so much we never yielded our defense. thank you.

-- this hearing is just over two and a half hours. >> the committee will please come to order. today we are hearing the latest update from officials about the efforts to fight the covid-19 pandemic. we will have opening statements and then i will introduce the

doctors walensky, fauci, nad and others. and i am glad to have you all back before the committee today. i know we will continue to hear from you as we work to end the pandemic. after the testimony today, each senator has five minutes for questions. before we begin, i want to walk to the safety protocols. -- through the safety protocols. we will follow the advice of the attending physician and conducting this hearing. we are grateful for everyone who was worked hard to get this set up and help everyone stay safe. remaining members are to stay seated at least six feet apart. while we are unable to have the hearing open to the public, live video is available on the website at health.senate.gov. and if you are in need of accommodations including close captioning, -- while we are not

yet through the pandemic, we are making significant progress. we administered well over 200 million covid vaccines in the first 100 days, over half the adult population has gotten at least one dose and a third of the country is fully vaccinated. schools and businesses are working to reopen, and the fda authorized vaccines for adolescents. as we are encouraged by the progress, we are all aware that more work lies ahead. this pandemic has touched every community in our country and every corner of the world. vaccines have to be just as widespread and while progress is being made, in my own state they have released a dashboard with data, the latest numbers which show washington state has vaccinated over 5 million and

we are vaccinating around 55,000 more a day. they are some communities that are lagging in vaccination efforts. especially black, latino, tribal and rural communities, not just in my stake but -- statement across the country. in some states we are still lacking some data on characteristics including rate and ethnicity grade we have to tear down barriers that make it hard for some to get vaccinated. everyone must have the opportunity to get vaccinated. regardless of race, zip code, disability, or internet access. we are seeing vaccination rates slow and we need to make sure that people can get vaccines. it is a reminder that that is half the battle. we need to make sure they get vaccines. to make that happen we need to make sure people are getting reliable information about

vaccines, and hearing from voices they trust about why getting vaccinated is important, not just to protect themselves but those around them and stop the disease from spreading or mutating. i'm glad the biden administration continues to release funds from the rescue plan to help address some of these challenges including when they announced money to strengthen the response in rural communities and more to develop and support community-based workforce to help underserved groups get information about vaccines and schedule appointments, arrange transportation and more. as we work to get the nation vaccinated, we have to acknowledge this is a global fight and do our part to lead on the world stage.

the outbreak in india is a heartbreaking reminder of what happens when the virus can mutate and overwhelms health-care systems and a reminder this pandemic will not be over until it is over for the world. that is why i am glad the administration is sending medical support to india and sharing some of our doses globally and even considering steps to remove barriers to vaccines for countries that need them. these moves will not just save lives in india but they will save lives in washington state, north carolina and across the country because people get when there is a fire down the street is in their best interest to put it out before it gets to their own home. i am hearing from people that

feel that we cannot simply end this crisis and never look back, we have to learn from it. we have to be better prepared, which is why we plan to develop bipartisan legislation to address and build on lessons learned from the response and improve and supplied the supply chain for critical medical supplies and tackle health disparities and strengthen the public health infrastructure and medical preparedness and response programs at every level. as federal officials on the front lines of the pandemic, you have the important perspective into the progress we are making today as well as the lessons we must learn for tomorrow. now i will turn it over to the senator. >> i am glad we are holding another hearing to update us on the status of covid-19 response. and to our witnesses, thank you for the work you have done.

it is been almost 18 months since the initial reports of severe pneumonia in china surfaced. we have tragically seen over a half million deaths of covid-19. it's jeopardized the livelihoods of millions of americans an spent more taxpayer money than i could have ever imagined than i could have -- in response to this virus and the devastating effect on our economy. now more than ever there's reason for hope. we're seeing the promise of vack seeps and treatments in real time. a month ago the case count in the united states was over 7,000 new cases a day. today -- 70,000 new cases a day.

today we're down to 40,000 and going down. we have demrivered almost 330 million doses of vaccines to states. operation warp speed and barta spent more than $18 billion to make vaccines available to americans, manufacturing vaccines at risk and the american people are benefiting from that today. manufacturers were able to produce vaccines, enough vaccines that the united states is now able to help provide vack seeps to countries in need like india. because of the collaborative efforts over the last year, we're ready to turn the corner. the partnerships developing and manufacturing the covid-19 vaccines have been one of the biggest scientific success stories in generations. industry appsed the call at the

start of the pandemic and partnered in an uns predened way to bring us these lifesaving products. intellectual property is part of the reason we have these life-saving products today. if these protections are not in place to innovate yoffers life-saving medicines, we'll not have them for the next pandemic. it's that simple. we held a hearing on the threat of china taking intellectual property from u.s. research. and now, the biden administration has agreed just to hand it over. there's a way to support the manufacturing of vaccines globally and help countries in need without acting in bad faith against innovators who stepped up when the world needed them the most. it's the partnership we're already seeing today that are saving lives. not silly ideas about socializing meeps of production.

the action from the biden administration to support waiving intellectual property rights will undermine the innovation we're relying on to bring this pandemic to an end and will leave us with a less prepared future. i'm encouraged that some of our european allies cautioned against this reckless action and i hope the adults in the biden administration will realize that what sounds good in a grad school ivory tower thesis paper does not make sense in the real world. you four are the adults in the room. i urge you to think about the real consequences if we just give away this science and this technology. the next part of our job is going to be the difficult part. i've been looking to israel to help predict the challenges that may be in store for the u.s. since they're ahead of us on vaccination rates today. israel was able to vaccinate 40%

of the adult population by the end of february. they're data shows that uptake stalled once they vaccinated about 60% of the adult population. while there are differences between our country, we have to use the information we've got to best predict our road ahead. every adult has the tun to be vaccinated. and supply is starting to exceed demand. in other words, we have more shots than arms to put it in. we need to address vaccine hesitancy and it needs to be done now. i know this is the case in my state with recent reports from wilmington, north carolina that local officials are changing their approach as vaccine demands slow. we must paint a picture exr the american people showing the benefits of both vaccination and a reopening of our country.

i got the vaccining, my wife got the vaccine, my sons got the vaccine, their wives got the vaccine, i've encouraged my taff to take i -- take it as soon as it's available to them. i've gone through the last 24 hours with a real fear that i had a 1 1/2-year-old grandson who might have had covid. fortunately, it all came back negative and he'll hopefully leave the hospital sometime today. but i would guess that everyone in this room is vaccinated. which means if we follow the c.d.c. guidelines we candy spence with masks and social distancing. tomorrow, i hope that we are going to have a vack scene that's approved for kids over 12 and one -- ones younger, hopefully, in the not too distant future. we must assure -- reassure merps that covid vaccines are safe. vaccines save lives. i might have been fie nye yves

when we started this, thinking that staying out of the hospital and not dying might be enough motivation to get people vaccinated. it clearly wasn't. that's why we must reassure americans that if you get a covid vaccine, our lives can and will return to normal. but we can't assure without painting that picture form -- forethem what that looks like. today's response is preparing us for tomorrow's threat. as senator murray said, we've launched a joint effort to strengthen our public health preparedness programs for the next threat, which we will inevitably face that threat could be emerging today or it could be a new virus, another curveball for mother nature, or the result of deliberate manmade attacks on our country. our framework has always been flexible and it needs to stay that way. there will always be lessons that we learn from each response and our threat land -- our

threat landscape is constantly evolving. our experience with this pandemic has made that even more clear. nart murray and i look forward to working with each of you and the members of the committee on this project to take stock of the lessons learned and put them into action. to our witnesses today, thank you for all you've done up to this point of the response. but know that the most challenging days may be the next several weeks an months ahead. as we attempt to get to the vaccination level. as we get there >> thank you, i look forward to working with you and wish your grandson well. >> thank you. >> i will introduce today's witnesses. dr. rochelle walesky, welcome back. thank you for joining us today.

next i'd like to introduce, dr. anthony fauci, director of the national institute of allergy and infectious diseases and chiefed me sal advisor on president biden's covid response team. dr. fauci good to have you back before the committee as well. thank you for joining us. dr. peter marks is the director of the center for biologic evaluation for the food and drug administration. dr. marks, glad to have you here again as well. finally, dr. david kessler. dr. kessler is chief science officer of the biden administration's covid-19 response. dr. kessler, glad to have you here with us as well. with that, we begin our witness testimony. dr. walensky, we'll begin with your opening statement. >> thank you for the invitation to speak before you todayism last testified before the committee two months ago. since that team the dedicated

professionals at c.d.c. have been working diligently to provide additional resources to states, localties, territories and tribes thanks to support from congress. we are updating our guidance based on the latest scientific evidence and we are working with our partners around the country and around the globe to reduce the burden of covid-19. i am pleased to report that since january, we have seen a consistent downward trend with daily averages of new infections dropping 6%, hospitalizations down 71% and reported deaths decrease big 75%. this progress is also reflected on our county level risk. just a month ago all counties were having high transmission rates. this morning it's down to 33% of counties. these trends give me hope. still i continue to emphasize that we must remain diligent and

committed to surveillance and prevention efforts because the emergence of variants could set us back. with your help, the c.d.c. is using the $1. billion congress provided to expand gee noemic sequencing efforts. since january, we have increased from 3,000 samples per week to approximately 35,000 samples per week. we are keeping our commitment to prioritize health equity. since march, we have announced a number of investments that center in health equity. these in$2.25 billion to address covid-19 related health disparities an advance health equity among high-risk and underserved populations. $3 million to increase confidence with a focus on increasing uptake particularly in communs hardest hit by the pandemic. $332 million in health workers to support covid-19 prevention and control. and $250 million to target --

for targeted strategies for uptake in specific communities. in addition, c.d.c. continues to update our guidance as we learn more. this includes a recent update outlining levels of risk of activities for fully vaccinated and unvaccinated people. we will continue to upkate this guidance to be clear that vaccines are a means of returning to activities we stepped -- we stopped as a result of the pandemic. i'm proud to report the administration of more than 261 million vaccine doses, including more than 133 million since i last testified before you in march. over 58% of all adult americans have now received at least one vaccine dose. we are cautiously optimistic but

the pandemic is more severe than ever. india's surge is tragic and reminds us the virus can upstrip our efforts to contain it if we're not careful. we will not end this pandemic without working hand in hand with countries around the gleb to figget covid-19. i want to take a moment to acknowledge that while we have made great progress over the last few months, more than 579,000 people in the united states have died from covid-19 during this pandemic. and just since i saw you in march, over 39,000 of our loved ones have died in covid-19 in the united states. every death is a stark reminder of why we must remain vigilant and focused to end this pandemic as quickly as possible. i want to close with a promise and an appeal to the american people. my promise is that c.d.c. will can't to follow the science as our guide. and my appeal is to implore everyone to get a covid-19 vaccine as soon as possible as

the fastest way to end this pandemic. but even with this powerful tool, wile we continue to have community transmission, we must also maintain public health measures we know will prevent the spread of this virus. mask, hygiene, hand hygiene, and physical distancing. finally as we get through the pandemic we must work together over the months an years ahead to build on the investments, partnerships an innovations we have created during this crisis. this includes achieving sustainable investments in public health infrastrubture to be better prepared for whatever comes next. it is one way we can turn tragedy into lasting progress and improved health for all. thank you again for the opportunity and invitation to testify today and i look forward to answering your questions. senator murray: dr. fauci. dr. fauci: thank you for giving me the opportunity to discuss with you the morning the role of

the national institute of allergy and infectious disease and the role of the n.i.h. in the covid-19 pandemic. as i mentioned in the last hearing, we have a strategic plan with four major component, fundamental knowledge of the virus, diagnostics, therapeutics and the development of safe and effective vaccines. for the purpose of today's discussion, i will focus on the issue of vaccines. we often get asked how it could be possible that the virus was discovered in january of 2020 and we had doses of vaccine going into the arms of individuals, a vaccine that was highly efficacious and safe, 11 months later in december of 2020. the story behind that has been the decades of investment in basic and clinical biomedical research that has led to our ability to accomplish this

extraordinary feat. some example, ebasing preclinical and clinical research in developing vaccine platform technology, particularly the highly successful mrna platform, in addition scientists at the vaccine research center at niaid and grantees and contractors throughout the country developed the optimal immunogen which is the correct spike protein used by virtually all the vaccines being tested right now. finally the utilization of a clinical trial network that we have set up decades ago for influenza and for h.i.v. when one thinks of efficacy, it really is, what are the results of a clinical trial, often, when you get into the real world the effectiveness of vaccines falls short of the original efficacy.

that is not at all the case with the vaccines for covid-19. because the real portland world effectiveness is even more impressive than the results of the clinical trial. one example, the university of texas looked at 23,000 of their employees and found that the incidence of infection was 0.05%, markededly lower than unvaccinated individuals. the c.d.c. has multiple mmwr's reporting on various aspects of the real world effectiveness. importantly, a recent paper in "the lancet" reported on the experience in israel which, as senator burr mentioned, has den an extraordinary job of getting their citizens vaccinated. what we have seen is a remarkable diminution in the number of infections that reached a critical turning point when they reached a certain percentage of the individuals who are vaccinated.

it wasn't only limited to israel. another recent paper in the country of qatar showed a similar type of result in which not only was the mrna vaccine highly effective, in over 300,000 individuals tested in preventing the original wild type virus, but it also had a very interesting capability of protecting against mild to moderate disease of a problematic variant from south africa, the 351, and protected virtually 100% from severe disease including hospitalization and death. so when the president makes the goal of 70% of adults receiving at least one vaccine by the fourth of july, we believe that that is an attainable goal. the reason we feel it's important is that i believe that we are about at that critical turning point where we get a

certain percentage, we don't know exactly what it is, but it -- clearly the majority of individuals in the country vaccinated, we will see a sharp turning point and a marked diminution in cases. as i said the last time i testified before you, we are in a race between the vaccine and the virus. if left to its own devices it will continue to surge. based on experience thus far in this country, an globally, i feel confident that if we continue to vaccinate people at the rate that we're doing, that we will very soon have a situation where we will have so few infections in this country, we will begin to return to normality that all of us desire so much. thank you very much. senator murray: thank you. dr. marks. dr. marks: chair murray, ranking member burr, members of the

committee, thank you for the opportunity to testify before you again to talk about the covid response effort, particularly our efforts on vaccines. first, yesterday evening, the f.d.a. announced the expansion of the mverage use authorize farings the pfizer-biontec h-vac seen to include adolescents down to age 12 years. we know this is a big step for our country, vaccinating a younger population can bring us closer to a sense of normalcy and ending this pandemic. to look at the safety of the vaccine, the f.d.a. evaluated the clinical trials more than 2,000 adlessents aged 12 through 15. half of the participants restheaved pfizer biontec h-vac seen, half restheaved placebo. the side effects experienced were similar to those experienced by individuals aged 16 and older. to look at effectiveness, the f.d.a. evaluated data about how participant's immune system responded to the vaccine, comparing 190 individuals aged

12 through 15 to 170 aged 16 through 25. the f.d.a. also evaluated data on kifes covid-19 among adolescents aged 12 through 15, seven days after the second dose of vaccine was given and no cases of covid-19 occurred among 1,005 adolescents who received the vaccine, compared to six cases in 978 placebo recipients, thus indicating the vaccine was completely effective in preventing covid-19 in the trial that was symptomatic. parents and guardians can rest assured the agency undertook a rigorous an thorough review of all available scientific will next review the data tomorrow. as we announced yesterday, we intend to convene a virtual meeting of the vaccines advisory

committee on june 10 2021, during which we will provide a status update on the approach to emergency youth also rosacea and individuals age 12 through 17 years of age, and we will also discuss the data needed to support emergency use authorization in a biological application in children less than age 12. as covid-19 vaccination expense -- expands into adolescence, we work diligently with the cdc and others on safety surveillance of the authorized vaccine. we are grateful to congress for the american rescue plan funds which expand these critical priorities. we have seen that our safety surveillance systems are doing what they are supposed to do. detecting important adverse events. recently the systems detected a safety signal for rare blood clots and low blood platelets with the johnson & johnson covid-19 vaccine.

following a brief pause taken to evaluate the situation, based on the rare but increased reese of this adverse event, mainly in women aged 18-50, the fda modified the fact sheet for health care providers to include the warning pertaining to this risk and the fact sheets for recipients was updated. we will diligently monitor the safety of these vaccines. the cdc and fda are working closely together to track the emergents of covid 19 variants. -- emergence and spread of covid 19 variants. we are working with many fractures and government -- manufacturers and government partners to plan the composition of the vaccine so that we can administer books or -- administer booster vaccination

if necessary. the fda recently completed an inspection of emergent biosolutions to propose a manufacturing facility for the johnson & johnson covid-19 vaccine. the fda investigators cited several observations concerning whether the facility's practices met the requirements. we are now working with the emergent biosolutions to address the conditions identified and it has made public that no product has been released from this facility for use in the united states and will not agree to the release of any product until we are confident that it meets our expectations for quality. additionally, moving forward, the agency is refining how to evaluate the manufacturing quality during this and any future health emergency. we are committed to maintaining the trust of the public in the vaccines and hope that every eligible individual consider getting vaccinated to help end the pandemic. chair murray: thank you.

dr. kessler: thank you for the invitation to provide an update on the covid-19 response. allow me to succinctly set out what we are focused on today. first, we have delivered to date 330 million doses of vaccine in the united states and have administered over 260 million of them. the most important thing we need to do is to get a vaccine to everyone who wants to be vaccinated in the united states. the current vaccine supply exceeds demand. nothing is more important than achieving the president's goal of having 70% of adults with at least one shot before -- by july 4. the long-term fate of many of

our communities depends on getting people vaccinated. there are many reasons why people have not yet been vaccinated. we need to recognize at the core for many is simply a fear of the unknown. all of the data supports the basic proposition that these vaccines are safe and effective. getting vaccinated will prevent hospitalization and death. second, the fda took a step yesterday in the fight against covid-19 and expanded the pfizer eua to people ages 12-15. pending the acip recommendation tomorrow, we plan to offer that pfizer vaccine to all young people ages 12-15. right now, the pfizer vaccine is

available at many local pharmacies and larger health clinics, and we are working to make smaller trays available so the pfizer vaccine can be administrated by more -- administered by more pediatricians and family doctors and burrell health care providers. by late fall we expect data on the safety and effectiveness of vaccines for children under 12. third, we are planning, and i underscore the word planning, to have booster doses available, if necessary, for the american people. increased age, the natural waning of antibodies over time and new variants increase the probability that boosters may be needed. fourth, it is absolutely essential that we began sharing doses made in the united states with the rest of the world. supplying other nations with vaccines is not just the right thing to do for lifesaving humanitarian purposes, it is

also in the best interest of the united states to mitigate the risk of viral evolution. and we need to hasten our search for an antiviral. i am concerned that even after we finish vaccinating host of the people -- most of the people who want to be vaccinated by this summer, there will still be a significant number of cases and an unacceptable number of death. -- number of deaths. people who are immunosuppressed who do not mount an immune response for a number of reasons or choose not to be vaccinated will continue to be vulnerable, and we need options for them. the antibody treatments are one approach, but a simple oral antiviral can add to the armamentarium to bring this epidemic under control. we need a program for future

pandemics, and this needs to be done in partnership with the private sector and build on all of the lessons we have learned to date. thank you for this opportunity today. i look forward to your questions. chair murray: thank you for being here today. we will now begin a round of five-minute questions of the witnesses. i ask our colleagues to stay within those five minutes. dr. fauci, let's start with the. the surge -- let's start with you. the surge of covid 19 in india is a reminder that we cannot end the pandemic here until we end it everywhere, and i'm glad the biden administration is leading that fight by rejoining the world health organization and funding global vaccine efforts and committing to donate 60 million astrazeneca vaccines to other countries by july 4. the outbreak in india really underscores the need for a robust public health infrastructure to respond appropriately to this pandemic and future outbreaks.

i want to ask you today, what can we learn from the outbreak in india that we should apply to our response here? dr. fauci: one of the import -- important things is do not underestimate the situation. the reason that india is in such dire straits is they had an original surge and made the incorrect assumption that they were finished with it. they opened up prematurely, and wound up having a surge right now that we are all very well aware of his extremely devastating. that's the first thing. the second thing, with regard to public health preparedness, which we as a lesson learned for future pandemics have to realize that we need to continue to build up our local public health infrastructure, which over the last decades, we have let in many respects go into disarray likely because of our successes in controlling some many diseases. -- controlling so many diseases.

the other lesson that is learned is that this is a global pandemic that requires a global response, and we need to pay attention to the responsibility that we have, not only for our own country, but to join with other countries to make sure we have the access to intervention, particularly vaccines throughout the world. because if it continues to have dynamics of virus anywhere in the world, we have a threat here in the united states, particularly with the variants. you know this one in india that is also a new variant, so those are just a few of the lessons that i believe we can take from what is going on in india. thank you. chair murray: dr. marks, i am really encouraged by how the fda has worked to get ultimo covid -- get multiple covid vaccines authorized. having said that, i am very concerned about the reports, the

emergent biosolutions, the contractor that received the money to fracture -- to manufacture covid vaccines and wanted to ask you to explain the fda recent findings, because after receiving reports of cross-contamination with another vaccine, the fda inspected the facility and asked the contractor to pause manufacturing, and the vaccine that was contaminated was not distributive for any use. -- distributed for any use. what steps is the fda taking to make sure the quality and safety and effectiveness of all covid-19 vaccines? dr. marks: we are actively currently working with all of the parties involved to ensure that the facilities are all remediated, so before they are actually able to release vaccine it meets all of the quality standards that americans deserve from vaccines. also, as we move on to other

facilities that may be producing vaccines, we will take the approach of using all of the inspectional tools to ensure that the quality of those is the highest nature, and as with all of our biologics applications, we generally will be performing on-site inspections of those facilities to ensure the quality of those products. chair murray: i am deeply concerned about what happened. in my expectation is in the future, nothing like that happens again. dr. walensky, the cdc says that children can be infected and spread the virus. with the authorization piece advisory yesterday, what would you say to parents who are considering getting their kids vaccinated now? dr. walensky: i would encourage all parents to get their children vaccinated. i recognize some parents want to

see how it goes, but i am encouraging all children to be vaccinated. some parents won't want to be first. but i also am encouraging children to ask for the vaccine. i have a 16-year-old and i know he wanted to get the vaccine. he wants his life back. sen. burr: dr. kessler, we shipped millions of doses of -- 2.7 million doses of astrazeneca to mexico, and that is the only country we shipped to. we have got additional doses of astrazeneca in inventory in this country. we talked about july 4 exporting more, why have we not taken the astrazeneca, which is not approved in the united states, why have we not mobilized that to other countries today?

dr. kessler: senator, this is a very important question. we have shipped a total of 4 million doses to date, including to mexico, and i believe 1.5 to canada. we are ready to ship up to 60 million doses of astrazeneca, but as the chair pointed out, and as my colleague responded, dr. marks, there are issues with emergents that are under review by the fda. if and when those issues are resolved, and we can say that these are quality doses, we will do just as you say.

>> correct me if i am wrong, i didn't think the emergent baltimore facility had anything to do with astrazeneca. i'm i wrong, dr. marks? that sham i wrong, -- am i wrong, dr. marks? dr. marks: the astrazeneca vaccine was being produced in that facility, and the fda feels it is imperative that before vaccine can be shipped to any other partner, it has to meet the quality standards it would meet for any american as well. sen. burr: how long do you anticipate that testing the astrazeneca vaccine that is currently many fractured would take to verify? >> we are working that as quickly as we can. we understand the imperative here. there is a working group across the office of regulatory affairs, and others at fda that are working together to clear that as quickly as we can. i cannot give you an exact time, but we understand the imperative to be able to have them available so dr. kessler can arrange for them to be shipped.

to those in need. sen. burr: that's one of the reasons we are successful today, is that partnerships have been leveraging vaccinations around the world, and over we have -- over 275 partnerships have been created to scale up vaccine manufacturing. i guess i am asking you this, if we waive intellectual property in the u.s., do we not stand the risk of affecting innovation in the future? when if we did it to scale up manufacturing capacity, the private sector has done that through partnerships already, and that is the reason the event successful. shouldn't we let the private sector continued to do something -- we never anticipated this. this is novel that they would have the relationship to do it. why mess with a good thing?

>> i applaud the actions of the pharmaceutical industry. senator, this is a once in a century pandemic, and i think we all recognize that extraordinary circumstances call for extraordinary measures. we know, and i agree with you, that the waiver alone will not result in the scale and speed we need to make enough vaccines to end the pandemic. that is why we will continue to ramp up our efforts, working with the private sector and all possible partners to expand that vaccine manufacturing and distribution around the world. our job is to do as you say, increase supply, that is what we are focused on, and we want to make vaccines available to the world. sen. burr: when pfizer went to

open up the kansas plant to produce vaccine, it took them i believe seven months to get everything done. to retool. this belief that you can export intellectual property and you will have a stand up around the world instantaneously is a joke. -- instantaneously of vaccine production is a joke. dr. marks expects concern over the backlogs for inspections, and how long would it take for us to inspect foreign sites if in fact there was a pool that found its way in and out of the united states. let me just get this before my time runs out, can anybody give me the number? there have been 33 million americans infected with covid that have actually tested positive. how many of that 33 million have then been vaccinated? anybody know what that number is? here is why i make the point,

here is why think it's relevant. if we are looking at a certain number that we do not know exactly what it is, that we want to get to, and meet vaccinated -- and we vaccinated 115 million, it is important for us to know, of the counted vaccine number, how many of those already have protection because they were covid positive? if we are trying to reach a number when the president says 70% vaccination, if we get to 65 percent vaccinated -- 65% vaccinated and 5% got protection, isn't that 70%? the goalpost continues to be too far, and we not have the part of how do we take the 40% that are not real comfortable with getting vaccinated and at least have a shot of vaccinating 50% of the 40%? it may be the number is higher today on the protected. i know it is. i think it is crucial that we figure out what that number is.

i don't think 33 million have all been vaccinated that were positive. i am not sure whose responsibility it is that we put that number into the formula of how many americans have protections. i think the chair -- i thank the chair. >> senator casey. sen. casey: i want to thank our guests. i have at least one question for dr. wilensky and one for dr. marks. i want to say thank you for your leadership and the leadership of the cdc and your efforts to make sure that children and adolescents are up-to-date on vaccinations. particularly as students return to and person learning. -- in-person learning. you and others have noted there are over 11 million doses for the vaccines for children program that had been missed.

these missed doses could seriously and negatively impact efforts to protect children and their families and communities from vaccine preventable diseases and conditions. of course, we are talking here about diseases other than covid-19. at the same time, with 12-15-year-olds now able to get vaccinated against covid-19, there is an even greater need to ensure parents are aware of all of the vaccines that children should receive to remain healthy. the rescue plan contains funding to build vaccine confidence and specifically includes provisions to ensure funding is allocated towards increasing vaccination rates throughout the u.s. here's the question. in addition to the public awareness efforts that you have already undertaken, will the cdc be releasing the funding to both states and communities to ensure that children and adolescents

are caught up on both routine and recommended vaccinations, particularly as children return to in person learning? dr. walensky: thank you for that. you raise an issue that is near and dear to my heart and i am very worried about. more than 20% of our measles vaccines were not used this year. we have the same issue with the meningacoccal vaccine. especially among adolescents. unfortunately, we don't have data on whether we can co-administer the covid-19 vaccine and other routine immunizations and whether we get the same protection from the covid-19 vaccines and the routine administration of other immunizations. that is one issue the experts are going to address tomorrow, as to whether that can safely be done and that we could get potentially adequate protection. as we put forth these efforts and vaccine confidence for the covid-19 vaccine, we need to take this outreach and make sure

we are reaching these communities and not only conveying the importance of the covid vaccine, but we have the ability to administer the routine vaccines that they have lost before the school year. sen. casey: any sense of the timing of when the funding will be released? dr. walensky: i do not. we can get back to you. sen. casey: dr. marks, we have heard a lot about emergency use authorization, and we know pfizer recently filed an application for full licensure of their covid-19 vaccine. we get a lot of questions at home on a range of these issues, and in particular, what does it mean? what does full licensure mean? one of the concerns that we have heard a lot about is that vaccines are provided this authorization, but what is the

next step for a vaccine? can you explain what it means? to get full licensure? that is question number one. secondly, what additional information would a company need to submit beyond what was required for the so-called eua? dr. marks: the full licensure is something that a manufacturer submits with a full data package. which i will talk about more any moment. i want to go back to pick up on something that dr. fauci said. these covid-19 vaccines were expedited not by cutting corners, but by going through a development plan in which the empty space, space that would've been normally not happening was taken away so manufacturing was done all the clinical trials was done. -- while the clinical

trials were done. the large programs were of the size of normally licensed vaccines in the u.s. the one place where we were a little bit short was the duration of safety follow-up. but we are confident from the amount of follow-up on this data set for this authorization, that the large majority of adverse events became apparent. we are very confident in recommending these vaccines for everyone, our families, all americans. the difference that will happen with the biologic license application is that the manufacturers will submit additional safety data, perhaps six months of data, rather than just the two months data, and additionally, there are some technical things that will be there that many people may not care a lot about. but we do. that is manufacturing conformance lots, an additional

-- inspections, and additional ancillary studies will be put in that package. i think the main message to the american public is, for all intents and purposes, the vaccine that is being used is very close to what we would normally have. in a biologic license application. there are some little things around the margins that will go into the application when we have formal approval. >> thank you, chair murray. >> senator paul. sen. paul: we do not know whether the pandemic started in a lab in one or evolved -- in wuhan or evolved naturally, but we should want to know. 3 million have died from this pandemic and that should cause us to explore all possibilities. government authorities self interested in continuing an function research say there is nothing to see here. gain of function research is juicing up naturally occurring animal viruses to infect humans. to arrive at the truth, the u.s. government should admit that the

wuhan virology institute was experimenting with this virus. juicing up super viruses is not new, and scientists have long known in the u.s. how to mutate animal viruses to infect humans. for years, a -- a virologist in the u.s. has been collaborating with a doctor from that virology institute. this research has been funded by the nih. the collaboration between the u.s. and the wuhan virology institute continues. they worked together to induce bat virus protein into the backbone of the deadly sars virus and then used this man-made super virus to infect human airway cells. think about that. the sars virus had a 15% mortality, and we are fighting a pandemic that has about a 1% mortality.

can you imagine if a sars virus that has been juiced up and had viral proteins added to it, if that were released accidentally? dr. fauci, do you still support funding of the nih funding of the lab in wuhan? dr. fauci: senator paul, with all due respect, you are entirely and completely incorrect that the nih has not ever and does not now fund gain of function research in that institute. we do not fund -- dr. barrett does not do this research, and if it is, it is according to the guidelines, and is being conducted in north carolina. >> you do not think that inserting a bat virus spike

protein is gain of function? you'd be in the minority because at least 200 scientists have signed a statement saying that it is gain of function. dr. fauci: it is not. if you look at the grants, and you look at the progress report, it is not gain of function despite the fact that people tweet that. >> so you support sending money to the virology institute? >> we do not send money to that institute. >> we were sending it to eco-health, a subgrant. -- do you support money from n.i.h. that was going to the wuhan institute? dr. fauci: let me explain to you why that was done. the sars-cov-1 originated in bats in china. it would have been irresponsible of us if we did not investigate the bat viruses and the sirology to see who might have been

infected. senator paul: or send it to the chinese government whom we can't trust with this knowledge and this incredibly dangerous viruses. government scientists le yourself who favor gain of function research. dr. fauci: i do not support gain of function research. you are saying things that are not correct. senator paul: government defenders of gain of function such as yourself say that covid-19 mutations were random and not designed by man. but interestingly, the technique that dr. barret developed forces mutation by serial passage through cell

culture that the mutations appear to be natural. in fact, dr. barrett named the technique the no technique. nicholas baker said nobody would know if the virus had been fabricated in a laboratory or grown in nature. government authorities in the u.s., including you, deny that covid-19 could have escaped a lab. but even dr. xi in wuhan wasn't so sure. according to nicholas baker, dr. xi wondered if it could come to her own laboratory. she said she had not slept for days. the director of the gain of function research in wuhan couldn't sleep because she was terrified it might be in her lab. dr. barrett, an advocate of gain of function research said the main problem that the institution of virology had it happened in close proximity. what are the odds? barrett responded could you rule , out a laboratory escape? the answer in this case is probably not. will you in front of this group categorically say that the covid-19 could not have occurred through serial passage in a laboratory? dr. fauci: i do not have any accounting of what the chinese may have done. and i'm fully in favor of any further investigation of what went on in china.

however, i will repeat again. the n.i.h. and niad categorically has not funded gain of function research to be conducted in the wuhan institute of virology. senator paul: we have 11 labs doing it and you have allowed it. we have a committee to do it but the committee is granted every exemption. you're fooling with mother nature here. you're allowing superviruses to be created with 15% mortality, it's very dangerous and is a huge mistake to share this with china and it's a huge mistake to allow this to continue in the united states. we should be very careful to investigate where this virus came from. dr. fauci: i fully agree you should investigate where the virus came from. but, again, we have not funded gain of function research on this virus in the wuhan institute of virology. senator paul: you're parsing words. there was research done with dr. xi and dr. barrett. they've collaborated where they enhanced the sars virus to

infect human airway cells and did it by merging a new spike protein on it. that is gain of function. that was joint research between the wuhan institute and dr. barrett. you can't deny it. chair murray: senator paul, your time is expired. we'll let you respond to that. we need to move on. dr. fauci: excuse me. chair murray: i'll let you respond to that and we'll move on. dr. fauci: i just want to say, i don't know how many times i can say it, madam chair. we did not fund gain of function research to be conducted in the wuhan institute of virology. chair murray: thank you. senator. >> thank you, chair murray. thank you so much to our panelists for being here today. i want to just -- following up on that exchange -- ask dr. fauci a question. dr. fauci, what is the impact of

conspiracy theories told by senator rand paul and others the willingness to take this vaccine, a vaccine that is remarkable for its safety and efficacy? dr. fauci: well, conspiracy theories certainly are not helpful in what we're trying to do, i guess i can say that with some degree of confidence. senator smith: i would agree. i think -- we are at a critical moment for our response to this pandemic. and only 14 months since we -- this pandemic started, we are here today to acknowledge we have 261 million doses of vaccine in people's arms. we have over 58% of americans with at least one dose. this has been an incredible -- an incredible accomplishment.

and we also know that we have more work to do. it seems to me we ought to be focused on that work. we have to make sure that our comprehensive strategy that you have been working on, dr. fauci, for a long time, and i'm so grateful for the support that you're getting from the biden-harris administration, a comprehensive strategy that's around vaccinations, around surveillance testing, around treatment, social distancing and masks, and also centering our work around health equity. that's what we need to be really focused on, seems to me. i'd like to ask dr. walensky a question of how we go about this question of -- this issue of getting people -- getting vaccines into people's arms now. vaccines -- vaccines seem to bea spectrum from people who are gung ho and ready to go to people that are resistant to vaccines. i have a great example of that in duluth, minnesota.

where public health nurses set up a pop-up vaccine clinic at the duluth transportation center. they can go to that vaccine pop-up clinic, get their shot in one dose. it's breaking down some of the logistical challenges that americans and minnesotans are having and they are finding great success. there was a story in minnesota public radio just in the last couple of days about a woman named karen moore who was waiting to get a vaccine and hoping that she would be able to get it at a convenient location. and was able to do it all in one spot. and that made all the difference in the world to her in terms of overcoming her so-called vaccine hesitancy, which wasn't hesitancy. it was just the logistic challenges. so dr. walensky, can you tell us a little bit about the c.d.c. is doing, working with states and localities, to deploy methods like we're seeing in duluth, minnesota, to help people get

easy access to vaccines? dr. walensky: thank you so much, senator. we have spent $3 billion getting money to states and localities to advance these efforts in trying to get vaccines into people and to enrich vaccine confidence. i would invite all of you to take out all your cell phones and text 438829. you put in your zip code and get a list of vaccines that are available to you. you can go to vaccines.gov and type your zip code and find out which vaccines are available nearby to you. we're working to make it easy. we have to do some of the pivoting, as you discussed, and ensure places now have pop-up sites, they have mobile vaccination units, that we're reaching out to rural areas. we are putting vaccines and federally qualified health care centers. we can do this campaign now, a campaign with 5,000 community corps members from everyone from

nascar and nfl to infectious society of america to faith-based organizations sending our messages, being the trusted messengers and we're starting to see the effect of this work. just this morning c.d.c. released new racial and equity data. on how we are doing in reaching ethnic and racial minorities. the bar graph shows not just our overall progress but what we've done in the last two weeks. in the last two weeks we've been really successful in reaching racial and ethnic minorities in ways we hadn't up until this time. we have to do more. we recognize we have to do more. we have vaccine confidence consults so local and states can call the c.d.c. and say we're having a hard time reaching people in this community. what are the things we can do? this is just a brief list of the many activities we're engaged with every single day to get vaccines into people for -- and to recognize that all hesitancy is not the same flavor. some people it's convenience. some people want to understand the science more. some people just need the time

off. senator smith: thank you so much. thank you, madam chair. i want to say i appreciate the work of the c.d.c. and others to support the innovative and strategic efforts that states like mine to overcome some of those barriers. thank you. chair murray: thank you. senator collins. senator collins: thank you. dr. walensky, i used to have the utmost respect for the guidance from the c.d.c. i always considered the c.d.c. to be the gold standard. i don't anymore. i want to give you three examples where i think the conflicting, confusing guidance from your agency has undermined public confidence and contradicts the scientific

guidance of many experts. the first has to do with school openings, an issue we talked about before. the new york post reported that a powerful teachers union, the a.f.t., successfully secured changes verbatim in draft guidance on school reopenings. this came about because of an outside group that did a foia request that revealed extensive interactions between the a.f.t. and the c.d.c. this has been described by a professor who has written extensively about the coronavirus as very, very troubling. she's referring to the emails back and forth between the c.d.c. and the a.f.t. and she says, this is not how science-based guidance should work or be put together.

my second example is from a new york times story that appeared today. it talks about c.d.c. guidelines on mask wearing and where the c.d.c. announced that less than 10% of covid-19 transmission was occurring outdoors. the article points out this is, quote, almost certainly misleading. and goes on to say there is not a single documented covid infection anywhere in the world from casual outdoor interactions such as walking past someone on a street or eating at a nearby table. the third example has to do with new guidance c.d.c. has issued for summer camps. and here are the reactions of two experts. one, a pediatric immunologist at colombia said it's senseless.

the editor in chief of the journal of the american medical association pediatrics called the guidance, quote, unfairly draconian. so here we have unnecessary barriers reopening schools, exaggerating the risk of outdoor transmission and unworkable restrictions on summer camps. why does this matter? it matters because it undermines public confidence in your recommendations. in the recommendations that do make sense. in the recommendations that americans should be following.

i'd like you to respond to why the c.d.c. is not following the standard procedures? why is having off-line secret negotiations with one stakeholder that was revealed only through reporting in a foia request, why it's exaggerating outdoor transmissions? we know masks make a difference indoors. they don't outdoors. dr. walensky: thank you for that question. maybe if i could take each of your examples one by one. first, the school guidance. as a matter of practice, the c.d.c. engages with stakeholders with consumers who take our guidance, who use our guidance before it is finalized so we can understand whether it addresses their needs. for our school guidance we did that with 50 different stake holders, over 50. i personally engaged with both parents and teachers and many different stakeholders to

address what can be done to improve the guidance we have. one of those stakeholders recognized that in our guidance we had addressed what you do if you have immunocompromised children, at risk of severe, but we neglected in our draft to address what happens if we have immunocompromised teachers, teachers that are getting chemo therapy. the request was we add some language for what happens if you have immunocompromised teachers and how they should behave in school. that is what we did, we used cdc science, but the request was to address what happens if you have immunocompromised teachers and that was an oversight in our initial draft. and we included a science-based response -- a science-based language in our guidance. with regard to "the new york times" piece, there was a meta-analysis from the journal of infectious diseases published in november, i believe, where

the top line result of all studies that were included in the systematic review said less than 10% of cases were transmitted outdoors. it is that meta analysis that combines science from all sorts of -- all different science from many different places. i think over 19 studies were included. the top-line result was less than 10%. published in the journal of infectious diseases, one of our top infectious journals. that's where that came from. it was a published study that synthesized studies from many places. with regards to camp. i have a 16-year-old. . have a 16-year-old. every year he writes the number of days until he returns to camp next year. this year it got to zero and i said you are not going. i want our kids back in camp. we now have 38,000 new infections on average per day. last may 11 it was 24,000 and we sent a lot of kids home and the camps were closed. the guidance is to get our kids to camp and allow them to stay there. thank you.

senator collins: madam chair, i would just ask unanimous consent that the full "new york times" story dated today be placed in the record because it answers -- i realize i am out of time. it answers dr. walensky's response. chair murray: so ordered. senator kaine. senator kaine: thank you, madam chair. thank you to the witnesses for your important testimony. some of you have been before this committee so often i can remember you were first before us, january 24, 2020. and so much has happened since then and there's so much to talk about. my colleagues have done a good

job addressing many of my interests. at the last hearing that we had together, which i believe was in march, dr. fauci, i talked to you a little bit about long covid. when the day comes that the president declares that the national emergency is over there's still going to be at least two challenges. long covid and the mental health challenges that have resulted. i want to ask dr. fauci and dr. walensky to dig in a little bit how you're using the funds that have been provided to deal with the long covid issue for folks who are suffering symptoms after they've recovered from covid. dr. fauci: thank you very much for that question, senator. this is really an important problem. the n.i.h. has been given $1.15 billion to study this. and we're doing this in collaboration with c.d.c. and other organizations. long covid is a real issue.

anywhere from 10 to in one study as high as 30% of individuals who recover from the acute manifestations of covid-19 who have viralogically no virus in them at all but should be on the road to an uneventful recovery. what we find out, and we're putting together a number of cohort studies for extent, duration, any underlying pathogenesis. the symptoms is somewhat common, there is a commonality. it's extreme debilitating fatigue, muscle aches, temperature disregulation, you feel hot or cold, disordernomia, which is related to that, unexplained rapid heartbeat, neuro logical symptoms, brain fog, the inability to focus or concentrate over an extended period of time. these are real symptoms. and they can last for a long time.

we have people that refollow now up to nine months -- that we followed now up to nine months or longer this occurs. this is a problem we take seriously. we have a task force at the n.i.h. multiple n.i.h. institutes, not only my own, neurology, mental health, all of which will look at this over the next year or so because it is something that we really do feel we need to find out what's the underlying cause and what we can do about it. senator kaine: thank you, dr. fauci. that will help people grappling with these symptoms. i want to shift to the second concern i have. we are not a point where the emergency is over and yet even when we are at that point, the mental health impact of this very, very challenging time on the american public and people all around the world is very significant. i have worked closely with

colleagues, including senator cassidy, really to pinpoint mental health on frontline health care workers whose the experience of dealing with death and illness at such a massive scale, dealing with end of life conversations with people, who would normally have those conversations with their own family members, this is a significant concern. my colleagues supported inclusion of provisions of the dr. lorna breen act, the recent work we've done. i understand that c.d.c. is starting to focus on public information campaign to frontline health care providers to reduce stigma to seeking mental health assistance should they need it. can you talk a little bit about those efforts and more broadly to keeping our healers healthy? dr. walensky: thank you very much for that question, senator, and for the resources. i think it would be hard to overestimate the trauma that our health care providers, our frontline workers have seen over

this last year. having been there before i was here, i can tell you pulling up to driveways in your hospitals that have morgues in the parking lot is a striking thing to find. i'm grateful for the resources. niash is collaborating with our injury prevention center within the c.d.c. to create mechanisms and support tools to do outreach for our health care workers and i would also mention that, you know, we saw mental health challenges ahead of covid-19, so these are not just the mental health challenges because of covid-19. even among our youth between 2009 and 2019 before covid started we saw a 40% increase in mental health challenges. we need this not just for our health care workers but for the society at large. senator kaine: thank you very much. thank you, chair murray. chair murray: thank you. senator cassidy. senator cassidy: doctors, thank you for being here. i approach you as a physician who has done research in vaccines more so than i'm

approaching a senator -- as a senator. i'm i creditably -- i am incredibly frustrated. the american people hear your following science but they hear the lag time of that and recommendations is far too long. it's not just the american people. put it this way, not the people in my state. c.d.c. cautious messaging seems out of step at the moment. want to go back to the office from "the wall street journal" and the liberals who can't quick quit lockdown from the atlantic. so first, i was struck when senator burr suggested that previous immunization actually confers immunity. do any of you agree with that? dr. fauci. dr. fauci: does previous -- senator cassidy: it does confer. senator cassidy: we still recommend they be vaccinated. that seems out of step. dr. fauci: studies have shown

clearly if you vaccinate someone who has previously gotten infected and recovered, the level of neutralizing antibodies in t-cells are extraordinarily high, not only against the -- against the variants. senator cassidy: i pulled some of the research. my concern that would happen if you had another infection. all the -- all the immunization does is mimic a pre-existing infection. that's very well-established with other viruses. no one has not established it for this virus. indeed, some of this research shows that within four days, which is the window period, if you will, for an infection to become an illness, those antibodies rise quite precipitously. but we still recommend they get two doses even though the same literature shows there is an

increase in side effects when someone gets a second dose and they've been previously immunized. so not life threatening but nonetheless an increase in side effects. nowhere do i see a recommendation that, don't get the second dose because the literature shows that after one dose you've topped out your immunologic response. would anybody like to speak to that? dr. kessler: there are studies ongoing to look at the first versus second dose. i agree with you, it's a very reasonable proposition for study. but the purpose of immunizing somebody who's been infected previously is to develop higher antibody titers. those are what is so critical in preventing -- senator cassidy: the studies in other viruses show -- hopefully we have other research here that a second -- that a reimmunization merely mimics what would happen if somebody were exposed to the virus. all it does is kind of mimic that which would consider.

-- that of which would occur. dr. marks: senator, this is a different virus. senator cassidy: is there research going on which i am referring to because the research so far shows that within four days you get a significant increase in antibody titer. dr. marks: the nature of the immune response gets higher titer antibodies - senator cassidy: that's with every virus. that's not unique to this. dr. marks: it's superior to natural infection in preventing some of these variants and i think that's what dr. fauci was getting to. senator cassidy: i also point out the vaccines themselves and presumably the previous infection is effective against the variants. by the way, can people go back to work if they've been vaccinated and not wear a mask? assuming they're not immunocompromised?

dr. walensky: we have about a third of people in this country who have vaccinated. we have about a third of counties in this country that still have over 100 cases per 100,000. we are working to review our guidance and to update our guidance. we have put out three different guidance. senator cassidy: let me ask you again. if i am vaccinated, and i have antibody and i'm exposed to somebody else, what is my risk coming down with symptomatic infection? dr. walensky: 5%. senator cassidy: 5%. that's overall. not if i have been vaccinated and i have antibody, that's if i'm vaccinated overall. correct? dr. walensky: we don't have -- i don't think we have data in what you're looking at. we did not check antibodies on anybody who is vaccinated. senator cassidy: we could. dr. walensky: we could. senator cassidy: if we know critical mass if -- if we know herd immunity is somewhere north of 60% or 70%, if we go into a workplace where within that workplace there is 100% immunization, such as here, we've achieved herd immunity.

yeah, there's somebody in here that may not be responding to the vaccine, but because everybody else has, they're protected. that's nowhere reflected. and right now we have federal agencies, which we've had employees not working for a year because the union says they have to have special workplace precautions for them to return to work. there is consequence to this kind of delay as the stat article shows of the kind of updating of these recommendations. the american people are incredibly frustrated. and as senator collins said, they're beginning to disregard what you say that's true. because what you -- so much of what you say is patently not true, i have to wear a mask when i'm outside and the wind is blowing 20 miles per hour, that was changed but only changed recently. they seek not to believe those things which are true. you have to realize. you got to be more real time. let me finish with this. i think on the stat article, "the new york times" pointed out on the h.i.v. epidemic, the

recommendations were much more calibrated to real life. listen, we know people are going to do this. if you're going to do it, please accept this recommendation. this is a blanket. walk outside and wear a mask. you're vaccinated and everybody else in the room is vaccinated but you're wearing a mask. the american people have just lost patience with us. you guys. i ask you to kind of be aware of their frustration and get a little real time into updating these things. sorry to be so frustrated. i respect you all and thank you for your service. i yield back. chair murray: senator baldwin. senator baldwin: thank you, madam chair. dr. walensky, as you know, i led the effort to ensure that the american rescue plan included funding for c.d.c.'s work to address variants of the coronavirus. specifically, through genomic

sequencing. i am really encouraged to hear from your testimony that we are now sequencing 10% of our nation's weekly cases. this is up from about -- well, less than half of 1% in february when i introduced my tracking covid-19 variants act. couple questions about what we're finding. last month, the white house announced that it would provide initial funding to jurisdictions so that health departments could conduct, expand and improve activities to sequence genomes and identify mutations of the coronavirus. i'd like to have you describe how health departments are making use of this funding and how this investment will improve our response to future public health threats but also any new variants that we should know about that -- particularly anything troubling from the perspective of eluding the therapeutics and vaccinations that we have produced.

dr. walensky: thank you so much, senator. i am -- we are so grateful for those resources and our ability to scale up. as you know, we are now sequencing about 35,000 virus samples per week. that is a broad collaboration with commercial labs, with public health labs, with academic partners and with the public sending samples to c.d.c. in terms of moving forward, i'm looking forward to bolstering the infrastructure to be able to do these sequences at the local level. to producing the infrastructure within c.d.c. to be able to follow these in a pandemic related way, not just for this pandemic, but for future public health threats and further to expand our ability and our workforce in genomics sequences and bioinformatics, not just address covid-19, but we need to address other threats.

thank you. senator baldwin: last week the administration supported the waiver of intellectual property on covid-19 vaccines to help end the pandemic. i believe that this news is the beginning of our work to restore america's public health leadership on the world stage. dr. fauci, can you explain how increases in new cases of covid-19 worldwide threaten the progress that we've made here in the united states? and how can we avoid repeating history when it comes to combating infectious diseases worldwide? dr. fauci: yes, indeed. as we said so often and it's true that a global pandemic requires a global response. and even if we successfully vaccinate our population and get the level of infection down to a low level, as long as there is a

dynamic of infection spread throughout the world and any place in the world, there's always is the danger that variants will be generated and ultimately will come to the united states because of the travel that we know makes no place in the world separate completely from any other place in the world. so that's something we really need to pay attention to. it's for that reason i keep saying and many of my colleagues keep saying we really do have a responsibility to the united states first. we do, for sure. we also need to take part in an effort, whatever effort, and it's going to be multifaceted effort to make sure that the rest of the world contains the outbreak and that could be from some of the things we're doing right now with india by giving them immediate help with oxygen, drugs, ppe. but also to provide for the availability of doses of the vaccine that we can make available to them, not alone, not just the united states, but the rest of the developed world.

senator baldwin: thank you. one last question to dr. kessler. in the first few months, the biden administration has surpassed every goal and expectation it has set in terms of getting shots in arms. because of this effort, we are moving into the next phase of our vaccination effort in which the focus is less on mass vaccination sites and more about meeting folks where they are to get shots to hesitant and hard to reach individuals. as you know, these vaccines come with certain logistical challenges and limitations, including cold storage and used by requirements, as well as specific numbers of doses in each vial. as we shift to a more individualized effort, how will the administration work to ensure that we are using our supplies effectively and maximizing the potential at minimizing the potential for wasted doses?

de. kessler: very important question. as everyone on this committee has recognized and has been part of this heroic effort, it has been certain decisions were made at how to maximize the number of doses produced. the decision, and order to get the hundreds of millions of doses that we have already administered, we have had to make sense of the trade-offs. that is why you see in the packaging, the way that it is, which is a considerable number of doses. we have to reduce that packaging. every day, senator, i am in all of the contributions that many of our local communities, health professionals, community

leaders, ordinary citizens are taking to be able to bridge the barriers that people are having. i would like to get this eventually down to very small individual doses, but that is going to take time, and right now, we're going to do everything possible to speed that up. sen. murkowski: thank you for being here. a lot of frustration this morning, and i think as senator cassidy said it reflects that we are tired with covid. how we are able to make sense of the guidance that comes out of the cdc is critically important. alaska was very early on in making sure that the vaccine was

available to all very quickly, and as a consequence we are proud of the fact that our numbers were strong, we were number one in the country. when you start out first you also are the forerunner in demonstrating what it means to see this vexing hesitancy. we are seeing that play out in different ways, different shapes. i appreciated your comment dr. walensky to senator smith about the ways that we can't address the concerns that have been raised. is it safe? who do i look to for guidance? the state of alaska indicated that people are not looking to you all for guidance, they are not looking to our chief medical officer, they are looking to see what their friends and neighbors do. they do not care what their senator or folks from the cdc

do. we have a lot more work to be doing with regards to that. i want to speak to my particular frustrations, you have had the benefit of multiple conversations with me, and that is how we can get our tourist sector back to work for even a small sliver of the season. 1.3 million tourists come to the state of alaska on a cruise ship. there were 48 tourists that came to alaska on a cruise ship last year, and right now, it does not look much better. we have been working back and forth with the cdc, trying to deal with these conditional sale orders, after many months of requests, we finally get to a place where we think we have some guidance out there. at 11:30 got new information that the cdc's last guidance still requires additional guidance to be published. yes, it is minor, but the fact

of the matter is it is still yet one more date that has to be gone through. our reality is, if you can't get ships turned north now, there is no season. whether it is for one week or one month. i guess, dr. walensky, i'm going to ask you one more time. can you give alaskans any guidance at all with regards to the ability to finally get this guidance fully resolved. you have got cruise lines that are saying, we're going to require everyone to be vaccinated. we will require that those who want to sail on our ships be vaccinated. those in the communities who are welcoming them are also equally committed to the vaccine. should i just tell folks back home, don't even bother revving up your seasonal operation --

operations because we can get that guns from the cdc? dr. wa;ensky: let me congratulate you on getting vaccines into arms. you have been a role model. with regard to sale, i was here in march. we were waiting on that to a guidance. we have been engaging with our key stakeholders. we have had twice weekly calls with the cruise ship industry to understand how they are interpreting their guidance and what they need in order to be able to get boats back in the water. that is our goal. 2a has been released, 2b has been released, our guidance on how we get conditional -- how to get trial voyages into the water, as well as step three, you get certificates. all three of us. . have been released.

we are actually having conversations and going back and addressing those challenges. we had a collect letter that went out after 2a and others in the works. we are working with those in the industry to do our best to get ships back, in the water this season and we have actually agreed to a five day turnaround when those proposals come to us. sen. murkowski: it was news to me that another thing came up this morning. my time is expired but i must raise the fishing mast mandate. if you think about those mandates that don't make sense, the fact that the coast guard is requiring, because it is federal law, that persons traveling on a conveyance or transportation hub wear our mask for the duration of their travel. i have fishermen, commercial

fishermen, out there on the water. crackers and salmon fishermen and cop fishermen that are trying to deal with a mask, because they are concerned about failure to comply. this is more of a safety hazard. you out on a boat, the wind is howling, your mask is soaking wet. tell me how anybody thinks that this is a sane or sound policy to do? we have a situation right now where the fishermen are more concerned about the liability and failing to have the mask on rather than prudent marine safety protocols. this is absolutely, absolutely a crazy policy. i just don't understand how we put our coast guard men and women in a situation where they

know that safety is at issue, a broader safety issue, then the fear of transmission, when you're outdoor in the elements, you are now being required to wear a mask. i would hope that the cdc would reconsider this quickly. dr. walensky: we're in the process of finalizing industry-specific guidance for this reason. >> we turn to senators murphy, marshall. about has been called. -- a boat has been called. sen. murphy: thank you all for the fantastic work you do. just a quick word on the frustration you're hearing regarding guidance. witnesses today could sit here and claim that we have definitive information on risks

or asymptomatic transmission, but they would not be telling the truth. we suffered through four years with a president who literally made things up about this virus, to simplify the story over and over again, because he thought simplifying things and being definitive would make him look good. including, giving free medical advice to americans on what therapies they should take, claims that the buyers would disappear after a matter of weeks. that was not good for the country. it did not help us fight this disease. we still have a lot to learn. i frankly appreciate the fact that we have leaders today who recognize we have gaps in information, who occasionally may air on the side of caution in order to save lives. i share the frustration. the frustration is rooted in the fact that we are still less than a year and a half into a virus that we are still beginning to

understand. to that end, dr. walensky, on this question of outdoor transmission. senator collins was asking you about a paper you put out suggesting that it could be 10% of cases, there are other folks that say it could be 1% of cases, their other epidemiologist to say it could be .1%. that is a really important difference. i assume the difference between 5% and .1% would likely educate decisions you would make about your recommendations you make for summer camps. how do we, on this question, close the gap in information that we have, given there are so many competing analyses out there of outdoor transmission.

what do we do to try and make sure, especially heading into the summer, that we have the best information possible? dr. walensky: thank you for that question. i think it is important to realize that we at the cdc are responsible for putting out guidance for individuals as well as for populations, for public health. we are responsible for putting out guidance for counties that have less than five cases per hundred thousand, and counties that have cases greater, and less than 10% people vaccinated, counties with more than 50% of people vaccinated. our guidance have to be science based for all of the situations. in our last iteration of what vaccinated people can do, we did update our guidance not only for not wearing masks outdoors, but also for not wearing mast outdoors in certain settings people were unvaccinated. in the situation, we also said if people are gathered with other unvaccinated people,

dining with their masks off, there may be a risk to that if they are dining close by. certainly, the analysis that was put forward that demonstrated the topline results of less than 10% transmission occurring outdoors with helpful scientific evidence, and we are following the science as it continues to emerge. i think it is also important to recognize that with vaccinations of 12 to 15-year-olds, our summer camp guidance is probably going to have to change and we have plans to do so. sen. muprhy: dr. kessler, you included in your testimony and expectation that we may be in the business of purchasing or disputing booster shots, maybe as soon as later this year. i asked the question at the last hearing about the transparency of contracts, i still did we can do better in terms of letting the american public no

policymakers know about the financial terms of these contracts. what do we expect when it comes to contracting for booster shots? we going to go back to the same companies that provided the vaccine, we go to open that tender up to a broader set of companies? how do we expect the process of procuring booster shots to work, and how do we make sure it protects taxpayer dollars? dr. kessler: thanks for the question. very important. in order to plan, that is really what we are doing. if they want vaccine with both the duration of immunity, increasing age so there are less

antibodies and variants, we have to take all those things into consideration, and if we want vaccines at the end of the year, we have to do that now. we are in fact in those negotiations. the best sign -- science to date, the data we have, i don't want to get too technical. but the question is, are we dealing with homologous boost or heterologous booths. basically, are you going to boost with the same vaccines, or are you going to switch that out and mix and match. that requires data. we are collecting that data, and it is going to be the data that drives what we boost with. but, for planning purposes,, i think the simplest and safest assumption is that it may be, at

least for the short term, the homologous boost with the same type of vaccine makes the most sense. i need a couple of more months in order to give you a definitive answer, but i have to plan now, specifically to answer your question, we are dealing with the same companies, because we want continued -- to continue with the safety and efficacy we have seen in those vaccines. down the road that may change, as we get other protein-based vaccines available. sen. murphy: i hope this committee is actively involved with the administration on the construction of those contracts to make sure we are adequately protecting our taxpayers investments. sen. braun: dr. walensky.

from the get-go, there has been that uncertainty of when we arrived at the moment when many of us feel that this is truly in the rearview mirror. from the early conversations i have had being on this committee, has always been interesting to understand if and when that comes with clarity, the only way i think we get true comfort back into the country, senator murphy and others have mentioned how things have changed, the goalposts have moved. that is inherently confusing to people, especially ones that might have other reasons for not getting vaccinated. i think that is so important that we get everyone vaccinated. my question is, on the education side of it, what, the service -- emphasis and resources along with logistics, it is difficult

to get vaccines in the arms when it is spread out. i would like you to zero in on, first it was six feet, that it was three feet, indoors and outdoors. so many things have involved. but something as uncertain as this is natural to have that dynamic. where in time does natural infection go along with vaccinations to have some weight in that point in time where cases really start to fall off the chart. dr. walensky: thank you so much for that question. i will start briefly with the rural and say, in our efforts over the last several weeks, resources have gone probably to rural communities. we are now funding federally qualified health care centers,

getting vaccines into areas in the centers, over 5 million vaccines have been given through federal centers. we know we need to do that outreach and that is part of this next chapter. in terms of the six feet versus three feet, from the school guidance, the first iteration in february, the biggest challenge in getting children back to school was this expert guidance. what happened soon there after was science emerge, and because that six feet proved to be such a sound challenge, within one month we had three studies that demonstrated that three feet and 60 were equivalent for younger children, so it was based on the science. i would like to say we are in a static situation in the science is not changing, but we are changing our guidance as the science evolved and as science emerges. we have to remain humble to the science. with regard to your question regarding natural immunity, we have several challenges there. the cdc has a map of presumed

zero prevalence by state, as to how much -- how many people have antibodies. of course, we don't know all of the infection that has happened. much of the infection has been a some thematic. as dr. contee has said, -- dr. fauci has said, prior infection likely confers some immunity, it might confer full immunity for some period of time. we are still learning and being humble. this past week, our data demonstrated that 72% of our sequences are now the b.1.1.7 variant. what do we know about how long prior infection will last with regard to do infection and the b.1.1.7 variant if you are not vaccinated? we don't have all of those data yet. they're doing studies, we are evaluating it. i do think we should continue to encourage vaccination of people who have had the disease before. sen. braun: dr. fauci.

the j&j vaccine, but i think for many people was a preference in terms of it being one-shot, high efficacy rate. do you think it was a mistake and that we hold it when statistically the rate of incident was so low, lower than i think on many other drugs out there that seemingly have much higher side effect consequences. without a setback -- was that a setback that put us in a place that has for us, are happy recovered from it? dr. fauci: if it was a setback, we certainly have recovered from it, because we know if u.s. people, there are a lot of people who really want to get a 1000 vaccine -- one dose vaccine. waiting for the availability of this. what i think we don't fully appreciate is that it really underscores how seriously we take safety.

to call a pause on an adverse event that as you mentioned correctly was really quite rare, because at the time, there were six cases in about 7 million people, which is less than one per million. really a low number. the fda and the cdc look at the data, wanted to find out if there was any more. wanted to other depositions that might be out there seeing patients about what the proper way to treat them is, because there is one general way to treat that people might use that would actually be contraindicated, so in the long run, in the big picture, i do not believe it was a setback. i believe it underscored how seriously we all take safety. sen. braun: comedy vaccinations that we need to get to the

theoretical herd immunity. dr. fauci: it's a difficult number to give as herd immunity is a concept, you get enough people infected or vaccinated so you have a core of protected people that is a blanket of protection over even the vulnerable's. the threshold of herd immunity is unnumbered number we don't really know yet for this particular virus. we know it for measles, we don't know, we can guess at a summer -- sen. braun: that uncertainty is the hardest thing to grapple with to get this fully in the rearview mirror. >> think the chair for holding the steering, thank you to all of our witnesses today for not being here but for your service. before i get to a question, dr. walensky i want to second what senator murkowski set about

getting the guidance to the fishing industry as quickly as you can. i just met with my fisherman at the yankee fisherman's co-op this week, and we have both fishermen who are fully vaccinated who say the coast guard comes and tells them they have to keep their masks on. not only is a wet mask dangerous, but because of the noise, these guys are used to rely on simon was on the boat. with the mask on they can't. i hope you will take this under advisement and get the kinds out as quickly as you can. dr. fauci, i want to follow-up. we have been talking about the good news of the pfizer authorization from 12 to 15 years old, and it looks like they may be thinking for authorization for 11-year-olds in september. that is welcome news. many families are still looking for guidance about how to protect children under the age of 12 until a vaccine is

authorized, especially as public health restrictions are being lifted around the country. i hearing from some parents that the schools are mostly reopened or hybrid reopened, but they are noted -- nervous about sending their kids to school. what advice do you have for families about what steps they can take to protect their children from the virus while we await fda authorization? dr. fauci: i recommendation would be to follow the cdc guidelines. both when children are in the home with vaccinated individual, the guidelines are clear, when they are outside, many things you can do without a mask outside. but if you are not vaccinated and/or interacting with people outside of the home, you want to be careful and have the children have masks. i think a good following of the cdc guidelines, which as dr. lindsay has said, continue to evolve in real time as they get more data. the guidelines get updated and upgraded. that would be my recommendation.

one other thing that i think is important if there is a lot of work we are doing now in clinical trials to get vaccinations for children younger than 12. a bunch of companies, several of them are doing what is called hd escalation studies, we are looking at children from 12 to nine and nine to six, 62, and then six months to two years. we think by the time we get to the end of this year, we will have enough information to vaccinate children of any age. >> that will be very welcome news. thank you. dr. kessler, i want to follow-up on a line of questioning that senator murphy was following. we have heard encouraging news that the protection from the vaccines remains strong for at least six months and likely longer, but also that americans will need booster shots. as you will have discussed. it is going to be critical that these vaccines are made accessible and are priced that

reflects the development and technology. what steps should congress take to ensure that covid-19 vaccines, including booster shots, remained available to americans even after the end of the public health emergency, >> senator, a key question. let me assure you that because of what this committee has done and your colleagues on appropriations, we do have the funds to purchase the next round -- again, if, if they are necessary. so we will be able to purchase the next round and to assure that if there are boosters, they are free. just as the last round.

i think you raise a very good question. beyond that, beyond 2022, i look to your guidance and your colleagues on at what point do you transition back to a commercial market. but i think for this coming round we are going to proceed as we have proceeded. you have made those funds available. senator hassan: i look forward to continuing the discussion. i see i'm almost out of time here. i did want to just ask the dr. walensky, quickly, can you speak to the importance of continued access to covid-19 testing even as we work to distribute the vaccine and people are getting -- we are building up our community and herd immunity? dr. walensky: thank you very much for that question. first of all we recognize that right now we have done an extraordinary job in getting vaccine to americans, yet 2/3 of

americans don't have vaccine. and our young children will not have access to vaccine for the rest of this year. we have put out $10 billion towards states to be able to do testing programs within schools. some higher ed have been able to successfully minimum wage in this past semester through testing programs on their college campuses. we need to continue testing through our long-term care facilities as well as our correctional facilities. our industries. so, yes, i think there has to be a huge corner of what we are doing that is related to testing. also surveillance water testing, sewage testing to look for outbreaks. we are doing a lot in the testing area. we are grateful for the resources to be able to do so. once we have vaccine in the majority of people, we are still going to have disease out there. we are going to need to rapidly be able to detect it. senator hassan: thank you very much, senator murray: senator marshall.

senator marshall: do you think it's possible covid-19 arose from a lab accident in wuhan and should it be fully vaccinated? dr. fauci: that possibility certainly exists. i am totally in favor of full investigation whether that could have happened. senator marshall: is it possible covid-19 is not naturally occurring? dr. fauci: again, that is a possibility. i don't know if we are ever going to be able to approve that. you always need to open up and leave all possibilities which is the reason why i and so many of my colleagues are very much in favor of what the w.h.o. said they want to go back again and take another look in there and see what was going on in that lab. senator marshall: will you commit to get to this committee all the records from viral experiments from 2013 to the present so we can review those? dr. fauci: certainly. i would comply with any request of the committee.

senator marshall: do you and others at n.i.h. have a conflict of interest when determining if the labs and lab work you help fund should be investigated and how it's investigated? dr. fauci: no, i don't think it's a conflict of interest. we are very open in wanting to make sure everything that has any questions is looked into. i have no problem with that. senator marshall: in 2013, president obama placed a moratorium on viral function studies with loopholes which you were able to use at certain times. i know we disagree. we can discuss what is the function and what isn't. in 2017 you had a long process and i assume it was you that decided to lift this moratorium. during this review my question is this, during receipt view did

you consider the risk of dual applications by military, terrorist, or other foreign actors? dr. fauci: i'm not sure what you mean by that, senator. did i consider applications from dual actors? senator marshall: did you consider the risk of dual application that there might be other folks that would use some of the discoveries they might be used by a military or other foreign actors. dr. fauci: in any research that we do we publish the research. it's available for anyone to use

it in any manner in which they can. that's the modus operandi of the n.i.h. we fund research. the research -- senator marshall: isn't it a national security decision. a biofunction could be more powerful than the nuclear weapons. to share that information with a government, foreign actor may be -- be like trying to do the manhattan project and nuclear energy, nuclear weapons doing it with hitler or the soviet union. dr. fauci: i'm not sure what you're getting at senator. we don't fund research. we have committees that look at that to make sure that research that is of any potential danger is not funded. i'm not exactly sure what your point is. senator marshall: my point is there national security implications with something as theoretically lethal as viral gaino function. dr. fauci: sure it is. that's why we have committees. we have a p-3-co, which is ask the pandemic pathogen care and observation -- oversight. that's a committee separate from the n.i.h. that looks at these types of grants to see if they need to be funded. so there is a considerable amount of oversight to make sure grants that are doing research that would obviously be of danger is not -- senator marshall: when you made the decision to stop the moratorium on the function was there national security -- in

the room was there state department? was there defense department? who were those people that might have been part of that decision? dr. fauci: first of all i did not make the decision to stop the pause and gain of function. if one looks what actually happened, we put a pause on and i was the one that was very much in favor of that pause. senator marshall: in 2013. dr. fauci: in 2014 to 2017, the pause was lifted because we established a committee that looked at what we called p3co. senator marshall: i'm familiar with it. dr. fauci: when that committee was able to make decisions about granting apart from the n.i.h. so we would not have any decision and it would be -- senator marshall: i have one last question. i still don't know if you answered were there national security people in the room when that process -- someone made the decision. i think you led that decision. we'll come back to that. here's my last question. if covid-19 is, indeed, a product of lab manipulation, can you sit here and unequivocally say the biostudies that n.i.h. funded, helped fund, could not

be indirectly or directly related to this final covid-19 virus? dr. fauci: looking at the experiments that were done, that we funded, there would not be that possibility. we are talking about a hybrid virus of a mouse virus that was adapted to a mouse that anyone that knows anything about virology would realize that that is not something that would infect the human much less the pathogenic and transmissible. senator marshall: it had the h.l.a. receptor that this covid-19 was specific for and you -- n.i.h. was involved in the development in had a humanized mouse? dr. fauci: yes. as i mentioned in response to senator paul, the n.i.h. and naiad did not fund gain of function research to be conducted at the wuhan institute of virology. senator marshall: that's not my question. the question is, could some of the funding you did -- can you call it gain of function or not, developing the h.l.a. receptor

of the mouse. i'm not sure if you call that gain of function, probably not. could some of the funding ended up in the contribution of covid-19? dr. fauci: i'm not sure exactly where that question is going. you could do research on something as benign as looking at something that has nothing to do with it and it could indirectly, someday, somehow be involved. so if you want to trap me into saying yes or no, i'm not going to play that game. senator marshall: we need to look at that very deeply and consider exactly -- that's why you committed earlier to make sharing all the viral -- dr. fauci: i would be happy to share any information you like with the committee. senator marshall: thank you. senator murray: senator rosen. senator rosen, i believe you are on mute. we'll hold one second for

senator rosen's mute function to work. i believe they are trying to undo senator rosen's mute function from the studio. senator rosen, if you can just be patient with us for a minute while we get that fixed. i'm going to go ahead and ask a question. senator rosen, if you can hold for a minute. i wanted to ask dr. walensky,

there are variant strains of covid-19 that threaten to disrupt progress made towards ending the pandemic. the c.d.c. reports that the b.1.1.7. variant is in the united states. we need to know which variants are out there and how they are spreading -- who they are spreading to. which is why we approved $1.75 billion in the american rescue plan to help c.d.c. shore up its genomic sequencing. do you have data? the right data and right data systems to be able to track these variances? dr. walensky: thank you, senator. we have scaled up our sequencing dramatically. every two weeks or so we get an update in data and look at the -- where these sequences are just yesterday, i believe. the most recent update that demonstrated 72% of our cases are now b-1-1-7, 6% are p-1. we are grateful for the resources to be able to do so. generally our ballpark was to have 10% of viral sequences able -- 10% of all circulating virus to be able to be sequenced. with cases coming down and our

sequencing rising up, we have been able to reach about that 10% mark right now. that is required -- a lot of collaboration across government. across commercial labs and what not. the function is -- and the impact of these, whether they are variant concerns, variants under investigation how we understand these is related to an interagency collaboration with barta, n.i.h., and c.d.c. in terms of seeing how transmissible they are as well as how they function against mono colonial antibodies in our vaccines. senator murray: senator rosen, do we have you back? senator rosen: can you hear me now? sometimes with zoom happens. there you go. thank you, chair murray, appreciate you calling this hearing and your patience. for all the scientists, medical

personnel, frontline workers i'm so grateful for what everyone's been doing to be sure we can keep the american people around the world safe, healthy, and informed. dr. fauci, when we last smoke in march you shared that n.i.h. had just launched a billion dollar initiative to study the long-term effects of covid-19 and identify potential prevention and treatment measures for the long haulers

because covid-19, of course, is a novel virus, there are so many gaps in our research and unknown for the people who have been affected and still suffering. that's why i introduced bipartisan legislation that will ensure that n.i.h. will continue to be able to work the c.d.c. and comprehensive and longitudinal studies of a diverse group of covid-19 patients. i know some of the research that's already been done. you shared earlier some updates on long covid. could you speak to the research gap that remain for learning more about the long-term effects such as lung capacity, heart function, some of the things that people really seem to be struggling with once they recovered from their initial symptoms? dr. fauci: thank you very much for that question. yes, we have initiated a series of studies, first of all, building up cohorts so that we can get enough individuals in the cohort to be able to do the kind of studies that you're going to do. as i mentioned in response to a prior question, it's a multi institute endeavor involving multiple n.i.h. institutes with different interests. just as you said the national institute of heart, lung, and blood is one that is looking at some of the issues that you raised in your question. the national institute of

neurological diseases and stroke. the national institute of mental health. and my institute the national institute of allergy and infectious diseases. we have also just now started the request for applications to be able to gather the cohorts and do those types of studies. so there is a considerable amount of interest in this and a major commitment on the part of the n.i.h. to study this thoroughly to fill in some of the gaps that still remain as to what the pathogenesis of this particular syndrome is because it is a real syndrome. that is very troubling to a large number of patients. senator rosen: thank you. i would like to move to the other part of this equation which is the therapeutic research and development. even though people are getting vaccinated, there are still people getting sick, and people like we said still suffering chronic pain, chronic illness as a result of covid-19. we have to be sure that we have those tools to continue to treat any cases that come forward. could you give us any updates about what therapeutics might be in the pipeline.

is there potential for any of these treatments to help some of the long haulers? maybe treat acute and chronic illnesses as a result of the function of covid? dr. fauci: senator, it's an excellent question. it's almost impossible to talk about treatment when you don't know what the underlying pathogenesis is. that's the reason why these studies are starting off by gathering the cohorts and trying to find out if there is a mechanism for some symptomology. the muscle aches, temperature disregulation, sleep disorder, brain fog as they call it. we don't know exactly what the mechanism of this symptomology. that's why it's so important to

do the studies that we are planning to do so that hopefully when we understand the mechanisms we'll be able to have some therapeutic intervention. senator rosen: i appreciate that. it's really going to be important moving forward. it's going to be important to our health care workers. to our surging of hospital capacities and globally around the world. i just thank you for that. i look forward to reconnecting with you as we begin to see more results of this really important longitudinal research. and progress that it's making. thank you, madam chair. i yield back. senator murray: thank you very much. i wanted to ask. the pandemic's deadly impact on communities of color shows we have a long way to go to address systemic racism and health inequities in this country. black and latino people are receiving vaccinations at disproportionately low rates. some of the systems designed to make vaccinations easier, like online registration for appointments, have made it harder for some like our native hawaiian and pacific islander elders. additionally, aapi communities have experienced higher rates of discrimination and violence as we know since the start of this

pandemic. dr. kessler, i wanted to ask you, how is the federal government working to decrease covid-19 related health inequities? dr. kessler: senator, thank you for the question. enormously important. there are some at least initial good news. we have seen the deaths down dramatically since january and we all know that they are down 80% among seniors. they also include that drop -- that drop includes a drop among hispanics of 80% and among

african-americans of about 70%. and in the past two weeks 55% of the people vaccinated were white. 45% were nonwhite. that compares to the general population it's about 60% white and 40% nonwhite. we have much more to do. especially in the area of confidence. we do see people's confidence in the vaccine is increasing. black americans' confidence increased by 24 points since january. latino americans' confidence increased by 22 points since january. but outreach access is absolutely critical. these vaccines are free. every adult in america is eligible. and about 80,000 locations. we have a lot more work to do. we are keeping equity at the center of the response. we will not leave anyone behind. senator murray: thank you so much for that effort. i appreciate it. senator burr, closing questions or comments?

senator burr: madam chairman, thank you. yes, i do. i've got a little bit of cleanup if i can. what i have been able to piece together since we started, and this is to you, dr. marks, and maybe dr. kessler, signed a

contract for $1.2 billion for 300 doses of astrazeneca vaccine. that's currently authorized in 70 countries around the world. its manufacturing capacity in 15 countries and 25 sites. in addition to the baltimore facility, two sites in the u.s. manufacturing in ohio and new mexico of astrazeneca vaccine. here's my question. of the stock that we currently have on hand, which i estimate to be about 60 million doses, is all of that being held because it came from emergent? or in that 60 million inventory that we have today is some of

that either foreign manufactured and/or ohio or new mexico, and would not have to be held up because of the current inspection concerns at baltimore? dr. kessler: senator, i have been talking to astrazeneca even last night. i have been talking to them regularly over the last several weeks. to answer your question very specifically, the 60 million that you reference, all that drug substance was made at emergent. there is another facility at catalant that manufactures drug substance, but we are not -- we have not contracted -- we are not involved and that's for global. there are two other facilities, one in westchester that you referenced, that is for drug product. but everything that we have involvement in that 60 that has been produced for that first initial 100, and they stopped at 60 when -- because of the problems at emergent, were all being -- are all being reviewed by our colleagues at f.d.a. because of issues in emergent. senator burr: follow-up question. over the two million doses that went to mexico.

million and a half dose that is went to canada, have there been any indications from those vaccines, if they have, one, i assume they have been used. is there any reason to believe that they are reporting any adverse effects? dr. marks: senator, no. those came at a time when those facilities were not being used for more than one vaccine. to produce more than one vaccine, sir. senator burr: the fact that they produce not only a.z. but j and j, now makes them susceptible? dr. marks: it's a matter of public record that the problem that occurred at the facility involves a contamination event between two vaccines. and that was the issue that we are dealing with. i just should add that you have our commitment that we are going

to work as quickly as we possibly can to get both clearance of the doses that are currently being held, because we don't have clearance of the safety of those doses yet, and also to get that plant back up and running in a manner that's fully consistent with what americans expect from their pharmaceutical products. senator burr: this question i'm going to go to dr. fauci, dr. marks, and dr. walensky. what percentage of your employees in your institute, your center, or your agency of your employees has been vaccinated? dr. fauci: i'm not 100% sure, senator. i think it's probably a little more than half. probably around 60%. senator burr: dr. marks? dr. marks: i can't tell you the exact number.

it's probably in the same range. some people vaccinated at our facility, and others at outside of the facility. senator burr: dr. walensky? dr. walensky: we are encouraging our employees to get vaccinated. we have been doing town halls and education seminars. our staff have the option to report their vaccination status. as you understand, the federal government is not requiring it. so we do not know. senator burr: listen, you're the face of why people should get vaccinated. and knowing and promoting and confidently giving numbers, percentages, i think is really, really important as we go into this last part. if you tell me that there's some statute that says you can't require somebody to tell you. imagine being the parent of a school-age kid who for generations has been required to have their kids vaccinated before they could start school. and the fact that even our

health organizations we cannot require that of people, we are going to have tough decisions to make. employers are going to make those decisions. there have been decisions already made by colleges around the country that said, if you are a faculty or student you are not coming next year if you are not vaccinated. they have the ability to do that. these are tough questions with even tougher answers. but if we are going to get that last mile coverage, we are going to have to start portraying that we are willing to do to ourselves what we are asking the american people to do. dr. walensky, i think it's safe to say that the 21st century is

something that c.d.c. has not totally entered, but i'm confident that you are going to take them there. especially as it relates to science and technology. my question is simple. do you believe the c.d.c. director should meet with private industry and innovators who have new technologies that can help modernize the c.d.c.? dr. walensky: thank you. i think i have an extraordinary opportunity as being director of the c.d.c. during this period of time. i think that much of what we are going to need to do in public health is going to take collaboration with academia, private sector, and nonprofits. i'm looking forward to engaging in this those in a transparent, open way so we can have that dialogue and create those collaborations. senator burr: let me go back and ask you one more time. do you believe that the c.d.c. director should meet with private industry and innovators that have new technologies? dr. walensky: i believe that we should -- i should be encouraging all of those collaborations and i am relying on my senior leadership team, my subject matter experts to engage in many of those conversations. senator burr: not you? dr. walensky: if it's a subject matter where i'm an expert i

would be happy to, absolutely. senator burr: i think in a question to your staff they suggested that you couldn't. but i'll revisit that through my staff to yours. i have to say i'm a little bit confused on the issue of c.d.c. guidance after hearing my colleagues, senator collins and senator cassidy, about exactly who is involved in content and language. i sent to c.d.c. an oversight letter and i got your response to it on 22 april. i'll just highlight a few things. c.d.c. uses mimicry response clearance protocol to clear items during emergency response. this clearance is applicable to all c.d.c. authored, c.d.c.

branded information, products with content related to an active or ongoing response such as covid-19 response. the clearance process consists of a series of formal reviews, approvals by relevancy, subject matter experts, s.m.e.'s and agency clearance officials. this typically consists of content, development, and review by c.d.c.'s relevant covid-19 response task force or s.m.e.'s followed by additional review coordinated by c.d.c.'s joint information center. at no point given the opportunity did the letter mention anything about people outside of government. could be parents. it could be the national education association. it basically said this all happens within government. that's not what i heard my colleagues say as it related to the guidance on schools. that there was input provided by outside entities. and as a matter of fact i went ahead and pulled all the email chains that i think was accessed by the media outlets that made

them write this story. i'll just say it's alarming because it's done on a timeline. it suggests that a.f.t. leadership, not sure what the issue was they raised, but they certainly changed the language of the guidance because there is actually email that thanked them for the language that they provided. when you look at the timeline between that and white house announcement, one would have a

hard time believing that everything went through a clearance process that was described in the oversight response letter to me. i'd ask you to clear it up for me, if you would. dr. walensky: thank you for that question. as i mentioned to senator collins, prior to our putting our guidance through a formal clearance process, we do an enormous amount of stakeholder engagement to ensure the guidance can actually address the questions asked. i can tell you on the other side when i was a health care provider at massachusetts general hospital i would frequently call my colleagues at the c.d.c. and say we need guidance on x. it needs to address x, y, and z. in the stakeholder engagement for the schools, we did outreach with over 50 organizations. we spoke to teachers, we spoke to parents, we spoke to superintendents, we spoke to many different stakeholders to understand what it is that they needed from our guidance. as i mentioned previously in doing so we recognized in meeting with the teachers we had actually failed to comment on what happened if teachers were immunosuppressed. if teachers were undergoing

chemotherapy, if they had family member with a transplant at home. how were we going to engage and provide guidance to those. it was the c.d.c. scientist that is provided the guidance that provided the science around what we should do. it was the request from teachers who said you didn't address this issue and we hadn't. senator burr: so the first contact by a.f.t. with your staff was on february 1, monday, february 1. your staff person -- we were able to review a copy of the draft -- excuse me, partner with the a.f.t. we were able to review draft guidance documents over the weekend, were able to provide some initial feedback to several staff this morning about possible ways to strengthen the document. that's on february 1, the morning. on february 2 your staff emailed to you that they had followed up with suggested language on accommodations per exchange and on february 3 at a white house

press conference you say schools can open -- reopen without teachers being vaccinated. would one reading this be concerned with this timeline and what the oversight letter told me was the protocol that you went through to have guidance signed off on? dr. walensky: in the february 3 -- first of all in the february 3 press conference, that was before our guidance was released. that was speaking to science and

studies that demonstrated that schools had effectively reopened -- without teachers being vaccinated and keeping students and children safe. february 3 predated our guidance release which i believe was february 12 but i would have to confirm. you may recall at the time that in the media i took quite a hit for commenting on that from teachers themselves. they were not happy with me at the time. senator burr: with the success of a.f.t. and n.e.a. engages you and you actually committed to do an n.e.a. town hall meeting. is that right? dr. walensky: we were engaging at the time with over 50 organizations. teachers, superintendents, parents alike at the time when our school guidance came out. as a matter of practice in an unbiased fashion. senator burr: madam chairwoman, i'm going to ask that the letter and the emails be part -- included as part of the record. senator murray: without

objection. senator burr: i only make this observation. i hope you can understand why members express frustrations. on guidance that there's a chain of information that suggests people had a preferred access to not only advice but actual language that went into the guidance. i know what your answer to my last question is going to be because i have stated it in one of the emails. should c.d.c. guidance suggest that all states should require teachers to be vaccinated? dr. walensky: i would encourage all teachers to be vaccinated. we spent the month of march providing vaccines to our federal pharmacy programs and got over 80% of our teachers and educators vaccinated through that process. i am certainly encouraging all teachers be vaccinated.

i think the guidance with regard to mandatory vaccination in schools will have to be done at the local level. senator burr: would you provide guidance that suggested to schools that they vaccinate teachers? dr. walensky: we have been encouraging vaccination -- senator burr: all teachers. dr. walensky: we have been encouraging vaccination of all teachers, all educators, all parents -- senator burr: is that in guidance? dr. walensky: i would have to confirm because i don't know whether our most recent updated guidance for schools actually had widespread availability of vaccine. senator burr: the chairman's been awfully kind to me. i'm not trying to pick. as i said when i started, the next several months are going to be extremely tough at getting people vaccinated. i don't want any of us to lose focus on what the mission is out there. i know for all of you i'm stating the obvious that we've got to stay focused on vaccines. but the confidence the american

people have in you is a lot of what's going to make us successful. as dr. fauci and i have talked many times about thank god we had in place an architecture we perfected over the last 20 years that allowed things to happen organically like e.u.a.'s and this type of thing. it wasn't because we experienced anything, it's we went through little red flags, h-1-n-1, sars, ebola, where we looked at it if this would have been the big one what would we have changed? and collectively we went through and changed 24e78 and we were much better prepared a year ago architecturally. and 80% of what we did was following the statutes that's out there and the authorities

that were given to many of your institutes or agencies, or in dr. mark's case, to the f.d.a. i've got to tell you that i believe what the f.d.a. has accomplished, i never dreamed they could do. my goal now is to make sure we don't roll back because as we move into technology platforms, that's not something that is easy to go back and do clinical trials on again if you are looking for a new indication. but i got to tell you that i believe that schools going back in person in the fall is absolutely crucial to get the majority of the parents who have yet to be vaccinated, vaccinated. knowing that at least by the end of this month, if we are not already there, every adult that wants to be vaccinated can be vaccinated. it's time for us to start setting the stage and think the picture for what the fall looks like. people can go on vacation this year and eat in a restaurant in

the outer banks of north carolina preferably that they can plan their summer vacation, hopefully in a few more weeks or days maybe they can go to camp. that in the fall we expect every school to be in person, short of some drastic change in the infection it bath, next thanksgiving you ought to plan to have thanksgiving with your family and extended family. christmas -- if we paint that picture i believe, david, we'll get people vaccinated. but if we continue to fail at the trust they have in us making the calls that are appropriate at the time, feeling like that they are influenced in any way, feeling like we are not out there where we need to be interpreting the science, we are going to fail. and we'll fail for the american people.

more importantly, we are going to fail for the world. because the world right now is relying on us getting to that number and us providing the technology and the manufacturing capacity for them to be vaccinated. so we've got a big step ahead of us. i'm delighted that all four of you are here today. i thank you for the work that you have done up to this point. and more importantly for the work you are going to do in the future. i thank the chair. senator murray: thank you. that will end our hearing today. i want to thank all of our colleagues who are here. i especially want to thank all of our witnesses today. thank you doctors walensky, marks, kessler, and fauci for updating us on this pandemic and thank you to all of he those who work for you and been diligent in trying to make tough decisions in a difficult time to help protect all americans. thank you very much to you and to all the people that work with

you. for any senators who wish to ask additional questions, questions for the record will be due in 10 business days. on tuesday may 25, at 5 p.m. hearing record will remain open until then for members who wish to submit additional remarks and materials for the record. the committee will next meet tomorrow, wednesday, may 12, to mark up the nominations of samuels to be a member of the equal employment opportunity commission. jennifer to serve as general counsel of the national labor relations board. and the solicitor for the department of labor. with that the committee stands at adjourned. \[captions copyright national cable satellite corp. 2021] \[captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> go to c-span.org/coronavirus for the federal response to the pandemic. use the interactive gallery of maps to follow cases in the u.s. and worldwide. go to c-span.org/coronavirus. coming up wednesday, the house is back at 10:00 a.m. eastern for general speeches followed by legislative business. members are working on several bills, including one that directs the v.a. to establish a program using service dogs to help treat veterans with ptsd. there's legislation that would designate the post nightclub site in florida as a national

memorial. on c-span two, the senate returns to consider moving forward with nominations for the u.s. postal service and centers for medicare and medicaid services. at 10:00 a.m. on c-span3, attorney general merrick garland and alejandro mayorkas testify on the threat of domestic extremism. also, there's more streaming live on or website including a hearing on the biden administration's trade priorities with trade representative katherine tai. at 10:30, health and human services secretary javier becerra testifies at a subcommittee hearing on the president's 2022 budget request. at noon, the house administration committee looks at how the u.s. capitol can be better prepared for an emergency following a january 6 attack.

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