Public school student Julio Valenzuela, 11, smiles as he gets a Measles, Mumps and Rubella vaccination (MMR) at a free immunization clinic for students before the start of the school year,  in Lynwood, California.

Public school student Julio Valenzuela, 11, smiles as he gets a Measles, Mumps and Rubella vaccination (MMR) at a free immunization clinic for students before the start of the school year, in Lynwood, California.

California’s new school vaccine law is one of the toughest in the nation: It requires all students to be vaccinated before they can attend public or private school. Medical exemptions are still allowed, but parents will no longer be able to forgo vaccinating their children because of religious or personal objections. Public health officials are praising the move. But California’s vocal anti-vaccine contingent is up in arms. A movement is already underway for a ballot initiative to repeal the law that Gov. Jerry Brown signed this week. We look at mandatory vaccines across the country — and the battle between parental rights and public health.

Guests

  • Dr. Anthony Fauci Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health
  • Dr. Allison Kempe Professor of pediatrics, University of Colorado School of Medicine; director, ACCORDS (Adult and Child Center for Health Outcomes Research and Delivery Science); director of Child Program ACCORDS, Children’s Hospital Colorado.
  • Liz Szabo Reporter, USA Today.
  • Dr. Bob Sears California pediatrician and author.

Transcript

  • 10:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. California, this week, passed one of the nation's strictest vaccination laws. Children must be vaccinated if they're to attend school. The legislation gained momentum after a measles outbreak at Disneyland. Unvaccinated children will still be able to attend school if a medical condition precludes their getting the shots, but the new law takes away exemptions for parents' religious or personal beliefs.

  • 10:07:26

    MS. DIANE REHMJoining me in the studio to talk about the push for mandatory vaccines in California and elsewhere, Dr. Anthony Fauci of the National Institutes of Health and Liz Szabo of USA Today. Joining us by phone, Dr. Allison Kempe of the University of Colorado School of Medicine. I do invite your questions, comments. Join us on 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or Twitter. And thank you all for being with us.

  • 10:08:07

    DR. ANTHONY FAUCIThank you, Diane. Good to be with you.

  • 10:08:09

    MS. LIZ SZABOThanks.

  • 10:08:10

    DR. ALLISON KEMPEThank you very much for having me, Diane.

  • 10:08:11

    REHMDr. Fauci, what do you think of California's new law, which goes into effect next summer?

  • 10:08:21

    FAUCIRight. I think it's a good idea and it was based on solid scientific information about the relative risk versus benefit of vaccinations in children not only for individual children, but for the societal responsibility, particularly in the case of something like measles, which has been something that has been on the front burner because of the outbreak last year in the amusement park in California.

  • 10:08:48

    FAUCISo I agree with Governor Brown and what he did.

  • 10:08:51

    REHMSo if most of California children have already been vaccinated and are up-to-date, is it really so dangerous if just a few opt out?

  • 10:09:07

    FAUCIThat's not the case. In fact, it is because if you have pockets in various communities where you have less than a certain percentage like you get, for example, 10 percent or more of people in a particular area, and we know that that's the case in certain regions within the state of California, you remove from society what's called the umbrella of herd immunity so that children can actually be vulnerable because infection can enter into the community.

  • 10:09:38

    FAUCIIf there were no measles in the world, you wouldn't worry about it. But there are 20 million cases of measles in the world. There are many, many deaths. And if someone comes into society, just a normal traveling and going out, and bringing measles into the country, if you have a certain critical level below that critical level of 90 plus percent vaccinations, you can start an outbreak. And the facts have show that that's the case.

  • 10:10:07

    FAUCILook at what happened in Disneyland.

  • 10:10:10

    REHMDr. Kempe, how big a problem is under-immunization?

  • 10:10:18

    KEMPEWell, unfortunately, under-immunization really has been increasing in recent years, although the percentage of parents who don't permit their children to get any vaccines remains very low at 2 to 3 percent, the percentages of parents who are choosing to either spread out the vaccine schedule over a long period of time and thus have their child under-immunized for longer periods of time and the proportion of parents who are choosing to skip or really delay one particular vaccine, MMR being one of the most common, the measles vaccine, is really increasing.

  • 10:10:59

    KEMPEAnd, as Dr. Fauci said, unfortunately, these pockets of under-vaccination tend to coalesce so that you get populations, sub populations where there is a high degree of under-vaccination and that's really a setup for an outbreak such as what we've seen in California.

  • 10:11:17

    REHMSo what you're saying is that children who are under-vaccinated tend to stay that way?

  • 10:11:26

    KEMPEThat's exactly right. If you look at children under 2 who have their vaccines delayed for one reason or another early in life, they tend to remain under-vaccinated so, again, contributing to these pockets of under-immunization.

  • 10:11:43

    REHMLiz Szabo, how many children in California are going to be affected?

  • 10:11:51

    SZABOWell, the number of kids who have exemptions, that's basically the permission to enter school without being vaccinated, is about 3 percent in California. But some experts are worried that the real number of under-vaccinated kids is much higher because kids who want to start school who are under-vaccinated can get provisional admission to school if they and their doctor talk to the school and say, well, we're working on getting this kid vaccinated.

  • 10:12:26

    SZABOThe school will admit them. And the problem, according to some, is that the schools don't always follow up and that can be an additional 6 to 7 percent. So the number of kids going to school who are unvaccinated or under-vaccinated statewide could be more like 9 or 10 percent. And as others have said, our research at USA Today has shown there are pockets around the country where maybe 50 percent of kids are unvaccinated or under-vaccinated just because of this birds of a feather flock together phenomenon.

  • 10:12:59

    REHMSo in, in California, the rule now is you must be vaccinated or homeschooled, how is that going to be enforced?

  • 10:13:13

    SZABOWell, apparently the schools are very much in favor of this law. Ultimately, the decision to admit a child comes down to the school district and there's been some criticism of California that not only were its state laws not as tough on vaccines as in other states, but that school districts were not being particularly tough about these exemptions, that they were granting them very leniently or very permissively.

  • 10:13:44

    SZABOThat's been a large criticism. But the schools ultimately will have to decide, okay, is this a valid excuse for not being vaccinated? Are we going to let this kid in? But apparently the school districts, the PTA, the unions, principals organizations all back this bill. So we'll have to see how it's enforced.

  • 10:14:04

    REHMDr. Fauci, a number of people have said they'd prefer to have the vaccinations spread out. Can you help me understand what that means and what impact it could have?

  • 10:14:21

    FAUCIWell, the rationale for people saying that it should be spread out is that you don't want to bombard the immune system with so many antigens, which is what they call it, which is the proteins and other components in a vaccine because that would...

  • 10:14:34

    REHMBecause the vaccines are given at what age?

  • 10:14:38

    FAUCIWell, they're given very, very early for almost -- some from birth and then within the first several years of a child. And if you cluster them, according to the CDC regimen, which I agree with completely, the rationale for those who say you want to spread it out is that you don't want to bombard the immune system too much. The problem with that is two-fold. First of all, if you do spread them out, you could miss windows of vulnerability of children and they could get infected at a time when, in fact, if they had been vaccinated in the cluster, they would not have gotten the illness.

  • 10:15:16

    REHMDo you have any idea at what age a child may be most vulnerable to contracting measles?

  • 10:15:25

    FAUCIWell, it depends on the individual disease. So let's take measles. Measles recommendation is the first shot at 11 to 12 months and the second shot in 4 to 6 years. So let's say someone said, well, you know, I want to spread that out and maybe give it at year 2 or 3. Then, that child is vulnerable to one of the most contagious infectious diseases that we know of. But if you look at what is the reason for that kind of frame of mind is saying that you're bombarding the system with so many antigens at the same time.

  • 10:15:59

    FAUCIAnd that flies in the face of the fact that a common infection that a child might get, that could be a flu or a respiratory syncytial virus or whatever you get as a child, the immune system is bombarded just with that single infection with more antigens than all of the vaccinations combined and then some. So the rationale to say you don't want to bombard the immune system with vaccine antigens flies in the face of that a normal infection does much, much more than that.

  • 10:16:32

    REHMDr. Kempe, would you agree?

  • 10:16:35

    KEMPEI absolutely agree. The other thing that I think is important point that refutes that argument is that the antigens or the immunogenetically active particles that are in the vaccines have gotten much purer over time so that, actually, the kind of -- the vaccines we got as children, adults such as myself, were far less pure and had many, many more immunologically active particles. So actually vaccines are getting very much purer.

  • 10:17:08

    KEMPEAnd so if you look at the antigenic particles, they're really going down anyway. So that argument really doesn't hold any scientific weight at all.

  • 10:17:18

    REHMSo as I understand it, there are, what, 10 or 12 problems, disease against which a child is vaccinated?

  • 10:17:31

    FAUCIEven more. It could be more. It's 15 or more. I mean, if you look at it, I mean, the standard ones, measles, mumps, rubella, diphtheria, tetanus pertussis, polio, haemophilus influenza B, rotavirus and on and on, hepatitis. So there are many that you'll protect. And if you look at the history, that protection is just extraordinary.

  • 10:17:50

    REHMDr. Anthony Fauci, he is with the National Institutes of Health. Liz Szabo covers medicine for USA Today. Dr. Allison Kempe is with the University of Colorado School of Medicine. After our break, you'll hear from Dr. Bob Sears who has very different ideas. Stay with us.

  • 10:20:02

    REHMAnd joining us now by phone from California, Dr. Bob Sears. He's a pediatrician and author of "The Vaccine Book." Dr. Sears, what's your response to the new California vaccine law?

  • 10:20:20

    DR. BOB SEARSWell, thanks for having me on, Diane.

  • 10:20:21

    REHMSure.

  • 10:20:22

    SEARSYeah, I am very disappointed by the decision. You know, in order to take away the constitutional rights of a group of children, you know, that they have to attend school in California, there would have to be an enormous danger of having those children in school. And to say that unvaccinated children attending school is a danger is just wrong. You know, the authors of this bill and the proponents of this bill completely failed to demonstrate that these kids are any danger whatsoever. And I think the current system has been working very well. These kids have been able to coexist together happily, despite the differing beliefs of their parents. And such a drastic measure simply was not warranted.

  • 10:21:14

    REHMTell me about your reaction to the serious measles outbreak that your state had among visitors to Disneyland.

  • 10:21:26

    SEARSWell, what's interesting is the California Public Health Department didn't report that even a single case of measles occurred within a school, not one case, Diane. And I find it so ironic that a measles outbreak which didn't even affect schools, even in one case, prompted health officials to decide to make the vaccines mandatory in the very place where the outbreak didn't even occur. And, you know, if they were serious about trying to reduce measles outbreaks, they should just make vaccines mandatory for every single person wherever you are. And, you know, you have to show your vaccine card before you go to Disneyland, before you go to the mall.

  • 10:22:11

    SEARSIt just makes no sense. There was no measles danger to our school children. And I feel like that's -- that alone makes this bill completely unnecessary based on that line of reasoning.

  • 10:22:25

    REHMAt the same time, last month, the American Medical Association adopted a policy that pushes states to allow vaccine exemptions only for medical reasons. So isn't it the responsibility of a physician to give these vaccines to protect those children?

  • 10:22:55

    SEARSWell, Diane, it's certainly the responsibility of physicians to offer these vaccines, as I do in my office every day. I give vaccines every day and many of my patients are vaccinated. But, Diane, there's an -- a very important responsibility that every doctor has. It's called informed consent. You know, children get 54 doses of vaccines throughout their childhood. You know, when I was growing up, I only got about eight vaccines. And, Diane, you probably got about eight vaccines as a child growing up. Now it's 54 vaccines.

  • 10:23:30

    SEARSAnd because that is a medical treatment, it's a medical procedure that's injected, doctors actually have a responsibility -- an ethical responsibility that is mandated by the American Medical Association -- to give parents informed consent over the risks versus benefits of these vaccines. Even though the, you know, when you weigh those, you know, I think it comes out in favor of the benefits, parents still should have that choice. Because with every does, there is a very small risk of a severe reaction.

  • 10:24:06

    REHMI gather you heard Dr. Fauci as he talked about an alternative vaccine schedule and the risks that that could bring on. Is that what you offer your own patients?

  • 10:24:25

    SEARSYes. I do offer patients the option to slow the vaccines down and spread them out. And I would like to, you know, state some science that directly refutes what the good doctors were saying about how you can safely administer an unlimited number of vaccines and there is no potential harm from, you know, from giving so many vaccines together. Let me give you a quote from the Institute of Medicine from 2013. And the Institute of Medicine is probably the most respected group of doctors and researchers nationwide. And here's what they had to say in 2013. "Studies designed to examine the long-term effects of the cumulative number of vaccines in our schedule have not been conducted." Studies have not been conducted.

  • 10:25:16

    SEARSAnd they say that, "Key elements of the entire vaccine schedule, including the number of vaccines, have not been systematically examined in research studies." The doctors have no research to back up their statements that say you can safely give this number of vaccines together. And I would point out their analogy that our immune systems are exposed to millions of germs every day. You know, we get -- we inhale, we breathe in, you know, we touch, we swallow millions of germs every day. And you can't compare that to vaccination, Diane, because all of our daily exposures are natural. All those exposures enter our immune system and our body through the natural mechanisms of our immune system.

  • 10:26:03

    SEARSWhen you inject 10 different vaccine germs into your body all at once, you are bypassing the natural immune system and introducing it artificially, directly injected into the body. And we don't know, according to the Institute of Medicine, how that process, you know, with the number of vaccines we give, how that exactly works and affects us and whether or not, ultimately, that is safe.

  • 10:26:31

    REHMAll right. I want to ask you one other question. And then, perhaps, Dr. Fauci would like to jump in, as would Dr. Kempe. What are the conditions under which a patient would be exempt from having these vaccinations?

  • 10:26:55

    SEARSWell, you know, the lawmakers here in California have left it fairly open to the judgment of the doctors. They stated, instead of patients requiring a contraindication to vaccination -- meaning, you know, what it used to be is patients used to have to have practically died from a vaccine reaction previously in order to have a contraindication, or they had to be severely immunocompromised. That's no longer the case in California. The new law actually leaves it open to interpretation and that, if it's -- if, under the judgment of the doctor, a patient's health status is such that the vaccines could pose a significant risk.

  • 10:27:42

    SEARSAnd then you can consider the family's history of vaccine reactions or if the family's -- the whole history of the medical problems that they family might have -- doctors can consider all of these factors to decide with a family whether or not vaccines might pose a considerable risk to that child. And then it's really between the doctor and the patient to make that decision. And so, you know, it's -- at least parents have the option to get medical exemptions. But they will -- they will have a hard time finding a doctor who will believe them or agree with them, because most doctors won't want to be as open-minded as parents are hoping they will be. And I think a lot of families who had a bad reaction won't find a doctor that will support their decision.

  • 10:28:35

    REHMAll right. Dr. Fauci, would you like to comment?

  • 10:28:40

    FAUCIWell, where to start?

  • 10:28:41

    REHMStart with the Institute of Medicine.

  • 10:28:43

    FAUCIOkay. Well, see, to say that a study has not been done and then use that as the fulcrum to make a decision, I think is a really quite -- with all due respect -- spurious argument. Because, if you look at the immune system's activation when you have a prolonged infection that lasts for five, six, seven days -- take respiratory syncytial virus, for example, which so many children get, or strep throats, or what have you -- and you look at the activation of the immune system, it doesn't matter whether the mode of presentation to the body is through the nasal passage or what have you, the immune system gets dramatically turned on.

  • 10:29:26

    FAUCIAnd that's the argument of why you shouldn't do a cluster. You don’t want to bombard the immune system. We know, from vaccinations, that the amount of turn on -- forgetting counting the number of antigens, which are infinitely greater with a natural infection, regardless of whether it's injected in a vaccine or it comes in through the GI tract naturally or through the nasal passage naturally. So I think that's a spurious argument to say, the IOM says that there really hasn't been any studies. Well, you know, there hasn't been any study specifically to look at that. But the indirect and relatively direct data indicating that a natural infection is far more bombarding of the immune system than a vaccine is very, very clear.

  • 10:30:10

    REHMDr. Kempe.

  • 10:30:11

    KEMPEYes. I agree with that, of course. Another thing I'd like to discuss, in relation to what Dr. Sears said, is the whole idea of the -- you know, he invokes the patient -- the sacred, you know, relationship between the parent and patient and the provider. And none of us, of course, would deny the importance of that. But there's a whole public-health aspect here, which he is not paying attention to and that many of these parents are not paying attention to. This is not a decision that just affects their child. This is a public-health decision. And public health requires a social contract. And that's gotten sort of lost in this whole discussion.

  • 10:30:53

    REHMHmm. Hmm.

  • 10:30:55

    KEMPEThere must be some degree of responsibility. The vaccines are supported by the strongest science of any other intervention we do in medicine. And the amount of safety data that we look at, have looked at, continue to look at is, you know, far surpasses any other intervention we have looked at.

  • 10:31:16

    REHMAll right.

  • 10:31:16

    KEMPESo that I think that, you know, that is being lost here.

  • 10:31:21

    REHMDr. Sears, how do you comment on the responsibility not only of patients but of doctors, themselves, to regard the entire public health system?

  • 10:31:39

    SEARSWell, I agree that must be considered as everyone makes this decision. And if making vaccines mandatory for school was going to dramatically impact this whole situation of diseases in the school, I could agree with that. But let me point out that I don't think this bill will effectively reduce diseases in schools. Because the only two diseases that schools are having any sort of problem with or they're out -- they're worried about are measles and whooping cough. And we could throw the flu in there as well. We know measles didn't occur within schools during this outbreak. So that's out.

  • 10:32:20

    SEARSWe know, for whooping cough, that the Centers for Disease Control has said that unvaccinated children are not the reason for the continued spread of whooping cough. It's because the whooping cough vaccine wears off too soon. So fully-vaccinated children in schools are still catching whooping cough because they don't get very much protection from the vaccine. So even if you fully vaccinate everyone against whooping cough in schools, we'll still see the disease. You know, the flu vaccine doesn't work well enough to dramatically reduce it. Last year's flu vaccine only worked 19 percent. So I would argue, even though it is in the public health's best interests, you know, in theory.

  • 10:33:04

    SEARSBut in practice, even with everybody vaccinating in school, we won't have a significant reduction in these diseases. Therefore making such a bill ineffective and unnecessary in that it doesn't warrant the removal of the rights for a group of children to attend.

  • 10:33:21

    REHMAnd you're listening to "The Diane Rehm Show." Liz Szabo, do we have any figures on how many children, say in the last year, have contracted measles or whooping cough in schools?

  • 10:33:42

    SZABOWell, I know California has had a very large whooping cough epidemic, over -- I think, over 11,000 cases. They just had a baby a few weeks old die. At that age, the baby wouldn't be vaccinated. In terms of measles, there were, I think 644 cases of measles last year, nationwide. And this year, I think it's about 179.

  • 10:34:09

    REHMAnd in California, specifically, do we have any numbers?

  • 10:34:15

    SZABOI think the Disneyland case was about 117 people. And what was interesting about Disneyland is 40 people, I think, were directly infected at Disneyland. But Disneyland -- if you were going to start a measles epidemic -- is pretty much the perfect place to do it. Because people come from abroad. Europe has had huge, huge measles epidemics, much, you know, thousands of cases. Much worse than here.

  • 10:34:41

    REHMAnd yet, as Dr. Sears said, not one case turned up in the schools.

  • 10:34:47

    SZABOYeah. I haven't heard of a case turning up in school. But it did spread nationwide. I think what really captured the public imagination about this measles outbreak -- because it's a third the size of last year's measles totals, but -- is that it spread nationwide. There were preschools in, I think, Detroit that were closing. I mean, people around the country go to Disneyland, get on planes, cough, expose other people. So it really did spread nationwide.

  • 10:35:19

    REHMSo, Dr. Sears, tell me what you do recommend to patients with regard to vaccinations.

  • 10:35:30

    SEARSWell, I certainly do support vaccinations. And as I'm talking to each patient in the office, I do recommend the vaccines. But I feel like I have to give them a choice and I have to, you know, make sure they read the Centers for Disease Control mandated discussion papers on, you know, the pros and the cons. And when, you know, when each of my patients reads, you know, reads all the information, some of them decide to opt out. And I feel, as their doctor, I can give them that right. And I feel, you know, that these families do not pose, you know, a danger to those around them, because children around them who are well vaccinated -- certainly vaccines don't work every single time -- but, you know, everyone around them is very well protected.

  • 10:36:24

    SEARSAnd, you know, people talk about the immunocompromised kids -- people with weakened immune systems in school -- I mean, we need to protect them. I would, once again, say that no one -- no immunocompromised kids caught measles during this outbreak.

  • 10:36:40

    REHMAll right.

  • 10:36:40

    SEARSAnd, excuse me. Go ahead.

  • 10:36:42

    REHMI know Dr. Fauci wants to comment.

  • 10:36:44

    FAUCISo I would ask the question of Dr. Sears. Do you ever talk to your patients about a societal responsibility? And what would happen, in your mind, if all of a sudden, virtually all of your patients decided, "Hey, why take the risk of getting, for example, a measles shot, if society is protected?" Have you ever spoken to them about societal responsibility?

  • 10:37:08

    SEARSYeah. We certainly do discuss societal responsibility. And I actually have patients who have decided to vaccinate on that issue alone, certainly. They feel, "Gosh, I feel vaccines are a little bit risky, but my social responsibility does -- prompts me to go ahead and vaccinate." Certainly, I do have those discussions. And they are important parts of the discussion.

  • 10:37:30

    REHMAll right. We've got to take a short break here. Dr. Sears, I hope you'll stay on the line with us. We've got lots of callers. Stay with us.

  • 10:40:02

    REHMAnd welcome back. We're going to open the phones. I know many of you have questions. Let's go to Matthew in Washington, D.C. You're on the air.

  • 10:40:16

    MATTHEWHey, I just wanted to bring up the point that talk about these measles outbreaks, like, the patient zero wasn't found out to have been vaccinated. And we talk about responsibility, social responsibility, what about the fact that -- how many people had died from measles last year verses how many died from vaccines? Those are my big points. Thank you.

  • 10:40:37

    REHMAll right. Dr. Fauci.

  • 10:40:40

    FAUCIWell, first of all, the question is getting around the point of if we had a measles -- no measles vaccination, and we had measles outbreaks, let me give you an example of what it was like when I was a child. So, in 1963, the vaccine program for measles was instituted. Prior to that, there were three to four million people in the United States who got measles. There were about 500 deaths, 48,000 hospitalization, and 4,000 babies developed encephalitis because of the measles. So, measles is a very serious disease.

  • 10:41:18

    FAUCISo, rather than saying how many people died of measles, you'd say, how many people would have died of measles if we didn't have vaccination? And it is an extraordinarily rare event. When I say extraordinarily, the almost unmeasurable that someone would die from a vaccination.

  • 10:41:32

    REHMDr. Sears, here's an email. What kinds of studies have been done on the small percentage of people who do adverse reactions to some vaccines? If we can just isolate those people with pre-screening, doesn't most of this issue go away? Dr. Sears, is there any way to know who might react to vaccines?

  • 10:42:05

    SEARSYou know, there is, Diane, and I feel like we will have that kind of information in the decades to come, you know, with genetic screening and immunological screening. You know, we do know some people, you know, have very serious vaccine reactions. You know, let's see, I was looking at even the Institute of Medicine was talking about that, this very issue. And they said that the committee found that assessing outcomes in certain populations of children who might be more likely to have a vaccine reaction, such as families with a large history of autoimmune disease.

  • 10:42:49

    SEARSThey feel like that should be studied. It hasn't been studied enough, because we just don't know. So, we do need to know that Diane, and I hope someday we will. And until then, I think parents are simply going to rely on how they react to the vaccines when parents got vaccines. Parents are going to look at how their first children react to vaccines. And families that have very severe reactions, I think, are going to consider their next children, possibly susceptible, and they're not going to want to vaccinate.

  • 10:43:21

    REHMAll right, and here's an email for you, Dr. Kempe, from Sarah. She says, I watched the hearings on the California bill. Hundreds of parents showed up to every hearing with vaccine injured children in tow. For reporting that they had a child with a vaccine injury, they were ignored by the state government. Why can't these stories be investigated? Forced vaccinations do not alleviate legitimate parental concerns about safety studies, corruption in federal oversight agencies, ingredients, liability and the schedule. How do you respond?

  • 10:44:12

    KEMPEWell, in -- if these parents reported a vaccine related injury or something they thought might be a vaccine related injury, all of these cases are very extensively evaluated. And in fact, there's a vaccine compensation program, even if there is no proof. In many cases, parents are compensated if there's even a possibility. The point is, we have extensive surveillance systems ongoing that look at potential problems with vaccines. They are more extensive than what we do for any other interventions.

  • 10:44:50

    KEMPEAnd the fact that we can't even quantitate the severe reactions, because they're so rare, says a lot about how rare they are. Now, parents, a variety of parents who have children with serious problems connect those problems with vaccination, but unfortunately, those are usually spurious connections. For example, autism. Autism happens, you know, when you pick up autism, as a pediatrician, is when children are not talking. And when is that happening?

  • 10:45:23

    KEMPEThat's about a year to 18 months. And that's when a lot of children are getting booster vaccines. So, that association is entirely spurious. It's been shown multiple times in huge databases to be false. There is no connection between autism and vaccines. So, I think some of these parents, unfortunately, are very unhappy about what's going on with their children, but they cannot prove any association.

  • 10:45:53

    REHMDr. Fauci.

  • 10:45:53

    FAUCII totally agree with Dr. Kempe said. And just to underscore that, the surveillance and the following of potential vaccine side effects is as intense as any medical intervention that is ever done.

  • 10:46:07

    REHMAll right. And here's an email, I'm not sure who the writer is. It says, I think people have a short memory. My father was a pediatrician, and during his internship at the Willard Parker Hospital, there were entire floors of children with diphtheria. Now, this is forgotten. How do you respond, Dr. Sears?

  • 10:46:39

    SEARSIt is a valid point. I mean, you know, these diseases used to run rampant and the doctors are right. You know, as far as what could happen with measles if we had no vaccine. My point is we have vaccines, they work very well in most cases, they have eliminated or reduced these diseases to the extent where, with almost everyone vaccinated, the proportion of the population who chooses not to vaccinate can safely do so. They don't pose the kind of danger to society that people are suggesting.

  • 10:47:20

    SEARSAnd I think it concerns me when we're gonna take a group of families who don't share our medical beliefs, who feel differently than we do, or even more scary is if their beliefs are based on their religion and we tell those families, you are unclean, your children are unsafe, your children should not be around our children, and we are therefore gonna keep you out of the society of school programs. I feel that that's a dangerous place to go because the status quo is working very well. Diseases are under control and I feel like we can safely co-exist all together under our current system.

  • 10:48:05

    REHMDr. Kempe, I know you've done surveys on parents choosing to spread out the vaccine schedule. What are the trends and what are the results?

  • 10:48:20

    KEMPEWell, yes, we did a national survey of family medicine and pediatricians a few years ago, and virtually all physicians are getting requests, within a month, from parents of children less than two. To spread out the vaccine schedule. Or skip individual vaccines. So, this is definitely an increasing phenomenon. The physicians themselves report a great deal of frustration with this. First of all, talking with vaccine hesitant parents for about -- 25 percent of physicians say it's taking them 10 minutes or more of a well child visit and an average well child visit is about 18 minutes.

  • 10:49:06

    KEMPESo, you can see that, you know, a lot of other things are not being discussed with these parents. So, it's been a major source of frustration in primary care. Because the burden of this is largely falling to primary care doctors and we really need to do a little bit better as communities to tackle this problem.

  • 10:49:27

    REHMSo, what about the current routine childhood immunization schedule? Can we know how many deaths it may have prevented? Can we know about how many cases of disease it's prevented?

  • 10:49:51

    KEMPEYes. I think probably Dr. Fauci has those data in front of him. They are enormous. If you put all of the diseases together, I can't give you the numbers, but I bet he has them.

  • 10:50:03

    REHMAll right. Dr. Fauci.

  • 10:50:04

    FAUCIOkay, so let's just take 20 years of childhood immunizations, the past 20 years. There have been 322 million illnesses avoided. 732,000 deaths avoided. And about 1.4 trillion dollars in societal costs that have been saved over the last 20 years.

  • 10:50:26

    REHMBecause of...

  • 10:50:28

    FAUCIOf childhood vaccinations.

  • 10:50:31

    REHM...now, Dr. Sears, what's your thinking on that?

  • 10:50:35

    SEARSWell, I mean, even though that that is true, we don't know that those numbers are completely solid or accurate, but those estimates, given that they are true, and we agree with them, I would add that and some parents still have the right to opt out because no vaccine is 100 percent safe. One of the members on the phone call here brought up, you know, the National Vaccine Injury Compensation System and how people are compensated for vaccine injuries.

  • 10:51:11

    SEARSYou know, in the last 25 years of that program, almost 30 years, about 4,000 people have been compensated through that program because of vaccine injury. And the government has paid over three billion dollars to these families because they have proven that they've gotten a vaccine injury, a severe vaccine injury.

  • 10:51:33

    REHMDr. Fauci.

  • 10:51:35

    FAUCIWell, as Dr. Kempe stated and knows probably more about this than any of us, that the government, in a very flexible way, compensates you for a vaccine purported associated injury in a very, very flexible way and I would ask Dr. Kempe, who probably knows the data on that, that is, that is, well, we'll hand it over to her, because I think that's something she studies.

  • 10:52:00

    KEMPEWell, actually, I don't study that specifically, but I do know that the majority of cases cannot be proven at all. And in fact, there are other plausible explanations, but the, you know, the intent is to compensate parents or families when there's a suspicion, a reasonable suspicion. So, actually, I would agree. It's fairly liberal.

  • 10:52:21

    REHMAll right. Let's go to Fort Worth, Texas. Hi there, Michael. You're on the air.

  • 10:52:27

    MICHAELHi Diane. I'm a long time listener. First time caller.

  • 10:52:30

    REHMThanks.

  • 10:52:30

    MICHAELGreat show today.

  • 10:52:31

    REHMGood.

  • 10:52:33

    MICHAELI had a comment and a question for the panel. So, I'm a father of two children who are on the autism spectrum. I have no doubt the vaccines did not cause my children's autism. But this anti-vaccine, autism connection is the main driver behind parents' decisions to not vaccinate their children. Yes, there is a possibility of reaction, but it's so infinitesimally small that most parents do not make their vaccination choices based on that. Some parents do validly choose based on palpable auto-immune response problems.

  • 10:53:15

    MICHAELOr, compromised immune systems to not vaccinate their children. My question is what do we do as a society to combat the anti-intellectualism and anti-science stance that people with loud voices and poor information are using to influence parents' decisions.

  • 10:53:35

    REHMAll right. And you're listening to The Diane Rehm Show. Liz Szabo, can you comment?

  • 10:53:44

    SZABOIf I may, I just wanted to correct one piece of misinformation. Earlier, someone had asserted that patient zero, in other words, the first patient who started the Disneyland measles incident, was vaccinated. The patient zero hasn't been identified.

  • 10:54:00

    REHMAll right.

  • 10:54:00

    SZABOThere's no evidence to say that. In fact, the vast majority of people who got sick through the Disneyland outbreak were not vaccinated, so….

  • 10:54:09

    REHMCan you talk about that anti-science/anti-vaccine connection and the spurious connection to autism?

  • 10:54:22

    SZABOYeah, the autism, really I think we can call it a myth at this point. It got started with an article, I think, in 1998, in the Lancet, that had made some kind of tenuous association between autism and measles. That article has since been retracted. Most of the authors pulled their names off of it. And the lead author of that study actually lost his -- the equivalent of a medical license in Great Britain. So, there have been really over a dozen studies now showing that there's no connection between autism and vaccines.

  • 10:55:00

    SZABOBut I think, really, you know, there could be a thousand studies showing vaccines are safe. But I think some people just aren't interested in studies. You can give them, like I said, thousands of studies, there are people who don't trust the government and the CDC and Dr. Fauci are from the government. There are people who don't trust the pharmaceutical industry, who of course, make vaccines. So, nothing they say will ever reassure people.

  • 10:55:26

    REHMDr. Fauci, I gather there's going to be a backlash on the part of many patients who do not agree with California's decision. Do you think that that could, in fact, affect people's thinking?

  • 10:55:49

    FAUCIThe backlash? Yeah. I'm not so sure, Diane. I'd like to just make the comment that when parents are concerned about the potential, in their mind, deleterious effects of vaccine verses the risk of the disease itself as well as the societal issue, I think we need to respect those opinions. Because they're coming to them under what they feel are the data they put together in their own mind. So, you should never have a lack of respect for those people. But what you can do is to try and get them the information so that they can make decisions about their family and their children based on solid scientific evidence.

  • 10:56:33

    FAUCIAnd that's what we try to do when we talk about that. We say, we understand your concern, but let's look at the data. Let's look at the data visa vi your individual child, and let's look at the societal data. So, we hope that by continuing to talk about that, we'll provide them with that necessary data.

  • 10:56:50

    REHMDr. Anthony Fauci, Dr. Allison Kempe, Dr. Bob Sears, and Liz Szabo. Thank you all so much. It is an important issue and I hope we've brought you information to make your own decision of wisdom. Thanks for joining us. I'm Diane Rehm.

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