Transcripts For CSPAN2 Senate Hearing On The Strategic National Stockpile 20240712

Into the congressional record as long as as well as my Opening Statements. I want to think everybody participating and covid19 continues to inflict terrible economic toll in the United States. Just over five months, weve express of our 120,000 deaths. 2 million total infections. Tens of millions have lost their jobs. This Congress Reviews response to covid19 is important take the lessons weve learned learned during this crisis to better prepare for pandemic are the biological events of the scale the future. Folks on todays hearing the Strategic National stockpile. First established with a 51 milliondollar preparations in 1998, was National Pharmaceutical stockpile. The s s was codified in 2002 and obtained his current name with expanded mission in 2003. Over the years, the response ability for the s s has changed between different agencies within hhs and vhs. Developing a plan for this communities oversight for the response to the coronavirus, the Strategic National area of interest as is vulnerability of our supply chain. The very inner related. I assume that staff would be able to quickly come up with a list of items to be held together with required inventory levels of each item. Once again ive learned it is dangerous to assume. We quickly found out that those lists do not exist are certainly not made available to congress or the public. As we will hear and testimony, normal edit of dedicated individuals working through the agencies. For the Strategic National stockpile. Instead is a more pervasive problem of a lack of clear gene understanding of exactly the s s role is and what it should be. As indicated above, to the centers been a congressional or executive branch by the Mission Statement, has evolved over time. Outside of the managing Department Agencies not been generally understood. Paying the price for this lack of articulation and clarity during the current pandemic. Frustration expressed by state and local and tribal and territorial governments and their elective representatives. The demand for so many needed products and supplies is dramatically exceeded supply. Available inventory and capacity. Manufacturing in the private sector whenever i was faced with a problem, i was always asking what opportunity presented itself in part finding a solution predict the same dynamic and apply harebrained the men and women who are working tirelessly to address the current demand of the models, the information needs to be captured and put it immediately to use, updating and redesigning the structure and management of the Strategic National stockpile. I like to thank our witnesses for here for the testimony. Their past efforts in the future hopefully can be provided to us. Thank you mr. Chairman. In q2 are witnesses for being here today. Over the past several months, the United States has faced almost unprecedented challenge. Finding a deadly virus that has infected millions and taken the lives of more than 120,000 americans. I pandemic and overwhelming even the most impaired communities. That is why we have these Strategic National stockpiles. The nations largest door of life saving pharmaceuticals and medical supplies. To ensure the federal government has the resources to help states protect the health and safety of americans during Public Health emergency. To the skill of the, depleted our National Stockpile in just a matter of weeks. Leaving the state and local governments scrambling to acquire the masks, gloves, and other supplies were so desperately needed in order to keep people safe. Many communities facing the highest needs of infection struggle to obtain the supplies that they need including my home state, michigan. Instead of providing a coordinated National Approach to effectively using the Strategic National stockpile of the tools to acquire distribute the supplies nationwide. The president told the state they were on their own. And that moved for states to compete against each other in the federal government, the lifesaving medical supplies that were already in shortage all across the world. Since this crisis began, the congress has passed several supplemental emergency appropriation bills to rebuild the stockpile. And while this funding will have provided some stability, there is no question that a nation would have been better positioned to tackle the pandemic of congress about the current and prior administrations have invested in more in the stockpiles before this crisis struck. It is abundantly clear that federal government was not fully report prepared to address the crisis on this scale of the coronavirus pandemic and the result is a tragic loss of 120,000 of our fellow americans. And millions of families who have suffered the consequences. Entering the preparedness of the Strategic National stockpile, is an issue of National Security. In the should be treated as such. We cannot allow a disaster of this magnitude to get our government off guard again. We must ride steady funding to all of our pandemic business efforts and also ensure the Strategic National stockpile is well maintained, and prepared to address a broad range of possible threats. We must improve the communication between states and the federal Government Regarding available resources and strengthen the federal Government Role in managing this and future crises. Finally we must also take steps to address our overreliance on foreign manufacturers, of drugs and critical supplies. This is a Serious National Security vulnerability in pandemic is only further heightened and highlighted just how significant this risk is to the health and safety of the american people. So todays discussion will help us identify and prioritize critical decisions and investment to ensure we can continue to combat coronavirus as well as emergencies in the future. I look forward to hearing from all of our witnesses in the forward to working alongside each and every one of you to deal with this very daunting challenge. Thank you mr. Chair. It is the traditions of this committee to swear in witnesses. You dont need to stand at rays right hand, do you solemnly swear that the testimony that you given to this community will be the truth and nothing but the truth so help you god. Thank you. Our first witnesses as an doctor, former director of the centers for Disease Control and prevention and former administrator training toxic substances in the disease registry. Now the executive Vice President for Strategic Communications, local Public Policy and health and the chief patient officer. She also cochairs the senator for internationals dennys commissioner. Guest im really honored to have a chance to talk with you today about the Strategic National, i know what an incredibly acid and is free to know how disappointed some people have been in certain aspects of it, the deployment of performance this year. I am going to testify in front of you, first and foremost as my background. As an Infectious Disease doctor was at the epidemiologic general responsible for Occupational Safety of Health Workers in the early aids era. An expert in personal protective equipment and to really keep workers safe. As you mentioned i also cochair with former senators kelly, see if i ask commission on strengthening markets Health Security and thank you for accepting that into the record. I also and the chief agent officer and edp where we have engaged from a manufacturing perspective it with various interactions with u. S. Government and her efforts to bring in a bowl of vaccine to the licensed process for the emergencies in the drc and west africa. And also other to our overall Health Security. And then finally, i will say i was the cdc director during the very beginning of the stockpile but in this infancy and watch it evolve over time. If i visited the sites where the stockpile is hidden in plain sight and dissipated it observing some of the exercises of deployment and so forth. I have a pretty deep knowledge of what is in their and how it has evolved over time. And what we may need to be doing moving forward. I do believe this is a Strategic National asset, somewhat unique in the world having such an asset at our disposal. And obviously an enormous investment and one that we need to make the best of. It is incredibly innovative and i would say overall through its entire history been reasonably well manage from a vegetarian fiscal responsibility perspective and it has been innovative in its approaches to preparing for many challenges. In spite of that overarching point of view i recognize many important areas the stockpile needs clarification and improvement. Dr. Julie gerberding and i will just mention a few. The most important thing is that clarification and consistency of the strategic on the stockpile. It is gone from a something is oriented towards bioterrorism and all hazard, preparations and influenza pandemics, have been debates and inconsistencies and whether or not it was conceived as something that would be deployed locally. Now preparing for a National Crisis of a pan american scale if you will. To where we are now today when we needed it to be able to meet the needs of our Health System across the entire country. It is also not clear whether it is been acted as we operate as a standalone entity. And be prepared for all of the needs or augment with the state in Healthcare Settings already doing and have put into their own planning. That inconsistency is led to a pingpong approach to a should be decisions about procurement. Think there is another opportunity for the improvement in terms of the Accountable Leadership of the stockpile. As you know, and is moved back and forth from the cdc to dhs to cdc to hhs and others have been involved. So there has not been consistent on Accountable Leadership are really making sure that number one, there is clarity of strategic and number two that the stockpile is consistently delivered and supported. And that there is accountability and measurement of success. In the third year area for improvement is the budget process. It is impossible for congress or anyone else to be able to budget to the stockpile if theres not clarity about if its supposed to accomplish at what scale. What is happened all too often is the tail wags the dog. Someone may have ideas about with the stockpile should be capable of supporting but the budget is the thing that determines what actually gets procured. The current budget going into the segment was not adequate to provide it for the kind of ppe that we need to do for a pan american Infectious Disease pandemic. In part, that is because theres not consistency in exactly what the requirements were for. Whether it was supplemental or whether it was intended to be able to supply the full force. I think lastly theres a real opportunity here to improve the engagement with the private sector. As you have said, our supply chains are very problematic in the people who know the most about that have the most to contribute our people in the private sector. Likely willing to be engaging in the things that how we can improve agility, resilience and Surge Capacity in support of the Strategic National defense. The last point i would make is one that is not come up through the csi have process but as a commissioner, very willing to take it on. And that is the stockpile is not aware, it is the capability and it needs to be thought of not just in terms of what can we buy but how do we learn how to display and utilize the state and local territorial and tribal level. In collaboration with the Health System and the Public Health and that users. Means a strong exercise curriculum continued deployment and utilization capability enhancements. In a cycle of planning and improvement is inclusive of the front line personnel. So i will stop there and again just thank you for the opportunity to testify looking forward to the comments. Thank you. Thank you doctor in her next witness is a senior policy researcher at the ram corporation. Prior to his work, he served as the acting undersecretary nwt undersecretary of the science and technology director. Before his time with dhs, he served in the u. S. Army both in activeduty and prince will director for the mass destruction the office of the secretary of defense. Guest good morning. It i think you for the opportunity to be here today. And to discuss the future of the pandemic preparedness and response and the Strategic National stockpile. I will focus the majority of my remarks on looking forward i do want to briefly assess u. S. Response. In short covid19 has exposed serious weaknesses in our National Preparedness and response systems. Justintime medical Delivery System that lacks resilience in times of crisis. We also went and sing and ability to scale of the National Level to meet the demands of the Public Health emergencies. Overall a federal response has been slow and inconsistent. And has deservedly become a target of criticism. We have seen shortfalls in the areas from the basic science or Emergency Management governments and doctorates, and Strategic Communications with the american people. One particular concern is a trustee jake National Stockpile in several key issues have been evident including Unrealistic Expectations for the s s. Historical finding of the stockpile and lack of timely decisions regarding energizing supply chains and the federal government and mission of the s s during this National Emergency. Looking to the future, should reestablish to review the nations performance during this pandemic. Basic assumptions regarding Emergency Management and response including the role of government at all levels should be on the table. One outcome should be in agreement the Public Health must be elevated to and received prioritization and funny as a National Security issue. Danein gerstein and the department of defense and challenging of the community. Specifically i offer five recommendations in the response capabilities. First reexamine the s s consecrated as congress should ask for a complete accounting during this pandemic. It should also be reconsidered. A new Mission Statement and not subject to the whims of any administration should be developed and single the capacities and limits of the stockpile. The federal governments hoses to the state and local authorities. Integrate stockpile concept must be stressed tested and optimized in the training and exercises to ensure it meets the preparedness and response goals that have been sent. Second, develop and National Strategic supply chain approach. Rather than consider the s s as a free omen, needs to be thought of as part of a broader National Supply chain. They combined the stockpiling and contracting with manufacturers. And key commodities, procuring a large quantities at the National Level to take advantage of economies of scale. And shortening supply chains. The most effective and efficient methods for ensuring critical needs will be met for the vision of s s areas. This will require mapping out critical equipment and supplies to allow for the determination of their anticipated development of time. Third, the Public Health funding. Years of underfunding the state and local and tribal territorial and Public Health programs, should be reversed. These shortages affect the response for a wide variety of national occurring Public Health events, accidents and natural disasters and deliberative attacks. During the covid19 in response, governor leaders at all levels, by surveillance activities, contact tracing. Stockpile shortages in the beginning of the pandemic and broader supply chain issues. Public health shortages have also adverse effects. Fourth, develop a Vaccine Distribution system now. An important supply chain process for this pandemic will entail the distribution of vaccines when it comes available. While the vaccine may be ready early 2021, much remains to be done to ensure timely distributions. Planning should be ongoing now for administering a vaccine here in the United States and globally. Only after a large portion of the worlds population is immunized, will the covid19 be controlled. Fifth, reestablish u. S. Leadership and global Public Health. This leadership is needed now more than ever. International collaboration will be vital for understanding that for the disease in the developing measures. We shall seek to repair our relationship with the world health organization. While working to make the organization more accountable. We need the who to serve as a coordinating and the nations and thus the trend 20 disease spreads to other parts of the world and for future health crises. In conclusion. Some of them called the novel coronavirus, a black swan events free to reject this. We have ample evidence of potential for a Global Pandemic however priorities inadequate funding and lack of National Lettuce to ignore the potential threat until it was too late. And unfortunately will see more pandemic events in the future. Human activities that distract the habitats. Allow humans and pathogens to crisscross along supply chains for different should be made now to rid ourselves of such a future event. Thank you for inviting me to speak today and look forward to your questions. The next window, andrew phelps. Office of Emergency Management. Department of homeland security, Emergency Management local Preparedness Program pretty also served as the Planning Section keep for new mexicos emergency set. He appears before our Community Today on behalf of the national association. Mr. Phelps. Guest thank you. I am proud to present testimony representing the National Emergency association. On behalf of mike colleagues, the National Stockpiles during the covid19 pandemic. 122,000 covid19 related deaths in the United States. Each life lost, is personal to me. Hard felt. [inaudible]. Governor brown took forward action, hundreds if not thousands. [inaudible]. Utilize our entire management emergency system. Its important work for Public Health partners. Continue to adapt for insufficient. [inaudible]. We expect action. [inaudible]. Surgical masks, and disaster declaration is appreciated. 75 percent federal at least 44 other states have also. [inaudible]. Lack of guidance and unwillingness, nervous about spending. Our expansion in oregon, has led to recommendations. We need to understand. [inaudible]. [inaudible]. [inaudible]. [inaudible]. [inaudible]. States and resources, stockpiles, and a minimum state led Emergency Management. [inaudible]. Other recommendations. [inaudible]. Lack of investment. [inaudible]. Allow for more sustainable responses. Thank you for the opportunity. Thank you mr. Phelps. I was able to hear you. But your audio is not coming in. You may want to see if you can have a different microphone. And when we start answering questions. Thanks witnesses, mr. Greg burrell. Former director of the Strategic National stockpile. Prior to that he served as he was director of administration and resource planning. Senior disaster logistics official. Hes the president of the consultant for hampton grace llc. Guest im honored to continue to support this Critical Organization by testifying today. And the privilege of serving as director almost 13 years rated on the pillow the National Academy of Public Administration. And as chairman johnson noted, present at hamilton grace lc. For more than 20 years, protected national Health Security and suppository of calvert threats. Highly specialized capable organization. This urgent such as those nationwide pandemic events, are constrained primarily by a lack of funding. When s s was established, as National Pharmaceutical stockpile, the design was developed the response to Chemical Biological radiological and nuclear threats. By december of 2019, round a billion dollars. Over time s s is tightly specialized conceptual medical logistics capability became apparent cross government. Its expanded uno handson mission for Administrative Mission free, and actually experienced mission. Social even expectation cannot occur without increase in funding. Appropriations has not kept pace the growing burden to expand inventory. In capability to about all hazards. The statutes require threat review. And drive the decision to drive this mission. To review the Public Health Emergency Management counter measures. They comprise of the cross government and disease threats, and other specialized medical and scientific areas. The recommended to be held. The top Level Committee hi led by the hhs secretary spots the director cec, and i and other highly senior officials across government. This group made the final decisions based on the recommendations. But because appropriations are limited to prudence necessary to balance riskbased native cross risk. Also notable that the statute requires s s prioritize products there essentially unavailable. Many are procured or purchased and held nowhere else. These for example the only fda licensed antitoxin, reduce illness during 2015 a break in ohio. Similar but, without s s procurement, these products would not be developed or manufactured. There insufficient demand for these products, mass. The federal government for them to allow the manufacturing. In a lack of National Prep Health Preparedness does not predominantly or any other individual pretty instead as a result of insufficient at levels of government. Manufacturing, compound these problems. In the nation also must rely on a very narrowly medical supply chain. In early 2007 congress authorized supplemental funds to prepare for influenza. Which of the products developed in the process were used, each one in one can include. And additional funds were never never reauthorized. The state and local and tribal and territorial Public Health or another ppe, Public Health preparedness puzzle. They have a vital role to play. These levels of government are responsible for planning in response to the unique jurisdiction. So federal assets can be called upon and used directly with other options a friend out pretty hard to the 2009 each one in one emergency response, many states have their own stock. These were ultimately disposed of lately because of the declining funds. Public Health Overall must be consistently robust. The long history of heavily investigating a Public Health when square there is a problem. The from the remote from the significant efforts, to funds often. The way forward must include more consistent mandatory, greater emphasis on publicprivate partnerships. Better prepared with government and private sectors working together. I will welcome the opportunity to work with the panels to and Congress Another stakeholders to improve this Public Health preparedness. Thank you again for the opportunity and participation today. Thank you. I dont think theres any doubt there were going to have to provide more funding for the Strategic National stockpile. But i think the first step, i think its incredibly important step, it needs a Mission Statement. Designed and codified and are articulated clearly. The current, the only one we can find a now is on hhs website. It is not but let me read the current Mission Statement for the s s. The Strategic National stockpiles role is to supplement state and local supplies during Public Health emergencies. Many states have stockpiled has chronic stockpiles as well. But im not sure this was true. This applies medicines and devices for lifesaving care contained in stockpile can be used the shortterm stop gap buffer. When the immediate supply of adequate amounts of these materials may not be immediately available. I think we just described it with the is. Strategic National Stockpile implies weve got this massive amount of well thought out supplies and then weve got this adequately stocked. To handle a pandemic. Theres nothing in the Mission Statement that even talks about the level of supplies that we need for a massive pandemic like we are going through right now. So that is the role that we expect at the stockpile to play, we need to articulate that. We need to codified that print is so from my standpoint the first of his as congress, we have to articulate the Mission Statement that we intend. We need to assign the proper roles between local state and federal government, then the next step is to really lay out that list. I want to start with a mr. Ralph, was there a different Mission Statement when you are ahead of the National Stockpile. Has this been modified or reduced. Guest thank you for the question. I think that you describe the situation we find ourselves in extremely well. Originally, we were working towards building stock. And to respond to biological terrorism chemical and Radiological Nuclear events. What we have seen over the years is more more emphasis have been placed in the Strategic National stockpile to be prepared for all hazards. Unfortunately the funding is not followed to the preparing for every hazard particularly in nationwide pandemic. We have been able to do is concentrate on primary mission we had from the beginning that is establishing material that really dont exist anywhere else. And we have developed capabilities to be able to respond to those types of events. And theyve been used well also to respond to national events. We responded nothing to successfully to the h1 n1 pandemic. Really comes back to an issue of what is the emphasis that the congress chooses and how can it be funded to meet all of the many requirements that is called upon. Guest again, i want to talk about at what level. To be the sole supplier. To stockpile or have Manufacturing Capabilities to provide every mask. Is there no response ability for the state or government to stockpile. I think there is such a lack of clarity when the Mission Statement is. We have been stockpiled. Do you agree at first step we have to define the mission of what the sns is going to be about . Unless we really know what its mission is, what its role is and what roles are, we are stillcompletely blind and will come up short. I cant hear you doctor gerberding. That is exactly what i hope to emphasize in my written testimony and my oral comments. If we dont have a consistent and clear strategic intent that the whole of government agrees with , and when i say full of government icy mean local, territorial and tribal, not just federal we are bouncing around from the last crisis to the next crisis and not consistently building that level of preparedness. Thats why one of the main recommendations from the cfis report is we establish permanent leadership at the level of the National Security council who has accountability or articulating among other things the strategic intent of the Strategic National stockpile to support the level of Health Security our nation intends to achieve. We have a number of different situations whether its cyber or bio defense and now here it seems like the recommendations of these commissions have been consistently somebody has to be in charge. And i dont disagree with that. I dont necessarily think its going to be that person to lay out this Mission Statement. I believe this fall to Congress Working with the administration and possibly that individual to codify what the statement isso that Everybody Knows what the role is, what the level of the role is. I agreewith you. I agree the National Strategy for Health Security is the responsibility of the National Security council but congress is the bill payer and obviously in order to build the stockpile that we need Congress Needs to access strategic intent in support of the nationalsecurity agenda but nevertheless it would be a great help to have that clarity and consistency from the congress. Mister thirsting, i appreciate your testimony. You laid things out quite nicely. Once weve established that Mission Statement we will then have to identify the items and figure out certainly what the inventory levels and the action capability needs to be, but i think you hit it in your testimony. This shouldnt, i dont think they should be filling a bunch of distinct warehouses. This needs to be the entire supplychain and figure out exactly how this flows through that , at what level do we have excess inventories and how do you keep rotating stock . This is actually a pretty complex logistics problem, would you agree with that . Absolutely senator, i think you hit it right on the head and i think were having a discussion about the sns and we are focused on this particular program and set of facilities but i think it goes broader than that. Its actually understanding where supplies come from and making Strategic Decisions about how to satisfy the requirements we anticipate. There is not enough money unless we completely redid lots of different programs in order to outfit for every envisioned scenario but what we can do is understand where supplies and equipment, reagent and such will come from and being able to map those in and determine what are those chokepoints that we need to resource or have manufacturing here in the United States . What are those we can outsource . We need to understand the timelines in which we can satisfy those so i like to see it as part of a broader discussion. The sns decision as essential starting out but we also need to on all sides of that talk about things like stockpiling and direct contracting and warm production lines and procuring large quantities. We need to have an agreement with the state and local in terms of what are they going to do and what are the federal responsibilities . Its very important so that the expectations on all sides by all stakeholders including industry, its an absolutely essential stakeholder needsto be able to come to the table and talk about how they would assist in this process. Im out of time but let me make my final point. I think we have to change the name of the Strategic National stockpile, i think its misleading. That will be one of the components of what we need to do. We will need to stockpile some things but this is more a coordinating role similar to fema where we rely on local governments to do what they can do first when they cant handle it. States step in and when they can handle it the National Government steps in so theres certain things only the federal government can do but its a coordinating role so as we look at legislative fixes i would first suggest we need that Mission Statement and we need a new name because otherwise we will continue to mislead people and have them believe that literally there is all this ppe sitting there in stockpile and why dont we have our fair share . Why cant you supply us everything we need . The frustration and its a legitimate frustration but its because we dont have the supplies to meet the enormous demand in this type of situation andwith that i will turn it over to senator peters. Thank you mister chairman thank you to each of our witnesses for your very comprehensive Opening Statements and i appreciate your testimony here today and i want to spend time focusing on the supply chain which has come up repeatedly in testimony as well as in some of the answers to the questions from the chairman so my first question is to mister burel. Certainly this pandemic has exposed our countries reliance on Foreign Countries to provide critical medical supplies to us and particularly china which manufactures critical drugs and medical supplies. In fact last year i released a report from this committee identifying vulnerabilities and called for action to address what is fundamentally in my mind a National Security threat given our reliance on these foreign entities. My question to you mister burel is as former director of the sns for 13 years, whats your opinion on our reliance on foreign suppliers for critical drugs and medical supplies and what steps specifically would you believe we should be taking to address this threat . Senator, im as concerned as everyone else on our reliance on foreign produced projects. I think this is a significant issue we face in this event but in all events as well. If something disrupts that supply chain outside the United States we cant do anything about it domestically. We have a significantly worse issuethan we would otherwise. Some of the things i think we can do is encourage manufacturing to come back. [inaudible] i think we also have a responsibility to expand the publicprivate partnerships so that we can understand what its going to take to get the private sector to come back and do more manufacturing and how they can create more robust capabilities themselves whether it be more manufacturing, additional security stocks of finished products, additional security stocks in the drug world of active pharmaceutical ingredients so i believe we must encourage continued relations with the private sector and that strong comprehensivecooperative play so that we can together find the best way forward not just for these events but for all healthcare needs in the United States. Many are impacted by the situation you describe. Thank you. Doctor gerberding, the same question to you. Do you have any recommendations on how the federal government can work more effectively with the private sector to address this National Security threat . I do and i think wehave to make known what the requirements are going to be. That the federal government in coordination with the state local tribal territory governments sees as what will be required for a pandemic. Or for any sort of event that we intend to have the sns for whatever follows, whatever we intend to have as the set of scenarios but i guess it all comes down to really mapping this out very methodically and understanding the types ofscenarios that we intend to be prepared for and building resilience and flexibility into the system. This virus has been very different then say what we faced in the h1 n1 2009 or during ebola. And if history is any indication, we need to design it with a great deal of flexibility. So i would saywe should rely on us innovation. We should get with stakeholder communities including the private sector and we need to figure out what their capacities are. In some cases we do need to have lines available that can be turned on rapidly. We know if its going to be a Global Pandemic we will face the exact same set of circumstances with the global competition which is unhelpful , but its a matter of whats going to go on for other nations to try to get supplies that they might need so we need to be prepared and build in resilience. Make no mistake though senator it will cost money to prepare for this and we have done this in other areas where we have prioritization and we should do it for global Public Health or for us Public Health as well. Very good and to the point about half how we have to have moreinformation i think is significant and my understanding is that after , we do not have the information we need to inform planning for the Strategic National stockpile or protect Critical Infrastructure such as essential manufacturing plants that we may have in this country. For example we should know the location of where those manufacturingplants are for some of the active ingredients, the apis and other critical drugs. Ive introduced legislation called the heart act which would address this by it actually requires the fda to share certain manufacturing data with asper and the dod to help serve the drug supplies so maybe your comments on what would Additional Information required by this act, how would that help us prepare for future pandemics and natural disasters as well. Im going to ask youto comment as well but first your comments. Youve been certainly focused on the lack of information and id loveto have your thoughts. I think you hit it right on the head senator. We need to understand in the same way that other corporations who are providing the supply chain support. I wont name them but i think we all know who many of them are. They know who their suppliers are real and they know what happens and what their leadtimes are and what happens is if the supply chain is disrupted so they have developed a Business Model that makes sure that they dont ever run out of those things within the supply chain. And we need to do the same thing. We need information. One of the problems that occurs interestingly when you have the transition from cdc to asper and then during this immediate pandemic to fema providing some sort of support and an interesting outcome was that it wasnt clear that fema new where all the doc outages were so they didnt have the initial understanding of what was remaining in thestockpile. Fema is good with management and logistics, but they do it for the sorts of supplies they typically rely on for naturaldisasters and such. And this is a very specialized set of requirements that is inherent in that sns so not having thatinformation is like trying to make allocations with blinders on. Thank you and im out of time now and miss burel we will get back to you to get information. Id like to get your viewpoints aswell but thank you for your testimony. Senator portman. Thank you mister chairman. I want to thank you for having the hearing and for our witnesses. This is a critical issue not just with regard to the pandemic but going forward, we need to change our approach. I agree with the chairman that there needs to be a mission that is clearly defined. I also agree and was struck by doctor gerberdings comments about the lack of Accountable Leadership. Ive experienced some of that in dealing with issuesof ppp. When you go from cdc to asper to dhs to fema, there is a lack of consistent leadership and certain accountability and i know theresinteragency groups as an example , mister burel talked about that deal with the contents of the Strategic National stockpile but the problem is there doesnt seem to be consistent and accountable Performance Measures are not in place to be able to keep people accountable. So a mission is a good idea but leadership to me is critical. I wonder doctor gerberding since you raised that issue if you could comment on what that leadership might be and perhaps mister burel youcould comment on that as well. Doctor gerberding, are you there . Im on. Can you unmute me please . You hear me now . We hear you. Tell me what your solution is in terms of leadership. As i tried to express people think of the stockpile as a warehouse of stuff we buy and store but it really is a capability and there are different aspects of capability and they may not all need to be under the same roof. Example asper probably is the right place to do the contracting and procurement for countermeasures that need that nih close interface for decisionmaking and management of those contracts and processes but the stockpile utilization and planning is a very operationally driven effort. To me thats why you have operating agencies like the cdc who are intimately connected with the users of the stockpile and is in a great position to beable to understand what what are we aiming for, where are the gaps and how do we plan , exercise, deploy and improve our ability to make sure the stockpile does meet the local requirements. In my world i think the accountability for the operation of Development Management exercise and deployment of the stockpile is best suited for an operating agency like the cdc but aspects of the contracting and pure government of these new and novel countermeasures and things that my might be on the innovation for upfront, that the things that asper and barber are designed designed to do well so it wasnt a onesizefitsall illusion but i think you can hold the accountability to the leaders who are responsible for their specific Performance Measures and requirements. Im going to ask you to think about that a little bit because you said leaders plural. If no one is in charge, its very difficult to hold one entity accountable. I would challenge you on that and i think cdc if you said operational,it certainly didnt work this time. So i would challenge you to just give us some more clear guidance as to how you get what you identify because we need assistance, Accountable Leadership. And i quickly come back to, thats why we need a National Strategy and i do agree. One person needs to have accountability. My own viewis that person should be the director of the cdc because thats been my experience and framework for that. I think its that having an accountable leader, plan horizontally and make sure you execute vertically the appropriate measures of success. Thats helpful. I will say im also intrigued by what ive heard today about our lack of understanding of the needs for a pandemic like this but also the reality that with regard to cdr and, Everything Else out there stockpile was supposed to be poor initially including a Nuclear Attack lets say. Cdc may not be the right before that the centers for Disease Control, not for a biological or Nuclear Attack which would be more of a war footing. We need to do thinking about that and figure out what is the right leadership model to go along with the appropriate strategy. With regard to this issue of ppe and the stockpile, my great frustration is we dont seem to be doing obvious things to be able to restore our ppe and i would ask the question i guess of the entire panel here and see who would like to answer but you agree one, we need a reliable source of ppe in the stockpile and therefore do you agree that maybe we are to be reassuring ppe, not all of it. Depending on again what we find is the real mission of the Strategic National stockpile but enough to be reliable. Something like a Global Pandemic you cant rely on Global Sources that you might otherwise because they need the ppp also and we learn that in the past few months. I have frustration with the executive branch providing longterm contracts because or domestic reassuring to have a market signal that youre going to have a customer and that customer will be the us governments in terms of stockpile and at the National Level. It may be the states, maybe even some private sector entities that are giving responsibility here but we dont have now. The oa is issuing contracts for 90 days right now so my question is you agree that we need to get industry this clear signal to build up our capacity and do you think that isnecessary to have a reliable search capacity. Youre on the video sowhat you think. Start by saying that we have to understand from the standpoint of pethat we are supply constraints, it doesnt matter whether its in the stockpile or the Healthcare System or the state. We have a supply constraints that is the first and foremost thing we need to concentrate on remediating and i agree that the more we can build out our National Capacity in that regard the more secure we will be in the context of a Global Pandemic. Your other point about longterm contracting agreement more. As the company just got an bola vaccine license and are under contract to fill a certain number of doses for stockpiles, what happens when that and . We built a factory to make this vaccine and were sitting with Vital Capacity because there really is no future there. You wont have the investment and i hope the other panelists, my time is up but me say today i am sending a letter to dla along with three other republicans and three democrats asking for them to change their policy with regard to the 90 day longterm contracts so us companies and big bad investment to bring ppe back to our shores. You mister chairman. Is senator harper ready . Could i ask unanimous consent that b made part of the record . Absolutely. Senator harper, are you available . I dont know who i do these witnesses but it reminds me of 1930. [inaudible] nice work. I am reading through the testimony, rereading during this. , ive been looking and doctor gerstein, we made five recommendations and im just going to repeat them. What im going to do is ask the other witnesses and have been what we would do on any ofthese five recommendations. Thats going to be my question. First recommendation that you make is reexamining the strategicNational Stockpile. And let me just say, for those of you who agree with that, raise your hand. If you agree with that recommendation, raise your hand. Some of you are raising two hands. Second recommendation you make is develop a Strategic National supply is developing a National Supply chain approach and maybe you agree with thatwould you also raise your hand . Okay, thank you but there is to release Public Health funding. Would you please raise your hand. Mister persing, you do not agree with yourown recommendation. All right. The first one is to develop the Vaccine Distribution system, and weve got two hands on those. Good. Finally to reestablish us leadership in global Public Health and do you agree with that . Good. All right. Good, weve got a lot of support here. Its always good to hear, senator. I wish i could do that well amongst my colleagues. I have a couple other questions. Next question is for all of our witnesses. Just take a moment to discuss the importance of oversight. Thats what we do, that what they paid the big bucks for and id also like to appoint high risk as our to do list. Here in this congress, eeo provide this committee every two years, you sort of agreement routine information that help us do our better jobs and electing oversight. The National Strategic stockpile has been managedand overseen by several different agencies. And it appears that effective management would require agencies partnering with each other and with congress to ensure that the stockpile as resources and management sponsor of the national. Questions and for all the witnesses read additional Action Congress and the administration inserting to ensure that effective oversight of stockpile is being conducted on a regular basis . Anybody want to take a shot that . Ill start with doctor gerberding. Thank you and i dont have a short answer today but as i do cochair the csi estimation i would say that i with former senator ayotte oversee a panel of some incredible expert but also some members of congress in both the senate and house side. Senators young and murray and Congress Representatives asher, cold, barren and ive forgotten my fourth mentor, i apologize but the point is that we are wellpositioned to be able to perhaps provide some advice on that issue. And we would be interested in it. Thank you. Next question, what additional action should congress and the administration to ensure the effective oversight of the stockpiles on a regular basis, mister burel. There are several Different Things that can be done. I have a fellow at the National Academy of Public Administration and nasa has done a good job making recommendations tocongress about how to manage government programs, think about government programs. Napa might be a source to get involved in thinking about these things. One of the things i would suggest is the good thing about the oversight, particularly with making people more aware of what the sns does and what the sns needs and how to move forward so i think to address a comprehensive oversight structure beyond what exists today as doctor gerberding suggested we want to come back to you with additional thoughts on. Had asked her other two witnesses to answer that question for the record and i have a different question relating to cios. Ive asked mister persing about organization, the task is regularly reviewing the stockpile and its ability to respond to a National Emergency. [inaudible] senator, this is dan bursting. You were thinking about should an organization do periodic reviews and is in answer to that i would say having been subjected to many of you during my service in government i would say absolutely. Especially given that we are talking now about redefining what the sns is, thinking about turning into an element within the National Supply chain for Public Health equipment and supplies and all of that is really something that is going to require somebody to take a look at. On the issue that you also brought up that had to do with and i use the military term and that is commandandcontrol, its going to be important to understand that cao is wellsuited to look at this and to determine if things are moving in the right direction with respect to whos going to be in charge, whos going to have oversight and the authorities to be able to manage this process. Same question. Are these organizations tasked with reviewing stockpiles to respond to the national dispensation. Absolutely. I think it would help withidentifying performance metrics , evaluating performance metrics and expectation management at the state level and local level and you can expect. [inaudible] i dont have use, i think that might be a good idea. And its something we can do on congress that would help with yours. Im sure they be instituted. Thank you. Appreciate that, justso everybody is aware , scott and rosen, langford, holly, ronnie and hassan so senator. I want to thank you chairman for organizing this and i agree with you. I think it starts with coming up with a order of what the mission is and if you have the right mission and you have the right funding and you probably get a good result. I think in my years as governor of florida we went through a few hurricane and we didnt just sit and wait for the government to show up, he created our own stockpiles for food and water and parts and things like that to make sure that we were prepared because we didnt, you cant expect Something Else is going to be able to take care of you. I think we had a lot of people up front of the country to try to figure out how to put ourselves in a better position for the next pandemic while theyre also trying to figure out how to make sure we have all the right protective gear with this 10 and. I know as i talked to some of my friends in the Healthcare Community struggling with getting the right protective gear and part of it is all being controlled by fema which might make a lot of sense but change how we do this. I think all of us on board we cant trust china. Its communist china. We know now they are adversaries and im very concerned that we do anything in the future that continues to rely on communist china before and are part of our protective gear or our pharmaceuticals or anything because we knowtheyre not a reliable partner. I think we figure out how to reduce American Goods and also have american copies ready to time that we happen next pandemic. So i propose i have a bill called the make americanmade protection or healthcare workers and First Responders and basically what it requires is whether its through stockpile or whether its through Companies Getting ready in america we build up american capacity to take care of our First Responders and deal with the next pandemic. I want to get you all feedback on how important you think it is to reduce our reliance on honest china and how important it is to help picture those through stockpile or whether its through having american companieswrapping up that we have American Made products ready for the next pandemic. Senator scott i appreciate your question. I think its vitally important to our preparedness overall that we ensure as many of the products we need for an official healthcare be made in the United States so that we can control the supply chain better. So that we understand how to protect it better. Weve done some work withthe Healthcare Industry , and locations of manufacturers we cant reach back to active pharmaceutical ingredient manufacturers for example or some constituents moments of divisiveness outside the United States. I think we need to have as much capability in the United States that as we possibly can. But weve got to work with the private sector to understand what its going to take to bring. What they need, whether the longerterm contracts for which i also support or anything else that we need to do to help encourage them to do their work with the federal government and forthe public. I dont want to do that and i would say if youre to your comment about femadoing fine, fema and a great partner for the sns and anyone else. As has been said previously, some of these are unique items and to try to find the right things that are licensed and appropriate for use in hhs and sns are best qualified to help direct and particularly to direct how we work this bringing manufacturing of those critical items back tothe United States. User. Doctor gersting, ms. Gerberding, what you think about our reliance on communist china and how the importance ofmaking sure it americanmade products . Ill start off and i mean, i certainly agree that we need to tailor the supply chain and understand those critical elements if you will that are on the Critical Path to be able to have the capabilities that we need for our future pandemic. I would try to inject just a bit of a dose of reality on a couple of things. The way our supply chain is still not with respect to things like active pharmaceutical ingredients, some of the ppe, these have been made through economic decisions essentially have been turnedover to industry. That is those that are providing healthcare so if those kinds of commitments are to be made, its going to be more than just putting out a pronouncement. It also has to do with looking at subsidizing the medical delivery industry to be to incentivize them to want to be a provider, to bring the manufacturing back. We should also recognize there are probably some elements that we are not all that keen to bring back if it can be done more particularly and theyre not on the critical so we need to figure out that Critical Path issues and the other thing i would say is that we do need to think about the International Role in global Public Health or in our national Public Health said another way so while there are frustrations with some of the ways in which china has gone about and with transparency and such, we definitely need to continue to rely on a global system and that was why i recommended in the recommendation about trying to repair our relationships on the global Public Health stage. Mister gerberding. From the commission, i think we are trying to bring Health Security in the same mental model that we used for other elements of ourNational Security. And in that sense i think we might want to have the same outlook on how we manage our critical supply chain that we would if we were thinking about how we fit our department of defense and our foot soldiers. If its in that domain we would not want to be dependent on an interNational Supply chain, i dont think we should be dependent on an interNational Supply chain when it comes to protecting the health of americans. I think thats a good way to think about it because youre not, its no different than buying supplies for our military and trying to keep our public safety. Its the same mission. We should be thinking about it the same way. Miss phelps, did you want to add anything . I think that the reliance on one supply chain has a couple of different policies at the state and local level. [inaudible] on where ppe is going. [inaudible] the masks we were told we could purchase only to. [inaudible] thank you mister chairman. Thank you senator scott and senator rosen. There i am. Thank you mister chairman and Ranking Member or bringing this hearing in and today i want to thank all our witnesses for their lifetime of hard work in this area. For preparing for emergency pandemics and disasters, we appreciate you there and were talking about the supply chain federal response so according to john hopkins the United States is over 121,000 deaths from covid19. Data shows 70 to 99 percent of the deaths fromthe virus so far could have been prevented. However, there is still time to make a difference on how we proceed. Doctor fauci has said we are still in the first wave and with this in mind we must respondto this pandemic with urgency. Our response must be timely and thoughtful. Different parts of the country are experiencing the pandemic different rates. We can and we must protect lives and livelihoods and we have to do better than weve donebefore. It does require a strong National Strategy and a process for delivering peace to all our communities and we should be correcting our actions to be sure that we include that response. So i know we need to improve transparency in the supply chain and of course were all going to recommend that area we should have greater use of a defense production act and our National Response but mister burel and mister phelps, our rural areas have seen fewer cases compared to urban areas but they have felt the real impact of this pandemic and they have huge scarcity of supply. Access to care has been a challenge for the more remote areas. My state of nevada know what recommendations would you have and how we might improve responses for rural areas, critical testing sites, ppe and what changes you recommended in the future . I guess you can go first and mister phelps. Thank you senator. We have long recognized there is a vast difference among states and localities in what their capabilities are to respond. How they are positioned in terms of whether it be material assets or personal assets to respond. Both from a regular Emergency Management perspective or from a healthcare need. I think that we need to continue to create better relationships , stronger ties with state and local government so that we understand better what some of those unique needs of those world localities are. As we might consider urban Populated Areas and how we need to respond to that differently , we need to think about the same thing for rural areas. I think that for the states to be able to establish files are independent of the federal government, as many of them have some years ago to try to help supply those rural areas directly as we bring in more product. They have a better understanding. We recognize state and local have a better understanding of what they need or support from the federal government and if we position them to be better able to afford themselves i think theresponse would be stronger in the rural areas. I actually am going to, senator hassan has a better call. So im going to deal with that. Thank you. Thank you so much. Thank you senator rosen so much for your graciousness and the chair for accommodating my schedule and to all of the panelists, thank you so much for your work in this area. I wanted to ask questions first to doctor thursday, we have to improve the distribution of Strategic National stockpile supplies during a pandemic. My state of New Hampshire so many others bottles to get the basics and when they did get supplies from theNational Stockpile , many items were unusable or expired. Its not enough to say that we had a stockpile area are stockpile have to be sufficient and it has to be uptodate. What best practices to you and that the assistant secretary for preparedness and response implement to ensure that the Strategic National stockpile supplies are adequate but also that there rotated and distributed before they expire area. Thanks for that question. Obviously the location of stocks is a big deal. Its very expensive process, the federal government is spending about 570 million a year to maintain a stockpile which includes rotation, it includes moving things through and restocking where necessary. I would also say that improving the stockpile is also going to come down to things like doctor gerberding talk about and that is last my about training the state and local. Its not that they are, they just have a different focus at the state and local territorial level and one of the things the federal government can do is to assist with training on these very complex medical countermeasures and let nerve agent antidotes and we you heard about the serum for neurotoxin. Besides the training capacities need to be pushed from the federal level down to the state local trial for and one of the calls i would have is once we get into position, once we get the stockpile away we want, we need to decide stress to make sure its doing what we think and that all partners, allstate partners can deploy in confidence. Thats what i would be interested in seeing. For the answer and one mister question to mister burel, the stockpile consists of a variety of items on the shelf. Some needing refrigeration and most requiring regular rotation before they expire as we discuss the sns maintain a database ofevery item in the stockpile including expiration dates . You maintain that information in a National Database that we rely on or the kinds of products we do and we also invest in ensuring that we can extend lifespan where it is scientifically proven that we can do that particular drug as long as possible to protect the nations investment. The other thing that would help us is if we have the ability to lets use the term set off stock as it near its expiration and realize the advantage of selling off that stock so we can invested in new stock. Right now wedont have that option. Thank you for that answer and it begs the question about why the ministration has failed to provide a clear picture of the local punishments over the last few months but illtake that with them and i thank you for your service. Senator milford, then will be calling misterromney. Pc up on what senator hassan was talking about on expiration. Because thats an issue that needs to be resolved longterm. Mister burel we mentioned before about the authority to sell off, theres too much here we talked about frequently this is not a big warehouse was for things at this point, its not that structure. Selling off things is one way to do this. Managing thestockpile in another location , that is going to produce, that they actually manage it and they do a regular rotation to be able to move allocation is another way to do it but you try to determine whatthe right way to do this. And then be able to ship that once he gets close to expiration so we can sell it with a loss. Or be able to maintain it in other locations and theres a normal return there. Already engaged in what you describe. We call it managed inventory but the problem is much of the material that we hold we hold in greater quantity that the market cannot absorb the rotation of that materialon a regular basis. We have to hold those quantities to protect the us and as we discussed in the pandemic it seems like weneed larger quantities. So i think that there is a lot of logic inducing their inventory accents and we actually got a lot of work in the National Stockpile i was there to do analysis of where that managed inventory works well and versus the government owning itself and then trying to dispose of it in some other way. Using the legislation for those resources on we can sell for expiration. We need legislation would allow us to sell off products before it expires but also to realize income and have it not go back to general funds we can use that to buy replacement for that product or by the next generation of products in line to buy whatever else the day. So i think its a reasonablerequest and its something our commission to be to work on as a result of this hearing. Next that youre proposing on or is it just an idea that you propose. I have proposed previously and i will sendyou under separate cover. We appreciate very much how do we avoid the pendulum swing that is always inevitable that Strategic National stockpile is not just about a virus pandemic nationally occurring, obviously theres a lot of other issues that we focus in on. The National Pendulum swinging here as we were ready for this so lets do whatever we can take our eye off the ball in other areas. What are we doing to be able to turn and statementshe strategic on all areas , not just overcompensate for one. Again is an excellent question. We get concerned about that and weve always been concerned about not having enough money to cover the entire known threats including pandemics. I would suggest that we consider making the Strategic National stockpile or the central organization, whatever we think we need to do mandatorily funded at a minimum level to be able to manage and rotate requirements at the time that mandatory appropriation isset. I think we can continue to grow the stockpile jan that. I think there are a number of things that can contribute to that whether additional supplemental appropriations and new requirements that cannot be covered in a mandatory appropriation, whether it may be for example setting a capability for the stockpile to receive donations, from philanthropic organizations to reinvest the sales up already and soon. We talked before about supply chain and thats a significant issue for all of us. Ive seen some for our military for instance where its not just the manufacturer of the parts, the plane, whatever it may be, the product. Its the products that go into that product keeping the supply chain and who manufactures and start working their way back to be able to identify. I would hope theres a process in place already like that that you are working through and its not just whos the subcontractor, we talked before about precursor chemicals for pharmaceuticals but the most obvious issue at this point because obviously we are dependent on communist china for a lot of the precursor chemicals, it might not be the pharmaceuticals but the chemicals that go into the pharmaceutical from their. It might not be the product but the Rare Earth Minerals that goes into that product 60 to 90 percent from communist china. So how indepth are you going as youre pursuing the supply chain . This is something weve struggled with for years and were trying to make in roads in this area. Much of that supply chain beyond the net proceeds that still finished product is extremely opaque to the federal government and to the Strategic National stockpile in particular. We understand that many private firms want to closely hold the information about their ultimate supply chain all the way back to the earliest item in that constituent product, but weve got to understand better what that comes from. So how only then would we be able to say to you we are particularly concerned about this product because the only active pharmaceutical ingredient availability comes from china or some other location and we are concerned that we may not be able to get it. We would need your help, allow the Strategic National stockpile to reach data they hold and possibly ask for Additional Data around things like what is the api force of all these critical products but with the authority to insist we get that data and i know that is concerning to private sectors. Do you believe you are the organization that should have that or is there someone else that should manage that supply chain and a little visit to you . I think the sns could do that work but its got to be expanded to do that work. One of the reasons i think its well placed under the assistant secretary for response is it can work across that organization with marta and the products that theyre buying in that death to be commercially available products and with the commercially available structure that exists, maybe combining that with the sns to figure out how best to understand that supply chain all the way back to the earliest precursor products in. I would hope we could do that and lets try to work on authority to break down barriers and try to get access to that information. Political entities have to be prepared for the ppe, weve got a lot of hospitals and clinics and only day supplies there, they also were prepared for this and there was a wide assumption that they would be able to get ppe when they needed it proved not to be true and so we are grateful for what youre doing and helping global institutions prepare for the next time as well so thank you. Senator holly. Thank you mister chairman andthanks all the witnesses forbeing here. Mister burel , i want to ask if i could couple of questions about the stockpile levels and replenishment after the ace one and one pandemic. In the late 2000, youwrote about this in your testimony. About the factors that affected replenishment following the line up rick. Ive seen reports that the pandemic drew down 100 billion masks including and 95 respirators from the stockpile, do i have those figures right . I no longer have access to that data but i believe your numbers are about correct. Its also my understanding that a federally sponsored h1 and one task force recommended replenishing those masks in supplies, is that your understanding . Do you have any idea why those Task Force Recommendations were not acted upon . Its a matter of available appropriations. All those were made with supplemental Funding Authority that we were provided to prepare for a pandemic funding after we used those products was never really authorized and never received funding to do that again. So we closely guarded but we had available in the event that it neededto be used again. We need more funds to be able to address our interest as well as emerging infection france. Let me ask you more about the funding. Back in 2012 i believe it was hhs secretary at the time was asked to explain the rationale for why the administration, president Obamas Administration was proposing putting 48 million out of the stockpile funding. This is a House Appropriations Committee Hearing and she responded that resources be focused on replacing expiring countermeasures such as anthrax treatments. Which i think we probably all agree are very vital, im wondering if you think enough attention was being paid to restocking ppe. At that time did you ever get the sense that when it came to the stockpile that in the balance of things ppe was being prioritized western mark. What we try to do is prioritize as best as we can do across levels available. We look at those emcees that i mentioned earlier help us make those priorities. Reality is many of the drugs we need for those, would never be produced and would stop being available if we didnt invest in those red unfortunately when we do that , it leaves limited Funds Available for many of these expected to be commercially available items like ppe. Your question, i think that we have to prioritize both. But the problem is support is able to do that. Do you give up buying drugs, they will not be made that we also see we need moreof the commercially available products. In your view what should have been done differently following the h1 and one pandemic to adequately stock the stockpile, particularly when it comes to these vital dvds. I believe that we should have had available funding so that we could buy what we use and replace that. Maybe thats something we need to think about legislatively. Such that every Time Products from the sns are being automatic, replenishing that. I also think that we never achieved the full amount of products to be prepared for a complex pandemic such as we face with covid19. So there were additional funds needed then. Very good, thank you for that and clearly as you look back theres a lot we can learn from this recent experience but as we look back at about choices that were made in the past, we arrived at the present crisis clearly at a deficit and i think weve got to take steps to make sure that that does not happen again particularly with something as basic as pde which was not adequately provided for in the stockpile and thats a big problem. Let me switch to you if i could. I like to discuss more visual that sns for a place in our crisis response. The chairman and my colleagues raised issues about the stockpile commission. Something that but lets talk about it just a little bit more. Youre right in your testimony we need an effective balance in the stockpile mission and you discussed covers Public Health threats and biological chemical Radiological Nuclear threats. Can you elaborate one what you think that balance is given the resource constraints that mister burel and i were discussing customer. I use the expression the tail lighting the dog and i just think when you listen to gregs testimony, hes basically saying the same thing. We had a finite budget so we build the stockpile to utilize the budget but we dont necessarily know the stockpile to address the threats that implicit or explicit are on the table and part of the planning scenario. So the history of the stockpile as lead between one point of view but another but i think always in the background intent was to see, to be assured that the stockpile was able to handle the cdr anthrax. And thats thin as greg said, thats an area where if we didnt invest federal dollars windows countermeasures we would not have those countermeasures and we are not done yet. Ideally in my point of view thinking about those bioterrorism or achievement, terrorism threats, is that we need to be thinking not whats the countermeasures for this but really what can we do to take the pressure off thetable . That mentality is not afforded by the current budget approach that we have the Strategic National stockpile. We have revealed how horrible we are to those kinds of threats. I dont think the terrorist threat is any less today than it was in 2001 when we were dealing with anthrax. In your experience doctor when you think about the role sns plays, Public Health, i o terrorism. As one of those been given priority over the other in yourobservation . Independent of the Strategic National stockpile alone i think broadly speaking we fight the last war. Creating a separate stockpile for the procuring an appointment at ppe in the disease outbreak or a. I dont think that would really help things because ppp would depend on the physical so its hard to drug dividing line in the capabilities and planning and exercising for that are going to apply too much broader set of issues so i think by fragmenting that out you would create to some extent an overlap between the ppe you need for covid in the ppe you need for amtrak so its hard to separate them. Given the fact that ppe was not prioritized after the last major pandemic and we entered this crisis at a very significant deficit of which until this time have recovered from and given your testimony about the lack of available funds to do her thing that you would like to do when creating a separate authorization and funding stream be something that is useful . Its always worth looking into. I do want to emphasize however the ppe bottleneck is a supply constraint and in order to improve the availability of those materials we really have to create the capacity in the market for us to collect an inventory and right now those products are climate sized and purchased justintime inmost health care settings. They count on the availability of the turnover so suddenly theres a surge in demand. Theres no pipeline that flows into it so the stockpile has to create a bubble in the system. That wont be efficient as greg has pointed out because materials will be at risk for x3 but if you are trying to build a stockpile for efficiency we party lost the battle. I see my time has expired. We will follow up with additional questions in written form. Senator sinema. Thank you for this important discussion and i want to thank our witnesses for joining us to discuss the National Strategic stockpile and its role. As you know we are growing hotspot. The number of confirmed cases positive testers and hospitalizations have increased dramatically since the end of the stay at home orders in the middle of may. We have lacked sufficient supplies of protective equipment. Of course it significantly contributes to our state crime. We are in the bottom quartile of states according to data from Johns Hopkins University Pet that leads me to my first question. When we lie at realize that state and local supplies of personal protective equipment and allocations for the stock i would be grossly inadequate prayers on a coronavirus respond i moved to help her local manufacturers which their production line in making ppe. I was inspired by the dozens of local businesses and manufacturers in arizona that shifted or retooled their production and Manufacturing Capabilities and began putting face shields massa gowns Hand Sanitizers and other needed ppe. These are Companies Like wl or t. Why are tactical and prs. Our breweries and distilleries began producing Hand Sanitizer for First Responders and local businesses. Arizona State University and entrepreneurs like tempe have used their 3d period theres to help produce nasal swabs in the face shields in to stand up the community. My question is how do we make it easier for the stockpile as well as stay local and federal government to cut through these domestic suppliers to step up during a crisis that dont normally produce these items during the regular course of business . For your question the recipient of several questions from Small Businesses that wanted to try to help and many of them want to try to do it in a philanthropic way than anything else that they knew they had the capabilities to make Something Else and they wanted to be able to donate those for use where they were most needed that one of the things we need to do is we need to continue the ongoing outreach for Strategic National stockpile. Maybe we need to think about how to align that audience from that health care that we talk to very frequently to other businesses. The thing that would be helpful is ive been able to watch over the years foundations orthopedic commission so to provide for the Strategic National stockpile to happen capability to work with the foundation dedicated to Strategic National stockpile to help look for the philanthropic and new capabilities and so on and bring those to the stockpile or directly to state and locals when they need it and it would be useful as well. From my perspective here in oregon we have been overwhelmed with outpouring support from private sector partners. As you saw in arizona we saw what distilleries producing Hand Sanitizers creag we saw are athletic Manufacturing Companies producing face masks. A lot of this equipment wasnt meant necessarily for medical use but for individual citizens for cloth face coverings and some of those individual protective measures. I think it empowers us and these private sector partners early on. Allowed manufactures to meet with new outreach for those manufactures. Also oregon has 4 Million People and its a drop in the bucket quite frankly and we rely a most mask producers for medical grade equipment to attack their First Responders but i will say they certainly had an impact on limiting the spread and the Community Spread in oregon. Another issue with a lot of these requests, its a lot of time and treasure tracking down whether they are a viable resource. Everyone knew someone who could produce n95 mask candidates spent an inordinate amount of time tracking those down make sure in we are getting the resources. Thank you. Im going to move on to my next question for dr. Burel and dr. Abner mares on. There were additional supplies of personal protective equipment and ventilators to the highest level of need. Our lack of testing made our caseload artificially low at the beginning of the coronavirus. What recommendations you have on how the stock well and federal resources can establish a better allocation and process that is more fair and equitable and take into account inconsistencies which of course are likely to be present in any pandemic type situation. Thank you. I think there is a situational dependency or because obviously in this case the pandemic didnt rollout around the United States and was initially at least concentrated in certain places that have higher needs and systems were very overwhelmed but i do think its an opportunity for fans planning and exercising could be an extremely informative. I looked at arizona could i know something about the population and the demographics in your state and you and i have talked about that. It wouldnt surprise me at all that they there would be a high need for arsenal protective equipment in arizona and i think that is something that in the process of planning ahead for the kind of situation that recognize would have what a benefactor that could have been better considered in the allocation process. I agree with doctors gerberding. Its very situationally dependent. When things we have at this Strategic National stockpile when i was director of was a strong Health Emergency preparedness level through to a certain extent even at the local level. Unfortunately the decision was made that was that are residing in another organization but that time it lost its direct ties to the state and the localities here to think that we need to reestablish those. The time we did that work we use a tool called Technical Assistance review to really understand what the demographics were, what they would really need and how we can better do allocation of this type of concern. Thank you. Mr. Chairman icy my time has expired. Thank you. Thank you senator sinema and i want to thank all of our witnesses. This is then first of all an incredibly important hearing but also a very informative one so i cant thank you enough. I really want to work with a number of you moving forward on this incredibly complex issue. I think we need to emphasize how complex this problem truly is which is why emphasize from the very beginning, we need to articulate exactly what the National Stockpile needs to accomplish, what those capabilities are, what the responsibilities are between local state and federal government. We start there and then once we have that established the new start dealing with the complexities thank you all for your participate in and look forward to working with you in the future as well as my colleagues not only in this committee but also in the senate or the record will remain open for teen days until july 9 at 5 00 p. M. For additional statements and questions for the record. This hearing is adjourned