Kerry Dooley Young
February 28, 2019
"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," said House Energy and Commerce Chairman Frank Pallone Jr (D-NJ) at the hearing.
The World Health Organization listed what it terms vaccine hesitancy — the reluctance or refusal to vaccinate despite the availability of these medicines — among the 10 major threats to global health in 2019.
In the United States, misinformation about the measles-mumps-rubella (MMR) vaccine is eroding one of the United States' recent medical victories, according to Pallone and committee colleagues in both parties. In 2000, measles was declared eliminated in the United States, meaning no continuous disease transmission had been seen for more than 12 months.
Slippage in use of the vaccine appears to be allowing the virus to regain ground. From January 1 to February 21 this year, 159 individual measles cases were confirmed in 10 states in the United States, according to the Centers for Disease Control and Prevention (CDC).
"This hearing can help provide important information to address questions for some people about the safety of the vaccine," said Rep. Greg Walden of Oregon, the ranking Republican on the committee. "If we don't reverse the downward trend of vaccination, we risk bringing back measles in full force."
To that end, the oversight and investigations panel called as the hearing's only witnesses two of the nation's experts on keeping viruses in check.
Appearing were Anthony Fauci, MD, the director of the National Institute for Allergy and Infectious Diseases, and Nancy Messonnier, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.
Both Fauci and Messonnier stated at the hearing that the MMR vaccine is considered safe. In his testimony, Fauci said the measles vaccine, when given in accordance with the recommended regimen, is 97% effective, making it one of the most effective vaccines.
"This fact together with its excellent safety record, the highly contagious nature of the infection, and its potentially serious consequences underscore the importance of not withholding measles vaccination from those for whom it is indicated," Fauci said.
A Matter of Misinformation
Social media is helping to spread concerns about the MMR vaccine. The Guardian newspaper on February 1 reported on how Facebook search results and YouTube's recommendation algorithms may steer viewers toward misinformation about vaccines.
In many cases, there's misinformation about a link between the MMR vaccine and autism, despite research that has examined this issue and has found no connection, Fauci said.
"The good news about the Internet is that it spreads information," Fauci said. "The bad news is that when the bad information gets on there, it's tough to get it off."
By 2004, for example, what was then called the Institute of Medicine (IOM) concluded that there was no evidence of a connection between the MMR vaccine and autism. A committee of the IOM, now called the National Academy of Medicine, had reviewed studies suggesting a link. It also reviewed work that sought to identify potential biologic mechanisms by which the MMR vaccine might cause autism.
But a link between autism and the MMR vaccine had already taken root in the minds of many people in America and around the world.
Congress aided in this, with then Rep. Dan Burton (R-IN) serving as a vocal proponent of the theory. It is estimated that he held about 20 hearings on the matter. Burton, who often talked about his grandson having autism, was a supporter of Andrew Wakefield. Wakefield was a British physician whose widely reported 1998 Lancet article on a link between the vaccine and autism was retracted in 2010.
At the Wednesday hearing, witnesses and lawmakers urged a thoughtful approach to parents' concerns about the MMR vaccine.
"We shouldn't be criticizing people who get this information that's false, because they may not know that it's false," Fauci said. "We need to try to continue to educate them."
Rep. Brett Guthrie (R-KY) stressed the need to build a strong scientific case for these parents, relying on the work done by the CDC and the National Institutes of Health.
"Whatever decision they are making, they are making it with love and in the best interest of their child," Guthrie said.
These parents often are innundated with a flow of misinformation about the safety of vaccines, the CDC's Messonnier told the subcommittee.
"Most parents are hearing this information and then going to their healthcare provider to help them sort it through," she said. "And most parents in the US are still going on to get their kids vaccinated."
Messonnier also observed that she and colleagues in the American medical community may be a "victim of our own success" regarding the measles vaccine.
"Fewer and fewer doctors and parents have witnessed the serious and sometimes life-threatening consequences of vaccine-preventable diseases," Messonnier said. "Because of our success, parents may wonder if vaccines are really necessary."
In her testimony, Messonnier noted that about 3 to 4 million people got measles annually in the United States before the measles vaccination program started in 1963. About 400 to 500 of them died, 48,000 were hospitalized, and 4000 developed encephalitis because of measles.
Messonnier also said that although overall measles vaccination coverage rates are high, at 92%, 1 in 12 children in the United States are not receiving the first dose of the MMR vaccine on time. In 2017, there were 11 states where more than 10% of toddlers had not received even a single dose of MMR vaccine, she said.
Children may miss out on measles vaccines for several reasons, including a lack of access to care, she said. In other cases, though, parents are deciding to skip the MMR vaccination.
A memo prepared by the Energy and Commerce Committee staff noted a relatively low vaccination rate in a part of the United States that is experiencing an outbreak.
Only about 81% of 1- to 5-year-old children and just 78% of 6- to 18-year-olds in Clark County, Washington, had received the age-appropriate number of MMR vaccine doses as of the end of last year, the memo said. In constrast, 91.1% of children aged 19 to 35 months nationwide have received at least one dose of the MMR vaccine, the memo said.
"Unfortunately, the case information suggests the region near Portland has been an area of under-vaccination," Walden said. "Most of these cases involved people who were not vaccinated, and most of those infected were children between the ages of 1 and 10."
As of the end of January, Washington was one of 17 states that allow so-called philosophical exemptions to vaccine requirements for school-age children, according to a tally from the National Conference of State Legislatures.
At the hearing, Guthrie noted that these policies mean "that most people can opt out for any reason."
Many states are rethinking this approach, given recent measles epidemics, Guthrie said. He noted that California, for example, had ended religious and personal exemptions for vaccines.
Yet, Arizona's House Health and Human Services Committee recently approved three bills to expand exemptions for mandatory vaccinations, the Arizona Republic has reported.
"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," Guthrie said.