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>> welcome back. at this time i would like to introduce our second panel of witnesses. the first witness on our second panel is dr. sharon watkins. dr. watkins is the director for the bureau of epidemiology in the state epidemiologist for the pennsylvania department of health. she's also the president of the council of state and territorial epidemiologists. dr. watkins is responsible foror management and oversight of the bureau of epidemiology which includes the division of infectious disease, environmental health and community health. dr. watkins has led disease prevailed at outbreak response efforts include those with zika, hepatitis a. dr. watkinss has over 40

peer-reviewed publications and over 20 years of experience in applied public health and epidemiology. thank you for being here, dr. watkins. our secondgy witness is dr. robin robinson. dr. robinson is currently vice president of scientific affairs for renovacare incorporated. director of development for wound healing. previously served as first direct of the biomedical advanced research and development authority, a deputy assistant secretary for preparedness and response for 2008-2016. she also served as the influence of emergent disease program director from 2004-2008. dr. robinson was the eight. dr. robinson was the recipient of the department of defense award in 2008, the hhs distinguished service award three times and the finalists for the service to american metal in 2009. thank you for being here,

dr. robinson. as i witnesses should know you'll hf five minutes for your spoken testimony. your written testimony will be included in the record for the hearing. when you have completed your spoken testimony we will begin with questions. each member will have five minutes to question then panel. we will start with dr. watkins. >> dr. bera, ranked member and members of the committee thank you foree the privilege to apper before you today. i name is dr. sharon watkins, president of the council of state and territorial epidemiologists, and state epidemiologist for the pennsylvania department of health. we are an organization of 56 member states and t territories representing applied public health epidemiologists for disease detectives. we work every day in partnership with cdc to detect and respond to have lunch outbreaks, gain an understanding of potential changes in the virus and deliver life-saving vaccines.

i've witnessed the devastating impact of seasonal influenza. the 2009 h1n1 pandemic, measles, and many of the vaccine preventable diseases in the communities i serve. public health threats require efficient, timely responses ever let on a network of public health agencies at all levels of government in coordination with healthcare providers. response to outbreaks happens at the local level. data on the age group affected, vaccination status, underlying illness, pregnancy status, and whether the outbreak is it a school or long-term care facility. for example, they'll need to be properly identified so that we know where to respond and what is needed. unfortunately, this public health network is choked by antiquated data systems that rely on obsolete and sluggish data sharing methods. faxes and phone calls are still in widespread use. the system is in dire need of

security upgrades. lack of interoperability, reporting consistency, and data standards lead to errors and quality and completeness, timeliness and communication. i have stood before communities in crisis who are justifiably bewildered and angered the public health cannot access disease data access itss faster. how is it that i can simply log into a portal and get my medical test results in the matter of minutes, and you who are charged with protecting public health don't have access to today's health data? it shocks people to warn we do not have aea national coverage connecting hospital emergency departments with public health surveillance systems. about 40% of all visits are not submitted to public health departments, leaving us flat-footed and identify and responding to the fearful infections among high-risk groups including pregnant women, children and elderly.

we are now entering flu season and are challenged by the current outbreak of lung illness associate with e-cigarettes. public health is actually deciphering medical records distinguished e-cigarette related cases from flu cases. this information arrives piecemeal atis different times through differentor channels. try to decipher addendum one in my written testimony. record we see by the pennsylvania department of health. and with the electronic health records cannot share the data with public health no way receives that death certificates are still pop on paper in some states and only 63% of all death certificates are submitted to cdc for aggregation within ten days. regrettably, most pediatric

deaths occur in unvaccinated children and it takes weeks to uncover and link the flu death fascination history causing lags and communication to stakeholders. we need answers to these questions. cste at aol parkinson's association for public health laboratories together with more than 90 other institutions believe the time is not to step up and take a coordinator approach to building a 21st century public health data superhighway. this superhighway look like health data from healthcare providers and reported automatically to public health departments. it will link to other key data including birth and death registries and share that with cdc, the technology is here. what we need are resources. that's what the proposed funding of $100 million that is included in the house labor, health and human services appropriations bill to support data

infrastructure at the cdc is urgently needed. during the ongoing deliberations cste hope you'll consider the need for a modernized electronic interoperable public healthze da system and skill public data for scientist to strengthen public health best prevention strategy vaccination do we recognize this effort must be funded with new money rather than cut already underfunded public health. without federal support, public health surveillance modernization will remain unattainable in the nation will suffer. we look forward to working with you and i thank you for the opportunity to testify before you today. >> dr. robinson. morning. thank you, acting chairman and ranking member and distinguished men of the committee. thank you for the opportunity to speak with you today. i'm dr. robin robinson, the vice president scientific affairs at renovacare, former director of barda and a developer of influenza vaccines in industry. four years ago i testified at

the bardic director for the house in state affairs influenza during a harsh season in what we could do to remedy mismatch of flu vaccine. >> since that time seasonal influence has returned each year and is brought illness and death despite a medicine cabinet full of vaccines and antiviral. >> new vaccines with a fourth straight influence of vaccines and a new class of antivirals were added since 2015. yet we still not solved the chief issue with its influenza vaccine, poor effectiveness. our domestic capacity to produce pandemicic influenza vaccine is quite tripled since 2005 thanks to investments in new seal of her, but based cell technology, however our ability to manufacture and make available pandemic influenza vaccines are not fast enough to preempt endemic peak effects. lastly many universal influenza vaccine candidates have emerged over the past 40 years that none across the line. today i wish to address four

vaccine effectiveness council vaccine vaccine production and elusiveness of universal influenza vaccines. vaccine effectiveness and universal inflows of vaccines are posted in on the selection of antigens that can elicit long-lasting wrought and strong the amino protective response many different influenza virus p subtypes. and i do -- would elicit strong and lasting immunity against early circulating and drifted strains of seasonal influenza virus to obviate the need for annual immunization against seasonal influence and service of vaccine primer for pandemic. the story of universal influenza vaccine development is long and willful. for the past four years multiple ways of innovation of driven universal influenza vaccine development. one of the earliest and the most expensive was in the 1980s focusing on vaccines comprised of highly concerned influenza

into the matrix protein. the candidates were poorly immunogenic. the vaccine candidates started the highly conserved mp proteins and shown to be poorly immunogenic as well. the story change with two discoveries one of which dr. fauci mentioned earlier. made this decadent antibodies were discovered in 2011 to specific epitopes on the conserved stem portion of the protein and shown to bind and neutralize widely influenza viruses. this discovery led to a new development ways of candidates that are undergoing medical evaluation presley. the other discovery which occurred this year was the finding of antibodies to conserved epitopes on the bible protein which is been a target for antivirals for many years. these antibodies combined and neutralize widely diverse

influenza viruses. this discovery will likely initiate another wave of vaccines the scientist will likely include the specific protein in the next generation of flu vaccine candidates. on the issue more rapid production of influenza vaccines, theti new synthetic technology may expedite vaccine production. they do not require the isolation adaption and production of viral vaccine stocks like the current a console-based vaccines can weeks to months may be saved in vaccine production. this time-saving allow the late production of seasonal influenza vaccine strains when a mismatch occurs between circulating influenza viruses and seasonal influenza vaccines. the production time for 600 million doses of pandemic influenza vaccine may be reduced from six months to three months and become available before the pandemic peaks. the added value may be a fast and easy way to distribute and administer these axioms. many messenger vaccines are

encapsulated with nanoparticles as dr. fauci stated in which they intrinsically have properties in the ability to administer vaccines transdermally. none of these innovations of the scope will make into the immunization faxing of the 2020s without funding and authorities to an age, barda, with partners plans of today and you stick to continue wisdom, generosity support have carried us this far. help us finish the journey. thank you. >> thank you, dr. robinson. at this point we will begin our first round of questions. the chair recognizes himself for five minutes. dr. robinson, thank you for your service at barda.

an organization that is looking at bringing the international community together, along with the private sector. look at vaccines for emerging diseases and so forth. if you could elaborate more on the mission and one of the biggest disciplines for me is the united states currently doesn't participate and yet i be curious about your opinion as to whether the u.s. should participate and if you want to elaborate on that. [inaudible] >> can you turn your microphone on? >> sorry. thank you for the question. i always smile when that's brought up because my former deputy at barda was richard hatch at any thicker ceo. should use participate in the

activities against emerging infectious diseases and development of vaccines? the answer is that we already are. this was when the inception occurred back around 2014 and it became a reality in 2017. .. but without duplication of exactly what they're doing . >> if we play off of that for a moment, in my interest in

pandemics and some of the threats, if we look at emerging diseases and some of those pandemics, what is our capacity within the private sector to quickly ramp up if we see an emerging pathogen? we identify a potential vaccine may pathogen and just from your perspective as an expert in the field. >> i'll give it in the context of when i started my public service in 2004 in which it would take months , a year to be able to respond to a new emerging pathogen. my first assignment was on the influenza virus and we how we can make a vaccine towards that. since then we had a live test in 2013 with the emergence of 87 and one viruses. what normally would take about six months nto produce these vaccines, we then

boiled down to closer to three months, there was a specific reason why. and you heard from doctor fauci and doctor jernigan, we were able to get the sequence of that virus immediately and it was on april fools' day of 2015 it moved forward within weeks to have that sequence distributed not only to the vaccine manufacturers and producers but also recombinant. by the summer we had those vaccines in clinical trials. so in record time we were able to do that. many of the innovations we are talking about today i would even expedite that further and our goal of course is to have pandemic vaccine not onlyavailable within 12 weeks . 1>> and doctor watkins, in a prior life i was chief ambassador for the county so i did a lot of public-health

work and it makes me chuckle because we would get information faxed to us and most of the public wouldn't believe that in this day and age in 2019 a lot of public health records and information is facts based so you talk about interoperability, you talk about collecting data and creating big data sets . could you just elaborate a little bit more on what that will allow you to do in terms of more rapidly identifying potential outbreaks etc. and why a more robust interoperable electronic medical record or an electronic public health record would allow you to do your job better? >> sure. when i think about medical delivery and the healthcare system today, it's amazing the advancements that have been made and i think

public-health has been left behind a little bit and we are still dealing with faxes and phone calls and spreadsheets, and written spreadsheets and it doesn't impact our ability to quickly respond to a situation so immunization records were able to be quickly linked to our electronic, to our disease recording system, if we were able to get electronic case reports and see data as it's coming in and digested in the health department we would really be able to respond much faster. much of what we do and many of the pandemics are the emerging threats that we have today, we scratch our heads and we are really struggling with the data sharing and the data management of so much big data. public health needs to have our systems renewed and reinvested in and cft has produced this book in conjunction, there are a lot of stakeholder stories in this that talk about why public health and the time is

now to investmoney in our data system . >> the chair recognizes the ranking member for five minutes. >> thank you mister chair. doctor, in your testimony you highlight the clinical trials have shown the vaccines that are stockpiled remain highly effective even after 10 years of storage. how do you work with the industry to improve the shelflife of stockpiled vaccines and other countermeasures in the event of a pandemic emergency ? >> thank you sir. we started in 2005 building our stockpiles for pandemic influenza and these would be to treat those individuals that are highly vulnerable, at high risk and our critical workforce to make sure the company still operates in a severe pandemic so around 27 million doses and that was actually for all the different strains that have been shown to have pandemic potential from the a5 and one viruses as i subscribed a

moment to go to the new ways of age 7 and nine viruses. >> the vaccines that you have stockpiled in these e companies, is it still good and the answer was we know the essays looked good but we said that's not enough so we went and did a clinical study using newly made h5n1 virus vaccines against a vaccine that had been made 10 years before and the results of that shthat have been published show that they were equal and they were still highly immunogenic and would be, could be used without or with an adjunct toprotect those

individuals . >> thank you doctor. doctor watkins, you suggest use of artificial intelligence could be a useful tool to identify outbreaks early and encourage individuals toget vaccinated. could you elaborate on how this technology could be utilized ? >> thank you for that question. public health does have a lot of data. it's not interconnected and i think the ability to look at birth and death certificates and immunization rates and existing comorbidities and combine that with census tract information and behavior information and information on poverty and pimmigration status, all of this other data sets help us better understand at the community level what are the hesitations or what are the limitations to vaccination or access to healthcare or maybe language barriers. and when we are able to use all the data that google has

up their hands and we don't, i think we will be better able to target where efforts should go. as an example during the opioid crisis, we and other states funded by cdc have been looking at vulnerability assessments so we're looking at where are our best deaths happening due to overdose? where are babies being born with neonatal abstention syndrome?where is hiv increasing and where does that overlaid withpoverty and other statistics so that use of a big data ina state to look at vulnerabilities and target where we should be working . we can be doing that with many more things had me the technology and interconnection . >> i like to recognize doctor murphy. >> thank you mister chairman. thank you guys for coming this afternoon and i

appreciate your expertise. first question i'm going to have is for doctor watkins because i was looking through some of the copies that you have of medical records and everything and having experienced the explosion of the electronic medical records just malpractice in ld the last 20 years i see the challenges. if you could wave a magic wand , there is a way to pull data out of these reports and quantify it, what would it look like because i preface it by saying we have so many different medical record systems in our country. most of which don't talk to one another and unless we have literally a single system, i'm not sure what this would look like so i'm ljust interested in your thoughts about reality of this, how we do this is i think the purpose is altogether a great one. but the devil is in the details what does that look like . >> thank you for that question, i would also refer you to this report that has been done and we can get you

a copy of outhat. but what we're talking about is modernizing systems we already have so our laboratory system which is called limbs , and its ability to rapidly transmit data between us and the provider and cdc and handle those genetic results. needs to be modernized and made more interoperable.ho our death and birth certificate registries need to be more rapid and we shouldn't be having paper records of these important documents. our immunization registry should be interconnected with our other disease reports . and our electronic disease collection system should be able to know if you've gotten influenza and death certificate comes in i shouldn't have to waitweeks . i should be able to see that area within real-time. so looking at being able to

bring those in, pc is doing a lot of work on electronic case records and modernizing all the systems area what we're talking about is bringing allstate to a better level. some states are far behind and some states are behind in something but not in others area and when i think about a pandemic for the next emerging issue. i mean, we don't want public health to be the weak link in the chain. we want public health to protect your family, my family and the public self with the same tools private medicine as in the same speed that's what we're talking about . >> thank you for the question and it's a daunting task. i think it's a good idea. i will tell you just it has an entirely additional level of just data entry but then again that's what we do. we work on data.>> we like to get out of the data entry. i have some analogies for you if i may and me, it's like

i'm sure we all have private positions. we have healthcare providers. and you know, they're not sharing information handwritten on you. they're not walking their lab test results in a spreadsheet. they're working in a modern world modern technology and modern genetics and public health is the frontline for pandemics. we should be working with those same speed. it's like building a space probe and forgetting to put in the advanced communication and data sharing aspect of it and i feel like in this modernization of healthcare and we're talking about the vaccine innovation, we're thinking about all that and we need to think about modernization of public health data sharing so that we can be thefrontline of public health and not be the week chain . >> thank you because i agree, those are the issues. if not cancer, is not other

things that you need an activity area just one other quick question doctor robinson, some of you could speak and we talked a little bit about the vaccines that come primarily from eggs versus the cell-based and recombinant. and you really why you don't believe at the technology of the latter is taking up or are we making good progress was moving away from the based vaccines? >> so because of the difference we had at hhs and primarily product, we made a paradigm shift where we were 100 percent egg-based to as they said 85 percent. how are we going to move to at least having greater adoption or recombinant cell-based when we don't have some of the problems with mismatches? >> first of all you have to realize the influenza vaccine industry is a commodity driven industry. and that the way that we were

able to move the needle again with was interacting with them as a public-private partnership. that has to be revised and continue to go forward with these new discoveries to make it worthwhile for them to have a product you can get out of the-based vaccine business. i will say that there's promising progress that companies that are slowly egg-based actually been bought recombinant vaccine candidates area and that are actually licensed now for their internally developing new influenza vaccine candidates sowe need to expedite that and facilitated with the continued efforts that we had with a good form of the four.>> do you think the recalcitrance to doing that is regulatory or is it the economies of the cost? >> is not regulatory. the industry and i know i am not part of the industry will

say we don't want to do that because we have to go through the entire process of getting a new vaccine license to the fda and but that's the normal course of vaccine development. the real problem is why spend money when we don't have to ? that's a reality. >> thank you very much, i yelled back my time. >> let me recognize mister cohen. >> doctor robinson, you've made, believe the first panel but the whole public media, social media conspiracy theories about vaccinations causing autism, how much of that in effect does this have on people getting vaccinated and how much of an effect of people not getting vaccinated on public health. >> to approach that question the first part is how much, what with the effective anti-vaccine groups for

autism? we fought this battle during the last decade and i will say that for the great extent that battle has been won. and so scientific data was shown that there is no link between vaccination and autism. the second part of that. >> me ask you a follow up, you say it's been one area. >> i'm going to answerthat because we have a new wave of anti-vaccination and i'm very concerned about this . the cause they don't have as their true agenda vaccination. they could care less whether it works ordoesn't work . because they have a hidden agenda for other things of anarchy and other things and the tactics they're using are ones of cyber terrorists have been using over the past several years and i'm very alarmed by that again, the rroot of vaccination is not their real issue. >> there are some i think not

robert kennedy junior, he's a major anti-vaxxer and he's not for anarchy. his issue was thinking that mercury as apreservative was the cause, is that correct ? >> that is one of the platforms that they have espoused. >> as urban studies toshow that that is wrong ? >> that was said by doctor fauci earlier and it's apple mercury that is in some multidose vials of some vaccines and i will say that we made a point effort in 2008 with influenza vaccines into remove that and the manufacturers did this without being mandated to do so and so that there are single dose syringes. without mercury in those vaccines and those are primarily givento children . and to pregnant women so

there is a has been major progress on this and as doctor jernigan said , the cdc and fda are melting efforts to be able to minimize that but again, the amounts there and the kind of mercury there are not the kind that mister kennedy has been talking about. >> doctor watkins, you have any perspective on this as well -mark. >> thank you. i think public health is clearly worried about these sentiments and we need to do a better job in community, communicating the efficacy of the vaccine and the benefits that it does in addition to preventing disease area and also the lessons, the severity and complications and particularly for those most at risk so it prevents death and hospitalization area i think public health thinks a lot about the fact that where do people get their health information and ehow they communicate with

each other? we need to do a better job of producing e, convincing messages that are shared on different platforms. >> how many people do you know use around the figure i annually of the flu? >> i don't have that figure in my head but we can get it for you. >> doctor robinson, do you have a clue ? >> at the low-end 10,000, upwards of 48,000 year. >> so those people will more likely than not if they had the flu vaccine and you don't know some of them might not have gotten the flu vaccine and it's not been a particular strain of more likely than not it would have been reduced greatly ifall those people had been inoculated . >> that's correct . >> thank you. i'm a big proponent of vaccinations. my father was a pediatrician. vaccines area in 1954

he gave the salk vaccine to second-grade students in the test trials. i had a brother in second grade in the vaccine. i was in kindergarten, he brought home to give to me and he had second thoughts because it was outside of his chart. within two months i got polio. vaccines are good. i yelled back the balanceof my time . >> thank you. we will open it up to additional questions from the members and also by recognizing myself. in my internship in pandemic preparedness we've been having conversations with companies like google and i know google has been doing some work in identifying particular search words that may pop up that would then allow us to rapidly say people are searching the term ifever or to try to quickly go

into let's say a country in africaor someplace else . are you familiar with any of those trials and have they been t successful, not successful, etc. >> public health is aware of those crowdsourcing tools that look at g.i. symptoms or fever, but we've not been using them in public elf. most direct physicians may have. what we are interested in because we are a system that uses case-based surveillance. we know your name if you are sick. we are counting you as an individual but we have expanded a little past that into syndromic surveillance where we are looking at identifying emergency departments and really gaining a lot of information that way . so i can't say whether google has been validated through public health methods, that crowdsourcing. i can say that looking at

emergency departments just, are you seeing a spike in this backdoor other has been incredibly effective not just in identifying the uptick of flu but of many other diseases includingbeing able to identify clusters of illnesses . >>doctor robinson , would you want to add anything ? >> i still think it's worth as we're looking at global health and pandemic preparedness that continue to work with these technology companies because part of rapidly responding idand getting ahead of pandemics is quickly saying let's get someone out there, let's identify what that pathogen is and see if we can mitigate it at the source, is that correct ? >> absolutely but with all due respect public health is under sourced and under resourced and the informatics world so our ability to be

doing that is contingent on us being able to modernize. >> do public health information systems speak across state lines? >> not necessarily, no. >> that's not because of any regulatory issues we place as congress? just under resourcing or? >> ohio doesn't have the jurisdiction oto see the john smith in pennsylvania as influenza.it's my jurisdiction. but we could do a better job of sharing not identified across state lines and when there's anoutbreak and we need to share that information we do so purely . but no, for example in my state philadelphia is on a different surveillance system and the state is and it does really matter. we have to work hard to share data.

when cdc wants to see statewide data we have to work with philadelphia to harmonize it.it's inefficient. >> as a public health expert let me ask another question about vaccination rates and i guess let me put it this way. when i was a child i got a lot of my vaccines at school and i'm in internist by training by pediatrician that it's interesting if that for efficiency's sakeespecially for multidose vaccines , you've got a captive audience for that school. kids are going there but the overhead if you have school-based nurses or public health nurses that they are able to go into those school systems . it would be more effective, more efficient and i just would be curious from your perspective doctor doctor watkins. is that something we made the

mistake of moving away from? >> we certainly do school-based vaccinations in outbreak settings and we use, we use that venue. i think school-based metrics are a resource that is shrinking and so not all schools have access to that. i think that looping schools into immunization and other kinds of issues is always a goal of public health and i think we've done it broader, we have shrunk that footprint . >> i understand there's probably concerned about liabilities and etc. to move this away from that but just from a pure cost perspective and efficacy perspective, i think those investments in public health nurses or school-based nurses, overhead and etc. and again, the efficiency to family with multidose vaccines, you lose

a lot of kids. they all come in for that month later for that second vaccine and again, i believe you could rapidly boost the number of children that are getting vaccinated. if we were to utilize tools like that. and i guess i'd ask one last question with regards to measles, etc. i'd be curious from your perspective as a public health professional, how pennsylvania and others around the country are trying to address the periodic outbreaks and again, >> sure, we're exhausted. i was just at a conference new york and i can't even imagine what it had to go through. to be able to address those thousands of cases. in pennsylvania we hoi think we're at 17 cases. what i think you don't realize is that for every case, hundreds of people are likely exposed. and it's that close contact exposure if you were

infectious with measles right now. everyone in this room and everyone in this room for the next two hours after you have left it would have been exposed. public health notifies you. we track you down when we can. we assessed your immunity. we work to make sure that not only are you taken care of but everyone you've exposed is notified, and properly treated either your immune or you're not and if you're not and we can't get prophylaxis in time you maybe quarantines. there are a lot of steps that go into measles and its an enormous resource for drain. it's been difficult for new york and for any of us who had to. >> thank you for your work and all those public health professionals and doctor murphy, if you have any additional questions. >> thank you mister chairman and thank you guys for coming area let me ask you a question just because we're

looking at this in one level of the problems that you face with interconnectivity and challenges . but my question is what have you done in the state of pennsylvania to talk to the other counties because public health departments at least in north carolina are run by county area what have you ar done on a state level to develop interconnectivity and i just on a corollary, i did a lot of work in the north carolina legislature with the opioid epidemic and we had people in on the board of north carolina going into virginia getting prescriptions vice versa so we worked close by with our state neighbors to develop a system that somebody in virginia could know somebody's jumping across the line and getting prescriptions in north carolina. it's the same thing, it's eight interconnectivity, not necessarily a federal push down approach and we look at the nation as a whole of pandemics going on by all means, we need that information but these tend to be localized so what have you guys done ona state level to

saddress this ? >> let me say that pennsylvania is structured differently in north carolina . you have 10 county and municipal jurisdictions for home rule, commonwealth so they are on our same system of diseasesurveillance so we are able to share that . what happens when lab reports come in or a court physician comes in to the state health office and we push it to the jurisdiction . or to the district office . mostly if you're in a home rule system, if you are in pittsburgh for example, pittsburgh is seeing their own records but we do collect all in the same data system. philadelphia is large and there able to have their own in a different system . so we work with them, we work with them from my disease

perspective and to share outbreak information all the time . we work with them from an it perspective . to try to harmonize what we do. and of course, we're always working with our neighbors whether it's hepatitis a outbreaks or measles or sharing, patients don't have borders. you can be hospitalized in new jersey and go into a long term care facility in pennsylvania. happens all the time. so we keep touch but we could do it better faster and without loss of information or misinformation if we were better electronically suited. >> are you not electronically suited in these different counties and why would you not appeal to your state rather than the federal government and make that happen ? >> what i'm talking about is the sharing of laboratory information disease or balance and that is happening at the state level, but it's

not an easyconnection. we've not invested money in this in a long time . and for example our immunization records are not connected to our disease surveillance records and i'm speaking from the national perspective. you've asked me a pennsylvania question but i could be answering for many states area and i don't know if you're in immunization records in north carolina is connected to your disease registry. for many states it's not so those are the kinds of things that would help us get data and respond faster. in a measles exposure situation, who's been immunized? that's a hard question. it shouldn't be a hard questionbut it is a hard question and we've resorted to actually going to high school , the old high school who stored records and looked them up for us to the position had gone out of practice. public health is a make it

work kind of system and we just do what we need to do but we're getting further and further behind. >> i see, thank you and one other quick question . in the success that we've seen with cervical cancer vaccine, against the hpv virus, here i am a physician tryingto put myself out of business . where are we and where do you see us as far as other malignancy vaccines, targeted prostate cancer for example because i've seen literature for that for 15 years. i just don't see the door being knocked down so can you speak that briefly and what your experiences ? >> 20 years ago when i was in industry we worked on lla prostate cancer melanoma vaccine. what is, what has driven the oncology vaccine has been supplanted by the antibodies

that have been developed. that's great success over the last15 years . though that is somewhat the vaccine programs move to let companies do it to a lesser degree. some of those vaccines were extremely promising as we and others were evaluating those in the clinic and i would suspect that once we reach the peak of the antibody for oncology purposes that we will actually see a resurgence of vaccines for different types of cancer. we appear probably in the next decade in fact. >> great. before we bring the hearing to a close i want to thank

both of our witnesses for testifying before the committee today. the record will remain open for two weeks additional statements from the members and any additional questions. the committee may ask other witnesses. witnesses are excused and the hearing iis now adjourned .

>> the house intelligence committee held five impeachment earrings over three days this weekend some of the key moments saturday testimony from lieutenant colonel alexander benjamin

the national security council six is director for european affairs and kurt holder, former special envoy to ukraine on that saturday morning at 10 easter on c-span and on sunday remarks from the sun when, us ambassador to the european unionfollowed by fiona hill , national security council director for russia and david holmes, us political affairs counselor in the ukraine area that sunday morning at 10:35 eastern on c-span and you can stream the hearings anytime online at c-span.org/impeachment. >> tv has live coverage of the miami book fair starting saturday and sunday, featuring author discussions and interactive viewer call-in segments. on saturday at 11 am eastern republican senator tom, thought about arlington national cemetery area former obama ministration national security advisor un ambassador susan rice assesses her life and career,

megan phelps roper on the westborough baptist church, patrick denny, chair of constitutional study at the university of notre dame on liberalism and wired magazine anti-anti-greenberg discusses russian hackers . on sunday at 10:30 a.m. eastern our live coverage continues former under secretary of state and the obama ministration richard stengelon the proliferation of disinformation in international politics . pulitzer prize winning journalist david marinus on the 1950s red scare. journalist eleanor randolph is former new york city mayor michael bloomberg. deputy director of the cia counterterrorism center a month it's about the state of tia detention centers . and former professional football player don mcpherson on toxic masculinity. watch live coverage of the miami book fair saturday and sunday on cspan2's book tv.