Pandemic. We follow the advice of the attending physician and the sergeant of arms that were seated at least 6 feet apart. That means theres no room for the public or media here, but the media is participating we hope. And we hope the public is as well. Our website. Our witnesses are participating by Video Conference which is change for the United States senate and a welcome one because it makes it possible for us to attract witnesses to have busy schedules on the same day such as today some are participating by Video Conference senators may remove their masks since we are great thank yout a part to the press gallery and the architect in the capital police, Committee Staff for all their hard work to help keep us safe. Senator murray and i each have an Opening Statement then we will turn to our witnesses we think for being with usfoo today we ask that you summarize your remarks and five minutes to have time for the large number of senators we expect to iparticipate we will have one round of questions for five minutes. Less than four months ago marc march 1st, coronavirus situation at the end of february there were 79000 cases around the world only 14 in the United States except 39 who had been brought home from overseas with the virus. By march 2nd there were two deaths in the United States by d when we had a hearing there were six and on march 1st on sunday the New York Times on the front page it said this, most experts were far from certain that this virus would carry to all parts of the United States and that with the top notch scientists modern hospitals and sprawling infrastructure most experts agree the United States is among the countrys best prepared to prevent or manage such an epidemic. Even six weeks after the first virus was found in the United States, even experts underestimated the ease of transmission and the ability of this coronavirus to spread without symptoms. These qualities made the virus, virus, my Worst Nightmare in the words of doctor fauci. In a period of four months it has devastated the world. This committee is holding this hearing today because even with an event as significant as covid19 memories fade and attention moves to the next crisis while the nation is in the midst of responding to covid19 United States congress should take stock now. With parts of the local and federal state response what can work better and how and how be prepared to pass legislation this year to be better prepared for the next pandemic. On june 9 i released a white paper outlining five recommendations for congress to prepare americans for the next pandemic. Number one, test and treatments and vaccines to accelerate research and development. Number two, disease surveillance to expand our ability to detect identify a model and track Infectious Diseases. Number three, stockpilesy t three, stockpiles, distributions and surges to rebuild and maintain federal and state stockpiles and improve medical supplies Surge Capacity and distribution. Number four, Public Health capabilities, improve state and local Public Health capabilitieser and finally , whos in charge . Improve coordination of federal agencies during a Public Health emergency. I have invited comments and any additional recommendations for the Senate Committee on Health Education to consider i will share the feedback with my colleagues on the democratic and republican side. This is not a new subject for any witness we have today 15 years ago than majority leader bill frisk said at a speech at the National Press club a viral pandemic is no longer a question of if but when. He recommended what he calls a six. Public Health Prescription to minimize the blow surveillance, antivirals, vaccis Surge Capacity. He is one of our Witnesses Today and i am including in the record two of his speeches. Our next witness serves as chief medical executive and chief Deputy Director for health at michigan depart on the department of health and Human Services to helps to work coordinate the states response to covid19 third serving as director of the cdc under president george w. Bush , she has helped to lead the preparedness efforts in response to sars and west nine oh virus h1n1 and the rise of multi drugresistant bacteria like merced. Governor of utah and secretary of hhs and administrator of the epa under george w. Bush following the emergence of the avian flu he left into focused on pandemic preparedness. And he said this 13 years ago the only thing we do have one before pandemic is alarms everything after pandemic we see an adequate thats the ngdilemma we face but that should not stop us from doing what we can do to prepare. Congress has passed legislation to prepare for tpandemics befor before, during the last 20 years for president president s, clinton, bush, obamd several congresses have enacted nine significant lives to help local and faye is and then including a Public Health emergency including a pandemic. 18billion to states and hospital preparedness systems were provided over the last 15 years to help them prepare as well. Congress considered many reports from president ial coomscommissions and inspectors general and gao and outside experts. The reports contain all sorts of warnings that the United States and those issues that are familiar by now im better to change the capacity and quickly and with that public Care Workforce and then the systems to share information within and between states and the federal government. They also report that while states play the lead a role , many states do not have enough trained Healthcare Professionals and had an adequate stockpiles and struggled with funding challenges and the over reliance of inflexible federal funding could contribute to these problems. Looking at Lessons Learned from covid crisis many challenges they are working to address the last 20 years still remain and additionally covid19 has some gaps that have not been those that are instead of drugs that is necessary instead of covid patients. Four months ago we were in the midst of the impeachment of a president now the seems like ancient roman history and makes it imperative they make these changes thiss year to better prepare for the next pandemic i look forward to hearing from the witnesses and appreciate the feedback we are receiving on the white paper said he deadlines of the committee has time to consider it and to draft and pass legislation this yea year, senator murray. Thank you mr. Chairman and oliver witnesses for joining us today i have said before we need to understand exactly anything that has gone rent long long long to our response to cove in 18 is to make sure we are never in the situation again. Went to be absolutely clear how we prepare for the next crisis is no substitute for responding to the crisis at hand to kill 120,000 and continues to spread. Unfortunately the white house is that President Trump has been fading even though there are record increases the Vice President wrote the oped to say we are winning the fight and there is not a second wave the doctor fauci said we are not even first through the first wave yet and those that slap and you so we dont have anything close to testing and any kind of capacity that we need to safely up in our community. Not just officials in the white house sticking their head in the sand leader mcconnell has suggested there is especially after losing 20 million jobs. Even to some of the younger students how that manifested. I hope we dont just spend our time but during this one and once they are risk of repeating because covid19 continues. One lesson we have alreadyh learned this is no gray of course and people with disabilities and so many others. We have known for decades and some are much worse than other especially communities of color that is alarm history of systemic racism and underfunding and those in charge have a responsibility to acknowledge the problem and give everything they can to close the gap. This administration has not taken that responsibility seriously. They turn a blind one a blind eye to the problem. But with the national and universal sick leave policy. So workers can stay home and do whats best and we learned howng important and they need to stop dragging their feet it and immediately checking the standards. Several lessons we need to apply we cannot allow the Trump Administration to bungled is like to have elsewhere. And that we can widely produce and distribute to everyone. When it comes to developing a vaccine we dont just need a fast process but a thorough andbl transparent we need to know its especially after hydroxychloroquine debacle. And with every light on for so long in l. A. Now to be as transparent about the Vaccine Development and the data to evaluate we also how it would everyone even that incomplete on incomplete data we have shows black latino and tribal communities are disproportionately impacted by cove in 18 and have significantly less access to testing than white communities. We cannot repeat this when it comes too vaccine and then what that caused by refusing to take responsibility for resolving coordination problems in the supply chain. To draft and release a comprehensive covid19 vaccine that type of comprehensive plan we still dont have comprehensivela testing. How do we fight this information how do we strengthen the immunization infrastructure to ensure it is ready to face the unprecedented challenge . And then to the people directly into harms way. Our nap waiting. Thank you senator murray. Each witness will summarized in a statement in five minutes and have more time for questions. I welcome the witnesses. Its a distinguished panel we look forward to hearing from each of you. Its my privilege to introduce the first one, senator bill frist. He represented tennessee for two terms in the senate and House Majority leader owas themajoritd States Senate and serve on this committee. Heart Lung Transplant surgeon by training first practicing physician to serve in the senate since 1928 and now serves on several boards including the Robert Wood Johnson foundation, senior fellow with the bipartisan policy center, chairman an founder of the health national. In 2005 and sure he would talk about this, he gave many speeches on the Global Pandemic and the importance of preparedness. Ive submitted two of those to the records during the committees may 7 hearing. Next we will hear from the chief executive and chief Deputy Director for the health of the Michigan Department of health and Human Services. In this position, she oversees the Population Health medical services aging and Adult Behavioral Health and Developmental Disabilities administration for the state of michigan. With extensive experience in state and local governments prior to the current role she served as director and Health Officer for the Detroit Police department. Shes a practicing emergency medicine physician. The third withth mrs. Doctor jue executive Vice President and chief patient officer at merck co. And serves as a cochair of the commission on strengthening American Health security at the er for strategic and international studies. She served as the director of the centers for Disease Control cdc from 2002 to 2009. Under her leadership, cdc coordinate preparedness efforts in responses to several Public Health threats including west nile virus and the avian flu. She played a key role in the cpc response to the anthrax attacks of 2001. Senator romney will introduce the final fitness. Thank you mr. Chairman. Ii am happy to introduce my friend, mike levin who is most responsible for moving me from the golden chains of the private sector. He got me to leave my position and as such he was my boss and since then has become a dear friend. When i was running for president to lead my Transition Team im not sure i would have been a great president but i would have had a greatat administration because he put together an Extraordinary Team and laid out a pathway to help the country in numerous. As youve indicate you indicatea three term governor of utah and in the Bush Administration he served as the secretary of health and Human Services. One of his priorities was to focus on pandemic t preparation. He secured some 7 billion in the ring with the administration to prepare for and ask. Since leaving the government, he founded a the premier Healthcare Consulting firm in the country with hundreds c of employees unr his management as well as a private equity firm that he has built. Its an extraordinary record and he continues. My friend, mike levin. Now we begin with senator frist. Good morning chairman alexander and Ranking Members of the committee. Its great to be back and to see so many old friends and colleagues. In preparing for the inevitable biological Infectious Diseases that absolutely will come in the future. As you mentioned december 82005 at the National Press club i said in the same speech i gave in this body 15 years ago and repeatedly across the country i said its no longer a question of if but a question of when and i even said it would come from china at the time. As a physician with the Senate Delegation during the pandemic of 20,031st claimed to the patients responding to the anthrax attacks that was chris who clear then we were woefully unprepared for what was to inevitably come. Theres the Manhattan Project plaprojectplan of the century te the nation and during my time in the senate we laid the foundation and subsequently as you outlined, weve done more but this wasnt enough. Most of what i recommended in 2005 remains undone so i used the same categories i used in the communication weve got to clarify whos in charge of the emerging pandemic and only then would be consistent to beco coordinated response must be led at the National Security Council Level to facilitate the whole of wvernment approach. They should retain the position as the nations political voice of health. We must modernize the realtime domestic and international for protection system. At the federal level with the testing and reporting across the country we must engage globally diplomatically and economically an outbreak anywhere in the world is a risk everywhere. Its a risk to every community in america. The ability of the developing nations will be inextricably tied to the Public Health, infrastructure which is vitally dependent on the u. S. Support. They must establish Public Private partnerships with industries to be sustained. To serve as a control tower function. As i said then and now Research Development i called for the massive investment to create a biologicallybased manhattan help better defend us against the naturally occurring personnel were accidental or intentional bioterror threats including Infectious Disease. Categories of stockpiling without pursuits. The federal government should take the lead serving as the overlaying simple repository with a well structured Surveillance System that would track outbreaks to ensure that supplies are distributed where the risk is greatest. I ago the recommendations and we must make permanent the majority ofma the changes to unleash its power of the virtual care delivery in america. In certain areas publichealth funding in the vulnerable populations but for the past 25 years i conclude like the Armed Service we must have predictable consistent base funding for the Public Health security programs. Health security is National Security so lets treat it as such to advocate for the specific Health Defense authorization budget designation. This would [inaudible] and last week for both of the populations Health Equity in any pandemic preparedness response leads to comprehensively considering the care for the most valuable here at home and globally. I would encourage the committee to underscore this connection between the health of the most vulnerable and the security of those at home especially as you soon consider Global Access to immunization. Thank you for having me today, the work your you are doing nol literally save lives in the future. Thank you, doctor. Thank you for the opportunity to speak with you today on how we can prepare for the future pandemic. And at least 61,000 killed over 5800 adults and children in michigan and a the peak in april they identified over 1500 cases and 180 deaths each day. At the work of the local Health Department numbers have declined by more than 80 . Let me be clear this isnt the times for victory. Its still present in michigan and across the country. We cannot let our guard down. More than ever theaters must be focused on protecting communities and addressing the Public Health infrastructure. The greatest tragedy is how its ravaged communities of color. We should be one of the first states to release the data. Just 14 of the population represents 31 of the cases and 40 . To michigan. Ique disparities cannot be explained by genetics. They exist because of racism that has deprived communities of color of resources and opportunities. Indeed its a publichealth pubh crisis that must be met with urgency. If we care about the health of every individual in the country im not sure if the access at no cost. Consistent and accurate messaging from highest levels of the government and as an emergency medical physician and leader i rely on swift guided from the leaders during the crisis. We need accurate and clear messaging from the white house about the truth, how and when to get a test and the importance of Wearing Masks andg social distancing. Next, we must develop a testing strategy infrastructure. As a country we didnt expand access to the testing to the cases quickly for tragic consequences. There are 250 testing sites and have the capacity to do more. Im grateful for the support of the partners and supplies they have received. We worked nonstop to ensure testing materials and a National Procurement and testing strategy would have prevented and local governments from competing with each other and avoid some of the most outrageous realities of the pandemic. Turning people away who should have been tested. Finally at the federal, state and local level more than 25 of local Public Health officials have been eliminated. Its minimal and declining. They hinder the ability to adequately respond. In my former role as the Health Commissioner i invited response to the largest outbreak in history with limited staff away from critical Public Health work too quickly ramp up the infrastructure. I scrambled to respond to the largest outbreak off encephali encephalitis, the mosquito borne illness that has killed a Record Number of people and animals. Simultaneously i had to pull together a team and we to respond to an illness without any additional funding for sta staff. My experience unfortunately is no different. Since march weve had to take extraordinary measures to set up the testing infrastructure and to ensure we can respond to the crisis and the next we need longterm investments in the publicHealth Departments and programs. Now isnt it tim the time to cee or turn the focus away from covid19. If anything we need to get more aggressive in addressing health onequities, extended testing and Contact Tracing and ensuring Public Health infrastructure is strong. Thank you for the opportunity to share the michigan experienced a. Thank you doctor calhoun. Welcome. Its been a long time since ive testified in front of the house of committee and its good to be back and i also thank you for your leadership in all you dosi to help protect americans. There is a lot of media claiming that this pandemic is the pandemic of the century but i agree i think that it is the harvester of things to come so while we focus on how we can mitigate the harm right now, we do i have to appear into the future and accelerate the preparedness efforts and really take seriously was needs to be done to truly create the agenda for america. Id like to start with what we rknow for sure, we know for sure its incredibly transmissible and it causess great harm, serious mortality especially among Vulnerable People and we know its going to continue to spread for many months to come. We are nowhere near the end of the mitigation phase of the crisis. We also know shelter in place and quarantine can be successful in slowing down foren transmissn of that comes at a tremendous price to individuals and families as well as economies and the global macroeconomic because it shuts down business and people dont have likelihoods and the economies dont have a base. Now what dont wee know . We dont know how it is going to peoples overtime. We dont know really how to calibrate our i balance between opening our societies and resuming some important functions and at the same time continuing social distancing so we can slow down the spread. We dont know to what extent they care, schools and colleges contribute to Community Transmission and transmission of the virus of her more Vulnerable People in society. And last but not least, wec dont know if we can stop the pandemic with a vaccine. Lets talk a little bit about avaccines. If we want to end the pandemic we need the vaccine to produce the large scale. We need a vaccine that i believe is successful in a single dose and we need a vaccine that we can reasonably predict will likely be effective and safe. Let me talk about why this is the context of covid19. First with respect to efficacy. We need a vaccine that produces effective immunity, neutralizing the virus, preventing infection even among the vulnerable from older immunosuppressed people. And we need a vaccine that is durable so that it lasts beyond a few weeks or months and finally of course ideally we would like it toot be robust. We also need a high bar for safety because they are going to be using it in some of the most Healthy People as well as the most Vulnerable People including children and potentially even in leings said we must not sacrifice safety and i think that is going to be an important component of the communication about the vaccine opportunity because people need to trust that it will be safe. Have concerns about the safety of the products in front of us are a deterrent to peoples willingness to step up and accept immunization. While i am optimistic about the prospects, we are a long way from the delivery date are the characteristics that will have different effectiveness different populations. The senator outlined in an incredible historic list of what they need to do for future pandemics that have been echoed in the white papers and presented in various forms by the bipartisan Blueribbon Panel at the commission you referenced earlier as well as many reports following ongoing outbreaks during my tenure at the cdc. All of these perspectives first and foremost is that a sustained National Leadership at the level of the Security Council but i want to highlight one other thing the senator got a up and that is of critical importance of sustained longterm budgetary investment ending the cycle of complacency into the crisis we have been in for so many years and instead its creating a budget process that the nations prepared to send particularly we should recognize the independent Scientific Organization that seeks to function in a political environment. Wede need to make sure we find a budget mechanism that allows the same funding cannot be subject and body something that gets involved in the budget balancing process an that alone would hels secure this in the preemptive preparedness isv truly watching the game for americans. Thank you for allowing me to testify in the forward to the question. Welcome, governor. Thank you members of the committee and a special thank you to senator romney for the introduction. Months intoo my service we participated in an emergency briefing on the Avian Influenza. We were told it was a virus with pandemic potential. A colleague of mine entered the office carrying about and it was titled the great influenza, of 1918. As it was handed to me, the message was uniqu you need to understand this, and he was right, not just for me but for all of us. As i read the book and several others advice all briefings and learn from others, it quickly became evident to me that ultimately a pandemic would occur if, and that is true today. We have it that we will have another and they need to be prepared. For that point in time the country was unprepared. It continued to spread as you indicated earlier mr. Chairman, the congress was alert and appropriated 7. 4 billion, several members of the committee will remember that while. Over the next three years we undertook an effort to heighten readiness and when h we sought o develop vaccine manufacturing inside the territories of the United States. Rewrote the National Pandemic Response Plan. Congress passed legislation to become a foundation of the plan. The act of 2005. Pandemic hazards and preparedness act of 2006. Those bills were added to the project was passed in 2004 to contain many of the legislative authority is were used in the recent months. 54 pandemic summits were held in partnership with the governors of each state and territory. There were three messages delivered. All three steals critical and certainly in the future. The first was just a reminder that the pandemics happen. They are biological fact and certainty. They occur and when they do they bring suffering and sweeping change. The second message was they happened in every generation has to prepare on their own or they will be complacent as well. Finally, Everyone Needs a pandemic plan. States need a plan, local governments need a plan, businesses, churches, schools, hospitals. Because it is different than any other disaster wech deal with. A Natural Disaster like katrina the federal response was to call on uninfected states to send people to the disaster area and the sources are to a large degree unavailable because they are neededr at home. The message is clear any state or community failed to plan somehow the government will be tragically mistaken not because it lacks the will or the ball at the federal Response Plan is based on focusing kennerly on localized disasters. Gratefully the Avian Influenza did not become a pandemic. The process has taught us a lot and its still true today. I will highlight for things. First we need to clarify the role between states and National Government in advance. Second, having the vaccine is critical, but its only the beginning. Why do we have the manufacturing capabilities, still the distribution priority as will inevitably begi a problem. Third, providing Situational Awareness of the critical role. If the investment and modernization. I will echo with my colleague said, pandemic preparation requires an investment every year. I look forward to our conversation. Thank you, governor into each of you. Oi will begin a fiveminute roud of questions and ask the senators and witnesses to observe ththe witnesses toobser. They have a lot of senators who want to talk with these very distinguished witnesses. When we are through and going to ask each of the witnesses to answer this question if you were the king or the clean and you could do two or three things to be ready for the next pandemic, what is next three things y the . I only have five minutes, but let me start with you. Someone might ask why are you taking time in the midst ofiv ts pandemic to talk about planning for the next one . How would you answer thata question . We need to end this pandemic. Thethey dont win a second seris is going to come so as much as we can do to prepare the infrastructure itself for the next emerging threat it will apply to what they are doing now so the sense of urgency is simply that they have identified pretty quickly in the last several months the needs that are out there which we talked about and now is the time to go and in a parallel fashion, pass the legislation and i would add the things you can do now that would make it more adequate. As each of you said, memories are short and we will move on to the next issue. Lets talk about manufacturing. Let me drill down on that a little bit. Weve talked with manufacturing before. Before. We built three manufacturing plants. Today we have ten, 12, 14 vaccines that are racing towards trying to produce several hundred billion doses by early 2021. Ideally with manufacturing capacity should the federal government have on hand to produce these doses and distribute them properly, can we rely on them to do that or should we have our own manufacturing plants . I thought we had with the manufacturing plants. Are they adequate and what happened . Dr. Gerberding, you have seen it from both sides. Should we build manufacturing plants or pay for the private sector to build manufacturing plants for the future, or can we remodel those . What should we do . One thing to point out that has been built it was targeting influenza, which is a dualpurpose vaccine. The idea is they could call upon the seasonal flu operations to flex in the case of a pandemic, as we did in 2009 when we were experiencing the h1n1 painndemi. Broadly speak the ones that are still in business are at capacity for creating the daytoday vaccines. We clearly need an emergency buildup. In my view thats best done in private Public Partnerships. We may get to a point as we experiment with the 130 products, that we understand the that we dont have to go d ck to groun they must not relive the incentives for the biopharmaceutical Industry Innovation has gotten this far this fast in this particular pandemic that we can invest at scale so thats the nih as interesting as your comments manny be any to watch a five minute limit. Thank you to all witnesses we appreciate your testimony today. United states response has failed to keep black and latino families and other people of color safe people are becoming seriously ill or dying from covid19. This is driven in part by longstanding systemic racism gnd underinvestment in communities of color but also the administration to fail to take this seriously and give attention and retails to those facilities most in need of assistance. What can we do to address the Immediate Impact on communities of color . We in the state of michigan identified very early to have a task force to understand with the specific recommendations of how we address them so what we have done is to make sure to be available in minority communities to bring testing to that access of care and inductively that if you dont have insurance and the primary care doctor a lot are testing you dont have to have a doctor order to get a test done. Those coming out of their homes you have to work and how we protect them so that they get the support at home. Thank you we honestly have to work on this we cannot ignore it and this is informed not just today but moving forward. We have a system to evaluate vaccines and some would not be willing to get the covid19 vaccine and a number of experts can undermine the confidence of the public perceives it was rushed out for to be rushed and what about to build that confidence . One is transparency of the investments the sba and other Scientific Organizations that have oversight that those of the National Academy of medicine this happened many years over childhood immunizations with the smallpox vaccination programs to monitor the safety of that program to help us identify the safety signal so involving experts is going to be an important part to buildun this. You have emphasized the funding and argued insufficient Public Health investments they are responding to covid19 and you argued for the creation of mandatory annual investment i think this is critically importanthi how do you prepare for the next Infectious Disease outbreak . Many of the panelist talk about the sustained finding and that Infrastructure Fund is one that i do support the Public Health system can quickly alert us to communities are healthy and socially connected has a reserve capacity to respond to an emergency of any kind which is why a coauthor the oped was senator daschle what was a four. 5 billiondollar Public Health infrastructure we have not consistently provided the type of money needed to have an ongoing strong Public Healthth system looking at the Great Recession state and local Health Departments have lost more than 56000 positions due to funding cuts these are the people we need whether Contact Tracing epidemiology so strong investments from the federal government will ensure that departments are fully staffed and resourced and able to handleti the needs like Contract Tracing. Thank you senator murray for 17 years busy writing many of the laws were talking about senator burr. Thank you for that recognition. Welcome. We value the ability to pick your brain this is probably the most important. Of thisrd pandemic to figure out what worked and why didnt and what needs to be changed. Its important for congress to go through this process. With the last reauthorization bill i reminded my colleagues at that time this by no means was the finish line and must on much work remains to be better prepared. You are in a unique situation at the cdc but in your testimony you advocate for greater use of private Public Partnership during the last ocommittee hearing i urge the cdc to put these in place to Leverage Companies to detect and identify and attract threats including emergency Infectious Disease. Given your experience at the cdc why was the agency so illequipped to put them in place before the pandemic and what would you recommend with private Public Partnerships . I i dont know what the cdc was or was not doing with private sector partners i just see from the outside looking in. There has been a tradition to recognize the private sector while i was there they have the emergencyde l Operations Center for those entities we look at logistics and supply and testing but i also say there are some complexities working with the private sector and i go back to at the governor said in the context of planning but we recognize the federal government has to play a role that what we are seeing now is the private sector is powerful to leverage those resources to scale. The deficiency was most evident in testing and the inability is cdc to reach out to the private d sector goodness private reauthorization allowed those authorities of the director of fda to use that emergencies authorization to set up these partnerships and we probably have more capacity than can be utilized nationwide today where those through production is Platform Technology for example merck license the ebola vaccine that is developing the Coronavirus Vaccine how do we enhance coordination to ensure that theseav platforms against these threats is as efficient as possible . How do we keep thes platforms as the approved entity and what we try to treat . Its well on its way to accomplish that and that preparedness and innovation but what needs to happen is not necessarily having a focus on efficiency, we need to have a broader expectation if we aim for efficiency we will miss the boat we need to be prepared to experiment i continue to think its critical to the coordination of all of that. And this is toh my a missed on to my friend mr. Love that we did what we that was revolutionary at the time with the investment flex manufacturing for vaccines. The testimony is correct it was designed for the annual influenza vaccine. They are different difficult to program over and surge in front of that for coronavirus. Can you give us what you think this committee should do legislatively to encourage the creation of some type of multi manufacturing facilities to be utilized when the government feels the National Need . I will respond quickly annual appropriations is the first thing that has to happen those that make itn. Possible. Thank you. It will come down about increased funding and how we dor it i am so in support of a mandatory appropriation but also why mentioned my a testimony the annual appropriation we talked about the annual appropriation in its category to allow you to barter individually and to the nih it is annual appropriations with oversight by the United States senate and congress that does have the advantage of this timeliness what is needed add a particular time and guarantees that money in a sustained way because that immediacy will be very different as we just saw with the flu vaccinee manufacturing versus the current manufacturing it has to be flexible and nimble and that annual appropriation oversight to support the privatewo partnerships. Senator casey is next and has been very involved with the democratic cosponsor. Senator casey. Mr. Chairman thank you very much and thank you for knowing that i am grateful for the testimony of the witnesses and wisdom and experience say bring to bear on this hearing. Doctor, regarding what you have seen with regard to the challenges you face in the state of michigan detroit one of the hardest hit cities in the country especially in the black community and its true were so many urban areas i know in your testimony to compare that percent of the population of africanamericans in michigan about 14 percent but 40 percent of the deaths in more than 30 percent of the cases in our state that is lower but far outstrips the population we have at least 1368 deaths. So how have the social determinants impacted peoples ability to protect themselves and their families from the covid19 disease . Thank you senator casey. Absolutely not just to initiate across the country but housin housing, transportation access to healthcare those are the things that are contributing to covid19 and other Health Disparities. People of color are more likely to live in poverty central workers coming out of their house instead of safely working from home or taking public transportationor living in crowded or unsafe Living Conditions so those are the things we have seen contributing to this theor theory. Africanamericans are on the front lines. That is true. But again, going back that people of color are more likely to live in poverty and more likely to have lower wage jobs like bus drivers or those types of jobs in those are the people across the country a lot of those people could stay on cannot stay at home that contributed to the number ofu deaths we have seen. We now Public Health is driven at the state and localan level but this pandemic has reminded us all levels of government need the help the federal government if you look at where we have been and the response so far what portion required coordination in the convening power of the federal government . Let me start by saying i really support my colleagues at the cdc have been supportive at the state and local level in michigan but we should have had a more urgent testing response and we try to perform the test and in michigan because of those delays people were notrf tested some i believe that coordinated strategy would help in that way. Also ppe state and local governments to have access. Also thank you for your help to better understand what we have been up against we are grateful for that. In the 30 seconds that we have you spoke about immunization infrastructure. Can you fill in for us the mechanics, who should be involved in what role the federal government should play . We are just beginning to improve that. But it is fragile and one of the most important things not getting enough attention righto now is distributing this vaccine will be incredibly challenging making a decision who goes first, how to allocate and how to sustain that. The infrastructure for that means we need to support local and state Health Officials to get ready to make those hard decisions to implement that macro program. Thank you mr. Chairman. It is great to see you again. We have missed you. One of the lessons from the covid pandemic is that our country is far too dependent on foreign manufacturing of drugs and diagnostics and medical supplies. For example, about 80 percent of the basic components used in medicine and active pharmaceutical ingredients , are coming from china into india for our us market. And since there is no api registry but what hasth happened is just about the time the covid teen epidemic hit the icUnited States india stopped importing the drugs this has legislation that i introduced that includes greater ioreporting requirements as well as redundancy plans intended to deal with shortages. But are there specific incentives the senate should consider specifically to encourage domestic manufacturing including perhaps tax incentives or greater investment d in emerging Technology Program . Thank you senator collins though whole topic of procurement is huge and we talked about coordination and procurement to be a very clear and important federal responsibility. As you point out we have been inadequately prepared. We see that day in and day out and we see this with manufacturing with supply chains and to ensure a robust support of the National Strategic stockpile. The real problem and the challenge in the publicprivate partnerships is the lack of continued funding over time to adjust to the market or the private sector they will be generous and patriotic that they do need to report physical a responsibility. We have to step down whether direct tax credits or a funding stream by the artificial market set up over time. We have to keep a revenue stream that is dependable and sustainable and longterm inflexible because it will change year to year with those specific manufacturing dates but the tests themselves are remarkable and the private sector to move ahead it came to late but now to encourage that with the financial incentives. Last month there was a hearing on the impact of the coronavirus on older adults living in Nursing Homes. That hearing reaffirmed my belief the baseline test for all residents and staffri, not just those that are simple and one symptomatic are necessary to prevent outbreaks. Covid19 directly intersects with the interracial disparities we are seeing and unfortunately with the nations worst Racial Disparity many of the worst outbreaks that occurred are in Nursing Homes and the cdc reports that 40 percent of those healthcare workers tested positive those were africanamericans as former director of cdc what do you recommend for the best way for congress to help address the Racial Disparity among those frontline workers in the nursing home . Obviously we need to test symptomatic people the biggest reason to test clearly Nursing Homes are at the top of the listeo those are intrinsic hotspots we need to check everyone until such time we can demonstrate transmission has been contained i cannot say enough how critical it is not toan overlook the elderly people that also those that are vulnerable on the basis of conditions with the racial and ethnic disparities its a very difficult challenge to be multi factorial that is a long answer but the third step is to make that measurement clear so that we are not successful until we deal with that challenge. Thank you. Senator baldwin. Thank you mr. Chairman im having trouble with my mute button. So i will start that every member of this committee would love to turn the page on the current pandemic but they cases of covid19 and hospitalizations continue to rise we cannot subvert our attention from the ongoing crisisan it is clear the administration has not yet learned particularly about worker safety without enforcing those workers Safety Standards they are needlessly put at greater risk for me go back to work and the Occupational Safety and Health Administration moving forward with a meaningful role for employers and in t response to widespread reports with preventable illnesses every Worker Protection act this bill would require osha to do its job with the Emergency Temporary Standard to establish a legal obligation for all workplaces with infectious Disease Control to keep workers safe during the pandemic so do you believe givingpa employers clear and mandatory rules would help improve the Public Health response by protecting workers and families and their communities during a pandemic . And correlated with that why is worker safety important for communities of color and those disproportionately impacted by covid19 . Thank you senator. Absolutely the health and safety is incredibly important it is unfortunate those that have died from covid 18 and that there is protection from workers that is critically important goes back people of color are more likely to live in poverty with lower wage jobs. And had to be at home its incredibly important. Senator baldwin we have oster signal be able wait a moment to see if we can regain that if not we will come back to you lets move on to senator cassidy then we will come back to senator baldwin and let her reclaim her time. Thank you for being here we appreciate your service during this epidemic. Reflecting yourem past history all of you are recommending a lot more money for Public Health. There a lot of folks at their that feel the cdc has not responded to the challenge with the money they had been given and forcing significant more dollars we would like to see some sort of recommendations for reform. So those criticisms made with outlined the fed tape and focus and to take action and by which the virus has spread throughout the community with another four or 5 billion, it is fair to say that it can be instituted youre just not putting more money to provide more money so that can streamline so what are your thoughts on that quick. It takes a long time before and after i work there and i just say the scientist they are our National Treasures and these are the same scientists when i with sars i dont think its a science or the scientific capability of theltth agency i do think the scale this response would test any agency that modernization needs to be the framework from considering where we go from here. So if we do expensive reversal for and them on pandemic preparedness we did everything except one thing because with influence i rely on the test to make the diagnosis for the decisions of that whole ability to scale test isnt something that we practice. But it seems that different times people are concerned of those other exotic Infectious Diseases but then to go beyond litigation so we have those committees moving on that should be with suppression so what is your response to that quick. Im not sure if i could agree withbu you. Im not saying nationwide but particular communities. But every Community People lare susceptible we are only one travel away from exposure. Mr. Levitt, as part of the cdc that they put a good drug out there but there is a review processou and to say montana you are low you can move to a suspect suppression strategy now between hhs and the cdc and the black box but somebody in congress should demand recommendations we get those i didnt we get them unvarnished and through that lens so what are your thoughts on that . I am inclined to believe in that good ideas would be held up under scrutiny. There are times even within the department or the government there are conflicting issues. The fda is not being accurate. Cdc is a tracer. And the disease around the world you will see at the heart of that and then to diminish that but it is easy to be critical in an emergency. Will what they said about modernization it would be difficult. Particularly with that Data Infrastructure to collect data in almost real time with Situational Awareness and the pandemic situation thank you senator cassidy. Senator murphy . Thank you mr. Chairman and to all the witnesses you know the high regard there needs to be reform at the cdc Going Forward and ways they didnt measure up lets be 100 percent clear the cdc is trying to do good work sending out regular guidance as the most evidencebased method the president of the United States refused to wear a mask. Thats an attack on him politically and for individual industries. And then the white house prevents that guidance and then to take responsibility. And then to do some hard look internally but also and then to do the best work they could by this administration. And focus moving forward and then to have a house on fire and one nextdoor in danger of catching fire and then the houses engulfed in flames and tried to do work nextdoor and prevent the next from catching fire and then getting ready for the next pandemic we are not taking up any legislation to address the existing pandemic. Frankly i would direct my questions to our witnesses with respect to what we could be doing now which is part of the conversation moving forward and the International Vaccine effort and multinational Public Sector that collaboration for covid19 as well i agree with you we should as a mechanism and then as we speak the vaccine for covid19. Why is that and pardoned with that covid vaccine. And then to already review. And then that allocation for how they will solve and not safe until everyone is safe with the billions of doses not just the hundreds of million and now the leading organization and then the scientific oversight to make sure they do the right. And then malpractice in part of that its part of the funding with those programs to develop the vaccine. But in my state the supplychain crisis in history and not even a hospital iltesting fight on site not have enough cartridges. So the supply chain crisis isnt fixed. Is it quick. Thats correct. In that capacity and limited by the and then from the beginning you cant wait for the next pandemic to hit us and then on sunday 183,000 cases reported globally the highest on any single day. And that was sunday. And we were going to break for members of congress who still have jobs and largely still healthy without having passed any legislationly f with the public local Health Districts and we need to do both and we are not during this work. Senator robert. Thank you senator chairman and the witnesses for working with me over the years to help address this issue particularly with the work on something called pandemic all hazardous preparedness act with response to the covid19 pandemic we are making progress and that had the cares act with the drug provision. To provide pathway of expedited approval available drugs and of the potential to treat days a wantedit disease. As if they have not been barking about this back in the day when i had the privilege on the Armed Services committee we are in church of the program and we were allowed into secret cities in russia at that particulare time. Obviously we are. Net on not now that 60 miles north of moscow it was there and with those pathogens it was stunning and shocking from smallpox with no preparedness that the big one was both and mouse disease they were trying to weaponize the pathogens on the nations food supply. And we have seen in the packing houses to the supplychain. At that particular time our majority leader was also our doctor. Bill, thank you for what you did for me for that one melody i was suffering from. He had no patience for those who are reluctant so he took me by the arm in march me into the room and got the Doctors Office on the line at Johns Hopkins made an appointment for me at 7 00 a. M. And then i had the wonderful experience of ten days of my life at Johns Hopkins the view was nice with baltimore but i did not went to and my days there. Thank you for everything you have done for me so the question that i have is what are we doing now . What i want to point out at the level the landgrant schools we are making progress that facility will be open 2022 its open right now and additional work at kansas state. The question i have we used to have exercises the first one is the role of the president with the hand foot mouth outbreak by the time it was in north dakota all experts the entire food supply with millions of heads of cattle something we never experienced before. I at least top. Others im not sure were doing that today we are doing a wonderful exercise withat covid19. That senator what can we do to consent on continue facilitating the agriculture sectors in the serious before we have an outbreak . So the reason and in 2005 to be so certain and then coming out of china and that with this integration and assimilation between human and animal. If you look at the layout for the future and how the next five risks would emerge of animals coming to humans but in 2011 anthrax hit and this symbiotic relationship and in our own ways and the only way to bring people together and all of thes exercises to be built into everynd administration and then with that we can predict the exponential thinking like the need for testing which we have missed in the past. Thank you mr. Chairman i am puzzled by as we start preparing for the next pandemic. What about the pandemic thats going on right now . Were still fighting coronavirus and losing. Cases are rising rapidly over 20 states people are dying every single day. Massachusetts we learned firsthand just what happened when federal government is not prepared for pandemic. And ask for medical supplies weeks later and then reportedly seizing shipments that were headed our way. And supply chain problems persist doctors are using construction goggles has ppe. And that the supply chain was fragile if we dont apply those hard Lessons Learned in massachusetts and where cases are now rising in michigan also experience some of the supplychain problem since march the federal government and in this systemic way to ensure and with that caseload to have all the masks and gowns and testing kits and other supplies that they need. Is that right is that what is happened in michigan . Im grateful for my support of the colleagues at the hhs and those that have received expired and then now and potential. And that clear supplychain Lessons Learned by the states and hit hard early on simply are not implied even though now we are more than three months into fighting the virus. Heres another want to focus on ase massachusetts looked at the threat of covid19 experts that Contact Tracing is to contain coronavirus michigan has also invested in Contract Tracing and 500 michiganders and then to have more support. And do you have a nationwide Contract Tracing program and to have 10000 michiganders with more than 500 and throughout the state and a hodgepodge for to focus that support would be welcomed at the federal level and we appreciate it. And with that national Contact Tracing program the house with that legislation to introduce with congressman levin from michigan and then to provide the states at the funds they need so lets have one more return of this and he will be hit the hardest if we dont learn the lessons and in massachusetts we alreadyut know that black and his stance on hispanic people are three times more likely than white people to contract covid19. And that response how is that failure impacts people color and those that are at risk for infection . Irus. Africanamerican communities latino communities. Thank you very much there will be a time and place and then apply them to the next place but right now and as that is the event from the past. 20000 are already dead and more are dying every day we must extend Contact Tracing and secure our supplychain. And we must stop pretending that pandemic is over. And then to go back to senator baldwin to let her reclaim her time when we last one lost internet contact with her. I so appreciate its very timely and i am not one that thinks we are beyond this pandemic that in the midst of it that even while in the midst of it but to understand where we are going i truly appreciate the comment that you made and 2007 while serving as secretary in your opening testimony. Everything we do before pandemic anything afterwords this is the dilemma to do all we can to prepare every day and those officials and what are the priorities and then to have what we need and Testing Capacity continues to be aan challenge which i credit on the state teams consistent messaging no different from alaska than what we see around the country. Levels of confusion to have that Mitigation Strategy that is conflicting. That is the issue of distrust. And with the Public Health it infrastructure to report for Contact Tracing is excel spreadsheets for Contact Tracing efforts 761 cases as of this morning 250 are active our teams have been working and staying on top of it that we are close to being maxed out so as we think abouthe that to recognize there are several proposals that the Contact Tracing diagnostic tracing supported isolation and the need to suppress are mitigated. To have a national Contact Tracing program and to focus to bolster the funding of Public Health departments at this day and locality level we think we have this and we want to this Financial Support that we want to national program. And for your views on Contact Tracing this is a a key aspect how we can stay on top of what with. Dealing thank you. At second pandemic may come in three months and thats why its important and that Contract Tracing workforce to a whole bunch as estimates out there it is the most effective at this point. Even if a federal Program Needs to expand to help control covid19 we have to. Th . Probably not because states have had their Public Health infrastructure underfunded at the state and local level. A lot of them dont have ep deemyologists in the local community much less contact tracers. So we need federal support this time around, maybe not next time around. Massachusetts has done a great job at hiring and training applicants and quickly gotten them out there. So dr. Gottlieb and i and andy slabit have proposed a federally funded workforce and then allocation of the funding to the states so they could get it up and running today. And we have that on record and that. Thank you. Senator, i believe that a National Strategy is required. It will require some local execution. Let me be deliberate about that. Clearly we will need to have National Funding to support this in the way that senator frist has articulated. Secondly, there has to be a National System that local input feeds into where standards are used and how data is collected so if could be rolled up quickly. So there are components of local execution that are required. But there is a clear need for National Funding on this pandemic as i agree with senator frist, Public Health has been malnourished over the course of the last almost 40 years. And we need to build up that infrastructure. So we could have a National System but it will require execution at the local level but ought to be done according to a set of national standards. Thank you senator murkowski. Now we go back to senator baldwin. Thank you, mr. Chairman and i apologize for the interruption in internet sfervice but im gld to be back to the panel. My first we was urging osha to issue a Emergency Temporary Standard that would be enforceable and mandatory as workplaced reopen. And i think especially before schools that are preparing to start inperson classes again, k through 12 and Higher Education and their needs. But i want to move to the companion issue of these shortages that we have been seeing in the very things that would likely be contained in an Emergency Temporary Standard that osha should promulgate. And just as the administration has failedw o to issue these enforceable standards to protect workers, theyve also failed to provide the leadership needed to take production of testing and testing supplies, other needed equipment, ppe here in the United States. Have some touched on this already. But it is why i introduced with senator murphy the medical supply transparent and delivery act. What it does is unlock the full authority of the defense production act to increase the production of critical supplies including ppe as well as the supplies needed for testing. So, dr. Khaldun, i directed my first question to you and i will follow up also with you. You could describe how shortages of testing supplies or ppe have hindered your states efforts to respond to the current pandemic . Yes. So like i said earlier, senator, in the beginning we had to delay testing even when the state lab could do tests. Initially there were only a few hundred where only the sickest could get access to a test while the disease spread in our state. They are still only able to test the sickest and because they have problem with reagent and testing swabs. Again, im grateful for what we received but when we received supplies from the federal government they dont match up with what our lab is able to run so we still cant use them so it is still absolutely a concern. Thank you, mr. Chairman. Thank you, senator baldwin. Sorry that we lost you there for a while. But thank you for sticking with us. Senator romney. Oh, excuse me, senator kane. Thank you, mr. Chair. Thank you to the witnesses especially to secretary levitt. We were dealing with h 5 n 1 and you were a great partner with the administration. I associated myself with comments of all of my colleagues, we have a current challenge. Last week in the United States the number of new covid19 cases increased by 25 over the previous week. And shows that the current challenge is getting worse not better. But we do have to plan for the future. And one of the things i want to do is take advantage of this experience to talk about the future. So first topic to the witnesses. Every pandemic would likely be a little bit different but it seems like there is a template that the successful nations have used to deal with covid19 and the template is aggressive early testing, and Contact Tracing to find those who are ill. The isolation of people who have covid19 and immediate treatment of those folks. Do you agree that those four elements, early testing, Contact Tracing, isolation, treatment should be a template that we should prepare to use in future pandemics . So, i will respond, senator kane. What weve collectively come to know as social distancing measures constitute the only medical intervention that we have absent a pandemic or absent a vaccine, excuse me. And the reality is that is likely to be the case in any pandemic situation. Well be without a vaccine for a time. So that fundamental health basic but we have to remember that any medical intervention has side effects and this has side effects. And if i were to take pain medication, for example, i would be told you cant use this too long and you cant use too much of it or youre going to have other problems develop. Were obviously trying to find the balance now in this medical intervention that we have used absent having no vaccine. So the answer is yes, but there is a limit as to which we could use them as a practical matter without the side effects of the economy, the side effects of the psych logic damage. You anticipated my next question, secretary levitt, the side effects on the economy. I was having this conversation with chairman risch last week because we had a similar hearing and he pointed out that the aggressive testing and Contact Tracing, some nations, some cultures accept it maybe a little bit better than would be accepted here. Were talking about south korea. And i responded and i said thats true. It might be hard for people here to accept Contact Tracing but because south korea did that early, they didnt have to use the heavy hand of government to shut the economy down. South korea Unemployment Rate has gone up 1 because they isolated sick people and they didnt have to do the large economic shutdown that the United States had to. So the basic measures are not only good Public Health measures, theyre also measures to protect the economy. I want to move one element of the basics and that is testing. Im very concerned about this. And youve all talked about it. Particularly dr. Khaldun, the difficulty of doing testing because of inadequate supplies and mixed messaging. Over the weekend the president said he had instructed his administration to slow down testk because he thinks increase cases is bad. Im going to be clear about this. Increasing number of cases isnt bad. Increasing deaths is bad. Increasing hospitalizations is bad. But the idea that you would slow down testing because you didnt want to find out if people were sick is just grotesque. The chairman, the Ranking Member of the committee senator murray and senator schumer wrote a letter to secretary azar that i would like to introduce for the record, mr. Chair, if i could. So ordered. Pointing out that 14 billion that has been provided by congress for testing has yet to be obligated by the administration. I am deeply worried that there is a bias against testing because we dont want to know bad news. Ive been puzzled now, in the fifth month of the pandemic why hasnt the administration issued National Guidance about how many tests we should do. The website of the cdc, instructions to colleges didnt mention the word testing and i believe there is a fear of finding out how bad this is or a desire to not be held accountable for falling short of testing guidelines as i conclude, ill just point out we heard from admiral giroir a month ago, may 12th and we had to drag out of him what would be an appropriate National Testing goal for september when schools go back in and he said 40 to 50 million tests per month which is 1. 3 to 1. 7 million tests a day and at that point were doing 300,000 tests a day and now were at 500,000 tests a day. If they are right and we have to do millions of testing in september, i have great doubt about whether this administration is going to ebb able our country to do that if were at 500,000 on june 23. With that, thank you, mr. Chairman. Thank you senator kane. Senator hassan. Well, thank you, mr. Chair. And thank you to all of the witnesses for being here today. As i look at your bios, im realizing that the combined years of Public Service sitting before us in extraordinary and i thank you all for your service. There will be time for thorough preview of everything that went wrong with the administrations response to the current pandemic. Our nation could better prepare for future pandemics by reversing cuts to Public Health and preparedness funding. Reengaging with national partners, and ensuring that key federal positions are occupied by quality fied staff. However were in the middle of a pandemic right now. Covid19 is spreading quickly through the United States as many european stations have gotten their outbreaks under control. America has 4 of the worlds population yet 25 of the overall deaths from this pandemic and 20 of new daily cases being reported. In my home state the toll our Nursing Homes continues to be extraordinary. 80 of the deaths in New Hampshire have been in longterm care facilities. Our primary focus must be on strengthening the federal response to the current pandemic that is still raging across our country. So i want to start with a couple of questions to dr. Khaldun. In the early stages of the pandemic, michigans per capita testing for covid19 was below the national average. Since then youve been able to not only ramp up testing but become one of the few states to have an infection rate of less than 1 of those being tested. What specific tests were critical to addressing the initial challenges in your state and what federal support is needed to help other states replication your approach by expanding Testing Capacity, improving Demographic Data collection from testing sites, and using that data to quickly respond to potential outbreaks. Well, thank you for that question, governor. It is certainly been a massive effort and response not only from our state and local Health Departments but our procurement and the national guard, many people have contributed to us to be respond, going from a few hundred tests to about 14,000 aday. We have focused on bringing testing into communities, working with community partners. Weve made sure that when we do our Contact Tracing weve updated and have to do it building the plane while flying it, updating our Contact Tracing platforms to effectively isolate and understand who has potentially been exposed and isolate them as quickly as possible. So again it is a massive effort. But i would not say were winning in michigan. Were still continuing to work hard to expand testing. That is helpful. Are there particular things that you think the federal government can do . Again, ive been really pleased that weve worked with our federal partners on testing supplies but we dont know when the supplies are going to come and when they come they are less than what we expected to get or not useful. So we need a Clear Strategy from the federal government so we could play on the state and local level on how to get the supplies out. Thank you. I also wanted to follow up with you on another issue. In april you wrote a letter to clinicians across michigan highlighting the fact that africanamerican residents comprised 14 of the covid deaths nationwide. And this is a disparity that youve talked about a little bit today. And it is a disparity we have seen across the nation during this pandemic. And in Overall Health care and outcomes. What types of dedicated investments from congress are needed to give state and local governments across the country the support they need to improve health and wellness in communities of color and work towards eliminating these Health Disparities during the pandemic and beyond. So, we really have to focus upstream and talk about the social determinance of health. So it is health policy. We have to make sure those living in poverty have access to healthy and safe housing. Making sure they have access to Health Insurance and expanding medicaid across the country is important. No one should have to pay out of pocket for testing or treatment for a vaccine or make sure there is equitable distribution to make sure that we address those disparities. I also talked about implicit and explicit bias in our Health Care System. It is well documented that these biases exist. And that is partly why i sent the letter as well. Thank you very much, and thank you mr. Chair. Thank you, senator hassan. Senator smith. Thank you, mr. Chair and Ranking Member murray and to all of you for being here today. I want to start by associating myself with the comments of my colleagues who made the really important point that we have so much work right now to address the existing pandemic that we are dealing with and living through right now. And i especially am concerned about how covid19 is exacerbating existing Health Disparities and the systemic racism that is deadly for black and hispanic and native communities in my state and all around the country. But here is one example that really shows what this means in real life. Recently an obstetrician shared a story about a black line earn immigrant who went to the emergency because she thought she had complications with her pregnancy related to covid19. So they goes to the emergency room and not once, not twice, not three times, but four times. The first three times shes turned away. Because even though she is covid positive it was determined that she wasnt sick enough to be admitted to the hospital. Two days later she returned for a fourth time and she is so sick that an emergency cesarean is performed and a lastditch effort to save her and her child and they both died. She wasnt believed and she died. Now, implicit bias in health care is kind of a wonkish term but this is what it means when bias and racism and disparity kills people. I know that we have talked a lot about what this disparity means when it comes to covid. But dr. Khaldun, i want to ask you this question. What can we do so that black that they need when it comes to covid. And of course i have to acknowledge that we know that Maternal Mortality rates for africanamerican women in our country are three or four times higher than they are for white women even without the complexities of covid. What can we do to address that problem . We experience that disparity when it comes to mattal infant mortality in the state of michigan. Even africanamerican baby is twice as likely to die before its first baby as the white baby in the state. So one of the things we can do is make sure that i believe that we should have mandatory implicit bias training for all Health Professional students. Schools sh work to expand diversity in their students. And i think, this is what were working on in michigan, we have to make sure that best practices when it comes to hemorrhage bundles and the top quality care for o. B. Care across hospitals, even though hospitals that take care of our most impoverished women, we have to make sure there are high standards set and everyone has the same access to eck witzable care. I agree. I think we need to do to diversify our Health Care System and make sure that we have communitybased care available for women and that would be, i would think, would be the same when it comes to covid. Let me ask you this question, dr. Khaldun, what should we be doing better in order to make sure that our Public Health messages are reaching communities of color and are relevant and appropriate for black and brown latino communities, Indigenous Community is part of my work here in minnesota also. So, for messaging those Community Partnerships are incredibly important. That is some of the work weve done here in michigan with our coronavirus Racial Disparity task force, were working closely with Community Members to make sure that messages that were putting out are resonating and that we use the community, the trusted communities to get Accurate Information out. Those partnerships are critical and we cant do this alone and we shouldnt do it from a state and local government election. In order for that to work the Community Organizations need to have capacity and local Public Health agencies need to have capacity. And i know that you worked at the local level as well as the state level and right now in congress were having a debate about how urgent it is that we get emergency resources to state and local governments right now in order to help make sure that this response happens. And so could you just answer briefly, i just have a second left on how important it is you think from where you sit that we get is it a state and local aid to governments right now as were dealing with this epidemic. That is right. Our state and local governments have been underfunded for decades. Especially our local Health Departments. They often dont have even one ep deemyologist. So funding at state and local level are important for Public Health work. And were supporting the heroes act funding to get emergency aid to state and local governments. Thank you senator smith. Senator jones. Well go back to senator jones. Senator rosen. Im sorry. I had problems with the mute. Mr. Chairman could i go forward. Senator jones. Thank you. Thank you, mr. Chairman. And i appreciate this hearing and i hope we have more to be honest with you. I dont think this is a topic that could be handled in one hearing and i hope our other committees will likewise have hearings about Lessons Learned from this pandemic. Id like to first go to my northern neighbor, tennessee neighbor senator frist and talk more about manufacturing. I know senator alexanders asked about it, senator collins and senator murphy mentioned it as well. But the focus i want to talk about is really on ppe. Masks, gowns, those kind of things. I really see it seems to me that weve had not only a shortage now but well continue to have a shortage in the future. We have to rebuild our National Stockpile. But also keep that replenished as our stock pail ages. Weve seen in alabama supplies from the National Stockpile that were ten years past expiration dates that were rotted. So it seems that one of the things we could do is in ve i incentivize. I have a bill to give tax incentives for repurposing facilities and stand up new facilities and give help for infrastructure such as broadband in areas that might not have it. So in adish to the tax incentive, i caught by your statement that we have to help with markets. Longterm markets. I cant remember the exact phrase. It might have been artificial markets. So in addition to the taxin sentives in my bill, what could be do to create those markets because even when were out of this pandemic were going to be living in a new world in which more masks, more gowns, more shields are going to be needed for businesses schools and Health Care Workers Going Forward. So how could we do that in addition to the incentives. Wee deal in pandemic. Virus become pandemics. So when we talk about pandemic were talking about something that explodes and goes around the country to multiple places. That is the global emphasis, if there is an outbreak anywhere it is important here. The markets does come in part to stockpiling but in addition it extends the whole concept of what were dealing with is a rare but certain event. A rare but certain event. And the rarity is hard for congress to deal with because of the Attention Span of congress having spent a lot of time in the room that youre in and that is where it is important to have timelines that are ten years or 15 years, markets tend to look daytoday. And therefore this sort of artificial market means we have to have some sort of public funding that will guarantee a market over the 10, 15year period. Your prior point is on the stockpiling. And it, too, and the cdc talked about modernization which i agree with, but we also need to modernize the stockpile. There is still a lot of debate. Is it a federal sponsor do we push it upon the states. States, because they have to balance their budgets, because of the immediate demands of the constituents is not going to be able to do it so the stom piles need to be not implemented at one point in time, just like the exercises every year, have to be looked at year to year as to the current threat or risk determined by our communities of science, the scientists at the cdc. If we do that we could have regional stockpiles coordinated with an over lay at the federal government with great coordination, better coordination going back to gov levitts plans with the states of what needs to be in the stockpile and then the markets designed around that. Federal government cant build the factories, to be those that could change with the time. Governor levitt, let me ask you real quick in the remaining seconds here, i agree we need to do more investing in Public Health, but in your testimony you mentioned that medicare funding crowds out state budgets for Public Health funding and i would like for you to explain briefly what you mean by that. Are you suggesting that we should cut medicaid and that would help Public Health funding . Because it seems to me in my state more medicaid is better for Public Health than less. Senator, let me just say that Public Health generally has been starved for resources for probably 30 or 40 years an the budgets have continue to go down. There is a direct correlation, this is just a fact, im not making drawing the causation, im just saying there is correlation here that medicaid budgets have dramatically gone up. When i was first governor i think medicaid was 6 of the budget. It would probably be 20 in the state i was governor now. Weve just undernourished it. And im worried about that. I dont think that every it is a local function, it is a state function. Right now it is being driven in funding primarily by federal dollars. I think that is not a good idea in the longterm. So im just advocating that states need to be to Pay Attention to the Public Health infrastructure as well. Right. Thank you. Thank you, mr. Chairman. Thank you, senator jones. Senator rosen. Well, good morning, everyone, and thank you, mr. Chairman, for bringing this important hearing and of course Ranking Member as well and everyone on the panel for all of your work in the past and youre comments about how we can plan for not just a Global Pandemic but all of those smaller kinds of prices that we may have that we have to plan for even if they are regional. And so i do believe that it is important to keep up with research in order to understand this virus because scientists around the globe are frantically working to gain a better understanding of covid19. How the virus attacks a patients immune system and how to best prevent infection. To make sure we dont have gaps in research and information and how the virus impacts a wide range of patients i riintroduce the covid to protect Public Health act to direct the nih to conduct a longitudinal study of patients that includes diversity among gender, race, geography and age and many other things. Were looking at both the shortterm and longterm impacts along with interventions. This would be reported publicly on a regular basis so that all researchers and Public Health officials have the latest information. So dr. Khaldun, as a Public Health official directly dealing with the current pandemic, what challenges have you faced in getting comprehensive information about the latest research on covid19 and could you please speak to how not having robust Data Available hurts not only Ongoing Research but patient care. Yes. So we all are learning about this virus. Obviously it is a new virus so were all learning how it responds in the human body and who is the most impacts. But absolutely it would be great to have more research to look at the disparities and why those disparities exist. If you look at how it even impacts children. Were seeing this disease in children as well. So absolutely, the research and the data would be incredibly important to advancing this response. So on building on that, what recommendations would you have for us maybe in kwogs or for others, how could we make it easier for doctors and Public Health officials to get this comprehensive data, updates are coming in rapidly. I want to avoid the gaps that we seem to be having in the data between states and counties and cities, et cetera, et cetera. I think we need uniform surveillance and data across the system. We have our own data system and the locals are doing their own and we have a hodgepodge way of getting information to the cdc and we recently updated that. We absolutely need more data. It would be great to have more coordination and updating when the cdc does come out with guidance or research to make sure that our state and local governments get that as quickly as possible. More coordination and better surveillance would be important. From the cdc . The cdc. Thank you. I want to move on and talk about telehealth. Last week we had a great hearing on telehealth. Showed how vital this tool is for caring for patients in the pandemic and also after. So along with many of my colleagues, we support continuing the flexibilities for telehealth reimbursement that weve allowed through medicare through the passage of the c. A. R. E. S. Act and i want to tell you i think it is fantastic. In nevada we have a model Health Company that will send paramedic or nurse to a patients home and use telehealth to connect with the physician to treat the patient. They do say history and physical, they take the vital signs, they may do blood work right there. And then they could speak with a physician if the situation is more serious, they could get the patient to a hospital or to a followup, kind of an urgent care situation. So again, dr. Khaldun from your experience during this pandemic. How do you think that telehealth has improved Patient Outcome and peoples ability to receive care . Well, telehealth has been incredibly important to maintaining our Health Care System during this response and i hope that we dont go backwards and that we continue to use the lessons weve learned from w this response as we move forward. Weve expanded access to telemedicine and telephonic and including teledentistry and Speech Therapy as well and so it is helpful with our Health Care System and i hope we learn from those lessons. I hope we do too. Thank you. I appreciate you being here today. Thank you, senator rosen. If the witnesses will stay with us another 10 minutes well conclude the hearing. Senator murray, do you have Closing Remarks . Well, thank you, mr. Chairman. I have to say covid19 has killed more than 120,000 people in the country and simm sickened more than 2 million. None of us would have said that four months ago. And we just have to just say this is stunning. Especially when i heard Vice President pence last week say, quote, our whole of america approach has been a success and the nations response to covid19 is a cause for celebration. I mean, we are in a pandemic that is just stunning this nation and we should not be ignoring that or talking nonchalantly about it. Ill ask dr. Khaldun to comment based on your experience in michigan, would you characterize the federal governments response as a cause for celebration . Is it time to declare Mission Accomplished . Absolutely not, senator. Were in the middle of a pandemic and still seeing outbreaks across country and increasing cases so we definitely should not be celebrating right now. Yeah. I dont think so either. So mr. Chairman thank you for this hearing. I really do appreciate all of our witnesses for taking the time to join us today and share your expertise. While it is clear we still have a lot of work to do to prepare for the next pandemic, it is even more apparent to me that there is a lot more that has to be done right now to respond to this one. Because despite what we heard from the white house, this crisis is far from over. Several states are seeing recordsetting new case counts. There are many steps that we need to be taking as soon as possible to fight covid19. We need to increase testing, not decrease it like we continue to hear President Trump suggest. We need to take steps to pave the way for a safe, effective vaccine that is free and accessible nationwide. And we need to take steps to address the harmful Health Disparities that are being compounded by this crisis. And of course we have to address Racial Injustice not just in health care but in so many other ways as well. So as we continue to focus on that, i would like to ask consent to submit for the record an outline of Health Equity principles from the Robert Wood Johnson foundation, mr. Chairman. So ordered. Okay. And so i really hope we continue to talk about this and build on this conversation. Not just with future hearings and discussions but we need to take Congress Needs to take immediate actions so our country can deal with the crisis at hand. Thank you. Thank you, senator murray and thanks for your cooperation and that of your staff in scheduling the hearing. In a moment ill ask each of the four witnesses if they could m summarize in 60 seconds the top three things they would do now to prepare for the next pandemic if they were the king or the queen of the United States. But first let me make a couple of comments. Several of my colleagues have wondered why in the middle of a pandemic we would be thinking about how to prepare for the next one. Well, i think senator frist made that argument very eloquent, as eloquently as did other witnesses. It is because our experience has been we havent been able to adequately take the steps that we need to take to prepare for the next pandemic if we wait until the current one is over. Over the last 20 years weve had four president s, two republicans, two democrats, several congresses, earnestly working on this subject. Theyve passed nine different major laws. I mentioned what those were before. But it was after anthrax and sars and ebola and the attention of congress on difficult issues was on other matters. The same thing happened in the states. Where hospitals in states allowed their stockpiles to be diminished because other matters demanded more budgetary considerations. So i would ask think colleagues, when do you think would be a better time to ask the United States congress, for example, to build a manufacturing plant for vaccines, that we more many years might not even use. Probably during this pandemic is the best time to get the attention of the congress for such a use. Or when would be a better time to accelerate research for testing and treatment if we could think of ways that would speed and accelerate the testing and treatment for the next pandemic. Or when will be a better time to do the appropriatel l l l l l l to look at our stockpiles and our hospital surging than while were in the midst of them. Whether would be a better time to talk about strengthening funding for state and local Public Health departments, which governor levitt said had been going down for 40 years in terms of funding. If we havent been able to do it for 40 years, why not try doing it in the midst of a pandemic. When would be a better time to consider who ought to be on the flagpole. It is not easy to accept the recommendation of dr. Gerber and the commission that recommended putting someone in the nsc in charge. Or to improve coordination of federal agencies in other ways. And when would be a better time to do what is probably the most difficult recommendation that many of you have made, which is create a funding stream that is automatic, that is mandatory at a time when the federal government has such a big deficit. So the reason were doing this today is because were in the midst of these problems and our eyes will be clearer on what the solutions may be and our wills will be better and we have a notorious poor record of short memories when it comes to doing everything we need to do. Weve tried but not done some of the things that we need to do. So in my view, and i think in the view of at least several of the witnesses and many others, now is the time to do those few things that we know must be done for the next pandemic while our attention is focused on these matters. A couple of other comments before i ask our witnesses for their concluding remarks. One was i appreciate dr. Gerbers comment about asking the National Academy of medicine to become involved in transparency for the vaccines. That is a very good idea and that is what theyre for. And i think their opinion about the safety of a vaccine would go along way toward dispelling any worries about it. And the other comment i want to make was on Contact Tracing. Of course Contact Tracing is essential. And of course federal funding is essential. But weve already done the federal funding. I mean, Congress Gave states 150 billion, all of which could be spent on Contact Tracing. That is a month ago. And then in addition to that Congress Gave states another 11 billion as part of a 25 billion testing package that was expressly for the purpose of contract funding if the state chose to use it that way. We decided not to tell states to use it that way but they could use it that way. And that is plenty of money to hire all of the contact tracers that you need. According to one estimate by a professional firm, average salary for a contact tracer might be 37,000. If that he were the case, the cost of 100,000 would be 3. 7 billion. A lot less than the 11 billion that was specifically allocated to states for the purpose of hiring contact tracers if they senator blunt, chairman of the Appropriations Committee for health wrote a letter to cdc asking them to make that clear to governors, that they have that money. And many states have not spent the 150 billion that we gave them earlier. This is an allowable expense there. So, yes, we need federal funding for Contact Tracing. Yes, theyre important. Yes, it might be 100,000, 150,000, 180,000 and many ought to use it and many already are. So conclude the hearing, let me ask the four witnesses even though theyve already said this in their testimony. If they were in charge and if they could do three things to get ready for the next pandemic, what would they be. Senator frist well start with you. The pandemic is growing around the world and an outbreak anywhere is a risk everywhere. We need to test more and continue to focus on the vulnerable populations as we talked about here and around the world. And to endorse senator murrays underscoring the Robert Wood Johnson foundation principle. We need to establish invest in longterm partnerships and engage with the private sector to develop the diagnostic test and treatment and vaccines and number two put in a budget mechanism to ensure that Public Health funding does not disintegrate. And number three telehealth. It works. It allows social distancing and Clinical Care to be delivered, and for the future it is convenient and it could be transforming. Thank you, dr. Frist. Dr. Khaldun. Thank you for the opportunity to speak today. The three things i would focus on is disparity and tracing and isolation and funding of state and local Health Departments. When you talk about disparities, we have to talk about housing. Everyone should have access to affordable and healthy housing. We have to invest in communities of color. Through education and jobs. Access to health care we have to focus on. So funding for the Health Care Safety net. Our federally qualified Health Centers who provide the care in the communities. We have to build up the testing capability, and the Contact Tracing capability. Were grateful for the funding in the state of michigan but it needs to be longterm funding and not just come up when we have an emergency. And finally we must invest in longterm Public Health departments. So as been said before, many only have one epidemiologist and were building this on the fly and this needs to be longterm far as funding for state and local Health Departments. Thank you. Thank you. Dr. Gerberding. Thank you. I certainly support what senator frist said and stand by the recommendations of the cis report as well. Ill emphasize three things. One is National Vaccine plan that includes not only the science and the development and the manufacturing piece and collaboration with the private sector, but also the allocation and uptick in monitoring fees because we know this is in the future and were not ready for it yet. The second thing i would say it were coming into a high probability of jointness of ongoing covid in the context of influenza and we need to exercise Health Care Surge under that scenario. Again, including the supply clain in the private sector and that process so that he with could understand how to create more robust supply and hopefully really improve immunization rates at a time when we need it now more than ever. And last thing i would reemphasize is the importance of the Budgetary Authority that allows for sustained investment, not just at the federal level and cdc but through the state and local Health Departments. You cant plan for preparedness in one year cycles any more than you could plan for the department of defense to be prepared for that kind of security in one year time frame. We need longterm sustained accountability and measures for progress. Thank you. Thank you. Governor levitt. Unless you think i cannot counts, im going to give you four. The first is to advance in clarity on the division of labor between state and federal government in a pandemic. States need to be armed with a clear understanding of their role and the federal government its role. Second rejuvenating the Public Health infrastructure. As others have stated, it is not only important at a time of pandemic, but in the Health System where were working toward value. The social determinance of health will play a dual role and ongoing role and have ongoing role in and out of a pandemic. Third the hhs, cdc data modernization, it is a critical piece of infrastructure that needs to be put in place in advance. We should be work on it now. It could be valuable in three months from now as well as in three years from now. And finally, again the echo, annual appropriation on emergency management, not just eposodic funding. Thank you, governor levitt. Thanks to each of the four witnesses. As i listen to the priorities, im reminded again most of the recommendations will help with the current pandemic. All will help with the future pandemic. And in my opinion, theyll all be easier to pass and turn into law during this current pandemic than they will be if we wait a year or two and try to compete with other priorities of the moment. The hearing record will remain open for ten days. Members may submit Additional Information for the record if they would like. Ive also invited comments and responses in any additional recommendations in response to my white paper preparing for the next pandemic, for our committee to consider. Ill fully share those recommendations that i receive with my colleagues, both democrat and republican. The deadline for submitting comments is 5 00 p. M. This friday, june 26. Comments may be send to pandemic preparedness at health. Gov. This is the fourth hearing this month on the covid19 pandemic. Weve had one on going back to school, one on going back to college, weve had one on telehealth. Weve had this one. And then well meet again at 10 00 a. M. Next tuesday june 30th for an update on progress towards safely getting back to work and back to school and our witnesses will be dr. Fauci, dr. Hahn, admiral giroir and dr. Redfield. Thanks again to our distinguished panel of witnesses, to the senators who participated and the staff who helped put this together. The committee will stand adjourned. Hamber of commerce, the gates are also working toward an International Coordinated Response to deliver a vaccine equitably once its created. Welcome to a special edition of the u. S. 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