Transcripts For CSPAN3 CDC Director Public Health Officials

The measures the respective agencies are taking to combat the spread of monkeypox. Other topics discussed in the hearing into the Monkeypox Vaccine, and the opioid crisis. Esses include doctor rochelle walensky, director of the cdc. Nih director anthony fauci, and fda commissioner doctor robert kayla. Live coverage on cspan three. Good morning. The Senate Education and Labor Committee will come to order. Today, we are having a hearing on the federal response to the monkeypox outbreak as we work to stop the spread of this virus. I will have an opening statement, followed by senator burr, and then we will introduce our witnesses. Before we start, i do want to take a moment to congratulate one of our witnesses, dr. Fauci. On announcing his upcoming retirement. Dr. Fauci, you have served through multiple decades and president s and Public Health threats, and worked to save countless lives. I hope you know that you have the thanks of a grateful nation for your Incredible Service to this country. So thank you. Thank you for being here today. After the witnesses gave their testimony, senators will each have five minutes for a round of questions, and while we are unable to have this hearing fully open to the public or media for inperson attendance, live video is available on our committee website. If anyone is in need of accommodations, including closed captioning, please reach out to the committee or the office of accessibility services. According to the center for Disease Control and prevention, the u. S. Now has over 21,000 confirmed cases of monkeypox, more than anyone else in the world. And my home state of washington has over 500 cases. Ive heard from families who are rightly concerned about how bad it is has gotten, and Public Health officials, including back in Washington State, who are frustrated by running into issues we should be prepared for buy now. Thats why i have continued to push the Biden Administration about my concerns with the pump response and urged quick action on testing, on treatment, on action, on vaccines, and unclear guidance to the public. There are Health Care Providers it is reassuring to see that we are making a progress on testing, capacity, and it has increased to 1000 . And fda just approved faster track additional testing. On vaccines, spart a is helping to send out a new vaccine in michigan. Hhs is it working to expand the number of Distribution Sites in the state, and the administrations advice for splitting doses has greatly stretched our vaccine supply. On average, the administration has started working with states to make Vaccines Available at an advanced for many people from the Lgbtq Community. And perhaps most importantly, the rate of new cases is going down. That is all encouraging news, but let me be clear, we must remain vigilant in our response. And the promising improvements do not excuse the issues i have been hearing about from communities, from state health officials, and advocates from the very start of this outbreak. Patients have spoken out about how hard it is to get tested, some even waited days despite having clear symptoms. Providers have had to jump through hoops together patients treatment and i am constantly talking, to Public Health officials in my state who have told me that communications with states could have been far clearer and faster, and how the accessing vaccines has delayed responses. I know states have especially struggled with the decision to forgo the system we typically used to distribute vaccines, the one we are already using for covid vaccines. When it comes to Vaccine Distribution, some shipments have been sent to the wrong state, and even spoiled after storage room temperature. Theres been issues with vaccine supply, like with thousands of vaccine doses were delayed because the fda had yet to inspect where they were coming from. Or when the Biden Administration is an opportunity at a Crucial Point in this outbreak. And again, we are seeing an outbreak in some communities. Advocates in the Lgbtq Community have faced the vast majority of cases have made clear they feel they are being overlooked. We need to keep focusing on outrage and getting to those who are most at need and most at risk. That includes communities of color, who we know do not have equitable access to vaccines. This is especially important as data suggests the black and latino communities are disproportionately burdened by this outbreak we have to do better. We have to be applying what we learned from the Covid Response and applying it to of course, there is an enormous difference between this and the covid pandemic, which is thanks to decades of investment, we already had test and treatments and vaccines ready to go before this crisis began. That should serve as a reminder to all of us about the immense value of investing in Public Health preparedness. But its also why theyre stumbles and getting these tools deployed were especially frustrating, and inexcusable. To learn from this, we need to be clear eyed about where we were wrong. Not just by the challenge we face for the past several months, but that we have faced for decades of challenges that, to be frank, have been for many champions, not just this one. They were not replaced and expired over the course of the decade. I know i joined my Ranking Members and members of the this committee when i say weve got to do better. Not just on covid, not just on monkeypox, but on Public Health threats period. Because we know there will be more. Just last week, new york declared an emergency due to polio. He had another Public Health risk. We need to watch closely. So i want to hear from our Witnesses Today about not just what they are doing right now to improve our response to the monkeypox outbreak, and fast, but also how we can fix this in the long term and make sure the stumbles of the past couple months never happen again. I want to know what you and the administration are doing to make sure we have enough tests and treatments and vaccines for this outbreak, and get them where they need to go, while also maintaining an adequate stock of supplies for any smallpox threat. What you are doing to improve outreach to the Lgbtq Community, address disproportionate harm to black and latino communities, fight stigma and misinformation, and rising inequities weve seen no response so far. How will we make the most of new research to develop promising vaccines with therapeutics, and make them more quickly available while continuing the covid Gold Standard of safety and effectiveness. And are we getting schools and colleges everything they need to stay open and keep students in schools and communities safe . I am glad a cdc has provided guidance for k to 12 schools, and fortunately the science tells us elementary and secondary school kids are not at higher risk. And cdc has also released research for colleges, which is critically students returning to campus in the full. We need to make sure colleges and universities are equipped to prevent outbreaks for students living into dorms. I realize youve got your work cut out for you in all of this, especially with covid still raging. But there is no reason for us to fall behind. So i am going to keep pushing in here, because families back in Washington State, and across the country are counting on all of you to get it right. That is also why i am going to keep pushing my colleagues here in congress about the need for funding to support all of this work. I know im not the only one here with concerns about the monkeypox response, but we cant just say this isnt working without providing the funding to end this outbreak and build a Public Health system americans deserve. So i will continue to work with colleagues on both sides of the aisle and push to deliver the resources that will help get families the testing, treatment, and vaccines they need. Im interested in hearing from the witnesses on what the needs are to invest in our monkeypox response. Its also important to me we continue to keep our eyes on the horizon when it comes to future outbreaks and pandemics and build a stronger Public Health network for whatever threat comes next. As the saying goes, an ounce of prevention is worth a pound of cure. And that starts with building a worldclass Public Health system, rather than one that legs behind our peers. Our communities deserve to be as safe as anyone in the world, which is why senator burr and i are continuing to work to pass our prevent the pandemic act. Our Bipartisan Legislation implemented the lessons from our Covid Response, and improves our policies and processes on issues like strengthening supply chain, improving management of our national stockpile, modernizing data systems, and other items which would address many of the challenges we face with monkeypox. A strong Public Health system also requires strong investment. Our Public Health system is underfunded before covid struck, and it has been overwhelmed ever since. We have to end the cycle of crisis and complacency by making the same investments that allow us to build and maintain a robust Public Health infrastructure at all levels. I will keep pushing for all of these steps, because we should all know by now just how much is at stake. I can tell you that families in seattle know, parents in spoken no, workers in olympia no. People across Washington State and across the country know. Covid was never going to be the last Public Health crisis we face. And neither is monkeypox. The question is not whether there will be a new threat, it is when it will strike and whether we will be ready. The truth is the monkeypox response so far has not been encouraging. But there are some signs of progress and there are clear steps we can and should take to improve. I dont want to hear today about the steps we will be taking, i do want to see action, and i will be watching closely. I hope we can Work Together to build on the progress and in this crisis to and make the kind of improvement we need to put our Public Health security on solid footing once and for all. Thank you very much, and i will turn over to senator burr for closing remarks. Thank you, madam chair, and good morning. I am glad we are finally here, having a hearing on the monkeypox outbreak. It is hitting our nation. Monkeypox is now a Public Health emergency. It didnt have to become one. I think the one promising thing that can be said this morning is the infection rate has slowed. That may be the only thing, since the first transmission was reported in the uk and europe. Ive been pressing the administration for a strategy and a plan. After almost three years, since the covid pandemic, you think the Public Health agency is responsible for our preparedness and response would be prepared for anything, particularly a threat like monkeypox, which weve known about for decades, and for which we have vaccines and treatments. Doctor fauci talked to this committee before about monkeypox. Its almost the definition case of what our sister agencies should be prepared to tackle. The virus spread through physical contact, the virus spreads when an infected person as an obvious sign of infection. Its not like covid, which was a newly emerged virus that spread asymptomatic infection. But by any measure, in fact by every measure, the response from the Biden Administration a monkeypox crisis has been a catastrophic failure. He repeated each of the mistakes from the early days of the Covid Response, and the cultural arrogance from Public Health officials who are supposed to be the forefront of our response lead this country down again. Since the covid pandemic started, the response during both the trump and Biden Administrations, i think we are being sick of plus having to hold you accountable for systematic errors. But it seems nothing has changed. We cant blame the last administration on this one. The first confirmed monkeypox case, 2022, was may 7th in united kingdom. The first case of monkeypox in this outbreak was reported in the u. S. On may 18th. We had warning. We had warning that this was coming, we should have been prepared to manage it when it arrived. Lets review. We failed testing. Although we eventually may Testing Available through the response network, these tests were too hard to access. It took weeks before doctors were able to get parents and their patients tested without first consulting there is also a significant delay in engaging the private sector on the outbreak. They waited until june 27th to engage the private sector. Still active after that company develop diagnostic tests that could help address some of the slow turnaround. They were left waiting months, without delay. We failed on vaccines. An enhanced strategy to offer vaccines to at risk individuals in known contact was announced june 28th. This was already after some local jurisdictions have taken it upon themselves to use the vaccine in this manner, and a whole month after the uk joint committee on vaccines and immunization met to discuss a similar strategy for their citizens. Why do we continue to be meanwhile, decisions about Vaccine Administration seem to have been made seemingly on the fly. Even when the fda issued an emergency authorization last month, allowing vaccines to be administered through durable injections. There were no Public Meetings of the fta cdc experts to discuss relevant questions on the minds of impacted americans, and inform these decisions. No professionals patients were scared that they were being experimented on. To make matters worse, they had no time to prepare for the change in Vaccine Administration. After the fda made its decision, they made the assumption every vial would yield five doses. We know this has not been the case in every state, resulting in some vaccines vaccinating fewer, not more at risk people. We failed to have a plan. Monkeypox outbreaks have been occurring in nigeria and other places with increasing frequency. It was identified as a threat under our and a threat for which we had countermeasures in our stockpile. I might also add that our earliest purchase of the nordic vaccine was in 2017. But it seems there was no real plan on how to respond to the information and research we needed to understand this outbreak. Only after both i and the chair sent separate letters asking for a plan, did the office of science and Technology Blog about their research priorities. The priorities were vague, it was not clear what Research Activities hhs was undertaking in response. These have allowed the disease to spread. 31 cases and may quickly turn to 650 cases in june. More than 6000 cases in july, and more than 12,000 cases in august. And near 22,000 since september. It should have been obvious to all of us, but the timing of these early cases coupled with the evidence would create a perfect storm for a large outbreak. Monkeypox is a virus that largely transmits through skin to skin contact, most easily it frequently between sexual partners. What do room just before pride celebrations across the country. And after two years of lockdown and social distance, agency should been screaming from the rooftops about how they suspected monkeypox was spread. Instead, we remain silent. People got sick, and paid for that silence. But consenting adults need to be told what Behavioral Changes they should consider to avoid getting a preventable disease like monkeypox. You failed at a time when communities were most at risk. Disease control and prevention preparedness and response is a literally in the name of two of your agencies. Yet you did none of that. It was no surprise to me that these administrations, that the coordinate shows why this committee passed the freedom act. The secretary of hhs has been totally lax, and when hes been involved only seems to make matters worse. But new ad hoc groups within the government are addressing the problem. We need a consistent and coherent government wide response to be effective. That could only be led by the white house. I hope that in the coming weeks, we will be able to get that legislation over the finish line, and i will be spending my remaining weeks in United States senate doing everything i can to help the white house set up the new office with a Lasting Mission and clearer judgment. I will spend the next several years conducting thorough examination of each of the agencies, flooding each and every one of those that we have seen now in response to the accountability of you have the authority. Its a question of you have been giving astonishing amounts of money. Its a question of leadership. Its a question of focus, its a question of squashing the typical bureaucratic roadblocks and ineptitude. We need to do better. We learned in operation that when you press outside the box, when you focus on Monkeypox Vaccine<\/a>, and the opioid crisis. Esses include doctor rochelle walensky, director of the cdc. Nih director anthony fauci, and fda commissioner doctor robert kayla. Live coverage on cspan three. Good morning. The Senate Education<\/a> and Labor Committee<\/a> will come to order. Today, we are having a hearing on the federal response to the monkeypox outbreak as we work to stop the spread of this virus. I will have an opening statement, followed by senator burr, and then we will introduce our witnesses. Before we start, i do want to take a moment to congratulate one of our witnesses, dr. Fauci. On announcing his upcoming retirement. Dr. Fauci, you have served through multiple decades and president s and Public Health<\/a> threats, and worked to save countless lives. I hope you know that you have the thanks of a grateful nation for your Incredible Service<\/a> to this country. So thank you. Thank you for being here today. After the witnesses gave their testimony, senators will each have five minutes for a round of questions, and while we are unable to have this hearing fully open to the public or media for inperson attendance, live video is available on our committee website. If anyone is in need of accommodations, including closed captioning, please reach out to the committee or the office of accessibility services. According to the center for Disease Control<\/a> and prevention, the u. S. Now has over 21,000 confirmed cases of monkeypox, more than anyone else in the world. And my home state of washington has over 500 cases. Ive heard from families who are rightly concerned about how bad it is has gotten, and Public Health<\/a> officials, including back in Washington State<\/a>, who are frustrated by running into issues we should be prepared for buy now. Thats why i have continued to push the Biden Administration<\/a> about my concerns with the pump response and urged quick action on testing, on treatment, on action, on vaccines, and unclear guidance to the public. There are Health Care Providers<\/a> it is reassuring to see that we are making a progress on testing, capacity, and it has increased to 1000 . And fda just approved faster track additional testing. On vaccines, spart a is helping to send out a new vaccine in michigan. Hhs is it working to expand the number of Distribution Sites<\/a> in the state, and the administrations advice for splitting doses has greatly stretched our vaccine supply. On average, the administration has started working with states to make Vaccines Available<\/a> at an advanced for many people from the Lgbtq Community<\/a>. And perhaps most importantly, the rate of new cases is going down. That is all encouraging news, but let me be clear, we must remain vigilant in our response. And the promising improvements do not excuse the issues i have been hearing about from communities, from state health officials, and advocates from the very start of this outbreak. Patients have spoken out about how hard it is to get tested, some even waited days despite having clear symptoms. Providers have had to jump through hoops together patients treatment and i am constantly talking, to Public Health<\/a> officials in my state who have told me that communications with states could have been far clearer and faster, and how the accessing vaccines has delayed responses. I know states have especially struggled with the decision to forgo the system we typically used to distribute vaccines, the one we are already using for covid vaccines. When it comes to Vaccine Distribution<\/a>, some shipments have been sent to the wrong state, and even spoiled after storage room temperature. Theres been issues with vaccine supply, like with thousands of vaccine doses were delayed because the fda had yet to inspect where they were coming from. Or when the Biden Administration<\/a> is an opportunity at a Crucial Point<\/a> in this outbreak. And again, we are seeing an outbreak in some communities. Advocates in the Lgbtq Community<\/a> have faced the vast majority of cases have made clear they feel they are being overlooked. We need to keep focusing on outrage and getting to those who are most at need and most at risk. That includes communities of color, who we know do not have equitable access to vaccines. This is especially important as data suggests the black and latino communities are disproportionately burdened by this outbreak we have to do better. We have to be applying what we learned from the Covid Response<\/a> and applying it to of course, there is an enormous difference between this and the covid pandemic, which is thanks to decades of investment, we already had test and treatments and vaccines ready to go before this crisis began. That should serve as a reminder to all of us about the immense value of investing in Public Health<\/a> preparedness. But its also why theyre stumbles and getting these tools deployed were especially frustrating, and inexcusable. To learn from this, we need to be clear eyed about where we were wrong. Not just by the challenge we face for the past several months, but that we have faced for decades of challenges that, to be frank, have been for many champions, not just this one. They were not replaced and expired over the course of the decade. I know i joined my Ranking Member<\/a>s and members of the this committee when i say weve got to do better. Not just on covid, not just on monkeypox, but on Public Health<\/a> threats period. Because we know there will be more. Just last week, new york declared an emergency due to polio. He had another Public Health<\/a> risk. We need to watch closely. So i want to hear from our Witnesses Today<\/a> about not just what they are doing right now to improve our response to the monkeypox outbreak, and fast, but also how we can fix this in the long term and make sure the stumbles of the past couple months never happen again. I want to know what you and the administration are doing to make sure we have enough tests and treatments and vaccines for this outbreak, and get them where they need to go, while also maintaining an adequate stock of supplies for any smallpox threat. What you are doing to improve outreach to the Lgbtq Community<\/a>, address disproportionate harm to black and latino communities, fight stigma and misinformation, and rising inequities weve seen no response so far. How will we make the most of new research to develop promising vaccines with therapeutics, and make them more quickly available while continuing the covid Gold Standard<\/a> of safety and effectiveness. And are we getting schools and colleges everything they need to stay open and keep students in schools and communities safe . I am glad a cdc has provided guidance for k to 12 schools, and fortunately the science tells us elementary and secondary school kids are not at higher risk. And cdc has also released research for colleges, which is critically students returning to campus in the full. We need to make sure colleges and universities are equipped to prevent outbreaks for students living into dorms. I realize youve got your work cut out for you in all of this, especially with covid still raging. But there is no reason for us to fall behind. So i am going to keep pushing in here, because families back in Washington State<\/a>, and across the country are counting on all of you to get it right. That is also why i am going to keep pushing my colleagues here in congress about the need for funding to support all of this work. I know im not the only one here with concerns about the monkeypox response, but we cant just say this isnt working without providing the funding to end this outbreak and build a Public Health<\/a> system americans deserve. So i will continue to work with colleagues on both sides of the aisle and push to deliver the resources that will help get families the testing, treatment, and vaccines they need. Im interested in hearing from the witnesses on what the needs are to invest in our monkeypox response. Its also important to me we continue to keep our eyes on the horizon when it comes to future outbreaks and pandemics and build a stronger Public Health<\/a> network for whatever threat comes next. As the saying goes, an ounce of prevention is worth a pound of cure. And that starts with building a worldclass Public Health<\/a> system, rather than one that legs behind our peers. Our communities deserve to be as safe as anyone in the world, which is why senator burr and i are continuing to work to pass our prevent the pandemic act. Our Bipartisan Legislation<\/a> implemented the lessons from our Covid Response<\/a>, and improves our policies and processes on issues like strengthening supply chain, improving management of our national stockpile, modernizing data systems, and other items which would address many of the challenges we face with monkeypox. A strong Public Health<\/a> system also requires strong investment. Our Public Health<\/a> system is underfunded before covid struck, and it has been overwhelmed ever since. We have to end the cycle of crisis and complacency by making the same investments that allow us to build and maintain a robust Public Health<\/a> infrastructure at all levels. I will keep pushing for all of these steps, because we should all know by now just how much is at stake. I can tell you that families in seattle know, parents in spoken no, workers in olympia no. People across Washington State<\/a> and across the country know. Covid was never going to be the last Public Health<\/a> crisis we face. And neither is monkeypox. The question is not whether there will be a new threat, it is when it will strike and whether we will be ready. The truth is the monkeypox response so far has not been encouraging. But there are some signs of progress and there are clear steps we can and should take to improve. I dont want to hear today about the steps we will be taking, i do want to see action, and i will be watching closely. I hope we can Work Together<\/a> to build on the progress and in this crisis to and make the kind of improvement we need to put our Public Health<\/a> security on solid footing once and for all. Thank you very much, and i will turn over to senator burr for closing remarks. Thank you, madam chair, and good morning. I am glad we are finally here, having a hearing on the monkeypox outbreak. It is hitting our nation. Monkeypox is now a Public Health<\/a> emergency. It didnt have to become one. I think the one promising thing that can be said this morning is the infection rate has slowed. That may be the only thing, since the first transmission was reported in the uk and europe. Ive been pressing the administration for a strategy and a plan. After almost three years, since the covid pandemic, you think the Public Health<\/a> agency is responsible for our preparedness and response would be prepared for anything, particularly a threat like monkeypox, which weve known about for decades, and for which we have vaccines and treatments. Doctor fauci talked to this committee before about monkeypox. Its almost the definition case of what our sister agencies should be prepared to tackle. The virus spread through physical contact, the virus spreads when an infected person as an obvious sign of infection. Its not like covid, which was a newly emerged virus that spread asymptomatic infection. But by any measure, in fact by every measure, the response from the Biden Administration<\/a> a monkeypox crisis has been a catastrophic failure. He repeated each of the mistakes from the early days of the Covid Response<\/a>, and the cultural arrogance from Public Health<\/a> officials who are supposed to be the forefront of our response lead this country down again. Since the covid pandemic started, the response during both the trump and Biden Administration<\/a>s, i think we are being sick of plus having to hold you accountable for systematic errors. But it seems nothing has changed. We cant blame the last administration on this one. The first confirmed monkeypox case, 2022, was may 7th in united kingdom. The first case of monkeypox in this outbreak was reported in the u. S. On may 18th. We had warning. We had warning that this was coming, we should have been prepared to manage it when it arrived. Lets review. We failed testing. Although we eventually may Testing Available<\/a> through the response network, these tests were too hard to access. It took weeks before doctors were able to get parents and their patients tested without first consulting there is also a significant delay in engaging the private sector on the outbreak. They waited until june 27th to engage the private sector. Still active after that company develop diagnostic tests that could help address some of the slow turnaround. They were left waiting months, without delay. We failed on vaccines. An enhanced strategy to offer vaccines to at risk individuals in known contact was announced june 28th. This was already after some local jurisdictions have taken it upon themselves to use the vaccine in this manner, and a whole month after the uk joint committee on vaccines and immunization met to discuss a similar strategy for their citizens. Why do we continue to be meanwhile, decisions about Vaccine Administration<\/a> seem to have been made seemingly on the fly. Even when the fda issued an emergency authorization last month, allowing vaccines to be administered through durable injections. There were no Public Meetings<\/a> of the fta cdc experts to discuss relevant questions on the minds of impacted americans, and inform these decisions. No professionals patients were scared that they were being experimented on. To make matters worse, they had no time to prepare for the change in Vaccine Administration<\/a>. After the fda made its decision, they made the assumption every vial would yield five doses. We know this has not been the case in every state, resulting in some vaccines vaccinating fewer, not more at risk people. We failed to have a plan. Monkeypox outbreaks have been occurring in nigeria and other places with increasing frequency. It was identified as a threat under our and a threat for which we had countermeasures in our stockpile. I might also add that our earliest purchase of the nordic vaccine was in 2017. But it seems there was no real plan on how to respond to the information and research we needed to understand this outbreak. Only after both i and the chair sent separate letters asking for a plan, did the office of science and Technology Blog<\/a> about their research priorities. The priorities were vague, it was not clear what Research Activities<\/a> hhs was undertaking in response. These have allowed the disease to spread. 31 cases and may quickly turn to 650 cases in june. More than 6000 cases in july, and more than 12,000 cases in august. And near 22,000 since september. It should have been obvious to all of us, but the timing of these early cases coupled with the evidence would create a perfect storm for a large outbreak. Monkeypox is a virus that largely transmits through skin to skin contact, most easily it frequently between sexual partners. What do room just before pride celebrations across the country. And after two years of lockdown and social distance, agency should been screaming from the rooftops about how they suspected monkeypox was spread. Instead, we remain silent. People got sick, and paid for that silence. But consenting adults need to be told what Behavioral Changes<\/a> they should consider to avoid getting a preventable disease like monkeypox. You failed at a time when communities were most at risk. Disease control and prevention preparedness and response is a literally in the name of two of your agencies. Yet you did none of that. It was no surprise to me that these administrations, that the coordinate shows why this committee passed the freedom act. The secretary of hhs has been totally lax, and when hes been involved only seems to make matters worse. But new ad hoc groups within the government are addressing the problem. We need a consistent and coherent government wide response to be effective. That could only be led by the white house. I hope that in the coming weeks, we will be able to get that legislation over the finish line, and i will be spending my remaining weeks in United States<\/a> senate doing everything i can to help the white house set up the new office with a Lasting Mission<\/a> and clearer judgment. I will spend the next several years conducting thorough examination of each of the agencies, flooding each and every one of those that we have seen now in response to the accountability of you have the authority. Its a question of you have been giving astonishing amounts of money. Its a question of leadership. Its a question of focus, its a question of squashing the typical bureaucratic roadblocks and ineptitude. We need to do better. We learned in operation that when you press outside the box, when you focus on Public Private<\/a> mergers, when you get bureaucracy changed so that it serves the American People<\/a> and doesnt try to control it, we can make government work. I would ask you for your plan, but you dont have one. Id ask you for what you would change, but your agencies seem to think they are doing everything right. I would ask you who you are going to hold accountable, but failures and sugar agencies showed you dont believe in accountability. Instead, i will express my outrage and hope that eventually we will get people in your agencies who will do the job to protect American People<\/a> instead of protecting their bureaucracies. Before i close, i want to address a serious issue. The last time we were here, there was a coordinated assault, pretending that somehow republicans were at fault for not giving additional money for the pandemic. Lets revisit some of the facts here. The senate on a bipartisan basis actually packed extra funding 18. 6 billion dollars in march for testing and treatment and vaccines. But the speaker of the house passed that legislation so she stripped it out. I have worked with her for a long time, im pretty sure shes a democrat. Then theres been senators romney and blunt, engaged in deep negotiations with the chair of the committee. And we arranged a deal with 10 million of domestic funding for covid. But the majority of the leaders did not want to take the vote against lifting covid restrictions across the southern border. Probably because he knew that im pretty sure chuck is a democrat. So then our last meeting, each of you got together and pretended that somehow republicans were at fault. Then atrepublicans tried twiceo provide additional funding for covid. But democrats couldnt take yes for an answer. Then last month, democrats conducted a spending exercise where republicans werent even in the room. They dramatically raised taxes by hundreds of millions of dollars, provided funding for 87,000 to audit the middle class and spend hundreds of millions of dollars on a Green New Deal<\/a> that will mostly impact billionaires and millionaires. The same democrats who complain about covid spending did not spend a dime of those taxes in the pandemic. I often hear my colleagues saying that if you choose your priority. But democrats have not wanted to spend money and chose not to. I guess making energy more expensive was more important. I think all of you know ive had in my jacket pocket a card with a simple request from this administration, and told him all he needed to do for me to get my senate colleagues, my republican colleagues to support additional funding was to provide answers to those four things. Give us a detailed plan for covid. Detailed accounting of where the money is going to go. Offsets to match new spending for the pandemic, and a simple vote on a covid restriction at the border. I first started that in april. Today, none of those four things have been presented. So to date, the administrations failed to deliver. Maybe they dont want to actually have transparency on what they have spent. When we really dont want to come clean to the American People<\/a> what their plan is until after the election. Have not sure what it is. Im tired of being the one that is blamed. Ive got just as much invested as much as anybody on this committee to make sure that we are successful for the American People<\/a>. I will continue to do that, whether i am in congress or not. I cant thank you enough for your years of service. Its been incredibly beneficial to the American People<\/a> into the health care of this country. I hate to see you go. But i also look forward to that day in january where we both are on the other side of this mountain, and i can actually spend some time with my wife and grandchildren. Having said that, madam chair, lets have a reset this morning. Lets quit blaming everybody, and lets start showing some leadership. If the Administration Needs<\/a> money, send us a budget request. There is no increased spending for covid in next years request. They believe that this is all going to happened by an emergency. The european that is wrong. Give the administration a request for money and lets work through the normal process. My hope is that there is a plan someday they will share it with us. Thank you, senator burr. I will now introduce todays witnesses. Dr. Rochelle walensky is the director of the center for Disease Control<\/a> and prevention, and the administrator of the doctor anthony fauci, the director of the institute for Infectious Diseases<\/a>, and chief medical adviser on president bidens covid19 task force. Doctor is the commissioner for the food and drug administration. Don oconnell is the assistant secretary for preparedness and response. Director walensky, and director fauci, and assistant secretary oconnell, thank you all for being here today. We all look forward to your testimony. With that, we will begin with dr. Walensky. Chair murray, Ranking Member<\/a> burr, and members of the committee. I appreciate the opportunity to discuss monkeypox and cdcs response to the global outbreak. To date, there have been over 59,000 cases of monkeypox reported globally, including over 22,000 cases and one confirmed death in the United States<\/a>. In the current outbreak, the first cases were diagnosed in the night kingdom on may 14th. And within days, additional countries began identifying the clusters. On may 17th, a case was reported in manage situ sits and was confirmed by the cdc the following day. Cdc immediately began its work, searching for additional cases, educating clinicians and the public about the disease. In less than one week, the cdc reached out to commercial to increase Testing Capacity<\/a> and began to scale up a response. Over the last several weeks, we have seen a decline in the growth of new cases here and abroad. Though there are areas in the United States<\/a> where the rate of rising cases is still increasing. We approach this news with cautious optimism, recognizing that we must aggressively respond with our entire toolkit, including destinations, testing, and education about risks to behavior change. This has been notable for transition primarily, but not exclusively through sexual contact. It has disproportionately affected gay, bisexual, and other men have sex with men a large majority of cases have been found in this population. Cdc has been studying monkeypox for decades, and has contributed to the creation of a test, experimental therapeutics, and vaccines that are available today. But as a relatively rare disease, although there are no providers in the u. S. That have seen or even heard of monkeypox, provider education is the name key component. Indeed, it has been a remarkable challenge. But it is critical to our response. Cdc has issued for health advisories, each reaching over 1 million people, and hope clinician calls we have also shared monkeypox information for congregant living to prevent monkeypox spread. Initially, our Public Health<\/a> Centers Across<\/a> the country were able to collectively test over 6000 cases each week, using a diagnostic test developed to detect orthodox viruses, including one quick monkeypox. Cdc worked with our Public Health<\/a> partners to quickly expand Testing Capacity<\/a>, and engage commercial laboratories to increase capacity to 80,000 texts per week. Well have volume is currently 14 of total Testing Capacity<\/a>, we are working with academic medical centers, commercial, and Public Health<\/a> laboratories to make testing even more accessible to all who need it. From the beginning of this response, the cdc has worked closely with to make jynneos a vaccine available. Based on data from 39 jurisdictions reporting to the cdc, a total of over 540,000 jynneos vaccine doses have been administered. Collaboration with communities most affected by the outbreaks, including the Lgbtq Community<\/a> is credible to our response. We rely on our partners across Public Health<\/a> and lgbtq advocates and Community Based<\/a> organizations to contribute to their expertise to our response, to challenge us to continue to do better, and to amplify our Public Health<\/a> messages. In recent weeks, the cdc has provided Technical Assistance<\/a> and support for Vaccination Efforts<\/a> and other monkeypox response activities at large events, serving lgbtq plus audiences. These efforts and others have facilitated the delivery of vaccines to those who may face unique barriers to access, including racial, ethnic, and geographically diverse populations. The robust response required for Public Health<\/a> underscores the importance of sustained investment in the core capabilities that should constitute the foundation of a 21st century Public Health<\/a> system. In addition, cdc needs additional policy makers to get the data necessary to take the informed action the public expects. Despite having a Vaccine Distribution<\/a> strategy since june 28th, it took until Early September<\/a> to complete all 61 data use agreements needed to receive Vaccine Administration<\/a> data. While we work to control this outbreak in United States<\/a>, plan to support that monkeypox will continue to be a global threat. Once this outbreak is controlled, we will need to maintain vigilance, education, and Vaccination Efforts<\/a>, so that another outbreak does not emerge. That is why now, it is important for congress to act upon supplemental requests. Cdc will use the Additional Resources<\/a> to support testing and Laboratory Capacity<\/a> expansion. Vaccination efforts, surveillance, epidemiologic investigations, outrage, investigation, and global efforts. Together, we can meet the fast evolving threat of monkeypox, successfully in the current outbreak, and prepare for any future outbreak. Thank you, i look for your questions. Thank you. Dr. Fauci . Madam chair, Ranking Member<\/a> and members of the committee, thank you for giving the opportunity to discuss with you the role of the National Institute<\/a> of allergy and Infectious Diseases<\/a> in conducting and supporting research to address the ongoing monkeypox a Public Health<\/a> emergency. I will outline how longstanding supported Research Efforts<\/a> have not enhanced our preparedness for, response to the emergence of the monkeypox virus. First, i want to provide some Historical Context<\/a> that relates to past, current, and future Research Efforts<\/a>. It is worth noting that the emerging epidemiological pattern of monkeypox cases there is a striking resemblance to the early cases of hiv a. I. D. S. In the United States<\/a> and other non endemic countries, monkeypox disproportionally affect men have sex with men. However, anyone exposed to the circulating virus can get infected with monkeypox, regardless of their age, gender identity, or sexual orientation. Thus, we would be wise to heed an observation i made 40 years ago in an article i published in the annals of internal medicine in 1982, during the first year of the hiv aids pandemic. When i referred to what we would soon call aids a disease that did not even have a name at that time. And i quote from the publication. Any assumption that it will remain restricted to a particular segment of our society is truly an assumption without a scientific basis, unquote. And so although we must focus our efforts on the group that is most predominantly afflicted and at risk, there is still much we must learn about this disease. Additional epidemiological and observational goals in the study include ongoing surveillance of cases that are critical. In addition, much work needs to be done in viral g, immunology, transmission, as well as diagnostic therapeutics and vaccines, which i will address in a moment. There are certainly some sharp just fences between the early years of age and our Current Situation<\/a> of monkeypox. On like the situation at the start of the aids outbreak, the e. T. A logic agent of monkeypox has been known for decades. And medical countermeasures have been developed, mainly a vaccine through genius, and an anti viral. This is the result of decades of supported research on the monkeypox virus, and other viruses including the variola virus that calls this supported research was essential to the development of jynneos vaccine. We funded a number of studies of jynneos from the pre clinical stage, through phase two Clinical Trial<\/a>s, to evaluate safety, immunogenicity, duration, protection, and administration. We then transition the vaccine to which supported advanced clinical evaluation, and we have recently launched the Clinical Trial<\/a> further evaluating alternative routes of administration. In the area of therapeutics, we funded the discovery of and the preClinical Study<\/a> determined the mechanisms of action and its safety and efficacy and animals. Again, together, we also funded phase one and phase two of Clinical Trial<\/a>s of take over a matt. Clinical trials to evaluate the interactions with humans with monkeypox are needed to gather Additional Data<\/a> about the safety and efficacy of the drug in the context of the current outbreak. And have recently launched a phase three Clinical Trial<\/a>, focused on patients in the United States<\/a> through the aids Clinical Trial<\/a> group. A separate and eac group in collaboration with research in the democratic republic of the congo will begin imminently. It is worth noting that the study was planned prior to the current global outbreak as part of our preparedness efforts to study high consequence pathogens in Key International<\/a> locations with Lessons Learned<\/a> during the response to aids and covid19, such as avoiding stigma and ensuring the medical countermeasures that get to where they are needed most. That they should help us in our efforts to respond to the ongoing monkeypox emergency. In addition, the u. S. Response to monkeypox should internet help to inform our response to the inevitable next emergency for reemerging Infectious Diseases<\/a> of pandemic potential. Thank you for your potential, i would be happy to answer your questions following the presentation of my colleagues. Thank you. Doctor kayla . Truman your mic. Oh, there we go. Ranking member burr, members of the committee, thanks for the opportunity to provide information on the fdas ongoing work related to the Public Health<\/a> emergency. The fda has been working with our government and private sector collaborators to respond to the continuing Health Threat<\/a> since the first monkeypox case came to the u. S. Weve been working hard to provide information to those who need it most. There is currently one fda licensed a vaccine, genius, available for the prevention of monkeypox. We originally approved this modified vaccine for the prevention of smallpox. Following reports that monkeypox the fda recognize that production of this vaccine would need to be accelerated. Fda and barnett worked together to submit a manufacturing settlement that would allow more doses to be used in United States<\/a>. The fda approved that supplement in july, following an inspection of the manufacturing facility in europe. In august, late granted an emergency use authorization for inter Terminal Administration<\/a> of the vaccine, which has helped increase the supply of vaccine available to americans up to five fold. The authorization allowed additional review of a 2015 Clinical Study<\/a> that evaluated a two dose series of genius, and given intra durham ali versus subcutaneously and individuals aged 18 years or older. Consistent with previous studies, data indicated the intra durable administration produced a similar immune response to subcutaneously administration, with a modestly different reaction profile at the injection site. The combination of vaccination and preventive measures to reduce the amount of contact with the virus remains the best way to prevent the spread of monkeypox. The vaccine is available bite in Traditional Administration<\/a> for individuals 18 years of age or older. They are determined to be at highrisk for monkeypox infection, and available by subcutaneously investigation for those under the age of 18 to be at high risk for the monkeypox infection. Its important to recognize that we should not have Clinical Data<\/a> on so the fda continues to monitor safety following the administration of jynneos nationwide. Additionally, as youve heard from doctor fauci and i, we initiated a Clinical Trial<\/a> to obtain for their data. The fda has also worked closely with the cdc manufacturer currently, cdc has an fda cleared test that can detect non variola or the poxviruses, including monkeypox by a swathe from the legion. This counts as three 67 cdc Laboratory Response<\/a> network labs, as well as through five large commercial labs. On september 7th, following an Emergency Declaration<\/a> from hhs, fda issues an eua for an additional test from a commercial developer. We also issued guidance from the development of diagnostic tests, and hope it will increase the diversity and availability of tests for. Monkeypox currently, there are no treatments for monkeypox. There is an fda approved treatment for some smallpox, currently made available under a cdc expanded access investigational new drug protocol. The animal rule is an approval pathway that remain relies on pathway studies that can be used when human trials are not the cost of monkeypox remains endemic in the country around the world, and we now have large outbreaks in the u. S. Given Clinical Trial<\/a>s are both in a way that they were not feasible for smallpox, smallpox has been eradicated and has a 30 to 50 mortality rate. Without human trials, we dont know if monkeypox is beneficial for patients with monkeypox. Drugs that show efficacy in animals are not always effective in humans. Therefore, Clinical Trial<\/a>s, one of which is now underway as doctor fauci has mentioned, will be necessary for the fda to determine if it is safe and effective to treat monkeypox. In the meantime, because there are significant risk of the development of viral resistance to depox, judicious use of deep talks and careful monitoring are of paramount importance for stewardship of this potentially while we study it in Clinical Trial<\/a>s. Fda is dedicated to continue to work to ensure appropriate and robust response to the monkeypox outbreak. I look forward to answering your questions. Thank you. Assistant secretary oconnell . Chair murray, Ranking Member<\/a> burr, and distinguished members of the committee, it is an honor to testify before you today. On aspers work in the ongoing monkeypox response. Let me start by sharing the work i have done to procure and distribute vaccines. The Strategic National<\/a> stockpile stores vaccines that can be used in smallpox outbreaks. Among the vaccines it stores is a small stockpile of jynneos, a relatively new vaccine for those that are immune compromised and unable to tolerate the live replicating virus in the other smallpox vaccines. And since jynneos is also and we have deployed these vaccines for the current response. When the first case of monkeypox in the u. S. Was identified, the sns had 2400 vials of jynneos in its inventory. It immediately deployed vaccines to support the first cases. When there were still only two known cases in the u. S. , we requested we ship to the sns from our u. S. Government on reserve, stored by when there were only 13 known cases, we ordered an additional 36,000 vials from its reserve, and when there were only 35 known cases, asper ordered an additional 300,000 vials from its reserve. All of this was done to stay ahead of the virus, so case counts were very low in United States<\/a>. We were watching the quick spread of cases in europe, which was about 2 to 3 weeks ahead of us. And we moved out quickly, anticipating similar spread in the u. S. In the weeks to come. So far, weve made over 1. 1 million vials of genius available to jurisdictions for use against the current outbreak. And we have purchased 5. 5 million more to arrive in the next two months. Bringing jynneos manufacturing capability on shore has been another focus at asper. This summer, when we purchase the second 2. 5 million doses from should be filled and finished, our contract required that those to speak he finished in the u. S. And we have been pleased to support the and arrangement to do that in michigan. We have provided graham with 11 million to secure equipment and staff it needs to wrap up quickly. I visited graham two weeks ago, as they are bringing on that was pleased with the proper and here they will be adding over 72 jobs in michigan to support this work. Vaccines are not the only medical Counter Measure<\/a> asper has made available. We have also made available therapeutic prior to the start of the outbreak, we had more than 1. 7 million vials of tpoxx. Today, over 37,000 have been distributed. I am pleased to make those medical countermeasures available for the current monkeypox outbreak. It is the right thing to do, but i have not lost sight that the genius and depox were stockpiled for the smallpox outbreak. I have consulted with the Inter Agency Body<\/a> responsible for advising hhs, medical Countermeasures Development<\/a> procurement, and they have agreed to approach weve taken. It is important, however, that as we move forward with our response, we continue to consider ways to we have also applied Lessons Learned<\/a> from the covid19 response to our work in monkeypox, as we digitize the countermeasure ordering system. We opted to use a program that allows states to order both vaccines and therapeutics from the same system. Rather than using separate noninterim operable systems for each, as they have had to do in a covid19 response. And using this platform ordering system is set to modernize our public we have also expanded the number of sites to which the sns delivers. At the start of the outbreak, the sns only delivered to five sites in each jurisdiction. This was more than enough for the largescale events the sns had been going to, such as hurricanes and tornadoes. However, after seeing the advantage of multiple Distribution Sites<\/a> in the covid19 vaccine and therapeutics effort, the sns contracted to create similar Distribution Networks<\/a> for its countermeasures. These are just two of the examples of the measures we have taken from the ongoing covid19 response that apply to responses cannot be static, they must continue to evolve and calibrate to the current set of circumstances, and regularly account for new information that evolving scientific understanding. This is true of the monkeypox response thus far, and will be true as it continues. Thank you again for inviting me to testify before you on efforts within asper to support the ongoing monkeypox response. I look forward to answering your questions. Thank you very much to all of our witnesses for your testimony and for being here today. We will now begin a round of five minute questions for our witnesses, and i asked my colleagues to keep track of your time. As always, hopefully can stay within those five minutes. I know each of your agencies have worked relentlessly. First with covid, and now with monkeypox. But frankly, too many missteps were made early on in the response, and a couple hundred cases turned into 21,000. It is unacceptable to communities who already experienced barriers to accessing health care, like the lgbtq and the black and latino communities, that are hardest hit by access to testing was an early challenge in the monkeypox response, with many people reporting significant delays in both accessing the test, and learning the results. We continue to have these challenges around testing, it is just simply unacceptable. So doctor walensky, let me start with. You how is the cdc working to make sure tests are more accessible and resources are available earlier . Thank you, senator, for that question. One of the big challenges we have in terms of access to testing was both patients, understanding what they were and providers understanding that this was a new infection that they had to test for. Indeed, another important clinical consideration was that people were coming in, requesting a test when they had no symptoms and they had no rush. Doctor kaylas noted, the test for this infection is a swathe of the rash. There is no other fda approved test. We need to have irrational her to conduct those tests. Much of what we have done, and i should mention that we have always had more capacity than weve had tests coming in. To date, we have used about 40 to 20 of our capacity. But you address these issues, we have to work with clinicians, we had to work with patients, we had to do an extraordinary amount of outreach so that providers would understand how to test, patients understand when to come in for a test. And our Public Health<\/a> partners would know not to gatekeepers tests. Outreach. That was the work we did early on as we were scaling up testing, knowing they may need more testing coming forward. So through the response network, we increased our capacity to test through this expanding the manual extraction to automated extraction. And then as you heard through our commercial lab, we expanded testing across the country. And simultaneously, working with outreach and education to clinicians, patients, Public Health<\/a>. Thank you. Thank, you doctor caliph. The fda can use a what steps are you taking to improve on the progress you have made . First of all, let me concur with dr. Walensky. There has never been a shortage of tests. Theres been a shortage of access to tests because of indecision in the system. Either way, it has enabled us to but we also have five commercial labs which are offering tests at this point, and we issue the guidance just the other day, which makes it clear that individual institutions are developing Laboratory Tests<\/a> and should proceed ahead. And weve given people clear guidance on developing their tests, and figuring out if they work. So thats on all fronts. We are under a watchful eye. Keep in mind that one of the lessons from covid was that when the gates were open a lot of tests turned out to be not so good. They got out, there and we had to rein them back in. I am encouraged by the decline in cases but it really is imperative that we remain vigilant and despite efforts by hhs to some people in my home state of washington still go to Great Lengths<\/a> to get one, including crossing the border into canada. People understandably want to be vaccinated before they get exposed, but that means we need more vaccines. There have been some serious symbols that were made this year when it came to our vaccine supply. What have you done to make sure that that never happens again . And what are you doing to increase the supply right now . Chair murray, thank you so much of the question. Whats most important to us and those that need access to the vaccine if you continue to hear from constituents that are unable to access the vaccine, that they are having to cross the border, please let us know. We are in the business right now of knocking down those hurdles and making sure that the vaccine can be accessed. We did take a very small it was intended for smallpox. That was intended to be freeze dried for smallpox and converted to this active monkeypox response. That required a couple of challenging problems to solve. We move the first 372,000 vials, as i mentioned in my opening statement, immediately. We needed the fda to approve, and they were terrific, moving quickly to approve that second manufacturing align at the end there were 308,000 vials we were waiting for, we need that approval to happen before we could put away those. The fda worked quickly, and we got out in july. Weve ordered an additional 5. 5 million vials of both drug substances that were intended to be layoff allys. We have ordered that to be filled and finished and shipped in United States<\/a>, and 2. 5 million of those will be manufactured in United States<\/a>. By adding a second line, domestic manufacturing will be able to access these vaccines much quicker in the future. Its a critical step, both for this monkeypox response and for future smallpox. Senator burr . Thank you. Tony, last time you spoke on monkeypox here, you made a very clear the monkeypox was capable of animal to human transmission. Heres my question. If we allow monkeypox to circulate in our population indefinitely indicted states, what are the chances it has been studied where there could be a transmission of human to animal in United States<\/a>, where we could have a threat that is animal to human transmission that is domestic . Its certainly possible, senator burr. Whenever you have a situation where you have an animal reservoir and the virus is already showing you from the standpoint of transmission, that it can infect animal species, and you have an individual who is infected, theres no real reason why that could not go the other way. I dont believe we have seen that, but i would not be surprised if we do see it going back and forth. That is possible. That will represent a real problem. That would prevent a problem of propagation. If you want to eliminate an infection, there is eradication, theres elimination, and there is control. The best way to eradicate or eliminate is that you keep it out of the realm of an animal reservoir, which continues to refeed into the human population. Don, news outlets reported the imminent administration is should be held back in the stockpile to meet our requirements for smallpox, rather than distributing this seems to conflict with the fdas recent decision to implement doses of varying strategies, which indicates we need to maximize the number of doses. Can you square this up for me . Thank you, Ranking Member<\/a>, for that question. So, we continue to maintain our smallpox preparedness. That is critical for our frontline vaccine, it continues to be able to the available. It is not been impacted by a monkeypox response. We have the capability to provide the genius vaccine to those who are immunocompromised, in the case of a smallpox outbreak. And we are evaluating with each dose that we make available to monkeypox outbreak, what it means for smallpox. I met with i consulted with them to understand whether we need a separate monkeypox stockpile, so we can pull those vaccines off the shelf and not worry about the preparedness for the immunocompromised smallpox. Have you ever thought about the message you sent to the population when you suggest to them that though they are in the midst of an infection problem, that we are discussing holding back in case we have an outbreak of smallpox . Let me explain. We know we have 13, 15 million gaming in this country. Tony, we have about 1. 10 million hiv a. I. D. S. Positive gay man. There is your immunocompromised population, 1. 9 million. Your risk pool of sexually transmitted monkeypox. And somehow, we are cheering the fact we put out 700,000 vaccines. If im in that community, and then on top of that, we have some durable decisions, about the amount you get, and there is not sufficient public transparent information about that, youve got a population that is a little bit questioning whether you are doing everything to help them. And that may be a reason we only have 261,000 people vaccinated. Out of a pool of up to 15 million people, of which 1. 9 million are immunocompromised, because they are hiv positive. Doctor kayla, currently the fda authorizes covid19 vaccines and antiviral treatments to be purchased only by the federal government. Prohibiting anyone else it is not government from purchasing these vaccines. I believe we all agree on the crucial role of vaccines and treatments at the play in stopping the spread of virus. Why must every dose pass through the bureaucracy of washington before and why are we still restricting access like that . Thank, you senator burr. By the way, i am glad that you are fully functional after a recent surgery. You are definitely showing evidence of that. Let me just say that we have a vaccine, its available, its everywhere and you can get it. And we expect that this will transition, and theres been much discussion. Those are the rules under which thats why the plan is somewhat important. Chairman, just one last question for doctor fauci. Tony, the pediatric immunization schedule recommends four doses of the vaccine before one reaches the age of six years old. With new cases of polio being protected in new york state, im wondering, do we know how long immunity for the vaccine lasts . To what extent if someone is completely polio vaccinated as a child . It is not necessarily lifelong, but it is measured in decades and decades. So if a person has a full series of vaccinations, you can expect that they would be fully protected. The situation we are concerned about are those who either have no vaccination, like we saw with the case in Rockland County<\/a> in new york, or individuals who have incomplete, they did not complete their full course. But if you have a full course, however it isnt necessarily lifelong. When a person goes into a zone where there is a lot of polio, you could recommend they would get a boost. But i would prefer to perhaps perhaps dr. Alinsky can add to that. I have nothing that. I think the chair. Thank you. Thank you, senator burr. I want to thank the witnesses, thank you for your public service. Ill start with doctor lewinsky. Part of the success of the covid19 Vaccination Campaign<\/a> as the gradual shift from large vaccination sites to hyper local sites where people could find vaccines in their own neighborhood. For example, at a local pharmacy. Weve seen the way in which local access to vaccines for new treatment like covid19, and a threat, i should say, like covid19, or for routine vaccines like influenza and childhood vaccines. Obviously, people know and trust their own doctor, and our providers, and they respond to Community Based<\/a> Community Member<\/a> led efforts to meet with them where they are. Doctor, how are you working with state and local partners to make sure we reach everyone whos at risk for infection to make sure they have the opportunity to get vaccinated if they so choose . Thank you, senator. A really important question in terms of outreach. Early on, when vaccines were being distributed, we were doing it in places where people were taking care, many places where in Sexual Health<\/a> clinics where patients were already sick receiving care. Its a case that not all members of this community have pulled their clinicians about their sexual activity, and so its very important that we do this in the sensitive and non stigmatizing, affirming manner. We were doing them in places and initially where people were receiving care, but a lot of the Lessons Learned<\/a> from covid as we roll that these vaccines and delivered over half 1 million to members of this community, is that we need to do more outreach. We need Community Based<\/a> organization. Im pleased to say that over the last several weeks, we have vaccine activities in several largescale Distribution Sites<\/a> like atlanta gay pride, like boise pride, like charlotte pride, and southern technical pins. Decadence. Weve vaccinated over 4200 people. In southern decadence, over 3000 people. What we need to do now is do this on the smaller scale. Were actively doing that smart scale up. We need to meet people where they are with Community Team<\/a> based organizations exactly as you say. Thank you. Thanks, dr. Next question will be for both you and the assistant secretary oconnell. We know that in the aftermath of the pandemic, and, now with the emergence of monkeypox as a Public Health<\/a> risk, the need for ongoing dedicated investment in our nations Public Health<\/a> infrastructure, which infrastructure save lives act, our state and local Health Departments<\/a> have been struggling for years after two and a half years of the covid19 pandemic, and monkeypox in addition to that. They simply dont have the resources they need for a routine Public Health<\/a> work. So when an emergency comes up, they have to move funds around and sacrifice their lab screenings, tobacco, cancer screenings, routine vaccinations, on a non. So how would additional local Public Health<\/a> infrastructure help us be better prepared for new threats like a new viral outbreak . Ill start with you, assistant secretary oconnell. Thank, you chair, for this question. We continue to see states jurisdictions worn out tired, exhausted. We know theyve been working for two and a half years around the clock. Weve been relying that on them to distribute vaccines and the covid19 outbreak as well as this new monkeypox outbreak. One of the most critical investments we can make not just throwing supplemental funds out that hire people but dont sustain them. We need multiyear funding that supports our Public Health<\/a> department. Its also critical that they can build the systems. I talked about the system we put in place for the digitized ordering, which is inter operable. Were no longer having them trained on something called v track, but the cdc sets up, and that h course sets up, but we have them on one system that talks to each other. They can order their vaccine and their therapeutics by by introducing this in this outbreak. We knew the states were tired. We worked carefully with them on making sure they understood why we made this decision and why was hired, it does push us forward as we face this current outbreak and future ones. Doctor lewinsky, i know you might want to see more. Thank you. If i could just briefly that the core Public Health<\/a> infrastructure is key. These need to be long term sustainable. Ill give you an example. Our Public Health<\/a> partners in the face of local jurisdictions do not have monkeypox resources. Theyve had to respond, trying to respond with other resources that are sometimes not legally allowed. As you know, the key corporate like Health Infrastructure<\/a> of the workforce, they work for the communities they serve. Laboratory infrastructure so we can scale up new labs quickly, and then Data Infrastructure<\/a> so its inter operable data. Thank you. Thanks, very much. Senator paul. Shes had the flu for 14 days. Should she have a flu shot . Now, if you got the flu for 14 days, shes as protected as anyone can be. The best and vaccination is to be infected. If she really has the flu, if you really has the flu, she definitely doesnt need a flu vaccine. If she really has the flu. She should not get it. She doesnt need it. Its the most potent vaccination and getting infected yourself. This is an ongoing question. Weve had ever evolving opinions from you, doctor fauci. Currently, antibody surveys show that 80 of children, approximately 80 of children, had covid. And yet, there are no guidelines coming from you or anyone in the government to take into account their actual acquired immunity. You seem quite certain of yourself in 2004, but in 2022, theres a lot less certainty. One of the things we also know after looking at this for 2 to 3 years is that the mortality from covid is very similar, if not less, than influenza. So when we look at this, we wonder why you seem to really embrace basic immunology back in 2004, and how or why you seem to reject it now. Well. I dont reject basic immunology, senator. And i have never denied that there is importance of the protection following infection. However, as weve said many times, and as has been validated by the authorization by the fda through that community and the recommendation by the cdc through that committee, that a vaccination following infection gives an added extra boost. And that film that you showed is really taken out of context. I believe that was when someone called in who had had a reaction to a vaccine, and asked me through a telephone in the interview if they should get vaccinated again. So it was in the context of someone who had a reaction. As a matter of fact, reuters fact checked looked at that, and said faucis 2004 comments do not contradict this pandemic actually, words dont lie. If you look at the words behind me, show them a bit at a time, she doesnt need it because the most potent vaccination thats getting infected yourself. Its true. It is true, senator. It is a very potent way to protect. But what youre trying to tell us, that kids need a third or fourth vaccine, are you including the variability where the variable of previous infection in the studies . Now, you know. Because when you have approved vaccines in recent times, and the committees dont report anything on hospitalization or death or transmission. They only report that if you give them the jab, theyll make antibodies. And you can give kids hundreds of jobs, and make antibodies every time. But that does not prove efficacy. So what youre doing is denying the very fundamental premise of immunology that previous infection does provide some sort of immunity. Its not an any of your studies. Almost none of your studies from the cdc or the government have the variable of whether or not youve been previously infected. So lets look at adults. Ive had three infections. Should i get a fourth one. If youre gonna venture a category that has a fourth one it, and you need one that has nothing in it. No vaccine or the fourth vaccine. But you also need to know whether theyve been infected. If you ignore whether theyve been infected, theyre ignoring a vaccine, basically. You are ignoring a fair ball. What youre giving us you decry vaccine hesitancy. Its coming from the gobbledegook that you give us. You are not paying attention to the science. The very basic science is that previous infection provides a level of immunity. If you ignore that in your studies, if you dont present that in your committees, youre not being truthful or honest with us. Senator, if i might respond. I have never, ever denied fundamental immunology. In fact, about the chapter in the textbook of medicine. Is any of the guidelines for vaccines do any of the guidelines for vaccines from the government include previous infections as something to base your decisionmaking on with vaccines . Do any of the guidelines involve previous infections . Thats why ignoring previous infections. Because it doesnt involve guidelines. And furthermore, weve been asking you and you refused to answer whether anybody on the Vaccine Committee<\/a> gets royalties from the pharmaceutical companies. I asked you last time, and what was your response . We dont have to tell you. Weve demanded them through freedom of information act, and what did you say . Were not gonna tell you. But i tell you this, when we get in charge, were gonna change the rules, and you will have to divulge where you get your royalties from, from what companies, and if anyone on the committee has a conflict of interest, were gonna learn about it. I promise you that. Mister chair, can i respond to that, please . Okay. There are two aspects to what you said. You keep saying you approve, you do this, you do that. The committees that give the approval are hefty a through their Advisory Committee<\/a>. The committees that recommend our cdc for their Advisory Committee<\/a>. And you keep saying im the one thats approving a vaccine based on certain data. I dont really understand, with all due respect, senator you said he would not reveal what well royalties, or what company gave the other senator paul. Lets move on. Can i please answer that . You keep asking committees. Theyre not my committees. But the very pack committees through the fba cdc. So i dont have any idea what goes on as well as you were gonna move on. Were overtime. Senator paul, your over. Everyones over a little bit. I wanna make sure we keep on time. For the record, i know chair murray and previous chairs of this committee of both parties, both parties, i found videos to be out of order. I will note for the record that videos out of order move to senator smith. Thank you. Unanimous consent to submit a letter from aids united, the national the National Coalition<\/a> of and the National Minority<\/a> aids council outlining recommendations for a comprehensive approach to the monkeypox response. Mister chair, and i have unanimous consent for that, please . Yes. Thank you very much. Thank you to our witnesses. I want to add my gratitude to dr. Fauci for your service to our country during some of our countrys most challenging times. Thank you so much. I want to also start by associating myself with senator murrays remarks about the importance of congress coming together to make sure the administration has the resources that it needs to respond to the monkeypox Public Health<\/a> emergency. I also agree on the need to sharpen our response and work effectively with Public Health<\/a> departments, including in minnesota. Secretary oconnell, we had a good discussion last week about distribution of the Monkeypox Vaccine<\/a>. We talked about some of the challenges that the Minnesota Department<\/a> of health has, the issue is that h pox system, the i understand you access covid vaccines were distributed, and what the department is used to. As i understand it from perspective, the h pox system works better for distributing both Monkeypox Vaccine<\/a>s and treatments from the Strategic National<\/a> stockpile. There are also some challenges with interoperability, as i understand it, with the v. Track system. But of course, the issue, as we discussed, is that by using two different systems, one for covid vaccines and one for Monkeypox Vaccine<\/a>s, this is a real challenge for the Minnesota Department<\/a> of health. I suspect this is a chance for other agencies as well. This is happening at a time when these challenges are falling on Public Health<\/a> department and staff that are exhausted and burned out after the last two and a half years of responding to covid 19 and learning a new system in the midst of all this is really a challenge. Its sort of exacerbated, i think, by the department having trouble tracking the shipments of vaccines. Sometimes, monkeypox dos is just showing up unexpectedly. Could you just address for me i appreciate you talked about this in your instant testimony. Could you address what sets your team to work with state Health Departments<\/a> that are in similar situations to minnesotas to help improve how this Distribution Process<\/a> is working . Senator smith, thank, you i thank you for the good conversation we had last week. And an opportunity to talk about some of these challenges. Most important to us is that those who have vaccines can get them. If anyone continues to find this to be a difficult system, reach out and left me no. We want to knock down these hurdles to ensure that folks have access. We now have enough vaccine supply to meet demand. So its important that people are able to access it. We have a similar challenge that doctor lewinsky mentioned with the state. The states arent able to use that covid funding for the monkeypox response. We havent been able to use our covid funding for the monkeypox response either. So when it came to digitizing the process, we were gonna have to put new money and tv track system or the h pox system. The h pox system is currently being used and covid19 to order therapeutics. States do you have familiarity with hpoc. We were faced with putting annual budget funding into one of these systems and ordered to digitize the sns ordering. We chose to put it into the system that could actually do both. We believe that wasnt an important step in moving forward, but we do acknowledge, senator smith, that our Public Health<\/a> Department Colleagues<\/a> are worn out and tired. Weve got countless office hours for them to make sure they understand the system, if theyre running into new problems, where available to answer them. And as hard as this change management as, and the middle of two responses, it was the right thing to move forward to an inter operable system. We also have added additional Distribution Sites<\/a>. Thats one of the things we did with the sns. We couldnt just piggyback on the covid19 Distribution Network<\/a>. That was funded with covid dollars. We have to go with the sns, do an entirely new contract with a different distributor, with annual funds. And set that up. Thats the reason why there was a delay. We needed to look forward to working with congress to making response dollars more fungible in the future. I know that would be helpful and i appreciate your obviously, getting the distribution right is everything when it comes to getting vaccines and making people have access to vaccines. Mister chair, im out of time, but also medic question for the record about the importance of tribal consultation to our witnesses and look forward to your response. Thank, you senator smith. Senator collins. Thank you, mister chairman. Secretary oconnell, i want to follow up on the statement you just made. I dont recall any request from the administration to use leftover covid money for monkeypox. Moreover, its not at all clear to me that you could not submit a reprogramming request to the Senate Appropriation<\/a> and have Appropriations Committee<\/a> that purpose. So what exactly are you implying when you say that you havent been able to transfer funds . Youve taken funds for other purposes, including sending it to the border. Senator collins, thank you for the question and the question first patients weve had recently about these issues. Weve been advised by our appropriations team, our budget and finance team, that the money that is currently in the contract for our Distribution Network<\/a> that h core is managing we could not piggyback on that same contract to set up a monkeypox Distribution Network<\/a>. The way those funds work, we were restricted to supporting Covid Response<\/a> efforts, and not additional response efforts. But id be more than happy to meet with you and your team again and see if its possible to do a reprogramming. But that was what we are advised, so we took of dimensional funds, different funds, not the covid funds, and set up a different contract with for the astronauts to set up a Distribution Network<\/a>. Let me turn to another issue that we discussed several times. And i do appreciate the fact that you have made yourself available. We have statements from doctor i wouldnt be back in march that laments the decline of domestic manufacturing for covid vaccines. And its march supplemental request the volatility which makes it difficulty to prove preserve domestic manufacturing. The United States<\/a> government put a lot of effort and resources into building up domestic manufacturing. What were seeing daybyday, week by week, is that that is beginning to go away. I would suggest that its the administrations contracting policies that have weakened our domestic manufacturing of covid tests. You when i have discussed before the majority of the at home tests, the administration for covid were manufactured outside the United States<\/a>. For example, the administration awarded a chinese company, i tell, a 1. 3 billion dollar contract. Thats roughly four times the size of the contract that was rewarded to an american company, abbott, which has a considerable presence in my state. So, how is it that the administrations working with domestic testing manufacturing when youre at the same time awarding contracts to Chinese Companies<\/a> . That does not help to preserve domestic manufacturing. Senator collins, thank you. Domestic manufacturing of tests is a Critical Mission<\/a> of ours. As for making sure its supported, and injuring part of the covid Pandemic Response<\/a>, when it moves to we will always want to know whether weve had covid, whether someone weve interacted with had covid. So testing is critical and domestic factoring of tests is also critical. Regarding the eye health contract, you will recall when the president made the announcement that he was gonna make one billion tests available through the u. S. Postal Service Distribution<\/a> system . At covid tests. Gov . He also vowed that he would not interrupt the commercial market. He would not take tests that were currently going to the pharmacies, and other stores. He would not take them out of the market and put them into the covid test. Gov program. In order not to just drop that, domestic manufacturers at the time where local pharmacies. We pulled in tests internationally so as not to interfere with what was available at the pharmacies. As soon as that level down, we made a commitment in the spring to only support domestic tests moving forward. But that initial decision was to not interrupt the domestic tests that were currently feeding the schools, pharmacies, and other pieces of the response. We wanted those to remain available. Doctor fauci, i just want to wish you well in your retirement, and a very quick question for you. And its based on what youve written recently about the lessons of the aids pandemic. The monkeypox cases are overwhelmingly related to sexual transmission, men who have sex with other men, should we be doing more to look at Community Spread<\/a> in cases in the Broader Community<\/a> . Such as, for example, testing anyone with any typical case of herpes or shingles, regardless of their sexual history . Thank you for that question. The answer, is yes. We are now doing surveys and surveillance that go beyond the wellestablished high level of infection in certain demographic groups. That was part of the five pillars that i mentioned in my statement about virology, immunology, transmission, reservoirs, and sorrow surveillance. Were doing that in some of our studies. But the cdc is also doing that. And were also doing it in collaboration with them using some of our cohorts and collaboration with the cdcs capability to do that. Perhaps you want to comment . Thank you, doctor fauci. Among our Health Advisory<\/a> networks clinicians American Academy<\/a> of pediatrics, we make recommendations just like that. There isnt a typical rational, we test it we make those recommendations. Thank you. Thank, you senator collins. Well turn next to senator baldwin. Thank you, mister chair. First, id like to ask unanimous consent to enter in the record april 11th, 2022 article entitled facts check of faucis 2004 comments without objection. Thank you. I want to join my colleagues, dr. Fauci, in which he knew very well in your retirement, and thanks so much for your service to the country. And then we start with you for a question on basic research. I think falling short when it comes to providing sustained investments and preparedness. Thats why had to lead the disease act to provide sustained funding for focus on medical Countermeasures Development<\/a> for viral families of concern. We cant just keep on responding to the threat and front of us. Doctor fauci, can you explain how investments in Smallpox Research<\/a> has made us better prepared for this at break, then i had we not made those investments . Thank you for that important question. It relates not only to smallpox and the extrapolation of knowledge to monkeypox, but it relates to virtually all elements of basic research. Ultimately, when you get to a problem with the is a Public Health<\/a> problem i mentioned in my written and oral statement, the original work that has been done on all pox viruses dating back to 2001 and two, following the anthrax attacks, when we put a lot of work into developing the countermeasures that assistant secretary oconnell mentioned regarding smallpox, it allowed us by getting another type of a vaccine that is less reactive genetic and has less advice to let the genius, which is now the primary vaccine for monkeypox. So the relationship between the Smallpox Research<\/a> that had been done for decades on all poxviruses, and the acceleration of that research when we had the bio Terror Threat<\/a> in 2001, 2002, allowed us to respond rapidly with already developed countermeasures in the form of and jynneos. Thank you. Doctor lewinsky, from me, as we had a chance to speak earlier, on monte talks monkeypox is all too reminiscent of our initial response to hiv a. I. D. S. I initially started my career in 1986 on the dane county board of supervisors. And that year, the first cases of hiv a. I. D. S. Were reported in wisconsin. That was a tremendous amount of fear and paranoia and sorrow and our community. We had to fight both the disease and the fear, the stigma, and the discrimination that was present in the community. So doctor lewinsky, can you describe the cdcs efforts to work with the Lgbtq Community<\/a> to combat misinformation, to reduce stigma, and to ensure that folks have access to care . Thank you, senator, for that question. Their involvement and integration into our response is incredible. One of the first things we did when we heard about the was outreach between our smallpox ranch and our hiv branch. We knew that it was both those communities, both of scientists, that were gonna need to come together to make a robust response. Weve had extraordinary outreach with the Lgbtq Community<\/a>. Human rights campaign, the enterprise and pride organizers, we facilitated best practice exchanges with tourism hub, we have cried for province time, fire island, palm springs, and then we supported these large events like a black gay pride and boise pride, charlotte pride. One of the things we did early on, and this was a Lesson Learned<\/a> from hiv decades ago, was not on may 27th, we First Published<\/a> an iteration of Sexual Health<\/a> information on monkeypox for the Lgbtq Community<\/a>. So they would understand what practices would decrease the risk of monkeypox. All this engaged in a very robust, active, helpful, an informed Lgbtq Community<\/a> that has been essential and not only working with us but in educating their own community. Thank you. Thank you. Ill enter my last question into the record for secretary oconnell. On what doing to ensure this delay in Vaccine Availability<\/a> its not a problem in the future. And anything you need from congress to help address this. Thank, you mister chairman. Thank you, senator baldwin. Ill be turning the gavel over to senator baldwin and our next senator, senator cassidy. Thank you, mister chair. I was a medical resident in 1983 to 1986 in the hiv epidemic. When hiv just exploded. So im aware of the need to have a Robust Research<\/a> and Public Health<\/a> response to Infectious Diseases<\/a>. Now, doctor lewinsky. Part of this has got to be predicated trust between the American People<\/a> and the agency, but the agencies are functioning as best they can. And i feel like that trust has frankly been dissipated. And im sorry to say that, because i respect you as a clinician and as a person. But i ask you on multiple occasions as to what percent of the cpc workforce is actually showing up. Frankly, youve always block that. Youve never given a straight answer. So id like an article an epic times when they did a foil request to find out how many folks of the cdc were actually working. Showing up to work. And roughly 2000 of them, 2772 out of about 13,000 employees are showing up every day. With 70 are working completely remotely, are coming in maybe twice every two months. Now, why is that important . First, that was a noble fact but it was not shared with congress. We, the representatives of the American People<\/a>. And i think the American People<\/a> would like to know that fcc is not functioning well, how many folks are actually showing up . Dimensions cdc is not functioning well because i now referenced an article which alcohol New York Times<\/a> on august 17th, in which you frankly, to your credit, point out the cdc has not been working well. And that there is need for wholesale change. And at the end of the article, they quote an acting director of dr. Busker who says that you yourself have worked remotely, at least till august 17th. And then, he said, its hard to see how doctor walenski could execute whole scale changes when she only sees most of her staff at a distance. Quote, i dont know how you motivate and inspire culture change when people arent together. Now, cdc is requesting billions of dollars for Public Health<\/a> initiatives. And an agency which by your assessment is not functioning well. In which only 22 of people are showing up every day and then which previously bomb officials are doubtful that you can effect change because you dont show up every day. And i say that kind of painfully. Because i want the cdc to work. And yet, one example, im sure theres a reason for, but theres been a lot of talk about the need for local agencies to have to modernize. But the cdc was given 200 million under the care act for data monitor isolation to be awarded 64 different state territorial local jurisdictions and maybe its not cdc. But most of it is not yet been spent. Or allocate it. This is according to crs. So its incredibly frustrating that a deliberate decision was made to not be transparent with the American People<\/a> as regard to the amount of people actually showing up for work. It takes a request from a newspaper, and i are asking for billions more. Why walensky should we trust . Thank you, senator, for that comment. I will say that we are an agency of 13,000 people. The people who need to be at cdc are at cdc. Of, course our laboratory workers. We have many people we have people in 60 different countries. The article points at that those its wide open. Theres nobody showing up. Offices are empty. So this is just of all these people are field workers, i think, again, as another example of being opaque. I dont imply that theyre all field workers. Seeing many of them are field workers. Many of them are working at cdc and the employed in responses. Many of them are on the road. I myself was in it atlanta last wrote week for a day, but i was in new mexico doing a secretaries travel Advisory Committee<\/a> meeting. So many of us are on the road. I am here today and im working. What percent of cdc employees before the pandemic actually showed up for work every day as opposed to only 22 now . I dont have those numbers for you. I just feel like let me go back to why should we trust the cdc with billions when its very difficult to get, i would say, a straight answer on what is the workforce in person effort, and particularly when byron assessment the agency is working poorly . The review that we did on august 17th was to demonstrate the Lessons Learned<\/a> from the covid19 response. People in the cdc are working well, theyre working hard, and they dont need to be onsite in atlanta. In fact, the office has been more productive offsite to the field doing the work with of Public Health<\/a>. Right of time, but let me just say that the former acting director of cdc from president obama, when he said in the last paragraph of the New York Times<\/a> article, he did not see how you are gonna be able to speaking of you in particular, effect change when you only see people every now and that. He was both suggesting it was not a work completed, but it was something that had to happen now. And that when people not working together made that more difficult to execute. And i dont think anybody in here or anybody watching really think that only 22 of the cdc employees shut up for work in the building every day before the pandemic. They probably think it was 70 , and now its reversed. Can be hard for me to support more appropriation until we have a better relationship and a more trusting relationship than a more transparent relationship between the agency and Congress Asking<\/a> to fund your activities. For that, i yield. Next, senator gray, thank you, madam chair. I think all of you for your service to, obviously, one of the great challenges the country has ever faced in Public Health<\/a>. The pandemic, were coming out of the pandemic now, we see other challenges. Let me talk a bit about covid19 and the Lessons Learned<\/a>. We learned what to do and also what not to do. Again, were back to another Public Health<\/a> emergency. I just had to ask you, dr. Fauci, and i also want to extend my gratitude and salutations. I know you wont really retire, because i dont think are capable of not contributing to the public good, but i know youll try. But the passage i was critical to the development of the pox vaccines and treatments. We may not have stockpiled vaccines for the next pandemic similar to covid. How concerned are you that this next one, this next Public Health<\/a> emergency, will be one that we dont have vaccines or therapeutics for . Thank you for that question, senator. We all raise our when you get a brandnew infection but youve had no experience with, that youre not going to have countermeasures, particularly vaccines, that already in a timely fashion. So there are two purchase to that. Weve described in detail, and several publications and then some of our white papers, what is called the prototype pandemic and prototype pathogen response. Another, whites to look at multiple families. And theres about seven or eight high priority families. By families, we mean alpha viruses, or we know viruses, flavor viruses. And to do fundamental Core Research<\/a> to get commonalities among the pathogens and the family and to start to develop vaccines, but the main phase one, and have them ready to go. With the new mrna technology, its very simple to switch one one antigen in and out that the vaccine. Thats the core of our approach right now. I think well probably be hearing more about it. Because thats the thing that were putting forth as the nih s contribution to the government wide pandemic imperatives. The prototype pathogen approach. And i support that approach. I think thats the right direction to go. To make sure that were as prepared as we convene for what is unbelievable. And respect that the challenges of that are preparation, but also the urgency. We can agree and argue about i think the Government Agencies<\/a> across the board are going to the issues are of how many people are going to work and working remotely. Every Large Corporation<\/a> is dealing with that right now. In the meantime, weve got to make sure we have the funding for pandemic preparedness. That is essential to the long term future of this country and almost every way. Let me switch to this outbreak of monkeypox. When it broke out, we had almost 800,000 miles sitting at the manufacturers facility and denmark. But the shipment of these critically needed vaccines, the u. S. Was held up pending there was fda inspection even though european regulars had approved it. So, doctor if i can ask you, how do how can we help the fda better balance the protocols with the urgency and need to respond quickly to these emergencies . Thanks, senator. You know, the issue that occurred in this case was it was a new plan. Had switched and had not been affected by the fda. I remind you that we had more than one incidents and covid times of a manufacturing facility not being up to par, which created a lot of difficulty in trouble. So, we thought it was essential to get their. In fact, we got that quickly. After the application came in from the company to do it. And the outbreak occurred. But i think the balance here is the risk of a vaccine which is not up to par with the time it takes to make sure that the vaccine coming out actually will do the job job thats intended. Europe doesnt have essential inspection for a vaccine facility. Each country does its own. And weve had some discordance, historically, between findings and some of those facilities. So we really felt we had to get this right, even if it took a bit more time. I yield back to the chair. Senator marshall . Thank you, mister chair. To my panel, as i read your testimony and listen to it, what you described to me as an academic response to a problem as opposed to being proactive or reactive. I would challenge you all to change your culture somewhere more proactive, more of a military response to a problem like this. When i look back to the history of this virus, july 20, 2021, there was a case in nigeria. A case in milan from nigeria. And may of 2022, there are cases in multiple countries all linked to nigeria. And there was a moment in time before the horse is out of the barn that we couldve stopped this. And, now i fear this virus is being transmitted from human to animal. And once its in the animal kingdom, will never be able to get ahead of this. So my question for secretary oconnell is, did you ever consider a travel ban . Or requiring vaccinations from people that have traveled from africa and get back in this country . And you made a statement on june the 3rd of 2022 that you said, i want to say we have enough on hand to manage this current outbreak. Do you still think that was the case then and if so, why is it still exploiting . Thank, you senator marshall. Id like to take the second one first, and then invite doctor walensky who has we dont have that much time. Go ahead. At the time i made that statement, we were using the ring vaccination strategy, which is a strategy thats been effective in monkeypox outbreaks, including one that you just mentioned previously. The vaccine being administered to the person who had the virus, and as the spread of the current outbreak began to indicate that anonymized partners would make it difficult for Contact Tracing<\/a> to happen, we pivoted to those that were likely to be exposed. We there are planning of vaccines and the problem is the execution. Getting the vaccines weather needed. The strategies that we were using to vaccinate the at risk population changed as we were seeing the transmission change. Okay. Doctor walensky, briefly, yes or no, did you all consider a travel ban, or requiring people to have a vaccine when they come to the country . If i could clarify, the two cases in 2021, one thing texas, one in maryland, you are aware of. There were no contacts that ultimately had monkeypox. Those were isolated cases. But they traveled from nigeria. Yes. And we have known that monkeypox is endemic in nigeria over the years, including two last year, we have intermittent travel cases that have led to no further cases. That happened in 2021. This is a different outbreak. May 17th was our first case, when we had our first case i spoke to the clinician in mixed diagnoses. We called Public Health<\/a> canada. That patient had traveled from canada. We immediately started outreach most of the cases in europe connect to nigeria. I want to move just a second, walensky. One or two people have died with monkeypox in the United States<\/a> that im aware of. But every day, hundreds of americans die from fentanyl poisoning. Why have you not declared this a Public Health<\/a> emergency . Why have you not ask the administration to shut down the border were 90 of fentanyl comes from . The declaration of a Public Health<\/a> Advantage Agency<\/a> is under the secretary, so i have to defer that comment. But you can recommend it would be done . And weve had those conversations. But our ability to shut down the border at the cdc level is related to communicable diseases. And while fentanyl bringing her back on the fentanyl. Not at war people have died from fentanyl poisoning than we lost in vietnam. This is killing americans every day. Fentanyl. Do you not have a hard for these people . For these deaths i do. In fact, through my career, ive cared for many of them. And its tragic. Were doing a lot what are we doing . We do not have the authority to shut down the border on anything except a communicable disease. So what are we doing . Were doing outreach, mental health, community violence. Were doing surveillance. Were doing but fentanyl continues to cross the border very quickly. And 2017, theres been no cases in nigeria for four years. Suddenly, there was an outbreak. 218 cases. Since then, the cdc, ecohealth, funded by were all doing research in nigeria at the time. I think its fair doctor walensky as well as dr. Fauci, were you aware that the purchase piece of the research . Was it just collecting or were we doing more than electing . We were concerned about lab outbreaks. Ive got a list of questions related to that. Doctor fauci, were you aware of that research in 2017 . Now. Im not. But i could get that information for you. I have to check i was not aware of it myself. Weve been conducting monkeypox research in nigeria for years. Id be happy to get you the details. Do you know the purpose of that research . I have to get you the details. As i mentioned in my remarks, we are conducting it will be imminently conducting a Clinical Trial<\/a> of genius, ive tpoxx, sorry, in the democratic republic of congo. Thats a Clinical Trial<\/a>, in the d r c. Thank you. I want to thank the chair and the Ranking Member<\/a>s in this hearing for their work. I want to start with a question for you, to really give you an opportunity to build on earlier testimony. The department of health and Human Services<\/a> has been responding to covid19 now for over two years. You addressed this to some extent in your testimony. But could you just explain for their how the departments experience of covid19 is informing its monkeypox response . Thank, you senator, for that opportunity. Were continuing to actively respond to covid19. Were continuing to pick up lessons as we go. One of the critical lessons as making sure that we have systems, when countermeasures are ordered, what states can order both the therapies and the vaccines on the same inter operable system. Weve done that now as we digitized the abscesses ordering process. It was also important that the astronauts have multiple departs tradition sites across jurisdictions and states. Jurisdictions in states got used to that and our covid19 response. The sns up until this point has really only been able to do five distribution points in any state, consistent with a large scale high consequence incident that has been responding to by hurricanes, tornadoes. Now that we move to the National Vaccine<\/a> strategy, what were trying to get vaccines out quickly to the high risk populations, having those additional distribution critical. The astronauts has entered into a contract now with which will allow it to distribute to multiple places. 500 500 frozen distributions a day for five days a week. So up to 5000 distribution points. Another thing that weve done is created a flea framework to ensure that the vaccines arent going to the wrong place. One of the things we saw when we in covid and made sure we are giving it out on a pro rata basis, sometimes it would end up in the wrong place and was not being administrate. So weve asked 85 usage. Is it going that the right places . Thats not been a barrier. Were continuing to work with states to ensure that their second forces dont count against their 85 . And that those that are out in the field thencandidate 5 . But its been a good most important thing right now, im not sitting on shelves. Thank you very much. I want to switch to a different topic with doctor and i want to the opioid crisis. During a confirmation hearing, we discussed how the fda helped fuel this crisis by approving and labeling opioids for long term use despite a lack of strong evidence supporting those labels. I was encouraged when you told the community that under your leadership, the fda would aggressively look at reliably. But in six months into a confirmation, the fda has yet to change any labels. The Opioid Epidemic<\/a> continues to average ravage communities a New Hampshire<\/a> and all around the country as weve acknowledged this morning. Your agency needs to move swiftly to correct its previous mistakes. You yourself have repeatedly said that the fda needs high quality evidence to support the long term use of opioids. The agency has the authority to remove labels from drugs now, given the absence of this evidence. So why is the process taking so long . I want to express appreciation for your question. Two were probably losing more people from opioids than we are from covid. So this is a National Issue<\/a> that we need to take seriously. Ive taken the First Six Months<\/a> to get an assay have everything going on inside the fda, and the government response, and also in the face of fentanyl mail order issues that are going on. None of that basics of the prescription of opioids. We published our framework last week. You will see changes over the next few months within the context of that framework. So are you telling me that you are considering that the framework calls for real labeling opioids . Its under active consideration and concise discussion within the fda. Look, i was just had a recovery rally in my state with people whove engaged in peer to peer recovery. People who are helping pregnant women with their recovery. Parents who have lost two children to fentanyl and to opioids. The fda first approved and labeled opioids for longterm use more than 25 years ago. That means theyve been in the market for more than 25 years without substantial evidence that are effective for that purpose. And with plenty of evidence about the harm that these drugs can cause. So i appreciate is a framework out there, but what people are looking for right now is action. We continue working with colleagues on both sides of the aisle to make sure it happens. And i thank you for your service. I appreciate that. Senator rosen. Thank you, chair murphy. For holding this important hearing. Thank you for everyone being here doing what you do, in these trying times. Thats for sure. I want to talk about clinical guidance for all our practitioners and support staff to prevent and treat monkeypox. I would say many clinicians, maybe the majority, have not directly treated monkeypox and have not seen a wide range of cases. So its critical for clear guidance to be widely available to all medical professionals, and i would also say there is support staff. To answer the phone, take the questions and the room when theyre doing their own its important for treatment and prevention. And so, regarding monkeypox prevention, i have concerns about not just the rollout of vaccines for the whole population, and i appreciate that you have been doing significant work to make vaccines more available. But with all the vaccines rolling out, theres new covid vaccine, the flu vaccine, theres an ammonia, theres a shingles, and those other things that people might get tested adult population. But a lot of confusion about boosters, can you combine vaccines, and so im really concerned that the cdc what are you doing to mount this Public Information<\/a> campaign on the wide for idea vaccines important ones available . My parents both had shingles, very painful. How are we gonna do that . Pharmacies, public spaces . People might not be going to a doctor a clinic, but maybe theyre going into their local drugstore or Grocery Store<\/a> every week. Thank, you senator. One of the things you raised is one of the challenges that weve seen. First with covid, now with monkeypox, and thats one of the places i would Welcome Congress<\/a> help. You dont have a mechanism in this country by which we inform all clinics of an new outbreak. This is been through a lot of public education. Weve had a massive amount of outrage. We have networks that we reach out to when we put out a Health Advisory<\/a>, and weve done four for monkeypox. They reach about 1 million clinicians. Weve done what we call clinician out reach webinars and they reach about 6000 conditions. We put them on line i personally have sent a letter to all board clinicians through the wham sea, working with each state to try to send news out to inform people of a d. C. Is that they may have never heard of and may have never seen, but tomorrow might walk into their clinic. One of the need to know, where the protections they need to take, and how do they diagnose, treat, and care for patients with infections. Thats been a lot of the work weve had to do during this outbreak. I will say from a Health Worker<\/a> safety standpoint, at least as far as monkeypox is concerned, weve seen very little outbreak in Health Care Worker<\/a>s. We had one diagnosed Health Care Worker<\/a> after a needle stick industry. But weve seen very little outbreak due to our personal protective equipment and the outrage that weve done and telling Health Care Worker<\/a>s how to protect themselves. What about the broader idea that we so many vaccines that are available to the adult population, preventative vaccines, that we normally have no covid, potentially monkeypox shot, how are you gonna get this out to people . We do a lot of provider calls as well. Our Advisory Committee<\/a> if youre not going to a provider . How are you gonna get it to the average person . So weve been doing public press conferences, weve been doing advisories, as weve rolled out by the we have a massive flu campaign that we were told out in early october which we will have done can do this year. One important thing i want to highlight, though, is that we have the cdc and we in this country do not have a mechanism like we do with children. You listed adult vaccines, i believe theres 13 of them that are advised. Adult vaccines do not have a mechanism in this country to finance thought vaccines the way we do vaccines for children programs. So when we look at the equity of getting vaccines for other populations, we do not have a mechanism by which to do this in an equitable fashion the way we do for children. Thats a big concern we have right now. Thank you. I know i only have 20 seconds left, doctor fauci, just want to ask you quickly, we have monkeypox, medication to treat infection. But theres simply management. We hear a lot of talk about opioids. I know its very painful, monkeypox. I dont know what the treatment might be. But what kind of guidance are you giving to the medical community about effective Pain Management<\/a> . I would imagine monkeypox them medications for the neuropathy. But importantly, particularly when its on the mucosal surface, the anal, rectal mucosal, or the rethrow mucosal, it can be extraordinarily painful. We recommend, and hospitals do this anyway, i think thats pretty common knowledge. It is an acute, not a chronic pain. So its the kind of thing you would not hold back on any type of pain medication just because youre concerned about addiction. The discussion that weve been having about fentanyl and the opioids is not using it for quick pain. And so this is not chronic pain. This is acute pain that usually resolves itself within a period of a couple weeks. But you still dont want your patient to suffer by holding back pain medication. Similar to that shingles in that same way. Thank you. My times expired. Thank you very much. Thanks, senator. I recognize myself for questions. I have to, one for you, doctor walensky, and one for doctor fauci. Doctor walensky, one of the things i panicked about is your access to data. He talked this committee about it. Weve talked personally about it. By emergency authorities, youre stuck in a position today where you have to negotiate 50 different data sharing agreements with states all over the country. And we expect a lot of the cdc. But its hard to expect too much of the cdc when you dont have the authority, as i understand it, to get the data you need, absent an emergency. And when you look at whats happening today with monkeypox, we are getting data. But its patchy. For instance, youre not getting full democratic drama. Theres a lot of states that arent reporting to you, for instance, breakdowns of cases on race or ethnicity. And that really hurts our ability to target who gets the vaccine, who gets resources. So, it certainly in the context of monkeypox, but maybe more broadly, what position does that leave you in when you dont have the authorities to be able to compel states in a uniform way to get good data . Thank you, senator, for your question and the leadership and working with senator cain, senator baldwin, and trying to get us the authorities so that we can provide the state of two. Weve been working closely, tirelessly, with state and local Public Health<\/a> staff who have been doing the same to extract data on the outbreak specifically. Weve negotiated now 61 agreements. Weve navigated approvals for dated to get falling. We set up voluntary arrangements directly with large commercial labs. But its been hard. And it should not be this hard. And if we cant make informed decisions based on the best possible data coming into us, were not making the best decisions for the American People<\/a>. The existing patchwork of data is not working. Its not working to the best ability of the American People<\/a>. For monkeypox specifically, i can tell you that i dont know the tumble member of people hospitalized. The data on Laboratory Testing<\/a> in the United States<\/a>. Complete Demographic Data<\/a>, as you noted. Which people with monkeypox have been vaccinated. We cant link the Monkeypox Vaccine<\/a> data to the Laboratory Data<\/a> and Demographic Data<\/a>. We get 20 of our Demographic Data<\/a> on testing. We received 47 of our democratic and 91 of our Demographic Data<\/a> because of vaccination. I would rather have you been in the business of fighting public fronts presented to the country them in constant negotiation over data sharing and basements. It seems like essential function of the federal government to set up a uniform way in which you get data. These data use agreements. Soon, i hope will be able to find a consensus on that here. Its great you dont know how many people are hospitalized with monkeypox today because of your inability to get that data. Dr. Fauci, and the minute and a half remaining, i just want to talk a bit about what we learned, what you learned over the course of the information Distribution Campaign<\/a> for the covid vaccine, and how that relates to what were communicating about genius. Because some amount of information regarding questions about the level of protection, the duration of the immunity when it comes to the Monkeypox Vaccine<\/a>, you know, i dont know this was necessarily your fault. But in the euphoria of the early muse of covid vaccine, we probably got a little ahead of ourselves in terms of what level of protection it could provide. So, what do we early distribution stages and how should that inform how we talk about the Monkeypox Vaccine<\/a> . Well, first of all, they have two entirely different pathogens, and the response and durability of response to each is really quite different. It was a rather unique situation with covid vaccines where there was no doubt that the initial protection against symptomatic disease, as well as severe disease, was well into the 90s. That was the really good news. The sobering news the durability of protection, particularly against infection and symptomatic disease. Fortunately, the durability against severe disease last it. But if you look at coronaviruses in general, which is usually a good parameter of what the response to a vaccine is, even with the coronavirus infection, the durability of protection against reinfection long before covid came along, just the typical common coronaviruses, did not last very long. And we see instances of reinfection with the same coronavirus. That poses a very different situation, which leads to the need for and the importance of updating vaccines and giving the boosters that are part of the regimen, in addition to the primary regimen. When youre dealing with a pox virus, inherently, poxviruses have a much greater durability of protection. We know that because smallpox itself, once you get infected, you are essentially protected for life against reinfection. Once you get vaccinated with the standard smallpox fence the nation, you can be sure that the durability is measured at least in decades, and maybe lifetime. What were dealing with now with genius is that it likely is gonna have a durability of protection if you get the two doses. Not just one. We want to make sure people get their two doses. The durability very likely is gonna be much greater than that shortened durability of the covid. Because they are really fundamentally two different viruses. Thank you very much, dr. Fauci. Senator brown. Thank you, mister chairman. I have two questions. First, for dr. Walensky, and done, for dr. Fauci kyi. Over the last two decades for Public Health<\/a> Emergency Declaration<\/a>s. H1n1, vedika, opioid crisis, and covid19. On august 2nd, it declared monkeypox a nationwide Public Health<\/a> emergency. Of the over 20,000 people diagnosed with monkeypox, as of 2022, theres been one fatality. Im concerned that the Public Health<\/a> Emergency Declaration<\/a>s will not be taken seriously if its a litany for every new challenge that comes along public to buy into it. I guess id like to ask, what are the criteria used for determining whether a disease or disorder constitutes a Public Health<\/a> emergency . Thank you for that question, senator. What were seeing in late may, early june, was a doubling time of new cases of about every eight days. So an increased number of new cases. And among the things that is important, i think, as we understand when a Public Health<\/a> emergency in fact, i will invite assistant secretary oconnell to maybe come in here as well, is one of the things about able to do, whether it be flexibility of funding and resources, whether it be emergency authorization, or whether it be another flexibility so we have the capacity as an agency to deliver i dont know if doctor secretary oconnell want to chime in there. Ave the just a can concur witt doctor walensky said, the Public Health<\/a> emergency created and environment in which authorization authority, by which it was easier for states to give us the data that senator murphy and dr. Just talked about. It makes it easier for local Public Health<\/a> departments to shuffle employees around to put them towards the current response. So it created some flexibility. It was also an important signal to the community that we are paying attention, that this is an emergency in our view, that we want to provide as much Counter Measure<\/a>s and response mechanisms as possible. That also aligned with what w. H. O. Did. It declared a Public Health<\/a> emergency of international concern. We had the most cases in the world, so it was consistent with what their determination was. Ultimately, its the secretarys decision, and he made that decision in august, as you said. I want to chime in quickly. I agree on all the things that were unlocked. The point is, we need to keep looking at our emergency capacity and are planning for. I think we all agree, we need to keep looking at this as a continuum. Because with Climate Change<\/a> and everything else, its gonna be a lot more of these to come along. I basically agree with that conscientiousness, that kind of being ready for it. But you do have to keep in mind that if it does enter some kind of sequence where it gets dismissed because its being declared too often, to me, it looks like hed want to develop some criteria that i know its difficult to get everything into a subset, but i worry about how people will view it if its a litany of Public Health<\/a> crises, when we went through the covid19 journey, not so much about it on the way, and of course, back to fauci, you when i spoke, we talked about shutting down the economy. And you said we did that out of uncertainty. We probably never want to do that again. We cost trillions of dollars along the way. So, we surely have learned a lot with that experience that we might use on others. Dr. Fauci, a lot of americans are worried about the power of social media. And it was back over a year ago, in july, but we talked about, had there been any contact with your office. And i know recently, a federal judge in louisiana ruled that the Biden Administration<\/a>, including yourself, must turnover external communications with social media companies. So well see what happens there. You said there have not been any contact up to that point, and any social Media Company<\/a> contacted you since july when we spoke last . I know thats been a decent amount of time. Im just curious. I dont believe i said there was no contact. Ive had, over a period of time, and have to check the dates, senator, honestly, enough to get the correct dates, that Mark Zuckerberg<\/a> of facebook had contacted me to make some Facebook Live<\/a> discussions about encouraging people to get vaccinated, and how we can make sure that people understand the importance of vaccination. So there has been, and thats public record, anybody has access to the public facebook, i think there were three conversations that i had back and forth with him about promoting the use of vaccinations as a Public Health<\/a> intervention. And i think on that particular Public Health<\/a> and about the benefits of the vaccine, its probably not where that contention arises. I want to narrow in on this. It would be the original discussion of where it came from, the leak. And then they used, you know, from a lab, or from a wet market. And was there a discussion on that . To me, thats a different kind of issue. To my knowledge, there was not. I want to make sure i get correct your question. If the question is, do we influence social media and anyway, the answer is, categorically, no. And any communications that are made in that regard, as far as im concerned, are an open book and available. The lawsuit that you mention, i think its misery and louisiana versus biden and h h s and ece an fda and the entire government. Because it involves the president , its under the department of justice right now. And i have handed, and my staff have handed over every document that the department of justice has asked for, and its up to them to make it available. But i have held nothing back from anything that i was asked to provide. Thank you. I want to turn it over to senator thank you, chairman. Let me conclude, if i can. I want to thank all of you for the work that youve done over the last three years. Tony, i wish you well in the transition. I want to state this and i want to be perfectly clear. We dont act or react fast enough. Ill say it again, we dont act or react fast enough. And weve been focused on monkeypox. Lets do a recap, real quick. May 17th, infection in the United States<\/a>. Two weeks prior, ten days prior, 11 prior days prior, a week, we see this in the uk. We already big bulk storage of vaccines sitting in denmark. Bomb, apparently, speeds up there that wasnt supposed to go on line until sometime in the fall. They apply, the fda on june 30 inspects, its july 27th before the approval is made, and heres the concerning part. Its april 18th when we sign a deal for domestic somewhere else. Ill say it again. We start in may, we know it got domestic infections. Were concerned with our ability to deal with this. And theres a big period that we dont look for domestic im not asking for a response. Im just making a point. But if we have a Pandemic Response<\/a> plan, things like this get resolved. And i dont know what the limitations have been placed on any of you about sharing the specific plan, whether it was monkeypox. And i dont really care today. What i do care about is that if you are in a role of leadership in your agency, or if somebody else is in a row of leadership in the future, the first thing they ought to be saying is, lets sit down as a group, and lets put together a plan. Thats not what everybody is gonna do. This bs of working independently, the turf wars that exist, we are in testing, we on this, we on that, to with it. These when you declare a national emergency, this is no time to protect territorial tariff. And every response to us is about money. If you need something change to reprogrammed, for god sakes, ask us. Bernie is that as an excuse as to why you cant do something. Weve reached out many times, and the only thing i hear, dana, dana, dana, money, money, money. Doctor thank you, when 70 of employees arent coming in the office, you dont get much sympathy for us. Maybe a long time to do a demonstration project about doing work remotely. You know, the biggest trouble weve got is putting people back in the office. Congress did it. Government is not capable of doing it. The private sector is struggling with that. Post covid is very difficult. But the responsibilities that you have as the Emergency Response<\/a> component have not changed. Youve got a look at the workforce, the challenges, youve got a look at the procedures that you have in place and say, have we really learned from the last one . Now, im not gonna be here to see you again. Im not sure will hold another hearing before the end of the air. But i want to let you know, i look forward to working with you and i will continue to be a resource to any of you. Because i only have one call. And thats that i know for the next one, weve gotta respond a of a lot faster than we did for covid, and weve got to do better than we did on monkeypox. Because on the other side of this, potentially, is when it gets out of control with massive amounts of loss of life. Miss chairman, i thank you for your indulgence. Ill probably missed about. Thats okay, because i think this is more important. Thank you very much, senator burr. Thank you to all the members of the committee for electrical walensky, doctor fauci, miss oconnell, thank you for this important and thoughtful discussion about the response to the monkeypox outbreak. For any senators who wish to submit additional questions, the record will be open for ten business days. The health committee, pretty generous, ten business days. You have until september 20th at 5 pm for additional questions for the record. What, that this committee stands adjourned. Generous. Ten business days. You have untold number 28 5 pm for additional questions for the record. This committee is adjourned. [noise] [inaudible] thursday morning, the director of the federal bureau of prisons, collect peters, testifies on Senate Judiciary<\/a> committee. Beginning at 12 am eastern on cspan 3. Cspan now, our free mobile video app, or online at cspan. Org. Cspan is your unfiltered view of government. Dave xin companies and more, including fox. Homework can be hard. But squatting in a diner for internet work can be even harder. Thats why were providing lower income students access to affordable internet. So homework can just be homework. Connect to compete. Giving you a front row seat to democracy. Live, sunday, an indepth, author, tv host, and abrams media and founder see eo dan abrams will be our guest talking about u. S. Legal history and the american legal system today. Hes the author of several books including lincolns last trial, kennedys avenger about the trial of jack ruby, and his latest, alabama versus Martin Luther<\/a> king jr. And the criminal trial that launched the civil rights movement. During the conversation with your phone call. Text and tweet for dan abrams, live, sunday at noon eastern on indepth. Next on cspan, a ukrainian medic held in russian captivity testifies before the commission on security and cooperation near. Often referred to as the helsinki commission, her testimony were about Living Conditions<\/a> and the torment she and others were subjected to","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia601407.us.archive.org\/25\/items\/CSPAN3_20220928_200800_CDC_Director__Public_Health_Officials_Testify_on_Monkeypox\/CSPAN3_20220928_200800_CDC_Director__Public_Health_Officials_Testify_on_Monkeypox.thumbs\/CSPAN3_20220928_200800_CDC_Director__Public_Health_Officials_Testify_on_Monkeypox_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240619T12:35:10+00:00"}