{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://globalhealthchronicles.aviaryplatform.com/iiif/rx93777p42/manifest","type":"Manifest","label":{"en":["Malone, Kevin"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","metadata":[{"label":{"en":["Source Metadata URI"]},"value":{"en":["12763"]}},{"label":{"en":["Publisher"]},"value":{"en":["David J. Sencer CDC Museum"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum","Interviews may only be reproduced with permission from the David J. Sencer CDC Museum."]}},{"label":{"en":["Agent"]},"value":{"en":["Kevin Malone (Interviewee)","Karen Torghele (Interviewer)"]}},{"label":{"en":["Date"]},"value":{"en":["2018-03-28 (Created)"]}},{"label":{"en":["Description"]},"value":{"en":["Mr. Malone talks about his role in talks about his work in prevention and containment of polio (Summary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Identifier"]},"value":{"en":["2016.400.29 (accession number)","OHCDCM400 (collection call number)"]}},{"label":{"en":["Relation"]},"value":{"en":["Polio: CDC's role in surveillance, prevention and containment (is part of)"]}}],"summary":{"en":["Mr. Malone talks about his role in talks about his work in prevention and containment of polio"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["All rights to the interviews, including but not restricted to legal title, copyrights and literary property rights, have been transferred to the David J. Sencer CDC Museum","Interviews may only be reproduced with permission from the David J. Sencer CDC Museum."]}},"provider":[{"id":"https://globalhealthchronicles.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["David J. Sencer CDC Museum"]},"homepage":[{"id":"https://globalhealthchronicles.aviaryplatform.com/","type":"Text","label":{"en":["David J. Sencer CDC Museum"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/289/original/CDCM_Mark_2.1.png?1728486742","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/250/511/small/Malone_Kevin.jpg?1727968047","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511","type":"Canvas","label":{"en":["Media File 1 of 1 - 20180328_Malone_Kevin.mp3"]},"duration":4866.248,"width":640,"height":40,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/250/511/small/Malone_Kevin.jpg?1727968047","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/250/511/original/20180328_Malone_Kevin.mp3?1726186772","type":"Audio","format":"audio/mpeg","duration":4866.248,"width":640,"height":40},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453","type":"AnnotationPage","label":{"en":["2016.400.29 [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":" ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: It is March 28th, 2018, I am Karen Torghele, and today I'll be talking\nwith Kevin Malone for the Global Health Chronicles Oral History of Polio\nProject. Mr. Malone is a Senior Attorney in the Office of General Counsel at the\nCenters for Disease Control and Prevention [CDC]. He has been the legal counsel\nfor CDC's Immunization Program and the Advisory Committee on Immunization\nPractices for 30 years and is the Office of General Counsel's Team Leader for\nCDC's Global Health Programs. He is also the first attorney we have interviewed\nfor this segment of the Global Health Chronicles. Welcome, Mr. Malone and thank\nyou for being here.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=0.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Hello Karen, it's nice to be here.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=41.0,44.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, to start, would you tell us a little bit about your background and\nhow you came to be working at CDC all these years?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=44.0,54.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure. I grew up in Kansas, in the heart of the country and wanted ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=54.0,60.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to see\nwhat the coast was like and went to college then out on the west coast. And my\ndad said okay, well you can go out there, but you need to get residency and so I\nended up working at the UCLA [University of California, Los Angeles] Medical\nCenter on the Pediatrics ward for a year and became very interested in medical\nethics during that time. There were a lot of new procedures, CAT [computerized\naxial tomography] scans were new, bone marrow transplants were still in the\nexperimental phase and so it was very fascinating, particularly in the context\nof children--to see how those were implemented and it just really got me very\ninterested in health care in general. My college major then at the University of\nCalifornia, Santa Barbara was in Environmental Studies, which is kind of a\nsimilar thing to public health.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=60.0,109.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Later I went to law school at the University of Kansas and upon graduation moved\nto Atlanta where I became legal counsel for the Georgia Department of Human\nResources where I worked on ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=109.0,120.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"licensing of medical facilities. Later, I went to\ngrad school at the University of Michigan School of Public Health where I\nreceived a master's degree and came back to Atlanta. At the time, I had done\nonly government work so I was really looking to be out in a private law firm or\npotentially in-house counsel at a hospital and so I actually didn't apply for a\njob at CDC. However, I answered the phone one day, and the General Counsel's\nOffice from CDC was on the phone, offering my wife a job interview. She had a\nlab background, had graduated from law school recently herself, had applied for\na job at CDC, but by that point, already had a job. And so, quick on my feet, I\nturned that into a job interview for me, which I later was told that the ability\nto turn the offer for her to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=120.0,180.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"interview into a job interview for me probably\nhelped my standing a little bit. I ended up getting a job at this incredible\nplace that is CDC, and I've been here 30 years now.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=180.0,195.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: And at the time--what year was that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=195.0,199.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: That was in 1987.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=199.0,201.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: How many other lawyers had worked at CDC around that time?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=201.0,206.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: CDC first got lawyers around the late 1970s, I believe. And we were kind\nof continuing to grow. By 1987, I was the seventh lawyer hired-- another lawyer\nhad been hired earlier that year. Effectively I was actually the lawyer for most\nof CDC. It was a much sleepier place, if you will, back then. We had people who\nspecialized-- AIDS [acquired immunodeficiency syndrome], of course, was very big\nby then so we had an AIDS ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=206.0,240.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"specialist lawyer. We had a NIOSH [National Institute\nfor Occupational Safety and Health] lawyer, we had environmental lawyers with\nthe development of ATSDR [Agency for Toxic Substances and Disease Registry] and\nother environmental things, and then, basically, everything else, infectious\ndiseases, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=240.0,300.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"immunization, quarantine, I ended up taking on. And it wasn't\noverwhelming, though, because at the time, people didn't naturally think to\nreach out to the lawyer for things and CDC was not big in the news. And so--","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=300.0,311.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, there were seven--seven lawyers when you first started in 1987?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=311.0,314.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Correct.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=314.0,315.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You were the seventh.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=315.0,316.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: I was the seventh, and most of the other folks then were basically\nspecialists. Then I became the general lawyer for the agency. As I said, it was\na sleepier time then, and there weren't a lot of controversial legal issues. But\nI quickly picked up the Immunization Program, and it became truly the focus of\nmy career over the last 30 years. And also--so I gradually ratcheted back my\nportfolio, but always kept immunization and then in the last decade have picked\nup global health law work as CDC's international presence has changed, and I've\nbecome the Team Leader for the Global Health Law Team.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=316.0,346.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So how would you describe an everyday work experience for you? Like,\nwhat kinds of things would you do? What were you tasked to do?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=346.0,353.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Well, a lot of it has had to do with statutory interpretation. Over the\nlast 20 years, in particular, the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=353.0,359.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Vaccines for Children Program came along in\n1994-- our office helped to draft the statute for that. It's the largest--makes\nCDC the largest purchaser of childhood vaccines in the United States, purchasing\nover half the childhood vaccines used in the country. And so, as that program\ncame into existence and then has matured over the years, there has been any\nnumber of questions dealing with immunizing many, many children around the\ncountry through that program.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=359.0,382.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Before you started working at CDC, what did you know about it as an organization?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=382.0,387.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: I think I first heard of CDC during the Legionnaire's disease outbreak.\nI was in law school during that outbreak, and I later attended a conference in\nNew York City. Within a year or two after that where there was also an outbreak\nof Legionnaire's disease and it kind of heightened everybody's interest in well,\nwhat's going on? What do they know about that? And so, it kind of grew from\nthere-- I started paying more and more attention over the years then. And then,\nof course, moving to Atlanta in the early '80s, it was already a prominent\ninstitution here. Although, it's ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=387.0,419.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"funny how you think that it's better known than\nit perhaps is, a lot of people probably to this day, have no idea that CDC is a\nfederal agency, for example, part of the Department of Health and Human\nServices. I remember going to parties and introducing myself with the acronym\nthat I work at CDC and folks a lot of times would say oh, Control Data\nCorporation? So, it kind of gave us our comeuppance, I guess around here. But of\ncourse, in recent years, particularly after 9/11, the CDC's prominence in our\nsociety and people's awareness of it, in general, has certainly expanded.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=419.0,455.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: There at the time too in the '80s when you came were there any\npolitical--was there any political impact on the work that you did? I know there\nwere some politics involved with AIDS, but was there in the specific work that\nyou did?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=455.0,471.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: You know one of the interesting things about working at CDC is it's the\nonly federal agency that is headquartered outside of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=471.0,479.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Washington, D.C. And I\nthink. As a result, there's a lot less politics if you will, that happens here.\nPeople can do their public health work without really having any kind of\npressure from the political side. And I think that that's led to a lot of the\nachievements actually at the agency by being able to focus truly in the public\nhealth arena.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=479.0,504.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I was also curious about what you might have had to do with media\nrelations. Did you have to go over things that people said in interviews before\nthey talked to the media?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=504.0,517.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: We did have close contact with the media relations folks, a guy named\n[Donald A.] Don Berreth, who was one of the great old lions of CDC, was\ncertainly a regular presence in our office, as we were in his. As we basically\nhelped people to respond in a way that made sure then that ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=517.0,539.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"politics was not\ninvolved in their decision and then to the extent that anything of legal\nsignificance that came up that it was dealt with.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=539.0,560.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Can you now talk a little bit more specifically about polio, when you\nfirst started to get involved with that and what that was like for you?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=560.0,583.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure. Polio then, certainly by 1987, polio and the vaccines that came\nabout, IPV [Inactivated Polio Vaccine] and OPV ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=583.0,599.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"[Oral Polio Vaccine], were well\nestablished-- people were regularly taking it. And so as often happens with\nvaccines or with the--well, what happened then with vaccines is that we went\nfrom folks, like I'm 62 years old and I stood in line when I was a child around\nfive years old I believe to get my first--or maybe a little bit older, to get my\nfirst oral polio vaccine on a little sugar cube at a public school. I remember I\nthink that they called them Sabin Sundays back then.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=599.0,641.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And you know, I certainly was well aware, I had neighbors who had had polio.\nEveryone was well aware, even at my age, were well aware of the risk of polio.\nAnd so, folks, in general, were pretty ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=641.0,659.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"amenable to the introduction of\nvaccination mandates over the years. And then, over time, you find that we\nreached the point in society where the impacts of the diseases themselves that\nare vaccine-preventable have been diminished because these diseases. Thankfully\nbecause of the creation of vaccines, have been incredibly reduced in their\nincidence in the United States so that almost any vaccine-preventable disease\nthat exists and for which folks are immunized routinely in the United States,\nthere are almost no cases of that anymore. And so, then what you had come up is\nthat people started to focus more on the adverse events from vaccines. And\nthat's actually where the legal side truly picked up, I would say-- is that with\npolio, in particular, you had VAPP, Vaccine Associated Paralytic Polio, where\nthe vaccine itself is not totally safe, and it actually ends up causing some\namount of polio in both recipients of the vaccine and in some close contacts. At\nthat time, probably by the late ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=659.0,719.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"'80s, certainly oral polio vaccine was routinely\nadministered for years before that-- there might be a half dozen cases a year of\npeople who got VAPP, were injured, and obviously needed some recourse to take\ncare of their medical condition.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=719.0,734.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Okay, so, as an attorney, you probably are familiar, although you\nweren't here, you're familiar with the Reyes versus Wyeth case that involved\npolio vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=734.0,744.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Correct. That's a 1974 case-- was certainly significant in that it\npotentially was going to change CDC's role in vaccination. What happened, in\nthat case, was a child was immunized in a county public health clinic and then\nended up getting polio later and the family sued the corporation that made the\noral polio vaccine, Wyeth. And the resulting court decision was relevant in that\nit established a difference between vaccinating people in what were called mass\nimmunization settings, such as public health clinics, and private doctor's\noffices. The significant point being that typically in an ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=744.0,780.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"immunization clinic,\nyou're not seen by a physician where you have an individual determination of\nwhether or not to be ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=780.0,840.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=840.0,840.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And the significance then of the Reyes v. Wyeth decision was that there are\npackage inserts that vaccine manufacturers write and are approved by the Food\nand Drug Administration as part of their licensure and those package inserts\nthen are provided with each vial of vaccine. The physician reads that and then\nmakes an individual determination about whether or not to vaccinate the child.\nIn a mass immunization setting, you don't have a so-called learned intermediary,\nthat is, someone like a physician who makes an individual medical determination\nabout whether or not the benefits outweigh the risks for you. And so, what that\ndecision said is that the vaccine manufacturer then, because there was no\nlearned intermediary, a physician who did an individual determination about\nwhether or not to vaccinate that person; the manufacturer has an obligation to\ndirectly inform the individual about the risks associated with that product.\nThey are marketing it in a way that balances out the negative and the positive\nso that you minimize the potential for adverse events. And so, after that\ndecision, the manufacturer said to CDC--which was the primary purchaser of\nvaccines for use in mass vaccination clinics around the country-- that we're not\ngoing to sell you vaccine anymore because we're going to be held liable all the\ntime. Because you are administering them in these clinics, where there's not an\nindividual determination by a learned intermediary. What we want to do is, we\nwant you to take on that obligation and so CDC, as part of our contracting for\nthe purchase of these vaccines, agreed to include a clause -- called a duty to\nwarn ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=840.0,900.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"clause. CDC takes on the manufacturer's responsibility to make sure that\neither the child is in fact seen by a learned intermediary who makes that\nindividual determination about using that vaccine or that they are given written\ninformation. At the time, they were called Important Information Statements, to\nlet the person know that these are the known risks and you can decide whether or\nnot then you're going to get your child, in this instance, vaccinated knowing\nthose risks. And so, given the inclusion of the duty to warn clause, CDC then\nwas able to continue purchasing vaccines.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=900.0,942.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Now later in the 1980s, in 1986, there was a law passed called the National\nChildhood Vaccine Injury Act. That was a law that was pushed, in part, by folks\nfrom the public health side and in part by folks who were very ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=942.0,960.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"skeptical about\nvaccines and were concerned about the very nature of these products. Vaccines\nare given to healthy people, unlike most medications that folks get in their\nlife. They are typically getting medication to treat them for some condition.\nWhat happens with the vaccine if you're being given a product to prevent you\nfrom getting the disease? And, on top of that, there is an interest in our\nsociety, given the nature of the way that vaccines operate, to have people as\nwidely vaccinated as possible because of the notion of--","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=960.0,1016.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Herd immunity.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1016.0,1018.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Yeah. Herd ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1018.0,1020.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"immunity is the driving force behind the success of vaccines\nto my knowledge as a layperson again working with vaccines. And what herd\nimmunity does is depending on how infectious a particular vaccine-preventable\ndisease is, if you get enough people in a community vaccinated against that\ndisease, that disease will ultimately die out because there's no way for that\ndisease to spread readily among the folks in the community. And in order to get\nherd immunity, though, you have to immunize as many people as you can, which\nagain varies depending on the infectiousness of the particular disease.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1020.0,1050.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Measles, for example, is highly infectious, it's one of the reasons we continue\nto see measles outbreaks in the United States even though there are no domestic\nroutine pockets of measles in the United States. Polio is not quite, but it\nstill has a requirement for herd immunity in order to be able to extinguish it\nfrom our society, which the use of vaccines in the United States did accomplish.\nAnd herd immunity, though, is accomplished by actual creation of immunity in the\nindividual. Not everybody who gets a vaccine gets immune because of the use of\nthat ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1050.0,1080.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccine for various reasons. So, you have some fall off, but the total\nnumber of ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1080.0,1140.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"people immunized have not been--had not created immunity. And then you\nalso have some people for which there is a medical contraindication to use of\nthe vaccine. They might be allergic to one of the components of the vaccine,\nmaybe had an earlier adverse effect with a vaccine and so it's not appropriate\nfor them to get that vaccine. So that's another group of people who cannot be vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1140.0,1193.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"When you set aside those people then, the unknown ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1193.0,1200.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"folks who were immunized who\nin fact are not immune to the disease and the folks who don't get the vaccine\nbecause it's medically contraindicated or in our system of law--here in the\nUnited States, it's the states that determine whether or not people are mandated\nto receive particular vaccines. And most states, in addition to having the\nprovision for a medical exemption also provide for a religious exemption. There\nare 47 states in the United States that say if you have a religious opposition\nto the use of vaccines, that you don't have to be vaccinated. In addition, a\nnumber of other states, currently 18, have what are called philosophical\nexemptions where folks who have reasons other than religious opposition to the\nuse of particular vaccines or vaccines in general under those particular state\nlaws don't have to be vaccinated. And so, you take all those folks, and you end\nup with a group of people who are not immune from the disease because they\neither are not immune because the vaccine did not take, or they never received\nthe vaccine, and you still want to create herd immunity. And so, with the notion\nthat I am taking a vaccine partly to protect myself from getting the disease and\npartly to create herd immunity in my community so that other people don't get\nthe disease. And of course, the fact that herd immunity protects me if that\nvaccine doesn't take with myself or with my child.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1200.0,1256.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But the legal issues then are--that are significant then is one of the reasons\nthere's been such great ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1256.0,1260.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"success in getting rid of vaccine-preventable diseases\nin the United States is because people have actually been required to receive\nthose vaccines from way back, back in the smallpox era in the 1700s and 1800s.\nIn the United States, smallpox was still quite a scourge in society, and so laws\nstarted being passed to require that people be vaccinated. Later on, as more\nvaccines were created for infectious diseases that were susceptible to\nvaccine-preventable vaccines, the focus was on--well we, as a society, to create\nherd immunity we really need to make sure that folks are immunized.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1260.0,1315.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There was a landmark public health decision called ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1315.0,1320.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Jacobson v. Massachusetts in\nthe U.S. Supreme Court in 1905, which upheld the right of the government. In\nthat case a city government in Cambridge, Massachusetts to require an individual\nto be immunized for ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1320.0,1380.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"smallpox, again, with that notion that we want to create\nherd immunity and we, of course, want to protect the individual. And a fellow\nthere, for no reason other than he simply did not want the vaccine, had\nchallenged the use of vaccine saying that he ought to have the right to not be immunized.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1380.0,1403.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, Mr. Malone, would you talk about the basis of the Jacobson decision?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1403.0,1409.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure. The Jacobson decision then was where a local government had\nmandated that smallpox vaccination be given to all the citizens. And what the\nbasis of that was under the U.S. Constitution there's something called the\n\"police power.\" And the police power are powers that are reserved to the states\nto fulfill the state's obligation to, among other things, care for the public\nhealth of the nation. And the states then use that ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1409.0,1440.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"authority to make various\nlaws, among them, vaccination mandates.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1440.0,1443.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So, what the Jacobson decision did then was that it upheld that police power as\na legitimate use of the government authority in order to create--in order to\nminimize the potential public health impact of having these vaccine-preventable\ndiseases if there are in fact vaccines being used in the United States. Over the\nyears then, that's been further elaborated on as we focused more on the nature\nof where are the pockets of disease that happen, and one of those is schools.\nThat schools are places where children are closely congregated, being young they\ntypically don't have a lot of the same kinds of immunities that older folks\nwould have, and so the law eventually started to focus on schools as the\nappropriate nexus for determining under the state vaccination mandates that\nfolks should be immunized. And so, these laws were created that, in order to\nattend school, you had to bring indications from your medical provider that you\nreceived whatever the vaccines were that were mandated at that time. Folks have\nchallenged that over time. There has been litigation where people say, for\nexample, in ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1443.0,1500.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Arizona, there was a case where the state constitution provided a\nright to education, where people were saying that my right to education then\nshould trump the ability of the state to exclude me because I don't want to get\na vaccination.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1500.0,1518.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In that particular case, what the court held is that fundamentally if people are\nnot safe in the classroom from the spread of infectious diseases, there can\nreally be no opportunity for education. And so what the court upheld in that\ninstance was that not only then could you be required to be vaccinated and bring\nevidence of that to the school, to the extent that either you had a medical\ncontraindication for which you could not be vaccinated or under the state's law\nyou asserted a legally allowed exemption. Such as a religious exemption or a\nphilosophical exemption, that in the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1518.0,1561.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"case where there was a disease outbreak,\ntypically measles outbreaks, the school district, if they wished, they could\nactually exclude you from attending the school since you were vulnerable to the\ndisease. And then, given the nature of the burden. Because of the challenge of\nmaintaining herd immunity, the schools then were given the right under these\nlegal decisions to exclude those children from attendance at school while there\nwas the risk that disease might--such as measles. If there is a current measles\noutbreak or there appears that there's an impending measles outbreak, that\nchildren who were not otherwise protected from the vaccine, could be excluded\nfrom that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1561.0,1604.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"One other thing I'd like to talk about is religious exemptions. People tend to\nthink well--I just have an inherent right under the U.S. Constitution to assert\nthat my religion prohibits me from having a vaccination and therefore, I should\nnot be vaccinated. In ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1604.0,1621.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"fact, the U.S. Constitution, the courts have held, does\nnot provide an inherent right to a religious exemption from vaccination based\nagain on the notion that the public health requires all of us as a community to\ndo the right thing, if you will, in order to create herd immunity. The courts\nhave held that that overwhelms any religious belief that you may have. On the\nother hand, under the First Amendment right to their freedom of religion, states\nhave been upheld in passing statutes that do allow people to assert that under\ntheir religion a particular vaccine is not allowed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1621.0,1675.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, as I mentioned earlier, 47 states, all but West ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1675.0,1681.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Virginia, Mississippi\nand just a few years ago the state of California, allow folks to assert a\nreligious exemption to vaccination. One of the other interesting things with\nreligious exemptions though is, what's the scope of that? Under the First\nAmendment, you not only have the right to the free exercise of religion, the\nstate itself cannot establish a religion. And so there has been some interesting\nlitigation where folks have asserted that they have a personal religiously held\nbelief that is contrary to vaccination. And the state has said, but you don't\nbelong to an organized religion that we recognize, and the courts have actually\nstruck that down saying that that interferes with the notion of the\n","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1681.0,1741.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"establishment clause of the First Amendment. The courts then have determined\nthat a state cannot basically decide which religions merit consideration under\nthe religious exemption. And they have held that because under the establishment\nclause of the First Amendment of the U.S. Constitution, the United States should\nnot be in the job of determining, or their state governments, of determining\nwhich religions are favored in any way.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1741.0,1795.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, this particular decision held that a ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1795.0,1801.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"sincerely held religious belief\nshould be all that's required-- that is, it is based on a religious belief in\nGod and the way that that person interprets the nature of their religious\nbeliefs that it has to be sincerely held. And as a result, then, typically\npeople who are not necessarily part of organized religions, but hold\nsincerely--held religious beliefs, can, in fact, qualify for religious exemptions.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1801.0,1828.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, what has been the effect of those sincerely held religious beliefs\non vaccinations?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1828.0,1834.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Well, vaccination exemptions, in general, can be problematic. There are\nparts of the country where a number of folks claim them. And you can end up\nwhere-- herd immunity shows up again--where you create the risk for importation\nof diseases since many of the diseases aren't naturally occurring in the United\nStates anymore. But when you have these pockets of anti-vaccination folks who\ndon't have their child ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1834.0,1861.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccinated, that can create problems because of the herd\nimmunity not being at quite the adequate level. And so there have been studies\nin recent years to determine about how that has affected immunizations and how\nhas that affected the possibility of having outbreaks of diseases. And what\nthese studies have found is the complexity of the process for obtaining a\nvaccination exemption seems to affect whether or not those exemptions are\nclaimed. In some states, it's actually easier to claim an exemption from\nvaccination than it is to get the form to take to school. You have to go to the\ndoctor, you have to get your child vaccinated, and you have to bring the form\nthat the doctor completes to the school. And in some states, it was as simple as\njust filling out a form saying that I have a religious or philosophical\nopposition to ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1861.0,1921.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccination. And I think one of the concerns then was that that's\nfine if people are educated about the risks of vaccines. And I think the concern\nis that not everyone was and when it gets easier to claim the exemption and\npeople don't have a lot of experience with vaccine-preventable infectious\ndiseases. Folks of my age are about the last folks around who actually even know\npeople who had polio, for example, or had measles or mumps or any of those\ndiseases. And it's to the point now that not only do most parents not have any\npersonal experience with endemic vaccine-preventable diseases. Frankly, most\nproviders who are active nowadays grew up in an era, and certainly were trained\nin an era, where there was, at best, outbreaks of disease. And so, because of\nthat, there was a complacency that existed among many people that they don't see\nthese diseases out in their community, they know there are ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1921.0,1981.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"risks associated with\nthe vaccines, and so it makes some sense, logically, to not want to have your\nchild vaccinated. But the concern is, is that you don't know the risks\nassociated with it and that if herd immunity is sufficiently undermined, in\nfact, these diseases will come back, and we will have outbreaks of these\ndiseases. And many of these diseases not only can have severe adverse events,\nthose can include dying. And so, the determination was made that in those states\nthat had a more complex system for asserting the exemption from vaccination that\nin fact, you had less people being exempted.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=1981.0,2034.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"What do I mean then by a more complex system? Typically what that ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2034.0,2041.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"constitutes is\na requirement that an individual be informed by a physician about the pros and\ncons of vaccination - of the possibility of getting the disease, the negatives,\nthe potential adverse effects of vaccination of the vaccinations themselves, and\nthen you will make an informed decision about whether or not to assert the\nexemption that you otherwise were thinking of having exerted, including actually\neven religious exemptions. We find that as folks get more educated about it that\nthey sometimes find that they're convinced that, in fact, it's in the interest\nof their own child to be vaccinated. And so, that's an example of the way that\nthe law has been modified to assist in creating a vaccine-preventable\ndisease--an infectious disease-free society by making sure that people are\nimmunized to the best extent ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2041.0,2101.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"possible.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2101.0,2101.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I would think too that some of the susceptible people would be\nchildren on chemotherapy, for instance, or people who are immune compromised for\nsome other reason. Are there ever--","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2101.0,2114.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: In fact, that's an interesting thing that you brought up because the\nreason that California in 2015 repealed their religious exemption and in fact,\ntheir philosophic exemption, was that there had been a big measles outbreak at\nDisneyland that year. Another gathering of a lot of people closely together and\nfolks from other countries and there were cases that were imported and people at\nthe park were vulnerable to it-- it's a very infectious disease and a number of\npeople got sick and it even spread a little bit around the United States as\nthose folks went home. And, partially in response to that, the state of\nCalifornia, where there are a number of these ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2114.0,2161.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"pockets of many people who have\nasserted a philosophic exemption to immunization. Which in my view, in some\ninstances is frankly not being adequately educated about the risks of the\ndisease creating an outbreak in a community and at the same time balancing in\ntheir mind, well, I only know about the adverse events about the vaccine rather\nthan the adverse events of the disease. And so, logically, people are choosing,\nin some cases, to not get immunized because they think, well, this is a good bet\nfor me, this is not really a risk for my child. But the problem is that because\nyou need herd immunity, in fact, and this ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2161.0,2221.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Disneyland outbreak showed, that you\njust never know when there might be an outbreak, that the more people who can be\nimmunized the better. And you mentioned about people having immune problems. In\nfact, there are folks for which vaccines are contraindicated. And in the\nCalifornia case there was an example of a young child in the Bay area, I\nbelieve, where the father was concerned that his child was attending a school\nwhere he believed that there were large numbers of children who were unimmunized.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2221.0,2254.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As just a side note, I might note right now that one of the other things that\nthey accomplished was getting a law passed that allowed people to find out how\nmany people, in fact, are claiming an exemption at your school so that you can\nhave some sense about the vulnerability that your individual child has given,\nagain, the herd immunity impact of vaccines. And in this particular instance\nwhere the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2254.0,2281.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"child was very immune-compromised, therefore, could not get the\nmeasles vaccine, but could have an incredibly severe reaction if he did get\nmeasles--the disease. The father went and lobbied the legislature to change\nthese laws. To take away the ability to have the philosophic exemption where\npeople based on whatever reason, whether they're educated or not, are deciding\nthat they are not going to immunize their child and his child and other\nvulnerable people who would like to be immunized are put at risk. And so that\nwas one of the reasons behind that change in the California law.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2281.0,2327.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Interesting. I wanted to go back for just a minute-- you mentioned\nsomething called Important Information Statements. Those were intended to help\npeople understand what the risks were for ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2327.0,2341.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccines, is that right?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2341.0,2343.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Correct.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2343.0,2344.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, can you give us an example of, for instance, maybe what the polio\nvaccine statement would say?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2344.0,2352.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure. Okay, and those have evolved a little bit over the years. The\nImportant Information Statements were created by CDC in response to the legal\nobligation that we took on through the addition to our purchase contracts for\nvaccine of the duty to warn clause where we said that we would notify people\nabout the risks associated with vaccines.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2352.0,2377.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And over the years, later that got codified in that there was a statute passed\nin 1986 called the National Childhood Vaccine Injury Act. Congress requires CDC\nto write what are now called Vaccine Information Statements that are provided to\neveryone then who receives these particular vaccines that are covered by that\nprogram, whether or not they receive ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2377.0,2401.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccine that's been purchased by CDC. In\nthe past, CDC would've purchased vaccine that was used in public health clinics,\nwith the creation of the Vaccines for Children Program in 1994 also in many\nprivate doctors' offices. But initially, our requirement under the duty to warn\nclause was only to inform folks who were getting vaccine purchased by the\nfederal government through CDC's contracts. And that 1986 law, the National\nChildhood Vaccine Injury Act, required CDC to write those materials for use by\nevery provider in the United States who administers any routinely administered\nchildhood vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2401.0,2447.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And what those do is--it's interesting the way that, I mentioned that those\nthings have evolved over time. The initial law required CDC to write those\nthrough a ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2447.0,2461.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"rule-making process, which is a legal, statutory process under the\nAdministrative Procedure Act, which is a fairly convoluted process through which\nyou publish a proposed regulation in the Federal Register seeking public\ncomment, you analyze the comments and you come out with a final version of that.\nWe found that with those particular materials that it was a years-long process\nto develop those materials, and we ended up because of the detail through which\nthat law required us to list the types of things to be covered by the Vaccine\nInformation Statements at that time, that we ended up with vaccine information\nmaterials that were often ten pages long. And we started thinking that given the\ncontext of where you get a Vaccine Information Statement. You're typically\ngetting it at the doctor's ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2461.0,2521.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"appointment, the well child appointment, where you\ndon't have a lot of time, you're out there in the waiting room with your child,\nmaybe some other children, might be a little bit unruly. You're sometimes given\nthese materials there, or other times you're given the materials actually in the\nexam room where you're going to see the physician. And we found that it wasn't\nvery practical, the idea that for each vaccine, you would read a ten-page\ndocument. So, there was an argument that you could actually, by providing people\ntoo much information, you were actually under-informing them because,\nrealistically, you knew that there was no way that they could read, much less\nunderstand, the content of those lengthy materials during that short period of\ntime. So, we sought a change in that law and a few years later, it changed it\nfrom having to go through a formal rule-making process, which is a bureaucratic\nprocess that itself requires a long period of time, to more of a process that's\ncomparable to that focused on developing any kind of public health ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2521.0,2581.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"education\nmaterials. And that's where the law requires CDC to develop materials in consult\nwith both medical providers and parents of children so that we get understanding\nnot only of where the physician is coming from, but where a parent (is coming from).","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2581.0,2602.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Often it is a brand-new parent, first child, where they are scared about many\nthings, scared about changing the kid's diaper, much less about the potential\nrisk that a vaccine may come from that -- what are the kinds of things that they\nneeded to know? And we determined that basically there were a few categories of\ninformation that would be good then and we came up with documents that we\nthought would accomplish that, which are two pages long, the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2602.0,2641.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Vaccine Information\nStatements. And each vaccine has them, many of the vaccines are multiple antigen\nvaccines, so you have measles, mumps, rubella given as a single vaccine and the\nVaccine Information Statements themselves cover all those things.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2641.0,2656.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The first thing we do is we talk about the history of the disease, why is it\nthat we needed to develop a vaccine for a particular illness, such as polio?\nPolio was a scourge for many, many, many years up into the 1950s before the\ncreation of the inactivated polio vaccine by Salk. Then later in the early '60s,\nthe creation of the oral polio vaccine by Sabin where--if nothing else, people's\nsummer lives were disrupted, that there was apparently a seasonality to polio,\nand typically then, it was during the summer that people were getting it a lot\nand so a lot of communities closed down their ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2656.0,2701.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"pools.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2701.0,2701.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Once again, it's that whole thing of people congregating close together-- that's\nwhere the risk is created. And so, the ability for people to congregate together\nwas at risk, with the risk of polio developing. And so, the incredible\ndevelopment of these two vaccines allowed folks to be vaccinated and then for\nthese diseases to eventually go away in the United States. And we're on the cusp\nof actually polio being eradicated from the entire planet Earth with only a\ncouple of countries left where there is any endemic polio, and that's because of\nthe success of these vaccines. And so, we wanted to provide some historical\ncontext because, as I mentioned earlier, folks don't have, generally speaking,\nmost people in the United States, both parent, and ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2701.0,2761.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"provider, have no personal\nexperience with most vaccine-preventable diseases, and certainly with polio. And\nso, we wanted to give them the historical context. That these are the numbers of\npeople who each year came down with polio in the past, prior to the development\nof these vaccines and this is what happened after the creation of the vaccines--\nthat the numbers of cases plummeted to the point that the United States has not\nhad any endemic polio disease actually for decades now. But there's, again, this\nrisk that if not enough people are vaccinated, that it will be imported by folks\nwho are not immune and have the disease when they come to visit the United States.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2761.0,2808.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, the next thing that the Vaccine Information Statement does is it tells\nyou about the creation of the vaccine and then it tells you the way that the\nvaccine is ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2808.0,2821.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"used. For example, it's given at two, four and six months of age or\nit's given at a later time. Some of the other vaccines are not given until even\nthe teenage years. And beyond telling people what the schedule is, you want to\ntell them, well, what are the risks of the vaccine itself? What are the adverse\nevents that we know about with this vaccine? So that's the truly important\naspect of these Vaccine Information Statements and the original Important\nInformation Statements, is to inform people to the extent that they know then\nthat their child or themselves have a particular risk for an adverse event. For\nexample, some folks are allergic to components of vaccines and by letting them\nknow that - one of the classic things is folks who have an egg allergy for the\nway that most current influenza vaccines are made, in eggs, and that if you have\nan egg ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2821.0,2881.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"allergy it's not advisable to get the flu vaccine. So, by being informed\nof that, you know upfront to say hey, I can't get this vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2881.0,2892.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, by informing people about the adverse event risks and what the numbers\nare, it allows them to make an educated decision. And then you piggyback that on\nmy earlier discussion about the way that the process works for claiming\nexemptions from vaccination. To make sure that people, not just at the doctor,\nreceive the Vaccine Information Statement because they are there to get the\nvaccine. But they may find that it's in fact, not indicated for them to get the\nvaccine, but that folks who have decided that they're not going to get the\nvaccine at all are educated so that they make an informed decision about whether\nor not to get the vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2892.0,2939.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The other reason that these ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2939.0,2941.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Vaccine Information Statements are created is they\nalso provide people with information about a program that was created as another\nresult of the 1986 National Childhood Vaccine Injury Act, and that's the\ncreation of the National Vaccine Injury Compensation Program. What the Vaccine\nInformation Statements let people know is that in some rare instances,\nparticular people, in fact, will be injured by these vaccines.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2941.0,2970.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In the past, there was the tort provision under which folks could sue vaccine\nmanufacturers. Vaccine manufacturers started dropping out of the production of\nvaccines because there was a fair amount of litigation with that but given the\nnature of tort law where they are not, in fact, warrantying the quality of these\nproducts, they're not warrantying that you will never get sick or have an\nadverse event from a ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=2970.0,3001.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccination. In fact, under the tort provisions that talk\nabout the utility to society of having vaccines that are imperfect, that as long\nas you inform people about the risks associated with that you, the vaccine\nmanufacturer, will not be held accountable for that so that people can make an\ninformed decision about that. And so, in general, people aren't going--in the\ntort realm, people are not going to actually frequently prevail in this kind of\ntort litigation because they will, in fact, have been informed about the risks\nassociated with that vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3001.0,3049.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But given the very nature of vaccines, that they are administered to healthy\npeople, that they are good for the individual by preventing the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3049.0,3061.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"potential of a\ndisease that frankly is quite rare and which in some instances there may be some\nfairly measurable instance of adverse events, that by encouraging people to do\nthat when there's little actual disease in the United States and that they're\ndoing it on behalf of their community at large in order to create herd immunity,\nthe idea was that perhaps what we ought to do, is recognize the benefit that\npeople are giving to society and the fact that why should an individual whose\nchild or themselves is injured by a vaccine have to totally carry that burden\nthemselves when in fact they are doing work on behalf of society too by helping\ncreate herd immunity.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3061.0,3111.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so by creating the National Vaccine Injury Compensation Program, what\nCongress did is it set up a separate program outside of the tort ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3111.0,3121.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"system of\nproducts liability law in the states that puts an excise tax on each childhood\nvaccine used in the United States to create a fund for paying compensation for\npeople then who go through this program that's administered by the Department of\nHealth and Human Services through HRSA [Human Resources and Services\nAdministration] and through the Court of Federal Claims-- where the way it's set\nup is that if you have a particular adverse event that's known and has then been\neither placed by Congress through the passage of the initial law, or by HRSA in\nan amendment, in this vaccine injury table. If there are known adverse events\nwith particular vaccines and you can show that your timing of post-vaccination.\nYou had this particular adverse event happen to you. You are then able to get\ncompensation under this program through this no-fault ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3121.0,3181.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"system that was set up\nthat's administered through HRSA as I mentioned and the U.S. Court of Federal\nClaims, so that people can be compensated for doing good for our society and yet\nnot having to take the full burden of those risks.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3181.0,3200.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Unfortunately, one of the reasons that there's a lot of anti-vaccine sentiment,\nI think, in the United States is that children get vaccinated typically at a\nvery vulnerable time of their lives--in infancy when they are actually\nvulnerable to many kinds of risks. They don't have well-developed immune\nsystems. They may have any number of things that will happen to them during\ntheir first year of life that could just coincidentally happen following a\nvaccination that are temporally associated, we say, with the vaccination-- that\nis, they happen in some time frame after the child is ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3200.0,3241.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3241.0,3241.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So, while the Vaccine Injury Compensation Program will compensate people for\nadverse events that are shown to be associated with vaccines and there is a\nprocess through which you can prove that ones that are not otherwise previously\nknown, in fact, have been caused by vaccines. In fact, certain things happen,\ncertain adverse events happen that are temporally associated with a vaccination,\nbut in fact, were not caused by the vaccine. This is a not a program that will\ncompensate you in that instance. So, some folks are frankly frustrated by that.\nThere are people who believe that vaccines cause any number of adverse events\nthat they've witnessed in their child. As tragic as this particular event is in\nthat child's life, the vaccines are not the reason for that particular ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3241.0,3301.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"outcome.\nAnd in fact, many people are then protected by receiving vaccines by preventing\nthe very well-known adverse events from the diseases themselves that often can\nlead to severe problems from encephalitis to death to other less severe outcomes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3301.0,3322.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, the Vaccine Injury Act would give people money, commensurate with\ntheir injury from vaccine?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3322.0,3330.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Correct. The Vaccine Injury Compensation Program is not kind of a\ntort-light version. It's not meant--because it's an easier process--it's not\nmeant to just give you a discounted amount of money for what you have--your\nproven damages. In fact, it's meant to give people a fair amount of compensation\nfor the nature of the adverse event that they ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3330.0,3361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"suffered.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3361.0,3361.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: And you had some part in that act, in the wording of that, is that right?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3361.0,3369.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: No, it actually was passed a year before I came to work at CDC. I have\nhad some experience with some modifications to that law and also with a number\nof other laws that have been passed in the vaccine realm over the years,\nincluding the statute that passed the Vaccines for Children Program, which was a\nprogram that was passed by Congress in 1993 and then implemented in 1994. And\nwhat that did is that prior to that time, CDC through a grant program called\nSection 317, which references section 317 of the Public Health Service Act, in\nwhich Congress gives CDC money to fund states in preventing ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3369.0,3421.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"diseases. And one of\nthose ways is to buy vaccine. And so, CDC, for many, many years since the\ncreation of Section 317 grants has funded the purchase of vaccines for use in\npublic health clinics. The value in the passage of the Vaccines for Children\nProgram is that it expanded the availability of federally purchased vaccines.\nAnd in part, they passed that statute because there was an interest in keeping\npeople in their medical home. One of the things they found is that by--because\nvaccines were also more expensive and more vaccines were being created, and it\nwas becoming a financial burden on people to get vaccinated; so, more and more\nphysicians were referring folks to go to public health clinics to get\nvaccinated. But the problem with that is if you send someone who already is\nburdened with a lot of well-child visits with their newborn and of course all\nthe other challenges of having an ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3421.0,3481.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"infant in your life, that if you require them\nto go to one more appointment, that may never happen. And so, a lot of people\nwere not ending up at that appointment or if they did get there, that the\ninformation wasn't necessarily getting back to the individual's primary care\nprovider that in fact the person was vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3481.0,3513.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, by creation of the VFC [Vaccines For Children] Program, Congress\nauthorized CDC to purchase additional vaccine to then give to a group of\nchildren who are uninsured, are Medicaid eligible, are Indians, or in some\ninstances at particular clinics called Federally Qualified Health Centers or\nRural Health Clinics, are ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3513.0,3541.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"underinsured. That is where they actually do have\ninsurance, but their insurance doesn't cover a particular vaccination. And what\nthat did is that then allowed CDC to purchase more vaccine. In fact, CDC\npurchases over 50% of the childhood vaccine used in the United States and\ndistributes it then, not only to public health clinics, but also to individual\nprivate providers who register to become VFC providers, and they can provide\nthese vaccinations to the child in their medical home so that the child is more\nlikely to get the vaccine, will be seen by the physician who can help determine\nthat it's appropriate given their medical condition in that moment to be\nimmunized at that time, in addition to simply relying on the Vaccine Information\nStatements, and that there is follow-up so that future vaccines are, in fact,\nadministered on a timely basis. Related to that in kind of a similar time frame,\nCongress started funding the development of Immunization Information ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3541.0,3601.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Systems,\nwhich have typically been implemented at the state and local level where there\nare systems through which providers can both insert information that they've\nimmunized a particular child and can get information out to find out whether or\nnot the child has been vaccinated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3601.0,3618.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Another thing you don't want to do is you don't want to over-immunize because\nthere are risks associated with receiving too many doses of particular vaccines.\nAnd so, by being able to refer to this system, you can make sure you know\nwhether or not the person's already fully immunized, is missing particular doses\nor is needing the full range of doses. And so those systems have also been a\nvery good instance of the way that the law has assisted in making sure that\npeople are immunized, that parents don't have to remember all this or keep that\nlittle card that you may get that I remember as a ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3618.0,3661.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"parent, ending up getting\nrepeatedly because I could never keep track of that card after we took it home.\nAnd that these systems exist to help inform your provider and, in some\ninstances, then, it also provides information then, reminders are sent to\nparents to let them know that it's time to take their child to the doctor to be\nimmunized. Also, some of those in some states are used by the school systems. I\nmentioned that schools have become kind of the nexus of finding out, in fact,\nare kids fully immunized by the time they hit school when they are going to be\nin these closely congregated settings. And by having access to these\nImmunization Information Systems, a number of schools are in the position that\nthey can get this information directly without having to burden the parent to go\nto the ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3661.0,3721.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"provider to get a copy of that particular immunization card.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3721.0,3725.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Those are digitized records?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3725.0,3727.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: They are typically digitized, correct.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3727.0,3729.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: Must save a lot of work for a lot of people.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3729.0,3734.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: I think it does. And I think they continue to grow, and CDC plays a\nstrong role, both in funding those and in assisting in their further development.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3734.0,3746.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: I guess what we have left is maybe talking about your international\nwork a little bit. You wanted to mention some of that and what it was like.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3746.0,3758.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure, okay, yeah, I've said I worked at CDC for 30 years. I started out\nwhere most of my colleagues were specialists, and I was kind of the generalist\nfor much of CDC, and as the agency has grown, we've gone from seven lawyers in\n1987 to over 24 now. And the world has become a more sophisticated, ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3758.0,3782.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"complicated\nplace and people have realized the value of law-- there's public health law. CDC\nhas a separate program beyond our in-house legal counsel called the Public\nHealth Law Program that is a resource to folks out there in the community, to\nstates, and others. Helping them develop laws at the state level that can help\nwith public health in creating ways for the law to assist in achieving the\nobjectives of public health.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3782.0,3817.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I know then, as I became more specialized, I was peeling off more and more\nlayers of the parts of CDC that I was the legal advisor for while always keeping\nimmunization because partly, I was having kids at that--throughout most of that\ntime so I had a personal interest in it and ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3817.0,3842.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"certainly brought that perspective\nto my work here. And CDC at the same time was starting to expand a lot\ninternationally, and it was becoming obvious that we needed to gear up from the\nlegal side to provide knowledgeable legal advice for working abroad.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3842.0,3863.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And so, I thought well, that's something I'd like to pick up. I knew that there\nwas this program called STOP, Stop Transmission of Polio program, that's\nimplemented primarily through the World Health Organization through a number of\nentities including CDC where the goal is to eradicate polio from the planet as\nsmallpox had been eradicated over 40 years ago. And I thought well, you know, I\nwould like to be one of the people. They basically have people go out on these\nSTOP ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3863.0,3902.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"fellowships, if you will, around the world where they help with National\nImmunization Days where every child in a country is immunized with oral polio\nvaccine on a particular day-- working on the logistics of setting up those sorts\nof things as surveillance, other sorts of things. I spoke to my colleagues in\nthe Immunization Program about my interest in that-- I don't think they could\never quite see the role of the lawyer in such work abroad and so I didn't end up\ngetting that opportunity. However, it did whet my appetite for the international\nworld, and certainly, a lot of my work was involved in advising our\ninternational program, not only through the STOP program but also with measles\nand a number of other programs beyond vaccines abroad. And so, I was able to\nparticipate in another CDC program called ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3902.0,3962.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"IETA. IETA is the International\nExperience and Technical Assistance fellowship program that CDC has for training\ncohorts of individuals to work abroad in CDC's ever-growing offices around the\nworld. And I applied for that program and was accepted and ended up working as\nthe acting Deputy Director for the Tanzania office of CDC in the early part of\nthe 21st century for a few months. And it was very helpful for me, not only in\nbeing able to provide assistance to CDC and its incredible work that it does\nabroad but being able to see the context of how CDC does its work in other\ncultures and within the diplomatic framework of working with other ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=3962.0,4022.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"governments.\nAnd so, that I believe, has helped me as I came back here and am now the Team\nLeader for what we call our Global Health Law Team of several lawyers who\nprovide legal advice to CDC on the full range of its international activities,\nincluding global polio eradication.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4022.0,4045.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: So, when you were working in the other countries, you worked with\nother lawyers as well as coordinators of vaccine programs and can you describe\nmore of your work?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4045.0,4059.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Sure. A lot of it was working more with diplomats than with lawyers. The\nfederal government doesn't station a lot of lawyers abroad. We often work\nthrough the auspices of the U.S. Embassy in country. The State Department itself\ntypically has their lawyers based back in Washington, D.C. and not ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4059.0,4082.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"abroad. That\nwas another interesting thing I picked up from my experience abroad is people\ndon't have ready access then to lawyers. And just given time zone differences\nalone, it can be problematic in the moment that some legal issue comes up to get\nlegal advice for some problem that may exist. And so, part of that was just\nunderstanding that challenge that people have in the field. So that helped in\ndeveloping materials that folks can use in the field for dealing with certain\nlegal issues without having to talk directly to a lawyer at the time.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4082.0,4125.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Certainly, we had a lot of contact with the diplomats in these other countries,\nwith the ministries of health in particular and with our U.S. diplomats in\nworking on the various legal--the various public health problems that almost\nalways ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4125.0,4142.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"dovetail into having some kind of legal significance that requires legal input.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4142.0,4172.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/152","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: You must have been so useful for them to have you ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4172.0,4202.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/153","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"there. ","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4202.0,4262.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/154","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"MALONE: Frankly, I think it was more a benefit to me to be able to just learn,\nlearn these things. But I hope that I provided some value from my law degree too.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4262.0,4307.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/155","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"TORGHELE: That's a good place for us to wrap up.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4307.0,4321.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/transcript/70453/annotation/156","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":" 1","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=4321.0,4322.0"}]},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/index/85545","type":"AnnotationPage","label":{"en":["2016.400.29 [Index]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/index/85545/annotation/157","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Educational Background/CDC  ","format":"text/plain","label":{"en":["Title"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=47.0,194.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/index/85545/annotation/158","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"Mr. Malone introduces his educational background and his work as a lawyer in the General Counsel’s Office of CDC. ","format":"text/plain","label":{"en":["Synopsis"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=47.0,194.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/index/85545/annotation/159","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"So, to start, would you tell us a little bit about your background and how you came to be working at CDC all these years? 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","format":"text/plain","label":{"en":["Synopsis"]}}],"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511#t=553.0,721.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2846/collection_resources/134221/file/250511/index/85545/annotation/169","type":"Annotation","motivation":"supplementing","body":[{"type":"TextualBody","value":"You can now talk a little bit more specifically about polio, when you first started to get involved with that and what that was like for you? 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