Action4Canada - Theresa Tam at a W.H.O. Planning Session, in May 2019

00:00:00.000 Welcome to the most important side event at WHA.

00:00:07.940 My name is Kate O'Brien.

00:00:10.540 I'm the director of the Department of Immunizations, Vaccines, and Biologicals at the World Health Organization.

00:00:17.760 I welcome all of you to this interesting panel and what I hope will be an active discussion to the degree that we can.

00:00:25.820 Clearly a lot of interest, a lot of people in the room, so this will be an important discussion.

00:00:34.720 We're going to be talking about promoting vaccine confidence, enhancing global immunization efforts to protect the health of all generations.

00:00:44.180 And this affects, as we know, vaccines are the broadest, deepest primary health care program that we have around the world.

00:00:52.020 And we're all in this together, especially because pathogens don't recognize borders.

00:00:59.660 So this is a topic that is critical for every country, every family, and every community around the world.

00:01:08.060 We have a fabulous panel here, and I'm not going to take more time because I think we want to hear from the panelists and hear from you as well.

00:01:18.140 So let me take the opportunity to turn it over to Secretary Azar from the United States.

00:01:26.420 Excellent. Thank you very much, Kate.

00:01:28.020 Fellow ministers, distinguished leaders, thank you for joining me at this important event.

00:01:33.180 I'd also like to thank in particular the European Union and Brazil for co-hosting with the United States.

00:01:39.520 Unfortunately, there is no better time than the present for us to come together to discuss how to make better use of vaccines.

00:01:46.520 Vaccines are some of the most thoroughly tested medical products that we have.

00:01:51.880 Vaccines are safe, effective, and life-saving.

00:01:55.140 But around the world, complacency among the public, coupled with misunderstanding and misinformation,

00:02:02.300 is causing vaccination rates to decline with tragic results.

00:02:06.560 Misinformation comes from a range of sources.

00:02:09.680 Insurgent groups in the Democratic Republic of Congo spread misinformation about the Ebola vaccine.

00:02:15.300 Terrorists in Pakistan do the same, preventing children from receiving the polio vaccine.

00:02:21.640 In my country, social media conspiracy groups confuse well-meaning parents so they hesitate to get the recommended vaccinations.

00:02:30.140 This misinformation has real impacts.

00:02:33.880 Consider the numbers that we have on measles.

00:02:36.200 The WHO estimates only 85% of eligible children received the first doses of the measles vaccine,

00:02:45.560 while only 67% received the second.

00:02:49.400 As of April 15th, the WHO reported more than 112,000 confirmed cases of measles across all regions.

00:02:57.520 In the U.S., we have seen more than 700 cases of measles just this year,

00:03:03.100 the highest number since the disease was declared eliminated from the United States in 2000.

00:03:09.340 But we can fight back, and you will find no government more committed than the United States

00:03:14.360 to combating these challenges and strengthening immunization programs around the world.

00:03:19.880 It is safe to say the U.S. supports in some way the national immunization programs of every low-income country

00:03:28.760 through a variety of mechanisms, and that work extends to a number of middle-income countries as well.

00:03:35.340 The U.S. Centers for Disease Control and Prevention provides technical support from its Atlanta headquarters,

00:03:41.140 our CDC offices overseas, and CDC employees embedded in WHO and UNICEF offices.

00:03:47.160 We provide technical and financial support for lab testing of vaccine-preventable diseases,

00:03:52.800 and CDC serves as a global specialized laboratory for polio and measles.

00:03:57.720 Through the National Institutes of Health, we generously support research on new vaccines for diseases such as Ebola and HIV.

00:04:05.280 We also provide financial support for vaccine provision through a number of channels,

00:04:09.400 including contributions to the Global Alliance for Vaccines and Immunization, or GAVI,

00:04:14.580 which I would like to emphasize is a highly successful public-private partnership.

00:04:20.540 Just recently, the U.S. supported a mass measles vaccination campaign in Nigeria that reached almost 10 million kids.

00:04:28.160 We assisted with the diphtheria outbreak among Rohingya refugees in Bangladesh.

00:04:33.840 We contributed to new research that found a one-fifth dose of yellow fever vaccine works as well as a full dose,

00:04:40.160 which is important in the event of a shortage.

00:04:41.860 At home, under my direction, the U.S. Department of Health and Human Services has ramped up nationwide education efforts

00:04:48.020 to increase vaccination rates.

00:04:50.540 Addressing vaccine-preventable disease has also been one of the top priorities of the U.S. response

00:04:55.960 to the crisis in South America caused by the former Maduro regime's destruction of the Venezuelan health care system,

00:05:03.640 which has allowed measles and other diseases to return to a region where they had been eliminated.

00:05:08.600 All sectors and all nations, large and small, have something to contribute in turning the tide against vaccine-preventable diseases.

00:05:16.180 I look forward to hearing from diverse perspectives today and to working with all of you in the years to come

00:05:21.040 to make real progress against preventable diseases.

00:05:23.840 Thank you for your attention today, and I look forward to our next speaker,

00:05:27.440 EU Commissioner for Health and Food Safety, Vitenius Andjukaitis.

00:05:31.740 Thank you.

00:05:32.740 Thank you.

00:05:33.320 Thank you.

00:05:33.700 Thank you, colleagues.

00:05:35.140 Director Katarina.

00:05:36.860 The success of vaccination is well documented.

00:05:39.980 It saves up to three million lives each year.

00:05:44.160 Big success.

00:05:45.220 It also offers important protection to the youngest and the oldest members of our society,

00:05:50.600 to those most vulnerable to illness.

00:05:53.280 It is a fundamental part of our public health systems.

00:05:56.800 But I am not here to highlight the vaccine success story.

00:06:02.640 Instead, I want to focus on what we as a public health community need to do better.

00:06:07.980 We have become the victims of our own success.

00:06:12.700 Vaccine works very well, but now we see a different picture.

00:06:17.080 As the incidence of vaccine-preventable diseases diminished in recent decades,

00:06:21.480 the perception of risk also decreased.

00:06:24.220 At the same time, citizens have become more concerned about possible side effects.

00:06:31.500 Doubts developed about the need to vaccinate.

00:06:34.700 And sometimes we reassure ourselves with the belief that we will get the appropriate treatment

00:06:40.480 if the diseases do occur.

00:06:43.100 Let me take measles as an example.

00:06:45.680 To be honest, I am not sure that many people truly understand how dangerous measles really is.

00:06:51.440 As a doctor, I have seen its impact at first hand, and we need to do more to prevent it.

00:06:58.820 In 2018, more than 12,000 cases of measles and 35 deaths are cured in the European Union.

00:07:08.300 It's very dangerous.

00:07:09.800 This is unacceptable to me, since an effective vaccine against measles has existed since the 1960s.

00:07:18.040 This disease should have been eliminated in the European Union by 2000,

00:07:23.660 according to the objectives established then by WHO.

00:07:27.300 Instead, only four countries in the EU achieve the necessary target of at least 95% coverage

00:07:35.080 for two doses that leads to herd immunity.

00:07:38.960 Moreover, WHO recently outlined alarming levels in measles in the European region,

00:07:45.240 taking into account EU and non-EU countries, identifying nine countries in the area as priority

00:07:51.780 and informed about their decision to scale up the response.

00:07:55.920 Situations in several of them affect directly the situation in Europe.

00:08:00.000 In this context, I will be awaiting with much interest today's intervention from Romania and Ukraine

00:08:05.520 to better understand the causes and the ways to improving the situation.

00:08:10.620 Individual decisions affect the whole population.

00:08:13.800 If you want to eliminate the disease, if you want to protect those who cannot be vaccinated,

00:08:19.340 that are too young, too old, or too sick, we all need to vaccinate ourselves.

00:08:24.340 So, how do we move forward from here?

00:08:28.320 Well, confidence in vaccine is absolutely crucial.

00:08:31.580 As European Commissioner for Health, I can't speak to this.

00:08:35.160 Currently, the EU is a region with the lowest confidence in the safety and effectiveness of vaccine.

00:08:42.660 This confidence is influenced by a number of factors,

00:08:46.020 including how important safe and effective citizens perceive vaccines to be,

00:08:51.020 but also how health professionals and national authorities transmit the information.

00:08:58.360 So, we urgently need to do more to reinforce the truth about both vaccines and diseases.

00:09:04.760 We recently conducted a survey across the European Union about attitudes and knowledge on vaccination.

00:09:11.260 Some of the results are worrying.

00:09:14.060 Let me give you a taste of the findings.

00:09:16.640 Forty-eight percent of European Union citizens believe vaccines can often produce serious side effects.

00:09:24.980 Thirty-eight percent believe vaccines can cause the diseases against which they protect.

00:09:31.820 Thirty-four do not see the need to be vaccinated.

00:09:35.400 And twenty-nine think vaccination is only necessary for children.

00:09:39.600 At the same time, the survey highlights where we need targeted actions, and it points to some solutions.

00:09:47.740 For example, it shows that citizens trust healthcare workers and health authorities to provide them with information and advice on vaccines.

00:09:56.880 So, we need to support health workers and empower them so that they can build on this trust.

00:10:03.740 They are the front line when it comes to vaccination.

00:10:06.840 The coalition of health workers for vaccination at EU level, which we recently established, recognizes this.

00:10:14.500 It looks to strengthen the engagement of healthcare professionals and aims to increase vaccine acceptance and counter vaccination myth.

00:10:23.420 The survey also shows that the majority of citizens have a positive attitude towards vaccination.

00:10:28.980 So, we need to reinforce these positive perceptions.

00:10:32.180 Colleagues, the ball is in our court.

00:10:35.400 And high-level side events like this want proof that the political will is there.

00:10:40.960 Now, we need to turn that political will into concrete actions.

00:10:45.200 Thank you.

00:10:47.240 Let me now introduce the Minister of Health from Brazil and welcome you, Dr. Mandetta, to give us some insights.

00:10:55.840 Well, thank you very much.

00:10:58.940 But I'm going to speak in Portuguese so that you can all have a taste from Brazil.

00:11:02.900 Thank you very much.

00:11:32.900 Thank you very much.

00:11:34.680 Thank you very much.

00:12:02.900 about vaccines. I start talking about my American colleague, Alex, who said that there

00:12:10.900 isn't any country more compromised than the United States. The Brazil is so or more compromised

00:12:16.900 than the United States. We already started a campaign, right at the beginning of this year,

00:12:23.900 due to this crisis without precedents, this Venezuelan diaspora, where more than 3

00:12:32.900 millions of Venezuelans from that country, with a health system that entered

00:12:37.900 in collapse, along with the other Venezuelan systems. And to enter in collapse,

00:12:44.900 rapidly, also by low vaccination rates, we had an epidemic of sarampo that entered

00:12:52.900 na divisa da Venezuela com o Brasil no estado de Roraima e rapidamente chegou

00:12:57.900 a Manaus, que é a capital do estado do Amazonas, uma cidade extremamente

00:13:02.900 populosa, onde nós tivemos quase 10 mil casos. Foi um esforço muito grande

00:13:07.900 para controlar esse surto em Manaus e, doravante, nós iniciamos não só uma

00:13:14.900 campanha de vacinação através do Ministério da Saúde do Brasil e do

00:13:18.900 nosso Programa Nacional de Imunização, mas nós instituímos um movimento nacional

00:13:23.900 pela vacinação. E esse movimento nacional, ele teve alguns momentos já de repercussão

00:13:33.900 nacional e internacional, quando numa parceria com a cidade do Rio de Janeiro, nós iluminamos

00:13:39.900 o Cristo Redentor, que é um dos nossos maiores cartões postais, com essa camiseta, que depois eu vou

00:13:46.900 presentear um de vocês, do nosso movimento pela vacina.

00:13:51.900 Nós estamos fazendo um enorme esforço, o Instituto Butantan de São Paulo já

00:13:56.900 trabalha na fase 4, esperamos que no próximo ano nós possamos apresentar a vacina

00:14:01.900 de proteção da dengue com dose única, com quase 86% de cobertura de proteção para

00:14:09.900 uma doença que aflige inúmeros países aqui presentes.

00:14:13.900 Na Fiocruz, no Rio de Janeiro, nós iniciamos a construção de um complexo industrial para

00:14:18.900 a produção de vacinas, porque nós percebemos uma diminuição de centros de produção de

00:14:24.900 vacinas imunobiológicos e deveremos trabalhar nos próximos anos procurando parceiros internacionais

00:14:31.900 para que nós possamos ter uma garantia de um padrão de qualidade em vacinas elevado e

00:14:36.900 segurança para que as pessoas possam, através da Fiocruz, ter a credibilidade suficiente para

00:14:44.900 que nós possamos fazer a mais moderna fábrica de produção de vacinas imunobiológicos das

00:14:50.900 Américas.

00:14:51.900 O Brasil trabalha fortemente e fomos também proponentes desse evento, talvez por imaginar

00:15:01.900 que na vacinação seja o nosso ponto de encontro de quando discutimos cobertura universal ou

00:15:08.900 sistemas universais.

00:15:09.900 A vacina tem que ser universal e a vacina tem que estar na agenda de todos os povos do

00:15:15.900 mundo.

00:15:16.900 Ela é um patrimônio.

00:15:18.900 Isso veio de Gênero, isso veio de Sabin, isso veio de Salck.

00:15:22.900 Isto não tem partido, não tem pátria.

00:15:25.900 Isso pertence às crianças do mundo.

00:15:28.900 Enquanto o mundo tiver crianças que precisam de vacinas, nós não podemos deixá-las à 0.80

00:15:34.900 mercê de especulações fantasiosas sobre vacinas.

00:15:39.900 Nós tivemos os pais dessa atual geração, não sabem o drama.

00:15:43.900 Talvez chamar os avós, chamar os cabeças brancas para que eles possam dar o testemunho

00:15:48.900 do que era o sarampo, do que foi a pole das milhares de vítimas que o mundo assistiu e

00:15:53.900 de tristezas que ocorreram. 0.99

00:15:55.900 Nós estamos juntos com todos vocês, juntos com os Estados Unidos, com a Comissão Europeia,

00:16:00.900 preparados para, juntos, liderarmos uma grande campanha mundial a favor da vacina, com

00:16:06.900 a credibilidade daqueles que podem falar sobre vacina, sendo verbalizado o mundo afora.

00:16:12.900 Essa é a posição do Brasil.

00:16:22.900 Muito obrigada.

00:16:23.900 Vamos continuar a dois tópicos de panel.

00:16:27.900 E o novo tópico é o desafio

00:16:30.540 Aqui é o tópico.

00:16:46.980 Nós possamos ter dois tópicos,

00:16:47.900 then algumas perguntas e hitsinose. 0.96

00:16:49.900 E então vamos ao do segundo tópico

00:16:53.900 first speaker is Dr. Peter Hotez, who I'm very honored to introduce from the Baylor College

00:17:00.700 of Medicine National School of Tropical Medicine. So, Dr. Hotez, please.

00:17:08.960 Thank you so much, Dr. O'Brien. I'd like to make a few remarks this afternoon in which I bring a

00:17:16.920 unique perspective to the vaccine confidence discussion. I'm a pediatrician scientist who

00:17:22.440 develops new vaccines for the poverty-related infections known as the neglected tropical

00:17:27.520 diseases, and I've had the good fortune to collaborate for decades with the World Health

00:17:31.980 Organization on both our vaccines and the global governance to control or eliminate these conditions

00:17:37.480 that literally affect more than a billion people in the world who live in poverty.

00:17:41.980 But with my wife, Anne, we're also the parent of four adult kids, including Rachel, who is now a 26-year-old

00:17:49.760 woman who has autism and significant intellectual disabilities. And the reason why being an autism 1.00

00:17:56.140 parent is relevant is that a major basis for vaccine hesitancy in both North America and Europe and now

00:18:02.760 moving globally is the false assertion that vaccines cause autism. And in response to that, I've written

00:18:09.740 a new book called Vaccines Did Not Cause Rachel's Autism, which, as you can imagine, is putting me in the

00:18:16.460 witness protection program. But it tells a personal story about Rachel's life and challenges finding

00:18:23.380 employment and mental health counseling. But also, it's a book that does a deep dive into the science

00:18:28.480 of both vaccines and autism. It details studies on over one million children, reporting how children

00:18:34.760 who receive their vaccines are no more likely to become autistic than children who are not vaccinated.

00:18:40.120 Conversely, it also summarizes the evidence showing that children on the autism spectrum are no more likely

00:18:46.240 to have been vaccinated than children not on the spectrum. It goes step by step, refuting each of the major

00:18:53.040 false claims, showing that MMR vaccine does not cause autism, as was first alleged in 1998. Then showing how

00:19:01.620 thimerosal preservative, now removed from many vaccines, also does not cause autism. Nor does spacing vaccines

00:19:09.000 close together cause autism, nor does aluminum adjuvants in vaccines cause autism. So we're in this

00:19:15.860 kind of parrot game of global health whack-a-mole where we knock one down and another one pops up. And

00:19:21.160 each time, the scientific community responds. I also go into depth explaining how autism occurs through the

00:19:27.820 action of more than 100 autism genes expressed in early fetal development, and how through whole exome

00:19:33.780 sequencing, we've now identified one of those genes in Rachel, encoding part of the neuronal

00:19:38.520 cytoskeleton, and neuronal connections. The point being that autism begins in early pregnancy well

00:19:44.700 before a child ever receives a vaccine. And then I go on to debunk other false claims made about autism

00:19:50.680 and refute statements that vaccines cause teenage depression and suicide or autoimmune disease,

00:19:56.380 other toxic ingredients in vaccines. As you might imagine, the book and subsequent media interviews have

00:20:02.140 put me and my family on the front lines of the vaccine hesitancy discussion, and have caused me to

00:20:07.300 sometimes have difficult discussions, even a few public confrontations with individuals who passionately

00:20:12.880 believe that vaccines injure children, or even that autism itself is nothing more than a form of vaccine

00:20:18.520 injury. So what do I say to worried parents? My major points include the simple truth that vaccine represent one of

00:20:25.360 humankind's greatest achievements, responsible for the eradication of smallpox, the near elimination of polio and

00:20:31.820 dramatic declines of deaths from measles and other killer childhood infections. I write and speak

00:20:37.400 about how as a pediatric house officer on the Children's Service of the Massachusetts General Hospital during

00:20:43.040 the late 1980s, I went from taking care of a terrible ill or permanently impaired child from

00:20:49.060 haemophilus influenzae type B meningitis on a weekly or monthly basis, to personally watching this disease

00:20:55.000 disappear from America, so that today we mostly talk about hib meningitis purely for historic interest.

00:21:01.580 I also point out, however, that our public health victories achieved through vaccination

00:21:05.480 are fragile, so that vaccine preventable diseases can return if vaccine rates decline. We've already heard

00:21:11.840 this to be true of measles, because the measles virus is so highly contagious, particularly for infants

00:21:18.100 under the age of 12 months, not yet old enough to be vaccinated. In 2017, I wrote in the New York Times

00:21:24.180 how measles could return to Texas and other states, where we've had a steep rise in parents accepting their kids

00:21:29.800 from vaccination. Then in 2018, in the Public Library of Science, we identified 15 urban

00:21:35.560 hotspots where kindergartners are not being vaccinated. So far in 2019, measles has returned to seven of those 15 sites.

00:21:43.720 Today in the United States and Europe, there is no reason why measles or other vaccine

00:21:48.120 preventable diseases should be allowed to return, and I know the leadership of the Department of Health and Human

00:21:53.500 Services, and CDC feels the same, and look forward to working together with them on this front.

00:21:59.080 Ultimately, we need to reinforce the message of vaccine safety, and remind parents there's a lot

00:22:04.040 of misinformation out there. They dominate the internet, at least 480 misinformation websites,

00:22:11.500 to be exact, 480 misinformation websites, all amplified on social media, as well as e-commerce

00:22:18.620 platforms that promote dozens of fake books alleging phony autism links, and other false assertions.

00:22:25.980 I love coming to the World Health Assembly. Here I meet my public health heroes, like the ones that you

00:22:30.820 see in front of you today, committed to vaccinating the world's children, ensuring the safety of our

00:22:36.040 global vaccine supply. Right now in 2019, vaccine hesitancy is a looming issue, and one that could

00:22:42.020 threaten the extraordinary progress since GAVI, WHO, UNICEF, and DHHS federal agencies recommitted to vaccines

00:22:49.840 almost two decades ago. But I have great confidence in our leadership to ensure that this will not happen,

00:22:55.560 will ultimately achieve important disease elimination targets in the coming years. Thank you again for this

00:23:01.380 opportunity. Thank you, Peter. Let me now turn over to Professor Dr. Ruffila from Romania.

00:23:16.860 Thank you very much. I want to congratulate you for being a sponsor, second sponsor of this event.

00:23:25.120 But I change a little my mind, because at the beginning I want to have a more technical presentation,

00:23:34.220 but now I see the opportunity to change it a little in a more political one, because 10 days ago we

00:23:47.360 organized in Romania and dedicated a dedicated workshop on immunization. Residency was the purpose of this

00:23:54.060 workshop, and we had some very interesting conclusions at the end of this workshop,

00:24:01.000 organized during the Romanian presidency at the European Union Council. I will start a little with

00:24:08.900 the situation in Romania regarding missiles, because we are facing an epidemics since the beginning of

00:24:15.140 2016. And we already have more than 16,000 cases. And what is very difficult to accept in these days,

00:24:26.580 it's more than 60 persons died. And some figures I want to present to you, and I think it's one of the

00:24:37.460 best evidence that immunization, it's the response to prevent missiles, is that 95% of the person who were

00:24:52.000 infected were not vaccinated. And only 1.2% of this person were vaccinated with the complete regimen of

00:25:01.560 two doses of missiles. So it's a very, very clear conclusion that vaccination is that one which will

00:25:09.560 stop epidemics. And another thing, which is also very unpleasant, very dangerous, is that most effective

00:25:21.140 were children below one year of age, which are not vaccinated because they didn't have the age. But

00:25:27.840 the incidence in this case was when the peak of the epidemics was 900 to 100,000 inhabitants from this

00:25:39.780 group. So we discussed about exposure of children to this illness. And subsequently, we had this number of

00:25:54.600 measures. And now I will turn a little to these conclusions we had about after the end of this

00:26:04.300 meeting. And the idea is that recognizing that vaccination is a cost-effective public health

00:26:10.580 intervention, reinforces the wisdom of prioritizing investment immunization program by national

00:26:18.360 governments and international governments and international organizations. The second, it's very

00:26:24.120 important, it's this political commitment to immunization. It's the key to realize its full potential to

00:26:31.860 protect health and fulfill its crucial role in helping to achieve 14th of the 70 sustainable development

00:26:39.660 goals, thereby reflecting the ethos of HGGs of leaving no one behind. And the ongoing missiles outbreaks and 0.75

00:26:51.180 associated deaths are a serious concern and indicate the presence of packets of suboptimal vaccination.

00:26:58.360 How to address this? Maybe an approach, a community-based approach is the answer. And also,

00:27:04.700 another proposal is that we should develop dedicated training programs about vaccine and vaccination

00:27:13.300 to healthcare providers and students from medical university in Europe and everywhere, because

00:27:23.200 the trust in health system, the trust in healthcare providers, it's essential in many countries, and this is

00:27:30.740 the way in which we can increase confidence. And there is something else we discussed there. It's not in

00:27:38.340 this conclusion, but it will already discuss. In my opinion, my personal opinion, it's where you should

00:27:43.920 address it. Developing programs, education programs for vaccination of adults will improve coverage of

00:27:50.980 vaccination in children, because vaccination is something which should benefit everyone during his whole life.

00:27:58.560 And if we will succeed to educate adults regarding vaccination, for sure, the impact on vaccination

00:28:06.160 of the coverage of vaccination of children will be, of course, very much improved. Anyway, multilateral

00:28:15.520 collaboration between countries should be further enhanced in sharing back practices on implementation of

00:28:21.660 national vaccination plans program. And of course, the support of international organization and agency

00:28:29.260 is essential. And I want to thanks to WHO original office for Europe and also to European Center for Disease Control

00:28:38.380 in helping Romania to finish with this epidemic. Thank you very much. 1.00

00:28:45.260 I do want to ask the Director General of Public Health from the Ministry of Health in Ukraine,

00:28:55.500 who's here, to say a few words about the current situations with measles outbreaks and actions being

00:29:03.900 taken to increase vaccination rates. Thank you.

00:29:06.860 Madam Chair, ladies and gentlemen, there is a huge measles outbreak in Ukraine. Over 100,000 cases have been

00:29:16.460 reported since the summer of 2017, over 40 percent of which have been adults. 38 people died. This is the

00:29:24.380 result of years of anti-vaccination propaganda, disinformation and lack of efforts by the previous

00:29:30.460 administration to dispel these myths and fakes. In 2014, 2016, a lack of supply due to difficulties in

00:29:38.620 procurement and delivery of vaccines because of external aggression against my country took its toll as

00:29:44.860 well. At the moment, we are able to procure enough vaccine easy for routine vaccine immunization and catch up

00:29:52.540 campaign for those children that skipped immunization in the past. But we have found another challenge that

00:29:59.420 some parents had purchased fake vaccine certificate. And in one region alone, medical records showed we

00:30:09.020 needed to vaccinate additionally 21,000 children. But review of true certificates revealed that the number

00:30:16.940 was closer to 50,000. Our analysis of vaccine refusal has shown that parents may well support vaccination,

00:30:25.580 but often the grandparents are the ones taking the kids to the physician. And we have now started

00:30:32.540 information campaign targeting grandparents and the caregiver population. In addition, we found the

00:30:39.420 large adult population that had been vaccinated in the 90s and early 2000s, but did not develop immunity.

00:30:48.140 We have been told by WHO immunization experts that this is likely due to poor quality of vaccines

00:30:54.940 procured at that time, combined with the problems with the cold chain. We would appreciate advice on how

00:31:01.020 to solve these problems as this is approximately 15 million additional vaccinations necessary. Ukraine has

00:31:08.540 been also facing the challenges with collecting information on vaccination coverage at the temporary

00:31:14.700 occupied territories. The lack of information formed their new myths and disinformation and required joint

00:31:21.500 efforts through effective health cluster led by WHO. Social media becomes the new source of information

00:31:29.820 where parents looking for answer and solution even more often than asking their physician. At the same time,

00:31:37.900 unfortunately, this is also a place where fake news and misinformation can be shared easily and widely.

00:31:44.780 We call to jointly find the solution to this new challenge. And finally, we would like to thank

00:31:50.380 to WHO UNICEF, the CDC Global Immunization Team for their help and assistance. And we would like to

00:31:57.660 reconfirm Ukraine's commitment to the Global Vaccine Action Plan and its further

00:32:02.780 elaboration. Thank you. Thank you.

00:32:09.820 So, the first question I'd like to ask is to you, Secretary Azar. In light of the recent measles outbreak in the United States,

00:32:18.380 can you tell us about domestic measures that are really critical to take in the near term

00:32:25.500 and what needs to happen over the longer term to reduce the likelihood of having these outbreaks again?

00:32:34.780 So, it's just heartbreaking to see a resurgence of measles in the United States. It's a disease that

00:32:40.220 had been effectively eliminated from our country. And it's reemerged with at least 839 cases in 23 states.

00:32:49.580 Measles is a preventable but highly contagious disease. And the best way to prevent measles is

00:32:54.860 with a safe and effective vaccine, which we have. So, what are we doing to increase and to take action and

00:33:03.340 increase awareness? First is close collaboration with all sectors. So, we are reaching out and working

00:33:09.660 with state and local health departments, with health care providers, very importantly religious

00:33:14.940 leaders, because some of the misinformation is actually coming through religious leaders.

00:33:20.300 And other stakeholders, such as social media companies and search engines, as they try to

00:33:25.580 prioritize accurate science-based information rather than misleading disinformation. We've also taken

00:33:33.340 advantage recently of National Infant Immunization Week, where we sent all of our top officials on TV

00:33:39.980 around the country, making it clear that it is the scientific expert opinion in the United States that

00:33:46.300 these vaccines are safe and that individuals should talk to their physicians about getting themselves or

00:33:51.260 their children or their grandchildren vaccinated. Part of that is leveraging parents and encouraging that

00:33:57.900 physician discussion. Talk to your physician. Talk to your physician. If you have a loved one,

00:34:03.820 the role of grandparents can be vitally important here. Grandparents who actually might remember

00:34:09.580 measles and people dying of measles and other infectious disease. Parents may not, but grandparents may

00:34:15.980 intervene. And we've just got increased risks about importing measles, and so we're ensuring that

00:34:21.180 people understand the risks of travel into areas that might expose one to measles and the need

00:34:26.540 perhaps to get a booster shot if you're going into an area. Ensure your immunizations

00:34:31.020 are up to date before doing that. So thank you.

00:34:35.980 So thanks for the sort of description around the actions that people can take. But I'd like to turn to

00:34:44.620 you now, and Commissioner, ask you maybe about something a little bit different, which is how you think the

00:34:50.460 quality of services and the training of frontline health workers and the availability of vaccines,

00:34:57.180 so more the supply side impacts on exactly what we were hearing about in the US on the demand side.

00:35:07.580 Are there some solutions that you'd like to highlight on that sort of more supply side end?

00:35:12.780 Thank you. Your question shows that we are facing very complex issue, multi-phased,

00:35:20.780 and because it includes supply, knowledge, access, and fear. Fear, you know, you can see a lot of

00:35:29.580 people who have fear about vaccination. You know, I think the recent Eurobarometer survey

00:35:35.580 highlights some important areas that require focus. A large majority of two citizens, 79 percent

00:35:44.220 call and trust health care professionals to get information about vaccination. And health care

00:35:50.140 professionals play a crucial role, no doubt. And of course, we need to strengthen the expertise,

00:35:58.220 training and engagement of health care workers. And of course, we need to help them to be prepared.

00:36:10.940 In many of the areas we serve, survey, perception of diseases, perceived effectiveness of vaccines,

00:36:32.060 reasons for getting vaccinated, knowledge about vaccination, the efforts of vaccines, health workers

00:36:39.180 play a crucial role. And of course, I think that now it is very important to educate health care

00:36:46.380 practitioners on the everyday basis. For a simple example, if you ask a patient, today we are going

00:36:52.700 to be vaccinating your child. Is it more effective than how do you feel about vaccination? Simple

00:37:00.940 question. How do you feel about vaccination? Absolutely different approach. But of course,

00:37:04.940 if we are more friendly and showing that we are ready to help your children to be vaccinated, it's a

00:37:12.220 little bit different. This seems like a subtle difference between simple exchanges like this can

00:37:19.580 have a significant impact on vaccine uptake. We are also taking more practical steps. The European

00:37:26.700 Center for Disease Control has produced communication guides and toolkits to help professional change

00:37:34.380 change behavior. And of course, our coalition of health care workers to help us once again to

00:37:41.660 encourage our health care practitioners to stay together and to build a network of practitioners

00:37:47.820 helping us address those issues. Of course, it will be good to listen to the audience of your

00:37:54.860 experiences on these very complex questions. Thank you.

00:37:57.820 So in order to have more time at the end for more discussion, I'm going to move on to the second

00:38:04.940 panel. And the topic here is the state of the globe, the role of misinformation and revitalizing

00:38:12.380 information and education on vaccines and vaccine confidence. So let me first introduce Dr.

00:38:19.180 Theresa Tam, the Chief Public Health Officer of Canada. Theresa.

00:38:22.540 Thank you very much, Kate. And I'd like to thank the US, the European Union and Brazil for

00:38:31.100 putting this panel together. And I certainly share concerns with the other panelists on the

00:38:37.260 reemergence of vaccine preventable diseases and the need to promote vaccine confidence. In Canada,

00:38:44.460 we have less than, you know, less than optimal vaccine coverage, but the coverage is pretty high

00:38:50.220 still. Only about 1.3% of parents have never had their kids vaccinated. So we know that there's a

00:38:56.780 quite a large and vast majority of parents who believe in vaccination. So we're looking at pockets

00:39:02.860 of under-vaccination. As we all know, you've all got your cell phones and all of us look online for

00:39:09.660 information when we need to know about something. But the problem is sifting through mountains of

00:39:16.220 information and not knowing where that information comes from. And seeds of doubt can be sown very

00:39:22.780 rapidly by these sources. And so what we know is that online information can have very significant

00:39:32.220 real-life impacts and consequences, some of which you have heard. And it's not just a domestic issue,

00:39:38.220 but it reverberates globally. And something said in Canada can result in a negative impact in another

00:39:44.860 country, for example. So as the Chief Public Health Officer of Canada, I actually made vaccine

00:39:50.860 hesitancy a priority. And just recently, I saw an opportunity to really escalate this issue because we

00:39:58.300 had a cluster, which was actually very tiny. So it was like 14 cases in British Columbia. That was enough to

00:40:04.860 ignite significant public discourse and journalists' interests. So I took that opportunity to just call

00:40:13.020 all the social media platforms because, well, if not now, when? So I sort of picked up the phone and

00:40:18.620 called Twitter and Facebook and Google and that type of all of these companies. We also did an analysis

00:40:28.700 just on the Twitter platform to show what's actually going on. So what we found is that,

00:40:35.020 as many of you might have also seen, a very small number of individuals actually do every day,

00:40:41.180 every minute is spreading misinformation in a massive way. So on the map, you see all these lines

00:40:46.860 going over the place. It's just a few people. The public health agency and maybe other public health

00:40:52.380 organizations have a tiny footprint. We're not connected. We're not spreading things around

00:40:58.300 very well at all. And there are bots at play. So bots are retweeting things blindly, essentially,

00:41:05.180 and spreading information. So that's our situation when we looked at it. And so I called together this

00:41:14.060 social media group. But at the same table, our parents who've had lived experience with vaccine

00:41:20.060 preventable diseases or have changed their minds about vaccination over time, I invited parenting

00:41:25.660 experts who are parent influencers, educators and, you know, obviously experts, but also journalists,

00:41:33.180 to have a really good discussion, well, what can we do? And so, but the first thing was that we

00:41:39.700 recognize with have a common goal, which is the health and well-being of children. Everyone has the

00:41:44.700 same goal. And trust is the underlying issue. And so, in order to rebuild trust between parents,

00:41:51.180 individuals and their health care providers, we need to build the environments where parents actually

00:41:57.420 feel that they're heard and that their questions are going to be addressed. And the panel that I pulled

00:42:02.460 together highlighted new forms of online media engagement. We need to up our game, basically, as public

00:42:09.100 health people and get engaged in more novel ways. And science literacy, science and digital literacy.

00:42:15.820 So digital literacy begins by realizing that the information online is created by someone with an

00:42:21.980 agenda, someone with an objective. You need to know who made it and why they made it. So some of these

00:42:28.300 fundamental questions need to be taught to kids at school or to parents or grandparents who didn't grow up in

00:42:35.820 this internet age. So we are working with Twitter on an initiative that will have users presented with

00:42:43.500 accurate information on vaccines if the user searches certain hashtags, such as vaccination or anti-vaccine

00:42:50.220 or those kind of things. Then the public health agencies website pop up. I know that they've done

00:42:55.420 similar initiatives with other entities as well. We've also had a discussion with Facebook on how we can

00:43:01.420 collaborate on removing information that has been scientifically disproven or debunked. So Facebook is

00:43:08.140 currently working with the WHO, with the US CDC, and essentially trying to work with us. So they'll need

00:43:16.780 some experts to actually say, is this misinformation? If it's scientifically proven to be misinformation,

00:43:24.620 there's an opportunity for them to actually remove that information. And we're also working with Google and others.

00:43:29.820 And so I think that a lot of people criticize social media companies for not doing enough. But I think

00:43:36.540 that we're all trying to figure out what more we can do together. So another thing that I thought about

00:43:43.180 is a coalition of public health partners so that we can retweet and re-read forward our collective

00:43:52.220 information in the same way that the anti-vaccination group has been doing. And this could be an

00:43:59.660 international collaboration as well. We need to collaborate across government departments

00:44:04.380 because there are other government departments sort of interested in impacts on the elections,

00:44:10.060 impacts on combating extremism, for example. And we can't all go to these social media platforms,

00:44:16.780 left, right, and center. We need to have a more cohesive approach.

00:44:20.380 And so the government of Canada invested $25 million just recently to increase vaccination

00:44:26.940 coverage rates. And we set up this fund called the Immunization Partnership Fund. And in order to

00:44:32.940 identify the pockets of under immunization, in order to have much more targeted interventions,

00:44:39.100 because we realize that in the Canadian context, at least, these small pockets are all very different.

00:44:44.620 Some of them are religious communities that need their questions answered in a certain way. Some of

00:44:50.140 them are schools with parents who believe in a certain perspective. And so another project that I

00:44:58.060 thought was interesting to just highlight finally is a project called Kids Boost or Kids Boost Immunity.

00:45:04.700 Started in BC. It's a school-based online platform that uses gamification, so turn it into something fun,

00:45:12.220 for learning to raise student literacy around the importance of vaccines. And the winnings,

00:45:17.660 the winnings that they get leads to vaccines being donated to UNICEF. And this has really caught on.

00:45:23.820 So as of September 2018, nearly 2,300 students earned over 21,000 vaccines for UNICEF. So there's

00:45:33.340 lots of different innovative ideas that we're hearing. And maybe the key is to sort of collaborate on lessons

00:45:40.140 learn, and maybe some of the innovative ideas. Thank you.

00:45:43.260 Thanks, Dr. Tam.

00:45:50.780 I'm going to zoom down now to the other end of the table. Welcome Dr. Seth Berkley to the panel,

00:45:58.300 who's the CEO of GAVI, as you all know. And Seth, I wonder if you could speak a bit about,

00:46:05.660 again, sort of moving on to the more the system side, the building of strong health systems. And

00:46:12.540 especially as that relates to access and high quality services, particularly in fragile settings

00:46:20.300 or conflict settings, some of the most difficult to reach. And this sort of link between the service

00:46:28.700 delivery and demand.

00:46:33.420 So thanks so much, Kate. And let me add my thanks to the groups that organized this. This is a very

00:46:39.500 important topic. And let me apologize for being a few minutes late due to a competing priority.

00:46:45.260 I will get to your question, but let me just start. First of all, I heard since I've come in

00:46:50.140 that increasingly people are using safety concerns or side effects as a base for vaccine hesitancy.

00:46:58.300 And frankly, you know, there is a scientific consensus, a very strong one about the safety

00:47:04.140 of vaccines. And we need to make sure that we can keep coming back to that. Now, the work we do at

00:47:10.220 GAVI is focused in the developing world. And we didn't used to have a lot of problems with vaccine

00:47:16.860 hesitancy because frankly, people saw the diseases every day. People saw people dying in their family,

00:47:23.420 in the community. They saw the side effects. Of course, now with the incredible success

00:47:29.020 in vaccination, they're beginning to see less disease. And so in a sense, the disease that we're

00:47:34.700 talking about here can spread to them as well. And we have to think of it as a disease. This is a

00:47:39.900 disease. The secretary has already talked about how measles is so infectious. This spreads at the speed

00:47:45.580 of light, literally. We've talked a lot about how this happens. So, you know, starting there as a

00:47:51.900 critical issue when we've seen the effects on the world. Second point is that, you know, the pro-vaccine

00:47:59.260 voices that exist in social media, the excellent work that Canada has just talked about, the challenge

00:48:04.860 is that they are being drowned out on social and digital platforms by the high visibility and

00:48:10.860 engagement of the anti-vaccine community. And the point here is that, you know, this is not about

00:48:18.700 each country having their own work. This is about this spreading globally. And so we have to keep in

00:48:25.100 mind even more than infectious diseases. And of course, there are no barrier to infectious agents.

00:48:29.820 There are no barriers to this information. And so, you know, the algorithms are favoring

00:48:35.260 sensational content over scientific facts. We're seeing this from, you know, from India to Kenya to

00:48:41.500 Nigeria. We're seeing this happen. And it's not just in the standard social media platforms. So we,

00:48:47.420 like others, have reached out to the platforms. But, you know, WhatsApp, for example, which is a private

00:48:52.380 messaging platform, not the standard social media platform, tends to be the tool that is used to

00:48:58.140 spread this information. Now, there are solutions to that. And as we've talked to companies, there's all

00:49:04.300 kinds of cool new technology. We just heard the other day about one called CrowdTangle,

00:49:09.180 which allows social media companies to begin to look at where rumors come from, trace the source

00:49:14.940 of them and understand them. But to do that, we have to have the ability to test and have trusted

00:49:20.220 people on the ground to say to us in these closed systems, what are they hearing? I must say, I'm worried

00:49:26.300 about how we have continued people. I mean, it's more than 20 years since Andrew Wakefield was discredited in

00:49:32.700 the UK. You know, he was a great export to the US. He set up shop in the US and he's continued. And

00:49:38.860 we've seen now actual outbreaks that have been linked to his advocacy. Those outbreaks have not

00:49:44.300 only been in Minnesota where he advocated against measles, but those spread to Sweden. And we think

00:49:50.780 also to Somalia, although we don't have the data to be able to do that. So this is a real challenge.

00:49:57.020 The challenge for me is misinformation is the toolbox. And there's now commercial drivers

00:50:03.340 of misinformation. You make money through the clicks towards that misinformation. And also,

00:50:08.540 this is the really scary one. There's a political side now. You can destable governments by having

00:50:15.340 both positive and negative information, which means that you confuse the population on, you know,

00:50:22.380 can we trust our governments or not? And that is now happening. And it's being accelerated by machine

00:50:27.740 loading, AI, etc. So now, to get to the point that Kate asked me, you know, our role in the developing

00:50:34.540 world is to strengthen demand in general, and to think about how we can build more capacity for

00:50:41.500 local leadership. Because at the end, it's local leadership that will fight back against this epidemic.

00:50:47.180 But we also need to try to stop the epidemic. Otherwise, you're not doing your job as a

00:50:52.700 as a good epidemiologist getting rid of the problem. So we need we need both. And to Kate's point,

00:50:58.300 one of the critical issue here is to build strong health systems that allow all the way down to the

00:51:04.780 frontline worker, whether that's a community health worker, whether that's working with village leaders,

00:51:09.820 religious leaders, being able to have the correct information so that when these campaigns start,

00:51:15.660 you have an ability to reverse them early, and to have that type of trust be able to be done.

00:51:23.660 You know, for me, one other point I'd say is that we've talked a lot on the panel about social media.

00:51:29.500 We've talked a lot about trying to stop the bad messages. The issue is going to be not only trying

00:51:34.940 to stop those bad messages, but to have positive messages. And it can't just be governments,

00:51:40.460 because some places governments aren't trusted. So how is civil society? How are societal leaders?

00:51:45.980 How can we get a drumbeat of positive information that is there and not drowned out by the vaccine

00:51:53.900 misinformation that's so critical? So in my discussions with social media leaders, that's my request.

00:52:01.340 And to be quite specific, is to go ahead and try to stop the misinformation, take it off the air.

00:52:08.460 I remind people that this kills people. It's like other misinformation. This actually has a real cost.

00:52:14.780 It's not a freedom of speech issue. This is wrong information that's killing people. And then,

00:52:19.180 how can they help us be part of the solution and not just part of the problem? But to Kate's point,

00:52:25.020 that has to extend all the way down to the health system. There has to be quality. People have to trust

00:52:30.700 that system. And if they don't do that, that will also flame the fires that are currently going on. Thank you.

00:52:39.260 Thanks, Seth. That really touched on a lot of the sort of key issues that I think we're all

00:52:43.420 struggling with. And new actions that need to really be sort of brought on board so that we

00:52:52.220 connect up and are limiting the misinformation that's out there. A couple questions for the panel,

00:52:58.540 and then I'm going to open it up to the floor. So get your questions ready. And I'll ask the panelists to

00:53:03.660 try to keep your answers as brief as possible so that we can get to the floor. So first for you,

00:53:12.380 Dr. Tam, a number of vaccines, a number of vaccine-preventable diseases, we clearly have

00:53:19.580 the technical tools to be able to either deeply control, eliminate, or eradicate the pathogen. But

00:53:29.580 the issues that limit the greatest impact are not really technical. They're, as we've been discussing,

00:53:35.980 social, political, financial, managerial. So can you think of how we could strike, how we could ignite a

00:53:44.940 stronger social movement around vaccines that could be sparked and a way to root vaccination

00:53:52.940 as a stronger social norm, especially in the generation that will be parents in the years to

00:54:01.260 come? Perhaps that's where we should be focusing more of our attention. Thank you for this question. I

00:54:07.740 think getting behavioral insights is an extremely important aspect of public health because we have

00:54:17.500 to try and get populations to change their behavior. That's what public health does. And so I don't think

00:54:23.020 we've been leveraging behavioral science and analytics in order to address some of those fundamental issues,

00:54:30.220 which is, as you say, not biomedical, but people's beliefs or interpretation and distrust. So I think

00:54:41.260 one thing that people have already touched on is that it is a social norm in many countries and that

00:54:47.100 over 90 percent of parents in many of our countries do believe in vaccines. So I think we need to leverage

00:54:53.340 that 90 percent and give them a voice so that the small number of people who's trying to

00:54:58.940 say there is a debate when there is no debate. It's a tiny group of people shouting really loudly,

00:55:05.100 whereas the rest of the population is actually on board. So telling, making sure that is realized,

00:55:10.860 it is a social norm. People do get vaccinated is very important. I do think that people, as I said,

00:55:17.740 the Canadian public may not listen to me, but they'll listen to parent influences. So we're trying to leverage

00:55:22.940 those people. And in our last National Immunization Awareness Week, we actually did that and that

00:55:28.540 really worked. Our messages got out through those channels much better. And also, I think,

00:55:35.020 youth influences. We've seen some youth questioning why they didn't get vaccinated when they were younger.

00:55:40.540 It's beginning to dig out information as well. I talked about, you can't start too early. So the

00:55:46.940 program that we talked about, education at schools, I think it's really important and start really

00:55:53.180 early. I also am quite concerned about the medical professions or the healthcare professions and then

00:55:59.660 all the other allied health professionals not actually that well educated because they haven't

00:56:05.180 seen the diseases themselves. So whether you're a chiropractor or someone else, you've got to get

00:56:12.140 trained in vaccines and vaccine-preventable diseases. I think one thing that the social

00:56:19.180 media platform said to me was, you've got to get into the trenches of Twitter and start responding

00:56:25.180 and start getting engaged so that people feel that there's a person behind that government voice

00:56:31.580 and begin to get engaged much more on a personal, emotional level. Because people don't understand

00:56:38.140 statistics and data. Like, if you start doing that, you've lost them. So I think, but the bottom

00:56:43.580 line is to listen. Because to engender trust, and this is behavioral science, is that you need two

00:56:49.900 things. Competence, so you need knowledge, and care. So that, so we actually have also supported

00:56:57.580 program on motivational interviewing. I think some of you might be familiar with it. And we're

00:57:03.900 doing a program in Quebec right now where this motivational interviewing is being done in maternity

00:57:10.460 wards, where the mom isn't getting their kid vaccinating that day. That's too late. You get

00:57:16.300 pregnant mothers delivering babies, undergoing the motivational interviewing. And that nudges them 0.68

00:57:23.100 to get their first vaccine on time and then further along. So these are just some ideas.

00:57:27.900 Thanks, Teresa. Can I, next question is for Minister Mandetta. Teresa really talked about

00:57:40.140 this, this complex local social environment. And so just turning to a different direction, which is,

00:57:48.380 is there a way, how can we effectively influence political and social leaders to commit more to sort of

00:57:56.380 bold, galvanizing, world-changing moonshots? Whether they're elimination or eradication,

00:58:04.140 or even just an agreement on some, some true commitment and, and authentic commitment to the

00:58:13.740 control goals. Are those the sorts of cross-national goals that just are not possible anymore? Or do you

00:58:19.820 think that's still out there?

00:58:20.860 Yeah, they're still out there. And I think that this has been said here by our colleagues, Berkeley

00:58:28.060 and, uh, and others, but maybe working with a minimum, uh,

00:58:37.660 number of vaccines that could be obligatory for people to travel, for people to take their passports.

00:58:45.500 I have here three congressmen from Brazil in this room, and I'm asking them to run some laws for our

00:58:53.900 kids to go to school. And how are we going to deal with that? The individual right versus the

00:59:02.700 public right. How to deal with, uh, all those fake news and this internet. Is this, uh,

00:59:13.020 something harmless? Is it something that they do, they do just to express their opinion?

00:59:19.580 Or is this like a kind of biological terrorism that has been done because it causes death to people?

00:59:27.820 This is something that all congress in the world should make their discussions and try to find ways.

00:59:35.660 We should have it a mobile. We cannot, maybe we could do this mobile so that people all around the

00:59:43.660 world would have their records on vaccines and they could travel. Because on paper, this is something

00:59:51.580 that it's, it's almost impossible for someone to find it and to show it and to keep it with them. So I

00:59:59.180 think that this has got to be done by a campaign, uh, in the way that people said here with elders

01:00:05.980 telling what happened. I have friends of mine. I was born in 1964. I have friends that had polio.

01:00:12.220 They are there with their, their, their, uh, all the troubles that polio brings for a kid and for an

01:00:21.500 adult. And I think that they are the ones that have to say, and maybe the World Health Organization

01:00:27.900 should be the one to hold the campaign because it has this world abroad, uh, performing to talk about

01:00:35.020 it. Comments. One is we've talked about health. You know, this is not a health problem. This in a

01:00:43.100 sense is a whole of government problem because we need to engage the local telecommunication

01:00:48.620 ministries. We need to think about defense. If it turns out that there is, you know, trying to create

01:00:53.900 instability, home ministries, local government ministries, communications, et cetera. So I think

01:00:59.820 it's important to not just pigeonhole this now as a, as a problem. And, and the counter wise of that,

01:01:07.020 I, I want to say that what we need is a movement that in a sense goes almost beyond immunization.

01:01:12.540 It's linking immunization to being a good parent. It's having people understand that value. And the

01:01:18.100 reason I say that, it's very interesting. We work with private sector partners and one of our private

01:01:22.440 sector partners is a, you know, large company. I can say a Unilever who's, you know, working on,

01:01:28.040 on selling things around the world. And when they began to test things as they do, because they

01:01:33.640 have very good marketing systems, that traditional things weren't as valuable as having parents feel

01:01:40.900 pride that they are doing the right thing for their children. And I think that's the type of proactive

01:01:47.520 campaigns we can do to make it a societal norm that in fact, if you're not immunizing your parents,

01:01:53.320 you're a bad parent. I mean, your children, you're a bad parent. And if you are, you're doing

01:01:57.900 something that protects them for life, that builds their, you know, ability to contribute,

01:02:03.260 et cetera. So I think there's a lot that we could do with that in terms of trying to make this a

01:02:07.720 social movement. I don't disagree with your slip of the tongue, which was maybe you're also a bad

01:02:13.420 parent if you're not immunizing your parents. But yes. Peter, please. And then we have one more hand.

01:02:20.300 We probably have time for two more questions. So one and two. Thank you. Thank you. Thank you. This has

01:02:25.240 been a great discussion. And one of the other challenges and big ideas that we have to think

01:02:29.720 about, in my remarks, I focused a lot on the measles vaccine and declining rates in the U.S. and

01:02:35.960 the anti-vaccine movement. But the anti-vaccine movement, now I see, now being out there in front

01:02:43.100 defending vaccines is drawing a new line in the sand. And the new line is around the introduction of

01:02:48.820 new vaccines. That seems to be the next big battleground that I'm seeing. We're already seeing

01:02:54.880 with targeted aggression towards the HPV vaccine. We're seeing, you know, terrible uptake rates in

01:03:02.480 parts of the United States where only half of teenage girls are getting vaccinated. We're condemning

01:03:08.420 a generation of women to cervical cancer. I think we're going to start to see it now. I'm seeing a lot

01:03:14.420 about the malaria vaccine now being introduced into Africa, the dengue vaccine. So I think this

01:03:20.940 is going to be a new battleground that we have to look at. As we advance introduction of new vaccines,

01:03:27.280 we have to anticipate that a big chunk of the anti-vaccine movement will come along with it.

01:03:32.860 We've got about 10 minutes that we're going to use to wrap up. And I'll just have some closing

01:03:40.960 comments from my side. And then I'll turn it over to some of the panelists here to provide some

01:03:46.520 closing remarks. And then we'll let you go to your next event. What's really clear is the way forward

01:03:52.840 is together. There's no question about that. Not one entity represented in this room, not one country

01:03:59.800 can go this alone. The issues are complex. They're often really local. And for that, we need local

01:04:07.380 solutions that are tailored to that specific context. And I think what's also clear is this

01:04:13.800 is not an issue that's going away. This is not a blip that we're going to get over and we're going to

01:04:19.060 sort of go back to an era from a decade ago. And we each have a part to play in committing to

01:04:27.660 solving these complex solutions, especially around demand, confidence, and hesitancy. And we've heard

01:04:36.400 hear how deeply linked those are to the services that are provided, the quality of health care workers,

01:04:43.620 the training, and the actual provision of vaccines that are of high quality and that people want to

01:04:50.680 get. So I want to just describe a little bit at WHO that we are leaning forward on leading and convening

01:05:00.900 on best practices around vaccine hesitancy and demand, and especially on how to measure it. I think

01:05:09.020 that's one of the key things that not, we really don't know how to track this, nor how to have

01:05:17.000 measurements that have some validity around predictions of what people will actually do with

01:05:22.740 respect to vaccinations. I think we have to remember this very firm link between confidence

01:05:28.860 demand and hesitancy, and the kinds of services that every government is providing to their communities

01:05:35.880 and the whole range of communities. We haven't spoken about vaccines across the life course, but I think

01:05:43.700 we shouldn't forget that, that adults, either older adults or parent age adults, when they understand

01:05:52.240 even the vaccines that they should receive for their own health, are more likely to actually seek

01:05:57.720 vaccines for their children. So we have to remember, Peter, that vaccines do not cause autism, vaccines

01:06:06.160 actually cause adults. So one of the key things that I want to highlight for you, especially as you walk

01:06:17.000 out of the room, is we're coming to the end of the decade of vaccines, the strategy from 2011 to 2020.

01:06:24.420 We're in the process altogether of standing up a new strategy for the global community, for all of us,

01:06:30.540 all countries, all partners, all initiatives. It's for all of the agencies, all of the CSOs, all of the

01:06:38.900 community organizations and technical agencies. It's for everyone, both within immunizations and outside

01:06:46.740 the immunization community. And I think this strategy has deeply heard that message and is really absorbing

01:06:53.260 that. So we have launched draft zero of the document. I'll just highlight the flyer that's

01:07:01.200 going around the World Health Assembly to indicate how you can get draft zero, how you can provide

01:07:07.300 comments, input, and this will move on to a draft that will be more finalized in the fall and will be

01:07:17.360 presented at WHA next year. So we will all be back here with a, I'm sure, a very robust discussion on

01:07:24.820 that. We are leaning forward, especially on the behavioral insights on vaccine hesitancy. And we look

01:07:32.720 forward to each of the convenings and the igniting of work around this area. And you will see us moving

01:07:41.920 quite rapidly forward on some of these issues from WHO. So with that, I would like to thank you for

01:07:51.260 being here. And I'm going to turn it over to three closing speakers, and then we'll let you go. So

01:07:57.000 first, to Secretary Azar, please. Well, thank you all for being here today. And I'd like again to thank

01:08:05.820 Commissioner Andrew Kytas and Minister Mandata for co-hosting this event. And Dr. O'Brien,

01:08:12.420 thank you for moderating us on time and to the World Health Organization for naming vaccine

01:08:17.780 hesitancy one of the top 10 global threats for 2019. We've enjoyed hearing from the diverse set

01:08:24.860 of perspectives represented. We hope everybody's benefited from today's discussion. I hope that

01:08:29.780 this exchange has inspired each of us to return to our work in our nations or at our international

01:08:34.420 non-governmental or private organizations with a renewed sense of commitment to promoting

01:08:40.420 vaccination. I want to highlight two particular areas for action going forward. First, we look

01:08:46.560 forward to ongoing collaboration with all of you on the development of a new global vaccine action plan

01:08:51.740 to follow the plan that concludes in 2020. Second, I encourage all of you to develop in-country

01:08:57.780 strategies to elevate vaccination coverage with efforts that meet your country's unique needs and

01:09:02.980 challenges. Today, I was particularly interested in to hear our discussion led by Dr. Tam and Dr.

01:09:09.680 Berkeley about social media interventions that we could all be trying, in addition to the importance

01:09:15.600 of modifying social norms as a means of increasing vaccination and thinking about behavioral economics as

01:09:23.740 what influences people's behaviors. Back home, I'm committed to continue leading efforts across the U.S.

01:09:29.980 government to raise vaccination rates within our own borders. I also encourage everyone to focus both our

01:09:36.240 global and national work in this area on outcomes. This is an area where outcomes aren't so hard to track or

01:09:42.980 understand. I think the gentleman from Nigeria focused our efforts around metrics, that what you measure is what you

01:09:49.080 get. Are our vaccination rates high enough to keep our population safe? And are they going up or going down?

01:09:55.980 Today, we are seeing unacceptable results on these measures, and I hope by the time we see each other

01:10:00.740 next year, we will all have some positive outcomes to report. So thank you again for this productive

01:10:05.800 discussion, and I look forward to ongoing cooperation with all of you.

01:10:08.980 Let me now ask Commissioner Andrew Catis to give us some closing remarks.

01:10:20.600 Thank you. Thank you so much. I have listened with great interest to these stimulating discussions, and in my five years, I saw a lot of people who were against vaccination, and then after some process, they changed their mind, being progressive and

01:10:37.740 being in favor of vaccination. It means that progress is possible. And let me start by saying there's a strong level of expertise, of commitment, of political will here today encourage me and gives me hope.

01:10:51.500 We have a lot of work to do, but with hard work comes high reward. Our citizens trust us as health care workers and health authorities to protect them from disease and infirmity. Immunization has to be a priority for our health systems, a fundamental part of primary health care, a crucial component of every health care package.

01:11:16.200 And we need to work together to share learnings and best practice to coordinate and collaborate and combine our political effort.

01:11:24.800 In this, it is with these goals in mind, the European Commission and the World Health Organization are organizing a global vaccination summit on 12th of September in Brussels.

01:11:37.300 This summit aims to boost political commitment towards eliminating vaccine preventable diseases.

01:11:43.600 It seeks to engage us, the political leaders, and identify opportunities for immediate impact on increasing vaccination coverage.

01:11:53.360 I hope to see you all there in Brussels in September. Thank you.

01:11:58.060 I see that DG, welcome. You have impeccable timing. We have just a few closing comments from the Minister of Health from Brazil, and then I'll turn it over to you, DG, to share your thoughts with us and close the session. So thank you.

01:12:21.860 Well, thank you, our director, Dr. Tedros, for coming. And I'm sure that when you stand for vaccination, you have the total name and status of the World Health Organization.

01:12:51.860 To call all the countries to call all the countries to come together. This is not a single country problem. This is not an easy problem.

01:13:00.820 Although we say primary care, although we say primary care, we should call it high-complexity care, because this has something to do about how people think and how they receive the instructions of their parents and their physicians and everybody that works on vaccination and health systems.

01:13:22.700 I'm sure that on the next year, I'm sure that on the next year, we might have many good works like the ones that were set here by Spain and other countries that I'm sure that can support other countries' initiatives.

01:13:37.180 And Brazil is committed to raise our vaccination rates and urge to call all the international partners like PAHO to work in Venezuela and in countries that, on the region, that are having trouble to do their jobs inside their countries.

01:13:57.020 So you may count on us, and we count on you to bring truth for people and have a good vaccination year.

01:14:05.460 I just came from Memorial Service for Kofi Annan, and he used to tell us a story about excellencies, ladies and gentlemen.

01:14:21.480 Thank you for allowing me to speak here today, even if I can only be here for a short time at the closing.

01:14:28.960 Vaccines are one of the best investments in a healthier, safer world.

01:14:35.460 Every year, we estimate that vaccines save at least 2 million lives.

01:14:40.460 Countless more children avoid debilitating diseases, prolonged hospital stays, and time out of school, thanks to vaccines.

01:14:50.120 Vaccines not only mean lives saved, they mean lives lived.

01:14:54.800 They help children become healthy adults, but despite progress, more than 1 in 10 children around the world still do not have access to vaccines.

01:15:05.720 Most unvaccinated children live in countries affected by poverty and conflict.

01:15:11.800 They are in the most marginalized communities or places where health services do not yet reach.

01:15:17.400 Recent measles outbreaks have occurred, even in countries where access is high, but where drops in immunization coverage have threatened hard-worn gains.

01:15:29.520 No country can afford to be complacent about immunization.

01:15:33.720 In some communities, vaccine hesitancy is intensifying.

01:15:37.320 Some parents are delaying or refusing vaccination because they are not sure that vaccines are safe, or because they doubt the value of vaccines.

01:15:46.380 We welcome initial steps taken by some social media companies to stop the spread of misinformation about vaccines.

01:15:55.540 But this is not simply an issue that can be managed online.

01:16:00.240 Governments, health workers, and health authorities have a vital role to play in building a systems that parents trust and believe in.

01:16:08.160 Governments must invest in immunization and make sure primary care services are affordable, accessible, and responsive to parents' needs.

01:16:19.100 Health workers must be empowered to be champions for vaccination so they can engage effectively with the parents and communities they serve.

01:16:27.460 Education partners must work to strengthen basic scientific literacy and ensure people can interpret and understand information about their health and vaccines.

01:16:38.740 And health authorities should undertake positive communication efforts so that people are engaged effectively on vaccines and the disease they prevent.

01:16:51.420 To do our part, WHO, together with partners, Gavi, CET, and UNICEF, is working to ensure vaccines reach more people in more countries than ever before.

01:17:04.940 We are proud to be part of a new hub for vaccine confidence and demand, which will generate critical evidence and recommendations in this area.

01:17:15.100 And critically, we look forward to working on the new global vaccine strategy, which will be presented at the World Health Assembly next year.

01:17:24.200 The new vision contained in this strategy must be much more flexible and innovative to address new challenges like vaccine hesitancy.

01:17:34.380 And it must better tackle all challenges like inequality and lack of access and redouble the commitment to our collective goals.

01:17:42.540 This will be critical for assuring that polio eradication is sustained, for getting measles goals back on track, and ensuring that everyone everywhere can benefit from vaccines.

01:17:55.240 Vaccination is a right and a shared responsibility. 0.99

01:17:59.140 It will take long-term efforts, political will, and continuous investment to ensure we are protected together.

01:18:05.560 Because there can be no health for all without vaccines for all.

01:18:12.360 And I join my friend Vitenis in inviting you to join us in September in Brussels.

01:18:20.920 That will be a paradigm, I think.

01:18:22.760 That will bring a paradigm shift and open discussion.

01:18:26.100 Thank you so much.

01:18:27.120 Thank you.

01:18:27.460 Thank you.

Action4Canada - January 09, 2022

Theresa Tam at a W.H.O. Planning Session, in May 2019

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