Our second panel will assess chinas role in Global Health and activities in the United States. We will start with rosemary gibson, introduce everybody first and then we will go to ms. Gibson. We will start with rosemary gibson, whose name has been mentioned already several times if you were here. Who is a Senior Advisor pasting Center Perspectives at the jama internal medicine. She is author china rx, exposing the risk ab next we will hear from ben westhoff an awardwinning investigative journalist mr. Westhoff new book retinol incorporated how roby chemists are creating the deadliest wave of the opioid epidemic. Will be published in september. The book focuses on that know with now kills more americans annually than any drug in american history. Our third panelist is jennifer buie who is a senior policy researcher and detained chair in china publicity stall is at the rain corporation. As an epidemiologist with training and clinical medicine and quantitative methods, doctor buie Research Centers on social determinants of health among marginalized populations. Finally, we will hear from mark awho is a scientist with griffin scientific, hes a molecular biologist with expertise in performing risk assessments to support government decisionmaking on issues of bio Security Public health and bio defense. He is also one of the authors of chinas biotechnology development, the role of u. S. And other foreign engagement report prepared for the Commission Published in february 2019. We welcome all of you, we ask that you would keep your remarks to seven minutes and ms. Gibson we will start with you. [inaudible] push the button. Good morning. Thank you senator how and all the commissioners for the chance to be here today. To talk about what has been a really hidden and overlooked threat to our National Health security Economic Prosperity and National Security. That is our dependence on china for medicine. As was discussed in the earlier panel, the medicines used by members of congress, president , members of the military, veterans and allamericans, these are the medicines body retail pharmacies and pharmacies and supermarkets in bigbox stores. The focus of my testimony today will be on generic drugs because they are 90 of the medicines that americans take. We can no longer make penicillin. That happened in 2004 when the last plant in the United States closed and that happened, this is indicative of the predatory trade practices happened when a handful of Chinese Companies dumped the Chemical Material to make penicillin on the Global Market. It drove out u. S. European and even indian producers. Then after it gained dominance, prices went back up. Thats the playbook that we see the same practice with the vitamin c cartel is emblematic of how he lost the capability to make so many core core components in our medicines. This playbook will extend to finish generic drugs eventually. In 2001 after the anthrax attack when the u. S. Government needed to buy 20 million doses of doxycycline, we dont make it here. The United States turned to a European Company that in turn had to get the starting cereal from a plant in china. I have four main points and that will highlight for recommendations. The first is our Industrial Base to make our medicines, its collapsing. We have virtually no manufacturing capability left in the United States to make generic antibiotics. These are the medicines you give to your kids for ear infections, strep throat and we are talking about also superbug treatments and last resort antibiotics. In 5 to 10 years we will have virtually no manufacturing capacity left generic drugs. This is 90 of our medicine. Second point is, chinas dominance is global. In february Dutch Public Television aired a documentary reporting the netherlands dependence on china for medicine. A former industry officials said on camera that they are concerned that china may not supply the medicine. As mentioned earlier, even india is dependent on china for 80 of the key ingredients it needs for its generic industry. When you control the supply of medicines, you control the world. Thats what we are looking at. We are losing control over the supply of our medicine. When we lose control over supply, we lose control over quality. Thats why we have Blood Pressure medicines with carcinogens in them and we can go into this more later in the q a but the fda cannot fix this problem its already in the position of having to make trade off between effective medicines and shortages. We lose control over supply we also lose control over price. China will be the price center and will be the price taker and members of congress will not be able to take in ceos of Chinese Companies and not asked them not to raise prices. The National Security risks are pronounced. China could withhold supply. It could put lethal contaminants in medicine or have no medicine at all and i do believe its in the realm of possibility to target certain subjects having access to medical records and distribute products to certain subjects. The most surprising thing i learned from reading china rx from working in china rx is reading it again it took three years to do it, its no ones job in the federal government to know who controls the supply of our medicine. We wouldnt do that for oil, we wouldnt do that for food, we considered our medicine as a cheap commodity to be purchased at the cheapest possible price. Thats the root cause, thats what needs to change. I have four recommendations that i will highlight. First is we need all goal of government review of our vulnerabilities similar to the defense Industrial Base report that was done for the dot i looked at that report senator, i didnt see any mention of medicines outside the dod purview and understandable i think we need a whole government review thats ongoing and identifies our borno abilities and recommendations for how we can rebuild our Industrial Base. I believe the dod and va should have the flex ability to purchase medicines not at the cheapest place but based on value. Right now american taxpayers will be shocked to learn that their hard earned money is going to help build chinas generic industry as our domestic industry collapses. Third, there is tremendous opportunity with advanced Manufacturing Technology to make active ingredients here and finish generic drugs its been done on a pilot basis for generics we need to take that to commercial scale it could revitalize communities economies around the country and finally, im sure you are aware of the africa swine flu thats devastating the pig population worse than what it was 12 years ago when we had the heparin contamination that killed hundreds of americans. One of the recommendations i have in my testimony is that the committee on Foreign Investment in the United States review the purchase of smithfield by a Chinese Company not so much for Food Security but for our National Health security and thats because pig intestines are rare earth of our healthcare system. I have 28 seconds left i will leave that to you and i look forward to your questions and comments box you are yielding back to 28 seconds, thank you for that. And for your testimony. Thank you senator tallon, the u. S. Opioid crisis began with the over prescription of pharmaceutical opioids like oxycontin, when users prescriptions ran out many turn to street heroin. Now the crisis is entered its third wave led by fentanyl. Fentanyl was already widely used medical drug but illicitly produced fat no is mainly abuse today. This fentanyl is mostly made in china and sent directly to u. S. Consumers through the mail or funneled into the country by mexican cartels. U. S. Political leaders have harshly criticized china for allowing large quantities of centennial, fentanyl analogues, fentanyl precursors and other new drugs called novel psychoactive substances or nps to be smuggled into america. In response, china has pledged strong action to stem the tide. However, my deep reporting and research for my new book shows that china has not been acting in good faith. I will explain. A critical part of chinas rapidly growing economy is its sprawling chemical and pharmaceutical industries. Most companies produce legitimate chemicals, some make illicit ones and others are in between. Reforms have been promised but inspections remain sporadic. Chinas clumsy understaffed bureaucracy involving at least eight different agencies as difficult time controlling these industries. Thus dodging companies that keep their heads down can operate without problems. Many chinese officials dont seem to fully understand the laws governing the manufacturing sales of these chemicals and companies manipulate the legal gray area to their advantage. At the same time, china encourages these industries for lucrative tax incentives and subsidies. These incentives have undoubtedly driven legitimate innovation and exports but the rise of fentanyl and nps has been a terrible side effect. Quietly, money has gone to Chinese Companies exporting deadly drugs that are killing tens of thousands of americans annually. For example, china designates Certain Companies as new and High Technology enterprises. Which helps these companies, including those exploring dangerous drugs to the u. S. Receive lucrative incentives. Also exploited are various programs administered by Chinas Ministry of science and technology. Chinese companies showered with these type of government benefits include one called longchain. Based out of the city of wuhan. He receives them even while by its own admission it sells ingredients to make fentanyl, precursors all over the globe including the u. S. Its possible that Chinese CommunistParty Officials dont realize this is happening. Then again its possibly they do considering the chinese tax code directly encourages the export of these drugs through reimbursements called the value added tax rebate or vat rebate. Not every exported chemical gets yvette rebate but thousands do, including fentanyl, other fentanyl analogues not used for medical purposes anywhere Synthetic Cannabinoids and anabolic steroids. The u. S. Says stemming the flow of illicit synthetic opioids and other nps from china is a top priority. China says it shares this commitment. Indeed on may 1, 2019 china scheduled all fentanyl analogues including those not yet created. China has difficulty enforcing its drug laws but this is the most farreaching and potentially significant type of action china has taken in its realm. There is much more the u. S. Can do can stem the flow of these drugs from china. My first suggestion is pressuring china to eliminate tax rebates, grants, and subsidies to Companies Making and exporting these dangerous chemicals. It makes sense for legitimate Chinese Pharmaceutical Companies to receive that rebate for exporting fentanyl for medical use. But its outrageous that china offers these tax rebates from any other fentanyl analogues that are illegal for chinese manufacturing export. China also needs to eliminate incentives given to these companies by the ministry of science and technology. My next suggestion is that the u. S. Schedule a more fentanyl precursor and pressure china to do the same. Making fentanyl from scratch is a complicated process. But making it from precursor to the fairly simple one. This is the process favored by mexican cartels who usually employed the precursors from china. Yet currently all but two of the known fentanyl precursors are unscheduled not just in china but in the u. S. And worldwide. The u. S. Should also pressure china to allow the dea and the fda to do their work. Chinas pledge to control fentanyl analogues are meaningless without enforcement. Its not just the american agencies, however, chinas own drugs and medicine regulating agencies need to be properly staffed and funded. My final suggestion is that the u. S. Should do more at home. China believes u. S. Demand is driving the opioid crisis. Indeed predatory tactics by u. S. Pharmaceutical companies and failed policies here have helped create the Worlds Largest market for opioids. Therefore, even if china rains in its Rogue Industries if american demand for these drugs is not subsided production will simply shift to other countries. Promoting Harm Reduction measures is critical. Advocates of Harm Reduction leave drug use is inevitable and that we must work to make it as safe as possible. I suggest much increased funding for medication assisted treatment for addicted users. In addition, First Responders and others to encounter overdose victims should be better supplied with no oxen which should be available and affordable to everyone. Users need better access to drug checking kits. These are inexpensive tests that inform users whats actually in their drugs and can detect fentanyl. Studies have shown these tests save lives. Also critical is overturning the illicit drug antiproliferation act of 2003. Known as the rave act. Which effectively inhibits concert organizers from allowing drug checking at their events and festivals. Information campaigns about nps are also critical. Especially when it comes to children. Parents in particular need to be properly educated. They need to believe that an overdose can happen to their kid because it can happen to any kid. Thank you. Thank you. Doctor buie, am i pronouncing your name correctly . Buie, thank you. Go ahead. Senator tallon, commissioner wetzel and distinguished members of the u. S. China economic and security review commission. Thank you for inviting me to testify before you the chinas activities on Global Health. The testimony will have three sections, first i will give a brief overview of chinas Global Health assistance activities and their motivations. Secondly i will summarize u. S. China collaborations on health and their differences in the approach. Lastly i will give some recommendations. Chinas current Global Health assistance can be grouped into five categories. Chinas medical team, their hospital clinic constructions, medicine and medical equipment donations, Health Related humanitarian aid and Disaster Relief programs and Health Professional training programs. The Chinese Medical Team and Hospital Construction have the longest history. Dated back to 1959 china built a tv hospital for mongolia and back in 1963 they dispatched their first medical team to algeria during the war. Over the past years, china has built more than 150 hospitals dispatched more than 25,000 medical professionals to 69 countries. These activities help to fill and some of the gaps when there is a severe lacking of Health Professionals and the basic Health Infrastructures in resource support areas. More recently china has suppressed the Global Health community with its timely and unprecedented response to the 2014 and 16 ebola epidemic in west africa. Chinas donation of the antimalaria medicine and vaccines has also peaked during 2010 and 12. Even though chinas Global Health assistance activities often overshadowed by the western Development Countries activities no one can deny the significance of chinas fast transformation from a major recipient of foreign aid to a critical provider of the resources. When they ask why china is scaling up its Global Health activities in my opinion i put into three reasons. First china felt they had something unique to offer, developing country not long ago they were in the same positions as the recipient countries now. They believe that chinas success in domestic Public Health can be easier translated into other developing countries. Secondly, like many other countries in this area of globalization china realize the impact of pandemic on the national economy. In 2003 acaused china ba interrupted International Trade and productivity. In 2016 the first case of yellow fever was diagnosed, this is the first case in asia was diagnosed in beijing. The patient was a chinese migrant in africa. At the time when they were over a million chinese migrants in africa and over 100,000 african in china china wants to strengthen its pandemic preparedness capacity and protect its own Economic Activities and investment. Lastly, china is always considered a Global Health assistant as a soft power and wants to be a part of the global governing. So what are the u. S. China collaboration on