Transcripts For CSPAN3 Senate HELP Hearing On Coronavirus Response Future Pandemic Preparedness 20240712

Www. Health. Senate. Gov is our website. I think it makes it possible for us to be table to attract witnesses who have very busy schedules on the same day such as today. Some senators are participating by videoconference. Senators may remove their masks since were 6 feet apart. Im grateful to the rules committee, the sarge want at arms, the press gallery, the capitol police, our Committee Staff for all their hard work to help keep us safe. Senator murray and i will each have an opening statement, and then well turn to our witnesses who we thank very much for being with us today. Each witness we would ask that you summarize your remarks in five minutes, which will allow more time for the large number of senators who we expect to participate to present their testimony. Well have one round of questions for a five minute round. Less than four months ago on march 1st the coronavirus situation was about this. At the end of february there were 79,000 cases around the world, only 14 in the United States except for 39 who had been brought home from overseas with the virus. By march 2nd there were two deaths in the United States. By march 3rd when we had a hearing there were six deaths, and on march 1st on sunday in the New York Times on the front page it said this. That most experts were far from certain that this virus would carry to all parts of the United States and that with its topnotch scientists, quote, modern hospitals and sprawling Public Health infrastructure most experts agree the United States is among the countries best prepared to prevent or manage such an epidemic. Even 6 weeks after the first virus was found in the United States even experts underestimated the ease of transmission and the spread of coronavirus without symptoms. These qualities made the virus in the words of dr. Fauci, my worst nightmare. In a period of four months he said it has devastated the world. This committee is holding this hearing today because even with an event as significant as covid19 memories fade and attention moves quickly to the next crisis. While the nation is in the midst of responding to covid19 the United States congress should take stock now of what parts of the local, state and federal response to this crisis worked, what could work better and how, and be prepared to pass legislation this year to be better prepared for the next pandemic which will surely come. On june 9 i released a white paper outlining five recommendations for congress to prepare americans for the next pandemic. They were these. Number one, test treatments and vaccines, accelerate research and development. Number two, disease surveillance. Expand our ability to detect, identify, model and track emerging Infectious Diseases. Number three, stockpiles, distributions and surges, rebuild and maintain federal and state stockpiles and improve medical supply Surge Capacity and distribution. Number four, Public Health capabilities. Improve state and local health capabilities. And finally, whos on the flagpole . Whos in charge . Improve coordination of federal agencies during a Public Health emergency. Ive invited comments and responses and any additional recommendations for the Senate Committee on health and labor and pensions to consider. I will share this feedback with my colleagues both on the democratic and republican side. This is not a new subject for any of the witnesses that we have today. 15 years ago the then majority leader of the United States senate bill frisk said in a speech at the National Press club that a viral fpandemic is o longer a question of if but a question of when. He recommended what he calls a 6 point Public Health prescription to minimize the blow. Research, stockpile Surge Capacity. Senator frisk is one of our witnesses today, and im including in the record two of his speeches. Our next witness, dr. Jonee c caldun serves where shes worked to coordinate the states response to covid19. The third witness is the doctor who served as the doctor for the centers of Disease Control and prevention under president george w. Bush. She helped lead the effort in response to sars, h1 virus, and the rise of multidrug system bacteria like mersa. He was administrator of epa under george w. Bush. The governor increasingly focused his efforts on pandemic preparedness. As secretary in 2007 he said this 13 years ago. Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate. Thats the dilemma we face but it should not stop us from doing what we can do to prepare. Congress has passed legislation to prepare for pandemics before. During the last 20 years four president s clinton, bush, obama, trump, and several congresses have enacted significant laws to help as well as hospitals and providers to prepare for a public emergency including a pandemic. Congress provided over 18 billion to states and hospital preparedness systems over the last 15 years to help them prepare as well. In writing those Laws Congress considered many reports from president ial commissions, offices of inspector general, the Government Accountability office and outside experts. The reports contained all sorts of warnings that the United States needed to address the following familiar issues, familiar by now. Better methods to quickly develop test, treatments and vaccines and scaleup manufacturing capacity. Better systems to quickly identify emerging Infectious Diseases, more training for the health care and Public Health work forces, better distribution of medical supplies, better systems to share information with and among states and between states and the federal government. Many reports also warn that while states play the lead role in a Public Health response many states didnt have enough trained doctors, nurses and health care professionals, had inadequate stockpiles and struggled with funding challenges. In some instances overreliance on inflexible federal funding contributed to these problems. Looking at Lessons Learned from the covid crisis thus far many of the challenges congress has worked to address during the last 20 years still remain. Additionally covid19 has exposed some gaps that had not been previously identified. These include unanticipated shortages of testing supplies and sedative drugs which are necessary to use ventilators for covid19 patients. Memories fade, attention moves quickly to the next crisis. Four months ago, five months ago we were in the midst of an impeachment of a president. Today that seems like ancient roman history. That makes it imperative that congress act on needed changes this year in order to better prepare for the next mpandemic. I look forward to hearing from our witnesses and i would also appreciate the feedback were receiving on the white paper. Ive set a deadline for june 26th on that feedback so the committee has time to consider it and to draft and pass legislation this year. Senator murray. Well, thank you very much, mr. Chairman. And i also want to thank all of our witnesses for joining us today and of course thank our staff for wrangling the technology to make this hearing possible. I said before we need to understand fully and exactly everything that has gone wrong in our response to covid19. Why and how we work to make sure we are never in this situation again, but i want to be absolutely clear from the start, reflecting how we prepare for the next crisis is no substitute for responding to the crisis at hand which has infected over 2 Million People in our country, killed over a 120,000 and which continues to spread. Unfortunately, the white house is pretending this pandemic is over. President trump has said its fading even as several states see record case increases. Vice president pence wrote an oped saying we are winning the fight and there isnt a second wave. While experts like dr. Fauci warn we arent even through the first wave yet. Admiral girard has stepped down from his role and President Trump is calling for less testing even though we dont have anything close to the testing and tracing capacity we need to safely reopen our community. But its not just officials in the white house who are sticking their heads in the sand. Leader mcconnell and some republicans have suggested theres less urgency to take further action since weve gained some 2. 5 million jobs after losing more than 20 million jobs. You know, as a former preschoolteacher i can tell you even some of our younger students know that math doesnt add up. So i hope we dont just spend our time today talking about hoato avoid mistakes in the next pandemic but instead address the mistakes this administration is still making dure this one and the ones theyre at risk of repeating as the response to covid19 continues. One lesson weve already learned, this crisis is no great equalizer but rather a force which perpetuates and deepens the injustices so many others face. We have known for decades that our Health Care System treats some communities much worse than others especially communities of color. Those disparities are caused by a long history of systemic racism and underfunding. And those in charge have a responsibility to acknowledge the problem and do everything they can to close that gap. This administration has not taken that responsibility seriously. At best they turn a blind eye to the problem. At worst they seem determined to make it worse as weve seen in the administrations irresponsible rule to allow discriminati discrimination in health care. So workers can stay home and do whats best for their health and for Public Health without fear of losing their job or their paycheck. And weve learned how important it is the department of labors occupational, safety and Health Administration is. They need to stop dragging their feet and finally make clear safety isnt optional by immediately oiging an Emergency Temporary Standard. Theres also several lessons regarding vaccines. We cannot allow the Trump Administration to bundle this like they have so much else. This pandemic will not end until we have a vaccine that we can equitably distribute and free and accessible to everyone. We dont just need a fast process, we need a thorough, transparent and science driven one. We need to know the process is free of political influence especially after the hydroxychloroquine. And the covid19 vax own or vaccines truly meet the Gold Standard families have rely on for so long, which is why the Administration Needs to commit now to being fully trance parent about the Vaccine Development and review process and about the data that is ultimately used to evaluate safety and effectiveness. We also need the administration to detail how it will produce and distribute vaccines everywhere to everyone. Even the incomplete data we currently have shows black, latino and tribal communities are disproportionately impacted by covid19 and have significantly less access to testing than white communities. This is an injustice that we cannot repeat when it comes to vaccines. Nor can we ford to repeat delays like those the Trump Administration cause by refusing to take responsibility for resolving coordination problems in the National Supply chain. Instead of the Trump Administration must work now to draft and release a comprehensive covid19 vaccine plan, the type of comprehensive plan we still havent gotten on testing. One that addresses all of these questions and other barriers like how do we fight misinformation and Vaccine Hesitancy . How do we strengthen our immunization instruct, and how do we build global partnerships in this effort instead of turning our backs on the rest of the world which not only betrays our American Values but also puts people here at home directly in harms way . Mr. Chairman, these are not questions we need to ask before the next pandemic starts. They are questions we have to answer before the current pandemic can end. I look forward to hearing our witness per speskts on all these issues today. And mr. Chairman, i hope in the future, very near future this committee will also get the perspectives of several important members of this administration we have not heard. Secretary azar, secretary scalia, and secretary devos. It is clear we have a lot more work to do to respond to this pandemic, and i urge our colleagues come back to the table so we can work on this together. The Public Health crisis of covid19, the economic crisis this pandemic has set in motion and of course the persistent systemic inequities driven by racism are urgent. Our nation cannot keep waiting. Thank you, mr. Chairman. Thank you, senator murray. Each witness well ask you to summarize your statement in five minutes. Well have more time for questions. I welcome our witnesses. Its a distinguished panel. We look forward to hearing from each of you. Its my privilege to introduce the first one. Senator bill frisk with whom i served and many of us served. He represented tennessee for two terms in the senate. He was the majority leader of the United States senate. He served on this committee in the United States senate. Hes a heart and lung trance pl plant surgeon by training. He now serves on several boards. Hes senior fellow at the Bipartisan Center and chairman and founder of health nashville. In 2005 and im sure hell talk about this, he gave many speeches on the inevitability of a Global Pandemic. Ive submitted two of these speeches to this committees may 7th hearing. Well hear from dr. Caldun. She serves as the chief executive and director for the Michigan Department of health and Human Services. In this position she oversees the population health, medical services and aging and behavior of health and departmental Disabilities Administration for the state of michigan. The doctor has extensive experience in state andc c c  and health Detroit Health department. Shes a practicing emergency medicine physician. Our third witness is dr. Julie. She is is executive Vice President and chief patient officer at merck and company and serves as a cochair on the commission of strengthening American Health care. She served as the director for the centers of Disease Control, the cdc, from 2002 to 2009. Under her leadership cdc coordinatedp coordinated preparedness efforts and responses to sars, west nile virus and avian flu. She played a key role in the cdc response to anthrax attacks in 2001. Senator rommy will introduce our final witness governor mike l levitt. Mike is actually the one whos most responsible for freeing me from the golden chains of the private sector. He got me to leave my position and come out and help run the olympic winter games in 2002 in salt lake city. As such he was my boss and the governor of the state of utah at the time, and we became since then dear friends. He also was kind enough when i was running for president to lead my transition team. Im not sure id have been a great president , but id have had a Great Administration because he put together an Extraordinary Team and laid out a pathway to help our country in numerous ways. Mike levit has you also have indicated was a three Team Governor of utah. In the Bush Administration he served as administrator of the epa and then for several years as the secretary of health and Human Services. One of his priorities was to focus on pandemic preparation. He secured some 7 billion in funding with the administration through the administration and congress to prepare for pandemics. Since leaving government he has founded a firm called levitt partners. It is the premier Health Care Consulting firm in the country with hundreds of employees under his management as well as a private equity firm that he has built. Its an extraordinary record and he continues to contribute to our country. My friend mike levitt. Thank you, senator romney. Now well begin with senator frisk. Welcome senator frisk, back to your old committee. Good morning chairman alexander, and Ranking Member, murray and members of the committee. Its great to be back in the halls of the senate even if only remotely and see so many old friends and colleagues. I do want to commend the committee on placing a focus now on preparing for the inevitable and Infectious Diseases that will absolutely come in the future. As you mentioned december 8th of 2005 at the National Press club i said at the very same speech i gave in this body 15 years ago and repeatedly all across the country i said a viral pandemic is no longer a question of if but a question of when. I even said it would come from china at the time. Grounded deeply in my own experiences as a physician in the senate being in china with a Senate Delegation during the sars pandemic in 2003, hiv patients responding to the anthrax attacks it was Crystal Clear then we are woefully unprepared for what was to inevitably come. In those talks proposed a specific six point plan called the Manhattan Project of the 21st century to prepare the nation. And during my time in the senate we laid the foundation with the bio terrorism act of 2002, the pandemic and all hazards preparedness act of 2006. As youve outlined in our white paper weve done more, but this was not enough, nor will it be enough. And a little bit disappointedly most of what i recommended in 2005 remains undone. Number one, communication. Weve got to clarify whos in charge in an emerging pandemic. Only then will the narrative be consistent and coordinated. But a response must be led at the National Security Council Level to facilitate this whole of government approach. The cdc, the trained and experienced experts should regain his position at the nations apolitical voice60606 Public Health. Number two, surveillance. This pandemic has laid bare our inability at the federal level to track out breaks with testing and reporting across the country. We must engage globally, diplomatically and economically. An outbreak anywhere in the world is a risk everywhere. Is a risk to every community in america. The ability of developing their capacity of their Public Health infrastructure which is widely dependent on u. S. Support. As in 2005 we have an inadequate vaccine Manufacturing Base here within the United States. We must establish public, private partnerships with industry that can be sustained. For supply chains including testing and Vaccine Development the federal government must be reengineered serve as a sort of control tower function. Number five, i said then and now research and development, in my work in 2005 i called for a massive investment to create a biologically based Manhattan Project who helped better defend us from naturally occurring or accidental or intentional biological threats. The federal government should take the lead role paired with a well structured Surveillance System that would accurately track outbreaks to ensure that supplies are responsibly and appropriately distributed where the risk is greatest. In telemedicine with which this committee has dealt i echo chairman alexanders recommendations with and i quote, ensure the United States does not lose the gains made in telehealth. We must make permanent a majority of changes with some modifications in order to unleash this revolutionary power of virtual care delivery in america. I want to quickly touch on important area, Public Health funding and vulnerable populations. For the funding, closely for the past 25 years ive concluded like a Armed Services defense we must have predictable based funding for our Public Health security programs. Yes, Health Security is National Security so lets treat it as such. Thats why i joined dr. Tom freedman and others to advocate for a specific Defense Operations budget designation. This discretionary approach would exempt a small number of critical preexisting Health Security funding lines. And lastly this whole concept of vulnerable population of Health Equity, any pandemic preparedness response needs to comprehensively consider how to protect and care for the most valuable here at home and globally. And real quickly i encourage the committee to underscore this vital connection between the help of the worlds most vulnerable and the security of americans here at home especially as you soon consider Global Access to immunization. The work youre doing here today will literally save lives in the future. Thank you, dr. Frisk. Dr. Caldun, welcome. Chairman alexander, thank you for the opportunity to speak with you about michigans response and how we can prepare for future pandemics. At our peak in april we identified over 1,500 cases and nearly 180 deaths each day. Due to the decisive and necessary actions of our Governor Gretchen Whitmer and with the sound judgment of our residents and the work of local Health Departments those numbers have declined by more than 80 . But het me be clear this is not the time for victory laps. Covid19 is still very prevalent in michigan and across the country. We simply cannot let our guard down on covid19. More than ever leaders must be laser focused on protecting our communities and addressing the inadequacies of our infrastructure. Michigan was one of the first states to release covid19 data by race and ethnicity. In michigan just 14 of our population is africanamerican. Yet they represent 31 of covid19 cases and 40 of deaths. This is not unique to michigan. Racial and ethnic e disp disproportionately being infected by and dying from covid19 across the country. They exist because of institutional and Structural Racism that has deprived communities of color of adequate resources and opportunities for prosperity and optimal health. Indeed, racism is a Public Health crisis that must be met with urgency, funding and an elimination of policies that perpetuate. We also need consistent and accurate messaging from the highest levels of the federal government. As aitousing emergency physician and Public Health leader i remind on swift guidance during the crisis. We need accurate and clear messaging from the white house about the true threat of the disease, how and when to get a test and the importance of Wearing Masks and social distancing. Next we must know and implement a National Testing strategy and infrastructure. As a country we did not expand access to covid19 testing at the rate needed to identify cases quickly with tragic consequences. Michigan has now built a Testing Network of nearly 70 labs and 250 testing sites and we conduct about 14,000 tests per day with the capacity do do more. I am grateful for the support of our federal partners, but we still struggle with a limited number and type of supplies we receive from hhs and fema. We work nonstop to procure supplies from the market but supply restraints remain a factor. Turning people away who should have been tested. Finally, we must invest in Public Health infrastructure at the federal, state and local level. More than 25 of local Public Health physicians have been eliminated in many years and federal spending on Public Health and prevention is minimal and declining. These cuts hinder our ability to ackwtly respond to Public Health threats. Ive experienced this firsthand. In my former role as doctor toits Health Commissioner i led the response to the largest help titing helptitis health work in history. As michigans chief medical representative i scrambled to respond to the states outbreak, a mosquito borne illness that killed and infected a Record Number of people and animals. I had to pull together a team within weeks to respond to a mysterious vaping related illness. Since march weve had to take extraordinary measures to build data systems, armies of contact tracers and setup testing infrastructure. To ensure the u. S. Can adequately respond to this crisis and the next we need longterm investments our Public Health kardepartments or progra. Now is not the time to celebrate or turn our focus away from covid19. If anything we must get more aggressive. More aggressive in addressing health inequities, and inensuring our Public Health infrastructure is strong. Thank you, doctor. Its been a long time since i testified in front of the Health Committee and its good to be back, but i also thank you for your incredible leadership and all you do to protect the health of americans. You know, theres a lot of media claiming that this pandemic is the pandemic of the century, but i agree with dr. Frisk. I think this pandemic is a harbinger of things to come. How we focus we can mitigate right now we do have the peer into the future and accelerate our preparedness efforts and really take seriously this time what needs to be done to truly create a Health Security agenda for america. Now, id like to just start with what we know for sure because were still in a learning phase here. We know for sure this virus is incredibly tran incredibly transmission and its going to continue to spread for months to come. Were nowhere near the end of the mitigation phase of this crisis. We also know that shelter in place and quarantine can be successful in slowing down transmission, but that comes at a tremendous price to individuals and families as well qqiqqi gl macroeconomic forces simply because it shuts down business and people dont have livelihoods and the economies dont have a base. Now, what dont we know . We dont know we need to know about the virus, its interaction with the host and how its going to evolve over time. We dont know really how to calibrate our balance between opening our societies and resuming some important business functions and at the same time continuing social distance so that we can slow down spread. We dont know to what extent day care, school and colleges contribute to Community Transmission and transmission of this virus to other more Vulnerable People in society. And last but not least we dont know if we can stop this pandemic with a vaccine. Lets talk a little bit about the vaccine. If we want to end the pandemic were going to need a vaccine thats feasible and produced at large scale. We need the vaccine that ideally is successful in a single dose, and we need a vaccine that we can reasonably predict will likely be effective and safe. Let me talk about why this is a stern task master, the science of vaccinology and covid19. First with respect to efficacy, we need a vaccine that produces effective immunity, neutralizing the virus, preventing infection even among vulnerable, older or immuno suppressed people. And we need a vaccine that is durable so that protection lasts beyond a few weeks or months. And finally, of course, ideally we would like to have a vaccine thats robust if the virus does change or evolve over time. As high a bar as efficacy sets we also need a higher bar for safety because were going to be using this vaccine in some of the most Healthy People as well as some of the most Vulnerable People including children and potentially even infants. So we must not sacrifice safety for the sake of speed. And i think thats going to be a very important component of our communication about the vaccine opportunity because people need to trust that the vaccine will be safe. We already have concerns that myths and lies about the safety of the products that in progress are a deterrent to peoples willingness to step up and accept immunization. Were a long way from being able to promise the delivery day or characteristics of what i suspect will be several vaccines that will have different effectiveness in different populations. So senator frisk outlined an incredible historic list of the six things we need to do for future pandemic. Thats been echoed in our your white paper, senator alexander. Its been presented in various forms by bipartisan blue ribbon panel, by the css commission that you referenced earlier as well as many after action reports following ongoing outbreaks during my tenure at cdc. All of these perspectives have some common themes, and first and foremost is the theme of sustained National Leadership at the level of the National Security counsel. But i want to highlight one other thing that senator frisk brought up and that is the critical importance of sustained longterm budgetary investment ending the cycle of complacency in crisis weve been in for so many years and instead creating a budget process for our nations preparedness and particularly for the cdc which you characterized as an independent Scientific Organization that needs to function in an apolitical environment. We need to make sure that we find a budget mechanism that allows the sustained funding to not be subject to budget caps and not be something that gets involved in horse trading and when the budget balancing process gets rolled around every year. That alone would help us secure an ongoing progressive investment in preemptive preparedness that will truly change the game for americans. So thank you for allowing me to testify, and i look forward to your questions. Thank you. And welcome governor levitt. Thank you, chairman alexander and Ranking Member murray and the members of the committee. A special thank you to senator romney for that generous introduction. Only months into my service as the department of health and Human Services indoctor and i participated in an emergency briefing for the h5n1 Avian Influenza. We were told it was a virus with pandemic potential. Book. The book was entitled the great influenza, history of the pandemic of 1918 written by john barry. He delivered me a message as he handed it to me. It was you need to understand this, and he was right. Not just for me but for all of us. As i read the book and sought briefing and learned from others it quickly became evident to me that ultimately a pandemic would occur, and that is true today. We have it, and well have another and we need to be prepared. At that point in time our country was unprepared. The h5n 1 continued to spread. Congress was alerted and appropriated 4. 7 billion. Members of this committee will remember that well. Underthe next three years we heightened our effort. We sought to develop vaccine manufacturing inside the territory boundaryoffs the United States. We wrote the National Pandemic Response Plan. Congress passed legislation thats become a foundation of that plan. Those two bills when added to project bio shield has been added in repeat months. 54 pandemic summits were held in partnership with the governors of each state and territory. There were three messages delivered at those summits. All three Still Critical in the midst of a pandemic and certainly in the future. The first was just a reminder that pandemics happen. Theyre a bilogic fact and a certainty. Pandemics occur, and when they do they obviously bring death and suffering and sweeping change. Part of the dilemma they happen far enough apart that we forget as people have made the point already. The second message was that pandemics happen and every generation has to prepare on their own or they will be complacent as well. And finally, Everyone Needs a pandemic plan. States need a plan. Local governments need a plan, businesses, churches, schools, hospitals because a pandemic is different than any other disaster we deal with. It is intensely local. A terrorist event like 9 11 or a Natural Disaster like katrina, the federal governments response is to call on unaffected states to send people and equipment to the disaster area. In a pandemic those resources are to a large degree unavailable because theyre needed at home. The message is clear that any state or any community that fails to plan thinking that somehow the federal government will ride to its rescue will be tragically mistaken. Not because the federal government lacks the will. Not because it lacks the wallet but because the federal Response Plan is based on focusing primarily on localized disasters. Gratefully the h5n1 Avian Influenza did not become a pandemic. The Lessons Learned are still true today. Ill just hoy light four. First the need to clarify roles between state and National Government in advance. Second, having a vaccine is critical but its only the beginning. While we have manufacturing capability fill, finish and distribution priorities will inevitably be a problem, and they still need planning. Third, providing Situational Awareness is a Critical Role of the federal government. Principally cdc. The information gathering capability of the federal government needs investment and it needs modernization. Lastly ill echo what my colleagues have said, pandemic preparation requires investment every year. Mr. Chairman, i look forward to our conversation. Thank you, governor levitt. And thanks to each of you. Well now begin a five minute round of questions. Ill ask the senators and witnesses to try to observe the five minute limit. We have a lot of senators who want to talk to these very gish distinguishes witnesses. Ill begin. When were through im going to ask each of the witnesses to answer this question. If you were the king or the queen and you could do lets say three things to be ready for the next pandemic what would those three things be . Now, i only have five minutes but let me start with you with this question. Someone might ask why are you taking time in theaaaaaaa . How would you answer that question . Yeah, i think the points are made we need to end this pandemic. We dont know even when a second surge is going to come. So as much as we can to do prepare that infrastructure for the next pandemic and emerging threat it will apply to what were doing now. The sense of urgency is simply that we have identified pretty quickly in the last several months the needs that are out there which we talked about in this hearing thus far, and now is the time to go ahead in a parallel fashion pass legislation and i would add things like the telehealth hearing you did the other day and the things you can do which would make even an second surge as each of you said memories are short and we will deal with the next issue if we dont handle it now. Lets talk about manufacturing. Let me drill down on that a little bit. We dealt with manufacturing before. We built three manufacturing plants. Today we have 10, 12, 14 vaccines that are racing toward trying to produce several hundred million doses by early 2021. If ideally what sort of manufacturing capacity should the federal government have on hand ready to produce these dose and to distribute them properly . Can we just rely on the private sector to do that, or should we have our own manufacturing plants . I thought we did that with three manufacturing plants. Are they adequate . What happened governor levitt. Has time has gone on and the urgency has diminished we have seen the ongoing funding of those particularly in the area of maintenance and keeping them we invested and i think properly invested in partnerships to enhance it. What i think we did not do ackwtly ackw adequately is maintain them in a way they were warm and stood up quickly. I should also mention that we have a big challenge in being able to fill and finish and distribute that infrastructure, yet the private sector can, in fact, be very important infrastructure. Yes that infrastructure exists but planning is a big need, an one well need to deal with to senator murrays point even now. So we have time and i know the department is likely working on this, about you thats a critical need. Dr. Gerberding, you have seen it from both sides. Should we build manufacturing plants or pay for the private sector to build manufacturing plants for the future, or can we remodel those . What should we do . One thing to point out that has been built it was targeting influenza, which is a dualpurpose vaccine. The idea is they could call upon the seasonal flu operations to flex in the case of a pandemic, as we did in 2009 when we were experiencing the h1n1 painndemi. Broadly speak the ones that are still in business are at capacity for creating the daytoday vaccines. We clearly need an emergency buildup. In my view thats best done in private Public Partnerships. We may get to a point as we experiment with the 130 products, that we understand the that we dont have to go back to ground zero and build anew each time a new, unfamiliar need for vaccine arises. So i think a Partnership Model works best, and we must not remove the incentives from the biopharmaceutical industry to innovate. Its the innovation thats got us this far this fast in this particular pandemic, but at the same time we could invest at skate for 130 candidates. We have to make choices. My time is you want, and i want to respect the fiveminute limit as the comments may be interesting. Sorry. Thank you. Senator murray . Dr. Khaldun, the response has failed to keep black and latino families, indian tribes, other people of color healthy and safe this tragic reality is driven in part by longstanding systemic racism and underinvestment in communities of color, which have contributed to Significant Health disparities, but it is also a result of this administrations failure to take these disparities seriously and devote attention and resources to the communities most in need of assistance. I wanted to ask you today, what can we do to address the Immediate Impact on the communities of color . Thank you, senator murray, for that question. We in the state of michigan identified this early. The government announced quickly a task force to really understand why these disparities exist and develop specific recommendations for how we address them we actually worked with the communities to bring testing to places where they wouldnt normally have access to care. We eliminated costs for a lot of our testing sites. You dont have to worry about if you dont have insurance or even dont have a primary care doctor a lot of sites you dont have to have a doctors order. And then we have the people who have been deemed essential, and them coming out of their homes to have to work, and how we protect them. So making sure theyre not allowed to lose their jobs and they get support at home to be as safe as possible. I think this is an important job we need to think about. Dr. Gerberding, we have a robust system for evaluating vaccines, and weve seen some pulling that some americans would not be willing to get a covid19 vaccine. The time to build that confidence is right now. A number of experts are expressing concern that President Trumps vaccine acceleration process, known as operation warp speed, could undermine confidence in covid19 vaccine, particularly if the public perceives that a vaccine was rushed out for political reasons or without robust review. What should we do right now to build confidence . Two things. One is transparency about exactly the safety assessments. That involves the participate of the acip, the fda, and several of the other Scientific Organizations that have an oversight of that. The second thing i would propose is the safety by monitored by the National Academy of medicine when i, for example, had responsibility for administration the smallpox program, it was the National Academy of medicine that monitored the safety of that program and helped us identify very early there was a safety signal. So i think involving the scientific community, credible experts, apolitical in orientation, is going to be a very important part of building this trust. And a conference in, i would assume . Absolutely. Senator frist, good to see you again. You have repeatedly emphasized the importance of Strong Health funding, and they are responding to covid19 with, quote, one hand tied behind their backs. You have argued for the create of a mandatory annual investment in Public Health infrastructure. I think this is something that is critically important. I wanted to ask you, if we were to create such a fund, how do you predict the u. S. Response to the next Infectious Disease outbreak would look different from what we currently have . The pub Health Infrastructure fund is one of options. I do support a strong Public Health system can alert us to new problems, build resilient communities that are healthy, socially connected. It creates a reserve capacity to respond to an emergency of any kind, which is why i coauthored that with senator daschle and fda commissioner in support of what was a 4. 5 billion Public Health infrastructure fund. Its really interesting. We have not consistently provided the funding thats needed to build an ongoing, strong Public Health system. If you look back at the Great Recession on these are the people we need, where its for Contact Tracing or epidemiologe, they have been lost over the last ten years. Strong investing will ensure that Public Health departments are fully staffed, resourced, able to hand the needs of todays demand for things like the Contact Tracing force. Thank you, chairman. Senator burr is next. Thank you for the recognition. Senator frist, secretary leavitt, dr. Gerberding, dr. Khaldun, we value the ability to pick your brain. The most important part i think is when we do the after review. Its important for congress to go through this process. When we moved the last reauthorization bill out of this committee, i reminded my colleague this was by no means the finish line. Much work remained for us to be better prepared. Dr. Gerberding you were in a unique situation in the cdc and now in the private sector, in your testimony you advocate for a greater use of Public Private partnerships. During our last hearing on the pandemic, i urged the cdc to put these types of collaborations in place so that we can leverage innovative technology, companies in our ability to detect and identify threats, including emergency Infectious Disease. Given your experience at the helm of the cdc, why was the agency so illequipped to put these agreements in place before the pandemic . And what would you recommend to cdc Going Forward . I must say i dont know what the cdc was doing. Im just seeing it from the outside looking in. There has been a tradition of recognizing the important of the private sector. When i was there, we had desks in the Emergency Operations center for a number of private sector entities that we recognized as importance with supply, logistics u. Testing, et cetera. But i also say there are some complexities of working with private sector in government. I go back to what governor leavitt said in the context of planning for a influenza pandemic, where we recognized that the federal government has a Critical Role, but weve learned then and what i think were seeing now is that the private sector is powerful in leveraging that power and those resources is essential to being able to scale a national response. I thank you for that. I think the distinguishes was most evident in testing and the inability for a cdc to reach out to the private sector. Thank goodness reauthorization allowed a greater expansion of authorities by the director add fda to use emergency use authorizations to set up these private Public Partnerships and probably we have more testing utilization today. For example, merck licensed ebola vaccine platforms being used to develop coronavirus vaccine. How can we enhance the coordination between innovation, barta, fda to enensure these platforms is as official as possible when the need arises. How do we keep these as an approved entity and only do the clinical proof on what were trying to treat off the platforms. I think barta is well on its way to doing that. I think cepi is also on the way. But we need to have a broader expectation that well invest in a lot of things that wont pan out. If we aim for efficiency, well be slow and miss the boat. We need to be prepared to experiment, try a broader array of things, and i continue to thing that barta is critical to the coordination of that. This is to my good friends mike leavitt and bill frist. We did what i thought was innovative in the flex of three manufacturing facilities for vaccine. The testimony has been correct, they were designed for the annual influenza or some variation. And theyre very different with the surge in front of that for a vaccine for the coronavirus. Can both of you give us what you think this committee should do legislatively to encourage the creation of some type of multimanufacturing facilities that can be utilized when the federal government feels a National Need . So i will responsible quickly. First, just annual appropriation supporting it when theres not a crisis. Thats the first thing that has to happen. Its keeping facilities warm and keeping access to them during those periods that makes it possible when there is a need. Senator frist . Yes, senator, thank you. I remember all the nights and the majority leader office, as you helped put together barta, so thanks for that. I think it is going to come down a bit to what senator murray asked about increased funding and how we do it. Im on record for supporting a mandatory appropriation, about 4. 5 billion fund, but also i mentioned in my testimony the h. D. , which is an annual appropriation that comes to what governor leavitt was talking about, an annual appropriation in sort of a defense category, would allow you to fund to barta individually, to nih individually, discretionary funding, and to the nih, all three, it would be annual and it would be annual appropriations with oversight by the United States senate, by the congress itself. That does have this advance of timelyness, what is needed at a particular time, so i would also encourage looking at that. That immediacy of what is needed two years from now is going to be very different, as we just saw with vaccine manufacturing its going to have to be nimble, and maybe you wont consider it with an annual appropriation oversight, to be able to support the type of Public Private partnerships in this area of manufacturing. Senator casey is next. Thank you for noting that. Im grateful for the testimony of our witnesses, and the wisdom they bring to bear to these issues. I wanted to start with khaldun, regarding what you have seen in a lot of your time with regard to the challenge you face. Like philadelphia especially in the black community. Thats true in so many of our urban areas. I know in your testimony which you compare the population, about 14 , but how of the deaths and more than 30 of the cases. It far outstrips the percent of the population. Weve had today at least 1,368 deaths of black pennsylvanians from covid19. Thank you, senator casey. We talk the social determinants of health, so housing, transportation, access to health care, poverty, those are the things we believe are contributing to the disparities in covid19, as they contribute do other Health Disparities, so against theyve been more deemed as essential workers coming out of their house, instead of being able to safely work from home, needing to take public transportation, living in crowded or unsafe conditions, so we believe those are the things contributing to the disparities. Many africanamericans are the ones who are on the front lines, and very often up the front of the front lines. Is that correct . That is correct, senator casey. Again, but back to the fact that people of color are more likely to live in poverty, and therefore more likely to have the lowerwage jobs. Some of our Grocery Store workers, bus drivers, and those are the people across the country when we have stay safe orders, those people were unable to stay at home. I believe that contributed to the disparities and disparate numbers we have seen. I know that Public Health is driving very much at a state and local level. Obviously this pandemic has reminded us all levels of government need the help of the federal government. When you step back and look at where weve been, what parts of the response so far do you believe require coordination and the convening power of the federal government . First let me start by saying i really appreciate the support of my federal colleagues who since january have been supportive of us at the state and local level in michigan. I do think we should have had, as i said in my testimony, a more urgent testing response in our communities. Early on in my state lab, we were preparing in january to perform the tests, but we ran into delays. Im sure in michigan, because of those delays, there were people who werent tested and the disease was spreading before we knew it. I believe a coordinated strategy at the federal level would have helped. Also ppe, we had to fight states and even local governments to gain access to ppe, and i think that exposed more people to the virus in michigan. Finally, dr. Gerberding, thank you for your help in pennsylvania, helping other citizens in our state to better understand what weve been up against. Im particularly grateful for that. In the 30 seconds weve had, youve spoken about an immunization infrastructure. I know your testimony spoke to this, the who, what, when, where, the mechanics of that, who should be involved and what role the federal government should play . They are just beginning to improve that for adolescents and adults, but its fragile. I think one of the most important thing thats not getting enough attention is the fact that distributing this vaccine, even in the United States is going to be incredibly challenging, making the decision about who goes first, how to allocate doses as they become available and how to sustain that atmosphere of trust and willingness to step forward and receive it. The infrastructure is going to be local. That means that we need to support or local and state Health Officials in getting ready to make those really hard decision and implement though real really macro program. Thank you. Thank you, mr. Chairman. Thank you, senator casey. Senator collins . Thank you, mr. Chairman. Dr. Frist, its great to see you again. We have missed you. One of lessons from the Global Pandemic is said our country is far too dependent on foreign manufacturing of drugs, diagnostics, and medical supplies. For example, about 80 of the basic components used in medicines, the active pharmaceutical ingredients are coming from china and india for our u. S. Market. The the exact dependence remains unknown, since theres no api registry. What happened is just about the time the covid19 epidemic hit the United States, india stopped exporting 26 apis and finished drugs. The c. A. R. E. S. Act inclusions portion that i introduced with senator tina smith, the medsac, that requires greater reporting, as well as redundancy plans interneded to deal with shortages. But are there specific incentives that the senate should consider specifically to encourage domestic manufacturing, including perhaps tax incentives or greater investment in fdas emerging Technology Program . Thank you, senator. I think this whole issue of procurement is huge. In the committees white paper you talked about procurement as being a clear and important federal responsibility. As you pointed out, weve been inadequately prepared here. Weve seen it day in and day out. We can do so much more to establish this resilient lines of tracking supply chains, ensuring a robust support of the to bepile. The real challenges in these Public Private partnerships is this lack of continued funding over time to adjust to the market where, on the private sector, theyll be generous and patriotic, but at the end of the day they do need to report fiscal responsibility. So whether its direct tax credits, whether its with a funding stream by an artificial market thats set up over time, we do have to keep a revenue stream out there that is dependable, sustainable and it is long term. And it is flexible, because it will change year to year in terms of what those manufacturing specific manufacturing needs are. As for the testing itself, the tests are remarkable right now between the Public Private partnerships and the private sector moving ahead, its being revolutionized before our eyes in a quick fashion. It came too late, but no encouraging more and more of that with financial incentives. Thank you. Dr. Gerberding, last month the aging Committee Held a hearing on the impact on the coronavirus on older adults living in Nursing Homes. That hearing reaffirmed my belief that a baseline test for all residents and staff, not just those that are symptomatic, is necessary to prevent outbreaks. Covid19s impact on longterm care settings directly intersects with the stark Racial Disparities that were seeing. Unfortunately and remarkably maine has the nations worst ko individual 19 Racial Disparity. Many of is the outside breaks are in Nursing Homes, and the cdc reports that some 40 of those health ware workers were identified as black, now what do you rem as the best way for congress to help address this Racial Disparity among those that are the frontline workers in our Nursing Homes. To my the third most important reason to test are the people who are working in these known highrisk environments. Those are intrinsic hot spots. We need to test often and test everyone who comes and goes in the centers until such time we can demonstrate transmission has contained. I cant say enough how critical it is, that includes the elderly people, but also those who are vulnerable on the basis of underlying conditions. Obvious that tracks with the racial ande any disparities that you are alluding to. Its a very difficult challenge and thats a long answer. I know i have a short period of time, but the first step is to make the measurement clear and transparent, so we all have to stare it in the face. Thank you. Senator baldwin. Thank you, mr. Chairman. Thank you, so i wanted to start by just reflecting that every member of this committee would love to be able to turn the page on the current pandemic and start planning for the next one, but the cases of covid19 and hospitalizations continue to rise. We cant divert or attention from the ongoing crisis. I think its very clear that the administration has not yet learned a critical lesson, particularly about worker safety. Without safety standards, workers and their family are needlessly put at greatest risk when they go back to work. Guidelines from the cdc are not good enough, yes the Occupational Safety and Health Administration has failed to move forward with meaningful rules for employers. In response to disturbing, widespread reports of safety concerns leading to inevitable illnesses and death, i introduced the covid19 every Worker Protection act. This bill would require osha to, frankly, do its job and issue a emergency standard that establishing Implementation Service exposure control plans that would keep workers safe during the covid19 pandemic. Dr. Khaldun, do you believe that giving employers clear and mandatory rules to an Emergency Temporary Standard, would help improve our Public Health response by protecting workers, their families and their communities during a pandemic . And correlated with that, why is a focus on worker safety particularly important for communities of color and others who have been disproportionately impacted by covid19 . Communities of color are more likely to live in poverty and have these lowerwage jobs,s so again, theyve had to come out of their homes instead of being at home during this pandemic. So its incredibly important. Senator baldwin, weve lost your signal, well wait a moment. If not, well go back to you. How do we move on to senator cassidy, and then well come back to senator baldwin and let her reclaim here time whenever she regains her internet signal. Senator cassidy . Thank you all for being here. I appreciate your service in this epidemic. I have questions with dr. Leavitt and dr. Gerberding, which kind of reflects your past history, if you will. Dr. Gerberding, all of you are recommending a lot more money for the cdc. Mandatory spending almost, if youre not saying that specifically, it seems as if you wish it to be mandatory. Theres a lot of folks who feel as if the cdc has not responded to the challenge with the money that they have been given, and before significant more dollars are given, theyd like to see some sort of recommendations for reform. So some of the criticisms made, which i have made some, by the way, whether its right to make it or not. Slow to the mark, laborious contracting with lots of red tape, a loss of focus, afraid to take bold action, and misjudged terribly the rapidity with which the virus would spread throughout our community. If were going to be asked to give another 4 and 5 billion and more, i think its fair to say, is there a form that would be instituted that youre just not putting more money into a system which is inherbally not working well, but rather more money in a system that is streamlined so that it can work better. Ive known the cdc before a long time before and after i worked there. I can say the scientists who are there are national treasures. The scientists there leading this pandemic are the same scientists that were there when i dealt with sars. So i dont think its deterioration of the science or of the agency. I think the scale of this response would test any Public Health agency, as it has around the world, but i think modernization is the word that needs to be the framework from considering where do we go from here. One of the things i would acknowledge, is when we did extensive rehearsal for influenza pandemic preparedness, we rehearsed everything except one thing. We didnt rehears testing, because in influenza you dont rely on the test to make the diagnosis and make the decisions. So the whole apparatus necessary to scale tests to 300 Million People was not something we practiced. So let me ask i can concede that, because i understand at different times people were concerned about bubonic plague and order exotic Infectious Diseases coming in, so it seems that testing could have been imagined as an issue, but theres so far not been a plan ive seen to go beyond mitigation into actual suppression. We have communities that should be in suppression, but we dont see a plan for that. What would be your response to that . Im not sure that i cant agree with you. Weve ended the mitigation face and were into recovery im not specifically nationwide. Im speaking specific communities. In every community the vast majority of people remain susceptible, so theyre only one visitor or one travel away from which is why you need suppression. The defenders of the cdc say they have actually put good stuff out there, but theres a review process that squashes them, yes, and they have ideas that say, montana, you are so lo, we can move to a suppression strategy, but they float it, it gets killed. I look at the interaction between cdc and hhs and the white house as a black box, but someone told mekong should demand a recommendations without review, meaning that we get the recommendations you know what that means, i didnt we get the recommendations unvarnished now if you will, through the political license of that which the administration wish to have. Its the pure scientists that dr. Gerberding kind of bragged on. What are your thoughts on that . Im inclined to believe that Congress Getting the facts in an unvarnished way is a good thing i will point out there are times even within a department, there are conflicting missions. Testing is a good example. Cdc had the mission of getting testing out quickly. Fda, it was about being accurate. Sometimes accurate and quick dont align. In a situation like that, an emergency situation, that occurred. I too agreed with dr. Gerberding. Cdc is a treasure, not just in the United States. Reality is they need support. I accept that, but i think what dr. Gerberding said about modernization, if we dont have modernization i yield back. I totally agreed, particularly with the data infrastructure. Our ability as to collect data from the state and almost in a real time create Situational Awareness, thats why the fundamental important duties in of a federal government is to provide Situational Awareness. Thank you. Thank you, senator cassidy. Senator murphy . Thank you very much mr. Chairman, senator cassidy knows the high regard in which i hold him. He is not wrong that there needs to be reform at the cdc Going Forward, and an admission of the ways they didnt measure up. But the cdc is trying to do good work here. They are sending out regular guidance on the importance, for instance of Wearing Masks as maybe the most evidencebased method. The president of the understanding refuses to wear a mask, his top adviser refuse to say wear a mask. He says its an attack on him politically for people to wear masks. The cdc develops guidance for individual industries and businesses to reopen. The white house then prevents that guidance from being dispen dispensed, so i think the cdc needs i think they may have been prevented from doing the best work they could by this administration and this president. Any good Fire Department that has a house on fire and the house next door in danger of catching fire, they do both. They try to do work next door to prevent the next house from catching fire. Were not doing both. So i want to frankly direct some of my questions to our witnesses with respect to what were doing now, which also is probably dr. Gerberding, you referenced how important it was for us to join the international, the collis n coalition, its a multisector collaboration to develop a vaccine for covid19. Its also working on other vaccines as well. I agree with you, we should join cepi as a mechanism to get ready for the next pandemic, but we should join now, correct . Theres no reason to wait especially since theyre doing most of their worry as we speak. I completely agree, senator. Cepi is already funding many of the they already reviewed and invested, but they are positioned uniquely to help adjudicate the allocation and the planning for how were going to solve this global problem. We are not safe until everyone is safe. That means we have to be thinking about vaccine in the billions of doses, not in the hundreds of millions of doses. So right now cepi is probably the leading organization, together with many other partners, to provide the credibility and the scientific oversight to try to make sure we do that right. It is Pandemic Response malpractice for the United States to not to be part of cepi. All of our allies are part of this organization. While we hope its our fund we want to be at that table. Thats something we can do right now. Dr. Khaldun, we talked about supply chain, but in my state, it isnt history, its praent. We still cant get ppe at our Nursing Homes. I was just at a hospital testing site, and they dont have enough cartridges to do their quick turnaround tests. I want to be clear, doctor, the supplychain crisis isnt fixed, is it . Thats correct. We still have lab capacity to do at least twice as many tests, but were limited by the number of swabs and fbfbfbfbfbfbfbfbfb is absolutely still a challenge. I think this discussion is really important. Ive argued you cant way for the next pandemic to hitting before we get ready. On sunday, there were 183,000 new cases reported globally. That was the highest number of cases on any single day since the beginning of this pandemic. That was sunday. That was sunday, and we are going to break for a very nice july 4th recess for members of congress who still have jocbs, who are largely still healthy, without having passed any legislation to help states, local districts address an epidemic that is still present. I worry, mr. Chairman, that we are not at least during this work period. Thank you for the opportunity to ask question. Thank you senator murphy. Senator roberts . Id like to thank chairman alexander, senator burr for working with me over the years to help address this issue, particularly during our work on something called pandemic all hazardous preparedness act, and in response to the covid19 pandemic. We are making progress, in march Congress Passed the c. A. R. E. S. A act, this provides a pathway in fda for expedited approval of animals drugs that have the potential to prevent a vectorborne disease. This isnt new, it isnt as if the dogs havent been barking about this. Back in the day of when i had the privilege of being chairman of the emerging committee. We are allowed into secret cities in russia at that particular time. Obviously were not now, but there was one in a i visited about 60 miles north of moscow. It was there that we had a whole range of scientists. I saw warehouses full of pathogens. It was stunning, shocking, everything from ebola to smallpox, where there was no preparedness or no, you know, treatment. The big one was hoofandmouth disease. These scientists were trying to weaponize these pathogens for an attack on a nations food supply. Now we have seen that with covid19. Not exactly with regards to the livestock that we have, but we have seen it in the packinghouses, and what it does to the food chain. Back in that time. Bill frist was our majority leader, also our doctor with regard to every senator. Bill, i still want to thank you for what you did no me with the one malady i was suffering from. Bill had no patience for patients that were a little reluctant. So he took me by the arm, marched me into the cloakroom, and got dr. Camerons office on the line and made an appointment the following monday at 7 00 in the morning. I then had the wonderful experience of enjoying ten days of my life at johns hopkins. The view was nice in terms of baltimore, but i didnt particularly want to end my days there, which was not the case. Bill, thanks for everything you have done for me, and for a lot of senators. The question suffer, we point out the National Cultural facility, at a level 4 lab at kansas state university, a consortium with other land grant schools. That facility will be open in 2022, but it is open right now doing some work and additional work at kansas state. Now, the question i have is we used to have exercises. I know of three. The first one i played the role of the president. We had a hoofandmouth disease outbreak. It started in texas. By the time oklahoma figured it out, it was in north dakota. Our entire Food Supply Chain stop. We had to euthanize millions of head of cattle. It was somethjethjethjethjen i know of at least two others. Im not sure were not doing that today, and i dont know why were not. We had a wonderful exercise with covid19. It just happens to be real. Senator frist, what can we do to continue facilitating coordination improving our surveillance in these areas before we have an outbreak . Dr. Frist, please. You know, one of the things that these pandemics bring out and the reason i was in 2005 to be so certain we would have an infection and i predicted coming out of china, or it could have come out of these congested areas in africa is this integration, this assimilation between human and animal. If you look at the layout for the future, almost certainly the next virus will emerge through this chain, and will come between animals coming to humans. I didnt first appreciate it, but in 2001 when anthrax hit or capital, and about a third of our senate was moved out of their offices for a year, this sim synbiotic relationship, in many ways we are thinking insular and silos, the only way to bring people together, expand their diversity of thinking, are these exercises, and it should by built into every administration, it should be done on an annual basis. From that, we will be able to predict in almost exponentially type thinking, like the need for testing,s which we have missed in the past. Thank you, senator roberts. Senator warren. Thank you, mr. Chairman. I am puzzled by the topic, which asks you to preparing for, quote, the next pandemic. The next pandemic . What about the pandemic thats going on right now . You know, the last time i checked, the u. S. Was still fighting coronavirus and losing conveyses are rising rapidly, and hundreds of people are dying. In massachusetts, we learned firsthand just what happens when the federal government isnt prepared for a pandemic. Back in march, we asked the federal government for medical supplies weeks later, only a fraction of those supplies had arrived, and the federal government was reportedly seizing shipments headed our way. Now even as the cases have come down, supplychain problems persist. Doctors in milton are using construction goggles as ppe. Massachusetts General Hospital told the boston globe that the supply chain was, quote, fragile. If we dont apply the hard lessons learns in massachusetts, states like florida, texas, arizona, where cases are now rising are going to pay the price. Mismarch, the federal government has implemented systemic ways to try to ensure that states with rising covid caseloads will have all the masks, gowns, and testing kits and other supply that is they need. Is that correct . Is that what has actually happened in michigan . Im grateful for the support of my colleagues at hhs and fema. They have been regularly sending supplies, but quite frankly they havent been enough. Some of the supplies we received have been expired, so were working aggressively to make sure we have ppe for now and possibly the second wave in the fall even though weir now more than three months into fighting this virus. It developed a s s s s s s s s khaldun, michigan has also invested in tracking information. And 5 hundred dollars michiganders are already working on tracking these infections, but the state could use more support. Do you need more resourceses for this work . And do you think we should have a nationwide Contact Tracing bram to help states that are dealing with covid19 cases . Absolutely i think we should have a federal strategy. We have over 10,000 michiganders who guaranteed too do this, and we have additional paid staff throughout the state. Its been a hodgepodge trying to support this. More support would actually be welcomed on the federal level. Its important to hear your voice on this. I appreciate it. We are nowhere close to a national Contact Tracing program. The house has passed key provisions of the legislation that i introduced with congressman levin from michigan, but republicans in the senate have refused to provide states with the funds they need to trace Coronavirus Infections. So lets have one more turn at this. Lets talk about who is going to be hit the hardest if we dont learn the lessons of the past few months. In massachusetts we already know data show that black and hispanic people in the commonwealth are three times more likely than white people to contract covid19. Doctor, if the federal government fails to right the wrongs of its early response to covid19, how will its failure impact people of color and other vulnerable communities that are at risk for the Coronavirus Infection . Oh, i think if we dont aggressively address both determinants of health, so adequate housing, no outofpocket costs for testing, absolutely africanamerican communities, tribe communities and more will be hit the hardest. Thank for you your work, doctor. There will be the time and place to take the lessons and apply them to the next one, but right now as covid19 cases top 2. 3 million nationwide, our country cant look at the coronavirus pandemic as if it is an event from the past. 120,000 americans are already dead, and more are dieing every day. We must expand Contact Tracing. We must secure or supply chain. We must product communities of color and must stop pretending this pandemic is over. Thank you, mr. Chairman. Well go to senator march cows can murkowski, and then back to senator warren. I think its timely, and i dont think were beyond the pandemic. We are in the midst of it, but even while we are in the midst of an active pandemic, it is important to not only understand where weve been, but where we are gus. I appreciate the comment dr. Leavitt made, and you repeated some of it in your opening testimony here. Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate. This is the dilemma we face, about you it shouldnt stop us from doing what we can to prepare and prepared every day to what we really dont know. We have heard our state officials, what should the priorities as were dealing with the here and now it is still supplies and manufacturing, still making sure we have what it is that we need. Testing capacity continues to be a challenge, but weve been aggressive with that consistent messaging, no different in alaska than what we are seeing around the country. That cause an issue of distrust from the public. We need to Pay Attention to that, but the one i want to speak to is the Public Healthun i. T. Infrastructure still lacking what were using is excel spreadsheets and faxes as our main tool, we have 76 is cases, our teams have been working and staying on top of it, but the article in the nub just yesterday is were close to being maxed out. As we are thinking about that ttsi, that the Contact Tracing diagnostic testing, supported isolation and the need to suppress or mitigate, so the question i would have is whether or not we need to have a national Contact Tracing program or do you believe we can focus of our as i talked to alaskaens, theyre saying we think we have this, we want the financial support, but we dont know that we want a national program. So i would i guess i would ask you, dr. Frist and you governor leavitt, for your views on that role with Contact Tracing, because i think Going Forward this is going to be a key, key aspect to how we can stay on top of what were dealing with. Your thoughts . Thank you. Just to premise what im saying, i think our second pandemic may come in about three months. Thats why i do think its important to do exactly what were doing. Learn very quickly, and apply what we can right now, and an exit review will occur in the next two, three years. There have been a whole bunch of estimates out there, as to what is needed. We know it is the most effective action at this standpoint. The work force does operate until state and local management, even if its a federal program, and it needs to expand to help control covid19. We have to. All of these we have about 180,000 people that are needed. And can states do that . Probably not because states have had their Public Health infrastructure underfunded at the state and local level. A lot of them dont have ep deemyologists in the local community much less contact tracers. So we need federal support this time around, maybe not next time around. Massachusetts has done a great job at hiring and training applicants and quickly gotten them out there. So dr. Gottlieb and i and andy slabit have proposed a federally funded workforce and then allocation of the funding to the states so they could get it up and running today. And we have that on record and that. Thank you. Senator, i believe that a National Strategy is required. It will require some local execution. Let me be deliberate about that. Clearly we will need to have National Funding to support this in the way that senator frist has articulated. Secondly, there has to be a National System that local input feeds into where standards are used and how data is collected so if could be rolled up quickly. So there are components of local execution that are required. But there is a clear need for National Funding on this pandemic as i agree with senator frist, Public Health has been malnourished over the course of the last almost 40 years. And we need to build up that infrastructure. So we could have a National System but it will require execution at the local level but ought to be done according to a set of national standards. Thank you senator murkowski. Now we go back to senator baldwin. Thank you, mr. Chairman and i apologize for the interruption in internet sfervice but im gld to be back to the panel. My first we was urging osha to issue a Emergency Temporary Standard that would be enforceable and mandatory as workplaced reopen. And i think especially before schools that are preparing to start inperson classes again, k through 12 and Higher Education and their needs. But i want to move to the companion issue of these shortages that we have been seeing in the very things that would likely be contained in an Emergency Temporary Standard that osha should promulgate. And just as the administration has failedw o to issue these enforceable standards to protect workers, theyve also failed to provide the leadership needed to take              production of testing and testing supplies, other needed equipment, ppe here in the United States. Have some touched on this already. But it is why i introduced with senator murphy the medical supply transparent and delivery act. What it does is unlock the full authority of the defense production act to increase the production of critical supplies including ppe as well as the supplies needed for testing. So, dr. Khaldun, i directed my first question to you and i will follow up also with you. You could describe how shortages of testing supplies or ppe have hindered your states efforts to respond to the current pandemic . Yes. So like i said earlier, senator, in the beginning we had to delay testing even when the state lab could do tests. Initially there were only a few hundred where only the sickest could get access to a test while the disease spread in our state. They are still only able to test the sickest and because they have problem with reagent and testing swabs. Again, im grateful for what we received but when we received supplies from the federal government they dont match up with what our lab is able to run so we still cant use them so it is still absolutely a concern. Thank you, mr. Chairman. Thank you, senator baldwin. Sorry that we lost you there for a while. But thank you for sticking with us. Senator romney. Oh, excuse me, senator kane. Thank you, mr. Chair. Thank you to the witnesses especially to secretary levitt. We were dealing with h 5 n 1 and you were a great partner with the administration. I associated myself with comments of all of my colleagues, we have a current challenge. Last week in the United States the number of new covid19 cases increased by 25 over the previous week. And shows that the current challenge is getting worse not better. But we do have to plan for the future. And one of the things i want to do is take advantage of this experience to talk about the future. So first topic to the witnesses. Every pandemic would likely be a little bit different but it seems like there is a template that the successful nations have used to deal with covid19 and the template is aggressive early testing, and Contact Tracing to find those who are ill. The isolation of people who have covid19 and immediate treatment of those folks. Do you agree that those four elements, early testing, Contact Tracing, isolation, treatment should be a template that we should prepare to use in future pandemics . So, i will respond, senator kane. What weve collectively come to know as social distancing measures constitute the only medical intervention that we have absent a pandemic or absent a vaccine, excuse me. And the reality is that is likely to be the case in any pandemic situation. Well be without a vaccine for a time. So that fundamental health basic but we have to remember that any medical intervention has side effects and this has side effects. And if i were to take pain medication, for example, i would be told you cant use this too long and you cant use too much of it or youre going to have other problems develop. Were obviously trying to find the balance now in this medical intervention that we have used absent having no vaccine. So the answer is yes, but there is a limit as to which we could use them as a practical matter without the side effects of the economy, the side effects of the psych logic damage. You anticipated my next question, secretary levitt, the side effects on the economy. I was having this conversation with chairman risch last week because we had a similar hearing and he pointed out that the aggressive testing and Contact Tracing, some nations, some cultures accept it maybe a little bit better than would be accepted here. Were talking about south korea. And i responded and i said thats true. It might be hard for people here to accept Contact Tracing but because south korea did that early, they didnt have to use the heavy hand of government to shut the economy down. South korea Unemployment Rate has gone up 1 because they isolated sick people and they didnt have to do the large economic shutdown that the United States had to. So the basic measures are not only good Public Health measures, theyre also measures to protect the economy. I want to move one element of the basics and that is testing. Im very concerned about this. And youve all talked about it. Particularly dr. Khaldun, the difficulty of doing testing because of inadequate supplies and mixed messaging. Over the weekend the president said he had instructed his administration to slow down testk because he thinks increase cases is bad. Im going to be clear about this. Increasing number of cases isnt bad. Increasing deaths is bad. Increasing hospitalizations is bad. But the idea that you would slow down testing because you didnt want to find out if people were sick is just grotesque. The chairman, the Ranking Member of the committee senator murray and senator schumer wrote a letter to secretary azar that i would like to introduce for the record, mr. Chair, if i could. So ordered. Pointing out that 14 billion that has been provided by congress for testing has yet to be obligated by the administration. I am deeply worried that there is a bias against testing because we dont want to know bad news. Ive been puzzled now, in the fifth month of the pandemic why hasnt the administration issued National Guidance about how many tests we should do. The website of the cdc, instructions to colleges didnt mention the word testing and i believe there is a fear of finding out how bad this is or a desire to not be held accountable for falling short of testing guidelines as i conclude, ill just point out we heard from admiral giroir a month ago, may 12th and we had to drag out of him what would be an appropriate National Testing goal for september when schools go back in and he said 40 to 50 million tests per month which is 1. 3 to 1. 7 million tests a day and at that point were doing 300,000 tests a day and now were at 500,000 tests a day. If they are right and we have to do millions of testing in september, i have great doubt about whether this administration is going to ebb able our country to do that if were at 500,000 on june 23. With that, thank you, mr. Chairman. Thank you senator kane. Senator hassan. Well, thank you, mr. Chair. And thank you to all of the witnesses for being here today. As i look at your bios, im realizing that the combined years of Public Service sitting before us in extraordinary and i thank you all for your service. There will be time for thorough preview of everything that went wrong with the administrations response to the current pandemic. Our nation could better prepare for future pandemics by reversing cuts to Public Health and preparedness funding. Reengaging with national partners, and ensuring that key federal positions are occupied by quality fied staff. However were in the middle of a pandemic right now. Covid19 is spreading quickly through the United States as many european stations have gotten their outbreaks under control. America has 4 of the worlds population yet 25 of the overall deaths from this pandemic and 20 of new daily cases being reported. In my home state the toll our Nursing Homes continues to be extraordinary. 80 of the deaths in New Hampshire have been in longterm care facilities. Our primary focus must be on strengthening the federal response to the current pandemic that is still raging across our country. So i want to start with a couple of questions to dr. Khaldun. In the early stages of the pandemic, michigans per capita testing for covid19 was below the national average. Since then youve been able to not only ramp up testing but become one of the few states to have an infection rate of less than 1 of those being tested. What specific tests were critical to addressing the initial challenges in your state and what federal support is needed to help other states replication your approach by expanding testing capacity, improving Demographic Data collection from testing sites, and using that data to quickly respond to potential outbreaks. Well, thank you for that question, governor. It is certainly been a massive effort and response not only from our state and local Health Departments but our procurement and the national guard, many people have contributed to us to be respond, going from a few hundred tests to about 14,000 aday. We have focused on bringing testing into communities, working with community partners. Weve made sure that when we do our Contact Tracing weve updated and have to do it building the plane while flying it, updating our Contact Tracing platforms to effectively isolate and understand who has potentially been exposed and isolate them as quickly as possible. So again it is a massive effort. But i would not say were winning in michigan. Were still continuing to work hard to expand testing. That is helpful. Are there particular things that you think the federal government can do . Again, ive been really pleased that weve worked with our federal partners on testing supplies but we dont know when the supplies are going to come and when they come they are less than what we expected to get or not useful. So we need a Clear Strategy from the federal government so we could play on the state and local level on how to get the supplies out. Thank you. I also wanted to follow up with you on another issue. In april you wrote a letter to clinicians across michigan highlighting the fact that africanamerican residents comprised 14 of the covid deaths nationwide. And this is a disparity that youve talked about a little bit today. And it is a disparity we have seen across the nation during this pandemic. And in Overall Health care and outcomes. What types of dedicated investments from congress are needed to give state and local governments across the country the support they need to improve health and wellness in communities of color and work towards eliminating these Health Disparities during the pandemic and beyond. So, we really have to focus upstream and talk about the social determinance of health. So it is health policy. We have to make sure those living in poverty have access to healthy and safe housing. Making sure they have access to Health Insurance and expanding medicaid across the country is important. No one should have to pay out of pocket for testing or treatment for a vaccine or make sure there is equitable distribution to make sure that we address those disparities. I also talked about implicit and explicit bias in our Health Care System. It is well documented that these biases exist. And that is partly why i sent the letter as well. Thank you very much, and thank you mr. Chair. Thank you, senator hassan. Senator smith. Thank you, mr. Chair and Ranking Member murray and to all of you for being here today. I want to start by associating myself with the comments of my colleagues who made the really important point that we have so much work right now to address the existing pandemic that we are dealing with and living through right now. And i especially am concerned about how covid19 is exacerbating existing Health Disparities and the systemic racism that is deadly for black and hispanic and native communities in my state and all around the country. But here is one example that really shows what this means in real life. Recently an obstetrician shared a story about a black line earn immigrant who went to the emergency because she thought she had complications with her pregnancy related to covid19. So they goes to the emergency room and not once, not twice, not three times, but four times. The first three times shes turned away. Because even though she is covid positive it was determined that she wasnt sick enough to be admitted to the hospital. Two days later she returned for a fourth time and she is so sick that an emergency cesarean is performed and a lastditch effort to save her and her child and they both died. She wasnt believed and she died. Now, implicit bias in health care is kind of a wonkish term but this is what it means when bias and racism and disparity kills people. I know that we have talked a lot about what this disparity means when it comes to covid. But dr. Khaldun, i want to ask you this question. What can we do so that black that they need when it comes to covid. And of course i have to acknowledge that we know that Maternal Mortality rates for africanamerican women in our country are three or four times higher than they are for white women even without the complexities of covid. What can we do to address that problem . We experience that disparity when it comes to mattal infant mortality in the state of michigan. Even africanamerican baby is twice as likely to die before its first baby as the white baby in the state. So one of the things we can do is make sure that i believe that we should have mandatory implicit bias training for all Health Professional students. Schools sh work to expand diversity in their students. And i think, this is what were working on in michigan, we have to make sure that best practices when it comes to hemorrhage bundles and the top quality care for o. B. Care across hospitals, even though hospitals that take care of our most impoverished women, we have to make sure there are high standards set and everyone has the same access to eck witzable care. I agree. I think we need to do to diversify our Health Care System and make sure that we have communitybased care available for women and that would be, i would think, would be the same when it comes to covid. Let me ask you this question, dr. Khaldun, what should we be doing better in order to make sure that our Public Health messages are reaching communities of color and are relevant and appropriate for black and brown latino communities, Indigenous Community is part of my work here in minnesota also. So, for messaging those Community Partnerships are incredibly important. That is some of the work weve done here in michigan with our coronavirus Racial Disparity task force, were working closely with Community Members to make sure that messages that were putting out are resonating and that we use the community, the trusted communities to get Accurate Information out. Those partnerships are critical and we cant do this alone and we shouldnt do it from a state and local government election. In order for that to work the Community Organizations need to have capacity and local Public Health agencies need to have capacity. And i know that you worked at the local level as well as the state level and right now in congress were having a debate about how urgent it is that we get emergency resources to state and local governments right now in order to help make sure that this response happens. And so could you just answer briefly, i just have a second left on how important it is you think from where you sit that we get is it a state and local aid to governments right now as were dealing with this epidemic. That is right. Our state and local governments have been underfunded for decades. Especially our local Health Departments. They often dont have even one ep deemyologist. So funding at state and local level are important for Public Health work. And were supporting the heroes act funding to get emergency aid to state and local governments. Thank you senator smith. Senator jones. Well go back to senator jones. Senator rosen. Im sorry. I had problems with the mute. Mr. Chairman could i go forward. Senator jones. Thank you. Thank you, mr. Chairman. And i appreciate this hearing and i hope we have more to be honest with you. I dont think this is a topic that could be handled in one hearing and i hope our other committees will likewise have hearings about Lessons Learned from this pandemic. Id like to first go to my northern neighbor, tennessee neighbor senator frist and talk more about manufacturing. I know senator alexanders asked about it, senator collins and senator murphy mentioned it as well. But the focus i want to talk about is really on ppe. Masks, gowns, those kind of things. I really see it seems to me that weve had not only a shortage now but well continue to have a shortage in the future. We have to rebuild our National Stockpile. But also keep that replenished as our stock pail ages. Weve seen in alabama supplies from the National Stockpile that were ten years past expiration dates that were rotted. So it seems that one of the things we could do is in ve i incentivize. I have a bill to give tax incentives for repurposing facilities and stand up new facilities and give help for infrastructure such as broadband in areas that might not have it. So in adish to the tax incentive, i caught by your statement that we have to help with markets. Longterm markets. I cant remember the exact phrase. It might have been artificial markets. So in addition to the taxin sentives in my bill, what could be do to create those markets because even when were out of this pandemic were going to be living in a new world in which more masks, more gowns, more shields are going to be needed for businesses schools and Health Care Workers Going Forward. So how could we do that in addition to the incentives. Wee deal in pandemic. Virus become pandemics. So when we talk about pandemic were talking about something that explodes and goes around the country to multiple places. That is the global emphasis, if there is an outbreak anywhere it is important here. The markets does come in part to stockpiling but in addition it extends the whole concept of what were dealing with is a rare but certain event. A rare but certain event. And the rarity is hard for congress to deal with because of the Attention Span of congress having spent a lot of time in the room that youre in and that is where it is important to have timelines that are ten years or 15 years, markets tend to look daytoday. And therefore this sort of artificial market means we have to have some sort of public funding that will guarantee a market over the 10, 15year period. Your prior point is on the stockpiling. And it, too, and the cdc talked about modernization which i agree with, but we also need to modernize the stockpile. There is still a lot of debate. Is it a federal sponsor do we push it upon the states. States, because they have to balance their budgets, because of the immediate demands of the constituents is not going to be able to do it so the stom piles need to be not implemented at one point in time, just like the exercises every year, have to be looked at year to year as to the current threat or risk determined by our communities of science, the scientists at the cdc. If we do that we could have regional stockpiles coordinated with an over lay at the federal government with great coordination, better coordination going back to gov levitts plans with the states of what needs to be in the stockpile and then the markets designed around that. Federal government cant build the factories, to be those that could change with the time. Governor levitt, let me ask you real quick in the remaining seconds here, i agree we need to do more investing in Public Health, but in your testimony you mentioned that medicare funding crowds out state budgets for Public Health funding and i would like for you to explain briefly what you mean by that. Are you suggesting that we should cut medicaid and that would help Public Health funding . Because it seems to me in my state more medicaid is better for Public Health than less. Senator, let me just say that Public Health generally has been starved for resources for probably 30 or 40 years an the budgets have continue to go down. There is a direct correlation, this is just a fact, im not making drawing the causation, im just saying there is correlation here that medicaid budgets have dramatically gone up. When i was first governor i think medicaid was 6 of the budget. It would probably be 20 in the state i was governor now. Weve just undernourished it. And im worried about that. I dont think that every it is a local function, it is a state function. Right now it is being driven in funding primarily by federal dollars. I think that is not a good idea in the longterm. So im just advocating that states need to be to Pay Attention to the Public Health infrastructure as well. Right. Thank you. Thank you, mr. Chairman. Thank you, senator jones. Senator rosen. Well, good morning, everyone, and thank you, mr. Chairman, for bringing this important hearing and of course Ranking Member as well and everyone on the panel for all of your work in the past and youre comments about how we can plan for not just a Global Pandemic but all of those smaller kinds of prices that we may have that we have to plan for even if they are regional. And so i do believe that it is important to keep up with research in order to understand this virus because scientists around the globe are frantically working to gain a better understanding of covid19. How the virus attacks a patients immune system and how to best prevent infection. To make sure we dont have gaps in research and information and how the virus impacts a wide range of patients i riintroduce the covid to protect Public Health act to direct the nih to conduct a longitudinal study of patients that includes diversity among gender, race, geography and age and many other things. Were looking at both the shortterm and longterm impacts along with interventions. This would be reported publicly on a regular basis so that all researchers and Public Health officials have the latest information. So dr. Khaldun, as a Public Health official directly dealing with the current pandemic, what challenges have you faced in getting comprehensive information about the latest research on covid19 and could you please speak to how not having robust Data Available hurts not only Ongoing Research but patient care. Yes. So we all are learning about this virus. Obviously it is a new virus so were all learning how it responds in the human body and who is the most impacts. But absolutely it would be great to have more research to look at the disparities and why those disparities exist. If you look at how it even impacts children. Were seeing this disease in children as well. So absolutely, the research and the data would be incredibly important to advancing this response. So on building on that, what recommendations would you have for us maybe in kwogs or for others, how could we make it easier for doctors and Public Health officials to get this comprehensive data, updates are coming in rapidly. I want to avoid the gaps that we seem to be having in the data between states and counties and cities, et cetera, et cetera. I think we need uniform surveillance and data across the system. We have our own data system and the locals are doing their own and we have a hodgepodge way of getting information to the cdc and we recently updated that. We absolutely need more data. It would be great to have more coordination and updating when the cdc does come out with guidance or research to make sure that our state and local governments get that as quickly as possible. More coordination and better surveillance would be important. From the cdc . The cdc. Thank you. I want to move on and talk about telehealth. Last week we had a great hearing on telehealth. Showed how vital this tool is for caring for patients in the pandemic and also after. So along with many of my colleagues, we support continuing the flexibilities for telehealth reimbursement that weve allowed through medicare through the passage of the c. A. R. E. S. Act and i want to tell you i think it is fantastic. In nevada we have a model Health Company that will send paramedic or nurse to a patients home and use telehealth to connect with the physician to treat the patient. They do say history and physical, they take the vital signs, they may do blood work right there. And then they could speak with a physician if the situation is more serious, they could get the patient to a hospital or to a followup, kind of an urgent care situation. So again, dr. Khaldun from your experience during this pandemic. How do you think that telehealth has improved Patient Outcome and peoples ability to receive care . Well, telehealth has been incredibly important to maintaining our Health Care System during this response and i hope that we dont go backwards and that we continue to use the lessons weve learned from w this response as we move forward. Weve expanded access to telemedicine and telephonic and including teledentistry and Speech Therapy as well and so it is helpful with our Health Care System and i hope we learn from those lessons. I hope we do too. Thank you. I appreciate you being here today. Thank you, senator rosen. If the witnesses will stay with us another 10 minutes well conclude the hearing. Senator murray, do you have Closing Remarks . Well, thank you, mr. Chairman. I have to say covid19 has killed more than 120,000 people in the country and simm sickened more than 2 million. None of us would have said that four months ago. And we just have to just say this is stunning. Especially when i heard Vice President pence last week say, quote, our whole of america approach has been a success and the nations response to covid19 is a cause for celebration. I mean, we are in a pandemic that is just stunning this nation and we should not be ignoring that or talking nonchalantly about it. Ill ask dr. Khaldun to comment based on your experience in michigan, would you characterize the federal governments response as a cause for celebration . Is it time to declare Mission Accomplished . Absolutely not, senator. Were in the middle of a pandemic and still seeing outbreaks across country and increasing cases so we definitely should not be celebrating right now. Yeah. I dont think so either. So mr. Chairman thank you for this hearing. I really do appreciate all of our witnesses for taking the time to join us today and share your expertise. While it is clear we still have a lot of work to do to prepare for the next pandemic, it is even more apparent to me that there is a lot more that has to be done right now to respond to this one. Because despite what we heard from the white house, this crisis is far from over. Several states are seeing recordsetting new case counts. There are many steps that we need to be taking as soon as possible to fight covid19. We need to increase testing, not decrease it like we continue to hear President Trump suggest. We need to take steps to pave the way for a safe, effective vaccine that is free and accessible nationwide. And we need to take steps to address the harmful Health Disparities that are being compounded by this crisis. And of course we have to address Racial Injustice not just in health care but in so many other ways as well. So as we continue to focus on that, i would like to ask consent to submit for the record an outline of Health Equity principles from the Robert Wood Johnson foundation, mr. Chairman. So ordered. Okay. And so i really hope we continue to talk about this and build on this conversation. Not just with future hearings and discussions but we need to take Congress Needs to take immediate actions so our country can deal with the crisis at hand. Thank you. Thank you, senator murray and thanks for your cooperation and that of your staff in scheduling the hearing. In a moment ill ask each of the four witnesses if they could m summarize in 60 seconds the top three things they would do now to prepare for the next pandemic if they were the king or the queen of the United States. But first let me make a couple of comments. Several of my colleagues have wondered why in the middle of a pandemic we would be thinking about how to prepare for the next one. Well, i think senator frist made that argument very eloquent, as eloquently as did other witnesses. It is because our experience has been we havent been able to adequately take the steps that we need to take to prepare for the next pandemic if we wait until the current one is over. Over the last 20 years weve had four president s, two republicans, two democrats, several congresses, earnestly working on this subject. Theyve passed nine different major laws. I mentioned what those were before. But it was after anthrax and sars and ebola and the attention of congress on difficult issues was on other matters. The same thing happened in the states. Where hospitals in states allowed their stockpiles to be diminished because other matters demanded more budgetary considerations. So i would ask think colleagues, when do you think would be a better time to ask the United States congress, for example, to build a manufacturing plant for vaccines, that we more many years might not even use. Probably during this pandemic is the best time to get the attention of the congress for such a use. Or when would be a better time to accelerate research for testing and treatment if we could think of ways that would speed and accelerate the testing and treatment for the next pandemic. Or when will be a better time to do the appropriatel l l l l l l to look at our stockpiles and our hospital surging than while were in the midst of them. Whether would be a better time to talk about strengthening funding for state and local Public Health departments, which governor levitt said had been going down for 40 years in terms of funding. If we havent been able to do it for 40 years, why not try doing it in the midst of a pandemic. When would be a better time to consider who ought to be on the flagpole. It is not easy to accept the recommendation of dr. Gerber and the commission that recommended putting someone in the nsc in charge. Or to improve coordination of federal agencies in other ways. And when would be a better time to do what is probably the most difficult recommendation that many of you have made, which is create a funding stream that is automatic, that is mandatory at a time when the federal government has such a big deficit. So the reason were doing this today is because were in the midst of these problems and our eyes will be clearer on what the solutions may be and our wills will be better and we have a notorious poor record of short memories when it comes to doing everything we need to do. Weve tried but not done some of the things that we need to do. So in my view, and i think in the view of at least several of the witnesses and many others, now is the time to do those few things that we know must be done for the next pandemic while our attention is focused on these matters. A couple of other comments before i ask our witnesses for their concluding remarks. One was i appreciate dr. Gerbers comment about asking the National Academy of medicine to become involved in transparency for the vaccines. That is a very good idea and that is what theyre for. And i think their opinion about the safety of a vaccine would go along way toward dispelling any worries about it. And the other comment i want to make was on Contact Tracing. Of course Contact Tracing is essential. And of course federal funding is essential. But weve already done the federal funding. I mean, Congress Gave states 150 billion, all of which could be spent on Contact Tracing. That is a month ago. And then in addition to that Congress Gave states another 11 billion as part of a 25 billion testing package that was expressly for the purpose of contract funding if the state chose to use it that way. We decided not to tell states to use it that way but they could use it that way. And that is plenty of money to hire all of the contact tracers that you need. According to one estimate by a professional firm, average salary for a contact tracer might be 37,000. If that he were the case, the cost of 100,000 would be 3. 7 billion. A lot less than the 11 billion that was specifically allocated to states for the purpose of hiring contact tracers if they senator blunt, chairman of the Appropriations Committee for health wrote a letter to cdc asking them to make that clear to governors, that they have that money. And many states have not spent the 150 billion that we gave them earlier. This is an allowable expense there. So, yes, we need federal funding for Contact Tracing. Yes, theyre important. Yes, it might be 100,000, 150,000, 180,000 and many ought to use it and many already are. So conclude the hearing, let me ask the four witnesses even though theyve already said this in their testimony. If they were in charge and if they could do three things to get ready for the next pandemic, what would they be. Senator frist well start with you. The pandemic is growing around the world and an outbreak anywhere is a risk everywhere. We need to test more and continue to focus on the vulnerable populations as we talked about here and around the world. And to endorse senator murrays underscoring the Robert Wood Johnson foundation principle. We need to establish invest in longterm partnerships and engage with the private sector to develop the diagnostic test and treatment and vaccines and number two put in a budget mechanism to ensure that Public Health funding does not disintegrate. And number three telehealth. It works. It allows social distancing and Clinical Care to be delivered, and for the future it is convenient and it could be transforming. Thank you, dr. Frist. Dr. Khaldun. Thank you for the opportunity to speak today. The three things i would focus on is disparity and tracing and isolation and funding of state and local Health Departments. When you talk about disparities, we have to talk about housing. Everyone should have access to affordable and healthy housing. We have to invest in communities of color. Through education and jobs. Access to health care we have to focus on. So funding for the Health Care Safety net. Our federally qualified Health Centers who provide the care in the communities. We have to build up the testing capability, and the Contact Tracing capability. Were grateful for the funding in the state of michigan but it needs to be longterm funding and not just come up when we have an emergency. And finally we must invest in longterm Public Health departments. So as been said before, many only have one epidemiologist and were building this on the fly and this needs to be longterm far as funding for state and local Health Departments. Thank you. Thank you. Dr. Gerberding. Thank you. I certainly support what senator frist said and stand by the recommendations of the cis report as well. Ill emphasize three things. One is National Vaccine plan that includes not only the science and the development and the manufacturing piece and collaboration with the private sector, but also the allocation and uptick in monitoring fees because we know this is in the future and were not ready for it yet. The second thing i would say it were coming into a high probability of jointness of ongoing covid in the context of influenza and we need to exercise Health Care Surge under that scenario. Again, including the supply clain in the private sector and that process so that he with could understand how to create more robust supply and hopefully really improve immunization rates at a time when we need it now more than ever. And last thing i would reemphasize is the importance of the Budgetary Authority that allows for sustained investment, not just at the federal level and cdc but through the state and local Health Departments. You cant plan for preparedness in one year cycles any more than you could plan for the department of defense to be prepared for that kind of security in one year time frame. We need longterm sustained accountability and measures for progress. Thank you. Thank you. Governor levitt. Unless you think i cannot counts, im going to give you four. The first is to advance in clarity on the division of labor between state and federal government in a pandemic. States need to be armed with a clear understanding of their role and the federal government its role. Second rejuvenating the Public Health infrastructure. As others have stated, it is not only important at a time of pandemic, but in the Health System where were working toward value. The social determinance of health will play a dual role and ongoing role and have ongoing role in and out of a pandemic. Third the hhs, cdc data modernization, it is a critical piece of infrastructure that needs to be put in place in advance. We should be work on it now. It could be valuable in three months from now as well as in three years from now. And finally, again the echo, annual appropriation on emergency management, not just eposodic funding. Thank you, governor levitt. Thanks to each of the four witnesses. As i listen to the priorities, im reminded again most of the recommendations will help with the current pandemic. All will help with the future pandemic. And in my opinion, theyll all be easier to pass and turn into law during this current pandemic than they will be if we wait a year or two and try to compete with other priorities of the moment. The hearing record will remain open for ten days. Members may submit Additional Information for the record if they would like. Ive also invited comments and responses in any additional recommendations in response to my white paper preparing for the next pandemic, for our committee to consider. Ill fully share those recommendations that i receive with my colleagues, both democrat and republican. The deadline for submitting comments is 5 00 p. M. This friday, june 26. Comments may be send to pandemic preparedness at health. Gov. This is the fourth hearing this month on the covid19 pandemic. Weve had one on going back to school, one on going back to college, weve had one on telehealth. Weve had this one. And then well meet again at 10 00 a. M. Next tuesday june 30th for an update on progress towards safely getting back to work and back to school and our witnesses will be dr. Fauci, dr. Hahn, admiral giroir and dr. Redfield. Thanks again to our distinguished panel of witnesses, to the senators who participated and the staff who helped put this together. The committee will stand adjourned. This afternoon the house ways and means subcommittee looks into childcare issue as mid the coronavirus pandemic. Watch live coverage at 2 00 p. M. Eastern on cspan3, online at cspan. Org or listen live on the free cspan radio app. Tonight on American History tv, beginning at 8 00 p. M. Eastern, a look at the lives of Lucretia Garfield and mary mcelroy and francis cleveland. Cspan in cooperation with the White House Historical association examine private lives and public roles they played, first ladies, influence and image features individual biographies in the roll over 44 administrations. Next we hear from fcc chair ajit pai and how he helped provi provide americans with access to Telehealth Services amid the coronavirus pandemic. Let me start over. The subcommittee meeting will come to order. Ve got a i want to thank everybody for coming. Ive got a fairly short and statement that i will read and s thenen i will turn to