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One of the first patients
I had to see as a pediatrician was Sol,
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a beautiful month-old baby
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who was admitted with signs
of a severe respiratory infection.
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Until then, I had never seen
a patient worsen so fast.
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In just two days
she was connected to a respirator
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and on the third day she died.
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Sol had whooping cough.
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After discussing the case in the room
and after a quite distressing catharsis,
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I remember my chief resident said to me,
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"Okay, take a deep breath. Wash your face.
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And now comes the hardest part:
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We have to go talk to her parents."
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At that time, a thousand questions
came to mind,
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from, "How could a one month-old
baby be so unfortunate?"
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to, "Could we have done
something about it?"
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Before vaccines existed,
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many infectious diseases
killed millions of people per year.
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During the 1918 flu pandemic
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50 million people died.
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That's greater than Argentina's
current population.
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Perhaps, the older ones among you
remember the polio epidemic
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that occurred in Argentina in 1956.
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At that time, there was no vaccine
available against polio.
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People didn't know what to do.
They were going crazy.
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They would go painting trees
with caustic lime.
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They'd put little bags of camphor
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in their children's underwear,
as if that could do something.
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During the polio epidemic,
thousands of people died.
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And thousands of people were left
with very significant neurological damage.
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I know this because I read about it,
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because thanks to vaccines,
my generation was lucky
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to not live through an epidemic
as terrible as this.
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Vaccines are one of the great successes
of the 20th century's public health.
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After potable water,
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they are the interventions
that have most reduced mortality,
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even more than antibiotics.
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Vaccines eradicated terrible diseases
such as smallpox from the planet
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and succeeded in significantly
reducing mortality
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due to other diseases such as measles,
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whooping cough, polio and many more.
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All these diseases are considered
vaccine-preventable diseases.
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What does this mean?
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That they are potentially preventable,
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but in order to be so,
something must be done.
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You need to get vaccinated.
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I imagine that most,
if not all of us here today,
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received a vaccine
at some point in our life.
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Now, I'm not so sure that many of us know
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which vaccines or boosters
we should receive after adolescence.
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Have you ever wondered
who we are protecting
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when we vaccinate?
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What do I mean by that?
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Is there any other effect
beyond protecting ourselves?
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Let me show you something.
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Imagine for a moment
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that we are in a city
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that has never had a case
of a particular disease,
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such as the measles.
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This would mean that no one in the city
has ever had contact with the disease.
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No one has natural defenses against,
nor been vaccinated against measles.
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If one day, a person sick with the measles
appears in this city
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the disease won't find much resistance
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and will begin spreading
from person to person,
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and in no time it will disseminate
throughout the community.
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After a certain time
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a big part of the population will be ill.
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This happened when there were no vaccines.
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Now, imagine the complete opposite case.
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We are in a city
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where more than 90 percent
of the population
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has defenses against
the measles, which means
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that they either had the disease,
survived, and developed natural defenses;
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or that they had been
immunized against measles.
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If one day,
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a person sick with the measles
appears in this city,
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the disease will find much more resistance
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and won't be transmitted
that much from person to person.
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The spread will probably remain contained
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and a measles outbreak won't happen.
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I would like you
to pay attention to something.
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People who are vaccinated
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are not only protecting themselves,
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but by blocking the dissemination
of the disease
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within the community,
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they are indirectly protecting
the people in this community
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who are not vaccinated.
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They create a kind of protective shield
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which prevents them from
coming in contact with the disease,
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so that these people are protected.
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This indirect protection
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that the unvaccinated people
within a community receive
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simply by being surrounded
by vaccinated people,
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is called herd immunity.
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Many people in the community
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depend almost exclusively
on this herd immunity
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to be protected against disease.
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The unvaccinated people you see
in infographics are not just hypothetical.
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Those people are our nieces
and nephews, our children,
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who may be too young
to receive their first shots.
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They are our parents, our siblings,
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our acquaintances,
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who may have a disease,
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or take medication
that lowers their defenses.
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There are also people who are
allergic to a particular vaccine.
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They could even be among us,
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any of us who got vaccinated,
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but the vaccine didn't produce
the expected effect,
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because not all vaccines
are always 100 percent effective.
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All these people depend
almost exclusively on herd immunity
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to be protected against diseases.
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To achieve this effect of herd immunity,
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it is necessary that a large percentage
of the population be vaccinated.
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This percentage is called the threshold.
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The threshold depends on many variables:
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It depends on the germ's characteristics,
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and those of the immune response
that the vaccine generates.
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But they all have something in common.
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If the percentage of the population
in a vaccinated community
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is below this threshold number,
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the disease will begin
to spread more freely
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and may generate an outbreak
of this disease within the community.
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Even diseases which were
at some point controlled may reappear.
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This is not just a theory.
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This has happened,
and is still happening.
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In 1998, a British researcher
published an article
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in one of the most important
medical journals,
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saying that the MMR vaccine,
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which is given for measles,
mumps and rubella,
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was associated with autism.
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This generated an immediate impact.
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People began to stop getting vaccinated,
and stopped vaccinating their children.
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And what happened?
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The number of people vaccinated,
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in many communities around the world,
fell below this threshold.
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And there were outbreaks of measles
in many cities in the world.
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In the U.S., in Europe.
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Many people got sick.
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People died of measles.
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What happened?
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This article also generated a huge stir
within the medical community.
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Dozens of researchers began to assess
if this was actually true.
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Not only could no one find
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a causal association between MMR
and autism at the population level,
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but it was also found that this article
had incorrect claims.
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Even more, it was fraudulent.
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It was fraudulent.
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In fact, the journal publicly retracted
the article in 2010.
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One of the main concerns and excuses
for not getting vaccinated
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are the adverse effects.
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Vaccines, like other drugs,
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can have potential adverse effects.
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Most are mild and temporary.
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But the benefits are always greater
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than possible complications.
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When we are ill,
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we want to heal fast.
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Many of us who are here
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take antibiotics
when we have an infection,
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We take anti-hypertensives
when we have high blood pressure;
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we take cardiac medications.
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Why? Because we are sick
and we want to heal fast.
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And we don't question it much.
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Why is it so difficult
to think of preventing diseases,
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by taking care of ourselves
when we are healthy?
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We take care of ourselves a lot
when affected by an illness,
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or in situations of imminent danger.
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I imagine most of us here,
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remember the influenza-A pandemic
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which broke out in 2009
in Argentina and worldwide.
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When the first cases
began to come to light,
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we, here in Argentina,
were entering the winter season.
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We knew absolutely nothing.
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Everything was a mess.
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People wore masks on the street,
ran into pharmacies to buy alcohol gel.
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People would queue up
in pharmacies to get a vaccine,
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without even knowing
if it was the right vaccine
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that would protect them
against this new virus.
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We knew absolutely nothing.
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At that time, in addition to doing
my fellowship at the Infant Foundation,
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I worked as a home pediatrician
for a prepaid medicine company.
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I remember that I started
my shift at 8 a.m.,
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and by 8, I already had a list
of 50 scheduled visits.
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It was chaos,
people didn't know what to do.
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I remember the types of patients
that I was examining.
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The patients were a little older than
what we were used to seeing in winter,
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with longer fevers.
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And I mentioned that
to my fellowship mentor,
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and he, for his part, had heard
the same from a colleague,
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about the large number
of pregnant women
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and young adults
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being hospitalized in intensive care,
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with difficult to manage
clinical profiles.
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At that time, we set out to understand
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what was happening.
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First thing Monday morning,
we took the car
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and went to a hospital
in Buenos Aires province,
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that served as a referral hospital
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for cases of the new influenza virus.
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We arrived at the hospital;
it was crowded.
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All health staff were dressed
in NASA-like bio-safety suits.
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We all had face masks in our pockets.
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I, being a hypochondriac,
didn't breathe for two hours.
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But we could see what was happening.
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Immediately, we started
reaching out to pediatricians
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from six hospitals in the city
and the Buenos Aires province.
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Our main goal was to find out
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how this new virus behaved
in contact with our children,
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in the shortest time possible.
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A marathon work.
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In less than three months
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we could see what effect
this new H1N1 virus had
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on the 251 children
hospitalized by this virus.
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We could see which children
got more seriously ill:
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children under four, especially those
less than one year old;
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patients with neurological diseases,
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and young children
with chronic pulmonary diseases.
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Identifying these at-risk groups
was important
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to include them as priority groups
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in the recommendations
for getting the influenza vaccine,
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not only here in Argentina,
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but also in other countries
which the pandemic not yet reached.
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A year later,
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when a vaccine against the pandemic
H1N1 virus became available,
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we wanted to see what had happened.
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After a huge vaccination campaign
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aimed at protecting at-risk groups,
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these hospitals,
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with 93 percent
of the at-risk groups vaccinated,
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had not hospitalized a single patient
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for the pandemic H1N1 virus.
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(Applause)
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In 2009:
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251.
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In 2010:
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Zero.
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Vaccination is an act
of individual responsibility,
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but it has a huge collective impact.
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If I get vaccinated,
not only am I protecting myself,
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but I am also protecting others.
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Sol had whooping cough.
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Sol was very young,
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and she hadn't yet received
her first vaccine against whooping cough.
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I still wonder what would have happened
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if everyone around Sol
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had been vaccinated.
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(Applause)