Chairman the committee will come to order. The department of health and Human Services, everybody is sitting six feet apart. All Witnesses Today are participating in person. We thank you for that. Participatingare by videoconference. I would like to say a word about masks. The office of attending physicians advised us we may remove the mask and talk to the microphone as long as we are six feet apart. Msak imask isy off. When i am walking the senate floor, i am wearing a mask. Simple clothsd, help from transmitting it to others. Unfortunately this practice has become part of the political debate that says if you are forced from you do not wear a mask, if you are against trump you do. I suggested the president occasionally wear a mask even though, in most cases, it is not necessary for him to do so. The president has plenty of admirers. They would follow his lead. End this help an political debate. The stakes are too high about this to continue. Masksrs and staff wear because we do not want to make each other sick heard for. Exposed on my was way to Dallas Airport and had to self quarantine for two weeks. The Senate Physician told me one reason i did not become infected was because the staff member was wearing a mask and that greatly anuced the chances of exposure. I like to wear my plans mask. Dr. Fauci uses his to demonstrate his loyalty to the washington nationals. Senator kaine is either a cowboy or a bandit, i am never first sure wish. Sure which. [laughter] theathletic director of university of tennessee said, if you want to see football this fall, wear a mask. That may have more influence than anybody else in tennessee. The United States is in the midst of a concerning rising cases. The experts in front of us have told us washing our hands, staying apart, wearing a mask are three of the most important ways to contain the disease and slow the spread of the virus. I am grateful to the rules committee, the press calvary, the architect of the capitol police, Committee Staff both democratic and republican, and all for their hard work to keep us safe. Senator murray and i will each have an Opening Statement and then we turn to our witnesses who we thank for being with us today. Each will have five minutes. We ask you to summarize your testimony in five minutes and then the senators will have a chance to ask if fiveminute round of questions. We have full participation today. It should be an interesting morning. Among the casualties of this dangerous and very sneaky covid19 virus are the 75 Million Students who were sent home from school and college in march. Add the teachers who were not prepared to teach remotely and the working parents who have children at home and not prepared to homeschool. Seasons and sports the graduation opportunities. Then there were o unprecedented dilemmas for school budgets. Being home from school does not rank with the sickness and death the virus has caused. The United States has over 2. 5 deaths cases and 125,000 according to Johns Hopkins. Well states and communities continue to take action to keep people safe nothing is more disruptive to American Life and nothing heading back toward normalcy then those public and private schools and colleges to reopen. Month thiss Committee Heard from College President and School Leaders about safely reopening this fall. s hearing is an opportunity for an update this hearing is an opportunity for an update. This Committee Last heard on may 12 when three were quarantined and most senators were participating virtually. That was one of the First VirtualSenate Hearings in history as surely the best watched. Every network carried the 2. 5 hours of statements, questions, and answers. The question before the country today is not whether to go back to school or college or childcare or work, but how to do it safely. Even though covid19 is not, in general, her Young Children and collegeage students nearly as much as older and more vulnerable americans there is some health risk. In my view the greater risk is not going back to school. Guidance for reopening schools from the American Academy of pediatricians tells administrators the following. Hour academy strongly believes all policy considerations should start with a goal of having students physically present in school. The academy continues, in Person Learning is well documented. There is already evidence of negative impacts on children because of school closures. Lengthy time away from schools and associated interruptions of supported services often results in social isolation making it difficult for schools to identify and address learning deficits as well as physical or sexual abuse, substance use, depression, and suicidal ideation. This in turn places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational and social impact there has been substantial impact on Food Security and physical activity for children and families as the American Academy of pediatricians says. Theincoming president of massachusetts chapter of that academy of pediatricians told reporters, while for most children covid19 has not had the devastating and lifethreatening physical effects that have occurred in adults the negative impact on socials of element, education, has been substantial. Many american colleges overall considered the best in the world will be permanently damaged or even closed. Ofch daniels the president purdue, failure to take on the job of reopening would not only be antiscientific, but an unacceptable breach of duty. In addition to hearing more about the concerning rise in cases and hospitalizations in some states i would like to ask yourselveses to put in the place of one of americas approximately 14,000 superintendents of School Districts or the principal or headmaster of one of hundred 35,000 schools or president or andcellor of 6000 colleges help them answer the question of how to reopen schools and colleges safely. Dr. Fauci, i hope in your Opening Statement or answers you will suggest steps a superintendent might take to open School Safely. Not only had to keep children safe, but the adults, teachers, parents, grandparents with whom they come in contact. Dr. Hahn, will there be treatment or medicines this fall that will speed the recovery or reduce the possibility of death . I belief your of going back to school, or going anywhere these days, is in large part because of the fear of severe illness or death. If that risk can be lessened by treatments, it should increase confidence in going back to school. I would also like to commend dr. Hahn and the work the fda did to get tests on the market as quickly as possible to help understand the spread of the virus. Since then the fda has worked out which tests have not worked as well as they should and taken steps to remove them from the market. That is what is supposed to happen and the urgency of a pandemic. R, you said you hoped there were dies in diagnostic testing by september . Is that true . How does the school make sure gets those and who pays for them . What are the prospect from the shark tank that there will be reliable and inexpensive tests so we can have even more widespread testing . Dr. Redfield, you continue to work on updated guidelines of going back to school and College Employees are cdc going to be available to work with School Districts to develop their plans . What advice do you have about the arrival of the flu season at the same time as covid19 . Discuss, but to there will be time to answer most of those questions. Let me quickly highlight three areas that have come up in earlier hearings that i think need clarification. Contact tracing is crucially important. It identifies the people who might have been exposed so that people do not in turn expose someone else. According to a npr report states have already hired 37,000 contact tracers. State officials and john hopkins issued a report estimating the need for as many as 100,000 contact tracers. Several imports suggested congress appropriate money to pay for those tracers. The reality is Congress Already has. On april 24, congress appropriated 11 billion which has been sent to states and tribes for the expensive testing. That legislation explicitly said the money could be used for Contact Tracing. To 755in addition million from the first emergency legislation on march 6 that could be used for Contact Tracing. That is in addition to the march 27 legislation in which congress appropriated 150 billion i mean 1. 5 billion in the cares act for states, territories, and tribes to use for preparedness and response. Thecares act also included 150 billion to states, but a significant amount of that has not been spent even though it is all designated for expenses related to covid19 which include Contact Tracing. For example, tennessees governor told me he is reserving as much as 1 billion so he could determine what flexibility he has. Washington state has not spent as much as 1. 2 billion. The Missouri State treasury has spent about 1 billion. According to the report by state Health Officials and Johns Hopkins the average salary would be a little more than 35,000. This adds up to 3. 5 billion for 1000 tracers. The point is congress has already sent to states plenty of money to hire all of the contact tracers needed. Second, who pays for the testing . Congress voted to make all covid19 tests available to patients at no cost. This meant insurers would cover diagnostic tests which detect whether a person is currently infected. Whichantibody tests indicate whether a person who has had covid19 in the past and may have protection in the future. Guidance from the labor department, treasury department, and centers for medicare and medicaid said last week that insurers are only required to pay for tests without patient cost sharing if a Doctor Orders it. I agree with that, but given that the cdc recommends doctors finally, flu shots. The cdc says more people need to get flu shots this fall so healthcare workers can better distinguish between covid19 and the flu. The cdc says the priority is for children over the age of six months to be vaccinated for the flu so they do not become sick and pass it to more vulnerable populations who could have more severe consequences. On january 24, senator murray and i hosted our first bipartisan briefing at a time when there were only four cases in the United States. Since then this committee has had four more briefings. Today is the eighth on coronavirus and u. S. Preparedness. Last weeks hearing was about steps to take this year while our eye is on the ball to better prepare for the next pandemic. I have issued a white paper outlining five recommendations for congress to prepare americans for the next pandemic. That paper is receiving more 350 comments that are available to all senators of the committee. I will conclude the hearing by asking our witnesses if they have two or three suggestions about steps congress should take this year to deal with the next pandemic, most of which will also help with this one. This hearing is about what happens now. As administrators prepare to reopen schools and colleges, experts underestimated this dangerous and sneaky virus and there is still much we do not know about it. But we do know the basic steps to take to reopen schools and colleges in 2020 before there is a vaccine and those are these social distance, wearing mask, nds, contact tracers, and isolate those who are sick. Hopefully by the fall there will be treatments to make the consequences less severe. I look forward to hearing from our distinguish witnesses how School Leaders and College President s can safely reopen 135 ,. Schools and 6000 colleges as well as the treatments we can expect before vaccines arrive. Senator murray. Murray thank you for joining us today and thank you to our staff for setting up the technology so we can move this hearing along. I want to get to the point quickly and i am going to be blunt. The covid19 response in our country is still a disaster. ,000 lives lost was once considered an estimate on the high end of the spectrum, but the year is halfway over and it is a grim reality. We have lost more americans to covid19 then we lose to the flu each year, in lost to the Opioid Crisis last year, and what that we have lost in every american war except the civil war and world war ii. Despite what President Trump claims this pandemic is not fading. Far from it. Several states are seeing rapid, recordsetting increases in the country just saw its largest single day increase to date. While this Public Health crisis rages across the country we have seen a leadership crisis ranging in the white house as the president proves time after time he cares less about how this pandemic is impacting families and communities and more about how it makes him look. Just consider his appalling continued failure on testing. President trump said, anyone who wants to test can get a test. They still cannot pick he said testing was overrated. It is not. He said we prevailed on testing. We have not. Now he is saying we should be doing fewer tests and testing makes us look bad. It clearly does not and we clearly need to be doing more. The most honest thing he has set about testing is that he does not take responsibility at all. That is exactly the problem. It is why Congress Took bipartisan action in the last covid19 response bill to required the Trump Administration to submit a comprehensive National Testing plan and why i am still pushing his administration to include more details in that plan and take more steps to ramp up testing. We are still nowhere close to the testing and tracing capacity we need to safely reopen our fortry and ending support federal testing sites is not going to get us there. The ongoing struggle to get President Trump to take testing seriously should be a stark warning to congress then when it comes to a vaccine, we cannot just leave this administration to its own devices. We have to hold it accountable. We know this pandemic will not end until we have a vaccine that a safe and effective that can be widely produced and equitably distributed and that it is free and accessible to everyone. Which is why we need a comprehensive National Vaccine plan from the Trump Administration as soon as possible. Given the testing plan, which congress only received after forcing the administrations hand, was too little, too late. We need to take the opportunity we have right now to get a vaccine plan much earlier and avoid the missteps we have seen. I hope republicans will work with me in a bipartisan way once again to require this administration to put forward a plan. We need the Trump Administration to show us how they will ensure a vaccine that is safe and effective. I am as eager as anyone for a vaccine, but this is not just about doing something fast. It is about doing it right and that is why we need to know the process for developing a vaccine. Is rigorous, inclusive, transparent, and science driven. In light of the hydroxychloroquine debacle and we removal of dr. Price cannot take for granted this process will be free of political influence. We have to demand serious oversight. In order to give the public full confidence that a vaccine is safe and effective the Administration Needs to commit now to being fully transparent about the standard of vaccine will be expected to meet and releasing the Clinical Trial data the fda uses to evaluate safety and effectiveness. We also need a plan detailing how to produce and distribute vaccines nationwide and make sure everybody can actually get them. We saw with testing how avoidable bottlenecks create damaging delays when the federal government refuses to step in and lead like it needs to do in a time of crisis. Unfortunately, we saw how existing Health Disparities are exacerbated without a plan to overcome them as even the incomplete data we currently have shows blacks, latino, and tribal communities has significantly less testing than white communities. This is an injustice we must not repeat when it comes to vaccines. We need a plan to guarantee vaccines are free so cost is not a barrier for patients. It is worth noting we still need to make covid19 treatment available at no cost and the plan must address barriers like Vaccine Hesitancy and misinformation, especially when one of the most prominent sources of information so far has been the president of the United States. While the discovery of an eventual vaccine may be far off these are issues we need the administration to answer now. I hope republicans will work with me to require the administration to submit a comprehensive vaccine plan and address many of the other urgent issues stemming from this pandemic. Our businesses, workers, teachers, students, and families do not have what they need to safely return to work or school period. Our medical system, doctors, nurses, face on unimaginable risk and fatigue. They need congress to help step up. Families need us to ensure they have basic services and can keep food on their table. The house passed the heroes act 46 days ago to give more relief to front line workers, families, and businesses. It is past time for leader mcconnell and republicans to sit down with democrats and get to work. There is no question our country is still in crisis and every day the senate fails to take action is a day we allow it to get worse. Hope, we will have , mr. Chairman, we will get to have another hearing on this. Thank you. I look forward to our witnesse testimonies and the questions we have. Chairman thank you, senator murray. We ask each witness to summarize his testimony in five minutes. Each of you are making significant contributions to our government response to covid19, helping us go safely back to school, back to work. We are grateful for your service to our country. Our first witness is dr. Anthony fauci. He is director of the National Institute of allergy and Infectious Diseases at the National Institute of health. He held this position since 1984. He has led Research Related to hiv, aids, malaria, influenza, ebola, and other Infectious Diseases. He advised six president s on Global Health issues, he is one of the principal architects of the emergency plans for aids relief. In 2014 he was involved in nihting ebola patients at and worked on vaccine trials. Next, dr. Robert redfield. Director of the u. S. Center for Disease Control and prevention. Years, he has30 been involved with clinical Research Related to chronic human Infectious Diseases, especially hiv. He was founding director of the department of retroviral Research Within the u. S. Militarys hiv Research Program and retired after 20 years of service with the u. S. Army medical corps. Giroir. Dmiral he is the assistant secretary for health at the u. S. Department of health and Human Services. He oversees the development of the departments Public Health policy recommendations. Specific to covid19 response admiral giroir has taken on testing and focused on increasing the number of tests we can do with existing technology. His federal Service Includes directing the defense side office of the advanced research otherts and a variety of important responsibilities. Finally, we will hear from dr. Stephen hahn. He is the commissioner for the u. S. Food and drug administration. Before joining fda he held a position at the university of texan, Md Anderson Cancer Center and head of oncology at the university of pennsylvania. He was senior investigator at the National Cancer institute. He has been commander of the in. Public health corps 2005. We welcome our witnesses. Dr. Fauci, let us begin with you. Dr. Fauci thank you, mr. Chairman, Ranking Member murray, thank you for giving me the opportunity to discuss briefly with you the role of the National Institute of health and research addressing covid19. Will, duringted i the question period, address some of the issues regarding schools. Plan for Covid Research involves four major components. The first is to improve the fundamental knowledge and understanding of the biology of the virus and immune response to the virus in order to better inform us in development of diagnostic, therapeutics, and vaccines. Some of the work that has come out of that program informs how we will address Vaccine Development, particularly understanding the confirmation of the components of the virus that induce a immune response. We will develop and are developing animal models apropos of what you mentioned about children in school. Heroes a program called which is determining the incidence and transmissibility among children. A very important issue when you talk about opening schools and the impact that might have. The development of diagnostics, pointofcare, sensitive and specific diagnostics under the rad x program. Third, to characterize and test therapeutics. He mentioned this as we open up schools. There are a number of programs, very active, that have already shown efficacy or not in some drugs as well as Clinical Trials that are ongoing. One in particular was the first randomized placebocontrolled showing the drug remdesivir diminishes, by about 32 , the time it takes to get to recovery in people with advanced disease pulmonary involvement. We have another study combining this with an antiinflammatory agent. Next, we have vaccines. As several have mentioned it is extremely important to have safe and effective Vaccines Available for everyone in this country as well as globally. In that regard, would put together, myself and my colleagues and publish nice in a science magazine, a strategic approach to covid19 Vaccine Research and develop it. Plan,not a comprehensive about every aspect but it is a strong plan regarding the research and development pathway. What we have done in this is we have a harmonized effect because we know there are many vaccines that are in trial now at various stages and what we did, and the federal government thanks the generosity of congress, has put a considerable amount of money in order to harmonize the trials of multiple candidates from different companies. We have common endpoints, data and safety monitoring, and common immunological parameters that are being funded and being pursued. In addition, there are a number of different platforms that are being pursued so we do not have all our eggs in one basket. Ready asose is getting we approach next month of going into phase three trials and others will be staggered along the way in the middle of summer and early summer. Anyone involved will tell you we have a safe and effective vaccine, but we are cautiously optimistic looking at animal data in the preliminary data that we will now the extent know the extent of efficacy in early winter or the first part of next year. Hopefully, there will be doses available by the beginning of next year. These are things we feel hopeful about and we will continue to pursue this. I will stop there and be happy to answer questions later. Thank you. Chairman thank you, dr. Fauci. Dr. Redfield, welcome. Dr. Redfield good morning distinct members of the committee. I want to thank you for the opportunity to test before you today with my colleagues. The covid19 pandemic is the most significant Public Health challenge that we have faced as a nation and more than a century. In the United States, daily cases are increasing after an extended decline. We are seeing significant increases in the southeast and southwest regions. The number of jurisdictions in upper trajectory has continued to increase 29 out of 55 jurisdictions. The evidence tells us these cases are driven by many factors to include increased testing, community transmission, and outbreaks in the setting such as Nursing Homes and occupational settings. Hospitalizations are going up in 12 states and as of this Weekend Daily death has increased in the state of arizona. Cdc is closely monitoring these increases and have 48 teams with more than 140 staff currently deployed in 20 states and two territories. The cdc is providing Technical Expertise to the Health Departments in Contact Tracing, prevention and control, and communication. Beyond providing this the cdc is working with states and communities in other ways. Cdc is speaking with the states, tribal, local government to stop covid well reopening businesses and schools. The initial guidance for institutes of Higher Learning was shared in march in the k12 setting. These have been updated since and over the past several months as more information becomes available. We will continue to disseminate that broadly. The cdc released consolidated recommendations for covid testing including interim testing guidelines for Nursing Homes as well as testing options for high density Critical Infrastructure workplaces after covid cases are identified. Guidance for Higher Education and k12, the Higher Education should be posted today and k12 later this week. These recommendations are consistent with previously published testing guidelines and metoo supplement, not replace, the guidance of local jurisdictions. Risk who are at heightened with our most recent analysis has hospitalizations six times higher and death 12 times higher among those with underlying conditions compared to those who did not have these conditions. We have expanded the list of underlying conditions where the evidence is clear they put people at higher risk of severe illness. These conditions include chronic copd,ey disease, organ transplant, obesity, heart disease, sickle cell disease, and type 2 diabetes. Our analysis provides further evidence that racial and ethnic populations are disproportionately affected by this epidemic. While the data is the backbone, containing the outbreak depends on four interventions. Available testing, copperheads of Contact Tracing, timely isolation of known cases, and quarantine to break the transmission. We are not defenseless against this disease. We have powerful tools at our disposal social distancing, wearing a Face Covering in public, and be disciplined about the frequent handwashing. It is critical that we all take the personal responsibility to slow this transmission of covid19 and embrace the use of Face Coverings. Specifically i am addressing the younger members of society, the millennials and generation z. I ask those listening to spread the word. Before i close i would like to speak briefly about how cdc is assisting the front lines of our Health Departments. With your support cdc has 64rded 12 billion to jurisdictions. Public Health Laboratories are building resilience, the number of contact tracers has grown 345 . The disease impacts us all and it is going to take all of us working together to stop it. Together i believe we can achieve the possible. I look forward to your questions. Chairman thank you, dr. Redfield. Admiral giroir, welcome. Admiral giroir distinct members of the committee, it is good to see you again. I want to clarify my current role. On march 12, secretary as are laid the task force. Although i am assistant secretary i am maintaining coordinating testing including the nih red x along with dr. Collins. In order to get back safely to work and school the over arcing, most critical and essential action we must accomplish is to control the virus. Meaning rapidly extinguishing any outbreaks and minimizing community transmission. All of us are concerned about recent data from several states indicating rising infections and now an uptick in hospitalizations and deaths even as other states and the majority of counties are remaining low. Knowing what we know about a symptomatic transition, we can reverse these trends if we Work Together. First, we must take personal responsibility and be disciplined about our own behavior. Maintain physical distancing, wear a Face Covering whenever you cannot physically distance, wash your hands, stay at home if you feel sick, if you have been in close contact with someone infected or in a gathering without appropriate precautions, get tested. Shield the elderly and vulnerable of any age and follow the guidelines for opening up america again. The criteria are very specific and are as relevant today as when we release them. In addition, this week we are initiating surge testing in multiple communities of highest concern. Back to schools and businesses. As dr. Redfield stated, the cdc will release recommendations on k12, institutions of Higher Education, and general business reopening. These will include considerations for integrated testing especially surveillance testing into a comprehensive strategy. As you asked me if you are a superintendent of the School System or president of a university, number one, apply the cdc guidelines in consultation with your state and local public Health Officials so that testing is a part of your comprehensive plan which should also include prevention and clear mechanisms to isolate positive students. Number two, assure your testing needs are incorporated into your state testing plans. As we outlined in the National Testing strategy each state has developed, and will continue to build upon, a customized state testing plan developed according to the federal government. The next iteration covering july through december is due july 10. These estate plans drive the allocation of scarce resources. For example, in may and june the federal government distributed nearly 26 million collection swabs and over 19 million tubes of transport. Hhs also prioritizes allocation of certain Key Laboratory tests like pointofcare tests according to state specific needs. There are strategies particularly relevant to surveillance testing, especially in universities and businesses. Pooling samples, combining two or more samples and possibly up to 10 into a single test, makes sense where the prevalence is low. Itsuch surveillance testing can be conducted in a University Lab outside a normal environment. If the pooled sample is positive, every individual would need to be tested through the health system. I would like to close by recognizing my fellow officers in the United StatesPublic Health service corps. 4536 officers have been deployed, exemplifying the care and compassion that all of us feel for those who have suffered during this pandemic. I thank each and every one of these officers and their families and on their behalf, i sincerely thank all of you in congress for supporting our Training Needs and establishment of a Ready Reserve corps to supplement our ranks during inevitable future national emergencies. Thank you for the opportunity to provide these remarks. Chairman thank you. Thank you, admiral giroir. Welcome, dr. Hahn. Dr. Hahn thank you, chairman and members of the Health Committee. I appreciate the support you have all provided for our efforts during this time of covid19. Fda has a vital role the federal governments response to the pandemic. One of our Core Missions is to advance Public Health by speeding medical products that are safe and effective. We have provided appropriate regulatory flexibilitys to assure the American Public has access to medical products and safe food and confidence are decisions are based on medicine and science. Since the Public Health emergency was declared fda has issued more than 100 emergency use authorizations for diagnostic tests, personal protective equipment, ventilators, drug products and issued more than 50 guidance dock used to make sure the continuity of health care and food supply. I am pleased to announce that today fda is taking action to aid the Timely Development of a safe and effective vaccine to prevent covid19 by providing guidance for developers with recommendations on the data needed to facilitate manufacturing, Clinical Development, and approval. We recognize the urgent need to develop a safe and effective vaccine to prevent covid19 and we want to work collaboratively with industry researchers and other partners to accelerate these efforts. Fda is committed to expedite this work we will not cut corners in decisionmaking and we are making clear in our guidance what are the days we need that should be submitted to meet regulatory standards of approval . This is particularly important as we know that some people are skeptical of Vaccine Development efforts. The fda strongly encourages the inclusion of diverse populations in all phases of Clinical Development including populations most affected by covid19 and specifically racial and ethnic minorities as well as adequate representation in late phase trials of elderly individuals and those with medical morbidity. We have information in this guidance about including women who are pregnant as well as pediatric assessments of safety and effectiveness. The American People should know we have not lost sight of our responsibility to maintain a regulatory independence and insurer decisions related to all medical products, including covid19 vaccines, are based on sound science and data. This is a commitment the American Public can have confidence in and i will continue to uphold personally. While Vaccine Research is ongoing Rapid Testing and Therapeutic Development can aid and the return to school in the workplace. We are constantly reviewing data so we can promote the development of new and better tests and remove tests that are not reliable from the market. We have put into place an initiative to accelerate the treatment called coronavirus treatment acceleration program. We have seen some of the consequences of that program such as the authorization of remdesivir in the recent information regarding other therapeutics that might be a benefit to patients with covid19. We are working day and night to provide guidance to and review proposals from companies and researchers were developing therapies. We are preparing for the next phase of addressing this evolving crisis. It is missioncritical the agency constantly evaluate whether our processes are maximum to protect Public Health. We are beginning a comprehensive realtime review and assessment of our action to address the pandemic and i am glad to answer questions about that review. I want to thank the more than 17,000 fda employees who have been working night and day to have expedite medical products, but also provide necessary oversight with the appropriate science and data. We know the rider virus remainsh us. The fda is committed to doing the critical work to get the country where americans judges safe to return to work in School Safely as possible. I am incredibly proud of the dedicated women and men whose commitment to defeating the pandemic has been unwavering. The fda will continue to provide leadership, expertise, guidance, and information as we continue to address this unprecedented challenge and fulfill our mission to protect and promote Public Health. I look forward to your questions. Chairman thank you, dr. Hahn and thank you to each witness. We will begin a round of fiveminute questions. All senators participating today, almost all, so i ask senators and witnesses to track segmentrying keep each to five minutes. Dr. Fauci, assume i am a superintendent and in our community we understand there are health risks for children going back to school, but we toe concluded the risk their education, mental health, and social develop it is a greater risk if they do not go back to school. What would your advice be to a School Superintendent about what he or she should be thinking about as children go back to school in a few weeks to keep them safe . Dr. Fauci thank you for the question. Question, buttant we need to point out it will really depend on the dynamics of the outbreak in the particular location where the school is. One of the things we want to emphasize, and have been emphasizing, is to take a look at where you are in the particular area of the socalled opening america again. Are you at phase i, phase two, phase three . The cdc has guidelines about the opening of schools at various stages of those checkpoints. The basic fundamental goal would be, as you possibly can to get the children back to school and to use the Public Health efforts as a tool to help get children back to school. Let me explain what i mean. If we adhere to guidelines of what we have heard in many of these presentations about the physical distancing, the use of masks, that will help to keep the level of infection in the community down which will make it easier to get the children back to school. If you are in a area where you have a certain amount of infection dynamics, there are things that can creatively be done about modifying things like the school schedule. Alternate days, morning versus evening, allowing under the circumstances online, virtual lessons. Those are the kind of things we need to consider, but also importantly always make the goal it is very important to get the children back to school for the unintended negative consequences that occur when we keep them out of school. Chairman thank you. Dr. Redfield, one of the concerns would be that children who, generally speaking, have not been damaged nearly as much as adults, particularly elderly carry to their teachers, administrators, or anyone at home. It seems to me the availability of treatments this fall, medicine for the environments that reduce the risk could be very important in increasing confidence and going back to school. You mentioned some of those in your testimony. Are there others . What will the availability of treatments be this fall and specifically, what about socalled anybody cocktails that were used for ebola and approved by the fda . Dr. Redfield i think that would be a great question for dr. Fauci as well. He may want to add to this. Ando hem remdesivir evidence that steroids can improve therapy. Thatve convalescent plasma dr. Hahn could comment on using the antibodies from individuals that have gotten better from covid that are currently under evaluation that would be available. Chairman just a minute, that go to dr. Hahn and let him answer. Thank you. Mentioned,as i remdesivir has been authorized based on hospitalization days. The steroids were mentioned, convalescent plasma we have evaluated safety through a program at the mayo clinic and it has been found to be safe and over 20,000 patients. We are waiting for the safety data and we will be passing those along to the sponsor of the program. I think that antibody data will help us in terms of the development of antibodies. We have a number of sponsors who have come in from these studies and we are well into that treatment. The antibodies are synthetic antibodies that will the theory is will provide protection against the infection of the virus and we are hopeful those studies, by late summer and early fall, will provide us information about effectiveness and safety. Chairman you are optimistic there will be more than one treatment available this fall for teachers, administers, older adults . Dr. Hahn yes, i am optimistic. Chairman thank you. Senator murray. Rray we appreciate your service and your work. Dr. Fauci the last time you testified you warned us of needless suffering and death if states begin opening to early and over a month later we are seeing a Record Number of cases. We do not have enough tests or contact tracers. Cdc said weay the have too much virus to control in the u. S. And i quote, this is really the beginning. Our strategy has not worked. I want to ask you, what does the federal government and more than 30 states with rising case numbers need to do to reverse this trend . Dr. Fauci thank you for that question, senator murray. I am also quite concerned about what we are seeing evolve right now and several of the states. In florida, texas, california, and arizona more than 50 of the new infections are in those areas where we are seeing resurgence. The things we need to do, we have got to make sure that when states start to try and open again they need to follow the guidelines that have been carefully laid out with regard to checkpoints. What we have seen in several states are different iterations of that. Perhaps in some going to quickly and skipping over some of the checkpoints, but even in states in which the leadership in the form of the governors and mayors did it right with the right recommendations what we saw, visually, and clips and in photographs of individuals in the community doing a phenomenon. Down or open up and away you see people in bars, not wearing masks, not avoiding crowds, not paying attention to physical distancing. I think we need to emphasize the andonsibility that we have as part of a societal effort to end the epidemic. We all have to play a part in that and if you look at the visuals, what we saw were a lot of people who may be felt that because they think they are invulnerable and we know many young people are not because they are getting serious disease that they are getting infected and has nothing to do with anyone else. It does. If a person gets infected, they c, butt be symptomati the capacity someone else who passes it to someone else who makes a grandmother, grandfather, uncle, or child the leukemia sick. If we are going to contain this, weve got to contain it together. Sen. Murray i would assume that Means Community leaders need to model good Public Health behavior and wearing mass . Masksuci we recommend for everybody on the outside. And a buddy who comes into contact in a crowded area. When you are outside and do not have the capability of maintaining distance you should wear a mask at all times. Sen. Murray thank you. The cdcield, last week director under president george w. Bush testified that if she were in charge one of her Top Priorities would be the creation of a National Vaccine plan that addresses the sides, development, allocation, and monitoring of a vaccine saying, we know this is in our future and we are not ready for it. I could not agree more and that is why i have to detail how the federal government will scale up manufacturing, coordinate supply chains so we avoid the missteps we saw with testing, combat misinformation and vexing hesitancy, and mature Vaccine Distribution addresses Health Disparities and a lot more. Dr. Redfield, do you agree it plan like that is needed . Dr. Redfield i think it is very important that we have an integrated plan for this vaccine. Sen. Murray when can we see one . Dr. Redfield i would like to ask dr. Hahn if you would like to comment. They had a vaccine plan, at least from the fdas perspective. Cdc is working on the issues that you said, which i think are so important. Murray when will cbc cdc be giving us their plan . Dr. Redfield we are working to rebuild Vaccine Confidence in this country, which is critical. Be ap of that, there will defined plan for distribution of this vaccine, prioritization of vaccine sen. Murray a couple weeks, a couple months . The end of the year . When do you expect us to see that . Dr. Redfield i think we will see that in the few weeks ahead, senator. Sen. Murray weeks, not months . Is a jointd it effort. The cdc has been working on this plan for the last 10 to 12 weeks. Sen. Murray at would say we need to see that plan, the American Public needs to know what that is, communities need to know what that is, so i hope that we urge that plan to be public as soon as possible, so we all know what to expect. Thank you, senator murray. Senator burke . You, mr. can thank chairman. After working on pandemic policy now for 17 years, i am reminded this morning, tony fauci has been doing it twice as long as i have, and most of you at the dais have been doing that as well. I urge my colleagues, Pay Attention to each of what these individuals say, because some things are predictable up here. What each of these individuals say because some things are predicta Congress Funds things, when there is a certain threat that is out there. Things get shelled, like platforms, then we could have loped and had better better measures today, platforms that then could address vaccines at a much faster pace than maybe what were doing. But we spend more time with the blame game than we do with focuses on how the future should look. While all of us, members of congress and people within government, wish we could get back to normalcy, your agencies and members of congress are also charged to make sure we map the future so future generations have better protections than what we have. Thats why i plaud the chaappla chairman for his white paper. We need you to be brutally honest where changes need to be made and dont need to be made. I think you would agree with me testing and surveillance has not been the best performance by cdc. I dont want to dwell on where we come up short. Share with these members and myself, what can we expect over the next several months from cdc that will be different than what the past has looked like. Thank you, senator, for your question. I think the cdc will continue to work with the state, local, tributary Health Departments to work to capacity. I think weve known for decades the theres not been a significant amount of work. These are Critical Infrastructure issues that the reality are they have been underinvested. The cdc right now is probably providing 50 to 70 of all Public Health funding to each state. We need to have a much more robust investment in these core capabilities. What you will see with congress acting, cdc has provided now 12 billion to the local, state, territorial tribal Health Departments to develop that core capability that wed like to have built over the last several decades so there was enhanced testing. Complicated because this virus is so asymptomatic for so many. The diagnosis, Contact Tracing, isolation are going to be inhibiinhib i inhibitive for so many. Theyre working with the local jurisdictions. Theyre going to have them in pl place for the rest of the year. Theres going to be enhanced surveillance, isolation to fwli bring this up to date and under control. I think as those of you know when i was given the opportunity to do this job very early on, within a month, i recognized that the core capabilities of our Public Health infrastructure is not there particularly with regard to data analysis. That is in progress. It cant happen too soon. Were appreciative of the support that congress has given. And i do think its fundamentally critical to bring the system and the data personnel that you have, and we thank you for your efforts. And as we need to hire individuals strategically, we will do that, to make sure the premier Health Agency has what it needs. I will say the other big issue we have to correct is that our Public Health system has that data. Dr. Hahn, i think you have used your authorities under p. A. P. A. In a very effective way. The fda has cut the red tape and reviewed the standards. You specifically mentioned innovative Clinical Trials and designs and the use of realworld data as areas where theyve gained ground with response to covid. How can you make sure this progress is maintained long after the Coronavirus Response is over . Thank you, senator burr. The Critical Issues you bring up, some of the things youre bringing up, working with developers, we will continue. Part of our review, our actions to date, so a midaction review, will help with how we move forward. Well look at the review cycle and innovative trials as you mentioned. Thank you, mr. Chairman. I hope you or another member will allow dr. Fauci at some point today to make any comments on the reports that theres a new flu that the chinese have identified and how that might affect us in the future in this country. Well, dr. Fauci, why dont you do that now. You do have anything to say about a swine flu . The chinese over the last week or two have identified a virus in the environment. It is not yet shown to be infecting humans, but it is exhibiting what we call reassortment capabilities. In other words, when you get brandnew virus that turns out to be a pandemic virus, its either due to mutations and or the reassortment of genes, and theyre seeing virus in swine or pigs now that have characteristics of the 2009 h1n1, of the original 1918, which many of our flu viruses have remnants in that, as well as segments from other hosts like swine. When they all mix up together and they contain some of the elements that might make them susceptible to being transmitted to humans, you always have the possibility that you might have another swine flutype outbreak as we had in 2009. Its something thats still in the stage of examination. Its not socalled an immediate threat where youre seeing infections, but its something we need to keep our eye on just the way we did in 2009 with the emergence of the swine flu. Its called g4 is the name of it. Thank you. Senator sanders. Thank you very much, mr. Chairman, and let me thank all of our panelists for being here and the great work theyre doing on this pandemic. Let me ask a question that has just bothered me lately. All of you and most americans understand how important social distancing is. Were told over and over again, the chairman told us at the beginning of this meeting, stay apart, at least six feet apart if you can. Just the other day, American Airlines announced theyre going to fill up all of their planes. Others are doing the same. Youre going to having people going from california to new york, five, six hours, sitting inches apart. And youve got buses where people are packed in like sardines. My question is why hasnt the government, whether its the cdc or the department of transportation issued guidelines prohibiting those violations of what we all know to be common sense . Who wants to dr. Inferior chch fauci, do you want to start out . Thank you, senator. Im not the cdc, but i would be happy to make a comment on that and bob maybe also. Obviously thats something of concern. Im not sure exactly what went into that decisionmaking. I would hope there would be something to mitigate against that because i know as weve said and i continue to repeat it that avoiding crowds, staying distant, and when in a situation like that, wear a mask. I think in the confines of an airplane, that becomes more problematic. Chairman, i understand the mask thing, but doesnt it sound silly and in violation of everything youve been talking about, to have people sitting next to each other for five or six hours in an airplane or crowded into a bus, and my question is why hasnt you know, the president has issued a lot of executive orders. Why havent we stopped that activity and told the airlines and Bus Companies that is unhealthy . Senator, i appreciate your question, and i think its a critical area. I can tell you when they announced that the other day, obviously there was substantial disappointment with the American Airlines. A number of airlines had decided to keep the middle seat thing. I cant say its not critical to the cdc. We dont think its the right message as you point out, again, we think its really important in individuals, whether its a bus or a train or a plane to have social distancing or at least reliable Face Covering. Thank you. I just hope very much that the cdc or the appropriate agency basically tells these companies that that is unacceptable, theyre endangering the lives of other people. Let me go to another question. I dont have a lot of time, so i would appreciate brief answers. At the university of washington, the institute of health there indicated if 95 of the American People were to wear masks, we could save some 30,000 lives. A number of countries including south korea, france, turkey, and austria have provided low cost or free mask to all people, something i believe in. Would you support the effort to greatly increase the production of highquality masks in this country and distribute them free of charge to every household in america, dr. Fauci or anyone else who wants to jump in on that . Yes. I think masks are extremely important, and i think what you mentioned is just as important. Theres no doubt the mask protects you and protects others. Its people protecting each other. Anything that furthers the use of masks, whether its giving out free masks or any other mechanism, i ampth thoroughly i favor of. I called on an environment that, we to provide universal masks. When you point out universal masks, would you be supporting the increased production of highquality masks and basically distributing free of charge to every household in america . Because i think thats going to save tens of thousands of lives. Would you agree . Yes, sir, i agree that that is very important because we need to support mask wearing. I would also point out that dr. Cadillac has asked for hundreds of millions of cloth Face Coverings to be distributed. I wear them. Theyre white. And i recommend them for the American People. Thank you. The last question. All of us hope to god that a good safe vaccine will be developed as soon as possible. But that vaccine may not mean anything to a lower income person who might not be able to afford it. I happen to believe that we should make these vaccines by the way, as you all know, federal government, our tax dollars, are going to Companies Creating the vaccine. Thats okay. Would you agree with me after that kind of investment, we should make sure every american in this country should get a vaccine regardless of their income . Yes. Okay. Anybody else want to comment on that . Yes, senator, agreed. Yes, senator. Yes, senator. Well, good. Thank you all very much. Thank you, senator sanders. Senator paul. Thank you. Fatal deceit is the concept that can never fully grasp the millions of complex individual interactions occurring simultaneously in the marketplace. It is a fate tall conceit to believe any one person or small group of people has the knowledge necessary to direct an economy or dictate Public Health behavior. I think Government Experts need to show caution in their prognostications. Its important to realize that if society meekly submits to an expert and that expert is wrong, a great deal of harm may occur when we allow one mans policy or one group of small men and women to be foisted on an entire nation. Take for example Government Experts who continue to call for schools and day care to stay closed or that recommend restrictions that make it impossible for a school to function. For a time there may not have been enough information about coronavirus in children, but now there is. There are examples from all across the United States and around the world that show that Young Children rarely spread the virus. Lets start in europe. 22 countries have reopened their schools and have seen no discernible increases in cases. These graphs behind me show no surge when schools open. The redline is where the schools opened. There is data from austria, belgium, denmark, france, germany, netherlands, no spike when schools are opened. Contact tracing studies in china, iceland, britain, and the netherlands failed to find a single case of childtoadult infection. Here at home child care for essential workers continue to be available in some states throughout the pandemic. Brown University Researchers collected data on day cares that remained open during the pandemic. Over 25,000 kids in their study. They found that only. 16 of children got inspected and there was 1,000 staff. The ymca put forward statistics as well. There were no reports of coronavirus outbreaks or clusters. A doctor of Johns Hopkins writes there is converging evidence the coronavirus is not transmitted by kids. Yesterday it was said we need the kids back in school. They even cite mounting evidence that children are less likely to contract the virus. Central planners have enough knowledge somehow to tell a nation of some 330 Million People what they can and cant do. Perhaps our planners might think twice before they weigh in on effort subject. Perhaps our Government Experts might hold their tongue before expressing the opinion whether we can play nfl football or major league baseball, not in october. Perhaps our experts might think twice before telling the whole world a vaccine might not impact herd immunity. We dont know. These are forecasts that may well be wrong. Perhaps our experts might consider the undue fear theyre instilling in teachers who are now afraid go back to work. No one knows the answers to these questions. We shouldnt presume that a group of experts somehow knows whats best for everyone. Only decentralized power and decisionmaking based on millions of individualized situations can arrive at what risk and behaviors each individual will choose. Thats what america was founded on, not a herd with washington telling us what to do and like sheep we blindly follow. This all begs the question. When are we going to tell them the truth that its okay to take their kids back to school . Dr. Fauci, every day we seem to hear from you things we cant do. But when youre asked, can we go back to school . I dont hear much certitude at all. Well, maybe. It depends. All the evidence around the world shows theres no surge. All the evidence shows its rare. Weve so politicized this and made it politically correct, the w. H. O. Says its rare. What happens when an expert gives her opinion . Shes blackballed and the report she refers to is taken off the website. When you to that scientists speech and try to click on the link, the w. H. O. Has screened it from us because something she said was not politically correct. Guess what is its rare for kids to transmit this. I dont hear that coming from you. All i hear is we cant do this, we cant do that, we cant play baseball. Even thats not based on the science. We wouldnt ban school in october. You might close some schools when they get the flu. We seem to not be so presumptuous that we know everything. My question is cant you give us a little bit more on school so we can get back to school, that theres a great deal of evidence and the kids arent getting this, its rare, and, yes, we can open the schools . Mr. Chairman, do i have a little bit of time . Thats well over five minutes. Thank you. Please answer the question. So very quickly, senator paul, i agree with so much of what you say, people putting opinions out without data. Sometimes you have to make is extrapolations because youre in a position where you need to give some sort of recommendation. If you were listening and i think you were to my Opening Statement and my response to one of the questions, i feel very strongly we need do whatever we can to get the children back to school. I think were in lock agreement with that. The other thing id like to clarify very briefly is that i when things get into press of what i supposedly said, i didnt say. I never said we cant play a certain sport. What happens is the people in the sport industry, they could either be people from the players association, owners, people involved in the health of the plays ask me opinions regarding certain facts about the spread of the virus, what the dynamics are, i give it, and then it gets interpreted that im saying you cant play this sport or you cant play that sport. I agree with you. Im completely unqualified to tell you whether you can play a sport or not. The only thing i can do is to the best of my ability give you the facts and evidence associated with what i know about this outbreak. Thank you. We need more optimism. All right. Senator casey. Mr. Chairman, thank you very much for the hearing, and i want to thank our witnesses for their public service. Mr. Chairman, let me start with dr. Hahn. And then ill move to the admiral. Dr. Hahn, i want to move to vaccines. As your testimony indicates and as weve been discussing over time, as researchers work to develop vaccines to protect against covid19, its important that the final fda approved products have the full confidence in the American People. A vaccine doesnt help if people dont choose to, in fact, be vaccinated. So my first question is given that weve seen very high rates of both vaccine refusal as well as skepticism, what role can the fda play in the coming months to earn the Publics Trust that the covid19s vaccines are safe and effective, thats question number one. And the second question is what steps can you take as fda commissioner to bolster Public Confidence . Thank you, senator, for that question. I couldnt agree more that Public Confidence in vaccines is so important. So to your first question, we have an obligation to use all of our scientific knowledge, Regulatory Framework to ensure that any vaccine that comes before us whether for authorization or approval meets our stringent standards for safety and effectiveness. One of the reasons i provided my initial statement is to get clarity with what the fda expects with respect to the data. We want to see certain parts of the data so we can demonstrate to the nation, the world, the American People, that were following the rigorous standards with respect to safety and efficacy. The other thing weve done is draw a very bright line between the fda and our regulatory independence and how many are putting forth plans for us. Were providing assistance to the sponsors. We will maintain our regulatory independence. Ly not prejudge. The agency will not prejudge any decision. We will use the science and data. With respect to what i can do personally, senator, i will continue to be a voice, emphasizing the regulatory independence. We have a number of communications in progress to communicate to the American People that the standards were going to uphold are firm. Theyre rooted in science and data, and they will ensure we meet the high standards of the fda with respect to safety and efficacy. Thank you very much. Just so i can get my question in to the admiral, i want to ask about testing and insurance coverage. Testing as you know and as weve emphasized in these hearings is so fundamental in order to prevent the spread of covid19. Congress acted upon that knowledge by mandating full coverage of covid19, diagnos c diagnostic, and Antibody Testing. Weve indicated americans shouldnt have to pay a dime for covid testing. But were hearing alarming reports of people not being tested for one of two reasons. Theyre under the impression they have to pay for testing and others who are tested are received surprise medical bills. Theres guidance that appears to be in conflict with professional intent and medical guidance. I ask you, admiral, can you ensure the American People that the department of health and Human Services will fulfill the intent of the Families First bill and the c. A. R. E. S. Act and ensure that the American People will be provided wide access to covid19 tests without cost or limitation . So, thank you, senator. I want to thank all of you for emphasizing the importance of testing and eliminating any barriers that there could be. I cant speak for the department. I certainly speak as the assistant secretary and testing person that we firmly believe and support the concept of no cost testing. There should not be a disincentive in any single way to get the diagnostic test you need to get tested during screening or theer is o seer ie. Thank you. Senator collins. Thank you very much, mr. Chairman. Ant i want to thank all of our Witnesses Today for your dedication and hard work. Its really been important. The chairman raised a very important question about who pays for the testing when a person has no symptoms and no known exposure to the virus. And i would add another key question, and that is how are such tests even accessed . These are critical questions for the reopening of schools and for the thousands of jobs and Tourism Industry upon which the economy depends. In maine, for tourists to come and visit, that outofstate visitor, one option, is to show a recent negative covid test. The problem is that when hotel owners in maine surveyed testing sites in ten states, they found that 90 of tests for travel purposes were denied. Now, this lack of access to tests is devastating for reopening maines Tourism Business businesses. One innkeeper told me last june she had an okay ccupancy rate o 94 . This year it was 6 . You can imagine the impact on that inn. Given the impact on reopening schools and jobs in the tourism and other industries, how is the federal government working with states to better match demand for testing with supply and to overcome these geographic variations . Admiral, i would direct that question to you. Thank you, maam. I will try to be brief and not take much of your time. We were very careful in our prioritization that we do prioritize persons without symptoms who are prioritized by Health Departments or carolinaicarolina i carolinaish clinicians for any reason. That is a priority that if its important for the state, those asymptomatic individuals can be screened. The second issue, again to be brief, we have worked individually with every single state to work on the context of it with the cdc. Every week shipments of the basic supplies go to every single state according to their state testing plans. We keat we keep a little for reserve. We will match those state by state. I hope that you will help us get that word out to testing sites in states from which a lot of tourists usually come to maine. That would be very helpful to s us. Dr. Fauci, let me turn to you. Earlier this month there was a plan for safely returning to campus this fall that recognizes the importance of testing and the need to include financially struggling institutions in partnerships in order to make sufficient testing protocols possible. You last week spoke about the possibility of the development of pool testing strategies, and as i understand that, this would allow more people to be tested using fewer resources. And the medical director of stanfo stanfords virology lab suggests that this makes particular sense in areas with low rates of covid19 where you would expect the large majority of tests to be negative. Could you expand on the possibility of expanding pool testing and tell us more about that. Yes. Thank you for the question, senator. What that really is f you want to get a feel for the penetrants of infection in a community, rather than testing multiple each individual person, which takes resources and time, what you do and you can do a Statistical Analysis of not losing sensitivity by pooling, lets say 10 or 15 or 5 together you put all the tests together and you do one test. If that test is negative, then you know those ten people are all negative. So instead of utilizing ten tests, youve utilized one test. Then you get another test of, well say, ten or so. And if you find one is positive, then you go backtrack and figure out who that person is. And if you do the mathematical calculation, you can save a lot of time, a lot of resources, and use the testing for a variety of other things that you would need. So its a really good tool. It can be used in any number of circumstance, at the Community Level or even in schools if you want dodd that. It clearly can be extrapolated to that. Thank you so much. That sounds like an excellent technique for our schools to use. Thank you, senator collins. Senator baldwin. Thank you, mr. Chairman. I want to thank all of our Witnesses Today for joining us. Like so many members of this committee, im concerned about new outbreaks and increasing cases. Certainly ive seen them in my home state of wisconsin, and i know were seeing that nationally. Now, cdc and osha have issued recommended safety guidance for businesses, but this guidance is not enforceable. Many businesses are truly trying do the right thing in protecting workers and customers who interact with those businesses. We also had a previous discussion. I think senator sanders raised the issue of American Airlines filling up their planes versus others who are still not trying to push to do so because of safety concerns. We also had i think it wassed a mirm g was admiral giroir to please pull up the guidance. Should we take that up by fully following the recommendations, yes or no . Yes, we should be supporting those businesses. Can you confirm, yes or no, all businesses have adopted and implemented this guidance as theyve opened up . I think, senator, as you know, unfortunately thats not been the case. So its an uneven Playing Field, and it hurts businesses that are trying to do the right thing by voluntarily adopting cdc and osha safety guidelines because their competitors dont have to incur the same safety and health costs. And if you believe we should be supporting the good actors, then shouldnt we create a level Playing Field by issuing an Emergency Temporary Standard to require all businesses to adopt and comply with enforceable Safety Standards . Ill make two comments, senator. The first one is so important. Weve tried to say this is a time that everyone in our nation needs to accept the responsibility that dr. Fauci and i spoke about to recognize they have the fundamental responsibility not just to protect themselves but to protect others by the social distancing, face mask, and handwashing. Secondly, again, as we look at the local jurisdictions to see where that enforceability would be, whether its in the local health department, the state health department, or the federal health department, i think, again, we see that the community can get behind that responsibili responsibility. Those businesses that support that responsibility may find their business is better than those that dont. Let me interrupt you. I apologize, dr. Redfield, but my time is limited. The panel right now is composed of people representing Public Health and Public Health institution. Osha is our lead federal agency for protecting worker safety and health. Have you had communication with the department of labor and osha about issuing mandatory enforceable standards rather than this voluntary guidance . Secretary scalia is a member of the task force, and hes in the discussions with us that the Vice President chairs. So the answer is yes . Weve not had a discussion directly, but we have had discussions in review of the guidance that weve put to businesses, both Critical Infrastructure and nonCritical Infrastructure businesses with osha. So i have limited time left. I do want to say the university of wisconsin say they will be reopening for classes in the fall. Theyve released a plan called smart restart. It calls for about 2,000 tests per week on campus. Theyll need supplies do this including ppe, reagents, and swabs. Weve heard about shortages of these supplies. Its why we offered the delivery act to unlock the full authority of the defense production act to release production of critical supplies and the things that are needed to conduct widespread testing. Admiral giroir, can you ensure us that universities and others will have access to the supplies and other testing in the fall . Thank you so much, senator. I want to communicate this, and im happy to work with any university. We coordinate what we give to the state tloos u ts to the stao its very important that the universities coordinate through the states. We provide them to a single contact point in the state who distributes them. Weve been through a lot, but we have a lot of swabs now partially because of increased doumestic production. What about reagents . So reagents, we do not purchase centrally because the market is a little bit more mature. So we can trust with an allocation strategy. Weve mapped every single machine in every single city, county, and state. Unfortunately theres not enough of one thing that if everybody wants it, they can get it. We do a matching thing understanding what the needs are for a particular state. For example, in alaska, theyre very rural and have limitations. We make sure they get what they absolutely need versus other states who can be a little more flexible. Im afraid im so sorry. Were well over time. We have a large number of senators who want to ask questions. Thank you, mr. Chair. I would renew my request that senators and witnesses try to keep the questions and answers within five minutes. Senator cassidy. Thank you, gentlemen, for all that youre doing. I have a couple of slides. Can i ask the staff to show the first two slides . So hear it shows that were doing poorly relative to the countries doing it best, and you can argue that taiwan is much smaller than we, but taipei is a very congested city. So if you consider our cities as a collection of taipeis, for example, then it would suggest what were currently doing is less robust and less whatever adjective you want to use than the countries that are doing it best. Could i have the next slide, please . So this is developed by a group out of harvard. Just so i can put a plug in it, theyll be speak at a roundtable thursday morning, and you can get details from my office if you wish. Theres that interplay of doing the testing, compiling your data, knowing what your hot spots are, and tracing. Even everyone on this panel knows how its done. This has been developed. You can take the slide down, please. So knowing that youre going to develop this strategy and kind of build upon what senator burr mentioned, what is the goal of the strategy . Is the goal of the strategy to achieve suppression . Thats number one. Number two, what metrics will you use. Knowing that the cdc is the one who gives guidance, it wont be up to the local and state who puts this together. It would be pretty detailed. If you have this kind of community, this is what you do. If you have that continue of community, thats what you do. Thats the kind of role the cdc is expected to play. Dr. Redfield, any thoughts on this. Thank you. Very important question. On the first slide, and ill try to be quick, it is really important. Its illustrated back to the first point, to really practice social distancing. Thats a given. Dr. Redfield, im going to ask you to go quickly. Thats a given. There has to be a testing aspect of this. You awaken people to the responsibility if they know theyve been exposed. If they dont know theyve been exposed, they tend to be more complacen complacent. Yes, senator. Obviously testing and Contact Tracing without isolation has little value. The challenge has been we learned in march this is significantly transmittable. So we have to look at another strategy. More of a communityled testing strategy where you go into a Broader Community and test a wide number of individuals as opposed to what metrics are you following . Is there a specific strategy thats going to be given to state and locals on how to implement this . Were currently evaluating this communitys testlead strategy. The metrics are simple. Its thecf3 part ercentage of c sorry to interrupt. Youre going to have some that are hot spots and some that are fairly safe. I guess im pulling to the gr granul granularity. Im frustrated. When i speak to my state and locals, theyre not getting that granularity. I have not heard that were doing what seoul and south korea are doing. Were sharing the exact kinetics. We have 130 counties out of this country out of the more than 5 those who have trouble. I÷ its critical. Dr. Redfield, do we have that granul granularity . We know where the people are that were tested. We have a federa tkted system. Im over time, but if you would allow him to respond. My comment is thats where were going with that granularity. We are now looking at the granular level. We dont disagree with the premise behind you. Its that granular response to control the many outbreaks, which is going to be fundamental to get this under control. Thank you. Thank you, senator cassidy. Senator murphy. Thank you very much, mr. Chairman. Mr. Chaurman, if this were the policy of the United States of america. The recommendations and guidelines being given by our panelists today, we would not likely be in the situation we are like we were in march. The president of the United States has set policy. So while our panelists tell us the important of wearing masks, the president of the United States is retweeting articles. He retweets people that are criticizing how folks look when they wear masks. Our panelists today are telling us about the effectiveness. He deliberate ly prevents peopl from social distancing. They rinp signs from chairs. Someones out there every day saying masks are dehumanizing. Someone said, a member of the house, viruss do what viruses do. The only way to get through it is to be exposed. So we have these two parallel messaging operations, and i just think its worth stipulating that everything were hearing today is based on evidence. But the representatives today have social media followings of about 5 Million People. The president of the United States has a following of around 82 million. You can understand why folks are confused out there. They hear the recommendations from dr. Fauci and dr. Redfield, but then they hear the prophet the United States criticizing a reporter for wearing a mask. Thats why were in the position were in today where you see large numbers of people not complying with recommendations because theyre hearing something very different from the chief executive, and theyre watching something that is directly contrary to what were being told today, and it just probably requires saying that out loud at this a few question chairman, if i can, about global Public Health because we havent covered that here today. Dr. Fauci, this virus got here really quickly. And what we learned is that, well, travel restrictions could help or give you time, they cant fully prevent a disease from arriving here. And so even if we do turn the corner in the United States and in a meaningful way, so long as this virus exists in large quantities outside of the United States, we are still vulnerable, is that right . Thats correct, sir. And so dr. Redfield, what is your understanding of why the United States has not joined the global vaccine effort, why are we not in Something Like sepi, an organization working with other nations to coordinate the development of vaccine and the distribution of the vaccine . Well, i think the u. S. Is obviously developed a aggressive comprehensive program, but senator, it wouldnt preclude being part of the international organizations, also, from my perspective. We have legislation pending before the Foreign Relations committee that would put the United States into the global vaccine and it makes no sense as why the Trump Administration has not joined. And finally, admiral, just maybe help us understand what our relationship with the w. H. O. Is today, right around the time that the president declared that we were pulling out of the w. H. O. , not just that we were not going to fund it, but his announcement was we were receiver our relationship with w. H. O. And you were confirmed to a seat on the executive board so have you been recalled from the w. H. O. . Are you attending meetings, are you participating, what are the details surrounding our withdraw from the w. H. O. , which, by the way, is maybe one of the most Dangerous Things in my opinion that the administration has done in the middle of a global pandemic, what is our status and your status as a confirmed member of the board. Thank you, senator and i do appreciate the confirmation. I was confirmed on may 7th and i did attend the board on may 22nd. The executive board was virtual. It did participate and support our our multilateral commitments. I have not been recalled or given any direction to recall myself in any way. There would be another executive Board Meeting probably in october. And i believe all of us on our Public Health standards still work with the w. H. O. As a w. H. O. Partner, for example, we participated with the w. H. O. Under a global sickle cell meeting just a few days ago. So we work from the Public Health aspects direction on the official, whether were a member or im not going to go to the executive board. I have not gotten that direction yet. Thank you. The announcement that were terminating our relationship with the w. H. O. Thank you, senator murphy. Senator murkowski. Thank you, mr. Chairman and gentlemen, thank you for not only your testimony but all that you have been doing. I think ive had conversations with each one of you about the alaska specific issues, most notably with regards to our seaFood Processing. This is the time of year where we typically welcome a million plus tourists as well as many thousands that come up from the lower 48 and other places to help with our seaFood Processing. And it has been very anxious time, i think, for all of us in alaska as we see outsiders coming in. We have seen obviously elevated cases of confirmed covid. Our numbers, i think, are enviable when other states look at us to know that were working about 500 active cases right now. About double that in terms of what we have seen throughout this whole pandemic. But, again, we know and you have stated that we dont have resources that we can look to to neighboring states. Were kind of on our own island there in terms of resources so what you have done to help facilitate, whether the plans with the Seafood Processors, the guidance, the ability to come in on an asneeded if the situation so demands, we appreciate that. We have seen the benefit of how these very rigorous plans have worked. An individual who comes up to work in a seaFood Processing facility is tested before they come to the state. Theyre tested when they get to the state. Theyre put in a 14day quarantine. We have seen positive cases once people have arrived. But weve been able to do what the plan calls for, which is that Contact Tracing and then isolation and keeping things to a minimum. So it does demonstrate the tough plansly can work. They are expensive, though. If you are bringing in several hundred or perhaps a thousand workers and you have to put them up in a hotel for 14 days, with pay, when you have to provide for the health protocols, this is costly. I would ask for your input and probably a question for the record in terms of which agencies can best help facilitate these Seafood Processors with not only i pleamentation of the guidance but how we deal with the costs. We do receive some benefit from the discretionary funds provided to the states. But i think we would all recognize, like the meat packing facilities, our Seafood Processors are an important and critical industry, not only to ala alaska but to the country so we want to work to address that. I do want to speak very quickly to the Public Health infrastructure. Im told that in alaska, as were doing our Contact Tracing, it is still a paper copy excel spreadsheet faxed to the ep deemiology labs. This is how were doing our tracing. I thought maybe that is just alaska but ive been told by dr. Zinc this is going on in california as well. That, to me, is not a Contact Tracing system that works and is sufficient. So i want to ask about not only your view of the sufficiency of Contact Tracing, and this is probably to you, dr. Redfield, but then dr. Fauci, i want to ask you about the concern that we have with certain parts of the country where you have public mistrust of vaccines in general. My fear is that we may get to the place where we will get to the place with we have that successful vaccine. But we still have the concern from many and a mistrust and whether it is vaccine hesitation or confidence, i dont know what the buzzword is, but im worried we dont have a plan to deal with that. So first Contact Tracing and then the vaccine. Thank you very much, senator. I think it is important to highlight what you said about the current state of data systems for Public Health in the United States. That they really are in need of aggressive modernization and, again, thank congress for the funding there. But it is a substantial investment that needs to take place. There are a number of counties still doing this pen and pencil as you commented. And we need to have a comprehensive integrated Public Health data system that is not only able to do something that is in realtime but actually predictive and it would be one of the great, i think, investments of our time to make that happen once and for all. I agree. And that is really fundamental to be able to operationalize Contact Tracing. And Contact Tracing doesnt really have any value, unless you could do it in realtime. It doesnt help like i just did with the airlines where we had people flying infected from afghanistan and we didnt get the information until day 14, day 15, day 16. It is irrelevant. We love the partnership to get an integrated Public Health data system, not just for cdc but for all of our jurisdictions across the nation into one timely integrated system. Senator, thank you for the question about if you could be succinct. Were well over time. We have a program embedded within the sites where the vaccine trials will be done because were thoroughly aware of what your concerned about it and it is a reality, a lack of trust of authority, a lack of trust in government and a concern about vaccines in general. We need engage the community by boots on the ground and getting community particularly those populations that have not always been treated fairly by the government, minority populations, africanamericans, latinx and native americans and we have a program operable right now to do that. Thank you. Thank you. Thank you senator murkowski. Senator warren. Thank you very much, mr. Chairman. Dr. Fauci, you came before the Health Committee seven weeks ago to discuss the countrys response to the covid19. And at the time you told me that the u. S. Did not, quote, buy any means have total control over this outbreak. But you also told me that we were, quote, going in the right direction. Now, on the day you testified before the committee, that was may 12th, 2020, there were about 21,000 new cases of coronavirus. Yesterday there were about 40,000 new cases of coronavirus. Dr. Fauci, do these numbers show that the country is still moving, quote, in the right direction . And that the coronavirus pandemic is under control . Well, i think the numbers speak for themselves. Although we do have a number of parts of the country doing well, im very concerned about what is going on right now, particularly in the four states that are accounting for about 50 of the new infections. But the other vulnerable states, so id have to say the numbers speak for themselves. Im very concerned that im not satisfied with what is going on because were going in the wrong direction. If you look at the curves of the new cases, so we really have to do something about that and we need to do it quickly. Short answer to your question is that clearly we are not in total control right now. Thank you. Thank you very much. And our case numbers are getting worse. And our death rates are going to get worse soon. During this same period of time, some other countries around the world have controlled the virus. Theyre reporting fewer cases each day and they are able to provide targeted testing and to keep it up so they could tell what is happening and follow up if there is an outbreak. In other words controlling the coronavirus can be done. But because of bad federal leadership we have not been able to do this here in the United States. So, dr. Fauci, the last time you were before this committee you told me that if the u. S. Did not have, quote, an adequate response that the country would, quote, have the consequences of more infections and more deaths. Now i know that weve made some progress. But have measures wont save lives. Dr. Fauci im asking you to be very direct with all of us on this. If we dont fully implement the testing Contact Tracing programs and social distancing practices that everyone seems to agree that we need, can we expect these spikes in an infection to keep happening in different places around the country. Thank you, senator, im always direct with you and ill tell you in direct answer to your question that if you look at what is going on and just look at some of the film clips that youve seen of people congregating often without masks, of being in crowds, and jumping over and avoiding and not paying attention to the guidelines that we very carefully put out, were going to continue to be in a lot of trouble. And there is going to be a lot of hurt if that does not stop. Okay, so if we dont get our act together more and more communities around the country will see these dangerous surges of covid19. Dr. Fauci, back in march you also said, quote, looking at what were seeing now, you expected there could be between 100,200,0 100,000 and 200,000 infections. So lets Flash Forward to late june. Here we are at the end of june. Weve already seen 126,000 deaths with infection rates rising rapidly. Dr. Fauci, based on what youre seeing now, how many covid19 deaths and infections should america expect before this is all over . I cant make an accurate prediction. But it is going to be very disturbing, i will guarantee you that. Because when you have an outbreak in one part of the country, even though in other parts of the country theyre doing well, they are vulnerable. I made that point very clearly last week at a press conference. We cant just focus on those areas that are having the surge. It puts the entire country at risk. Were now having 40plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day if this does not turn around. So im very concerned. Can you make any kind of estimate on what were looking at overall on the number of deaths before this is over . You made an estimate back in march. Between 100,000 and 200,000 but we have more information now and were already at 126,000 deaths. Right. I cant make a estimation because that would have to be modelled out because when models are done, and that is where those original numbers came from, senator. As ive said very often, models are as good as the assumptions that you put into the model. And those assumptions often change depending upon what your response is. So i would really be hesitant to give a number that will come back and either be contradicted and overblown or underblown. But i think it is important to tell you and the American Public that im very concerned because it could get very bad. All right. I appreciate that, dr. Fauci. We all want our economy were long over time. I would like the same time that my republican colleagues got. Because i want to say. All right, then your time is up. Senator warren. We cant keep pretended. Senator warren. Im just as fair to you as i was to senator they got more time. Senator warren, i always treat you fairly and i would appreciate you respecting the chairmans rules. If you would like to make a closing statement, you could go ahead and do so but i dont appreciate because ive been scrupulously. That you were allowing so much more time since well when you are chairman, you can make those decisions. Thank you. I just want to make the point that we cant keep pretending this virus is Getting Better when it isnt. That is how we end up with messages like the situation in texas. Racing to reopen too soon and scrambling to close down before the hospitals get overwhelmed. If we dont get our act together, this is our future. Seesawing back and forth between too few restrictions and then exploding cases and repeated shut downs. In this future, thousands more americans will die and our economy will be brought to its knees. Weve got to have a National Strategy that makes Testing Available to everyone school, and business and every hospital, every church. Anywhere that americans come together. We need to expand Contact Tracing and we need leaders starting with President Trump who have enough backbone to face reality, distribute our resources, set our standards and stick to them. Because if we dont, the result is more economic wreckage and more death. Thank you, mr. Chairman. Thank you senator warren. What ive tried to do in this hearing is to ask senators to stay within five minutes and the answers within five minutes. And if the answers go beyond that, ive tried to be respectful of that. But i would ask senators not to ask their questions well past five minutes and then expect to make a speech at the end. Senator scott. Thank you, mr. Chairman. And i will certainly respect your time limits. I think we all should do that and frankly as were asking, dr. Fauci for an estimate of how many lives would le lost i thought the first were between 1 and 2. 4 million lives. And perhaps one of thes why we should be thankful for where we are now and force ourselves to have a serious conversation about continuing to flatten the curve is because the all hands on deck approach is effective. We just need as much cooperation from as much as many people as possible and every state around the country for us to see these numbers continue to make a dive in the right direction as opposed to spike in the wrong direction. And i think about the operations warp speed along with the crucial support from barda and other partnerships and accelerating groundbreaking technology that could eradicate covid19 and revolutionize the Vaccine Development landscape. Because of these efforts by industry, academia and government working in concert, we could see a viable candidate or candidates in a matter of months for a vaccine. And because of the growing number of large scale manufacturing agreements with Companies Like moderna, pfizer and j j producing hundreds of millions of doses at risk, which means in advance, were already working to address issues of access and this is critical, especially for our most distressed communities. That said, Effective Development and widespread access, while essential are only part of the equation. If and when, and i feel optimistic it is when and not if, we get a viable vaccine, we need to encourage folks to choose to get vaccinated. I was really concerned when i saw a recent a. P. Survey that showed only 49 of American Adults plan to get vaccinated once the covid19 vaccine came to market. A full 20 said that they did not plan to get vaccinated and onethird of americans were not sure. Given the publics recent and vital focus on Health Disparities, it is worth noting that among certain groups these figures are even more alarming. Just 25 of black americans, 37 of hispanic americans plan to get vaccinated against the coronavirus. My question to the full panel, what steps can we take at every level of government and in the private sector with Health Care Providers to ensure a proact Education Campaign and outreach strategy on the importance of getting vaccinated both for covid19 and for, frankly, even more broadly. Ill take a shot at it first, senator. As i mentioned in response to another question, that we have a Community Engagement program that actually operates out of operation warp speed, the Vaccine DevelopmentProgram Component of that. Also there needs to be engagement of people who the community trusts. Particularly individuals who are noted, sports figures or whom ever. When we were involved and continue to be involved in Community Engagement with hiv, we used people in the community, boots on the ground, to go out and looked and lived and are like the people theyre trying engage. It is very critical. Because i share with you the concern that we get to the hoop and we get through it, of getting safe and effective vaccine only to find that a substantial proportion of the population do not want to get vaccinated. Of particular concern is it is that proportion of the population that are generally the most vulnerable in the sense of minority communities, africanamericans, latinx and native americans, who because of underlying conditions make it more likely if they do get infected it is a poor outcome. So it is extremely important engage them at the local level. Thank you. Thank you very much for your answer, dr. Fauci. Let me disclose any 40 seconds that i have left and respecting the time and i hope that we continue to do so. The pandemic has triggered a drop of 60 to 80 of immunization rates among children. And even now that states are reopening, were not seeing the rebound in the rates that are necessary. This creates a real risk of secondary infection and disease outbreaks that are not on the general publics radar as they reckon with the chief crisis at hand. So i think it is important that we follow your strategy, dr. Fauci, as it relates engaging Community Leaders and perhaps people with notoriety to get involved in taking the vaccine. Thank you, mr. Chairman. I apologize for being four seconds over the time. Thank you for respecting the time. We have eight senators remaining who have questions and we should have time for all of them to have a chance to ask their questions. Senator kane. Thank you, mr. Chairman. Thank you to the witnesses. Dr. Fauci, i saw an interview with you last week where you talked about a concern that there is two sizable percentage of our population that doesnt like science and scientists and advice from scientists. And i hear real emotion in your voice as you express concern about people gathering in large groups and without masks and i gather that is the kind of antiscience concern that you were worrying about when you had that interview last week. Yeah, that is part of it, senator. Because a disregard of recommendations that come from authorities only because it is a recommendation. I think the attitude of pushing back from authority and pushing back on Scientific Data is very concerning. Were in the middle of a catastrophic outbreak and we really do need to be guided by scientific principles. And this could cause problems down the road if we get to a vaccine and people dont want to get the vaccine. So we all have to message this pretty strongly. Dr. Redfield, i want to thank you. I was going to ask you a question that ive been asking over and over again, why does the cdc guidance for institutions of Higher Education not even mention the word testing. But as as your testimony was done this morning the cdc website changed. And there are now guidelines for the institutes of Higher Education with fairly extensive recommendations and guidance, not mandates about testing. I didnt get a chance to read them but i saw them popping up on the cdc website and i want to thank you for that. And your testimony and the written testimony talks about the fact that the Public Health system relies on timely and accurate data systems. But that weve underinvested in them and the crisis highlights the need to modernize the Public Health systems. Last year i introduced a bill called the saving lives do better data act with senator isaacs and king and colleagues were helpful in there. They were able to get 50 million in december in the appropriations deal and another 500 million in the cares act. But i would urge my colleagues to do even more because our request from the Public Health communities is significantly more sizable. I hope we could get that into the next covid package. Dr. Fauci, this is a challenging question. Challenging how to figure it out. The cdc last week said that a new group that we have to considerate risk is pregnant women and lactating women. The niads, remdesivir testing and vaccine testing often doesnt include pregnant women. I think for safety reasons. But we would want to make sure that pregnant and lactating women have access to treatment and access to vaccines. So how will we be trying to do research and testing so women could safely access these treatments or vaccines . That is a great question. And it applies also to children. So what were doing with the vaccine is you do a phase one trial, in normal healthy adults, not pregnant, not children. And you show initial safety. Then when you move into the phase two and three studies, if you get even the slightest glimpse of efficacy and safety in that population, you go back and do a phase one in pregnant and lactating women as well as in children and if that is safe there, you bridge the data so that you could use the efficacy data that you already started to apply back to pregnant women. I see. That is how you do it. Let me ask you this. At this point is the nations goal with respect to coronavirus to mitigate it or suppress it . You know, vaccines right now, youre talking about vaccines sir . No, im talking about what is our goal. Are we trying to mitigate or trying to suppress . It depends on where you are. There is containment and mitigation. So if you have a level of virus that is low enough that you can adequately contain by the standard way of identification, isolation, contract tracing, particularly if you make sure you link the identification with isolation. Because if you just do Contact Tracing without isolation, it is not going to work. When you get into a situation if i could, dr. Fauci, because i dont want to go over time. I want to say one thing about testing really quick. Admiral giroir when you were here last you said we would have the capacity to 40 million tests in september and that is about 1. 3 million a day and we have done 310,000 and yesterday we did 560,000. Are we going to get to 1. 3 to 1. 7 tests a day by september . So thank you for asking that. We will absolutely have the capacity to do that. It is depending on the need. And, again, as you might expect, a few weeks ago the need for testing was much less than it is now. We had a good system that it was very good that we were able to identify a increase in positivity early but with the outbreaks were having now we need to massively surge testing in those areas. Well have that capability across the board, yeah, well have that and assuming no pooling. When we start pooling these together, three or four tests, then you do the math. Im never happy until we have more tests so we dont have the say the word test again but were in reasonably good shape given those tests. Thank you. Senator romney. Thank you mr. Chairman and thank you to each of the panelists for the sacrifice and the effort that youve been making over these past several years, or past several months as well as years. As you know, because we didnt know a great deal about this virus, never seen in america, we asked the American People to basically shut down their lives, cut back on flying, family reunions, funerals, church services, restaurants, bars, theaters, everything got shut down. And now it is end of june and hopefully weve learned something about how this disease actually spreads. And the American People need to go back out. Theyre going to go back out and they are going back out. We saw in the lake of the ozarks, all of the people and we said oh, my goodness this is a major problem but because people were outside, it wasnt a major problem. So my question is this, where is the risk greatest . How is it that it is spreading . Is it spreading indoors, more at restaurants and bars, is it okay to be outdoors and perhaps not socially distance, are family reunions okay. You could give us guidance based on what we know as to where the risks are greatest. I know you say social distance and masks. But people are getting in airplanes, theyre going to restaurants. Where is the risk greatest and where are we relatively safe . You could help us through that. Family reunions . Can we get together with family reunions doors. Is it safer outdoors or indoors. Give us some guidance. You could do that dr. Fauci and dr. Redfield. Thank you, senator. I think first and foremost, the most important thing in that assessment is knowing at the granular level what the kinetics of transmission are in the community. As i mentioned we have 130 counties right now in the United States where we consider them, quote, hot spots. We have many other areas where there is limited transmission. So first and foremost it is knowing if youre in that area of active transmission. And then secondly, it is knowing what you do when youre in that area of active transmission. And what precautions one takes. Got to be brief, doctor. I have only five minutes. Well i think those are the two things. I will say there is more and more data showing that the use of Face Coverings and masks are an effective way to prevent transmission in these gatherings and i think were just going to come back and tell you the most important thing, if youre within a community, with limited transmission, and youre wearing face masks or there is significant transmission youre wearing face masks, and you practice the social distancing and hand washing, that is the best recommendations i could tell you. In addition, senator, outdoor bedder than indoor, bars really not good. Really not good. Congregation at a bar, inside, is bad news. We really got to stop that right now when you have areas that are surging like we see right now. But in answer to your question, a lit bit more granular, outdoor is better than indoor. If your outdoor distance as bob said, wear a mask if you can. But you can have some social interaction. The one point i want to make very briefly is that we should not look at the Public Health endeavors as being an obstruction to opening up. We should look at it as a vehicle to opening up. So that you dont want to just restrict everything. Because people are not going to tolerate that. So you could get outdoors and interact, wear a mask, try to avoid the close congregation of people, wash your hands often. But dont just make it all or none. Weve got to be able to get people to get out and enjoy themselves within the safe guidelines that we have. So make Public Health work for you. As opposed to against you. I very much appreciate those responses. I think it is helpful for all of us as we go about our lives if there is data that indicated where people are getting infected. Were they in a bar or a restaurant or outdoors at a pool. Ive heard reports that virtually nobody has been infected if theyre outdoors. Is that true or not true . Given how long weve been at this, we have got to have more granular data so people know where there is greater risk. How many people have been infected as a result of flying on airplanes. We have to know that. If we could publish that American People they will know where they could be safe and go back to continue to be social distancing and we need that data. And who is responsible for distributing the vaccine . What person or what agency determines how the vaccine, when it is available, will be distributed . Well, thank you, senator. This is a central function of cdc. Where we really help with Vaccine Distribution throughout the nation. Child hook vaccines. So that is the cdc. That is on your shoulders. Thank you. Mr. Chairman, back to you. Thank you very much senator romney. Senator hassen. Well, thank you, mr. Chair and thank to you all of the witnesses for being here and for the teams you lead. I know how hard everybody is working. Dr. Redfield, i want to start with a question to you. 43 of the deaths in this country have been in Nursing Homes or longterm care facilities. In my state of new hampshire, 80 of our deaths are attributed to residents of Nursing Homes and longterm care facilities. In mid may the white house urged states to complete covid19 testing on every Nursing Homes resident and that has not happened. They have called for a baseline test for residents and weekly testing for Nursing Homes workers. Given the widespread outbreak and the unique risk to residents what is cdc doing to ensure that states carry out the recommendations for nursing home testing issued by cdc on june 13th and how many states have met these guidelines so far . Thank you, senator. We are working in close contact with cms on that issue. As you say, were not an enforcement agency. We make recommendations. But im asking and my time is short. Im asking what you are doing to keep track of compliance with guidelines. 43 death rate nationwide is huge. And people are looking to yall for granular guidance here. So what are you doing to find out what is in compliance and who is not . I was trying to emphasize that were working in partnership with cms which has the regulatory over sight. Were there to continue to reinforce the guidance as you mentioned which we think is critical and we think we do have to get everyone screened in the Nursing Homes and the employees every week. Unfortunately we still think we need to keep visitors isolated from the homes, in areas with high jurisdictions but the regulatory function of this is cms but we are meeting with them daily to see what more we could do to try to ensure that there is greater compliance. I thank you for that. People are looking to the cdc for very clear and granular guidelines and youve heard that throughout the questioning but particularly in Nursing Homes and longterm care facility and theyre still not getting useful personal protective equipment either. And let me go to another question and dr. Fauci ill start with you. Weve heard discussion already today about the difference in the effectiveness of measures taken for instance in europe and the United States. This is a graph that shows the disparity between new confirmed races per million residents over the previous seven days, to the United States, europe, canada and japan. The disparity is eyepopping. Surveys suggest that mask wearing in the United States occurs less frequently than in europe and youve talked about mask wearing in public places. Do you attribute the improvement in europe to more widespread use of masks or are there other specific Government Policies or individual behavioral differences that you believe should be incorporated into our National Strategy . It certainly is masks that play a role but there are a number of other multifaceted things in each of those very disturbing graphs that you show. One of the things that became clear, when we shut down as a nation, in reality only about 50 of the nation shut down with regard to other things that were allowed. In many of the european countries, 90 , 95 of all activities were shut down. So that is one of the reasons why you saw, particularly in italy, which shut down to a much greater extent than we did, the cases came way down in a sharp curve downward and then stayed. So it is not only masks, it is the fact that the countries in europe and the other countries that you have there had a much more uniform response. Were a very heterogenius country and we have a heterogenius response depending whether you are in the northeast or west or what have you. There are probably some that we still dont even understand. And im going to move on to one other issue and it is really just to urge dr. Redfield and the cdc to issue Additional Guidance for schools in particular on reopening. I understand that you are continuing to do that. I appreciate that the cdc has released faq, frequently asked questions on things like youth sports which provide more concrete useful information for families and im hoping that youll do the same kind of faq documents for parents and teachers that directly address practical questions and concerns about School Reopening plans, like what happens, and what should a school do specifically if one or two positive cases come up in a classroom or in a teacher. What should parents and teachers expect School Administrations to do. So we could follow up with that. I appreciate the chairs indulgence. Thank you, senator hassen. Senator brawn. Thank you, mr. Chairman. Ive got two sets of questions and like for dr. Fauci and redfield to give about a minute even to the first. I want to get the broad numbers. I think dr. Redfield you might have been on record you think there is ten times as many cases out there and i know that is a guess. I would like to know, if that is the case, all of a sudden the fatality rate goes from 5 to five tenths of a percent and from 2. 5 point down to. 25. Dr. Redfield, how many cases do you think we actually have out there. And then how many vaccinations and are herd immunity combinations as a percentage of the total population do we need to get to for this thing to be in the rearview mirror. So we have big numbers to relate the journey ahead. Thank you very much, senator. Quickly, we now know this virus began to spread in the United States in march and in between march and the end of may. Weve been able to do Antibody Testing and thats allowed us to understand how many people were really infected. So during that period, it was our best estimate, about 10 to 1. So were probably talking over 20 million, 22 million americans infected. I dont want people to assume that is the same ratio now in june and july going forward. Because you think it is more than that. No, it is less because were doing more and more testing. But clearly it gives us a good idea of the extent of infection was more in march, april and may. Not 2 million individuals but more closer to 20 million individuals. What is your opinion of how many individuals we need vaccinated and or having herd immunity before this thing goes into the rearview mirror. Tony could comment on that too. It has to be over 70 of the population before we see impact of herd immunity. Dr. Fauci. I totally agree. You need somewhere between 70 and 80 . I would say 70 at the lowest. Okay. Second set of questions would be on the issue of herd immunity. Because we have the we dont know how long it will take to have an effective vaccine and im guessing when you talk about herd immunity, it has to confer immunity if you get it. Lets assume you do get the immunity, what is the how do we go about the approaches that weve used to this point. Is herd immunity going to be something that you think will march through if we take the strategy of having a different approach for younger people, that seem to have lower hospitalization rates and less significant consequences, because i think that is another thing we need to know because i think that is already going to be done by each individual in a way as they size up their own personal risk. So how much can we count on herd immunity . I answer quickly and turn it to tony. Even now were looking at somewhere ben 5 and 8 of the American Public is experienced this virus. So for me herd immunity as a basic strategy, youre talking about a multiyear strategy. This is why it is so important that the alternative strategy is a biological Counter Measure and in the development of a vaccine. One of the issues that might be complicating, i dont think it is something that is going to be any kind of a showstopper, but we have to realize and as senator paul said, we have to be humble and know there is a lot we dont know. And what we dont know is with the durability. So in other words if you get herd immunity, 70 , to 80 and what we need to learn and only time could teach us this, is how long the immunity lasts. Is it a year, two, threear four or is it less and is it months . We dont know. When we find out that will inform us as to whether or not you get a vaccine how often you need to boost it. So we dont really know the answer to your question in any definitive way. At least that gives us some clarity, some parameters to live within. Senator hassen stressed the point of protecting the most vulnerable because to me the one thing it looks like we could certainly do is to take that highest risk group, from the data weve already got, and build in essence an iron dome around them as the one thing that would seem to be the most important thing to do. Where you get certain results. And i think that has to be in place as we the uncertainty of herd immunity and when we get an effective vaccine might emerge. We think about herd immunity with regard to natural infection and or a vaccine but when you talk about protecting the vulnerable, we want to see in the other programs that are more prophylactic treatment, like passive transfer of plasma or hyper immune globulin, that could protect the vulnerable until we do get an effective vaccine. Thank you. Thank you. Senator smith. Thank you, chair alexander and Ranking Member murray, it is go to see all of you today and thank you again to our panelists. So we need robust surveillance occupation ago testing if were going to safely reopen our economy and our schools, our Nursing Homes and our group homes to make sure theyre not a conduit for infection. And were seeing this. A good example is in in new york state where employees of Nursing Homes are required to get a covid19 test twice a week. So here is the problem if youre a worker. Who pays for that test . Is it my employer, my private insurance if i have insurance or do i pay for it out of my pocket. So im thinking about that low wage worker, working in childcare or Food Processing or a security worker or janitor. And the average cost of the test is somewhere in the neighborhood of 75 to 150. There were reports of people charging over 6,000 to be tested, assuming you could find a test. This is my first question. Last week federal agencies posted guidance on this question and the guidance said that health plans are not required to cover the full cost of tests for surveillance, for occupational reasons. And the federal testing plan, which talks about the value of surveillance testing and occupational testing, is silent on this. So let me ask you, dr. Fauci, do you agree that we are going to be better able to contain the spread of covid19 and save lives if we have surveillance testing . No doubt surveillance testing is going to be a very important part of the program, to understand not only the current penetrate and where it is going. The short answer is it is very important in our Public Health measure. Would not only the price of these tests or the ability to pay for the tests be a pretty significant barrier to having that surveillance happen. I think common sense tells you that. If people cannot pay for it, theyre not going to do it. And that is one of the reasons why we have to figure out how we can do it without having the stress of people who cant afford it to be part of that process. And of course the worry is that this ability to pay for the surveillance tests or this kind of surveillance testing that could really tend to exacerbate underlying inequities since a lot of frontline and essential workers who dont have the privilege of working from home are much more likely to be black and brown and indigenous people, people of color, isnt that right . As in all cases, that people who are economically not able to engage some some of the things that benefit others, they always in general get a short end of the stick on that and that is what we have to be concerned about. Right. Right. Well, colleagues, i think this is a really important place where we have the potential to Work Together to make sure that as we expand surveillance testing and occupational testing and as we look at schools and higher institutions of Higher Education coming back that we have the ability to do this and the ability to pay for the test isnt a barrier so i appreciate chair alexander, you mentioned this at beginning, other colleagues have mentioned this and i think it is a place where we could Work Together in a constructive way. Im going to ask a question specifically related to vaccines. Because it is been a lot of discussion about this. A lot of discussion about how we can make sure that people trust these vaccines. That they are safe. This they work. And that the longterm consequences potential negative side effects, we understand those. So let me just ask, maybe ill ask you again, dr. Fauci, how do we trust a vaccine that has only a short number of months potentially being tested in the human body . There are a couple of ways to over come that. First is that you have a large number of people in the trial. The trials that were talking about now were going to have 30,000 people in the trial. And maybe even more in some of them. You can get a considerable amount of safety data. But then there is a process after a vaccine, maybe would show efficacy to do further studies following licensure availability. Ill let dr. Hahn comment on that more because that becomes something very much involved with the fdas authority in making sure that we do have safe vaccines. So steve. Let me just if i could maybe put a finer point on this question for you, dr. Hahn, what if a manufacturer would say they could get a vaccine to market in january but only if they were released from reliability. What is the fda policy on that, how would you resolve that question . Thank you, senator. So we would not get into the issue of liability for an individual sponsor. And what we would do, and that is why we released the guidance this morning, is we would ensure that our normal regulatory approach and our standards for safety and efficacy are met. So not you would not release a manufacturer from liability. That is not an fda authority that we would use. Okay. And how do you guard against senator smith, were running a little late. Go ahead with your question. But lets the witness hopefully this is an easy one. What im worried about is that there is an october surprise and there is a pressure put on the Decision Makers here to announce a vaccine in october of 2020. Dr. Hahn, could you tell us how we could have transparency so people could trust that that isnt happening. Senator smith, a very good question and really important and leads to the issue of Public Confidence. It is why we released our guidance today. We want to be clear about what the standards and the data that well need to make a decision and what factors go into those decisions. And what the American People hear me when i say well use the science and data from the trials and ensure that our high levels of standards for safety and efficacy are met. Thank you, senator smith. Senator loeffler. Good morning, thank you all for being here. Sorry, i cant be there in person. I wanted to ask, dr. Redfield, can you outline what steps the cdc is taking to look at, as we prepare for handling both the flu and covid19 season simultaneously this fall, i know the cdc recently developed a test that diagnosed both covid19 and the flu but what other acts is the agency engaged in and are there any novel approaches in terms of implementing this. Would love to hear about the agencys process for approaching the season this fall and your thoughts there. Thank you very much, senator. I think it is really important to recognize that it is going to be difficult with flu and covid19 this fall. First and foremost is to try to increase the American Publics acceptance of flu vaccine. As you know, less than 50 accept it. Were working hard to begin to reach out, particularly to groups that have been underrepresented to try to build that confidence in vaccination. Weve worked with the manufacturers to see if they could boost the amount of vaccine that would be available. Theyve now increased their commitment to almost 189 million doses. Cdc bought another 7. 1 million doses. Normally we buy about 500,000 to be available to the states and local Health Departments for uninsured adults. We increased that to 7. 1 million doses. Weve augmented our commitment to the Children Vaccine Program and anticipating there is more children that will qualify in light of the unemployment. So those are some of the areas that weve begun to prepare for. Thank you. And this question is for dr. Hahn. The pandemic has exposed our vulnerabilities in the medical supply chain and obviously we have a reliance on imports from countries like china that could quickly pose a National Security risk in the face of an outbreak of infectious disease. We need to come up with a strategy to boost our production here. Both pharmaceuticals and supplies. Ive introduced some legislation titled the beat klichina act, t bring manufacturing back to the United States. But would like to hear from you what additional steps could policymakers take to boost our capability to produce these supplies and pharmaceuticals domestically. Thank you senator, loeffler and your leadership on this. One issue we could agree on is the lack of redundancy in the supply chain and the dependency that weve seen during the covid19 pandemic has been a problem. The agencys primary focus has been on instilling redundancy in the supply chain, particularly pharmaceuticals by diversifying that supply chain. And really looking for opportunities to encourage domestic manufacturing. We, of course, on the regulatory side, provide guidance as well as regulations around the manufacturing specifications to ensure quality of pharmaceuticals and other medical products. Well continue to do that particularly in the advanced manufacturing space in order to encourage domestic manufacturing. We look forward very much to working with you and other members of congress to see how we could create the proper incentives to have that redundancy and particularly to have as much domestic manufacturing as possible. Thank you, dr. Hahn. No further questions. I yield my time. Thank you, senator loafler. Senator jones. I appreciate your consistency over the last few months. It has to be discouraging to see these numbers. I want to folks a little bit on schools. As well start opening schools up in alabama in august. And let me give you a little chronology here. The state of alabama began to open up its economy more in may and more toward the end of may and then for memorial day we saw the photographs and videos that dr. Fauci referred to with everybody just having a big time for the memorial day holiday. Now at the end of june, we are at our highest levels, the last 14 days have shown over 10,000 cases, which is 28 of the cases that we have seen have occurred just in the last 14 days. In the end of this week we have the july 4th holiday coming up. And were going to see a delay in hospitalizations from right now if we do the same thing on july 4th, well have a huge problem at the end of july and early august when we start opening schools up. Our state School Superintendent this week said that it would cost about 1. 8 million for the average School System to do those things necessary to try to protect kids and the faculty. But i heard senator paul in his comments and discussing a number of things to where you would get the impression that we could just open schools back up without spending any of that money. So my question primarily to dr. Fauci and dr. Redfield, could you comment on some of the statistics and things you heard about children transmitting this disease and whether or not we need to spend some additional monies for our schools to do things like have extra ppe, to do things like potentially hiring Additional Health offers, temperature screenings, those kind of things. Are those necessary based on what ive heard from senator paul and what happened on his charts in other countries. Dr. Fauci and dr. Redfield . Ill quickly give it a shot and hand it over to dr. Redfield. We dont know precisely. I think the data that was very interesting that senator paul showed about School Openings and not seeing any real obvious surge in cases is important. But we dont really know exactly what the efficiency of spread is. First of all, how many children get infected. That is the reason why in my Opening Statement i mentioned the study at the nih of 6,000 families looking at children, what is the rate of infection and how often do they infect their families. Because if it is true that the rate is down, we know that they dont get seriously ill with hospitalizations when they get infected. But if the rate of infection is down, and they dont readily transmit to their parents and family members, that is going to be very important and the decisionmaking process of opening schools. Hopefully were going to find that out reasonably soon by the study that were doing. Id echo what dr. Fauci said. Cdc has a number of household studies going on to try to get a better Understanding Social distancing et cetera, so there is information that we are gathering. I think we dont know the impact children have yet on the transmission cycle, so i think we should just acknowledge that. The greater threat, obviously, is again the children to the vul neshl, but i think one can have social behavior that can prevent that. So i think that would be, just to emphasize, i think its really important. Its been said already that we move forward and work to reopening schools in a safe way. I think as of note, the cdc never really recommended closing schools. It sort of just happened, as you know. We can do targeted School Closings in a particular region like weve done for other viral diseases, but i think we need to move forward now and work to reopen these schools safely. Thank you. Admiral, just i want to make sure youre, were tuned in and we talked about it a little bit. Are we going to be able to make sure that we get vaccines distributed in the most vulnerable of communities . Because that seems to be where so much is happening right now. In the rural south. Are you making specific plan to make sure we get that into the rural areas . So, thank you very much. We all work on parts of this problem, right . So the cdc actually controls the distribution but what my office does, run ining the National Vaccine program, does things like the morehouse grant, cooperative agreement that we announced last week, that really reaches into the rural, hispanic, into africanamerican, to really have the community, the people who are in that community. Not only link to Services Like testing, but to lay the ground work for vaccine acceptance. Because we know that the burden of disease is fundamentally burdened on these individuals. These are the people, assuming the science works out, that we want to get vaccinated first. Thank you. Thank you, senator jones. We know the witness witnesses need to leave about 1 00 and were going to try to respect that. Senator rosen. Hold on. Can you hear me . Yes, we can. Morning. I will try to be as quick as i can talking about antibodies this morning. Thank you, chairman alexander, all of our witnesses for being here today. As our communities focus on how safely to get back to work and school, just like were all t k talking about, we know we have to follow the science and a adapt to new information, be sure that were making timely, targeted, and thoughtful decisions to protect both lives and livelihoods. So dr. Fauci, the last time you were here, we talked about the antibody treatments and i would like to follow up u on that c conversation if we could. As we learn more about the virus, how it functions, how its different from other respiratory illnesses, what can you tell us about the development of preventive treatments that block the virus from attaching to the cells that its targeting . Thank you for the question, senator. You mentioned monochloalal antibodies. Theyre going into trials right now, in a number of trials sponsored by a number of groups ch hopefully in a reason abl amount of time, well get information thats effective both in the prevention as well as in the treatment. These antibodies are directed against a component of the virus that is whats called a spike protein and that protein is the one that binds to the now well established receptor in your body for the virus. And thats a receptacle ace two. There are studies that are not necessarily antibody studies, but studies that have an effect on the virus and its initial replication. An answer to a question that the chairman mentioned just a bit ago, is that there will be therapies that we will be giving some for treatment early on and others for prof lax is and as we hope, as we get into the fall and winter, well have everything from small molecule treatments and prof lax is to the kind of antibodies that youre talking about. So theres a lot of activity going on to do that early in disease. Both for prevention and for the treatment of early disease. I know youve been doing a lot of serology testing and that individuals are presenting with antibodies, so off the five types of antibodies that people are most likely to have, which ones do most recovered, which ones do they show and if one of these are present, does that make a difference and if the patient can be reinfected or not . Are they effectively immune, at least for some period of time . What kind of answers does this give us if you have the presence of certain antibodies . Id love to give you a really precise scientifically based answer, but the fact is, we dont know. When you get an acute infection, you get an igm antibody. As you develop a more mature response, it becomes an igg. There are subclasses, some more protective than others. The thing we dont know, senator, that we will know in time, but its going to take time to know it, is what the relationship between the neutralizing antibody and binding antibodies that dont neutralize, what is the relationship between the titer and degree of protection and what is the durability of protection . Weve seen some puzzling things. Weve seen people recover from Covid Infection and find out they dont have very high numbers of aept body. Could it be a cell mediated response that got them through the illness . And some individuals have very high levels and we dont know how long those levels last. So were get there with regard to our knowledge, but its going to take several more months to a year to really be able to answer your question about the role of antibodies in protection following natural infection. Building upon that, id like to ask this question. We know this virus affects, is multi multiorgan. Affect your heart, lung, stro strokes, digestive system, sense of smell. Of the science youre talking about in the antibodies, is the science of stop iping the virus from causing harm the same regardless of which organ it attacks and how udoh we help direct funding for the kind of research that youre going to need to look at this multiorgan attack of this virus if you will . This is a very perplexing virus because its a respiratory virus and gets in through the respiratory tract. If the virus stays in the respiratory tract and doesnt go systemic to involve other org organs, thats good news because you dont get very sick. The other side of the coin is your antibody response is not as potent because when you get systemic involvement, invariably, you will have a more potent and robust immune response. So many people, and probably people who are the asimp tympto carriers, they have a reasonable titer of virus in their nasal fair but it doesnt go anywhere else. People who get triggered by the virus are the ones unfortunately get more sick but make a more immune response. Thank you so much. I appreciate you all being here today. Thank you. Very interest iing questions. Senator murray, do you have closing remark sns. I have one additional question then closing remarks. I wanted to admiral gerard one question. Yes, maam. Thank you. Despite some of the limited data, we do know that covid19 is infecting and killing black, latino, and native American People at a much higher rate than white people. How is hhs going to reduce its response in communities of color . Specifically, can you commit to directing some of the 14 billion in unspent Funds Congress provided to address those disparities . Let me answer two parts of the question. First, really appreciate your suppo support, weve tried to focus our testing into high social vulnerability communities. 70 of our over 600 pharmacy sites are in high svi communities. That means racial and ethnic mightie mighties, language disparities, socioeconomic. We made a major push that the federally qualified Health Centers that take care of one out of three of those in poverty, over 1300 of those are offering testing. Of course, were super excited to award to Morehouse School of medicine last week that has a large ecoalition to reach minorities and underserved. Thats what were really doing. My office, this is what we do on a daily basis even without a pandemic. Your second question is i dont commit the money. So, i certainly think we need continued investment in this area. Continued significant investment in this area that the 40 million is a down payment on how we could best reach the underserved community, but youre going to have to talk to omb about how the money is spent. Well, actually, hhs oversees that, so we will ask them, but its an important question. Ill keep following up. Thank you, mr. Chairman. I appreciate all of our witnesses taking the time to join us today to update our committee on course of this pandemic and all of our efforts to respond to it. I hope we will continue to have an opportunity to continue to hear from all of you as well as other key officials because the absolute worst thing we could do right now is to pretend this crisis is over when it is painfully obvious that is not true. The reality is that the losses in this pandemic so far are nearly unthinkable. And any further delays in our response is really unacceptable. We need to take this president to take this crisis seriously and lead and we need congress to act, so i hope we can all get back to work as soon as possible. We need to support our families, our front line workers, our businesses, schools, communities. We need to get testing where it needs to be. We need to make sure we are making progress towards a safe, effective, widely available vaccine and we need to strengthen our ties with the Global Community rather than cut them. So theres a lot left to do, mr. Chairman. I look forward to working with you on this. Thank you, senator murray. I know our witnesses have a meeting they need to go to, so ill abbreviate my remarks, but one thing i want to ask you, perhaps you could each do it in a a minute or less. Ive put ott out a white paper in recognition of what some of you have said, which is that in between pandemics, we have found it difficult to do some of the things we need to do to prepare for the next pandemic. So there were one or two things that you thought we should try to do now in order to be prepared for the next pandemic, what would those one or two things be . Dr. Fauci . One of the things that i would like to see is an appreciation on the part of our entire nation of the importance of responding as a nation as a whole and not have a situation where we have a challenge such as we have right now. We have very desperate respon s responses. Weve got to do it in a coordinated way because we are all in this together. The other thing id like to do now is to cement in our minds as we bridge to the future, the fact that we cannot forget that what was thought to be unimaginable turned out to be the reality that were facing right now. So it relates to the kind of appreciation that outbreaks happen and you have to deal with them in an very aggressive, proactive way. Dr. Redfield . Thank you, mr. Chairman. I think the most important thing that i could say is that when it comes to Public Health threats, our nation needs to be overprepared, not underprepared. And as i mentioned before, decades of underinvestment in the core capable ilities of pub health, day modernization, laboratory resilience, workforce, emergency response, i think is fundamental. Weve really been hit with this simple virus. And i think at the end of the day, its going to cost our nation trillions of dollars. And i think that we have a moment in time where i think people are attuned and i would say now is the time to make the necessary investment in our Public Health at the local territorial, tribal state and federal level, so that this nation finally has the Public Health system, not only that it needs, but that it deserves. Of course i agree completely with my colleagues and were all singing from the same hymnal here. Data infrastructure is really important. When we came into this, we didnt know how many ventilators were in use, how many tests were out there, were they positive or negative . The couple plecomplete soup to s for example, you need those decisions to make decisions and now we built this on the fly, but we absolutely have to invest in that. Secondly, resiliency of the health care system. Yes, we need the attack covid, but what happens to Everything Else . Weve seen cancer screenings go down by 80 . Childhood imizatiommunizations plumet. Its Everything Else we need to do and third thing i would say is we continue to have to focus on health despaisparities. If everyone was healthier, if we invested into hyper tension, obesity, diabetes, all the things that could bring the General Health up, you would not see the horrible outcomes as we have in any pandemic. So working on Health Disparities is critical to raise our General Health and prepare us for whatever is going to hit us. Dr. Hahn, you can have the last word. Thank you for your leadership and your white paper. I think thats really important to put this conversation forward. There are two things i want to emphasize. One is the data modernization, but from an fka perspective. Its a very manual process to number one, collect data on demand and also the supply chain. We need a very robust system to understand that. We also need a robust, real world evidence approach so when we make decisions in real time during an emergency, doctors do that all the time. Agency docies do that, we have correct information to collect evidence and feed back into our decisions then revise as needed. The second thing that is linked and that is to my previous comments that senator leffler asked about. We absolutely need redundancy in the supply chain. In manufacturing and we need to emphasize the im response the federal to the coronavirus pandemic at cspan. Org coronavirus. Watch congress, white house briefings and track the spread throughout the u. S. And throughout the world. Anytimedemand unfiltered at cspan. Org coronavirus. Q and a, an author on the response to the covid19 pandemic and the medical science being used to combat it. A level ofot seen collaboration within the Scientific Community of this stature in my life. That is very encouraging news. By sponsors,oved they will possibly move, we will have by the end of this month two to four potential drugs including antibodies that will attack the virus. These are still in advanced stage studies. I cant comment on what settings they work on. We will also have about four or five or six new modalities to treat the inflammatory phase of the virus. Announcer 1 watch tonight at 8 00 eastern on q a. Monday, the Atlantic Council looks at russias future under Vladimir Putin and a constitutional referendum that was secure his rule until 2036. That is 1 20 p. M. Eastern. Later three appropriation committees hold markups on the appropriations1 bill. Each subcommittee will be reviewing its part of the measure. At 4 00 low humidity on state and foreign operations the committee on state and foreign operations. At 8 00 p. M. We join the subcommittee on military construction and veterans affairs. On cspan two at 9 00 a. M. , a discussion on the European Unions economy hosted by the American Enterprise institute. The general director at the European Commission talks about efforts to promote growth and Sustainable Public finances across the continent. Later the discussion on how deep the covid19 recession could be from the Brookings Institution at 1 00 eastern on cspan 2. Irs commissioner Charles Rettig testified before the Senate Finance committee about the impact of the coronavirus pandemic, 2020 filing season. He discussed efforts to deliver payments owed to individuals and Small Businesses provided by the cares act and addressed the filing deadline which had been extended until july 15. This is about two hours