[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> i now call to order the hearing on fiscal year 2023 president's budget for the national institutes of health. this is a hybrid hearing so we need to address a few housekeeping matters. welcome my colleagues who are with us the screen. for the members enjoying virtually, once you start speaking there is a slight delay before you are displayed on the main screen. speaking into the microphonemaee activates the camera, displaying the speaker on the main screen so do not stop your remarks if you do not immediately see the screen switch. if the screen does not change after several seconds please make sure you are not muted. to minimize background noise and insure the correct speakers being displayed we ask you remain on mute unless you sought recognition. the chairir or an individual designated by the chair may get participants microphones when they are not under recognition to eliminate an important background noise. members or virtual are responsible for muting and unmuting themselves. finally, house rules require me to remind you with set up an e-mail address to which members can send anything they wish to submit in writing at any of our hearings. beene-mail address has provided in advance to your staff. with that what i'd like to do is acknowledge and thank ranking member tom cole and all of the members of the subcommittee joining today's hearing both virtually and in person. and i thank you to our witnesses testifying before us today, dr. tabak, welcome to the subcommittee. you started in this role just a few short months ago. you have proven in your over 12 years as principal deputy director of national institutes of health and ten years as a director of the national institutes of dental and craniofacial research to be a thoughtful, efficient leader. thank you for your commitment to making america i hope your place and our healthcare research more equitable. our deepest thanks. let me also welcome institute directors joining dr. tabak today, and are subcommittee this morning. dr. diana bianchi, director of the eunice kennedy shriver national suit of child health and human felt with her dr. anthony fauci director of national institute of allergy and infectious diseases. dr. gary gibbons,r director of the national heart, lung, and blood institute. dr. doug lowy, director of the national cancer institute and doctor nora volkow, director of the national institute on drug abuse. i also want to note and i think i've said this before, we were able to get once before, i do intend to invite an additional panel of institute and center directors to testify before this committee later this year. we have not been able to hold a second panel in the past two years that i value the research of every institute, every center, and want to make sure the subcommittee has thesu opportunity to hear from others directly. i'm also going too be reviewing the funding across all the institutes and centers for looking for a pattern over time, and to hear more about how the institute and the centers set priorities. and i just say this with all sincerity, i mean, i always think this is one of the most exciting and exhilarating and meaningful hearings that we have before the appropriations committee. the work thate. you do, all of e staff, the grantees that the nah supports g and what you're doneo continue prioritizing covid-19 research over the past two years, we would be nowhere close to where we are in defeating this virus. through the research of the nihs own science, and everyone talks about, you know, how quickly we moved and how successful we were in terms of a vaccine. it just didn't happen overnight. it was the years of research of investment in research that allowed us to move as quickly as we were able to. so through the research of ourch scientists, research grant institutions a partnership with the private sector, our knowledge of buyers has dramatically improved, reliable protection diagnostic technologies have been developed, treatment options have been committed and vaccines and other prevention methods were accelerated and distributed all in record time. nih's response to desperate what i've known for for a long tt are significant a long-standing support for biomedical research is absolutely critical to ensuring we are prepared to prevent and address healthcare crises whenever that may arise. the work you do save lives and protect family centered families were over. with the proper resources and leadership at nah are biomedical research can move very quickly, refocused ways to achieve high priority goals and continue to save lives. none of these transformational advances would have been possible without the annual sustained investment in basices biomedical research made by this committee in a bipartisan way in recent years which is why i am so proud that over the past seven years congressve has increased nih funding by nearly $15 billion, or 49%. and i i repeat, this has been de in a bipartisan effort. and in the 2022 on the bus recently passed, congress provided congress provided a 2.25 billion increase over 2021 -- omnibus. this includes an increase of $353 million to fund a greater number of research proposals at the national cancer institute and support for the canister moonshot initiative that will save lives by speaking cancer research progress and improvinge prevention, detection and treatment effort. we also provide an increase of $289 million for the alzheimer' alzheimer's, for alzheimer's disease and related dementia research to help you understand the cause of alzheimer's and advanced research and diagnosis, care, treatment and prevention for those with and at risk of developing these. i am especially proud of the $30 million increase for the improve maternal health research initiative and maternal mortality rate in this nation is far too high, high, the hy developed nation.f and more must be done to address this crisis that killed hundreds of mothers every year. these increased funds to support research on maternal more improve the health of pregnant people, especially those mothers, the victims of our nation's health disparities will have been historically underserved. and health disparity impacting underrepresented communities are an unacceptable issue in nearly every corner of our physical and mental health care system. which is why we delivered an increase of $50 million for research to identify and reduce health disparities across our country. i'm also proud of the $8 million increase congress provided for the office of women's health, research on women's health, to further promote the interest and involvement of women in nih supported research. and i am personally grateful to the $159.4 million in fiscal year fiscal year '22, the nih grant that has been delivered, many have been delivered to my own district, connecticut's third, following 572.8 million in fiscal year 2021. that's nih funding for the district. this funny has already advanced reticle research efforts, strengthen the future economy and growing opportunitiessunitst request for 2023 proposes an increase of nearly a $4.3 billin for nih. i'm pleased the proposed increase research to address health disparities and thehe opioid crisis. to make major issues impacting the health far too many across the nation.he particularly glad to see the proposed $50 million increase for universal flu vaccine research and development an issue i have been fighting to address for years. and the request would double funding for gun violence prevention research nih building off investment the subcommittee has made over the past few years. despite all the great investment in the bill, however, i am concerned about the lack of balance between the budget request for arpa-h and the request for other more quote traditional nih activities. i know the the president fir 123 budget request for nih was developed before the 2022 omnibus was enacted and might've been different had it been an acted sooner. however, the proposed increase, $274 million, core nih activity, is insufficient and threatens the progress this committee has made in the past several years. a significant, sustained investment in biomedical research. i have said before and i will repeat it, i am proud of the work we've done together to establish our age. it is clear the $1 billion investment in 2022 funding this committee made to establish arpa-h has incredible potential to develop transformative technology that saves lives to the stored funding and it will be used to research the causes and address debilitating impact of major diseases like alzheimer's, diabetes, cancer, als, and others that impact allies of millions of americans, and exacerbate already existing health disparities. however, it is critical we strike a balance between investments that we make in our age and those in basic research and discovery at the nih. dr. tabak, i know this was not true decision but while i strongly support nih and recognize its long record of success, in supporting our medical research i believe that placing arpa-h within nih is mistake and will have the agencies ability to achieve the breakthroughs i just outlined. i strongly believe our h would be moreon successful in its unie mission if it were established as an independent agency within health and human services. with that, let me just say i thank you all for joining us today. your work again is invaluable to the health infrastructure of our nation. to really improving our medical discoveries from making his medical discoveries and ultimately saving lives. i look forward toward discussions morning and her work together in the months to come, and by the recognize congressman lieu goal for his opening remarks. >> thank you very much. before you begin my prepared remarksuc i draw one great lessn as brodeur graduate, it's a great thing to represent yale. what a great magnet for research and good things. well, good morning. i am please we can come together in person this morning for the first time in two years to tr directly from the institutes of health about the administration's budget proposal for fiscal a year 2023. this is our first hearing in many years without our friend francis collins, and we all wish him well in his new endeavors. as i say every year, a sustained commitment to increasing funding for the nih is a vital step to preserving our status as a world leader in biomedicals research and to finding cures for many diseases burdening our healthcare system. and we know the funding also goes, does far more. several studies have shown funding ator the nih has a multiplier effect contributing to overall u.s. economic growth. like the chairman, the chair, i am proud what this committee has done year after year on a bipartisan basis since 2015. then nih budget has increased every year beyond inflation during that period, regardless of who was president, regardless of which party was in control of the congress. and it shows there are certainly some important things we can work togetherth on and and k will have positive results for the country. and i particularly want to praise my good friend, i make this point a lot, the chairwoman, when i was privileged to be the chair of this subcommittee for four years she was kind enough to back my budget not the first one but the last one, the one that passed, every single time. i have been very proud to vote for her budget for three terms since then. we may start in different places but we have a way of ending up at the same place, and this agency, the nih, is a big reason why quite frankly, so you can shave it to bipartisan comity and cooperation. given all that i had to kick off a hearing on a sour note, but i probably, where the chairwoman is, i am perplexed as to why the administration has chosen to pour billions of dollars of funding into the new arpa-h program at the expense of ongoing basic research at the nih. arthur h was funded for the first time in march, and i might add with my support, like the chairwoman i see much potential goodti here, but as you pointed out in her remarks there are still great deal of controversy around it and different if pain is for both republicans and democrats and, quite frankly, within their ranks over how it should be organized, where it should be placed. in the end, almost every decision was simply left to the secretary of health and human services, someone i hold in high regard but he is an executive official and a think it's unprecedented for the creation of a new agency to be, lie largely in the hands of one individual. we still don't know the structure of thisan new agency will ultimately take. we don't have a director. any possible of a director or any idea when this individual will be named. we don't have a a physical location for the new agency. we don't know how grants will be made and who will be responsible for deciding how billionsl of tx dollars are dispersed or . we don't know how arpa-h will interface with existing nih institutes and research or how weh can ensure that it will be value added rather than an agency that competes with an siphons off talent. we don't know the rules for hiring staff or how they would be compensated. so i think it makes no sense to propose an enormous increase off $4 billion for this new agency while proposing what is essentially flat funding and for some important agencies even a modest cut for the rest of nih. i will have some tough questions about that today but sounds to me like we probably have some of the same concerns, madam chair. next, i think everyone in this room needs to address the difficult topic of the loss of public confidence and credibility across our public health agencies including the nih during the covert pandemic. i fear that mistrust in our government public health system has eroded to a dangerous level. from our own leaders placing too much trust in the chinese government in the beginning of the pandemic to locking down our society, economy and schools, mixed messages unmasking and vaccine mandates through what many believe is a cover-up and the role if any at the wuhan lap played in the origins of the covid virus. public health agencies have made mistakes may need to be acknowledged and corrected. this has weakened confidence in oured public health and governmt system for many of our constituents at a time when we desperately need to comee together as a people and heal. i pledge to work with my friends across the aisle to rebuild a bipartisan coalition of support for basic science and research, and talk honestly about ways we can translate that information into evidence-based practices using data, not just talking points. most of our constituents want to do the right thing to stop the spread of covid. many just don't believe what they're being told by government officials anymore. i suspect will hear some difficult questions about that this morning. much attention in the past year has gone to covid, and rightly so. but i hope we can also continue our conversations and scientific advancements in such areas as cancer treatment and dealing with alzheimer's, diabetes, other diseases and chronic illnesses. these diseases are responsible for the loss of hundreds of thousands of american lives every year. h again i fear this work may be shortchanged by the hyperfocus on the newd arpa-h, and i sincerely hope that will not come to pass. we have an excellent team representing some of the largest institutes and most promising frontiers of new discoveries before us today. as we know, nih is composed of 27 institutes and centers, most of whose leaders are not able to be with us today. but even though we are not able to each director, before us, our office is continually learn about the groundbreaking work and collaborative partnerships that all of the nih component and were all very proud of that work and know our role in making sure it goes forward. we know the work done at nih in each institute or center is a contributor. in closing i wantr to stress eah dollar invested in the nih is in my view a down payment on our future. this work has in the past and in the course, and will change in the course of disease detection, jurors in the years and generations to come. i know congress commitment to advancing these shared objectives is unwavering and bipartisan. i want to thank you, madam chair for holding the hearing and thank our witnesses for being here. i yield back. >> thank you, ranking member. dr. tabak, your full written testimony will be entered into the record. and now you're recognized for five minutes of for your opening statement. thank you. >> thank you chair, ranking member and distinguished subcommittee members. i am honored to be your two of my colleagues represent the national institutes of health. this is a time for nih and the entire biomedical research community to re-examine all of our efforts to rake the covid pandemic we are driven by the urgency of the moment. nih must learn from this experience and seize the opportunity to define a new normal exacting director and committed to new strategies, new voices and a renewed focus on the future. now is the time to reflect on what worked and did not work to address covid and shape new strategies. sustained investment nih research set the stage for the mrna technology design key to development of safe and vaccines unprecedented timeline. since these vaccines have become available to estimated more than 2 million lives were saved and more than 17 million hospitalizations were averted. now we need continued support for a wide range of biomedical fields including behavioral and social sciences, to identify successfully implement better ways of responding to the short and long-term health effects of covid-19 to prepare for future pandemics and to ensure equitable protection of our diverse population. it is not just about vaccines. rapid acceleration of diagnostics covid-19 testing to help ensure his benefits showed those disproportionately red x underserved populations and nih community engagement alliance. these experiences along with other nih led efforts focused on covid treatment development, demonstrate the extraordinary value of public-private partnerships. the nih could build upon momentum of the covid response and apply it to other challenges for the advanced research project agency for help. thanks your inclusion of key authorities and funding nih is beating to frame the basic administrative infrastructure. this is a first key step in creating permanent home with the strategic partnership there so urgently needed to address cancer, diabetes, alzheimer's and many other diseases. but we cannot stop there. in addition to new strategies biomedical research needs new voices. growing body of demonstrates inclusion have better outcomes clinical setting, diverse medical teams provide more accurate diagnoses and improved health for patients while building trust. we do better science we have a diversity of scientists of different backgrounds and communities, scientific fields and various career stages. nih continues to prioritize fund and empower early-stage investigators so that they can succeed as independent researchers in 2021 reach an all-time high of early-stage investigators funded 1513. voices of people living with the lot wide range of diseases and conditions conversations with patients and their advocates are sometimes difficult. those are often the discussions that teach us the most. from the aids advocacy group of the 1980s to today's groups for autism dcfs on covid and many others these voices have refused to be ignored and ultimately all of us benefit assist for renewed focus on the future spent a lot of time encouraging early-stage scientists i also think about the importance of engaging elementary school age children like those my wife has taught for over 40 years. during the covid pandemic exposure to the importance of science has been a big part of many of their lives. past pandemics have inspired to young people become scientists. the images they saw were usually of older men who looked pretty much like me. hopefully today's kids are seeing more scientists look like them. still we need to do better. our nation needs all of the bright minds we can find. i hope you will continue to work with nih to make this happen. thank you for your time and i welcome your presence and questions. >> thank you very much. i am going to try to get into questions on this first round. mention the subcommittee has increased the budget by roughly $15 billion almost 50%. i would like to have you talk about how the nih determines research priorities. in many the small number of initiatives with medicine initiative this year, significant increase in fact the proposed increase significantly larger than the increase for the entirety of nih research combined. my question is what are the determining factors with nih research if there is what is being left behind? what happened to research in important areas of health that are not included in large-scale initiatives? and how do we determine progress in these initiatives? >> as you know it is a balance that needs to be struck. and in recent years there has been an emphasis on large-scale investment the scientific opportunity presented itself either due to new technologies or emerging areas of concern. but in east each instance institute centers try to prioritize their effort based upon the science is ready to move forward with the public health need is and then whether or not the portfolio they currently sustain is sufficient to move the field forward. each institute center has a strategic plan and that work closely their national advisory council make sure work is supported are aligned with the strategic plans. >> i want to get onto my next question the concern is what do we believe with these being left behind and are not included in the large-scale initiative? successfully overall is roughly 20%. and i think historically we have observed their applications coming at least to the top one third period the difference between the 20% and the 33% represent what's being left behind as you put it. those are studies that are certainly worthy of support. obviously with finite resources. >> let me just ask you you mention success rate. success rate increase each year from 17% 2013 however despite a funding increase $1.3 billion in 2021 the success rate declines to about 19%. i know there are several factors that are at play here. why does the success rate decline despite the funding increase in 2021? and what is nih doing in 2022 to avoid another year of decline? >> as you know the success rate is simply the number of applications funded divided by the number of applications that we receive. fiscal year 21 we received an unprecedented number of applications. this increase is a largely what drove the modest decrease in the success rate. obviously we cannot control the number of applications that we receive there are other factors the main driver for this decrease was the unprecedented increase in applications. >> thank you. i've got a few seconds left them going to yield back. i also want to mention i have to step out there are two other hearings i have to pop into. and then i will be back and i'll ask congresswoman to take the chair. with that congressman cole. >> thank you madam chair. we really to not coordinate our questions they are very close some days. i want to go back to this concern i think the chair and i both have about the in balance we both see and i don't presume to speak for her as i see it between this and nih. i suppose and i want to i recognize you to hunger to all of these decisions either. i suspect honestly we are speaking and more than any of you could admit. do not want to throw out the baby with the bathwater here are the basic mission of nih which i think you've all done a remarkable job advancing over the years is the most important element. arthur h, i hope over time will develop we just simply don't know that yet. so, tell me what would happen to $4 billion we don't know the director we don't know the procedures and you cannot possibly have that set up to be fair to you. you didn't know how much of this was even going to exists we through this at you with the billion dollars don't think we could afford to follow that with 4 billion more particularly pinch the budgets of the other institutes. again tell me what the $4 billion would do. >> our first step of course is to build out the infrastructure on the administrative infrastructure of the organization. from the practical standpoint with the new organization within nih we can draw upon some equities that can be used across hhs and indeed other departments like electronic er a system for grant following the tracking and so forth. search is underway for the inaugural director and our charged at the moment is to really focus on the administrative issues we brought in a small group of senior operational people focused on the administrative side but no program managers will be driving the science will be recruited until the director is in place. >> again i want to switch in the area that would suggest to meet we should be very cautious here about this amount of money. i think is going to take a while to set this up and get it right and frankly i'm not energy and commerce are going to want to have something to say about this are not going to just let the committee. that again makes me very uncomfortable. although it let me make this very clear to predict till he figured the money we are talking about and have a problem with that ever profit the distribution of nih given form and successful one is the others in the process of being formed. doctor lloyd is good to have you back. i want to do this question quickly and think probably we are seeing one of the most difficult jobs is a sheer number of applications that you are getting. what is the funding rate at nci how promising is the science and cancer going forward? >> thank you. the funding of rate at the nci currently is 11% of pay line for experienced investigators and 16% for early-stage investigators. last year, thanks to the generosity of congress we were able to give more awards than we have ever given before. actually gone up by about 25% experienced investigators over the last four years about 60% for early-stage investigators. as you know there has been a big increase in the number of applications to nci substantially larger than the rest of the nih. this is very good news in the sense that it is a reflection of the optimism that people have of being able to make progress in cancer. but a direct consequence is that there is a decrease in the pay line and success rate. >> my time is up but to me again you've made the point as to why we need to get more resources into various agencies yours in particular. i was said this is across the a lot of promising research here. and i don't to tie up money as we create new agency when you have got worthy recipients right now that we can make immediate contributions to the mission that we have there. i feel back madam chair. >> i would like to ask about the retirement to sanctuary. in 2000 congress and signed the chimpanzee making this protection act into law instituting the national sanctuary system to resettle the chimpanzees that are no longer needed in research by federal agencies. since november 25 being nih announced it would support biomedical research is a bit of priority of mine to see these primates retards was fully and successfully to the federal sanctuary chimp haven. however 2019 despite congressional directives in strong humane organization recommendations, nih made the unilateral decision to make the remaining 24 chimpanzees at the alamogordo primate facility which is run by the research laboratory global corporation whose business model is to breed, import, sell an experiment on nonhuman primates and other animals. since that time, 12 chimpanzees have died at least half were euthanized. multiple animal welfare experts have expressed concern charles river managed may expose chimpanzees to an environment which results in chimpanzees meeting some criteria which is a euthanasia decision because invasive research on champs would still legal when the chimp act was passed congress chimp speak congress would likely be older have serious health conditions they would no longer be useful for research effect nih own regulation recognize the possibility that ships with infectious disease and other health conditions will survive at century nih has been moving champs from climate health to chimp havens for years. do you believe laboratory facility managed by charles river laboratory the physical and psychological needs of chimpanzees previous use him biomedical experience better meet the needs of chimpanzees retired from research? >> it is a balance between the facility the chimp is currently housed in verses there physical condition, their medical condition if you will. it is the opinion of a panel of veterinarians from nih and from chimp haven and from the facility in this case that a certain number of chimpanzees are just too frail to be moved safely. there is also some consideration several of the chimps who are part of a social network that they should remain for that purpose as well. so when you balance those two things that's why there are some chips remaining at that facility. >> with all due respect they appeared to be dying or being euthanized is a much higher rate that would be expected if they were in sanctuary and the humane society society has filed a lawsuit to force the transfer of the remaining champs both the humane society and animal protection new mexico chimp experts have reviewed the chimp health records and strongly believe the chimps couldn't survive but transfer a much better quality of remaining life at chimp haven. i guess there is disagreement on that. i'm very much concerned the record of euthanasia in the fact so many have already died does not uphold the recommendation of nih i hope you will look at that more carefully. my concern is i don't know what directive congress could give that would make the nih actually stop the current violation of the chimp act and move them to chimp haven. i don't know what it would take to do that. i won't expect you to answer that question but he certainly hope you'll take that into consideration. i have one question but i'm running out of time i will yield to mr. harris. >> thank you very much. good to see you all again here. doctor i'm going to ask you a question. last week the white house wants or could be of the cases because of waning immunity and other things but we do not know what variant it is going to be depending upon the variant one and 20 could end up on a ventilator. of those it could be up to 40% actually diapered we know people have died from coded usually people end up on a ventilator and have untreatable lung disease. and because it does not appear it does anything in the late stage pages that may be the last remaining therapy that we have. i and other physician members of congress have experience with some constituents who recovered under the drug the right to try that is anecdotal we do need more evidence than that. the nih is taking on the risk of studying this medicine from a small drug company to small drug company that makes it. no one could have predicted the last drug standing for late stage covid. the bottom line is if we are going to have a surge in the fall and right now we have no late stage therapeutic for the person who's failed all of the therapy on the ventilator in the icu. going to need months to ramp up production of therapeutic. so the question is, the problem right now is because the enrollment has slowed down and i'm sure you are aware of that they just are not that many people who proceed to that level. the question is are your statisticians going to take an early look at that data and see if it works or it works enough to authorize, scale it up so this fall when we have this potential surge will have a late stage therapeutic. because we desperately need when we still do not have something for those patients it is terribly go to the icu there is nothing left you call that family in for a meeting. can you do that can you look at some of the data? >> as you well know doctor harris, the company who sponsors this has the opportunity to present the data to the fda for an application for emergency use authorization. the nih in our clinical trials provide all the resources necessary to do that. with all due respect is not an nih issue whether or not this gets submitted. >> your going to meet this month on this. it could choose to take an early peek at the results for. >> yes it will. one of the things that is very clear as we do not interfere with the dsm v -- the way they look at the clinical trial data that would be a conflict. we would always welcome what they do but they look at the data and feel it should be an early look then we welcome that we have nothing against that a promise you that. >> good they will never get to 650 and think that is the end number. >> it is a good news/bad news thing. >> thank you very much. i'm going to ask you something because for years i've been holding up a graph of the young investors age of disk every you are aware of this paper that suggests the inventiveness peaks in the late 30s or so. yet i see the report from last november that looked out from the nih looked at the long-term trends in the age of investigators, you are aware of this, right? you have created all kinds of committees, you have done everything and the result is what ages been continuously increasing the rate of increase has slowed over the last ten years. it is not going to continue forever it's not going to continue to age 100. i mean i don't get it. nih has failed at reducing the mean age i'm looking at it, the mean age increase in 2015 -- 2020 whether you are mail or female the mean age increase. there failing to address this properly. what are you going to do? it's nice to say we need a diversity of people we need people who look like a college age graduate but we are not funding those people. what is the concrete plan? >> doctor harris you are correct in the data. and we are doing several things. first unfortunately institutions around the country increasingly want their new faculty hires to have a bridge funding before they give them a permanent appointment on their faculty. that was never an intended purpose of some of these transitional awards they become a surrogate for who gets a tenure-track position or not. one of things were doing is we have instituted what's known as the cap award which is an application that does not require in fact no preliminary data is allowed for the submission of that award. the purpose there of course is it frees the young person from the work they did as a postop or a graduate student and allows them to go straightaway to apply. we have also done a series of men touring networks if you will to convince young people that first award the first r1 is something they should really be striving for sooner rather than later despite with the old sages the institution may be telling them you will never get that award it is too big, apply for a small little award. trying really hard to get the word out in fact we are incentivizing, we are prioritizing early-stage investigators. the final piece of this, and i don't have a good answer for and it does not account -- make it only accounts for a fraction of the time, students enter graduate or prevention later. they take gap years one or two more years that is something i do not have a good solution for. he of all of these things together it has kept us in stasis with regard to our ability to drive that number down. we're going to keep working at it because it's important i agree. >> thank you very much to the committee. really respect and appreciate all of the work everyone at the table does as many of your peers. doctor failed joan to single you out for a second and say thank you. you have been the face it everyone at this table and many other researchers. you've taken a lot of unfair abuse next to french social media and crackpot theories out there on behalf of normal people. to you and your family thank you because your family has also had to go through bunch of this. appreciate it. wanted to ask you a question you talked at our meeting you mentioned something about the number of coronavirus we have had over several decades. i found that very interesting i don't think i've heard other people talk about that. what aren't we doing to address what is potentially whether it's the coronavirus or whatever else what are we still need to be doing that were not doing? >> thank you for that question. that is very important it's really part of the strategy that we have already put into place not only to address the current outbreak of coronavirus in this case sars covey two. also part of a forward-looking pandemic preparedness plan so very briefly what we are doing with regard to the current coronavirus is having already in place studies that have entered into preclinical and early clinical studies of what some people referred to as a coronavirus vaccine. which is really very aspirational the coronavirus is pretty big. if you focus on sars covey two that in the world the strategy is to develop the vaccine that would have not only effectiveness against all of the current and any variant that might actually arise out of the sars covey to group and to extend that throughout the tree of coronavirus that just addresses coronavirus. but the pandemic preparedness plan is built on a concept that was developed in our group by bernie graham who was the person who developed sars-cov-2 to mrna vaccine for each of the multiple families that have potential pandemic capability and to do studies that would essentially position us that if we do get an outbreak from an arena virus, and virus to be able to get a vaccine into trial and ready to go within 100 days in the second 100 days to start distributing it. we are referring that for prototype plan to make a plan that's overdoing for a. >> great to hear i found that very helpful when you talk to us about it and carcass. in other threat to national security. >> there's no doubt about that. whenever you have something that threatens the economy and political stability of nations it is part of global security. that is the reason we take very seriously outbreaks and sars-cov-2 to covid-19 is a stork that likes we have not seen a 104 years. >> thank you. doctor same question do you consider pandemics like covid threat to national security? >> absolutely. anything that destabilizes the economy and the nation represents that the writer. >> it's interesting where talk about the 4 billion and lots of conversations we talked about the department offense budget it is 12 times nih is about 70 times the cbc budget. i think it's time for may be more modern definition of the fence. i agree this is been a national security threats. since that budget seems to have an easier time moving forward if we could use more of those resources to protect our country and for that matter the globe i think that would be helpful if 37 seconds i think i can get this in. dr. kagan global vaccine we just talked about having the chance to be a broader vaccine will it require its awardees to be global access conditions on pricing, supply, technology sharing or any future vaccine? >> can i turn it to dr. fauci for that question? >> sure. >> we do not have that capability of guaranteeing global access that is part of the broader government plan which we are trying to do right now for it as you well know $5 billion of the $15 billion was supposed to go to global. that global was not necessarily to get vaccine doses because we do have enough vaccine doses for the developing world. it is to get vaccines into vaccinations to develop the infrastructure to be able to do that. we are very committed to that we have always been that's not within the realm of what nih can do. >> thank you. my time is up i yield back. >> thank you. before i yield i would like to say i was just in a hearing with director at usaid. i would like at some point to really hear from all of you about what the effect of not moving forward on a covid supplemental will have on our ability to deal internationally for this pandemic we are a great risk. i question i want to yield. i think it's an important issue we need your voice is loud and clear about what the consequences are. >> thank you madam chair and ranking member cole i appreciate having this hearing today into each and every one of the witnesses, thank you very much. i've enjoyed my tenure on the subcommittee. i love to be an appropriate or but this subcommittee is really incredible the depth and breadth of the nia research is truly outstanding. i appreciate your being here today. i have two questions if i may. as most of you know i have substantial concerns concerning fetal tissue research part of the debate right now is not necessarily about initial cell lines but the continued collection and use of aborted fetal tissue in federal dollars to support that research. much of the available fetal tissue is children children killed by abortion their bodies are used for experimentation at taxpayer expense. dr. kagan what if any -- what is the nih plan for moving towards more ethical alternatives? >> we continue to support research for alternatives you know in order to validate the alternative i have to compare it to something. and that in fact in many instances fetal tissue. but we have awarded a number of grants in this area. we continue to make progress in that direction. it is difficult work. we continue to fund that type of effort. >> yes, sir i could speak for myself i would continue to wholeheartedly oppose the use of aborted fetal tissue for experimentation for that is my personal position on that. moving onto another topic sir, the undiagnosed disease network has been a very successful program building on the strength specialized knowledge of the clinical center and a network of 12 academic centers across the country in my home state of tennessee. the past decade the program has been helping patients with rare and undiagnosed conditions find answers and for many informed path towards treatment. often these families and individuals have been on a diagnostic odyssey having seen countless medical professionals unable to give them a full picture of their rare or unknown medical condition. my question, doctor is how plan to support the network and view the insights once the comment fund support expires and as a follow-up to that, how can we help develop a plan to sustain the work going forward sir? >> as you know, programs that are initially supported by the common fund do graduate if you will out of that program it's meant to be an incubator space. in this instance this program done outstanding work but you reach a point where the effort begins to blend into standard of care versus research. and so we need to define where that boundary is. and we are working with the various groups around the country as you said to see what options we have moving forward to sustain that portion allow the portion to move into that arena. >> yes, sir thank you. for dr. fauci good morning sir. there is been significant debate in the scientific community regarding the risk of benefit gain of function research including unintentional lab leaks and the intentional release of pathogens into the population. my question, dr. fauci, considering the impact of covid-19 pandemic is had across the world, you advocate for a continued positive gain of function research sir. >> i think it is very important congressman to make sure we abide by these set guidelines of the conduct research. one of the problems with gain of function it means so many different things to different people. so what we have done and we are very, very flexible we are looking at those guardrails when you are doing work on different pathogens and has been a multiyear process that have set the guardrails of doing that. those guardrails have worked really quite well, we, as everyone is been very sensitive to make sure research that is conducted is conducted in a safe manner and it is peer-reviewed before it is done by a group of people who are really qualified to make that determination. >> madam chair i yield back. >> thank you. congresswoman watson. >> thank you madam chair. thank you to the acting secretary. i do know if these questions have asked of was in another appropriation hearing. i am very concerned about nih and the investment that is made in diversity and inclusion. not only the application of resources >> the reviewers of grant applications, as well as the recipients of the grant applications. we're fortunate to have conversations with director who was committed to expanding the diversity of the work force and the diversity of the grants that were actually funded and so, i'd like to know specifically as you can, what kind of success you've had in moving in that area. >> i want to assure you and all members of the committee that i'm equally committed to diversifying of the biomedical research work force. we have been using a variety of approaches to try and diversify our grantees, for example, we have developed the first award, which is designed to build communities of scientists, cohorts, if you will, in an effort to ensure that you have a sustainable and inclusive environment for new hires. we have also increased support for the nih enrollment program which supports over 100 scientists each year from racial and ethnic backgrounds to help with research. and some of the institutes have specific programs, for example, the nigms mosaic program is specifically designed to unramp individuals from diverse backgrounds into positions of tenure track of faculty level positions at universities. >> let me interrupt. let me ask you this, which of the initiatives are you talking about that you-- that have just been sort of implemented in the last year half? are you talking about programs that have been in existence longer than that? >> the first program that i mentioned, it's in its second year and we're currently looking at applications for year two, they're under review. the mosaic program is within the last year. the loan repayment program has been prior years. >> okay, how about your recruitment efforts and interactions with an outreach to the hbcu's? has anything been innovated there? has anything been increased there? >> so, the most recent innovation there has been specific outreach with your contract organizations, many hbcu's do not avail themselves of government research and development contracts and we've had a specific outreach specifically with four hbcu's and now we work together with their administrative offices to guide them how one goes about applying for successful r and d contracts. >> so, i'm interested in what successes built upon in terms of individuals who get to look at the grant applications and rate them and the number of grants that are actually funded that are directed to cultural competencies and the underserved communities, black and brown communities in particular. and so, you probably don't have time to answer that, but through my chairman, i would like to ask for kind of an update of where the-- where your agency is, where your institute is with regard to those issues, measuring from where you were to where you are now, and what you plan, how you plan to move forward and i thank you for this time. thank you, madam chairwoman, i yield back. >> ms. butler. >> thank you, madam chair. i'd like to ask a couple of questions and i think in light of ranking member's comments, overall nih has done great things and i think we've been supporters in terms of funding because we believe in what you're doing, but it has been a little challenging in the last couple of years when there were times when i do think the image has been called into question, not-- i'm not talking about-- i'm talking about average americans, don't see up close and personal what's happening and we get conflicting information. and one of the areas where i think it will be possibly helped, i found last year, i followed the reports that the data, early geonomics data were deleted from the archives and we worked to get to the bottom of this and i think partially because there were concerns, rational concerns that the chinese communist party had something to do with this and where is the information. i wanted to see what-- with regard to the archive you're doing to secure it from the types of either truly harmful things or image thing, but what are you doing in that space? >> there's no question that the communication that we had about the archive, sequence read archive has been improved. i freely admit that. if i may, the archive never deleted the sequence. it just did not make it available for interrogation. >> so, you have the information? >> we have the information. >> so, the way it was reported is it was pulled out, that the early genomic sequence was removed by a chinese researcher. >> and anyone who submits to the archive can alo you had to ask for it to be removed and the investigator did do that, but we never erase it. >> so you don't have the information anymore? >> we do. we never erased the information, we keep it-- >> so they were able to withdraw public viewing of it? >> that's correct. >> so researchers can apply to the nih and get the information from you. >> and so in the way that it was originally eliminated from public view, it was withdrawn and that's the most difficult for people to access. the error that was made and we found this out after a review of all of our processes, was it should have been suppressed. the distinction being that if it's withdrawn, it is kept archively on a tape drive, old technology, but that's how it's done, but when it's withdrawn, it can still be accessed by accession number so researchers are able to access. >> the information is still there. >> that's correct. it was never lost. >> i wanted to switch gears quickly, i could spend a lot of time on that one, but on to overuse and opioids and overdose deaths. in washington state just in 2021, there was a 60% increase in drug related overdose deaths and more than half of these are due to fentanyl. i wanted to-- your testimony talked about working on research decrease overdose deaths. i wanted to see if you could explain ow the budget 23 request could reduce that. >> if i may i want to turn to the doctor. >> sure. >> thank you very much for that question and it's going to help us accelerate research in these areas that's becoming very, very challenging and become challenging because of the complexity of overdose deaths actually has increased and made worse during the covid pandemic. originally we started with investments and patients suffered with pain, so they would be given opioids and now fentanyl is used with cocaine and amphetamines, so we need diversify our scientific projects to go beyond intervention and prevention. very important, crucial, but not sufficient. we need to expand into addressing the needs and vulnerabilities that may be exposed by accident to these. and so it's a range of intervention, from implementation sciences to services research and at the same time during the research that can give us better medications to reverse those overdoses. because naloxone is-- >> i'll yield back and i had more questions for the doctor, if we have a second round. madam chair. >> thank you. >> thank you to our panel today. i've got a question, i think it's for the doctor or whoever can answer it i'd be happy to hear from you. my question has to do with patient navigator programs which help low income patients and low and underserved communities and screening diagnosis and treatment and specifically in temps of cancer. can you tell me how the cancer moon shot program will invest in patient navigated services to ensure access to any of the new treatments? >> congresswoman, thanks for this question. patient navigation is one of several aspects of trying to provide optimal treatment for patients with cancer, which has become much more complicated in recent years in part because of success. in terms of approval of patient navigation, this is beyond the nih. but we conduct implement takes research to try to optimize patient nolf navigation, along with other aspects of trying to help people have appropriate and full access to cancer care. this includes doing patient care at home, changing radio therapy, for example, shortening the duration of radio therapy and trying to look at patient navigation in the context of this real overall issue of how to provide optimal care to virtually everyone in the united states who is unfortunate enough to develop cancer. >> well, thank you, and i hope you will work closely with whichever agency that is that directs the navigators, because, obviously, you can have all kinds of new developments, but if we don't-- if we're not able to get it to our full population, i think we will be missing a lot. >> thank you. >> i want to ask a question-- let me ask this question in terms of research on something sort of basic. i think everybody i have ever met in my life and you hear about this on tv. all kinds of diets and fad diets and then you read about, especially in underserved communities where people are not getting access to the nutrition that they need. what kind of research is being done in that regard in terms of dieting and access to-- everyone else? >> so we have recently launched a new set of nutrition. among them is a study of so-called food deserts, where inadequate nutritional foods are available within a given neighborhood, and part of this research will be focused on how one can, you know, address that in the best way possible. other areas of research have been empowered by advances in analytical technology, just as you have the human genome and the human protonome and you have the metabolome and we can study things at the molecular level and the value into nutritional agents. so, we are doing this from both the community-based level all the way to the molecular level. at some point i'd love to get some information on that, and i know tomorrow we're going to be talking about-- or this week, on elderly issues. but i do have a research question. the health care system selected over $50 billion annually on falls for older people, 36 million older adults will report falls every year and i'm sure it's much more than that. we heard about technology, in older adults and can change to the system. is there a timeline for these products? can you explain what they are, these products to monitor? is anybody aware of that? >> yeah, so, through the national institute of aging, their sbir small business program has made several awards. association, they've supported a small company that has developed something known as active pers which is a medical alert pendant that does do automatic fall detection and this has now been licensed and integrated into medical devices broadly, available through a wide variety of retailers, but they're supporting additional research to develop centers, for example, that detect more vibrations which can be very valuable for those hospitalized or otherwise infirm. >> thank you, and i yield back, madam chair. >> thank you, madam chair, good to see you all and thank you for being with us. doctor, i'd like to start by asking you, i know you're new in this role, but you're familiar with policies and i notice you have a background as an ethics-- advising on ethics and it's recently come to my attention that there is a policy at the nih where scientists and people can receive royalties. one of the concerns i have, and i'd like you to speak to this issue, is the nih is in the process-- you know, in the midst, as you know, of awarding grants for research, it's also in the position of sort of evaluating or giving opinions on drugs that work or don't work and the idea that scientists may be benefitting financially from work this they've done at nih, that creates, to me, an appearance of conflict of interest. and just building on what mr. cole said about public confidence and the nih, to me, one of the biggest concerns people had during this last couple years is were they getting truthful information from their government? could they trust what people are saying about the medicines. and to me, that creates a very disturbing appearance, and i'd like you to comment on that policy, and whether you are going to take a fresh look at that policy. >> the award of royalties is based on -- which makes no distinction whether or not the inventor is paid by the government, the private sector, academia and so forth. so we're following by that. >> if i understand what you're saying, you're saying that it's federal law that allows the nih to do that. >> that's correct. >> okay. in terms of the potential for conflict, no individual who is in a decision-making role on a particular product would have benefitted from being the inventor of that product because we separate out those functions. the individuals who make recommendations to leadership of instances and centers, are in the space and the individuals making the discoveries that you speak to, are in the inmural space, they're active scientists and we do not allow those two things to-- >> but my understanding is leaders of the organization receive royalty payments. i think that dr. fauci, you've said that you've donated your royalties to charities, is my understanding. but what strikes me is, you're in a position where you're saying certain drugs don't work, but then you can at the same time be getting royalties from other -- and i understand you're saying there's a firewall, but that information has not been made public and i think sooner rather than later, you should make that information public because right now, i think the nih has a credibility problem and this only feeds into this. and i'm just learning about this. people have always, in my district, have been saying, well, so-and-so has a financial from in a certain, you know-- they don't like ivermectin because they're not benefitting from that royalty. and they don't like who cans-- hydroxchloriquin, but research done and grants awarded that to me is the height of an appearance of a conflict of interest. >> again, nih does not -- we support the science that validates whether an invention is -- application, we don't say this is good and this is bad. >> well, truthfully, i would say you've had leaders of nih saying certain medicines are not good. >> based upon the clinical trials that were supported by the agencies. >> but if the agency is awarding who the beneficiary of the grant whos' doing the trial and somehow finances involved that there's a financial benefit that could be accrued if someone's patent or invention is considered valid. do you not see that as a conflict or an appearance of conflict of information? >> i certainly can understand it. it might seem as appearance and it's the sort of thing that maybe we could work together on so that we can explain to you the firewalls that we do have in place, because they are significant and substantial. >> okay, well, i would appreciate that and i think in terms of restoring public trust, i think that would be a good step. thank you, i yield back. >> congresswoman. >> thank you, madam chair. appreciate you for being here and your service. i'm going to address my first question to you, doctor tabak. i want to look at what you're doing there. and i want to address the inequitities. and the nih advancing medical diagnostic. >> improves cures for diseases and ailments. the impact that nih makes is tremendous. and you know, if i want to -- you know all the stats, but i drill down to the state of illinois where i'm from, and you get 732 awards that were given totalling 311 million dollars and these are in these competitive grants so we're very closed with that. this opportunity to use the funding to advance biomedical research is tremendous, but it also plays a meaningful role in addressing health disparity. that's what i'd like to ask you about. i know the nih budget requests $350 million in increase know support research on health disparities. can you talk about what broader impact that the president's budget request would have on addressing inequities that lead to disparities in patient care and outcomes? >> it will do so in several ways. our work in health disparities increasingly is done at the community level. we have learned that you can't just parachute into a community, study it, and then disappear. and you have to establish meaningful trust. that takes time, but, but it's obviously quite, quite worth it. and indeed, dr. givens has set up the so-called seal program and if i may, if he could comment on that. >> thank you for that question, and this is important in addressing health inequities and involves the context, the place matters, and so often because these are such vexing problems, you need a multi-pronged, multi-level strategy that is indicated often begins in the community, that indeed, knows its assets, knows its challenges and even can co-develop with us strategies to address them. certainly, we-- the nhobi has a program that rates cardiovascular health, in some communities, low income, rural, communities of color, and engage strategies, are being showed the affected, for example, maintaining blood pressure control, preventing strokes, indeed, mentioned illinois. we have teams in south side of chicago literally working on this, involving members of the community, actually mental health issues that are intersecting with their challenges in terms of their cardiovascular risks, that holistic approach that we can take in this context. and this has been born out to be successful in addressing the pandemic, and indeed, has a broad array of capabilities for a variety of those conditions, whether it's cardiovascular disease, hiv research, maternal, morbidity, mortality, these strategies we're finding to be effective. >> can we drill down and whoever is going to address the budget request, nih supporting the recently announced equity action plan. would that be better for you to address, dr. gibbons or doctor-- >> each institute and center is developing such a plan for their own individual organization, roughly understandings there is some variation among the groups and in it, they will point out what gaps exist within their own organization, both in terms of what they do externally, but also internally and these plans are going to be shared among all the institute center directors so we can learn best practices, this will be an annual event so they will be updated going forward. >> great. and just to play off of dr. gibbons a little bit about what you said. chairwoman delauro and others have been on this, the i'm the co-chair of that, and we have a bill accelerator act, we initially after $25 million to your point, dr., that would start at the local level to come up with plans, and then we would have the interagency council that would help decide where the grants go. so we got $3 million last fiscal year, $8 million this fiscal year and the president put in 153 million for that the and we want that to grow and that's the job of the appropriators to get that through and i think is the answer to having these, and looking at a local level. the social determine nates and people needing to look at this. thank you for your service to america and trying to make people healthier, with that, madam chair, i yield back. >> congressman klein. >> thank you, madam chair, my questions are for dr. fauci. dr. fauci, in 2020, a professor of epidemiology, and a doctor from harvard and dr. gupta oxford, the barrington declaration. the declaration these medical scientists said the way to cope with covid-19 was targeted response for populations, and older personses without lockdowns with social and economic costs like we've seen and forced isolation of younger and healthier persons, with less hospitalization and death. dr. collins described these as fringe and you likened them to aids anilism. >> and there was a request i can published takedown of the authors in the declaration. the claims of those opposing lockdowns was fringe was proven to be baseless. the professor of the department of medicine at stanford university published quantitative analysis of the publications as well as the social media visibility of the 47 original signers of the great barrington declaration in a british medical journal this year. he found that among the 47 original signatories of the gbd. 2019, and 21 for the recent impact of 2019 or either. likewise, professors at boston university of school of public health recent debate of the great barrington declaration of the sign of growing intolerance of disagreement in the field of public health. so, i'll ask you, on what basis did you and dr. collins identify these doctors, the authors of the great barrington declaration of fringe out of the mainstream. >> i never characterized them as fringe scientists. >> dr. collins did. >> you're asking me the question. i never called them fringe scientists. >> and your comment regarding aids denialism? >> well, the issue with the barrington declaration is that what they were stating is that if you let the virus run free in society and only so-called protect the vulnerable and the question is, who are the vulnerable in society that you're going to protect? and most public health officials totally disagree with the barrington declaration. if you did that and let it run free and not try to protect the population in general. we almost certainly would have had many more infections, many more hospitalizations and many more deaths. so, with all due respect, for the scientists who signed the declaration, i completely disagree with them. >> okay. would you agree that during the time that the lockdowns, the data that we've seen following these lockdowns has shown that we've had increases in depression among young people? >> there's no doubt that when you-- >> yes or no if you could just-- >> i'll answer the question, there's no doubt when you put restraints on society that it causes emotional and mental stress, there's no doubt about that, but you have to have a balance of saving people's lives from getting infected and hospitalizations. >> would you agree that suicide rates have increased among young people. >> indeed, they have. >> would you agree that domestic violence rates have inleased? >> the answer is yes, but i'm wondering what it has to do with the question you're asking. >> would you agree that drug and alcohol use increased during the lockdowns? >> i'm not sure the lockdowns itself did it and i'm wondering why you're asking me about lockdowns because there were not complete lockdowns in this country. there were restrictions, obviously, but there were not lockdowns. china is now going into a real lockdown so i would disagree with characterizing whatever went on in this country as a full lockdown. >> all right. moving on, when the prospect after lab leak, move on in april of 2020. dr. collins told you you should find way to quote, put down there conspiracy and emphasized that the lab leak theory could damage science and international harmony. >> did you direct letters to two professional journals be written the lancet and nature medicine? >> no. >> you did not ask to write the willer to lancet. >> no. >> did you review it before it was sent? >> no. >> i yield back. >> congressman carter. >> thank you so much chair delauro for hosting this hearing and for all of you before the subcommittee. since we last met, the american lung association released their 2022 state the air report. that report gave my district in california both -- an f grade. this means f grade ozone and particulate and a failing grade annually, huge health impacts for my constituents. one of five kids in our community have childhood asthma. i had it, my brother had it and i know what it's like to worry if your inhaler is in your backpack and what everybody in our community knows, our air is bad and getting worse and frankly i refuse to let my daughter grow up breathing worse air than i did. and my question for dr. tabak. in many parts of the country, quality of air, and asthma. what will nih do with this year's budget to make sure to research to tackle the issue of air quality and asthma? >> the budget does request resources to study effective climate on health and certainly, this is part and parcel. if i may, i'll turn to dr. gibbons who is deeply involved with this initiative. >> thank you. for pointing out that very challenging situation. we've known for many years, obviously, that air pollution has an impact, actually, on the lung development of children. such that it stunts the development of lungs and predisposes the conditions like asthma as you described. and we've actually seen trends over time that when the air quality improves, there is an improvement in that childhood lung function. so, we know that if we can mitigate that exposure, it can have benefits. and we recognize that there are many communities, often lower income communities and communities of color that are particularly besieged by the challenges of the matter that you described and clearly, that's an exacerbates these -- we're making progress in terms of the history with asthma. certainly we're getting greater understanding of the inflammation and the inflammation induced by those particles on the lung and i think the treatment strategies that they can improve as a result of basic research which we're understanding now the pathways and now, new therapeutic targets to reduce that inflammation and enhance lung health. so, indeed, there's precision medicine now how we treat asthma, but certainly, we still need to do a lot more with the root causes that relate to climate, climate change and the effect of wildfires and everything that's exacerbating that whole spectrum of etiology of asthma, i'll stop there. >> thank you, dr. gibbons. and these wildfires, something we're seeing in california how influential that is on some of the asthma and air quality we're seeing? >> it's an important observation. it clearly is contributory and we're seeing that pattern as measured in changes in those particulate matters. the air quality is deteriorating and moreover as you can appreciate there on the west coast, with the revealing winds, even those changes in wildfire and declines in air quality, sweep across the country as well. so we recognize that this is going to be a national problem and with the trends of climate change, wildfires and declining air quality, ongoing problem that we hope we can potentially address the health effects through this nih program and climate change and health. >> thank you, that's very helpful. and i'd draw the attention to some of the efforts in this budget for new community air quality monitoring and notification programs and in he is essential, take some of that research and i think that's a no-brainer that we would benefit from. thank you so much, dr. gibbons, with that, i'll yield back my remaining time. >> thank you, madam chairwoman. again, it's an absolute honor and delight to be here with so many representatives of nih and our deep gratitude for your science, your research, your leadership, in this time of great challenge globally and certainly here in our country. i want to start with one of the increasing crises that we're seeing and that is worsening mental and behavioral health. we're especially seeing this in our young people. while much of the concern is focused on the limits of caring for this population, i am concerned that we need to be redoubling our commitment to better understand the issues that span neuroscience, genetics, and my question for dr. tabak and-- how is nih ensuring this multi-facetted topic an addressed including coordination among relevant institutes and do you have the resources necessary to meet this moment? >> we do have opportunities across nih for the different institutes and centers in this space to collaborate with one another, through, for example, the brain initiative which is now seeking to understand the circuits, how the circuits of the brain work. but there's also emphasis on the community-based level, making sure that mental health services are provided to those in needs and as well as efforts to avoid the stigmatization of the company's mental health conditions. let me turn to dr. volkov for her input. >> thank you very much for that question. i think as we're addressing the challenges with the covid pandemic. we realize when we solve the covid pandemic, the problems that arise for mental health issues are going to be remaining and particularly vulnerable are children and alt adolescents, we're seeing that increasing depression and loneliness, increasing suicides among teenagers even though it's not happening in adults. and we're also seeing an increase in intentionnal over doses among adolescents. for the first time overdoses in adolescents from fentanyl. it's urgent and doing what dr. tabak is saying, we're joining across the different institutes to understand what are the effects and how they effect ultimately that behavior of a child. what are the trajectories are and interventions we can do to support them. it's clear it's going to have to be personalized and it's clear something we have been discussing here and it's crucial. we've learned to recognize that those that are in adverse economic situations or social stressors are the most vulnerable. so, understanding those factors so that we can be developing interventions that can be targeted. and importantly, putting the resources that are necessary to provide evidence-based intervention to protect our children and adolescents. >> thank you so much. and i want to go back to arthur h, and my colleague, mr. cole, the question around the national cancer institute and i share those concerns and also has the potential to transform frontiers biomedical research. i, obviously, think that if the decision has been made that it should be located outside of nih and outside of washington, that massachusetts as the home of the most vibrant and promising biotech life science companies, leading edge research, academic institutions and hospital is a place where it should go. but as far as i know, there's no proposed selection process for siting this agency and even less clarity who will return it. can you tell me, is there a plan on how to solicit and evaluate proposals to site it and when do you expect a director to be appointed. >> the search process is underway for the inaugural director of arpa-h. this is a presidential appointment so obviously, this is driven by the white house. there has been no commitment made to the physical location where it will be located. we obviously are continuing to frame this out for the consideration of the secretary and for whoever the inaugural director may be. but until that appointment is made, no decision will be made on those physical locations. >> and there's no timeline for an approval process selection? >> i can tell you that the search is definitely ongoing. and i know that the intention is to move that as rapidly as possible. >> thank you. i see my time has expired, thank you, madam chair. >> congresswoman lawrence. >> thank you, madam chair. dr., i recognize that last september, the nih announced 10 grants, focused on violence prevention, specifically firearm prevention tactics, as you know, we had the last mass shooting that happened was right outside my district at a high school. and so i hope that the research that's happening in detroit, which i hope are just the first of many to address gun violence epidemic that we have. while i recognize that these awards were just made, can you speak to the performance of resuing federal research into firearms reduction? >> well, as you point out, 10 awards were recently made, the future research directions will likely include work to better understand the interplay of the neurological, biological, psychological and social and structural processes that may enter into this. also, emphasis on violence and trauma screenings and interventions need to be developed and then made available both in health care settings as well as school settings. and we have come to understand that the violence prevention efforts have to be multi-level and focused on mechanisms of action. so, just to give you an example, there's a-- one of the-- one of the awards was made to evaluate the effectiveness of trial and family traumatic stress intervention to reduce ptss in youth after they were assaulted. it's things like this that will hopefully help us reduce and eventually eliminate these tragic events. >> well, i just want to tell you, i'm very excited about the grants, but this must be kind of priority for us in america. too many moments of silence and wishes for your family. we have to do something for america, to address gun violence. in that vein, i want to include the targeted mental health. we know that mental health plays a major role in gun violence in america. and covid-19 just added another whole level to mental health awareness and drug addiction. a lot of that is tied to mental illness. so, and my question is, can you highlight the impact of last year's investment on mental health research and how this year increases builds on nih work from last year? >> so, the work that has been recently supported is really the strength and mental health response during the time of the pandemic. it really-- it seeks to really increase uptake of those practices that we know that are effective, so, for example, turns out that digital health care platforms are really good approaches and we have to be able to figure out how to adapt those formats and platforms to where it is most needed. if i may, nichd issued a joint notice of interest that the doctor may wish to speak to. >> dr.-- before you speak i just want you to note that the mental health piece and the virtual part of that was tremendous and we hope to continue. >> thank you very much for your comments. one. things we are very excited about is the destigmatization of youth mental health issues and we are co-funding, along with a number of other institutes, but mih is the lead on this, and we're funding a high school essay challenge to bring high school students in to write about their experiences and again with the goal of destigmatizing some of the issues. we need to bring this out in the open and there is no question that children and adolescents have significantly been affected by all issues related to the pandemic. >> and also, we must look at the work force in mental health. we know and i hear all the time that schools and other places today, we don't have enough social workers and mental health professionals for the growing demand in this crisis of mental health. thank you and my time has expired. >> thank you. we're going to move to a second round and we'll try to get in as many questions as we can and going to allot five minutes per member after the second round of questioning. so, with that, let me-- i'm going to try to get in two or three questions if i can. dr. fauci, first of all. my congratulations on being named chief medical advisor of the president and i want to ask about universal flu vaccines. can you provide us with an update on the development of the universal flu vaccine, the 15-- you're looking at $15 million in increase. what will we accomplish with those funds and with what we have there with what's in for 2022 and the additional funds requested in 2023? >> thank you very much for that question, madam chair, yes, the money given to us in the last appropriation has been helpful and i'll summarize briefly what happened since we spoke last and the current 2023 budget will be helpful. what we've been doing the last couple of years now has been bringing a number of new concepts into the universe of flu vaccines. as i mentioned when i briefed you in a previous time. one of the approaches is to use new platforms, one of which is referred to as nanoparticle, a component of a vaccine that allows you to tack onto microparticles any other number of ent gens as we all them. one for a particular group of influenzas. in preliminary studies look very good both in the animal model and phase one studies, you're inducing a response that goes well beyond just a particular flu that you're vaccinating against. in addition, a number of studies, both intramurally at the nih campus in bethesda, as well as in our grantees have now put into both pre clinical and phase one study a number of candidates using these various platforms. the results look actually really very good in the sense of vaccination now, that goes well beyond the particular isolate that you're dealing with and covers. as you know, flu is divided into two main groups, group one and group two, and the ones that we get to exposed to predominantly h1n1 -- and now the a's, and have good responses against multiple ones either group one or group two. each months and years that go by we're closer and closer to what i think will be a much more effective and universal vaccine. thank you for the support, it meant everything to get us there. >> thank you. and you know we'll look to the $15 million to see if we can continue that. doctor, just if i can, $30 million increase to ramp up the improve initiative. and dr. tampa bayback, the testimony you talked about establishing maternal research center of excellence. can you tell us a little about your research to reduce rates of maternal mortality and morbidity? are you seeing progress? how are the centers going to help to achieve the long-term success? if you can tack onto that, the 8 million that we're looking that we did in 2022 for women's health research, and research for the office of research, you know, where that's going. >> thank you for your question. and importantly, thank you for the support for the improved initiative, which is an nih wide initiative and it's addressing many of the themes that we've heard about today in the session. the social determinants of health. and to prevent maternal mortality which shows major health disparities. also to decrease severe maternal morbidity and importantly, to promote health equity. because of the timing of the budget this year what we've decided to do this year is to have three very strong pillars that will roll into the centers of excellence, the injuries of excellence, funding opportunity, announcement that will come out this summer. in the meantime, we have a major goal of increasing community partnerships and in particular, we want to bring in communities that have knowledge of the local culture and have a trusted relationship. trust has come up today as well, and so we need people who have a trusted relationship in the community to begin to implement changes that will result in improved maternal care. the other thing that we're doing is we are developing technologies that will particularly improvement care for women who are in underserved areas, the so called maternity deserts and as well as women in rural environment that don't have access to obstetric care. so we're looking at wearables, we're looking at apps on your cell phone, ways to monitor women in trouble and need appropriate care. as far as the research on women's health, i think that dr. tabak will answer that. >> so the additional resources up to orwh which we are thankful for. they will invest that in their so-called birch program which i think you're familiar with. this is an interdisciplinary program which provides mentorship to the participants, that connects the junior faculty. they're known as birch scholars to senior faculty that have an interest in women's health and this is really a program that is key to supporting multiple goals of the nih-wide strategic plan for women's health. >> i've gone over my time and i have another question which i'm going to try to squeeze in not now, but later on cancer, immuno therapy. congressman cole. >> thank you, madam chair, i couldn't help reflect my good friend from massachusetts when she made the pitch for arpa-h. the patriots could come to oklahoma city we could work something out. that's a private question. and i have two questions, and you can split the time. and this first one probably be better directed to dr. hotis, but he's not here. i'm curious on the alzheimer's front, considerable investments and a lot of concerns about the sheer expense this disease poses on us, not to mention the tragedy. how do you mention the state of play, we've had controversy over a drug, personally, i'll state for the record, i don't care about the cost. i care whether it works, over time we can bring the cost down if it works and i know that's not your decision to make, but any thoughts you have in that area, and dr. volkow, a heads-up, what i want to get from you, i'm curious your thoughts on marijuana use given the prevalence now, we have looks like honestly the social use has outrun the science. we really don't know, to my way of thinking, the potential damage here and you know, the horse is already out of the barn, probably, but i'm curious where you see the problem areas here and where the research is taking us, so with that, if i may, dr. tabak, will et -- let me go to you. >> topline, more than 350 trials in this space now, 70 are from a treatment and prevention trials. 120 are nonpharmacological prevention and trials and the reminder are related to dementia care and care giving tools, very importantly, obviously. public-private partnership has identified over 550 new drug targets. the impact to the laboratory is pragmatic infrastructure to how we improve care for the patients and i'm sensitive to the time. >> i'm very much for the question and indeed, marijuana has gone up, particularly those 18 years of age or older, and during the covid pandemic we see the increase among the areas we're most concerned, of course, are pregnant women and we've seen during the covid pandemic a significant rise of the use of marijuana whether for so-called medical purposes or recreational use and all along, the effects on the developing brain, starting with the fetal development and childhood, and adolescents and the outcomes are worse for women who smoke marijuana during pregnancy and show that the use of marijuana actually significantly incurs the performance of teenagers at school. what's worrisome is that we've seen significant increases in acute psychosis associated with the use of marijuana cross all ages and this is in fact, driven by the fact that the current available marijuana has higher content thc so it's much more powerful and it's associated with higher risk for accidents. there are other areas that are not clear, but the numbers seem to suggest that there is an increase risk, for example, on suicide of behavior, on people using marijuana regularly and in effect, they're using marijuana to escape the thinking. and association is here, where we are prioritizing these areas because the american public deserves to know ultimately they're going to be making a decision of taking marijuana for medical or nonmedical purposes, what are the potential consequences. and we as a government, of course, need to identify what our potential adverse effects for resources and prevention intervention and therapies to support the victims of these effects. >> i would urge you to do what you can in the time i have left, to get as much information out quickly. i think we're going to wake up some day and it's a lot like tobacco, too late, reacting with the state levels to deal with that and could have the same thing here. ... i am not going to ask you to respond, but maybe the doctor could follow up. i am very interested in, the one time we thought the investments we made may be the curve looking forward in the cost of care in this particular disease with alzheimer's. i would love to know i would love to know if we e making the kind of progress i know dr. lowy and his folks at the national cancer institute is making or that's for seo? >> we will follow-up. >> thank you for that. i yield back back, try to. >> congressman goal, just asked a question i was going to ask with regard to marijuana. i just want to add to what was already said that according to the national voice and data system they identified a rise in marijuana use in children zero to secure old with over 70% of those cases in states that legalize recreational use and that's just number based on those of common hospitals for emergency treatment. so there is, i share the congress men's concern on the fact that withhe the legalizatin of marijuana there's also a decrease in the perceived harmfulness of it, and so i appreciate the research that you are doing and i hope at some point asnd congress considers legalizing it across the nationu can give us some guidance on safeguards that could be put into that legislation is, in fact, that does happen. i want to follow-up on a a question that was asked by congresswoman herrera beutler with regards to fentanyl. several states have adapted preventive tool such as fentanyl test strips into their overdose prevention strategies, and as you are aware approximately half of states continue to oppose implementation and decriminalization fentanyl test devices. what does research tell us about the effects of decriminalizing fentanyl test strips on opioid overdose? for example, is there a difference in the drug overdose deaths across states that have criminalize fentanyl test strips versus those that havee not? >> that is an important scientific question and actually one we were looking. currently we do not have that data but we can clearly tell you from the studies that have reported that significant number ofof overdose deaths from like cocaine and methamphetamine that are contaminated with fentanyl whilst unbeknownst to the user, so providing them with a tool that enables them to actually test the drugs that they are buying to see d if they have or not fentanyl would significantly decrease the risk of overdosing. >> dr. tabakak come on december 2014 a congressionally national children's study was terminated despite ongoing congressional concerns that this study was critical to assess the impact of environmental risks upon children's health and development. to address congressional discomfort with the nih decision former director francis collins instituted the environment influence on child i health outcomes, known as the ankle program. as you know the echo program aegis of existing maternal pediatric cohorts which were c recruited through the nl children's study to address the health outcomes of pregnancys ad birth upper and lower airway conditions, obesity, neurodevelopment and positive health. we are curling in a final year of the seven-year program, and before i retire from from congress i would like to have some assurance that the echo program has even met most of the goals of the original congressionally directed study, or that there's a plan in place to continue and build on the echo research thus far. since the exception can highlight some of echoes key accomplishments with respect to his observation and anva eventul research component and what approaches as the echo program taken to ensure that its research findings are widely disseminated amongst participants, policymakers, and other stakeholders? >> so there are a number of high impact findings that i could share with you. echo is the first to show disparities in as the incident rates across the united states by racial and ethnic populations in early childhood. this might lead to solutions to address the health disparities. we spoke earlier about particulate matter in the air. echo has found ultrafine particles late in pregnancy are associate with development of asthma in the first years of life, and this obviously has the potential to inform regulation of these ultrafine particles which are not currently regulated by the epa. finally, there is an obesity study of over 37,000 babies and young children from thef 70 echo cohorts. obesity rates were higher among the older than younger children, and rates are higher in nonwhite races and ethnicities. going forward, they are expanding to include 20,000 additional women recruited duringlu the pregnancy and have included a preconception pilot of 10,000 couples which the estimate would result in about 3000 births. so that ultimately will allow understand questions about health disparities in health equity, social determinants of health as well as naturalf experiments as you follow these individuals. >> my time is about up but i just want to know, is there any plan to extend the echo program beyond the 2023 -- >> we certainly will be asking for additional support. >> thank you. >> congressman harris. >> thank you very much. a lightning round here. dr. lowy, listen, i want to thank the nci for issuing a notice of special interest to promote research and understand the mechanism by which cannabis and cannabinoids can affect cancer biology,e cancer treatmet resistant, et cetera. dr. volkow, is this ready shoot aim? we're basically approving a medicine, so-called medical marijuana around the country, without having done the studies yet. we don't know what effect on tumors are, of all widespread marijuana use. this is a rhetorical question. can a bad idea, isn't? should we know the questions to whether testicular cancer for instance, is increased by marijuana before we actually legalize it everywhere. rhetorical question. >> this is why we do research. >> thank you very much. dr. tabak any notes you noticed in your adjustment nutrition research is going to be kind of overseen by the office of the director. do you think it would be worthwhile to study whether snap purchases should be limited to the wic nutrition-based d list or to deal with the problems with obesity, diabetes, things likewi that? do you think that would be worthwhile thing to look a? >> i think would be worthwhile. >> we know from covid pandemic that obesity is a real problem in america that leads to a series morbidities and metabolism and yet as a government to the s.n.a.p. program we encourage obesity by allowing the purchase of things like soda and chips and things like this. dr. tabak, also because we talked about alzheimer's research, i know the institute of aging did not directly fund the research but the fda decision, andec again the firing of the ceo, the company, the decision to take the particular track they have towards payment for it, do you think that's going to have relatively enchilling effect on privately funded alzheimer's research going into the future? >> well, this is something that nih has no authority over. >> iri know but nih obviously cares about the broad spectrum of alzheimer's research nih funded directly and the fact that the private sector is an important r&d sector. does it give you a little heartburn that g might be a a pullback on privately funded research due to that cms decision? >> partnerships with an industry are very important moving our country for. >> that's what i imagine. just one brief last question, dr. fauci. not everyone will know -- you and i do know that refers to. you are respected as the scientific voice of the country. does the physical and genetic life of a human being begin at conception? does the physical and genetic life of a human being, not human person, a human being, begin at conception? >> i don't know -- >> you can do it as a qfr if you want. youu can respond to that but i will ask that question as a follow. i yield back, madam chair. >> mr. pocan. >> thank you, madam chair, and thanks for the second round. i also want to thank dr. volkow for the work you've been doing around research, around, you know, vast majority of states, it's legal, in my state it's not, wisconsin. i think even the way you describe it on your website you've always been an advocate for additional research that is help many people to get off of opioids. we are in the tens of millions of people there but there are thousands and thousands of peoplean who do such work for quite well. i just want tod say thank you. you don't even have to answer a question. i just want to make sure i acknowledge the work you're s doing. w i do want to ask dr. tabak a question. you are a dentist in addition to be a site is a new health often take the hippocratic oathft or similar commitment to medical ethics. the pharmaceutical companies have similar obligation to prioritize the well-being of the patients they serve even if it means putting the greater good and of their own profits? >> i'm not aware of w what their standings are. >> would you think that would be a good standard? >> of course. >> of course. >> of course. >> can you say that again? >> of course. >> i think that i got a little ahead of myself. all the money that nih is providing a promising next generation is really a question currently with a drug, and i'm probably going to kill the name, if i am saying it correct. right now, this is a prostate cancer medicine marked by a subsidiary of the japanese pharmaceutical company. they charge taxpayers and consumers twice the price of other countries despite u.s. taxpayers having funded the invention of this through nih. this question is simple. has it changed in the last decade? no drug has not had -- >> specifically to this drug, honestly, price gouging, we are getting ripped off right and left by pharmaceutical companies in so many cases. this drug in particular the u.s. government and taxpayers funded an invention, we have the rights to that when u.s. taxpayers are price gouged. you've gotten a letter of a number of elected officials on this drug, just one of many that i think we could point out and have a long conversation. will you step in as nih and be responsible stewards of the medical and pharmaceutical inventions that use tax dollars to help develop ensuring that tax payers are not being forced to pay twice. once on the front and through nih and then again through these higher prices, more than other people in the world, are you willing to start seriously looking at doing rights on these types of drugs? >> as you know, it is a complex space. up until now, neither nih or other agencies that have looked at this have thought that price per se met the criteria that are needed which depend more on the availability of the drug. for example, if there are no manufacturing plants that are available to manufacturing drugs , that would be an example where it would be used. in this case, the barrier is quickly a financial one. we are just as concerned about high prices as any other person or agency, but we need to ensure that we are using the right tool for the right job. the request that you referred to is under consideration and we are looking at it both specifically and in the context of the plant that the department has for lowering drug prices. >> i sat down with someone recently who every year i meet with on his particular ailment. recently he told me there was a drug that he was considering passing up that was $50,000 he had to do twice a year. i watched his condition and i just think that it is time. back in the future we will look back at why we did not address this. i think we have the tools to. if you need additional tools, please let someone know. very quick, i know that cancer moonshot getting additional dollars and that is great. how about some of the smaller cancers are they also going to be able to see a good chunk of that money? >> rare cancers are, of course, very important. they represent about 28% of cancer. the people that get them are just as serious as common cancers. we, of course, thanks to the generosity of your committee are in a position where we can study rare cancers. in addition, we can look at potential interactions, if you will. findings of one kind of cancer may have implications of another. very importantly conducting clinical trials. they involve, you know, rare cancers and then many of our trials really now are eligible for people have particular molecular abnormalities. there are many people with rare cancers who are eligible for those. thank you very much. >> thank you. thank you for the extra time. madam chair. >> this really has for none outstanding hearing. thank you for all you're doing to combat cancer. lost both parents to cancer. one when i was very young. this and something that i think our investments with you all are really proving to be great. i keep up with doctor jordan berlin at vanderbilt sometimes just pick up the phone and start talking about stomach cancer or other different types of cancer. the research is just truly incredible. keep up the good fight, sir. >> thank you. on a different topic, organ transplant shortages. an overwhelming shortage of health organs in this country. district show that over 100,000 men and women in children are currently on the national transplant waiting list. our traditional cadaver organ donation processes becoming increasingly inadequate to meet the needs? if i may, given the recent efforts in transplantation, does the nih have any plans given the shortage of organs readily available for patients in need? >> let me turn to doctor givens. >> certainly, from a stand point from the institute, this is an area that is been investigated pretty much for decades and certainly there have been some progress made, particularly related to newer tech allergies, even genetic engineering, genetic tech allergies that are making at least on the horizon there may be some feasibility here. i do think that we need to be sure that it is keeping with that science. it is quite clear that there still needs to be a lot more work done before this is really translating into clinical practice and still some major issues that may need to be addressed with regards to acute rejection and what have you. doctor fauci may want to comment on this as well. this is an area that has been on the horizon for many years. some opportunities for progress. it is still early days. >> thank you, doc. anyone that would like to answer the question. >> there are a lot of problems with zeno transplantation. i think we just recently had a pig in the heart of an individual. there was a pig virus in the organ that was transplanted. it was very likely following the transplantation, it may have actually caused the death of the individual. it is a very important goal because of the reasons you delineated in your question about the shortage that we have and it's an area that continues, as doctor givens mentioned, a lot more understanding about gene editing of the particular zeno that will be transplanted may actually make it a lot better. >> thank you, doctor. madam chair, i will yield back. >> thank you, madam chair. i had not seen the end of that story. i knew the transplantation had taken place. i was watching it with great interest. let this be a reminder that when it comes to certain organs, donation, both deceased and living remains a really viable option and not enough of us do it in there a lot of people waiting. on the maternal and child front, i think i'm going to ask, with regards, i wanted to know if they will be providing funding for pediatric research and just kind of ask for that commitment that it not be left behind. obviously, we do not know what they will be funding yet. that will really be driven by the inaugural director and the program manager that he or she hires. >> and the members of congress upper dog that new director phenotype would not imagine we would let that happen. >> thank you. i appreciate that. i wanted a quick follow-up on research with regard to stillbirth. do we know more about this? are we able to treat this better >> thank you for that question. stillbirth refers to a spontaneous death of the fetus after 20 weeks in the womb. it is a tragedy and it is something that we still do not know a lot about. what we do know is about 20% of the stillbirths are caused by an extra chromosome. presumably there are some additional genetic causes that involve only one gene or a cluster of genes. one of the things that we are funded in the past year in conjunction with the human genome institute is an expert duration panel on gene mutations as a cause of stillbirth. we know how to sequence the genome, we know in the past year that there has been tremendous progress in the sequencing, but what you need to know is how to interpret that information. we are funding an expert panel to look at these mutations and then determine which ones may be associated with stillbirth. adverse outcomes of pregnancy are very, very high priority for our institute in preventing those. >> i appreciate that. >> excuse me. i wanted to talk about research with regards to drug use. washington state, practically speaking, you can do drugs, about anything, in front of an officer. you still cannot sell drugs over a certain amount. they call it the wild west for region. we -- the data on that is rolling in and is not promising when you added to any type of substance, i am curious whether or not you all are following the different states in regards to these lax regulations. i don't even know how to talk about it. are you following the population trends of the states? >> yes. absolutely. a unique opportunity that we have to understand the different policies affecting the outcome in children, adolescents and adults. in these cases, we know for example the policy implementation can significantly affect the birth defects. so we expect, unfortunately, similar trends to start to emerge by other states legalize. >> i think that one of the things we are talking about was fentanyl and over dose deaths and those increasing. there are multi- legs to this dual in terms of the problem. affording a home in my area, that is different from drug legalization. it is different from the predatory nature of, you know, gangs that bring drugs up from mexico and make their own pills. then we have children that are dealing with mental health challenges. here, i have a pill for however much money. you can take it. it is laced with fentanyl and we lose that person. the one thing we have a little control over is at least getting the data. i am very hopeful that you are look at this will provide information for lawmakers. >> we need to identify what areas are challenging and how to intervene it for example we are monitoring the increase in overdose deaths. these overdose deaths are likely -- as i mentioned before by the contamination of prescription drugs. manufactured drugs by fentanyl not teachers looking for heroin or fentanyl teenagers not knowing they purchase an adderall pill that contains fentanyl and then they overdose. >> thank you, madam chair. >> thank you, madam chair. doctor fauci, i wanted to ask your insight on when we would no longer call the public health emergency a pandemic. what kind of a process will we go through to make the kind of determination? >> there is no firm widely acceptable definition. you talk about a highly transmissible infection that is widely distributed throughout the globe. i spoke about this recently. when you are in the stage of a pandemic the way we were in the united states just a few months ago, you may remember we had 900,000 cases a day, tens of thousands of hospitalizations. averaging 3000 deaths a day. that is the high stage of a pandemic. now we are unfortunately picking up a bit. when you get up to a level where it is not disrupting society, it is not causing deaths that stress your hospital system and you have a level of infection that may be comparable to what you see, even though it is prevalent throughout, it would not be considered a pandemic in the classic sense. there is a lot of gray zone about the definition. i do not think you will see all of a sudden one day there will be a declaration that the pandemic is over. it will likely be that it is no longer in the pandemic phase and it is an endemic kind of infection you can live with. right now we are not there. >> the public health emergency and the legal definitions and states throughout the country, where do we stand with that given the sort of open-ended nature of that? >> i am not sure that i can answer that with any authority, congressman. that is not essentially what we do here at the nih. there will be a time where the level of infection in the level of act in the country will then dig it whether it as an emergent he. i don't think that i can give you a really good answer on that. >> thank you. on the vaccines for covid, i think that people are weary. you follow the recommendations of vaccines, boosters, but i think that there is a certain weariness. what is your sense and recommendation going forward to vaccinations. what a definition of fully vaccinated with the. >> it is really very clear right now. you look at the need for vaccination. the hospitalization and deaths of those unvaccinated compared to those that are vaccinated and boosted it the data is stunning. they are striking, the distance. in that era of omicron, it is very clear that they needed a third shop. if you look at the durability of protection, there is no doubt to natural infection for which you recover, but also vaccination over a period of time is a waning of immunity. when you get x number of months out, even from the third shop, you get an increased risk particularly among the elderly and those with underlying condition of hospitalizations and deaths. right now we are in a situation, as you recall that the fda and cdc have said people aged 50 years and older are eligible for fourth shot. not only the third boost, but a fourth shot. they are looking at what the recommendations will be as we get to the fall. what will happen when we get to september and october. it is very likely that all of us that have been vaccinated will have a level of protection after a certain number of months. it is likely that it will be recommended for everyone to get up boosted and then it will determine, does that have to be every year of the way we do with flu? we do not know that right now because of the fact of having different variants. right now we are in an omicron era. i think sometime in the middle of the summer we will know what the cadence is going to be about how often we have to vaccinate. >> thank you. madam chair, i yield back. >> thank you. with that, let me turn to my ranking member and colleague here for closing remarks. >> i want to thank all of you, frankly, for not only being here but being so generous with your time. i am a huge believer in what has been done at the nih. as i said in my opening remarks, it is one of the things that the chair and i share in common. one of the things that have made it easier for contentious issue. let's just send the extra money to the nih. we agree on that. you have been the beneficiary of stalemates and other areas perhaps. the work that goes on is really extraordinarily important. the one pledge that i will make to each of you and to my good friend and the chair is we will try to continue to do what we have been doing since 25th teen and that is make sure that you have resources above the rate of an elation to continue to expand your mission. i do as i said share your concerns. i had concerns about the ambitious fund of the president's budget. simply because i think that may come, but i think that it is a little bit soon, in my opinion, for us to do that now. we have a better sense of the structure. some questions our colleagues have indifferences, again, this is not a partisan issue. i find a white bactrim as to how to structure this, where it should go, what the appropriate level of funding is. we just were not prepared to make that big of an investment. particularly, if it comes out the cost of being able to continue to have the regular and steady increases that we have had at nih. i think it's been a good course for the country. i think it's paid off, i think you've use the resources well. i am thankful for that. i am particularly grateful for the role that the nih and some of the things that the subcommittee did pre-pandemic. how i positioned all of you to help the country during a covid crisis. i always point out to my constituents at home what an enormous difference it had to have three vaccines in months. what an accomplishment that was in it was a public private partnership. if the resources are not there early and often, you don't have the resources, labs. to my friends point, you have to think about this as part of national defense. it is an extraordinary thing. it would have been a lot more had the investments not been made early and we had not had the exceptional capabilities that we have at nih and biomedical research community had we not mobilized and dealt with his spirit this will not be the last one that we see. the biosphere will continue to throw things at us and we have to have the capability at all times. i want to particularly and by thanking my good friend and chair. she has been my wonderful advocate for the nih long before i was in congress. played an important role from when she first arrived at the furthest distant chair now to her pinnacle. more importantly, as the chair of the entire committee. that has been and advantage, i think for folks engaged in biomedical research. she has been a tireless advocate and she has been in a position with not only this committee, but the entire committee to do that. i would also be remiss to not tip my hat to senator murray and senator blunt who also have been extraordinary advocates. i think that we have had an unusual collection of, you know, folks at all wanted to move in the same direction. again, it doesn't matter very much who was the president and which party happened to be in power at the time. i think that that is a tribute to you. you can unite us in that way. that, really, it does need to continue going forward. i guess it is and indispensable, you know, national priority, a serious lesson of how important these are and continue to be. last point, you know, you cannot just do it at the chair and ranking member level. you have to have a lot of members interested in doing this, to, and we do. we will try to continue down that course. continue to make their resources available to you. do what we are required to do in terms of asking tough questions. again, i think, you know, there are lots of critics, but i will just go back and look at what was done over the last two years and the speed in which it happened in the lives that were saved i think as a consequence of what you did. not to mention all the other things that happen to be going on out there simultaneously. it's not like you stop everything else. .... .... thank you so much and thanks to >> thank you so much, and thanks to the ranking member. i think we're both so really proud of the support that we been ableee to really, you know, to reach out and get, and ranking member said that just that on this committee and just up on the house side, on the senate side there really is such an interest in our looking at the discovery to cure, which is what you are engaged in on a daily basis. and what we've d been able to provide for nih research, the $15 billion dollars, almost 50% over the past seven years really very proud of that. it's also why speak about critical, to strike a balance, strike a balance and to continue to support important research really in all areas. and the concept of our age is very, very exciting. it needs to get lifted off the ground. we have started in that direction but we need to get a sense to create that balance and nott leave behind areas of research that we need to try to be pursuing. a very seriousus dash i am very serious about wanting to review funding across the institutes and centers, and what that's been over time because i want to see that we are creating opportunities across the 27, you know, institutes so that each of the areas is rising to its potential and what we can do to alleviate some of the pain associated with so many diseases that don't rise to that top level. dr. tabak, given what you said, if there were more research and some of these areas they could then be inou that category where it is time to move because of the discoveries that have been made. i thank you and we appreciate so much everything that youmu do to deal with scientific breaks and the reason were so concerned around us is because of the outcome. you save lives and you protect families, and that requires sustained investment, sustained investments over time. we will look at that balance effort. there are two or three things i just wanted to mention. started in kind of the conversation. i would go back to what i said. i think we were able to move as quickly as we did on covid was because of the years of investing in research, and it allowed us to spring forward when this horrific pandemic, you know, was upon us. i get annoyed when i see, you know, pharmaceutical companies who won't recognize the work of nih scientists who were instrumental in moving forward. we know the power and the strength of the nih, and it is, that is something that we really need to think through this is taxpayer research, and we are so deeply invested in want to continue to be deeply invested. just think about areas of two or what people can't get access to it because it's priced out of the market. they can't g get access. my family could afford what i needed for ovarian cancer. not every family can o do that. that doesn't mean that women should die because they just don't have the financial wherewithal, especially when we see an industry which is just making money hand over fist. talk about balance. we need to do that. we need to be able to negotiate price. we need to be established to some parameters around where we need to go and bring down costs so people can afford to survive. so this is, i also just want to say and i would like to hear voices, not now,im obviously we are well over time here today, but the pandemic is still with us. it's with us here and it's with us overseas. and i view us as having a moral obligation for us to have a covid supplemental bill which allows us to continue to provide the vaccines and the treatment that people need here, and we have an obligation to make sure that we're looking at, what you said, dr. fauci, is we have the doses, thehe delivery system of getting shots in to arms and creating an opportunity for those countries who can do it to be involved in the manufacturin manufacturing. those patents don't have to be on a permanentosos basis, but bd they should be there now and allowing people to be able to survive. we are not safe unless we do something about curtailing the effort overseas. i did say to you, dr. lowy, and i'm going to set the question because immunotherapies are there but they were, they don't work, it's a o co-relative stud. would love to get your view of how that is being used and how we can move forward. i am just going to make this last statement for the record.he it's clear that elite supreme court decision that would overturn roe v. wade will have an effect, negative i believe on maternal mortality. and i believe that women will be harmed by this decision. i think that's something we need to take a look at and something we need to examine in a scientific way. and not on the basis of politics or ideology, but we need to understand what that means to women's health. for all that you do every day, we're so grateful, please understand i think this is a committee that wants to see you be able to think outside of the box, take your talent and make sure that we are finding that discovery to t cure. thank you, and with that, , the steering is adjourned. thanks so much. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> c-span is your unfiltered view of government. we are funded by these television companies and more including charter communications. >> broadband is a force for empowerment. that's why charter has invested billions building infrastructure, , upgrading technology, empowering opportunity in communities big and small. charter is connecting us. >> charter communications supports c-span as a public service along with these other television providers giving you a front-row seat to democracy. >> coming up in about an hour president biden will award medals for valor to public safety officers during a ceremony at the white house. we will have live coverage starting at 11:45 a.m. eastern on c-span2. connecticut senator chris murphy joined the american security project to talk about the war between russia and ukraine. you can see that life at 2 p.m. eastern also on c-span2, online c-span.org or watch full coverage on c-span now, our free video app. >> marine corps and pentagon officials stressed u.s. weapons given to ukraine to fight russia must be quickly resupplied with new ones. they testified on the president's 2023 budget rst