Transcripts For CSPAN2 Hearing On Presidents 2021 NIH Budget Request 20240713

The subcommittee will come to order. Good morning. Welcome back to the appropriations subcommittee also to those that are joining us this morning the director of the Kennedy Shriver National Institute of Human Development and the subcommittee on health and education services. Doctor fauci director of National Institute of allergy and Infectious Diseases. And then the director of the National Cancer institute and director of the National Institute on drug abuse. Again, welcome to all of you leader hoyer asked me this morning you have the nih coming he said can you get all the Institute Directors and he said he will this is one of the most remarkable hearings that we have and we thank you for the great work that we loan that you do and saving lives the people of the great country. Let me touch on the matter of the coronavirus i just want to say i thank you to the director and all the institute tends particular thank you to doctor fauci i want to say Public Health experts deserve our praise for what is the excellent work that you are doing and clearly a matter of National Importance and National Urgency as you know we will be discussing the 2021 budget request and i intend to invite and eight Additional Panel because i believe we will learn a lot from all of you and that happened last september as well before we get into the nih 2021 budget just let me bring you uptodate the committee has been working hard to develop an emergency supplemental to fund the response of this outbreak there are still one or two issues that remain open but with all speed and deliberation with the intent the chairwoman can speak to that if she cares to hopefully today and tomorrow but before the end of this week to get this voted on. The funding includes for the nih with the diagnostics therapeutics and vaccines that will be critical to managing the outbreak i also might want to note now not starting at square one the years of Building Research of coronavirus and Vaccine Development, what i want to say to the whole subcommittee on both sides of the aisle, i have a sustained investment in Biomedical Research in recent years and i really Proud Congress has increased by 100 billion last year it provided an additional two. 6 billion over fiscal year 202,019 and is different from the bipartisan bicameral way we are very proud of that another Ranking Member is and we work closely but i would just say to you i think the president s budget would hurt the project proposes to cut the funding by a three. 3 billion that the 2020 levels this results in nih having 1500 fewer by 16 percent the subcommittee will not assume these cuts with a continued increase in investment from nih and again it will be on a bipartisan basis if we know anything about what we are going and what we are doing congress is providing 25 million for firearm violence prevention including 12. 5 million from nih i am glad to see that budget has funding for research on flu and on the universal flu vaccine but as we continue to grow this research as we did in 2020 and look forward to hear more what could be accomplished with these funds and with a cut to the National Cancer institute add a time of the promise that has led to more Promising Research with those grants and then to cut the funding sends the wrong message and the fewer exceptions to touch every institute every researcher last year in addition to new funding with that increase to each institute and center. And the Biomedical Research is an important thing they can make and thats what we need to support we promise that we will so thank you again and i look forward to our conversations. I will turn it over to my good friend from oklahoma the Ranking Member of the subcommittee. Thank you madam chair. Before i get to my prepared remarks i want you to know how deeply you expanded the bipartisan divide and actually made a steep one statement tweeted out by howard dean last night. Very seldom do i get tweeted so i was pretty proud of that. [laughter] so if i buying real estate in new york all listen to the president of the United States if talking about Infectious Diseases i will listen to tony fauci. [laughter] i want to thank all of you for what you have been doing with a difficult National Crisis and every day the amount of hope you give to people around the world for fellow americans and you have been extraordinary custodians of the investment this committee has made over multiple years if we can find any way to do it, we will i think we will the current challenge that we have frankly is a reminder to go on a regular basis you cant just show up on game day. We have to make the commitment over a long period of time. We have done that but we have done this said no disrespect to anybody but this can go down from what any congress that the president has asked it to do. There is also a Congressional Initiative if you recall and has a very keen sense of how much fellow americans value those endeavors of the nih so after five years sustained increase from National Institutes of health were pleased to welcome to this hearing room doctor collins once again and went to commend you on your long and distinguished career you have left a legacy of excellence when i say this often you have to be the best politician in town to go against donald trump and barack obama but it talks about the bipartisan nature of what you do. I made no secret increasing funding for nih is one of the best bipartisan accomplishments to increase of nih funding is critical to ensure the future for Biomedical Research and unlocking cure so many diseases putting a strain on the Healthcare System what this fosters is part of the force of the United States Economic Growth leaders in the house and Senate Democrats and republicans have unified behind the is increases i hope this trend continues for years to come i appreciate the fiscal restraint expressed of the president s budget i do not think that is in the best interest of American People reduce nih funding at this juncture over the past five years single to the Research Community and then could be delayed by years or decades including curing diseases and finding better treatments for cancer also want to caution against the proposed changes for the negotiation for indirect cost as part of the grant to cover facilities its serves as a foundational element for research and support that i hope we can continue that restraint this will hurt research not provide additional dollars we need to protect the institutions we have the opportunity to sit down with a new one Nobel Prize Winner with his work on immunotherapy to chart a course for new direction of treatment for deadly cancers. The noninvasive nature and the time of treatment is nothing short of remarkable in that could take a decade before Standard Health insurance reimbursement an application for research are overwhelmingly available and this is what we look at very carefully Going Forward companies have noticed those that can invest their own sources as well if we have our own cancer survivors those protocols would not have felt this reminds me of support of the nih every dollar investment is a direct payment with tens of millions of others around the world also to highlight the progress of Alzheimers Disease Research creating an enormous strain on the Healthcare System in the federal budget the rising cause of death impacting more americans each year they will exceed 1 trillion if it remains on the current trajectory. We must make progress theres no other option im pleased to learn those that are partly funded by the nih is made more progress and now involving data for more than 35000 individuals to identify the variance of five new genes with the most emotional and physical toll you must have a better understanding of the underlying genetics. I will not take additional time to recognize the directors because quite frankly i word rather hear from them about the Exciting Research they are all involved in but i want to think each of you and your colleagues were not on for your passion and dedication and hard work i do believe you will change the course of disease and treatment for many generations. I Hope Congress continues to be a supportive partner. Thank you madam chairman for holding this important hearing. It is my pleasure to yield to the chairwoman of the Appropriations Committee and someone to make sure we respond in kind. Thank you chair in the Ranking Member for holding this hearing and welcome once again to our very distinguished guest. [laughter] thank you to everyone. Let me say at the outse outset, president trumps disastrous budget has deep cuts that tear the fabric of our nation. Instead of building of last years appropriation bills he double down on partisan and talking points proposed investing 2 billion and cutting three. 3 billion of the National Institutes of health really does expose the Trump Administration for what they are of political rhetoric but as you know this committee is on your team and at a time with surging cases and cost associated with Heart Disease, s and related dimensions, and now the coronavirus this commitment to nih is as strong as ever. I would be remiss not to mention this will likely be my last nih budget hearing. And when i think about it, we have come so far since we joined the subcommittee in 1993. When nih was funded ten ten. 3 billion we committed to doubling the nih budget and then more than tripled it together raising leadership on the subcommittee the past five years we have increased 11. 6 billion the total funding level of 417 billion we are so appreciative to all of you your talents and hard work in commitments it has been an honor for me to serve on this committee. But i do remember touring the lab with doctor Francis Collins who had plan to map the human genome i remember that first map. [laughter] and the advances to combat Breast Cancer have revolutionized survivor rates in immunotherapy has given life to people who wouldve had a death sentence one decade ago. We know more about Childhood Development in the human brain and we are witnessing amazing strides in medicine. If you recall now we even have female lab rats we were convinced they were all males are delighted to know you have female lab rats. Your work has filled me and millions of americans with hope. Never in all of Human History has medicine had more to offer and with all these great achievements, there is so much more to do. I recently came across questions from an nih hearing in 1989 when i asked why women are more likely than men to have alzheimers. And we still dont have the answer in fact we dont have many answers. Lord knows why they asked me to be on the panel is were sitting around the table with one person that was assigned to talk to doctor gibson so what do you recommend there were experts people who have been working on this for years and years he said diet and exercise. Doctor felt she knows that. [laughter] weve had conversations with that. And with all the investment investments, thats all we are offering those people with alzheimers. We still dont know the answer and we still dont have a method for Early Detection for certain cancers. We still dont know why it works for some patients and not others and we still dont know why rates of autism are raising and why there are higher rates among boys than girls. By the way if you have answers to any of these questions toda today, feel free to share them with us. Maybe i thought as of this morning but if you have answers. [laughter] so there is so much we need to achieve i can think of no better to do list in the people sitting in front of us today. You have saved lives you are our superheroes and if the American People could see how we come together to fund such important work, i would say they would be proud but they would probably be shocked to understand how bipartisan nih is and how bipartisan this committee is and that is why we cannot let up by one a partisan budget request get in the way of saving lives. I thank you all it is a pleasure to welcome you once again madam chair. Thank you and doctor collins we will turn to for testimony. That will be entered into the record and you are given five minutes of time. Thank you and good morning and Ranking Member and especially chairwoman lowly i did not realize you are going to make this announcement 1994 is the first time i appeared. Thank you for that reflection. On behalf. [inaudible] please. [inaudible] i do want you to know that condition is a great concern to nih. Go ahead and mention that. I will say that for a later point but on behalf of the nih thank you and the subcommittee for the two. 6 billion increase the study increases you have provided brought new life to Biomedical Research and to take on new and unexpected challenges that is on everyones mind like the global coronavirus outbreak enabling nih to go against a Serious Health threat and we will hear more about what we are doing later. In the meantime i would like to highlight other recent achievements. And maybe i can turn your attention to the screen announcing the short list of 2019 supported by nih first the lifesaving progress against ebola and the first effective therapies and the second breakthrough was the development of the specially formulated foods to combat malnutrition and the third is a highly effective triple dog drug therapy among the legion of researchers the part of a long journey of targeted therapy that is me on the left. [laughter] thirty years ago on the team that discovered this disease and i was in michigan the mutations that normally help to maintain the bodys balance and then its built up in the lungs and then potentially fatal infection that triple drug therapy kicks the drug back into shape as the snapshots show the parents spend hours each day on the respiratory tract later she was a section to give up her beloved teaching career just five weeks after starting triple therapy the lung function improved dramatically the active life she had always imagined and even set a new personal best and told me the medicine has revolutionized her entire life 30 years of research came to this point in a wonderful example of basic science and collaboration between public and private. Stories like robbins with innovative ways to help folks with all kinds of diseases among the exciting possibilities is a new generation of gene based therapy. I have introduced you to those who have been helped by those therapies like spinal muscular atrophy, sicklecell disease and many have met kent on Cancer Patients those whose lives are saved by immunotherapy. But we need more breakthroughs that we know the molecular basis and with theres about 500 them the latest development promises to boost that number and then to replace that function allow themselves to be reprogrammed five years ago i never would have predicted the explosion of opportunity and gene therapy it may take two years to produce material for the Clinical Trial for those theories and then rely on the private sector and with tens of millions of people and then to enter with those potential partners. And that budget is a 30 milliondollar initiative and with those Rare Diseases customizing processes and today i focus on those gene therapies and the advances on the horizon in the coronavirus. And the Opioid Crisis. And with more types of answers because of view we look forward to your question. Thank you this makes it real how peoples lives have been changed growing up with two wonderful friends with Cystic Fibrosis and now we can save lives so doctor fauci you have been very generous with your time to provide the subcommittee with information and for those activities including diagnostics and therapeutics this is a twopart question of the end a a id because then i ate on and each one nih is not starting from scratch with the coronavirus or Infectious Diseases. With the prior investment that would lay the groundwork for the coronavirus. Thank you very much if you look at that fundamental basic research and the ability which comes from nih itself and to identify a pathogen to allow us to do the things i will mention in a moment but this goes back to fundamental basic research with genetics et cetera. Remember the first coronavirus that weighs 8000 people 775 deaths of nine or 10 percent several years later we have the mass coronavirus at the middle east now we have the third coronavirus one of the things you been able to do what we are studying intensively and with the genesis of the disease but what were doing right now in the form of intervention and in therapeutics. It is extraordinary that from the first time the sequence was made public by the chines chinese, literally within days to insert into the vaccine platforms and stepwise is the approach i predicted two or three months for phase one trials that would be about six weeks which as a matter of fact is the fastest anyone has gone with the identification with the phase one trial thats the good news. The sobering news what is paramount is safety and whether or not it works so including the center at the nih that would take three or four months and then to be successful theres a reason to believe it wont be in with 45 individuals it takes between a year and a year and a half to be fully confident to have a vaccine to protect the American People. The bad news with the reality is that in contrast we have a number of therapies that were used in vitro. We already started a trial in the United States with both Washington State which is having a problem as well as the university of nebraska for those who were repatriated in the Clinical Trial would be done and is shown to be effective but at least somewhat effective you would imagine over the next several months to have that intervention so to go back to what you said to the molecular biology decades ago to where we are right now with that investment through research. As her grandmother said that will help your voice a lot. [laughter] with a shot of whiskey so now i will yield back my time. In the spirit of bipartisanship that cannot help you. [laughter] that works very well. Raising this issue because it is critical to the functioning of this remarkable engine of discovery of the National Institutes of health and its program. We have over the course of quite a few years been falling behind in terms of maintenance because of the way the funding comes through we are not allowed to build facilities unless appropriated and we are about 2. 1 billion in the hole in terms of the kind of funds that would be necessary to keep the place in the kind of circumstances you would like to see weve had a number of major problems in our Clinical Center which has caused quite a lot of difficulty. If it comes up i can show a particular example of some of the things you can see that have happened in the course of the last few months in terms of the floods we have had to close down big parts of the clinic so we have a big backlog to meet. The academy was asked to look at this issue and agreed that we need an urgent attention to this matter. We also believe in order to be fully effective we need to replace current operating rooms which are at risk of having leaking in the ceiling in the middle of an operation and is something you would ever want to see happen so we have on the books already surgery and radiology which is about 500 million. What you have done in terms of increasing the support for this is hopeless hugely and it will help with the backlog of maintenance we need to Pay Attention and it would be gratefully much appreciated if that can also be sustained in fy 21 use all the budget actually did call this off of the special needs by increasing the number to 300 million so i know this is not sexy in the same way we will cure cancer but we cant take care of infrastructure in d the way they are counting on us to search them in m him in my sh has a high concentration in highest death rate if you tell us what the nih is doing to help these disparities. Thank you for that question that addresses the really important concern we have in the disparity as you pointed out with concerns about the rural populations and be recognized that and started the new cohort study is known for this to be over 70 years ago and starting to understand the driving factors that have now taken us to a program that is called that focuses on kentucky, alabama, other areas with large populations thats where we are seeing cardiovascular disease going in the wrong direction as it is with certain populations. Similarly, we are engaged in studies taking communitybased efforts to address how can we engage communities in the process of creating healthier communities recognizing that often social, behavioral and cultural factors that involves the engagement strategy and the fact a native american leading the effort of the strong heart study that is based in oklahoma, but the code is in arizona and shes engaged in a project to promote Healthy Lifestyles particularly the communit commus taking them into more traditional diet of fruits and vegetables so this is very top of mind in high priority i think i ask this question every time. Are we learning anything about the development of alzheimers, how far are we from a cure, but they ask how far are we from a cure or prevention of alzheimers . I wish i had an answer to that but i would say progress in the last few years has been really impressively moving forward. We have identified pathways involved going well beyond the hypothesis which has been so dominant. Genetic studies have revealed about 100 different places in the dna that provided the risk for this and it tells you that there are things going on we didnt appreciate such as the immune system. It is at least as important as the neurons that are getting all of the attention. The identification into the last year to the academics at Drug Companies which will lead us down a whole bunch of new directions in terms of therapeutics so the hypothesis is still very much on many peoples minds its still taking the position of the most recent trial and they realize the data it looks as if it provides a benefit to people who got the highest dose of this antibody for the longest pier co. Of time and theyve gone back to the fda and theyve been willing to look at the data again. Watch this space closely if the fda decides there is something there we might finally be in a place we have a signal of some benefit and then of course the whole game changes and there is a difference in having everything sale and something work because they can build on that and we are watching that closely so its all hands on deck not just about drugs but also about preventive interventions and the study that gary can tell you about has shown reducing Blood Pressure seems to be a good way to prevent the onset of the vascular contributions that are important. We are pretty sure physical exercise helps and cognitive exercise also benefits. I wish i was able to say that with absolute certainty. Lets make no mistake this is a really hard problem. I will write you a letter next year. [laughter] another one of my favorite issues because its been so disappointing are there any advances that have been made in Early Detection and treatment for Kidney Cancer . We think its gone up modestly finding smaller missions earlier provided challenges we have made some progress but theres more to be made. It isnt one of the most outstanding successes. It has a role for these patients in terms of Early Detection we are still concerning a number of approaches including the most fuzzy right now in addition to imaging is the ability to detect acid in the blood of we have a number of approaches that its still early. My time is running out, so im sure you all know about the rising rate of e. Cigarettes. If you want to make a quick statement and that we can go back and get into it because i am really concerned about the incredible rate. The number of kids dating thc so they are becoming addicted to nicotine and we may lose a big battle that was one over combustible tobacco i dont want to overstate my welcome. Im surprised yoi am surprisa voice left at all there must be twins here everywhere. But they ask a question because you used the word d. Sequence for the coronavirus 19 and that is the one the chinese have shared a theres other samples of the virus the sequence is one flavored in time and then it would be useful to know and see other samples. Is that true is it something that would be useful . We are mitigating the problem because we now unfortunately have another case that is of concern to me that the chinese did not share that because i dont know in this instance days or weeks might be very important and im afraid we might have lost it because of the unwillingness to share those early taste samples. Now the fatality rate is controversial because they think it is 3. 4 or in the journal of medicine a few days ago it 1 . You said it, sir. If you look at the cases that have come to the attention of the medical authorities in china and you do the math, it is about 2 . If you look at certain age groups, the fatality is much higher but as a group that is goinit isgoing to depend complen what the factor of asymptomatic cases are so if you have asymptomatic cases, it is going to come down to what we are hearing right now on a recent poll from the who this morning is that there are not as many asymptomatic cases as we think which made them elevate i think what it is. You know as well as anybody that the mortality is. 1 , so even if it goes down to 1 , it is still ten times more fatal. When will we know if court on data . I am torn because its going to be bad news for us. The thing that is encouraging is it as part of the Umbrella Team that went to china after a long period of time there were two usa individuals one from the cdc and one from the National Institutes of health. He has come back and is now in a self isolation giving a report soon and the individual who is my deputy i think we are going to get the information that you need. A couple of questions about the data and information shari sharing. In the process of updating the policy i am curious if you have any information on the amount of data shared by the guarantees and whether you believe mandatory sharing should be a requirement of all of those receiving Grant Funding and the related question the administration suggested that someone receives federal funding to published research should be available free upon publication, not a oneyear waiting period so can you comment on those two those are very much on our mind, and certainly in terms of having our guarantees share the data that they generated with public funds we feel very strongly that this part of the responsibility and the policies weve been putting together it is the term and condition of the award that is the expectation. We also believe the public has paid for science, finance off to be accessible to people that are looking at it and you know this is a controversial topic because some of the journal journals wod it an accidental moment. We have for a few projects required that everything that comes out of the projects has to be accessible at the moment it is published without any charge or firewall and that is a signal of where we want to go eventually bu but its a complicated negotiation. But is it your feeling that it would be an existential threat or the journals could probably find a way around . They are looking at options they might adopt as alternatives to the complicated and expensive journal restrictions. Thank you. I yield back. Thank you for this hearing is always good to see you. Talking about the importance of continuing with our bipartisan work because really you are in the business and thank you for everything that you are doing. Of course you know i focused a lot on the institute of Minority Health and Health Disparities and i see this 30 million cut above what it was into the inactive list 336, so it is a 30 million cut. We know there are many disparities as it relates to the communities of color when you look at the disproportionate rate. Thank you very much for following up with the request in terms of an action plan higher rates of alzheimers, Sickle Cell Disease and in many ways i feel like ive received a medical education because so many of my family members, friends and communities suffer from multiple sclerosis, lupus, sickle cell, hiv and aids, diabetes, trade relationships, so i personally like most members have gotten into the weeds in a lot of these diseases and we have put in budget requests and language and i want to thank you for being responsive and bringing forth the plans that we have asked for. In terms of th these cuts, im curious to 326 milliondollar cut the National Heart lung and Blood Institute in terms of the action plan. Also the cut again in the National Institute for Minority Health and disparities. Multiple sclerosis and other Brain Initiative and about 40 million. My second question is coming and i want to thank you for the report as it relates to the growing absence and we are working very closely with partners and i want to ask with regards to the fund how can we support more comprehensive work because this is outrageous how we can help fund the National Academy of Sciences Based on their roundtable work. 42. 6 million less than 2020. My time is short. With regards to what the nih does when we encounter the circumstance of the resource constraints i think all the people at the table would agree with me that we try to still identify with the priorities are and we looked around to see if there are things that could be slowed down without as much of a serious impact its that kind of priority setting. Im glad you raised the issue if thabout the workforce and the nd for more representation. It doesnt look like our country and it should. I want to mention and this is something you brought up in terms of the fund. Its called the build initiative which is a way in which we are making it possible from people in underrepresented groups to have a scientific experience as undergraduates which is how to capture the attention and imagination and passion of young people and that the program which has now been going on is looking very promising. None of the programs would be done without evidencebased analysis. We are not going to support things that dont work. We also supported a network for people who may not be likely, white male who would naturally have a network they could depend on. Thatthis turned out to be quite positive. Maybe an area we are worried about is africanamerican and we have a recent initiative we are discussing about healthy interest, athletes in science provides insight into the opportunities like summer internships so that that will be seen. They are closely aligned with the National Academy on the topic and theyve been partners we would like to build on that and do even more. We will follow up. We appreciate your years of service and wonder if you and also could talk briefly about the Childhood Cancer initiative. Even the kids we are able to cure are often left with lifelong survivors of challenge because of significant surgery and therapy so we need clear progress and the Administration Announces Childhood Cancer and the state of th state of the unn a year ago and they are grateful for that important devotion of effort and resource to the topic so its underway we had a sort of thought leader in the community about how to make progress most expeditiously with Childhood Cancer to come up with ideas i expect we would create a registry that has data on every Childhood Cancer in the United States in terms of outcome and followup that woulfollowup wit improvement over what we have now so it is an Exciting Initiative to get started. I wondered in the past for both acute and chronic pain i wonder if you could give an update on the status of the research. The general support from congress or the intervention of science itself the Opioid Crisis where investments on understanding pain and to determine what implementation we could currently do they emerge the creation of the network that will enable the development of new molecules and testing into the other one will enable the intervention and this is done in the industry and partnerships with industry so we can help accelerate but also with academic centers. Its so incredibly elegant i would like to emphasize this is another hands on deck initiative for helping end the addiction long term and for that we need to have nonaddictive but effective pain medicines. Weve been talking about the coronavirus and i wondered if you could comment on some of the partnering for the development of mental debate on medical countermeasures for these threats in general the fundamental research and its translation into the research which is then translated into a product or intervention and if you look at things that are now out from a number of diseases from hiv to a zika and now coronavirus is where we do the fundamental research to the early stage of development usually in phase one and handed over. They get their resources and partner predominantly with Biotech Companies or larger pharmaceutical companies to make a product based on almost invariably if you look at some of the things that have now come out with products almost every single one of them with few exceptions so i think that its a nice marriage and part of the continuing from the fundamental research. When the Ranking Member shows how much we all value its how many for a sixyear period its every single 360 approved by the fda each and every single one had support from the nih. Its very helpful. Over following the World Health Organization from various sources on this i have to be critical on one area and i would love for you to talk me off the ledge on this but i dont know if you can. Is the lack of how we are handling testing right now and its effect on the facade of the cpc has dropped keeping track of how many people we test we had someone this morning talked to us as a part of the response. The comment and to paraphrase a if you figure out how t figuredl with the things and the fact not keeping track of this and the amount of times anyone that has pneumonia we should be testing because medical professionals need to know. I think this is one area finding something to help whether it is treatments were otherwise. Topping off the ledge im nervous that they are not keeping track of who we are testing it is less than keeping track of the test then it is making the test available into withdrawing the restrictions on who can be tested. The test from the cdc was a Public Health component and the test comes back to the cbc and that starts off with some technical problems which they laid that going out. The major issue that i find many of my colleagues find problematic is that if you look at people in the community who dont have a recognized link to a test we call it community transmission, then youve got to withdraw the restrictions that in order to get a test you have to have the link to something. Its almost inherently contradictory. Those have been lifted. The fda has taken the constraints off and now we finally have companies that are going to be making many, many more. Should we be proactive especially in hospitals and places like that rather than waiting for people to come and get tested backs i feel like that is one of the concerns. Yes. I feel strongly about that. I love when i get a oneword answer. Maybe you can meet with the secretary and explained to her yes or no questions. Second area, and worried about supply chain. Ive got Mike Gallagher and i am concerned about the fact as weve had the conversation previously the number of drugs that are made in places like china and i dont know do we really know what the supply chain is we did a letter this morning the top 20 or so are asking this very question do we keep track of this anywhere to know how many are made and where we could be for the potential shortages in a place like this . I believe that the fda does it affect that you are concerned is when we have been talking about as a part of pandemic prepared us for years when we put together the plan back in 2005 we said one of the problems its supply chain. I wouldve someon would somewhas impressed or shocked that Something Like 90 of the fundamental ingredients that go into many of the drugs, not the actual drug itself comes from china so that is a problem and i dont have an answer for you. Its something that impacts us. Should we be tracking active ingredients for supply chains . I would imagine yes. But again that is out of our purview. We will do a briefings we can talk about that. Thank you madam chair. Im glad you asked about this. This is one at the white house i asked Vice President mike pence about the supply chain issue and they know that in the last number of months we have heard we are fine, were for weeks and this past week we started to hear there are some concerns and andi think february 27 is the te the prescription manufacturer noted theres a supplychain issue with response to the coronavirus. We have already seen the shortages for unknown reason and this is an area that im focused on seeing what the solutions can be in the short term. People say get three weeks of your prescription. If it is being rationed, you cannot do that. What type of solution can we so there is now and in the coming year we are going to be dealing with maintenance and treatment of the virus what should we be doing and obviously that is the big picture we talked about needing to fix the supplychain overall for preparedness. The supplychain problem as you know very well a is a longterm problem that has been brought to our attention multiple times and you cannot fix it immediately and there is no easy fix for it. I dont have an answer for you but maybe this can be a lesson as we go forward as i sai but ad to the Committee Many times this isnt the first or last that we are going to be confronted with and one of the things im sorry i cant pull you what to do tomorrow or next month but maybe we can talk about the future and how we might turn this a little bit. I want to hear about the future and how we can change the big picture. I do think there are some immediate solution im going to be asking the administration to consider and a Different Task tk force to make it easy to access and how can we make that costeffective as an area that im looking out for the medium and short term. The other thing i wanted to ask about, being from Washington State and my district on the coast between seattle obviously people at home are in tune with what is happening. The state has requested and theres been a lot of coordination on the phone with all sorts of talking to the task force and senators like everybody is mobilizing and im very proud of our Public Health response and for the cdc and folks on the plane immediately so we are moving forward. One of the things that was asked if its kind oand its kind of e Strategic National stockpile which isnt under your jurisdiction but perhaps you can speak to what we have made a request for personal protective equipment. I think we are at about half of that. And then also whats your opinion about expanding the cdc testing criteria because i agree i think that the state can only test a certain amount. We need it in a commercial lab for people to go in and test. Would you support expanding that criteria to get more people access . Yes i would support expanding criteria with withdrawing restructurings. I just want to hear it another way. I think we can say it enough. I feel very strongly about that. Washington has a very good Public Health, theyve put together a test that theyve done. Theyve been able to do it. They need help and support. I was on the phone late into the night last night with my colleague from washington and we really do need to act aggressively. Give me specifics. For example, they are doing Contact Tracing on the nursing home outbreak. Now if they find out its community they have to contract trades on that. They are stretching their resources and that is an issue. Subject to support a they need some help and in fact im certain, not i think that im certain the cdc as we speak is helping them. Thats my understanding. We appreciate that. Thank you madam chair. On the supplychain issue i would hope on a bipartisan basis to take a look at the subject not just this committee that advanced manufacturing and what we can do in the long term on manufacturing those ingredients here rather than china and i think that is well worth our time and effort. Congresswoman. Thank you very much for being here. I just have to ask you a supermarket question. People think members of congress should know everything. One of the questions i get is if the coronavirus is just a cold symptom, thats what we hear on the news, okay more like the flu, so its not just a i guess the question i have is how long does it last and what makes it so serious . Isnt a common cold. The confusion is that about ten to 30 of the common cold that you and i and everyone else gets during the season happened to be a coronavirus, but a certain subset of the virus can cause extremely serious disease. It did it with sars and mers and now they are doing it here with the novel coronavirus. The reason its serious is the question that was asked by doctor harris is that the mortality of this is multiple times what seasonal flu is so the seasonal flu spreads widely and mortality is low. Right now in china the mortality for this particular infection is the latest report was three to 4 . It might be a little bit less. It isnt a cold. Its interesting that most of the common cold have upper respiratory infection. This virus not to get too technical, the component that binds to the receptor in the body to allow it to infect, those are rich in the long. Thats the problem. It binds onto it so a person can show no seizing or fever, shortness of breath do a chest xray and you have the pulmonary. That is in the common cold. Thank you for that. Now i will have a better answer for people. Next question if you are able to comment on this in terms of research, is there anything you think the fda can do to speed up your research . I see a shaking of the head. You are referring to the coronavirus. Any drug that you have been researching. We work very closely with the fda. We have a joint leadership is there anything we can do to speed up the fda. Maybe you should say specifically what a coronaviruse coronavirus because theyve been all hands on deck and its been recently pretty actively enhancing the ability to do laboratory tests. I dont think there is anything that you could do to speed up the fda. Quite frankly there may be more resources to do the kind of things they are doing, but we have, thats right armchair. But we have good relationships with them. They have been very, very cooperative and collaborative with us trying to get these measures out as quickly as possible without cutting corners that would impact the safety and our ability to evaluate efficacy. The former acting commissioner might want to answer this as well since hes now the head of the cancer institute. What can congress do to help . I dont want to speak on behalf of a different federal agency that i think that this challenge is trying for the food and Drug Administration because it is so southern. I think probably the device centers decisionmaking about the Lab Developed test more widely releasing restrictions is an Important Development and academic labs will be able to preview these very quickly. They will definitely need more funding. I think that they have hiring challenges theyve worked on a lot. Theyve been given authority of its much appreciated and that they will be using it robustly but they are great people and ad ensure they are up to the task. I think im running out of time. One more question on alzheimers is the private industry doing any research because ive always heard it is so expensive that they are cutting back on that. They are but its not all companies. Again i had the privilege of serving as the cochair of the committee on whats called the accelerating Medicine Partnership focused on alzheimers and lupus and diabetes and there are five companies there that are interested in this in a big way and they have been willing to put their funds as well as ours together into a partnership where all of the results are open access but it has been concerning a number of other companies have ceased working on alzheimers disease because of so many failures. I mentioned earlier we have more than 50 new drug targets we are trying to encourage them to get into. I will yield back. Thank you madam chair. First of all thank you for answering so many of the questions that we have around the virus. Im going to actually switch topics is that okay . Im from illinois. The congressional distric distri serve goedistrict iserve goes un state line, the Mississippi River on the western part of this track and 11 of the 14 counties are rural independent Population Centers oand then thd cities. So each of these counties and communities face the unfortunate circumstances that can lead to negative Health Outcomes like almost every Congressional District in the country. And as you know these are called social determinants of health and im going to give you a few examples. In peoria illinois we have a problem with food deserts and there was a person in my district that takes them 16 bus stops to be able to access fresh fruits and vegetables. In rockford illinois, she is the cochair of the black Maternal Health task force so we can bring Health Professionals together to find out why do we have six times more likely to die as a result of pregnancy related conditions. Its something to begin social determinants of health, how do we get to this . We have a hospital in the district that took seven years to higher a primary care physician and then we just closed within the last year or two Obstetric Services of illinois. Along with congressman cole, we introduced the social determinants accelerator act and we are very proud weve gotten that out there. Maybe you can start. Im wondering if you can talk about how you were working together to address this and what i can take away from this i would love the power house we have sitting in front and thats what i would like to focus on for the couple of minutes we have. Its a problem. Fullstop spirit these. I share in your concern. The problem that we have although it is rising it is still a rare effect but its difficult to study it from about 700 but its hard to study 700 a year. We are focusing on the socalled near misses there are 50,000 more that are near misses and they can help us to identify differences in survival, why dio these women survive where there are others who do not. We also need to understand why theres a difference as well as alaskan native women that have higher risks. Its also important to recognize it doesnt just encompass pregnancy, labor and delivery but it encompasses the full year after delivery so we need to connect obstetrics of internal medicine. Pregnancy puts the stress on a womans body as you know it unmasks diabetes, depression and Heart Disease, so it is an opportunity to intervene. Weve put up the slide because e we are now developing an initiative that is going to be known and this is the first time youve heard about this its implementing the pregnancy outcome vision for everyone. It has two components one site on the righsideon the right is l biology which is aimed at determining predictive biomarkers and on the left there is a social game its important to connect the community is not only to hear from them what they needed them to bneed but then to implement some of these changes. Everybody can tell you more about it and im sorry because of the time i cant thought we would love to talk about this its a very high priority for us. We will set aside some time where we can talk outside of the hearing but thank you very much i appreciate your perspective on that. Can you take those seconds off of my time . Im so sorry that i missed a lot of the testimony. I think that you do important work and i thank you for the service that you provide. You said that you support proactive testing. So what does that mean and who would be tested and under what circumstances . Proactive testing means when you have communities that had you do not have a known index case we brought them back to the United States and the thing you needed to do this test the obvious contact and they wind up seeing that they are infected or not. Proactive means im going to go to a bunch of Emergency Rooms andsign people present symptoms even though they have no connection with anybody who has a coronavirus, they didnt travel anywhere and test them. If i go to the emergency room in new jersey where there is no confirmed case but ive got some symptoms they would test and make sure that its not. There are not enough resources to deal with every single centers with the cbc has done, they started by taking six. Its whats under the radar screen that is missing. Are these cities near like the state of washington . Washington, los angeles on sasanfrancisco, new york and ch. And there will be more. My understanding is that some of the cbc is managing diagnostic testing sent to the state Public Health labs. How is it determined who gets what . It is not a question of managing. Its a question of the cbc fundamental mandate is to develop the test and provided for Public Health purposes. When they can get permission to the Medical Center you pick it. To develop their own test or to partner with a biotech and do their own test on their own without needing the very intensive Quality Control that the fda generally gives to help many more centers do their own test. My husband had pneumonia and is still talking and its like i want to send him and have him checked out. Im very interested in research into the Health Disparities among the minorities in small minorities and minority children and whats happening with the suicide rate in how it seems to be growing exponentially and im wondering the budget as proposed what does it impact to support this kind of numbers. Hispanic they try to identify the most high Priority Issues and try to protect those even if it means we have to cut back in other places. It is something as heartbreaking as suicide has to be a high priority. Theres a big investment in that space and in particular trying to understand are there ways of identifying who is at risk. We are getting closer to that and using things like Machine Learning, taking advantage of what happens because everybody is carrying around a cell phone and theres indicators of the interactions they are in a depressed state you may not have otherwise known. Its very appropriate to focus on the Health Disparities part of it. Is that my 33 seconds . I have other questions regarding this. Thank you so much, madame chairwoman and esteemed panel. Im hearing from hospitals in my state in massachusetts who are feeling under resourced and unprepared for the coronavirus. Can you tell us a little bit about as we are anticipating moving from containment to medication how we are going to help with the hospitals around the country . [laughter] are you talking about the United States the nih isnt going to be able to do anything except make as quickly as possible the results of that research we do to be deployable in places like massachusetts. The cbc works very closely with state and local authorities and thats one of the reasons i think youre going to see coming and i dont know what it is going to be, there will be resources that have to be forthcoming and i understand there is a supplemental package that is one of the bes least anr the question is the state, massachusetts including have to implement the kind of things i think are going to be needed. One of the things im glad about is massachusetts has a high number of insured people. That does not hold true across the country, and i am concerned about how our Health Insurance policy plays out. Can you tell from me where you see the gaps and most immediately what is obvious about what they can do. Sorry, that is a very good question. In the last couple of days they all seem to mention one of these its been made a member of the president s task force t so that person is there. The Task Force Meeting last evening its going to be addressed. That is not my area but it came up like you said. How are we going to get the text distributed not based on whether somebody can pay for them or not . In the paid family leave policy, all these Different Things we dont expect the cbc to take on that whole policy agenda but they are so intertwined they hope the task force will also look at the immigrant communities if we cannot get a emigrants to figure out a census hell are we going to get them to Access Health care for their children . What im hearing that isnt going to be an impediment. We will wait and see. Good to see you. I was also very concerned that the Trump Administration proposed transferring 5 million from Substance Abuse and Mental Health services nearly 63 from nih to fight a coronavirus i dont think we made the tradeoffs between Public Health emergencies, but i wonder if you can call me what progress has been made and what steps are you taking to work on the youth focused intervention Recovery Support services . One of the things that has helped us enormously has been to 500 million because one of the projects that has been prioritized is to help it doesnt work specifically in the general sense and this is also important because it is not just from opioids to getting into the stimulus so its not like we have to address the prevention for one drug. Of one drug. We need to address the question of speaking us vulnerable as a country, and the most vulnerable of all of them, so we have the cities that are going to be expanded, to address how for example to rule out the communities that are very, very high risk. Endometriosis. One out of ten women the leading cause of hysterectomy so tell us your top priority for research and those forever serious interest in this area. So hating on want to that doctor collins we gave 12 and a half Million Dollars also with the office of research of Womens Health and h budget has grown with 39 percent but research on will then one Womens Health is increased only 8 percent. And then the office to better advancing coordinate and the women and the leading cause of death for women and what research improves that diagnosi diagnosis. Thank you madam chair one out of ten women have endometrial to one dash endometriosis it is chronic pain with Enormous Economic impact the leading cause of infertility and associated with an increase of cancer. And then i got a logical Disease Branch we are Funding Research and made it one of our ten aspirational goals im proud of the fact and those that were developed as a result because of nih support. And the newest and that is what came out of it with a graph. And then we will get all the information that we need. We have invested in Firearms Research all along and we are invested in a full set of research and will continue to do so we have already written up these announcements momentarily just to be clear with the role of video games and trying to keep firearms out of the hands of adolescence and the violence interrupter scheme. Do they actually work we need data and we are the data people you can count on us. So let me emphasize and while the funding is modest the overall funding with all of the institutes a very concerned with the office of Womens Health research so we want to make sure they are getting all the dollars that they need. And to take off on that point the key part of the initiative so during those reproductive years and then to read to cardiovascular disease. On the reproductive and childbearing years so for example pregnancy is a stress test and with that cause of morbidity and mortality. Those genetic factors that would be predisposing to that. And with those pregnancy outcomes. And those for those moms to be and to recognize there could be interventions with that whole trajectory. And these things play in together in isolation. Thank you very much madame chair it is too easy to get caught up what we are doing and the rally is the latest process from appropriations. And for the nih funding so i also want to ask you two of my favorite questions. One of the things we have been able to do had we not made these consistent investments, and looking forward what could we do if we continue down the path we were on . It over the next five years. But the five years of steady increases what we been able to do for earlystage investigators funding 600 of those grants it isnt nearly enough but people are concerned if they had a career path. And then to more than double and that the morale has changed in meeting with investigators and then its impossible to take risks. And with those that enrich for the entire workforce. And then to put forward projects that are bold and the single cells to go after things like the influenza vaccine and universal flu vaccine and to develop platforms we cannot have done that without the support to initiate a dramatically bold program to have those in the study of health and that is a platform so many things you want to learn about that the Brain Initiative to figure out why the brain does what it does and with half a billion dollars on that it is remarkable the technologies and the impact that would have cancer and immunotherapy we cannot do that as quickly without your help and then to find those alternatives those are just a few of the things we could not do and to see this upward trajectory what could we do Going Forward . This guy is the limit i mentioned gene therapy where we can take what has been done and curing sicklecell lets cure other conditions and you can see the path forward do opportunities with Artificial Intelligence Machine Learning we will have a big investment there in the next year or two because we can see this play out in multiple different about nutrition. An area we know is critical for health and science has necessarily gelled around that opportunity its time to do that. And with Health Disparities and the difficulties and also cocaine those are on our minds with this path being continued i love the question i gave you a bunch of mine. So what is not known is when he started out in a Small Institution in texas, that is where the first paradigm change in research was done. It was not glamorous. I was obsessed they were great scientists with an explosion of those and then they try to get the numbers up the making it different. I hope we look at this. And as doctor collins said we will stay on the track. Thank you very much and to take this opportunity for your extraordinary work. To get back to the whole issue of ecigarettes. What is out there it is now all penetrating the kids with the ecigarettes and young people use is startling. Look at the numbers may be 3000 more than last year with those related illnesses. As i understand that many but not all cases are attributed to the longterm impacts of vaping but the concern is growing it could be longterm Health Consequences Heart Disease or stroke or cancer. Trying to hear from both of you what do we do about it . If you have any ideas it would be welcomed and that is exponentially. And these vaping devices it makes a very rewarding and addictive. And that is also a tobacco. It would take hours or months to escalate. Now thats what we are facing that one of the main reasons so the message is we need to stop it because otherwise well have tobacco smoking again and all the points that they are saying that we dont really know what are the consequences of vaping. You raise an important area of concern and just last summer you are describing the cases of ecigarettes and the long injury that is a new epidemic and a mysterious illness. We dont know why they were presenting with those symptoms so we got this history of vaping. And nih and cdc responses. And to be collaborating and we were convening around the country and then to leverage prime investments and then to leverage centers of excellence for those people who were already studying ecigarettes together what is going on with the new vaping epidemic that mobilized a Research Agenda and within weeks to engage in what was driving and cdc with that Case Definition and the substances that could be combined with the thc and clearly we had a sense of vitamin e acetate may be an element of this phenomenon. And again related to the research routine we have established and in those animal models. And with those just getting the vitamin e acetate through the vaping device they word recapitulate so literally within eight months of the nih cdc. And with that awareness but we still dont know as mentioned the longterm effects to fund the cohort and the tip of the iceberg subclinical. I just hope we can Work Together if think its pretty conclusive but what are we doing about it . And in working with cdc . Im with you i would panic completely but i would like to follow up with you. It seems what are we going to d do . Thank you very much. Thank you for being here it makes me nostalgic for the days of being recent doing research. [laughter] and that still is the pace of a quarter billion dollars per year and then to reduce of the regular cells into stem cells and then to destroy human and beer on embryos through the nih that they are in fact and they believe human life should never be used as a mere means for achieving the benefit of another human being. So if the president responds positively to come up with a way to phase out use of a quarter of a billion dollars that has no clinical benefit i understand the basic science reasons but these are humans we should move away from that. Doctor its good to see you again you probably know what i will ask about i want you to update us after one year on the marijuana our research you have done with the attempt to move to Recreational Use of marijuana fortunately the last on this bill it was turned to make Recreational Marijuana into more profitable removing banking instructions but those are still in place so now giving us time to educate the American Public and thinking about how dangerous it can be. So just as an aside i do believe we will move finally on the medical Marijuana Research bill making it easier to do research to surely discover what is a pieinthesky promise for those what it could really be of help. So with that research that indicates how dangerous or expansion of marijuana with those younger individuals whether ecigarettes or marijuana you can make it illegal but the young people will use it. Thank you for asking this question it is an area we are seeing major changes in the perception as a drug that is benign and as a result a dramatic increase of the number of people that are consuming marijuana 44. 5 million in 2018 but a concern relates to children because the brain is developing and the euppercaseletter system is crucial to enable that Development Including those that communicate with one another so the test that shows to be much more likely to show the structure and function of the brain they look at this retrospectively and those ways that cannot be challenged and from those stories that come at us all over the world that the use of marijuana and the thc is associated of having psychosis. If this is acute or chronic psychosis now there is data to show unequivocal chronically now the data indicates you could develop psychosis so this highlights why we provide information so they go in with eyes wide open and then to make policy decisions. I yield back. Doctor felt she we have worked many years i cochaired bipartisan congressional hivaids caucus to make sure we have the resources to address this epidemic so in the field of hiv research with Vaccine Development so in terms of vaccine so in terms of the corona violence one byron so how do we explain the epidemic and a pandemic as serious as this is how do we make sure the public i think. Doing a good job to explain the transmission but with the vitality rates and impacting people who are elderly from your perspective is that accurate in terms of fatality rate with sicklecell how close are we now . We are waiting and i know you are close one out of ten africanamericans has sicklecell so we wanted to see how close we are and how we are doing as it relates to identify the trait early enough and could provide false results. So as you know we had a disappointing situation with the vaccine that was funded in south africa which was using the model in the time trial no deleterious effect into other major trials that are going on one in Southern Africa we dont have the data on them for a couple of years they are using a different concept a different protein. So i cannot give any prediction but there is another whole effort on hiv vaccines using the structural biological approach to induce those antibodies that is the Gold Standard so there is some good work going on but it was disappointing. And with it can be because they havent had very sustained transmissions throughout the world so technically is not a pandemic it will be up to them to make that declaration that 2 percent mortality the report that just came out today looking at the totality of the data it was somewhere around 3 percent that depends on the number of cases and the mortality would be high if they are subclinical then it becomes low. No matter how you slice it many more time than the influence. Particularly for the elderly because most death and hospitalization the v. A. Is 70. Very quickly those that are in the lead of the effort we have appears sicklecell initiative now we have three Clinical Trials using gene therapy that appear to be working dramatically very high tech with a Specialized Technology so its not ready for broad extrapolation but we will see sicklecell disease becoming one of those conditions we have started a new initiative with the Gates Foundation to extrapolate that in Subsaharan Africa and it would be unethical and with high tech environment in that resource setting as well. And then to see a significant publication to layout the data and that this has to be paid attention to with managing diabetes. Thank you so much i was delighted with those increases and to add inject a virus into the retina to restore vision it is unbelievable. But i know there are many concerns and the technology after the chinese scientist from the bbs last year i know theres great work going on putting up those ethical guardrails so i am wondering if you can tell me what steps nih is taking to mitigate wrongdoing as we push the boundaries of science of medicine. And with that gene editing and the one that was just reported one of the most exciting things that has happened so let me make it clear those approach is a way to fix the gene in the body. I think probably in the next few months, sometime during this calendar year would begin to close in on the conclusions. Certainly in this country that wouldnt be something we could do but at the same time as all this promise if you dont deal with the hereditary applications and semantics, you are dealing with maybe the brain for a child that has otherwise and im treatable disorder. This is potentially exciting. We have a whole program trying to develop ways to deliver the gene editing apparatus to the tissue where you want it to go. How do you send it to the right zip code there is a lot going on in that space. 7,000 genetic diseases waiting for some kind of solution this is a scalable approach that might not work in the next hundred years but maybe the next decade. 20 of cancer trials fail due to insufficient because there are barriers if they traditionally be engaged in Clinical Research earth so many ideas but if we can test the them then we cant really make progress in fixing the problem is intense focus for the institute. One big issue it was not to be done in the other source of environments and the required process that was bad and so one of the things that happened is 6,000 patients at 11,000 site. We have a network that allows people to get into the community anand they know it provides betr care and also more diverse population and last i should mention we made a crusade to the somewhat silly Eligibility Criteria people keep hiv positive. We are working with others to try to make trials similar. Congresswoman . Thank you for being here. I have three questions. Number ones iv one i have readt or study that women are feeling like doctors are dismissing their complaints. Im curious whether or not there is any research on sex discrimination. Number two where i live in West Palm Beach it seems like the Entertainment District every other storefront selling cbd. Is there any research to show that cbd or marijuana is medically effective than third tonight questions on the coronavirus i know you are not supposed to touch her face, but is it any part of your face, or where are the germans going and if someone gets corrine teamed where are the germs going and if someone gets corrine teamed, do you think this is going to be a widespread issue in our country . Sex discrimination first. Certainly with regards to mortality, there is discrimination in a womens voices are not being heard, and that is one of the aspects of the end prove initiative that we want to address. That is the communitybased initiative. We know that there is not only a dismissal of womens voices but also infrastructural racism and we are definitely including that as a part of this overall initiative. Cbd and of marijuana. We know that there is evidence for it to be effective for helping to treat seizure disorders in children, tourettes syndrome otherwise there are no fda products approved for cbd. We expect some inflammatory effects and there is the potential for different types including opiate addiction. Does that mean there is research being done . With respect to thc, the information is more limited. There is some that can be beneficial for multiple sclerosis and also pain indication otherwise the evidence is not very good in terms of the potential benefits. Researchers are doing studies on ptsd. Back to coronavirus, how do the germs get in you . U. S. Touching your face. So the Public Health the way to avoid similar to those to avoid influenza and that is particularly as simplistic as it sounds, washing your hands as frequently as you can. One of the problems with respiratory diseases is that they are spread either by droplets, someone coughs or sneezes on you or even you can be sitting next to someone very closely and you dont cough and sneeze the virus does it go from your knows where your mouth . It will get in through a surface that could either be your nose, your mouth or even your eye. The reason for washing your hands is that people often do the wrong thing. Thats why you hear us say cough into your elbow because sometimes people go like this or blow their nose, shake hands with you, touch a doorknob, 15 minutes later you come by and do that and then touch your face and thats how you get it so that the first thing. Second, incubation period quarantined, incubation period the time from when you get exposed you get clinical symptoms is about 5. 2 days. The range is between two to 14. 14 is much more the outer limit so when someone is suspected of being exposed to be either self isolate or get institutional corrine teamed for 14 days. There are multiple quarantined. What if you get exposed and stay home and get exposed again, do you have to stay home every time you get exposed . It depends what you mean by exposed. If you are exposed to someone with a documented infection and then you are tested and you go into voluntary isolation not necessarily quarantined, the only time you get quarantined is if it is clear that you had direct contact with someone. And it could be multiple times . It could be if you were in a situation you are in an outbreak thats interesting because when you go from containment which means to preventing the spread of two mitigation which means in a community distancing yourself socially if, i dont want to say when because it will be a headline. If it gets to the point where there is widespread infection if that ever happens do you expect that . I cant predict that. Are you worried about his . I just do things to prevent it. Thank you very much. I yield back. When there is a vaccine available o, who gets it first besides the colleague to my left. [laughter] who gets it first . The Standard Approach when you have a vaccine or example for influenza you have limited vaccine you give it to the most vulnerable and the most vulnerable clearly are the elderly and those with underlining conditions and those generally are Heart Disease, chronic lung disease, kidney and ofdiabetes and obesity or those that are immunosuppressive drugs that might have been underlining cancer. So 18 months or so away from the . At least. The other thing thats important is that the healthcare workers and those that are the frontline responders, because those are the ones in every disease we know they are the most formidable in fact if you look at china for people that are most formidable before they had were the healthcare providers. Doctor collins, following up on my interest on the whole issue of Health Issues and the disparate impact on minorities, one of the things i learned from the Emergency Task force that we have on Mental Health and suicide is that researchers, black researchers in particular havent been having their Research Requests considered and theyve been denied of these requests for regions having to do with not communicating clearly what it is youre looking at, the implications of Community Outcomes or collaborations not necessarily recognizing the significance in our space with regards to issu issues. One of the institute is having more workshops and what would be considered big. What are the things we can do to ensure researchers of this nature are getting an equal opportunity to do the research thats important for the disparities that exist in the Minority Community . This is an issue that we are looking at with great seriousness an since it was documented a few years ago in fact an investigator that comes to nih with their best and brightest ideas has a lower chance of getting some did and other groups and that is very disturbing to look at it there are many hypotheses about what might be involved. I think weve not completely sorted out all the reasons that weve discovered a number of them. Certainly part of this issue does relate to i think the fact that often times investigators may not have been in as strong a position to be able to put forth a Grant Application because the lack of mentoring and opportunities to sort of be involved in the networks which may be a natural thing for others but for the minorities, not so much and we are working very hard on ways to do a better job of mentoring Something Like the National Mentoring research. They also identified the fact that there are different areas of research where the minorities tend to migrate and Health Disparities research is one of those. You can see why that is. Often times it is a passion for somebody that gets into research or comes from an underrepresented group they want to work on understanding why their communities are not as well served. And yet it is clear that some of the research that goes on in that space does not fare as well in the peer review system regardless of whether the applicant happens to be a minority or not. Theres some action there that we need to take. We are still trying to sort this out. This paper we published a few months ago that got a fair amount of attention and we are continuing the analysis to see what else we are missing. We are determined to sort this out. Im glad. Im a cofounder of the caucus on black women and girls and we are interested in the things that impact individuals particularly because of the intersection of gender and race and as well as the interest in whats happening with our children and the mental Health Disparities and things of that nature. If she was in my community, so i thank you for the work that you are doing and we look forward to the work he will be doing in the future. Thank you and i was told. We are going to do a kind of third round here but i want to let you know i do not know what the dollar amounts are but it would appear that it comes from the supplemental. We actually just got the notice and so the word will be getting out about the dollar amounts etc. So again, yes, wonderful this is where we need to go. Im going to do my rapidfire piece here again. Status update on the efforts on a commission on the diseases. Mci h people got lots of activities, doctor sharpless. Tell us a little bit about what is driving the interest in the cancer research, because you have so many more. I would like to know at some point and maybe i can talk about where we stand with Ovarian Cancer and finding a marker for Ovarian Cancer. Universal flu vaccine update, doctor fauci, if we could provide Additional Resources in 2021, how quickly might we move to some success and doctor collins, the ni e. H. S. Have supportive training for healthcare workers at airports, correctional institutions etc. So it is a quick overview of the training activities in recent publichealth emergencies, the flu pandemic, e. Ebola and what we need to do for this current conv19 outbreak so that is the commission of lymphatic lightning round. You hit on an important area and its often debilitating affecting women. We have established a task force that is focused on this issue. Certainly it is one we spend 20 million a year and a space along with again many others contributing to that collective effort. One of the key areas i might note in particular is as described we were able to get a single cell resolution characterization of many of the cells in the body and one of the key organs if you will is the emphatic system, so understanding the system both in the normal human health and development as well as the response to injury and disease is fundamental to Getting Better treatment. We will have further conversations on this but we did encourage them t the last omnibs a commission on lymphatic disease and we are going to pursue that with you. Mci, most people come in with ideas. We have to be able to fund them. The National Cancer Center Program plays a role and the pay line people write more grants but the main one i think is the exciting time in cancer research, scientific progress. I saw this at the fda with 30 of the business approvals and devices and drugs for cancer related products and i see this in big pharma. Theres a lot of people who think they have good ideas for cancer sforcancer so that is a i would be happy to follow up with you. Ovarian cancers cholesterol we dont seem to have a marker and we know how many thousands of women die every year to varying cancer. Doctor Anne Schuchat for universal flu vaccine. Thank you for the committee for the plus upon the universal flu vaccine. Were making significant progress as i mentioned last time, the first phase one trial for the universal flu vaccine for the group one influenza which is a whole cluster of influenza went into Clinical Trial and was shown to be safe. We will start very soon a trial for the group to which is the whole group of influenza so we are moving along very quickly. By the end of the summer we will be able to go into the phase two trial and thats going to be important because it will involve hundreds if not a couple of thousand people and we will need the resources that you gave us to be able to do that. And there are some Additional Resources. That you are going to give us. [laughter] very quickly weve played a Critical Role in training people who can deal with outbreaks and previously worked as they are totally prepared to step in on this and basically at airports as you said, correctional facilities, hospitals, they both do training. They do facetoface and run courses. You mentioned you need some help with that. Can we be instrumental in pushing first be engagement to be involved in this training . We are looking into the supplemental to see if theres a way this can be factored into that. We are going to need a lot of training for people who are not quite prepared. Thank you madam chair. I want to follow up on the question you raised with doctor sharpless and have a little more information. Are there some things we should do so that we dont leave good finds on the table just because right now cancer seems to be the one wherplain where there is a e happening than maybe some other areas . I think that there are. The main thing to realize is that its like a mortgage. We gave these grants and they have four or five budget details in so when we invest in the pool of grants today which goes up three, five, 8 over the past five or ten year years and thats an out you year costs that is qe significant and so, you know, that provides some hesitation on the part to be good stewards. So this realization is the problem isnt going to be fixed this year or next year. We expect we are going to get the increased number of grants for a while because people generally have a lot of great ideas, so this commitment that you have provided for so many years is what the doctor order ordered. I couldnt agree more. Doctor collins, the attorney general raised awareness of the threats posed by foreign governments have obviously particularly the peoples republic of china print they were rating the science and interfering in research. Can you tell what your level of can turn is and measures you might be taking to respond . We are quite concerned. The head of our Research Division has spent probably two thirds of his time now over the course of the past many months. First let me say that we greatly depend upon and value foreign investigators who are part of our work force. The vast majority of whom are honorable, hardworking, incredible contributors and one thing we have to be careful of is even if we identify this as a serious issue that we dont extrapolate and anything that would look like a racial profiling that would be unfortunate and unforgivable. At the same time, weve identified numerous examples, im sorry to say, of individuals who have been receiving substantial financial benefits from relationships with Foreign Countries coming dissolve, yet a without disclosing that ended the requirement that they do so. Likewise we have instances where individuals have share shared gt applications that were not even yet reviewed with colleagues in other countries to give them some kind of edge on developing a new mentioned and it has consequences for intellectual property. We are very serious about identifying the circumstances. Youve probably seen dramatic examples of individuals whove been founthen found to be egregy against the way scientists should behave and as a consequence of lost jobs and in some instances have been brought forth for various kinds of prosecution. Again i think most of the people that you might see in our workforce are honorable that we are determined that we are stewards of the public trust if there are instances that are not going the way they should, we will be following up on them. At the moment, we have dozens of these investigations that are currently underway. We are working with the fbi and theyve been good partners with us and we will keep our eye on this and continue to see where the trouble is and act upon it. I want to commend you for your vigilance and also that evenhanded attitude. There is a danger that this could degenerate to a place none of us would ever want it to go into so thanks for having to focus on the problem but also thanks for remembering as you say most of the folks that are involved in these endeavors are honorable, able and serving humanity so it is a tough problem and i think you struck the right balance. Thank you madam chair. First i want to thank the chair and Ranking Member and all the panelists. It is so refreshing and we are blessed to be able to have a bipartisan discussion on Health Research and very fortunate to have people of your caliber leading the way. Im not going to ask for supermarket questions but i know i touched my face so many times today. [laughter] seriously im very worried about the social and Economic Impacts of the potential of this virus thats very frightening and im not going to get into it with you guys, so im going to ask some different questions. Specifically in florida and i also know in the nation that suicides are a big issue, and also i saw something that its a leading cause of Maternal Death is that right . I want to combine the question because im curious not only about suicide research, but also postpartum depression research. I will quickly start with suicide and then asked about postpartum because it fits the maternal mortality. Certainly suicide is increasing in any different communities and demographic areas that are of deep concern and that there are many diagnostics about why that might be going on as it relates to peoples sense of isolation which is a growing problem in this nation. We at the nih are doing everything we can to identify the factors and in particular the predictors of who is at risk and with the intervention mightt be and there is certainly some of those such as trying to make sure people dont have access to lethal force for the moment where somebody makes a sudden decision to end their life and its often a rather sudden decision. I would say also in terms of treating the clinical depression often undergirds this is a Major Development that happened which is the development of this drug called ketamine which has this remarkable phenomenon in many people whove had chronic clinical depression and not responded to anything else after an Intravenous Infusion having an almost within an hour lifting of the clones. That is now being tried on people that are acutely suicidal and starting to look pretty promising in that space if you can catch somebody before they take the drastic action and lift them out of what seems to be the hopeless circumstance that is one brighso that isone bright sa very tough problem. So Funding Research that is currently looking at postpartum women who potentially are at risk for suicide so the difficulty with the postpartum situation is something of prior history of Mental Health problems, so how do you again if this greater issue of how do you know if someone is going to be at risk so we are funding an investigator that is actually looking into taking a Machine Learning approach through the Electronic Health record to begin to identify certain clues in the record but the other issue is about of pregnant women are depressed and taking antidepressants during pregnancy, so we need to know are these drugs are safe to take during pregnancy and there is an area where im concerned because women who are at risk are not taking their medicines because they think its better for the baby. So we are doing research to show what is safe and what isnt and we have a study where women are taking the medicines into donating breast milk so that we can see what is actually in the breast milk. Thank you very much. Thank you chairman. Doctor sharpless, i would like to talk about endometriosis cancer have shown a lot of improvements and improvement inf deaths over the time. The National Cancer institutes surveillance epidemiology Resource Program shows the worsening survival rate from a endometriosis cancer from 1996 to 2016. The incident is a more aggressive cancer that is dramatically higher than for white women. Im wondering what your plan is, what is happening in the field and what are you planning in terms of funding of the Clinical Trials and try them to come up with specific therapies that address these disparities . This is the problem across many cancers and the findings are with access to care poorly driven by biology or some part thereof and then specifically to address that question the center of Research Excellence we are funding and area with a lot of focus. Three have any final comments before we conclude . Like many members this is my favorite hearing of the year because we all marvel at your abilities and the work you are doing and what your colleagues are doing and we all feel as if you have been really good stewards of money that congress has chosen to put at your disposal in the American People have benefited enormously as a result. I am proud of the subcommittee and im proud of my german and the colleagues on the other side of the rotunda whos worked with us for years and its absolutely critical that continue i would be the first to say my chairman knows this better than i do but its been a very tough year we have a twoyear budget agreement that is flat funding if you look at the requirements that will take many veterans in particular and the counterpart that will be confronted with really tough decisions and i have had this conversation and i use the phrase were in another one of those years where we are robbing peter to pay paul. Somebody else will have to its not your job to make those decisions but the job of this committee and we have commiserated there is a lot of things in this bill that are National Priorities but this committee has made the right decision in the bipartisan sense but that priorities every single year i dont think thats ever been more dramatically demonstrated than right now. Talk about the coronavirus but yet there will be another one out there one of the most telling answers of the hearing when doctor collins made the point these past investments put us in a stronger position to deal with the current challenges and then to talk about those extraordinary opportunities in a particular area right now and those opportunities come into use those resources to take advantage of this openings the committee has to think in terms of incremental whether infrastructure or those projects that take multi years to come to fruition to make the revenue stream is there and available. Again thank you all for the work and we think the committee on a bipartisan basis for its sustained commitment and madam chairman and the wisdom is borne out and i hope we can continue that if its up to you and me we would. We are pretty persuasive with our colleagues we make a pretty good team and dealing with our friends across the rotunda that have approach this with the same mindset. Hopefully we continue because frankly will render enormous benefits. I yield back. Thaou you very much to my dear friend and colleague and coconspirator of the subcommittee and indeed this is always been extraordinary. It is a revelation. We have a doctor on our committee. I know the rest of us are not scientist or doctors. Yes. You are a Political Science doctor. [laughter] but what you are about is trying to grapple with the issues that what we try to study and learn trying to do the right thing every day of your life to focus on the mission of which there is enormous cost of the highest commitment and we get to work in cooperation with you to make sure we push the edge of the envelope you do and we need to do that with the resources that provide you to do your work. I would just say to my colleagues that yes you are you are probably have to worry about peter as well. But you know where our heartsbus and commitment are and one other thing. This is a committee working together which does not deal with gotcha. We are not sitting here to try to stop you or make political comments. We are here to try to get the best information and the best advice so we can respond some of the questions are hard and tough but not for political purposes but it is to look at our stewardship of the public dollars and where they are going we are so thoughtful of you being good stewards and we can sell that to other members of this subcommittee as well as those across the aisle i will and on a humorous note and i just need to make sure that people can afford it. Thank you the hearing is concluded. Thank you. [inaudible conversations] [inaudible conversations]