and, I think, transforming studies
that were done years ago in sub-Saharan Africa, is that with
Vitamin A supplements and particularly in Vitamin A deficiency
that children who get measles have a much more difficult
course.
So Vitamin A associated with measles can actually protect
you against some of the toxic and adverse effects. Importantly,
since in a country--a developed nation where you really don't
have any issue with Vitamin A deficiency, that you don't really
see that transforming effect.
But some really good studies that were done years ago show
that Vitamin A supplementation can be very helpful in
preventing the complications of measles.
Mr. Guthrie. It doesn't prevent onset of measles, if you
are not immunized?
Dr. Fauci. No. No.
Mr. Guthrie. Is that what you are saying? I don't want to
put words in your mouth.
Dr. Fauci. It doesn't prevent--it doesn't prevent measles.
But it is important in preventing some of the complications in
societies in which Vitamin A deficiency might exist.
Mr. Guthrie. Thank you. I appreciate your indulgence.
Ms. DeGette. The gentleman yields back.
The Chair now recognizes the gentlelady from Illinois, Ms.
Schakowsky, for 5 minutes.
Ms. Schakowsky. Dr. Messonnier and Dr. Fauci, if we could
just once--maybe once again put on the record, yes or no. Is
the highly contagious measles virus life-threatening--deadly?
Yes or no.
Dr. Messonnier. Yes.
Dr. Fauci. The answer is yes. It rarely occurs. I mean,
most children--myself, Mike Burgess----
Ms. Schakowsky. Myself.
Dr. Fauci [continuing]. Who developed measles--yourself and
many people on the committee who got measles would recover
completely. But you ask yourself, is there a potential to be
deadly?
History tells us unequivocally that's the case, because
when you were talking about the measles vaccine before we
vaccinated here in the United States in the early to mid-'60s,
there were 400 to 500 deaths directly due to measles.
Prior to the measles vaccine globally there were over a
million--1 to 2 million--deaths in a year. So as Dr. Messonnier
said in direct answer to your question, is it potentially
deadly? Absolutely.
Ms. Schakowsky. That is very important. Thank you.
And that deeply should concern all of us and over the past
two weeks a new outbreak has sprouted in my home State of
Illinois with four confirmed cases in Champaign County, the
home of the University of Illinois. It happens to be my alma
mater.
And I am trying to understand what has happened between
2000 and 2019 and why we have fallen so far from the public
health success stories when the CDC actually said that there--
we had eradicated in the United States measles in 2000.
So, Dr. Messonnier, yes or no. Do you believe the primary
cause of the spike in measles outbreak over the past few years
is due to vaccine hesitancy and misinformation?
Dr. Messonnier. Yes and no. I think vaccine hesitancy is a
word that means many different things. Parents have questions
about vaccines. They get those questions answered. That is what
you should call hesitancy.
So I do believe that parents' concerns about vaccine leads
to undervaccination and most of the cases that we are seeing
are in unvaccinated communities.
However, if you look nationally at measles vaccination
coverage, there are other things that are associated with low
coverage. For example, living in a rural area versus an urban
area. Rural areas have lower vaccine coverage with measles.
Ms. Schakowsky. How would you account for that?
Dr. Messonnier. Well, I think that there are other things
besides the choice that are around access to care. For example,
kids without health insurance have lower measles vaccination
coverage.
Ms. Schakowsky. So, generally, lack of access to care?
Dr. Messonnier. In addition to parents making decisions not
to vaccinate their kids, yes.
Ms. Schakowsky. More than 50 percent of the current
outbreak cases this year occurred in Clark County, Washington.
In that region, only 81 percent of 1-to-5-year-old children and
only 78 percent of 6-to-18-year-olds received the age-
appropriate measles, mumps, and rubella vaccine dosage. So it
is really deeply troubling that it seems to cluster in certain
places.
Dr. Messonnier and Dr. Fauci, what do you believe would
happen--let us say if only 78 percent of the entire U.S.
population was vaccinated against the--against measles or,
worse yet, what would happen if we stopped all measles
vaccinations?
Dr. Fauci. Well, measles, as I mentioned in my
presentation, exists. There were 110,000 deaths in 2017. So
measles is out there.
Even though we, as a country, now have a high degree of
vaccination, if we did what you are suggesting and essentially
dropped it down to 70 percent, 50 percent, or even stopped, we
would have an entirely susceptible population. We would be like
countries prior to the vaccine era and that would be a
catastrophe waiting to happen.
So even if you go down to a certain level, if you look not
only at the United States--we showed the figures of the United
States--but right now there is a terrible outbreak going on in
Madagascar. There have been 900 deaths so far in Madagascar.
We are seeing that in other countries in which when you go
below a certain level and that umbrella of herd immunity lifts,
it truly is a catastrophe waiting to happen. So that is
something that would be very scary to think about.
Ms. Schakowsky. Let me just say as an organizer, I think
part of it is a communications issue, an organizing issue, and
we need to mobilize the public on this question. It is not just
up to the two of you. We want to work with you but I think we
need to get some organizers going.
Thank you. I yield back.
Ms. DeGette. The Chair now recognizes the gentleman from
Texas, Dr. Burgess, for 5 minutes.
Mr. Burgess. Thank you for the recognition.
I learned something this morning. I always learn something
on this committee. Mr. Guthrie asked a question about Vitamin A
and, Dr. Fauci, thank you for your answer.
I did not know that in Vitamin A deficient individuals
perhaps there was going to be a harder course for the disease.
I do feel obligated to mention that Vitamin A is not like
Vitamin C. You may not take unlimited quantities of Vitamin A
with impunity. It is a fat-soluble vitamin and it is stored in
the body. So don't go out and hyperdose on Vitamin A because it
will not accrue to your long-term benefit.
So vaccines themselves are at the very heart of medical
innovation and some my parallel the history of this country.
Dr. Edward Jenner began his career and introduced the first
vaccination in 1796, 20 years after our Declaration of
Independence. So a long history of an association with
vaccination.
So the two of you work together on these issues. So can you
perhaps tell us a little bit how you work together to prevent
the reappearance of vaccine-preventable diseases, focused on
measles this morning?
Rubella--something I remember from my residency at Parkland
Hospital. A congenital rubella syndrome in a child was
devastating. These are illnesses that new generations of
doctors don't see because of the effectiveness of the vaccine.
Can you speak just briefly of how you--how your agencies
interact and work together?
Dr. Fauci. Well, as you know, Dr. Burgess, that the CDC and
the NIH are within the Department of Health and Human Services.
So we consider each other sister agencies, as it were, and the
CDC has the major responsibility, as Dr. Messonnier will tell
you, about the public health--the surveillance and the
messages.
We, as a research institution, try to fill in any of the
gaps that occur from a research standpoint. What we are talking
about today is really less of a research problem than it is an
implementation problem.
So how we help and work with our colleagues at the CDC is
to continue to provide the evidence-based--the science-based
evidence of why we need to implement a highly successful
program that is, as we know, the vaccine program that we are
talking about.
Dr. Messonnier. No, I think this is an area where CDC does
have the leadership role within HHS and our program is vast and
diverse including all the operational pieces that it takes to
deliver vaccines and, importantly, all the local partnerships
that it takes to make the--to make the case for why vaccines
are important.
Communication is a hugely important part. Monitoring the
effectiveness and safety of vaccines so that we can continue to
assure the public that we know that the vaccines are working
like we think they are.
Mr. Burgess. And, Madam Chairman, I will just say that both
of these--both NIH and CDC--where Members of Congress come
visit it. I know it is a pain in the neck but you are always
very good to receive us.
Dr. Fauci, I try to come to the NIH once each congressional
term and, Dr. Messonnier, I was at CDC--it is harder to get to
Atlanta for me, but the--you have been very good about when I
have come to make available information and personnel and it is
very, very helpful in sort of setting the background for what
you just described.
Let me ask a question of either of you or both of you. The
1999--the Public Health Service recommended removing
thimerosal, the mercury-containing compound. My understanding
is that childhood vaccinations now no longer contain thimerosal
except for a select few--perhaps the multidose flu vaccine.
Did the measles-mumps-rubella vaccine ever contain mercury
or thimerosal? I need a verbal answer for the clerk.
Dr. Fauci. No, it is preservative free.
Dr. Messonnier. No, and you didn't ask this but I just
would also point out this is an area where we work with FDA
very closely since vaccine safety is their mandate.
Mr. Burgess. Was there ever any evidence to suggest that
mercury or thimerosal was unsafe? I guess that is a better
question for the FDA but you all are experts--subject matter
experts.
Dr. Fauci. There is no evidence that it is unsafe.
Dr. Messonnier. The thimerosal was removed from vaccines
out of an abundance of caution at a time when there wasn't
enough evidence. But evidence since then has been very
conclusive.
Mr. Burgess. Well, I thank you for that. I have some
additional questions. I will submit those for the record.
I yield back.
Ms. DeGette. Thank you very much.
The Chair now recognizes the chairman of the full
committee, Mr. Pallone, for 5 minutes for questioning.
Mr. Pallone. Thank you, Madam Chair.
The elimination of measles in the United States in 2000 was
a testament to science research and the public health system we
have in place in this country. So it is disturbing to see the
numbers on the current measles outbreaks and just how common
these outbreaks are once again becoming in the United States.
You know, I mean, I guess the CDC made the announcement
based on the number of cases that had been eradicated. But even
I myself, when I was doing my opening statement this morning,
you know, my staff said oh, it is, you know, over in New Jersey
and then we have a new outbreak.
So, you know, I think there is reason to be concerned. So
let me just say, Dr. Messonnier, is--what is the reason or the
reason why we should be concerned that measles cases and
outbreaks are increasing or may increase in the coming years, I
mean, and do you agree that we should be concerned?
Dr. Messonnier. Yes, we should certainly be concerned. So
measles was identified as eliminated in the United States in
2000 because there was no longer sustained transmission in the
U.S.
However, measles continues to circulate globally, which
means unvaccinated U.S. travelers can be exposed to measles and
bring it back home with them and folks in their families and
their communities, if they are not protected by vaccine are at
risk. Measles is so incredibly contagious that it can spread
really quickly. So yes, we should be concerned.
Mr. Pallone. All right.
Now, given your answers, I am glad we are focusing on it
today. But this threat, in my opinion, is amplified,
unfortunately, by the spread of disinformation. There has been
a significant--there has been significant reporting in the past
few weeks regarding the use of digital media platforms to
spread misinformation and fear about vaccinations.
So let me go to Dr. Fauci. What role do you see the spread
of disinformation online playing in the rise of these
outbreaks?
Dr. Fauci. I believe, Mr. Pallone, that it--that it plays
an important role. It is not the only one but I believe it
plays an important role and I think the classic example of that
was the disinformation associated with the relationship between
measles vaccination and autism, which back when it came out
years ago there was a big concern that this was the case.
When it was investigated it became clear that the data upon
which those statements were made were false and fraudulent and
the person who made them had his medical license revoked in
England.
And yet, as you know very well, the good news about the
internet is that it spreads important information that is good,
and the bad news about the internet is that when the bad
information gets on there, it is tough to get it off.
And yet people refer to things that have been proven to be
false. So disinformation is really an important issue that we
need to try and overcome by continuing to point people to what
is evidence based and what is science based.
So in so many respects, we don't--we shouldn't be
criticizing people who get these information that is false
because they may not know it is false. We need to try and
continue to educate them to show them what the true evidence
base is.
But in direct answer to your question, that is an important
problem--disinformation.
Mr. Pallone. Now, do you think that the promotion of this
inaccurate and fear-based messages--would you consider that in
itself a threat to public health?
Dr. Fauci. Yes, of course. I think the spread of false
information that leads people into poor choices, even though
they are well meaning in their choice, it is a poor choice,
based on information. I think that is a major contribution to
the problem that we are discussing.
Mr. Pallone. I mean, part of the problem is, you know, is
this 30 seconds. In other words, you know, people will listen
to the news or watch the internet and they will hear, as you
say, that somehow vaccinations lead to autism and they will
hear that and then, you know, they won't hear what comes later
that says that that is false because that is more complicated,
you know. I mean, it is just the nature of it.
Look, the main thing I wanted to say because we are--you
know, I only have 5 minutes--is that you keep stressing the
science and that we have to follow the science and protect the
public health based on what the science tells us, and I think
that is what's so crucial here, and that is the one thing that,
you know, we have and that, you know, CDC and National
Institutes of Health are providing for us, is the science-based
information and we have to rely on it and get that out.
So thank you so much. Thank you both. Thank you, Madam
Chair.
Ms. DeGette. The gentleman yields back.
The Chair will once again remind the persons in the
audience that manifestation of approval or disapproval of
proceedings is in violation of the rules of the House and the
committees, and if these violations continue then we will
notify the Sergeant at Arms, who will have you removed.
So I would appreciate cooperation of everyone so we can
hear the witnesses and so we can hear the Members' questioning.
And with that, I will now recognize the gentlelady from
Indiana, Mrs. Brooks, for 5 minutes for her questioning.
Mrs. Brooks. Thank you, Madam Chairwoman.
Dr. Fauci, I would like to focus--and actually both of you,
Dr. Messonnier and Dr. Fauci--I would like to talk a little bit
about U.S. biodefense.
And Congresswoman Eshoo and I led the Pandemic All-Hazard
Preparedness Act bill, which we have gotten passed through the
House once again, and I think what a lot of people in the
country don't fully appreciate is the importance of a
biodefense and defending our country, whether it is for
national security reasons or with respect to public health
threats.
Is undervaccination to U.S. biodefense and how does--how do
vaccinations play into the protection of our country and what
does biodefense mean?
Dr. Fauci?
Dr. Fauci. Yes. Thank you for that question. That is a very
good question because we have been involved in biodefense for
quite a while. The effort really galvanized at 9/11 when we had
the anthrax attack and we put a consideration amount of
resources into developing countermeasures in the parts of
vaccines, therapeutics, diagnostics, against what were
classically agents that were used in bioterror.
When we analyzed our approach back in 2001, 2002, and 2003
it became clear that it really is all a part of emerging and
reemerging infections--those that naturally emerge as new
infections, like we saw with AIDS and SARS. Those that----
Mrs. Brooks. Zika?
Dr. Fauci. Yes, Zika.
Mrs. Brooks. Ebola?
Dr. Fauci. But those that--those are reemerging so there
are brand new infections. There are reemerging infections and
we would consider as part of the big problem and the link that
I think you are referring to, and I totally agree with you,
that if you have a vaccine-preventable disease but you still
let that disease go unchecked because of lack of vaccination,
that is all part of the problem of not adequately addressing
reemerging infectious disease.
Measles in an old disease. Right now what we are seeing on
the charts that we showed is the reemergence of a vaccine-
preventable disease, which to me falls under that broad
category that you are referring to.
Mrs. Brooks. And I--and I appreciate you giving us the
numbers. We were at 159 as of February 21st. The numbers might
be slightly higher. But that--those numbers are dramatic for
only two months of the new year.
How is it--and both of you have talked about the importance
of eradicating it entirely with a concerted global public
health effort because you have got 900 people who have died in
Madagascar, and I know while people here in this country may
not think that people in Madagascar can infect our country, why
do we believe it is possible to eradicate a disease like
measles? Why do we think it is even possible?
Dr. Messonnier? Dr. Fauci?
Dr. Fauci. So I have been saying that it is a--the vaccine
is extraordinarily effective. We have eliminated--the
agricultural industry has eliminated a closely related virus
among animals called rinderpest. So it is, essentially, the
same virus only the animal version of it.
So when you have a highly effective, and I want to
underscore that because measles is one of the most effective
vaccines that we have of any vaccine, that a massive public
health effort could lead to eradication because we don't have
an animal vector.
We don't have an intermediate host. We don't have a vector
that transmits it. It is just person-to-person
transmissibility.
So, theoretically, we could eradicate it. The problem
between eradication and elimination, if you eliminate it like
we did in this country in 2000, as long as there is measles
somewhere you always have the threat of it reemerging if you
let down the umbrella of her immunity.
Mrs. Brooks. And so, Dr. Messonnier, helping other
countries with vaccine implementation would be helpful to our
country. Is that correct?
Dr. Messonnier. That is right. I mean, control of measles
around the world is a priority for CDC and there are a whole
variety of efforts towards that.
I do think it is important, though, Dr. Fauci is correct
about Madagascar. But I think Americans don't realize that in
2018 there were also outbreaks in England, France, Italy, and
Greece. American travelers going abroad need to think about
their immunization status, not just when they are going to
countries like Madagascar but even going to Europe.
Mrs. Brooks. Thank you. I yield back my time.
Ms. DeGette. The Chair now recognizes the gentleman from
California, Dr. Ruiz, for 5 minutes.
Mr. Ruiz. Thank you very much for being here again. My
questions are going to be in line of two separate topics, which
are interrelated as well.
One is the disparities that we see in the vaccination rates
and two is the coordination between your agencies and the
State, Federal, nonprofit in dealing with communications and
the outreach.
So, Dr. Messonnier, you said that one of the biggest
challenges is access to these vaccines and so we see
disparities in low income, uninsured, underinsured populations
in getting the vaccine.
The Affordable Care Act made it a mandatory coverage for
private health insurance through the essential health benefits
to provide these vaccines.
If we eliminate or repeal these essential health benefits
and allow insurance companies to not cover these vaccines,
would that--would that worse the problem of access to these
vaccines?
Dr. Messonnier. So thanks for the opportunity to talk about
this. In fact, the vaccines for Children's Program provides a
safety net. Vaccines----
Mr. Ruiz. So if the private--if the private health
insurance were no longer required to provide vaccines, would
that decrease perhaps the vaccination rate?
Dr. Messonnier. So right now the issue is not in private
insurance. All insurance companies provide vaccines free of
charge.
Mr. Ruiz. Of course. So the Affordable Care Act right now
makes it mandatory to provide. It is part of the essential
health benefit. So if they repeal that essential health benefit
and they are no longer required to provide it, they can choose
not to provide, which then makes it difficult to get access to
the care.
Medicaid is also a good program that gives low-income
children and other families the ability to get the vaccination,
along with the programs that you administer as well.
So if we repeal those, then we are going to make the
problem worse by not having those vaccinations available. Can
you speak, broadly, to the coordination role that CDC plays and
how that is important for responding to outbreaks?
Dr. Messonnier. Sure. The backbone of our response to
outbreaks is the State, local, Federal, community interaction
around immunizations. I think Clark County is a perfect
example.
The health departments, certainly, at the local level was
the first to respond. These outbreaks can be quickly
overwhelming because every case has potentially hundreds and
thousands of contacts that need to be tracked down.
The county quickly got overwhelmed. They came to the State
asking for support and then the State came to CDC. CDC already
has folks embedded in the health department and we work closely
with them every day. But they asked for more support and we had
boots on the ground right away.
Mr. Ruiz. Would--Dr. Fauci, when it comes to the measles
cases or other vaccine-preventable diseases, are there
particular challenges to mobilizing and promoting a cohesive
preparedness message or communications plan within communities
at a national level?
Dr. Fauci. At a national level, the communication I think
from the CDC is quite good. I mean, if you look at the messages
that come out from the CDC--and I could let Nancy speak about
this better than I--but the beauty about what the CDC does is
that they work very, very closely with the State and local
health authorities. I mean, that is a very, very important
partnership.
So you have the Federal level with a very important message
that gets disseminated through the State and local health
authorities.
Mr. Ruiz. And what is the coordination with the Indian
Health Service in reaching out to rural and reservations?
Dr. Messonnier. Yes. It is a close partnership and has been
for a long time. The immunization community--again, State,
local, Federal community--is very closely aligned and works
really closely together.
We understand that a lot of these issues are local. So
while CDC provides scientifically credible information, it is
often most effective for folks in the community to be the ones
conveying that information.
Mr. Ruiz. Are you talking more about the programs that you
offer to low-income and uninsured, underinsured and how do you
get to those communities that are very underinsured?
Dr. Messonnier. I mean, the vaccine for Children's Program
has provided that safety net for a number of years and it is
one of the reasons we have enjoyed such good control of measles
and other vaccine-preventable diseases.
This data that suggests that there are some communities
that are not taking advantage of that program is concerning and
we are working closely with our local and State partners to
understand the drivers.
I am not sure the issues are the same everywhere. We really
need to understand what the local issues are and then figure
out how to solve them.
Mr. Ruiz. I agree. I think that local communication plans
is very important and herd immunity is also very important as
well.
Thank you. I yield back my time.
Ms. DeGette. The Chair now recognizes the gentleman from
South Carolina, Mr. Duncan, for 5 minutes.
Mr. Duncan. Thank you, Madam Chair.
When I travel I carry a yellow card with me in addition to
my passport to have a record of all the shots that I have
taken--immunizations--and as a father of three sons, when my
sons entered kindergarten and grade school we had to provide an
immunization record for them and I would argue that they
probably would not have been able to attend public schools in
South Carolina without certain immunizations and vaccinations.
We had a hearing last week about unaccompanied children and
child separation at the border, et cetera, and one point I made
then is that, you know, we don't know the vaccination history
of a lot of the children that show up at our border and we have
a porous southern border and there are children and other
individuals that come into this country that we don't know
about--that aren't apprehended, they don't go through a normal
port of entry--and what we are seeing is a rise of certain
diseases--not necessarily measles but diseases in this country
that we had beaten back over the years.
And so I think it is alarming from a subject of vaccination
and immunization when we see those diseases rising, and one of
the world's measles outbreaks right now is happening Brazil
where people fleeing a completely broken country of Venezuela
are spreading measles.
And Madam Chair, I would like to submit for the record an
NPR article, ``Collapse Of Health System Sends Venezuelans
Fleeing To Brazil For Basic Meds,'' and I will submit that for
the record.
[The information appears at the conclusion of the hearing.]
They have been in an unvaccinated population because of the
collapse of the failed socialist state in Venezuela, where
there should be an instructive example for some of us in this
committee room of the lack of that sort of medical treatment of
vaccinations.
I would note that the humanitarian aid that countries like
the U.S. are trying to send to Venezuela is being burned on
bridges by the Maduro regime instead of actually being used to
help his own people.
This includes vaccinations like the ones we are discussing
today. There were measles vaccinations that were burned on the
bridges as part of the relief effort to Venezuela.
So now the CDC tells us that the first dose of MMR vaccine
provides 93 percent of coverage against measles. The second
dose increases that number to 97 percent.
We also know from reports here in the U.S. and around the
globe that some kids have faced adverse reactions to this
powerful and life-giving immunization.
Therefore, my question for each of you on the panel is
this. Considering the prodigious advances in technology and
medical research that our Nation has discovered since around
the 1960s when the MMR vaccine was first introduced, how can we
now further increase the efficiency of the MMR vaccine to fight
measles while at the same time work to limit the adverse
reactions that some children have had after receiving the MMR
shot?
And I ask both of you that.
Dr. Messonnier. This is a great example of a vaccine that
is so good, so effective, and so safe that we haven't tinkered
with it. I think that while there are many challenges in
immunizations, the effectiveness and safety of measles vaccine
isn't one of them.
The measles vaccine has mostly stayed the same because of
the high effectiveness and the long track record of safety.
Mr. Duncan. Dr. Fauci?
Dr. Fauci. There was--I totally agree with Dr. Messonnier.
You know, as a person who has been involved with developing
vaccines for a long time you really don't get much better than
97 percent. That is really good.
So the thing that you, I believe, were alluding to when the
Edmonston strain came out in 1963 it was highly effective and
not serious--any serious adverse events. But there was a
percentage of fevers that were associated with an occasional
rash. That was improved in 1965 to develop another strain.
And then since 1968 what was--a strain that is now being
used in Attenuvax it is called is one, as Dr. Messonnier has
said, that not only maintains the 97 percent effectiveness but
it is very, very free of serious toxicities.
Mr. Duncan. And I agree. I mean, I think these strains are
adaptive. We see that in the flu virus where we can only
anticipate what the virus is going to look like this year.
Sometimes it adapts or sometimes it changes and the vaccine for
the flu isn't quite the right flu vaccine for the year and we
see an increase.
So I want to continue to raise awareness that we need to
make sure as asylum seekers come to this country whether they
are coming along our southern border or whether folks are
immigrating to the Nation from other places that we make sure
that those countries have the right immunization schedules and
vaccinations for the children and the adults because,
ultimately, when they come to this country and live amongst us
they may not have the same vaccinations and immunizations that
we experience in this country and we may see measles today and
maybe something else in the future.
And with that, I yield back.
Ms. DeGette. The gentleman yields back.
The gentleman from Texas has a unanimous consent request.
Mr. Burgess. Thank you, Madam Chair. I have a unanimous
consent request to place into the record a letter from Dr.
Peter Hotez from Children's Hospital in Houston.
Ms. DeGette. Without objection, that letter shall be placed
into the record, and also without objection the NPR article
that the gentleman from South Carolina requested be put in the
record will be placed in the record.
[The information appears at the conclusion of the hearing.]
The Chair now recognizes the gentlelady from Florida, Ms.
Castor, for 5 minutes.
Ms. Castor. Thank you, Madam Chair. Thank you very much for
being here today.
I want to get a little more specific on Dr. Ruiz's
questions on disparities. You said, Dr. Messonnier, that
disparities exist when it comes to the MMR vaccine. What do
those disparities look like and how do they break down by
demographics?
Dr. Messonnier. Thank you.
So, you know, there is always the national picture and then
the local picture. Nationally, I can tell you that there are
certain groups that have lower risks of MMR vaccination,
although overall everybody and generally nationally has high
rates. But there are low rates of MMR in those of lower
socioeconomic status, those without insurance, and those who
live in rural areas as opposed to urban areas.
The specific drivers, though, locally may be different and
that is why we really have to work closely at the State and
local level to understand at a community level what that is. Is
that access, is it misinformation, and how can we resolve the
issues?
Ms. Castor. How about by location?
Dr. Messonnier. Oh. So there are States in the U.S. that
have higher vaccination coverage than others. But I would also
say that, if you talk to any State health department, what you
find is that even within the State there are differences at a
community, local, county, school level.
I think one real advancement in using the data that is
available is that some States have actually put that data
online and so you can go to a website and look, for example, at
a State and see at a county level and at a school level what
immunization coverage is. It is really powerful information for
parents to understand what is going on in their communities.
Ms. Castor. What is the biggest source of the reemergence
by demographic?
Dr. Messonnier. So I think it is an interesting question.
The groups that I was talking about with lower vaccination
coverage are a concern because it is a failure of our safety
net.
But most of the disease and certainly the large outbreaks
we are seeing in this country are actually not associated with
those. It is associated with groups of people like close-knit
communities that are undervaccinated and clustering together.
Ms. Castor. Because I--and that was my impression and I was
a little confused by the last line of questioning that the
alarm should be over immigration and asylum seekers.
Do you have a comment on that? Dr. Fauci?
Dr. Fauci. Well, I think what Dr. Messonnier said is
absolutely correct. If you look at the known outbreak, so if
you take the outbreak in the Williamsburg section of Brooklyn
in New York City and in Rockland County it was a relatively
closed group who had a rate of vaccination that was below the
level of a good herd immunity.
A person from Israel, understandably, came over legally as
a visitor into the community and then you had a massive
outbreak in New York. The Somali community in Minnesota, the
same thing happened.
You had a group there who had a lower rate that went below
the cutoff point for herd immunity. Some immigrant came in as
one of the members of the community. It was a relatively closed
community and that is what you have.
So I think when you talk about outbreaks, it really
transcends some of the demographic issues that you were talking
about about lower income or rural versus urban. It really is in
a closed community that we are seeing it.
Ms. Castor. With lower vaccination rates. So that is----
Dr. Fauci. Right. Exactly. It is all lower vaccination
rates.
Ms. Castor. So it is pretty remarkable. We really are
fortunate that we have such a safe and effective measles
vaccine. I mean, these statistics are fairly remarkable.
Prevaccine, 2.6 million deaths each year.
After the vaccine was introduced in 1963 a dramatic
decrease. Dr. Fauci, you say from 2000 to 2017 over 21 million
deaths have been prevented, and it used to be that most
children were--acquired measles by age 15 but thanks to all of
the great work by scientists and public health agencies like
you all, as a result, we were able to practically eliminate
this.
But despite this breakthrough, the millions of lives it has
saved, there is still so much misinformation about the vaccine.
Today, you all, leading health experts, help us clarify some of
this.
Dr. Fauci, looking at the science, what do we know about
the--again, I don't think we can say this often enough because
of the misinformation--how safe and effective is the measles
vaccine--the MMR vaccine--and how would you compare it to other
vaccines?
Dr. Fauci. Well, let us talk about efficacy first. It is,
clearly, one of if not the most effective vaccine that we have.
As Dr. Messonnier said, you really can't get much better than
that.
That is the reason why we don't want to tinker with its
efficacy. Ninety-seven percent is really, really good. And as
both of us have said many times, it is a very safe vaccine--
over millions and millions and millions of doses that have been
given. It is a very, very safe vaccine.
Ms. Castor. Thank you very much. I yield back.
Ms. DeGette. The Chair now recognizes the gentleman from
New York, Mr. Tonko. I was trying to figure out the order. New
York. Mr. Tonko, for 5 minutes.
Mr. Tonko. Thank you, Chairwoman DeGette.
Promoting healthy families in communities is possible
thanks to the dissemination of science-informed health
information directly to patients and health providers play a
critical role as the most trusted source of health information
for people and, certainly, parents.
However, ensuring that patients receive accurate
information has grown complicated in the digital age. In fact,
according to the Pew Research Center, seven in ten adults in
the United States look online for health information, and even
when they are not searching for information online, content
finds them.
I know you spoke a bit about this with Chairman Pallone. I
went to delve a little more deeply. Recently, the Guardian
reported that antivaccination content is being recommended to
users on a range of digital media platforms proliferating
misleading information, testimonies, and advertisements on
mediums used to explore news-related topics.
So, Dr. Messonnier, what do the data and examples of recent
measles outbreaks tell us concerning the impact of
disinformation on public health and in these communities?
Dr. Messonnier. Yes. I am certainly really concerned about
the misinformation. But I also understand how complicated it is
for parents that are inundated with information and aren't sure
what information to trust.
All our research continues to show that among all groups of
parents of all ages of children they still trust their own
health care provider most. So most parents are hearing this
information and then going to their health care provider to
help them sort it through and most parents in the U.S. are
still going on to get their kids vaccinated.
Mr. Tonko. Thank you.
And Dr. Fauci, what guidance do you have to assist patients
in discerning fake information from science-based information?
Dr. Fauci. What we try and do is to steer them towards the
well-established scientific literature as opposed to claims
that are just made in a almost haphazard way.
I mean, that is one of the problems, that if a person makes
a claim it gets onto the internet and, understandably, people--
parents, in particular--have a difficulty discerning what is
false equivalency. Like someone says this and then the other
one says that and they say, I don't know who to believe.
But if you delve deep into it and you look at some of the
published work from organizations like the CDC and other
organizations you will see that that is based on very strict
science and that is what we hope we can get them to understand.
Mr. Tonko. Thank you, Doctor.
In response to the spotlight on the monetization of
misinformation about vaccines, are there ways in which
platforms are being manipulated to promote antivaccination
messaging? Some companies have announced new policies. For
instance, Facebook says it is working on its algorithms to
prevent antivaccination content from being recommended to
users.
Pinterest has decided to remove all vaccination-related
posts and searches, even accurate information, and YouTube just
recently announced that it would prevent channels that promote
antivaccination content from running advertising.
Dr. Fauci, do you think these actions are a step in the
right direction to ensure parents and families have access to
science-based factual health information?
Dr. Fauci. Obviously, it is a very sensitive subject
because it then gets in that borderline between the--you know,
essentially, crushing of information that might actually be
useful information.
However, having said that, I do think that a close look and
scrutiny at something that is egregiously incorrect has some
merits of taking a careful look as to whether one--you want to
be participating in the dissemination of that.
Always being careful about not wanting to essentially
curtail freedom of expression, you still want to make sure you
don't do something that is so clearly hazardous to the health
of individuals.
Mr. Tonko. I appreciate that.
And, Dr. Messonnier, as the agency charged with protecting
our national public health, what efforts are underway at CDC to
counter the online proliferation of antivaccination
disinformation?
Dr. Messonnier. As a science-based agency, CDC really
focuses on making sure that we get scientifically credible
information available to the folks at the front lines that need
it every day.
In order to do that, we do scan social media to see what
issues are arising and what questions are emerging to make sure
that we can then gather the scientifically appropriate answers
and get that to our partners on the front lines so that they
can talk to patients about that information.
Mr. Tonko. Thank you. I appreciate both of you testifying
today and with that, Madam Chairwoman, I yield back.
Ms. DeGette. The gentleman yields back.
The Chair now recognizes the gentlelady from New Hampshire,
Ms. Kuster, for 5 minutes.
Ms. Kuster. Thank you, Madam Chair, and thank you to our
witnesses for being with us and to all the caring families that
are here with us today as well.
Thanks to the introduction of the MMR vaccine, 56 years ago
the vast majority of families in the United States have never
had to experience firsthand.
Perhaps the fact that measles is so rare now has
contributed to the misunderstandings about the disease itself,
its potential severity, and the threats posed by the outbreaks,
and you both testified to us today about how measles poses a
public health threat and we have evidence ongoing right now as
these pockets are--the contagious nature of the disease is
being demonstrated in these communities with low vaccination
rates.
We have been fortunate in New Hampshire to have very high
vaccination rates and thus we have not experienced--and I
should knock on wood--an outbreak of measles in the Granite
State.
But recently we have a new threat and that is an outbreak
of hepatitis A. Hepatitis A is not currently a required vaccine
in New Hampshire, though it is in 13 States.
I would love to ask you, are you concerned about that the
continued distrust of vaccines like the MMR or hepatitis B will
detract from efforts to vaccinate for future maladies and in
particular, in this case, hepatitis A and how concerned should
we be in terms of protecting my constituents from outbreaks of
new pathogens including hepatitis A?
Dr. Messonnier. Yes. I think that is a great point. You
know, in the equation that a parent has in terms of what they
believe is the risk of disease and the safety and effectiveness
of vaccine, if they don't see the disease as a clear and
present danger sometimes they don't vaccinate.
When I try to talk to families and parents about
immunization, I don't want to scare them into getting measles
vaccine. I want to increase their faith in the U.S.
immunization program and in the immunizations that are part of
it so they don't just get measles vaccine. They get all of the
recommended vaccines.
Ms. Kuster. And could you comment? For something like
hepatitis A that's not required as a vaccine in most States how
do we get to the point where we would have herd immunity--where
people would be safe from this public health threat, and how do
we go about educating the community of what the risks are to
individual families with hepatitis A?
Dr. Messonnier. I am sorry to say that I am not enough of
an expert in the hepatitis A vaccine to answer that. But we
will certainly get----
Ms. Kuster. Could you answer just generally about herd
immunity, not using hepatitis A per se but just the concept of
getting us to the place where most people in the community are
safe from a particular pathogen or contagious disease?
Dr. Messonnier. So the concept of herd immunity is that by
vaccinating an individual you don't just prevent them from
getting disease but you also prevent them from transmitting it
to others.
And what that means is that in a community individuals who,
for example, can't get the vaccine because they are too young
or they have some kind of illness that prevents it are still
protected by the question of protection provided by their
community. It is a really important concept and it is why we as
a society need to take care of those most vulnerable children.
Dr. Fauci. Hepatitis A is a bit different than measles, as
we all know, for a number of reasons is that if you look at the
level of herd immunity that you would need with measles, it is
really 92, 93 to 95 percent.
Ms. Kuster. It is quite high.
Dr. Fauci. It is much less so--it is much less so with
hepatitis. Hepatitis A is something you want to avoid. You can
avoid it. It is a really good vaccine, and it is a safe
vaccine.
It tends, unlike measles, which is essentially an equal
opportunity microbe, in that it is, as we have seen the
outbreaks of hepatitis A they are very much more skewed towards
homeless individuals, individuals who are in a situation where
hygienic issues are a problem. We have seen outbreaks in
different cities throughout Nevada and Las Vegas and other
places.
So it is a preventable disease and, as Dr. Messonnier said,
we would encourage people to embrace the entire vaccination
program because we have vaccines that are preventing diseases
that were problems years ago.
Ms. Kuster. Well, thank you for your work. We appreciate
it, and certainly as a mother I appreciate keeping my own
family safe. Thank you. I yield back.
Ms. DeGette. I thank the gentlelady. The ranking member has
some final comments.
Mr. Guthrie. So I just want to close and thank the
witnesses for coming, and I have discussed this with several
people back home, and I just want to reiterate what I said. I
know there are a lot of parents in the room here today.
There is not a parent I have talked to that whatever
decisions they are making are making it--what they believe in
the love and the best interests of their child.
And so I think it is important that we do have the science,
the CDC, the NIH, and people with your credentials and
reputations to present this evidence, and hopefully people have
the opportunity to see it and to read it because I--like I
said, there is not anyone that I have ever talked to that may
have a different opinion from me that the opinion wasn't formed
in what they thought was for the love and interest of their
child.
So we appreciate people being here today. Thank you.
Ms. DeGette. I want to thank the witnesses for their
participation in this hearing and I want to remind Members
that, pursuant to committee rules, they have 10 business days
to submit additional questions for the record to be answered by
witnesses who have appeared before the subcommittee.
I ask that witnesses agree to respond promptly to any such
questions should you receive any and, again, thank you for
giving us your science-based testimony today. We appreciate it.
And with that, this subcommittee is adjourned.
[Whereupon, at 11:34 a.m., the committee was adjourned.]
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