0:00:00.280,0:00:05.060
One of the first patients[br]I had to see as a pediatrician was Sol,

0:00:05.370,0:00:08.150
a beautiful month-old baby

0:00:08.150,0:00:11.830
who was admitted with signs[br]of a severe respiratory infection.

0:00:11.830,0:00:16.110
Until then, I had never seen[br]a patient worsen so fast.

0:00:16.810,0:00:19.810
In just two days[br]she was connected to a respirator

0:00:19.810,0:00:22.550
and on the third day she died.

0:00:22.550,0:00:25.300
Sol had whooping cough.

0:00:25.300,0:00:30.010
After discussing the case in the room[br]and after a quite distressing catharsis,

0:00:30.460,0:00:32.509
I remember my chief resident said to me,

0:00:32.509,0:00:35.850
"Okay, take a deep breath. Wash your face.

0:00:36.430,0:00:39.050
And now comes the hardest part:

0:00:39.050,0:00:41.460
We have to go talk to her parents."

0:00:42.150,0:00:46.120
At that time, a thousand questions[br]came to mind,

0:00:46.120,0:00:50.450
from, "How could a one-month-old[br]baby be so unfortunate?"

0:00:51.200,0:00:54.070
to, "Could we have done[br]something about it?"

0:00:55.400,0:00:57.680
Before vaccines existed,

0:00:57.680,0:01:02.550
many infectious diseases[br]killed millions of people per year.

0:01:03.100,0:01:06.630
During the 1918 flu pandemic

0:01:06.630,0:01:09.780
50 million people died.

0:01:09.780,0:01:13.060
That's greater than Argentina's[br]current population.

0:01:13.060,0:01:17.110
Perhaps, the older ones among you[br]remember the polio epidemic

0:01:17.110,0:01:20.030
that occurred in Argentina in 1956.

0:01:20.240,0:01:23.560
At that time, there was no vaccine[br]available against polio.

0:01:23.560,0:01:26.090
People didn't know what to do.[br]They were going crazy.

0:01:26.090,0:01:28.370
They would go painting trees[br]with caustic lime.

0:01:28.370,0:01:29.940
They'd put little bags of camphor

0:01:29.940,0:01:33.460
in their children's underwear,[br]as if that could do something.

0:01:34.080,0:01:38.600
During the polio epidemic,[br]thousands of people died.

0:01:38.600,0:01:42.770
And thousands of people were left[br]with very significant neurological damage.

0:01:44.650,0:01:47.290
I know this because I read about it,

0:01:47.290,0:01:51.080
because thanks to vaccines,[br]my generation was lucky

0:01:51.080,0:01:53.890
to not live through an epidemic[br]as terrible as this.

0:01:53.890,0:01:58.680
Vaccines are one of the great successes[br]of the 20th century's public health.

0:01:59.210,0:02:01.230
After potable water,

0:02:01.230,0:02:04.840
they are the interventions[br]that have most reduced mortality,

0:02:04.840,0:02:06.970
even more than antibiotics.

0:02:07.570,0:02:12.560
Vaccines eradicated terrible diseases[br]such as smallpox from the planet

0:02:12.590,0:02:16.200
and succeeded in significantly[br]reducing mortality

0:02:16.200,0:02:18.450
due to other diseases such as measles,

0:02:18.450,0:02:21.780
whooping cough, polio and many more.

0:02:22.320,0:02:29.200
All these diseases are considered[br]vaccine-preventable diseases.

0:02:29.910,0:02:31.670
What does this mean?

0:02:31.670,0:02:34.690
That they are potentially preventable,

0:02:34.690,0:02:37.660
but in order to be so,[br]something must be done.

0:02:37.660,0:02:39.760
You need to get vaccinated.

0:02:40.270,0:02:43.970
I imagine that most,[br]if not all of us here today,

0:02:43.970,0:02:47.210
received a vaccine[br]at some point in our life.

0:02:48.510,0:02:52.960
Now, I'm not so sure that many of us know

0:02:52.960,0:02:57.290
which vaccines or boosters[br]we should receive after adolescence.

0:02:58.710,0:03:02.790
Have you ever wondered[br]who we are protecting

0:03:02.790,0:03:04.640
when we vaccinate?

0:03:05.070,0:03:06.700
What do I mean by that?

0:03:06.700,0:03:11.670
Is there any other effect[br]beyond protecting ourselves?

0:03:13.050,0:03:15.170
Let me show you something.

0:03:15.760,0:03:18.220
Imagine for a moment

0:03:18.220,0:03:20.230
that we are in a city

0:03:20.230,0:03:23.480
that has never had a case[br]of a particular disease,

0:03:23.480,0:03:25.180
such as the measles.

0:03:25.430,0:03:30.290
This would mean that no one in the city[br]has ever had contact with the disease.

0:03:30.290,0:03:34.880
No one has natural defenses against,[br]nor been vaccinated against measles.

0:03:35.680,0:03:40.420
If one day, a person sick with the measles[br]appears in this city

0:03:41.000,0:03:44.510
the disease won't find much resistance

0:03:44.510,0:03:47.440
and will begin spreading[br]from person to person,

0:03:47.440,0:03:51.500
and in no time it will disseminate[br]throughout the community.

0:03:51.810,0:03:53.530
After a certain time

0:03:53.530,0:03:56.900
a big part of the population will be ill.

0:03:57.750,0:04:01.910
This happened when there were no vaccines.

0:04:02.630,0:04:07.110
Now, imagine the complete opposite case.

0:04:07.420,0:04:09.830
We are in a city

0:04:09.830,0:04:12.650
where more than 90 percent[br]of the population

0:04:12.650,0:04:15.100
has defenses against[br]the measles, which means

0:04:15.100,0:04:18.839
that they either had the disease,[br]survived, and developed natural defenses;

0:04:18.839,0:04:22.540
or that they had been[br]immunized against measles.

0:04:23.200,0:04:24.810
If one day,

0:04:24.810,0:04:28.740
a person sick with the measles[br]appears in this city,

0:04:29.230,0:04:32.610
the disease will find much more resistance

0:04:32.610,0:04:36.100
and won't be transmitted[br]that much from person to person.

0:04:36.780,0:04:40.330
The spread will probably remain contained

0:04:40.750,0:04:43.680
and a measles outbreak won't happen.

0:04:45.060,0:04:47.760
I would like you[br]to pay attention to something.

0:04:48.810,0:04:51.490
People who are vaccinated

0:04:51.490,0:04:54.290
are not only protecting themselves,

0:04:54.290,0:04:57.900
but by blocking the dissemination[br]of the disease

0:04:57.900,0:04:59.540
within the community,

0:04:59.540,0:05:04.220
they are indirectly protecting[br]the people in this community

0:05:04.220,0:05:06.390
who are not vaccinated.

0:05:06.690,0:05:09.660
They create a kind of protective shield

0:05:09.660,0:05:12.760
which prevents them from[br]coming in contact with the disease,

0:05:12.760,0:05:15.380
so that these people are protected.

0:05:16.670,0:05:19.870
This indirect protection

0:05:19.870,0:05:23.370
that the unvaccinated people[br]within a community receive

0:05:23.370,0:05:27.380
simply by being surrounded[br]by vaccinated people,

0:05:27.950,0:05:31.010
is called herd immunity.

0:05:33.130,0:05:35.590
Many people in the community

0:05:35.590,0:05:39.090
depend almost exclusively[br]on this herd immunity

0:05:39.090,0:05:41.750
to be protected against disease.

0:05:42.760,0:05:46.720
The unvaccinated people you see[br]in infographics are not just hypothetical.

0:05:47.260,0:05:50.600
Those people are our nieces[br]and nephews, our children,

0:05:50.600,0:05:53.970
who may be too young[br]to receive their first shots.

0:05:55.100,0:05:57.410
They are our parents, our siblings,

0:05:57.410,0:05:58.840
our acquaintances,

0:05:58.840,0:06:00.710
who may have a disease,

0:06:00.710,0:06:04.360
or take medication[br]that lowers their defenses.

0:06:06.010,0:06:10.080
There are also people who are[br]allergic to a particular vaccine.

0:06:11.350,0:06:13.750
They could even be among us,

0:06:13.750,0:06:15.610
any of us who got vaccinated,

0:06:15.610,0:06:19.410
but the vaccine didn't produce[br]the expected effect,

0:06:19.410,0:06:23.600
because not all vaccines[br]are always 100 percent effective.

0:06:23.600,0:06:28.800
All these people depend[br]almost exclusively on herd immunity

0:06:28.800,0:06:31.360
to be protected against diseases.

0:06:32.390,0:06:37.200
To achieve this effect of herd immunity,

0:06:37.200,0:06:41.870
it is necessary that a large percentage[br]of the population be vaccinated.

0:06:42.500,0:06:45.570
This percentage is called the threshold.

0:06:45.570,0:06:49.330
The threshold depends on many variables:

0:06:49.330,0:06:51.740
It depends on the germ's characteristics,

0:06:51.740,0:06:56.040
and those of the immune response[br]that the vaccine generates.

0:06:56.040,0:06:58.430
But they all have something in common.

0:06:58.430,0:07:03.640
If the percentage of the population[br]in a vaccinated community

0:07:03.980,0:07:07.050
is below this threshold number,

0:07:07.050,0:07:11.110
the disease will begin[br]to spread more freely

0:07:11.110,0:07:15.780
and may generate an outbreak[br]of this disease within the community.

0:07:15.780,0:07:22.860
Even diseases which were [br]at some point controlled may reappear.

0:07:24.550,0:07:26.740
This is not just a theory.

0:07:26.740,0:07:29.100
This has happened,[br]and is still happening.

0:07:31.050,0:07:35.750
In 1998, a British researcher[br]published an article

0:07:35.750,0:07:38.530
in one of the most important[br]medical journals,

0:07:38.530,0:07:41.150
saying that the MMR vaccine,

0:07:41.150,0:07:43.880
which is given for measles,[br]mumps and rubella,

0:07:43.880,0:07:45.750
was associated with autism.

0:07:45.750,0:07:48.450
This generated an immediate impact.

0:07:49.010,0:07:53.660
People began to stop getting vaccinated,[br]and stopped vaccinating their children.

0:07:53.680,0:07:55.300
And what happened?

0:07:55.300,0:07:57.980
The number of people vaccinated,

0:07:57.980,0:08:01.960
in many communities around the world,[br]fell below this threshold.

0:08:01.960,0:08:05.520
And there were outbreaks of measles[br]in many cities in the world --

0:08:05.520,0:08:07.960
in the U.S., in Europe.

0:08:07.960,0:08:10.120
Many people got sick.

0:08:10.120,0:08:12.900
People died of measles.

0:08:13.870,0:08:15.350
What happened?

0:08:15.350,0:08:19.470
This article also generated a huge stir[br]within the medical community.

0:08:20.020,0:08:23.690
Dozens of researchers began to assess[br]if this was actually true.

0:08:25.130,0:08:28.420
Not only could no one find

0:08:28.420,0:08:33.669
a causal association between MMR[br]and autism at the population level,

0:08:33.669,0:08:38.570
but it was also found that this article[br]had incorrect claims.

0:08:38.820,0:08:41.370
Even more, it was fraudulent.

0:08:42.120,0:08:44.510
It was fraudulent.

0:08:45.120,0:08:51.550
In fact, the journal publicly retracted[br]the article in 2010.

0:08:52.880,0:08:56.780
One of the main concerns and excuses[br]for not getting vaccinated

0:08:56.780,0:08:58.970
are the adverse effects.

0:08:59.770,0:09:05.410
Vaccines, like other drugs,[br]can have potential adverse effects.

0:09:05.970,0:09:08.480
Most are mild and temporary.

0:09:08.480,0:09:14.470
But the benefits are always greater[br]than possible complications.

0:09:15.740,0:09:20.300
When we are ill,[br]we want to heal fast.

0:09:20.300,0:09:22.420
Many of us who are here

0:09:22.420,0:09:26.090
take antibiotics[br]when we have an infection,

0:09:26.090,0:09:29.270
we take anti-hypertensives[br]when we have high blood pressure,

0:09:29.270,0:09:31.450
we take cardiac medications.

0:09:31.450,0:09:34.700
Why? Because we are sick[br]and we want to heal fast.

0:09:34.700,0:09:36.720
And we don't question it much.

0:09:36.720,0:09:41.150
Why is it so difficult[br]to think of preventing diseases,

0:09:41.890,0:09:45.100
by taking care of ourselves[br]when we are healthy?

0:09:45.100,0:09:48.290
We take care of ourselves a lot[br]when affected by an illness,

0:09:48.290,0:09:51.250
or in situations of imminent danger.

0:09:52.140,0:09:54.810
I imagine most of us here,

0:09:54.810,0:09:58.540
remember the influenza-A pandemic

0:09:58.540,0:10:01.930
which broke out in 2009[br]in Argentina and worldwide.

0:10:02.490,0:10:05.520
When the first cases[br]began to come to light,

0:10:05.520,0:10:09.360
we, here in Argentina,[br]were entering the winter season.

0:10:09.910,0:10:12.120
We knew absolutely nothing.

0:10:12.120,0:10:13.530
Everything was a mess.

0:10:13.530,0:10:18.900
People wore masks on the street,[br]ran into pharmacies to buy alcohol gel.

0:10:18.900,0:10:22.250
People would line up[br]in pharmacies to get a vaccine,

0:10:22.250,0:10:24.810
without even knowing[br]if it was the right vaccine

0:10:24.810,0:10:27.350
that would protect them[br]against this new virus.

0:10:27.350,0:10:29.650
We knew absolutely nothing.

0:10:29.650,0:10:34.480
At that time, in addition to doing[br]my fellowship at the Infant Foundation,

0:10:34.740,0:10:38.650
I worked as a home pediatrician[br]for a prepaid medicine company.

0:10:39.670,0:10:42.910
I remember that I started[br]my shift at 8 a.m.,

0:10:42.910,0:10:47.060
and by 8, I already had a list[br]of 50 scheduled visits.

0:10:47.060,0:10:49.940
It was chaos;[br]people didn't know what to do.

0:10:50.860,0:10:55.410
I remember the types of patients[br]that I was examining.

0:10:55.690,0:11:00.050
The patients were a little older than[br]what we were used to seeing in winter,

0:11:00.050,0:11:02.390
with longer fevers.

0:11:02.390,0:11:06.070
And I mentioned that[br]to my fellowship mentor,

0:11:06.070,0:11:09.590
and he, for his part, had heard[br]the same from a colleague,

0:11:09.590,0:11:12.320
about the large number[br]of pregnant women

0:11:12.320,0:11:14.010
and young adults

0:11:14.010,0:11:16.250
being hospitalized in intensive care,

0:11:16.250,0:11:19.160
with hard-to-manage clinical profiles.

0:11:20.760,0:11:26.600
At that time, we set out to understand[br]what was happening.

0:11:27.300,0:11:30.420
First thing Monday morning,[br]we took the car

0:11:30.420,0:11:33.350
and went to a hospital[br]in Buenos Aires Province,

0:11:33.350,0:11:39.020
that served as a referral hospital[br]for cases of the new influenza virus.

0:11:39.020,0:11:41.550
We arrived at the hospital;[br]it was crowded.

0:11:41.550,0:11:45.470
All health staff were dressed[br]in NASA-like bio-safety suits.

0:11:45.470,0:11:47.670
We all had face masks in our pockets.

0:11:47.670,0:11:50.400
I, being a hypochondriac,[br]didn't breathe for two hours.

0:11:50.400,0:11:53.520
But we could see what was happening.

0:11:53.520,0:11:57.210
Immediately, we started[br]reaching out to pediatricians

0:11:57.210,0:12:01.430
from six hospitals in the city[br]and in Buenos Aires Province.

0:12:01.440,0:12:04.770
Our main goal was to find out

0:12:04.770,0:12:08.660
how this new virus behaved[br]in contact with our children,

0:12:08.660,0:12:11.240
in the shortest time possible.

0:12:11.240,0:12:14.200
A marathon work.

0:12:14.200,0:12:17.070
In less than three months,

0:12:17.070,0:12:23.160
we could see what effect[br]this new H1N1 virus had

0:12:23.160,0:12:29.300
on the 251 children[br]hospitalized by this virus.

0:12:29.520,0:12:33.500
We could see which children[br]got more seriously ill:

0:12:33.500,0:12:37.120
children under four, especially those[br]less than one year old;

0:12:37.120,0:12:39.920
patients with neurological diseases;

0:12:39.920,0:12:43.210
and young children[br]with chronic pulmonary diseases.

0:12:43.210,0:12:48.020
Identifying these at-risk groups[br]was important

0:12:48.020,0:12:50.730
to include them as priority groups

0:12:50.730,0:12:53.730
in the recommendations[br]for getting the influenza vaccine,

0:12:53.730,0:12:55.590
not only here in Argentina,

0:12:55.590,0:12:59.650
but also in other countries[br]which the pandemic not yet reached.

0:13:00.750,0:13:02.430
A year later,

0:13:02.430,0:13:07.520
when a vaccine against the pandemic[br]H1N1 virus became available,

0:13:07.520,0:13:10.240
we wanted to see what happened.

0:13:10.240,0:13:13.410
After a huge vaccination campaign

0:13:13.410,0:13:18.180
aimed at protecting at-risk groups,

0:13:18.180,0:13:25.140
these hospitals, with 93 percent[br]of the at-risk groups vaccinated,

0:13:25.140,0:13:28.770
had not hospitalized a single patient

0:13:28.770,0:13:31.450
for the pandemic H1N1 virus.

0:13:31.450,0:13:34.500
(Applause)

0:13:35.920,0:13:39.880
In 2009: 251.

0:13:41.490,0:13:44.440
In 2010: zero.

0:13:44.440,0:13:49.220
Vaccination is an act[br]of individual responsibility,

0:13:49.220,0:13:53.250
but it has a huge collective impact.

0:13:54.790,0:13:59.410
If I get vaccinated,[br]not only am I protecting myself,

0:13:59.420,0:14:02.630
but I am also protecting others.

0:14:03.520,0:14:05.890
Sol had whooping cough.

0:14:07.500,0:14:09.700
Sol was very young,

0:14:09.700,0:14:14.230
and she hadn't yet received[br]her first vaccine against whooping cough.

0:14:15.160,0:14:18.960
I still wonder what would have happened

0:14:18.960,0:14:24.870
if everyone around Sol[br]had been vaccinated.

0:14:25.740,0:14:27.800
(Applause)