♪ >> sees bet about of as washington journal, every day we are taking your calls live on the air of the news of the dyad will discuss policy issues that impact you. coming up writing morning, adam rendon, president of conservative group freedom works on election integrity. then, i talk about efforts in several states to restrict voting rights. watch c-span's "washington journal" live at 7:00 friday morning and be sure to join the discussion with your phone calls, facebook comments, text messages and tweets. >> dr. anthony fauci of the cdc director testified before the senate house committee on the federal covid-19 response. dr. walensky announced that as of march 17, more than 113 billion doses of the vaccine had been administered, including 73,000,001-does recipients at 40 million who are fully

vaccinated. this hearing is two hours and 45 minutes. 0 eastern. but it looks like they're running a little bit behind. when it starts, live coverage here on cspan3. chair: good morning. the hearing will come to order. where holding a hearing on the federal response to the covid-19 pandemic with administration

officials at the forefront of these efforts. the ranking member and i will have opening statements, and then i will introduce the witnesses. i appreciate each of you being here today and i expect to hear from you often as we work to end at the pandemic. after witnesses give testimony, senators will have five minutes for a round of questions. i want to walk through covid-19 safety protocols in place. we will follow advice of the attending physician and sergeant at arms hearing. committee members are seated at least six feet apart. some senators are participating by videoconference. and while we are unable to have this hearing fully open to the public or media for in-person attendance, live video is available at health. senate got. if you need accommodations including closed captioning, reach out to the committee or office of congressional accessibility services.

we are all very grateful to everyone, including our clerks, who have worked very hard to get this set up and help you -- and help everyone stay safe and healthy. thank you to all of them. we have recently seen a change for the better since this committee had its first covid-19 hearing with federal officials over a year ago. the difference between how president widened has been handling the crisis and how former president trump refused to staggering. when it comes to public health guidance, former president trump spread misinformation about masks and refused to wear them while one of president biden's first acts as president was to urge all americans to wear masks and keep each other safe. president trump consistently interfered with experts. president biden empowered them to lead a science-based response to the pandemic. when it comes to testing, former president trump was concerned testing too many people would make him look bad, while

president biden is concerned that not testing enough will leave let risk and let new variants of the virus spread undetected. when it comes to getting vaccines into arms, the trump administration approach on distribution was essentially, give vaccines to the states and call it mission accomplished. the biden administration is directing vaccines to pharmacies , through a partnership reaching over 40,000 locations, to community health centers through a program they have expanded to 950 locations, and to patients, by standing up federal vaccination sites, which it announced last week it will double. the result? recently, my home state of washington administered its 2 millionth vaccine. our country administered its 100 millionth vaccine. we saw the first day without 1000 covid-19 deaths in our country since november.

and president biden announced he will direct all states, tribes and territories to make all people 18 and over eligible to be vaccinated no later than may 1. while we aren't through this pandemic, we are finally on the right track and can see light at the end of the tunnel. but we are going to have to keep pushing. that is why the american rescue plan makes investments in testing, ton tact racing and sequencing, so we can identify new variants of covid and slow the spread, investments in new vaccines so we can administer them quickly, widely and equitably, fight misinformation, promote vaccine confidence and engage trusted partners in communities, investments including training 100,000 new health-care workers for those efforts, and investments to address inequities that have made this pandemic more deadly for communities of color, to

address mental health, behavioral health and substance abuse challenges that this pandemic has worsened, to support home and community-based services that help people with disabilities, and older americans, and support community health centers which continue to be a lifeline to so many hard-hit and hard to reach communities. now, we must work to make sure these investments have the impact we need them to come in order to wring an end to this pandemic. for this to happen, we need to fight vaccine hesitancy. over half of people now say they will get vaccinated, compared to a third at the end of december. but that is still too low. as we promote vaccines, we also have to ensure equity and get vaccines and information to communities of color, rural communities, people with disabilities, people who don't speak english and people who do not have access to the internet. the biden administration plan to develop a federal website showing vaccine locations, and a

1-800 number to help those people without internet are a promising start, as our efforts spearheaded by community groups like the pacific islander community association in washington, which i talked about in our last hearing. but we have to keep our focus because this pandemic will not be over for anyone until we can vaccinate everyone that we can. and even when we are all safe from covid, our work will not be over. we have to rebuild our country, stronger and fairer, and that work needs to start with a stronger and fairer public health infrastructure, which is why i introduced the public health infrastructure safe live act last week. but it can't and they are and that is why ranking member berger and i and of the committee are focused around the need to live the lessons of this pandemic and take action so nothing like this happens again. together, i hope to work with ranking member burr and members

of the committee to hold hearings, talk with experts and stakeholders, and work across the aisle with our colleagues to consider the many lessons of this pandemic and drafted bipartisan legislation to act on those lessons. i know we will have different views on this committee about what that means, but we share a common goal to keep our families and communities safe from uterine pandemics and public health threats. i am hopeful we will find common ground when it comes to what we can do to address the need for a strong public health system, the painful health inequities that hurt communities of color, the way this pandemic was exacerbated by a lack of paid leave every worker and affordable childcare for working families, the importance of protecting schools and workers, and more. we all want to make sure we learn from this moment in history, because we owe it to every american who has suffered or who is grieving after this year, to make sure we never find

ourselves here again. i would like to thank all our witnesses today for joining us. i look forward to hearing from each of you about issues we faced as we work to end this pandemic, and i will turn it over to ranking member senator byrd for his remarks. senator burr: thank you, and it is great to see all of you doctors. continuity will be critical as we work through lessons learned from the covid-19 pandemic and move into the next phase of the response and hopefully, our recovery. this hearing is going to take stock of our federal covid response, but it is no time to talk about where we are going in the next 30, 60, and 90 days and beyond. america needs to reopen our schools. we need to reopen our businesses. and we need to open up to local

commerce, a much more challenging thing. actions taken by each of your offices affect these goals. some of you are new to the response and some of you have been in the fight for the last year, alongside members of this committee. my request to each of you, however, is the same -- this pandemic has shown us very clearly how we can prepare for the next threat and that is, being a better partner to the private sector at the top of the list. dr. well lenski, i think -- dr. walensky, i think you have the hardest job ahead of you. your agency is responsible for communicating to the american people based on facts, how to return to normalcy.

but guidance documents coming out of cdc have been two steps behind the data. all i am asking is for cdc communications to be fast and transparent. tell the american people what we know, when we know it, and when we don't, so that they can make the best decisions for themselves and their families. your best to to keep pace with science is the private sector. last week, during the committee covid hearing, i said cdc can no longer be in charge of all testing in the early days of novel threats. let me be blunt. the cdc's go it alone mentality in the past on testing was arrogant and wrong. let me propose a solution based on the succession that they -- based on the success of dr. hahn at cdc, lean on your test makers like roche during an

emergency outbreak. the same is true of the surveillance system. last week, a doctor from brown university public health schools that -- public health school said we need a new approach our surveillance. we discussed weather patterns and mobility information alongside traditional testing and patient data from health-care providers. we need a layered surveillance system in partnership with the private sector, states, and local public health experts to get a true picture of the threats on the ground. the covid relief packages have given cdc billions of dollars to modernize systems. cdc must not hoard that money for yourselves. instead, use these funds to identify technologies that equip us. i employ you to not build

internal systems that only become obsolete before they even get up and running. dr. fauci, welcome back. you are everywhere these days. i have worked out -- you and i have worked on these issues together for two decades. a lot of what we built worked. the nih recognized the importance of technology, leveraging clinical trials and research networks, partnerships with the private sector through the nih foundation, programs in partnership with barda to cast whitest net possible for novel technologies and testing. now, the challenge will be for your center along with other institutes and centers at nih to maintain this pace and apply to the next set of health-care challenges in the future. i read yesterday's articles on

the ebola outbreak, and it seems the strain of ebola in this outbreak might have been dormant for five years and yes, this is about what we know, but about what we don't know as well. voices at the nih will be important to determine how we can expand, solidify, and maintain this public and private approach to the biggest health care issues facing our country. dr. marks this is where your efforts come in. i can think of another medical product center at fda that will see more of the technologies that will benefit america in the next decades. the covid 19 vaccine -- the covid-19 vaccine comes in for review, but so too -- but so do gene therapies and many rely on platforms for diseases.

the pandemic has altered the model at fda and the agency should not go back to its historical approach. dr. hahn used his emergency authorities exactly how we envisioned the fda use them. in my mind, the dedicated professionals at the fda are unsung heroes of the federal sponsor. the anyway -- nua standard -- and we can adjust these authorizations as we learned during a response. this is how statutes are designed to work now, as the makers of these products and tests and treatments apply for full approval, the agency should take this opportunity to use real-world information to inform their review. and i hope you take advantage of the unique opportunity you have had. each medical product center at the fda can apply their practices during the applications that come across the reviewers' desks. we can accelerate development

for the benefit of patients in the united states and around the world for more than just covid, but for cancer, diabetes and more, stacking clinical trials, receiving ruling sets of data, coordinating with global colleagues have been available to those at the agency for a long time. i urge you to continue to use these as you have over the past 12 months. dr. kessler, david, it has been a long time. much of what we implemented, we didn't talk about when you work fda commissioner. i don't think it was a lack of vision. it was yet-developed future technologies. you were serving at fda when our conversations about pandemic preparedness again. now, you are in position to use those authorities to their fullest extent. operation warp speed or the new name, the operation, did i get

that right, as used nih expertise, early research, barda manufacturing capabilities and dod logistic muscle to achieve scientific breakthroughs that can rescue the world from this virus. the operation's speed was a huge success and i am glad you are planning on building on that success. in the next few months, this project will have made available vaccines for all eligible americans in eckerd time about cutting safety or efficacy corners at the fbi. -- at the fda. the operation showed us where our gaps exist. we need ways to rapidly identify candidates for tests, treatments and vaccines this area is primed for partnership with academia

and especially the private sector. we learned our manufacturing capabilities came up short, but we saw a remarkable thing when private-sector drugmakers partnered with competitors to make vaccines. it is my hope that you are willing to work with my office to address gaps we found during the operation, and uphold the pieces that worked for the future. now, one year into the pandemic, even as the vaccine offers hope that a return to normal will continue and speed up, the offices and new responsibilities that each of you hold will become more challenging. not only will you be required to maintain the pace of our current response, but to begin to change the architecture of our public health agencies. the novel coronavirus has irreversibly altered our ability

as the federal government to interact with innovators that bring real solutions to the greatest health-care challenges in generations. do not take this moment for granted. strengthen relationships and partnerships that have been established during this response protect stock of the needs that exist, and have partnerships like these can help us all address them. my staff and i are in the midst of a review with the same goal and my office is available to each of you at any time, for us to work together on these efforts. thank you for your willingness to serve at a difficult time for our country. i look forward to working with each of you to reopen our country and to memorialize what we have learned. thank you. chair murray: thank you. i will now introduce today's witnesses. i am pleased to welcome back dr. anthony fauci, a trusted voice in guiding hand route covid 19 pandemic, -- throughout covid-19

-- throughout the covid 19 pandemic who now serves as chief medical advisor for president biden's covid-19 response team. dr. fauci was appointed director of the national institute of allergy and infectious diseases in 1984 and has led the institute since. he has advised six presidents through deadly global health crises like hiv, aids -- hiv --, zika, ebola and now covid. he received is md from cornell and completed his residency at cornell medical center, now the wild core medical center -- the wild cornell medical center. thank you for joining us again today. dr. rochelle walensky is

the administrator of the toxics substances and disease registry, was chief of infectious diseases at massachusetts general hospital, and a professor of medicine at harvard medical school. she has worked throughout her career to advance the national and global response to hiv and aids and is an expert in the testing and treatment of deadly viruses. during the covid 19 pandemic, she conducted crucial research on vaccine delivery and helped develop strategies to support underserved communities. dr. walensky received her md from johns hopkins -- john hopkins -- johns hopkins school of medicine, trained in internal medicine at johns hopkins, became a doctor indian -- doctor in the infectious disease programs. dr. walensky, congratulations on

your appointment as director. we are glad to have you here and what i am sure will be the first of many productive conversations with the committee in your new role. thank you. dr. david kessler as chief science officer of the biden administration covid response. in this role, dr. kessler is focused on vaccine review and approval and logistics of manufacturing millions more doses of vaccine. he has been instrumental in helping reach president biden's goal of 100 million vaccinations and 100 days. congratulations on that. he brings to his role a wealth of experience from his time serving as commissioner of food and drugs under presidents george h w bush and president clinton and from his work on a range of public health issues like hiv-aids, tobacco regulation and helping americans improve nutritional habits. dr. kessler completed his jv at university of chicago law school, his md from harvard medical school and his residency

in pediatrics at johns hopkins hospital. we are glad to have you today. dr. peter marks is the director of center for biological evaluation and research for the food and drug just ration, a position he assumed in 2016 after serving as deputy director of the center for several years. he helped lead the center through approval of several groundbreaking treatments including the first cell therapy for advanced cancer, the first gene therapies, and the first ebola vaccine. dr. marks has played a critical role in the development of guidance for many of the -- vaccine manufacturers. dr. marks received his md and phd in cell biology and molecular biology at new york university and completed internal medicine residency in hematology and oncology fellowship at brigham and women's hospital. after completing training, dr.

marks worked as a clinician, scientist and clinical director for hematology at recommend women's hospital, and later managed adult leukemia at university and served as chief nickel officer of the yale new haven cancer center. we are glad to have you today. we will begin our testimony. dr. fauci, i will start with you. dr. fauci: thank you for giving me the opportunity to discuss with you the role of the national institute of allergy and infectious diseases, and research addressing covid 19. i think we have some slides, so if we could show them. if not, i will go without them. the nih strategic plan has four major components, proven fundamental knowledge of the virus, developing diagnostics, developing and testing therapeutics in developing safe and effective vaccines.

the first we will discuss is the characterization and testing of therapeutics. when one thinks about therapeutics for covid-19, one thinks first of early to moderate disease and next, moderate to advanced disease. in the first category, there are a number of interventions that have been approved such as remdesivir, or received emergency use authorization from fda, including monoclonal antibodies from lily and regeneron, and plasma received -- and convalescent plasma received an eua. -- a drive has shown

improvement in patients with advanced disease, including those requiring mechanical ventilation and heart flow oxygen. however, the future of therapeutics, we'll feel strongly -- we feel strongly, lies in identification of vulnerable targets in the sars cov 2 cycle and to develop drugs to inhibit those vulnerable targets. this strategy has been successful to a great degree with hiv drugs as well as drugs for hepatitis c. the development of safe and effective vaccines, next. although we have done very, very quickly with regard to the -- on very, very quickly with regard to development of a vaccine, work on the vaccine started literally decades before the january recognition we were dealing with a new virus. i refer to the role of the nih

vaccine research center and our large number of grantees and contractors who, for decades, were doing preclinical and clinical research to develop vaccine platforms, including the messenger rna which has proved so successful. in addition, at the vaccine research center, the ground breaking work -- the groundbreaking work of the stabilization of pre-fusion spike protein which fuse -- which served as the engine of five of the six vaccines in the united states but finally, we pivoted our niaid clinical trial networks previously established for hiv and influencer, and used them in extensive clinical trials for covid-19. this slide shows the three platforms in six companies that have not been used successfully

to develop the three vaccines they currently have an eu way with a high degree of efficacy and to good safety profile, as well as to others that are on the way. this slide is a prototype of what has happened with multiple vaccine candidates. it is an extraordinary reflection of scientific advances. on january 10, the sequence of the virus was known. 65 days later, the phase-one trial was started. july 27, two vaccines went into phase-three trial and in an extraordinary feat, less than one year later, they were vaccines that showed to be highly efficacious with a good safety profile. this is unprecedented in the history of vaccines and is a reflection not only of scientific advances, but extraordinary partnerships

between the public and private sector. although this is good news, there are challenges ahead, particularly with guard to the variants that have become very familiar to us. they are mutational changes in virus strains that challenge us, both from the standpoint of spreading more rapidly, having a greater degree of pathogenesis and even evading some monoclonal antibodies. but we can counter that in two ways. one, by vaccination, maintaining the immune response either by continuing to get vaccinations, or boosting potentially in the future. also and finally, as always, to continue to implement public health measures in the forms of masks, distance, avoiding congregate settings, and washing hands. i would be glad to answer questions, madam chair. thank you.

dr. kessler: members of the committee, i am dr. david kessler and am honored to be serving as chief scientific officer for the covid-19 response. for two years ago, i had the privilege of sitting in those seats behind you, as the most junior member of the staff of this committee, led senator happened -- led by senator hatch and senator kennedy. thank you for having me back, and for the opportunity to testify today. senator berger: could you make sure the microphone is on? or pulled closer? there you go. dr. kessler: today, the u.s. is in a very special position with

three authorized vaccine for prevention of covid-19. i want to acknowledge the significant work of those who came before and worked tirelessly to make this happen. if i could have the first slide, please. as you can see from that slide when we get it up, we now have enough vaccine available for all american adults by may 31. when we first arrived, at the president's direction, building on the work of our predecessors that are done, niaid, fda, hhs and the private sector, we made additional purchases of the pfizer and moderna vaccines, making 300 million doses of each available by july 31. working with pfizer and moderna, we were able to get

each country to agree to deliver 200 million doses each. that is 200 million regimens each, by the end of may. we also worked with johnson & johnson to help accelerate their delivery of 100 million doses by the end of may. to provide additional vaccine availability, we worked to forge a historic manufacturing collaboration between johnson & johnson and merck. i want to update you on three critical initiatives. first, as a pediatrician, we need to carefully evaluate data on the safety and effectiveness of the vaccines in adolescents and children. we are currently supporting multiple clinical trials to help us understand vaccine safety in p.a.d. after -- safety in pediatric populations, which is a high priority for us.

second, we are working to address questions about variants. while the current vaccines have been highly effective, we are also supporting studies on variants and efforts to produce the next iteration of these vaccines. we will remain vigilant and pursue options to protect americans if the need arises. finally, we are planning for potential boost doses of vaccines if they are needed. we are studying the durability of existing vaccines and their ability to maintain an immunological response. as with other vaccines, a subsequent dose may be needed. there are many options we can consider for booster doses. we are studying potential booster doses and planning now to have sufficient vaccine available if necessary. i look forward to working with members of this mentee as we

address the issues i highlighted. thank you for the opportunity to testify. i look forward to your questions. chair murray: thank you. we will turn to dr. marks. dr. marks: chair murray, ranking member burke, members of the committee, i am peter marks, director for scientific evaluation and research at the food and drug administration. thank you for the opportunity to testify to describe the agency's covid response efforts. all our efforts are in close coordination with partners across the government, to ensure development, authorization or licensure and availability of safe and effective medical products to address the covid-19 public health emergency. while my testimony will focus on fda work regarding covid vaccines, i want to note at the outset that this is in the context of the breadth of work

we are doing across the agency, including our work on therapeutics and diagnostics. with the urgency called for during this pandemic, fda, through our scientific review process, provided emergency you thousand was asian -- emergency use authorization, eu way for short, in approving vaccines. in doing so, we relied on rigorous standards of safety and quality. there may be differences using these three covid-19 vaccines, but it should be noted they were not compared in a head-to-head clinical trial. all three were found by fda and its external advisory committee to exceed standards for eua that we articulate in guidance and importantly, all did an excellent job in preventing hospitalizations and deaths from covid-19. following vaccine authorization

or approval, fda works with manufacturers to ensure critical supply. the agency does this by reviewing proposed manufacturing changes in monitoring the quality of the products. fda recently reviewed data submitted by pfizer to allow undiluted vials of the pfizer biontech vaccine to be stored and transported at temperatures commonly found in pharmaceutical freezers for up to two weeks. this will help ease the burden of procuring ultra-cold storage equipment for vaccination sites, and should help get vaccines to more places. fda also plays an integral role in the monitoring of safety of authorized covid-19 vaccines, doing so in collaborations wit -- collaboration with the cdc, center for medicaid services, department of veterans affairs and other academic and not governed until health care data systems.

in addition, fda participates in international pharmacological experts, including those organized by the international coalition of medicine at the world health organization. these are in addition to vigilance efforts taken up the manufacturers of the vaccines. given the importance of passive and active safety monitoring, a coordinated and overlapping approach using state-of-the-art technology has been implemented. this can be leveraged to assess safety in specific populations and vaccine effectiveness against variants. variants raise questions about covid vaccines, therapeutics and diagnostics. last month, fda issued new guidance and an up date to fda guidance on variants.

by issuing these, we want the american public to know we are using every tool at our disposal to fight this pandemic, including pivoting as the virus adapts. these guidances will help manufacturers develop medical products and provide health care providers with the best diagnostics, therapeutics and vaccines to fight this virus as variants emerge. we remain committed to getting these life-saving products to front lines. i would like to stress that having read vaccines authorized by fda only one year after declaration of the pandemic is a tremendous achievement and a testament to the dedication of a multitude of partners. these include fda career scientists and physicians, who have been working tirelessly to conduct rigorous evaluation of data submitted for vaccines to prevent covid-19. all of us at the agency are grateful to contribute toward bringing this >> thank you, dr. marks.

i will turn to dr. walensky. >> thank you, ranking member, for your invitation to talk to you today and for your leadership during the response to covid-19. i have had the honor of being the director of the centers for disease control and prevention for two months. taking on this role in the middle of a pandemic has presented no shortage of challenges and i am so grateful for the guidance of the dedicated staff and the deep expertise they bring. cdc staff continues to work tirelessly to respond to the covid-19 pandemic and i am committed to supporting their efforts to ensure that science and evidence drive our path forward. last week, we crossed the one your mark since covid-19 was declared a global pandemic. i would like to recognize the more than 500,000 american lives lost during the past year. that is .5 million mothers,

fathers, sisters, brothers, grandparents, and children who have died because of this virus. every loss is felt by grieving families, by friends unable to say goodbye, and by communities that have been devastated by this pandemic. while we have recently seen reductions in cases and deaths, we must remain cautious. the average daily death rate is tragically no more than twice the rate seen in september. we are in a race to stop its mission and the emergence of variants that spread more easily and it has made this even more challenging. i am committed to closely monitoring the proliferation of these variants in this country and around the world. we are doing that by rapidly scaling up genomic sequencing and we are well on our way to 25,000 samples per week. as we monitor disease transmission and variants, we are monitoring as equitably as

possible. having three vaccines that are highly effective at preventing serious illness, hospitalization, and death will help us end this pandemic. as of march 17, more than 100 13 million doses of covid-19 vaccine have been administered. over 73 million people have received at least one dose including 40 million who are fully vaccinated. this is a remarkable accomplishment and yet we have so much more to do. cdc is working in coordination with national, state, tribal, local, governmental, and nongovernmental partners to build trust in the vaccines, the vaccinator, and vaccination system. instrumental to this work is addressing barriers to vaccinations in communities of color and disproportionately affected groups. covid-19 has highlighted long-standing systemic health disparities and health equity must be a cornerstone of our public health work.

cdc is committed to expanding evidence-based approaches to reducing disparities in covid-19 cases, hospitalizations, and deaths. prioritizing equity in vaccine distribution and expanding a diverse workforce. this is not our first emergency. since 2009, the u.s. has faced four significant emerging infectious disease threats. the h1n1 influenza pandemic, ebola, and covid-19. while urgency demanded rapid and unique approaches in response to each of these threats, none resulted in the necessary sustained investments for public health infrastructure. this lack of preparation continues to present significant challenges in our ongoing fight on covid-19. if we do not act with permanent fixes, these challenges will continue to exist when the next public health threat emerges. i would like to leave you with four points today. first, cdc is leading with science and will continue to be the public health resource,

scientific resource, for the american public and for our international partners. second, we are expanding the reach of life-saving vaccines and improving vaccine confidence. to end this pandemic, we must maintain improving -- proven, effective prevention measures. masks, hygiene, and physical distance. health equity must be at the intersection of everything we do in public health, and i am committed to doing that as cdc director. we must work towards a sustainable investments in public health infrastructure to be better prepared for whatever comes next. i look forward to working together to address both the immediate challenges ahead and the deficiencies in our public health infrastructure that left our country vulnerable to this pandemic. we will get through this pandemic and i look forward to working with you to support cdc and address our public health challenges at home and abroad. thank you again for the invitation to testify today and i look forward to answering your

questions. >> we will now begin a round of five-minute questions of our witnesses. thank you all again for being here today. i asked my colleagues to keep track and stay within those five minutes. dr. fauci, we have spent over a year responding to the biggest public health crisis in a century. since he last testified before this committee, life-saving therapeutics and vaccines have reached patients with increasing speed and save lives. we must all do more to end this pandemic and build back stronger and fairer. the majority of people in this country are not yet vaccinated and the variants are continuing to threaten our progress as the nature of the pandemic and the virus itself changes. our response has to change, too. what is the biggest challenge ahead in our response to this pandemic? >> right now, the biggest challenge -- right now, the biggest challenge i think is

multifaceted. one is staying ahead of this virus itself. we are doing a good job, up to 2 million to 3 million vaccinations per day. the more we get vaccinated, every day that gets by, and more and more people get vaccinated, we can stay ahead of what i would consider a race between our ability to vaccinate people and the emergence of variants. we have variants that are well-established like the 117. the vaccine does very well against it. there were other variants that when you look at the antibodies induced by the vaccine, and the capability of essentially fighting against these variants, they diminished i anywhere from two full to sixfold. fortunately for us, the response to the vaccine has been so robust that there has been enough question that you likely would maybe not necessarily prevent infection but certainly prevent severe disease resulting

in hospitalizations and deaths. the challenge is to stay ahead of the variant. make sure it looks like we are adding better and better every day. get accessibility and implementation, getting the vaccine into people's arms. making sure that we do it not only quantitatively and with equity to underserved populations. there's a lot of activity right now that's focusing on making that happen. thank you. >> thank you. i have been really encouraged to hear good news about ranting up vaccine supply in the coming weeks but i want to ask about what the administration is doing to make sure people trust of the safety of covid-19 vaccines. we have to overcome skepticism about the science as well as active disinformation campaigns and false rumors. i want to ask dr. walensky and dr. kessler, how are you working to debunk misinformation about

vaccine safety and encourage people to get vaccinated? i will start with you. >> i think we need to understand exactly the reasons for lack of vaccine confidence and we need to address them at the local level. we are working closely with our state local health departments, resources from the american rescue plan will help in that regard towards education. we need to address vaccine hesitancy with regards to its roots. is it because people are not deeming it safe? people are sharing ideas of how they are addressing the local community and we are continuing in those efforts. we have vaccine confidence consults where we have people able to call in and get advice, received toolkits as to how they can promote vaccine confidence. thank you. >> thank you.

>> madam chair, we will have as a country, through the hard work of this committee and everyone who has come before, we will have within 90 days, in essence, quadrupled our vaccine supply. i believe that we are going to be shifting from a supply issue to a demand issue pretty soon. just as a pediatrician, i have dealt with the issue of vaccine hesitancy in children. i think it's very important that we understand that the american people look to their health professionals for guidance. we are approaching 100 million shots in arms. that is a remarkable number. and i think that one of the most important things that we can all do is when we look at those 100

million shots in arms, look at the remarkable safety profile. things can happen. we are ever vigilant. that's the job of my former agency and dr. marks, but i think that, to date, we can sit here in front of the american public and say, these are very safe vaccines. >> thank you very much. i will turn it over to the senator. >> i will start with you and i will work my way down. you and other experts have suggested that we need to get 60% to 70% of the population vaccinated to achieve heard immunity. if the numbers are higher now, can we reach the number without vaccination of children under

18, which is roughly 140 million americans? >> i would like to maybe backtrack a bit and i think we should be careful about wetting ourselves to this concept -- wedding ourselves to this concept of herd immunity because we don't know what it is for this virus. that is purely an estimate of 70% to 85% of the population. if it is that. we will probably have to get more children. as we get high school students vaccinated in the fall, we will be able to reach that. let me emphasize that comment. as i said in my response to chairman murray, that every day, we get closer and closer to where we want to be. we don't know where that magical point of herd immunity is but we do know that if we get the overwhelming population vaccinated, we are going to be

in good shape and you are right in your question that we ultimately would like to get children into that mix. >> david, we can both agree that operation warp speed is a success story of american innovation and ingenuity. what you see as -- what do you see as the biggest challenge we face? >> in the next 30 days, 60 days -- >> 30, 60, 90, and beyond. that's vaccine hesitancy. i think we will have to make sure that people understand how important being vaccinated is and how -- what the safety profile is. i was not convinced when i started but i am convinced now

that as dr. fauci said, we are in a race against these variants , and the most important thing we can do currently is to step up, not for us but for our families. and for our fellow citizens to become vaccinated. senator, in your opening comments, i think you hit the nail on the head. there are many things we can do to learn the lessons over the last year. i think it is a phenomenal story , but i think there are lessons to learn and i look very much forward to working with you and your staff to doing that. >> fda now has experience evaluating the message in the platform. a baseline understanding of the

technology. what steps will fda take to make sure that the technology does not have to go through approval again but knew indications would. if you look at our annual flu process, we use the same technology but with a different formulation on an annual basis and that is an expedited process. can you expect to see over time a similar type of approach to messenger and the clinical requirements only for the new indications? >> thank you for that question. i think we can say that that is the case over the course of time for the first couple of changes that might be made for variants, we probably will have to have some clinical studies. they will not be clinical outcome studies but they will be ones where we look at the immune response. once we understand how these

perform, we will not actually need studies and people will be able to do what we do for influenza. we have to get to understanding which pathogens go with which platforms. it turns out that the mrna platform seems to be very good for certain pathogens. it may not be good for others just as the virus that was used for the ebola vaccine seems to be very good for certain pathogens but not for others so we need to be able to do the science to understand that matching and that, in the future, will hopefully expedite this even further to rely on platforms that we understand. >> a quick question for the cdc if i have the intelligence of the chair. can you understand why the american people were somewhat baffled when it took three months for cdc to issue guidance

on what vaccinated americans should do, precautions they can take, things that they could -- that they could forget that you said were leaning on the science and the science suggested something. is that the norm in the future that it will be delayed like that or do you see that being expedited in the future? >> we are looking at the science as it emerges and evaluating the science in real time. our cdc guidance on what to do when you are vaccinated came when less than 10% of the american public was vaccinated. during a time of emerging variants and science, and during a time we were looking to see whether vaccinated people could transmit disease, we needed to see what that science was before we were able to provide that guidance. we were working in real time as additional science emerges to update that guidance as more people get vaccinated. may i just returned to the question of herd immunity?

the concept of herd immunity is an epidemiologic term -- that is the transmissibility of the virus. that turns out to be a moving target. as we think even conceptually about herd immunity, we need to understand that as we have more transitional variants, our target may change. if we look at children, if they are not as transmissible to young children, we may not have to vaccinate at the same level. i believe the children should be vaccinated. we have to understand the target. >> thank you very much, senator baldwin. >> thank you. it seems to me and certainly i have heard testimony from our witnesses today that one of the most significant threats to the progress we are making in this pandemic is the emergence of variants and mutations that could possibly elude the

treatments that will be developed and the vaccines that are being deployed. fortunately, the american rescue plan provides $1.75 billion for cdc to scale up efforts on genomic sequencing and surveillance. i was a proud champion of this provision because i think it is so important that we know what possible threats to our progress exist. dr. walensky, can you describe how the cdc will use this 1.7 $5 billion to combat emerging mutations and variants of the coronavirus? and also, give us a sense of how many of the positive test samples ought to be sequenced to

really have a firm grasp on the emergence of variants? >> thank you, senator, forgetting us resources to be able to do so. the initial 200 million given to the cdc to scale up sequencing, we are now doing somewhere between 10000 and 14,000 sequences a week and that is in collaboration with commercial labs, public health labs, academia. the additional 1.7 $5 billion is in fact essential to fund restrictions for next genome sequencing capacity, not altars for half the capacity. they want to scale this up across the country. we need to be able to scale up our own capacity within the cdc for sequencing infrastructure. for competent labs, for having scientific computing and i.t. in cdc so that we can use that infrastructure for when the next surge arises. we need to develop a workforce so that people understand how to

do genomic epidemiology. that is not standard education, what people standardly know. we need to develop that workforce. . the number of sequences depends on the amount of cases that you have circulating. we would like to be up to 25,000 somewhere in the 10% -- 5% to 10% for the amount of cases that we have. thank you. as the government looks to invest in supply chain resiliency using funds provided by congress for covid response and pandemic preparedness, we know one thing to be true, that we can no longer afford to have an inadequate domestic vaccine supply chain. while the delivery method will always be vaccine dependent, there are certain supplies that

seems to me makes sense to have advanced -- sufficient stockpiles of syringes, need all caps, and manufacturers must be able to rapidly surge production for a future pandemic without doing long-term damage to their broad customer base. can you describe some of the early obstacles that fda faced as a result of our overreliance on foreign manufacturers for critical medical supplies and what role do you think our national stockpile system could play in helping to maintain surge capacity for american-made critical medical supplies including those needed for vaccination? >> i have to defer some of the stockpile. there clearly was a critical storage -- shortage of vials and

other manufacturing equipment to move ahead and rapidly produce vaccines. i think that was part of what was overcome, a cooperative effort between industry and government partners early on in this pandemic. to try to pick up the pace on that but a key piece of learning for the future is that we have to start to rely on more advanced manufacturing technologies. allowed to scale up production not just for drugs and biologics but also for devices so that we can move more quickly. >> senator. >> please, go ahead. >> senator, if i can add, there is a very dedicated team, hhs, who spend their days in doing this for months, sourcing the globe for supplies in the rescue plan. there is a specific provision

that will enhance our ability to make sure, going forward, things like lipids that are key ingredients, that we will have adequate supplies prior to the time we need them. >> with your indulgence, i would just like to formally request that our committee receives a briefing on the state of the strategic national stockpile and that the administration will provide members with detailed breakdowns of supply chains associated with the current approved vaccine candidates including manufacturing locations. classified if necessary, i know some of the information regarding the national stockpiles is sensitive. >> thank you. we will do that. senator paul. >> dr. fauci, in a recent british study, david and others

say that no symptomatically infections from covid-19 after following 2800 patients for several months, there have been no reports of significant numbers of re-infections after acquiring covid-19. it concludes from his experiments that the amount of immune memory gained from natural infection would likely prevent the vast majority of people from getting hospitalized and severe disease for many years. in this study, the doctor showed that antibody levels stayed constant with only modest declines over six to eight months. notably, for the spike protein, they were detected in almost all covid-19 cases with no apparent half-life. in other words, they found significant evidence of long-term immunity after covid infection.

furthermore, it has been preserved for as long as 60 plus years. even 90 years after natural infection with influenza. the woman who got the spanish flu showed immunity years later. rather than being pessimistic towards people gaining immunity towards people who had covid or had a vaccine, studies argue for significant optimism. in fact, there have been no scientific studies arguing or proving that infection with covid does not create immunity. there have been no studies showing significant numbers of reinfections of the 30 million americans who have had covid. only a handful of reinfections have been discovered. the new york times reported last fall more than 38 million people at the time worldwide had been infected with the coronavirus and as of that date, fewer than five of these cases had been confirmed by scientists to be

reinfections. scientists interviewed for the article concluded, in most cases, a second bout with the virus produced milder symptoms or none at all. given that no scientific studies have shown significant numbers of reinfections of patients previously infected or vaccinated, what specific studies do you site to argue that the public should be wearing masks well into 2022? >> i'm not sure i understand the connection of what you are saying about masks and reinfection. we are talking about people who have never been infected before. >> you are telling everybody to wear a mask whether they have had an infection or a vaccine pit what i am saying is they have immunity and everyone agrees they have immunity, what studies do you have that people who have had the vaccine or infection are spreading the infection? if they are not spreading the infection, isn't it just theater? you are wearing two masks, isn't

that theater? >> here we go again with the theater. let's get down to the facts. the studies that you quote look at in vitro examination of memory immunity, which in their paper, they specifically say this does not necessarily pertain to the actual protection. it is in vitro. >> what study can you point to that shows reinfection? there are no studies that can show -- >> let me finish the response to your question if you please. the other thing is when you talk about reinfection and you don't keep in the concept of variants, that is an entirely different ballgame. that is a good reason for a mask. in the south african study conducted by j&j, they found that people who are infected with wild type and were exposed to the variant in south africa, the 351, it was as if they had

never been infected before. they had no protection. so when you talk about reinfection, you have got to make sure you are talking about wild type. i agree with you that you very likely would have protection from wild type for at least six months if you are infected but we and our country now have variants that are circulating. >> what study shows significant reinfection, hospitalization, and death after either natural infection or the vaccine? it does not exist. there was no evidence that there are significant reinfections after vaccine. in fact, i don't think we have a hospitalization in the united states after the two-week period after the second vaccination. we have a death in the united states -- >> you are not hearing what i'm saying about variants. we are talking about wild type versus variants -- >> what proof is there that there is significant reinfections with hospitalizations and deaths from the variants?

not in our country, zero. >> because we don't have a prevalence of a variant yet. can i finish? we are having 117 that is becoming more dominant. >> its policy based on conjecture. >> it is not based on conjecture. >> you have been vaccinated and you parade around in two masks for show. you cannot get it again. there is virtually 0% chance you are going to get it and yet you are telling people that have had the vaccine, who have immunity -- you are defying everything we know about immunity by telling people to wear masks who have been vaccinated. there is no science to say we are going to have a problem from the large number of people being vaccinated. you want to get rid of vaccine hesitancy? get rid of the masks after they get the vaccine. give them a reward instead of telling them that the nanny state is going to be there for three more years and you have to wear forever. people don't want to hear it. there is no science behind it. >> let me state for the record

that masks are not theater. masks are protective. >> immunity theater. if you are already having immunity, you are wearing a mask for others. >> i disagree with you. >> dr. fauci, if you could respond so we could understand the difference between the virus itself and the dr. fauci: i'm sorry? >> if you could respond to the question so we understand the difference between the vaccine controlling the wild type versus the vaccine and reasons for wearing a mask. dr. fauci: first of all, when you have a variant, you have an immunity that you get with convalescent. and if i vaccinate you and me against the wild type, you get a certain level of antibody that's specific for a particular viral strain. if there is a circulating variant, you don't necessarily have it.

you have some spillover immunity, to be sure, but you diminish anywhere from two to eight-fold the protection. so the point i'm saying is that there are variants now circulating. the point that senator paul was making was that if you look at wild type only, there is some clear cut credence to what he is saying. but we are living right now in a situation where we're having a dominance of 117, which was the original u.k. we have a troubling variant in new york city of 526. we have two variants in california of 427 and 429, and we have a number of others. we're not dealing with a static situation of the same virus. that was the only point i'm making. >> thank you. senator murphy. >> thank you, dr. fauci, for setting an example over the course of the last year for americans. you have made it clear that

masks save lives and the example you have set that has not been followed by other leaders in this country have made a difference, have kept tens of thousands of americans from contracting this disease, so thank you. i wanted to turn to the question of the massive contracts that we've signed with vaccine makers and to talk a little bit about the path forward. pfizer reported about $9.6 billion in profit last year. moderna, a very small company before entering the vaccine market. there chief executive owns shares that are -- their chief executive owns shares that are worth about $500 billion. thank goodness for these companies. they have saved lives. at the same time, we want to make sure we are making wise use of taxpayer dollars, and so i'm

going to direct this question to dr. kessler and others can weigh in. dr. kessler, do you sort of understand what the difference is between astrazeneca and johnson & johnson, who said they are pursuing a nonprofit model this vaccine versus pfizer and moderna, who, i assume, since they haven't made the same statement, are producing a for profit model. help me understand the difference between the two. dr. kessler: senator, all those are good questions, and you have every right to be -- what's the right word -- confused, because it is very confusing. i lived very much in the 1990s. we worked on hiv when i was at fda and chaired the pediatric

aids foundation, so we cared about getting drugs in that instance to the world. that led to something called tiered pricing. you will see there are multiple numbers. there is this that is cost, there's cost plus, there is a not-for-profit cost, and all of those have, very honestly, different definitions. i think the most important thing to stress right now, and i have been no defender of the pharmaceutical industry and certainly on pricing over my career, but i think the fact is that this committee, the congress, you allowed the administration to go at risk, right?

the administration bought different vaccines regardless if they worked, at the best price. the reality is thank god for that, because we are in a very fortunate position today. i am sure, with hindsight, there are a lot of legitimate questions, and we have to do better at understanding these prices, and i pledge to you, we will do that. it's not an easy answer. sen. murphy: i understand. because i've got a minute left, let me ask two quick follow-up questions. on an earnings call last month, when asked about profit margins for the vaccine, the chief financial officer at pfizer suggested the company was going to "get more on price" after he what -- after what he called the

pandemic pricing environment. one analyst projected the company could make vaccine prices three to four times higher than they are today. do you believe that we have the ability to keep vaccine prices at a point that is favorable for the american taxpayers? and then what do you think about making these contracts disclosable? it's sort of hard for the american public and outside groups to do oversight when they can't see the contracts. dr. kessler: i can tell you, senator, the president believes very firmly in making sure that there are affordable medicines and vaccines, and we will work very hard. it's my understanding that the contracts are publicly available, albeit with redactions. i'm happy to work with you to even improve on that. sen. murphy: great. i appreciate it. i know this administration has a

commitment to getting the best value. obviously the priority is getting shots in people's arms, so let's not let the perfect be the enemy of the good. at the same time, hearing we might be looking at three to four times the amount of price as we move into booster shots or childhood immunizations certainly be something we should pay attention to. i appreciate it. >> thank you. senator collins. >> dr. walensky, the cdc school of reopening guidance has been at odds with what many public health experts are recommending. when we discussed this issue recently, i really detected a lack of a sense of urgency on your part to reopen schools.

let me share a little bit with everyone here what the public health experts are saying. in "usa today," four prominent school reopening guidance released by cdc is an example of fierce influencing and resulting misinterpretation of science and harmful policy. the american academy of pediatricians cautioned against if that forces students into remote learning. dr. jha, who testified before us just last week, said in an interview that the guidance, quote, didn't feel to most of us in the public health world as particularly well grounded in evidence and science. maine's own cdc director made the point to me that children are less likely to contract covid in schools than they are in other settings.

dr. jha also said that we were focusing on the wrong things. we should be focusing on mask wearing, ventilation, and he said, i did not mention three feet versus six feet. i did not mention deep cleaning of surfaces. there is a lot that's going on that has gotten us distracted. we can keep teachers safe, we can keep kids safe. we can open schools and we have the ability to do that now. in the meantime, the negative effects on our children continue to grow. and i'm not just talking about the lost learning, i'm talking about social development, i'm talking about behavioral problems, stress on the children, on their parents. a hospital administrator in maine told me just yesterday that they're having children dropped off at the emergency

room with behavioral problems and the grandparents or the parent who brought them just driving away, just leaving them there. we have got to get the schools reopened. and you've presented no timeline at all for doing that, and the cdc recommendations, particularly on physical distancing of at least six feet, are just not in sync with what most public health experts are recommending. so i'd like to know what you're going to do and when to get our schools reopened. >> thank you for that question. thank you for the conversation we had, and i'm very sorry it appeared like it wasn't urgent to me. i'm a mother of three, one of whom has been home this entire year. this is an urgent issue.

i understand the mental health challenges, i understand the educational challenges, the food insecurity -- this is urgent. please don't get me wrong, this is urgent. there was a study out of wisconsin that demonstrated in schools that in a time of high disease prevalence, that with 92% mask wearing in classrooms, we could get children back to school safely. there is a similar study from georgia that shows without masking and without the proper mitigation strategies, our outbreaks in nine elementary schools -- there were outbreaks in nine elementary schools. schools that were doing well and were open, we wanted to keep open. as we released this guidance several weeks ago, it was intended for schools to lean in -- for schools that were clamped shut to use this guidance to decide what mitigation strategies they needed to do,

recognizing that the mmwr that we reported several weeks ago, 60% of students were wearing masks in classrooms. we needed to get those numbers up if this was going to be done safely, and this was the road map to do so. on the question of three feet and six feet, we looked for science to determine what was the proper distance on the question of three feet and six feet. as you recall, there were about 250,000 cases per day and many of our community were in a high rate of community spread. we agree on the science that the spread was happening less in the schools than the community. just last thursday, there was a study from massachusetts in a place where there was about 100% mask wearing that three feet and six feet yielded the same amount of infections, so that was the first study we looked at on three feet versus six feet.

because six feet has been such a challenge, science has leaned in and there are now studies of 3 feet versus six feet. i'm aware of several that will be released in the next few days and we are looking to our guidance to update that science. sen. collins: you need to do it now. i agree with you on mask wearing, but i really wish you would look at this testimony and what these public health experts are saying. thank you. >> thank you, senator collins. >> thanks to the witnesses. i generally don't like to respond to a colleague after the colleague has left the room, but the public is watching this hearing. i want to get into this mask issue briefly. i have had covid and have been vaccinated and i wear a mask. i wear a mask to make other people feel safer, even if there weren't variants. i went to my grocery store during senior hour when there

are not a lot of people there. my grocery clerk, who cannot telecommute, is petrified about getting covid. she stands eight hours a day a few feet away from people in line, and she's petrified. she doesn't want to take covid home to her child in the small apartment where they live. she doesn't want to take covid home to her mother, who also lives in that small apartment with her. maybe 30 million americans have had covid. that's the reported cases, so say it's double, say it's 60 million. hundreds of millions of americans have not had covid, and they are afraid of getting it, because they have seen 500,000 people die. they have seen a whole lot of people suffer and they have seen people lose their jobs, lose their income, lose their business. there's people in this room who haven't had covid. it makes people around you feel

a little bit safer, it makes my grocery store clerk feel a little bit safer if people she's standing a few feet from every day are wearing a mask. is that so hard to understand? is it so hard for us to do? we don't care about these workers? i mean, if she saw me come through with no mask, she would be afraid, and i could say, look, i've been vaccinated and i've had covid. maybe she isn't reading the science about what that means. it's just such a minor thing to do to try to protect the hundreds of millions of americans who are deathly afraid of getting covid. that's a reasonable fear, and this is a reasonable step that we can take to try to bring down the fear level that people legitimately have. so i have two issues i just want to put on the table and i would love any of you to address them. they are long-term issues. there will be a day when a president will say the public health emergency is over. there will continue to be a very long tail of consequences on people's mental health. seeing death, seeing illness,

losing their jobs, losing income, isolation. that will be a long consequence. many members of the committee have worked together on this already, but we think we have more to do. second, many americans who have had covid will have continuing symptoms. i have these weird neurological symptoms a year later. they're not debilitating, they're not painful, but they're weird, and they're 24/7. many people have symptoms that are more serious, heart impairment, respiratory impairment, impairment of mental functioning, fatigue challenges. how should we as a committee, how should we as a nation, how should the institutions you work for be thinking, planning, investing in these two sets of consequences, mental health and the physical covid long symptoms? dr. fauci: let me address the one you mentioned about the

persistence of post-covid sequelae, which is a really serious and real issue. it's not imaginary. it varies from person to person. the nih, with the generosity of the congress, has invested $1.15 billion in collaboration with the cdc and other agencies in looking at the scope of this real phenomenon, this sequelae. what their ultimate path of genesis is, because we don't know what the mechanisms are. you mentioned a weird neurological symptom. we're not sure what that is and we're putting together large cohort studies to be able to find out what the incidence of it is, what the variability, what the range of organ system dysfunctions are and what the underlying pathogenic mechanisms. it's really puzzling, senator, because it's different than if someone is in icu and has lung damage and you have pulmonary abnormalities or cardiomyopathy

and stroke volume is down. it's different. people who recover have the virus no longer there and have a persistence of chronic fatigue, muscle aches, temperature disregulation, funny neurological issues they can't explain. that's what we're really focusing on in cohorts of tens of thousands of people. so we are looking at that seriously. dr. walensky: maybe i'll chime in on the mental health side and say we need to collect the data and understand in real-time what the impacts of this are. we need to work with our state and local health departments to ensure that the resources they have can be disseminated to their local jurisdictions, that we have tool kits on culturally sensitive prevention strategies for prevention of depression, toolkits for mental health, resources to provide -- we need to get those into the local jurisdictions.

we are working to do the science, and cohort studies, as dr. fauci noted, on mental health issues as well as the long haul issues. >> thank you very much. senator cassidy. sen. cassidy: thank you, all. you are generous in your comments of the previous administration's efforts, so thank you for that. i have to admit the chairwoman's opening comments would indicate operation warp speed was a biden administration effort. obviously it's not. dr. walensky, i want to point out as we speak of equity, the pfizer vaccine tracker shows the greatest hesitancy for the vaccine right now is among those in the rural areas and republicans. for some reason when people speak about equity and outreach, those folks never come up. i know you are aware of that,

but i want to say that for the record. a survey group recently found if you present them with facts over and over again, they will be persuaded, but they need to be spoken to by trusted folks. i'm not scolding, i am just pointing that out, because that is a need. dr. fauci, always enjoy your comments. dr. kessler, we've spoken before. it's a mixed message that we know we need to test in children, but we know the incidence among children will be so low that it could be difficult to have an outcomes-based result. if the incidence in the community is so low, no one is getting infected anyway, how do you compare a vaccine versus placebo group? that begs the question, we need the kind of surrogate marker, those b-cell and t-cell markers that would correlate with immunity.

i am struck there is a letter to the new england journal of medicine in which it says antibody response in a material positive persons after a single dose of the mrna vaccine, showing that anti-body after someone infected shoots up after someone who has never before been infected. a second dose does not improve that, it just stays flat. where are we in establishing a surrogate marker that could be used to see if children are immunized related to that? where are we in establishing that if you have been previously infected, if we have a shortage of vaccine worldwide, it would be very important in asia and africa, mexico, to know that if someone was previously infected, at the most they would need one more dose of a vaccine.

it seems like we are being fairly conservative about this. will we have answers? i'm not scolding, i'm just asking. dr. fauci: thank you for that question, senator cassidy. you make a very good point and we will get -- what you're referring to is a correlate of community -- correlative immunity, the surrogate marker. we're collecting data of trials we did in adults that clearly showed a high degree of efficacy that is associated with a very high degree of neutralizing antibodies, measuring also t-cell responses, but mostly neutralizing antibodies. when we get a firm correlate of immunity, we will be able to answer the question you say about what sort of surrogate marker we can tell someone is actually protected. i think in the next couple months at the latest, we're going to get that data. sen. cassidy: you say a correlate. you already correlate the

association the increase in anti-body and some sort of proliferation of the t-cells. presumably these are neutralizing antibodies similar to those used in the monoclonal anti-bodies. what information do we need? obviously the sooner we know this, the better. i have been infected. i really did not think i needed the vaccine, but my wife told me to not come home unless i took it. but we could have given that vaccine to somebody else. when do we think we will have it? what will be in addition to that which we already know? dr. fauci: another good question. in the long run, the real proof in the pudding is when the level of antibody goes down below a certain level. if you still have protection, that means there isn't a direct correlation with the height of the antibody level. sen. cassidy: that's not necessarily true. if i may, and in all due

respect, what you really want to know is if there is memory when you are exposed to the vaccine, and in that window your -- it seems like that could be easily done with the folks infected now. dr. fauci: you are quite correct. the example you gave is an excellent example of people who have been infected, and even if you look at them and they don't necessarily have a high level of antibodies multiple months later, when you vaccinate them, their level goes up 100 fold as opposed to tenfold. it is extraordinary. that means they have more competent memory b-cells than they do level of circulating anti-bodies. sen. cassidy: that is what always happens. i guess i'm asking since we know that's the case, and you've already seen evidence of it, it

seems there is great hesitancy to admit, if you will, that this could be protective when we know the same is true of other viruses. your antibodies falling to zero does not mean you are not protected, your memory b-cells will quickly proliferate. this has such implications for how we use our vaccine now. if you could answer this and i'll yield back because i'm out of time. dr. fauci: you are making good points, senator cassidy, but since this is the virus for which we don't have previous experience, it is risky to make an extrapolation to influenza or others. it is conceivable it will match what we have seen with other viruses, but we don't know that has a definite scientific fact yet. sen. cassidy: i yield back. thank you. >> senator hassan. sen. hassan: thank you, madam chair and ranking member per for

having this meeting. thank you to all of our witnesses for your extraordinary hard work and commitment to helping us get through this pandemic and beyond. i also want to take a moment to thank senator kaine for the comments he made about the importance of mask wearing as we continue to combat the pandemic, as somebody with a highly vulnerable family member who is cared for by a woman who is 80 years old, i have been holding my breath throughout this, and the fear is real, so i'm very grateful to you, senator, for your comments. dr. kessler, earlier this month i led a group of my colleagues in writing a letter to the departments of health and human services and justice to urge them to address serious barriers for individuals with disabilities in the covid-19 vaccine distribution process. this letter followed reports from constituents in my home state of new hampshire that they could not access the vaccine registration website using a

screen reader, which is a crucial tool for people with vision loss. ensuring that individuals with disabilities in other vulnerable communities can easily register for appointments and access vaccination sites is essential for equitable dystrophy should of the vaccine. how will the federal government partner with states to improve access to the covid-19 vaccine for individuals with disabilities and older adults? dr. kessler: absolutely key points. no doubt we can do better on that. i think we have all been frustrated getting appointments, people staying up throughout the night, refreshing their computers, trying to get appointments. what we've been trying to do is to increase the number of access points, increase the number of vaccinators. as you've heard, we are going to

increase not only the number of appointments, the vaccinators, the number of sites, but also working on the information systems. this was a mad dash getting this out, and what you see is just very real, but there is a real commitment at the state level, at the federal level to improving those information systems and the ease of use, right? we have to do better. sen. hassan: i appreciate that. i also want to point out that as a civil rights issue, the american disabilities act does apply here. it is quickly important that whether it is telephone systems that someone that has a hearing impairment can use or a screen that someone with a visual impairment can use, or a vaccination site where someone has a difficulty being exposed to bright lights or loud noise for a long time have a place

to be. we'll talk another time about how far health care divisions have to go generally, but for vaccinations right now, it's an issue we're hearing a lot by constituents. i wanted to bring that to everybody's attention. let me move on to another question for dr. kessler and dr. fauci. you mentioned we will need booster shots for covid-19 and future variants of the virus. are there additional steps we should be taking now to ensure americans will have timely access to any necessary covid-19 boosters and make sure they will understand the importance of taking them, including when the current public health emergency declaration ends. dr. kessler: first, we are

looking at the data. we know, at least for some of the vaccines, that there appears to be durability at the six-month point. the reason i use the six-month point is because that's how long the first people have been immunized, so we're continuing to monitor that. and i think what we see -- the good news is that durability seems to exist. there is a slow decline and there is some variability between individuals. so we can't sit here today and tell you when, and definitely there will be boosters, but i think we have to plan for it, and i think at some point, my colleagues, it may be more likely than not that at some point we will need to boost with the durability. it depends on a number of questions. so we need to make sure that we have enough vaccines in the

cupboard that are ready to go when we need to do that, and we are doing that planning, senator. sen. hassan: dr. fauci, i know we're short on time, but if you could comment. dr. fauci: i agree completely with dr. kessler, but one thing that adds in the mix of variability, there is a significant degree of variability across the population in the responsiveness to the original vaccine. remember, we have a lot of people in this country who have underlying conditions, many people are on drugs for autoimmune diseases, cancers and things. they get vaccinated, their level of antibody may not be as high or a multi fold lower than an otherwise healthy person. that person would likely need to be boosted before the others. there is a considerable amount of variability. what we need to find out is what's the minimum cutoff? where is the point where absolutely you have to start giving?

we don't know that yet. -- start giving boosters? a healthy person may hang up there for months and months and months. somebody who is on chemotherapy for cancer or for an autoimmune disease may come down. that is the point. dr. walensky: cdc has active toolkits and playbooks for folks with disabilities. we are working with our partners and jurisdictions to make sure vaccine sites have equitable access, so i wanted to let you know those resources are available. >> thank you. senator murkowski. sen. murkowski: thank you. it is not often alaska makes the news in the good news category when it comes to health and statistics, but we are number one. we have moved out front in terms

of vaccinations of alaskans. 18.9% are fully vaccinated. 28% have received their first vaccine. we have some communities approaching 90% vaccination, so we're pretty proud of that. the rest of the country is looking at the model as to how we were able to do it, open it up to everybody over 16. you don't perhaps need to follow the model of us delivering the vaccine to the clinics by way of snowmachine with a sled in back, but the model is good and it's one that has demonstrated how quickly we can move out. the vaccine guidance and the vaccines shots in arms has given us kind of a ray of hope here. spring is coming, vaccines are getting in arms and people are feeling better, but the economy is still struggling, and the guidance that seems to be coming is not perhaps consistent with what we're seeing on the ground,

or this is what alaskans are sharing with me. we have a significant tourist industry. we want people to come up. we want them to be safe. we are going to encourage all the continuing protocols, but we've been struggling in trying to get the economy back when 60% of your tourists that come to the state of alaska come by cruise ship. we have a conditional sail order in place, effectively a no sail order. we had an opportunity to speak with folks on your team, dr. walensky. alaskans are saying -- they are asking for some kind of guidance in terms of a timeline, a timeline so you can know to plan. the hundreds of small businesses that are reliant on these tourists coming up, do they open up, or do they acknowledge that this will be the second season in a year where they will have

nothing, and effectively nowhere to shutter their operations now. when we are talking about health impacts, we want to follow the guidance in the science, but there is also this recognition of the economic impact. certainty is helpful. we haven't had much certainty with this virus and it's been challenging. can you give me any kind of guidance to get alaskans in terms of what we might be able to expect with where this guidance is in the process? when you say later, does that mean at the end of 2021? does it mean in three months, one month? what kind of guidance can you provide when it comes to the cdc 's order as a relates to the conditional sail order? dr. walensky: thank you for that question. first of all, i am -- i understand the economic impact of the no sail, the conditional

sail, and the travel. and so we don't take that lightly. we have provided technical assistance on the conditional sail, where we've provided a four-phase strategy for how we could get sail open. we are in phase one of that, moving into phase two. this is an inter-agency decision. it is not solely up to the cdc. the decision is not solely up to us. sen. murkowski: going to that second phase, can you give me some indicator in terms of a timeline there? dr. walensky: i can't simply because i don't believe it is solely in our jurisdiction to address. it is not necessarily a cdc -- sen. murkowski: who else is part of the decision-making process beyond cdc? dr. walensky: i believe department of transportation, numerous others who are making these decisions. sen. murkowski: i want to follow up with you, and i know we have an opportunity for that later,

and i'll look forward to that. but, again, you need -- cdc's role is to work through the health safety. we understand and we respect that, but just trying to gain some sense as to timing. quick question for you with regards to vaccine hesitancy. we've got alaskans vaccinated, they're ready to go. understand that, okay, we have to keep masks on, we have to continue social distancing, there is still the issue of whether or not the guidance for the schools is going to allow kids to get back in. one of the things i am hearing from folks is why am i even going to bother getting the vaccine when after i am fully vaccinated, everything is still the same? i'm told it's not safe to be on an airplane or a cruise ship. if i'm exposed to someone who has the virus, i still have to quarantine, maybe not for as long a period.

how much of the guidance that we have in place, and to senator burr's point, about how long it takes to get that clear guidance, to senator collins' point about the school guidance and the reopening. is that contributing to the hesitancy that we're seeing? dr. walensky: thank you for that question. i think there are a lot of reasons for vaccine confidence. we articulated some of those earlier, convenience, speed at which this happened, and personal, you know, concerns about side effects and whatnot. i do think, as more people are vaccinated, we are working to move forward on that guidance. the initial guidance was put forward with just 9% of the population vaccinated. that allowed for small gatherings for grandparents to hug their grandchildren, even if they have been vaccinated.

one of the things that's been challenging with travel is, as i think people are aware, last friday was the busiest travel day of the season since covid-19 was declared a pandemic in march of 2020. 1.3 million people traveling through our airports. this just at a time when we have still 50,000 cases a day and we know our variants have traveled through these airports, we know that travel is a time when people -- not necessarily in-flight itself, but travel is a time when people bring these variants to other places. vaccinated people will likely travel with unvaccinated people. we had surges after july 4, after labor day, after the business holiday, and we want to make sure we're doing it safely. we're actively reviewing it now. sen. murkowski: i am well over my time. thank you. >> senator casey. sen. casey: i want to thank the

witnesses not only for appearing, but for your service to our country. i have two questions. i'll start the first one with dr. kessler and dr. walensky, and this comes right from home. local communities asking me to ask this question. as vaccine production increases dramatically in the next couple months, and that's good news, and the venues in which people are vaccinated increase, it's critical every stakeholder in the distribution and administration process have access to the data they need. at the state and local level, that includes getting data from the federal government, not just about the vaccines allocated to that jurisdiction directly, but information about vaccines that will be flowing to that jurisdiction through some of the direct federal partnerships like the programs for federally

qualified health centers and retail pharmacy partnership. here's the question for dr. kessler and dr. walensky, will you commit to ensuring transparency of this information to assist state and local leaders in axing campaigns within their jurisdictions -- in vaccine campaigns within their jurisdictions? dr. walensky: those vaccines are allocated directly to the states. i have been on weekly governor's calls where we have provided the governors a three-week timeline for how many vaccines they can expect in this week and two weeks after this week. that is the first time this happened during this administration so we have been able to give governors a line of sight so they can plan three weeks ahead of time. there is also allocation to federal agencies, the department of defense and va and bureau of prisons and fema, and then there's allocations that go directly to federally qualified

health centers and the federal retail pharmacy program. those decisions are made after extensive deliberation and discussion. they are made by the operation, but those discussions happen at all levels of hhs. thank you. sen. casey: dr. kessler, anything you wanted to add? dr. kessler: the answer is yes, we commit to that transparency. the administration is looking ahead three weeks. the reason why it is late three weeks is the realization the vaccine is being made real-time, it is coming off the line, and there are projections. we have every confidence we will have enough vaccines, but it is a very human process. biologics have to be made carefully, so we are making projections three weeks ahead of

time. we want to be fully transparent on what we see coming, and we are trying to do that. sen. casey: i guess my last question and try to ask in the raining time of dr. fauci and if others want to chime in if we have time, but this is projecting the biggest challenges we face, the most urgent and difficult. i realize there can be multiple at the same time. dr. fauci melania look forward down the road in a few months just in terms of the public health challenge we have, how would you rank or itemize the challenges we face, are you more concerned about the impact of variants or the struggle to get people vaccinated, or is it both or other worries that i have not articulated? >> i know others may have spoken

to this earlier, but i would like to get your view. dr. fauci: thank you for the question. there are a couple things that concern me, and probably the one that is most prominent is my concern that we will declare victory prematurely. if you look at the dynamics of the outbreak, it's a very, very high peak that we had following the holiday season that was expected to have a peak, but it went up to 300,000 to 400,000 cases a day at one point. it is coming down sharply now, but we seem to be plateauing at a level that is unacceptably high, around 50,000 cases a day. this happened in previous surges where you come to a high level and then start to surge. europe is three to four weeks ahead of us in the dynamics of

the outbreak. what they saw was a plateauing. they were coming down nicely, then they plateaued. they then started to go up. a couple weeks ago they had a 9% increase. now they have a 5% increase. i'm concerned if we pull back in our enthusiasm for the fact that vaccines are rolling out and things look good -- if we pull back prematurely, we could trigger another surge. that would set us back in the things we are trying to do. >> senator braun. sen. braun: two questions. one, you can sense the frustration from senator paul, murkowski mama many of us, because we don't -- murkowski, many of us, because we know we don't have complete data.

in the top level way i'm looking at it, we have to get to herd immunity through natural infection or vaccination. if the conferred immunity is going to be about as good as vaccination versus getting the infection, i am taking 30 million as the number of cases tested. i would like your opinion on how many completed vaccinations there have been. the big variable, how many untested cases to get to that 250 million. like your opinion on those numbers. when you can give us a little bit of certainty, it gives us hope to stay tough and get through it. second question is if vaccinations are not as effective as we want them to be due to a cascade of variants, then do we need to turn our attention to therapeutics if this is going to be something we

battle with over the long haul? dr. fauci: thank you for that question. i want to harken back to what i said some time ago to senator burr and some of the comments dr. walensky said about the magical terminology of herd immunity. we could get to where you and senator murkowski and others want to get without necessarily reaching this arbitrary percentage, because it will depend on a number of things. it depends on what the ro of the virus is. if you have variants that come in, and there are a lot of things that modify it. i like to look at it in a different way. i like to look at it in that every day we get 2 to 3 million more people vaccinated, we also still get people infected. if you look at all the people protected, we don't have to reach necessarily 85% of the population to get to the things you were asking for about your

businesses in alaska and about schools being open the way senator collins had said. we can approach that in a real meaningful way before we get to this magical number. sen. braun: do you think those that are untested, but out there? to be, that is the big variable. is it four or five, or is it two or three? if we have no idea, that is the biggest variable when you get to what you're talking about. what do you do in your modeling? how many untested cases do you plug into the model you are using? dr. fauci: see, there really is no model right now for herd immunity. it's purely an estimate. take measles for a second. we absolutely know what the level of herd immunity is for measles, because we had multiple instances where when you went below a certain protection in the community, you

had outbreaks. it is a highly transmissible virus. the vaccine is 98% effective, and when you get down below 90% of the population being immune , when you get into the 80%s, you get the kind of outbreaks we see in the new york city metropolitan area. we don't know that for the coronavirus. sen. braun: i understand that. if it seems to be an elusive thing to get through vaccinations and natural infection, where do we start putting more emphasis on therapeutics? dr. kessler: there's a fundamental difference between measles and covid-19. measles is a virus that does not vary with time the way that covid-19 is varying, and the reason for having this issue of needing to have the best immunity you can and potentially vaccinating people who already had covid-19 is to get to high enough antibody levels to make sure that as the new variants

come along, we are not basically decimated by yet another version of covid-19 coming across the population, so it's essentially doing it right the first time to prevent another set of closures. sen. braun: which has a lot of uncertainty, timeline, indefinite. i think that's the tough thing that i think you guys have to contend with. let's get to the question of therapeutics versus vaccines. isn't that the way we finally hammered aids was with the therapy? a vaccine is never -- dr. kessler: for a global pandemic like we have here, -- i will defer to dr. walensky. don't get me wrong, we need better therapeutics. sen. braun: and/or natural infection, right? dr. kessler: we would like to avoid natural infections because we have this covid long hauler

syndrome. i would prefer not to have those people have those long-term effects. we would like to prevent natural infection by providing immunity through vaccination. sen. braun: you want to add anything? dr. fauci: i agree completely. the idea of treatment as prevention as we had with hiv doesn't work because you are dealing with an acute syndrome that lasts for a few weeks. you have a persistence of symptoms. treatment is important, because you don't want people to get ill . you can avoid the debts with good treatment. -- deaths with good treatment. >> i would like to note dr. fauci has to leave at 12:15, so we will get through as many as we can. senator smith. sen. smith: thank you very much. i think you almost promoted me to doctor. [laughter] i want to thank our panelists

for being with us today. as i have been listening to the testimony and the questions being asked, i am thinking about a conversation i had yesterday with the folks at a safety net health system in minnesota, level one trauma center in minneapolis. one of the things that one of the caregivers said has stuck with me. he said we are so worried here as we continue to grapple with the impact of covid in this community, that the world is going to move on. as dr. fauci and others have said, we are seeing in the neighborhood of 150,000 cases or more of covid a day and 1200 daily deaths. it is imported we stay vigilant. of course, look to where the good news is. i think we can do both of those things. dr. walensky, i want to ask you

something about vaccine distribution. this is a bright spot. tribal nations in minnesota have done an exceptional job in distributing the covid-19 vaccine. here is one example. one nation partnered with the county to distribute the vaccine and has now one of the highest vaccination rates in the whole state. what they did was established a joint task force with the county, helped to streamline vaccine distribution and manage the supply in order to get the vaccine out. today, on the reservation, where there is a mix of native and non-people living -- and they are a sovereign nation, so they set their own guidelines -- today, because of this close collaboration and the partnership they had, anyone who is over 18 who lives on the reservation has been able to be vaccinated.

another example is the mobile vaccination clinic. this is a northern minnesota tribe. they have brought their mobile vaccination unit to tribal members in duluth and minneapolis, those who don't live on tribal land. could you comment on why you think this is working and what this can teach us about addressing the challenges we see around the country in getting equitable distribution of vaccines? dr. walensky: i think, as i mentioned weeks ago, we had a vaccine fourm were -- forum where we talked about lessons learned. we had over 100 tribal participants. those are among the examples

where we can say this is community engagement, this is people getting the message from people they know, places they trust. this is part of why we want to engage at not necessarily only the state level -- we need to get down to the local level. people don't necessarily want to hear from me they should be getting there vaccine, they want to hear it from the local pharmacist, from tribe members. they may need to have it not just be convenient, but we visit it. -- revisit it. i am not ready today, but tomorrow i noticed five of my community members got it. these are important lessons we need to be learning and we need to replicate those lessons around the country. sen. smith: thank you. i couldn't agree more. one of the things that is important is we sometimes think

what we are experiencing is vaccine hesitancy when really we are experiencing a lack of access. i think it's important. dr. fauci, the minneapolis star tribune reported minnesotans are using websites for vaccine shopping. they are trying to figure out what is the best brand and shopping around for that, trying to figure out the benefits of one vaccine versus another. what would be your message to people trying to compare the efficacy of these different vaccines as they are making decisions about how to move forward? dr. fauci: thank you for bringing that up. that is an important issue. we have three highly efficacious vaccines with a good safety profile. it is not appropriate -- unde

rstandable, but not appropriate to shop around to see what you can get. the only way you know one is better than the other is do a head to head comparison in a clinical trial. my advice when people ask me is the most important thing is to get vaccinated as quickly as possible when your turn comes up to get vaccine. which particular candidate you get is not nearly as relevant as getting it as soon as you can. if you go into a clinic and they have anyone of the three available, i would just take it rather than waiting a few weeks to a month for something you think might be better. all three are highly efficacious. sen. smith: thank you so much. >> senator marshall. sen. marshall: leadership is

what america is now looking for. they are looking for a strong, consistent, honest voice from the nih, cdc, and white house. frankly, dr. fauci, the nation is turning its eyes to you for leadership. let's talk about schools. our schools, our youth are in a mental health crisis. a true epidemic. this was very predictable from the health care field that when we closed down schools, without the social interaction, we have seen an increased mental health crisis. let's talk about the sirens of viruses -- the science of viruses. as a practicing ob/gyn, i would tell you viruses are predictably unpredictable. how they impact a pregnant versus non-pregnant women is different. when i try to listen hard to you

all, the little science we do have is being presented as dogma, and we know it is not. it is anecdotal at best. all i heard today was anecdotal experiences. when it comes to schools, we need to hear a stronger voice from you all, from leadership, not a wishy-washy voice. dr. fauci, you agree with me that the benefits outweigh the risks of getting children back in school. will you tell america we need to get our kids back to school? dr. fauci: i have said that repetitively, as you know. you have obviously been following what i have been saying. i have been saying the most important thing we need to do is try as best as possible to get our children back to school safely. that is exactly what i have been saying in this room in previous hearings. the chair has heard me say --

sen. marshall: based on everything we know about the virus, you feel the benefits outweigh the risks of getting children into schools across america? dr. fauci: if you listen to the cdc's recommendations, that is what they are saying. they are talking about the benefits versus the risks. they are trying to get people to follow guidelines that will get children back to schools with minimum risk. sen. marshall: i was hoping a yes or no answer. president biden recently i will move onto masks. president biden recently said we should all wear masks until vaccinated. that is probably the worst thing to say for compliance. we americans feel like the goldline keeps moving, and i understand your fear of the different variants and all those different things going on, but

where is the science that clearly shows wear a mask's help after you have had the vaccine? for the sake of time, i need to move on, but i've heard the question asked already and i heard anecdotal evidence, but i would love for you to send me the studies that show that it is absolutely beneficial to wear a mask after you have been vaccinated or if you have had the virus. we all want to know -- where is the goal line? when can we stop wearing masks? i want to talk about the border, the. i just visited the border. it is a humanitarian crisis, and after anyone would agree with me that it is a national security crisis. i went down with a group of physicians three years ago or so. i was concerned about doctors and nurses being overwhelmed. i was concerned about tuberculosis, hepatitis, sexually-transmitted diseases and other communicable diseases, but based on what we know, the

instance of covid has spiked 21% in people coming across the border, and then i see they take a group of folks, 50, 60 people, put them on one bus, give them exams, and then put them in a dorm setting. if they don't have the virus, they soon will, and then we let them go out for the public. that just seems hypocritical. the application you're talking about for when we can let ships come into alaska and the variant from south africa, it seems hypocritical to me. while i respect completely where you're coming from, it seems like it is a double standard. are you comfortable with what we are doing on the border from an id standpoint? over, and it feels like a double standard. are you comfortable with what we are doing at the dr. fauci: the reason i have to hedge on that is because i'm not really familiar with the details of what is going on at the border.

if i was, i would. senator marshall: if i was, i would -- whose job is it to know that? >> i can chime in and say that i am aware that at cvp sites there's overcrowding and from an infectious disease standpoint we need to intensify what is happening there, and we are working towards getting them screened and tested, which is why they have -- you know what percentage positive rates they have there, and who is caring for them, we are providing technical guidance on the oor sites to work to make sure they are as safe as possible using mitigation strategies -- >> do you see the hypocrisy in what we are doing to america? we are saying i can't have a

barbecue with my entire family on july fourth, but we are going to let people come across the border in mass numbers and just release them into -- does that not seem hypocritical? >> i think there are two different situations that we have to handle in two different ways, and we have guidance and strategies for how we are providing technical guidance for the challenges that are occurring in the density at the border and we are trying to use the public safe using the evidence-based strategies there. >> thank you, i yield back. >> senator rosen. >> i would really like to thank all the doctors for being here and for their tireless service to our nation and their hard work in the studies, and i want to make the other comment that most of us here do understand that data takes time, good data takes time. coronavirus is a new virus. it hasn't been around that long.

we haven't collected all the data to show us what the trends or variants may be, and that good data that will help us do the predictions that epidemiologists and doctors like yourself will help to do, it will be there and i appreciate how quickly you are working on that, and we have to work on treatment options as we have more variants, and we know vaccinations need to go up and we want to reduce the deaths if you do contract the disease. you know, 5,100 nevadans have already died from covid and i don't want to see that going up. i have introduced bipartisan legislation to hopefully track a diverse set of covid patients long-term and report those findings on a regular basis. dr. fauci, i really appreciated

so much the conversations we have had in the past, talking about mono chrome annual antibodies. what is in the pipeline for those that may still contract the disease? >> i had outlined -- i will briefly repeat it -- in my opening statement that we have therapeutics with people with early disease, and the difficulty logistically is getting people enough to make it work. phaupb every study that has looked at the antibodies after a

person has disease advanced in the hospital has shown no benefit. we have good drugs for advanced disease, particularly the state of the art, and we have others under emergency use authorization. getting to the point that i think you are suggesting, senator, is that the real end game for this is to develop targeted anti-viral drugs very similar to what we did so successfully with the anti-vie virals for hiv. we have a couple candidates now that look good that had been developed previously that we are putting into phase 1, 2, and 2a and 2b trials. we need to do better on therapy and the strategy for the future is the direct anti-viral therapies that are similar to

what we did with hiv. thanks. >> i would like to build on that, then, because we hear about the long haulers or the long-term affects of covid-19. we see people really suffering from this. we know about 30% of all covid patients really continue to suffer from some form of ill-defined symptoms, prolonged fatigue, brain fog as some people are calling that, and it may render folks unable to go to work and it puts people at risks for isolation and other issues, and it could decrease their immune system. we have to be sure that we don't deny benefits to these folks who have the long-haul symptoms, but what can you tell about nih, how you are evaluating the long-term health consequences, and are there treatments available?

what is in the pipeline for those people? some people say they have a smell that is sour or rotten. what are you doing? >> we have a program that we are doing at the nih in collaboration with the cdc and following cohorts to determine the incidents, prevalence, and how long the systems last. some studies say they go out to eight months or longer. you asked a relevant question. what about the treatment of them? it's difficult to device a therapeutical regimen when you don't know what the underlying pathogen of the disease is, and that's the stumbling block and why we are intensely studying these individuals, and because it's a real phenomenon, we don't have any pathogenic mechanisms right now that we are certain of that has a commonality among all

of them, and when we do we will be able to device effective therapies. >> thank you for everything you are doing. madam chair, i yield back. >> thank you, senator rosen. >> thank you very much. thank you all for your service. kind of reminds me of my old job, 40 years of coaching college football, sitting here listening to a bunch of armchair quarterbacks, and everybody has an idea of how to run your job but thank you for what you are doing. this country is counting on you all, and several billion not in this country. so it's very important. you know, it just brings to the fact where we are in this country on the campaign trail for the last two years, i kept telling people, really the last

year, you know, that everybody thinks they are going to come up with a vaccine, and americans are going to come up with the vaccine, because that's what we do. but we need leadership. dr. fauci, you are the tom brady of the covid team. you have had good days and you have had bad days, and we thank you for what you have done. we just need leadership from you and consistency. everybody that i talked to, you know, they understand where you are coming from but sometimes we change in mid stream, and coaches can't do that, you have to stay what you believe in, so we just ask you to just be firm with us, tell us, you know, you had people in here today, senator rand talking about the mask, and tell us what you believe because we know very little about it. you know, the american people don't know anything about it. dr. walensky, you have a tough job in front of you and thank you for taking it on, really. again, this is not a republican or a democrat disease.

this is a worldwide disease, and we are -- our kids are hurting. i will tell you that. our kids are hurting. i have had friends that have died. i have had people go out of business. we have got to get this country back open as soon as we can. we can't drag our feet much longer, and we can't put people in harm's way either, we really can't. so thank you for what you are doing. i will reiterate what mr. marshall said, senator marshall said, about people in alabama can't understand why we are letting people in when we know some of the people have coronavirus, and we are a loving country and we love everybody and we put our lives and our country on the line and businesses and everything else on the line for the last year and for some reason the white house continues to let people in with this virus, and it's just mind-boggling to us that pay taxes -- everybody that pays taxes that we'll help them, but

this is not the time. this is not the time to do it. i think it's your -- you guys' job to go up and there say, listen, what are we doing? we can't do this anymore. we have to get people back to work and kids back to school and back to church and a normal life. we have a double standard right here that just amazes me. again, i don't have any questions. thank you for what you are doing. we're looking up to y'all and tell us what to do. please, tell us what to do and how to get through this because we have a lot of people in trouble, mentally in trouble, not just physically, but mentally. thank you. >> senator, can i make a comment in response to something you said that is really very important. >> when you have a situation that doesn't change, and you do change your mind and you are flip-flopping but when you have a evolving situation when the scientific evidence and data roll out and you learn more things in march that you didn't know in february that you didn't know in january, that's the

reason why you may hear us be saying things that seem to be different from one month to another, because you make a decision, you make a policy, you make a recommendation based on what's going on and the data at the time. so i just wanted to say that, because you make a very good point when you were talking about consistency. we try to be consistent but we have to be consistent with the data as it exists. >> the game plan changes, doesn't it? >> you bet. if you are playing against the zone or the man-to-man, it's different. >> you are exactly right. you are exactly right. but when you do change it, sell it and stick with it. that's what we are all counting on. >> thank you. >> we're counting on y'all. >> thank you. >> senator moran. >> thank you for being here and thank you for your service to our nation. dr. marx, it's nice to see you, and i will see you in the fda and the appropriations process,

and dr. kessler thank you for helping with the care for veterans and we are working to pass legislation in the senate last night arguing about spouses and caregivers for veterans, so that issue i raised with you is progressing. dr. fauci, i didn't have enough of you in the appropriations process so i joined the health committee. >> good to see you. >> thank you very much. let me ask you a question and then i will visit with dr. wow lynskey. -- walensky. >> you better than anybody knows the resources nih has devoted to compating covid-19, the research and the response. i would like to be reassured that despite that important work that the other things that are important to america that are led by nih research are not

suffering, so how would you -- how do you see the overall picture at nih during this time in covid-19? >> i think i would not be totally frank with you that i told you things are just exactly the way they were prior to covid, senator. there has been a dem tphaougs of activities for the simple reason that a lot of the clinical center, for example, is not going to full capacity for reasons that relate to the outbreak itself. as for as the grantees on the outside, we are continuing to support all the other diseases, cancer, parkinson's, alzheimer's, all of those are going well. but across the country, the same way other areas of our society has been dampened down a bit by the outbreak, the very nature of when you shutdown, you shutdown

a lot of things including accessibility, for example, of certain types of approach. i want to give you my absolute promise, and i am sure that dr. collins, were he here he will tell you the same thing, we give you our absolute commitment that we will do everything we can to make sure nothing important slips in the area of research. >> it's a matter of saving lives with covid and with the other diseases americans are inflicted with. dr. walensky, it seems important to me, and -- well, i have three hearings going on this morning at the same time, and i have heard most of the testimony and responses to questions, and i certainly am a promoter and proponent of people being vaccinated, and i think the cdc could be helpful if there are guidelines for instructions and suggestions for those who have

been vaccinated, current, consistent and timely. what is it that the cdc would tell somebody today, their behavior or conduct could change or what it should be following vaccination? >> thank you for that question, senator. about a week ago we released our first guidance, our first step on what you can do if vaccinated, and that includes things like small visits in your home and visits with other vaccinated people unmasked so you could dine with them in your home, and you can visit with unvaccinated people as long as people in their home don't have a high risk of severe disease, and we are still looking at data regarding people who are vaccinated could be asymptomatic infected and can transmit to other people, and in that case we wouldn't want you to be

living with somebody compromised on chemotherapy and what not, and we released guidance on the fact that you don't have to quarantine if you have been exposed and are vaccinated. so the quarantine has gone away with regard to people who are being vaccinated. we are revisiting what we should do regarding travel with those vaccinated, and that should be coming forward soon and that's going to be the next step in this regard. we have now 12% of the population vaccinated, and the initial guidance was released when we had 9% of people vaccinated. as more and more people are getting vaccinated, and as we are getting more and more data about the implications about investigation with potential transmission of the asymptomatics. >> i would ask you to be concerned -- this is true for

every agency here -- that is represented here. a rumor in today's social media world, a rumor about a problem with a vaccine, a consequence which could be false, but it's easy for fear to spread among americans, you need to be prepared with the science and medicine to respond quickly to put down a rumor, and i hope that's the case in all of your circumstances. >> thank you, senator. senator lou an. >> does wearing mask stop the spread of covid, dr. fauci? or help prevent the spread of covid. >> i dependant hear your question. >> dr. fauci, does wearing masks help stop the spread of covid? >> absolutely. >> should people keep wearing masks? >> absolutely. >> i think there's a reason, dr.

fauci, that even physicians when they are in surgery and practicing that they wear face coverings because it stops the spread of infection and i think it's important, and i wanted to make sure we gave you time to clarify that, after some of the previous questions that have been asked today. dr. fauci, first to each and every one of our panelists, including yourself, thank you for what you have been doing to save peoples lives and to defeat covid-19. there are a couple areas where i do have some concerns, and it's based on some of the data. according to the cdc, native american and latino populations, living in the united states are more than twice as likely to die of covid-19 and more than three times as likely to be hospitalized as their white counterparts, and despite the data showing us communities of color in the united states have been hitting harder with the pandemic, and they are receiving

less vaccines. you said the racial disparity was very disturbing, and given the resent polling there's little difference in terms of how much they want a vaccine and racial groups, how will the federal government and will the government increase the vaccine to native american and black and latino americans. >> it has to do with a number of things that are being put in place to allow equity and easy accessibility. for example, community vaccine centers in areas that are demographically represented by minority communities, and having pharmacy that are stocked with vaccines in areas where there are representation of minorities to a high degree, to have mobile units to go out into the community, particularly in those

areas that are under served and increase the number of vaccinators, be the retired military, retired physicians, nurses and health care providers, and this is a high, high priority for the administration to include equity into the vaccine program. >> i appreciate that response. while a do have some concerns and questions surrounding the decisions made by hursa with the initial 250 sites identified, including the first 25, i appreciate the expansion of the sites expanded to 700. with that being said, dr. fauci, i believe the cdc social vulnerability index, a measure that takes into account racial and socio factors. the state of new mexico

designated 25% of vaccine doses based on svi do you agree that using svi as a measure in allocating vaccine doses could potentially address vaccine disparities? >> i think it would, and i would ask dr. walensky since it's a cdc issue if you have comments on that. >> yes, we are using svi as a mechanism to include fema sites, and we have a benchmark svi, and we are looking at that data for distribution. we know we have work to do in this area, and while we are looking at the data we also know we don't need the data in order to improve because we know we have improvements to make. >> i raise my concerns about the

initial decision with the first 250 sites, and the first 250 in new mexico was only identified with one center. dr. kessler and dr. walensky, can i get your commitment today that future programs focusing on vaccine equity will also focus in rural regions as well? >> maybe i will just chime in here and say i was pleased yesterday when cdc announced $2.25 billion in funding to go towards testing in areas that need it more with regard to health equity. this was the first time we have been able to give directly 19% to the funding in rural jurisdictions, and it is actually leaving a workforce capacity in those areas. >> can i get your commitment that future programs will make

that commitment to rural regions as well? >> senator, the answer is yes. >> that's what i was looking for. i very much appreciate the explanation there. >> thank you, chair, and i yield back my time. >> thank you, senator. guys, we are at the end. i do want to make comments to sort of tie together much of what we have heard today. senator kaine said about a reference to a woman, maybe she didn't read the science. well, i am going to tell you something you already know, most americans don't read the science and if they do, they are like me, they don't understand the data. i think there's a lesson to that and that is that when we put out guidance, when we make suggestions, you can reference to the science but you have to say it in a way that the american people understand it. it's not just the guidance that

we need, it's an explanation in a common sense way as to why that's the guidance today, so they can apply that to their own lives. two, senator murray said something really important, that we need to do everything we can to raise the confidence of the american people to take the vaccine. to you, dr. walensky, guidance contributes to that, to dr. fauci were he here a simple pitch if you take the vaccine, data shows you won't die and go to the hospital, and that's the most compelling thing to say, and we don't come up with words like that. now, these are my comments. i hope the vaccine policy will

change in the not-too-distant future with the appropriate focus on geographical under served needed areas, where the policy is we are going to stick the next person in line. now that we have addressed long-term care facility care, the most at risks, i fear, david, that in the not too distant future we will be sitting there with vaccines and no arms to stick based upon the inability of the americans to get through this, and you just say, i will wait until it opens wide open. i may be wrong, but what if i am right? i just implore all of you to begin to think through at what point do we pivot where we say to the american people, if you are over 17, then the vaccine is

available to you. you might have to go and stand in line or get a reservation, but i remember the day i walked into a hospital and their specialty was bypass surgery and they explained to me the first two surgeries in the morning spent the night in the hospital before, i said, why? they said if they don't show up on time for their pre-op, we miss two surgery windows and those are our profit. we break even that day if we miss those two. well, if we miss that next person in line, if we have to wait five minutes to stick that person, we have not maximized the limitations we have of people, of professionals that can load that syringe and stick it in the arm, and that's going to become more and more of a concern. lastly -- well, this first. with what we know today, our

goal of everybody who would like a vaccine by the end of may, i think it's fairly easy to say to the american people next fall schools should open and they should all be in person. i think it's fairly easy to say by the time we get to summer americans should fly and they should feel comfortable on an airplane. i think we should be able to tell people to plan their summer vacations. i think we should say next thanksgiving and christmas, spend it with your families, both immediately and extended. we have to accept the fact that our goal right now is to be fully vaccinated then. dr. walensky, i am not saying to travel to germany or wherever, because we are at the mercy of their investigation schedule as to when we open it up, but

providing some certainty of next thanksgiving, next christmas, next school year, and even if the administration policy is not that we are going to open all the schools today, we can sort of lean out over our skis and say, we can open in the fall or in person and there are a lot of parents out there that would be relieved and teachers and students are on notice. last thing, i recognize the fact that when a year ago when the pandemic hit, businesses altered what they did and how they did it, and schools altered what they did and how they did it, and congress did that, and the one thing that did not change is your agency where the responsibility was the same for

everybody to show up and do their jobs, and we have been reliant for those that work with you and beside you to do their job, and if not we would not be here with three vaccines and ample supplies of syringes and all the ppe that is needed to carry out the most massive vaccination program that the world's ever seen. we wouldn't be in a position where we could be talking about what to look around the corner and see and what to be prepared for, and i want to ask you to thank the people that work with you and for you, because without them we would not have the hope this could soon be over and we would not have a commitment where we could explore how to

ensure this doesn't happen again. thank you each of you for your testimony today, and thank you for your indulgence, madam chair. >> thank you, thank all of your staffs and everybody working on this, and we appreciate all they are doing, so thank you for bringing that up. i just have two additional questions and then we will close the hearing. first, dr. marx, for a year now your team has been working around the clock and making sure vaccines and therapeutics are effective and safe and effective and we are all working on making sure vaccines are safe for our children and vaccine manufacturers have began work on clinical trials in pediatric populations, and can you talk about that. >> all of the manufacturers of

the three currently authorized vaccines have plans -- either they have clinical trials ongoing or about to start trials in children. they are already trials very advanced in the adolescent age group that is 12 and over, and so there's hope, i think, as dr. fauci said that we will be able to get that population vaccinated for the fall for junior high and high school students, and for the younger children we do this stepped program -- the trials will look at the older young children and then move down. that's to make sure that we don't injure any children as we are looking at the vaccines. we have to make sure every step is safe and we don't skip any steps because obviously the safety of our children is paramount. we have a good program in place and we are working with the operation to make sure that that program really will move through

and -- the hope would be towards the end of this year we will have data in the younger children. >> very good. thank you very much. dr. walensky, this pandemic, as you know, has been especially deadly for communities of color, and recent cdc data shows that black and latino people are more likely to die from covid-19 compared to white people. in order to address these disparities effectively, we need to collect complete and reliable data that completely reveals the scope of the problem, and especially in regard to vaccinations, and even when we do collect data it often doesn't break out in important groups like native hawaiian or pacific islanders.

>> i think there are numerous components there. first of all i think we need to realize that we know we have a problem before we collect the data, so we are actively working towards resolution of some of these issues. even without seeing the data, we know that access to vaccines is more among the white community than the communities that have been hardest hit. we need to act before we see the data. we are a data-driven organization and we need to see what the data is. there are seven or eight states, and their agreements did not allow them to report data to us that is ethnically and racially divided, and we are working to get so we get those data. patients don't want to report, and so we have, a, we have providers that don't ask the question. many of these states' data form says unknown, and we get the

race and ethnicity data, and it's checked off and it says unknown and that's not particularly helpful so we are working with states to get rid of that so people have to report it. we are working to try and encourage people to report their race and ethnicity data. one way we have been able to do this is include the electronic case reporting forms, and we have been scaling this up over the last several months. it can link the test positivity with their medical report in sirner, and we are working hard and i think it will be a key component of data modernization. >> thank you very much for that explanation. that ends our hearing today, and i really want to thank all of our colleagues and witnesses for thoughtful discussion. i think everybody wants you to say it's going to be over tomorrow and nobody can predict that and i know you are all working hard to make sure we have the best scientific and

informative information that we can to make good decisions about ourselves and our nation. for any senators who wish to ask additional questions, questions for the record will be due in ten business days on thursday, april 1st at 5:00, and the hearing record will remain open for those that wish to submit additional materials for the record, and this commit will meet next week, march 24th at 10:30 on the nomination of [indistinct chatter]

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