The subcommittee will come to order. Good morning. Welcome back to the appropriations subcommittee also to those that are joining us this morning the director of the Kennedy ShriverNational Institute of Human Development and the subcommittee on health and education services. Doctor fauci director of National Institute of allergy and Infectious Diseases. And then the director of the National Cancer institute and director of the National Institute on drug abuse. Again, welcome to all of you leader hoyer asked me this morning you have the nih coming he said can you get all the Institute Directors and he said he will this is one of the most remarkable hearings that we have and we thank you for the great work that we loan that you do and saving lives the people of the great country. Let me touch on the matter of the coronavirus i just want to say i thank you to the director and all the institute tends particular thank you to doctor fauci i want to say Public Health experts deserve our praise for what is the excellent work that you are doing and clearly a matter of National Importance and National Urgency as you know we will be discussing the 2021 budget request and i intend to invite and eight Additional Panel because i believe we will learn a lot from all of you and that happened last september as well before we get into the nih 2021 budget just let me bring you uptodate the committee has been working hard to develop an emergency supplemental to fund the response of this outbreak there are still one or two issues that remain open but with all speed and deliberation with the intent the chairwoman can speak to that if she cares to hopefully today and tomorrow but before the end of this week to get this voted on. The funding includes for the nih with the diagnostics therapeutics and vaccines that will be critical to managing the outbreak i also might want to note now not starting at square one the years of Building Research of coronavirus and Vaccine Development, what i want to say to the whole subcommittee on both sides of the aisle, i have a sustained investment in Biomedical Research in recent years and i really Proud Congress has increased by 100 billion last year it provided an additional two. 6 billion over fiscal year 202,019 and is different from the bipartisan bicameral way we are very proud of that another Ranking Member is and we work closely but i would just say to you i think the president s budget would hurt the project proposes to cut the funding by a three. 3 billion that the 2020 levels this results in nih having 1500 fewer by 16 percent the subcommittee will not assume these cuts with a continued increase in investment from nih and again it will be on a bipartisan basis if we know anything about what we are going and what we are doing congress is providing 25 million for firearm violence prevention including 12. 5 million from nih i am glad to see that budget has funding for research on flu and on the universal flu vaccine but as we continue to grow this research as we did in 2020 and look forward to hear more what could be accomplished with these funds and with a cut to the National Cancer institute add a time of the promise that has led to more Promising Research with those grants and then to cut the funding sends the wrong message and the fewer exceptions to touch every institute every researcher last year in addition to new funding with that increase to each institute and center. And the Biomedical Research is an important thing they can make and thats what we need to support we promise that we will so thank you again and i look forward to our conversations. I will turn it over to my good friend from oklahoma the Ranking Member of the subcommittee. Thank you madam chair. Before i get to my prepared remarks i want you to know how deeply you expanded the bipartisan divide and actually made a steep one statement tweeted out by howard dean last night. Very seldom do i get tweeted so i was pretty proud of that. [laughter] so if i buying real estate in new york all listen to the president of the United States if talking about Infectious Diseases i will listen to tony fauci. [laughter] i want to thank all of you for what you have been doing with a difficult National Crisis and every day the amount of hope you give to people around the world for fellow americans and you have been extraordinary custodians of the investment this committee has made over multiple years if we can find any way to do it, we will i think we will the current challenge that we have frankly is a reminder to go on a regular basis you cant just show up on game day. We have to make the commitment over a long period of time. We have done that but we have done this said no disrespect to anybody but this can go down from what any congress that the president has asked it to do. There is also a Congressional Initiative if you recall and has a very keen sense of how much fellow americans value those endeavors of the nih so after five years sustained increase from National Institutes of health were pleased to welcome to this hearing room doctor collins once again and went to commend you on your long and distinguished career you have left a legacy of excellence when i say this often you have to be the best politician in town to go against donald trump and barack obama but it talks about the bipartisan nature of what you do. I made no secret increasing funding for nih is one of the best bipartisan accomplishments to increase of nih funding is critical to ensure the future for Biomedical Research and unlocking cure so many diseases putting a strain on the Healthcare System what this fosters is part of the force of the United StatesEconomic Growth leaders in the house and Senate Democrats and republicans have unified behind the is increases i hope this trend continues for years to come i appreciate the fiscal restraint expressed of the president s budget i do not think that is in the best interest of American People reduce nih funding at this juncture over the past five years single to the Research Community and then could be delayed by years or decades including curing diseases and finding better treatments for cancer also want to caution against the proposed changes for the negotiation for indirect cost as part of the grant to cover facilities its serves as a foundational element for research and support that i hope we can continue that restraint this will hurt research not provide additional dollars we need to protect the institutions we have the opportunity to sit down with a new one Nobel Prize Winner with his work on immunotherapy to chart a course for new direction of treatment for deadly cancers. The noninvasive nature and the time of treatment is nothing short of remarkable in that could take a decade before Standard Health insurance reimbursement an application for research are overwhelmingly available and this is what we look at very carefully Going Forward companies have noticed those that can invest their own sources as well if we have our own cancer survivors those protocols would not have felt this reminds me of support of the nih every dollar investment is a direct payment with tens of millions of others around the world also to highlight the progress of Alzheimers Disease Research creating an enormous strain on the Healthcare System in the federal budget the rising cause of death impacting more americans each year they will exceed 1 trillion if it remains on the current trajectory. We must make progress theres no other option im pleased to learn those that are partly funded by the nih is made more progress and now involving data for more than 35000 individuals to identify the variance of five new genes with the most emotional and physical toll you must have a better understanding of the underlying genetics. I will not take additional time to recognize the directors because quite frankly i word rather hear from them about the Exciting Research they are all involved in but i want to think each of you and your colleagues were not on for your passion and dedication and hard work i do believe you will change the course of disease and treatment for many generations. I Hope Congress continues to be a supportive partner. Thank you madam chairman for holding this important hearing. It is my pleasure to yield to the chairwoman of the Appropriations Committee and someone to make sure we respond in kind. Thank you chair in the Ranking Member for holding this hearing and welcome once again to our very distinguished guest. [laughter] thank you to everyone. Let me say at the outse outset, president trumps disastrous budget has deep cuts that tear the fabric of our nation. Instead of building of last years appropriation bills he double down on partisan and talking points proposed investing 2 billion and cutting three. 3 billion of the National Institutes of health really does expose the Trump Administration for what they are of political rhetoric but as you know this committee is on your team and at a time with surging cases and cost associated with Heart Disease, s and related dimensions, and now the coronavirus this commitment to nih is as strong as ever. I would be remiss not to mention this will likely be my last nih budget hearing. And when i think about it, we have come so far since we joined the subcommittee in 1993. When nih was funded ten ten. 3 billion we committed to doubling the nih budget and then more than tripled it together raising leadership on the subcommittee the past five years we have increased 11. 6 billion the total funding level of 417 billion we are so appreciative to all of you your talents and hard work in commitments it has been an honor for me to serve on this committee. But i do remember touring the lab with doctor Francis Collins who had plan to map the human genome i remember that first map. [laughter] and the advances to combat Breast Cancer have revolutionized survivor rates in immunotherapy has given life to people who wouldve had a death sentence one decade ago. We know more about Childhood Development in the human brain and we are witnessing amazing strides in medicine. If you recall now we even have female lab rats we were convinced they were all males are delighted to know you have female lab rats. Your work has filled me and millions of americans with hope. Never in all of Human History has medicine had more to offer and with all these great achievements, there is so much more to do. I recently came across questions from an nih hearing in 1989 when i asked why women are more likely than men to have alzheimers. And we still dont have the answer in fact we dont have many answers. Lord knows why they asked me to be on the panel is were sitting around the table with one person that was assigned to talk to doctor gibson so what do you recommend there were experts people who have been working on this for years and years he said diet and exercise. Doctor felt she knows that. [laughter] weve had conversations with that. And with all the investment investments, thats all we are offering those people with alzheimers. We still dont know the answer and we still dont have a method for Early Detection for certain cancers. We still dont know why it works for some patients and not others and we still dont know why rates of autism are raising and why there are higher rates among boys than girls. By the way if you have answers to any of these questions toda today, feel free to share them with us. Maybe i thought as of this morning but if you have answers. [laughter] so there is so much we need to achieve i can think of no better to do list in the people sitting in front of us today. You have saved lives you are our superheroes and if the American People could see how we come together to fund such important work, i would say they would be proud but they would probably be shocked to understand how bipartisan nih is and how bipartisan this committee is and that is why we cannot let up by one a partisan budget request get in the way of saving lives. I thank you all it is a pleasure to welcome you once again madam chair. Thank you and doctor collins we will turn to for testimony. That will be entered into the record and you are given five minutes of time. Thank you and good morning and Ranking Member and especially chairwoman lowly i did not realize you are going to make this announcement 1994 is the first time i appeared. Thank you for that reflection. On behalf. [inaudible] please. [inaudible] i do want you to know that condition is a great concern to nih. Go ahead and mention that. I will say that for a later point but on behalf of the nih thank you and the subcommittee for the two. 6 billion increase the study increases you have provided brought new life to Biomedical Research and to take on new and unexpected challenges that is on everyones mind like the global coronavirus outbreak enabling nih to go against a Serious Health threat and we will hear more about what we are doing later. In the meantime i would like to highlight other recent achievements. And maybe i can turn your attention to the screen announcing the short list of 2019 supported by nih first the lifesaving progress against ebola and the first effective therapies and the second breakthrough was the development of the specially formulated foods to combat malnutrition and the third is a highly effective triple dog drug therapy among the legion of researchers the part of a long journey of targeted therapy that is me on the left. [laughter] thirty years ago on the team that discovered this disease and i was in michigan the mutations that normally help to maintain the bodys balance and then its built up in the lungs and then potentially fatal infection that triple drug therapy kicks the drug back into shape as the snapshots show the parents spend hours each day on the respiratory tract later she was a section to give up her beloved teaching career just five weeks after starting triple therapy the lung function improved dramatically the active life she had always imagined and even set a new personal best and told me the medicine has revolutionized her entire life 30 years of research came to this point in a wonderful example of basic science and collaboration between public and private. Stories like robbins with innovative ways to help folks with all kinds of diseases among the exciting possibilities is a new generation of gene based therapy. I have introduced you to those who have been helped by those therapies like spinal muscular atrophy, sicklecell disease and many have met kent on Cancer Patients those whose lives are saved by immunotherapy. But we need more breakthroughs that we know the molecular basis and with theres about 500 them the latest development promises to boost that number and then to replace that function allow themselves to be reprogrammed five years ago i never would have predicted the explosion of opportunity and gene therapy it may take two years to produce material for the Clinical Trial for those theories and then rely on the private sector and with tens of millions of people and then to enter with those potential partners. And that budget is a 30 milliondollar initiative and with those Rare Diseases customizing processes and today i focus on those gene therapies and the advances on the horizon in the coronavirus. And the Opioid Crisis. And with more types of answers because of view we look forward to your question. Thank you this makes it real how peoples lives have been changed growing up with two wonderful friends with Cystic Fibrosis and now we can save lives so doctor fauci you have been very generous with your time to provide the subcommittee with information and for those activities including diagnostics and therapeutics this is a twopart question of the end a a id because then i ate on and each one nih is not starting from scratch with the coronavirus or Infectious Diseases. With the prior investment that would lay the groundwork for the coronavirus. Thank you very much if you look at that fundamental basic research and the ability which comes from nih itself and to identify a pathogen to allow us to do the things i will mention in a moment but this goes back to fundamental basic research with genetics et cetera. Remember the first coronavirus that weighs 8000 people 775