Strategic plan on testing include specific numeric targets for testing capacity, supply chain capacity and projection of shortages . Thank you for that question and statement, senator murray. Yes, as ive stated, we continue to have a work in progress as we built the testing capacity. We have established the targets with the is states of over 12 million tests over the next four weeks. We think those targets will be good in may and june. But as dr. Fauci said, we really have to be evidencebasesed. We expect those targets to go up as we progressively open, as communities go through phase one and into phase two, and certainly those numbers will need to go up significant in the fall when we potentially have influenza circulating with covid. Yes, there will be targets. The targets will need to change based on the evidence that we see. We are highly committed to securing the supply chain. We work daily with every manufacturer. Im pleased were in may and june able to get ahead of the states so we can comply them what they need so they have those assurances. Dont let there be any doubts about that. My question to you is, when you put out that specific plab that youre required to do, we will see numbers that you are going to tell us you will reach, targeted for testing and supply chain capacity, instead of saying we hope to have a million this week, next week, you will give us the specific targets, correct . Ill say yes, maam, we know the specific amounts of tests we have over the summer not that we have. How many we need. Yes, maam. We developed the need statements by working with the states individually with epidemiologists, with the cdc so overall in may well be testing about 3. 9 of the overall u. S. Population. Im telling you youre well over time, senator murray. How many we will need, not just for may, but the coming months so we can be prepared to have them . Yes, maam. Not to be repetitive, we need to be evidence and data driven because what we may see in may or june will drive differences in the amount of test goals we have. We really just need to be very humble about this. We need to look at the data. We know the testing needs will go up over may and june as we possibly open, and we will do our best to predict that. You have to understand we have to see what the data and the evidence show at that time. I appreciate that. Mr. Chairman, again, what our Strategic Plan requires is what is the goal. Not how many we have, but how many we need. Thats what well be looking for. Thank you. Thank you senator murray. Senator inslee. Thank you, mr. Chairman. I appreciate your Opening Statement where you had a very succinct list of items we need for not only this pandemic but the next one. We need to look at the future, too. I think weve learned a lot. Were fighting a virus at the same time that scientists are learning about it. So we need to be nimble. We also need to be sure that we are prepared for a second wave of outbreaks that could coincide with the start of the flu season, potentially stressing our Health System even more than it has been. Admiral giroir, i thank you for your comments. I think they have been comforting about what has been done and what can be done. I believe with senator murray that we need to have specific goals. As an accountant, thats one of the things im looking for. Dr. Hahn, our understanding of the clinical picture of covid19 continues to evolve, what first looked like a respiratory illness now seems much more comprehensive, potentially affecting the heart, the brain, the kidneys and other organs. How does this evolving picture impact the ability to evaluate the appropriate clinical or surrogate end points for review of vaccines and treatment . Thank you, senator, for that question. The evolving clinical picture and obviously the way this is manifesting around the country clinically does, in fact, inform the end points that we will work with developers of therapies on so we can get the absolutely most efficient, but also the most Accurate Information and appropriate end points to make the necessary authorizations and approvals. We have set up this program called the Coronavirus Treatment Acceleration Program where our top scientists and clinicians have been at the table consulting with our colleagues at nih and cdc to actually address those questions. What are the appropriate end points . Ill give you an example. We do know that in some circumstances patients who had severe covid disease developed tlom bottic or clottingtype episodes. Weve compiled agents that might be beneficial. The clinical end points for those trials will be different than an agent thats an antiviral like remdesivir where, as dr. Fauci mentioned, were looking at time to recovery. We want to adapted it to the clinical circumstance as well as to the type of therapy thats put before us. Thank you. Another question to dr. Hahn, we have made a lot of progress in Vaccine Development all right. But domestic manufacturing of needles and syringes is a significant gap in pandemic preparedness. What has hhs done in advance potential National Vaccination campaign to ensure we have sufficient capacity to administer a vaccine . Senator enzi, thank you for that question. This is a really important point. As you mentioned, its not just about the vaccine or hopefully vaccines that are developed, its also about the supplies that are needed as well as an Operational Plan for administering the vaccine. So this is an allofgovernment approach. There is a program thats been set up called operation warp speed that includes dr. Collins, dr. Fauci, his colleagues at nih, the department of defense as well as other members of hhs and fda. Dr. Peter marks from our center for biological evaluation has been helping coordinate that, working very closely with dr. Fauci and his team. We created whats called a gant chart to look forward, what are the necessary supply change items, syringes, needles, how many times they have to administer and the route of administration. So weve been leaning in on this supply chain so that when the vaccine is ready to go, we will have what we need. Thank you. I have a couple more questions, but again the clock is not visible there. I suspect ive used up my time. Ill submit those in writing. Thank you senator enzi. Senator sanders. Thank you very much, mr. Chairman. Let me thank all of the panelists for the hard work theyre doing and for being with us today. It is sad to say we have a president of the United States, the leader of our country who from day one downplayed the dangers facing this country from the pandemic, who told us that the crisis would be over in a few months, that we did not have to worry, who fired those members of the government who wanted to act aggressively and, among other things, at a time when we need International Cooperation cut funding for the world health organization. Let me also say that i think we understand that facts are terribly important. Not everybody that we dont fully understand all the ramifications of the covid19 epidemic. Let me ask dr. Fauci a few questions if i might. The official statistic is 80,000 americans have died from the pandemic. There are some epidemiologists who suggest the number may be 50 higher than that. What do you think . Im not sure, senator sanders, if its going to be 50 higher. Most of us feel that the number of deaths are likely higher than that number. Given the situation particularly in new york city when they were really strapped with a very serious challenge to their health care system, that there may have been people who died at home who did have covid who were not counted as covid because they never really got to the hospital. So in direct answer to your question, i think you are correct that the number is likely higher. I dont know exactly what percent higher, but certainly it is higher. Dr. Fauci, let me ask you this. In the terrible pandemic of 1918 the virus exploded in the fall, came back with a vengeance. Are we fearful if we dont get our act together, as bad as the situation is now, it could become worse in the fall or winter . Senator, thank you for that question. Its a frequently asked question. I think that possibility does exist. However the reason i say that is that when you talk about will this virus just disappear . As ive said many times, thats not going to happen because its such a highly transmissible virus. Even if we get better control over the summer months, its likely there will be virus somewhere on this planet that will eventually get back to us. So my approach towards the possibility of a rebound and a second wave in the fall is that, a, its entirely conceivable and possible that would happen. But b, i would hope that between now and then, given the capability of doing the testing that youve heard from admiral giroir and the ability of us to stock up on personal protective equipment and the workforce that the cdc under dr. Rhettfield will be putting forth to be able to identify, isolate and contact trace, i hope that if we do have the threat of a second wave, we will be able to deal with it very effectively to prevent it from becoming an outbreak, not only worse than now, but much, much less. Let me ask. Weve heard a lot of discussion about vaccines obviously. Everybody in congress and in this country wants a vaccine. We want it as quickly as possible, as effective as possible. Let me ask the honorable fda commissioner. Sir, if, god willing, a vaccine is developed and were able to produce it as quickly as we all hope we can, i would imagine that vaccine would be contributed to all people free of charge, make sure at least that everybody in america who needs a vaccine will get it regardless of their income. Is that a fair assumption . Senator, i certainly hope so. Fda is very committed to making sure all populations in the United States including those most vulnerable are included in the Clinical Trials sir, thats not what im asking. What im asking is, if and when the vaccine comes, it wont do somebody any good if they dont get it, and if they have to pay a sum of money for it in order to profit the drug companies, that will not be helpful. Are you guaranteeing the American People today that that vaccine will be available to all people regardless of their income . The payment of vaccines is not under the fda. I share your concern that this needs to be made available to every america. Does anybody else want to comment on that . Do you think we should make that vaccine when hopefully it is created available to all regardless of income . Do you think poor people and working people should be last in line for the vaccine . Im sorry, senator. Were you asking me . Yes, i was. My office is one of the offices committing to serving the underserved. We need to be absolutely certain that, if a vk seen or an effective therapeutic or preventive is available, that it reaches all segments of society regardless of their ability to pay or any other social determine nance of health that there may be. Good. When youre telling the American People today regardless of income every american will be able to gain access to that vaccine when it comes . They should gain access to it. I dont control well, you represent an administration that makes that decision. I will certainly advocate that everyone is able to receive the vaccine regardless of income or any other circumstance. Youre over time, senator sanders. All right. Thank you, mr. Chairman. Those are important questions. I dont want to cut senators off and its hard to see the time clock. If we can stay as close as possible to five minutes, then all senators can get their questions in. Thank you senator sanders. Senator burr. Thank you, mr. Chairman. I thank the Witnesses Today for what youve done for peoples safety and the people around the globe. Dr. Fauci, youve been on the task force and at a majority of the press conferences. Has anybody in this administration ever asked you or any member to take the foot off the gas in trying to find a cure or any type of countermeasure . No, senator, not at all. As a matter of fact, we at nih have been from the very beginning put our foot on that accelerator in every aspect including the development of vaccines and therapeutics. As i described in my Opening Statement, we actually started that in january, literally days after the virus was known and the sequence was published. So, no, i have never been told by anyone to pull back on the development of any countermeasure or any research po jekt that weve been involved in. Thank you, dr. Fauci. This question is for dr. Redfield. We have authorized in this committee and appropriated out of congress multiple times over the last few decades money for virus surveillance. From fy 16 to fy 20, 23 million a year. The c. A. R. E. S. Act is over a billion in bio surveillance. Weve seen the private sector go out and use Data Available to track the progress and spread of coronavirus around the world. Why is cdc not contracted with private Sector Technology companies to try to use their tools for bio surveillance . Senator, thank you for the question. This is a critical issue, as you know, and also comes into one of the core capabilities i talked about, Data Analytics and modernization which were appreciative of the additional Funding Congress has given. This is under critical review. We do have contracts with some of the private sector groups now to try to make the type of availability of date that weve seen in florida available in all of our jurisdictions across the country. Were in the process of making that happen. Dr. Redfield, in june of last year we authorized the pandemic and all hazards legislation which authorized at that time 30 new employees at cdc specifically in surveillance. I asked dr. Shook in march how many of those 30 had been filled. She said zero. As of mid april, zero had been filled. How many of those 30 employees that this committee authorized cdc to bring on for bio surveillance have been filled today . Sir, again, thank you for the question. I know our staffs have been in discussions since dr. Shukts testimony. I know were in the process of continuing to try to figure out how to move that forward, sir. I can get back to you on it as i discuss what progress has been made when we had that discussion, post her hearing with you when you brought that to light. I brought it to light the first of march. Now were in mid may. So im hopeful that we wont just talk about surveillance. Well actually execute it and focus the unbelievable amounts of money that weve provided for you, that they will show some benefit to the American People. Dr. Fauci, let me come back to you. This is one of the fastest Development Timelines weve ever seen for vaccines. The American People and hopefully people around the world will be the beneficiary of what you find and the eventual licensure of that product. One of the biggest unknowns with this particular virus that can affect the Development Process dr. Hahn, if you have anything to add after this, please do. Dr. Fauci . Thank you, senator burr. There are a couple of things that are inherent in all Vaccine Development. First of all, theres no guarantee that the vaccine is actually going to be effective. As you well know, because weve discussed this many times in the past, you can have everything you think thats in place, and you dont induce the kind of immune response that turns out to be protective. One of the big unknowns is will it be effective. Given the way the body responds to viruses of this tierngs im cautiously optimistic that we will, with one of the candidates, get an efficacy symbol. The other thing thats unknown and is of concern, well be able to get around it by doing the tests properly is do you get an enhancement effect. There are have been two tests in particular where the vaccine induces a suboptimal response and when a person gets exposed, they actual will have an enhanced pathogenesis of the disease which is always worrisome. We want to make sure that doesnt happen. Those are the two major unknowns. Putting those things together, i feel cautiously optimistic that we will have a candidate that will give some degree of efficacy, hopefully a percentage enough that will induce the kind of herd immunity that will give protection to the population on a whole. Dr. Hahn, anything to add to that . Yes, sir. Thank you for the question. From a regulatory point of view, i think are being met by the approaches taken out of hhs and led by peter marks. Thats a common pre Clinical Development pathway so we can appropriately evaluate one vaccine against another and a master protocol that allows for a common control group and assessment of very common end points. That will allow us to be as efficient as possible for the development of vaccine. We will evaluate approximately ten candidates pre clinically. In the phase one and two studies and take four and five into phase three studies in this hhs effort. I think those are the obstacles that can be broken down to allow us to assure safety and effectiveness. Mr. Chairman, yesterday the state of North Carolina started to publicize the recovered numbers, those individuals who had coronavirus but had recovered. Its my hope that nationally we will start reporting the recovered numbers. I think thats important for the American People to hear. I yield back. Thank you, senator burr. Senator casey. Mr. Chairman, thank you for the hearing as well as Ranking Member murray. Mr. Chairman, i wanted to start today with a question regarding Nursing Homes. In particular across a state like ours, weve had, as you might know, a high number of cases in pennsylvania. At last count over 57,000 cases. The number of deaths have gone above 3,700. Of course, a lot of those deaths are in Nursing Homes. Were told that nationally more than a third, as high as 35 of all deaths have been in Nursing Homes, either the death of a resident of a nursing home or a worker. I want to start today with a question for dr. Redfield