Transcripts For CSPAN Former Senate Majority Leaders Discuss Federal Response To Coronavirus... 20240711

Centers event on the nations response to the coronavirus pandemic. I serve as the chief medical advisor. Today the Bipartisan Policy Centers future is releasing a new report. You can find this report at bipartisanpolicy. Org. That is bipartisanpolicy. Org. Since the beginning of the pandemic a year ago, there has been more than 25 million confirmed cases of covid19 and more than 430 cases deaths across the country, accounting for 25 of deaths worldwide. While cases, hospitalizations and deaths have slightly decreased, the numbers continue to be staggering and there is great concern variants, more transmissible strains of the virus, may become dominant over the coming weeks leading to a further worsening of the pandemic. Todays report comes as president Bidens Administration launches an effort to combat the pandemic in Congress Considers additional aid to bolster the response and jumpstart the economy. The initiative released its first report, bipartisan subscription for health care in 2020, Offering Practical Solutions to make Health Care Coverage more affordable without adding growing Systemwide Health expenditures. Todays report is led by a Bipartisan Group of Health Care Leaders which include former senator majority leaders tom daschle and bill frist, former administrator of Health Care Financing administration, now now cms Gail Wilensky come also sheila burke, fellow bpc of strategic advisor, baker donaldson, president fellow Milton Friedman chair at the American Enterprise institute, dan crippen, former director dan crippen, former director congressional budget office, former commissioner of fda, Chris Jennings fellow at bpc and former clinton and Obama White House Senior Healthcare policy advisor. Lisa, former president and ceo of Robert Wood Johnson foundation, bill roper, former director for the centers for Disease Control and prevention, Senior Advisor at bpc and president of the foundation for research on equal opportunity. Mark smith former founding president and ceo of the california healthcare foundation, and leana wen, former Baltimore City health commissioner. They will augment Public Health infrastructure, bolster health care capacity, improve federal interagency coordination coordination during public on Public Health emergencies reviewing federal health care , coverage policies during the pandemic, and enhancing safety in congregate living facilities and in transitions to homes and communitybased services. Todays events will consist of opening remarks from dr. Kathy hempstead, senior policy advisor at the Robert Wood Johnson foundation am followed by remarks from senators daschle and frist. This will be followed by a moderated discussion with Gail Wilensky, doctor bill roper, dr. Mark smith and dr. Leana wen. At this time would like to thank the Robert Wood Johnson foundation or its a generous support of this initiative and listen to some remarks from kathy. Kathy hello and welcome. We are proud to support the group of the bpc future of healthcare leaders, a a Bipartisan Group that works together to reach consensus on a poor Health Policy recommendations. This group of leaders have been expanded this year and includes members of the broad range of valuable expertise and perspectives. I want to give a special thanks to our own doctor. Todays bit addresses our nations most Urgent Health crisis in many generations. The covid19 pandemic cast not only created extraordinary challenges for our Public Health and Healthcare Systems but has also exposed preexisting vulnerabilities, most particularly the terrible burden , of inequity. Today you will hear our leaders recommendations to policymakers regarding the most urgent issues and Pandemic Response. They include recommendations about testing, vaccinations, Surge Capacity, supply Chain Management, and better measuring the dimensions. Future work by this group will cover Public Health infrastructure issues and coverage and Health Insurance market reform, all of these areas have been made far more critical by the pandemic. I am looking forward to todays event, too. I will turn things over to anand. Anand thank you. I would like to welcome former Senate Majority leaders tom daschle and bill frist, both are cochairs of the bpc future of health care initiatives. They will be discussing the foundational principles behind todays report as well as the overarching recommendations. Thank you, anand, for your leadership on covid19 pandemic as well to bill hoagland and denis mcdonough, the entire Health Care Team at the Bipartisan Policy Center, and my fellow Task Force Members who worked on this important report for over the past six months. Today we are releasing six key recommendations for immediate action by the new administration and congress to address the challenges of the current pandemic with additional supporting recommendations under each one. As President Biden has said many times, we cant afford in action, especially with more than 3000 americans dying from covid19 each day. Since the covid19 pandemic began, there have been no National Comprehensive strategy to address this devastating crisis which caused delays in our nations response, and far too many senseless deaths. Thats what were glad to see the Biden Administration has released a Robust National strategy for the covid19 response, issued a series of executive orders to implement the strategy, and called on congress to provide additional funding to support activities such as testing, vaccinations, supply chain strengthening, and school reopenings. We are also pleased to see many of the recommendations we are releasing today in our new report align with the goals and actions that the Administration Strategy implies. They also include Additional Details we believe are important to implementing an effective and immediate response. Underlining our recommendations are five critical Guiding Principles i would like to review. First, political and Public Health leadership are central to successfully cordon aiding and managing a pandemic crisis. Looking back to the 1918 influenza pandemic we learned lessons that could be translated across the century to todays Public Health emergency. In 1918 and the covid19 pandemics were and are highly political events. Leaders selectively chose which scientific results to recognize and in some cases ignored science and downplayed the seriousness of the illness. Crowds continued to gather, cities shut down, but reopened too soon and people refused to , wear masks. Successfully tackling a Public Health emergency of this magnitude requires federal leadership, establishing a National Plan, paired with unified coordination and Communications Efforts across the country. Second, trust in science and commitment to Public Health are paramount to making progress in fighting a pandemic. At the federal level, bipartisan leadership our nations federal must support and elevate our nations federal allowing scientific guidelines. Science to guide the critical decisions and response to the covid19 crisis. Leaders must emphasize the importance of science and communicate the scientific basis upon which public guidelines are issued. Particularly those that require economic or personal sacrifice of the American People. Restoring trust in our Nations Health institutions, our leading health experts, will demand transparency at all levels with a focus on safety, efficacy and equitable distribution of treatments and vaccines. National and state leadership lead by example, and adhere to the scientific guidelines by Wearing Masks, physically distancing and obtaining the vaccine. Trust in science, our Health Agencies and worldclass scientists, is imperative for reducing transmission successfully defeating the , coronavirus. Third, national third, National Leaders must communicate and adhere to clear, consistent and customize Public Health and safety messages and serve as role models. Transparent communication with the American People will ensure people understand and trust the scientific process, and the tools and actions needed to end the pandemic. When new evidence emerges prompting Public Health leaders to update scientific advice, it is imperative to communicate with humility and transparency, sharing and repeating clear, consistent and customized Public Health messages by leaders at the national and local levels will help change of the conversations between people and on social media where many people keep informed. Tailoring messages and Public Education campaign to focus more on empathy than authority or politics and target specific , communities will go a long way for changing behavior and moving public opinion. Fourth, federal, state and local leaders, democrats and republicans must take action to , debunk conspiracy theories. Conspiracy theories have evolved around covid19 treatments and vaccines, even the existence of the virus itself have been dangerous and put communities and individuals at greater risk illness and death. Our political leaders need to speak out against these conspiracy theories and theorists speak about what is , actually known and true. Fifth, federal efforts must recognize and address vulnerable communities. Public official must consider the unique experience of communities of color and other vulnerable populations, including native and rural there must be recognition the need for political leaders who engage with the American Public in a culturally competent manner. This pandemic has also exposed the need to focus attention on our nations nursing homes, chronic conditions understaffing, lack , of accountability in isolation has been hallmarks of covid19. An effective Pandemic Response must include a dedicated effort to address and mitigate the Health Disparities and unique challenges facing these vulnerable populations who are shouldering the burden of covid cases, deaths and hospitalizations. These are the foundation for the wreck and dacians the recommendations we are making today. Let this time i like to introduce my friend and colleague, senator bill frist, who will review the report. Mr. Frist thank you. It is an honor to participate with you and release todays report that outlines bipartisan recommendations for accelerating our nations Public Health response to the pandemic. I want to thank fellow Task Force Members for reaching consensus on this report. The same spirit must carry over to congress as it considers our stimulus relief package to support the covid19 response. As senator daschle mentioned we are releasing six key recommendations today that a align with the Biden Administrations national covid19 strategy, and include Additional Details that we believe are important to implementing an effective, immediate response. Recommendation number one, expand testing and contract tracing. We recommend the administration develop and implement an National Testing strategy that reduces Positivity Rates in each state to under 5 . This is 5 . This is a wellestablished metric that gauges the sufficiency of testing as recognized by the world health organization. We also call on congress to allocate additional funding required to implement this strategy. We believe a National Testing strategy should detail how Positivity Rates should be defined and standardized and reported by states. It should explain the amount and type of tests that are needed over the course of the pandemic. For example diagnostic tests , versus screenings. Testing such as saliva and home tests. Include a userfriendly diagram for the public to understand which test to obtain and under what circumstances, produce algorithms for the group of test s in specific atrisk populations in high risk settings. Offer guidance on the payment for these tests. Conduct a transparent analysis of the supply chain necessary for test production, provide a timeframe to achieve these stated goals. For states with a Positivity Rate higher than 10 we recommend assigning tiger teams to assist Public Health leaders in ascertaining and addressing testing and insufficiency. Number two, ensure Vaccine Distribution and update is efficient, transparent and equitable. We recommend the administration launch a national covid19 Vaccination Campaign that ensures efficient and prompt Vaccine Distribution, and educates americans on the importance of obtaining a vaccine. The current delay in Vaccine Distribution must be reduced through coordination at the federal, state and local levels to ensure there are ample, publicly accessible, and appropriately staffed vaccination rates. And federal assets such as fema and the National Guard should be deployed to support staffing and to build more Community Vaccination locations. The covid19 vaccine equitably to allocatethe covid19 vaccine equitably the administration should reevaluate the decision to allocate vaccine to states on a per capita basis in order to optimize saving lives and reducing viral transmission. To achieve both of these goals the administration should consider whether alternative allocation strategies and criteria such as taking into account Priority Group population size or severity of outbreak are warranted. Our report also calls for a national Public Education campaign that is based on science with a specific focus on communities of color, older adults, low income americans, and those living in disparate rural and urban geographic areas to ensure gaps do not develop over time. We strongly feel that Healthcare Professionals must also be a focus of this campaign, as there their acceptance will help of the vaccine will help instill confidence in their patients to do the same. Number three, to support Health Care System Surge Capacity. We recommend the Administration Direct hhs to engage in continuous Quality Improvement in its covid19 hospitalization dashboard and to publicly disclose realtime Healthcare System capacity data such as icu beds and staffing and ppe. An accessible and accurate dashboard will enable leaders at all levels of government to have better Situational Awareness and appropriately adjust the Community Mitigation measures. These data will also identify settings with adequate capacity for designation as relief healthcare facilities. The hhs protect public data hub currently collects information from hospitals related to beds, staffing and ppe availability. While facility level data on bed capacity, hospital admissions, Emergency Department visits have recently been added to the hhs protect public data hub, similar granular data on medical matters such as ventilators, medicines and ppe could also be helpful. Number four, enhanced supply Chain Management. To improve federal supply Chain Management activities and ensure ppe and other critical medical materials are adequate we recommended the administration clearly define and publicly communicate the roles, responsibilities and authorities of agencies at the federal level to better coordinate efforts to stabilize the supply chain, addressed supply issues rapidly, and ensures sufficient resources. We are pleased to see that the Biden Administration has already conducted a gap analysis and identified a shortage of 12 critical medical materials crucial to vaccination, testing and also including personal protective equipment. As we note in our report, this will help federal agencies in determining how to use the defense production act to increase domestic manufacturing capacity. Number evaluate and address five, racial disparities. To ensure accurate race and ethnicity data are available to policymakers congress should , provide the cdc with the authority to require states and localities working with Healthcare Providers to submit a race and ethnicity data on covid19 testing cases, hospitalizations and deaths on a regular basis. Currently, states report this aggregated data by race and ethnicity to the federal government on a voluntary basis. This change would allow policymakers to have access to consistent and comprehensive data for informing policy decisions, addressing the allocation of critical resources. Given that some states and localities do not have the infrastructure necessary to conduct comprehensive aggregation, they should offer relief in the next relief package. Number six, increase state, local, and provider funding. To ensure that state and local Public Health departments have necessary resources to adequately respond to covid19 we recommend that congress provide an additional onetime emergency appropriation for state and local Public Health departments to conduct Contact Tracing, surveillance and testing activities, Vaccine Distribution, and to engage in the critical efforts to educate communities about the importance of vaccinations, to reduce Vaccine Hesitancy, and improve vaccination rates. While congress recently passed a significant relief package with substantial funding for critical Public Health activities, it did not include a direct flexible allocation for state and local Public Health departments. Further, regularly monitoring state and local needs and available resources to address covid19s demand under public on the Public Health systems systems is critical in the near term. Equally as important for preparing for future Public Health challenges. Overall, safety net providers, state medicaid programs, Community Health centers and Public Health departments are all critical for mitigating the spread of covid19 as well as better addressing social determinants of health. Improving access to care such as chronic conditions and reducing Health Disparities in communities of color. My colleagues and i understand that took combat covid19 demands bipartisan solutions. We know these proposals will enable the nation to make progress in stopping the spread of this menacing virus and its new variants, and saving lives. Our recommendations provide the Biden Administration and congress with important details on how to implement an effective plan. They represent both republican and democratic ideas. An ideas. An effective Pandemic Response must be bipartisan with a focus on putting the health of the American People first. I will turn it over to anand and my fellow Task Force Members for discussion. Anand senators, thank you so much for your comments at this time. We will move forward with our Panel Discussion with members of the future of health care initiative. I would like to remind all attendees to submit questions using the live chat feature on youtube or facebook or on twitter using bpclive. That is bpclive. Welcome, thank you for joining us. Thank you for your leadership on bpcs future of health care initiative. The first place to start, what is the major take away from your perspective with respect to this report . It comes at a critical time in this pandemic and also politically with the new administration, new congress. Mark, we can start with you. What is the big take away . Mark the word i would emphasize [indiscernible] as you heard senator frist say, bipartisanship is so important here. We have gotten use to there being a partisan divide in many matters of our country but theres no issue around which there is more of a partisan divide than this. There are highly partisan differences in people Wearing Masks and people taking up vaccines and people even believing that this pandemic is real. That is why a sense of bipartisanship and a sense of urgency is so importance. You heard about these new variants. We have two challenges. One is the challenge of the variants. The other is the challenge of logistics of getting this vaccine to people as a matter of efficacy. I would point out in november an article on Health Affairs the , author is now the head of the cdc. He pointed out of vaccine of vaccine the implementation distribution is as important or more important than clinical efficacy in terms of the success of the Vaccination Campaign. We have to have a sense of urgency both about reinforcing these messages, making sure they are reinforced in bipartisan fashion, and making sure the implementation of this vaccine which is so promising and helpful really goes better in the future than it is going currently. Anand thank you, mark. Bill . Bill what i would say, building on marks very good point, we very much need now, in a bipartisan way, to come to agreement on a way of managing the entire covid pandemic. I think we have had a need for some time for greater federal leadership and that will be able to guide the decisions made on testing and Vaccine Distribution and hospital and other Health Care Surge capacity and , disparities, implications and on and on. We have to have leadership from the National Level to guide peoples decisions. Because if everyone is free to make their own decision at the state level or within some states at the county level, we end up with mass chaos that only adds to the publics distrust of can they really believe whats going on if its so different from one county, one city to the next or one state to the next . I am not suggesting the federal government has all the answers but theres a very established , and proven process for bringing experts together, debating, discussing things, coming up with agreedupon consensus, and then moving out to implement that and thats what we so badly need right now. Anand gail . Gail i will try to put what i think is important between the comments we just heard. Bipartisan is the word all of us are raising, as we all believe. As important as a National Policy is, and we have been lacking that, and that has not served us well, we have to make sure we allow for the kinds of differences that will permit governors and local governments to best reach out to their people. There are different population mixes in each of the states with different needs. We have two both make sure there is a consistent overall message , but do so allowing for the fact that the flexibility still needs to be there in terms of how to outreach best, particularly to the communities that have been hurt the most, our communities of rural individuals, native americans, those who are in inner cities and in close housing conditions, people in nursing homes. Their needs are not quite the same in each of those areas, and so we have to make sure in our rush to have a more consistent, coherent National Message and strategy, we still recognize this is a very big country, very diverse, and what will be most appropriate needs to have some variation permitted so that it can really react to the communities needs in a most effective way. I think our six recommendations that the senators have mentioned attempt to do that, but we have to acknowledge this will be an important balancing act in order to get it right. Occasionally, we will make missteps and then well have to fix those and get those even better. Thanks, gail. I i want to piggyback off of what galen mentioned in terms of the federal local dynamic because i think sometimes when we talk about a National Plan it could be misunderstood to some of the federal government wants to swoop in and do everything. Actually i can show as a former local official that will not be helpful but that there is a balance exactly as gail said. I think theres very much a role for the federal government in doing things like synthesizing data. No local official is a a time to be looking at dozens come hundreds of new studies that is being done every day and coming up with policy recommendations that something that is best done on the federal level, or things like securing testing, having enough ppe. Weve seen what happens when hospitals are feeding a can states come states bidding against each other, its the hunger games and thats not an appropriate way to do things and also when there is not consistent messaging. You also run into the problem of significantly eroding trust when various public leaders are saying Different Things and on Public Health experts are people saying Different Things acrostic lines. That is an appropriate role of the federal government, having a National Strategy am communicating national messaging but at the same time very much recognizing that the work is done on the ground, that everything that can be done to empower local officials to do their work and allow for maximum flexibility because these local officials know their communities the past. I will say one more thing about the report because others have emphasized why this urgency bipartisanship is so important. One more aspect i am particularly proud of in this report is the emphasis on equity, that equity is embedded in every component of our recommendations and i think that also is in the biden plan that i think has long been neglected but if its anything that covid has done it as unveiled many of the underlying severities and i was a time for us to address not only how to prepare for some people but actually how we should really and that equity into every aspect of the report. Great. Thank you, leana. I want to start with a focus on vaccines and vaccinations. Marquez already alluded to this. A lot of issues are going now as of this morning nearly 50 million doses of pfizer moderna vaccines have been distributed across the country. Reportedly about half of those doses have now been administered. There is some data lag and certainly some states are holding back their second dose. President biden has committed to ensuring the administration of 100 million doses in the first 100 days. We understand that is a floor and not a ceiling. We also know their significant Vaccine Access issues across the country. Theres background Vaccine Hesitancy ongoing. We know that the vaccination rate for white americans is two to three times the rate of like americans. So many, many issues currently ongoing with respect to vaccines and vaccinations, notwithstanding the news this morning from johnson johnson. Leana maybe you can start us off here. What is the way forward with respect to both vaccine and vaccination . Yeah, so i think if we look at the three major bottlenecks, because right now, and i think bill priestly mentioned this. Its not just the development of a vaccine that will save lives. Its the shots in arms actually critical. So, so what other bottlenecks . Three categories. One is supply. Two is distribution and administration. The last mile. And then three Vaccine Hesitancy. And what our report attempts to do is address all these components. Certainly we need to have more supply. Thats very clear and the need to be prompt, around getting enough supply but we focus a lot of attention on the distribution aspect recognizing this has to be partnership between federalstate locales and with the third part which is a Vaccine Hesitancy. Right now the mans outstrip supply and so it may seem to some of if its premature to talk about this. However, we know its not develop overnight. There are many communities that for understandable reasons have discussed of the medical profession to the been expended on an ethically in the past and we have to have the trust the earned inbuilt overtime. We talk about continuing to be transparent about the data, to make sure we are enlisting custom messengers and develop that message, having again in National Communication strategy to overcome Vaccine Hesitancy is going to be really important. I want to come back to this equity focus because our emphasis is on speed. It will do no one any good if there are millions of vaccines that are sitting in freezers so it also have to focus on equity. It cannot just be firstcome first serve because we know unless there is an explicit emphasis on equity those who are left behind are going to be left further without access to vaccines. One of the compulsory talk about is getting datacomp that the needs to be tracking of who is getting the vaccine across race, age, income level and geography. So that we can know what is happening with the disparities and also the we can target interventions accordingly. I will sit on my own path i think that expediting vaccine rollout now is the number one focus for the Biden Administration and for every person really across the country. We have these variants that are fast approaching. The cdcs estimating the b. 1. 1. 7 variant from the uk could well become the dominant very yet by march, and were facing these other areas that may not be very effective or the vaccine may not be very effective against so were really in a race against time. Yes, we have to have the other mitigation measures but getting the vaccine rollout to be as efficient, prompt and equitable as possible, that should be our number one focus. Thank you. Gail . Additional comments . Yes. This is going to be a time when you have to be careful not to get too caught up in the numbers game. Because the easiest way to get the vaccine numbers up is to respond to the people who most want it, which tend not to be the people in inner cities, minority, those who have lower education levels. So what is going to be, as leana pointed out, very much this balancing of going to the targeted populations that we know are most at risk because they live close together in housing, because historically they had been badly treated or misled. Because they have a predisposition to worry about their safety or efficacy of vaccines. The report is coming out now that they take up rate for the workers in nursing homes, probably the single biggest contributor to the early mortality rate, that is in the nursing homes, are refusing to take the vaccines in very high numbers. Having very targeted approaches by people of trust in those relevant communities, reach out and tried to both provide encouragement and assurance about the efficacy of the vaccine and the importance of people taking it as soon as it is possible. Bill roper and i have both had the privilege of running medicare and medicaid, and we frequently have found in our past that it has been very hard to get programs that are directed to looking, populations taken up in the numbers we all want to have occurred. So there is some experience in how best to reach out to communities that may be hesitant. It involves bringing in the black churches and their leadership, and while not everything tends to be remote, people are still attending Church Services in large numbers remotely in some places, also in person. We need to make sure that it is not only the professional community that is involved in terms of medical care. That is very important. People have a lot of trust in their physicians and their nurses in general. But we need to reach out to all of the relevant communities, and particularly making sure that the minority and underserved communities which have been most at risk in this epidemic are brought in to take advantage of what is really an amazing circumstance, which is ten months, maybe now closer to 11 months, after the first indigenous case was reported in the United States sometime in february of 2020. We are approaching three vaccines that are available and millions of doses that are being produced. We need to jump on that and distribute it. But as my colleagues here have made clear, we also need to make sure that we reach out to the communities that may be most hesitant in terms of taking advantage of what we have. People like me are going to run and get the vaccines as fast as they can. We just need to make sure that those most at risk are encouraged by the people that are important in their lives to take advantage of these vaccines as well. We are approaching three vaccines that are available and millions of doses that are being produced. We need to jump on that and distribute it. But as my colleagues here have made clear, we also need to make sure that we reach out to the communities that may be most hesitant in terms of taking advantage of what we have. People like me are going to run and get the vaccines as fast as they can. We just need to make sure that those most at risk are encouraged by the people that are important in their lives to take advantage of these vaccines as well. Thank you, gail. Mark and then bill. So i think the task here is to combine people who have cultural credibility and the peoples of scientific credibility. As gail said its important that ministers and other Community Leaders reach out. Its also important, the scientific credibility and the skepticism of black americans quite understandably have about this and other issues, has to overcome. I think there are some encouraging examples. Theres an effort being organized by all the black elected most of the academy of medicine of which i am one come to speak out. I think one needs to combine people that some scientific credibility with the kinds of cultural credibility that celebrities and local Community Leaders have, because this is not going to get overcome overnight. We should be realistic about the fact that the skepticism that is around in many communities, particularly the black community and latino communities who are understandably hesitant to come forward to authorities given the events of the last four years. Those things will become overnight. We have to keep at it and keep at it and make sure were consistent messaging because again people have been fed a steady diet of misinformation and disinformation and it will take a while before those things to overcome for it with a consistency and and i think it can be done by this not going to happen overnight. Thank you. I just would add to the very good thinks my colleagues have said. When i was director of cdc in the 90s we were 20 years after the uncovering of the horrible mistakes, tragedies that were perpetuated by the syphilis experiment. We are now 50 years after that time and were still paying a very heavy price for that, we just need to acknowledge that that was a terrible mistake. People just were totally offbase in what was done. And at the same time we need to say going forward, we will be doing things in Public Health in an open and transparent way that invites the public into understand why we are doing what were doing, why why the decision i made the way they are, and those messages can most appropriately be put forward by, as gail and mark are saying, people who are members of those communities, people of color, scientists, faith leaders and others. That is so very important if we are going to get to take advantage of this wonderful scientific success of vaccines, as gail was saying, ten ten or 11 months into the epidemic. I trust were going to get this right but it is not simple and is not easy and it wont be as quick as we wish it would be, but we have to trust that if we are truthful and consistent and open to public and all the communities within the public, that we will get there. Thank you, bill. I want to stick with you, bill, and moves to the topic of testing. Obviously during this pandemic testing, rapid test, antibody tests, where do we need to go with testing in this country, the focus of the bpc report, how do we maximize the utility of testing . Particularly, whats the role of testing to get students acting school and businesses up and running . What this report calls for is a National Testing strategy funded by the federal government with partnerships with others to push forward the notion of testing and ultimately Contact Tracing and the epidemiology that undergirds all of this. Just to pause for a minute. Testing is not on its own going to yield the end of the epidemic. Testing is an important strategy in controlling the further spread of the epidemic, and it will be the thing that localities need to have in hand in order to make decisions about opening schools and opening businesses and how to do that safely, et cetera. But its an elemental notion in Public Health that you cant have a strategy for containing and epidemic if you dont know whos got it and who doesnt, and how to quarantine people have been in contact with someone who is positive and how long should that last and so on. All of those questions are to be answered and guided by a consistent testing strategy, and thats what the report calls for here and if i could just build on what my friend gayle was making earlier. Consistent does not mean all over the country. It means scientifically valid strategy that will be implemented in a thoughtful way across the country. It will be different in rural areas than it is in urban areas. It will be different in some communities than in others, but it all ought to be scientifically guided. One of the things the report talks about is how will this testing be paid for, and one of the things we would point out is for testing in broad communities whether in schools or prisons or other locations, that ought to be a federal government responsibility. For testing and workplaces, businesses ought to pay for their workers to be tested. For people who need to be tested for healthcare reasons, their Health Insurance to cover that without copay. And for people without Health Insurance, Public Resources to be used to cover the cost of testing. But its important we do this using the latest techniques for testing, and we will be discovering through the scientific process new and better ways of more rapid task and more easily deliver tests, and we need to take advantage of those as they become available. I didnt hear the question. I lost you. Gail . Sorry. Theres something that i think we were talking about testing, that we dont usually talk about as much, and the has to do with whats going on in the supply chain. That to my mind at least is implied when were talking about the testing protocols, making sure we have adequate tests available and discussing who should pay for that, either in general or as we are going through an epidemic. One of the things that is, very clearly during this past ten months is how important it is to do something thats refer to as supply Chain Management which we in the United States dont tend to focus on very much. In terms of making sure that the places that are delivering care have knowledge about and access to where materials are, and that when they need them they can get them, and that there is some kind of centralized federal management of this information system. And to make sure especially that hospitals are able on a facility basis to know whats around and how to access what they need. We have periodic shortages, a very big issue right now in california where because it had a surge in january in terms of the number of patients post holiday travel, that a number of the hospitals are running out the very basic material and treating patients like ventilators and oxygen and other supplies. Having an opportunity when we are able to catch our breath a little from the pandemic to review issues like Surge Capacity, to review issues about supply Chain Management, not the kinds of things that those of us who are in Public Policy tend to focus on very often, but which in an epidemic like the one we have been in become vitally important come sometimes the difference between life and death in terms of whether or not the facility can provide the kind of care it needs to for its patients, becomes very clear. And i think it will require some very thoughtful future planning as we begin to feel like we are making progress about getting our arms around the current epidemic, that we have better systems in place for tracking the equipment that is needed, the general supply Chain Management focus, and that we know who is supposed to be responsible for maintaining adequate supplies at a National Level. Because my mind based on the reading ive done and talking to people like the colleagues on this panel, we need to assume that once we get through this particular epidemic, this is probably not the last virus epidemic we are going to have in our lifetimes. We have already experienced several in the past ten to 15 years, and we ought to assume, as leana was talking about, some of the new variants that are already being observed, which right now look like they are responsive to the vaccines we have out, but the newer variants that, or the next virus that strikes will raise many of these issues again. We need to be able to put in place better systems of processes so that we can be prepared for when this happens, having learned from having been hit so hard during these past ten months. Thank you, gail. Mark and then leana. So let me try to tie together all three of my colleagues have said that relate to testing. We heard dr. Roper talked about the need for federal leadership. We heard gail talked about the need for local flexibility and you heard dr. Wen talk about the lack of resources by local and state officials. So on the subject of testing i think one of the important things for the federal government to be doing is reestablishing the supremacy and competence and integrity of federal agencies that can guide people to know what tests are appropriate and what circumstances, what their actual sensitivity and specificities are, which ones could be used where. So now were beginning to see the flowering of a private sector that is delivering and marketing varies tests. On the one hand, is a good thing. On the other its now the wild, wild west and every School District and every employer and every Health Department is kind of their on their own to try to somehow read the literature or believe or not believe the marketing information by the makers of these tests if weve already seen some kind of tragic missteps. Ive seen as more and more private sector test manufacturers get involved, as we get more and more home tests and saliva tests and other kinds of tests its really a role for the federal government not to decide exactly how to get a flight in each local area having the level of Scientific Authority that can allow local agencies to apply these tests in appropriate ways because is no way local authorities to do that scientifically. Great. Leana . Just adding to what my colleagues said, specifically as it pertains to the support. Completely agree about the idea of having a National Strategy. Also agree that if we do not have a testing strategy, weve seen again what happens. Our proof is what happened last year where when we were essentially flying blind, that when case turned out to be the canary in the coal mine. And, in fact, that is what we are seeing now when it comes to these variants. A couple of cases it with her but almost certainly theyre not the only cases that exist. Understanding testing as part of the overall strategy is really important. Just on the point of variants because everybody else covered the other components, the one part of the report is specific emphasizing the importance of continuing to monitor the tests that are approved and distributed as well. And actually the fda has come out out in the last couple of weeks to say there might be concern about the existing test, of their ability to pick up on these variants. The data are still in process of being collected. They are saying just be on the lookout basically to clinicians, if their patients it might have a high pretest probability of having covid but theyre their testing negative, is a because there is a variant and are not picking up on that . That component as part of our ideas that there needs to be a strategy by the strategy needs to continually the revised especially as the size continues to evolve. Great. Thank you, leana. I want to move this to Surge Capacity, and gail maybe we can start with you. I think weve seen really across the country where theres been a dramatic influx or rapid increase in covid cases. Many Health Systems have been entirely overwhelmed, whether thats dealing with insufficient ppe or icu beds or simply having an Inadequate Health workforce. Once the best way to ensure these Health Systems that received the support they need when they need to ramp up in the face of a surge of hospitalization . Probably the single concept if we could get it across with regard to Surge Capacity is called cqi, the continuous Quality Improvement. The whole nature of the need for Surge Capacity is to be able to go from what is an average efficient level of operation to ramping up in a hurry when you need to do so. But to understand that it would be unwise as caretakers of the nations resources, and probably impossible anyway, to run at the level that is needed in the middle of the pandemic. And what needs to occur is to have a balancing between whats appropriate to run in general in terms of hospital capacity, in terms of supplies, in terms of ppe, personal protective equipment, in terms of other types of machines that are needed like ventilators, et cetera. And how to ramp up quickly in the face of epidemics. And were going to have to have that thought out better than weve had the chance to do. We saw in the beginning of the epidemic that there was some use of Field Hospital equipment from the military. Some mobilization actually of some of the military equipment. There was a movement of the mercy in comfort, Navy Hospital ships, ran to new york. As it turns out those were not needed. That really wasnt where the constraints in new york were felt most. But it does people that we need, i came when we are a little further along this process, to think about how we should work in general, the average operational capacity that makes sense, and who should be responsible, single point person, for example, for the country, and you in various states in local areas ought to have this responsibility. That has been put in place by hhs. It doesnt have quality information that we might now think is critical , particularly when it comes to minority communities and those that are being particularly hard impacted by the current epidemic. So there have been some important steps along the process, but we really need to think about the best way to be at an efficient operating capacity in general. And then who and how we are going to serve when we have sudden needs that require us to ramp up. I have long thought that this is a place where we want to reach out to the military a little more quickly than we sometimes do. Sometimes we do in terms of katrina or some of our other national disasters, in terms of we hire foreign actors, military people. They have had an enormous amount of experience in terms of logistics and for much of this, it really is a matter of having the best Logistical Support that you can. These are the kinds of things that we need to both be thinking about now but especially to put us in a better position than we were when the next virus comes along and hits the country thank you gail. Mark. I agree. I also want to ask two questions that come from viewers answer, by definition of Surge Capacity is doing things the way weve been doing and moving people, thats one thing we need to do but the other thing we need to do is move information, people not moving patients not moving caregivers so if you think about the role of primary care, every health provider. Dramatically to virtual care when it started. I dont think were going to go back to the old ways. If you think about responding in the future, part of what we need to do is think long and hard about making permanent of the waivers on a temporary basis that have to do with where people get paid, how they have to establish relationships, other things that have allowed us to surge without moving people or patients into brick and mortar places so one of the policy issues i think coming out of this is how can we use the increasingly capable capacity to monitor people at home with false activity and temperature and not have them come to the er to be able to monitor peoples conditions and to move expertise maybe is needed in one place that exists in another place without expecting that person to get in the car and drive across the country so unleashing the creativity of virtual care is part of how we can purge those validations. Thank you for weaving in some of the youtube questions we are betting in real time. Any additional comments on this topic either from nina or bill . Okay. I do want to spend a few minutes, its important to us and we talked about this already during todays event. The important area of disparities and we talked about a number of different disparities, along standing disparities in this country whether its race and after the city, rural, urban but particularly honing in on race and ethnicity. I think weve seen during the pandemic many of the same racial and ethnic groups experiencing highest rates of diseases or obesity or lack of care. Also at dramatically higher risk of infection as well as mortality so mark, maybe we can start with you. How do we begin to address these Health Disparities and of course beat go beyond that in the Important Role of social determinants of health and really address some of the Health Inequities that are at the root of these. One thing heard often was black people are in the hospital more because they have more comorbid conditions. Course part of that is true but that doesnt explain why latino meatpacking workers have extraordinary high rates or dominican people who have to get to work on the subway in europe have high rates so part of what weve learned this is theres a nonrandom relationship between race, ethnicity and the jobs people have in our society. The density of their housing, the number of generations that live together and all those things have to do with your risk of this pandemic so i think part of what we thought of is this is a collocated and nuanced issue and for us to get a handle on it we have to understand factors that go beyond whats the race box on their patient form, understand where they work, how they get to work, whether they can work from home as many of the people who are on this call do or whether their jobs involve getting on mass transit and being shoulder to shoulder with 600 other people, packing the chicken that we eat and get delivered so its a comp located issue but i hope that the pandemic has focused on it as a way that has really never been part of it before and im encouraged by the fact that once these professional associations of every type, hospitals all pointing Vice President s towards inclusion or edps for equity, i think thats a good start but the question remains how can we follow up on this and actually stop this admiring problem and try to elaborate a solution to the problems. Thank you very important. Lena. I love what mark just said about not admiring the problems because we have been teaching about disparities but theres something we can do. Actually, just to backup the moment because there is a concept in medicine about we talk about, which is chronic. That reminds me of whats happening here. That we have an acute crisis. The acute crisis is on top of underlying issues. It was a question from a viewer about what the role of chronic illness is. And everything mark said, when were talking about why it is that certain relations, black americans, Business People are disproportionately affected by coronavirus, is the conditions under which they live and work. Multigenerational housing where its difficult to move. Some of it is that people are essential workers who have not had the privilege of working from home and physical distancing. Some of it is also underlying medical issues. Look at my city in baltimore. What if the africanamericans live in food desert, is it any surprise africanamericans are disproportionately affected by heart disease, obesity, but that also our factors are predisposed and additionally to having severe effects from coronavirus. So i think thats the acute on chronic issues that were talking about here is actually not the virus, thats discriminating. Its all these other social determinants that we have to turn our attention to but sometimes i think when these issues are still big and so entrenched, sometimes there is a tendency to say theres nothing i can do. Everything ties to one another, where do i even did again but i think thats why our proposal for example starting with the data are really important because you cannot identify disparities, you dont know what to expect and i think there are shortterm actions even things like openness on testing and Contact Tracing and making sure that we have vaccines that are equitably distributed. Those are shortterm solutions that can make a big difference. In the long term, also making sure to not lose the momentum at this moment has provided us to address these underlying disparities. That are predated. But that it has unveiled and thank you elena, bill. I just would add that this is an opportunity not only to do the right thing immediately, whether its testing in a convenient and appropriate way or tailoring messages in a culturally confident fashion or delivering vaccine in a way that reaches underserved communities. Right now we need to be entering data and beginning to do the studies that will inform how this is handled next year and five years and 10 years from now. Theres a great opportunity and i just would urge the report actually urges the congress to rent direct the cdc and other federal agencies to fund the research that needs to be done to inform decisionmaking in the future. Gail. Im still thinking about the comments that mark and lena have made. And that is , marks very poignant phrase which i wrote down. Stop admiring the problem. Im going to remember that and focus on the solutions. But also, this concept of focusing on where people live and work. The socalled social determinants of health. And while it is easy to feel overwhelmed, when you think about the social determinants and health, i think our experience now with the epidemic has shown us that we cant not consider these issues if we want to have a longterm resolution to some of the problems that we have seen. We dont have to feel all that once. But as we start coming out. As we appear to be from this epidemic although we will see whether or not the mutations, the variations that are already being reported both from south africa and the uk form another major hurdle for us to get over. We really do need to start tackling piecemeal , if thats what we can do. Some of these social determinants of health are places where people live and work and age. Because it does come back to impact Everything Else we do. We dont have to solve them all at once. We can think about starting at the most vulnerable ages. The very young and very old. And what we can do to make a difference there. And pick off places as we can. I think that the focus of our report has correctly indicated the various pieces that need to be put in place , having a National Strategy and looking at a Vaccine Campaign and looking at these technical issues like supply Chain Management and Surge Capacity but probably the experience with the epidemic has more than almost anything else indicated the differential vulnerability of some of our populations. And indicated the importance of attacking them however we can. So we can make some progress on these issues. Text thank you gail and thanks to all of you for your comments there and to all of you and the full group really in the report goes beyond Just Healthcare disparities in calling for really approach that looks at the underlying inequities in the social determinants of health so thanks for your comments there. There are questions coming in from viewers that relate to the final topic we want to focus on which is state and local funding and nina, maybe you can start us off here. I dont know if state and local Health Department have historically been underfunded. Many have not had the infrastructure to combat the pandemic. How do we ensure that particularly state and local Public Health departments have the resources they need. Out the support they need to succeed and then an additional question to all of you beyond eight and local Public Health departments, safetynet providers, how can we best support them to do what they need to do during this pandemic. The lack of Public Health infrastructure is one of these other issues that this pandemic has highlighted. Even before the pandemic we have seen how state and local Health Departments are underfunded, under resourced and understaffed. They have lost about 30 percent of their workforce in the last 20 years. So even again before it, if you look at local Health Departments, you saw people who are having multiple jobs where just any kind of emergency had, even when we had a snow emergency, people had to be pulled off of their school work. And basically there was no take on anything new. Because people were already stretching so thin. And on top of that, a pandemic that not a onetime event. It is not like a hurricane that hits for a week and everybodys really busy for a couple of weeks. This is lasting as all of you know so well and on top of all the testing , Contact Tracing, Public Education and Health Department are doing, where asking them to hold onto the process of this most ambitious Vaccination Program our country has ever seen so it should be no surprise the program has faltered area and i get all this context because its in this milieu that has we came up with this particular focus and recommendations that we need the very least this one Time Allocation of funding. That also very importantly includes maximal flexibility to meet the needs of individuals communities because they know what their needs are the best. Speaking for myself i think that we need far more than a one Time Allocation. These are continuing needs. I think again im speaking for myself here, i think the combined team has done in terms of saying we need more workforce and saying we need 100,000 new Health Workers in Public Health is good. Although its too germane for me to see whats going to happen to these people after the pandemic. We need more Health Workers until we as a country and understand that the local Health Departments are our safety net. They provide health care and they also are critical in preventing diseases from spreading and then taking care of so many other parties where its seniors or children or the Opioid Epidemic or chronic diseases. Until we can understand that, we are going to continue to see our only not only pandemics, but lack of attention to our most vulnerable so i hope that we will see attention to this critical idea of funding local and state Health Department infrastructure moving forward. Thank you so much, bill, from your perspective. Formerly of the cdc of the state and local Health Department. I just would say well before i was cdc director i was a local health director. That was my first job after my training. And as doctor nguyen just said, these agencies have been chronically underfunded and we seemed repeatedly, the learning the same lesson over again. That is we need this local infrastructure to do very important functions, but we dont have a sustained way of funding such local and state Public Health. We do it in one time bonuses so yes, i fully agree with this report request for a onetime surge in funding. But we need continued funding over the long haul if this is going to be in place for the next epidemic. It surely will come. Thank you, marks a lot of things have made me sad and angry over the course of the last year. I dont think theres anything thats made me sadder or angrier than to see local Health Officials who now have to have bodyguards and bulletproof vests because they are caught between an epidemic which had very little support and guidance from the federal government and toxic extremists and desperate people in their own local communities so it seems to me part of what we have to do and we said in the report they need funding and they do. We also said they need guidance from the cdc and fda on such things as testing and whether the outside. Because they cant face the mom without some science with which to guide them but its important for us to recognize just to do the kind of stress theyve been under and we talked before about the relief package. I think combining the relief package with our other recommendations is important in part because people who may not be extremists or vaccine deniers or pandemic deniers are desperate and local and Public Health officers are often the people who are bringing them the bad news or the messages for their compromises and sacrifices that we have to make so i think their job will be easier if we can try to help support small Business People and other people through this pandemic economically. They need economic support but they also need moral support because i cant imagine that i could look forward hopefully to a career in Public Health if i thought i was going to be at odds with many people in my local community over things that are largely beyond my control. We just need to knowledge they too have had a tough time and they deserve our support. Thanks mark. Gail . As the economist on this group, im going to raise something that i know my colleagues know only too well and have heard too often. Were going to have to decide is this more money that we need to spend or should we be primarily reallocating some of the 18 percent of our gdp on healthcare but dont spend as well as we might. The rational response would be to do some reallocation of that very large amount of money. But the easier political response is that will cause a lot of unhappiness by those who are used to receiving assistance, care and financial payment under the existing system so its easier to say, make these additions to what we already spend. That is going to be an issue that were going to have to avoid. To base at some extent because of our aging population and what its doing to medicare and now what we have seen get raised during this epidemic in terms of not having made investments for years in local Public Health departments and what that produces. My prediction is we will probably mostly and up spending more than reallocating , but we do have these serious issues that we are going to be confronting as a nation because they dont occur in a vacuum. They occur during the few decades where now on the second decade, will the baby boomers are retiring and at the end of this decade we will have managed to double the population on medicare. So while we think about the Critical Issues of what do we do to medical care for the next epidemic, that will happen sooner than what im describing. We also have these major public issues coming at us which is how are we going to provide healthcare for the doubling of the population on medicare which will have happened by the end of this decade. So so many issues for our Bipartisan Policy Center to worry about going forward. None of these have easy answers. Gail, thank you. Were nearing the end of our time. Maybe willow doral and the final concluding remarks from each of you. Perhaps those remarks can be guided by two questions that just came in. From youtube, the first is what do you foresee being greatest obstacle in the near future and getting transmission rates under control. And the second question from youtube is given that we are seeing a divide in the perception of reality, to define heavily with a partisan design divide, so if you want to take some concluding remarks and see if you want to try to answer all those questions. You want to tackle that first . I didnt see you. I did see what you said. Why dont you go ahead. Sure. Maybe its harder to go last. I will be very briefly here and say that i think the urgency of this moment should not be overemphasized. Unless we are able to get this pandemic under control, we are also not able to get the other aspects of our lives and our economy and Everything Else back either. I think there is, it has been a tendency to say its Public Health versus something else, Public Health versus school or versus the economy and im glad that this report is out there to play out how we can focus on Public Health. Get the pandemic under control. And that level of urgency. Its going to be critical to drive Everything Else forward to. I think the other component for the other thing that ill add just to answer the questions you raised about whats the major barrier, i think it is the hearts and minds issue. We do have a very divided, polarized country. Mark, i think mentioned earlier the pandemic of misinformation and disinformation, thats going to be our single biggest challenge of how can we convince people to stick with us just a bit longer because if you have the end approaching but its going to take us a little bit more time. And how to get people to stick with us. In this midst of so much divide is going to be challenging but thats why this bipartisan approach is so critical. Did you call me, i didnt hear what you said. Two things that i would say, first of all is yes, we will always have or we surely do have right now disagreements across the political spectrum. Left, right, center. Red, blue etc. This bipartisan effort that we are putting forward as an effort to say we need to come together, find solutions that work and see that their implementation. My concern is about a different divide that we are having in our country and that is between people who seem to be guided by the truth and those who are entirely devoid of facts and separated from reality and i think we need to be putting forward efforts not just in health and Public Health and whatever but broadly efforts to get us to come to agreement on what the facts are and how can decisions be made in the process to be based on those facts. The second thing id say is we need the best of science and the best of politics, policy to deal with the Public Health crisis. Yes, we need the best scientists around but we need the political leaders to come together in a democracy to debate, discuss, come to consensus where possible and to take votes because thats the way we make decisions in a free society and we need both science and politics working together to deal with this. Thank you bill, gail and then mark. The greatest obstacle is pandemic fatigue. I think we are seeing that people just are desperate to get back to living their lives. Even if in especially some parts of the country it is especially unsafe to do that and all of us need to heed the basic Public Health cautions of dealing with this pandemic in terms of mask wearing and hand sanitation, etc. The most serious problem is the partisan divide and my colleagues have mentioned this. I dont know how we heal the the country. I just want to remind people particularly the winning side because thats where the power is that the country remains very divided. President biden is our president , by some 74 Million People voted for the other candidate. Thats a very large number of americans who need to be made to feel that the democracy is working and is important that they continue to participate in it. As opposed to going off to opposing camps. Its of course like all of us devote our time to the Bipartisan Policy Center because we believe that when our heart and soul. Gale. , thank you mark you have the final word. We have about a minute gail, thank you. Mark, you have the final word. We have about a minute. Its possible to heal the country. You cant heal people who cant distinguish fact from fiction. But i believe in the end, it is possible for patriotism to prevail over partisanship, at least for the majority. That may be naive. It may be naive in washington but to the extent that the vaccine can be rolled up and people rolled out and people can be educated about the truth and begin to see their lives get back to normal. This will break and we will be able to move forward. It will be easy wont be easy. And it will take skill and empathy on everybodys part. But im reasonably optimistic that we can get there. Let me just say thank you to all four of you. Thank you for your leadership, your expertise and your service. Thanks to the entire future of health group for really finding a bipartisan consensus and showing the nation a bipartisan way forward. I want to also think the bbc health team for all of its efforts in this project, and really thank you to the audience for your superb questions. I hope you found this program informative, enlightening, as well as valuable. Please visit our website, bipartisanpolicy. Org, or you can download the full report. With that, take care, stay safe, and well see you soon. Thank you again. [captions Copyright National cable satellite corp. 2021] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] heres a look at our primetime schedule on the cspans network. 8 00 p. M. , lawmakers and prolife advocates take part in the annual march for life rally. On cspan2, several u. S. Mayors discuss current challenges facing their cities. On cspan3, American History tv, with a look at the apollo 14 mission. Cspans washington journal. Everyday, were taking your calls live on the air on news of the day and well discuss policy issues that impact you. The future of alzheimers policy. Watch cspans washington journal live at 7 00 eastern saturday money. Be sure to join the discussion with your phone calls, facebook comments, text messages, and tweets. Debate is happening here in washington over Marjorie Taylor greenes comments back in 2018 and 2019. Cnn is reporting republicans are facing pressure to review those comments. Rebuke those comments. Cnn reported from their k file series that the freshman republican posted posted supporr violence before running for congress. What they found is that in one post from january 2019, greene like to comment that set a bullet to the head