Transcripts For CSPAN CDC Director Dr. Redfield Others Testify On Coronavirus Response 20240712

Coronavirus pandemic with dr. Redfield. [inaudible chatter] appropriations subcommittee on labor, health, human services, education, and related agents these will come to order. Witnessesthank our for appearing before the subcommittee today to provide an update on where we are on the areas that they are so involved in on covid19. Challengednue to be by this pandemic in the country, we know that 195,000 961 americans have died as part of the pandemic and 6. 6 million have tested positive during the process of testing in the pandemic. 6. 6 million have tested positive during the process of testing in the pandemic. This has rapidly swept across the globe, and even countries who thought their cases were contained are facing new outbreaks and dealing with those new and unanticipated outbreaks. This is a new disease in many ways. And even after 9 months we still know relatively little about this disease or coronavirus generally. This has hindered our Public Health response. In many ways this has been like trying to build a plane while we were flying the plane, and that is a challenging, challenging thing to deal with. Thats not to fully exonerate certainly the way the administration has dealt with it or the way its been funded, and im sure that justified criticisms can and will be leveled. But history allows us to look back over past events and to put current ones into perspective. If we wanted to look back just 6 years to 2014 for instance when west africa faced the largest Ebola Outbreak the world had ever seen and unlike covid19 we knew a lot about ebola at the time. The disease has been around since the mid70s. It was a disease scientifically we knew a lot more about in 2014 than we do about covid19 even today. And frankly we just didnt handle it very well. We made significant mistakes, and weve seen those mistakes occur in other disease areas. Members of congress use words when they talk about the cdc response like cryptic and misleading and thought the information provided wasnt enough. We even had a case found in a dallas hospital and the cdc director blamed the hospital. At the same time one of the nurses in the hospital was allowed to board a commercial flight with cdcs consent. So we seem to keep having to learn these lessons over and over again that we have to be better prepared. Public health is hard and it seems to be hard for us to keep our eye on what might happen in the future once we get beyond that moment. We should have learned and more importantly implemented more than we did from ebola or from h1n1. Hope wale well do a better job learning the lessons we need to learn right now. We know that in our committee weve worked hard in the last 6 years and in the last five budgets in a bipartisan manner to increase the funding in the annual Appropriations Bills for nih by nearly 40 , for cdc by 21 . And for preparedness by 44 . But those numbers all have to be coming together before we begin to use them the way that our Witnesses Today or this committee would like to see them used. Weve proven in our committee that medical research, Public Health preparedness are all priorities. And because weve done so we were more ready than we were at the last time or hopefully more ready in the future for the next pandemic. Right now 238 fda emergency use authorizations for diagnostic or antigen tests are on the market. And every day we get closer to an affordable reliable rapid test where you can get an answer in a way that allows us to really fight the pandemic rather than have another data point. In a few years when someone gives a History Lesson about covid19 response there will be criticism. Itll go back about 20 years, and it will be significant. But i know there are things we all agree on. We need to have more investment in testing, more resources for our candidates to finish their trials, manufacture the vaccine and for cdc to distribute through a vetted, well thought out plan. I hope we learn more about, and im going to insist we learn more about all those things today. I hope we might be able to include child care in our hearing today. We werent able to do that because of time, but clearly if youre going to get back to school, back to work and back to Better Health child care has to be part of that and something this committee has to stay focused on. So, again, welcome our witnesses. And senator murray and joining us from her office, i believe. And senator murray, were ready for your opening comments. Thank you very much, mr. Chairman. And thank you to all our witnesses joining us today. You know, as our country approaches a tragic milestone in this pandemic 200,000 dead, i want to recognize that our Rising National death count represents countless personal losses. Families have lost parents and grandparents and children. Communities have lost educators and Health Care Providers and other front line workers. And people have not only lost loved ones but many have lost the small solace of being able to visit and comfort those they care about in their final moments. My heart goes out to everyone struggling with the hardship caused by this virus. Whether theyre suffering with the loss of life or livelihood. You all deserve leaders who take this crisis seriously, who take action to support and protect you, your family and your community. Who arm you with the facts you need to stay safe. Unfortunately, we have yet to see that leadership from the president. Like Many Americans i was deeply angered last week to hear President Trump admitting that even though he understood covid19 was more deadly than even your strenuous flu, thats a quote, he was intentionally playing down this crisis. But i was not surprised. These recordings were not a revelation. The reality has been painfully obvious for months. Early on President Trump not only claimed this virus was contained, controlled, going away, he claimed it was a democratic hoax. His Vice President wrote on an oped arguing that there would be no second wave just before we saw a heart breaking and record breaking increase in new cases and deaths across our country. When it came to testing, President Trump didnt just say he took no responsibility at all. He said he liked the numbers where they were. He said he wanted to slow down testing. And he blamed testing for the rise in case numbers. When it came to Wearing Masks he not only said that masks caused problems, too, he also shared a tweet saying masks represent a culture of silence, slavery and social death. And a video falsely claiming people dont need to wear masks and there is no cure. He made false claims on treatments as well, continuing to promote hydroxcl hydroxclori. And hes still saying weve rounded the final turn. Dr. Fauci is saying thats not true and pointed out weve plateaued at around 40,000 cases a day. That daily deaths are still regularly around 1,000. And experts have kwarned we still need to prepare for a fall wave that will coincide with the flu season. President trump has not been listening to the Public Health experts. He has been fighting them and suggesting fda is part of a deep state conspiracy and cdc is overstating the death count. But not only is he spreading inaccuracies and outright lies at a time when truth is a matter of life and death and trust trust in our Public Health agencies is paramount, his administration has been recklessly interfering with the work of these agencies for political benefit to promote unproven treatments, alter cdc guidance on reopening and testing and more. Just over the last week we have learned that President Trump put pressure on nih and fda to authorize convalescent plasma as a treatment and that political appointees at hhs have worked unsuccessfully to dictate talking points for dr. Fauci and has succeeded in demanding oversight of and changes to cdcs flagship scientific publication, the morbidity and mortality weekly report. That publication is a cornerstone of Public Health work across the world. It is dangerous and unprecedented that political appointees are editing, sensoring and ultimately undermining a report that is intended to give families, Public Health professionals, researchers and Health Care Providers what they need the truth. Trump Administration Political meddling shows a dangerous disregard for truth, facts, science, and most importantly peoples lives merchandise data and science are key tools in our fight against any health crisis. And the damage being done to public frust in those tools by this administration threatens to undermine our ability to respond to this pandemic, public truts in an eventual vaccine and Public Health efforts for years to come. The Trump Administration needs to leave the science to the scientists immediately. Full stop. The leaders of our Public Health agencies need to provide a full account of what political pressure has been applied and what steps they are taking to make sure it does not influence their work or the work of the agencies they lead. Congress needs to act now to demand the transparency we need to hold this administration accountable. Democrats will be laying out steps soon for how we can do that, and i hope every republican who has said they believe we need to follow the science will prove it by working with us on this because you cannot be for science if you arent against political interference. I also hope republicans will come to the table to work with us in earnest on a larger covid19 package that our communities so desperately need. Unfortunately, theyve not taken this seriously so far. And when democrats put forward the heroes act back in may republicans said there was no rush, they would wait to see if more was needed. When republicans finally did put forward a proposal months later it was woefully inadequate to address the crisis at had. While democrats have moved to find Common Ground and even offered to negotiate towards a lower top line number republicans refused that offer and instead put forward a bill last week that moved us even further away from Common Ground. This isnt serious negotiating and the ideas that have been put forward are not serious solutions. But the crisis we face remains deadly serious. We cant afford to waste anymore time. We need to stabilize the child care sector and make sure schools can educate schools safely whether theyre remote or in person. We need to make significant investments in Public Health particularly regarding testing and Contact Tracing and distributing and administering a safe, effective and trusted vaccine. And we need to demand the type of comprehensive National Plan for those efforts that has been long overdue. The Distribution Plan that cdc finally put out just today is a long overdue step forward, but there is still more to do. Im still reviewing this, and ill have more to say, but its clear this is still not the kind of comprehensive, end to end National Plan ive called for and that we desperately need. We are still missing important details on research and review like what standards fda would use to authorize a vaccine for emergency development, like how we make sure disparities are addressed in Clinical Trials. And manufacturing, like how we address supply chain issues. And we still need more details on addressing disparities. We also need to protect the safety and civil rights of those going to work and provide relief to those who have lost their jobs. We need to support families who are struggling to make rent and afford health care and get nutritional meals. And we need to address the severe disparities were seeing in how much harder nis crisis is hitting black and latino and tribal communities. We need to provide relief for our state, local and tribal governments. And last, we have seen recently certainly not least, we need to make sure once and for all that political interference from President Trump does not further undermine our response to this crisis. Now, im going to have several questions from our witnesses, but i hope were all able to get more than just answers in the days ahead. I hope were all able to finally come together and take action before we lose anymore time to save lives and prevent costly mistakes. Thank you, mr. Chairman. Thank you, senator murray. Again, let me welcome our guests today, our Witnesses Today. Admiral brett giroir, the assistant secretary for health, and dr. Robert redfield is the director for the center of Disease Control and prevention. Were pleased youre here, like to give you time to make an Opening Statement. We have the statements youve presented. You can summarize those if you want, but we are eager to get to questions, but were also eager to hear from you. So admiral giroir, why dont you start with your Opening Statement . Chairman blunt, Ranking Member murray, and distinguished members of the subcommittee, im honored to update crow on our nations effort to combat covid19 with a specific focus on testing. Testing is an essential component to americas response to the pandemic. Recommended practices like wearing a mask, avoiding crowds especially indoors and washing your hands combined with smart testing is the formula to effectively slow the spread, flatten the curve and save lives. By being Evidence Based, providing county specific weekly guidance to governors, expanding supplies and managing their distribution, providing the right test to the right person at the right time and developing and allocating safe therapeutics we are seeing promising results. Specifically since the post memorial day peaks in Community Spread the number of new covid19 cases is down 48 . The number of people hospitalized with covid19 is down 49 persz. The number of people in an intensive care unit due to covid is down 62 , and deaths associated with covid are down 33 . But let me say emphatically that these gains could be fleeting or even reversed if we do not continue to follow the National Plan and exercise personal responsibility especially Wearing Masks and avoiding crowds. Now, specifically regarding to the over 2,700 federally supported or federally enabled Community Based testing sites at trusted retailers focused in areas of moderates to high social vul 234b89, and the literally thousands of hersa federally qualified Health Centers that offer testing to predominantly racial or ethnic minority patients. We are now at an Inflection Point in testing. This month we anticipate the availability of approximately 3 million tests per day, and at least half of these will be rapid point of care. We will have available more point of care tests in september than the total number of tetsts performed in august. Weve been building towards this Inflection Point, and i previously testified to its coming several times over the past months. As a result of regulatory flexibility, investment in the public and private sectors weve implemented cutting edge initiatives to flatten the curve and save lives while supporting the reopening of america. Protecting the elderly has been, is and will continue to be a foremost priority for this administration. So on july 14th we announced that every single eligible nursing home in america would receive a point of care instrument and point of care testing supplies. We have delivered on this promise. All 13,850 eligible nourish homes have now received a total of 13,985 instruments and over 4. 9 million rapid point of care tests ahead of schedule. On august 27th after months of planning and only one day after its fda authorization the administration announced a 760 Million Contract with abbot for the delivery of 150 million rapid by next now point of care at thes. This test is easy to perform, does not require an instrument, delivers test results in 15 minutes or less and costs 5. It can easily be deployed to many settings across the country, and it comes with a companion app that enables instantaneo instantaneous reporting. This week we will ship our first 2 million tests to further prevent spread covid in Nursing Homes, assisted living and in tribes. And to support vulnerable populations at hbcus. Thank you for the opportunity to provide these remarks, and i look forward to your questions. Thank you, admiral. Im the assistant secretary of preparedness and smchbs as a medical doctor and retired military officer and having served in the white house ive spent my entire adult career working and serving the american people. Our progress in Vaccine Development and our efforts to confront and mitigate this pandemic. I want to thank this committee for providing supplemental resource for Covid Response as well as sustaining operations in the past. Throughout 2020 weve used these resources to protect american lives and assisted in the repatriation of citizens from america and japan at the start of the pandemic. And today we have teams deployed to louisiana and mississippi prepared to assist in response and recovery operations following hurricane sally. Weve deployed personnel and teams to california and oregon to support wildfire response, and the secretary has just signed the Public Health emergency for oregon to assist in the search and rescue of personnel of individuals who have been affected there. Weve deployed personnel to beirut. With that we supported these calls to action while simultaneously responding to state, local, territorial and tribal requests for assistance in the Covid Response. It is an honor to lead this organization. Im truly humbled by the selflessness and dedication of the men and women of asper. We know it tabes constant vigilance and personal responsibility by aern american to wash hands and keep our social distance. As everyone does their part asper continues to work hard to enhance our countrys preparedness and response capabilities. Since early 2020 asper and barta workedearth to forward Vaccine Development. A whole of government approach working with our private sector partners to produce and deliver a safe and effective vaccine asfast as possible. The supplemental appropriations provided by this committee have been essential in permitting significant advancements under warp speed. As a result america is far better positioned than before to keep america safe, protect vulnerable communities and individuals and defeat the covid19 virus. To date weve awarded 13. 6 billion to support over 50 medical Counter Measure projects. Some of these awards are vaccine contracts. Were making significant progress in advancing these vaccines through Clinical Trial process. In fact, three candidates are in phase three Clinical Trials meaning that were closer than ever to a safe and effective vaccine available to the public. Three others are in phase one and two. Safety is our top priority in the development of vaccines and therapeutics which is why science is driving the development of all covid19 Counter Measures to ensure they meet the fdas Gold Standard of approval. In the meantime weve implemented an intensive and efficient process to promote Vaccine Development and in parallel manufacturing. Supporting these efforts simultaneously ensures were able to distribute once approved. Asper also continues to support as vancements in live saving therapeutics. For example asper has taken a data driven approach to oversee inequitable distribution of remdesivir. Today weve distributed to states enough to treat almost 650,000 patients. Asper has also supported mitigation efforts to slow virus transmission. Since march asper has produced and distributed more than 500 mill cloth facial coverings across the country to protect vulnerable populations and essenti essential workers. Were sending an additional 125 million cloth facial masks to states and territories for distribution to low income students in order to support the safe reopening of americas schools. Asper is capitalizing on existing relationships to coordinate a more comprehensive medical nationwide response. Weve responded to requests from 32 states, three territories, five tribes with nearly 100 medical support missions with over 5,700 staff from aspers disaster medical teams, the Public Health service, the va and dod. Weve provided personal protective equipment that i know will be subject to quite a few questions under this sns 2. 0 initiative to expand the depth and breadth of our stockpile and reduce our vulnerability to foreign suppliers. Weve used the defense production act as well. I thank you again for your support and the opportunity to testify before you on espers efforts during this pandemic. And im happy to answer any questions you may have at this time. Thank you, doctor. Dr. Redfield. Good morning, chairman blunt and Ranking Member murray and members of the committee. Thank you for the opportunity to be here today. On behalf of the cdc thank you also for your continued support of our Public Health professional and the lifesaving work theyve committed to do 24 7. Over 6,400 cdc staff have been engaged in the agencys covid19 response. 1,200 of whom have been deployed to more than 200 locations in the United States and abroad. And i know you share with me gratitude for their resilience. Conducting rapid investigation of disease outbreaks and identified the highest risk populations and settings. Understanding which populations are at risk and how the virus is spread in various settings is critical developing the guidance and protecting the health of americans. Today and even after we have a vaccine cdc encourages all americans to embrace the powerful tools that we have right now. To wear a mask particularly when theyre in public, mabe tain social distancing, routine vigilant hand washing, be smart about crowds and stay home when youre sick. And as we move into the fall, were adding one of the most significant scientific contributions to medicine to our Evidence Based mitt dpaigation strategies, flu vaccination. Flu vaccines are safe and the cdc encourages americans to embrace flu vaccines for themselves and their communities. These simple actions combined will help this nation avert a very difficult fall, lessening the burden upon our Health Care System and saving lives. Cdc has awarded 144 million to districts to scaleup flu vaccination this season. With the focus of ensuring flu vaccine coverages can reach the populations at most risk. This year cdc purchased an additional 9. 3 million doses of adult influenza vaccine up from the usual annual 500,000 dose purchase in prior years as well as 18. 5 million doses for children. And cdc has developed a new multiplex Laboratory Test that can check for three viruses at the same time, influenza a and b plus sarz covid 2 in a single test from a single sample. This test was granted by the fda and will save Public Health laboratories time and resources and help better understand and identify coinfections with influenza 1 and covid. Cdc is also working with 64 immunization grant recipients to build readiness for timely and most importantly Equitable Administration when a covid19 vaccine becomes available. Cdc is leveraging its expertise and immuniization infrastructure. Cdc is working closely with state and local Tribal Health departments and Community Organizations to prepare a detailed yet flexible plan for Vaccine Distribution to Critical Infrastructure, workers and people at increased risk for serious outcomes. At this time cdc continues to support partners with its Ongoing Community mitigation efforts including case notification, Contact Tracing, surveillance and reporting as well as testing capacity. To support these activities on behalf of hhs cdc has awarded 12 billion to these jurisdictions in 2020 thank tuesday the support of congress. Included in that amount was more than 200 mill to support the American Indian and alaska native communities which have had some of the most significant effects from covid19. Timely, accurate and most importantly actionable data are essential if were going to learn the impact of covid19 on all populations. Cdc reports monthly to the congress. The most recent Data Analysis on the impact on racial and ethnic groups. As ive emphasized in my prior hearings now is the time to commit to prioritize and sustain investment in the core capabilities of data health, laboratory resilience, work force expansion and capabilities. Covid19 is the mostsignificant Public Health challenge to face our nation in more than a century. Now is the time to build not only the Public Health core capability that our nation needs but that the people of our nation deserve. As we Work Together collectively to fight covid19 to end the pandemic cdc is committed to the mission to protect all americans from the disease threats to save lives now and in the future. Thank you for the opportunity and i look forward to your questions. Thank you, dr. Redfield. So were going to have a series of five minute round of questions here. A dozen members either here or virtually here ready to ask questions. Itll be an 11 30 vote that we will kind of work around those folks that come around 11 30. And certainly we hope to have an opportunity for a second round of questions if people have them after their first round is gone. Let me start, admiral giroir, with you. On tests i think tests are essential to get pack to school, back to work. And for tests to really work they have to be easily taken. There needs to be a quick response, and they need to be affordable. It seems to me that with the shark tank effort that the members of this committee particularly senator alexander and i were involved in trying to encourage looking at ideas out there, i think the shark tank has approved at least 16 different tests now. In your testimony you mentioned that a significant number of these tests were point of care response tests. What should we expect in october of this month ive been told in october we could reach 100 million tests between the shark tank and abbot alone. Is that a number that you think is close to right . Yes, sir, and thank you for the question, and thank you for the support of the shark tank and all of the nih efforts. Weve seen just a tremendous blending of programs at darpa and nih, at cdc and barta, in my office with the defense production act all coming together, and we do meet every week to put these together in a very cogent, synergistic way. Yes, in october and again these are conservative estimates based on what we know has euas, and what we know the manufacturing will be. In october were looking somewhere in the neighborhood of 125 to 135 million tests available. That does not mean that 125 to 135 million tests will be done, but these will be easily and readily available. And a majority of them, we really hit that Inflection Point, will be point of care. Many of them will be what we talked about that will be made at approximately 48 to 50 million per month. Again, oo 5 test, 15 minute result, no instrument. Very, very important but were starting to see the point coming from the shark tank really hitting the streets. So the next generation sequencing, the microfluidics platform and some point of care are all starting to hit from shark tank. I think you said in your testimony some time this month we would have passed the first 100 million tests that people have taken, is that right . Yes, sir. Todays total as of about 5 00 this morning was 99. 3 million tests performed in the u. S. Starting from the first of the year. This is from the outbreak of covid19, right . Right. I mean when i took over march 12th i think there were 15 or 20,000 tests done. It was a small number. This has ramped in a historic way, not just the number. The number is important but its the ecosystem, the point of care and these all have to fit together. And i think im right in assuming that the three of you would know this better than anybody, if you take a test and dont get a result for three days or five days or seven days you find out a data point and you find out from that individual the problem they have, but youve generally done nothing to tell them that they could be spreading this disease, is that correct . Clearly we want tests to be turned around as rapidly as possible, and thats why point of care is so important. The issue with most point of care tests is theyre not as, quote, good, sensitive and specific as the very important Laboratory Tests. Now, everybodys making progress, but you are want rapi because we have more point of care tests and because were doing more in the Nursing Homes that way, for the major referral labs that had such an issue with turnaround times, our average turnaround time for quest, labcorps, et cetera, this month is 4. 9 days. This is improved dramatically. Thats thanchlg. That averages out to point of care plus the test that averages all this down to 1. No, thats just the referral laboratories, quest, labcorps. The other half of testing is either point of care at your local hospital, which is generally either 15 minutes or within 24 hours, so the turnaround time, at least right now, with all of the investments coming together, is under control. I think our sense, many of the members on this committee, certainly my sense of testing has been we want a test that millions of people can take, maybe dozens of times, and get the information at the time they take the test. It sounds like to me that were finally getting to where thats a real realistic likelihood. All right. Senator murray. Thank you very much, mr. Chairman. And let me just say, again, i am deeply troubled by reports of rampant political interference in scientific Decision Making at the cdc. It is unprecedented, and it is unacceptable. We learned last week that despite knowing in january how serious covid19 was, President Trump has been working to downplay this crisis. And on friday night, we learned that trump political operatives in hhs Communications Office have been manipulating cdcs flagship publication for months to align with that messaging. Dr. Redfield, did anyone at cdc advise the president to downplay this crisis . No. Did you agree with the president s decision to downplay it . Im not going to comment on that, but no one advised the president to downplay this crisis. Well, understanding the dangers, why have you not done more to push back on President Trumps political interference and its efforts to downplay this . I want to make it really clear, senator, and i appreciate your question and the opportunity that about the respect for the science at cdc and the independent integrity of the mmwr. At no time has the scientific integrity of the mmwr been compromised, and i can say that under my watch it will not be compromised. Well, i understand the efforts to edit the cdc publications started in response to a may report that reviewed the spread of covid19 in the u. S. That was offered by cdc, highly respected career deputy, hhs political officials perceived this report as reflecting negatively on the president. Dr. Redfield, yes or no, did that may report as drafted by the doctor, adhere to the agencys strict code of scientific integrity . Yes. Well, the spokesperson for hhs claimed that there is a Resistance Unit at cdc and voiced concerns about ulterior deep state motives, and President Trump has bolstered skepticism in the agencys death toll. Do you agree with me that there is no truth to all those claims . Absolutely, senator. And i want to make a comment that not only is it not true, it deeply saddened me when i read those comments because as i said in my statement, cdcs made up of thousands of dedicated men and women, highly competent, it is the premier Public Health agency in the world, dedicated 24 7 to use their skills to protect the American Public and the world from the health issues. And it deeply saddened me that those false accusations were made by a group of really unbelievably professional people that serve this nation. Well, i agree. And let me ask you, then, what can congress do to make sure we are hearing directly from Public Health officials without political interference . Well, again, im going to commit, you know, that were going to continue to give congress and the nation the best Public Health advice. Were not going to let political influence try to modulate that. As i mentioned, the mmwr, and its another thing that has saddened me to hear on our watch the concern that somehow, some have that the integrity of this really important publication was somehow compromised. And i just want to assure you and the other senators and the American Public that the scientific integrity of the mmwr has not been compromised. It will not be compromised on my watch. And i will stand by the men and women that are the scientific experts that are there to do their job, to express what they know in a way that can be interpreted to the American Public. Well, i hear you, but i do think Congress Needs to make clear that theres no political interference there. I will be pursuing that. Admiral giroir, on the same issue, you are among hhs top health officials. What are you doing to protect scientific integrity of the work done by the scientifics and Public Health experts at cdc, prsa, and nih from political interference . Part of my job as the scientific Senior Scientific adviser to the secretary is to make sure that he gets the best science and the best Evidence Base thats unfiltered. I do that every single day i work with bob redfield, i work with bob kadlec, Francis Collins and i are on speed dial, tom ingles, very important with hrsa. You have my commitment, as you always have, senator, that i will provide the best advice to the Decision Makers that will be based on science and evidence and thats the way were going to operate going forward. Can you can you right now reject the unfounded, harmful Conspiracy Theory that career professional leadership of cdc or any of our Public Health ageagies have, quote, deep state ulterior motives that other trump appointees have claimed . Can you reject that . I have not seen anything out of cdc, hrsa, any of the agen agencies i work that is anything other than people acting in the best interests of the american people. I certainly have not seen anything you have described. Senator alexander. Thank you, mr. Chairman, and thanks to the witnesses for coming. This committee has shown on many occasions a good capacity to work in a bipartisan way, so i would like to Say Something to my democratic friends as well as my republican colleagues on the subject that i think we agree on, but the congress has had a hard time doing over the last 20 years. And that is preparing for the next pandemic. I have been rereading Jared Diamonds book guns, germs, and steel. And he wrote an article in the wall street journal a few months ago about the current infectious disease. He said the most different thing about covid19 is not that its more infectious. But the jet plane is what is different about this disease. That it can spread instantly from wuhan to San Francisco to nashville to boston. And that the next pandemic could be next year. So we had a hearing about preparing for the next pandemic, and people like bill frist, who is majority leader 20 years ago, said we keep trying to do things to prepare for the next pandemic, but we go, and dr. Tom friedens words, from panic to neglect to panic. In other words, while were in the middle of a pandemic, its got our attention, but as soon as its over, we dont do all the things we should do. So my hope is that with any action that we take this year, we would include the three or four things that we should take to make sure that we sustain funding, which is the hardest thing to do. How do you fund for more than one year . For onshore manufacturing of vaccines, for example, for stockpiles that were depleting between vaccines. For making sure that fema and dr. Kadlecs organization are aligned properly and operating together. Dr. Redfield talked about it and mike levitt did, to former governor of utah, that we have been underfunding Public Health for 30 or 40 years. I think its important we do it this year. And so in the republican bill that we offered last week, we did have in there some authorization from our committee to fund onshore manufacturing and continuous funding of stockpiles so they would be full. And i would just like for our committee to give that the same kind of attention, the subcommittee, that we gave, for example, to funding for nih. Because it will take some sort of mandatory funding or advanced appropriation as this subcommittee did under senator gregg a few years ago for bioshield. Its not a lot of money. I think what i would what we suggested was a half a billion dollars a year for ten years for onshore manufacturing. Why is that important . In 2012, we created three manufacturing plants just for this purpose. But two of them, and governor levitts words, went cold. They werent available instantly to do what we needed done, and the third one had a hard time finding anything to do between pandemics. So we need some funding for it. And then for stockpiles, stockpiles got depleted at the federal level, in hospitals and states, because of budget cuts. And so we werent ready for what we needed to be ready for. And then Public Health funding is a separate one. Bioshield is another one. I think were not talking about lots of money. What were talking about is different, is sustained funding for a period of years. Now, dr. Kadlec, i have taken most of my time, but would you comment on that . And precisely, in the ideal world, what should we do now to prepare for the next pandemic, which Jared Diamond says might be next year . Well, thank you very much, senator alexander. I agree entirely with your proposition that we do need to make investments over the long term, we need to look at it as a National Security problem as it is a Public Health problem. We lose on a day but what are the specific things. We have about 30 seconds . Manufacturing, domestic manufacturing for biologics and vaccines. We need to have a capacity to manage those stockpiles effectively through both commercial and state level processes. And we need to probably require hospitals and other Health Care Institutions to have some baseline level of preparedness and stockpiles. We need to keep thestockpile. Are we talking about a lot of money . No, sir, i think in your bill, you have identified about 2 billion. I think thats where you start. And then, again, most of these items are common use used any daily in hospital use and health care use, and just maintaining that stockpile over time, but it does require a Business Model to support that. Thank you, mr. Chairman. Thank you, senator alexander. Senator durbin. Thanks, mr. Chairman. Dr. Adlkadlec, last night the president of the United States said, quote, were within weeks of getting a vaccine. Could be three weeks, four weeks. True or false . Sir, its possible. And so with operation warp speed, we have basically worked to basically do simultaneously the Clinical Trials as well as doing the manufacturing of vaccines, so if and when, whether thats two weeks three weeks, two months, or four months, once a Clinical Trial is complete, and that Scientific Data is reviewed by the fda and approved, then we have vaccine potentially available immediately to use. And thats the strategy that has been adopted in operation warp speed, sir. So i want to make sure this is on the record. Yes, sir. Youre saying three weeks to four weeks for a vaccine . Sir, thats manufactured, yes, sir. Now, is it approve bide the fda . That is a decision that they will have to do based on the Scientific Data that is that they receive from the Clinical Trials. So what youre saying to me is they can manufacture it before its approved as being safe and effective for distribution in america is going to be beyond three or four weeks . Sir, it depends on the outcomes of those Clinical Trials. I cant predict that. Theyre ongoing right mplew. In october. And the fda is the one who will make the decision to determine safety and efficacy, sir. The president predicted it last night. We have about 4. 5 of the worlds population in the United States. We have more than 20 of the deaths from covid19. Last night, the president said we have 20 of the cases in the world because of the fact that we do much more testing. If we wouldnt do testing, you wouldnt have cases. You would have very few cases. So let me ask admiral giroir. Would ending testing end the spread of the covid19 disease . No, sir. Could you explain the president s explanation last night . Does it make any sense to you . I didnt hear we have heard this over and over again. Come on. Hes repeating what he said over and over again. So, let me just clarify that the number of cases are going to be the number of cases. We do more testing so we can detect more and more cases. Thats a good thing. We want to detect as many cases as we can so that they can be appropriately isolated, do Contact Tracing, et cetera. It is true that the more testing you do, the more cases you will discover, but the cases are there no matter what. Now, you talked in your testimony here about expanding testing. And i couldnt endorse that more heartily. The president says just the opposite. If we wouldnt do testing, you wouldnt have cases. I mean, dont we want to create the mindset in america that regular testing to make sure that were not positive and not spreading this disease should be routine until we come to grips with a therapy or vaccine to deal with this . So, i do want to state what i did state earlier in multiple testimonies. I have never been asked, told, hinted, suggested that we should decrease testing. In fact, basically every time at the task force, we work to expand testing to the degree possible, investing hundreds and billions of dollars in that. So my job is to expand testing as much as feasibly, even infeasibly possible, and get the right test to the right people at the right time. And thats been my mission. No one has told me to alter that. In july of 2017, the United States Senate Considered the repealing of the Affordable Care act on the floor of the senate. Ill remember that morning, that night forever. A few feet away from me, the late senator john mccain cast a no vote in the Affordable Care act survived. The president said repeatedly that he has a replacement plan for the Affordable Care act. As head of the agencies responsible for dealing with such a Public Health undertaking, i would like to ask you, does a replacement plan exist that you are aware of . Any of you . Yes or no . Admiral . Im not involved in the replacement plan. I dont know what that is. I supply Public Health advise as much as i can for whatever that plan would be. Dr. Kadlec, are you aware of such a replacement plan . Sir, its not in my portfolio, and i have been so busy with the other things, i have no awareness of that. Dr. Redfield, are you aware of a replacement plan . Again, its not really in my main lane, but im not aware of one. Just a few weeks ago, the nine Major Pharmaceutical Companies had fullpage ads saying they would not bow to political pressure to rush a vaccine production. Were any of you consulted before they made the decision to buy that ad across the United States . Sir, not consulted, but aware of it, and it conforms with i think the feelings and the commitments that the leadership in warp speed and my organization are committed to as well. Do you know why they did it . Sir, i think to the point of being sure that everyone is believing in the same way, which is the safe and efficacious vaccine has to be trusted. Thank you. Thank you, senator durbin. Senator capito. While were trying to figure out how we get the senator for her questions, senator kennedy, why dontio you go ahead and then well go to senator reed and see if senator capito is ready. Thank you, mr. Chairman. Thank you, gentlemen, for being here today. You are all mds, medical doctors, is that correct . Yes. Yes, sir. Would any of you do anything to violate your hippocratic oath . Never. No, sir. Have any of you, as senator murray alleged, recklessly interfered with the treatment or prevention of covid19 . No, sir. No, sir. Do you know of anyone who has in the Trump Administration . No, sir. No, sir. No. Okay. Dr. Redfield, have you ever had polio . No, sir. Me neither. Thank you, science. When the coronavirus was first discovered, we didnt have much science about it, did we . No, sir. We couldnt, like, go to web md and look it up, could you . No, sir. We have learned a lot about it, havent we . Yes, sir. Would it be fair to say and disagree with me if you do, i know you will, that the coronavirus is a lot more contagious than we originally thought . Is that fair . Yes, sir. Now, i read on the cdc site, tell me if i misinterpret this, that out of every 1,000 people who get coronavirus, not out of every 1,000 people, but out of every 1,000 people who get the virus, six are going to die. Is that accurate . It depends on age group and risk factors, sir. So if you were to look right now, individuals under the age of 18, its about. 1 . 18 to 19 to say 69, its more like. 3 . And if you are over the age of 70, its about 5 now. Okay. Now, if you but if you look at population as a whole, its about 6 out of 1,000, is that correct . I would have to get back to you. Its overall, were probably looking at an overall plmortali of. 4 to. 6. That would be 6 out of 1,000, on the high end. Obviously, the older you get, the more at risk you are. Tell me tell me when you think well have a vaccine, as best you can, ready to administer to the public. Dr. Redfield. Well, i think, as dr. Kadlec said, i think there will be vaccine that will initially be available some time between november and december, but very limited supply, and it will have to be prioritized. If youre asking me when is it going to be generally available to the American Public so we can begin to take advantage of vaccine to get back to our regular life, i think were probably looking at late second quarter, Third Quarter 2021. And so you think by the late second or Third Quarter, we will have started to vaccinate people . I think the vaccination will begin in November December and then will pick up, you know, and it will be in a prioritized way. Those First Responders and those at greatest risk for death, and eventually, that will expand. Theres about, hard to believe, but theres about 80 Million People in our country that have significant comorbidities that put themselves at risk. Right. They have to get vaccinated. Excuse me for interrupting but im about to run out of time. What do you call this effort . This worldwide effort led by the United States of america to develop a vaccine . What is the term for it . Operation warp speed, sir. Have you ever seen anything Like Operation warp speed . Its unprecedented. How long does it usually take this will be my last question, mr. Chairman to develop a vaccine . I think the fastest prior was two years, and usually four to six years. Thank you, mr. Chairman. Thank you, senator kennedy. Senator reed. Thank you very much, mr. Chairman, and thank you, gentlemen, for your testimony. I was particular struck how emphatic you all were in insisting the use of face masks is absolutely critical in a social setting. Youre all wearing face masks. I have mine. I took it off so i can question. Yet, last evening, the president once again disparaged the importance of wearing face masks. He does not wear one usually. Hes conducted rallies in which many of the participants arent with face masks. He doesnt have a face mask. So let me just ask all of you, admiral, youre a uniformed officer. Is the president providing appropriate leadership when it comes to this critical issue, one of the most direct and important things anyone can do to protect themselves and the community from this disease . Well, as a uniformed officer, im not going to comment about the president , but i do want to emphasize that wearing a mask is one of the most important things that we can do to prevent spread, particularly because people who are asymptomatic, you can feel totally fine but still be spreading the virus, which is why wearing a mask when you cant physically distance is absolutely critical. And i think i probably speak for my other two colleagues, but youll want them i want them, too, but i think you have just directly contradicted the president s behavior and the president s comments. Even though you have done it politely. Doctor . Sir, were supportive of the masks. Thats why we produced half a billion of them and made them available to the American Public at large. The answer is yes. Is the president undercutting what you have all said, and you have repeated, one of the most important steps that americans can take to defend themselves and the country against this disease . Sir, my view is that he is an individual who can exercise his rights to do what he pleases, as we see other americans doing that. And so he is its also the leader of the country, trying to cope with a disease, a pandemic that has killed over 100,000 people. And hes not hes rejecting this emphatic advice that you give repeatedly, and you yourselves demonstrate. Dr. Redfield, your comment. Im not going to comment directly about the president , but i am going to comment as the cdc director that face masks, these face masks, are the most important powerful Public Health tool we have. And i will continue to appealto for all americans, all individuals in our country, to embrace these face coverings. I have said it, if we did it for six, eight, ten, 12 weeks, we would bring this pandemic under control. These actually, we have Clear Scientific evidence they work. And they are our best defense. I might even go so far as to say that this face mask is more guaranteed to protect me against covid than when i take a covid vaccine, because it may be 70 . And if i dont get an immune response, the vaccine is not going to protect me. This face mask will. So i do want to keep asking the American Public to take the responsibility, particularly the 18 to 25yearolds where were seeing the outbreak in america continue to go like this, because we havent got the acceptance, the personal responsibility that we need for all americans to embrace this face mask. Once again, i think you have refuted the president more eloquently than i have heard. Youre the expert. Leaders have to depend on expert advice. Thats why they have people like you there. And when they dont take your advice, in fact, when they disregard it and its been said so emphatically here, its not a question of any doubt at all in your view, all of you. Just a final quick question, and i only have a bit of time. And dr. Redfield and dr. Kadlec, quickly, your vaccine plan has to involve the states. Can you just very, very briefly, dr. Redfield, is there a conscious integration of the states in terms of their Public Health services and is there Resources Available for the states in this plan, because theyll need them . Yes, sir. Its critical. We have done microplanning already, with five jurisdictions, north dakota, minnesota, california, florida, and philadelphia. And this plan will be going out today to all of the states. Ill be talking to the state Public Health leaders this week. Well be working with them so that they can integrate this plan in their own, in a unique way for their own state, and there will be support to help them begin to resource this plan. Thank you. Thank you, mr. Chairman. Thank you, senator reed. Senator capito. Thank you, senator blunt. And thank all of you. Im pleased to be a part of this hearing today. And ill start off with dr. Redfield. Im not sure if youre aware, dr. Redfield, but im abiding now by the cdc guidelines. I was made aware on monday that i had been exposed to somebody who tested positive for covid. I had, according to what the physician told me, i had been in and around that individual for at least 15 minutes, around within 48 to 72 hours of when he exhibited symptoms, and out of abundance of caution, and i think ceding to your guidelines, i went immediately to the physician at the capitol who advised me then that i must quarantine for 14 days. I did subsequently take a test and tested negative, which im very obviously pleased about. But i want to ask you, are your guidelines on quarantining, for those of us who are quarantining, following the rules, what kind of success does that bring in terms of isolating and containing the spread . And do you further recommend further testing as people are coming out of their quarantine and at what points of the quarantine would they need to get retested if thats necessary . Well, first, i want to thank you for setting the example and embracing these guidelines. Although misinterpreted some of the changes we put in the guidelines, the whole purpose of those guidelines was to engage the Public Health and medical Community Back into the decisions when people get tested so it was talked about earlier, there was the appropriate Public Health action. So the tests led to an action. It wasnt just a test. And so i want to thank you for setting that example. The reality is, if you have had close contact, it could take 7 days, it could take 10 days, it could take 12 days before you turn virus positive. Thats why we have our current recommendations based on the data we have for isolation for 14 days. And you know, as we get more data, that may change. But the reality is, the data we have today, we still support the 14 days of isolation. We do have very good data in our household studies. Where households that have introduced covid where individuals practiced masks and hand washing and distancing, we have been able to show theres limited transmission in those household settings. And in households that didnt, we have seen attack rates of 20 , 30 , 40 , 50 within the household. So again, thats where the state of knowledge is right now. There may come a time when we have better data that can shorten it, but right now, even if we shortened it to ten days and the number of people have asked to look at the data, we would still then send home probably 10 to 12 of people who would later turn out virus positive. Well, thank you for that. Admiral giroir, dr. Redfield brought up an issue that i know is cascading across the country, and that is, as some of our colleges and universities are opening, the incidents of testing and the incidents of positives have gone way up because of some behavioral issues and just the whole atmosphere at times in a college and University Setting. So theres a great interest on tests, to get the rapid turnaround tests, the abbott test, i know, is of interest to the universities. How are you i know youre beginning to deploy these to Nursing Homes and highly, highly challenged communities, which i applaud. But how do you deal with a college and University Setting in terms of testing, and what do you recommend here . What do you see in the future . So thank you for that question. Universities generally have a very substantial capability to do testing in their Research Laboratories and their veterinary diagnostic laboratories. We have had multiple calls, seminars, technical webinars to allow the universities to turn on their research equipment. We have done the cleo waivers, all of that to really use that to support testing. Eventually, we want to get to a point that rapid point of care tests are available for everyone, but 50 million a month doesnt go into 300 Million People, so what were advising universities is to use those rich resources that have been funded by the nih, that they have to use them, a nursing home cant do that. Many universities using their veterinary laboratories which are very successful, and again, university of illinois has done just really tremendous. We had them on one of our leadership calls as an example telling the rest of the country. Thank you very much. And just in closing, i know my time is up, i am concerned, dr. Redfield, as we talked about before, the rise in overdose and Overdose Deaths during this pandemic is extremely alarming. And im very concerned as we keep moving forward what kind of impact this is going to have on the addiction community. You and i have talked about it. We have to keep our eye on it. Thank you so much. Dr. Redfield. Yes, i couldnt agree with you more. We have seen an increase in almost 18 now in our overdose suspept suspected overdose submissions into hospitals. Clearly, the isolation thats been associated also the ability to get access to the proper pain control when a lot of the medical services are cut back. Cdc recently did a survey and it actually shock mead, just a survey across our nation, found that 31 of adults reported now significant anxiety and depressive disorders. So this is a significant comorbidity that has been negatively influenced by the Covid Response. And it is something that we have to continue to double our efforts to try to prevent death from overdose. Thank you, dr. Redfield. Thank you, senator. Senator shaheen. Thank you, mr. Chairman, and thank you to each of you for being here. Admiral giroir, in your Opening Statement, you talked about the importance of protecting the elderly, which i think all of us would agree is critical, yet the elderly have been impacted the most by this covid19. In New Hampshire, over 80 of our deaths from covid19 have been in longterm care facilities. Thats why i am so concerned about the slow pace that hhs has provided in giving support for Infection Control in these facilities. The c. A. R. E. S. Act provided up to 200 million for nursing home Infection Control efforts, and to date, only 17 million of that has been spent. On top of that, hhs has only spent about half of the 16 billion that congress has provided for the acquisition of personal protective equipment, which continues to be a need. Nursing facilities and providers across the care system in New Hampshire desperately need these supplies. So admiral, the Infection Control funds are vital to helping our Nursing Homes reduce the spread of diseases. You alluded to that. When can we expect the remaining funds to be distributed . I cant answer on that specific. I dont know when they will be distributed. I can say, what i canat i know couple of months, theres been 5 billion of extra funding to Nursing Homes, 2. 5 billion of that is to support testing. Which is really in our regime. And we do get the other admiral on the team with an unpronounceable name, every day, we get about 99 of Nursing Homes reporting, so we know exactly what their ppe situation is. But in terms of that specific fund, im going to have to have the team get back to you on that. I would appreciate that. One of the challenges with that 5 billion that was just distributed is that it can only be used for hiring only, not retention. And the biggest challenge our Nursing Homes have in New Hampshire is retention of employees. So is there going to be any thought given to providing more flexibility for longterm care facilities and how those funds can be used . And im really sorry, im going to have to get seema verma and the secretary to respond to that. Thats not within my realm of responsibilities. Well, i would urge you to do that because if were providing funds to longterm care facilities that cant be used, then its not accomplishing the concern that all of us share. I want to go on to another issue because there was a report that just came out about hhs seeking bids for 250 Million Contract for Public Relations campaign to defeat fear and inspire hope regarding the pandemic. And while i think all of us want to make sure that americans know that there is going to be a better time ahead for us, the timing of this contract raises real concerns about a potential intersection with the president s Reelection Campaign and more importantly, congress didnt direct hhs to conduct this campaign. So is the 250 million thats going to that coming from funding that should be going out to our longterm care facilities, to our hospitals, to our medical providers to actually respond to the spread of covid19 . And what is the purpose of this contract at this time to do a Public Relations campaign . Wouldnt to be better to give information to the American Public about what all of you have said so eloquently this morning, about what we need to do to respond to this virus and what we need to do to insure that people have the health care they need if they contract it . Admiral . Can you answer that . And maam, i really do apologize, but i dont know anything about Public Affairs campaigns or where that money comes from or what its going to do. Thats just not something that i deal with. We all try to provide the best information we can through whatever vehicles we can, but i just dont know about Public Affairs contracts. So youre not aware that the department is going to be spending 250 million on that Advertising Campaign . I mean, im generally aware from what i read in the news but im not involved. Im really not involved in that. All i know about Public Affairs is that we do want to get all of us in front of the public to make sure, number one, they get their flu vaccines this year because thats really critically very important. Thank you, i think thats very helpful. Dr. Kadlec, were you aware of this expenditure . No, maam. Mr. Chairman, i would hope that this committee would ask some very tough questions about whats going on here, because thats a lot of money for a campaign that we ought to be spending to address this pandemic. And senator alexander, i totally agree with you on doing some work now to respond to the next pandemic. And i would suggest that we also ought to restore the Global Health security and biodefense unit, either at the National Security council or somewhere where it can provide an Early Warning for whats ahead. Thank you very much. Thank you, senator shaheen. Senator hyde smith. Thank you, mr. Chairman. And to the panel, i truly thank you for all you have done and your tremendous, tireless efforts of guiding this country through covid19. You are to be commended, applauded, and im certainly one that appreciates you being here today. And answering the questions that we have and being willing to serve in the capacity that you serve in. I represent mississippi. Were less than 3 Million People. And one of our largest challenges is Rural Health Care and getting these vaccines to rural areas such as those in mississippi. Of course, im very concerned about the universities and colleges and the protection that we need there through that age population. But im just going to ask you, what are your agencies working on to help address the challenges in unique Rural Americas response to covid19, but mainly, how can this subcommittee support you in that . How can we help you address those issues there . And i would like to hear from all three of you on that. And getting the vaccines to Rural America where it needs to be, where we have such a challenge. Thank you very much, senator. Very, very important. We have continued to try to develop outreach and Vaccine Distribution, particularly in the hard to reach rural areas. This is part of the efforts that we have accelerated with our flu program right now, with the idea of how to vaccinate with confidence by trying to protect communities, empower families, and stop myths. We have developed rural partnerships with the National Rural health association, the National Association of Rural Health Clinics and the National Organization of state rural Health Offices with the goal to really work to improve the acceptance of vaccination in general. Flu being the important one, with confidence. I do think the recent decision that the secretary made in expanding the ability of pharmacies to vaccinate down to age 3 to age 18 is going to be an important expansion of being able to engage pharmacies throughout our nation as vaccine centers. But were continuing to work with those rural organizations to see if theres other Innovative Solutions to try to expand vaccination. I am hopeful that the pharmacy expansion is going to have a significant impact. Thank you very much. Maam, with regard to Rural Health Care, what aspr has been doing prior to the covid event was trying to expand what would be the regionalization of disaster care, emergency care, to really focus on areas where you have critical access hospitals or underserved populations. In the current covid event, we have been working with the department of defense to employ a system that they originally started, which was called the National Emergency teleCritical Care network or netcn, which is a means to do telemedicine to rural and critical access hospitals to make them available, the best information, Critical Care specialty support as well as arranging for transportation and referral of cases to a higher level of care. So were actively doing that right now. We have done it in many parts of the country as a result of our work, and Covid Response, and were also trying to do that for ambulatory care telemedicine as well. So by building out our regionalization approach, our hope is not only to create those established referral patterns but also establish telemedicine consulting support so we can support the rural parts of this country over. Thank you. And i will add on, again, what the prep act guidance that allowed pharmacists to do covid vaccines. I issued that last week to get in the pharmacy communities. I want to be a little bit of a cheerleader for federally qualified care centers. We now have 221 federally qualified Health Center sites in mississippi performing testing. I think fqhcs are a real gem. They take care of 30 Million People and very much the underserved, migrant farm workers, homeless, and they do so at a savings. Better outcomes at less cost. So again, thats a major point for us in mississippi, where were reaching people, both urban and rural. And anything i can do anything for hrsa and the Health Center, thats going to be money well invested. Thank you all for those answers. And i truly appreciate that. Because it is one of my Top Priorities. We had a young lady not long ago that died of an asthma attack because the emergency room had been closed in her area. So i certainly appreciate your work there. Thank you, senator hydesmith. Senator merkley. Thank you very much. And director redfield, i am concerned that the cdcs revised guidelines that no longer recommend testing for asymptomatic individuals who have been in close contact of a person with covid19 infection for at least 15 minutes. Just a few days ago, in a media interview on september 10th, admiral giroir stated that all of us in the room have been hearing from Public Health expert, we need to test asymptomatic individuals. So explain this to me. Is the admiral right or wrong . Thank you very much, senator, for the opportunity to address your question. I think first and foremost, i want to say the cdc guidance that came out was clearly misinterpreted. And within 24 hours, i published a statement to try to make it clearer what cdc was recommending. We were never recommending not to test asymptomatics. We were never recommending, obviously, not to do the Public Health Contact Tracing and trace them. What was attempted was to replace the emphasis of testing so that as we talked about earlier, testing led to an action. It drove Public Health objectives. So we placed the emphasis on testing symptomatics, but then we placed the emphasis on individuals with significant exposure, theyre asymptomatic or vulnerable populations, Nursing Homes, Critical Infrastructure workers, health care workers, theyre asymptomatic, and the last group was individuals who may be asymptomatic and rather than just get tested, what we asked them to do is consult like we heard from the senator of west virginia, consult with your medical and Public Health officials and follow their direction, because as you saw with the senator, when she chose to get tested, even though the test was negative, there was a critical Public Health action that was for her to stay home for 14 days. Were going to continue to try to make sure our guidance isnt interpreted incorrectly. Because as the admiral said and as i have said, asymptomatic infection and presymptomatic infection is a critical component of the transmission cycle of this virus. I would ask you to stop here because i have other questions and i think you have answered it. Even the example you have given shows that positive impact of testing asymptomatic individuals because they can get appropriate guidance on how to behave thereafter, and we know that a tremendous amount of infections are happening from people who are asymptomatic. And so i think thats such an important point to keep driving home. I wanted to also ask you, you told governors to prepare for the distribution of covid19 vaccine on november 1st. It escapes no ones perspective that youre deliberately laying it out two days before the election. Who in the administration asked you to choose that particular date . No one, sir. You just chose it on your own political motivation to try to influence the election in this manner . What happened to science driving decisions . There was no political interest in it whatsoever. It was actually prepared by our subject Matter Experts because we wanted to get to the point of realizing that vaccine may be available, we dont know when, and we wanted the governors to be able to not have red tape interfere with the distributor, mckesson, from setting up their Distribution Sites. I will argue that the thing that i was most concerned of, and my subject Matter Experts were, who actually generated the letter, which i signed, was that the worst thing that could happen is we had vaccine delivered and were still not ready to distribute. I can tell you, there was absolutely no political thinking about it. You could say in retroactive somebody should have thought more political, but there was no political intention whatsoever. Okay, well i must say that i dont find that persuasive. Youre saying there was not a single contact from the administration, after the president said i would like to have a vaccine before november, before the election, no one from the administration contacted your team at any level to say, can you please emphasize that message . There were no emails, no meetings, no phone calls, no back room chats connected with your choosing that particular date . Absolutely not. It was independently developed by our subject Matter Experts that were laying out this document to start to plan for the jurisdictions that we needed to get that letter out, so mckesson could get the Licensing Agreements they needed to get their Distribution Sites up. And they drafted the letter. The subject matter of the experts that i signed. Thank you, senator merkley. So much misrepresentation by the president , i think americans would find it hard to believe there were no conversations when the administration is actively pushing every piece of the federal government to engage in actions to promote their election. So it undermines your credibility that you should have at least thought about how it undermines your credibility because its so important to have the cdc be above politics. Thank you, senator merkley. Senator langford. Thank you. Its been interesting how much the dialogue today has been about politics and about the election. I do appreciate the work youre doing regardless of party. I dont find people getting covid only if theyre republican, democrat, or independent, voters or nonvoters. I appreciate the ongoing work you have done for a very long time. To be able to work us through this, your days are very long, and your work is very important. And so we appreciate the work that you continue to be able to do, and this hearing shouldnt try to be some sort of political trap for the president. It should be about the facts and details. So i appreciate that. Let me ask you a couple quick questions on this. One i want to dig into more. The first one is, theres been a lot of conversation about the amount of resources that is needed for the vaccines especially. And for vaccine production and distribution. What do you still need for vaccine production and distribution as far as supplemental appropriations . Senator, thanks for that question. At this point, we have funded six vaccine candidates for both advanced development and manufacture. I think at this stage, to the 13. 6 billion that has been appropriated or pardon me, committed for this purpose, is adequate for that, for the initial part of this. If youre talking about at the point in time when one vaccine candidate may fail and we may have to replace it with another candidate, or expand production of another, that could basically change our accounting and our calculus for what we would need. But at this stage, we have what we need. And were poised at least at this point by, i think, by the end of this month and into early october, to at least have the funds we need to basically provide for the first several candidates. Okay, thats good to know. Theres obviously six different candidates going through the vaccine process right now, because no one knows if any one of them is going to be successful. You have six hooks in the water at this point. I want to drill down a little bit on the vaccine candidates out there and some of the treatments. Some of the pharmaceutical companies have chosen to do ethical production, that is theyre not using tissue from aborted children for the production of the treatment or of the vaccines. Some of them have chosen to use aborted fetal tissue in the production of the vaccines. How are you balancing out to be able to make sure that there will be an ethical alternative for individuals who dont want to take a vaccine that is also produced using the tissue of an aborted child . Sir, thank you for that question. Im going to have to take that for the record and bring you back an answer to get more details on those particular matters. I dont have those immediately available, and i do not want to misspeak on this issue. Fair enough. Dr. Redfield, you have any comments or thoughts on that, on the production . Again, i would have to go back and see specifically. I think my recollection is were going to have a number of candidates thats not going to compromise ones ethics related to the use of human tissue. But i will have to get back to you, too, because i dont want to Say Something thats incorrect. I get that. Its not just human tissue in the production. There are some companies that are usic adult stem cells. There are some using placentas from children after birth. Those are not objectionable. I dont find anyone challenging that. Its not just the use of human tissue. Its specifically the use of tissue from aborted children. It becomes the challenge, and moderna is using embryonic kidney cells from aborted children. Johnson johnson is using aborted children embryonic retinal tissue for its production of the vaccines. There are others that are not choosing to use those tissues from children. And so i think there just needs to be as many options out there as we can, and again, i just wonder on the science side if we dont have to use tissue from aborted children, why would we do that when theres others that are choosing to be able to develop vaccines that are not being used that way. So i want to be able to follow up with you on that and just be able to see what options are out there and how were handling the funding and what direction were going to go, and long term, for vaccines, most of the vaccines we have in america now dont use embryonic tissue in it. There are still some that still do, that that is the line that is still used. Again, when we dont have to do that, why would we do that . And to have it as ethical as we possibly can. So again, i appreciate the work. Well follow up in the days ahead on this particular topic because i think its very important that as many people get vaccinated as possible and i dont want to have a reason for people to not get a vaccine because theyre concerned about the origin of the vaccine. I want as many people as possible to actually get a vaccine because i think its important. And its been an odd conversation to hear so much people saying, well, im challenging whether were going to get a vaccine because the Trump Administration may be rushing this. And so i dont want to get one. I think we need to have nothing that distracts from the science and the details of it as we walk through it as well. Appreciate your work. Thank you, senator langford. Senator schotts. Thank you, mr. Chairman. Thank you to the panelists for being here. Ill start with admiral giroir. You said in july that it was not a question that we would be soon running a million tests per day. We have gone from about 800,000 tests per day to 675,000 tests per day. Whats happening . There is i want to be clear that were talking about capability to produce tests. I think we need to always draw the distinction between how many tests we have that can be deployed and what the states are doing. In august, for example, the states total, the states combined goals were in the low 20 millions of tests, which they exceeded to 25 million. But what were seeing at some parts of the country is testing is going down. Were trying to change that. I know youre from hawaii. We have a surge site in honolulu right now that we can test up to 5,000 per day. Youre saying this is volitional . I guess it question is, is this is a supply chain problem or states are individually deciding to do less testing . This is not a supply chain problem. We will have we had double the availability of tests that were done in august. And well be over 90 million tests available in september. I would presume that a higher proportion will be done because theyre going to be very easy to do. Theyre going to be point of care by next testing and were surging in Nursing Homes. But this is not a supply can we talk a little bit about the about the bine ex testing. Yes. Because i guess where a lot of people are coming from is that we hope youre right, this new test is a game changer and we are pleased and i think it is helpful in the context of First Responders and Nursing Homes and perhaps educational context as well. But it is a card and as you know you cant really process that many tests at once this way. And so although it is really useful in certain contexts, it is not going to get you the to your 90 million tests goal. In your testimony today, today you say that we should have 90 million tests completed by the end of september and were half way through september and were at 10 million tests. Did not say that. In todays testimony. I said well have the availability of 90 million tests in september, i never stated that we could do 90 million tests in september. Were hoping that the testing will go up. Let me say about bineax, it ome takes a swab and wait 15 minutes. I could probably swab everyone in this room in about five or ten minutes. It is a low throughput test but you could do them rapidly and quickly. So i would expect that as many as these as get put in the market particularly using in Nursing Homes and assisted living and so support k through 12 that they would be used rapidly. What is the difference between testing availability and testing completed. That is a distinction that is lost on the ground. To know that there are 90 million tests theoretically available, but the Nursing Homes, the schools, the First Responders, the firehouses, they dont have the tests available. So what does it mean that this is theoretically available to do 90 million test and yet people cant get their hands on a test . I dont think that is true. I think people could get their hands on the test, even with federal sites we have 2700 in retailers, we have surge sites, there is enormous capability in the referral labs. So the testing is available. Even when we do surge sites, unless there is not a public order that demands people to come in and get a swab up their nose. This is voluntary and sometimes the demand is not there. And with the binax, that is one reason that we purchased them all for the federal government, the first 150 million to make sure they got to sites that could use them and benefit them like Nursing Homes, assisted living, tribes, hcbus, disaster situations and in just a couple of weeks to support k through 12 so i do expect i know youre working on this and trying to do this in good faith. But i want to convey to you that when the surge testing happened in the state of hawaii, on the island of ohaio that we were able to have the tests available to do what it is that is possible under circumstances and only because we saw a precipitous spike no covid cases. So it is not true, it is not true that tests are available for First Responders. I disagree, i respectfully disagree with you that if the state of hawaii, you have a turnaround time of under 24 hours with the acla labs and im happy to work with your state but there is no reason before the surge, i could have hired this company to come do the surge for you. We did it, sent it down there. And the demand was great. Hawaii has been unbelievable to work with. Weve been doing fully subscribed 5,000 tests aday but im happy to work with hawaii. The Surgeon General just went down, were expanding on the big island. There is no reason that First Responders could not have been tested before the surge. And ill end with this, and im sure my time is almost up, there is continuing to by a disconnect of how things are represented in this committee in the u. S. Congress and how things are felt on the ground. This was evident in february when we met with hhs and it continues to be the case here. We hear lots of triumphant entertainments with lots of data, but on the ground people still lack res. Thank you, mr. Chairman. Senator baldwin. Thank you, mr. Chairman. So, the administrations failure to confront this deadly pandemic has led to lost lives. There is still an urgent need to provide more support to our communities and im increasingly concerned that the funds appropriated thus far have not been handled as well as they could. Theyve been misused and miss handled. Last month i wrote to Vice President pence about a Health System in my state that temporarily suspended covid testing for patients undergoing surgery because of the supply shortages. Ive heard from assisted living facilities that they cant get the tests that theyve ordered and Academic Medical Centers that arent able to secure a reliable source of reagent. However, wisconsin did receive unrequested hydroxychloroquine before it ever received a ventilator. Congress provided more than 16 billion for the Strategic National stockpile for critical supplies of ppe. Less than 9 billion of that has been obligated for the stockpile. Dr. Cadlick, what percentage of the funds appropriated for the stockpile this year have helped states get the ppe and testing supplies they need as of this moment, what is that percentage . Maam, ill have to get back to you with the percentage. But what we have done in terms of our approach to basically managing the ppe part, and ill defer to admiral giroir to talk about the testing piece, is that weve basically made available everything that we had in our stockpile by may, beginning in march with the monies available in the c. A. R. E. S. Act, the subsequent c. A. R. E. S. Act, weve been funding, if you will, the purchase of personal protective equipment to be distributed through commercial distributors directly to hospitals and only beginning in june and july have we been filling, replenishing our stockpile as part of a strategy to make available three months of supply for the fall and winter should that be necessary. We are by a virtue of teletracking now getting information from hospitals. Last week about 95 of hospitals have been reporting to us. And im just looking at your state, maam. Weve identified that 16 of hospitals have one shortage of ppe that may be one type of ppe that may be three days of supply or less. Right. Im aware of the wisconsin statistics. But im also aware of the 16 billion that we appropriated to address stockpile issues. So you may have chosen a different strategy. But i think when were six months into this pandemic, and we still cant get the supplies we need, and youve identified the supplies that are in high demand, that you should use the money we appropriated to obtain those things. Congress also provided 1 billion for department of defense for similar purposes and the president delegated authorities under the defense production act to hhs to increase production of personal protective equipment, department of defense has only used 300 million for ppe and said they would use the rest to support the Defense Industrial base. Dr. Cadlick, how much funding have you spent on increasing domestic manufacturing capacity using all of the dpa authorities available to you so that we could prepare for the remainder of this pandemic or future pandemics . Yes, maam. So far weve awarded 638 million for that purpose. Which runs the gamut from addressing shortages of diagnostics and ancillary supplies, n95 respirators and filter media for masks and ventilators and gloves and surgical masks and ventilator supply cain. There are other things to be considered at this point in time to use the rest of the fund but were trying to be strategic. What is melt blown. That is the fiber material used in the disposable surgical masks, n95 and the and have you used the dpa to either increase production of melt blown in the u. S. . Im not talking about contracting, im talking about using the dpa authorities . Yes, maam, we have. And have you used dpa authorities to shut off the export of melt blown when it is obviously so needed here . Maam, im going to have to get back to you on a firm answer on that but my recollection is that we have. We did limit the export of that material and i have to be sure and return to please do. Thank you, mr. Chairman. Thank you. Senator graham. Thank you, mr. Chairman. Dr. Redfield have you been part of the task force since this beginning . Yes, sir. So see if i got the time line right. I believe president was briefed by mr. Obrien on january 28th. You had a major problem coming out of china when it comes to the coronavirus. He sets up the task force on january 29th, that correct . That is my recollection, sir. Okay. On january 31st the president issued a order called the china travel ban. Does that sound right . Yes, sir, 31st of january is when the request was to inhibit travel to china. Okay. On february 29th dr. Fauci was asked by a host of the today show, this is saturday morning, people waking up right now were real concerned about this. They want to go to malls and movies and maybe the gym as well. Should we be changing our habits and, if so, how. Dr. Fauci said, february 29th, no, right now at this moment there is no need to change anything that youre doing on a daybyday basis. Right now the risk is still low but there could change. Is that the general view back in february 29, did you agree with that assessment . At that time there was limited evidence of Community Transmission in the United States. Okay. So, in march there was an order basically issued declaring this a National Emergency. Do you recall that . March 11th. Yes. I think secretary azar called it a Public Health emergency. I think it was on the 27th and the 13th. On march 11th we do a travel ban from europe is that right. Yes, sir. Between january 29th and the 14th did the Task Force Rep recommend shutting the country down. No, sir. And when they declared this a National Emergency to encourage shelterinplace orders, did the president respond to the recommendation of the task force. Yes, sir. Was there any question about shutting the economy down before he made that decision . Not in the decisions that i was involved in. Thank you. So, vaccines. If we found a vaccine, lets say next month, at the end of october, how long would it take for it to be distributed throughout the country and to become effective . Well, i think that is a critical question. Because currently weve used the supplemental resources to get this distribution capacity up, about 600 million but the funds that we currently have arent sufficient to get all 64 jurisdictions ready to implement this plan that we issued today. Im sure youve made a request to the committee for additional money. But if a vaccine was developed tomorrow that was considered to be safe and acceptable, how long would it be before it would have a real effect in terms of controlling the virus . I think we have to assume that, if we have a vaccine say released today, that it is going to take us probably in the order of nine months, six to nine months to get the American Public vaccinated. So i just want everybody to understand that were working operation warp speed, do you feel like it is going well . Yes, sir. Okay. So if we got a vaccine in the near future, before it would have a massive impact. It would take six to nine months to get it distributed and for it to begin to take effect for lack of a better word, is that accurate . In order to have enough of us immunized to have immunity is going to take six to nine months. During that six to nine month period well continue to do what were doing now, is that correct . Yes, senator, that is why it is important to embrace the mitigation techniques that we talk talked about. So is it fair to say that at no time did President Trump reject the recommendation by the task force when it came to slowing down the economy or putting shelterinplace orders that when it was recommended to him to take those actions, he complied, is that correct . Yes, sir. Is it fair to say that as late as february the 29th, dr. Fauci, one of the experts of our time, was telling peoples it okay to go to the gym, it is okay to go out and about because at that time we thought the risk was relatively low . I have to defer that. I didnt follow dr. Faucis statements but i would say in general we all felt that is what he said on national television. That is what he said that day on february the 29th. So this idea that President Trump didnt respond i think is ridiculous for the president to be shutting the whole economy down when his leading expert is telling people you could go to the gym, you could go to movies and go out and about. So lets dont rewrite history here. Thank you, mr. Chairman. Before we go to senator murphy, dr. Redfield, be sure were clear here on the vaccine, youre not saying that it would take six to nine months before the vaccine would do any good for anybody . That is correct. And you are trying to come up with a priority that the country and governors should look at of who is the most at risk that would get that vaccine first . Is that right . Yes, sir. And if the vaccine works with the efficacy that we would hope for, most of the people that get the vaccine are then protected from the virus for at least the near term future, is that right . The fda has set guidance that if it is 50 efficacious, similar to the flu vaccine, that would meet the threshold for approval. And i do want to be clear that as soon as this vaccine gets approved by nua or approved we want to be in a position to distribute that within 24 hours. Because you point out very clearly, this vaccine has the potential to save a lot of lives in november and december. But we need to be able to get that vaccine once it is ready to once it is approved, we need to get it distributed as rapidly as we can. Right. In july at the hearing we had in july i asked you specifically to focus on being able to report back on a plan that hopefully well get to later. I just dont want to leave this moment with any thought that just because everybody who wants to have the vaccine might not have it before memorial day, that doesnt mean that many people who do have and hopefully would be the most in need would be substantially better off than they are right now. Is that right . Yes, mr. Chairman. Youre going to have an enormous impact, we believe, on the mortality and the most vulnerable and an enormous impact on protecting those at greater risk from infection and we should see that impact relatively immediately. Thank you, sir. Senator murphy. Thank you very much, mr. Chairman. Thank you for spending so much time with us today. Just a note on communication to and through congress to this committee. Senator asked about a 250 Million Contract awarded by hhs to defeat despair and promote hope which sounds an awful lot like a political reelection yearoriented message out of the administration and we have two deputies secretaries from the hhs and neither can explain why it was awarded and it is impossible to know who is in charge. We have two people at highest echelon of hhs and cant answer a question about a massive contract that has been awarded. And i think that is the same thing for the American Public. Dr. Birx was in charge and then Vice President pence was in charge. It is really hard for there to be any accountability around decisions when can decisions when we cant get the basic questions answered. And i want to talk about the changed guidance, dr. Redfield, so the president said he wants less testing. He said that out loud. Hes asked for clarification. He doubles down, said i want less testing. And then right around that time you issue this guidance that dramatically scales back recommendations for who gets tested. And the New York Times reports that that is because, in part, of instruction from the white house. You say today that that report is, in fact, untrue. But to many of us, it just belies reason that we would be encouraging fewer people to get tested today. Given the massive expansion of this virus. On the day that we passed the c. A. R. E. S. Act, there were 10,000 new cases reported in this country. On average we are seeing 34,000 new cases all across this country today. Your testimony was that you werent necessarily saying folks who are asymptomatic shouldnt get tested, theyre saying they should see a doctor first, is that correct, that is your clarification for today. No, i was saying when you get a test, it needs to be linked to an action. And what we trowere trying to ds reemphasizing that testing is linked to an action. The senator said she got tested, she was in quarantine, she got tested and was negative. But that still was linked to an action to stay in quarantine for 14 days. What was happening was people were getting tested and there was no action. So we were trying to bring action back into testing. We were not trying to limit. And ill be very clear before you do that. Let me read this from a medical journal, from the american journal of managed care, cdc changed its guidance, a test is not necessary if there is no symptoms. That is not true with the guidance was attempting to say. It is true that some people interpreted it that way and that is why i issueda clear statement in 24 hours afterwards to say the cdc is not trying to emphasize. I do believe that more tests, as was said by senator durbin, more tests actually could lead to less cases if testing is linked to Public Health action. But you did say they dont need a test. No, we said they may not necessarily need a test. What does that mean. I mean youre speaking to the American Public when you tell them that they dont necessarily need a test. A Public Health person to make that decision. What is the difference . A Public Health action could be taken in conjunction. When you tell them that it is not automatic that they need a test, that they should see a doctor first, it gets communicated to people that the urgency is much lower. For all context, sir, were recommending all of them be tested. It was a misinterpretation by some and again well continue to clarify because were not recommending less tests. I do believe more tests ultimately are going to lead to less cases in this country because it is going to allow Public Health action to happen just like it did for the senator and we could use those tools to stop this pandemic. I will ask this question for the record, mr. Chairman, to admiral giroir, there is a report earlier this month that the United States is going to scale down its engagement further with the w. H. O. Including recalling details from w. H. O. Headquarters, regional offices and Country Offices and then reassigning these experts. I acknowledge i dont have time to get the answer today. But i think its incredibly concerning that we might not have american personnel on the front lines to sort of watch this virus and others through w. H. O. Field offices and so i would appreciate a answer for the record regarding who is going to replace those individuals inside countries of concern and how we keep this virus and future viruses. Thank you, mr. Chairman. Thank you, senator murphy. Senator moran. Chairman, thank you. Dr. Cadlick, let me start with you. I want to talk about ventilators. Hhs has entered into inventory contracts most of which were canceled a week or so ago before they reach their intended, i guess, conclusion. And is there an accounting of how many ventilators, which is trouble some to me because the signals even a week before that was fulfill your responsibilities first to u. S. Aid and then come back and finish your contract at hhs and then a week later it is we dont want any more ventilators and the contract requires hhs, the taxpayers to pay for the startup cost, the closing down cost and all of the equipment and materials that have been purchased. So for a marginal amount of money, the contract could be fulfilled. Setting that aside, what is the accounting on how many ventilators that highly high acui acuity ventilators in the Strategic National stockpile and is there a calculation by hhs of how many need to be this higher acuity as compared to a more standard ventilator with kind of one dial that you adjust . Well, thank you, sir, for the question. And yes, sir, we have been looking at our ventilator supply. Just to put this in context, when the covid 19 event occurred in january, we had 17,000 ventilators in our stockpile with another 10,000 ordered. As a consequence of the modeling and the concern that we may need much more ventilators, by prepandemic calculations for pandemic influenza, it was a figure calculated that you needed about 170,000 ventilators. As the course of this event, there was a concern that we may actually need more than that number. And that is when we went into agreements with seven Companies Across the country and a few from outside of the United States to basically produce over 200,000 ventilators. With that, as things progress, as we learn more about the disease, and more importantly how to clinically manage this disease, both from a respiratory setting as well as an intensive care setting, we identified we needed to change our strategy with the ventilators. Maybe needing less but also different kinds of machines. So with your point the higher acutity kind of ventilators which we have over 120,000 of at this point was to basically diversify that so use for high low naz canula. And we also identified that we could meet our pandemic requirements of 170,000, make available to other countries additional 20,000 ventilators that we decided to then, if you will cut back on the number of ventilators that we needed to order, and to have shipped. Yes, there is a cost to that. But there is a significant cost on the back end of this with the Maintenance Requirements that you need to maintain these ventilators. And so that is why we did it sir. Im the responsible party. And, sir, ill be happy to get with you and your staff to provide you any other details you need. Doctor, thank you. Let me quickly turn to admiral giroir. I think the stand, the position the witnesses have taken this morning is that youre incapable of telling us but would take back the issues for the record, incapable of telling us about future spreads from the Provider Relief Fund. Let me just suggest to you that please take back for the record that the ability to get information from hhs on any spending from the Provider Relief Fund has been minimal at best. As the United States senator who appropriates money, who supported the kacares package a what the plan is next to nil. And i would ive not experienced that during coronavirus with other departments, with other agencies. But hhs has failed time and time again to respond to congressional inquiry and provide us with information about how money, taxpayer money is being spent. But how to help our constituents prepare for what you are doing or might not do. Admiral, in that regard, the increasing cost associated with complying with hhs rules and regulations by our Nursing Homes, our Skilled Nursing facility and Senior Living face ilt is significant. An my question for hhs, because i understand that you will defer to somebody else than who is here today to answer the question is what could they expect to help them pay for the tremendous increase in costs in compliance with covid regulations in policies that they are attempting to comply with to protect the safety and well being of their residents but have little Financial Capability to actually pay for it . Thank you for that question. Independent of whatever regulations there are Nursing Homes have the responsibility and the ethical responsibility to do the types of testing that we recommended. It is the only way that protect the elderly. Full stop. Number two, the reason why we distributed point of care tests to the Nursing Homes is because there are about 20 of the costs that they would incur as opposed to a Laboratory Test. The binax test that were distributed right now, 2 million this week, are at no cost to Nursing Homes and come with automatic reporting and i do refer to seema about sending money but i know 5 billion was sent to Nursing Homes of which 2. 5 billion was to support testing. That is the level of detail that i know. But im happy to bring anything back from her or from our assistant sect for finances to you, sir. Admiral, im using you as a conduit for persons of expressi expressing my concern and expressing my desire for a lot more information. Yes, sir. I would point out that every time that ive raised this issue, these issues with hhs, i talk about Senior Living, Nursing Homes and Skilled Nursing facilities and every response just as i think yours was, comes back to what were doing for Nursing Homes. And again i cant determine if there is any plan to be helpful which i think is necessary for example to Senior Living. So i will bringing that back and well take it for the record. I do want to let you know that the moment we have the binax test were sending to 5,000 assisted Living Center this is week to support testing in an assisted living environment. Not a nursing home environment. There is still 6,000 of those or even more that dont have a clear waiver that we need to work with but were going to work with them as soon as we get the technology, it is out to the door to support our seniors. You caused me to change my commentary slightly. So every time i raise this topic, now you mentioned two of the three topics and i still would raise for you and for hhs Senior Living which never seems to be a component of any conversation that ive had with what few conversations ive been able to have with hhs. Yes, sir. Thank you, senator. Apparently my time is expired. Thank you. Ive got a couple of other questions and senator murray has another question or two. On the point that senator moran raised, what is going to happen at department is an increasing reluctant by the committee to appropriate money and give the department flexibility. You know, we appropriate money for the provider fund, we expect that money to go to the provider fund. Not to go to whatever other fund the department thinks it is better spent. In fact, when we appropriated the second 75 billion to the provider fund, we absolutely prohibited spending that money any other way or some language close to that and that is all because of the departments actions. The appropriating committee appropriates based on your request and response to that request in ways we think is appropriate and you cant just decide to ignore that. On the vaccine, dr. Cadlick, we specifically did not appropriate to warp speed, we appropriated money to the partners, nih and barta, my understanding is at least 16 billion has come through those agencies for the vaccine up until now. Hhs has told us that to have 300 million copies of vaccine available, they need another 20 billion that they dont have in any specifically appropriated line. Do you agree with that number . Sir, based on current situation, yes, that seems to be the number. All right. Dr. Redfield, the plans you expect to get back from the states by november 1 on distribution of the vaccine, do you think youll be ready shortly after that to announce your final Distribution Plan for vaccine . Senator, it is going to be dependent on the Advisory Committee of immunization practices which will make the final recommendation for prioritization. I think im asking another question. Maybe i didnt ask it well. I want to talk about that, too. But surely prioritization will not impact how you send this out to the states. It might impact the number they get. But in terms of the protection of the vaccine, the way its distributed, to be sure that you have a plan to get this in response to all of the state plans as soon as possible, is that your intention . Yes, sir. Obviously the issue that i tried to mention earlier is that, and ive said this in our earlier testimony, some people may be not it doesnt seem like they see this. Just as it was important it is important. It is a second issue but it is really important and that is my next question. Where are we on the prioritization and that will be recommended to the states or will that be prioritization we expect the states to comply with . It will be in a recommendation of the Advisory Committee for how this vaccine, whichever ones are approved, are recommended to be used. And when will that be available . That will be available after the committee gets to see the data on the particular vaccine. So, but, to answer your first question because i think it was really important, i want to get to it. This plan for distribution is what we are now to get and i was trying to say, i said before this committee it is as important that we start that plan back in june totally agree. As manufacturing and right now we have leveraged 600 million but we dont have the resources to support 64 jurisdictions to get this plan operational. So to me it is an urgency, you know, that we get thatch and weve done this in the past and weve experience in terms of distribution and modern safety and get the vaccine, as i mentioned we distributed 80 million doses of vaccine at cdc, we have an idea but this is going to take substantial resources and like i suggested in june, the time is now for us to be able to get those resources out to the state and we currently dont have these resources. There were no resources provided in the heroes act in the house, in both the bill we voted on in the senate and the bigger bill we proposed in the senate. We had roughly 6 billion for distribution. Is that the right number or is that close to the right number . Senator, my professional opinion, i think youve got that really nailed. That was somewhere between 5. 5 and 6 million is what it will take to distribute this vaccine. And you dont have that money right now . Nos. And you need it to distribute the vaccine. I think it is as urgent as getting the manufacturing facilities up. Yep. I think i said in july and you agreed that if you have the vaccine and dont have either the plan or the resources to distribute it, that is a huge failure on the part of the congress to provide the resources that we know are going to be necessary. I hope it is part of whatever package we put together this very month to be sure you have the capacity to do that. Senator murray. She may have gone to vote. Mr. Chairman, can you see me . There you are. I see you now. Well, thank you so much, i appreciate it. And im just getting back to my desk here so hold on one second. Thank you. Thank you very much. I appreciate it. Listen, i waned to follow up on senator shaheens question regarding hhs 250 Million Contract for Public Service advertisements to, quote, defeat despair and inspire hope amid the coronavirus pandemic. Based on comments by Michael Caputo it looks like the administration intends to use a quarter of a billion dollars on a Massive Media campaign. To mislead the public that actually a downplay the pandemic and that is really unacceptable. Congress provided the funds for covid, not to support any kind of campaign or Reelection Campaign. Dr. Redfield, you could clarify if cdc was tapped to provide that funding . Thank you, senator. Cdc received a direct from hhs and omb to transfer 300 million to hhsaspa. What role has cdc played in the awarding process and developing that Media Campaign . We havent played a role. We were just, as i mentioned, instructed by hhs and omb to transfer the funds to hhs aspa. What role is cdc going to play in making sure the messages put out will include accurate Public Health information based on science . Again, senator, at this moment we havent been involved other than to be given the directive from hhs and omb to transfer the funds. So funds only youre not going to help them with information to make sure its accurate . Well, again, i would assume that they would want our instruction to do all of that. But i we havent been involved in this other than the extent that the funds were transferred to hhs and i assume that theyre going to come back to the different subject Matter Experts. But again, we havent been involved in that. Okay. Dr. Giroir, what role are you going to play in making sure the immediate caw ca the campaign will be used for science. I have not been involved in any discussions. Ive only been asked peripherally, which i think is the same campaign, to be subject to questions and to have a lyle og about Public Health issues. But i havent been involved in the development of the content the same way dr. Redfield mentions. Do you think it is your role, either of you, to weigh in to make sure this is accurate . I certainly believe that the cdc director has an Important Role in messaging and im the senior Public Health adviser to the secretary, so we certainly would welcome the opportunity to help support the correct messages to the american people. Dont mean to speak for bob but again, i would echo that, you know, if given the opportunity the cdc would obviously want to put forth the accurate messaging for the American Public. Well, finally, dr. Redfield, Public Health groups have really raised the alarm that billions of dollars are needed for vaccine and administration. Cdc should be leading that effort and i want to know what activities should be included in the Distribution Campaign and how you plan to make sure youre involved . Thank you very much, senator. I think it is critical. Cdc does have the lead within operation warp speed, again the pl playbook that we put out. Again, it is version one. It is going to go through iterations as the states get involved and help improve the plan. And so cdc is in the lead of working with the state and territories to do this. As i mentioned, since the last time, i think it was june when you asked me and we really didnt have the funds and weve been able to leverage about 600 million to start some of the most critical activity, but as i mentioned to the chairman just a minute ago, now is the time. It is now. The rubber is hitting the road now to get the 64 jurisdictions up to speed. This is going to be a very resource intensive distribution. Weve never tried to distribute a vaccine that has a cold chain requirement like this one does. Minus 80 degrees for one of the vaccines. So were prepared. We do meet with five of the jurisdictions, north dakota, california, minnesota, florida and philadelphia to go down to micro planning so we have a pretty good idea. But now were getting the plans for the rest of the 61 jurisdictions and it really is going to require resources, these jurisdictions are not going to be able to put plans in place without resources. Thank you, mr. Chairman. Let me emphasize that response because as we just heard, one of these vaccines is going to require cold storage, i think you said minus 60 or 80 degrees. Distribution is going to be extremely challenging and we need to make sure that the resources are there and has a National Plan for distribution and that communities that dont actually have often access to health care really get access to this and the distribution and storage and all of the things that go along with this, it is going to be very complex and will require resources and it again required a National Plan. Thank you, senator murray. I couldnt agree more. It is all about priorities and this should be one of our Top Priorities at this moment. Senator moran, for the last question. Mr. Chairman thank you for that courtesy and i know the second vote has been called. So this question is for admiral and i think it is it should be brief if i would start asking it. Admiral, we were alerted just recently about an hhs request for information that was posted, i think it was posted last week, soliciting interest from laboratories. Yes. That could scale up with additional equipment from Thermo Fisher scientific. They are located in kansas and we have a just recently they are had an expansion to create more test tubes to do the test results. Could you tell me what the ultimately plans are assuming that you receive interest from these laboratories and what is the budget for this strategy, how many labs do you intend to support and how much more testing will get accomplished . Let me say first, it was an nih solicitation and we received interest from 27 universities that had interest. And a top line piece particularly now is there are certain times of assays that are relatively plat but there is huge supply of outstanding assays of which Thermo Fisher has. They have instruments, they have everything that goes with it. It is soup to nuts, full happy meal, however you want to say it would so were trying to encourage universities to use theme because Thermo Fisher could make tens of millions of high Quality Laboratory based assays. Weve supplied some of these to private laboratories like sonic and egis and trying to make sure that universities use what they have but if they need help, were happy to fund this. This is a relatively small amount of money to get them the capability to do assays and thermal fisher has been good to work with knocking down the prices particularly for surveillance. So it is another way to try to get the message out. We talk of thousands of universities. But thermo is just one of those assets that we have a lot of. It is an excellent test and a great company. We want people to use it. And too early to tell whether there is a response, whether your outreach is having any effect . Seriously probably three times a week we match a major laboratory up with Thermo Fisher, getting their instruments together with their supplies. So it is absolutely having effect. Again, we have a lot of capable. We just want to make sure that people understand where the capabilities are and thermo is one of them. Admiral, thank you for your work. Thank you, senator moran. I think im going to turn to senator alexander for a final question. Before we do that were going to go vote. I want to thank you for being here. The country is zee pending on all three of you to lead on these critically important issues as dr. Redfield and one way or another all of you have said this, were at a critical moment in testing and vaccines and therapeutics, in distribution, no prioritization, all of these things need to come to as much of a conclusion as they could so we could move forward. I think youve all been great Witnesses Today. There were questions that you were asked outside of your area of responsibility and the proper answer to that is that is not what im doing every day and that totally is fine. Were grateful for your time. I know this is a critical time for all of you and im grateful to you for having been here. The senator alexander will mention that the record will stay open for a week for additional questions. But we hope you respond as quickly as possible to those questions. We are intensely involved in being your partner in this effort but we need to know what we need to do so we could do it and do it in the right way. Senator alexander. Thank you, mr. Chairman and thanks to senator blunt for being aggressive on all of these issues and leading especially in the area of support for the maximum number of tests. I do have some rapid questions. Dr. Redfield, i heard the questions that senator murkily asked you about whether there was some inviddious request for the vaccine and you said no it is recommended. Am i remembering right, when we had problem with a virus called h1n1 that the administration and the companies had a virus to distribute but the states werent ready to receive it and that was a big problem, is that right . Yes, senator. When was that . 2009, 2010. What happened . I wasnt there but were fortunate to have the gentleman that was part of that and had the opportunity to learn from all of the experiences and now leading our distribution for this to ensure that we dont have the same hiccups. That is why i was stressing how important it is for us now to be able to operationalize this plan. More than a hiccup. It would be a tragedy if we have vaccines ready and available and we couldnt distribute them because no one asked the states to be ready. I believe you said, doctor said, i believe you said that vaccines could be ready as early as november, december, is that correct . Yes, sir. So they would be ready in larger, much larger volume most likely after the first of the year and then on into the second and Third Quarter, correct . Yes, sir. And how long does it take to a state to get ready to manage the distribution of these vaccines and make sure they go properly to the right people with the right equipment at the right time . Ill defer to dr. Redfield. Dr. Redfield. I think this is why ive said it is urgent. When we say that the vaccine could be ready in november, thats really six weeks away. Yeah. So it is really urgent that we operationalize as rapidly as possible. What do you suppose this committee and others would say to you if you had a vaccine ready in november and december and you had not asked the states to get ready to receive it. You would probably be recommending that i get replaced. I think so. I think so. So i think this criticism of you and the professionals at the cdc for asking states to get ready to receive the vaccine when we know full well that its likely to begin to be available in november and december is very, very misplaced and i think and i appreciated your comments and the way you handled them. A dentist told me there is no evident, dr. Redfield, of transmissibility of covid19 in a dentist office. Is that true . I wouldnt necessarily state that. I think the dentist is probably going to say there is no proven transmission in a dentist office. Yeah. So i was a little surprised by that. That the dentist said that that dentists have a a history of handling infections all of the type. All the way back to hiv and so theyre trained to do that and they know how to wear protective equipment and adopt practices and do any of you know whether it is true that, that in other parts of the world and the United States there has been problems with going to the dentist because of transmissibility of covid . I would just come back to the statement that i tried to make earlier. These masks work. And one thing youll know about when you go to a dentist, everyones masked up. I could say we havent had evidence outbreaks that weve linked back to dentist. Im not going to say it never will han. Just like we reported two hair salon people that were highly infected and went and did their work to over 100, over 150 people but they wore a mask and there was no evidence of transmission. So keep coming back to the importance of wearing, Wearing Masks. And i have one last question and i understand senator murray would like to make a closing statement or question so ill go to her when ive finish. I want to go back to the cdc guidance on asymptomatic testing. Which is which you acknowledged has created confusion. And i wonder what else you might be able to do to limb knit that confusion. And let me tell you why i think it is important. My feeling all along has been that it was a good idea to produce tens of millions of rapid tests so that anybody who wanted a test could get one, basically. Now, from a medical point of view, there is no reason to do that. But, thats not the only concern we have in the United States right now. I mean, we like to go back to school. Wed like to go back to college. Wed like to go back to childcare. Wed like to go back to work and go out to eat. And if by frequent testing, or surveillance testing, or any of the a whole number of strategies that tests a lot of people who dont have symptoms, we build confidence that your school is a safe place, your College Campus is a safe place, that your Child Centers is a safe play and your work place is safe, that your restaurant is safe. If we build confidence, well have better lives. And so it seems to me that there is particularly, since admiral giroir said were now heading toward a situation where we may have 100, 120, 150 million tests a month, were going to have plenty of tests. Were going to have capacity for plenty of tests. And by frequent tests i mean what if a school wanted to test every student at the beginning of school or at the beginning of a week for two or three weeks, just to make sure that there wasnt some spreading and wanted to create a a regime where you do random testing, surveillance testing is a word for it. At the kind of testing they go through the airport and pull you out of the line to check to see if you have explosives on your hands. That makes us feel better when we get on an airplane, that were not going to blow up. And so people fly 2 million a day without worried about getting blown up by passengers with explosives on their hands. And the university of illinois i think is testing twice a week. Think the university of illinois must have 40,000, 50,000 students and staff on campus. The president of brown wanted to test everybody before they came back. I could imagine in a workplace that somebody would worry about being working next to somebody who is infected and worried they might have just be afraid that they might have covid. And wont it be a good idea for the manl manager to say come in here and take a 15 minute test and say you dont have it today. And to say we give you tests if your symptomatic and we also give you random tests so you could have more confidence when you come back to work. So it seems to me that it is a good thing for our country to have more tests than we need, more rapid tests than we need, so that anyone who wants a test could get one, if they knefeel is necessary. Once they know that they can, they wont want one. And i think that is one reason were seeing a lower demand in other parts of the country because people understand the limited value of a diagnostic test, just on the one day whether you have it. But this is a little bit of a long question. But what im trying to get around to, is there some way that the cdc could clear up whatever confusion has been caused and make it clear that we since we now have such a large supply of tests, that different strategies for testing people without symptoms is a perfectly good idea and doesnt and doesnt take tests away from Health Care Professionals or people in Nursing Homes or assisted living or people like that. That clearly would help, i think, as we move into october and november and december to encourage people to use this growing number, especially of rapid tests that we have to build confidence that the schools, the college, the childcare center, the workplace and the restaurant are safe places to go regularly checked and that would help restore our economy. What you could do about clearing up the confusion. I appreciate the comment, senator. First, because i want three areas here but ill be brief. First, were working on clarification document related to the diagnostic and Public Health use of testing. And, again, weve never recommended against asymptomatic testing. Youll see in the clarification, it is very clear that we make it very clear that asymptomatic and presymptomatic transmission is porn. We ma is important. And if you are exposed you need to fwe tested and contact traced. So that is going to come out, ive done my clarification statement in 24 hours after you but it didnt solve the problem. So we are going to come out with that, hopefully sometimes in the next, i hope before the end of the week. Secondly, and the admiral may want to comment, were working on guidance because in addition to the diagnosis Public Health, there is screening and screening could be very powerful for maybe nonPublic Health reasons. Maybe getting us back to life. And screening in schools, k through 12, screening in universities and business. So youll see that the cdc will be coming out in conjunction with the admiral, well be coming out with this some guidance around screening. And then there is the other word that you use, which we also believe is really important, which is surveillance. Where you could actually systematically begin to look at random individuals to get an idea, is this outbreak starting to pop into a new community. So all these of those are important. All three of those youll see were developing followup guidance for. It really wasnt possible to have a lot of guidance when there was no test. Right. But as you point out, admiral giroir, is really done a yo mans job with the private sector and gotten to the point that were going to try to clarify the clinical Public Health use, were going to try to give guidance to screening, particularly in k through 12s and universities and it is also going to have a role in businesses and also in entertainment activity, like sports, and that there was a huge new o outbreak that we just didnt have eyes on until it got too great. But admiral, you want to admiral, you want to add to that . I just agree 100 with with everything that has been sate. We are going to continue to invest in a number of different types of platforms, but clearly, low cost, ultra available, sensitive and specific tests like buy nex now. There are going to be r more like that coming through. And again, were going to increase that supply as much as possible. There are also going to be some new point of care tests that are very sophisticated and specific that can be layered on top of that and our goal is to provide as many tools as possible in the right domain so we can implement this type of guidance. Again, in march, it doesnt make sense to talk about random screening of children going to school because you didnt have that available. Now that we have a very robust ecosystem of testing, this is the exact right time, which is why we purchased 150 million of those card based tests while we have point of care and distributing them, first, to protect the vulnerable, but then within a couple of weeks, theyre going out to states to support School Reopening and other infrastructure according to their priorities. We are at that point, at that inflection. Now, how many will be going out to states in a couple of weeks . Can you give me a rough idea . So, when, when abbott gets to their full production capability of about 12 million per week, which will be within a few weeks, we anticipate you know depending on how things go at the Nursing Homes, et cetera, somewhere between five to eight million per week going to states that we can provide them for those needs. Again, if the cases continue to go down in Nursing Homes, well need less and less tests. So thats 5 to 8 million a week . Yes, sir. Tennessees usually about 2 of everything. So that will mean a state like tennessee would be getting a few hundred thousand tests a week or several hundred thousand tests a month at least that the state could distribute according to its priorities. Is that the general idea after youve used, with that 5 to 8 million . Yes, sir. Theres some policy discussion and we certainly want to support the states, but we think its a priority as i know you do, to open education. K12. Even preschool. And potentially universities, but i think universities are on a different class because they have resources, so we want to emphasize very strongly the protection of teachers and the reopening of k12 as a significant priority. I do, too, but you wouldnt, some states are doing some thing, some states are doing others. I think its a good idea to verve some of, first, i congratulate the administration on buying the full three months supply of that, which as i understand it, about 50 million tests a month starting in october, with several million this month and then assigning it to priorities like Nursing Homes et cetera, then giving a lot to states, which would be i mean of the state of tennessee got 200,000 tests a week, that it knew it could distribute during the rest of this school semester, my guess is many of them would go to schools because the ones who are most worried about that, its not the kid, its the teachers, and the parents and grandparents when the kids go home. So i think thats a tremendously reassuring prospect that a state might receive that many rapid tests just from that source. And dr. Redfield and well conclude it with this because i think senator murray does not want to say anything now, but one time, you and i had a discussion b about guidance that used examples. I think we talked about colleges. And i think you did that. Maybe one way to help clarify the use of tests for asymptomatic individuals would be to list five, six, eight, ten examples of schools, colleges, workplaces that are doing that now. That makes sense. That, that whether, whether and ill let you decide what those might be. And it wouldnt be only those things, but i think if you said these are all the kinds of ways that this large number of tests that we have may be used effectively and sensibly to build confidence in going back to school, work, child care and out to eat. That might be easier for people to read and understand than the words in a guidance. So the use of examples is a suggestion i should make. I appreciate your advice, sir. Thanks to the three of you. As the senator said, were grateful to you for your long hours, Effective Work and for your planning and if the money that this appropriation subcommittee has targeted for you isnt forthcoming in the way the congress intended for it to be, we expect you to let senator blunt, murray and others of us on the subcommittee know that. The record will stay open for one week. The subcommittee stands adjourned. Announcer you are watching cspan, your unfiltered view of government, created by americas Cable Television companies, as a Public Service, brought to you by your television provider. Announcer our campaign 2020 coverage continues with candidates campaigning and debating. Cspan, your unfiltered view of politics. Live thursday on the cspan networks the house returns at 9 00 a. M. To take up legislation against antiasian sentiment related to the coronavirus pandemic. And the pregnant workers fairness act. That is on cspan. Later at 8 00 p. M. , President Trump holds a Campaign Rally in wisconsin. On cspan 2, the senate convenes at 9 45 to continue work on two nominations to District Courts in illinois. Later at 7 00 p. M. , coverage of the formal dedication of the do dwight d. Eisenhower memorial in washington, d. C. On cspan 3 at 9 00 a. M. , acting Homeland Security secretary chad wolf and fbi director Christopher Wray testify at a house hearing on National Security threats. In an hour, New Hampshire representative ann mclane kuster, a member of the energy and commerce committee, on the Trump Administrations pandemic response. At 8 30 a. M. , arkansas congressman bruce rester