the tenet appropriation subcommittee on labor, health and human services, education and related agencies will now come to order. today we are having a hearing on the biden administration fiscal year 2023 budget request, for the national institutes of health. senator blunt and i will each have an opening statement, and then i will introduce our witnesses and after their testimony senators will each have five minutes for around questions. what we were unable to have this hearing fully open to the public or media for in-person attendance, live video is available on our committee website. if you are in need of accommodations, including close captioning, you can reach out to the committee or the office of congressional accessibility services. every day across my home state of washington, research inches the research of washington, washington state university, seattle children's hospital, so many other world class institutions are working around the clock and making groundbreaking discoveries. discoveries that don't just drive innovation in economic growth but also bring families cures, treatments, and hope for the future. discoveries that save lives. discoveries that don't just drive innovation and economic growth, but also bring families cures, treatments, and hope for the future -- i am pleased to say that this budget request shows that the administration understands the tremendous importance of administrating the final world of -- and our tradition of global leader here. especially as the past years have been such a stark reminder of the investments we make and research day, pay off down the road the rapid development of safe affective covid vaccines, was made possible by researching into mrna vaccines we funded and response to ebola and other viruses. but bio medical research enterprises, built over decades. today, thanks to the back scene and their punic's, and the research we help develop, covid deaths and hospitalizations are the lowest we have seen in two years. however, we are not out of the woods yet when it comes to this pandemic. there is still the threat of new more deadly variants, especially right now, in case loads are inching up again. but our communities resources have largely been spent down. we need to defend the progress we have made. and that means passing i'm urgency covid funding, so our community can have the tests and treatments and vaccines and tools they need to keep families safe. this is really urgent, i will keep fighting to make sure that we get it done. in addition to providing our communities research that they need to fight this pandemic, i hope we are able to come together this year, as we have so many times in the past, to continue providing our researchers, what they need to help us to fight covid-19, and so many other challenges. challenges like developing better tests. making next generation vaccines, better effective against all covid variants. and understanding, long covid, and how we support the millions of people who are living with it. and challenges like the mental health crisis this pandemic has made so much worse, especially for young people. overdose deaths that have been skyrocketing due to the rise of fentanyl. we have a record of 107,000 people to overdose deaths in a single year. and washington state, opioid deaths increase -- increased by two thirds in 2021. it is tearing a hole in so many communities and so many families, it is truly heartbreaking, we have to pull out all the stops, to get this under control. that is why i am working on bipartisan legislation, to strengthen programs, that help our first responders, health care professionals, and others on the front line. why i want to make sure that we continue investing in research here, of course, the measure of success against any disease is not how much we invest to fight it, it is how much we are helping patients. for example, when it comes to alzheimer's disease, it is exactly what we need to be focused on. for patients fighting this disease, the stakes are intensely personal. they are fighting to hold on to cherished memories of loved ones, and a feeling of control over their daily lives. and the weight of that fight, falls on their family members, friends, and caregivers. with so much at stake in their lives, these families deserve to know that the research projects they are depending on, are being thoughtfully designed and prioritized, for meaningful outcomes and results. this is really important for me, especially with increased funding for alzheimer's research in 2015. when the 2025 target date is established in the national alzheimer project act, it's just around the corner. when there are so many other terrible diseases that are desperate to put more research into it as well. another important undertaking is the launch of the advanced research project authority for health. which aims to break the mold for how cutting edge research is conducted. with the discovery of medical treatment, and projects that have the potential to transform medicine. i worked hard to provide researchers to establish a bipartisan funding bill this year. i am working hard right now to pass prevent the pandemic -- to set it up for long term success. that requires striking of balance. to ensure we can compliment nih we'll still operating independently, to seize the opportunities to accelerate innovation and breakthroughs. i'm really focused on getting that balance right. i will be asking more about why so much of the and i h budding increase, requested by the administration, goes for -- when it is yet to bring on its staff. and what that means for the other nih institute senators. of course, at the end of the day, innovation is not driven by new programs, and new investments. it is driven by people. which is why, with as much as we invest each year, and as important as this work is to our families. we cannot afford to have this agency's potential-limited, or success threatened by biased discrimination, or harassment in the workplace. we have to do more to address harassment in the biomedical research community. as well as address the facts and the number of research -- and even clinical trials, often failed to be adequately represented. these are real problems, with real consequences, to research. and i have been pressing for progress on this, for years. i have been glad to see and i it's working to examine barriers, in diversity among the returners, addressed how it practices, and structural biases and discrimination, and implementing a policy, i've secured in this committee, that requires those that receive nih grants, to notify the agency, when a principal investigator is removed, even temporarily, for sexual -- that work remains to be done, to remove racism, discrimination and harassment from research. i will continue to follow up on the progress here. finally, before i send it over to senator blunt, i just want to take a moment to note that, this will be the last nih hearing, we have with him. and to say, how grateful i am, senator blunt, with all the work you have done over the years, for this issue. it's great to have a partner who really understands why these investments are so important to families. washington state, missouri, and across the country. and really willing to sit down and work on a bipartisan way that make sure we are delivering for folks who are expected. thank you senator blunt, i'll return it to you. >> thank you chair. i appreciate the work we have done together, as you said, in all likelihood, this is my last nih hearing, as i have started to look back on the time i have spent in the senate. one of the things, i think we'll have the most long term impact, is what we have done together. for nih research. you have been a great partner in that effort. we work closely with chairman the laura, and congressman cole. that is subcommittee, and share the committee during the eight years that we have been doing this work together. the entire committee of course, was involved. i would like particularly like to mention senator durbin. and former senator alexander who were right there at the beginning, trying to see what we could do to change a trajectory that really was, not good. of course, doctor, thank you for you, and the directors being here with us today. like all of you would remember i became chairman nearly eight years ago. and i h funding was stagnant, and had been for about a decade. over the past seven years working together, we've increased that funding by nearly 50%. it was a period of time of looking back, and i could only count on sustain funding but also having substantial increase every year. i am hopeful and confident that senator murray's continued partnership, and that commitment, will let us do that again, this year. i hope we are able to successfully work together, and have a bill this year. i'm disappointed that this budget request reduces funding for 12 of the 27 institutes. including the national cancer institute, and the national institute of allergy and infectious diseases. the latter of course, was demonstrated over and over again, how important it was during covid. there are very few increases, frankly. that are proposed in this request. and, one light the cures, of the increase in cures is coincidental and this fy 23 year, has that number, already built in the only significant increase is that the chair is pointed out, and i age this year would be an increase of four billion dollars -- i'm a supporter of arpa h. i'm a supporter of the secretary's decision to have it associated with nih. four billion dollar increase from arpa-h and no increase for nih would really verify the words concerns that people have had about arpa-h as a competitor to our ongoing research, as opposed to finding a way where the government can and should be willing to take on more financial risks, become a real partner in targeted research outcomes, that have a specific short term goal in mind, and help us reach that goal. that does not mean we should jeopardize research challenges, as big as a cancer and alzheimer's disease. or as small as hearing aids. as we look to build frankly, the goal of doing more of what we were able to do in the pandemic. i was also surprised budget requests failed to take more of the lessons learned from the pandemic into consideration, instead of embracing more high risk high reward science and focusing on projects with instant impacts which proves so successful with programs like red x, it appears that the budget cut bogged down with political priorities that don't quite fit the agency's long-standing mission. this is clearly illustrated, with the request of a new senator for sexual orientation and gender identity at virtually no additional money for the cancer moon shot. nih is clearly in a period of transition. if there is one lesson to be learned from the covid-19 pandemic, it is that our nations success depends on medical research infrastructure across the country, supported by nih. now is not the time to abandon that goal. now is the time, in fact, to make it even stronger. i hope the original, eventual budget that we propose to our colleagues in the senate and to the whole congress will reflect that determination to make and i h stronger, across the board rather than the way this budget proposal looks at nih. chair, thank you for your comments. and for the chance to speak in for this hearing. >> thank you. i will now introduce our witnesses. we have dr. lawrence tabak acting director of national institutes of health dr. anthony fauci head of national institute of allergy and infectious diseases dr. gary gibbons director of national heart, lung, and blood institute doctor joshua gordon director of national institute of mental health and doctor nora volkow director of national institute on drug abuse. welcome to all of you, thank you for being here today. acting director tabak you may deliver your opening remarks. >> thank you chairman murray, ranking member blunt and distinguished subcommittee members. i'm on the to be here today with some of my colleagues representing the nih. this is a time for and the entire biomedical research community to re-examine all of our efforts. during the covid-19 pandemic, we were driven by the urgency of the moment. nih must learn from this experience and sees the opportunity to define a new normal. as acting director, i am committed to new strategies, new voices, and a renewed focus on the future. now is time to reflect on what worked and did not work in addressing covid into shape new strategies. setting the stage for the new mrna technology of image and design that were key to developing the safe and effective vaccine in unprecedented timeline. since these vaccines became available, it is estimated that more than 2 million american lives were saved and more than 17 million hospitalizations were reverted, now we need continued support for a wide range of biomedical fields, including behavioral and social sciences, to identify and successfully implemented better ways of responding to short and long term health effects of covid-19. to prepare for future pandemics. and to ensure equitable protection of our diverse population. it is not just about vaccines. our rapid acceleration of diagnostics, or read an x initiative fueled the development of many new initiatives of covid tested that are being used in our communities. top ensure that such benefits would help with those disproportionately affected by the pandemic we initiated underserved population and the antigen community engagement alliance. these experiences along with other nih led efforts focused on co-treatments of the private and public partnerships nih can build upon the momentum of the covid response to develop other challenges through radx. thank you for the authorities of key development including the omnibus, and the aim of the basic administration of infrastructure for arpa h. this is a key first step for the permanent home of strategic partnerships that are so urgently needed to address cancer, bile leading to alzheimer's, and many other by diseases. we cannot stop there. in addition to new strategies, biomedical needs new voices. a growing body of evidence demonstrates that inclusion of diverse perspective yields better outcomes. in a clinical setting, medical teams provide diverse more accurate diagnoses for more patients and building trust. we do better science when we have a diversity of scientists from different backgrounds and different communities. scientific fields, and a different story or stages. senate appropriations subcommittee on labor, health and human services, education, and related agencies continues to prioritize early stage investigators so that they can succeed as independent researchers. in 2021, we reached an all-time high over the stage investment, 1313. the passion and commitment of our scientist is matched by the people living with a wide range of diseases and can be conditions. conversations we are having are sometimes difficult, but those are often the discussions of teach us the most. from the age advocacy groups of the 1980, to today's groups for autism, along with covid and many others, these voices have refused to be ignored. ultimately all of us benefit. this is a movement for renewed focused on the future. i spent a lot of time encouraging early state scientists. i also like to think about the importance of engaging elementary school age children, like those my wife has taught for over 40 years. during the covid pandemic, exposure to the importance of science has become a big part of many of their lives. past pandemics have inspired young people to become scientists. the images they saw were usually of older man who looked pretty much like me hopefully today's kids are seeing more scientists that look like them. we need to do better. our nation needs all the bright minds they can find. i hope they will continue to work with the way nih to make this happen. thank you for your time, my colleagues and i welcome your questions. >> thank you very much. i realize that as i was going to the list of panelists in front of us that i missed doctor richard hodes. . i have my we will now be in a round of five minute questions. doctor -- and i mentioned in my opening statement overdose death begin to rise drastically. much like the rest of the country, it is really driven by fentanyl. this is really a national crisis. we have to be using every tool that we have two some you are communities, including fentanyl strips. secretary becerra mentioned at his hearing here a few weeks ago. the research that i have seen that those trips are used to determine fundamental to test other drugs. they have many steps, including chipping off the pedal to be able to test it. can you tell us about the research says on the effectiveness on those test trips? are that easy to use? can you talk a little bit about that. >> thank you very much for that question. indeed the fentanyl test trips that are being used for sensitivity and specificity. the data shows the high sensitivity, and they are only a few fantino analog that are not detected. the fentanyl test trips were developed for testing urine. so patients who are being monitored. so this is a new application. as a result of that there can be problems on how is it implemented. overall, patients who have used the fence about test rip report positive outcomes. actually in terms of identifying terms of higher risk. now, what are the optimum guidelines of how to use these? number two, if the results are positive, what should that individual do in the case that they don't want to consume them. as you know, there are still multiple problems in terms of making these fentanyl tests available throughout the united states. there is interest on actually determining on getting some food and drug administration which can be used in health care settings, which is not possible at this moment. >> are there other overdose prevention strategies that you hope to roll out in the coming months? talk to me a little bit about what we are doing in terms of prevention. >> prevention strategies that have been shown to be wildly effective is perhaps one of the most important ones, widespread distribution of naloxone. that becomes a challenge because naloxone is not necessarily available for those who use these drugs. another harvard action practice that have generated a lot of attention is -- the drug supply is so extremely dangerous these days, we have safe injection sites could be valuable for patients who otherwise may be at very high risk of overdosing, and while the data is still preliminary in the united states, in other countries that have shown that in certain settings it can be quite effective so there is interest on evaluating them. there is also interest in their community to test other products that may serve for samples that include trenton, which is sold as t, and contains a drug molecule that has effects that are similar to those of -- could be utilized for decreasing withdrawal, depression. these are more novel and we do not have sufficient data. those are things that are being discussed. >> perfect. thank you. doctor, it is said that science is a marathon not a sprint. congress has really invested in research to treat alzheimer's disease, with a sense of urgency. 17 billion since 2015, to really supercharged the discovery process. the goal of finding a treatment for a cure by 2025, i'm concerned that, given the sheer scale of federal investment, what is -- to deliver meaningful outcome on this progress towards finding affective treatment? >> thank you for that critical question. let me answer very briefly. and with some examples of meaningful accomplishments during this time. as you know, we've counted on critical input from the national global resource community, advocates, with our annual summits. all which feet into a careful