Senator Warren Discusses Importance of Vaccines to Preventing and Controlling Disease Outbreaks
"The more we do on the front-end to ensure that everyone gets access to the vaccines-the less we'll see individuals contracting hepatitis A, measles, whooping cough, and all of the other vaccine-preventable diseases."
Washington, DC - At a Senate Health, Education, Labor and Pensions Committee (HELP) hearing today, United States Senator Elizabeth Warren discussed the hepatitis A outbreak in Massachusetts and questioned health experts about the importance of vaccines and public health funding to prevent and control disease outbreaks.
A transcript of Senator Warren's exchange with experts is below.
Transcript: Warren Discusses Importance of Vaccines to Preventing
and Controlling Disease Outbreaks
Tuesday, March 5, 2019
Senate Health, Education, Labor and Pensions Committee
SENATOR WARREN: Thank you, Mr. Chairman. So we've heard today about how important vaccines are to preventing and controlling many diseases, and I want to zero in on one that we are battling right now in Massachusetts. Since last April, 318 outbreak-associated cases of acute hepatitis A virus have been reported in the Commonwealth of Massachusetts. Hep A is a contagious virus that causes liver infection. Older children and adults who acquire the hepatitis A virus can experience a slew of incredibly unpleasant symptoms - fever, nausea - and in rare cases the virus can even lead to death. In Massachusetts, four people have already died since the outbreak began. Now, we didn't used to have a hepatitis A vaccine at all. But in 1995 and '96 the Food and Drug Administration approved two hepatitis A vaccines and soon after, CDC recommended vaccination for certain populations, including routine vaccinations of children living in areas with elevated rates of the virus. Dr. McCullers, you study infectious diseases. What impact did the introduction of the hepatitis A vaccine have on the national rates of the virus?
DR. MCCULLERS: Well, thank you very much, Senator Warren. Yes, hepatitis A can be a very severe disease in particular high-risk groups. The vaccine that came out in the late 1990s is a very safe, very effective vaccine, and as we've increased vaccination rates, we've seen a tremendous decrease in the rate of the disease. We've seen more than a 50-fold decrease nationally over those years, primarily eliminating a lot of the disease in children as well as some of the food-borne outbreaks. But there's still a lot of public health work to do, as illustrated by your current outbreak.
SENATOR WARREN: So that's the question I want to ask. We developed the vaccine, the rate goes way down. So we now have a vaccine-preventable virus here. Why are we seeing so many hepatitis A cases emerging now?
DR. MCCULLERS: Well, what you're seeing is the vaccine's administered in childhood, it's only been around for about 20 years, so if you're 21 years or older you probably haven't had it. Now it is recommended that high-risk groups, such as recreational drug users (as is part of the problem in Massachusetts) be vaccinated, and we haven't gotten to all those groups yet. So, efforts to really find the high-risk individuals, which are well-defined, and to get them the vaccine, would help prevent these outbreaks in the future.
SENATOR WARREN: Yeah, and this is part of what's happening in Massachusetts. We've been battling the opioid crisis for years and hepatitis A is just another place we need to fight on this. But we are learning from this. Just this past October, the same CDC committee whose recommendations in the 1990s helped the rates of the virus decline sharply added "persons experiencing homelessness" to the list of those who are recommended to get the hepatitis A vaccine. I see you're all nodding, right? So in Massachusetts, our public health workers, our community health centers, and our jails have sprung into action to try to get the vaccine to those who are most at risk. Dr. Wiesman, as Secretary of the Washington State Department of Health, you oversee your state's public health response. What can we be doing to ensure that local public health officials have the resources they need to be able to do their work?
DR. WIESMAN: Yes, thank you. Part of this is making sure that the Prevention and Public Health Fund is funded, and that we look at the funding to CDC. We've been asking ASTHO, the Association of State and Territorial Health Officials, and local public health, for increasing the CDC budget 22% by Fiscal Year '22.
SENATOR WARREN: Alright, so we're talking money now.
DR. WIESMAN: We are talking money.
SENATOR WARREN: We're talking money, and whether it's a situation like the hepatitis A outbreak in Massachusetts or the measles outbreak in Washington State, how do the preventive costs of a vaccine program compare to the containment and treatment costs of an outbreak?
DR. WIESMAN: Well, in general we do know that for about every dollar spent on vaccines, you save about ten. So it's definitely a cost-effective intervention.
SENATOR WARREN: Ah, good. So the more we do on the front-end to ensure that everyone gets access to the vaccines, the less we'll see individuals contracting hepatitis A, measles, whooping cough, all of the other vaccine-preventable diseases. This administration has repeatedly sought to cut the Prevention and Public Health Fund, which supports key immunization programs, and they've continued their efforts to weaken the Medicaid program, which covers all of the recommended vaccines for children and for many adults as well. I am glad that most of my colleagues are on the same page about the importance of vaccines. Now let's make sure we're also on the same page about the importance of public health funding so people get access to those vaccines. Thank you.
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