Esses include doctor Rochelle Walensky, director of the cdc. Nih director anthony fauci, and fda commissioner doctor robert kayla. Live coverage on cspan three. Good morning. It is unhealthy labor and pitching committee will please come to order. Today we are having a hearing on the federal response to the monkeypox outbreaks as we work to stop the spread of this virus. I will have an Opening Statement followed by senator burr and then we will introduce our witnesses. Before we start i do want to take a moment to congratulate one of our witnesses, dr. Fauci, announcing his upcoming retirement. Dr. Fauci, you have served through multiple decades and president s and Public Health threats. And worked to save countless lives. And i hope you know that you have the thanks of a grateful nation for your Incredible Service to this country. So thank you, thanks for being here today. After the witnesses gave their testimonies, senators will each have five minutes for a round of questions. And what we are not able to have this hearing fully open to the public or media for inperson attendance, my video is Still Available on our Committee Website at health dot senate. Gov. If anyone is in need of accommodations, including close captioning, please reach out to the committee or the office of congressional accessibility services. According to the senators for Disease Control and prevention, u. S. Now has over 21,000 confirmed cases of monkeypox, more than anyone else in the world. In my home state of washington has over 500 cases. I have heard from families who are rightly concerned about how bad this has gotten. And Public Health officials including backing Washington State, who are frustrated to see the response run into issues which should be prepared for by now. This is why i have continued to push the Biden Administration about my concerns with the monkeypox response, and urged quick action on testing, treatments, vaccine in clear guidance to the public. To our Health Care Providers and state Public Health officials. It is reassuring to see that we are making progress on the Testing Capacity, which is increase 1000 . And the fda just approved a faster track for additional tests. On vaccines waters hoping to stand up a new vaccine finish site in michigan. A process is working to expand the number of Distribution Sites and states. And the administrations advice for splitting doses has greatly stretched our vaccine supply. And at the administration has started working with states to make Vaccines Available and events with many people from the Lgbtq Community in attendance. And perhaps most importantly, the rate of new cases going down. Now it is all encouraging news news, but let me be clear we must be vigilant in our response. These prominent saying improvements do not discourage issues that we have discussed from the very start of this outbreak. Patients have spoken out about how hard it is to get tested. Some even waited days despite having clear symptoms. Providers have had to jump through hoops to get their patience treatments and im constantly talking to Public Health officials in my state have told me how communications with states could have been far clearer and faster and how the challenges and accessing tests and vaccines have delayed the response. I know states have a specially struggled with the federal governments decision to forgo the system we typically used to distribute vaccines. The one we are already using for covid vaccines. When it comes to Vaccine Distribution, some shipments have been sent to the wrong state and even spoiled after storage at the wrong temperature. There are been issues with Vaccine Supplies as well, like when thousands of vaccine doses were delayed because the fda had yet to inspect the new plants that they were coming from. Or when the Biden Administration missed an opportunity to procure more vaccines at a Crucial Point in this outbreak. And again we are seeing inequities worse in this outbreak for some communities. Advocates in the Lgbtq Community to face the vast majority of cases have also made it clear that they feel they are being overlooked or in some instances stigmatized. We need to keep focusing and improving on outrage and getting information and resources like vaccines to those who are most in need and most at risk. And that must include communities of color, who we know do not have equitable access to vaccines. This is especially important as early data suggests that black and latino communities are disproportionately burdened by this outbreak. We have to do better. We need to be applying what we learned from the Covid Response, and providing the resources communities have made clear they needs. Of course there is an enormous difference between this and the covid pandemic. Which is thanks to decades of investments in smallpox, we already had tests and treatments and vaccines ready to go before this crisis began. That should serve as a reminder to all of us about the immense value of investing in Public Health preparedness. But it is also why the stumbles and getting the tools deployed where specially frustrating and inexcusable. To learn from this we need to be clear eyed about what went wrong. Not just on the challenges we face in the last several months, but that we have faced for decades. Challenges that to be frank house spent many administrations, not just this one. For example had over 20 million vials of the smallpox vaccine in our national stockpile. But they were not replaced as a expired over the course of the decades. I know i joined my number and members of this committee when i say we have got to do better. Not just on covid, not just on monkeypox, but on Public Health threats periods. Because we know there will be more. Just last week you are declaring them urgency due to polio. Another Public Health risk that we need to watch closely. I want to hear from our Witnesses Today about not just what they are doing right now to improve our response to the monkeypox outbreak, and fast, but also how we can fix this in the long term and make sure the stumbles of the last couple months never happen again. I want to know what you in the administration are doing to make sure we have enough tests and treatments and vaccines for this outbreak, and get them where they need to go. And also maintaining an adequate stock of supplies for any small parks throughout. What you are doing to improve outreach to the Lgbtq Community, address the disproportionate harm to black and latino communities, fight stigma and misinformation, and writes the inequities we have seen in our response so far. How are we making the most of new research to develop promising vaccines and therapeutics, and make them more quickly available, while continuing to pull the Gold Standard of safety and effectiveness . And are we getting schools and colleges everything they need to stay open and keep students in schools and communities safe . I am glad the cdc is providing guidance for k12 schools, and the science tells us that elements of new school kids are not at high risk. And cdc is also release resources for colleges, which is critical for students returning to campus this fall. We need to make sure the colleges and universities are equipped to prevent potential outbreaks as students move into dorms and living close quarters with each other. I realize you have got your work cut out for you and all of this especially with covid still raging, but there is no reason for us to fall behind. I will keep pushing you here because families back in Washington State and across the country are counting all of you to get it right. It is also im going to keep pushing my colleagues here in congress about the need for funding to support all of this work. I know im not the only one here of the concerns with the monkeypox response but we cant just say this is not working, without providing the funding to end this outbreak and build a Public Health system and americans deserve. I will continue to work with colleagues on both sides of the aisle and push to deliver the resources that will help get families the testing treatments and vaccines that they needs. And im interested in hearing from the witnesses on what the news is when it comes to investment in our monkeypox response. It is also important to me that we continue to keep our eyes on the horizon when it comes to future outbreaks and pandemics. And building a stronger Public Health system for whatever threat comes next. As the saying goes, an ounce of prevention is worth a pound of cure. And that starts with building a worldclass Public Health system, rather than one that lacks behind our peers. Our communities deserve to be as safe as anyone in the world, which is why senator burr and i continue to work to pass a pandemics act. Our Bipartisan Legislation implements the lessons from our Covid Response, and improves our policies and processes on issues like strengthening supply chains, improving management of our national stockpile, modernizing data systems, and other items which would address many of the challenges we face with monkeypox. But a strong Public Health systems also require strong investments. Because our Public Health system was under funded before covid struck, and it has been overwhelmed over since. We have to end the cycle of crisis and complacency but making sustained investments that allow for us to build and maintain robust Public Health infrastructure at our levels. Well keep pushing for all of these steps because we should all know by now have just how much is at stake. I can tell you that families and seattle know, parents and spoke and now. Nurses in yakama no. Workers in olympia. No people across Washington State and across the country now. Covid was never going to be the last Public Health crisis we faced. And neither is monkeypox. The question is not whether there will be a new threat, but when it will strike and whether we will be ready. The truth is the monkeypox response so far has not been encouraging. But there are some clear signs of water, and there are some clear signs that we need to improve. I dont just want to hear today about the steps that we will hear, today i want to see. Action and ill be watching closely. We walking closely on the progress and making the improvements that we need to put our Public Health security on solid footing once and for all. Thank you very much and i will turn it over to senator burr for his opening remarks. Thank, you madam chairman. Good morning. Im glad we finally have a hearing on the monkeypox outbreak as it sweeps our nation. Monkeypox is now a Public Health emergency. It did not have to become one. I think the one promising thing that can be said this morning is the infection rate has slowed. Now maybe the only thing. Since may when the first transmission was reported in the uk and europe, im impressed in the administration for strategy and appointment. After almost three years of the covid pandemic, you would think that Public Health agencies responsible for preparedness and response would be prepared for anything. Particularly a threat like monkeypox. Which weve known about for decades. And for which we have vaccines and treatments. Doctor fauci talked me before about monkeypox. It is almost a definitional case of what the cdc and our sister agencies should be prepared to tackle. The virus spreads their physical contact, it spreads when an infected person has an obvious sign of infection. This is not like covid, which was a newly emerged virus that spreads and asymptomatic infection. But by any measure, or in fact by every measure, the response from the Biden Administration on the monkeypox crisis has been a catastrophic failure. You repeated each of the stakes in the early days of the Covid Response. And the cultural arrogance of Public Health officials who were supposed to be at the forefront of the response let this country down again. Since the covid pandemic, started this committees in 13 years on the response from both the trump and the Biden Administrations. I think we are sick of being called to the carpet and us having to hold you accountable for systematic failures. But it seems nothing has changed. You cannot blame the last administration on this one. The first confirmed monkeypox case in 2022 was may 7th in the United Kingdom. The first case of monkeypox in this outbreak was reported in the u. S. On may 18th we had a warning. We had warning that this was coming. We should have been prepared to manage what came with arrived. Lets review. We failed testing. Although we eventually made Testing Available through Laboratory Response networks, these tests were too hard to access. It took weeks before doctors were able to get their parents and their patients tested without having to First ConsultPublic Health officials. There was also a significant delay in engaging the private sector on the outbreak. Until june 22nd it took that to announce engaging with the private sector. Still to, that Companies Interested in developing additional diagnostic tests that could have helped address some of the slow turnaround times and improve access have been left waiting months for samples needed to develop those tests. Without delay. You failed on the vaccines. An enhanced strategy to offer vaccines, to at risk individuals, and known contacts, was announced june 28th. But this was already after some local jurisdictions had already taken it upon themselves to use the vaccine in this manner. On the full month of the uk joint committee on vaccines enemy as a shuns matches gets a similar strategy for their citizens. Why do we continue to be behind . Meanwhile, decisions about Vaccine Administration in the u. S. Have seem to have been made on the fly. Even when fda issued an emergency last month, allowing vaccines to be administered in thermal injections, there were no Public Meetings of fda cdc outposts. Experts discussing relevant questions on the minds of impacted americans. Which inform these decisions. Health professionals were confused about the decision and patients were scare they were being experimented on. To make matters worse, he states had no time to prepare for the strange Vaccine Administration. Right after the fda made its decision, or use state vexing allegations under the assumption that every vile would yield five doses. If we know that this has not been the case in every state. Resulting in some vaccinating more at risk people. We feel that having a plan. Monkeypox outbreaks have been occurring in nigeria and other places where the increasing frequency. It was identified as a threat. Under a threat matrix. And the threat for which we had countermeasures in our stockpile. I might also add that our earliest purchase of the bavarian ordered vaccine in bulk was in 2017. But it seems there is no real plan and how to respond with the Information Research that we needed to understand this outbreak. Only after the chair sent separate levels outlining a plan to the policy lock about the resource priorities. But it was clear it was not clear what Research Activity hss actually undertaken in response. These delays allow the disease to spread. It quickly turned it is 650 cases in june. And more than 12,000 cases in august. And near 22,000 so far in september. It should have been obvious to all of us that the timing of these early cases, coupled with the evidence that the cases were not linked. Which would create a perfect storm for a large outbreak. Monkeypox is a virus that largely transmitted through skin to skin contact. Most easily and frequently transmitted between sexual partners. Monkeypox arrived just before the price elevations across the country. One of her two years of lockdown and social distancing, your agency should have been screaming from the rooftops about what you knew or suspected about how monkeypox would spread. Instead, we remain silent. People got sick. Because of that silence. This is not rocket science. But consenting adults need to be told what Behavioral Changes they should consider to avoid getting a preventable disease like monkeypox. You failed at a time when the communities most at risk needed you. Disease control and prevention response is literally in the name of two of your agencies. Yet you did none of that. It was no surprise to me that the administration after months of founder in the news are that the white h