Hazards preparedness act. I will collect all hazards preparedness act, that makes it better for me. Fromaw helps protect us the full range of Public Health threats. Then in 2013, senator burr and , senator casey led the authorization. Many members of this committee some are still on the committee. Now, the bill needs to be reauthorized for a second time. Todays hearing is the second we have had this year. Last week, we heard from the oninistration recommendations in advance of the reauthorization act, including the secretary from preparedness response, the food and the administrator centers for Disease Control and prevention. The middle of the flu season, it is critical that we reauthorized the act before many of its provisions expire in september. I hope will do this in a bipartisan way, and i expect that. It has been tradition with the law and this committee with all of our major bills. People are not as aware of the devastation of, for example, flu, and they mentioned the flu season. I think the figures are between 12,00050,000 americans die of flu every year. Dr. Collins has talked to us about expediting a universal flu vaccine which he sees soon. Tennessee has seen heartbreaking stories already this winter as the flu spread across the state and country. In our state already this season, a pregnant woman and three children have died and tennessee of the flu. The act provides a preparedness framework that enables us to be prepared and respond to Public Health threats by ensuring we have enough medicine to ensure americans and to ensure our Health Services can respond to Public Health emergencies. Thanks to all of our witnesses were here today. Thank you. This morning we are holding a hearing entitled facing the 20th century threats. We will hear from the director of the center at John Hopkins School for Public Health. Commissioner of Tennessee Department of Public Health. President ande cochair of the alliance for bio head of and the pediatric emergency medicine at Childrens Hospital. Senator casey and i will have an Opening Statement and then we will hear from witnesses. Members will have up to five minutes for questions. I am pleased to chair the second hearing to inform our work. Id like to thank the chairman for giving the opportunity to senator casey and i to lead that discussion. Today we will hear from individuals with firsthand knowledge. Since the last authorization, the Emergency Response framework has been tested by the emergence of pandemic flu, multiple Natural Disasters, and ebola breakout and the zika virus. The Lessons Learned from these events come from individuals like those sitting before us today, and their efforts to protect and to save lives. The last Hurricane Season resulted in three major storms, devastating many communities and raising questions about our ability to withstand multiple periods of response. The instances of zika showed us the need for more protections for as many mothers and babies as possible. The ebola breakout in 2014 highlighted the need for knowledge of the potential damage that can be brought by these threats and a deep understanding of the effort undertaken for research, development, and procurement of medical countermeasures. I look forward to learning more about the opportunities and barriers each of you see to better Leverage Innovative Technology to solve these problems. Whether it is information crucial to the Public Health department and myths of a crisis, the infrastructure of needs to rapidly care for patients are improvements in the way these policies complement one another, your experiences reminds us we cannot let up on these efforts or lose sight of the urgency this mission demands. We must not get distracted by making changes to the laws that are outside of our focus of protecting the public, improving and strengthening our policies and programs to make them more effective now and in the future. I look forward to the inside each witness can provide, and i will now turn it over to senator casey for any remarks would like to make. Sen. Casey thank you for joining us today. The give for this opportunity. I also want to thank our witnesses for breaking their experience and work to these issues and for joining us today. This is our second hearing on and the focus is our nations preparedness to combat Public Health threats as we look towards reauthorizing the pandemic and all hazards impairment procurement act. Now more than ever we must rebuild our nations resiliency to help security threats. The threats that face our nation today are increasing in both frequency and intensity. It is critical to foster an advanced innovation and drugs devices. Yet, when we are considering any merging Infectious Disease or in engineered bio weapon that is yet to be seen by man or the response to a Natural Disaster like a hurricane, we do not and will not have a vaccine or countermeasure to protect us from these scenarios. So in addition to supporting biomedical innovations, we must also strengthen our hospitals and our Public Health professionals, our front line of defense against these health threats. We must ensure we get our communities the support to be ready when, not if, the next emergency strikes. While accounts, we have come a long way. I spoke at the last hearing about the success of hospital preparedness programs, hpp. The Public HealthEmergency Preparedness program in the context of a Train Derailment in pennsylvania, and of many examples we can cite. Programsnts for these also facilitate preparedness activity that help hospitals and Public Health systems with more regular occurrences. When subzero temperatures cause bursting pipes in st. Vincent pennsylvania,ie, and they got hit with worse than any place with snow. The hospital got in contact with emergency and the Health Care Coalition created through hpp funding. Responsested in the that circumstance, and yet, the funding for these preparedness grams have decreased from appropriations falling behind authorized levels, spiking only in the response to ebola and zika. In the amount of time that hospitals and medical staffs have to plan and train for an emergency. The loss of thousands of public inlth jobs, the reduction emergency managers, and Public Health lab technicians. It is very dangerous to wait for a threat to emerge to pass Emergency Funding bills. Proactive, not reactive. So how can we improve our Health Care System preparedness and Public Health capacities and thereby improve our Situational Awareness in an emergency . Can work towards a precision Public Health using baiter data better data to guide and help emergencies to benefit our communities . I think we can. As reported by the publication, nature. The entire country whence igo struck was not considered at risk. Showed to atnce miami county. This allowed for targeting of resources to these regions. Building on that experience, we can expand surveillance to eliminate causes of disease and spark opportunities for prevention. Week, at last weeks hearing, we also heard from assistant secretary about the to of empower Program Identify at risk individuals requiring electricity dependent medical assistive equipment. Yet, he also identified a weakness. This system only pulls in medicare data, not medicaid and try care data. So how do we ensure that we are acting on the data appropriately to protect these moldable individuals . Seniorsic death of 12 in a nursing home during Hurricane Irma september highlights that more needs to be done to protect our most honorable citizens. In fact, most of our citizens have additional characteristics that make them more vulnerable during a Public Health emergency. This includes our children, our parents, our rural communities, individuals with limited jewish proficiency. Individuals with disabilities, and individuals with chronic illnesses, and more. We must do better to help our communities about potential Health Security threats, and we must invest in innovative biotechnologies, and what must also improve our nonpharmaceutical interventions. I look forward to the hearing, the witnesses testimony, and how we can continue to prepare our hospitals and Health Systems to ensure equal consideration of all of our constituents. Senator, thank you very much. I am pleased we have our fort when this is here today, and i thank you for taking your time to be here today. I would like to introduce all four. The doctor is the director at john hopkins, and his recommended as his work as a writer with numerous publications focusing on public pandemic,paredness, and emerging Infectious Disease. As was the prevention of and response to biologic threats. Im turn to senator alexander for an introduction. Dr. Ould like to welcome john dreiser who is the tallest commissioner of health in our history, maybe in the country. He served as the commissioner of Tennessee Department of health yes men cant express responding to state and local Health Department agencies, including Infectious Diseases like cigar, and Natural Disasters just wildfires that devastated eastern tennessee in 2016. Insightswill provide about fairness at a state and local level, what is working, where we can improve, where we can save more lives. The doctor is a professional with more than years of Service Coming he helps protect his community, and i appreciate his leadership in tennessee, and we welcome them to the committee. I am sure if you were a little younger, there are a couple of tennessee basketball teams will recruit you tomorrow, given their record this year. Next, i would like to introduce mr. Mcgregor. He is the Senior Vice President for commercial operations. The second largest Vaccine Company in the world. Darren example of the success that can be achieved through Publicprivate Partnerships to ensure we are better prepared for the threats that face us. They are based in North Carolina, and are part of three advanced manufacturers in the country in the event of a pandemic, flu outbreak. He is also the culture for the alliance of bio security. Promotes critical partnerships between the government industry and other stakeholders to advance and encourage the development of medical countermeasures. Dr. Steven krug is the head of pediatric emergency and the Childrens Hospital in chicago. Is also the professor of pediatrics at the lemberg school of medicine and serves as the chair of the American Academy of idiot trick disaster Advisory Council. Dr. Krug, welcome. Advisory disaster council. Think you for the chance to speak to the on these important issues. Healthe director of security at John Hopkins School of Public Health where im a professor of Public Health. Our mission is to protect people from disasters and to rebuild communities. Ill provide key areas that might colleagues and i consider vital response capabilities. The opinions expressed are my own and dont reflect john hopkins university. There is a range of Public Health threats that can occur without much warning. These include Natural Disasters, bombings, shootings, nuclear threats, and biological threats. Whether theyreats, are viruses in china, were accidental, such as a viral strain released from a lab, or deliberate like smallpox and anthrax, and that is a big focus of my comments today. Biological threats can reach from modest in size or could pose as global, catastrophic threats. First, we need to strengthen the Health Care System preparedness. That is the capacity to care for high numbers injured in emergency. Progressstantial prepared for disasters in the country, the nation is not ready for medical care in large catastrophes. Or age 50,l program, has been funded at state and local levels, but Significant Resource constraints limit wage what hpv can do. That trend should be reversed. A new initiatives could be a strong additional component in improving medical preparedness. Second, we need and the ability of our Public Health system detect and respond to threats. Since thousand one, there have been serious efforts in state and local levels to provide Early Warning of outbreaks, provide that agnostics, make it to the public, and sure biosafety in bio security, and much more. Theres too much to you and not enough professionals to do the work. Public health relies on Funding Grant funding. By 30 been reduced since 2002, even though public crisis have not declined. In addition, i believe a Public HealthEmergency Fund should be established which allow rapid Public Health response funding and emergencies. To move ahead in medical countermeasure development. There has been good progress, but many parties remain, including sustained funding and manufacturing of countermeasures. Flu vaccineg new technologies, and setting up more ambitious targets in emergency so that they are ready the course of a given pandemic or epidemic. Fourth, the u. S. Needs a recognized that that could emerge from biological research. Research was lifted last month researchers can now apply for funding to study, for example, ways of making the worlds most flu,l viruses like bird respiratory Transmission Oil like season flu. Ofcould be accidental strain a virus that could cause an epidemic or pandemic. I dont believe the benefits of this work are worth the risks, but if it is going to go ahead, i devised theres be high transparency in the program answer is dialogue concerning governments in how to proceed. Finally, we should fund the in security agenda 2014, the u. S. Launch the program with a billiondollar commitment to help countries prevent, detect, and respond to infectious threats. Dc has been the c working on programs to help forces,en Public Health and much more. At this point, the funding is ending soon. Of a pullout, other countries will do the same. We should continue to support it, it is the most Effective Program we have to contain international operates at their sources overseas. Improving our nations preparedness capacity is a complex and ever, but it is an achievable goal if we focus on these efforts. I welcome your questions. Good morning. Distinguished committee members, think rick thank you for this opportunity. A strong, agile, and resilient Public Health and medical preparedness response system, it is an honor to be here. Im the commissioner of health in tennessee. The thoughts i will be sharing with you today are my own, but i am confident it will be shared by my colleagues across the country who strive every day to prepare to respond to any threats of all kinds. These threats can be outbreaks just measles, foodbornecountry o illness, or seasonal influenza. Readinessur responses , these threats can also be largescale, international, or global events. The ebola, zika, epidemic, or act of terrorism area of ehealth during naturalis disasters, storms, tornadoes, floods, wildfires, and other extreme weather events that unfortunately seldom there is a jurisdiction of any size that experiencing. As well, through mechanisms like impact, even unaffected jurisdictions are called upon to assist neighbors. Public Health Response and recovery is responsibility discipline, and service that we have to get right. Economic health the pen on it, it is something we do every day, it is a matter of local resiliency. All disasters play out locally, and it is also a matter of National Security. I like to share my perspective with you and how i have been directly involved the planning, and the limitation over 25 years. I start with a simple question, what is health and emergency medical preparedness . At root, it is people. Shelters dont staff themselves. A fire truck cannot put out a fire without firefighters. And people cannot be hired and trained after the alarm sounds. They need to be there and ready to go before the fed emerges in order to respond to it. Preparedness is about people responding to interconnected networks. To truly be prepared, we need three things, one is to train people. Two, expertise and leader