STATE OF WASHINGTONDEPARTMENT OF HEALTH
PO Box 47890  Olympia, Washington 98504-7890
Tel: 360-236-4030  TTY Relay: 800-833-6384

United States Senate Committee on Health, Education, Labor, and Pensions“Vaccines Save Lives: What is Driving Preventable Disease Outbreak”
March 5, 2019
Testimony ofJohn Wiesman, DrPH, MPH
Secretary of Health, Washington State Department of Health

Chairman Alexander, Ranking Member Murray, and distinguished members of theCommittee, thank you for the opportunity to appear before the Senate Committee on
Health, Education, Labor and Pensions today to discuss an issue of significant
importance to the lives of the American people--protecting people from vaccinepreventable diseases. State, territorial, tribal, and local public health agencies are on
the front lines implementing vital public health programs, including immunization
programs, and responding to a wide array of public health emergencies such as disease
outbreaks.
One of our objectives in public health is to share accurate, science-based information.
To that end, allow me to say at the onset, vaccines are safe, effective, and the bestprotection we have against serious preventable diseases like measles. Vaccinating
children in the United States has saved millions of lives, increased life expectancy, andsaved trillions of dollars in societal costs.1 Yes, like any medication, vaccines havesome minor side effects and can have rare serious complications.2 They can also
eradicate diseases from our planet, like they did with smallpox and hopefully soon with
polio.3, 4 And in the United States, we have eliminated a number of vaccine preventable

1

Whitney, C. G., Zhou, F., Singleton, J., & Schuchat, A. (2014). Benefits from immunization during the vaccines forchildren program era—United States, 1994–2013. MMWR 2014;63(16): 352-355.
2
McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of Measles, Rubella, Congenital Rubella Syndrome,and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 2013; 62(RR04):1-34. Available at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
3
https://www.who.int/csr/disease/smallpox/en/ (accessed March 1, 2019)4https://www.who.int/features/factfiles/polio/en/ (accessed March 1, 2019)1

diseases. In 2000 we thought the United States had eliminated measles, but that is nolonger the situation with the number of outbreaks we have had since then.5
As secretary of health for Washington state, my mission is to protect and promote thelives of all the people in our state and when making public policy to ensure that it isbased on the best science available to us. To that point, I want to speak directly to theparents who have children with autism and other serious health issues and who havebeen attending our hearings in Washington state and who are watching this hearing
today. I see you and your children. I see your pain, your desire for answers to yourchildren’s health issues, your skepticism of government and the pharmaceuticalindustry, your mission to give your children the best life they can have and your desire
to prevent other parents from the pain and suffering you and your children experience.
Your mission to protect and promote the health of your children is a mission I share.
And I know on this point, some of you will strongly disagree with me: the sciencedemonstrates that autism is not caused by vaccines. But while the science on that isclear, we do need to better understand the causes of autism and other diseases better
than we do today. We need to develop together—scientists, public health officials andaffected families—research agendas to get the answers we all need. We need to create
an environment where we can respectfully listen to each other and engage.
Public health systems at every level are struggling due to chronic underfunding,increasing population size, and the emergence of new threats. We find ourselves
constantly reacting to crises, rather than working to prevent them. It is therefore
incumbent upon all of us at the federal, state, and local levels to provide the sustained,
predictable, and increased resources necessary to focus on health promotion anddisease prevention work as well as respond to emerging and reemerging diseases.
Measles Outbreak
Currently, there are six ongoing but completely preventable measles outbreaks in the
U.S., including one in Washington, three in New York, one in Texas and one in Illinois.6
Over the last 10 years, Washington state has had three measles outbreaks, one ofwhich included the death of an immunocompromised person exposed to measles in aclinic waiting room.7 The current outbreak is larger and infecting people faster thanthose in recent history. Between the end of December 2018 to March 1, 2019,
Washington State has had 69 measles cases in our outbreak, plus four additional cases
associated with our outbreak in Oregon and one in Georgia. Of the 69 Washington
cases, 60 were unvaccinated, two had one dose of the measles vaccine and sevenhave an unverified immunization status. Two cases were hospitalized.

5

Papania, M. J., Wallace, G. S., Rota, P. A., Icenogle, J. P., Fiebelkorn, A. P., Armstrong, G. L., ... & Hao, L. (2014).
Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US
experience. JAMA pediatrics, 168(2), 148-155.
6https://www.cdc.gov/measles/ (accessed March 1, 2019)7https://www.doh.wa.gov/Portals/1/Documents/5100/420-004-CDAnnualReport2015.pdf (accessed March 1,
2019)

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In a global society with increased air travel, a disease outbreak in one part of the world
can easily be transmitted to another by travelers. Our best protection against thesepreventable diseases is quite simple—vaccination. Currently, many countries in Europe
are experiencing significant measles outbreaks.8 In this latest outbreak in Washington,
we know that an individual traveled to Washington state from Europe who was alreadyinfected, but not yet symptomatic, with a wild strain of the measles virus circulating
there.9 Fighting disease outside the U.S., as well as inside, promotes health security foreveryone. Research shows every dollar invested in global immunization programs in theworld’s poorest countries saves $16.10 This is why we must fully fund the CDC andother health organizations to maintain disease-control activities globally.
According to the CDC, measles can be serious for all age groups. However, children
younger than five years of age and adults over 20 years of age are more likely to sufferfrom measles complications. Common complications from the measles include ear
infections, which can lead to permanent hearing loss, and diarrhea. However, somepeople may suffer from severe complications such as pneumonia and encephalitis.
Finally, for every 1,000 people who get measles, one or two will die from it.11 Measles is
so contagious that if one person has it, 9 out of 10 people of all ages around him or her
will also become infected if they are not protected.12
Even though there is an effective vaccine, measles still caused 110,000 measles deaths
worldwide in 2017, mostly among children under five years of age.13 In 1963, prior to theUnited States measles vaccination program, three to four million people a year were
estimated to get measles, resulting in 48,000 hospitalizations and 450 to 500 measles
deaths a year.14 From 1989 to 1991, a resurgence of measles in the United States
resulted in more than 55,000 cases and 120 deaths.15 More than half of the children had
not been vaccinated, even though they had seen a healthcare provider. In response,
Congress created the Vaccine for Children program, which covers vaccines for thoseunder 19 years of age on Medicaid, uninsured, underinsured, and American
Indian/Alaskan Native.16 In addition, the Advisory Committee on Immunization practices
recommended the second dose of MMR.17 We must continue the forward progress wehave made protecting people from vaccine-preventable diseases.

8

http://www.euro.who.int/en/media-centre/sections/press-releases/2018/measles-cases-hit-record-high-in-theeuropean-region (accessed March 1, 2019)9https://www.clark.wa.gov/public-health/measles-investigation (accessed March 1, 2019)10
Ozawa, S., Clark, S., Portnoy, A., Grewal, S., Brenzel, L., & Walker, D. G. (2016). Return on investment fromchildhood immunization in low-and middle-income countries, 2011–20. Health Affairs, 35(2), 199-207.
11https://www.cdc.gov/measles/about/complications.html (accessed March 1, 2019)12https://www.cdc.gov/measles/about/transmission.html (accessed March 1, 2019)13https://www.who.int/news-room/fact-sheets/detail/measles (accessed March 1, 2019).
14
https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf (accessed March 1, 2019)15
https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html (accessed March 2, 2019)16
https://www.cdc.gov/vaccines/programs/vfc/about/ (accessed March 2, 2019)17
CDC. Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR
1989;38(No.S-9):1-18. Available at: https://www.cdc.gov/Mmwr/preview/mmwrhtml/00041753.htm

3Vaccine Effectiveness
The widespread use of measles vaccine led to a greater than 99% reduction in measles
cases compared with the pre-vaccine era.18 Two doses of the measles, mumps, andrubella (MMR) vaccination are 97% effective against measles.19 And it is estimatedworldwide that because of the measles vaccine, 20.5 million deaths were prevented
between 2000 and 2016.20
It is important to note however, that some vaccines are not as effective as we would
like. For example, according to the CDC the overall effectiveness of the 2017-2018 flu
vaccine against both influenza A and B viruses was estimated to be 40%. This means
the flu vaccine reduced a person’s overall risk of having to seek medical care at adoctor’s office for flu illness by 40%.21 While the effectiveness of the flu vaccine canvary, it is still the best protection against this annual illness, and was estimated toprevent about 110,000 flu hospitalizations, and 8,000 flu deaths during the 2017-18
season.22 A more effective vaccine would save even more lives. Similarly, protection
from the current pertussis vaccine has been shown to wane during the five years after
completion of the 5th childhood dose.23 As a nation, we must continue to invest in criticalresearch and vaccine technology to improve vaccine development.
Consequence of Vaccine Success
Due to the success of vaccines, fewer people have witnessed the complications andseverity of vaccine preventable diseases. Unfortunately, this means that some parents
may believe that vaccination is no longer necessary or that the minor or rarely severe
complications from vaccines are somehow worse than getting the disease, resulting insome parents not vaccinating their children. Discredited and fraudulent research has
been used as a basis to claim a link between MMR and autism.24 Moreover, publichealth officials throughout the country are gravely concerned about the latest
misinformation originating from a well-organized and orchestrated anti-vaccination
movement.
In communities across Washington state and our nation, there are pockets of children
who are not fully vaccinated or not vaccinated at all. This puts them at risk to contract
measles and unintentionally spread it to others, especially since one is infectious withmeasles four days before the rash develops. It is absolutely paramount that publichealth and healthcare professionals across the nation join together to share the science
about the safety and efficacy of vaccines with the public. And we must equip health care
18

https://www.cdc.gov/measles/vaccination.html (accessed March 1, 2019)https://www.cdc.gov/measles/hcp/index.html
20
https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf (accessed March 1, 2019)21https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm
22https://www.cdc.gov/flu/about/burden-averted/index.htm
23
Cherry JD. The 112-year odyssey of pertussis and pertussis vaccines—mistakes made and implications for the
future. JPIDS. 2019; XX(XX):1-8.
24
Eggertson, L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines. Canadian Medical
Association. Journal, 182(4), E199.
19

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providers to be able to effectively answer the questions their patients may have about
vaccines, as we do want parents with questions to engage their trusted health careprovider. The health concerns that parents have over the risks of vaccination must be
addressed with compassion, care, and evidence-based practice so that informed
decisions can be made, and so that people can protect themselves and their loved ones
from dangerous, vaccine-preventable disease.
Communications Challenges
Public health and healthcare professionals face significant communications challenges
with those who are uncertain about vaccinations because of fear, distrust, and/or
misinformation. The increasing influence social media has over personal healthdecisions by promoting false information is alarming.
Admittedly, public health officials must be smarter in using media of all types to share
factual, credible information. We must call on social media companies such as Twitter,
Facebook, and Google to use whatever mechanism they have available to stop
promoting pseudoscience. And the problem isn’t limited to social media, traditional
media can spread this false information as well. As public health officials, we often
partner with traditional media outlets to spread critical life-saving information to the
public. When traditional media invites and promotes celebrity spokespeople who
question the validity of immunizations and remain blind to the body of scientificevidence, it makes our jobs all the more difficult, and frankly, puts the public’s health atrisk.
Civic discourse on vaccinations must be improved. Individuals opposed to vaccinations
are extremely well organized across the country. In Washington, state lawmakers who
proposed legislation to remove the personal exemption from vaccination have received
death threats and been stalked. A health care professional who recently testified insupport of removing philosophical exemptions for school entry vaccination has been
vilified on their health practice website and in nasty social media posts.
For my part, I recently received an email from a parent who does not vaccinate theirchild concerning a social media post from my agency. Many of you have probably seen
the post as it was going around many people’s social media accounts during valentine’sday. It’s a cartoon of a school boy asking a school girl if she will be his valentine, andshe asks if he has been vaccinated. While this social media post had one of our mostshares ever and most likes, laughing faces, and angry faces, I have come to understandhow this post just furthers the divide. I can do better, we all can do better. In fact, wemust do better to focus on our mutual interest of keeping kids healthy.
I completely agree with CDC Director Robert Redfield who said we need to change thehearts and minds of people in this country to not leave science on the shelf. 25 Additional25

https://www.seattletimes.com/seattle-news/health/cdc-director-federal-health-officials-stress-importance-ofmeasles-vaccinations/ (accessed March 1, 2019)5

federal funds should be provided to determine how best to communicate with vaccine
hesitant parents and to counter the misinformation currently being spread.
Washington State’s Vaccine Program
Each year Washington State receives $105 million in federal funding and $66 million instate funding to support a comprehensive immunization system. Federal funding has acritical role in achieving national immunization coverage targets. It supports
immunization system infrastructure and the purchase of vaccines for children who
qualify and adults without health insurance. Our state supplements these federal funds
to support health care providers and facilities, help parents make informed decisions,and partner with schools.
During my tenure we’ve worked hard to keep communities protected, ensure stable
funding for vaccines and build public/private partnerships to strengthen the
immunization infrastructure. For example, we have increased the number of 13 to 17
year olds who started human papillomavirus (HPV) vaccination series from 46 percent
in 2015 to 61 percent 2018. This means that more youth in Washington are protectedfrom the many cancers that HPV can cause.
One of the biggest challenges with childhood immunization in Washington is thepercentage of students out-of-compliance with state law because the parents have notsubmitted immunization documentation or exemption paperwork with the school. In the
2017-2018 school year, 8.0% of kindergarten students lacked appropriate paperwork
and were out-of-compliance. We believe this is largely because of the administrative
burden on schools to staff this health work and track the paperwork from parents. To
address this, we need to adequately fund school nurses. Our schools today are woefully
understaffed with school nurses. This does not put our children first. Public health needs
to partner with school nurses to ensure kids are vaccinated and keep our kids safe andhealthy, especially during disease outbreaks. We are also working on health technology
solutions to help school personnel easily access immunization records in our state
immunization registry, which reduces duplicate data entry and allows for the easy use ofreport writing functions to track the immunization status of students.
In addition, Washington is one of 17 states that allow parents to send their children toschool and child care unvaccinated for personal or philosophical reasons. Two statelawmakers from Clark County have each introduced legislation designed to protect
more children from vaccine preventable disease and increase the safety of theseenvironments. One bill would eliminate the philosophical exemption for the MMR
vaccine. The other would eliminate that exemption for all vaccines required for school orchild care entry. This approach honors the responsibility we all have to protect eachother. This proposed policy change is a good step forward and one I support. Vaccines
are the best protection we have: they are safe, readily available, given without charge toall kids under 19 years of age in Washington state and proven to be effective. And I
believe that parents want safe schools and childcare centers for all kids and those6

adults who serve them, including those who can’t be vaccinated for medical reasons or
who have lost their immunity due to serious medical conditions.
Public Health Response to a Measles Outbreak
In Washington, Governor Jay Inslee issued a Public Health Emergency Proclamation on
January 25, 2019 to support the response efforts to our measles outbreak.26 This
proclamation allowed mutual aid assistance through the Emergency Management
Assistance Compact enabling the state to request public health responders from otherstates to support the outbreak response. North Dakota, Idaho, and Oregon provided
staff to assist with the outbreak response.
To date, this preventable outbreak has cost over $1 million and required the work ofmore than 200 individuals contributing over 10,000 hours of work. These estimates do
not take into account the health care costs of those ill, the cost to schools andbusinesses as they responded to the event, the cost to student learning for thoseunvaccinated children excluded from school, and to the lost productivity of their workers.
In comparison, the cost of an MMR vaccine dose is about 20 dollars.27
Importance of Federal Funding and Programs
Our response to this outbreak has benefited greatly from the Federal government. The
Pandemic and All Hazards Preparedness Act (PAHPA) authorities and funding over theyears have allowed us to train, build, and maintain a strong Incident Management
Team, which has ably led the response, and it has allowed us to develop strike teams tosend into the response to carry out public health functions.
The public health system is often invisible to most Americans when it is working well. It
is when an emergency or a disaster or an outbreak strikes where the fragility andchronic underfunding of the public health system is laid bare. As just one example, in
Washington, Clark County repurposed their home visiting nurses to address thisoutbreak. The day to day job of the home visiting nurses is to assist expectant and new
mothers, many in high-risk situations, to help improve birth outcomes and raise healthy
children. By redirecting their work, families are going without this critical service andincreasing the risk for bad health outcomes.28
In public health, we see the need to modernize. We do our best to make the most withthe limited budgets we have. This is why federal funding is foundational for state,
territorial, tribal and local health agencies to provide a comprehensive immunization
system and emergency preparedness and response capability.

26

https://www.governor.wa.gov/news-media/inslee-declares-local-public-health-emergency-after-identifyingoutbreak-measles (accessed March 1, 2019)27https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html (accessed
March 1, 2019)28
https://www.columbian.com/news/2019/feb/25/nurse-family-partnership-takes-on-intangible-costs-ofmeasles-outbreak/ (accessed March 2, 2019)7

In this case, federal funds from Section 317 of the Public Service Act are used tosupport the immunization grant program and provide vital resources to support ourcomprehensive system. Section 317 funding provides support for our state to educate
and inform the public, monitor vaccine effectiveness, account for the use of federal andstate dollars, decrease ethnic and racial disparities, have strong outbreak investigation,
improve tracking systems, and continue to provide the necessary support to health care
professionals. Yet, the 317 immunization grant program has been flat funded since2009. Without increased funding, we cannot afford to develop new and innovative ways
to increase immunization rates especially in light of the anti-vaccine movement.
Research shows every dollar spent on childhood vaccines saves 10 dollars, so this is aworthwhile investment.29 Additional funding would help address growing gaps inimmunization coverage and strengthen the scientific foundation for vaccine policy
decision making.
The Pandemic and All Hazards Preparedness Act (PAHPA) provides a framework andresources to support our emergency preparedness and response. Funds from the
Public Health Emergency Preparedness Cooperative Agreement Program allows state
health departments to build and strengthen our ability to respond to public healthemergencies. Without this funding, state and local public health agencies would havebeen significantly delayed in identifying and containing this measles outbreak. This
program is currently funded $400 million below funding levels in the 2000s. More robust
funding would allow public health agencies to not have to reallocate resources fromother vital public health programs to respond to urgent public health emergencies likemeasles outbreaks or other disasters. Despite this Committee’s action to reauthorize
the law last year, it has now lapsed; I ask you to move quickly to reauthorize PAHPA.
The Prevention and Public Health Fund is the nation’s first mandatory funding stream
dedicated to improving our nation’s public health system. The purpose of the fund wasto supplement core public health programs with increased investment in disease
prevention, yet it has primarily been used to backfill the funding of core public healthprograms. Currently 47% of the 317 immunization program is funded by the Prevention
and Public Health Fund. Research shows every dollar invested in community-based
prevention saves $5.30
I’m here to make clear the threat of these vaccine preventable illnesses, so we canrespond together to restore health to the very part of our system responsible forprevention. One immediate response Congress can take is to raise the budget of theCenters for Disease Control and Prevention by 22 percent by 2022, as requested by the
Association of State and Territorial Health Officials and over 80 other organizations.31
Doing so will immediately begin to save lives, promote optimal health for all, bolster our
prevention services and reduce healthcare costs.
29

Rémy, Vanessa, York Zöllner, and Ulrike Heckmann. "Vaccination: The cornerstone of an efficient healthcare
system." Journal of market access & health policy 3.1 (2015): 27041.
30
Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger
Communities, Trust for America’s Health, 2009.
31
http://www.astho.org/Advocacy-Materials/22-by-22/ (accessed March 1, 2019)8

Conclusion
Vaccines are a testament to human ingenuity to ward off morbidity and mortality.
Vaccines activate the natural human immunity system. The science is clear thatvaccines are safe and effective. Vaccines can eradicate diseases. Vaccine programs
are one of public health’s greatest accomplishments. They are under great threat and
we need to reverse course.
I thank you for holding this hearing and increasing awareness about the importance ofvaccines and public health. Everyone has a right to live in a community free of vaccinepreventable disease. We must continue to invest in and strengthen our public healthsystem.

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