Welcome back. At this time i would like to introduce our second panel of witnesses. The first witness on our second panel is dr. Sharon watkins. Dr. Watkins is the director for the bureau of epidemiology in the state epidemiologist for the Pennsylvania Department of health. Shes also the president of the council of state and territorial epidemiologists. Dr. Watkins is responsible foror management and oversight of the bureau of epidemiology which includes the division of infectious disease, Environmental Health and community health. Dr. Watkins has led disease prevailed at outbreak response efforts include those with zika, hepatitis a. Dr. Watkinss has over 40 peerreviewed publications and over 20 years of experience in applied Public Health and epidemiology. Thank you for being here, dr. Watkins. Our secondgy witness is dr. Robin robinson. Dr. Robinson is currently Vice President of Scientific Affairs for renovacare incorporated. Director of development for wound healing. Previously served as first direct of the Biomedical Advanced Research and development authority, a Deputy Assistant secretary for preparedness and response for 20082016. She also served as the influence of emergent Disease Program director from 20042008. Dr. Robinson was the eight. Dr. Robinson was the recipient of the department of defense award in 2008, the hhs distinguished Service Award three times and the finalists for the service to American Metal in 2009. Thank you for being here, dr. Robinson. As i witnesses should know youll hf five minutes for your spoken testimony. Your written testimony will be included in the record for the hearing. When you have completed your spoken testimony we will begin with questions. Each member will have five minutes to question then panel. We will start with dr. Watkins. Dr. Bera, ranked member and members of the committee thank you foree the privilege to apper before you today. I name is dr. Sharon watkins, president of the council of state and territorial epidemiologists, and state epidemiologist for the Pennsylvania Department of health. We are an organization of 56 Member States and t territories representing applied Public Health epidemiologists for disease detectives. We work every day in partnership with cdc to detect and respond to have lunch outbreaks, gain an understanding of potential changes in the virus and deliver lifesaving vaccines. Ive witnessed the devastating impact of seasonal influenza. The 2009 h1n1 pandemic, measles, and many of the vaccine preventable diseases in the communities i serve. Public Health Threats require efficient, timely responses ever let on a network of Public Health agencies at all levels of government in coordination with Healthcare Providers. Response to outbreaks happens at the local level. Data on the age group affected, vaccination status, underlying illness, pregnancy status, and whether the outbreak is it a school or longterm care facility. For example, theyll need to be properly identified so that we know where to respond and what is needed. Unfortunately, this Public Health network is choked by antiquated data systems that rely on obsolete and sluggish data sharing methods. Faxes and phone calls are still in widespread use. The system is in dire need of security upgrades. Lack of interoperability, reporting consistency, and data standards lead to errors and quality and completeness, timeliness and communication. I have stood before communities in crisis who are justifiably bewildered and angered the Public Health cannot access disease data access itss faster. How is it that i can simply log into a portal and get my medical test results in the matter of minutes, and you who are charged with protecting Public Health dont have access to todays health data . It shocks people to warn we do not have aea National Coverage connecting hospital Emergency Departments with Public HealthSurveillance Systems. About 40 of all visits are not submitted to Public Health departments, leaving us flatfooted and identify and responding to the fearful infections among highrisk groups including pregnant women, children and elderly. We are now entering flu season and are challenged by the current outbreak of lung illness associate with ecigarettes. Public health is actually deciphering medical records distinguished ecigarette related cases from flu cases. This information arrives piecemeal atis different times through differentor channels. Try to decipher addendum one in my written testimony. Record we see by the Pennsylvania Department of health. And with the Electronic Health records cannot share the data with Public Health no way receives that death certificates are still pop on paper in some states and only 63 of all death certificates are submitted to cdc for aggregation within ten days. Regrettably, most pediatric deaths occur in unvaccinated children and it takes weeks to uncover and link the flu death fascination history causing lags and communication to stakeholders. We need answers to these questions. Cste at aol Parkinsons Association for Public Health laboratories together with more than 90 other institutions believe the time is not to step up and take a coordinator approach to building a 21st century Public Health data superhighway. This superhighway look like health data from Healthcare Providers and reported automatically to Public Health departments. It will link to other key data including birth and death registries and share that with cdc, the technology is here. What we need are resources. Thats what the proposed funding of 100 million that is included in the house labor, health and Human Services appropriations bill to support Data Infrastructure at the cdc is urgently needed. During the ongoing deliberations cste hope youll consider the need for a modernized electronic interoperable Public Healthze da system and skill public data for scientist to strengthen Public Health best prevention strategy vaccination do we recognize this effort must be funded with new money rather than cut already underfunded Public Health. Without federal support, Public Health surveillance modernization will remain unattainable in the nation will suffer. We look forward to working with you and i thank you for the opportunity to testify before you today. Dr. Robinson. Morning. Thank you, acting chairman and Ranking Member and distinguished men of the committee. Thank you for the opportunity to speak with you today. Im dr. Robin robinson, the Vice PresidentScientific Affairs at renovacare, former director of barda and a developer of influenza vaccines in industry. Four years ago i testified at the bardic director for the house in state affairs influenza during a harsh season in what we could do to remedy mismatch of flu vaccine. Since that Time Seasonal influence has returned each year and is brought illness and death despite a medicine cabinet full of vaccines and antiviral. New vaccines with a fourth straight influence of vaccines and a new class of antivirals were added since 2015. Yet we still not solved the chief issue with its influenza vaccine, poor effectiveness. Our domestic capacity to produce pandemicic influenza vaccine is quite tripled since 2005 thanks to investments in new seal of her, but based cell technology, however our ability to manufacture and make available pandemic influenza vaccines are not fast enough to preempt endemic peak effects. Lastly many universal influenza vaccine candidates have emerged over the past 40 years that none across the line. Today i wish to address four vaccine Effectiveness Council vaccine vaccine production and elusiveness of universal influenza vaccines. Vaccine effectiveness and universal inflows of vaccines are posted in on the selection of antigens that can elicit longlasting wrought and strong the amino protective response many different influenza virus p subtypes. And i do would elicit strong and lasting immunity against early circulating and drifted strains of seasonal influenza virus to obviate the need for annual immunization against seasonal influence and service of vaccine primer for pandemic. The story of universal Influenza Vaccine Development is long and willful. For the past four years multiple ways of innovation of driven universal Influenza Vaccine Development. One of the earliest and the most expensive was in the 1980s focusing on vaccines comprised of highly concerned influenza into the matrix protein. The candidates were poorly immunogenic. The vaccine candidates started the highly conserved mp proteins and shown to be poorly immunogenic as well. The story change with two discoveries one of which dr. Fauci mentioned earlier. Made this decadent antibodies were discovered in 2011 to specific epitopes on the conserved stem portion of the protein and shown to bind and neutralize widely influenza viruses. This discovery led to a new Development Ways of candidates that are undergoing medical evaluation presley. The other discovery which occurred this year was the finding of antibodies to conserved epitopes on the bible protein which is been a target for antivirals for many years. These antibodies combined and neutralize widely diverse influenza viruses. This discovery will likely initiate another wave of vaccines the scientist will likely include the specific protein in the next generation of flu vaccine candidates. On the issue more rapid production of influenza vaccines, theti new Synthetic Technology may expedite vaccine production. They do not require the isolation adaption and production of viral vaccine stocks like the current a consolebased vaccines can weeks to months may be saved in vaccine production. This timesaving allow the late production of seasonal influenza vaccine strains when a mismatch occurs between circulating influenza viruses and seasonal influenza vaccines. The production time for 600 million doses of pandemic influenza vaccine may be reduced from six months to three months and become available before the pandemic peaks. The added value may be a fast and easy way to distribute and administer these axioms. Many messenger vaccines are encapsulated with nanoparticles as dr. Fauci stated in which they intrinsically have properties in the ability to administer vaccines transdermally. None of these innovations of the scope will make into the immunization faxing of the 2020s without funding and authorities to an age, barda, with partners plans of today and you stick to continue wisdom, generosity support have carried us this far. Help us finish the journey. Thank you. Thank you, dr. Robinson. At this point we will begin our first round of questions. The chair recognizes himself for five minutes. Dr. Robinson, thank you for your service at barda. An organization that is looking at bringing the International Community together, along with the private sector. Look at vaccines for emerging diseases and so forth. If you could elaborate more on the mission and one of the biggest disciplines for me is the United States currently doesnt participate and yet i be curious about your opinion as to whether the u. S. Should participate and if you want to elaborate on that. [inaudible] can you turn your microphone on . Sorry. Thank you for the question. I always smile when thats brought up because my former deputy at barda was Richard Hatch at any thicker ceo. Should use participate in the activities against emerging Infectious Diseases and development of vaccines . The answer is that we already are. This was when the inception occurred back around 2014 and it became a reality in 2017. But without duplication of exactly what theyre doing. If we play off of that for a moment, in my interest in pandemics and some of the threats, if we look at emerging diseases and some of those pandemics, what is our capacity within the private sector to quickly ramp up if we see an emerging pathogen . We identify a potential vaccine may pathogen and just from your perspective as an expert in the field. Ill give it in the context of when i started my Public Service in 2004 in which it would take months , a year to be able to respond to a new emerging pathogen. My first assignment was on the influenza virus and we how we can make a vaccine towards that. Since then we had a live test in 2013 with the emergence of 87 and one viruses. What normally would take about six months nto produce these vaccines, we then boiled down to closer to three months, there was a specific reason why. And you heard from doctor fauci and doctor jernigan, we were able to get the sequence of that virus immediately and it was on april fools day of 2015 it moved forward within weeks to have that sequence distributed not only to the vaccine manufacturers and producers but also recombinant. By the summer we had those vaccines in Clinical Trials. So in record time we were able to do that. Many of the innovations we are talking about today i would even expedite that further and our goal of course is to have pandemic vaccine not onlyavailable within 12 weeks. 1 and doctor watkins, in a prior life i was chief ambassador for the county so i did a lot of publichealth work and it makes me chuckle because we would get information faxed to us and most of the public wouldnt believe that in this day and age in 2019 a lot of Public Health records and information is facts based so you talk about interoperability, you talk about collecting data and creating big data sets. Could you just elaborate a little bit more on what that will allow you to do in terms of more rapidly identifying potential outbreaks etc. And why a more robust interoperable Electronic Medical record or an electronic Public Health record would allow you to do your job better . Sure. When i think about medical delivery and the Healthcare System today, its amazing the advancements that have been made and i think publichealth has been left behind a little bit and we are still dealing with faxes and phone calls and spreadsheets, and written spreadsheets and it doesnt impact our ability to quickly respond to a situation so immunization records were able to be quickly linked to our electronic, to our disease recording system, if we were able to get electronic case reports and see data as its coming in and digested in the Health Department we would really be able to respond much faster. Much of what we do and many of the pandemics are the emerging threats that we have today, we scratch our heads and we are really struggling with the data sharing and the Data Management of so much big data. Public health needs to have our systems renewed and reinvested in and cft has produced this book in conjunction, there are a lot of stakeholder stories in this that talk about why Public Health and the time is now to investmoney in our data system. The chair recognizes the Ranking Member for five minutes. Thank you mister chair. Doctor, in your testimony you highlight the Clinical Trials have shown the vaccines that are stockpiled remain highly effective even after 10 years of storage. How do you work with the industry to improve the shelflife of stockpiled vaccines and other countermeasures in the event of a pandemic emergency . Thank you sir. We started in 2005 building our stockpiles for pandemic influenza and these would be to treat those individuals that are highly vulnerable, at high risk and our critical workforce to make sure the Company Still operates in a severe pandemic so around 27 million doses and that was actually for all the different strains that have been shown to have pandemic potential from the a5 and one viruses as i subscribed a moment to go to the new ways of age 7 and nine viruses. The vaccines that you have stockpiled in these e companies, is it still good and the answer was we know the essays looked good but we said thats not enough so we went and did a Clinical Study using newly made h5n1 virus vaccines against a vaccine that had been made 10 years before and the results of that shthat have been published show that they were equal and they were still highly immunogenic and would be, could be used without or with an adjunct top