many of our television programs are also available as podcasts. you can find them all on the cspan mobile app or where ever you get your podcast. health officials including dr. anthony fauci testified bf the senate health committee tan biden response and getting children vaccinated.

good morning. the senate health education and labor pensions committee will please come to order. today we are holding a hearing with members of the president's covid-19 hearing.

ranking member burr and i will have an opening statement. while we're unable to have this hearing fully open to the public yet, live video is available on our committee website. if you are in need of accommodation, including closed captioning, you can reach out to the committee. a few months ago president biden announced his plan to respond to the delta variant which was surging and jeopardizing our hard won progress against covid-19. cases, hospitalizations and deaths are trending down.

the vaccination rate is continuing to go up. age 12 and older have gotten their first dose of covid-19 vaccine. nearly 70% have been fully vaccinated. we're seeing a clear majority of americans support can bring vaccination rates even higher. as of last month, vaccine requirements had increased vaccination rates by over 20%. united airlines have seen vaccination rates for employees go from 57 to 99% since they announced their vaccine retirements. tyson went from less than half workers vaccinated to over 96%. across the country, health care

facilities, universities and other employees are seeing similar results. i expect that progress to continue now as the department of labor has put forward an emergency temporary standard on this issue. we're seeing progress on booster shots with three different booster shots authorized and over 13 million add ministered. shots for children younger than 12 with the fda authorizing vaccines for children ages 5 to 11 last week and the cdc issuing decision on this recently. even with the progress we made so far, we must not take our foot off the gas. we know it led to burn out among so many more. vaccines are one of our best tools for making sure that does not happen again and making sure we can build back from this pandemic stronger and fairer.

in fact as the white house notes in its report on vaccination requirement, an outside economic analysis found that increasing vaccine and reaching near full vaccination in more places could encourage millions of people to return to the workforce. tests also continue to serve a critical role stopping spread concerning our ongoing response which is why we plan to scale up testing even more. in a larger sense we must learn the lessons of this pandemic so we can finally bring an end to this pandemic and be better prepared for the next public health crisis, whatever it may be. -- get that done at every possible opportunity and why senator burr and i continue to work on bipartisan legislation and also why i'm pushing for critical steps in build back better to strengthen our public

health infrastructure. among other things, build back better will help public health departments increase testing and tracing capacity train and retain public health workers, upgrade to more modern inclusive interoperable data system, communicate with the public on issues like vaccines. and build partnerships in hard to reach communities. also help our federal public health agency likes to fda, cdc and the assistant secretary for preparedness and response take action to increase lab capacity so we can sequence viruses and identify variants quickly. facilitate the development of new treatments and tests and vaccines and improve the supply chain of medical supplies like syringes, ventilators and personal protective equipment. this up and down has been long

and its been deadly it. has hurt our economy, our community and our families beyond measure. but if we continue to take bold action, if we continue to follow the science and experts, if we continue to get people vaccinated and take steps to keep ourselves and those around us safe, we will get through this. and if we learn from this pandemic, if we finally end the cycle of crisis and complacency for public health funding and ensure we have an economy that works for everyone, not just those at the top, we can rebuild our country stronger and fairer. and we can make sure we are never in a situation like this again. with that i will turn it to ranking member burr's opening statement. >> thank you madam chairman. we're grateful to you and we thank you for your service to the american people. each time you have all come before the committee, i charge

you to look ahead the next 30, 60 and 90 days and figure out where we needed to be and what we needed to do to keep up with this virus. i'll say it again. you are the adults in the room. and you need to look for -- look around the corner to anticipate what we will need. more than 90 days from our last hearing. and we still have much to do to ensure that we're better prepared and better at responding than we've been in previous weeks and months. as we get closer to the two year mark of living with covid-19, we need to take stock of the current state of our response and identify the next critical steps that will lead us out. senator murphy and i have been working closely to develop a pandemic bill and at some point in the near future, senator murray and i will release a discussion draft of the reform. and we believe this is needed for our country's future response.

i very much appreciate the ability to work together on an issue so important to our national security. we've obviously delayed from previous schedule but to appear on --. we need to use all the tools at our disposal to keep pace with the virus which continues to evolve. recent reports of a new delta plus which is accounting for increasing portion of cases in the uk in the past month. i hope to discuss that in person when i leave sunday for the uk. and spending some time in london next week to look at in fact what dealt plus has done there. cases and hospitalizations are down in the united states but the administration cannot declare premature victory like we did in the summer. the mistake only brought us do a place where we are today with shortages of -- therapeutics and continued lag in extremely

important data about the disease. in september, even cdc warned of shortages in point of care and over the counter tests. and to expect increased demand for lab-based testing. to state the obvious, we need more rapid tests that are available and in stock. north carolinians are calling my office desperate for help in accessing therapeutics and even with new announcements on oral therapeutics, americans are waiting for these drugs. this administration bears 100% of the responsibility for lack of testing and lack of therapies. you got complacent, you let your foot off the gas, you didn't order enough tests. you didn't purchase enough

therapeutics and now we're rationing. the private sector will respond to purchasing agreements in the contracts. they cannot and will not produce things. that customers are not ordering. congress has given billions of dollars and billions more of dollars. we've demonstrated bipartisan commitment -- purchase vaccines, tests, therapeutics, even if we don't use them. the administration squandered

time and resources you have already had available to you and the american people are suffering as a result. as we look ahead we need plans in place that handle covid as endemic disease that will be part of our lives for the foreseeable future. so my question in the headlines for this hearing is simple. what's the plan? we need to take stock of less sons learned to strengthen our ability to be ready for the next

threat that we may face, but also learn from successful approaches and put those into every day practice. we need to identify information gaps and map out how we're going to address them so that we can make the best decisions based on sound sights and sound data. most importantly we need strong leadership. we need a nominee for the fda commissioner and this administration cannot drag its feet for a new leader at the nih. both nominees have challenging missions to complete under difficult circumstances and

nearly impossible shoes to fill. qualified non partisan leadership is paramount. dr. woodcock, i'm still rooting for you. we must leverage the developers and bring more innovative rapid at home and point of care tests to mark. we need not let our guard down as we did this summer. we're reaching the time of the year where we're all looking forward to spending time with loved ones and access to testing will help this happen safely. but we're still behind. these tests which we need to keep our businesses and schools open and families safe are still far too difficult to find for most americans. testing shortages and delayed tests results are keeping children out of school. parents away from the office and limiting our understanding of where virus is circulating in our community. the administration had to scramble to order 200 million at home tests per month. many of which won't even be

ready until december. and that is not enough. in early october, fda announced it authorized new tests to expand access to reliable at home testing. europe's been using these same tests for seven months. just this past weekend, my 2 year old grandson was notified on friday that his teacher tested positive. teacher of a preschool class, masked 100% of the time if they were there. they did the appropriate thing. they shut the class down four weeks. the problem was that his siblings could no longer go to school. school not only required him to be tested before his sister could return to school, but didn't accept an at-home test or a negative test for the 2 year old. they required a pcr test. it's confusing. america does not understand the standards that we've set. and in that case, she lost three days of school. even though they could afford the pcr test, how many families can't? the american people are tired of accepting better late than never from our public health agencies. and testing shortage will only get more pronounced if the department of labor issues its threatening temporary standard, which it did right before we came in, which will create an even larger demand for tests for those who don't choose to get vaccinated.

one recent survey found 59% of unvaccinated workers are still not likely to get vaccinated. despite the mandates from this administration. with a heavy-handed vaccine federal mandates on employers, this administration completely disregards the legitimate question raised by many americans and specifically dr. pauline marshall what role does natural immunity play in protecting against this virus? i said before i did not believe the federal government mandates will solve our problem. we're seeing cops and firefighters quit, and pilots engage in sick outs. and nation's military contractors worry about our preparedness if personnel are fired over mandates. and just this morning, a mandate from cms to all healthcare providers that accept medicare and medicate, that if they don't mandate to their workforce they are no longer participants in medicare and medicaid. will only suggest the doctors not to accept medicare or medicaid patients if in fact they choose as a medical professional not to be vaccinated. so there likely will be controversies over whether to require the vaccine for children, when even your own experts raise concerns about mandating children get vaccinated. i've heard all of you, back away from mandates. and instead use your platform to educate, encourage, inform. don't be divisive. while more therapeutics and more tests are the tools we need to manage the constant demands of virus, we also need better information to make the best decision. we need realtime data to understand and get ahead of covid today. and to detect the next emerging, infectious disease for public health threat in the future. so far congress has dedicated 1.1 billion dollars to improve our public health data sharing.

and turn it into an actionable information through our surveillance system. but we still do not have up-to-date and actionable data. we need to answer some of the most common questions from the american people. effective communication of information and data is the best way for the public health officials to win back the trust of the american people. and it is clear to me that cdc has lost the trust of the american people. show americans the evidence for why the tough choices are the right ones. and don't just expect that compliance gets you there. use the best information available at the time. even if it isn't perfect. and update action as the information evolves. this is a particular challenge for what is supposed to be our leading public health agency, the cdc.

an agency that i have watched agonize over having perfect, clean data to make decisions for americans. by time we get their data, it is too late. we still don't have the answers to basic questions. we need real, usable information about masks. how well do different types of masks work? when should we use them? the cdc continues to change its posture on the collection of information --. how many breakthrough cases result in hospitalization? how many do not? cdc is not in a place where the nation looks for realtime data, and we need to change that. the cdc is too focused fighting academic papers about something that happened weeks or months ago. when americans want real data they are forced to look elsewhere like johns hopkins university or hhs protect. i worry the new approach to hhs protect will not be able to overcome the complacent academic culture of cdc without serious

reforms. so i'll be watching very carefully. we must all come to terms with the reality the virus is here to stay. it is vital that the four of you sitting here today take the initiative to lead, empower americans with data, tools and clear and actionable guidance needed to get back to normal. the more people that get vaccinated to protect against covid the better. the more tests available to americans to detect and diagnose covid, the better. the more therapeutics we have to rapidly treat covid, the better. the more we can continue to learn from this experience, the better prepared we will be. i thank the chair. >> thank you senator burr. i will now introduce today's witnesses. again thank you for joining us today. dr. rochelle walensky director

of center for disease control and prevention and administrator for agency for toxic substances and disease registry. dr. anthony fauci is the director of the national institute of allergy and infectious diseases and the chief medical advisor on president biden's covid-19 response team. dr. janet woodcock, acting commissioner of the food and drug administration and donald call. thank you all for joining us once again. we look forward to your testimony and dr. walensky we will begin with you. >> good morning. i'm honored to join you today to provide an update on the covid-19 pandemic. since i last testified before this committee on july 20th, we have witnessed a steep increase

in covid-19 cases, hospitalizations and deaths around the nation largely fueled by the delta variant. the delta variant reminded us we need to be humble in our response to this virus and to follow -- as we modify guidance and address the pandemic. here are a few things we've learned the last four months. first, the delta variant is notably more contagious and spreads faster than previous variants. second, though breakthrough infections are infrequent. vaccinated individuals who are infected with delta are able to transmit the virus. and third, while we have seen waning vaccine induced immunity in certain populations leading up to recommend the rollout of booster shots, covid-19 vaccines are still highly effective and provide strong protection, particularly against severe disease, hospitalization and death. while we are once again pleased to see downward trends in cases,

this decline seems to be slowing. on average we still see over a thousand deaths every day. and tragically there have been more than 138,000 deaths since i last spoke here. as we look towards the coming weeks and months with some optimism we must remember what the delta variant did to this country. erasing weeks of prior progress and long downward trends, and reminding us that this novel coronavirus is unpredictable. in addition we're entering the winter season where we are predicting increase in influenza and other respiratory viruses. we are concerned about this year's flu season has the potential to be severe. it is just as important as ever to get vaccinated for covid and influenza. we've made incredible strides. as of november 3rd we've vaccinated about 85% of the united states population 65 and older. 70% of those 18 years and older.

68% of those 12 and older and nearly 50% of the entire united states population. some of our latest data only reinforce why vaccination is so important. showing that unvaccinated people have six times greater risk of testing positive for covid-19 and eleven times greater risk of dieing from covid-19 than people who are fully vaccinated. importantly we now have data showing that the pfizer vaccine is nearly 91% effective in preventing covid-19 infection in children 5-11 who did not have covid-19 infection previously. why is this such important news? surveillance data indicate that 9,000 hospitalizations among children agency 5-11 from the beginning of the pandemic. mortality data have reported more than 97 deaths in this age group. there are now well over 5,000 diagnosed with mis-c and living with complications of this disease.

as a mother i know that no parent should have to see their child face long-term complications of an infection or be hospitalized. and we now have a highly effective tool to prevent this disease in our children. following fda's authorization, i endorse the cdc's advisory committee on immunization practices, recommendation in children ages 5 and up should receive a covid-19 vaccine. i strongly encourage parents and their children to get vaccinated. and if you have any questions about the vaccine, please talk to your child's pediatrician, a school nurse, your local pharmacist or a trusted medical professional. in addition to the critical work to get out of this pandemic through vaccination and other prevention strategies, we need to better prepare for future outbreaks and pandemics. -- we can take to support these efforts is to support sustained disease agnostic funding for public health. this is how we will accomplish our goals to rebuild our public health workforce, invest in our public health laboratory infrastructure, ensure rapid response readiness and improve

our ability to collect and use data. i hope these bipartisan goals for members of this committee and i look forward to continuing to work with you to achieve these investments. before i close, i want to emphasize that the work we've done collectively to invest in and distribute vaccines has for members of this committee and i look forward to continuing to work with you to achieve these investments. before i close, i want to emphasize that the work we've done collectively to invest in and distribute vaccines has given us our most powerful tool to get out of this pandemic. data show, again and again that vaccines work. they are safe and they can save your life. thank you, i look forward to your questions. >> thank you. dr. fauci? >> this doesn't seem to work. >> it works. we can hear you.

>> madame chair, ranking member burr, members of the committee, thank you for giving me the opportunity to discuss with you the role of the national institute of allergy and infectious diseases and the conduct and support of research addressing our nation's response to covid-19. i previously discussed the development of covid-19, the testing and clinical trials as well as the proof of their real world effectiveness. today i would like to focus my remarks on studies aimed at on the optimizing the degree and durability of protection. in addition, i'll mention our recent work in the development of effective therapies to prevent the progression of covid-19 disease, and i'll close by briefly mentioning our involvement in preparedness for future pandemic threats. it has become apparent as we follow cohorts of vaccinated

individuals over time that the durability against infection and development of severe disease gradually wanes over time. this has led to a considerable amount of activity aimed at optimizing protection by boosting with an additional dose of vaccine, several months after the primary regimen. one can gauge the effect of these booster shots by measuring the induction of high levels of neutralizing antibody, as well as the clinical effect of enhanced protection. in this regard, it has become clear given the third boost approximately six months or more following the original primary regimen, provides a dramatic enhancement of protection against infection as well as severe disease, and in the studies from israel, this is beginning to be seen across all age groups. in this regard, certain subsets

of individuals who received any of the three vaccines available in this country are now eligible for booster shots, importantly to increase the flexibility of the administration of boosters and we conducted a critical study which is called mix and match where individuals are divided to three groups of the three products. these individuals were then boosted with a product other than the original one with which they were vaccinated. data indicated that boosting with a different product than the original was both safe and induced an immune response.

this gives flexibility if it is difficult to receive the original product. let me move to a brief physician of the n -- particularly in the context of treating an individual early in the course of infection to prevent progression to severe disease. there's a program called the anti-viral program for pandemics. it's aimed at cat liezed the development of new medications to combat covid-19 as well as to prepare for future pandemic threats. the program has two pillars. pun pursues aimed at various vulnerable components of the replication cycle.

recently conducted clinical trial in which the drug was administered early in the course of infection and it decreased hospitalization and death by 50% in the treated individuals compared to the placebo group. i bring this result of nih grant support to academic institutions for the fundamental basic research which led to the discovery and development of this molecule. finally, i would like to close by looking forward to how we might best enhance our preparedness for what will be the inevitable future pandemics. in this regard, the nih has already initiated its plans for the rapid development and implementation of successful countermeasures against several prototype pathogen families of viruses that threaten the health and safety, not only of our nation but of the entire world. i look forward to describing these plans to you in more

details. thank you for your attention. and i would be happy to answer your questions following the presentation. >> thank you. dr. woodcock. >> good morning, chair murray, ranking member burr and members of the committee. thanks for the opportunity to testify here today. and for the continued bipartisan efforts of your committee to address the covid-19 pandemic. fda appreciates productive discussions and we look forward to continuing our partnership on these legislative efforts. fda has achieved some of the most impressive scientific based regulatory advances i've fda has achieved some of the t drst impressive,

scientific-based regulatory on thvances i've seen during my entire career ate+++i:# vaccina they can do if they get sick with covid-19 and how they can further protect themselves and their loved ones against the virus. let me provide a brief update on the actions the agency has taken to protect public health in three key areas since i last testified before this committee. first, regarding vaccines, fda has authorized three covid-19 vaccines and approved one vaccine. these have met fda's expectations vaccines and approved one vaccine. these have met es fda's expectations for safety and effectiveness appropriate either for authorization or approval in preventing covid-19. in the last few weeks the agency's made additional critical decisionsin about the e of the vaccines.

fda authorize od. theor data suggested the effectiveness of the initialti doses started to wab, meaning use of a booster dose would be important in bolstering protection for these populations. and the agency also authorized the use of mix and match booster doses for covid-19, using data from naid as was mentioned. this means eligible individuals can getli any of the three authorized vaccines as the booster dose and really simplifies availability for the public. also fda authorized the pfizer vaccine forhi use in children as 5 through s11. i know because i've had many messages on this. manyre parents have been waitin

impatiently for c months for th authorization. and i'm happy to say as we speak here today, young children across the country are starting to get vaccinated against covid-19. and to be clear, fda is confident in the safety and effectivenesseh data behind the decisions. the american public can and should feel confident in receiving any of these vaccines. they will help bring this pandemic to an end and we strongly encourage all eligible americans to get vaccinated and get their children, vaccinated. we ally have an important role o play here. second, diagnostic tests are key line of defense in the pandemic, and will become increasingly important, i think, increasing accesswe to accurate rapid at-he tests is a priority for fda. we prioritize the review of at-home rapid antigen tests and we're actively engaging with

test developers to increase their availability. last month the agency authorized additional over-the-counter at-ohm tests we expect to significantly increase the availability of rapid tests to the a possible. thesee authorizations add to a growing lists of tests that can be used at home without a prescription in the u.s. additionally last week fda provided recommendations for labeling updates to facilitate better over the count every single-use testing for symptomatic people. it's currently only for serial testing. this iss single tests meaning greater availability of more individual tests. fda remains focussed on speeding the process to get appropriately accurate and reliable tests in the hands of all americans who need one. third, there a need for medical products to treat and prevent covid-19, especially for those unable to get vaccinated or who

don't develop an immune response. we h continue to carefully evaluate the data on any promising therapeutics and our priority is to have fast discussions between fda and drug sponsors. we are hoping a that we will se morere therapeutics authorized soon to treat covid-19 in the future as another weapon in our arsenal. and finally,it i want to stress that ally of fda's work and effort is toward the goal of protecting the public. it's a responsibility we take seriously, and we rely on science. this is what allows us to expedite development and availability ofwa medical produs to address covid-19. thank you and i look forward to your questions. >> thank you. assistant secretary o'connell.

>>. >> i'm pleased to have this opportunity to provide a few key updates before i last testified before you in july. ensuring you have the necessary vaccines and diagnostics to covid-19 remains a primary focus of response. to date barta supported 77 medical countermeasure products. this includes 15 therapeutics, 5 5 diagnostics and seven vaccine candidates. notably as part of the countermeasures' acceleration group effort with dod, barta placed o $1.5 billion of vaccin under contract, distributed overer .88 million doses of antibodies, and shipped more than 144 million diagnostic kits. accelerating the supply of available rapid point of care and over thee counter tests has

been another important focus of the work while there is currently enough testing capacity across all types of tests, we have seen a growing preference for rapidid tests. especially those that can be used at home. over the last few months, asper has invested over 3 billion to bring additional rapid point of care and atal home tests to mart with $1 billion of that going specifically to at-home tests. as production hasec ramped up since september, these investments put us0 on pace to quadrupleng by december the numr of at-home tests available each month to nearly 200 million. supporting hospitals and health care systems that are overwhelmedd by covid-19 patiens is another important focus of aspers response. since july 27th national disaster medical system teams nearlyst 600 team members have

deployed to supportt sites in 1 states. we have teams in wisconsin, new mexico andti montana. for thede deployments personnel support a range of functions including hospitalen augmentati and decompression, setting up medical overflow centers for patients and offering mortuary support. ensuring the necessary medical supplies they need is a focus of efforts. the stockpile shipped more than 250 million items to aid the national response over the course of the pandemic including deploying more than 3,000 ventilators to 17 jurisdictions since i last testified. we continue our work to replenish the s and s to levels at or above precovid-19 amounts. thanks to the supplement cal

funding congress provided. the s and s has spent approximately 11 $.9 billion to replenish the inventory including purchasing from dmes ig manufacturers whenever possible. while ly replenishing it is essential, we continuepl to address theng root cause of why public health supply chains are so strained in the first place. we are investing critical funding and expanding domestic manufacturing includingng investments of 250 million in ppe manufacturing, 268 million incc manufacturing of testing consumables, 14.8 million in vaccine rawaw material manufacturing, 160 million in fuel finishma capacity, 65 milln in vaccine vile manufacturing. 186 million in manufacturing kpas if ith for at home and poi of care tests. and 53.8 million in testing raw materials with additional funds going out the door every day.

iio firmly believe that running all of this from d.c. without the view from the states and regions is unwise. and i have made it a priority in my first few months to get to the regional offices to meet with those 1 teams and local leaders and understand the unique challenges they face. so far i have been to four out of ten regions withrl plans to t to all of them coming months. i met in new orleans and i have hosted three. tribal consultations to ensure that tribal institutions and urban indianan organizations are ableo access the s and n. i wantme to review analyze and adjust our response efforts based on what i'm seeing and hearing in the field. and become feedback from your w constituents and seeing when you're home. thank you again for inviting me tok testify before you on effos within asper to support the covid-19 response. i look forward to working with the team at asper and our

colleagues at hhs. >>s. thank you. we'll begin as round of five minute questions of our witnesses. please keep track of your clock and stay within the five minutes. the fda's emergency use authorization of the pfizer vaccine for children 5 to 11 is really a big step. it will make 28 million children eligible to receive a vaccine and given the spread off varians getting kids vaccinated is critical to protecting them while protecting our educators and care givers. doctor, i want to ask if you -- your advice to parents who are hesitant to get their children vaccinated. > certainly. the fda first reviewed the

manufacturing of a new dosage. a lower dose.eed that was very carefully reviewed as well as the stability of the new dose to make sure that it was appropriate. then all the data on the children were reviewed at the patient level. in other words,de we went to th rawo data and rereviewed that ad made sure that the evidenceen presented to, us reflected both the data on effectiveness, on efficacy, on the immune response and on safety. we looked at all the adverse events to make sure that they wereth properly reported and th we understood the magnitude of these events. so in this a trial of thousandsf children receiving the vaccine, ages 5 to 11, we saw mostly very mild to moderate flu-like

symptoms primarily after vaccine or a sore arm which people can expect after getting aas shot. but we did not see any serious adverse events and the vaccine was over 90% protective. so we feel very confident along with all the adolescent data we have on the vaccine and on the data ind. the administration to adults that this vaccine is safe and appropriate for children. it will protect them from severe covid. >> thank you. dr. thiswalensky, this morning sha released an emergency temporary standard to protect workers against covid-19. this is a critical step to reducingke workplace transmissi and. making workplaces safer nationwide. especially for our frontline workers whoen are at high risk covid-19. can you justt speak to us from public health perspective about the urgent need to get more vaccinated and the

importance of implementing measures to m protect people fr infection in higher risk settings like ouris workplace? >> yeah. thank you so much. we've hadad 745,000 deaths from this disease. and we're continuing to have aboute 75,000 cases every singl day. we know the most disruptive thing in a work force is to have a covid-19 outbreak and to have workers in that work force come down with covid infek, severe disease,ti and in some cases death. vaccination asho we have seen decreases your risk of infection by insix-fold, decreases your rk of hospitalization and death by ten-fold,nd even during this dea surge.t there is absolutely a public health priority to get people vaccinated. and to continue the importance prevention and mitigation strategies including masking to keep them safe. thank you.u. >> thank you. this is a w question for the whe panel, and iog don't have much time left, but i would use my chair prerogativee to ask you. because it's an issue we are all

concerned iabout. senator burr mentioned it. and that is the issue of testing. we know diagnostic testing is critical. we've --at but we've continued experience critical challenges with testing shortage of rapid tests, not enough locations to get y tested. supply chain issues and more. so i'd like to ask all of you quickly to respond, what is your agency doing to make sure our well-equipped to handlee current and future testing needs and i'll begin with dr.- walensky. >> thank imyou. technical assistance as to how to utilize it and peer to peer school to school advice on how best to utilize the testing program as well as the hiring f school nurses in order to use the testing program. >> thank you.

dr. ndwoodcock? >> we have streamlined recently ourd standards and approach for overre the counter tests. so we -- as i said in my testimony, so, we hope they should get out more quickly. we prioritize testing that -- where there's a public health need whichy right now is the ovr the counter tests. and we also try to move very quickly those manufacturers that can make large supply of tests. because there is still an unmet need there. andes so we think between that,e have authorized 11 over the counter tests and expect more to comesp between that and what asr is doing that the supply should increasera rapidly. >> miss $ o'connell? >> thank you, chair. we have invested $3 billion in the last two months on increasing production and supply of rapid point of care at home

tests.o 1 billion of that focussed on at home a tests. so we continue to try to get those out. we also through hersa started a pilot programam which would provide free at home tests through the federallye qualifie health centers f. thr those families that aren't able to afford the tests in the pharmacies, this would allow free. access. >> dr. fauci? >> yes, thank you, madame chair. the ni shh prioritizing the development of affordable at home tests through a program calledwh the independent test assessment enprogram. wewe will provide reliable, independent laboratory and clinical tests to the fda for the manufacturer so they can scale up quickly and if the tests meet the fda's performance and quality standards, the fda hopefully will then give an emergency use authorization. with providing data for the companies to be able to expedite

the availability of tests that are rapid, efficient, and point of care. >>s thank you. senator burr? >> thank you, chairman. this question is f directed to . fauci and f walensky. in january o an nih study found that u 95% of people who recoved from covid had at least three out of five components needed to recognize the virus up to eight months after infection. in august israeli researchers found that the natural immunity can confer longer lasting and stronger protections against infection, severe disease, and hospitalization resulting from the e delta variant. rockefelleral university found that while vaccination induces memory cells to evolve over the course of a new weeks, natural infection produces memory cells for up to one year after infection. this is likely because remnants of the virus remain longer in the bodyrs than a vaccine and gives the body more time totu adapt to sit. i understand it's not all black andd white. uk researchers released studies

suggesting that fully vaccinated individuals with covid-19 had the highest immunity. m additionally last week there was a new report found unvaccinated people who previously were infected were fivene times more likely to test positive for covid-19 thanut people who were fully vaccinated with an mrna vaccine. i my question is simple. what does the science say about the s durability of natural immunity, and when can we expect answers on the benefit? >>-p thank you so much, senator. the cdc did publish a 96-page paper review in a scientific brief on friday. i want to be clear that the cdc continues to recommend that people after review of that scientific brief, that cdc continues to recommend that people who have been previously infected get their covid-19 vaccine. we know in our vaccine studies

effectiveness studiesec with das certain when people are vaccinatedtu and we can follow them through our effectiveness studies andva our effectiveness cohorts. through that we see the durability with the vaccines. the data on the infection inducedd immunity are murkier. they rely on retrospective studies, observational studies and studies where we can't do a prospective study. we arertt following these peopl. we are following people who have been previously infected in our infection cohorts. but the data and the science are harder. youu a talked about infection induced immunity with b-cells and antibodies but another arm of the t cells are harder to study and evaluate to try to do this in a commercial type fashion. what i would saytroo is the fin study that youly cited, the stu from the cdc, that looked at a ly cohort of people who were

previously finfected and those who have been previously vaccinated and as you noted, there wasid a 5.5 times fold mo likely chance of being diagnosed with covid if you had infection induced o rather than vaccine induced immunity, and that's among thee studies we reviewed. that led us to our current recommendations. >> dr. fauci? >> just to add to that. senator burr, the studies you referred to were nih funded studies about b-cell and t-cell responses by nih grantees. both from natural infection as well as from vaccine-induced immunity, youou have not only antibody responses but you have the development and the maturization of b-cell and t-cell responses. one of the goals over the next several months being done currently is to determine the clinical correlation between the development and maturing of b-cellvi and t-cell responses a

clinical effect. we've looking at that both post vaccination, post boost and in individuals infected. we'll get more definitivebe information over t next severalim months. >> should an individual with covid be exempt from the mandate to be vaccinated even if they have natural immunity? >> cdc recommendations suggest that yound have both more durab and robust and known immune response if you're vaccinated after you've been previously infected. >> do children 5 through 11 who haveha recovered from covid j whould theyva be vaccinated exempt? >>ur our guidance is they get vaccinated. data arear emerging on the impa of natural infection. in adults our data are sparser among children. >> how does the concentration of antibodies in a recovered covid

positive patient compare to an individual six f months after they've had a vaccination? >> it varies from study to study. the onecc thing we do know that very important when you talk about post infection immunity is when you vaccinate a person following recovery from infection, the level of antibodies are considerably higher than post infection alone and higher than vaccination alone. so the best combination of high degree of laboratory-related protectiveness is if a person who gets infected and recovers ultimately getsst vaccinated. and thathe looks like the most powerful of the protectivest responses. clearly i understand that from the data. myva question on whether a covi recovered patient should be mandated to take a

vaccine, if they've not had covid, then you take a vaccine to boost your'm immunity level a certainin degree. covid positive patients have alreadynd done that. and i'm just telling you it's a hard sell tove tell people who have had covid they're now under a mandate. mandate by the federal government, to bedo vaccinated. i think you've got an extremely tough sell to a health care professional. doctor, nurse who had covid. might have a hesitancy about the vaccine, andst i look at what aspersrs required for the healt carere vacancies. you start doing this to people, medicare and medicaid providers, community health centers, we're not going to have the people to serve from the health care professionals that make a decision. i have natural immunity, i have

some protection, but i don't yet believe i need to be vaccinated. i think we need tou think about this. thank you, chair. >> senator king. >> thank you, chair murray. thank you to the witnesses, the ranking member.. i wantou to ask about two topic supporting the mental health of our hifrontline health care workers that has been such a challenge in this time and along with h covid. dr. walensky, we talked about this before. thep pandemic has taken a huge toll on frontline health care workers. this committee has come together toin help pass the health care provider protection act. pastbo the senate in august ands marked up in the house today. happy about that. we're proud to have worked together with i folks in this by toto get $140 million of fundin for thisma initiative in the american rescue plan. doctor walensky, we worked closely with the familyha to bud the support for the work, introduce thear legislation, ge

funding in the american rescue plan, and we're encouraged by progress being made on the bipartisan tiinitiative. as thene cdc works to implement this bill and use these funds to promote education and awareness campaigns, what can those of us who havero worked on this bill o care very much about this issue do to help the cdc effectively communicate with ourha frontlin health care l workers that ther are resources and help available for them? >> thank you so much, senator cane, and thank you for your leadership inhe this very much-needed bill and thesese resources. first,t, let me just give you a sense of the scope of the challenges and the problems that we rcface. cdc published not just in health care but p also in our public health work force, half the people had -- half the people surveyedan had more than one mentalub health challenge in th year and in the year prior. a third reported depression. a third reported anxiety. 8 % of our public health work force reported suicide ideation

in the past year. when we talk about our health carere workers, yes, you are hearing about ouraf places that are stressed with covid surges. but we're not hearing about our public -- health care workers who are left after those surges. who are taking care of people where amputations are higher rates than ever before. missedar cancer diagnosis becau ofe missed care. this is what is w impacting our public health -- our health care workersth and these resources a now -- some of the resources are now witht niash so we can provie them for mental health, for resources for support, for -- to research what it is that they need so that we can provide this health care workk force as well as our public health work force, the iresources they desperatel need. i'm grateful. thank you. >> thank you. dr. fauci, on long covid, i've had covid and i'm still dealing with nerve tingling issues 18 months after having had it. they're mild, thank goodness, but others who are dealing with long covid effects, they aren't

so mild. fatigue,e, respiratory, cardiac other issues. what evidence can you provide about nih research on efforts to better understand thehe symptom of long covid and how to expand treatment options for patients who have this condition? >> yes. thank you very much for that question, senator. this is a very important problem which we take very seriously. at nih since our last hearing when you also brought up that very important question, we have now in full implementation of a program called recover program. it's about a 1 $.5 billion program looking at the formation of large cohorts of individuals to been able to study them from the standpoint of the incidents, the prevalence, and importantly, what the pathogenic mechanisms of symptoms such as your tingling, but even as you mentioned correctly, so many

people have much more severe in thee sense of almost incapacitating fatigue, sleep an normalities, a variety of other things. there's three components to the program that we've just recently awarded. one is amount of resources to the niy, langone center in new york which m takes the scientif lead for the program. theol data collection will be l byby massachusetts general hospital and harvard medical school, and the repository for specimens will be led by may owe clinic. since we last spoke, all three have becomepe operable. hopefully the next time we speak in a situation like this, i'll be able to give you scientific data that resulted from those studies. thank you. >> thank you very much for that answer. i yield back, chair murray. >> senator paul. >> dr. fauci, i don't expect you today to admit that you approved of nih funding for gain of

functionon research in wuhan, b your repeated denials have warn thin, and a majority of americans don't believe you. even the nih admits they did perform experiments in wuhan thatti created viruses not in nature that did gain in lethality. the facts are clear the nih did fund gain of function research innap wuhan. you can deny it all un, but even the chinese authors of the paper in their paper admit that viruses not found in nature were created and yes, they gained an infectivety. your a denials are not only a stain on your reputation but a clear and present danger to the country and thect word. as professor kevin sfelt has written, gain of function research looks like a gamble that civilization can't afford to risk. yet, here we are again with you steadfast in your denials. why doesau it matter?

because gain of function research withfe laboratory cread viruses not found in nature could cause a pandemic even worse the next time. we're suffering today from one that has a mortality of approximately 1%. they're experimenting with viruses with mortalities of between 15% and 50%. yes, our civilization could be at risk from one of these viruses.nc experiments that combine unknown viruses with known pandemic-causing viruses are incredibly risky. experiments that combineav unknn viruses with coronaviruses that have ass much as 50% more tallt could endanger civilization as we know it. and hereac you sit. unwilling to accept any responsibility for the current pandemic,, and unwilling to tak any steps to prevent gain of function research from possibly unleashing a a more deadly viru. youes risk the public by saying the virus could not be covid.

no ones is alleging the publisd viruses by the chinese are covid. what we are saying is that this was risky-type of research. gain of function research, it wasa risky to share this with te chinese. and that g covid may have been created from aow not yet reveal virus. we don't antibiotic the chinese are going to reveal the virus if it came from their lab. you know that, but you continue to mislead.pp you continue to support nih money going to wuhan. you continue to say you trust the chinese scientists. you i appear to have learned nothing from this pandemic. will you today take responsibility for funding gain of d function research in wuhan? >> senator, with all due respect, i disagree with so many of the things that you've said. first of all, gain of function is a very nebulous term. we havee spent not us, but outside eabodies, a considerabl

amount of l effort to giving mo precise definition to the type of research that is of concern that might lead to a dangerous situation. you are aware of that. that is called p-be-co. >> we're aware you deleted gain of function from the website. >> i can get to that in a moment if we have time, but let's get backve to the operating framewo and guide rails of which we operate under. and you have ignored them. the guidelines are very, very clear that you have to be dealing with a pathogen that clearly is shown and very likely to be highly transmisable in an uncontrollable way inn humans ad to have a high degree of morbidity and mortally, and tht you do experiments to enhance that. hence the word e-p-p-p. pathogens of --

>> eco health alliance took the virus -- >> can i -- i would love to finish. >> combined it and caused a virus that doesn't exist in nature and it made mice sicker, mice that had humanized cells, you're saying that's not gain of functionse research? >> according to the framework and guidelines -- >> whatwe you're doing is defing a away gain of function. you're saying it doesn't exist because you changed the definition on the website. this is terrible. to escape the idea that we should do something about trying to prevent a pandemic from leaking from a lab.ch the preponderance of evidence points to this coming from a lab. you changed the definition of your website to try to cover yourur ass basically. you've changed the website to try to have a new definition that doesn't include the risky research going ton. until you admit that it's risky, we're not going to get anywhere. you have to admit this research was res can i. the dmnih is now rebuked them. your own agency rebuked them.

the thing is you're still unwilling to admit they gained in? function when they say they became sicker. they gained in lethality. it's a new- virus. that's notse gain of function? >> according to the definition that is currently operable -- senator, let's make it clear for the people whoer are listening. the current definition was done overwo two to three-year periody outside bodies including the nsabb, two conferences by the national academy of science engineering and medicine on december, 2014, march 2016. we commissioned external risk benefit assessment, and then on january of 2017 the office of science and technology policy of the white house issued the current policy. >> and coincidentally -- >> i have not changed any definition.n >> on the same day the nih said that yes, there was a gain of

function in wuhan. the same day the definition appeared the new definition to try to define away what's going on in wuhan. until you accept it and responsibility, we're not i goi to get anywhere close to tryin to prevent another lab leak of this dangerous sort ofen experiment. you won't admit it's dangerous and for thatt lack of judgment,i think it's time that you resign. >>t thank you, senator paul. i would like to give the time to dr. fauci.ep >> yeah. well, there were so many things that are egregious misrepresentation here, madame chair, that i don't think i'd be able to u refute all of them, b just a couple of them. for the listeners to hear. it was said i am unwilling to take responsibility for current pandemic. i have no responsibility for the current pandemic. the current pandemic. okay? number two, you said the overwhelming amount of evidence indicates that it's a lab leak. i believe that most card

carrying viral vie rolgss would disagree. it's much moreli likely even though we leave open all possibilities, it's much more likely thato this was a natural occurrence. third, you say we -- >> 800,000 animals and no animas have been found with covid. >> senator paul, the time is for dr. fauci to respond. >> third, you made a statement just a moment ago that is completelyti incorrect. where you say we continue to support research at the wuhan institute of vie rolling. >> you proved it in august of last year.tiup >> no, no, your statement says,. quote, i wrote it down. you continue to support research at the wuhan institute -- >> a month ago you said you still trust the chinese scientists and you still support the research. you said it a month ago in committee. >> senator, i haveho allowed dr fauci to respond. you had your time. i'm going to -- >> he's dishonest. heft ought to be challenged.

>> senator paul, we will allow dr. fauci tore respond after you've given accusations like that. dr. fauci? >>es i don't have more to say except to say as usual, i have a great deal of respect for this makes the senate and it me veryry uncomfortable to haveo say something, but he is egregiously incorrect in what he says. thank you. >> history willur figure that o over time. >> wee will turn to senator hassan. thank you.n >> thank you, madame chair and ranking member burr. i want to thank all the witnesses for being s here toda. and for your work. i want to startco with a questi to assistant secretary o'connell. last month i sent a letter to health and human services secretaryy highlighting the difficulty that some granite staters have faced in. accessin covid-19 rapidoo tests and urgi they secretary to take action. these tests are essential tools to help ensurere that people c stayt safe, kids can stay in ss school, and we can keep our

economy open. so assistant secretary o'connell, what will the department do to address the issues raised by my t constitues inin new hampshire about accesso covid-19 rapid tests? >> senator, thank you so much for the question, and of course, thank you for theou letter. your letter raised two key points. one, the amount of time it was taking foror some of your constituents to get the results. and the otherth was the lack of the over thech counter tests in new hampshire. so we responded to both. the asper testing team reached out to the state official to understand thens delay, and learned that thehe average turn around time right now is about days, though it sounds like your constituents had different experiences. we'll continue to watch that. the second issue was lack of over thel counter tests. the team reached out to abbott and they secured the 60,000 tests new hampshire ordered. they will come in 10,000 increments for six weeks.

you should have 60,000 tests in new hampshire by christmas.ly >> thank you very much. i appreciate that. my constituents do, too, especially parents of school-aged children who want to get those t results quickly so e kids can get back into the classroom.d dr. fauci, as i think probably somela colleagues have already noted, but i i wanted to talk about the availability of vaccines formi younger children. i think all families in new hampshire were relieved when the food and drug administration and the cdc signed off on pfizer's covid vaccine forip children ag 5 to 11 last week. at a hearing earlier this year, i asked when you anticipated that vaccines would be available for children of all ages. you toldil me you thought vaccis would be ready for children of any age by the end of the year. do you still anticipate vaccines will be available for children under age 5 by the end of the year? >> iie don't know. when you say available, senator,

that's the difference between the clinical studies that are done to showe- the data. currently as we are speaking now, the age deescalation studies are part of a spectrum. onets of the spectrum was what u just heard, 5 to 11. thetu data were convincing. you've heard of the results from the doctors.ti the studies are ongoing now from six months up to two years, two years to five years. i would anticipate, i would have hoped that the data might be available by thehe end of the year. i would say, and again, it's difficult to make hipredictions because you don't want o to get ahead of the data, and you don't want to get ahead of the fda's analysis. >> but you're thinking -- i'm trying to get a sense of timeline. >> i would think it might be toward the s beginning of the coming year or theue end of thi year. i hope. >> thank you very w much. doctor woodcock, i want to shift tolt another issue. as we deal with the pandemic, we

also continueed to deal with th opioidid epidemic. idu recently sent you a bipartin letter about the consulting firr mackenzie which worked for both opioid manufacturers and for the fda on a variety of projects including a track and trace system to monitor dangerous prescriptionti drugs. the fda response to my letter statedye that mackenzie never disclosed these potentialgh conflicts of interest and thert fda only learned about them earlier this year. nearly a decade later through media reports. macr kenzie's work for perdue pharma was made public last year in major newsse story and mackenzie issued a public apology for actions last e year. why wasn't the fda aware last year when it was front page news and the o company was speaking publicly abouton it? >> speaking for myself, i was aware of that. at that time mackenzie was only

doing consulting work of an administrative nature for the fda, so the -- there was nothing that had to do with any product or any o standard or anything le that. it had --nt >> doctor, i'm sorry to interrupt, but i'm almost out of time. in want to point out that they were consulting on a track and trace systems to monitor dangerous prescription drugs. that your response to my letter alsoit says that since finding t about mackenzie's work for b perdue, quote, no additional contract asreviews or outreach mackenzie has occurred. because my time has expired, i will follow up with you in the fda. it a seems to me we have a majo conflict ofnd interest between mackenzie'sea work for perdue a mckesson f at the same time it s a track and trace system. we have to geth to the bottom

it. i thinkad it helped fuel the opioid epidemic which has devastated my state. >> happy to work with you. >> thank you. senator collins. >> dr. fauci, first, let me make clear that i believe in the efficacy of vaccines and have encouraged my constituents to become vaccinated, but i'm hoping you can explain what it peerss to be a contradiction whn i look at the data for the state of maine. maine ranks in the top five states in the number of people, the percentage of people who have been vaccinated. in fact, 95% of those over age 65 have been fully vaccinated. and yet, maine has the 15th highest confirmed deaths from

covid on a per capita basis. our hospitals are overwhelmed. we've seen a 6% increase in hospitalizations, 18% increase in people in the icu, a 37% increase in people on ventilators recently. and while it's largely individuals who arebr unvaccinated, there are some that are breakthrough cases and of us know individuals who despite being fully vaccinated, havee experienced covid. can you explain to me why a state that done a terrific job in getting people vaccinated has -- is seeing this surge in cases?se it'sal overwhelming our hospita

and causing great fear and pain and loss. >> thank you for that question, senator. first of all,m i think you did say something just a moment ago that i i think is part of the explanation. you said thatre most of them ar among people who areio unvaccinated. however, and it's quite true, that there are breakthrough infections. because no vaccine is 100% protective. and you will always get breakthrough infections. in nggeneral, for the most part breakthrough infections for people who have been vaccinated all other things being equal, are usually less severe, don't lead as much to t hospitalizations, and don't leae to as much death. the data in general as was mentioned, i think specifically thero numbers that were given b dr. p walensky are incontrovertible. a vaccinatedf compared to an unvaccinated person as a

multi-foldlessrs likely of bein infected andlt being hospitaliz dying. i think there are probably confounding multiple factors going into the difficult situation that yourr citizens i yourur state are going through. but there's no doubt that the vaccinese clearly much, much better that the sense of protecting you from infection, hospitalizations or death, compared to the unvaccinated. > dr. walensky, parents, teachers and pediatricians have alll talked to me about the learning loss, the emotional behavioral health programs, problems rather, that have occurredho among children due t their not being in school. and in contrast to the quarantiningne option, the test and stay approach allows asymptomatic students who test negative for covid to remain in

school rather than quarantining after another student or staff member has tested positive for the virus. one study shows that case rates were not significantly higher at schools t that use the test and stay approach versus schools that require students to miss schooled and quarantine at home. and, indeed, your home state of massachusetts has adopted a test to stay strategy. brown university a professor emy yoster has expressed great frustration with the cdc has being slow to take a stronger position in favor of test to stay. asking what evidence are they waiting for?o she says school quarantines should end and be replaced with test to stay or nothing.

another public health expert says simply, it's madness to quarantine school children. the cdc policies hinder learning andio provide no meaningful reduction in covid transmissions. my question for you is why doesn't the cdc issue guidance or recommendations to encourage school districts to adopt test and stay in order to avoid these highly? disruptive quarantines f are asymptomatic and could be tested? >> thank you, senator. thank you forur that question. when youou and i spoke in this room or in this ren view in july, we shared the priority of getting our children back to school. i've said it's the first place that should be open and the -- the first place that should be opentr and the last place to

close. in thathi context, we have studs just the school year that have demonstrated that we have 96% of our schools open for which i am pleased and still, we have 4% of schools over a million children who have been impacted by covid-related outbreaks and the schools have had to be closed. our data also demonstrate our preventionus measures have been working in schools that are practicing prevention measures including masking have been 3.5% less likely to close because of an outbreak than those that masked. the question iste important. these are new data out of the uk that haveha demonstrated this n test to stay strategy. thatse is a strategy after a chd is exposed in a classroom that they stay in that classroom with sequential tests every day, every other day to demonstrate they'ree negative to stay in school. we have updated our frequently asked questions.ra this is a promising practice. we're working with local jurisdictions now to demonstrate thect domestic data in the unit

states that this t practice wor. it's safe. it's effective. it gets our children back to school.juri importantly, we recognize the jurisdictions are actually doing this. and other a jurisdictions may want to. and in t that context, we're dog peer to peerso matching of schos that are interested in doing the test to stayat practice, and having them talk to schools that are also doing it so they can use thein implementation strategies that a school has already used. we're actively studying this to provide the data on it works and actively encouraging it as a practice. thank you. >> thank you. to >> thank you. senatoror smith. >> thank you, madame chair and ranking member hburr, and than you to our panelists for being with usti today. so i just want to start by highlightingev that we have mad major steps forward in getting americans vaccinated.in vaccine requirements are working, i believe, to encourage peopleo to get these highly effective vaccines. we also have seen progress with children. it's great news and a big news

that children age 5 to 11 can get their shots this. wein clearly have more work to . this is progress. i'd likee to spend my time focusing on the trajectory of this pandemic and what normal is going to look like going forward. starting out,el it seems to me that people thought of covid-19 as something like polio, for example, where we could quickly develop a vaccine and then we could controlol or even potentiallynz eradicate this disease. now it seems that covid-19 will be more like an influenza, an infection that will recur for the, foreseeable future, though lopefullyy with less and less severity. dr. fauci and dr. walensky, can you help us understand how we should think aboutha the path o this pandemic over the next couple of years? dr. fauci,o understanding thate don't have crystal balls and this is an unpredictable virus, what do you think the next six months to two years are going to look like? and do you expect that covid is

going to become moree endemic ad less pandemic as we move forward? and what doesve this mean for h people are going to be living their lives? >> yyeah. let me put a very brief perspective of the senator when you think about pandemics, you're in the pandemic phase. and then you have a deacceleration phase. then you have a control phase. then hopefully elimination and maybe e rat kags. i think eradication is out. we've only eradicated one disease, smallpox. we've eliminated polio from the united states, measles exempt for some pockets of undervaccinated olgroup. so what we're really talking aboutnf is control. and control has a wide bracket. you could have it under control where yout have enough infectios in the community where it isn't a pandemic phase, but it's still interfering with what we would like to get back to, what we used to know as normal.

what we hope to get it at is at such a t low level that even though it isn't completely eliminated, it doesn't have a major impact on public health or on the way we run our lives. we would hope that as we get people more dynamics will be so. i can't predict for you today when thatl will be, because ase see, we i know have a situation we're entering the winter. the good news is we're continuing to come down and hopefully we'll go further and further down. but what happens globally will impact us.pa if we get more people vaccinatede globally and more people vaccinated now, hopefully within a reasonable period of time, we will w get to that poi where it might occasionally be up and down in the background, but it won't dominate us the way it's doing right now. >> thank you for that. i appreciate you bringing in the issue of h global vaccination rates and how that affects our health at home. i hope, madam chair, that this

is ae topic we can devote a little more timeec to in this committee, because i think it is very salient to our work to protect anamericans. dr. walensky, let me return to the question of data and metrics. you and i had a great discussion last week aboute what is the mot useful data to track the course of this pandemic as it evolves and how difficultlt it is for peoplepe to assess their own relative risks, especially now that t we have a vaccine that provides such strong protection against serious iodisease. dr. walensky, in this phase of the pandemic, what are the bestst metrics for us to pay attention ioto? should we be paying more orr less attention to positivity rates, case rates, oe should we be paying more attention to breakthrough infections that cause seriousea illness and hospitalization, more like we track influenza outbreaks, for example. >> yeah, thank you for that question and for that conversation earlier this week. we've been thinking a lot about what anex endemic phase looks le andnk the data that were neededo collect during that phase.

certainly right now wend are collectin data on cases, hospitalizations, deaths. we know that not all of our cast data is 100% because not every rapid test is being reported. and importantly, as we do with flu, we h collect death tata. we absolutely needy to know how our health care systems are re doing, and we absolutely need to know how deadly a flu season is. we'rea- currently collecting da now on coronavirus-like illness. so we c are working towards tho metrics of what we need. some of them -- in fact all of them we're already collecting. and the question is what are going to beha our best metrics moving forward, and probably modeling it on flu. the other metric i think is critically important is vaccinations rates. and onecc thing that we haven't really touchedn on just in conversation, wee are absolutel

working on and doing muchng betr is our race and ethnicity data our equityit data. because iflo we are not followi how yes i doing in these communities with racial and minorities we are not going to understand the impact of the pandemic on all the immunities in this nation. we actively worked on making up to speed as well. thank you. >> well thank k you. thank you very much. as we moved, forward, i think i is crucial that we are tracking the right metrics so americans have a useful understanding of relative risk and r better understand the steps that they can take to limit their own risks, including the vaccines that work, that arek safe and that saveha lives. thank you. > thank you, senator braun? >> thank you, madam chair. first questionn will be for dr. was watching the interchange andni that is always entertaining. i think what i'm interested in today, because it was back on may 26 we had a hearing. and what's happened at the wuhan

institute of virology, there is a debate out there.er it's not clear what happened. the thing i remember at the taii end of our conversation, because thehe merits of the case either way senator paul makes it one way. you make it the other way. eco health comes into play what happened there. transparence it is. you were on record as saying you like it. you love it. you believe in it. i pressed you that day, well, on something i'll get to in a moment. but what about releasing all the information that you do have under your control? because i think as long as the american public can't see it, with all the mystery surrounding what happened in terms of its origin, and i think then you said well, maybe you could suggest it to president biden on declassifying information when it comes to the subject i'm going to geta to in a moment, willmo you agree, liking

transparency to get allcy of th information out therere as it relates to the originre so we c all see it? >> right. >> here in the senate, across the country? >> thank you for that question, senator.sena i have been, always will be very, very much for transparency in everything we do. as far as i'm concerned, what you're saying resonates very strongly with me.at i do want to make one point, because itof gets confusing to people. one of the things that is very, very fuclear, irrefutable, that the nih funding of grants in wuhan and the viruses that were discussed, including the viruses that senator paul mentioned would have been molecularly impossible to have resulted in sars-cnov-2. that sometimes gets inflated when you talk about your funding

research there. people can argue about the definition of gain of function or t.not. ii gave you the process whereby that definition was established. but what gets confused is that any of the card-carrying molecular virologists will tell you that notwithstanding the debates about definitions, the funding by the nih of the grant and the viruses that were worked on.. could not possibly have turned into sars-cov-2 because they're evolutionarily so distant that nothing anybody could have done haveld done that. getting back to your question, i'm all for alit. >> i'm talking about, so has all the information, period, been released that pertains to that subject? because that looks like it would be under your control to do that. so is it out there publicly? ic >> you know, i'm not sure

exactly what you mean by all the information. but i can tell you, anything that is under my control, that is legally able to be released, i am all for 100% releasing. i promise you that. >> well, we're going to make at sure that all of that is out ng there, because one of the most difficult things about this whole navigation is that there are varying opinions. not everybody is going to agree with you.. we would like to see it so we can sort through it, where othe. experts look at it, and the american public., now, let's get back to the wholt housing that we have within our own departments. josh hawley and i had a bill i that passed by unanimous consent through the senate to declassify that information. and again, you said you preferred transparency, you were hesitant about that not being your bailiwick. is that something you would want to go on record with, to advise the president to get that

declassified so that we can see it, the american public can seet it, and that was discussed, and you thought you might be willing to do it back on may 26th. do you want to publicly say do it?? >> so senator, to be quite honest with you, i don't -- i don't really know, when you say classified information, what n' information are you referring to? because the nih, the information that we are involved with, is not classified at all. >> this would be stuff that we > hold within our intelligence departments. t senators have been able to look at it. it's not been released. department of homeland security. that's not what you house within the nih. and that is you being the main adviser to the president on this issue. why wouldn't you say, declassify it so we can look at it?su >> well, i would have to find out, senator -- when you're talking about classified ou information, that's certainly y above anything that i do,

a because i want to reiterate for the record that the nih does not do any classified anything. everything we do -- >> all 100 senators were for doing it.ng many of us had the ability to look at it.he you or others, dr. walensky, it would be a big deal to do it. real quickly, thank you for those answers.s. i've got a question about -- and this is aimed at dr. walensky. what about the importance of therapeutics in -- i asked this back on may 26. where is that in the whole ti journey in terms of having a tool and prophylactics as well? because there is a lot -- all of usl acknowledge that the vaccin was a miracle to get. you're seeing where you run into some that won't get it.yo it's hard for me to imagine that you'll vaccine the rest of the world. when will you put the same amount of enthusiasm on the

other two tripods of the stand to actually put every tool in the tool chest aimed at gettingt rid of this or at least treating it? >> thank you, senator.hi i am absolutely for using therapeutics but i think they should be used after we use vaccination, because vaccination -- certainly we have seen that the therapeutics that are out at there, the remdesivir, dexamethasone, the molnupiravir the f therapeutic that dr. fauc just m mentioned a few minutes ago, all ofbe those would be afr you're infected. they w work to prevent severe disease and death. they're not foolproof. so certainly my first tool in the toolbox would be for vaccination. and then of course we would need testing, because most of these therapeutics actually work best after you have -- especially the oral one, molnupiravir, works y best if you can give them early. so i do think we need as many i tools in this toolbox as possible.. i would also say that the best public health intervention heree would be vaccines.ic

>> you've said that before, and thanks for reiterating.ve i just ask you to put that samed enthusiasm and speed behind the other things that might be out there to help us. s thank you.ha >> thank you. i'm going to go vote. as senators know, a vote is open. t the next two senators will be senator murphy and senator murkowski. i hope to be back by the end of that. t >> thank you very much, madam chair.sk thank you to all of you for your service to this country during an incredibly trying time. i thought that senator collins' line of questioning deserved a followup. she asked a good question. she says we have good vaccination rates in maine, so why do we still have so many deaths. ut i think it's important to sort of step back and look at the national data here. i'll direct this to you, dr. walensky. i was looking at a survey of national data that was published now back in the spring, so it's a few months old.wa but in it, it suggested that if you look at the ten states with

the lowest rates of vaccination versus the ten states with the highest rates of vaccination, it's black and white. you are four times more likely s to be hospitalized if you live in one of those states with thes lowest rates of vaccination.os you are five times more likely to die if you lived in those states.. and so, you know, each individual senator will have their own experience, but tell t us what the story is, now that n we have lots of variation t amongst states when it comes to vaccination rates, and what that tells us about your likelihood to ultimately end up in the e ou hospital or end up dying from covid.d >> thank you for that question, senator.d. so yes, we have about 75,000 cases a day right now.r. and there are places, there are0 states that are highly r vaccinated and they're still having cases, as senator collins has commented on.y a this is going to be very local, very community-based.. this virus is an opportunist. it is rapidly transmissible. and if you have communities that

are undervaccinated, even if a state averages at 70%, this virus is going to go to those communities. importantly, we have actually looked during the delta surge at three states with high vaccination rates, connecticut being one of them, and three states with lower vaccination rates. and we see even just in this ei delta surge, just since june, that the death rates in the a undervaccinated states, in the states with vaccination rates ci that are 10, 20% lower than the highly vaccinated rates, the death rates are five to tenfold higher.ra so we absolutely can see the impact of this.. there are cases that occur in vaccinated people.e. they for the most part don't lead to death. sometimes they do but for the most part they don't. these vaccines are preventing g disease, they are preventing -- tenfold more likely to prevent hospitalized if you're unvaccinated versus vaccinated. 11-fold more likely to die --

less likely to die if you're vaccinated versus unvaccinated. >> senator collins' question was a good one, the story of the national data is compelling. but there are other senators wha are deliberately trading in jusl dangerously false information.in it's stunning that the misinformation about covid is not just coming from purveyors of propaganda online. it is often coming from our nd colleagues here in the senate. i was on the floor a few weeks ago listening to senator johnson, who suggested pretty sort of transparently that there was a correlation between those who got vaccinated and a post-vaccination deaths, noting that 5,000 deaths that were reported on the adverse event system happened one or two or three days following a vaccination, suggesting that r there was a correlation. so i'll d ask this to dr.

walensky. is there any increased risk of death to individuals who get a vaccine? is there any data to back up the claim that senator johnson was making, that there's some um correlation between risk of death and vaccination? w isn't it exactly the opposite? >> it is. for covid-19 it is, in fact, exactly the opposite. our vaccine adverse event system collects all deaths after vaccination. that means if you were hit in a motor vehicle accident and succumb to that event, that would be reported in our system. clearly that is not a cause sal effect from the vaccine. yes, these vaccines are workingn to prevent deaths from covid-19. what i would just say, when p people ask me all the time what they can do, what congress can do, what senators can do for us as a country, for me at the cdc, it is to encourage your constituents to get vaccinated. thank you. a >> one of the things i hope this committee will work on in the middle of this pandemic and following is health literacy, is

helping americans understand where good sources of medical information are and where the dark spots are, where you're listening to political actors who have their own agenda, not one based in science.or and i think this is frankly a place where republicans and ie democrats can collaborate hi because i think we have found as general lack of health literacy during this pandemic. but it was a problem that existed beforehand.t while it pains me to know some of our colleagues are the purveyors of this misinformation, it's a project d that probably should be able to be bipartisan moving forward. i appreciate you all being here thank you, mr. chairman. >> senator romney.ll >> thank you, mr. chairman. i appreciate your service and rm the information you provided this morning. just following up on senator murphy's question, there is a perception that side effects, adverse effects from the vaccini are not being gathered, that they're not being made available to the public.ar are the side effects and adversu

effects, dr. walensky, being captured, are they available to the public? is there a place we can go to see what the likelihood is of various side effects and getting a vaccine? >> we have the most robust w vaccine safety system than we have ever had in this country in the rollout of this vaccine.ha our vaccine adverse events reporting system, as senator murphy has just described, has over 600,000 reports publicly available.re we have a new v-safe system m ai which was developed specifically for the covid-19 vaccine program. it uses a text message system, web surveys to get people to provide their symptoms after o they've been vaccinated. it includes over 9.5 million people and over 12 million health surveys. we have a pregnancy registry where we survey pregnant women.e we are getting their information during their vaccine, after p their vaccine, in their first trimester, we follow them in their second trimester, third trimester, after their baby is s born and at three months.

we have registered over 5,000 women in that, and we have overe 24,000 who have been contacted. we have a vaccine safety data a link which is collaboration with our academic institutions whichw includes over 7.5 million people who initiated vaccinations. this is the most robust vaccine safety system that's ever been documented.os >> and where might the public go to see what the probability is of various side effects or adverse effects from the vaccination?be >> on our cdc website.te >> thank you, appreciate that. dr. fauci, a number of us are concerned about mandates, obviously. the question i sent you a text just to prep you for the question, but the question in this regard is, if we do have a mandate, and i'm thinking now with a'm mandate for private companies, if we do have a mandate, will it save lives? and is there an estimate of the number of lives that might be saved by virtue of having our

private companies that havet ovr 100 employees either having their employees receive a vaccination or get a weekly test? if that occurs, will it save kl lives, and do you have an estimate of the number of lives it might savet >> i have a very firm and confident answer to your first question, senator. and i don't have one to your second., but let me just explain very briefly. we know that vaccines absolutely save lives.. and we know that mandates work. if you look at, for example, the percentage of people at united airlines or in the houston medical association or in other organizations that have mandated, it works, 99-plus me percent, for example, with united airlines. if you take the fact that mandates work and vaccines absolutely save lives, the answer to your question is yes,i it does save lives.ve how -- what that number is, you would have to do modeling, senator, that i don't have in front of me right now to d t determine, when people get

vaccinated in a certain areas, h what is the chance of their having gotten infected and highways therl chances of their having died or not. that information can likely be modeled. but i don't have that for you right now. >> yeah, i would think that gwynn the information you do have, if yough extrapolate from the information youap as to whe mandates have been imposed, such as united airlines, and you apply it, you can calculate what the numberr of lives saved migh be. i would thinknk t that would be helpful for me and for others who are concerned about man dates. we're alsoatat concerned about s lost and protecting human life. we alsoo had a question from senator, the long haulers if you will, the long l covid-19. how serious are these long-haul cases? and what proportion of those that haveha covid-19, do we hava

sense, do we know the number? what proportion of those that have covid-19 are subject to if you l have serious long covid-1 conditions? >> a very good question, senator, that we are now finding out more definitive data. there have been a number of published papers from different smaller cohorts. we're now putting a massive cohortrt study. and among the smaller cohorts, it ranges from 10 up to 35% of peoplee have varying degrees of prolonged symptomologyng followg the so-called resolution of the acute disease. some of them can be relatively minor, but some of them can be incapacitating. for example, there are some individuals who have truly incapacitating fatigue where they were pretty healthy, athletic, and then following covid-19, they never getn back o their baseline. there are sleep disturbances. there are a thing called brain fog, which can be very

disturbing to people where they can't focus or concentrate. so the spectrum is wide. it can go from something that just isng modestly bearable to something thatth incapacitates you. and that's the reason why we have this study right now, looking at it, that's about a $1.5 billion investment to try and sort that out. >> i would just note, i know my time is up. but i would note that it would bebe helpful for those of us th are concerned about our children or grandchildren to have a sense not just of the number of deaths associated with covid-19 in children, but alsoil the numberf long covid-19 cases, severe long covid-19 cases because it would be myd estimate that that probably t substantially exceed the numberee of deaths among yog people. and thator information i think would be helpful for parents and grandparents like myself. thank you. >> senator hickenlooper? s

>> here we go. sorry about that. once again, i want to thank eacu of you for your -- not just for your testimony today, but for all theut work that you have do overth this entire -- and it is campaign. it's very similar to a war.r. we're seeing a covid-19 surge right now in colorado that has led to emergency capacity issues in our hospitals, and that's non just in certain parts. it's pretty muchh across the state. just about 80% of those in the hospitals are unvaccinated. and dr. fauci, i guess my question, my first question in a state like colorado where we have madeav real progress, grea strides in vaccinationn rates, how are you thinking about this recent surge? that it's still the tail of the unvaccinated? >> yeah.

that is not unexpected when you get into, for example, the situation where the weather starts to get colder and people do things more indoor. buts as you said quite correctl, when you see surges, they are very, very heavily weighted towards the unvaccinated. not only in the incidents of infection, but also in the incidents of severe disease that might lead to hospitalization. i believe that's a pretty obvious p type of an explanatio for that, which is the reason why we continue to push to get as many peoplee vaccinated as w possibly can. >> all right. and dr. walensky, i thought that senator romney's comments about his children and grandchildren, and i thinkoo soon if not alrea his great grandchildren, that is -- that's what we're seeing more questions every day.

and so this week's vaccine approval for 5 to 11-year-olds, i think one question we've heard is how is that going to affect this rising -- this increase in infection rates? how are we going to be -- how do we do d everything we can to ma sure these kids get vaccinated, those who want to be vaccinated? >> thank you, senator. first, let me go back to senator romney's spin on percent of children who get long covid-19. we've had about 1.9 million children between the ages of 5 to 11. we've seen a long covid-19 rate in those children of about 4.5%. it's less than adults, but it's still high and we should note it. we've also seen in that demographic 5,000 cases of misd, the inflammatory syndrome that can be devastating. we've had s 46 deaths from misd alone. and nearly 100 children in the doig ages 5 to 11. we have a lot to do to reach out

to our pediatricians, to reach out to our t parents to make su we have the communication, the education, theo information tha parents need. this is ave new vaccine to them. they perhaps received the same pfizer vaccine themselves, but for their children, it's a new vaccine. one t think i think is really important and probably worth grounding people on is a we hava lot of vaccine preventible disease for our children now. varicella, meningocoxsi. s. the death rate for covid-19 in this age demographic was 66. >> very sobering. i'm absolutely aware of the high levels of unvaccinated kids in certain -- especially certain geographic areas. now off to , who iss college, but when he had just turned four months, he was to be get his second whooping cough

shot, and he got infected by an unvaccinated kid who we were -- well, it's the most terrifying experience i think i've everos been in where you just can't stop him from coughing, and you're in aus hospital and you have to blowin oxygen on his fa to try and shake him out of the coughing. absolutely terrifying. it was amazing and it took us a long time to get a doctor to diagnosis it because at that pointit we were just beginning seeeg whooping cough again becae everythingng was in the habit o getting their children vaccinated. and suddenly that changed.ld ms. o'connell, i also worry that the recent surge is further stretching th situations around our front line workers. after already the last couple of years tremendously difficult. we hear that in colorado.

isun that happening across the country as well? senator, yes. thank you for that fequestion. we have sent 27 different teams out to augment hospitals that were overrun by patients of 600 team members to 12 different states. so we are seeing that. >> ingreat. how do we address burnout among health caree workers? what advice can you provide? >> well, we've been happy, of course to go in and help where we owcan. but we know we're not the sustainment. and one of the things that the american t rescue plan provided was funding for the public health ubworkforce. and so we're continuing to look for ways to invest in a long-term public health workforce. to support these first responders andnd health care workers that are burned out and worn out from this pandemic.ed >> wow. again, i was just finish by saying thank you to each of>> y. one of the most amazing thanks

to me as a scientist who recognizes thehe importance of data, your ability and your vision to start collecting data beginning and make sure that we take the lessons that we learn in this situation where soea often people are makg decisions without enough data is really going to inform our pandemicur preparedness and hel not just our country, but the worldsun we go forward as we this virus, but the others to come. thank you. >> thank you. >> senator tuberville? >> thank you very much, madam chair. thank you for being here today. i know it's hard work and you need to get back to work. you know, my former job i had to win games. in your business, we got to wino and right now we're not winning. johns hopkins university just made a report last week that this year we've lost 353,000

people. and to this point. last year that's how muchpe we lost the entire year. a littleha perplexing that we'v got two vaccines, boosters, and we've got masks and all that, we still gotot to win. we got win this fight. i think everybody understands that. i u recently wrote an op-ed talking about how we need an all-above approach. we need every tool in the tool box to be used. it's been tough for alabama. we've had a tough problem. they were very upset that they don't have the freedom to treat like they should have the freedom to treat. they're being told by officials hospital that they can't use certain drugs, such as ivermectin or whatever. and they know that it works. that's what they tell me. i'm not a doctor.

monoclonal antibodies. we ran out because we're starting to ration those inrk t last few months. i think they'd all say to some degree, they work. but this specific question is for ms.mo o'connell. i want to ask you this. congress gave money to the c.a.r.e.s. act to help the production of therapeutics. within three months of being in office, president biden andnd t administration i decided not to buy orn they declined to exercie contract options on monoclonal antibodies. i know you weren't there at the time. theyan. inherited these contrac from the trump administration. those decisions caused a shortage forse us in alabama. at the same time, the biden administration wason ramping up monoclonal production, as we're trying to get back toio it, hhs turned and gave $142 million noncompete contract to an accounting firmon to market the

treatments to theen public. thebl administration hired kpmgo promote apr therapeutic that th government stopped buying. that makes no sense. i looked at the website and i -- my son and i could probably put it together for $10,000. we paid $142 million. so i'm just asking you, ms. mcconnell, i understand that hhs is currently reviewing this. i would hope that you would commit to reprograming some of that money to monoclonals if there is any left. could i get a commitment downfor that? >> senator thank you so much for the question. we y have seen a change in the monoclonal landscape, when the therapeutics team beganan looki at the distribution models in february. a lot different than we experienced during the delta surge. twentyfold increase in demand for monoclonals, and we went to

a state distribution system. so you're absolutely utright. it's time too reevaluate whethe we need this distribution helped to get to the harder hit communities. and that review is under way right now. i'mde expecting a memo any day with the team's recommendations on whether to keepom that fundi going. >> thank you. you know we just need to get more of g.them. i knoww we're trying to do that and we're all trying to do best. doctor fauci you talked a lot about gain ofke function in research. i'm not a doctor.es i'm not a scientist. oi'm just going to ask you straight forwardto here. what kind of biological research is china actually conducting as we speak that we know of? >> well, right now, when you say "china," china is well beyond the wuhan situation. there is research that goes on collaboratively with the united states, not onlyti with nih, bu with any of a number of organizations, including the cdc

where we have chinese researchers. the funding that guess on right now that was just mentioned with dr. paul, we are not funding the wuhan institute anymore, that's for sure. butpa i can't testify to the sce of research that goes on beyond what the nih -- >> so the w.h.o., they don't communicate with us? because we're paying them 400 o? $500 million. surely toe goodness they have something to do with what china is doing. >> for the most part, the research that comes out of china, if you t look at the thia over the years, i'm talking not in this capsule of period where it's allhe focused on china, anti-china. i'm talking aboutre decades of collaboration, particularly in the arena of influenza and other diseases, there ise a lot of research going on. i don't think i can tell you what all the research is going on because i dent have eyes on o all the research. >> are we communicating with them, though, somehow, some way,

with china? >> well, yeah. we communicate a c lot with the. certainly there has been a loft stress and strain right now when you talk about the wuhan situation. but our colleagues inur shangha colleagues in beijing, we communicate with them all t the time. the chinese haveave a very, ver fine centers for disease control and prevention modeled against our own cdc. and our cdc is in very good collaboration and cooperation with them. >> i just think they'd have let us in early, that we may not v notin been in this situation, the world the situation we're in. i hope you agree with that, and they shut us off. >> no, absolutely. and we want toab find all the information we can. and the wnih and the entire hh has been very much in a favor o all transparency in getting to know all the transformation of what's going on in china. in favor of ch that. we want very much transparence it is. >> thank you. senator casey? >> chairman, thank you.

i would ask first consent, unanimous consent that the statementt from the alzheimer's association and alzheimer's impact movement be submitted for the record. >> without objection. >> thank you, chairman. i wanted to start with assistant secretary o'connell about in particular the hospitalt preparedness program. it's a program i've long supported aggressively, and so many others have as well. for those listening, this is a program that supports hospitals and other health care facilities, and the providers who work at those facilities in preparing for public health emergencies. as we all know, covid-19 has taxed the health care system h like never before, and at various points in the pandemic, as surges have hit communities u across the nation at different times, these hospitals and icus have been overrun with patients, most recently has resulted in

the delta variant. so assistant secretary o'connell, i've got three questions.ee first, what role have the local health care coalitions,wo which are the core element of the program, what have those coalitions played in responding to the surges in hospital admission? >> senator, thank you so much for that question. and you're absolutely right. the hpp program that you referenced is thet only federaly funded program to help health care systems and hospitals prepare for eemergency. so it'spi critical. and we've seen it play a significant rolee in this pandemic response. coalitions were very important because as we were seeing hospitals overrun with covid-19 patients, they were able to work with their coalition members to move patients to icus that actually had beds. soov we did see that play a significant and important role. >> second question, are you

planning any after action review to incorporate lessons learned from the l pandemic with regardo that, thega hospital preparedne program? >> absolutely, senator. one of the things, as i have been out inof the regions meeti with local leaders and coalition leaders, i've seen there has been an uneven use and success of the hpp program based on regional strengths, you know, based on state situations. so i think one of the things i'd like to do as we look at lessons learnedoo is figure out how to have a more uniformed successful model for thefu hpp program. >> andhp how about the third question, how about goals for the program in the near term? >> well, a couple of things that we've learned in the near term, the need to secure ppe within health care systems and coalitions. we have also learned the value of telehealth and how important it was for systems to be ready to do some care remotely. so we're going to take these

near term goals and begin applying them for longer term preparedness. > i appreciate that -- those answers.ne i wanted to move to i dr. waleny on a broader question about public health infrastructure.as one of the challenges in the response has been building the systems that we need to track information necessary to manage everything from hospital capacityty and icu bed availability toed critical medil supplies, vaccine t components. you know the long list that that is. the concern, of hecourse, is th we're going to. reach a point where we all start saying the pandemic is over and we move on. we've got to finally at long last invest in our public health infrastructure. how would you leverage any tool that we have now, especially the existing data systems that's been created for covid-19 to ensure that we'rere prepared fo

the next major public health emergency? > yeah, thank you so much fo that question, senator casey. my hope and i'm grateful for the supporty. to date for long-term disease agnostic public health infrastructure investments that are bipartisan so that we don't find ourselves in the situation again. we need to be prepared for any pandemic to come, and we need to get outd of the current pandemi. as you emknow, this is multi-pronged in my view. we need a public health workforce that is upskilled, that iss trained, that is as diverse as the communities from which they come. we've lost 60,000 jobs in the last decade and thousands more since the pandemic started. s so we not only have to work to rebuildre that public health ut workforce, but to skill it up in ways that can be i empowered to prevent the next pandemic. laboratory infrastructure is going to beemra key.

we'vee built up genomic sequencing. now we're doingse tens of thousands aho week. is something we weren't even doing much of prior to the beginning of the pandemic. we need the workplace, the tools, the collaboration in order to place these all across thee country. and of coursela you know data monitorization. wewe absolutely need interoperae data. we've been able to scale this up enormously over the last year pandemic.is we have tens of thousands of lectronic health records that we're now accessing in a hipaa compliant way where we were doing just 100 before this pandemic. it needs to be interoperable, and we need to invest in it. we, you know, to get a full-scaleit hospital system upn ethics, for example, is over a billion dollars for a single health ilsystem. so when we scale that nationally to what we need for our public health workforceee across all o our states and territories and tribes and localities, this --

the investment is so very needed. thank you. >> thank you, doctor. >> thank you, madam chair. >> thank you all for being here. dr. walensky, a couple of things. as i walked in -- i came in late -- you or dr. fauci were saying the reason we'rewh not saying natural immunity is as protective as ate vaccine, even though there is recent publications six to eight months out 92% of natural immunity have t-cells, b cells and immunity adequate to protect and b cells continues to climb. now we don't have data. in yourou response to mr. casey you just mentioned that cdc has access to tens of thousands of ehrs. and i've been told that hhs or cdc has access to patient identifiable data as to who tests positive. so i do that as a prologue. if we don't know that natural

immunity confers protection against future infection, it's because we've decided not to look. because i've learned that there is ao cohort of people that we know have beenre previously infected. we've gotot the bench research showing that the h triad of antibodies, t cells and b cells are there, and that 92% of them are stillce there at six months out. so why don't we -- why have we not done the research showing that natural immunity confers protection against recurrent infection? >> yeah, thank you so much for allowing me to clarify this point, because i understand -- i understand the question. fist ofst all, let me just reiterate that our current stand after reviewing 96 papers and a scientific research on this everyone infect showed be vaccinated. >> but that's notcted my questi >> agreed. andy part of the challenge is here as youth know the infection-induced immunity and the buy-in fees associated with retrospectively looking at the

data. several of the papers we looked at for the brief have indicated the kind of disease you had at the time you had it matters. did you have disease a year and a half ago?ea did you have -- were you an older -- >> can i stop you for a second? we can do this prospectively because apparently i'm told you have patient identifiable data. you would be able to say six months ago, we're going to start everybody infected within the last sixta months and be able t follow their ehr, prospectively to see this. i mean, theoretically cdc has the ability to do this right now. >> that too would have its own biases. things we have demonstrated in the scientific brief is that asymptomatic and mildly symptomatic people who might not present to their providers, might present to an urgent caree clinic might not b recorded in their own ehr likely have less robust protection. >> but that could be established prospectively if using the data that you t have.

and you could even say, if you had symptomatic infection, you don't need to be vaccinated. we wouldve consider you immune. you don't have to be subjected to the mandate. >> if we had data that demonstrated a correlation of protection dr. fauci already mentioned, dataa they're lookin at core risks of infection, not justio antibodies but as you nod inut t-cell function as well. if we were able to document a infection -- >> but i'm reading from nih speaks that there isnd durable memory of the virus up too eigh months after the infection in 95% of the people whoig recover, cells which continue to climb, t cells and antibodies. and i'm also saying you could do itng clinically, because we hav data that is patient identifiable that we could go back and look and w see if they wereha exposed. they could be in a hot spot like louisiana where you know they're beingg exposed. and then you would see. not just t by lab data, but empirically.y. i can tell you, the american people intuitively understand this, and they feel a little bit

like we're being willfully blind to it. i have limited time. let me ask you something else. what percent sent of cdc employees are vaccinated?pi >> we're actively encouraging vaccination in all of our employees and doing a lot of outreach and a education to vaccinated. >> and the percent? >>ha i don't have that right no >> i'm told north of 75% of cdc employees at headquarters are stillpl working remotely. that correct? >> we are following regulations through hhs and the federal government. >> that's not my question. i apologize to be rude. but i'm asking a very straight forward question. i've been told that north of 75% of employees at cdc headquarters aree working remotely. that correct?t? >> senator, i don't actually know the number offt the taupef my head. >> when you look down the hallway are, there empty desks? are over 50% of the desks empty? >> senator, i don't have if

numbersse off top of my head. worry working closely to follow the governmental rules for returns. >> there is a recent gao report that shows in the last two weeks there has been no coordinated response from the federal government to t t get people ba into work. now if p there is any agency, since teachers in fulton county are back at work, that the caseload of covid-19 in fulton county is about 88 at its peak it was 606. if what i've been told by someone who frankly kind of knows that people b in laboratories are not showing up. ikn have no clue how people, ho laboratory workers who are presumably vaccinated wearing ppe would consider themselves eligible to stay at home. i say this because i want to echo, we got to lead by example in the federal government. if our public health agencies don't have enoughd confidence i the immigration and in theer pp to go back to work, fighting infectious diseases is going to be a lot of undermining of a willingness to a further fund public health.

>> we absolutely have our central labs back at work, conducting theirac essential research towards this response. and we are following the regulations, and providing technical assistance and technical support to the federal government for return to work policies. >> one more thing. angus king and i had sent a letter dated february 25 asking about genomic surveillance. we stillmi have not have receiv a response. youll referenced in your earlie remarks. both senator king and i would appreciate a response. >> we'll get backierk to you. thank you very much. >>ia i yield. >> thank you. i'm going to go vote. the next four senators are senator baldwin, marshall, rosen, and murkowski. i will return. >> thank you, madam chair. so we're here today to discuss the roadd ahead on the pandemic response. and i fear that that road will be a rocky one if we forget the lessons that we've learned thus far.hu particularly when it comes to our act to make critical

supplies like ppe in this country. ay. "new york times" headline ts summer declared, i quote, a glut of chinese masks driving u.s. companies outut of business. in response i joined several of my colleagues in writing to the u.s. trade representative katherine tai to urge her to lt tariffs exclusions on chinese ppe expire. the u.s. trade representative is currently weighing that decision. one reason these chinese masks may be so cheap is that they are counterfeit, some of them. in fact, the fda has pulled emergency usese authorizations from c several chinese mask manufacturers. so i'm pleased that as per plans tola use the defense production act funds to procure masks and the material needed to make n95s from domestic sources. ii work to include that funding

in the american rescue plan.ca however, government procurement can only support so much american industry. topr retain a strong base of medical supply manufacturers and to reduce ourre reliance on foreign manufacturers as a whole, we need to prevent dumped and knock-off chinese ppe from driving american manufacturers out of business as well. so first, ms. o'connell, are you concerned about the practice of dumping ppe from china, undermininga, the ability of domesticde manufacturers to remn competitive in the u.s.? and if so, have you conveyed these concernsd to the u.s. trae representative? >> senator baldwin, thank you so much for thiss important question. we do participate in interagency process where various departments have had the opportunity to share our

support. so, yes, we have conveyed. >> okay. dr. woodcock, the fda has revoked authorizations for masks. chinese are you concerned that increased reliance on chinese ppe will threaten the safety of the u.s. health care workers, and if so, have you conveyed that concern toce the u.s. trade representative? >> well, i can't answer the last part of your question. i don't know. i will. look into the u.s. trad representative. we are concerned about lower quality appe coming from anywhere. and we have, of course, put in import alerts. we have chased down and identified suppliers who have sent in h counterfeits. we have tried to do recalls throughout the united states to gethr these off the market. we are interested in increased authorities because we do not have seizure authority for devices and several other authorities that we have been

talking to staff about.t that would improve our ability to interdict these counterfeits. >> thank you. per dr. walensky, throughout the pandemic, we've heard about how gaps in the clinical and public health workforce have significantly hampered our response. in particular, we've long faced significant recruitment or retention issues among infectious disease clinical workforce and with health professors who conduct outbreak preparedness and response activities. as this committee considers policies to care for the next pandemic, i'm working to introduce the biopreparedness workforce act with senators collins,s, rosen, and murkowski which would create a new provider loan repayment program focused on encouraging students to pursuet careers as infectiou

disease clinicians and biopreparedness professionals. dr. walensky, as an infectious disease physician and public health leader, i know that this issue is particularly important to you. and ca you share your perspective on some of the serious workforce challenges i p mentioned? and how proposals to bolster this a workforce might make a difference in responding to futurere outbreaks. >> thank you so much for thoses efforts, for your support, and for that question. we know that about 80% of people leave medical school now with debt. about half of those actually have undergraduate debt as well. and the debt for an average medical student is about $215,000. in terms of going into the field of infectious diseases, it is one of the lowest paying fields all of medicine, all the subspecialties. in fact,st in most hospitals i you are an infectious disease provider ratherec than a generalist, your salary is less.

if we are going to bolster the public healthst workforce with infectious disease positions, this kind of support would be essential. >> thank you. >> thank you, mr. chairman, and thank you for being here this afternoon. -- or this morning.mo 11 hearings. this is the 11th hearing that this committee has h had on the covid-19 pandemic. we had all of course hoped we would be well beyond this, but instead we are well in the middle of wit, and we see it changing. i talkkee to folks back home, a theyac really wonder aloud whats theth path out of this. my state is we're four times the national average in terms of number of positive cases. our hospitals are still overwhelmed for the past month we have been -- we've been

number one in the country. nobody wants to be number one here. and we're going into the winter season. so it's kind of discouraging right now. so we've talked about the strength of theke vaccines that have been developed through operation warp haspeed. but i think everyone would acknowledge that the pandemic that we p encountered in march 2020 is different than where we find ourselves today with the delta variant. we're talking about vaccine hesitancy, very, very real in my state. we still don't havee a highly effective vaccine that is stable withoutt refrigeration or a nasl or an oral vaccination option. i'm -- i'm worried that we're prioritizing vaccine technology that may not necessarily be feasible to bring this pandemic to a close globally.

and so a question to you, dr. fauci, andu, then to you, dr. woodcock, do you think, dr. fauci, that what we have today, the existing vaccine technology that'st currently authorized by fda isre truly sufficient to brg usci out of this pandemic, not just thehe united states, but globally? and what, then, is the administration doing to support and to accelerate development of the next phase of vaccines that longer and broader immunity to the covid-19 and of course all of its variants? >> thank you for that question, senator.r. so first, the vaccines that are currently available,y particularly the ease of use of the mrna and the extraordinary effectiveness of both the moderna and the pfizer rna are if properly utilized, we believe would have a much, much better

control of this outbreak as we have right now.l but to your specific question, we are also supporting the development oft other platforms of vaccine. for example, the soluble protein, recombinant protein with an adjutant is something traditional in vaccines that aa used in other diseases and have muchch less stringent requiremes for cold chain and other things that might logistically get in the way of t getting it more widely distributed. so in specific answer to your question, even though i we have very effective and very safe vaccines that are being implemented now, we're not stopping there. we're making investments in the development of other i platform. some of them are already well on their way.ing >> i think it's important to hear that, because i think par of what we're dealing with vaccine hesitancy is saying people okay,ar you got your vaccine.

believe me, ir got my vaccine ad i've gotten my second vaccine and i've now gotten my booster. i'mm hearing from people much more hesitant than i. well, if you're going to have to keepf getting one of these ever sixo months, how really effectie is that? so dr. woodcock, let me ask you, i've h spoken to some researche that are working on these next generationo of vaccines. they've told me that fda is not prioritizing new vaccine technologies now, but rather they're focusing on therapeutics and existing vaccines. is thisxi accurate? and can you speak to that? >> well, the group that regulates therapeutics is different than the group that regulatesat vaccines within the fda. so they're not competing with each nother, right. as far as vaccines, we have been prioritizing the ones we could get out immediately because of health emergency. however, i think there will be new forms of vaccines, as dr. fauci said there may be new

vaccines that don't require the cold chain. the manufacturer macect be ableo modify the current vaccines to what areo called formulations that doesn't require refrigeration that would be good. and people are t looking at different types of vaccines such as oral, nasal and so forth. it's just taking longer. i don't think the fda is not standing in the way of that development. it is the fact that the tried and true platforms are easier to get a new vaccine up and running. and we hadad to do that in the middle of this emergency to get things done as quickly as possible. but certainly there is a lot of research going on in vaccines. and the fda is not impeding that.iona >> mr. chairman, i have additional questions that i'll submit to the record. certainly hope that we're going havepp an opportuni

to hear a l little bit more fro the administration now about the mandates that had been put in place, this newly released emergency temporary standard from osha. we're talking about areas of vaccines and vaccine hesitancy, we need to be talking to those e that put in place some of these standards where in my state are causing an extraordinary issue and problem within our work re force. >> thank you, chair murray, and ranking member burr.yo i want to thank you for being here today and for your lifelon. commitment to saving lives and protecting us. it is something that people don't realize as you go into these careers what the

motivation is, and i thank you for that. i want to talk to you a little bit about the supply chain, especially emergency medical supplies.pe it really leaves us vulnerable to critical shortages. we are experiencing acute a shortages of essential supplies like masks and gowns, many small manufacturers in the united states, well, they stepped up tt change what they were producing to meet this public need, like e polar shade, a los angeles company that switched from making window coverings to ppe during the crisis.os my office heard from a number of companies to receive technical assistance on quality standards where the essential goods were needed most. but there is no system in place to handle this type of situation. that's why i introduced to senator cassidy the strategic planning for emergency medical manufacturing act. it's going to create a voluntary, domestic, back-up

manufacturing network, a proces for manufacturers to plan ahead, prepare, receive this guidance and federal contract opportunities before a disaster strikes.rt they're ready to go, and we e heard from senator baldwin about people dumping supplies that are not quality. so, ms. o'connell, how does the gap in our domestic supply chain, how do they hinder covid, the initial response last year, and what gaps exist today. i want to work with you on a bipartisan solution to strengthen our networks. >> senator rosen, thank you so much for bringing up this s important topic, and i would really look forward to working h with you as well. when the pandemic first started, we experienced something where the whole world wanted and needed the same supplies at the exact same time, and many of them were being made overseas. w

so in that time, thanks to a lot of funding that's come from congress, we've been able to invest a billion dollars in various domestic manufacturing efforts. now, that doesn't fill all the t gaps yet, but we're continuing to look at various projects and send money out the door. one of the things we're doing that i think you'll be interested in is creating a domestic warm base. we started to see, and we t experienced that at some phasesm in the pandemic, where demand for certain supplies increased, then immediately decreased. what we need is to have this warm base. we, for example, are putting out a statement of interest in having 140 million n-95 capacity to manufacture those per month,e and having that warm base capacity we're investing $115 million in that effort.15 we're trying to fill some gaps f and we're continuing to look for opportunities.dr >> great, i look forward to

working on that with you. dr. fauci, in that same vein, we have critical supply shortages when we think about ppe and other things. what about critical supplies of equipment and things for our ?bi research labs? how does that impact our ability to do the research, to advance the latest treatments, and how can we overcome those challenges?es we had three agencies, i know, where we were trying to get a a lot of different things.r, >> that is an issue in some circumstances, senator, where we have certain reagents as you ly mentioned that are not w immediately available because of supply chain issues, and that'sf the reason why we get concerned when we have supply chain interruptions, which could impact what we do at nih, which is research. >> well, thank you. i look forward to working on that.or dr. walensky, testing, testing, testing. it's the key to moving forward i through a lot of this whether you have vaccination treatments or not, we need robust testing and a lot of people can't pay

for out of pocket, the turnaround can be slow. what support is the federal government providing to help increase their ability to have fast, reliable and free testingk when it comes to labs and d staffing? that is critical for our economy for people to go back to work. >> absolutely. we've been working closely with these jurisdictions to roll out free testing support. we are working closely with states and schools.ol we provided $10 million for testing in schools as well as 0 for school nurses, and toolkitse for our schools to how we use these tests, where best to use which tests, and then peer-to-peer advisors, how they might work with another school to understand what the challenges are and how to overcome them. >> i see that my time has expired.

thank you all again. i appreciate it.ma madam chair?o >> thank you. senator marshall. >> thank you, madam chair.ca i want to ask for unanimous consent to submit several documents.th the first are 40 publications are support natural immunity, 40 publications. the next i want to submit is a i cdc briefing that dr. walensky was kind enough to bring to our attention. it was dated october 29 of this year, "sars-cov2 infections and immunity." the immunity provided by vaccine and prior infection are both high but not complete. for now the last of what i'd like to submit is something cdc wr, laboratory-confirmed covid adults hospitalized. along with that a review by dr.d martin kuldorf along with comments of 20 physicians.t i asked about concerns for that particular study. >> without objection.

>> this morning i'd like to focus on immune versus ct non-immune as opposed to conflating those who have natural immunity plus the vaccination. i will give you there is some studies that would support some benefit to giving a vaccine to those who are already immune ea from natural immunity. i give you that. but the issue today i really want to lock in on is natural immunity versus vaccination immunity.. many we could have a frank debate, i'm sure, all day long about the pros and cons, and if

we were to give a lecture to our medical students, we would l probably say the jury is still h out.os here's all the information and the data, and i think that's why we are positioned to be able to look at this data and look at this particular person's medical history about do we feel the benefits of this vaccine y outweigh the risk? dr. walensky, my question for you is going to be, are you so convinced that they are so much in favor that the vaccine by itself is better than natural immunity by itself?an are you inclined to give that t information to the white house y and protect the navy s.e.a.l. from the military. g a young, healthy navy s.e.a.l., if he gets covid, he has a one in a million chance of having a serious hospitalization. at the same time he has a 50 ous of a million chance of getting heart swelling which knocks himc

out of being a navy s.e.a.l. for at least six months and probably forever.mm are you so convinced that the data is so compelling that natural immunity isn't as good a as vaccination -- again, don't put the two together -- are you convinced that the nurses i worked with when this epidemic was rolling, the nuclear plant that kept the electricity on ch months ago, that we hailed as i heroes that now we're going to punish them and separate them from the job. we took an oath to do no harm. is the data so compelling that you think that's what we should do? >> thank you, senator, for that question. let me just go back to the initial point which i don't want to conflict them, but i think the studies are uniform that tu vaccination after -- >> that's not my question. that's not my question. >> i understand but i want to make sure we correct the record, because you said some that it's uniform.

if we look at infection-induced immunity versus vaccine-inducedt immunity, i think if we were talking to our medical students, we would tell them we do not have correlative protection. we cannot meriwether you are c protected or not, and we do know by virtue of the fact that our vaccine-induced immunity studies know for certain a date that wey can follow what those protections are in effective studies. not do we not have correlative n protection of antibodies -- >> i need to move on. w i apologize. next i want to submit for the record. i ask unanimous consent, first of all, an e-mail from peter u dassick dated january 11, 2016. we're very glad to hear that our gain of function pause has been lifted along with, of course, the studies that go along with that. dr. fauci, who reviewed the grant proposal? 1r01ay. who reviewed the grant proposal? who made the decision that the

grant would not be subject to the pause, who allowed the injunctions to be made? >> i'm not sure what you're asking. did you say did i do that? >> i said who would make that type of decision? >> as to what? >> who would decide to make a pause in the bio gain of functions decision for this particular research policy, this research request. again, romico health has statedr

512,514.h we're very glad that our research funding pause has been lifted. >> i think the research funding pause, the question is it was asked of the trained staff at ns the institute if this research r would fall under the pause for gain of function. it was determined by trained staff that it did not. because at that time the, there were two components of guard rails. is the guardrail prior to 2017 which is whether or not an experiment is designed to enhance the transmissibility -- >> you think these are very important questions that america would like to know the answer f to. >> if you could submit them for the record, we could get a response. >> will you commit, dr. fauci, to answering our questions we're going to submit for the record. >> we always answer questions that are submitted to the record, of course.rig fre >> thank you. >> thank you.

senator lujan. >> thank you, madam chair, ranking member burr. i appreciate my colleague comments and attention to ensuring maximum vaccination in the united states, especially ensuring all american children who are eligible get vaccinated. because of that line of li questioning, i'm able to turn my attention in another area that has been talked about a bit today, but i hope we can dig a little deeper. although the united states is da making progress vaccinating people, i'm concerned about the low level of vaccination in low and moderate-income countries. for interconnected border states like mexico, physical and economic health depends on vaccination. 49.6% of the world's population has received at least one dose of covid-19. only 3% of people in low-income

countries have. and yet in the united states, 15 million vaccines have been thrown away since march 1. dr. fauci, i appreciate your comments to senator smith on this topic, and again, i'd liked to dig in a little more. dr. fauci, do low vaccination rates concentrated in certain ld parts of the world allow covid to spread unchecked? >> yes, senator, and that's the reason why, as i stated publicly very often, that a global pandemic requires a global response. because when you have vaccine dynamics that are rather robust in countries that are e undervaccinated, then what could conceivably happen may be likely, certainly there will be mutations and sometimes mutations aggregate to the poinf that they lead to a new variant

which would be of concern, particularly if that variant has the potential of evading the vaccines that we already have. >> dr. fauci, you anticipated tl both of my follow-up questions, which were asking about the concerns with new variants and evading vaccinations that are currently available. now, i open this question up to the panel, yes or no. do low vaccination rates in large swaths of the world put united states' health and economic recovery in jeopardy? dr. walensky. >> we certainly need a global response. my line is no one is safe untiln everyone is safe. >> dr. fauci? >> yes. >> dr. woodcock, the more attention that is brought to this area, my question is, what more can be done or it we be doing in the united states to ni ensure they have the data they need to improve vaccinations in

country. during a recent visit with other colleagues, we found out that some countries had not yet approved vaccines that were available across the united states and in many parts of the world. >> well, we post as much information as we can. we post our reviews which have a large amount of information, the material that goes in front of the organization is posted. often i will be on a call. there will be representatives from 90 to 100 different countries. it's only regulators and we talk about the challenges and thousand we can overcome them, and specifically in the vaccine area. so the fda is very happy to

collaborate to the extent we can by law with any country to help them with their regulators in getting information that they t need. >> you said something very key there. one thing i want to pursue is what is not allowing the united states to work with other countries fully in this space. the united states is enacted by covac and other efforts, but other countries remain largely c unvaccinated.va while the amount of discarded vaccines are a small percent of vaccine doses successfully administered, each wasted vaccine is one less person to help stop the spread. how can we maximize that? i'm interested in pursuing what is standing in its way, how can we increase those efforts? what is required to work with other countries so they have a rapid response ready to go.

that even exists in ecuador where they've proven if they can get vaccines into people's armsn they can recover relatively quickly. i want to thank each of the experts who are here today and i look forward to working with o each and every one of you to gee more people vaccinated and stop the spread of covid. >> thank you.pl >> chairwoman, thank you, and thank you, witnesses, for joining us this afternoon. dr. walensky, i am interested in learning what the ha administration's plan may be in regard to vaccination mandates. just days ago, you signed off on emergency use authorization for pediatric covid-19 vaccine. a the issue of mandates is roiling across the country. while there are many parents who are interested and willing to a get their young children ng vaccinated, there are also other parents who still question the pediatric use, emergency use

authorization and are concerned about a potential federal vaccine mandate. i share the concern about federal vaccine mandates. i urge the cdc and the rg administration against implementing a vaccine mandate e for students, forcing parents tg vaccinate their children is a requirement to attend public school would be, without a doubt, a federal overreach. the federal government mandates for children to attend school.ov it would represent an extreme o departure from our educational system's historic, longstanding reliance on local and state ti control. and in my view, the decision to vaccinate a child should be left to the parent and their trusted physician. the private relationship of the

federal government should not be inserting itself into with a mandate. perhaps all that commentary is unnecessary, and you can assure me that that is not what is the next step in mandates from the biden administration. and perhaps you can't answer ld what the biden administration is going to do, but what is your thoughts and what would your recommendation be?e? >> thank you, senator moran. i am delighted this week we were able to strongly recommend thatd 28 million children receive a covid-19 vaccine to prevent infection, to prevent severe disease, long covid, multi-system inflammatory syndrome as well as death in the children that we have seen between the ages of 5 and 11. those recommendations are strong. they are after endorsement of oc the fda's emergency use authorization. vaccine requirements for schools are left to the local jurisdiction, so we will leave

those to the local jurisdiction to make those decisions. >> so kansas parents who may have concerns about whether or not their children will be able to attend school, that will not be a decision that's made -- without a vaccine, that's not a decision made by the cdc or thea biden administration but remains a local decision to be made by a local board of education. >> i will always encourage that parent to get their child vaccinated and speak to them about the information and ab education, education they need in order to get their children vaccinated. right now at this moment those decisions are made at the jurisdictional level as they are with all other vaccine-preventable diseases for children. >> i heard you say "right now."a is there any intention to change that longstanding challenge? >> not at this time. >> ms. o'connell, i've been a supporter and seen the value a long time ago as a house member. he relied on the savings plan to reduce health care costs. i would like to give you the opportunity to tell me what has. been done, should be done for nn those centers who have played an integral part that they are more capable and prepared should there be another pandemic. >> well, senator rand, thank

you. this is one of the things that you and i have in common. strong supporter of our r federally qualified community health centers, our rural health centers and the program that hrsa runs to support. we've seen them play a significant role in the vaccine. we're also running a pilot program which allows them to distribute free at-home rapid d tests to families, and i think that's another important way in which they can contribute to ay this response.

we're hoping to scale that up bh thanksgiving. right now it's in eight states. we've also been able, through ow the fqhcs and rural health centers, distribute masks to families that might need them, high-quality masks, and of course they continue to provide clinical care to families that get care there. so continue to see them play a significant role, and we're always looking for opportunitiee to increase the impact they can have in this pandemic. >> i thank you for that answer, and i want my community health a centers to know how valuable ni they are, not just in the time of a pandemic, but throughout the daily lives of lots of americans. i just visited one in kansas city, kansas last week.ai again, reminded that they serve a very valuable purpose and a a way for those who might not otherwise access the opportunity to have a consultation with a n health care provider to be able

to do so and to make a decision about how to care for themselves and their families. thank you very much. >> thank you, chair. >> thank you. senator burr, any closing ha remarks? >> thank you to all our a witnesses and would you go to the host of people that are behind you in this work and d thank them on behalf of the committee? dr. walensky, i didn't have this on my list today but the te questions have precipitated it. do you really not know the answer to the number of vaccinated individuals at cdc or did you just not want to answer the senator's questions? >> we're still actively collecting the data in realtime. >> could you provide that to the committee by monday of next week? >> we are working toward updating that data..ti i would have to speak with my te staff about where we are and whether those numbers are going to be available on monday.y. >> dr. walensky, i just remind you there is an executive order in place for all federal y

agencies that vaccinations for federal workers be concluded by november 22nd, and it says that actual date is november 8, which is next monday, because disciplinary actions have to begin on november 9th. if the collection is still in be process, how are you going to on start disciplinary actions placed upon the executive orderw >> we're actively updating the e data, i just don't know when they will be fully in, but certainly we will have those t data by the appropriate ly deadline. >> if the cdc don't have to live by the rules, why should employers have to live by the mandate rules? >> as i said, we will actively make sure we are complying by se the rules because we want everybody else to as well. >> let me ask one last questioni i think what you have heard is a frustration by members about confusing messages that go out. it's confusion when somebody has to be vaccinated though they have natural immunity.

it's confusing when this policy is in place for masks and then t over here, it's changed. i realize this is an evolving thing. but correct me if i'm wrong. the cdc website currently says e that if you have had covid in the last 90 days and you leave the country, and you come back in, you're not required to be e tested before you come to the united states.g the website says, we recommend it within three to five days of returning to the united states, you should have a covid test. i'll leave on sunday, i have double vaccination. i have a booster. c next thursday in london, i'll have a covid test in london before i can fly back into the f united states.it the cdc's own website puts more value on natural immunity than they do on two vaccine shots and a booster shot. >> our guidance is intended,

first of all, let me just say, i think our guidance is very simple when it comes to vaccination. that has nothing to do with ng whether you have been infected or not. we recommend everybody be vaccinated with two doses of pfizer or moderna or a single dose of johnson & johnson. everyone should be vaccinated d who is eligible to be vaccinated. with regards to our travel, our travel guidance and our travel restrictions are to keep americans safe, to keep people traveling to the united states safe, and to keep our local communities safe. ual >> let me repeat what the guidance is. that if i leave the country and i have been infected and recovered from covid in the last 90 days, i can come back in the country without a requirement to be covid tested before i come ie the country. though i'm recommended once i get in the country to have a r test within three to five days. if i'm vaccinated, and i'm boosted, if i leave the country, i have got to physically be tested outside of the united states before i can return to he

this country. i'm not asking a question. i'm making a point. it is so confusing. that is so confusing. there's every reason to believe the american people can look at this and say, what the hell ares you guys doing? what are jow judging this based on? it's not common sense and it's g certainly not science. >> the science is the pcr tests can stay positive up to 12 weeks. so what we're working to prevent is people who would have a persistently positive test from prior infection not be confused with people who are newly p infected in that country. they have to prove they had a positive test, so we're not looking and misdiagnosing them as newly infected. it's the science informing us. >> your stated policy suggests you put more value on natural immunity. it does. it does. v

>> it's the performance of the diagnostic tests, unfortunately. >> thank you, madam chair. >> thank you. >> that will end our hearing today. i want to thank our panelists. and dr. walensky, dr. fauci, and assistant secretary, you have all been very patient and we appreciate a very thoughtful discussion about our ongoing response to this pandemic and the path forward, and i really v on do appreciate all you being here today.is for any senators who wish to ask additional questions, questions will be due in ten business days, november 19th at 5:00 p.ms with that, the committee stands adjourned.n us

sunday on in-depth, historian and conservative commentator victor hanson joins us live to talk about war, politics and citizenship in the united states. his book title includes the father of us all, and his latest

"the dying citizen", where he says the idea of american citizenship and the ideals associated with it are disappearing. join in the conversation with your phone call, facebook comment, text and tweets. sunday, december 5th at noon eastern on in-depth on book tv. before the program, visit c-spanshop.org to get your copy of the book. next testimony from fema administrator. deanne criswell. she spoke before the house oversight, and reform committee. >> the committee will come to order. without objection, the chair isu authorized to declare a recess of the committee at any time. i now recognize myself for an an opening statement. the committee is holding this hearing to address the serious and growing crisis imposed by ed natural disaster and extreme tr