WEBVTT

00:00:00.280 --> 00:00:05.060
One of the first patients
I had to see as a pediatrician was Sol,

00:00:05.370 --> 00:00:08.150
a beautiful month-old baby

00:00:08.150 --> 00:00:11.830
who was admitted with signs
of a severe respiratory infection.

00:00:11.830 --> 00:00:16.110
Until then, I had never seen
a patient worsen so fast.

00:00:16.810 --> 00:00:19.810
In just two days
she was connected to a respirator

00:00:19.810 --> 00:00:22.550
and on the third day she died.

00:00:22.550 --> 00:00:25.300
Sol had whooping cough.

00:00:25.300 --> 00:00:30.010
After discussing the case in the room
and after a quite distressing catharsis,

00:00:30.460 --> 00:00:32.509
I remember my chief resident said to me,

00:00:32.509 --> 00:00:35.850
"Okay, take a deep breath. Wash your face.

00:00:36.430 --> 00:00:39.050
And now comes the hardest part:

00:00:39.050 --> 00:00:41.460
We have to go talk to her parents."

00:00:42.150 --> 00:00:46.120
At that time, a thousand questions
came to mind,

00:00:46.120 --> 00:00:50.450
from, "How could a one-month-old
baby be so unfortunate?"

00:00:51.200 --> 00:00:54.070
to, "Could we have done
something about it?"

NOTE Paragraph

00:00:55.400 --> 00:00:57.680
Before vaccines existed,

00:00:57.680 --> 00:01:02.550
many infectious diseases
killed millions of people per year.

00:01:03.100 --> 00:01:06.630
During the 1918 flu pandemic

00:01:06.630 --> 00:01:09.780
50 million people died.

00:01:09.780 --> 00:01:13.060
That's greater than Argentina's
current population.

00:01:13.060 --> 00:01:17.110
Perhaps, the older ones among you
remember the polio epidemic

00:01:17.110 --> 00:01:20.030
that occurred in Argentina in 1956.

00:01:20.240 --> 00:01:23.560
At that time, there was no vaccine
available against polio.

00:01:23.560 --> 00:01:26.090
People didn't know what to do.
They were going crazy.

00:01:26.090 --> 00:01:28.370
They would go painting trees
with caustic lime.

00:01:28.370 --> 00:01:29.940
They'd put little bags of camphor

00:01:29.940 --> 00:01:33.460
in their children's underwear,
as if that could do something.

00:01:34.080 --> 00:01:38.600
During the polio epidemic,
thousands of people died.

00:01:38.600 --> 00:01:42.770
And thousands of people were left
with very significant neurological damage.

00:01:44.650 --> 00:01:47.290
I know this because I read about it,

00:01:47.290 --> 00:01:51.080
because thanks to vaccines,
my generation was lucky

00:01:51.080 --> 00:01:53.890
to not live through an epidemic
as terrible as this.

NOTE Paragraph

00:01:53.890 --> 00:01:58.680
Vaccines are one of the great successes
of the 20th century's public health.

00:01:59.210 --> 00:02:01.230
After potable water,

00:02:01.230 --> 00:02:04.840
they are the interventions
that have most reduced mortality,

00:02:04.840 --> 00:02:06.970
even more than antibiotics.

00:02:07.570 --> 00:02:12.560
Vaccines eradicated terrible diseases
such as smallpox from the planet

00:02:12.590 --> 00:02:16.200
and succeeded in significantly
reducing mortality

00:02:16.200 --> 00:02:18.450
due to other diseases such as measles,

00:02:18.450 --> 00:02:21.780
whooping cough, polio and many more.

NOTE Paragraph

00:02:22.320 --> 00:02:29.200
All these diseases are considered
vaccine-preventable diseases.

00:02:29.910 --> 00:02:31.670
What does this mean?

00:02:31.670 --> 00:02:34.690
That they are potentially preventable,

00:02:34.690 --> 00:02:37.660
but in order to be so,
something must be done.

00:02:37.660 --> 00:02:39.760
You need to get vaccinated.

00:02:40.270 --> 00:02:43.970
I imagine that most,
if not all of us here today,

00:02:43.970 --> 00:02:47.210
received a vaccine
at some point in our life.

00:02:48.510 --> 00:02:52.960
Now, I'm not so sure that many of us know

00:02:52.960 --> 00:02:57.290
which vaccines or boosters
we should receive after adolescence.

00:02:58.710 --> 00:03:02.790
Have you ever wondered
who we are protecting

00:03:02.790 --> 00:03:04.640
when we vaccinate?

00:03:05.070 --> 00:03:06.700
What do I mean by that?

00:03:06.700 --> 00:03:11.670
Is there any other effect
beyond protecting ourselves?

NOTE Paragraph

00:03:13.050 --> 00:03:15.170
Let me show you something.

00:03:15.760 --> 00:03:18.220
Imagine for a moment

00:03:18.220 --> 00:03:20.230
that we are in a city

00:03:20.230 --> 00:03:23.480
that has never had a case
of a particular disease,

00:03:23.480 --> 00:03:25.180
such as the measles.

00:03:25.430 --> 00:03:30.290
This would mean that no one in the city
has ever had contact with the disease.

00:03:30.290 --> 00:03:34.880
No one has natural defenses against,
nor been vaccinated against measles.

00:03:35.680 --> 00:03:40.420
If one day, a person sick with the measles
appears in this city

00:03:41.000 --> 00:03:44.510
the disease won't find much resistance

00:03:44.510 --> 00:03:47.440
and will begin spreading
from person to person,

00:03:47.440 --> 00:03:51.500
and in no time it will disseminate
throughout the community.

00:03:51.810 --> 00:03:53.530
After a certain time

00:03:53.530 --> 00:03:56.900
a big part of the population will be ill.

00:03:57.750 --> 00:04:01.910
This happened when there were no vaccines.

NOTE Paragraph

00:04:02.630 --> 00:04:07.110
Now, imagine the complete opposite case.

00:04:07.420 --> 00:04:09.830
We are in a city

00:04:09.830 --> 00:04:12.650
where more than 90 percent
of the population

00:04:12.650 --> 00:04:15.100
has defenses against
the measles, which means

00:04:15.100 --> 00:04:18.839
that they either had the disease,
survived, and developed natural defenses;

00:04:18.839 --> 00:04:22.540
or that they had been
immunized against measles.

00:04:23.200 --> 00:04:24.810
If one day,

00:04:24.810 --> 00:04:28.740
a person sick with the measles
appears in this city,

00:04:29.230 --> 00:04:32.610
the disease will find much more resistance

00:04:32.610 --> 00:04:36.100
and won't be transmitted
that much from person to person.

00:04:36.780 --> 00:04:40.330
The spread will probably remain contained

00:04:40.750 --> 00:04:43.680
and a measles outbreak won't happen.

NOTE Paragraph

00:04:45.060 --> 00:04:47.760
I would like you
to pay attention to something.

00:04:48.810 --> 00:04:51.490
People who are vaccinated

00:04:51.490 --> 00:04:54.290
are not only protecting themselves,

00:04:54.290 --> 00:04:57.900
but by blocking the dissemination
of the disease

00:04:57.900 --> 00:04:59.540
within the community,

00:04:59.540 --> 00:05:04.220
they are indirectly protecting
the people in this community

00:05:04.220 --> 00:05:06.390
who are not vaccinated.

00:05:06.690 --> 00:05:09.660
They create a kind of protective shield

00:05:09.660 --> 00:05:12.760
which prevents them from
coming in contact with the disease,

00:05:12.760 --> 00:05:15.380
so that these people are protected.

00:05:16.670 --> 00:05:19.870
This indirect protection

00:05:19.870 --> 00:05:23.370
that the unvaccinated people
within a community receive

00:05:23.370 --> 00:05:27.380
simply by being surrounded
by vaccinated people,

00:05:27.950 --> 00:05:31.010
is called herd immunity.

NOTE Paragraph

00:05:33.130 --> 00:05:35.590
Many people in the community

00:05:35.590 --> 00:05:39.090
depend almost exclusively
on this herd immunity

00:05:39.090 --> 00:05:41.750
to be protected against disease.

00:05:42.760 --> 00:05:46.720
The unvaccinated people you see
in infographics are not just hypothetical.

00:05:47.260 --> 00:05:50.600
Those people are our nieces
and nephews, our children,

00:05:50.600 --> 00:05:53.970
who may be too young
to receive their first shots.

00:05:55.100 --> 00:05:57.410
They are our parents, our siblings,

00:05:57.410 --> 00:05:58.840
our acquaintances,

00:05:58.840 --> 00:06:00.710
who may have a disease,

00:06:00.710 --> 00:06:04.360
or take medication
that lowers their defenses.

00:06:06.010 --> 00:06:10.080
There are also people who are
allergic to a particular vaccine.

00:06:11.350 --> 00:06:13.750
They could even be among us,

00:06:13.750 --> 00:06:15.610
any of us who got vaccinated,

00:06:15.610 --> 00:06:19.410
but the vaccine didn't produce
the expected effect,

00:06:19.410 --> 00:06:23.600
because not all vaccines
are always 100 percent effective.

00:06:23.600 --> 00:06:28.800
All these people depend
almost exclusively on herd immunity

00:06:28.800 --> 00:06:31.360
to be protected against diseases.

NOTE Paragraph

00:06:32.390 --> 00:06:37.200
To achieve this effect of herd immunity,

00:06:37.200 --> 00:06:41.870
it is necessary that a large percentage
of the population be vaccinated.

00:06:42.500 --> 00:06:45.570
This percentage is called the threshold.

00:06:45.570 --> 00:06:49.330
The threshold depends on many variables:

00:06:49.330 --> 00:06:51.740
It depends on the germ's characteristics,

00:06:51.740 --> 00:06:56.040
and those of the immune response
that the vaccine generates.

00:06:56.040 --> 00:06:58.430
But they all have something in common.

00:06:58.430 --> 00:07:03.640
If the percentage of the population
in a vaccinated community

00:07:03.980 --> 00:07:07.050
is below this threshold number,

00:07:07.050 --> 00:07:11.110
the disease will begin
to spread more freely

00:07:11.110 --> 00:07:15.780
and may generate an outbreak
of this disease within the community.

00:07:15.780 --> 00:07:22.860
Even diseases which were 
at some point controlled may reappear.

NOTE Paragraph

00:07:24.550 --> 00:07:26.740
This is not just a theory.

00:07:26.740 --> 00:07:29.100
This has happened,
and is still happening.

00:07:31.050 --> 00:07:35.750
In 1998, a British researcher
published an article

00:07:35.750 --> 00:07:38.530
in one of the most important
medical journals,

00:07:38.530 --> 00:07:41.150
saying that the MMR vaccine,

00:07:41.150 --> 00:07:43.880
which is given for measles,
mumps and rubella,

00:07:43.880 --> 00:07:45.750
was associated with autism.

00:07:45.750 --> 00:07:48.450
This generated an immediate impact.

00:07:49.010 --> 00:07:53.660
People began to stop getting vaccinated,
and stopped vaccinating their children.

00:07:53.680 --> 00:07:55.300
And what happened?

00:07:55.300 --> 00:07:57.980
The number of people vaccinated,

00:07:57.980 --> 00:08:01.960
in many communities around the world,
fell below this threshold.

00:08:01.960 --> 00:08:05.520
And there were outbreaks of measles
in many cities in the world --

00:08:05.520 --> 00:08:07.960
in the U.S., in Europe.

00:08:07.960 --> 00:08:10.120
Many people got sick.

00:08:10.120 --> 00:08:12.900
People died of measles.

00:08:13.870 --> 00:08:15.350
What happened?

NOTE Paragraph

00:08:15.350 --> 00:08:19.470
This article also generated a huge stir
within the medical community.

00:08:20.020 --> 00:08:23.690
Dozens of researchers began to assess
if this was actually true.

00:08:25.130 --> 00:08:28.420
Not only could no one find

00:08:28.420 --> 00:08:33.669
a causal association between MMR
and autism at the population level,

00:08:33.669 --> 00:08:38.570
but it was also found that this article
had incorrect claims.

00:08:38.820 --> 00:08:41.370
Even more, it was fraudulent.

00:08:42.120 --> 00:08:44.510
It was fraudulent.

00:08:45.120 --> 00:08:51.550
In fact, the journal publicly retracted
the article in 2010.

00:08:52.880 --> 00:08:56.780
One of the main concerns and excuses
for not getting vaccinated

00:08:56.780 --> 00:08:58.970
are the adverse effects.

NOTE Paragraph

00:08:59.770 --> 00:09:05.410
Vaccines, like other drugs,
can have potential adverse effects.

00:09:05.970 --> 00:09:08.480
Most are mild and temporary.

00:09:08.480 --> 00:09:14.470
But the benefits are always greater
than possible complications.

00:09:15.740 --> 00:09:20.300
When we are ill,
we want to heal fast.

00:09:20.300 --> 00:09:22.420
Many of us who are here

00:09:22.420 --> 00:09:26.090
take antibiotics
when we have an infection,

00:09:26.090 --> 00:09:29.270
we take anti-hypertensives
when we have high blood pressure,

00:09:29.270 --> 00:09:31.450
we take cardiac medications.

00:09:31.450 --> 00:09:34.700
Why? Because we are sick
and we want to heal fast.

00:09:34.700 --> 00:09:36.720
And we don't question it much.

00:09:36.720 --> 00:09:41.150
Why is it so difficult
to think of preventing diseases,

00:09:41.890 --> 00:09:45.100
by taking care of ourselves
when we are healthy?

00:09:45.100 --> 00:09:48.290
We take care of ourselves a lot
when affected by an illness,

00:09:48.290 --> 00:09:51.250
or in situations of imminent danger.

NOTE Paragraph

00:09:52.140 --> 00:09:54.810
I imagine most of us here,

00:09:54.810 --> 00:09:58.540
remember the influenza-A pandemic

00:09:58.540 --> 00:10:01.930
which broke out in 2009
in Argentina and worldwide.

00:10:02.490 --> 00:10:05.520
When the first cases
began to come to light,

00:10:05.520 --> 00:10:09.360
we, here in Argentina,
were entering the winter season.

00:10:09.910 --> 00:10:12.120
We knew absolutely nothing.

00:10:12.120 --> 00:10:13.530
Everything was a mess.

00:10:13.530 --> 00:10:18.900
People wore masks on the street,
ran into pharmacies to buy alcohol gel.

00:10:18.900 --> 00:10:22.250
People would line up
in pharmacies to get a vaccine,

00:10:22.250 --> 00:10:24.810
without even knowing
if it was the right vaccine

00:10:24.810 --> 00:10:27.350
that would protect them
against this new virus.

00:10:27.350 --> 00:10:29.650
We knew absolutely nothing.

00:10:29.650 --> 00:10:34.480
At that time, in addition to doing
my fellowship at the Infant Foundation,

00:10:34.740 --> 00:10:38.650
I worked as a home pediatrician
for a prepaid medicine company.

00:10:39.670 --> 00:10:42.910
I remember that I started
my shift at 8 a.m.,

00:10:42.910 --> 00:10:47.060
and by 8, I already had a list
of 50 scheduled visits.

00:10:47.060 --> 00:10:49.940
It was chaos;
people didn't know what to do.

00:10:50.860 --> 00:10:55.410
I remember the types of patients
that I was examining.

00:10:55.690 --> 00:11:00.050
The patients were a little older than
what we were used to seeing in winter,

00:11:00.050 --> 00:11:02.390
with longer fevers.

NOTE Paragraph

00:11:02.390 --> 00:11:06.070
And I mentioned that
to my fellowship mentor,

00:11:06.070 --> 00:11:09.590
and he, for his part, had heard
the same from a colleague,

00:11:09.590 --> 00:11:12.320
about the large number
of pregnant women

00:11:12.320 --> 00:11:14.010
and young adults

00:11:14.010 --> 00:11:16.250
being hospitalized in intensive care,

00:11:16.250 --> 00:11:19.160
with hard-to-manage clinical profiles.

00:11:20.760 --> 00:11:26.600
At that time, we set out to understand
what was happening.

00:11:27.300 --> 00:11:30.420
First thing Monday morning,
we took the car

00:11:30.420 --> 00:11:33.350
and went to a hospital
in Buenos Aires Province,

00:11:33.350 --> 00:11:39.020
that served as a referral hospital
for cases of the new influenza virus.

00:11:39.020 --> 00:11:41.550
We arrived at the hospital;
it was crowded.

00:11:41.550 --> 00:11:45.470
All health staff were dressed
in NASA-like bio-safety suits.

00:11:45.470 --> 00:11:47.670
We all had face masks in our pockets.

00:11:47.670 --> 00:11:50.400
I, being a hypochondriac,
didn't breathe for two hours.

00:11:50.400 --> 00:11:53.520
But we could see what was happening.

00:11:53.520 --> 00:11:57.210
Immediately, we started
reaching out to pediatricians

00:11:57.210 --> 00:12:01.430
from six hospitals in the city
and in Buenos Aires Province.

00:12:01.440 --> 00:12:04.770
Our main goal was to find out

00:12:04.770 --> 00:12:08.660
how this new virus behaved
in contact with our children,

00:12:08.660 --> 00:12:11.240
in the shortest time possible.

00:12:11.240 --> 00:12:14.200
A marathon work.

00:12:14.200 --> 00:12:17.070
In less than three months,

00:12:17.070 --> 00:12:23.160
we could see what effect
this new H1N1 virus had

00:12:23.160 --> 00:12:29.300
on the 251 children
hospitalized by this virus.

00:12:29.520 --> 00:12:33.500
We could see which children
got more seriously ill:

00:12:33.500 --> 00:12:37.120
children under four, especially those
less than one year old;

00:12:37.120 --> 00:12:39.920
patients with neurological diseases;

00:12:39.920 --> 00:12:43.210
and young children
with chronic pulmonary diseases.

00:12:43.210 --> 00:12:48.020
Identifying these at-risk groups
was important

00:12:48.020 --> 00:12:50.730
to include them as priority groups

00:12:50.730 --> 00:12:53.730
in the recommendations
for getting the influenza vaccine,

00:12:53.730 --> 00:12:55.590
not only here in Argentina,

00:12:55.590 --> 00:12:59.650
but also in other countries
which the pandemic not yet reached.

NOTE Paragraph

00:13:00.750 --> 00:13:02.430
A year later,

00:13:02.430 --> 00:13:07.520
when a vaccine against the pandemic
H1N1 virus became available,

00:13:07.520 --> 00:13:10.240
we wanted to see what happened.

00:13:10.240 --> 00:13:13.410
After a huge vaccination campaign

00:13:13.410 --> 00:13:18.180
aimed at protecting at-risk groups,

00:13:18.180 --> 00:13:25.140
these hospitals, with 93 percent
of the at-risk groups vaccinated,

00:13:25.140 --> 00:13:28.770
had not hospitalized a single patient

00:13:28.770 --> 00:13:31.450
for the pandemic H1N1 virus.

00:13:31.450 --> 00:13:34.500
(Applause)

00:13:35.920 --> 00:13:39.880
In 2009: 251.

00:13:41.490 --> 00:13:44.440
In 2010: zero.

NOTE Paragraph

00:13:44.440 --> 00:13:49.220
Vaccination is an act
of individual responsibility,

00:13:49.220 --> 00:13:53.250
but it has a huge collective impact.

00:13:54.790 --> 00:13:59.410
If I get vaccinated,
not only am I protecting myself,

00:13:59.420 --> 00:14:02.630
but I am also protecting others.

00:14:03.520 --> 00:14:05.890
Sol had whooping cough.

00:14:07.500 --> 00:14:09.700
Sol was very young,

00:14:09.700 --> 00:14:14.230
and she hadn't yet received
her first vaccine against whooping cough.

00:14:15.160 --> 00:14:18.960
I still wonder what would have happened

00:14:18.960 --> 00:14:24.870
if everyone around Sol
had been vaccinated.

00:14:25.740 --> 00:14:27.800
(Applause)