Transcripts For CSPAN2 Senate Hearing On Coronavirus Response Future Pandemic Preparedness 20240712

To do here. I have always been reluctant to say this truly could be one of the most important things we as members of this committee do. The world is experiencing today and what the american and as is americas face is one of the most significant challenges that a lot of us will face in our lifetime. The bad news, the really bad news is that its entirely possible that it will happen again. I say this of course because the experts tell us that this virus that made the leap from one species to another can very easily happen again and if there are 2000 of these viruses out there you have no idea what they can do when they get into a human being. Thats what experts and scientists tell us have identified within their branch about 2000 different viruses. Having said that we need to look forward and i want to stress what im trying to do with this and what about all of us are trying to do, to look forward. There are a lot of hearings going on and a lot of hyperbowl going on and a lot of blame assignment but that is not what im focused on here and i hope we will all avoid that. Certainly a person cant help but think about how did this happen and whos responsible for this and who could have done things better . Sen. Jim risch there has been a number of systems in both of the Health Organizations and i have spent a considerable amount of time talking to people at the who. And they themselves recognize that things should be looked at. And they like us are or would really like to see things work better in the future. In any event, there has been legislation prepared. Im going to urge the committee the strongest way possible for everyone to get together and vote and is in place for you have a peaceful legislation that will actually help in the future. As i said, this future is so important when it comes to how we react next time. Very important for daily if it turns out to be a worse virus. The world will probably not know what we did. If we failed, the morning and probably that we made an effort. All of us want to make a difference. Particularly in the future. This is our opportunity to do so. This is my 40th year. Anna legislative body, over two decades. I know good faith effort when i see it. It will tell something the future. The 22 members on this community, theres a tremendous element on both sides of the aisle. They spent many years dealing with the challenges. And they are challenges that we face with other countries. He brings back to the table and much more. Across his company, as deeply involved in health and Human Service is an on security. And on services and intelligence and everything. Everybody bring something to the table. When im hoping is we have a product that would reflect the best of all of us in bringing the matter into about. As i have said over and over again, myself and senator murphy is introduced, we want the best possible ideas in the best possible outcome as we move forward. Everything is on the table. Theres no pride of authorship here. I hope that everyone will sites, the move forward. Obviously the more innovative approach. To this problem. Then hopefully, we are fortunate to have with is a panel of experts with an impressive range of Infectious Disease detection and diplomatic engagement in Emergency Response we know that all of these are incredibly important to put together a holistic approach to this problem. Each of us bring something unique to the table. Thank you for sharing predinner last night, we had another vicious including the needed for the World Health Organization perform. Again, we talk about World Health Organization we dont want to demonize people the need incredible efforts to address the problems we have today. I am aware of the challenges and differences the several of our panelists face when they have worked with Health Organizations when the Ebola Outbreak in africa which ultimately had to a number of things the race where we are today. Some improvements have been made. Since the bullet the situation. It appears we may be repeating history today. On a much grander scale. And there was an agenda that was formed. And didnt get us where we need to be there. Some have just suggested the World Health Organization, that we called them for obligation under International Health regulations. That probably can be fixed. They make credible cases as to why they couldnt do some of those things they really wanted to do. Those are things that we really need. That is artifacts. But again we need to focus on this friday as appropriate for us to recognize what World Health Organization is. Its a convening mechanism, best practices and norms. We want to look at our own consciousness. Ask if we are asking the world Health Organizations. I would repeatedly ask what entity if this gets out of control. What entity and again i want to especially say that we should avoid what is happened in the past. Look forward to the future. Ive repeatedly been disappointed by the responses to help his and one thing is clear, is not the World Health Organization. At least, well it doesnt mean it cant be fixed. What entity is it. And the mandate capacities that will do not yet exist to home and where it should that has to be invested in. My question is why not. And the answer that we need the right answer is not an answer that is dictated by political entrant politically taken sides. What entity and how can we prove that a global level. And how to operate. The Global Health security has been provided useful and fully for addressing these issues. How can we more effectively operationalize it. And our suggestions are only for discussion. How can we incentivize and mobilize Global Health security. Strengthen response and share the critical Global Healthcare. It is really a comparison from countries that demonstrated will read but have the capacity for the operations. And importantly, fundamentally incentivize in developing and manufacturing equitable these are difficult challenges for the history of solutions. We are rightfully focused on the covid19 response. Particularly how the Southern Hemisphere is into that winter months. This is not our first pandemic. It wont be our last. A number of ideas have brought forward in a bipartisan bill. We hope everyone will be able to have a discussion about this. Im hopeful to have a discussion today to help refine the die does not bill so that we can answer these questions, and charged with the path forward. And protect the americans. And taking ideas from everyone. Which continue to try to operate relational eyes the ideas that were getting to other members. We strongly urge that if we are to succeed and we must succeed for the future of america, to work on solutions and not necessarily focusing on failures of the initial response. And with that i think everyone again for joining us today. And everyone to work in good faith height and try to actually reach some conclusion. Honey is one of the most important things that we can probably do here in our service in the United States senate. With that. The story is an integrated. Thank you mr. Chairman and thank you for convening another hearing on the ongoing covid19 pandemic. As of june 26, 2020, the World Health Organization had reported just under 9. 5 million confirmed cases of covid19. And more than 494,000 deaths worldwide. One and 2 million of those cases are right here in the United States. And claim more than 120,000 american lives and span of five months. I know it well because unfortunately, at least 14 or 15000 are those from my home state. And it has proven resilient, across the United States and china. And alarming increases in the number of cases in south africa, india and brazil. This pandemic presents one of the most complex and novel threats to the United States rated indie the world has faced in several generations and it is clear that even if we stop the spread of the disease here, which we certainly have not, that a series global effort to understand and confronted, and 20 and will return to our shores. If ever there was a need for the United States be an active leader in International Coalition to respond to common thread, it is now. Recently cannot safeguard an american lives without one. And fortunately the United States is not yet been to meet this challenge. I have seen half as a response going so far as to effectively withdrawing from the very International Institution best poised to respond to this question entrant crisis. When anna united critical partners and have been absent critical convening meetings and all of this at the expense of the health and safety on the market people. I believe there is a market can and must do on the congress as a Critical Role to play. And by faith as you referred to mr. Chairman, and make all of the democratic members of this committee introducing comprehensive legislation playing out concrete actions the United States could take the lead in the Global Response. The covid19 and the National Response and recovery act this is a strategy to confront the ongoing pandemic. And prepare the United States to deal with the next and compel the Trump Administration to constructively engage with other countries International Organizations and Multi Lateral to stop the spread of this deadly pandemic. Specifically, an additional 9 billion in funding to fight the covid19 pandemic to contributions for Vaccine Research that the coalition of preparedness and a contribution to the global fund for aids, tuberculosis and malaria. Against the covid19 response mechanism and additional funding for emergency overseas united terriehumanitarian response to pandemic, ensuring that the funds are to the Global Response plans as well is directly to ngo working on the frontlines. The new surgical Financing Authority of the use International Development finance corporation, would allow the dfc to expedite decisions to make Strategic Investments quickly and to aiden covid19 efforts. They also was in place mechanism to help as better prepare for the next enemy. He requires an annual intelligence estimate on pandemic threats and establishes Global Health security to coordinate the whole of government u. S. Response to Global Health security emergencies aimed at improving both domestic and International Capacity to prevent, respondent detected epidemic and hypodermic threats. Clearly, nine he is role of the state department. The usaid and the centers for Disease Control and prevention and responding to pandemic threats. An address u. S. Executive director to the world bank. To begin negotiations to establish a trust fund at the world bank design not to compete with, with that World Health Organization but to walk intended with him. On a mobilizing their own resources for epidemic and pandemic preparedness. Mr. Chairman, more than 700 americans are dying each day. Neither the fingerpointing line game, race statements linked to the origins of the disease, our strategies southern on denial of the battle against covid19. It is painfully apparent progress will have to lead in this effort. Just as that led and domestic relief and recovery efforts. I enjoy and appreciate and embrace you call as developing a proposal the bully and robustly addresses the current crisis. And in is that we are adequately prepared for the next month and kate countries across the globe. Falling short of the legacy such as the president s emergency plan great relief. The marshall plan. I look forward to our discussions. Thank you. While spoken. Your reference to the success that we have had in addressing the aids pandemic, as appropriate. When i started out to construct the bill, as i said, starting point, i use the successes that ahead. Certainly if we can replicate that, for the future pandemics, i think we will all be given great credit. Your remarks about the united since being a leader absolutely right. Simmer standing in the world. Some of the ideas that you had her novel to me. The discussion about the annual credit assessment. We have then every year. But unfortunately, it gets an audit, if there is a threat of the pandemic, particularly a form of assessing and dont really focus on other pandemics and what they look like. Our that may be due to the fact that these pandemics are different. Each one is different. It has things that are the same but each virus has a different way of acting and reacting in the world. We probably ought to. [inaudible]. With that so lets move to our panel. We have a very impressive panel. I must say that the last panel was good. It helped clear my thinking on this. One things i learned i think from last panel was about how there just is a disabled bullets. In a coordinated effort. Today we will look at this a little bit differently. If we each went to our accomplishments, we would be here all day. So each of us will give a brief introduction for an effort witnesses as ambassador. Hes an accomplished diplomat and medical researcher. Currently serves as a professor in the department of medicine as codirector of the center for Global Health practices and impacted georgetown university. Recently served as the executor, to fight aids, and malaria and is the u. S. Global aids coordinator. It certainly an impressive resume. He joins us today. With that, the ambassador. Thank you. It is a great privilege to be back before this important phonics. I would like to think the committee the entire congress for the bipartisan effort to ensure the u. S. Has them, the covid19 as made clear that a Global Pandemic requires a global. We are not quite there yet. But there is good news. What is needed is not rocket scientist. Number of countries who did well in the early stages covid19 were not after setting up systems. There are many had them. They were prepared. They never had to enforce a lockdown. Other countries rapidly putting best testing and tracing and courting systems as a result they begin safely reopening within six weeks. Identifying fabrics as the card and im very grateful to determine on the bipartisan cosponsors as well as the Ranking Member for putting forward a proposal to help ensure the u. S. Cornings International Bio program and ensure multilateral institutions. With great interest the Committee Held on june. One perspective on the chairmans question, how is the Fire Department pretty could recall. From a bilateral perspective, the coordinator at the state department resonates. From the perspective of legislative oversight, the colonnade would seem to be the Fire Department for bilateral engagement. When pepper was developed, and i was fortunate to be involved in the creation of the small group that put together the plan. We struggled with where to house it. The court and enter less churchills click on hypocrisy, the worst approach except everything else. Multiple parts of u. S. Government was being engaged in Global Health. Including a pandemic. U. S. Is deeply involved in many aspects of health as well as those that impact health. And of course, a humanitarian responses. Cdc is the premier government Health Organization in the world. It is the only agency on spans domestic and Global Engagement including pandemics. And is involved with and provides Technical Support to and is up to and respected by governments and institutions in the high middle and lowIncome Countries. And we must be involved with the three country is no. Cdc is built for what is most built for the Global Response. However more than this, the National Apparatus is needed to first noted. The requirement complicates both a full coordination from the department of state. In that regard is important to note that this proposal identified the National Security council, has been noted. Perhaps more opportunities legislation which is now unprecedented. Multilateral perspective on the world has come together and created the Global Health agenda. However, gh essay is not the Fire Department. They provide an action plan for every country to have an Emergency Operation center or eeoc capable of mounting response and fabric within two hours. It must also be responsible for surveillance down to the Community Level with systematic reporting to rapidly detect an outbreak. We need a global as a Fire Department. Should be multi spectral the printable functions of it would be to learn from the past, what has worked in work during previous epidemic and pandemic to connect to regular simulations of local outbreaks. The National Regional and Global Responses to them. Regularly integrity getting gaps in the system. To support regional and national nancys pretty be fully operational and coordinate with the Financing Mechanism and what we will call the fire hydrants to help and drop them up use of resources. The Global Pandemic, can b cannt be effective without the defendant engagement at the who. In my view w child doing the job under the circumstances and vastly improved from ebola. I know the director general since 2004. He was initially installed administrator. Often systematically transform one of the worst performing ministers of health in the world to one of the best print hes been a steadfast partner and alley of the u. S. Global health. Anything in a difficult pass to the reforming of the who and is made significant strides. As the first african director general he also has the unwavering support of african countries. As the second most populous continent, africas total engagement is welcomed. The u. S. Can best run the reform wonderfully engaged pretty cant lay best when youre playing at the table in front of the table, and others are ready to step in and take her place including china and russia. In my view of financing facilities, the fire hydrant related to but organizationally separate from our globally would create the optimal condition for success. One exist to preserve for low and middle coat Income Countries. There is a great deal of preparedness and protection response and need to be responded before and after a vaccine becomes available and for future pandemics. The principal function of the fire hydrants, the debtfinanced priorities identified by the global and regional and national nancys, the Fire Department. I appreciate the discussion during the Governance Panel hearing. The bank and trust funds, on the ranking noted. Its something to be created no. Ill have pros and cons. Seem to be the best approach is for the administration to play a leadership role in a time bound way the parameters set by congress to identify the most likely mechanism to succeed now and for the future. An epidemic preparedness and response. In the shortterm, congress has an important opportunity. This committee has a long history of supporting both u. S. Leadership in the commitment of significant resources. Including at least 12 million in the hero act, will save lives, protect the u. S. From additional of this pandemic incident most Important Message abroad as well as here at home. There is no time to lose. You mightve seen the troubling report today avenue swine flu. When there is hence no reporters human to human contact, if there is reason for concern. The nest pandemic might be upon us. Mr. Chairman, Ranking Member, members of the committee, no country is safe and no one is safe until everyone is safe. The good news is this is one of the most solvable problems facing the world. Throat history, we have seen that when we come together and look forward, outward and without, there is no problem we cannot solve and in particular the u. S. Has shown when we take a leadership role, it is a blessing serving others while protecting and promoting our interest in our lives. I think the committee for which you are doing to leave. And agai thank you very much and first of all it is good to hear when the structure was put together, he struggled with some because youre certainly facing with issues that we have struggled with. Also, i appreciate your remarks about that you have a place at the table. Not only do you have beverly think that because of our unique standing in the world, we need very significant voice. Thank you so much. Retired in 2017, ambassador served three years newest Diplomatic Service including investor, and deputy chief commission in denmark. Completeness Government Service rate represented the states in who meetings. And a member for tuberculosis and malaria. Thank you very much. I am jimmy and i am pleased to be with you today. I am very proud to have been a state Department Officer and with that date department of hhs is five years as you said and then those jobs, i have develop and implement the president s emergency plan for aids relief in Global Health security in the Obama Administration. These are the two exceptional examples of Global Leadership. And its all americans should be proud of. Some people have dismissed the war because we do not prevent response of the Novel Coronavirus outbreak. The five countries actions because of this and extra merry extraordinary results. In numerous outbreak of 2015, south korea became one of the most active members in reviewing its own procedures and when covid19 had, they were ready with surveillance and management capacity, and was all due to the efforts. In uganda and vietnam, where the two pilot countries the u. S. Centers for Disease Control and prevention help develop comprehensive prevention, protection and response to outbreak. Both have been examples in the region, of controlling the coronavirus and did so without extensive outside help. My point is the republic of georgia the involvement of cdc, and the department of defense. In his coronavirus rather than any other country in the form of the soviet union and within the European Union ca. It did and exceptional job of preventing and controlling covid19. The gh essay has followed successes. And despite some justified criticism, so does the World Health Organization. Its Emergency Health Emergencies Program responded immediately to validate good diagnostic test for covid19. World Health Organization was the only organization to get chinese approval for independent scientists enter china. Who is they always would, included American Government of experts in the delegation. Dimaggio also could be the most stakeholder meetings to look at access to original vaccines, treatments and countermeasures. Asking the Department Department was prett. My reply is there is no alternative to who. Others will mobilize, such as the cdc, and the global outbreak and response network. In the collation for academic preparedness and innovation. The laboratory network. But who, has to be the corporate after ebola with the u. S. Leadership, i was involved personally i would help make who more effectively and we can do so again. The reform needs to be made. And we talked about more later if you wish. But the main also time for the strengthening of the u. S. Leadership. Imagine my experience, initially i was ambassador to uganda. That worked. There was one president ial leadership in bipartisan support, and implementation organize country by country or significant new money, hardly over 15 million over five years. I emphasized the rain of the new money. As for the establishment of her senior Global Health and the, coordinator. Only if there significant new money. Simply redirecting the appropriations to state well result in gridlock. Embossed renovation on the other hand and incentivize them to other games. How can they experience make the leadership more effective critical heres the criteria that i would use to evaluate any new proposal. One of restoring white house and expert really leadership. It should be bipartisan. Should define responsibility and division of labor or implementation. To recognize the unique role the teams play in allocating resources to build on the comparative advantage of usaids, cdc, and other parts of the department of health and Human Services. Most important, and a new muzzle request, authorized and appropriated through their apartment committees, these agencies to do the work, they need enough money to do it. The proposal the 3 billion over five years, is not enough. As less than the commission of the member of. That was recommended and i will hover there. Recommended for preparedness and involve for covid19 cant breathe Health Committee hhs appropriators will have to come up with millions more. In a harris act, is likely also to be required to reach Health Security goals. Funding should also include more money for the world Health Organizations, the u. S. Contribution to the college and far preparedness and innovation, and incentivize low Income Countries. Possibly their already created Health Emergencies funding at the world bank. I thank you for your attention and i welcome your questions. Thank you very much. Appreciate your focus on the structure for all those of the exciting think the world. But certainly it is critical here. I really appreciate all of the other suggestions make and i would hope that we can discuss this more. Thank you for your experience. And next we have a physician researcher and enthusiast pretty i have never met one like him. And i am glad we have one here. As a professor in Global Health at harvard. And the Chance School of public a real effectively director of the Global Health institute. Practicing and professor of medicine at harvard medical school. An mp h. We welcome you. And you start by telling us what the enthusiast is. It is indeed an honor to be here this morning. I dont think i would just for myself that way but to believe that dana evidence should drive our decisions. Presumably that is it. Im against my testimony. We are in the middle of the greatest mobile Public Health crisis in the century. A Million People around the world have gotten sacred and hundreds of thousands died from this disease. Despite this, our best estimates are that less than 2 percent of the World Population have been infected with this virus. The Global Pandemic, is just getting started. In the second biggest obligation we all have is to protect the lives and wellbeing of the American People and the people around the globe. In this light i that the administrations decision to withdraw from who is so deeply unwise. Is there some irony it in my testifying today. For years, i have been seen as a critic of w joan rightly so. I was one of whos harshest critics of the disastrous of the Ebola Outbreak in west africa pretty coming out of the number, i cochaired an International Panel the recommended major changes at who. Said who changed. Is always innocent and otherwise nobody in the response of the covid19 has been better. Im not perfect. After they were were alerted, they alerted the world because those investors have talked about what they had done well, let me focus for a minute on what who has in poorly. To be the single biggest failure of who in this outbreak has been many excessive sprays for the Chinese Government and handling of its outbreak. The response is not worthy of praise. They clearly had the virus in silence doctors and scientists for weeks if not months. The delayed notifying growth. China is the major world powers. We should expect better. So i was disappointed to see their talk of china pretty disappointed but not surprised. Because who is a Membership Organization. And and has had a long tradition of shunning present government even when those governments are behaving poorly. When that criticisms has been in and send it to china. I have to tell you that i find it puzzling. And he never with that possibly could mean. Theyre not to compel china to do anything pretty new more than he has the authority to compel our government to act in this into my. Debbie and joe is a Membership Organization pretty can only be effective as its members allow it to be. Let me be clear my testimony, i believe they can be more effective. One of the areas where i think they can be effective is its mission is too broad. It literally works on every Health Related issue in the room. I believe the who should only do those things that who can do. Pellets collective have a might apply in this pandemic. Walking away from who at this moment is an extraordinarily that idea. It will harm the world and harm america. Because they do critical work that will benefit from. There in the solidarity, 35 countries, to find new treatments for covid19. But who escorted 90 until the rain vaccines was they become availablavailable. Theyre looking close these every nearly high and middle and low Income Countries normal. They are a trusted partner to ministries around the world. The country struggle to control the outbreak, it will be better not to just people of the stations but for all of this because no one think that we have learned is that an outbreak anywhere, can quickly and outbreak everywhere. Student during this sinema, we have many difficult months ahead of us. Walking away from them makes controlling the virus harder. And harder to manage the virus he recuperated walking away from that leaves us with have a voice at the table and better manage this oblate and literally we will have no influence on how to be ashoka shaped and improving on this pandemic when it comes to an end. I believe that they can and should be more effective. The bottom line is that are essential. For the sake of the wellbeing of the world importantly for the health and wellbeing of the market people, oblivious critical to use americas leadership to improve their performance and for future ones. Thank you very much. Thank you. They were very helpful remarks i think. Quite clearly incorrectly you noted, they have no authority over the countries. And as i have discussed this with the Management Team from the stress that over and over again. I think the criticism perhaps is more directly directed at the fact that they do have a public. And as we all, it can be as effective and sometimes more effective than having actual authority. I think from my own personal standpoint, i was disappointed. And at the same time, understanding that the minute you step up, youre going find yourself in an adversarial position with someone or some country that youre trying to get to cooperate. And it might dissipate. It is a filing. Theres absolutely no question about that. Thank you so much. We now have mr. Jeremy, he is a senior policy fellow for the center of global development. He has served in the usaid office of foreign assistance. During which time he read the u. S. Humanitarian response. Another complex emergencies. Hes a member of who oversight advisory committee. And previously served as an independent Advisory Group of the bhos overseeing of the reports. Im told that having little bit of technical difficulty with your audio. So i hope this works. Thank you. For the opportunity to testify. I apologize that you cannot see me. I have logged in part in the new so at least we have the phone as backup. Would you like me to repeat the second half of my opening statement. No, i heard it perfectly clearly on my phone. And i clearly appreciate it so much. He sai such a wonderful time. On the thank you committee for the opportunity to testify today on this important topic. The trend 20 pandemic has made incredibly clear the accordance of expanding u. S. Government investment in global and during preparedness and also the linkage between that and her own domestic preparedness. Within our own borders. Investments like this global outbreak cooperation or not just ultra stick. They need to keep her safe. Home. So i commend the money awful ideas that have been put forward by members of the committee. And the plans that are reportedly being developed by the administration as well. Because its clear that the is now need to take advantage of this moment to take a really big on a global partnership. It means investing more in surveillance diagnostics in Early Morning so that we can build the same kind of Early Morning capacity for Infectious Diseases. And that we currently have four like hurricanes and tsunamis. In these, creating that and treat eight clear triggers, the global and country actions so that we never again have to see patrick that we have seen in response to the covid19 credit and make one of the things that the current pandemic shows clearly as i kind of early action is just as important as they find national capacity. The countries that acted really have done better. Whether or not they have the full capacity that they might want. In countries that waited, and have the capacity of paper have really struggled. So both capacity nearly action are incredibly important. It also means that things like investing in the readiness and resilience of medical and Public Health systems, and we can low Income Countries, means reversing supply chains. It means towards the development of innovative diagnostics and therapeutics on a global level. As an courage to see and since bill the u. S. Report which is incredibly important. And of course all of these things will require robust u. S. Funding. So i urge congress to include Pandemic Response and funding in the heroes act and continue supporting on more on going and reliable basis over time as we have done. And if we are to do all of the sinks, night entered raises the natural question of how should be organized these organizations to deliver on that. First within the u. S. Government, is incredibly important to establish clear and division of labor. This is something have been struggling this property has produced a lot of issues. We didnt struggle with this nonbillable. Because we laid out a Clear Division of labor right at the onset of this response. And funding based on that pretty soon there was less to fight over between agencies. Our roles were clear from the beginning. So Something Like an interNational Response, it is to peril that what we have with the national framework. It helps to clarify those rules for institutions throughout the state department. I was in great to see that. Second, the state Department House incredibly Important Role in building diplomatic readiness and can play a role in also coordinating with the u. S. Engagement. They do not believe that they have centralized authority at the state department over programs and budgets of interagency partners pretty for this particular role played i believe it would be to be more effective. The approach was tasked similarly with building a Global Coalition of la starts during this case. That is a sweet spot role for the state department. The coordination function. It was shared with senior efforts at the embassy who could more effectively coordinate with the interagency productively that that sort of model would give other partnerships here ending of course on restoring the white house senior director in the company team for Global Health security. That is crucially important. Some of the others have already noted. Thirty, as several of these rip proposals, they must be revoked sleep disorders. That this is cost trillions of dollars in the economic and other spending. So investing in pandemic preparedness on things to say billions of dollars a year, is an extremely good return on investment and can prevent that kind of economic damage in future pandemics. Of our is impossible to the estate succeeding in this agenda without the full engagement of the World Health Organization. Frankly the rest of the world working together with us as they view it, is a u. S. Alternative are competitive as rather than the complement and supportiv an. In withdrawing will be tragic. Its entirely unjustified. An earlier hearing, u. S. A group of administration witnesses to identify the Fire Department, Global Health emergency, i agree with the other witnesses who have noted that such a thing already exists is called Health Emergencies program at the World Health Organization pretty was established and have had a hand to help senator. It was established following the failures of the 2014 Ebola Outbreak. It is not perfect, is still a work in progress but is making great progress and has exceeded in addressing several outbreaks of ebola. As well as other outbreaks in yemen. Theres no question the who continues to meet the reforms and i would echo what the senator said about the challenges with those limitations with the help organizations put on who. But we should focus on those programs. In her best chance to focus on those problems is by staying part of the organization. Despite his flaws and working to improve it. And finally, is a bit painful to say this but we have to acknowledge of the u. S. Leadership, will really hand on our ability and credibility and competence within our own borders. We need to take the advice that we have given to other countries for many years. All the evidence, communicate and risk effectively, build public trust and build competent structures. Recognize that even the United States can falter when it departs from some of these things. First of all, the last point made, that was such a good point. I want to say that ive sent him a lot of panels. This probably the best one that was put together. I cant take credit for this. The majority of the staff in the minority staff, have clearly picked the best possible people. I really appreciate the tone of the panel. Not being in a condemning mood. I think one thing that is become clear to all of us, how this is going to take more dollars. For those of us who have a difficult time spending money. Spending other peoples money. This is a real challenge. But obviously, you dont have any troubles with us most of the time. This is going to fall in the category because without it the consequences are phenomenal. All you have to do is look at the 2. 8 trillion, an annual budget. That indicates that we are going to have to be spending more to avoid having future pandemics. I coming to that realization is difficult. Emergency Health Program and who, is probably one we will have to take a real serious look at. I think one thing has become clear here as i have tried to figure out who the departmen Fie Department is pretty but there is not one. [inaudible]. Maybe we could go around may be very quickly each of you give me your brief thoughts on the emergency, and how where we started and im going to turn it over to others. With that, we start with mark. Hi i am here and thank you. So within that response, theres something called the strategic health. It is similar to the cdc. We need them however, is not funded sufficiently. There will be limitations for some of the reasons that have been discussed. They do not have authority to compel countries to act norwood others have that in the private sector. So i think who absolutely need to be there and like we should host. We would need to supplement the authorities, as heads of state and the private site sector and so that we are ready to go. And a key piece. They have to do regular simulations. The National Security apparatus, and of the world, my detectors explicitly have visited these and identify the where the gaps are. They would literally pick up the phone a call to translate you havent had a break and then the whole system would kick in and see how it works. And then you would start to see how this important regional and national so that they can be ready at the same time. So i totally agree the who has to be central to that. It would be a driving force. But i think the supplemental things that we need to be done to make it totally effective with National Security and private sector and Civil Society and other groups and to have the simulations which who can manage and should run. This would be and i think a conversation we have to have globally this put together the right piece. Thank you. Ambassador. It. Thank you very much. I agree with mark. Because the who, but the entire operation of all of the mandates that they have, is one third of the state of maryland budgets every year. So we need to go to quantum levels more. In that regard, independence of the Health Emergencies program on the overall budget of the who and a small amount of the contributions from the u. S. Traditionally, now more than ever have the voluntary contributions. It always depended on the aspirational budget to do its work. And to defend and raise the money to pay for what it just did parlay to other programs. I guess to work for a company who has a tremendous ability to raise money from individuals from foundations and the private sector. In a way that the who does not. The red cross also has a huge advantage on emergencies one americans in particular want to respond and donate money. Who is just set up a foundation that can scratch that surface. But i think we really need to look at the World Food Program models and look at the way that the world Health Organizations can raise money wisely from individuals and organizations that now contribute because as another state organization with the best contributions. In addition, i think we need to look at International Health regulations which are the basis on which the countries need to cooperate. With the Health Emergencies programs. I think you need to be strengthened maybe three review conference or through state efforts likely reviewed the Health Outbreaks in emergency programs up with the apollo outbreak symptom who with the should be a stronger rise of international inspection. And on the energy agencies, can require the countries inspect if they think that something has been gone wrong. Its harder but i think it is something that we need to look at. And at the declaring levels of Health Emergencies. We need to prepare a proportionate response pretty and less to do with travel regulations and more to do with Laboratory Requirements so there right now, as either an outbreak or a Public Health emergency of International Concern which triggers a number of different requirements for states. We need to have a system in which there are more levels of public Health Emergencies that we galvanize the states to take action earlier before this Public Health emergency has taken place. I fully endorse what mark said and others have. Whos inability to deal effectively with the private sector with Civil Society and even with finding a way in which many other multilevel organizations have to engage in taiwan, policies and practices that can be addressed. We have found is an International Agency can use it to shame countries into doing what needs to be done. I am not so sure its more of a challenge. That is an interesting idea and i havent heard that. Thats one of the biggest complaints that who has is their lack of authority. I am going to be very brief and echo a few of the points that have been made today because i agree largely with their points let me emphasize there be three or think the Health Emergency program is clearly underfunded. One of the reasons it feels like a volunteer Fire Department because in some ways it is theyre always out there asking for money. If we are going to use them as one of the kids drink keep pillars of our Global Response they need sustained and adequate financing. So whatever mechanism we use that has to be essential. Second is on the Public Health Emergency Declaration, one of the calls in 2014 as many that graded a system it cannot be all or none. It raises the threshold for calling out a problem until it comes much worse than what it needs to be. We called for essentially a version of what the department of Homeland Security does, green, orange, yellow, red. That would be very, very helpful. We would probably require something looking at ihr and what can be done there. One of my broader questions thats been coming up and has been mentioned by the ambassadors, i think this is extraordinarily important, is a difficulty who has with the nongovernment, nonstate actors part has the framework but largely, who struggles. One of the things weve learned as a Global Response to a pandemic is not just about Government Action about Civil Society that is a broader and not just about the Health Emergency programs by like to see them more deeply engaged more welcoming of nonstate actors because i think that is something that hinders their effectiveness. Great thoughts. You are up. Civic thank you my internet has returned hopefully could all see me again. I agree with everything that my colleagues here have said. I think the framing is a Fire Department and its a volunteer Fire Department is a real nice shorthand for the challenges that the World Health Organization continues make. Them Great Strides i think there a point where the group of concepts have been demonstrated and we need to strengthen and institutionalize their emergency capacity. That means more consistent funding. I have watched them for my perch on the independent oversight committee, i have watch them struggle constantly with tradeoffs of trying to cover everything they have to cover in their mandates without receiving enough resources to do so. Theyre trying to contend with everything the world throws at them with a budget smaller than most u. S. Hospital systems. We are tied to that. They need greater staffing, but they also need to invest more partnerships. Im so w. H. O. Should not have to do everything alone. They have made progres progress on the cultural challenges around partnerships and nongovernmental actors that is an area that needs to continue. And then finally, it is very, very important to take a look at the International Health regulations and some of the authorities that w. H. O. Has to operate under that really do tie their hands and their ability to be more forward leaning and more assertive. In particular, looking fresh at the Public Health emergency is a National Concern mechanism which is a binary mechanism. It either is or it isnt. There is a huge difference between Something Like the covid19 pandemic and the a Ebola Outbreak that was in the eastern congo. But within the Emergency Declaration that cannot be acknowledged. They need a mechanism that looks perhaps more like what we do within the humanitarian sector. With the famine prediction it can be very helpful in triggering early action and differentiating between different issues. So thank you very much for those remarks. Im going to turn it over to senator i want to stress every member of this committee and their staffs, we will be meeting regularly as we have been and talk about ways of moving forward in getting things in the bill. There are no close secret meetings, everyone is invited to these. You can meet with our staff briefly to talk today about next steps forward. I want to invite everyone to participate so we can try to pull this wagon together. And with that, senator menendez. Thank you, mr. Chairman and thank you with some very thoughtful testimony. Doctor in your written statement, you mentioned the global and American Partners are looking for a sign that the United States will once again demonstrate its commitment to a comprehensive Global Response. Investing in the Immediate Response now, laying the foundation for the future will require leadership and resource resources. So, do you or any of the witnesses testifying today, believe that the administrations response has been commensurate with the scope and nature of the covid19 pandemic domestically or abroad . Thank you, senator menendez. I think the only honest answer to that is no, we are not quite there yet. I think we have some of the best people and i think we all know all of them in the administration and in our civil surface. They are capable of mounting a strong engagement internationally. I just saw from a Government Panel a few weeks ago that we do have room to make up in terms of being engaged, our leadership, joining which both of the bills called for, engaging with w. H. O. , supporting debbie which over form and engaging with International Partners which i point out which is think is important to establish that fire hydrant. I know theres a trust fund and maybe thats the best mechanism but until we talk to the rest of the world and know where they would put money, its difficult to know that. I think we have the right people, with got a great team that can do the work. But we have some ground to make up and i really think congress and the committee for the leadership. People do look to congress, not just the administration. When they see leadership coming from congress, that makes a big difference in the world. I think we are positioned well to be able to engage and to see this through. I would point out again that the swine flu report todays very disturbing. If we have at the same time waves of the coronavirus, the potential for a bad flu season, or the swine flu, it is a catastrophic future we could face. I think all of you and the people in ministration during the work but we have some work to do. So let me ask you all, what lessons should we learn from other countries who have successfully responded to the covid19 epidemic . I open that up to anyone who wants to give any insights. Senator menendez, maybe i can begin. There are lots of lessons but the single most important one is countries that have taken the buyer seriously and have moved aggressively. This is a virus that is unforgiving if you fall behind. And unfortunately for much of the time we have been battling this virus we have been behind them playing catch up. Certainly south korea, new zealand, germany, taiwan, hong kong, singapore, is a list of countries that have it all done the exact same thing. Some have pushed more with testing and tracing, others more aggressive lockdowns but they all to get much more seriously than we have and that is been the single most biggest difference in my opinion for countries that have done wellin countries like ours that have really struggled. So quick thoughts on those two questions, first i would agree the countries that have done the best been the most robust in Public Health with tracing and strong Public Health systems to present prevent from overwhelming their hospitals. Thats an area that needs more focus. We also have to act early and be guided by evidence. We waited too long that really hurt us. I dont think our engagement has given uncharacteristically absent from International Leadership on this pandemic. I look at the past outbreaks under the Bush Administration for the u. S. Is showing leadership, engaging with the world trying to convene and bring the world around a common vision. We dont see it happening here we have the administration attacking w. H. O. They are going it alone on things like the Vaccine Development where the rest the world is working together we really do need to step up into the customary leadership role we showed in the past. Moving into what would this should look like then, the Trump Administration is proposing an initiative as called the president s response to outbreaks which would consolidate International Pandemic preparedness under a new state Department Coordinator and establish a new central fund to fight pandemics using money out of the covid supplemental. Let me go back to you, you say clearly in your testimony that you do not believe modeling a new initiative proposed by the administration or as the chairmans bill envisions is a good approach would taking Budgetary Authority and programs from the u. S. And moving to the state department at all improve the ability of usa id or the u. S. In general to respond to epidemics, pandemics . What impact would further stove piping and response funding for prevention and response have on Global Health programs and relief to Development Continuum . Thank you for that question, senator. I dont think creating a highly empowered centralized coordinator at the state department is the right model for what we need to do here. I think something would be counter structure it was a lighter touch it was led in close conjunction with the white house and it left the budgetary in program this image agenda decisionmaking in line managing to agencies themselves were thats a much better way to go. Right from the outset we clearly define who is on the hook to do what across the interagency. That was one of the challenges that the coroner has had to be so empowered is because that was kind of a freeforall in the early years between them. At sethi foundation for many years of turf battles between those two agencies. If course the coordinator was more of a referee between those inter agencies. If we design it well up front i dont think we need that quite heavy structure. On the Ebola Outbreak will be did that, worked very well and we got along because we didnt have that much to fight over. We do that by not outline rules clearly thats when you need the heavyhanded coordination. And finally on may 18, President Trump called for w. H. O. Reform within 30 days. Eleven days later he announced the United States would withdraw from the w. H. O. Former deputy secretary of state, bill burns, one of americas preeminent diplomats would serve for 33 years commented that you dont reform the fire brigade when the fire is raging out of control. As someone who has been both a severe critic of the w. H. O. , but todays testimony balances with some of the realities, what is your assessment of the Trump Administrations efforts to reform the w. H. O. . Have they been effective . What lessons can we learn now from the United States efforts to work with and perform the w. H. O. During and following the 2014 Ebola Outbreak . Senator thank you for that question to stick with the analogy of a Fire Department that is struggling to manage a blaze that is engulfing our neighborhood, it is important to look at how that buyer fire brigade is doing and assess its performance. But too distracted in the middle of fighting the fire is probably not ideal. So i believe we have to do a very thorough and careful examination of what they do well, did it do badly and how do we make it better. Interim assessments have been proposed. May be reasonable as long as are not too distracting. I believe at this moment, all of us have one job in one job only which is to try to manage the pandemic and bring it to a close as quickly as possible. Anything that helps us as a good thing to do with anything that distracts is a bad thing to do. I believe at the end of this pandemic which hopefully will be within a year on controlling the pandemic by then there will be plenty of opportunity to do a very deep dive on what wh did well, badly, what reforms are needed. After ebola it took independent commissions and u. S. Leadership to make those changes. I suspect we will need both of those independent assessments as well as u. S. Leadership to make the necessary reforms, to make w. H. O. Better and more Effective Organization yet. So i have a lot of questions i will submit for the record i would love to have your expertise on that and with that i will turn it back to mr. Chairman. Thank you i think we all have questions we will be submitting for the record unfortunately technology does not help me know whos on the line here. Of going to do this on seniorit seniority. Going to move as quickly as i can sent rovio are you on . Senator johnson . Senator garden . Senator romney . Senator graham . Senator barrasso . Senator portman . Senator paul . Senator young . Cruz . Senator perdue . Senator. [inaudible] im here thank you. Thank you for your work on this your work has been very helpful, very instrumental in moving the entire issue forward it is greatly appreciated. I hope we can all move forward with whatever that may look like that will move the ball down field, thank you very much. Civic thank you, mr. Chairman i agree with your assessment spin an excellent panel i think each of them for their contribution. A couple of observations that i will ask specific questions about what we should be doing in the United States congress. Observations that you have all said if you are in country you are not going to be safe and less all countries are safe to be in. Because it will spread. The u. S. Leadership is. The United States pulling out of w. H. O. During the middle of this pandemic made no sense whatsoever, recognizing w. H. O. Definitely needed to be reformed. We also recognize the United States must lead by example. We live in a country where we have the continuation of the first wave and the escalating number of cases and whats the best way to handle the pandemic . All of that we have to deal with. Senate relation committees has a strong record of the independence of the congress and leading our nation. And yes, weve all mentioned the fact we need to provide greater resources and i could not agree more. Congress has the responsibility to provide the resources. We need to do more than provide resources. So thats my question to you what should the United States congress do . For example during the previous legislation we disagree with the politics on ironically pass the bill much stronger against the regime of iran. This administration we disagree with the administrations policy regards to russia we had to stand up to russia aggression purred we acted independently. Now i may have some different views but it could be very inconsistent and kind but is not given the leadership we need for the Global Community to deal with this pandemic. What steps should we take in order to exercise Global Leadership to protect the help not just the Global Community but the help of americans. What action would you like to see come out of congress . Senator, i would like to take a stab at that. First of all, people said the u. S. Was the best prepared country in the world. The nuclear with john hopkins published a study we did get the highest score, 83 out of 100. It is not an a grade, but if you look at the areas in which we failed, we had a grade of 60 or less in three of the 34 indicators in that study with Global Health security index. One was in preparedness of our clinics and hospitals for pandemic outbreak in supplies, training, all those things we have a score of 60. Live a score of 23 out of 100 phenomenally bad grade in terms of health access. How easy it is the axis to healthcare in the United States, a low score. We got in even lower scored exercising our team carried all three of these we did not have the team in place that was used to working with each other we did not have access to the most vulnerable population and our hospitals have been struggling to meet the demands had been placed on them. So domestically, Congress Needs to look at this holistically. I also want to make one other point about china. Its absolute true china was not transparent in the way they looked at this. But historically the United States has not been reliant on chinese official statements or on World Health Organization information. China systematically set up a cdc model on their own cvc. With cdc people code located in china. In 2016 number 47 of them on the campus of the china cdc and daily contact with their counterparts without breaks and epidemics training sharing information. In 2013, many people thought was going to be an epidemic, we sent 40 cdc people to china to help control the epidemic and they did. What is post benghazi of all u. S. Personnel onto compounds which during the Obama Administration this is not in the interests of our Public Health repaired nest. In the Embassy Compound and we talked about reducing our footprint of a presence in china lists 14 and most would we have this outbreak would none of the three protocols. We didnt use the what we could have used to engage china with bilateral cooperation. The last one of those three which is an emerging factious disease protocol expires today, june 2020 is the expiration date. But emerging Infectious Disease protocol and they have not convened a meeting under that protocol since 2017. So this itself is a sharing of information directly to us weve not use those authorities. Civic i want to see if anyone else needs time, senator if i could as a constituent i live in kent county. Your direct question of what can congress do is very poignant. And what i would say what you are doing is to link that more clearly which is been working across committees. Thats one thing i would emphasize this across a cdc and the domestic response that crosses International Activity both at the state department and in defense it becomes complicated its important to work across those committees as i know you have begun to do. The second thing is to do precisely what youre doing with that legislation that is been proposed. See how the government can lead and then bilateral new nevada roadway open that up and pass legislation to work with the appropriators to make sure it gets funded. I do believe this committees actually taking the steps necessary. And again there are people in the administration who can work with what you can do. If it is clear that congress is acting, i can tell you it matters both here but abroad because people understand our government a clear action on finance, structure, activity, what you want to see done makes a big difference in terms of how the rest of the world views the u. S. Response for north think this committee and now we have to drive it forward, get it down to make a big difference. So just complimented the committee am sure the chairman did not find iran over my time. Thank you if that had not been so complementary had been very angry. I thank you for those remarks and i want to underscore again this is a full committee response. With that, senator your own are you on . I know she is with us earlier. Senator coates . Okay i can see in front of a state flag in the mountains behind him. [inaudible] you can hear me i take it right . I can. Ambassador first i like to thank you for your previous work. The covid19 pandemic demonstrates how crucial it is for us to engage early on with our International Allies and neighbors to address emerging Public Health issues. Only with open communication and focused coordination can we effectively take on this virus. The u. S. Mexico Border Health Commission has a tradition of working bilaterally to tackle shared Public Health challenges. That is why i introduced Bipartisan Legislation with senator cornyn and others. The border held security act with Better Health response along the northern and southern borders by increasing emergency preparedness, developing Stronger Health than strengthening the Public Health infrastructure by providing Additional Resources at the chairman has talked about. Our bill uses the commission to effectively guide resources along with input on the administration. Ambassador in your opinion will providing Additional Resources to build Public Health infrastructure better which my bill does, improve our ability to combat covid19 and future pandemics . Senator thank you for your question and of course the answer is yes. I did represent the secretary of health and services with cochair with the Mexican Ministry of health to lead these sessions of the Border Health commission. It is a littleknown operation but we think about border security, it is really important to think about border cooperation. This is a great example of where the four u. S. Border states and a five Mexican Border states meet regularly to exchange information. The direct involvement of the populations that live across the border and state departments of health. In that capacity we were able in the past to give small grants a total of only about 2 million a year to state Health Departments to enable them to leverage state support and support state and local efforts to do things like surveillance, tv control, and looking for infections and outbreaks. And this, unfortunately, with the reduction in budget with the secretary budgets, the grants for the states have ended. You earmarked some money that i really saw good results from, especially at this time Health Security is National Security. I really appreciate it. Great, i hope i can persuade them to put this border Health Security package into the next covid relief package we will be working on. As you have said all in the northern border and southern border. Doctor john your opening remarks he said recently had twopoint to million cases after doubles over the last two months it is combined death toll cost 100,000 last week. Yet the Trump Administration has repeatedly cut the american region furthermore instead of helping our neighbors in cuba its cut off communication and Family Support networks. These simply were not prudent in light of the current pandemic. What impacts will they have on our effectiveness in dealing with the pandemic here at home and across latin america . Senator thank you for your question and your comments. Latin america is our neighbors in mexico and cuba and crossing america. When i look in across the entire globe, senator, i see whats happening in mexico peru brazil other countries as well as incredibly concerning. These have really become, along with the United States the hotspot of the world. If you think of this as a fire raging across an entire city and these are our neighbors. Got to work with our neighbors to put the fire out if there is a raging fire in our neighbors home there is nothing we can do to protect our home that would not require us also working with their neighbors. I believe deeply in american engagement globally. But i believe particularly in our engagement locally and in our own neighborhood. Its a good thing to do et cetera dish and with what america has always done it helps protect the American People. Thank you very much for this hearing. Thank you, senator udall i appreciate that. Senator murphy are you with us. Yes i sure am. Mr. Chairman we calling on murphy merkley . That is not me. Senator murphy are you with this . Senator markey . Looks like youre going to get your chance after all senator merkley you are up. Thank you very much. I wanted to start by asking for some thoughts on secondary impact were facing. One of the secondary impacts is a potential massive increase in Food Insecurity and doubling of severe Food Insecurity and estimated one or 50 more people driven into extreme poverty is an erica weathers injured National Leadership in take that on . Thank you center for that question i think youve raised an important point the full impact of the pandemic is nothing faction that causes but the economic damage, Food Insecurity damage, we are seeing increasing reports of Food Insecurity and countries that have locked down tactics without having the Economic Impact of wealthy country i am concerned about what that will mean for much of the developing world as they try to contain the virus. We need to then support not just with fighting the pandemic but we also need to provide more comprehensive support. One of the areas ive been concerned and i wrote a peace about this last week, is that not much in funding whether from the u. S. Or others is reaching frontline organizations and developing countries they have a role in cushioning the impact. I would urge the u. S. And other global donors to focus on getting money as judiciously as possible while supporting organizations like the World Food Program which has a normatively important responsibility. Okay looking at another aspect may be i direct this your way, there were reports that International Refugee camps are starting to show the signs of outbreaks that could move very critically i been there were there densely populated most recently is that in area where the United States could really focus world attention and resources on the refugee camps . Yes, thank you for that question. Absolutely we have more people displaced in the world than we have ever had since world war ii, about 70 million around the world. And refugee camps are breeding grounds for a large outbreak for this virus obviously very difficult to socially distance they do not have strong infrastructure and there is a very mobile population often people with chronic illness. He think this is an area of extreme concern to me as a Public Health person and an area this got very little attention globally. So leadership in this area will be very helpful were not tying medicine more group of individuals 70 Million People around the world we need a concerted effort to make sure we manage these outbreaks in the communities. Thank you i think an organ relook at the high risk areas and errors in prisons and so forth and how they could be looking at highrisk areas around the globe. Let me turn to a nether peace of the puzzle, perhaps i ask you to respond to this that is vaccine strategy there are groups pursuing a vaccine, there has been conversation that if the United States organization develops a vaccine thats approved whether we should insist on all of the vaccine being available in the United States first before it can be exported. Or whether it should be available to be developed or reproduced i guess in factories around the world to quickly spread it. In terms of vaccine strategy, assuming we get an effective approved vaccine, what is the best way to pursue the production and distribution of that vaccine . That is an excellent question. I dont think any of us agree we should get into the u. S. First before we give it to anyone else because that does not make us safe. Other countries have widespread virus and we dont we are stuck here. We need fox nation across the world. What is happening here is very exciting. In the research world, the International Collaboration is very strong across the private sector we have three candidates moving and there is a significant investment both by other mechanism in the Gates Foundation which imports of the u. S. Did not participate in. They basically put bets on seven vaccines we dont know if theyre going to work but going to begin starting that now. Hopefully therell be more than one approach theres about three major approaches being taken to the Vaccine Developments. Decant just switch one factory from one type to another. So people are investing aliens of dollars including the Gates Foundation and bill said is going to lose a couple billion dollars because hes going to create the production now for those vaccine should they become available so he can massproduce. There is great work being done there and support from the u. S. Government including financially and additionally to nih which is hugely important the bills call for would be important. Secondly to understand that just waiting until we get every last person and the United States is not the best way to protect us from the virus. We actually need the world to have the vaccinations so we can have the open Global Economy we need of our economy is going to grow. The last thing i would say to that its important that the w. H. O. Be at the table because Something Congress can do to make sure we dont withdraw from w. H. O. Thank you very much mr. Chairman. Thank you, senator. Weve got less than 15 minutes left of had a couple members join us who want to participate so we will do that. Sorry i had to leave for a few minutes. I very much appreciate the thoughtful discussion and our panelist testimony this morning. Doctor, i want to begin with you because one of the things you talked about you have been critical of the World Health Organization for the way they praised chinas response to the coronavirus. Given what has been said about the lack that aa show actually has what you think they should have done in the way china behaved . Yes, senator this is a very difficult question. W. H. O. Chastised china they should have done that but im sure they did not do that well. I think the alan singh act that was brought up would have been one to acknowledge the information, demand letting those investigators and but they did not have to go as far as to praise china for the model. I remember listening to those early w. H. O. Press conferences and being struck by what he thought was an excessive level i suspect it was done i think the motivation was probably good i think it also let a lot of people be less suspicious of the data coming out of china than it should have been. I think it had cost site easy to armchair quarterback but i think they wish to far and i wish they had not heard. The United States dunmore the time to criticized demand china provide accurate data . I always believe that direct engagement by Global Leaders in issues like this and moments like this is very important. Harsh criticism may not work some of the Chinese Government just like it would not work with our government if another government or w. H. O. Criticized us harshly. More of a demand for accountability and sharing information. The Chinese Government response to pressure when its done respectfully as much organizations do i think that couldve been been done more effectively than it was. Thank you, one of the questions i asked at the last hearing we had about the current pandemic is what opening the United States withdrawal from the global stage has done to china to extend their influence in other parts of the world that they respond as the country that there to provide materials to provide guidance based on their experience. Can name you comment on the opening that has given china what the United States has sacrificed and not being a leader on the global stage right now . Senator, having run an International Organization i know it is significant. Its not just chide us rush into. They have both been, over the last three or four years been increasing their footprint in Global Health significantly and particularly in africa. This is a real risk to the United States. There should be a balance. We need china there are lots of resources and a lot to offer. Wherever we have stepped back not just in the w. H. O. But in other areas. You are a great risk the world. If we do not stay actively engaged i would say its not just china, russia has also been increasing their footprint in the Multi Lateral and in specific countries in terms of health because they know countries value health. The u. S. Has been the preeminent leader, unquestioned and Global Health. We need to maintain that role for many reasons including who are going to be our trading partners in the future. We need and want to have those relationships maintained not only for health but for many reasons with economic strength. If i could just reinforce what mark said, i was in the service from within 30 years the u. S. Is the aspirational nation. People and many, many countries especially in africa were served for 14 years look to the u. S. How do you solve that problem in the u. S. . How do you get u. S. Expertise, u. S. Energy involved in our project spread that is especially true with health. If we see this as a zerosum mist opportunities we took advantage of chinese to solve this together with the african cdc that was set up after ebola and has responded well. There are opportunities by lateral but particularly with the w. H. O. And the rest of the world people look to us for expertise, guidance, we are the best prepared delegation. We have the resources they want. If we arent there they can find somewhere else and china certainly eager to play that role. Thank you very much, do you want to add to that . Yes i think the u. S. Posture globally has been a real coup for china on this. But the world a scene of the past few months is china because they controlled their outbreak, relatively quickly, has been able to go around the world disturbing ppe and other supplies to developing countries. Most of that. The u. S. Weather than providing aid is we customarily would have been competing with a lot of the same countries for scarce supplies of testing material and ppe. Its only recently that has begun to reverse. So with the world has seen as they are competing with the u. S. Who theyre usually accustomed to partnering with. Instead theyre getting help from china. And china has been very happy to step into that gap. And theyre really playing that up. That is something made to be very wary of as they get it domestically under control we get to the end the world. Thank you all very much. It seems to me as we talk about the importance of health around the world, it is something that those of us in congress have missed because its also a huge issue here at home and we need to make sure were also looking to the health of the American People as well as globally. Thank you all very much. Thank you we are down to about five minutes senator booker has been with us for the entire meeting. Have at it. Seniority and looks by the way. [laughter] so are you with this . Looks like cetera brooker you are up. I am grateful make sure someone tells senator cano sang good things about him behind his back. I will. I want to thank everyone on the panel for being here its been a substantive discussion and dialogue part i want to get really quick, you were also a member of the csis task forces senator young and i cochaired just last year. Your expertise and were producing the report was really invaluable, frankly. I just thank you for your engagement and your commitment to easing suffering around the world. It was a great experience for me and my team quite frankly. On just some real quick questions and hopefully get answers knowing we have a time limit. Understand we really need global coordination and information sharing to bring covid19 other pandemics under control will be less costly to the american taxpayer . That something is a good lens to look for. Is it less costly to remain in the w. H. O. . Or set up a whole new organization . Thank you thats a very easy question i can answer quickly. Its much cheaper and easier to stay in the w. H. O. Than fix it and set up something new. The last administration we look very hard as you will remember try to figure out what to do with w. H. O. After really dropped the ball badly in 2014. With serious consideration to list of options we came back to his least expensive and most expected solution must try to make w. H. O. Work. That prompted the Health Emergency program which, over the past years has proven the concept i would point to the outbreak and congo is an incredibly complex outbreak which w. H. O. Was able to handle largely without the kind of intensive support and got from the u. S. And the uk during the west african outbreak there is no deployment of the military personnel there is no deployment of civilian personnel w. H. O. Still got the job done and the u. S. Spent far less to the congo outbreak that we had the billions of dollars we spent containment african outbreak. Let me ask the same kind of Balance Sheet announcement but where the working through the existing system to reform or corralling the entire International Community into it w. H. O. Already does . Of course its the same answer. I would add or think the rest of the world is not as upset with w. H. O. As a Trump Administration is paired we are not seeing other countries threatened to abandon w. H. O. Or even launch criticism towards w. H. O. Like the u. S. Has. I dont think there is any appetite for that. The u. S. Would really be banging its head against a brick wall through trying to create a new organization. Its more than just banging your head against the wall. It is so resource intensive to go out and develop relationships and help administer and every country in the world as opposed to just tapping into the relationships that w. H. O. Has already developed in its presence is already welcome and some of the countries are understandably where part of the globe its not welcome. Thats very well stated. One of the things ive seen doing this work is w. H. O. Is almost an extension of the Health Ministry many developing countries. That is not a role that a new organization could take over. We need to capitalize on that. Its a huge advantage they are beginning to do so. You could have that same deep relationship and trust that wh oh has with Health Ministries and need to be partners. In terms of making america less safe is it trying to replicate the solidarity trial which is the World Largest trial of covid19 therapies of scientists exchanging scientific results is a test vaccines are really being isolated with the efficacy of vaccines ourselves. That does not seem a wise way to go. We should be spreading her bets when it comes to vaccines. Im glad to see the work that the administration has launched but we should not be putting all her eggs just in that basket. If there are other mechanisms that might pay off sooner, we dont know which of these things will ultimately hit first. So we wont have a hand in all that. Thats the challenge i hear using taxpayer dollars wisely. That just seems like on a law of levels so deeply unwise wildly fiscally irresponsible to try to remove ourselves from the w. H. O. And then think we will be able to replicate that without an extreme expense putting health and wellbeing at risk. What is the role they play in the seasonal flu vaccine and ending our involvement in the w. H. O. Will for the first time cut the u. S. Government out of the seasonable influenza vaccin vaccine. Thats a process its actually coordinated by the w. H. O. In partnership with the United States. So really quickly, do we know how or if the u. S. For chain access to the most uptodate information needed to develop the vaccine . Is it for the americans to take the flu shot every year end will be the consequences for the world of not sharing and coordinating information for the development of the seasonal flu vaccine . Can you give me a window on that and then i wheel back. Senator booker thank you ten institutions around the world come together to collaborate i have no idea whether we would continue to be engaged and have a hand, what i know is if we could not access that information if we had to go it alone our ability to make the right vaccine every year would be substantially diminished. As you know, the flu while nothing like the current coronavirus it is still a deadly virus. Vaccine has been incredibly helpful. The main people who would suffer from that the American People and theres a lot of questions will be able to continue to engage in. Walking way from w. H. O. In my mind is leaving the American People much worse off. The influenza vaccine is just one example of how they would be hurt by this decision. I am grateful for that and thank you for mr. Chairman i will yield back. Thank you, senator booker and for being with us for this hearing. We are past time but senator murphy has joined us. He supposed to be an important meeting with the distinguished member of the body right now will give him a shot at this. Senator murphy . Thank you very much mr. Chairman. I know im a little late to the party here, there is one topic thats not been covered by think its important. That is the status of Global Health infrastructure. What weve learned its fragile local Health Infrastructure makes it very, very difficult to respond to new and evolving diseases. I know ambassador you are involved with the malaria the mandate of the fund is really limited and right now theres not a robust financial application which we can muster partners together to go and help to rebuild local Public Health infrastructure. And also partner with nations to try to prompt reforms in ways that govern their publichealth space. So one of things we talked about across the aisle if there is a need for the nine states to stand up that capacity with other partners and on a non disease specific basis go in and work with nations that we know theres a vulnerability theres likely going to be future viruses and pandemics and do some basic Building Block work of Public Infrastructure is lacking. I just wanted your thoughts quickly on how we go about doing that . Is that an work through another entity the w. H. O. , new authorit authority, prompted by congressional action . Your thoughts . Thank you center thats an extraordinarily important question especially right now. From a thn w. H. O. Plays a role often w. H. O. Is an extension of health in countries. On the technical side but not the financing peace the global fund would have the capacity certainly with new money now to scale up, support the companies for Infrastructure Procurement for the pieces necessary to respond to covid right now. For the longer term it would be an open question where the best International Facility as we had a little discussion about that earlier. I would also point out there are different approaches. We saw those taiwan had a relatively lowtech approach because of the investments u. S. And others have made in hiv, malaria vaccinations, child health, 28000 commuting Health Workers to go out a new contact tracing. In the bullock crisis it was those workers that went around that were repurposed in a sense from what had gone into the Institution Goal but we absolutely need more Laboratory Capacity with timor structure, this is where complementary opportunity for cdc which does this all the time in g hsa, by laterally with the financing institutions or complement the technical institutions we will not be able to get there. thank you, mr. Chairman and appreciate the time. Thank you, senator murphy, that pretty much run the thought of time but senator menendez, first of all let me think the panelist for being frank in their good faith on the exchange of ideas and i really appreciate that and on behalf of the committee i want to thank each and everyone of you. Mr. Menendez mr. Chairman with your indulgence, if i can ask him one quick question so i can devise a response to what youre trying to do and with my thanks to everybody, i echo the chairmans remarks, its been extraordinarily helpful and insightful, you mentioned in your testimony that your team and the counterparts at cdc define each agencies role clearly at the outfit of the response to a bullet outbreak or west africa based on each institutions respective comparative advantages, a provision that we have in the legislation that we drafted clearly spells out the roles of state usc in the Pandemic Response, if such a provision useful and if so why, secondly another provision creates a special advisor at the white house rather than the state department, what is your view and having a nation function at the white house. Thank you senator i will be very brief. Unmute yourself i cannot hear you. How about now are you able to hear me now . This is jim i hear you. Ill try this again, it is not just helpful, it is essential to define each agency compared to advantages upfront and i think the provision in your bill is on the right path. When its clear what agency is supposed to do over the far left battling during a bullet outbreak. On the white house piece, i would not say you need the white house cord meeting instead of the state department, i think one of the helpful things with the model is a partnership and i spoke earlier this week who served in the world to pick his brain and prepare for the hearing, he talked about the partnership that he had in his team with the nsc because nmc has coronation leverage that the state department does not have with the other agencies. I think you need both, the coordinator based at the state department with a restored Global Health Security Director in an empowered senior director at the white house is probably the best structure. Thank you, mr. Chairman. Thank you, thank you torah panel, i think we have all learned a lot that will help us get to a place that will make the world a better place. Thank you will and the hearing is injured. Coming up a special additional book tv airing weeknights this week, tonight we focus on the presidency, university of virginia officer argues against the expanding powers of the presidency. Then author Kate Anderson brower talks about her book team of size, the president s club in the age of trump and later a president ial historian and former aid to president george w. Bush and the internal sites that shape several pension under president ial ministrations. Next the university of virginia law professor on his book the living presidency. It argues against expanding powers of the president. This hourlong program was sponsored by the cato institute. Im going to start by intruc