Transcripts For CSPAN3 Hearing On Presidents 2021 NIH Budget Request 20240713

The subcommittee will come to order. Good morning all. Dr. Collins, welcome back to the labor hhs education appropriations subcommittee. Let me also welcome all of you, the five institute and Center Directors who are joining in this morning. Dr. Bianki, director of the u. S. Kenne kenne Kennedy Shriver National Institute and committee. Dr. Anthony fauci, director of the National Institute of allergy and infectious diseases. Dr. Gary gibbons, director of the national heart, lung and Blood Institute. Dr. Ned sharpless, director of the National Cancer institute, and director of the National Institute on drug abuse. Again, welcome, welcome, welcome to all of you. This is leader hoyer asked me this morning, he said do you have the nih coming . I said, yes, indeed. And he said, are you ultimately going to be able to get all the Institute Directors to come up. This is one of the most remarkable hearings that we have, and we thank you for the great work that you do and what a difference you make in saving lives and the people of this great country. At the start, let me just touch on a matter of the coronavirus. I want to just say a thank you to the director, to all of the institutes. I want to say a particular thank you to you, dr. Fauci. I want to say that our publicly Health Experts deserve our praise for what is the excellent work that you are doing on what is clearly a matter of National Importance and national urgency, as you know in so many ways. Today we will be discussing the 2021 budget request for nih, and i want to note that i intend to invite an Additional Panel of directors to testify before the subcommittee later this year, because i believe that we all learn a lot from all of you, and we did that happened with us last september as well. Before we get into the nihs 2021 budget, let me just, if i can, bring you up to date. I think you know that the committee has been working hard to develop an emergency supplemental to, you know, to be able to fund the response of this outbreak. And there are still one or two issues that remain, you know, open, but with all speed and deliberation, the intent is that and the chairwoman can speak to that if she if she cares to, but were looking at trying to move as quickly as we can between today and hopefully tomorrow, but before the end of this week to get the this finalized and voted on. So, the funding, you know, includes funding for the nih, the funding will support research on diagnostics, there pursuedics and vaccines for covid19. That will be critical to managing the outbreak and, again, to save lives. I also might want to note that niaid is not starting at square one, rather, the years of building the research on coronaviruses and Vaccine Development and i just want to say to the whole subcommittee, to my colleagues on both sides of the aisle, have invested sustained investments in Biomedical Research that the committee has made in recent years. And i am very, very proud that the congress has increased the nih funding by 11. 6 billion, 39 over the past five years. Last year alone, the congress provided an additional 2. 6 billion increase over fiscal year 2019 level for the nih. And this was in the bipartisan, bicameral way that this was done. And were very, very proud of that. I know certainly the Ranking Member is, and we work closely together on this issue. I would just say to you that, you know, i think the president s budget would reverse this project. The budget proposes to cut nih funding by 3. 3 billion, 7. 9 below the 2020 level. This would result in nih making nearly 1,800 fewer new grants to researchers, a reduction of 16 . This subcommittee will not be pursuing these cuts. We intend to move forward with a continued increased investment in nih to build off that progress that we have made in recent years. And, again, that will be on a bipartisan basis. I know that, you know, as i know anything about where were going and what were doing. I am especially proud that the congress provided 25 million for research on firearm violence prevention, including the 12. 5 million to the nih. I was glad to see that the nih budget request maintains funding for research on flu, including on the development of a universal flu vaccine. However, i believe we need to continue to grow this research, as we did in fiscal year 2020, and i look forward to hearing more about what niaid will accomplish with these additional funds. I was disappointed to see a 559 million cut to the National Cancer institute at a time of unprecedented promise in Cancer Research that has led to more and more promising researchers seeking nci research grants. I think cutting the funding for nci sends the wrong message. In fact, with only a few exceptions, the proposed cuts to nih would touch every institute, almost every field of research. Last year, in addition to new funding for several initiatives, we were able to provide a 3. 35 increase to each nih institute and center. We need to keep up that momentum and not reverse it. I believe my friend, my colleague, Ranking Member tom cole will concur. Biomedical research is one of the most important investments that a country can make because it gives the gift of life. So which we need to support and promise you that we will. Thank you again for everything that you do, and i look forward to our conversation today. And let me turn this over to my good friend from oklahoma, the Ranking Member of the subcommittee, congressman tom cole. I want to thank the madam chair and thank you all for being here. Before i get to my prepared remarks, i just want you guys to know how deeply you how you span the bipartisan divide that we have here. I actually made a statement, and it was tweeted out by howard dean last night. So i thought that was worthy of note. I very seldom get tweeted out by governor dean, so i was pretty proud of that, and the statement was, if im buying real estate in new york, ill listen to the president of the United States. If im asking about infectious diseases, im going to listen to tony fauci. So i think that kind of sums up where we are as a committee, and i want to commend all of you and thank all of you for what youve been doing in the middle of a difficult national crisis. But more importantly, what you just do day in, day out, every single day, and the amount of hope you give people around the world, certainly our fellow americans, and i think youve been extraordinary custodians of the investment that this committee has made on a bipartisan basis for multiple years. I know intends to make again if we can find any way to do it, well do it, and i think we will find a way to do it. I just the current challenge that we have, frankly, is a reminder that you need to do these things and you need to do them on a regular basis. You cant just show up game day and think youre going to be able to deal with something. You have to have made the commitments, the investments over a long period of time to have the frubts infrastructure able to do it. Im very proud of this committee and your counterparts in the United States senate. Im proud of congress, quite frankly. This not disrespect to anybody, but this committee in the past five years has gone beyond what a president of either party asked it to do. We actually doubled the nih budget many years ago. That was actually also a congressional initiative, if youll recall. I think congress because its very close to the people has a has a very keen sense of awareness of how much your fellow americans value the endeavors that go on at the nih. So ill go to my formal remarks. After five years sustained increases for the National Institutes of health, im pleased to welcome once again to this hearing room director Frances Collins. You must get tired of hearing this, but i want to commend you on your long and distinguished career in federal service. Youve left a legacy of excellence and its really an honor to work with you. Ive said this often, too, youve got to be the best politician in a town of politicians to get appointed by donald trump and barack obama. That doesnt happen very often. But, again, i think it says something about the bipartisan nature of what you do and the National Commitment there. Ive made no secret of the fact that increasing funding for the nih is one of the proudest bipartisan accomplishments of this subcommittee. A sustained, steady commitment to increase nih funding is critical to ensuring our nations future as a leader in Biomedical Research and unlocking cures to so many of the diseases burdening our Strained Health care system. The hard work and innovation this funning federal governments is part of sustaining the United States economic growth. Leaders in the house and senate, democrats and republicans, have unified behind these increases over the past five years and i ardently hope this trend continues for years to come. While i appreciate and sympathize with the fiscal restraint expressed in the president s budget, i do not think the reduction proposed for nih is in the best interest of the American People. Paris for reduce the nih funding at this juncture would erode the progress weve made, as the chairwoman mentioned, over the past five years, signal to the Research Community instability and quite possibly delay by years or perhaps decades advances in modern medicine, including curing diseases, finding better treatments for cancer and unlocking the power of precision medicine. I also want to caution against the budget request proposed changes to the negotiation for indirect costs. Our funds included as part of the grant to cover facilities in the administration. This critical funding serves as a foundational element for research, and i support the enacted bill language. I hope, madam chair, we continue that restraint. This is a false economy that our friends at in some quarters have pointed out and one that will hurt research, not provide additional dollars. We simply, you know, need to protect the institutions that weve been investing in. This past year, we had the opportunity to sit down with a nobel prize winner, dr. Jim alison. His work on immuno therapy for Cancer Treatment promises to chart a new course for treatment for our deadliest cancers. The noninvasive nature and the rapid time between treatment and resuming daily life is nothing short of remarkable. Coming to market faster than therapies of the past and could take a decade before Standard Health insurance reimbursement. New applications for research in this area are overwhelming available federal funding, and i hope thats something we look at very carefully Going Forward. Companies have noticed the promise of such methods and are beginning to invest in their own resources as well. Ten years from now, we may have thousands of cancer survivors that under todays treatment protocols would not have been helped. Its stories like this that remind me the support for the nih has a reallife impact on life and that every dollar investment is a direct down payment to a Better Future for millions of americans and tens of millions of others around the world. I also want to highlight the progress weve made on alzheimers disease research. This is creating an enormous strain on the federal budget and families. Its a rising cause of death and impacting more and more americans each year. Total spending will exceed 1 trillion by 2050 if it remains on its current trajectory. We must make progress. Frankly, fiscally, there is no other option. Im pleased to learn an International Team of researchers, partly funded by the nih, has made more progress in explaining the genetic component of alzheimers disease. There is analysis from 35,000 individuals with the late onset of alzheimers disease has identified varyients in five new genes that put people at greater risk of the disease. In order to tackle the physical, emotional and financial toll of this disease its having on families, we must have a better understanding of the underlying genetics. I do not want to take up additional time recognizing the distinguished Institute Directors before us today, madam chairman, but, quite frankly, like you, i would rather hear from them about the Exciting Research that theyre all involved in. However, i do want to thank each of you and your colleagues and those ins tout and Center Leaders who are not with us for your passion dedication and hard work. I believe the work at the nih has and will change the course of the disease direction and treatment for many generations to come. I Hope Congress continues to be a supportive partner in these efforts. Thank you, madam chairman, for holding this important hearing. Thank you very much. Its my my pleasure to yield to the chairwoman of the full Appropriations Committee, and someone who has had just a major role in making sure that we respond in kind and wi i thank you for holding this hearing. And welcome once again, our very distinguished guests. I dont know how youre awake, dr. Fauci. Its all those exercise routines. Thank you. Thank everyone because i know it is a team effort. Let me say at out outset, president trumps disastrous budget is filled with deep cuts that tear at the fabric of our nation. Instead of building on the historic investments in last years appropriation bills, the president doubled down on partisan talking points. To propose investing 2 billion for the wall and cutting 3. 3 billion from the National Institutes of health really does expose the Trump Administration priorities for what they are. Political rhetoric over Public Health. But as you know, this committee is on your team. And at a time with surging cases and costs associated with Heart Disease, cancer, alzheimers, and related dementias, a vaping epidemic, and now the novel coronavirus, this panels commitment to nih will remain as strong as ever. I would be remised not to mention that with my retirement this will likely be my last nih budget hearing. Ill have to ill have to come and be in the audience. And when i think about it, weve come so far. Since i joined this subcommittee in 1993. I was a kid then. When nih was funded at about 10. 3 billion. We committed to doubling the nih budget. Then more than tripled it. Together with the great leadership of this subcommittee in the past five years, we have increased increases of 11. 6 billion for a total funding level of 41. 7 billion. And, frankly, every penny was worth it. And we are so appreciative of all of you for your talents, for your hard work, for your commitment. Its really been an honor for me to serve on this committee. I do remember touring a lab with a young doctor Frances Collins who had a plan to map the human genome. I remember that first map, there was nothing in it. [ laughter ] and the advances in combatting Breast Cancer have revolutionized survivor rates as immuno therapy has given life to people who would have had a death sentence a decade ago. We know more about childhood development. And the human brain. And we are witnessing amazing strides in precision medicine. And if you recall, we now even have some female lab rats. For those who werent part of that humor at the time, we were convinced all the lab rats were male, so im delighted to know that you have female lab rats. Your work has filled me and millions of americans with hope. Never in all of Human History has medicine had more to offer. And yet, with all these great achievements, we have so much more to do. I recently came across my questions from an nih hearing in 1999. When i asked why women are more likely than men to have alzheimers. We still dont have the answer. In fact, we dont have many answers to alzheimers. I was on a panel. Lord knows why they asked me to be on a panel, and it was about 35 of us sitting around a table with one person who knew what he was talking about, a scientist from columbia. Everyone was kind of quiet and i said, dr. Gibson, from columbia, so what are you recommending . Many people around that table, they were experts, people who have been working on this for years and years, and he sat up and he said, diet and exercise. Dr. Fauci knows that, right . Weve had conversations about that. Actually, so many of you. But after all the san clemente investments, thats really all were offering most people when it comes to alzheimers. We still dont know the answer. And we still dont have a method for Early Detection of certain cancers. We still dont know why treatments work for some patients but not others. And we still dont know why rates of autism are rising. And why there are higher rates among boys than girls. By the way, if you have answers to any of these questions today, feel free to share them with us. This may be up to date i thought as of this morning, but if you have some answers to these questions, wed love to hear them. So theres so much we need to achieve, and i can think of no better people to do it than the people sitting in front of us today. You have saved lives. You have eased suffering. You are our superheroes. And with the polarization in our politics, if the American People could see how we come together to fund such important work, i was going to say theyd be proud. Theyd probably be shocked, but maybe we should invite more to really understand how bipartisan the nih is and how bipartisan this committee is. And that is why we cannot let a partisan budget request stand in the way of saving lives. So i thank you all. Er if its a pleasure for us to welcome you once again. Madam chair . Thank you. Dr. Collins, im going to turn to you for testimony. As you know, your full testimony will be entered into the record and i yield five minutes of time for your testimony. Thank you. Good morning, madam chair. Ranking member cole, and especially chairwoman lowey. Did not realize you were going to make this announcement about 1993 to today. I think 1994 was the first time i appeared in front of this committee to defend the genome project, so thank you for that reflex. Reflection. Please what did she say . There are over 1 million sick americans dr. I do want you to know that the condition, Chronic Fatigue syndrome is of great concern to the nih. If you need time to mention that, please go ahead and do it. Okay . And in the course of, you know, the proceedings this morning. Sure. Just please, okay . Go ahead with your testimony. Id like to talk about it at a later point. Let me continue. On behalf of the nih, i want to thank you, this subcommittee, for that 2. 6 billion increase in last years omnibus. The steady increases you have provided have brought new life to Biomedical Research and built a foundation for us to take on new and unexpected changllenges challenges like the one thats on everyones mind right now, the global coronavirus outbreak. Your investments have allowed nih to be at the forefront of action against a Serious Health threat. Im quite sure youll hear more about what were doing from dr. Fauci a bit later. In the meantime, id like to highlight some of nihs other recent achievements. My computer is talking to me. And maybe i can turn your attention to the screen. When Science Magazine announced its short list of breakthroughs of 2019, three of them were supported by nih. The first is the lifesaving progress weve made against ebola virus disease, including the first effective therapies. Our second breakthrough, according to science, was the development of kids getting specially formulated foods to combat malnutrition, taking advantage of what weve learned about the microbiome. The third is a highly effective drug therapy for cystici fibrosis. Or cf. Thats me on the left. Thats wheres the guitar . Its off in the corner. On the left, 30 years ago, when i led the nihfunded team that codis covered the gene for this devastating disease while i was at the university of michigan. Newtations in that gene lead to dysfunction of a protein that normally helps maintain the bodys balance of salt and water, and without that, mucus builds up in the lungs, setting the stage for potentially fatal respiratory infections. The new triple drug therapy kicks that protein back into shape. And does it work . Well, take the case of robin t petris, an ohio woman who recently wrote to me. As these snapshots show, she slept in a mist tent as a child and her parents spent hours loosening the mucus that clogged her respiratory tract. Later she became so sick, she had to give up her beloved teaching career, but just five weeks after starting triple therapy, robins lung function improved dramatically. She now lives the active life she had always imagined. Shes even set a new personal best, swimming a full mile in 60 minutes. I could not do that. She told me this medicine has revolutionized my entire physical and mental life. What a transformation. 30 years of research to get to this point and a wonderful example of basic science, collaborations between public and private leading to this kind of breakthrough. So stories like robins inspire researchers to keep searches for innovative ways to help folks with all kinds of diseases. Among the many exciting possibilities is a new generation of genebased therapies. At past hearings, ive introduced you to just a few of those who have been helped by these therapies. People like mateo with spinal muscular muscular atrophy. Janelle with sickle cell disease. Many of you met Cancer Patients like emily whose lives were saved with tcell immuno therapy for Cancer Treatment. The pace of discovery has increased rapidly, yet we still have effective therapies for only about 500 of those. The latest development in genebased treatments, the chris per gene editing system, promises to boost that number. It provides a precise find and replace function for dna, allowing cells to be be reprogrammed. Five year ago, i never would have predicted this explosion of opportunities in gene thefrp, but actualizing the potential poses real challenges. Today it can take two years to produce the materials needed for Clinical Trials of genebased therapies. A new one Just Announced this morn. We can rely on the private sector to support trials for more common diseases, but for ultrarare diseases, which involve tens of millions of people, nih must do more to derisk projects if we hope to enter as potential partners from the private sector. So to that end, president s budget for fy 21 includes a 30 billion initiative to shepard technology from concept to clinic, customizing processes for gene delivery, manufacture, regulatory review and testing. To conclude, these are dramatic times for nih research. The day i focused on genebase therapies, but many other remarkable advances are on the horizon, like developing vaccines for the coronavirus and other infectious diseases. Using science to address our nations Opioid Crisis and applying the power of immuno therapy to other kinds of cancer. None of this would be possible without your support. Because of you, we at nih are working hard to turn dreams of healing and health into reality for all. So thank you. And my colleagues and i look forward to your questions. Thank you for the slides, its always and the stories. Because that makes it real in terms of how peoples lives have been changed. I lost two growing up, two wonderful friends with cystic fibrosis. It was extraordinary, you know . How we can now save lives and thinking about what you can do. Let me just dr. Fauci, i recognize that you have been very, very generous with your time in providing the subcommittee with information about nihs current and proposed activities related to covid19. Including basic research, development, diagnostics, there pursuedi would you give us an update on nihs work in this area. As i mentioned, nih isnt starting from scratch with regard to the research on coronavirus or an emerging infectious disease. If you can tell us about how prior investments in niaid, that research have laid the groundwork for what were able to do now with the coronavirus. Thank you very much for that question, madam chair. Yes, in fact, if you look at the fundamental basic research on molecular viralogy. To allow us to do the things that ill mention in a moment. This goes back to fundamental basic research on molecular biology, et cetera. Remember, the first coronavirus that caused the problem globally was the sars virus in 2002. 800 people for a death rate of 9 or 10 . Several years later, we had the mers coronavirus again causing a problem in the middle east. Now we have the third coronavirus. One of the things that weve been able to do, and the nih, as you know, does many things and were studying very intensively, the virology of the disease, but the things were doing in the form of interventions are in the form of vaccines and therapeutics. Its really extraordinary that from the first time the sequence was made public by the chinese when they discovered what virus it was, literally within days, we took that sequence off the database and inserted it into one of our vaccine platforms called the messenger r a at the nih. What we did was a stepwise approach, which is to first determine, it is immun immunoge . Meaning can you stick it into an animal. The answer is yes. I think well be in phase one in about six weeks, which as a matter of fact, will be the fastest that anyone has ever gone from the identification of a sequence into a faze one trial of any vaccine thats ever been done. Thats the good news. The sobering news is since vaccines are given to normal individuals, its paramount is safety and whether or not it works. So well do a phase one trial. Well do it in a number of our centers, including our center at the nih. That will take about three to four months. And then if successful, i believe it will be, theres no reason to believe it wont be safe, well go into whats called a phase one trial. Phase two trials are hundreds if not a couple thousand of individuals. It would take then a year or year and a half to be fully confident that we would have a vaccine that would be able to protect the American People. So although the good news is we did it fast. The bad news is that the reality of vaccinology is something that were not going to have tomorrow. We dont know if they work, but weve already started a trial in the United States on a drug in both washington state, which is having a problem, as you know right now, as well as in the university of nebraska, where we have put the people who were expatrioted repatriated and brought back. A Clinical Trial will be done and if, in fact, its shown to be effective, maybe not perfectly effective, but at least somewhat effective in bringing down viral load, we would imagine in the next several months, and it will take that long to do the trial, we might have an intervention. So going back to what you said all the way to the molecular viralology. My grandmother would have said lemon and honey is going to help your voice a lot. Maybe a shot of bourbon. I dont know. In any case, ive just about 13 seconds left, so i am just going to yield back my time and get around to my other question. Second round in the spirit of bipartisanship, i want to assure you that shot of bourbon can help you, madam chairman. Yeah. I test it routinely and it works very well. Dr. Collins, last year when we were, you know, we are always interested in stretching these dollars as far as we can and putting money behind research, but i think one of the smart things we did last year in a bipartisan, bicameral way was to set aside 225 million for infrastructure, frankly, and for facilities, maintenance, and we know that is does not meet your needs. Er if the idea, i think, the hope would be well see where our allocation is, what we can do. That would be something we can sustain on an annual basis for a number of years to let you catch up to where you need to go. So, one, can you tell us how that 225 million has been used . Two, what would you do if you had additional funds in the next year of comparable size . Congressman cole, i really appreciate you raising this issue because it is critical to the effective functioning of this remarkable engine of discovery at the National Institutes of health and its intermural program. We have over the course of quite a few years successively been falling behind in terms of maintenance because of how the money comes through. Were not able to spend money on buildings and facilities unless its designated as such. Were at 2. 1 billion in the hole in terms of the kind of funds that would ideally be necessary to keep the place in the kind of circumstance that you would like to see, and weve had a number of really major problems in our Clinical Center, which have caused quite a lot of difficulties in terms of being able to take care of patients. I can if you like, if it comes up here, show you a particular example of just some soft things you can see that have happened in just the course of the last few months in terms of floods. Weve had to close down big parts of our clinic at times. So we have a big backlog of needs. The National Academy of sciences was asked by the congress to look at this issue, and agreed that we need an urgent attention to this matter. We also believe we need in order for the Clinical Center to be fully effective, to replace our current operating rooms which are at risk of having a leaking in the ceiling in the middle of an operation, obviously something you never want to happen. We have in the books with a surgical raid ideology wing with the cost of about 500 million. What you have done increasing the support for this has helped us hugely and will help us both with the backlog of maintenance we need to Pay Attention to, also to build up a sufficient amount of funds to start that new wing. It will be greatly much appreciated if that can be sustained in fy 21. The president s budget called this out as a special need to increase that number by 300 million. So i know this is not sexy in the same way were going to cure cancer or find an answer for autism. Without infrastructure, we cant take care of patients in the way they are counting on us to do. The fact you showed up with slides might suggest to people that we coordinated this in some that would never happen. Never want to miss a chance, do i, to show visuals. Dr. Gibbons, Heart Disease are seven types higher in American Indians and alaska natives than their white coups. A high concentration of the american the highest rate of death from Heart Disease in the done. Can you tell us what the nih is doing about some of these disparities and what progress youve made . That addresses a really important concern. We have an Important Health disparity. As you pointed out, we particularly have concerns about rural populations. And we reck my that that started a new cohort study. Our institute is known for the framingham heart study of over 70 years ago of taking communities and starting to understand what are the driving factors . Weve now taken this to a program that is actually called rural, that focuses in on kentucky, alabama and other areas with large rural populations. Thats where were seeing actually cardiovascular disease going in the wrong direction, as it is with certain populations of American Indians and rural americans. Similarly, were engaged in studies what we like to call to cipher, were taking communitybased efforts to address how can we engage communities in the process of creating healthier communities . Recognizing that often there are social and behavioral and cultural factor. That involves a Community Engagement strategy in fact, dr. Frets is a native american who is leading an effort shes now the Principal Investigator of our strong heart study, which is based in oklahoma, the dakotas, and arizona. And shes engaged in a project to promote healthier lifestyles, particularly in American Indian community. In fact, taking them into more traditional diet of fruits and vegetables, whole grains that we knew can help prevent Heart Disease. This is very top of mind and high priority. Thank you very much. Madam chairwoman . Congresswoman lowey. Thank you. Think i this question every time, dr. Colin. Are we learning nag about development of alzheimers . How far are we from even a temporary wont say a cure but let me ask you, how far away are we from a cure or real prevention, alzheimers . I wish i had a crisp answer to that, but i would say progress in the last few years has been really impressively moving forward. We have identified pathways that are involved in alzheimers disease going well beyond the amaloid hypothesis which has been so popular. Genetic studies reveal 100 different places in the dna that provide a risk for this. It tells you things going on that we didnt appreciate, such as the immune system is involved in some way and lip ids are involved in a way that go beyond what we knew about before. Le the cells in the brain, the supporting krelg are at least as important as the neurons, which have all gotten all the attention. All of that has led to a partnership with the accelerating medicines partnership, the Development Last year of 352 new drug target of great interest to academics and drug companies, and which will lead us down a whole bunch of new directions in terms of there pursuedics. I have to say the hypothesis is still very much on peoplemileperhours, even though weve had all thee failed trials. Biogen is taking the position that their most recent trial when they reanalyze the data did look as if it provided benefit to people who got the highest dose of this antibody for the longest period of time, and theyve gone back to fda and fda has been willing to look at the data again. Watch this space closely. If fda decides there is something there, we might actually finally be in a place where we have some signal of benefit. Then, of course, the whole game changes. There is a huge difference between having everything fail and something work a little bit because then you can build on that. Were all watching that closely. So its really all hand on deck. Nih is now running over 200 Clinical Trials. Not just about drugs, but preventive reducing Blood Pressure seems to be a good way to prevent the onset of dementia and susceptible individuals. Vascular contributions are really important here. Were pretty sure that physical exercise helps. Were pretty sure that cognitive exercises are also of benefit. I wish i was able to say that with absolutely certainty. We are making progress. Lets make no mistake, there is a really hard problem. Okay. Ill ask you next year ill write you a letter next year because i cant ask you. Can i come as i guest . Okay. Dr. Sharpless, another one of my favorite issues because it the. So dipointing. Are there any advances that have been made in Early Detection and treatment for Kidney Cancer . Yes. We think the incidents, in fact, of Kidney Cancer has gone up modestly related to improved detection, finding smaller lesions earlier. This provides challenge because we worry about the issue of overdiagnosis and dangerous cancers from the more i think Kidney Cancer is an important human cancer where we have made some progress. But there is nor to be made. It is not one of our most outstanding successes in the cancer world. Immunotherapy has some role for these patients. In terms of Early Detection, we are still considering a number of approaches, including i think perhaps the most promising right now in addition to imaging is the ability to detect nucleic acid in the blood. So we have a number of approaches, but stay tuned, its still early. Well, my time is running out, so im sure dr. Gibbons and dr. Vulko, you all know the rising of ecigarettes among people, which is just startling. Okay. If you want to make a quick statement and then we can get back into it, because i am really concerned about the incredible rates. And i think we should be concerned. In 2018, we saw a doubling in one year of the number of kids that were vaping nicotine. If and in 2019, we saw a doubling of kids that were vaping thc. So the concern is, of course, that thee kids are becoming addicted both to thc and nicotine and we may lose the big battle that weve won over combustible tobacco with all the adverse consequences. So, yes, we should be very concerned. So well save for the next round. I dont want to overstay my welcome. Thank you. Congressman harris. Thank you very much, madam chair. Dr. Fauci, im surprised you have a voice left at all. You appear to have been everywhere. You must have twins or something. Youre everywhere. Let me ask you a question. Ow used the word the sequence for coronavirus 19. I take it thats the one the chance have shared for that sequence. My understanding also is that theyve been unwilling to share other other samples of the virus. That is that sequence, just one place in time. Right. And that it would be useful to know to see other samples. Is that true . I mean, from a scientific point of view is that something that would be useful . It would be very useful, but were mitigating that problem, dr. Harris because we now have, unfortunately, enough cases in our own. Of our own. And thats of concern to me, you know, that the chinese did not share that because i dont know, look, in this instance, days or weeks my be very important. Im afraid we might have lost days or weeks because of chinas unwillingness to show the early case samples. The fatality rate is controversial. Who Just Announced it, they think its 3. 4 . I think you were quoted in the new england journal of medicine that its less than 1 . Is that true . No. We dont know the denominator. You said it, sir. If you look at the cases that have come to the attention of the medical authorities in china and you just do the math, is the math is about 2 . If you look at certain age groups, certain risk groups, the fatality is much high, but as a group, fatality is much higher. But as a group, its going to depend completely on what the factor of asometommatic cases are. So if you have asymptomatic cases that are a lot, its going to come down. What were hearing right now on a recent call from the w. H. O. This morning is that there arent as many asymptomatic cases as we think. Which may then elevate what the mortality is. You know as well as anybody that the mortality for a seasonable flu is 0. 1 . Even if it goes down to 1 its still ten times more fatal. When will we know with our own data . Im torn, dr. Harris, because if we get enough data to have a big n its going to be bad news for us. So, but were learning more and more. The thing that encouraging is that as part of the w. H. O. Umbrella team that went to china finally after a long period of time, there were two usa individuals on there, one from the cdc, and one from the National Institutes of health. He has come back. He is now in selfisolation in his home. But hes going to be giving us a report pretty soon about that. And i think from him, you know him, cliff lane, hes the individual whos my deputy. And i think were going to get the information you need. Thank you. Dr. Collins, a couple questions about data and information sharing. In your budget justification it said the process of updating the data sharing policy, im curious if you have any information about the amount of data shared by nh granties and whether you believe it should be a requirement of all those receiving grantor funding . And the administration has suggested if someone received federal funding the publication should be free upon publication . Could you comment on those two transparency issues with regarding federal funding . Those are very much on our mind, dr. Harris. Certainly in terms of having our granties share the data theyve generated, we feel very strongly. Thats part of their responsibility and the data sharing policies that we have been putting together make that increasingly clear. There are some legal limb taxes on our actually making that a mandate but we can put in terms of a term and condition of the award that thats the expectation and can monitor that to see if in fact that is happening. With regard to publications, we believe if the public is paid for science it out to be accessible to people who are interested in looking at it. Some of the journlds would find that to be existential if erring is free. We are working in that direction. We are for a few projects, like the cancer moon shot, the heel issue initiative, require everything has to be accessible at the moment its published without any charge. That is a signal of where we want to go but this is a complicated negotiation. Is it your feeling that it would be an existential threat or that the journals could finally find a way around it . Theyre looking at options they might try to adopt as alternatives to those that require complicated and expensive journaling subscriptions. Thank you very much. I yield back. Congresswoman lee. Thank you, thank you, thank you for your team. Its good to see you. I associate myself with the remarks of everyone who has talked about the importance of continuing with our bipartisan work. Really you are in the business of life safing, life affirming, and just thank you for everything that youre doing. I of course you know, i have focused a lot on the National Institute of Minority Health and Health Disparities. Unfortunately i see this 30 million cut above what it was. It requests 305 and enacted is 366. It is a 30 million cut. We know there are many disparities as it relates to communities of color. When you look at lupus, and thank you very much for following up with our request on lupus in terms of an action plan, higher rates of alzheimers among older africanamerican, sickle cell disease, and in many ways i feel like ive received a medical education from all of you, you because so many of us suffer from multiple sclerosis, hiv and aids, diabetes and sickle cell trait, i have gotten into the weeds on a lot of these diseases, and we have put in budget requests and languages and i want to thank you for being response inand bringing forth the plans we have asked for. In terms of these cults, im curious with regard to what the 326 million cut to the national heart, lung and Blood Institute would do in terms of the copd action plan. Also the cut again in the National Institute for Minority Health and disparities, the 30 million cut, and over and over i can talk about these cuts as it relates to some of these diseases, multiple sclerosis, the brain initiative, i believe there is a cut of about 40 million. Can you just kind of tell me how youre going to deal with this if these cuts in fact go through . And my second question, i want to thank you for the report as it relates to the growing absence of black men in medicine and science, and were working closely with partners in this. And i wanted to ask you with regard to the common fund, how can we support more comprehensive work . Because this is outrageous in terms of whats happening to black men in medicine and the sciences. And how we can help fund the National Academy of Sciences Based on their round table work that they want to continue. And can we look to the common fund . Unfortunately i see a cut of 196 million less. And so can we im sorry, 42. 6 million less than 2020. So can we kind of talk about how were going to address these issues within this budget . There are so many important questions there. Let me just try, because i know time is short. With regard to what nih does when we encounter a circumstance of really Significant Resource constraints, i think all of the people at the table would agree with me that we try to identify what our priorities are and try to protect those as much as we can. We look around to see if there are things that could be slowed down without much of a serious impact. It is painful. Every one of the areas, we would have to struggle with exactly that kind of priority setting. Im really glad you raised the issue about our workforce and the need for more representation for under represented groups. Our workforce does not look like our country and it should. I want to mention, you brought this up, the program called the build initiative, which is a way in which we are making it possible for people from traditionally underrepresented groups to have a real preerns as under grad waits, which is how the capture the imagination of young people. That program is looking promising. None of these programs would be done without really evidencebased analysis. Were not going to support things that dont work. We have supported a National Mentoring Programming Network for people not me, a white male that would have a network. You are right, maybe an area were worried about is africanamerican men. We have a recent initiative were discussing with the ncaa about how to interest athletes in science and provide them with scientific opportunities like summer internships in a research lab so that will be seen as a more attractive possible career path with mentors and role models that they can learn from. Were all over this. [ muted ]. Would it be possible to work with your team to present excuse me new strategies, new ideas and see if we can develop some broader partnerships that would actually enhance what youre doing . Absolutely. Were closely aligned with the National Academy on this topic, and theyve been very much partners, and we would like to build on that and do even more. Thank you very much. Well follow up. Thank you, mad am chair, and thank you for being here. Good to see you. Dr. Collins, appreciate your many years of service. I wondered if you and also dr. Sharpless could talk briefly about the president s Childhood Cancer initiative . Thats something i know we funded, and just wondered if you could give us an update . Happy to take that. Childhood cancer is an area weve seen significant progress the last few decades but have a ways to go. Too many dying. Even the kids were able to cure are left with lifelong survivorship challenges because of therapy. Its an area we need clear progress. And the Administration Announces this is a top priority of theirs to make progress. The president announced this at the state of the union more than a year ago. Congress has appropriated the funds. Were tremendously grateful for that important devotion of resources to this topic. Its underway. We have had a skrooend a lot of the thought leaders in the community about how to make progress most expeditiously in that. We have charged a working group to come up with ideas. And were well underway. The focus here is on sort of how to use data better for Childhood Cancer and sort of radical data aggregation. I suspect well be able to create a registry on every child with cancer in the United States. That will be followed up. So its very Exciting Initiative thats really getting started. Thank you. And dr. Voco, i wonder in the past, youve discussed efforts to drepil6 several projects that have emerged including the creation of a network that will enable two networks. One of them will enable that development of new molecules and testing. And the other one will enable the testing in patients with pain of the interventions. And this is done with industry, with partnerships with industry, so that we can help accelerate, but also with academic centers. And in turn, this has been an incredibly challenging area to develop treatments that are as effective for pain, but safe. And yet we and thats why its so incredibly relevant that we create a partnerships with faus pharmaceutic industry. France has taken a lead on this. I dont know if there is anything else. France is worth mentioning. Youve said it well. I would like to emphasize this is an allhandsondeck circumstance, 20 have gathered together, we call h. E. A. L. , helping end addiction longterm. We need to have effective treatments. Its a really hard problem. Dr. Fouci, weve been talking a little bit about the coronavirus, and i wondered if you could comment on some of the partnering that you naiad has been doing with barta on the development of medical countermeasures for these threats in general, biological and pandemic . Yes. Thank you very much for the question. It tran skends coronavirus, certainly. Because the nih is fundamental mandate and work is in fundamental basic research and its translation into translational research, which is then translated into a product for intervention. And if you look at the things that are now out from a number of diseases, from h. I. V. To zika, and now to corona, its essentially a process where we do the initial fundamental research, bring it to its early stage of development, usually in a phase one, and hand it over to bota. What bota does, get their resources and partner predominantly with either Bio Tech Companies or larger pharmaceutic companies to make a product based almost invariably in fact if you look at some of the things that have come out with products, almost every single one of them has nih finger prinds on them from the beginning. I think its a nice marriage and part of the continuum from the fundamental research to the product, and its worked very well. Thank you very much. Thank you, madam chair. I cheeld back. Congressman foecan. Thank you all for being here. Dr. Collins, thanks for having all your colleagues here. I think the single easiest thing to say is the afribute to all your work when you see the bipartisanship when this comes forward when our ranking chair was the head, we as congress increased funding to nih. I think it shows how much we value everything you do. Thank you. I want to say thank you so much for updating the statistic. Ill mention it because i think its good for everyone to know. We used to have how many drugs approved in a sixyear period that had nih support, you look back of the 356 drugs, each and every one had support. Thats our tax dollars. Thank you for updating that number. I think its something as we talk about drug pricing, its helpful. I feel like i would be doing legislative m legislative malpractice if i didnt talk about the coronavirus. I have respect for you. Ive been following Scott Gottleib and have respect for him. Following the World Health Organization trying to get various sources on this. I have to be critical in one area. Id love you to help me talk me off a ledge on this. I dont know if you can. Is the lack of how were handling testing right now. The fact that all of a sudden cdc has dropped keeping track of how many people we test. We had somebody talk to us this morning about as part of the ebola response. They comment, when you dont know what you dont know, thats not a great place to be in trying to figure out how to deal with things. The fact if we start not keeping track of this, the amount of tests and who were testing, we should be much more aggressive, in the hospitals, anyone whos good pneumonia that we cant identify, we should be testing. I feel like this is one area, you gave me great response on where we are on fund finding something to help whether it be treatments or otherwise, vaccine. I feel like this is one where were dropping the ball. I do want to get to another question, but let me ask you on this particular, talk me off the ledge. Im nervous were not keeping track of who were actually testing and the fact that were not more aggressively testing. Im not going to try and talk you off the ledge because youre making a good point. Okay. All right. So push him off. No. Its less than keeping the track of the test, sir, than it is making the tests available, and withdrawing the restrictions on who can be tested. So let me explain, because this is really an important issue. I just want to leave a minute for the other question. Yeah, okay. So the issue is the tests from the cdc were for Public Health components, state and Public Health groups that have to give it to them, the test comes back to the cdc. That started off with some technical problems which delayed that going out. The major issue that i find and many of my colleagues find problematic is that if youre looking for people in the community who dont vp have a recognized link to a test, Community Transmission oob youve got to withdraw the restrictions, that in order to have a test up to have a link. Its almost inherently contradictory. Those have been lifted. The fda has taken the constraints off. And now we finally have companies that are going to be making many, many more tests. Should we be pro active in testing in places like hospitals rather than waiting for people to come and be tested . Yes. I feel like thats one of the components. The answer is yes, and i feel strongly about that. I love when i get a one word answer. Maybe you could meet with secretary de vos and talk to her about one word answers. Rosa told me, and now mike gallagher, a republican from wisconsin, going to read the book next, i am concerned about the fact that as weve had the conversation previously about this, the number of either drugs that are made, active engrooinds made, medical devices that are made in places like china. Do we really know what that supply chain is with the various companies . We did a letter this morning to i think the top 20 or so Prescription Drug companies and are asking this very question. Do we keep track of this anywhere to know how many of the drugs are made in places like china and where we could be for potential shortages in a case like this . I believe that the fda does, and the fact youre concerned is one that weve been talking about as part of pandemic preparedness for years. When we put together the plan back in 2005, we said one of the real problems is supply chain. I was somewhat i would say impressed, slash, shocked that Something Like 90 of the fundamental ingredients that go into many of the drugs, not the actual drug itself, comes from china. So that is a real problem. And i dont have any answer to you. Its not anything that we do. But its something that impacts us. One really quick followup . Should we be tracking active ingredients in medical devices as well, supply chains . I would imagine yes, but again thats out of our purview. Thank you. Thank you. We will do a hearing or a briefing with rosemary gibson, china rx so we can talk about that. Congresswoman herrera butler. Im glad mr. Boekan asked about this, i was at the white house and asked Vice President pence about, the supply chain issue. I know in the last number of months weve heard refine, refine, refine, refine, refine, or weeks. And this this last week we started to hear, well, there are some concerns. I think february 27th was the first time that a prescription manufacturer noted that theres theres a supply chain issue with regard to the coronavirus. Weve already seen shortages for unknown reasons on things like imewno suppressive drugs and this is an area im focused on, seeing what the solutions can be in the short term. People say go get three weeks of your prescription. If youre prescription is being rationed, you cant do that. What types of solutions can we so theres now, in the coming year, that were going to be dealing with maintenance and treatment of this virus. What should we be doing . What can you see . Obviously theres the big picture you talked about needing to fix the supply chain overall . The supply chain problem is a longterm problem that has been brought to our attention multiple times. And then when you have Something Like this, you realize you have a supply chain problem. Which you cannot fix immediately. And theres no real easy fix for it. I dont have an answer for you. But maybe this would be a lesson as we go forward, that as ive said to this Committee Many times, this isnt the first nor the last emerging micro that we are going to be confronted with. And if one of the issues thats vulnerable when you have an emerging infection is getting cut off from things that we depepd on from other nations, so im sorry i cant tell you what to do tomorrow or next month, but maybe we could talk about the future and how we might turn the knob a little bit. Im interested in that. I want to hear about the future and how we can change the big picture. I do think there are some Immediate Solutions that i am going to be asking the administration to be considering and the Different Task forces to make it easier for people to access their tripgss if maybe its even accessing a brand thats available over a generic thats not available, and how can we help make that Cost Effective for patients and hold them haurnlless. Thats an area im looking at. People need to have access. The other think i wanted to ask about, your being from washington state, my district is on the coast, between seattle and lake oswego, people at home are very attuned to whats happening. The state has requested, and theres been a lot of coordination, been on the phone with all sorts of with the governor talking to the Vice President talking to the task force talking to our senator. Everybody is mobile liesing. I am very proud of our Public Health response, grateful for the cdc and even fda folks were on the plane immediately. We are moving forward. One of the things that was asked, kind of around the National Strategic stockpile maybe not under your jurisdiction but maybe you can speak to, weve made a request for personal protective equipment. I think only about half of that has been let us to as a state. And then also with whats your opinion about expanding cdc testing criteria . I agree. I think the state can only test a certain amount of folks. We need it in the commercial labs available for people to go in and test. Would you support expanding that criteria to get more people access . Your thoughts . I would support expanding criteria, means withdrawing restrictions. Thats the point. I just want to hear it another way. Yeah, okay. I think we cant say it enough . Right. And i feel very strongly about that. Washington has a very good Public Health group. Uhhuh, we do. They have put together a test theyve done. Theyve been able to do it. They need help. They need support. I was on the phone late into the night last night with my colleagues from washington, and we really do need to act aggressively there. When you say help and support, give me specifics . We need for example, they are doing Contract Tracing on the nurse be home outbreak. If they find out its community out there, theyre going to have to do Contact Tracing on that. Theyre stretching their resources, and thats an issue. Backfill support . They need help. And they need bodies . Im certain, the cdc right now is helping them. Thats my i understanding. But it is an evolving situation. I was on the phone with both of them last night. We appreciate that. Thank you, madam chair. On the splay chain issue i would hope we could take a look, but advanced manufacturetioing, what we can do on the longterm on manufacturing those ingredients here rather than in china. And i think thats worth our time and effort to take a look at. Congresswoman frankel. Thank you very much for being here. All right. I just have to ask you some supermarket questions. People think, like when i go to the supermarket, people think that members of congress should know everything. So this is these are very simple, but so one of the questions i get, if the coronavirus is just a cold, symptoms, thats what we hear on the news. No. More like the flu. Okay. So its not i guess the question that i have is, how long does it last . And what makes it so serious . Okay. It isnt a common cold. The confusion is that about 10 to 30 of the common colds that you and i and everyone else get during a season happen to be a coronavirus. But a certain subset of coronaviruses can cause extremely serious disease. They did it with sars. They did it with mares. And now theyre doing it here. With the novel coronavirus. The reason its serious is that a question that was asked by dr. Harris is that the mortality of this is multiple times what seasonal flu is. So seasonal flu spreads widely. The mortality is 0. 1 . Right now in china, the mortality for this particular infection is the latest report was 3 to 4 . It might be a little bit less. It isnt a cold. Its very interesting that most of the common colds have upper respiratory infections. This virus, not to get too technical, the component of the virus that binds to a receptor in the body to allow it to infect, those reseptors are rich in the lung. Thats the problem. It binds to it. So a person can present no sneezing, no sinusitis, fever, shortness of breath, you do a chest ectsray and you have pulmonary infiltrate. Thats not the common cold. Thank you. Now ill have a better answer for people. Next question, if youre able to comment on this, in terms of your research, is there anything that you think the fda can do to speed up your research . I see a shaking of the heads by dr. Collins. Youre referring to coronavirus specifically. Or any drug that youve been researching. We work very closely with the fda. We have a joint leadership. Maybe a better question. Is there anything that we can do to speed up the fda. Tony maybe should say specifically with coronavirus because its been allhands on deck and thats been pretty recently enhancing the ability to do laboratory tests. I dont think theres anything you that could do to speed up the fda. Quite frankly they may need more resources to do the kinds of things theyre doing. Thats right, madam chair. But we have very good relationships with them. They have been very, very cooprative and collaborative with us in trying to get these countermeasures out as quickly as possible without cutting corners that would impact safety and our ability to evaluate efficacy. Former acting commissioner of the fda might want to answer this question. Well, since hes now the head of the cancer institute. What could the congress do to help the fda, ned . Thats a good question. I wont speak on behalf of the fda, a different federal agency. A challenge like this is trying for the food, Drug Administration because its so sudden and the machinery is built to be deliberative. I think the Device Center making these Lab Developed tests releasing those restrictions is an important development. I think the academic labs will be able to bring these up to speed quickly. They need funding, have hiring challenges, 21st century cure has helped. Im sure theyre up to the task. I think im running out of time. One more question on alzheimers. Is the private industry doing any research . Ive always heard that, because its so expensive, that they really are cutting back on that. They are but its not all companies. Again, i have a privilege of search serving as the cochair of accelerating medicines partnerships, focused on alls mooirmsz, rheumatoid arthritis, loupis and diabetes. There are five Companies Invested in this. They havent been willing to put their funds as well as ours into a partnership where all of the results are open access. It has been concerning that a number of other companies have seased working on this. I mentioned earlier we have more than 50 new drug targets, trying to encourage them to get interested again. Thank you, i yield back. Congresswoman boostas. Thank you, thank you for answering so many of the questions we have around coronavirus. Im going to switch topics. Is that okay . So the im from illinois. The Congressional District i serve is 14 counties, goes to to the wisconsin state line. Mississippi is on the western part, goes into illinois. 11 counties are rufl and then we have the quad cities, pieria and rockford. Each of these counties and communities face the unfortunate circumstances that can lead to negative Health Outcomes probably like almost every Congressional District in the country. These are called social determinenats of health. And in im just going to give you a few examples. In peeria illinois, weve got a problem with food deserts and heard a story from a person in my district takes them 16 bus stops to be able to access fresh fruit and vegetables. 16 bus stops. And then in rockford, illinois, congresswoman Lauren Underwood came to my district. Shes the cochair of the black Maternal Health task force. We brought her in so we could bring Health Professionals together and find out, why do we have in the state of illinois six times black women are six times more likely to die as a result of pregnancyrelated conditions than white women . Its something that again, social determinenats of health. How do we get to this . We have a hospital in my district that took them seven years to hire a primary care physician. Seven years. Weve just closed within the last year or two, the Obstetric Services out of peekon illinois and galesberg illinois. Those are some of the things were facing. We introduced the social determinants accelerators act. Heres what id like to ask. Maybe dr. Collins, you can start, but would love to hear from the rest of you on this. The National Institute on Minority Health and Health Disparities has a strong focus on social determinants of health. Each of your institutes has skin in the game on this. Talk about how youre working together to address this, what i can take away from this, love the powerhouse that we have sitting in front of us, and thats what id like you to focus on for the couple minutes we have here. And its a wonderful topic. In fact, every one of the nih institutes as you say has skin in the game in various ways. I could give you many examples because of the time. Maybe ill first ask dr. Byancy to say what were doing in terms of this very thorny and difficult issue of mortality which is a disparity. Nih shares your concern. The problem that we have is, although ma term mortality is rising, its a rare event. Its difficult to study it. There are only about 700 women, its too many, but its hard to study. Were focusing on the near misses. There are 50,000 more women who are near misses. These women can help us to identify differences in survival. Why do these women survive whereas there are others who do not . We also really need to understand why is there a difference in africanamerican women as you mentioned, but also americanindian women, as well as alaskan women, as well as all women over 40 . Its also important to recognize that ma term death doesnt just encompass pregnancy, labor and delivery but also the full year after delivery. We need to company on stret ricks with internal medicine. Pregnancy puts a stress on a womans body as you know, unmaskds diabetes, depression and Heart Disease. Its an opportunity to intervene. Dr. Collin has put up the slide, because we are now developing a transnih initiative thats going to be known as the improve. This is the first time youve heard about this. Its implementing a ma term health and tregcy outcomes vision for everyone. It has two components, one side on the right is foundational biology, aimed at determining predirktive bio markers as well as novel technology. On the left, a social and bio behaifrl aim. We need to hear from the communities, and be able to implement some of these changes. Everybody could tell you more been i cant call on the other folks because of the time. Id love to talk to you more. Well set aside time we can talk outside of this hearing. Thank you very much. I appreciate your perspective on that. I yield back. Congresswoman clark. I yield to congresswoman . She wants to yield to you. Go for it. Can you take that 33 seconds off of my time and go for it. Good morning, everyone. Thank you for being here. Im so sorry that i missed a lot of the testimony. I think that you do important work, and i thank you for the service that you provide. Dr. Fouci, you said you support pro active testing, true, right . Yes. What does that mean . Why are we not doing it . And what does it mean . And who would be tested . And under what circumstances . Were gypping to do it now. There was not implemented earlier, and what does that mean . Pro active testing means to when you have community spread, where you do not have a known index case, so let me give you an example of what nonpro active is and it will be easy to show you pro active. You bring in someone as we did when we flew many of our diplomats and others from wuhan, we brought them back to the United States, and the thing you needed to do was to test their obvious contacts, like their wives or husbands or what have you. And you wind up seeing that theyre infergted or not. Pro active means i dont know whats in the community, so im going to go to a bunch of mnch rooms and when people present with symptoms that look like they might be coronavirus, even though they have no connection with anybody who has coronavirus, they didnt travel anywhere, and test them to see if theyre infected. Thats even in communities that have no knowledge of having any . Absolutely. If i go to the emergency room in new jersey, where theres no confirmed cases or anything. Right. But ive get some symptoms. Right. Flulike symptoms. Right. They would test and make sure that its not the coronavirus. There arent enough resources to do it every single emergency room in every single center. So what the cdc has done, they started by taking six sentinal cities and now are expanding that to many more cities, essentially doing sentinel surveillance in places. That will give us a good idea or at least a partially good idea of whats under the radar screen that were missing. So are these cities clustered only near like the state of washington . No, no. Cities all over the country . Cities, washington, los angeles, san francisco, honolulu, new york and chicago. And there will be more. My understanding is that some of the that the cdc is managing diagnostic tests sent to state Public Health labs while fda is managing tests at priority labs. How does it get determined who does what . Its not a question of managing. Its a question of the cdcs fundamental mandate is to develop the test and provide it for Public Health purposes to individual state and local Public Health authorities. The issue with the fda came in when the fda can give permission for a medical center, you pick it, university of washington in seattle, cornel in new york city, to develop their own test or to partner with a bio tech or dying noftic Production One and do their own test on their own, without needing the very intensive Quality Control that the fda generally gives to a test. So that gives much more flexibility to have many, many, many more center do their own tests. Okay. My husband had numbenia in december and hes still kufing. Im like, i want to send him. I want to send him to have him checked out. Im very interested in research in the health care, Health Disparities among minorities and nonminorities and minority children and whats happening with the suicide rates, how it seems to be growing exponentially or disparitily in the africanamerican community, and im wondering, the budget as pro posed, what does it impact on the institute that would do that kind of research and be able to support those kinds of services . So as we mentioned earlier, when nih is faced with resource constraints, we try to identify what are the most high Priority Issues and try to protect those even if it means we have to cut back in other places. I totally agree with you, the question of Health Disparities and in especially something as heartbreaking as suicide, has to be a very high priority. The National Institute of Mental Health has a big investment in that space, and particularly trying to understand are there ways of identifying whos at risk and making an intervention before its too late. Were getting closer to that, even using Machine Learning, taking advantage of what hapz, there are indicators in terms of peoples reduced social interactions, they are in a depressed state otherwise you might not have known, its very appropriate to focus own that. Make note that we did im sorry. Is that my 33 seconds . I yield back. I have other questions regarding this issue. Thank you. Thank you so much, madam chairwoman, and thank you all, this incredibly esteemed panel. Dr. Fouci, i am hearing a lot from hospitals in my state in massachusetts who are feeling under resourced and unprepared for the coronavirus. Can you tell us a little bit about, as we are anticipating moving from containment to mitigation, how we are going to help with the hospitals around the country . Uh oh. Was that a response. Yeah. So when you say we, are you talking about the United States government . Nih and cdc. The nih is not going to be able to do anything there except make as quickly as possible the results of the research we do to be able to be deemployable. Right. In places like massachusetts. The cdc works very closely with state and local health authorities. And thats one of the reasons why i think youre going to see, and i dont know what its going to be is that there are going to be resources that are going to have to be forthcoming to go. And i understand theres a supplemental package, i dont want to address that. But thats one of the ways to answer the question, is that the states, massachusetts including, are going to need some help to be able to implement the kinds of things that i think are going to be needed. Looking at massachusetts and this entire health crisis, one of the things im glad about is that massachusetts has a very high number of insured people. That does not hold true across the country, and i am concerned about how our Health Insurance policy plays out in Something Like this. Can you tell for me where you see the gaps and whats most immediately obvious to you about what we can do to redress it . Sorry, thats a very good question. Because of that, most recently it must have been the last couple of days, they all seem to mention to one of these days, but a couple of days, that the director of the cms has now been made a member of the president s task force. So that person is there. Those questions came up exactly the question youre asking, came up at the Task Force Meeting last evening. And that is going to be addressed. I dont know what the answer to it is, because thats not my area. But it clearly came up just like you said. That some states, some territories, some regions have good insurancing with good care, and ooze donthers dont. How are we going to get the tests equitably distributed. It pulls in paid family leave policies, all these different things, and we dont expect the cdc to take on that whole policy agenda. But theyre so intertided. And i hope the task force will look at immigrants. If we cant get them to fill out a census because of fear, how are we going to get them to Access Health care for their children and themselves . A good question. That also came up from the task force. From what im hearing thats not going to be an impediment. Excellent. We will wait and see. Dr. Vocal, good to see you. I was also very concerned that the Trump Administration had propos proposed troonz ferg 5 million from Mental Health substances, nearly 63 to fight the coronavirus. I dont think we made tradeoffs between Public Health emergencies. I wonder if you can tell me what progress has been made and what steps is needa taking to work on the youth focus interventions and Recovery Support services . One of the things that has helped us enormously has been the 500 million to address the Opioid Crisis. One of the projects that has been prior tiesed is presention interventions. When you address that to help to avoid kids taking drugs, you dont do it specifically for opioids. You do it in a general sense. And this is important because were seeing now that the Opioid Crisis is shifting not just from opioids to getting into psycho stim lants. Its not like were going to have to prevent one drug, were going to have to address what is making us vulnerable as a country. We have several nish gives that are going to be expanded to address, prevents to rule out communities that are at very, very high risk for drugs, to the criminal justice setting. How do we enter vooen in schools . Another project that we have been able to hopefully launch, as you know weve done a tenyear followup for children from 9 to 10 upward, to understand what are the factors in the brain that made you vulnerable to drugs, but how does the environment influence them . We want to start in infancy to look forward. These are just some of the examples that were targeting to try to develop knowledge and implementation to prevent youth from taking drugs. Id like to follow up with you on another way on medically assisted treatment for younger people as well. Thank you. Thank you. Im going to try to ask three or four questions, and get quick answers to them. So let me just start with this. Dr. By anky, endo meetriosis, afekz one in ten women. Can you describe nichds research related, tell us your Top Priorities for the research would be if pro rided with Additional Resources . Im asking my question, where is my colleague, congresswoman affectenour, who has an interest in this. Hold on to that. Dr. Collins, we gave 12. 5 million for a gun violence prevention research. I want to have you tell us what do you expect to do with that . Also with the office of research and Womens Health, nih budget has grown by 39 , office of research and Womens Health has increased only 8 . Anyway they have a Critical Role in doing what we need to do across all of the institutes. How would additional resours for the office of research and Womens Health enable the office to better advance and coordinate Womens Health research . And dr. Gibbons, cardiovascular disease and women, stroke, Heart Disease, leading cause of death for women in the United States. What research is nhlbi supporting to improve diagnosis and treatment with women with Heart Disease. Dr. Byanci . Thank you, madam chair. One in ten women have endo meetryoisis, chronic pain, Enormous Economic impacts because women do not go to work, its a leading cause of infertility and associated with an increase in cancer. They have a branch where we are Funding Research on the diagnosis, prevention and treatmentweve made it one of our ten aspirational goals in our plan. And im very proud of the fact that nichds research, we were talking about drugs developed as a result of nih support, the drug aura lisa, which is the newest drug to treat pain in women with endo meetriosis came out of a grant. Thank you. I would say this to congresswoman finger nour, that you out to be in touch with dr. Byancy to get the information you need to move forward. Quickly to preserve firearms, we have invested in Firearms Research all along. And having this additional funds from the congress in the current fiscal year is something that we welcome. We are invested in a full set of Threat Research to americans well being. We will continue to do so and executed Funding Direct tifbd from the congress. We have written up various funding opportunity announcements, waiting momentarily for them to be cleared. We will look at such things as the role of video games, the role of trying to keep fire aurmds out of the hands of adolescents. Such things as the violence interrupter schemes that are carried out in cities, do they work . We need date awe. Were the data people. You asked about orh, an important part of what we do. Jeannine is a wonderful catalyst. While the funding is modest, about 43 million, the overall funding for Womens Health research is about 4. 4 billion. So its reflective of the way in which this involves all institutes. Im concerned about the amount of funding to the office of Womens Health research. Its crosscutting, but this is something that many, many years ago we identified as something critically important, and i want to make sure theyre getting the resources they need. And let me just say, go ahead, dr. Gibbons, on nhlb maybe ill take off on that point, a key part of the initiative to address Womens Health and cardiovascular decease is to take more of a focus in the reproductive years. And to do that, we recognize that leading cause of mortality relates to cardiovascular disease, particularly women over the age of 30 in their reproductive and child bearing years. We have a number of initiatives tarting that. For example, pregnancy is often a stress test. Peri cardiomyopathy is a major cause. Were trying up an initiative to understand what the bio markers and genetic factors to predispose. We recognize that women who have adverse pregnancy outcomes often have a longterm trajectory of increased cardiovascular risks. We have the new moms to be Health Heart Study and recognizing there may be interventioned we can do to change the trajectory of those women. [ muted ]. And really these things play together. Theyre not in isolation, not in silos. Thats correct. They Work Together on this. Let me [ muted ]. Thank you, very much. And when i think about the appropriations, you know, its too easy sometimes to get caught up in a what are we doing this year . The reality is everything is cumulative. Under that philosophy weve adopted over the last five years a cumulative and incremental increase for nih funding. So dr. Collins, i want to ask you two of my favorite questions, because you always take me in interesting directions. First is, what of the things weve been able to do that we would not have been able to do, had we not made these kind of consistent investments . And looking forward, what are the things that you think we might be able to do if we were to continue down the path that weve been on . That is, sustained inflation plus increases for the nih, over the next five years. Love being asked these questions. Thank you, mr. Cole. The way in which the five years of steady increase has influenced things is perhaps most dramatically visible in what weve been able to do for early stage investigators. Back in 2015 we funded 600 of those grants and that was not enough. People were getting concerned whether they had a career path. We funded over 1,300 of those this past year, more than doubled in the next generation of talent. The morale has changed. Ill be in alabama tomorrow and friday, meeting with investigators. Theyre going to be excited about science, because now the environment makes it possible for them to take risks. Similarly, weve been able to increase the number of overall grants and the number of pranz approximate principle investigators. Weve been able to enrich the breadth and depth. Weve been able to put forward projects that are bold, moving our understanding of life to single cells, single cell biology effort. Going after things like the influenza vaccine at a higher rate than otherwise and develop platforms like what were using for coronavirus. We couldnt have if we hadnt had the support initiating this bold program called all of us that amds to enroll 1 million americans in a study of health. That is going to be aplatform for so many things. The brain initiative, trying to figure out how whats between your ears does what it does. Again, now spending half a Million Dollars on that, and it is remarkable what kind of technologies have been invented and what impact that will have on brain diseases. Cancer imuno theyrepy making great advances, we would not have been able to do without your help. The focus on opioids and alternatives through the heal initiative. Those are a few things we would not have been able to do had it not been for your support. What we could do Going Forward . The sky is kind of the limit here. I mention in my Opening Statement about gene therapy, we are at a cusp, curing sickle cell disease, lets start curing a lot of these other conditions. You can see the path forward to do that. New opportunities in terms of Artificial Intelligence Machine Learning applied. Were going to have a big investment there coming in the next year or two, because we can see ways this can play out in multiple different applications. A new focus on newtration, seriously. Its an area we know is critical for health, and yet the science hasnt necessarily gelled around the new opportunities ppts its time to do that. Again, its going to take resources. All the things we talked about in terms of Health Disparities, ending h. I. V. In the u. S. , dealing with the new difficulties with methamphetamine and cocaine, not just opioids. Those are all in our minds as things we can accomplish. I really love the question. Everybody at the table would have their own answers, but i guess i kind of gave you a bunch of mine. Mr. Sharp, your answer . I think you mentioned earlier someone who won the noble loriat, jim story started out in a Small Institution in texas. Thats where his first paradigmchanging research was done. It was before he went to berkeley, sloan kettering. I think that im obsessed with the fear that there are these great scientists with terrific ideas who are working out there sending grants, weve had an explosion of grants, 15 increase, and were not able to get to their great idea. So that with the generous appropriation congress has been giving us, weve been trying to get the numbers up to get to the cutting edge science that make a difference for patients. I would say, madam chairman, i hope we look at this. We ought to about this. As dr. Collins says everybody here can give us a different answer. We are going to stay on the track that we have been on and we want you to think that way and present those kinds of possibilities and the community has done that and done a good job at it. Thank you very much, i want to take the opportunity to thank you all for your extraordinary work. I want to get to the whole issues of cigarettes. With all the information out there it is not penetrating the kids, the rising rates of ecigarettes among young people are startling. I look at the number 64 people died and nearly 3,000 more hospitalized last year with vaping respiratory related i illness illnesses. Now, as i understand it, many but not all of these cases were attributed to vitamin e, acetate or vaping. Concern is growing there could belong term health consequences, Heart Disease stroke cancer. The couple of minutes we have, i would like to hear from both of you. What can we do about it and if you have any ideas, we would welcome. I see these numbers increasing at College Campuses exponentially. One of the things we dont recognize is these vaping devices, making them rewarding and addicting. You can deliver huge quantities of nicotine and high concentration as you do with normal tobacco. What we are observing in the past where it takes several months to escalate and now we see it escalate in a couple of weeks. Thats associated with toxicity. Thats what we are facing. The number speaks for themselves, one of the main reasons which was not even recorded in the past. Teenagers vaping in this canico because they are hooked to it. The message is that it is urgent and we need to stop it otherwise we will go into tobacco smoking again but also all of the points that you are saying that we dont really know what are the consequences of delivering these vaping into your lungs as well as other organs. Just last summer you are describing the cases of ecigarettes and Vaping Associated lung injury that are starting to explode and of a new epidemic and mystery illness. We didnt know why people have symptoms. Fda and cdc, Public Health threat was immediate and collaborative in which are nearly within weeks we were convening subject Matter Experts around the country and again leveraging prior Investments Committee made, bringing and convening people who already been studying ecigarettes together. What can we do and whats going on about this new vaping epidemic and so again within weeks we put out a notice to engage our Research Community to start studying, whats driving this and cdc with its Case Definition and surveillance apparatus starts to make this link to thc and substances that may be combined with thc that may be driving it. By december we clearly have a sense that at least you pointed out that vitamin e acetate from samples alone, a key associated element of this phenomenal and related to the research and communities that we establish. Investigators were already beginning to study and get the link between studies. Last couple of weeks published related to an investigative from roswell park that indeed just given the vitamin e acetate through a vaping device was able to capitulate a lot of the things we have seen in patients. Nearly within eight months we were able to close the mysterious disease involving with the cdc and fda to address that Public Health address. We still dont know the longterm effects. We recognize it is probably at the tip of the iceberg. Whats happening to sub clinical injury of the longterm of these young people thats still an unknown. My time is up but i would just hope that we can Work Together. I think it is pretty conclusive, this is not good for kids or adults or anybody. Absolutely. What are we doing about it . Kids dont believe it and working with the cdc. I am with you. I would ban it completely. I would like to follow up with you because it seems to me that science is conclusive and get these kids to understand it. Thank you very much, thank you all for being here. How exciting it is when we have discoveries. Dr. Collins, a group of us are going to send a letter to the president asking him to look at human human embryonic stem search. The idea that we are destroying human embryos and funding the destruction basically through the dnih is a mistake. Human embryos are the youngest humans. Human life is a mere means of achieving the benefit of another human being and thats not the purpose of human life. I would hope that if the president responds perspectiosio a letter that we can phase out that. I understand that basic science reasons to pursue it but these are humans. These are youngest humans. We should move away from that as soon as practical. It is good to see you again. You know what i am going to ask you about, it has been a year and i want you to update us on you know the Marijuana Research thats done looking at effects of brain. The last bill, turning back to make Recreational Marijuana industry much more profitable and widespread through removing banking restrictions, those restrictions are still in place. It advised us some time to educate the American Public of how dangerous it could be. If you can talk about that and i do believe our college and congress is going to move a medical Marijuana Bill that makes it easy to do research and discover what is merely a promise with regards to what marijuana can do and those diseases will be of help. You can just update us about some of the research that indicates just about how dangerous expansion of marijuana especially with the bleeding down to younger individuals, whether it is ecigarette rets marijuana. If you can discuss that. Thank you for asking that question. It is an area where there is major changes of the perception of the American Public that we have a drug thats benign. As a result of that we are seeing a dramatic increase in the number of people that are consuming marijuana, 4. 5 million in 2018. A great concern relates to children because the brain is developing and until we are in the mid20s. The system which is basically stimulates by marijuana is crucial in enabling that development. So what the research has shown is that adolescence consuming marijuana and there is an effect that much more likely to show disruption in terms of function of the brain that appears to be associated with cognitive i impairme impairment. They look at the threat respectively which is the reason why we are looking at it respectively. What also has been very clearly and this has been studies from all over the world by independent nations is that marijuana with high content of thc is associated with a greater risk of having psychosis. There is data showing tha that chronically now that data indicates it does increase the risk that you could develop a chronic physchosis. These highlight why we need to provide information with the public so they go in with eyes wide open so they make decisions and when we make policy decisions. Thank you very much, i yield back. Congresswoman lee. Thank you very much. We worked together on hiv and aids on the epidemic. We are still working together in a bipartisan way make sure we have the resources to address this epidemic. We are at the Tipping Point now in the field of hiv research including Vaccine Developments, so just would like to ask you if you have an update of the future progress in these areas in terms of vaccine hiv and aids, secondly, i would like to ask you in terms of the coronavirus. Has it hit a pandemic level or not and how do we explain to our constituents the difference between an epidemic or pandemic and i want to find out, given that there is a 2 in fatality rate for this virus and it is impacting people who are elderly, i want to find out do you think from your perspective that 2 is accurate right now in terms of fallaltality rates. On sickle cells, how close are we now . You have done some remarkable work on sickle cells disease and we are waiting. I know you are close. One out of ten of after condition america have the trait. I want to see how close we are identifying the trait. Really quick because thats a lot of questions. Vaccine we have a disappointing situation with the vaccine trial that was looked at in south africa which is called htcm 702 which was using model that we use and showing safety and no effect but no efficacy. There were two other major trials going on. One in Southern Africa and one in the america and europe. Those trials we dont have the data on them probably for at least a couple of years. Theyre using a different concept. Theyre using a different vector and protein and different adjective. I cant give a difference of what it is going to be. Simultaneously there is a whole new effort using biological approach to get the right confirmation to induce more neutralizing antibodies which are the goal standard. There are many, many people have different descriptions and definitions of pandemic. Pan meaning widely distributed. They have not had sustained transmission throughout the world. Technically it is not a pandemic. It will be up to them to make that declaration. Next, the 2 fatality. The report when came out when they look at the totality of china, it was some where around 3 up from the 2. The percent mortality depends on the denominator of number of cases. If you are not counting every case then the mortality will be high. If you are counting a lot of cases that is are sub clinical, the mortality will become low. No matter how you slice it, it is many, many more times lethal than the influenza that we get in the season. Particularly for the elderly, most of the deaths and the hospitalization, the mean age is 70. Very quickly. We have a whole cure sickle cells initiative that nhl is leading. We have three Clinical Trials that are using gene therapy appears to be working dramatically. Theyre very hightech and requiring Specialized Technology and Hospital Services so it is not quite ready for broad extrapolation. I think in the next few years sickle cells disease becoming one of those conditions that we can cure. And it would be unethical at this point, we are fine and could we figure out how to do this in a hightech environment. The interaction with a1c, the trait that lays out the data about a year ago. There has to be recognition of someone with diabetes or sickle cell trait. Thank you. Thank you so much. I was delighted to hear this morning the story on mpr about incredible advances that you did a good job dr. Collins on you know injecting a virus into the retina and potentially restoring vision. It is unbelievable. I know there are concerns and technologies after the chinese scientists did genes of babies last year. I wonder if you can tell me what steps nih is taking to protect patient and mitigate wrong doing as we continue to push the boundaries of science and medicine for amazing cures. This is an area of tense interest for all of us. Gene editing for many different diseases, the one reported this morning was the cause of blindness is one of the most exciting things thats happening right now. Those approaches approach a way to fix the spelling of a misspelled gene some where in the body but it does not get passed onto the next generation, it is nonhereditary. What happens in china was an intent to make this change in an embryo. We all agree thats utterly inappropriate at the present time. There is so much we dont know about that and so many risks and so many theological and consequences to begin to change our own instruction. We at nih do not support that and that kind of embryo manipulation. When do you expect that recommendation . W. H. O. . Probably in the next few months, sometimes during this calendar year, theyre beginning to close in on some sort of conclusions. Again, w. H. L. Has a challenge because they got to have all those countries signed onto it and there will be a draft. Certainly in this country thats not something we would do. At the same time there is all these promises. What we call is a sematic cells part, the eye or the liver or a brain for a child who has an untreatable genetic source. We have a whole program at nih trying to develop the gene apparatus to the tissue of where you want to go. It is one thing you want to do it in the culture. How do you send it to the right zip code and have the results happening safely and effectively. There is a lot going on in that space. For me whos a genesisist, there is 7 thousands waiting for some kind of solutions. This is a scaleable approach. We have to work hard to knock out all the barriers. Thank you. To my attention recently, 20 of cancer trials failed due to insufficient Patient Enrollment because there are barriers as restrictions on eligibility and access to transportation and etcetera, ability to take time off work. What efforts is nci under taking to enhance Clinical Trial recruitment and operations at Smaller Community sites that may not traditionally be engaged in clinical research. I think it is an important topic. It is sort of the whole foundation. We have so many trials and great ideas and cancer if we cant test them then we cant make progress. Fixing this problem is intense focus for the cancer suit. One big issue trials in prior era were designed done poorly. Requiring just a process that was bad. One of the things that has happened the last few years is focus on these kind of basket trials that can be done. The nci match trial, 6,000 patients at 11,000 sites. Providing a diverse population on the trial so it is really important and lastly i should mention we should have made a crusade to get rid of the arbitrary enrollment criteria and things like that. We are working with others and trying to make trials simpler and doable in the community. It is an area that we need to improve. Thank you so much. Thank you again for being here. I have three questions. Number one, i read a report study that women are feeling like doctors dismissing their complaints. I am curious of any research on sex discrimination in medicine. Number two is where i live in West Palm Beach seems like in the Entertainment District every other store front is selling cbd. Florida also legalized marijuana. I am curious whether or not there is any research to show either cbd or marijuana is medically effective and my third is back to my Grocery Store question on coronavirus. I know you are not touching your face but is it any part of your face and where is the germ going . Someone gets quarantine and how long can they be quarantined for and can there be repeated quarantin quarantines . Do you think this is a widespread issue in our country . Certainly with regard to maternal mortality, there is discrimination and womens voices are not being heard. Thats one of the aspects of the improved initiative that we want to address, thats the Community Based niche tiinitiative. We know there is infrastructure racism. We are including that as part of this overall initiative. Cbd and marijuana. We know there is evidence from cbd to be effective for helping to treat seizure disorder in children, tourettes syndrome. We also are interested in evaluating different types of addictions including opioid addiction. Does that mean research is being done . Research is being done both in animals and humans. Thc, information is limited. And for pain indications and otherwise the everyday is not very good in terms of potential benefits but researchers are doing work on ptsd. Back to the coronavirus. Touching your face. How do the germs get in you . First of all, you asked a question about touching your face. Public health ways to avoid getting coronavirus is similar to those getting influenza, washing your hands as frequently as you can. One of the problems of respiratory born diseases is they are spreading droplets and someone causing sneezes on you or you can be sitting someone closely and the virus can air slide. What it is it will get through a surface that could be your nose, mouth or eyes. The reason for washing your hands because people do the wrong thing. Thats why you hear we say cough into your elbow. Theyll blow their nose and shake hands with you and 15 minutes later you come by and do that and you touch your face, thats how you get it. Thats the way. Thats the first thing. Incubation period quarantine, the median time when you get exposed to get clinical symptoms is about 5. 2 days. Thats the median. The range is some where between 2 and 14. So when someone is suspected of being exposed, they either self isolate or be in quarantine for 4 days. You can have multiple selfquarantine. What if you get exposed and you stay home and you get exposed again you stay home. Do you have to stay home every time you areexposed . Depends on what you mean. If you are tested and you go into voluntary isolation, not necessarily quarantine. The only time you get quarantine is if it is clear that you have direct contact with someone. It could buy multipe multipl. Thats very interesting because when you go from containment which means to prevent things to spread to mitigation which means in the community distancing yourself socially. If it gets to the point where there is really widespread infection, if that ever happens you kpaekt expect it to happ our country . I cant predict it. Do you worry about it . I try to do things that can prevent it. Thank you very much. I yield back. When the vaccine is available, who gets it first besides my colleague to my left . The Standard Approach when you have a vaccine for influenza, we have limited vaccin vaccines. You get it to the most vulnerable. The most vulnerable are clearly the elderly and those with under line conditions and those are Heart Disease and chronic lung disease and kidney diabetes. So we are 18 months or so away from that, probably . Least. The other thing thats important is that the healthcare workers and those who are on the front line responders. Those are the ones in every disease we know that are the most vulnerable and in fact if you look in china, people who are most vulnerable before they have good epes with healthcare provider. Dr. Collins, following up on my interests in the whole issue of Health Issues and disparity impact of minorities. One of the things that i learn from Emergency Task force that we have on Mental Health and black suicides was that black researchers have not been having their Research Request considered and they been denied for reasons having to do with not communicating clearly, what it is you are looking at, the implications of community and outcomes or collaborations not necessarily recognizing the significance in our space with regards to that nature. One of the Institute Directors talking about was having more workshops and input from black researchers into what will be considered and who. What are things that we can do to ensure that researchers of this nature are getting an equal opportunity to do the research as important where the disparity that exists in the minority communities. This is an issue that we are looking at with great seriousness since it was documented years ago. Thats very disturbing to look at and many hypothesis of what may be involved. I think we have not completely sorted out all the reasons but we have discovered a number of them. Part of this issue does relate to the fact that often times africanamerican investigators may not have been a strong position putting forward of the lack of mentoring and lack of opportunities to be involved in network which may be a natural things for others or minorities not so much and we are working hard on ways to do a better job of mentoring Something Like the National Mentoring research network. We identify tl fa he facts ther different areas of research that minorities tend to migrate and Health Disparity is one of those. You can see why that is. Oftentimes is a passion. They want to work on understanding why their communities are not being as well served. Yet, it is clear that some of the resurgence goes on in that space does not fair as well regardless whether the applicants happen to be a minority or not. There are some action there we try to take. We still try to sort this out and published about this and we got a fair amount of attention and continue to do the analysis to see what else we are missing here. We are determined to figure this out. I am glad, we are interested in those things that impact individuals particularly because of the intersection of their gender and race and as well as the interests in whats happening with our children and Mental Health disparity and thing things of that nature. I thank you for the work that you are doing and i look forward for the work that you will be doing in the future. Thank you, i yield back. Thank you, we are going to do a kind of a third round here with threeminute. I want to let you know that i have been informed, i do not know what the dollar amounts are but it would appear that the house and the senate would have come to an agreement. We just got that notice and so well get out by dollar amounts and etcetera and etc. Again, wonderful. This is where we need to go. I am going to do my rapid fire piece here again. Dr. Gibbons, status update on commission of the disease. Nci, you talked about a lot of activities in the area. Tell us a little bit about whats driving the interests in Cancer Research because you have so many more. I would want to know at some point, maybe i will talk with you of where we stand with o Ovarian Cancer and finding a marker. Universal sack vevaccine, if we provide Additional Resources in 2021 if we can move to some success there. Dr. Collins, the niehs, past emergencies, they supported training for workehealthcare wo and etcetera, a quick over view of their training activities and recent Public Health emergencies, pandemic and ebola and how could they support what they need to do for this common covid 19 outbreak. Sta stay with status of the commission. Lightning realm. You hit on an important thats built in affecting women. We have established a task force that is focused on this issue certainly it is one where we spend of 20 million a year in that space along with many other icus contributing and more to that collective effort. One of the key areas is we are able to get single cell resolution characterization, one is the emphatic system, understanding that system on both the normal and human health and development as well as response to injuries and disease is fundamental to really getting to better treatments. We did encourage, a National Commission on emphatic disease, well pursue that. Nci, whats driving this interest . It is a good problem. All these people coming with great ideas. There is probably a lot of things. I think our low pay lines, the main one i think, really inherit one is exciting time in Cancer Research. I saw this at the fda like 30 of the business in terms of new a approvals. I see this in basic science and big pharma. I would be happy to follow up on it. Ovarian cancer and we dont seem to see a marker and we know how many women have died. We are making significant progress and as i mentioned last time the first in human phase one trial for University Vaccine for group one influenza went into Clinical Trial was successful and it shows to be safe and gentlemen of the juene. Well start phase one trial for group two. So we are really moving along quickly. By the end of the summer, well be able to go into phase two trial. Thats going to be important. Thats going to involve hundreds or if not a couple of thousands of people. Well need the resource that is you give us to be able to do that phase in trial. I assume some Additional Resources. Yes, indeed. That you will give us. Amen. Nihs has play a Critical Role in training, people can deal with outbreaks they previously worked with ebola, theyll step in this space, too. Airports and correctional facilities and hospitals. They do facetoface and run courses. You mention that we need some help in that, can we be instrumental and pushing for it . This could be factored into that because well need a lot of training for people who are not quite prepared for this. Thank you. I want to follow up quickly on the point you raise with dr. Sharp. A little more information. We have got obviously explosions as you pointed out for a variety of reasons. Are there some things we should do so that we dont leave good science on the table just because right now cancer seems to be a lane where a lot are happening in some areas. Yes, i think you know the probably the main thing to realize about this problem is not a one year problem. It is like a mortgage. Grants of four or five or six year budget pay. When we invest in the pool of grants today which goes up 3 or 5 every year of the last 5 or 10 years. And so you know that provides some hesitation on the part of the nci, if we invest today, we can have a real problem three years from now if we are not smart on it. The realization this problem is not going to be fixed this year or next year. We expect that well get these increase numbers of grants for a while because people generate a lot of great ideas. This commitment that you provided for so many years is what the doctors ordered for nci. I could not agree more. Dr. Collins, attorney general raised awareness threats posed by the foreign government, interfering with our research. Can you tell us your level of concerns on that and what you may take in respond . We are quite concerned. I talked tomike lauer spent twothirds of his time over the course of many months. First let me say that we greatly depend upon and value foreign investigators who are apart of our work force. The vast majority of who are honorable and hardworking and incredible contributors and one thing we have to be careful that even as we identify this as a serious issue that we dont extrapolate anything looks like racial profiling would be unfortunate and unmerited and unforgivable kind of approach. We have identified numerous examples, i am sorry to say on individuals who have been receiving substantial financial benefits from relationships with Foreign Countries and often china without disclosing that. It is a requirement that they do so. Like wise, we have instances for individuals who have shared grant applications who are not reviewed with colleagues and other countries to give them some kind of an edge on developing some new developments. We are serious of identifying those circumstances. You have seen in the press of some dramatic examples of some individuals who have been found egregiously. Most of the people you may see in the work force are honorable. Well be following up on at the moment, we have dozens of these they have been good partners with us and well keep our eyes on this and continue where we see the trouble is. There is a danger here that is put into place. None of us ever wanted to go. Thanks for having the focus on the problem but also thanks for remembering as you say most of the folks that are involved in this are serving humanities. It is a tough problem and i think you struck the right balance. Thank you madame chair. First of all, i want to thank all of our Ranking Members and panel panelists. I am fortunate to have people here leading the way. I am not going to say more super market questions but i just note that i touched my face so many times today that i am seriously very worried of the social Economic Impact of the potential of this virus. It is frightening and i am not going to get in it with you guys. I am going to ask you different questions. Specifically in florida and i know in the nation, suicides are a big issue. I saw something of a leading cause of maternal death, is that right . No . I am glad you said no. Ism curioi am curious not only Suicide Research but postpartum and depression research. I will start with suicide. Certainly suicides increase in many demographic areas are deep concerns. It is a growing problem in this nation. We are aiming to do everything we can to identify factors and particularly the predictor of whos at risk and what interventions may be and there are some of those such as trying to make sure people dont have access to lethal force for that moment where somebody makes a certain decision to end their life. I will say also in terms of treating the clinical depression, there is a Major Development that happens which is the development of this drug called katamin and not responding to anything else. Lifting in the clouds. Thats now being tried. If you can catch somebody before they take the drastic action and lifting them out of a hopeless circumstance. Thats one bright spot and it is a tough problem. Nichd is Funding Research and looking at postpartum women who are at risk for suicides. The difficulty of the postpartum situation is some of these women have no prior history of Mental Health problems. It is this rare issue where how do you know someone is going to be at risk. We are finding an investigator who someone is looking through electronic helper to identify certain clues in the record. A lot of pregnant women are depressed and they are taking antidepressan antidepressant antidepressants. We need to know if these are safe. We are doing research to show what is safe and what is not safe. We have a study called the cuddle study where women who are taking these medicines are donating their breast milk so we can see whats in their breast milk. Thank you very much. I would like to talk to you about endometrial cancer. I know cancers have shown a lot of improvement in the number of deaths for some time. The incident rate for black women in 2007 and continues to increase until this day. The incident have been more aggressive treating cancer is dramatically higher treating black women than white women. I wonder whats your plan and what are you planning in terms of funding Clinical Trials and trying to come up with specific therapies that addresses these disparities . I think are equally concerned by statistics that you mentioned. This is a cancer thats increasing mortality in the United States. Most cancer as are declining in mortality and particularly of a concern and why is it happening. We think endometrial cancer is partially related to obesity. Obesity is related to endometrial. Disparity is an area of active research between afric africanamerican women and other populations. So we have funded efforts of endometrial cancer. An area where we are devoting a lot of focus because of statistics that you mentioned. I yield back. Ranking members for final comments before we conclude . Thank you very much. Like many members, this is my favorite hearing of the year. We all marvel at your abilities of the work that you are doing and we all feel if you have been good stewawith the money. We all thank the American People and humanity benefited enormously as a result of those invest investmen investments. I am proud of the subcommittee and my chairman. I am proud of my colleagues on the other side and i have worked for years. I think it is critical that it continues. I am the first to say and i know my chairman knows this better than i do. This is going to be a tough year. We have two years of budget agreement, it is flat funding and if you look at some of the requirements and a couple of other departments theyre going to take money that we know, veterans i am thinking of in particular, my friend the chairman and her counter part are going to be confronted really tough decisions. I have discussion many years with dr. Collins and i use the phrase worrying in one of those years where we are robbing peter to pay paul. Somebody else is going to have to be the peter. It is the job of this committee. My friend chair and i commiserated over thmany years because there are a lot of wonderful things we agree on and a lot of things are national priorities. I think this committee has made the right decision over the last fiver years by making you the top priority in the bill every single year. I dont think thats ever been more dramatically demonstrated right now. How many questions do we have on coronavirus and yet there will be another coronavirus out there. I thought one of the most telling answers of the hearing when dr. Collins made the point that these past investments put us in a stronger position to deal with these current challenges. I thought dr. Sharp made an excellent point of the opportunity that we have in a particular area right now. Those opportunities come and you have to use resources that you have to take advantage of those openings. You have to make commitment to sustain themselves over years, the committees have to think whether to invest in infrastructure or thoughts in projects that takes multiyears to come. I thank all of you for the work and this committee on a bipartisan bases for its sustained commitment and i think madame chairman, the wisdom of that has been born out. I hope we can continue on that. I know if it is up to you and me, i know it would be contained. We are persuasive with our colleagues sometimes too and making a good team and dealing with our friends across the rotunda approaching of the many mindsets that we have for many years to come. Hopefully well continue this because we are rendering an enormous benefit to the American People. I child back madame cha yield b. Thank you very much in this subcommittee. This is always an extraordinary hearing. And it is a revelation. We have doctors on our community, dr. Harris and as far as i know the rest of us are not scientists and we are not doctors you are a Political Science doctor here. But we are about trying to grapple with issues about which we spend time studying and learning so that we can try to do the right thing. You do everyday in your life focus on the mission of the highest commitment which is to save lives and we get to work incorporatiin cooperation with you to make sure that we push the edge of that envelope, you do and we need to do that with the resources that is we provide you to do your work. I would just say this to my colleague that yes, you are paul but i always have and you heard me say this that i have to worry about peter as well in looking at that. I think you know where our heart and commitments are to make sure we go down the road. I would say one other thing, this is a committee working together which does not deal with gotcha. We are not sitting here to try to stomp you or make a political comment. We are here to get the best information and best advice so we can respond. And when some of the questions are hard and theyre tough, it is not for political purposes but it is to look at our public dollars and where those public dollars are going. We are so trustful of you. We cancel that and both colleagues and i and other members of this committee and as well as the committee across the isle. I am going to end on a humorous note, i want to make sure to stop hugging people. Thank you, the hearing is concluded. Thank you all very much. Our coverage of the coronavirus will continue this afternoon with the hearing on how airlines are handling the spread of the virus. Mark morgan is among the witnesses before the subcommittee along with the respiratory disease director. Well have live coverage of that starting at 2 30 eastern. It will be live online on cspan. Org or you can listen live with our free app. To follow the federal response to the coronavirus, go to cspan. Org coronavirus. Find all of our coverage including hearings, briefings, and review the latest events any time at cspan. Org coronavirus. Congressional negotiators have reached a deal on additional spending for federal coronavirus response. Senate Appropriations Committee Richard Shelby announced that question agreed to 7. 8 billion in emergency spending. The house is planning a vote on the measure later today