[inaudible] okay, thank you. The Senate Committee on Health Education labor and pensions will come to order. This afternoon, we are going to hear from two panels. We are going to hear from, on our first panel, the assistant secretary for preparedness and response, rochelle walensky, and robert califf. Second panel, we are going to hear from doctor Reshma Ramachandran and dr. Martin makary and dr. Marshall. Let me begin by thanking all of the folks on the panels. All of us know that the last three years have been unprecedented in our lifetimes martin makary, we dealt with the worst Public Health crisis in 100 years, i want to thank all of you under those difficult circumstances. Today, what our job is, is to take a hard look at where we are today, in terms of preparing for another pandemic. And the need to reauthorize the pandemic and all hazards preparedness app act. And i want to take this opportunity to acknowledge the previous leadership, senator murray, who was chair of the committee and senator burr who was the Ranking Member, as well as the working group that ive helped convene with Ranking Member cassidy, to include senator casey and senator and all of those senators have set aside time for their staff to meet with mine, every week, because we all understand how terribly important the issues are that we are facing, concerning the possibilities of future pandemics. As everybody here knows, tragically, in the United States we lost over 1 Million People from covid. And putting that in perspective, we lost more people from covid in the last several years, then we did in world war ii. Cases, deaths, and hospitalizations are all declining, covid is still today the leading cause of death in our country, with some 250 americans on average dying every day. The World Health Organization reports that 7 Million People have died from covid globally. But there are experts think that underestimates the number of people who have died, globally. I think, to be honest, as americans, we can understand that every public official tried their best during covid, god knows how hard people worked and the stress they worked under. What the truth is, we were very, very unprepared for what hit us three years ago. It took a lot longer for us to effectively respond to that emergency then it should have. All of us will remember claude that months after the pandemic erupted, we all saw pictures of doctors and nurses in overwhelmed hospitals, lacking the personal protective equipment to keep themselves healthy. We all remember those images. And doctors and nurses, people using plastic trash bags, because they didnt have the personal protective equipment they needed. And we also know that many hundreds of medical personnel died doing their duty trying to save their fellow americans. During that time we did not have the tests needed to find out who had covid and who did not. It would not have the infrastructure we needed to deal with the pandemic. All of us remember the overwhelmed hospitals in intensive care units from one end of the country to the other. We did not have the vaccines or the treatments the American People, and people throughout the world, desperately needed. We all recall that we had to shut down our schools, our businesses, and much of the economy for far too long, causing millions of americans not only to lose their jobs, but their health care as well. So in the middle of a pandemic, millions of people actually lost their health care. Here is a scary piece of news, we have to face up to, it really do. Maybe the most important part of holding this hearing. What scientists are telling us is that there is a reasonable chance that, god forbid, a pandemic as deadly as covid wooded here in ten years. All of us hope that that will not occur, but our job is to make sure that we are prepared if it does occur. Thats what this hearing is about, thats what this legislation is about. Scientists have told us that there are now seven viral families that could cause the next pandemic, because they contain viruses that spread to the respiratory system and can easily spread from person to person. Our job is to make sure that we are protecting we spend huge amounts of money on the military. We say hey, we have to protect the American People. If you want to protect the American People, you have to deal with this issue as well. And it means that we must have a capable workforce in place, not just nurses and doctors, but also Public Health officials, disease detectives. Well hear more about this in a few minutes. People who can tell us where to set up a vaccination clinic, for example. If there is an outbreak developing on the west coast, can we learn about it immediately, and so the rest of the countrys alerted . Et cetera. Tragically, during the pandemic, nearly one and this is incredible. It impacts not only this hearing, the future hearings. During the pandemic, nearly one out of every five Health Care Workers quit their jobs. And contemplated doing so as a result of enormous stress and burnout they experienced. Further, we need to have accurate Public Health data, to know who is getting sick. We need it did not only have tests, vaccines, and treatments available, we have to be able to get those out everybody who needs them. We need to make sure that medical personnel have the supplies, the masks, the gloves, the gowns they need. We need to have Clear Communication to the public. Something that has been really difficult to do, but we need to improve our communications capability. We need especially, to make sure we protect the most Vulnerable People in our society. The seniors in nursing homes, those with disabilities, our children, and our infants. So, thats where we are right now. We have experienced a terrible pandemic, our hope is that we have learned something from that. And that will be better prepared as we face an unsettled future. Senator cassidy . Thank you senator sanders. Before beginning, director rochelle walensky, i think we all experienced sympathy for the families of the cdc employees killed yesterday. Always a tragedy, but we feel in particular. Today we are discussing an important responsibility of the committee, the reauthorization of the bipartisan pandemic and all hazards prepared this act. Many will focus on the word pandemic, which is obviously a big part of the discussion, but we need to keep in mind the wide array of threat that this bill seeks to address. Not just diseases, natural disasters, attacks, accidents, other things or get our country at risk. I feel connection to the origins of this bill, although it was not in congress at the time. It was first enacted in 2006 to address the failures of following hurricane katrina. And anybody from louisiana firsthand, the devastating impact on the community. When governments are illiquid and ill prepared to manage a crisis. So we have to support everyone. The biomedical but you come up with awkward sounding acronyms. Also made improvements today for they stop treatment, easily available during emergency. In both 2013 and 19, congress acted in a bipartisan way to reauthorize the bill. And this year senators romney and casey are spearheading this. We dont always agree, but we set politics aside and come together on really authorizing papa. We know it is key to protecting all of us. The papa framework is far from perfect, poor management and maintenance of the stockpile meant that doctors and nurses were meant to use force to use ppe for firefighters. One picture a member was a huge quantity of masks being dumped, right as the pandemic was starting, because they were two weeks from being expired. It certainly wasnt a first in, first out, manage the inventory situation. I think we can say in some ways, the government hampered the private sectors ability to launch tests at the beginning. And they consistently failed to communicate the public. Lets get better. We made mistakes, we learned some tough lessons. So lets Work Together to make it so that next time it isnt on the fly that we are figuring it out, rather, there are systems we can put into place. Update the playbook, make sure whatever we do is flexible enough to address the threats beyond just pandemic. And emphasizing, we need to look toward the threats in the future, not to prepare for that one was already gone by. Limited taxpayer resources, and better partnered with states in the private sector, so we are already, and willing, to step in for the next Public Health threat. To accomplish this, the meaningful policies, to i thank you for being here, i look forward to hearing your testimony. And with that, mister chair, i yield. Thank you senator cassidy. Now we are going to hear from our witnesses, first witness is miss dawn oconnell, assistant secretary for response in the administration from the tragic in the heart of health and Human Services. Miss oconnell, thanks very much for being with us . Chair sanders, Ranking Member cassidy, distinguished members of the committee, it is an honor to testify before you today about and the additional authorities we are seeking in the upcoming bill. But, first let me join the senator for my we are very sorry, we are living in an increasingly interconnected world, where diseases and other tribes can travel quickly unnoticed for days. We are also experiencing increase in interconnectivity we are working on more high consequence, no failed visions than ever before. We are proud to lead so much work on behalf of the country and want to be sure we have the authorities we need to continue to execute that work with the excellent, efficiency, and expertise the American People deserve. As we move out of the acute phase of the covid19 response, it would be management malpractice for us to look the same and at the same as we get at the start of the pandemic. Ive taken several important steps in the last few months to transform our organization and to incorporate Lessons Learned from the covid19 response. For example, asper is now a Standalone Agency within hhs. This important change in our departmental status gives me the independents to build out our human resources, acquisitions, and finance infrastructure. So it better supports our unique mission. I also just completed a structural reorganization that institutionalized important new capabilities, like our stockpile, supply chain, and domestic manufacturing work. The capabilities that we built during covid, and needs to keep using moving forward, like i also made the Strategic National stockpile in office, that reports directly to me, to increase visibility into, and accountability of, this critically important part of the nations preparedness and response apparatus. With these changes, ive taken the two most transformational steps available to me, to build a better preparedness and response organization. And now i need your help to ensure i have the appropriate authorities to execute our mission faster and stronger. With the authorities im requesting, i am trying to sell all of three key problems. The first problem im trying to solve is how we can procure, more quickly, the tools and supplies a country needs when responding to a bio threat or disaster. Early in the covid19 response, it became clear that hhs could not procure the products our country needed, at the speed at which our country needed them. As a result, we entered into a memorandum of understanding with the d. O. D. , in which they provided acquisitions for on our behalf, using their unique authorities, executing more than 90 billion dollars of contracts for us over the three years of the acute response. Our agreement with d. O. D. Comes to an end at the end of this fiscal year. Which is why im requesting similar authorities for asper. These include funding promising prototypes, and moving the successful ones through the research by a plan without having to recompete the contracts, like we do now. We are also seeking the ability to quickly procure experimental supplies, an important finished products. Each of these new authorities will allow us to do for ourselves, moving forward, we have to rely on the d. O. D. To do for us during covid. The second problem im trying to solve is how aspr can continue to invest in the expansion of the domestic base for keep the email surprise, to ensure we are never again the position we got ourselves out in march 2020. When our doctors and nurses did not have access to the masks, gowns, and gloves they needed. As far Construction Authority to build new factories, nationwide. To produce the ppe and supplies we need in times of emergency. These investments also provide good paying jobs to many hardworking americans, but what if the covid 19 funds run out . We lose our Construction Authority, and our ability to continue investing in similar projects. That is why i am requesting Permanent Authority for aspr. Its important we have funds and Construction Authority to sustain the work we have started. And to expand this work to other parts of these public supply chain. The third problem i am trying to figure out is how we can hire staff more quickly during large response efforts. In the early days of the cruel covid19 response, just as we were live for acquisitions war, we also relied on fema and the coast guard to bolster our response staff. The ability to hire people quickly and competent them appropriately for their long hours and sometimes hazardous work, our important tools missing from asprs response tool box. Which is why i am requesting direct tyrant authority, which will allow me to quickly scale up our response efforts, so we have enough people when we need them. And pay flexibility will go along it saves our staff and assure is that we do not lose these seasoned First Responders and subject Matter Experts to the private sector, who pay much more, and often require much less of them. To solve each of these problems, i have just laid out, i have requested important new authorities, i want to solve these important problems with, you and many others, as you draft a new bill. Thank you again for inviting its justified today. I look forward to answering your questions. Thank you very much. Our next witness is doctor rochelle walensky, director of the centers for disease control. Dr. Walensky . Chair sanders, Ranking Member cassidy, and distinguished members of the committee. Its an honor to be here. Before i begin, i would like to take a moment to mention that our cdc family suffered a horrible loss yesterday. Amy was a valued member of the team at the division of reproductive health, or she worked every day to save lives of mothers and infants. Our hearts are with her, her family, friends, and our colleagues, as they remember her and grief this tragedy. In addition to the work that people like him you do every day im here to talk about how the cdc works 24 7 to protect america. And i want to thank you for this important opportunity. Cdc has led Public Health response since our founding in 1946. Providing expertise and resources and workforce support to states, local, and tribal communities on local territories. No matter the outbreak, h1n1, zika, ebola, covid19, polio, and pox, cdc has been there offering worldclass assistance. Alarmingly, bees Infectious Disease spreads have been emerging at an increased pace, and are increasingly complex. The increased frequency of outbreaks means we should not be asking if will face another serious Public Health threat, but when. For many, life has turned to normal after three years of covid19. Agencies like cdc and is to continue to remain response ready, to protect americans from any was delving or emerging health threat. And we do this by actively supporting the four capabilities of Public Health. Including stateoftheart laboratories, a diverse Public Health portfolio that is culturally competent worldclass, data and analytics, Rapid Response to outbreaks at their source, and strong, domestic, and global preparedness. We are enhancing these through an allagency review. The cdc moving forward. We are committed to addressing the Lessons Learned from covid19, including accountability, and improving how we deliver information to americans. The end of the Public Health emergency once again reminds us that policy changes and funding are essential to the readiness of future we will continue to close modern covid19 and provide information to which we have access. After three years of the pandemic, and three months of preparing we have worked hard to sustain data to understand whats happening with the virus in america. But the end of the pag means the cdc will no longer be able to collect data and share information, Many Americans have come to expect. A cdc often does, we will adapt to limitations and utilize tried and true systems to monitor other respiratory diseases, to keep our eye on covid19. And some cases we will use surrogate data, but sounded will no longer be submitted to us. For example, certain data for National Pictures of Health Disparities for race and ethnicity, along with urban and rural lines. We will make do. However, the should worry us all. Primarily because what it says about the visibility we will have in the next outbreak. We will be back to square. One having to build and negotiate surveillance capacity while we fight a pathogen. I know members of this committee are interested in advancing p