[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
FULL COMMITTEE HEARING ON THE
CHALLENGES OF THE 2009-H1N1 INFLUENZA
AND ITS POTENTIAL IMPACT ON SMALL
BUSINESSES AND HEALTHCARE PROVIDERS
=======================================================================
HEARING
before the
COMMITTEE ON SMALL BUSINESS
UNITED STATES
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
HEARING HELD
SEPTEMBER 9, 2009
__________
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Small Business Committee Document Number 111-044
Available via the GPO Website: http://www.access.gpo.gov/congress/house
U.S. GOVERNMENT PRINTING OFFICE
52-260 PDF WASHINGTON : 2009
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
HOUSE COMMITTEE ON SMALL BUSINESS
NYDIA M. VELAZQUEZ, New York, Chairwoman
DENNIS MOORE, Kansas
HEATH SHULER, North Carolina
KATHY DAHLKEMPER, Pennsylvania
KURT SCHRADER, Oregon
ANN KIRKPATRICK, Arizona
GLENN NYE, Virginia
MICHL MICHAUD, Maine
MELISSA BEAN, Illinois
DAN LIPINSKI, Illinois
JASON ALTMIRE, Pennsylvania
YVETTE CLARKE, New York
BRAD ELLSWORTH, Indiana
JOE SESTAK, Pennsylvania
BOBBY BRIGHT, Alabama
PARKER GRIFFITH, Alabama
DEBORAH HALVORSON, Illinois
SAM GRAVES, Missouri, Ranking Member
ROSCOE G. BARTLETT, Maryland
W. TODD AKIN, Missouri
STEVE KING, Iowa
LYNN A. WESTMORELAND, Georgia
LOUIE GOHMERT, Texas
MARY FALLIN, Oklahoma
VERN BUCHANAN, Florida
BLAINE LUETKEMEYER, Missouri
AARON SCHOCK, Illinois
GLENN THOMPSON, Pennsylvania
MIKE COFFMAN, Colorado
Michl Day, Majority Staff Director
Adam Minehardt, Deputy Staff Director
Tim Slattery, Chief Counsel
Karen Haas, Minority Staff Director
.........................................................
(ii)
STANDING SUBCOMMITTEES
______
Subcommittee on Contracting and Technology
GLENN NYE, Virginia, Chairman
YVETTE CLARKE, New York AARON SCHOCK, Illinois, Ranking
BRAD ELLSWORTH, Indiana ROSCOE BARTLETT, Maryland
KURT SCHRADER, Oregon W. TODD AKIN, Missouri
DEBORAH HALVORSON, Illinois MARY FALLIN, Oklahoma
MELISSA BEAN, Illinois GLENN THOMPSON, Pennsylvania
JOE SESTAK, Pennsylvania
PARKER GRIFFITH, Alabama
______
Subcommittee on Finance and Tax
KURT SCHRADER, Oregon, Chairman
DENNIS MOORE, Kansas VERN BUCHANAN, Florida, Ranking
ANN KIRKPATRICK, Arizona STEVE KING, Iowa
MELISSA BEAN, Illinois W. TODD AKIN, Missouri
JOE SESTAK, Pennsylvania BLAINE LUETKEMEYER, Missouri
DEBORAH HALVORSON, Illinois MIKE COFFMAN, Colorado
GLENN NYE, Virginia
MICHL MICHAUD, Maine
______
Subcommittee on Investigations and Oversight
JASON ALTMIRE, Pennsylvania, Chairman
HEATH SHULER, North Carolina MARY FALLIN, Oklahoma, Ranking
BRAD ELLSWORTH, Indiana LOUIE GOHMERT, Texas
PARKER GRIFFITH, Alabama
(iii)
Subcommittee on Regulations and Healthcare
KATHY DAHLKEMPER, Pennsylvania, Chairwoman
DAN LIPINSKI, Illinois LYNN WESTMORELAND, Georgia,
PARKER GRIFFITH, Alabama Ranking
MELISSA BEAN, Illinois STEVE KING, Iowa
JASON ALTMIRE, Pennsylvania VERN BUCHANAN, Florida
JOE SESTAK, Pennsylvania GLENN THOMPSON, Pennsylvania
BOBBY BRIGHT, Alabama MIKE COFFMAN, Colorado
______
Subcommittee on Rural Development, Entrepreneurship and Trade
HEATH SHULER, North Carolina, Chairman
MICHL MICHAUD, Maine BLAINE LUETKEMEYER, Missouri,
BOBBY BRIGHT, Alabama Ranking
KATHY DAHLKEMPER, Pennsylvania STEVE KING, Iowa
ANN KIRKPATRICK, Arizona AARON SCHOCK, Illinois
YVETTE CLARKE, New York GLENN THOMPSON, Pennsylvania
(iv)
C O N T E N T S
----------
OPENING STATEMENTS
Page
Velazquez, Hon. Nydia M.......................................... 1
Graves, Hon. Sam................................................. 2
WITNESSES
Blank, Ph.D., Hon. Rebecca M., Under Secretary of Commerce for
Economic Affairs, U.S. Department of Commerce.................. 3
Schuchat, M.D., USPHS, Rear Admiral Anne, Assistant Surgeon
General, United States Public Health Service, Director,
National Center for Immunization and Respiratory Diseases
(NCIRD), Centers For Disease Control and Prevention, Department
of Health And Human Services................................... 4
Mcgaw, Mr. Bridger Acting Assistant Secretary for the Private
Sector, Office of Policy/Office of Private Sector, Department
of Homeland Security........................................... 6
Demangone, Mr. Anthony, Director of Regulatory Compliance, Senior
Compliance Counsel, National Association of Federal Credit
Unions......................................................... 21
King, Md, Dr. Jim, Chair of Board of Directors, Selmer,
Tennessee, American Academy Of Family Physicians............... 23
Jackson, Mr. Harold, President and CEO, Buffalo Supply, Inc.,
Lafayette, CO. On Behalf of The U.S. Chamber of Commerce....... 24
Tayloe, Jr. Md, Dr. David T., President Goldsboro, NC, American
Academy of Pediatrics.......................................... 26
Thatcher, Ms. Mary Kay, Director of Public Policy, American Farm
Bureau Federation.............................................. 28
(v)
APPENDIX
Prepared Statements:
Velazquez, Hon. Nydia M.......................................... 36
Graves, Hon. Sam................................................. 38
Blank, Ph.D., Hon. Rebecca M., Under Secretary of Commerce for
Economic Affairs, U.S. Department of Commerce.................. 40
Schuchat, M.D., USPHS, Rear Admiral Anne, Assistant Surgeon
General, United States Public Health Service, Director,
National Center for Immunization and Respiratory Diseases
(NCIRD), Centers For Disease Control and Prevention, Department
of Health And Human Services................................... 44
Mcgaw, Mr. Bridger Acting Assistant Secretary for the Private
Sector, Office of Policy/Office of Private Sector, Department
of Homeland Security........................................... 51
Demangone, Mr. Anthony, Director of Regulatory Compliance, Senior
Compliance Counsel, National Association of Federal Credit
Unions......................................................... 57
King, Md, Dr. Jim, Chair of Board of Directors, Selmer,
Tennessee, American Academy Of Family Physicians............... 68
Jackson, Mr. Harold, President and CEO, Buffalo Supply, Inc.,
Lafayette, CO. On Behalf of The U.S. Chamber of Commerce....... 72
Tayloe, Jr. Md, Dr. David T., President Goldsboro, NC, American
Academy of Pediatrics.......................................... 81
Thatcher, Ms. Mary Kay, Director of Public Policy, American Farm
Bureau Federation.............................................. 93
Statements for the Record:
American Farm Bureau Federation.................................. 99
National Pork Producers Council.................................. 101
American Hotel & Lodging Association............................. 108
(vi)
FULL COMMITTEE HEARING ON THE
CHALLENGES OF THE 2009-H1N1 INFLUENZA
AND ITS POTENTIAL IMPACT ON SMALL
BUSINESSES AND HEALTHCARE PROVIDERS
----------
Wednesday, September 9, 2009
U.S. House of Representatives,
Committee on Small Business,
Washington, DC.
The Committee met, pursuant to call, at 1:08 p.m., in Room
2360, Rayburn House Office Building, Hon. Nydia M. Velazquez
[Chair of the Committee] Presiding.
Present: Representatives Velazquez, Moore, Dahlkemper,
Schrader, Ellsworth, Luetkemeyer and Thompson.
Chairwoman Velazquez. I call this hearing of the Committee
to order.
Every flu season we encourage Americans to take precautions
like getting vaccinated and washing their hands. However, this
year's flu season is different. Because of H1N1, our Nation can
expect a new set of public health issues. For those in the
small business community, the 2009 H1N1 flu season will mean
new challenges.
The World Health Organization and the CDC announced the
outbreak of H1N1 in March. By July, the number of confirmed
cases have reached 100,000. While it is too early to tell how
fast the virus will spread, it is almost certain that a
pandemic will mean significant economic consequences. The CBO
has suggested a full-blown pandemic could draw $700 billion out
of our economy at a time when we cannot afford any economic
setbacks.
The administration recently released its plan for employers
to respond to and prepare for H1N1. This week we expect to see
a similar plan that is specifically tailored for small
businesses' needs. Today's hearing will look at these
recommendations and the issues facing small firms.
For small companies this year's flu season raises many
questions. How should small businesses handle leave policy? One
of the best ways to combat the spread of H1N1 is to encourage
employees to stay home if they are ill. Clearly, limiting
exposure is important for fighting the spread of flu; however,
sending too many workers home can also impede small firms'
operations.
While most small business owners want to be responsible and
protect their employees' health, we also want to ensure that
they do not needlessly slow down their operations. Big
companies usually have enough employees to continue operating
even when part of their workforce grows ill. That isn't always
the case for small businesses. So we cannot assume that
solutions that work for big firms will work for small ones.
We also need to think about how disruptions to small
businesses will impact the flow of commerce. Entrepreneurs rely
on other firms to provide them materials, but they also supply
products to other businesses. If H1N1 interrupts the supply
chain, there are questions about how the overall flow of goods
and services will be affected.
We need to examine these problems and think about solutions
for minimizing this economic ripple effect. Perhaps, most of
all, we must look at what tools are available to help small
businesses as we head into flu season and consider whether
those tools are sufficient.
Just as small employers are taking steps to slow the spread
of H1N1, entrepreneurs will be critical to helping our Nation
overcome this pandemic. Some of the most promising research is
conducted by small companies. As we race to develop effective
vaccines, these companies will be instrumental. Small health-
care providers have always been the core of our medical system.
Eighty percent of doctor office visits take place in a small
practice. These providers will be vital in distributing
vaccinations and treating Americans who fall sick.
Clearly all types of small businesses will be on the front
line this flu season. As employers, as health-care providers,
and as a source of medical innovation, entrepreneurs will be an
important part of how our Nation responds to this public health
problem.
At this stage numerous questions remain unanswered. All of
us hope that infection rates are moderate, but regardless, the
wisest course of action is for all of us to be--the most
important thing is to be prepared.
Today's hearing will explore how small businesses can help
us through this year's flu season, the challenges they face,
and what we did do to support their efforts.
With that, I thank our witnesses for being here and yield
to Ranking Member Mr. Thompson for an opening statement.
Mr. Thompson. Madam Chairwoman, thank you for calling this
hearing on a very important issue, the H1N1 influenza virus and
its effects on small businesses and family farms and health-
care providers, and thank you to all the witnesses who are
testifying today.
The H1N1 flu virus appeared in the United States in late
April of 2008. Since that time the World Health Organization
and the Centers for Disease Control have said that there is no
evidence that H1N1 is spread by the consumption of food.
Nevertheless, pork consumption is down, and exports of pork and
pork products have declined, and farmers, owners of the related
industries and their communities are feeling the negative
ripple effects.
Now, this comes at a time when small companies are already
struggling in a difficult economy. Small businesses of all
kinds have been affected by H1N1, and this hearing will provide
an opportunity for us to examine the many related issues that
center around this.
Madam Chairwoman, I look forward to hearing from our
witnesses, and I yield back the balance of my time.
Chairwoman Velazquez. And now I want to welcome the
Honorable Rebecca Blank. Ms. Blank is the Under Secretary for
Economic Affairs at the U.S. Department of Commerce. She has
been confirmed by the Senate and was sworn in on June 9. In
this position Dr. Blank's principal responsibilities include
economic forecasting, consultation with the private sector, and
policy analysis. Welcome.
STATEMENT OF REBECCA M. BLANK
Ms. Blank. Madam Chairwoman, Representative Thompson, and
other members of the Committee, thank you very much for
inviting me to be here this afternoon. I appreciate the
opportunity to appear and discuss the efforts of the Department
of Commerce to educate businesses, including small businesses,
on how to minimize the negative economic impacts of the H1N1
virus.
I commend the Committee's focus on this topic. We don't
know the specific course that the H1N1 flu will follow over the
next few months, but we do know there are actions that can be
taken to minimize its impact. The Obama administration has
developed preparedness guidance and is working with State and
local governments and the private sector to promote awareness
of these steps.
It is predicted that the arrival of the H1N1 flu, in
conjunction with the regular seasonal flu, will bring more
illness. The more severe the flu outbreak, the greater the
impact on the economy. We don't know precisely what these
impacts will be, but it is likely that businesses will be
confronted with greater absenteeism as their employees or
family members become ill, which will in turn affect
productivity.
In a more severe outbreak, concern about the flu can lead
people to avoid public places. This will reduce consumer
spending and means that some industries, such as travel and
tourism, retail sales, and service-oriented businesses will
experience greater economic impact than others.
Just recently Secretary Locke participated in several
outreach calls to CEOs in the retail, travel, tourism, and
technology sectors. The response to that outreach has been very
positive. The Department will remain in contact with the
business community on this matter through an outreach plan that
will provide regular opportunities to share information,
promote preparedness, and monitor responses should H1N1 occur
this fall.
Let me emphasize that all businesses, including small
business, should develop plans in advance to respond flexibly
to either the current level of severity or a more severe flu
outbreak. The coming influenza season is likely to prove
challenging, especially to small businesses, as they can easily
be affected by the absence of just a few key employees. Small
businesses may have fewer resources available to cope with
unexpected events. That is all the more reason for them to
prepare now for how they would handle future problems.
Whatever the magnitude of the flu outbreak, there are steps
that can and should be taken to mitigate the impact of the
upcoming flu season on productivity and to better protect
workers and their families.
The Interagency Committee Guide has recommended that
businesses establish an influenza plan and involve employees in
development and review. This may be particularly important for
small businesses where there is more need for employees to take
over responsibilities when other employees become absent.
Understand the organization's normal seasonal absenteeism
rates so that businesses can monitor any unusual increases and
know if they are being affected. Engage with local health
authorities to confirm channels of communication to know if the
local outbreak is becoming more severe; share best practices
with other similar businesses; and implement sick-leave
policies that are flexible and consistent with public health
guidance so sick employees may remain home.
Unfortunately, it is possible that the flu outbreak in the
coming season could be worse than what we experienced in early
2009. In this case there may be a need to implement plans that
would allow more workers to telecommute or temporarily limit
noncritical activities.
Businesses should follow updates on the course of the flu
to be aware of changes in occurrence and severity in their
local area. The most up-to-date information on this will be
available on the www.flu.gov Web site. I have been told by my
staff to repeat that Web site as often as possible. It is the
most authoritative source of information for people.
We cannot stop the flu season, but with adequate
preparation and planning, we can minimize its impact on people,
businesses, and the economy.
Thank you for the opportunity to testify on the activities
of the Department of Commerce. We look forward to continuing
our collaboration between the Department and the agencies
represented here today, as well as other Federal agencies and
the business community. I look forward to your questions.
Chairwoman Velazquez. Thank you, Dr. Blank.
[The statement of Ms. Blank is included in the appendix.]
Chairwoman Velazquez. And now it is my pleasure to welcome
Rear Admiral Anne Schuchat. She is the Assistant Surgeon
General for the United States Public Health Service. She is
also the Director of the National Center for Immunization and
Respiratory Diseases. Dr. Schuchat has played a leadership role
in the Health and Human Services response to the 2009 H1N1
influenza virus.
Welcome.
STATEMENT OF REAR ADMIRAL ANNE SCHUCHAT
Admiral Schuchat. Good afternoon. Thank you, Chairwoman
Velazquez and distinguished Committee members. I am Dr. Anne
Schuchat, the Director of the National Center for Immunization
and Respiratory Diseases, and delighted to be able to update
you on the H1N1 situation.
Increased disease from the 2009 H1N1 virus has already
begun in the Southeastern States, and we expect in the coming
months more and more communities around the country to
experience increases of influenza, including this new virus.
Communities may be more severely affected, reflecting wider
transmission and potentially greater impact. Seasonal influenza
viruses may continue to circulate at the same time as the H1N1
virus this fall and winter. It is also difficult for us to
predict the severity that these outbreaks will have, the number
of hospitalizations, the deaths that will occur due to either
the H1N1 virus or seasonal flu.
Small businesses play a vital role in community functioning
during influenza pandemics. They form the critical backbone of
supply chains for larger businesses and are central to the
strength of local economies. Many health-care providers are
also small businesses, and they are critical to caring for
patients, to delivering vaccine, and to managing and informing
influenza decisionmaking in their communities, yet small
businesses also suffer disproportionately during disasters, and
they are especially susceptible to the negative economic
impacts of an influenza pandemic.
The CDC and Health and Human Services work closely with the
Department of Homeland Security, the Department of Labor,
Department of Commerce, and the Small Business Administration
to help small businesses address issues they may face during an
influenza pandemic. In response to our expected spread of the
2009 H1N1, CDC has updated our recommendations to assist
businesses and other employers of all sizes, and, in fact, we
are now working on updating guidance that will address the
small business community in particular.
The guidance for small businesses will recommend that small
businesses should plan for and respond to two possible
scenarios: One where the severity of illness is similar to what
we saw in the spring and summer, and a second scenario where
the severity might be worse.
Even if the severity of this virus doesn't change, though,
small businesses should expect that there will be more illness
this fall and winter, and that this may significantly raise the
levels of absenteeism and could have an impact on their
business operations.
That second scenario of greater severity involves more
people becoming ill with severe illness, more hospitalizations,
and even more deaths, an even greater escalation of
absenteeism. Businesses need to be ready to implement
strategies to protect their workforce while ensuring continuity
of operations.
During an influenza pandemic, all sick people should stay
home and away from the workplace. Hand washing and covering
your cough continues to be important, and routine cleaning of
commonly touched surfaces is also important.
Employers of all sizes should consider plans to implement
flexible sick-leave policies. CDC recommends that employees
with influenza illness stay home until at least 24 hours after
their fever is gone. Sick employees would be out for about 3 to
5 days in general, even if antiviral medications are used.
Businesses should also not require a doctor's note for workers
who are ill with influenzalike illness to validate their
illness or to return to work. A doctor's visit might strain the
health system and isn't needed for most people with
influenzalike illness.
Businesses should also inform employees that some people
are at higher risk of complications from influenza. People at
higher risk should check with their health-care providers if
they become ill. Early treatment with antiviral medicines is
important for people at high risk because it can help prevent
hospitalizations and death.
CDC also recommends businesses encourage employees who are
recommended for the seasonal flu vaccine and for the 2009 H1N1
vaccines get vaccinated as soon as those vaccines are available
in their communities.
Small businesses should consider developing other flexible
leave policies to allow workers to stay home to care for sick
family members or for children if schools dismiss students of
child-care programs or if child-care programs close.
It may be helpful to consider ways to cross-train workers
to perform essential functions so the workplace is able to
operate even when key staff are absent. To maintain critical
operations, small businesses should be prepared to change
business practices as needed during an outbreak. Small
businesses should prepare to identify alternative suppliers,
for instance, or prioritize customers, or temporarily suspend
some operations if that is needed.
So I want to end with stressing four points that small
businesses can take. Plan now to prepare for the impact of flu
this fall and winter; take into account two planning scenarios:
similar severity and greater severity; protect your workforce
by encouraging people to stay home if they are sick; and take
steps to maintain continuity of operations even during high
levels of absenteeism.
We are working across government to try to develop
practical, clear guidance and tools that small business can use
to protect their workforce and maintain operations during what
I think is going to be a challenging flu season.
Our Nation's current preparedness is at the greatest stage
it has ever been, but we all need to work together going
forward, and I look forward to working with the Congress in
answering your questions.
Chairwoman Velazquez. Thank you, Dr. Schuchat.
[The statement of Admiral Schuchat is included in the
appendix.]
Chairwoman Velazquez. And now I welcome Mr. Bridger McGaw.
He is the Assistant Secretary for the Private Sector in the
Office of Policy in the Department of Homeland Security. The
Private Sector Office engages businesses, trade associations,
and other nongovernmental organizations to foster a dialog
between DHS and the private sector.
STATEMENT OF BRIDGER McGAW
Mr. McGaw. Chairwoman Velazquez, Ranking Member Thompson,
and members of the Committee, thank you for the opportunity to
discuss the Department of Homeland Security's effort to prepare
small businesses for the upcoming flu season.
I am Bridger McGaw, the Acting Assistant Secretary for the
Private Sector Office, and I have held this position since
March of this year. As Homeland Security Presidential Directive
5 states, the DHS's role in a pandemic is to act as the
principal Federal official for domestic incident management.
In anticipation of this year's flu season, DHS has worked
extensively with our interagency partners to provide H1N1 flu
guidance for schools, universities, and businesses. This
includes the development of a guide for small businesses. By
providing this guidance, DHS is promoting tools that
individuals and businesses can use to mitigate the impact of
H1N1 and help minimize disruptions in society and the economy.
Preparedness is a shared responsibility of the public and
private sector as well as every household and business of every
size. As this spring's outbreak developed, Secretary Napolitano
stressed the importance of getting timely information out to
the public, including the private sector, about the extent of
the outbreak, the government's response efforts, and guidance
on what the public could do to stay healthy.
We found that businesses of all sizes generally had very
similar information needs. They want to know what was happening
from a medical perspective and what they should do to mitigate
the potential impact of the outbreak. DHS employed several
strategies to get this information out to the broadest base
possible. We held press conferences and phone briefings, sent
out e-mail updates, met with various stakeholders, and held a
flu summit in July. In each case, we coordinated with HHS and
CDC and our partners in the Federal agencies.
The private sector responded very positively to these
outreach efforts. For example, the American Hotel and Lodging
Association, which estimates that half of their 11,000 members
are small businesses, applauded DHS's updates, using the
information to inform their membership.
When the spring outbreak transitioned to a steady state,
DHS worked with the interagency to take advantage of these
summer months before the fall flu season to update our planning
resources for businesses, schools, and universities. As a
result the Federal Government has released guidance for all
three of those elements.
In conjunction with the business guidance, DHS also created
a short, user-friendly guidebook on H1N1 preparedness aimed at
small businesses. This guide highlights how to make a plan to
ensure their continued operations, steps businesses can take to
protect their environment, and steps that employees can take to
protect themselves from H1N1. The small business guide is in
the final stages of review and will be available at flu.gov
soon.
To reach America's 30 million businesses, 99 percent of
which are small businesses, my office partners with umbrella
organizations that can disseminate updates and guidance
throughout their networks. For example, we work with the U.S.
Chamber of Commerce, the National Association of Manufacturers,
the National Retail Federation, all of which represent small
businesses.
My office also regularly works with local Chambers of
Commerce, which are typically comprised of small and local
businesses. For example, the Business Council of Fairfield
County, Connecticut, recently distributed our e-mail update to
their 300 members and posted links to flu.gov on their Web
site.
This hearing is especially timely, given that September is
National Preparedness Month. This month we all need to check in
with our family, our workplace, and our community to make sure
we have a plan to stay safe in an emergency. Good emergency
planning will continue to yield returns for small businesses
beyond this fall. By preparing for the flu season, small
businesses will also be likely to be prepared for other hazards
or threats they may face.
DHS's site Ready.gov is another resource for individual and
business preparedness information. In particular, Ready
Business has a mentoring initiative designed to help small to
medium-size businesses prepare for emergencies.
Materials for small businesses include a sample emergency
plan, worksheets to help inventory assets and equipment, and
information on dealing with employee concerns, facility
management, and more. There are also materials to help business
and community leaders lead preparedness workshops and training
sessions.
My Senator, the late Ted Kennedy, once said, We do not have
to compel citizens to serve their country. All we have to do is
ask and provide the opportunity.
This month we are asking all Americans to help us build a
more resilient Nation. The opportunity is here. We have
provided guidance and planning tools for individuals and
businesses to build actionable emergency plans. Now each
business and community needs to act on this information.
I would like to also use this opportunity to ask all of you
to help us get the word out. As advocates for small businesses
and leaders in your communities, we want to work with you to
get this information linked on your Web sites to get you the
tools you need so you can encourage your constituents to take
action now.
The lines of communication to DHS are open, and we remain
committed to an ongoing dialog with the private sector and this
Committee on how can we can build a more resilient and prepared
Nation moving forward.
Chairwoman Velazquez, Ranking Member Thompson, and members
of the Committee, thank you for this opportunity to testify. I
look forward to your questions.
Chairwoman Velazquez. Thank you, Mr. McGaw.
[The statement of Mr. McGaw is included in the appendix.]
Chairwoman Velazquez. Admiral Schuchat, a severe influenza
pandemic could overwhelm the capacity of our health-care
system. Can you envision some of the difficult choices we may
be forced to make about care, and what strain will it place on
the practice of medicine?
Admiral Schuchat. The challenges of a busy influenza season
are great, and we are working actively with the medical
community, the health-care system, as well as the private
sector to anticipate the kind of challenges that will be out
there and to be ready for them. We are trying to develop better
tools for providers and for the public to know when they need
to see the doctor or nurse and when they don't so that we can
relieve some of the pressure on the outpatient offices and
avoid those long lines in the emergency department.
For instance, we have testing recommendations that we
really don't need to get a test for everyone. The testing for
influenza this year really ought to be focused on hospitalized
patients.
We are also working with training to make sure that we have
intensive care unit capacity and people who know how to work
with ventilators and so forth.
So there are a lot of challenges on the health-care system,
both the outpatient and inpatient part of it, some of which we
can address with training and coordination.
Chairwoman Velazquez. What about choices or who gets care
and who doesn't?
Admiral Schuchat. At this point what we are tying to do is
use the best scientific evidence to understand what kind of
care makes the most sense in different circumstances. We also
have learned a lot from the Southern Hemisphere about what to
expect, and they didn't really have to make those difficult
choices of who gets a ventilator and who didn't. They were able
to make it through in terms of their intensive care unit
capacity.
But we know that there are some communities that are
vulnerable, and that is why we have some of the Federal assets
available for particular special needs. So at this point we are
really trying to use the science of what is going on to make
clinical recommendations of who should get what kind of
treatment. So we are not really looking at a rationing.
Chairwoman Velazquez. Let us talk about resources. Given
the existing shortage of physicians, what strategy is the
agency employing to improve the capacity of the physician
community to provide care during a pandemic? What does this say
about this Nation's need to address its shortage of physicians
as part of health-care reform?
Admiral Schuchat. Scarce resources in terms of providers is
a large problem in many of our communities. For a pandemic we
really can't expect to have enough assetseverywhere. In terms
of a hurricane, for instance, we can send people from one part
of the country to another part of the country, but with a
pandemic, everyone may be affected.
We are taking steps to try to broaden the provider
community, trying to enroll the Medical Reserve Corps as
something we can tap into, for instance, and also understanding
when health care professionals are needed or when home care is
enough.
So I think that this pandemic hasn't come at a good time in
terms of our health-care system's capacity, and what we are
trying to do is get as much support ready for the fall as
possible.
Chairwoman Velazquez. Do you have a sense as to where are
the most vulnerable communities?
Admiral Schuchat. There has been an effort to work with
States and cities to understand their gaps. They have been
submitting reports to us at CDC and at HHS about their
readiness, both their health-sector readiness and their public-
health readiness, and at this point I think it is fair to say
that everyone is going to have a challenge this fall with
managing the kind of health-care challenges we expect, as well
as a large vaccination program.
What we are trying to do is work across the board with
everyone to share best practices and to get resources out to
the States and cities, because we know they can't really handle
this without those extra resources.
Chairwoman Velazquez. Thank you.
Dr. Blank, developing general preparedness guidance seems
key to survival of any small business operation during a
pandemic, but unlike large firms, the resources of small
businesses are much more limited. How do you expect a small
business to prepare for a pandemic without placing serious
financial strain on itself, particularly in today's financial
climate?
Ms. Blank. It is a very important question. Of course, the
answer has to be particular to the specific small business, and
will vary by type of business. Cross-training of employees in
important, which small businesses do naturally because more
employees often cover more functions. Businesses might want to
expand that to really think about what would happen if one or
two key employees were out, who would take over, and how they
could use remaining employees.
Telecommuting in some places where you are not doing
customer service may be more possible. They may want to
coordinate and communicate with other small businesses in the
area so that, say, if you are a small health-care practice,
that you could actually work jointly to cover your patients in
a way that you wouldn't in normal times.
Chairwoman Velazquez. I hear you, and I know that is the
right proactive way to plan for a pandemic, but given the
constraint on financial challenges that small businesses are
going through, it is quite difficult for them to think
proactively.
Ms. Blank. I agree with that. I think it is one reason why
we all here are trying to get the word out to both large and
small businesses about the need to do some advanced planning,
because if this comes, it could come quite quickly to your
local area. If you haven't thought about it ahead of time, you
will be in worse shape.
As you pointed out in your opening statement, small
businesses will be more negatively impacted because they don't
have the same flexibility.
Chairwoman Velazquez. Mr. McGaw, in light of the recent
avian flu scare a few years ago, significant strides have been
made to prepare businesses for an H1N1 emergency. What kind of
support should small businesses expect from State and local
governments during a pandemic, and who will coordinate those
efforts?
Mr. McGaw. Thank you. It is a great question. One of the
things that we have been really relying on is the fact that
this is a true partnership between the intergovernmental actors
at the Federal, State and local level. We are also recognizing
that, as we saw in the spring, H1N1 presented itself around the
country in different ways at different times and different
places, so what that resulted in was an effort to make sure
that each of those areas had the right information, and that
they were interacting with their local health officials to make
informed decisions based on the impact they were seeing
locally.
What we were trying to do and continue to do is to inform
the decisionmakers, and our Intergovernmental Affairs Office,
for instance, works with all the State homeland security
advisors and emergency managers to make sure that they are
informed with the information that we have. So we work through
our intergovernmental processes at DHS.
The key here is that the same information is available from
any actor. So you are going to hear the message from the
Intergovernmental Affairs Office to the homeland security
advisors; you are going to hear it from my office working with
our infrastructure protection community and making sure the
business community is hearing that; and then you are hearing
the same information and guidance coming from the CDC and the
health community.
So I think what you saw in the planning for 2006, 2007, was
an example of all of listening to each other and working in a
more collaborative manner to make sure everyone has the
information to make more informed decisions.
Chairwoman Velazquez. Well, I am concerned about the fact
that the General Accountability Office report, they heard from
the private sector the fact that it is unclear for small
businesses and businesses about the respective role and
responsibility of the Federal and State governments during a
pandemic emergency. My question is: Do you feel that there is a
coordinated effort between State and Federal Governments in
working together for a strategy in terms of preparedness?
Mr. McGaw. From the Department of Homeland Security side
and then maybe from the public health side, I would say very
much so; we are coordinating on the governmental level. The
shared-responsibility model approach that we have taken is to
make sure that State actors have what we know when we know it.
We are trying to be very open and transparent with the
information that we have based on the science, but also using
the updated guidance and making sure that people are kept
abreast. In my office we send out a weekly e-mail with any
updates we have.
Chairwoman Velazquez. I hear you when you talk about
providing information. My question is coordination. So if any
of the others--
Admiral Schuchat. I think that the public really expects,
appropriately, that we have a seamless coordination at the
public-health level between cities, counties, States, an the
Federal level, and very much a part of our planning process
this summer as we are readying the government for an increase
in influenza has been this city-county-State-Federal
partnership. So our Vaccine Task Force that is trying to figure
out how we implement this large-scale, voluntary vaccination
program has a steering committee composed of people from
several different levels of public-health government. And so
from the strategy to the planning to the evaluation and
feedback, we are really trying to work seamlessly.
I think most of what happens with influenza happens at the
local level, and if we don't have strong local implementers, we
will fail. And so we are trying to incorporate that local
perspective and the State leadership into the Federal planning
at every step.
Chairwoman Velazquez. Thank you.
Mr. Thompson.
Mr. Thompson. Thank you, Madam Chairwoman.
Once again, thanks to the panel for your service and for
being here on this important topic. I want to keep going down
that line of inquiry that the Chairwoman had.
In terms of collaboration, we have three very important
departments represented here that are three or probably even
more that would be impacted if this pandemic would become a
reality. Can you give me specific examples of communications
and collaborations between your three departments on this
particular issue?
Mr. McGaw. Starting in April, all of my communications from
the Private Sector Office have been linked to the CDC. So in
all of our outreach efforts we are working to include the CDC,
and we talk about what we are going to say, how we are going to
say it, and who we are going to say it to. And those
communications have been--we have had--back in April we had
private-sector calls on almost a weekly basis that went out to
about 1,100 trade associations and other organizations and
their leadership as we briefed them out, and each of those
calls had representatives of the different agencies. As we
learned what kind of questions people wanted, we brought in
more subject-matter experts.
We continued that operational tempo through the summer,
through our business planning guidance, through our K-through-
12 guidance, through our higher ed guidance, making sure our
agencies were working together. Those are three examples. I
have a half dozen others.
Ms. Blank. Obviously, the medical leadership here has come
from outside of Commerce, but Secretary Locke and other senior
staff have been quite involved in communicating about the
guidance. We really see ourself in the role ofinterfacing
between the CDC and DHS and the guidance it is giving, and the
business community. We have the connections into the business
community to try to be the coordinating agency that gets this
message out as fully as possible, and in turn sends information
back from what the business community is saying about what is
helpful or what they still need.
Mr. Thompson. All right. Secretary Blank, you talked the
outreach to the business community, obviously, which is
extremely important, from both perspectives, workforce issues,
which annually with the flu is always a difficult time,
especially in small businesses that have a very small workforce
and a lot of folk wearing a lot of hats in terms of duty and
responsibilities, but also on the customer side, and especially
what could be very devastating to commerce is people tend not
to go out into public areas as much, and the economic impact of
that.
How is the Commerce Department or, working your other
partners, getting that message out to small businesses? I have
heard some great resources and great strategies in terms of
managing flu symptoms and minimizing exposure and Web sites and
all that. How are you getting that message to the small
businesses?
Ms. Blank. Of course, some of this gets out simply through
the general media. At colleges or places that have come back
into session, there has been news about this. This raises
awareness, and people start looking for resources. You need
supply and demand. People have to be looking for this help and
this information before they hear it.
Secretary Locke has been on a number of phone conferences
with various representatives of the business community. He has
particularly been focusing on talking with travel, toursism and
retail businesses, those particular sectors that are likely to
be most affected if consumers start staying home and not going
out into public places. And I know that there is a plan to
continue those sorts of phone calls and outreach as we move
into the season with various sectors and groups within the
economy.
Mr. Thompson. Great.
Has there been discussions of thoughts of what the
potential economic impact could be with this projection of--and
especially with small businesses as it impacts our cash flow,
even for a number of weeks in the economy that we have been in,
could be absolutely critical for small businesses.
Ms. Blank. The effects obviously are going to depend very
heavily upon how severe this flu season is, and where it hits,
and whether it is regional, or whether it becomes more national
or global as well, because international trade and travel will
be heavily affected.
I know that there is a report coming out sometime later
this month from the Department of Homeland Security done by
their National Infrastructure Simulation and Analysis Center
that is going to look at various scenarios of what the impact
on the economy could be.
We do have estimates from past flu incidents. So in 2006,
the Congressional Budget Office, for instance, estimated that a
moderate bird flu pandemic would reduce GDP by around 1
percent, where a severe one would reduce it be 4 percent. Those
are big, but my understanding is that the duration and the
severity of an H1N1 flu is likely to be less than a bird flu.
So those would be absolutely maximal effects.
Mr. Thompson. One last question. Mr. McGaw, this past week
I had the privilege of being present when the USDA presented a
grant and a loan to an ambulance company. I was impressed with
this, as an old EMT, the new technology, some of this
technology that had ultraviolet lights in the back of the
ambulance specifically to address the viruses and keeping a
sterile environment.
Is the Department reaching to the local level with local
paid and volunteer emergency medical services who, frankly, if
the flulike symptoms escalate to a point where people need more
professional care, that they are going to be involved with
that.
Mr. McGaw. I don't know of particular targeted outreach to
the volunteer companies of EMTs and firefighters around the
country. The same information--we can probably do that, and I
will look into it.
I think the importance is we are pushing out this really at
the State homeland security level and making sure the State
homeland security advisor has all of the information they need
to push down to their first-response community. That can be
pushed via the FEMA avenues as well, the key being all the
things that we are talking about right now can be accessed by
those local fire companies and EMTs. But it is going to be a
pull probably from their local emergency coordinators. I can
look into it.
Mr. Thompson. Thank you.
Mr. McGaw. You are welcome.
Chairwoman Velazquez. Mr. Schrader.
Mr. Schrader. Thank you, Madam Chair. Dr. Schuchat, I guess
I was curious as to how has this particular flu been spreading,
and what has been its morbidity and mortality in the United
States compared to past flus we have had?
Admiral Schuchat. The H1N1 influenza virus has been what we
are calling a moderate severity. This is not like 1918, what we
saw in the spring anyway, and the Southern Hemisphere this
summer does not have the enormity of the 1918 pandemic, which
was, of course, really absolutely devastating. But what we
don't know is exactly how bad things will be this fall and
winter. We have been trying to learn from the Southern
Hemisphere's flu season. Their winter was our summer. So many
of the Southern Hemisphere countries have just been through a
season where the new H1N1 did dominate. It caused most of the
illness in a number of these places. There were some places
where the health-care capacity was really somewhat strained,
but in most of the places it was a severe year, but not their
worst ever. So that gave us a sense of what to expect.
Mr. Schrader. Is that actually true? I assume their
sanitation, health-care opportunities are not quite what we
might have in the Northern Hemisphere. Is that factored into
your calculus when you are looking at what to extrapolate?
Admiral Schuchat. The comparisons I am making are with
places like Australia and New Zealand that are a little closer
to our health system capacity. But, importantly, even in some
of those countries there were hard-hit communities and hard-hit
populations. We are concerned in a couple of places we have
heard of indigenous populations having a higher morbidity and
mortality: Aboriginal populations in Australia; in Manitoba,
some of the Native Americans there.
So I think that we need to be ready to be flexible and as
prepared as possible. We may have this H1N1 on top of the
regular seasonal strains, we may have sort of two seasons, or
almost three.
Mr. Schrader. To that point I guess my next question would
be how do we gauge of the flow as we get into the fall-winter
flu season here in America how we are doing compared to our
normal in terms of the values, and will the CDC and others
continue to be slightly alarmist, which may be viewed as your
job. But as a small businessman, I would like to get some
pretty good, solid information as to how we are compared with
trends we have seen in the past.
Admiral Schuchat. We have enhanced our surveillance to have
more timely information that is helpful to people and also to
get information that is more useful locally. We are already
seeing increases in flu, but it is only in some parts of the
country; the Southeastern States, but not the rest of the
country in general.
The State and local governments are going to try to share
the information they have so that you will know in your
community what is going on. And I think we have learned a lot
from the spring about interventions. We have learned it was a
new virus. We took it very seriously. We imposed some
interventions to be on the safe side. And we have been able to
take the knowledge of what the experience really was like to
sort of temper those interventions to have a good balance
between protecting health and safety and not in untowardly
disrupting the economy.
Mr. Schrader. I just would hope as we go forward we have
accurate, timely, somewhat authoritative, as much as you can be
with a disease, information to guide the small business
community going forward.
Ms. Blank, what are we doing to protect the agricultural
industry from the misnomer about the flu and the porcine
population being the big cause of this? What actions do you see
the government or Department of Commerce or Chambers or the
farm organizations doing to make sure Americans get good
information here?
Ms. Blank. It is extremely unfortunate that this flu has
gotten an animal name, which by all accounts is not a very
accurate title at all.
Mr. Schrader. Keep emphasizing that, please.
Ms. Blank. I have cousins who are pork farmers who are
quite upset about this. Obviously the government has tried very
hard to use the right nomenclature here, and continues to do
that. I think the information on the CDC Web site, on the
www.flu.gov site, emphasizes this does not relate to eating
particular This is a flu that is transmissible the way that
other flus are, and one should think of it in those terms.
It is hard to counter a name once it gets out there, and I
think we just have to all keep making sure we use the right
language and we keep saying the right things and hope that gets
through.
Mr. Schrader. Thank you. I would yield back.
Chairwoman Velazquez. Thank you.
Mr. Leutkemeyer.
Mr. Leutkemeyer. I would like to follow up on a couple of
Congressman Schrader's remarks and questions, just to kind of
nail down the effect of the flu versus the bird flu.
Dr. Schuchat, can you give me just how many people were
affected with the bird flu, and you said this is going to be
less than the bird flu?
Admiral Schuchat. There are two principal differences
between the avian bird flu that we have been talking about for
the past few years and the 2009 H1N1. One difference is that
the bird flu strain, H5N1, was very lethal. Abouttwo-thirds of
people who got that infection died from it. That is just
extraordinarily lethal. The H1N1 2009 strain is not of anywhere
near that magnitude lethality.
On the other hand, the H5N1 bird flu strain did not acquire
the ability to spread easily person to person. Almost all of
the cases that we have, the several hundred cases that we have
had since 2003, have been animal to human, bird to human; very,
very few, probably a couple, that were human to human; whereas
virtually everything we are seeing with the 2009 H1N1 is
extremely efficient person-to-person spread.
So that bird flu strain, fortunately, has not become
pandemic, but it is very, very severe. The H1N1 strain has
become pandemic. It is very easily spread person to person,
spreading around the world. Fortunately, it doesn't have that
severity or lethality that the bird flu strain had or that the
1918 strain had. That is really good news right now because we
think we can manage this with prompt treatment of people who
are at risk with antivirals, and we are close to having a
vaccine to prevent and mitigate disease.
So the lethality and transmission are the two big
differences there.
Mr. Leutkemeyer. Mr. McGaw, with regards to Homeland
Security, are you monitoring other countries where this is
popping up? Obviously, some folks have testified with regard to
the southern part of the hemisphere, much more prevalent. Are
you monitoring that? If so, are you going to restrict travel
between those countries if you see a problem with it being
exported to our country?
Admiral Schuchat. I can speak to the monitoring, and he can
probably do the travel issues.
We have been intensively monitoring the virus and the
disease it causes around the world, including Southern
Hemisphere countries. So far the virus is the same. It hasn't
mutated. It is the same as what we have and what we had last
spring.
Mr. Leutkemeyer. Could you name a couple of those
countries?
Admiral Schuchat. Yes. Australia, New Zealand, South
Africa, Argentina, Chile, those are countries where there has
been a lot of information. Peru. I may be forgetting a few. So
we actually have people and partnerships in a number of
countries. And at flu.gov, HHS has released a report on the
Southern Hemisphere that describes the assessment of what we
saw there and how that can help us anticipate what we are going
to have this fall, knowing that the health systems might be
different.
Mr. Leutkemeyer. My question is if you see that it is a
pandemic level there, are you going to restrict travel? Is that
an option?
Admiral Schuchat. There is not a plan for any travel
restrictions. At this point the U.S. has as much or more
disease than anyone else does. We are strongly encouraging
others not to restrict travel of Americans, and we are not
intending to restrict travel elsewhere. We think it is so
important for people who are sick to stay home and not spread
their illness, but we don't think that one country is a riskier
place than another right now. Unfortunately, the virus is all
over the world.
Mr. Leutkemeyer. Okay. Thank you.
Secretary Blank, very quickly. I am running out of time
here. I also want to follow up to Congressman Schrader's
remarks with regard to getting a better handle on the name of
the flu. Are you working with the national media to see if
those folks would try and not use other words other than
"H1N1"? Are you briefing those people, and are you keeping
track of their lack of doing that?
Ms. Blank. I think CDC is involved with this quite closely.
Admiral Schuchat. We have been working intensely with the
media to try to ready them to help with the falloutbreaks. We
have had workshops and tabletops and so forth. We have
discussed the name issue. I think their view is the name has
stuck, and many of them are trying to use the H1N1 term that we
are using consistently, but I don't think we will be able to
convince the headline writers.
Mr. Leutkemeyer. How do you think we ought to address that
problem, because this is significantly impacting the pork
industry. Just to say, Well, they are doing their best; is that
good enough?
Admiral Schuchat. One thing we are doing is monitoring
understanding. There have been several polls to understand are
people not eating pork, or are some of those factors happening.
We think we are actually winning with the American public's
understanding. So I think that is probably going to be more
helpful. I do think it is important to look at all the economic
consequences.
Mr. Leutkemeyer. Don't you think it wold be wise you have a
meeting once a week, once a month, with the national media and
say, hey, in your articles following up on this disease, we
noticed a number of times that you were incorrectly using the
name of--the slang name for this flu.
Mr. McGaw. It is an important point and one that we should
continue to emphasize. So I will make sure our public affairs
offices are aware and continue to push. We are all coordinated
in our use of the H1N1 moniker and away from other names, and
so we will continue to push on that.
Chairwoman Velazquez. Will the gentleman yield?
Mr. Leutkemeyer. Yes.
Chairwoman Velazquez. Dr. Schuchat, on this point of the
name issue, for the record, is there a direct correlation
between swine farms and the H1N1 pandemic?
Admiral Schuchat. This virus is spreading person to person.
We have no information that this virus is spreading through
swine farms. Right now this is a human-to-human problem, and
that is how we are addressing it.
Chairwoman Velazquez. Mr. Moore.
Mr. Moore. Thank you, Madam Chair.
Dr. Schuchat, I believe you testified--and I don't have a
direct quote--but persons should stay home and not spread the
disease by going to work. You said something to that effect.
I think probably all of us agree with that. My concern is
for hourly employees who may not have paid sick leave. What, if
anything, do you think we can do to encourage employers to work
with people in that situation? And I am asking you. Then I want
to ask the other witnesses if they have any thoughts about it,
too.
To me, this is something that we have to consider, because
we could--by having that situation, people could
inadvertently--not intentionally, but inadvertently--spread the
flu to others. Any thoughts?
Admiral Schuchat. This is one of the mostheartbreaking
parts of this, because we need people to stay home and not
spread their infection and take care of themselves and get
better, and we need the workplaces to support them. It is a
really difficult time in our economy. Leadership has sent
letters out. We are working with the Chambers of Commerce. We
are trying to get the word out that this is better for
everyone, but when it is your paycheck, it is really hard to
understand.
Ms. Blank. I do think that there is really a role here for
public leadership by saying exactly what you have said as often
and as publicly as possible; to say to employers this is an
unusual time, and we need to support workers and what they
should be doing to keep us all healthy.
Mr. Moore. Mr. McGaw, any thoughts?
Mr. McGaw. The more that employers understand the severity
of the disease and how it is going to impact our workforce, the
more they will understand that the workers aren't going to be
gone for long. And so the more that we can communicate just
what exactly they need to understand about the severity of H1N1
and the concrete steps they can take, and then actually have
the conversation with their employees about understanding
expectations, the more there is a dialogue about this, the
better off I think the employees and the employers will feel
about the decisions about letting them stay home.
Mr. Moore. Thank you very much. I yield back, Madam Chair.
Chairwoman Velazquez. Mr. Ellsworth.
Mr. Ellsworth. Thank you, Madam Chair.
Thank you all for your hard work that you are about to
undertake, and have. I know one of you talked about seamless
coordination. I think that is very difficult, especially when
that many layers of government, and then to the people and
private industry.
I would like to take a little different line. Has there
been any discussion of doing absolutely nothing, of staying out
of it and letting it handle itself? May not be that bad, may
not come here. There will be a few cases, and we let it handle
itself.
Let me ask you, Mr. McGaw, you said you talked to NAM and
the Chambers. Have they said, Don't worry about us, we will
take care of ourselves?
Mr. McGaw. No. They have been a true partner from the
beginning. The dialogue that the Department has had with those
organizations across a spectrum of challenges in thehomeland
arena really paid dividends, and all the planning that went on
during the avian flu discussions of 2006 and 2007, that paid
dividends as well.
In April, when this first arose, those were some of the
first conversations we had were with those organizations,
because the reality in trying to reach out to the millions of
businesses and people that are potentially impacted requires
media coordination and communication, and organizations like
NAM, the Chamber, the National Federation of Independent
Businesses, they can immediately put solid information in the
hands of decisionmakers broadly. And we saw a substantial
amount of open rates on e-mails. So the media communication
between our organizations was pretty significant.
I have an op-tempo of we went from 100 participants to 518
to 1,100 participants on conference calls over 4 days. So just
us using our standard incident command structure, we were able
to get information immediately out to those businesses. So
standing by and doing nothing was never part of the
calculation.
Mr. Ellsworth. We read the Constitution quite a bit. I am
sure you all have the pocket Constitutions and page through
those. I have never seen H1N1 mentioned in any of the articles
or any of the text of the Constitution, and yet do you think
that the American people expect the government to do something
in this and not just stay out of it? Would you say that that is
an expectation the American people have, that government is
prepared to do something to prepare for H1N1?
Admiral Schuchat. I think the administration's view is
protecting the safety and health of the American public is
extremely important. We this summer did public engagements in
10 cities or towns around the country to talk to Americans
about what was important to them from the government on this
particular threat, knowing that we don't know everything; that
we don't know if it will be worse in the spring, if it will
affect their own communities. What we heard was an expectation
that protecting health was important to people, and that this
was something where government had an important role.
I think that there is a strong feeling that this is
something that is really important. It will be wonderful if we
work really, really hard and seamlessly and it is not a bad
year, but I think we can hope for that.
Mr. Ellsworth. I am making my comments tongue in cheek. I
hope you realize that at this point. We heard a lot over the
last 30 days about government keeping its nose out of people's
business, let the market handle it, let people do their own
thing, we should stay out and things would be much better.
If we did nothing, what do you expect--you know, I am
hearing about GDP, percentage of GDP of the economy, all the
things that if this turns sour, which it very well may, if we
did nothing, do you anticipate that the American people would
then turn on government the other way and say, You fumbled
this, and you weren't prepared, and this is something why we
want our government to get involved.
Mr. Ellsworth. What would happen if we just let it go?
Admiral Schuchat. I think that there is our actively doing
nothing, is very hypothetical, but the reality is that, without
applying the science of what we have learned to the problem, I
think we would have worse problems from the disease than what
the disease would cause on its own.
You know, we saw in the spring a lot of fear, a lot of
altered behavior, not all of it constructive. And by learning
what this virus was doing and what was effective in intervening
and what wasn't effective, we could direct people to effective
interventions. We could make a vaccine. We could learn how
better to intervene in schools in a way that was sustainable
for our communities and healthier for families.
So I think that if government weren't there, there would be
a lot of activity and disease and bad impact, but there would
also probably be a lot of unintended consequences of people
reacting to the problem.
Chairwoman Velazquez. Time is expired.
Mr. Ellsworth. Madam Chair, can I just close the comment?
I agree 100 percent. I commend you for your hard work. As
somebody formally in emergency services, there are a lot of
things we prepared for, hoped we never had to use, tornados,
natural disasters, floods, that people were glad we were there
when the bad things hit.
Thank you very much.
Chairwoman Velazquez. Mrs. Dahlkemper.
Mrs. Dahlkemper. Thank you, Chairwoman Velazquez, for
holding this important hearing today.
And I thank those on the panel for coming and telling us
how you are preparing our country for this pandemic and any
future ones that we may face.
I did want to ask, as you are looking forward and as you
have been preparing for this, do you see a need for us in terms
of public health infrastructure and what we currently have and
whether we need to invest more for the future? And I will just
open it up to each one of you.
Admiral Schuchat. I think that the last several years,
there have been investments in preparedness, in vaccine
development and so forth. But our public health infrastructure
is really weak right now, and there are gaps at many local and
State levels that are hard hit by the economic realities.
So I know that for surveillance and prevention and
communication, there is a lot of strengthening that would put
us in better shape for dealing with this kind of problem and
then the kind of problems that are every day, that aren't just
every 20 or 40 years.
Mrs. Dahlkemper. Where do you see the biggest gaps? If you
had to ask us as Members of Congress to do something soon, what
would be the key thing you would say we need to do to improve
our public health infrastructure?
Admiral Schuchat. I think that the workforce is a big
challenge right now in terms of enough workforce and a pipeline
of folks. And it is very economically driven right now.
Mrs. Dahlkemper. Workforce on a more local level, State
level?
Admiral Schuchat. Yes, I think local is the most vulnerable
right now, and after that, the State.
Mrs. Dahlkemper. Mr. McGaw, did you want to add to that at
all?
Mr. McGaw. I think we would all agree that public health
infrastructure serves a dual purpose and can be used in
emergencies, and it is also used on a daily basis. So the
investment, pays dividends constantly, whether we are concerned
about public health crises or normal public health activities.
Mrs. Dahlkemper. And I have just one further question,
having just sent two children off to college, and you saw in
the news the quarantined dormitory areas. Have we learned
anything from what has happened in the last few weeks as we
sent our children off to school?
Admiral Schuchat. The American College Health Association
is tracking illness in colleges and in interventions, and the
news so far is pretty good, that the colleges are following
this guidance that was issued and trying to keep ill kids
separate from others. And they are not overreacting. They are
appropriately reacting. And I think that it has been heartening
to see them being able to apply practical information. And the
professors are understanding when the students aren't turning
in their homework and encouraging them to stay home and get
better.
We aren't seeing a different pattern of illness yet. We
are--we believe that the interventions we have recommended are
sensible and practical and can work, but it is still too soon
to know what will be happening around the country.
A reminder, though, that people from the ages of 6 months
to 24 months--or to 24 years, including those college students,
are recommended to receive the H1N1 vaccine when it becomes
available, and we know that a lot of universities are planning
on ways to be able to offer it.
Mrs. Dahlkemper. Thank you.
I yield back, Madam Chair.
Chairwoman Velazquez. Any Member that wishes to make any
other question?
Well, let me take this opportunity again to thank all of
you for your participation and your service and you are all
dismissed.
And I would ask the members of the second panel to be ready
to take your seat.
Chairwoman Velazquez. I would like to introduce Mr. Anthony
Demangone. He is the director of regulatory compliance and
senior compliance counsel for the National Association of
Federal Credit Unions. The National Association of Federal
Credit Unions was founded in 1967 to directly shape the laws
and regulations under which Federal credit unions operate.
Mr. Demangone, you are welcome and have 5 minutes to make
your opening remarks.
STATEMENT OF ANTHONY DEMANGONE
Mr. Demangone. Good afternoon, Chair Velazquez, Ranking
Member Graves and members of this committee. I am Anthony
Demangone, NAFCU's director of regulatory compliance and its
senior compliance counsel.
I am here today on behalf of the National Association of
Federal Credit Unions. In my role, I represent NAFCU before the
Financial Services Sector Coordinating Council. This is an
organization that champions the protection of America's
financial critical infrastructure. I am a member of FSSCC's
Infectious Disease Forum, and I was a member of the 2007
Financial Services Pandemic Exercise Control Team, which helped
to manage a financial services industrywide tabletop exercise
on pandemic preparations.
While the subject of today's hearing focuses on a very
unpleasant topic, the unsettling specter of an influenza
pandemic, I want to commend the leadership of the Small
Business Committee for holding this hearing to address
readiness and preparation within America's small businesses.
NAFCU has been working with financial regulators on this
important issue, and we have educated our member credit unions
to help them prepare for a pandemic.
I want to recognize the work of the Treasury Department and
the FSSCC, of which NAFCU is a member, for its diligence in
helping financial institutions identify and address the complex
issues surrounding pandemic business continuity planning.
Credit unions have been preparing for a pandemic for more
than 3 years. The National Credit Union Administration provided
important guidance to credit unions in the first quarter of
2006 to increase awareness concerning the potential threat of a
pandemic.
More recently, financial regulators have been providing
guidance concerning the current H1N1 pandemic. The NCUA
reiterated key elements for credit unions in a letter addressed
to them just this past June. In its letter, NCUA directed
Federally-insured credit unions to review their disaster
preparedness response plans to ensure that their pandemic plan
is appropriate and provided a series of issues credit unions
must consider in their pandemic planning.
Credit unions have listened to this guidance and have
created plans that address the following: Pandemic-related
communications to employees, members, and their communities;
policies to implement social distancing, proper hygiene and
other preventative measures; cross-training of appropriate
staff to maintain operations during a pandemic; and the review
of operations and facility management to ensure a proper
response to pandemics.
Many credit unions have formally tested their pandemic plan
in a national tabletop exercise. The Treasury Department, in
conjunction with the FSSCC and others, sponsored an
industrywide pandemic flu exercise in 2007. The results
demonstrated that even businesses that had pandemic plans in
place found a global flu outbreak posed complex issues in areas
where more preparation was needed.
While financial institutions have been preparing, some
questions remain unanswered. The following issues clarified by
Congress and the Federal Government would help America's credit
unions better prepare for future pandemics and handle this one
right now.
First, the financial services sector needs accurate, and
timely information about any developments concerning the
current pandemic and what steps that Federal, State and local
governments are taking in response. In addition, information on
important infrastructure is vital. For example, will mail
service, public transportation and telecommunications
infrastructure be available for credit unions and their
employees?
Second, with credit unions facing increased levels of
absenteeism during a pandemic, it may be difficult for them to
comply with certain regulatory requirements. Staff trained to
comply with the Bank Secrecy Act or that works with the SBA may
be at home sick for long periods of time. If we have this
flexibility plan in place beforehand, financial regulators will
not have to answer repeated questions during a pandemic,
especially when the regulators themselves may have high
absenteeism.
Third, many credit unions continue to ask questions
concerning who will be responsible in a given area for pandemic
related issues. Will the Federal, State or local governments
decide if a quarantine or a closing of a business is necessary,
or will this be a private decision made by each business one at
a time? On the flip side is the question, who will give the
all-clear signal once a pandemic has passed?
Fourth, the impact of Hurricane Katrina demonstrated the
need to have cash available to meet liquidity needs. Current
economic crisis has demonstrated the importance of liquidity
for financial institutions. Should the current pandemic develop
more deeply into a health-care crisis, it will surely strain
the liquidity and put more challenges on financial institutions
already facing a tough environment.
Thank you for the opportunity to provide our views on this
timely topic. Again, I commend the Small Business Committee for
its commitment to address concerns relating to pandemics. And I
will be pleased to respond to any questions that the committee
members may have.
[The statement of Mr. Demangone is included in the
appendix.]
Chairwoman Velazquez. Thank you, Mr. Demangone.
Our next witness is Dr. Jim King. He is a family physician
in Selmer, Tennessee, and currently serves as the board Chair
of the American Academy of Family Physicians. The American
Academy of Family Physicians is one of the largest national
medical organizations representing family doctors with more
than 94,000 members.
Welcome back to the committee.
STATEMENT OF JIM KING, MD
Dr. King. Thank you, Chairwoman Velazquez.
And thank you for having me, Ranking Member Graves and
other members of the committee.
I am one of approximately 95,000 family physicians who are
located across this country in almost every county. We are in
solo and small group practices, and I am happy to be here to
talk to you about H1N1 virus and the economic health of the
Nation on small businesses because we are small businesses. I
am a small business.
The last patient I saw--because it was mentioned earlier in
the southeast, and I am from Tennessee--was a 10-year-old with
H1N1 flu before I flew up here. Driving here in the car on the
radio, the first death in Memphis is a high school football
player who died in the hospital with H1N1 flu. So we are seeing
it already. It is a very important issue.
Family physicians are affected with outbreaks of diseases
like H1N1 in two very important ways. First, we are the
frontline of diagnosis and treatment of the disease. Patients
who begin to experience H1N1 symptoms often go to their
personal physician. Frequently it is the primary care physician
who begins to see the pattern of infection.
Once the outbreak is determined, the primary care physician
will need to provide health care services to both the infected
patient and the worried well, the patients who need to be
reassured and educated.
Secondly, small group practices like myself may be affected
significantly ourselves in doing business. A family physician's
practice, especially in rural areas and underserved city areas,
often consist of only one or two physicians in a small clinical
and administrative staff. When one staff member begins to show
H1N1 symptoms, it is vital that they stay away from the
practice and office so that patients do not become ill.
As a result, if the influenza outbreak infects just a few
members of a practice, that practice may have to close
temporarily. Unfortunately, this is likely to be a considerable
length of time. We talked about this when being a little mild,
3 to 5 days, but you wouldn't want a sick person in that office
if you were coming in for maybe even longer.
Last, an outbreak of H1N1 will expose two major
deficiencies in our health care system: the lack of
coordination, and workforce shortages. For example, patients
can get vaccinations at multiple sites, retail health clinics,
work-site clinics, health fairs, pharmacies, school-based
clinics. While these sites make immunization convenient, they
lead to fragmentation of patient care; especially it makes it
very difficult for a practice to ensure that all of the
patients have received the necessary shots.
The Academy along with other primary care groups, including
the American Academy of Pediatrics, have recommended
implementing a patient center and medical home to address the
lack of coordinated care. The patient center and medical home
also would connect primary and public health, especially in
areas in which the medical home and public health functions are
more tightly integrated.
Second, even before H1N1 becomes a pandemic emergency,
family physician practices will pay the price for our Nation's
shortage for primary care physicians. As the number of
infections increase, family physicians in small and solo
practices will be overwhelmed by the number of patients simply
because there is nowhere else to go. These practices who
usually serve rural and inner city populations will not have
all of the resources to handle a growing number of infected
patients.
That is why Congress must address education and training of
primary care providers in health reform legislation. The
Academy has recommended that Congress increase medical graduate
education payment for primary care residency slots. This would
provide incentives for the Nation's teaching hospitals to
invest in primary care residencies.
Family physicians and the Academy are taking the threat of
the H1N1 outbreak very seriously and are engaged in extensive
preparation. We see it as a fundamental responsibility to
provide patients with the right information at the earliest
possible time.
However, they and their patients will feel the blunt of the
deficiencies in the Nation's fragmented health care system. We
will need a better investment in primary care to meet these
challenges and look to Congress to make this happen.
Thank you for the opportunity to testify, and I will be
happy to answer any questions.
[The statement of Dr. King is included in the appendix.]
Chairwoman Velazquez. Thank you, Dr. King.
Our next witness is Mr. Harold Jackson. He is the president
and CEO of Buffalo Supply, Inc., located in Lafayette,
Colorado. Buffalo Supply has been providing medical and
surgical equipment and supplies to the Federal Government since
1983. Mr. Jackson is testifying on behalf of the U.S. Chamber
of Commerce, which is the world's largest business federation
representing 3 million businesses.
Welcome.
STATEMENT OF HAROLD JACKSON
Mr. Jackson. Thank you.
Good afternoon, Chairwoman Velazquez And Ranking Member
Graves and members of the committee.
Thank you for inviting me to testify before the committee
today. My name is Harold Jackson. I am the president and CEO of
Buffalo Supply, a 15-employee woman-owned small business
specializing in the sale and distribution of medical surgical
equipment.
I am pleased to be able to appear today on behalf of the
United States Chamber of Commerce. I commend the committee for
holding this hearing to discuss the challenges of the 2009 H1N1
influenza and its potential impact on small businesses. The
committee has my prepared statement, and I will give the
following summary.
If I leave the committee with a single point, it is that
absenteeism will likely be the central issue that businesses
wrestle with during this pandemic. Businesses should focus on
keeping the workplace healthy, including encouraging sick
employees to stay home to avoid infecting coworkers and
maintaining business continuity.
We are all in this together. H1N1 preparedness is
everyone's problem, from households to schools to businesses to
government. To put it into perspective, according to CDC, in
communities where the H1N1 flu circulated this past spring, the
infection rate was about 6 to 8 percent of the population over
a 3 to 4 week period. During the winter season, infection rates
could be two to three times as high as both the H1N1 flu and
the seasonal flu circulate and sicken people simultaneously.
Each winter in the United States, the seasonal flu kills
approximately 36,000 people and hospitalizes more than 200,000.
The cost to the U.S. economy is more than $10 billion in lost
productivity and direct medical expenses.
Predicting what influenza might do this flu season is
challenging, and so is predicting the absenteeism.
Nevertheless, business owners and managers should prepare by
taking a number of actions to protect the health of their
employees and maintain business operations. Running a small
business leaves little time for planning for a disaster. Yet a
major incident could force a business to close its doors
permanently.
Buffalo Supply has taken the following actions to keep our
employees healthy and to maintain business operations. We are
communicating with employees about H1N1 to increase awareness
and education. We are cleaning keyboards, desks, file cabinets
and other equipment regularly with disinfectants. We have
installed hand sanitation stations much like they are in
various buildings on Capitol Hill. We are having a visiting
nurse give free seasonal flu shots to all employees, and we are
requesting H1N1 shots when they become available. We have
purchased additional copies of software that will allow some
employees to work from home instead of coming to the office.
Buffalo Supply is taking these and other actions because we
want our employees healthy and our doors open. Few industries
will be insulated from the economic effects resulting from
absenteeism in the workplace.
The United States Chamber and the Trust For America's
Health have teamed up to produce a guide titled, "It is Not Flu
As Usual," to provide businesses with practical recommendations
on how individuals and organizations can prepare for the next
wave of H1N1 flu. This guide includes a list of Internet sites
that can provide businesses with a wealth of detailed
information on topics like vaccines, anti-virals, face masks
and respirators. It will be released in a few weeks on the U.S.
Chamber Web site, and hard copies can be obtained from the
National Security and Emergency Preparedness Department.
The U.S. Chamber believes that the Obama Administration
deserves praise for the attention it has paid towards planning,
preparing and responding to a potentially severe H1N1 flu wave.
Since the spring outbreak, the administration has captured the
right mix of communicating concern and encouraging the public
to be prepared. Last week, President Obama said, "I do not want
anyone to be alarmed, but I do want everyone to be prepared."
In conclusion, preparing for a potentially severe flu
pandemic is everyone's problem. It is a shared responsibility.
To be prepared, government health agencies encourage
individuals, businesses and communities to talk with their
local public health officials and health care providers, adapt
business practices encouraging sick employees to stay home, and
take steps to stop the spread of germs, and stay informed.
I appreciate this opportunity to testify, and I would be
happy to answer any questions.
[The statement of Mr. Jackson is included in the appendix.]
Chairwoman Velazquez. Thank you, Mr. Jackson.
Our next witness is Dr. David T. Tayloe. He is the
president of the American Academy of Pediatrics. Dr. Tayloe is
also a full-time pediatrician in Goldsboro, North Carolina. The
AAP is the leading medical association representing the
interests of over 60,000 pediatrician members.
Welcome.
STATEMENT OF DAVID T. TAYLOE, JR., MD
Dr. Tayloe. Thank you.
And good afternoon, Chairwoman Velazquez and members of the
committee.
I am Dave Tayloe, Jr., President of the American Academy of
Pediatrics. I have been a pediatrician in rural private
practice where the cash flow of the practice is two-thirds
Medicaid and SCHIP in Goldsboro, North Carolina, for over 32
years. I appreciate this opportunity to testify today before
you regarding the impact of a novel influenza H1N1 virus on
American small businesses.
On August 24th, the President's Council of Advisors on
Science and Technology estimated that the novel H1N1 flu strain
could result in the hospitalization of up to 1.8 million people
and cause as many as 90,000 deaths, a number that is roughly
double the death toll from a normal flu season. If these
projections prove accurate, this flu epidemic will tax every
aspect of our Nation's health care system, emergency
departments and hospital wards to private practices and public
health departments.
Of special concern to the American Academy of Pediatrics is
the fact that this flu strain is impacting children
disproportionately. Based on infection rates to date, the
Centers for Disease Control and Prevention calculate that
infection risk in the 0 to 24 age group is 4 to 5 times greater
than for those in the 25 to 49 age group and 20 times greater
than for those over age 65. If the virus sickens half of U.S.
children this season, the number of ill children would exceed
37 million. Infection rates could ultimately be even higher.
The President's Council of Advisors on Science and
Technology warn that of the 30,000 to 90,000 deaths
anticipated, most would be concentrated among children and
young adults, and we are already seeing that in our State.
Pediatric medical practices and other medical providers who
serve children face a special challenge from the H1N1 virus.
The AAP anticipates that our membership will face a double
whammy of business interruption due to staff absence and
illness combined with much higher workloads from sick children
and families seeking vaccination.
Over 95 percent of office-based pediatricians practice in
settings defined as small businesses. Many practices operate
with very small staffs, meaning that one absent nurse or
receptionist can all but cripple the office's ability to
function. Most small pediatric practices are also facing
serious challenges in remaining financially viable due to the
economic downturn and employers' quests to decrease health
insurance expenses.
AAP membership report that practices have seen increases in
families with Medicaid, high deductible plans, or no insurance.
Also the payment differential between private pay and Medicaid
is so severe that there are significant downstream impacts on
pediatric practices' ability to keep their doors open. For
example, Medicaid and most private insurers pay approximately
$20 for vaccination administration of adults. State Medicaid
program payment to pediatricians ranges from $2 to $17.85 for
the same service with 38 States paying less than $10 for
vaccine administration. Nationwide, Medicaid pays an average of
72 percent of what Medicare pays for the same services and only
64 percent of average commercial payment.
We are the public health infrastructure for this problem.
We understand the vaccine is coming from the Federal Government
to the States to the health departments, and then our office
has a contract with the health department to deliver the
vaccine. The Academy has a real ethical dilemma. Do we ask our
members to fully participate in a program that is going to
cause them to take business losses because of the poor Medicaid
reimbursement that hasn't been fixed since 1965?
So this crisis in public health is shining a bright light
on the problem with the State's failure to pay adequately for
physicians to participate in Medicaid. As a result, the more
Medicaid patients are seen by pediatrician, the greater the
financial challenge to the practice of the small business. Due
to servere strains in the states as well as decreased tax
revenue, pediatricianse have seen cuts in Medicaid payment
rates. We took a 3 percent cut this year and will take a 3
percent cut next year in North Carolina.
From a clinical perspective, pediatric practices must also
plan for greater workloads. The Academy and the CDC recommend
all children ages 6 months to 18 years receive the seasonal
influenza vaccine, adding 30 million children who need to be
vaccinated for seasonal flu only. Then, because the H1N1 strain
is different, it is going to be a separate vaccine. Children
have virtually no immunity, and we anticipate the CDC will
instruct us, the pediatricians, to give each child two doses of
H1N1. So that is three office visits for each child. Parents
may therefore need to make all these trips, taking time off
work, to cover seasonal flu and the H1N1.
The AAP encourages vaccination of children in the medical
home, and pediatricians want to do whatever they can. And we
recognize that schools and other nontraditional locations may
be utilized as vaccination sites in some states. Children, in
particular those who are 6 months to 5 years, still need access
to H1N1 influenza vaccine through their medical home.
Chairwoman Velazquez. Dr. Tayloe, time has expired, and we
are going to have four votes. But, during the question-and-
answer period, you will be able to expand on those points that
you were not--
Dr. Tayloe. Fine. Thank you.
[The statement of Dr. Tayloe is included in the appendix.]
Chairwoman Velazquez. And the Chair recognizes the ranking
member, Mr. Graves, for the purposes of introducing our next
witness.
Mr. Graves. Thank you, Madam Chair.
Madam Chair, I am very pleased to introduce Mary Kay
Thatcher, who is the director of public policy for the American
Farm Bureau Federation. The Farm Bureau is an independent
nonpartisan organization representing farm and ranch families.
They are the voice of agriculture. The Farm Bureau is local,
county, state and national and international in scope.
Ms. Thatcher, thank you for being here, and I appreciate
you coming in and look forward to hearing your testimony.
STATEMENT OF MARY KAY THATCHER
Ms. Thatcher. Thanks very much for allowing us to come
forward and share the concerns of agriculture as it relates to
the H1N1 virus.
Madam Chairwoman, we had many, many pork producers who
would have relished the opportunity to come in today and talk
and testify about their personal experience, how H1N1 has
impacted the bottom line for pork producers.
Influenza has indeed impacted many family farmers. Many
have been forced to make serious changes to their operations.
When it hit, they had already been struggling through about 18
months of losses due to increased expenses, many of those
expenses beyond their control, and they were looking forward to
a summer that might bring indeed them out of the negatives.
The futures market indicates that we are going to have very
little chance of profit in the pork industry for at least the
next 9 months. And we anticipate the credit markets will
continue to be a problem for pork producers and that many of
them will be forced to sell off a sizeable portion of their
inventory to reduce herd size.
This isn't going to affect just pork producers but
obviously the employees who work for them. And those folks will
not only be without income but also likely without any type of
health insurance.
The impact on our rural communities is also going to be
tremendous. The impact of decisions forced on pork producers,
partly by H1N1, does not stop at the farm gate but also greatly
impacts businesses in town. If herd sizes are further
downsized, farmers will purchase fewer supplies from local
businesses, such as the fuel station, propane supplier and
veterinarians. Rural communities are already struggling to
maintain businesses, and the credit issues currently facing
both the pork and dairy sectors are very likely to further
erode the viability of many rural communities.
I want to emphasize the importance of agriculture to the
recovery of our economy. While fewer than 1 percent of
Americans are engaged directly in agriculture, the sector has a
huge impact on our economy. According to USDA, ag and food
account for about 13 percent of U.S. gross domestic product.
Agriculture withstood the downturn in the economy longer than
most sectors, but the downturn has now caught up with the ag
sector in general and our livestock producers specifically.
The recently sales price received for hogs is down $25 per
head in only the last 4 months. If the December Chicago
Mercantile Exchange lean hog futures price is an accurate
forecast of where hogs will be priced at year end, producers
will be losing $50 per head. Even the futures price for April
of 2010 indicates a $25-per-head loss.
We believe Congress and the administration could do several
things that would be helpful to the pork sector specifically
and would also impact the livestock industry in general.
The H1N1 influenza strain cannot be transmitted by eating
pork. It is a food-safety issue, not a food-borne illness. We
have talked a lot today about the fact that the virus doesn't
spread to meat. Pork is safe to eat. We applaud the
administration for what they have tried to do to get that
message out. But we need Congress and the administration alike
to keep reminding consumers of this fact and use every means
possible to ensure that some in the media quit referring to it
by other names than H1N1.
We also applaud USDA and the United states Trade
Representative. We think they worked diligently with our
trading partners to ensure that they know that U.S. pork and
pork products are safe, and there is no basis for restricting
imports. Yet in China, the world's largest pork export market,
64 percent of its consumers stopped eating pork in the early
stages of the H1N1 influenza outbreak. More than one in five
consumers in China still believe that eating pork can result in
catching the flu virus. This is according to a survey
commissioned by the U.S. Meat Export Federation; 54 percent of
those also said in the survey they fear the connection between
pork and the flu virus and say it is because the virus has been
labeled swine flu.
In the U.S., we have had market access issues in two of our
top six pork export markets, China and Russia. We believe this
is a large part of why, during the first 6 months of 2009, U.S.
pork exports have dropped 18 percent from the levels in the
same 6-month period during 2008.
Also just before the August recess, the House and Senate
passed legislation that provides $1.85 billion in funding for
the Public Health and Social Services Emergency Fund to prepare
for and respond to an influenza pandemic. The conference report
on that legislation states that funds appropriated and not
specifically designated may be transferred to and merged with
other appropriation accounts of the Department of Health and
Human Services and other Federal agencies as determined by the
Secretary of HHS.
The Senate version of the language actually specifically
called for the transfer of $100 million to USDA under the
heading, "Ag Programs, Production, Processing, and Marketing."
We have asked the administration to transfer at least $100
million of the $1.85 billion for use in additional government
purchases of pork. Without question, part of today's decrease
in pork prices is due to the media's misuse of the term swine
flu rather than the H1N1 virus.
Pork producers are facing dire circumstances and need the
government to step up to purchase more pork products. Any
assistance that this committee could provide in encouraging the
administration to make such a transfer of funds would be
greatly appreciated.
We are very concerned about the many farm families around
the U.S., and we want to make sure that they continue to raise
pork and that they are able to sell it here and around the
world. We must all continue to work with our trading partners
to assure them we are open for business and U.S. pork is safe.
There are many hardworking families whose livelihoods depend on
us conveying this message of safety. We must also use whatever
means possible to encourage additional purchases of pork in the
near future.
[The statement of Ms. Thatcher is included in the
appendix.]
Chairwoman Velazquez. Thank you, Ms. Thatcher.
And the committee stands in recess subject to the call of
the Chair.
[Recess.]
Chairwoman Velazquez. Okay. So I don't think we are going
to have any more votes.
Mr. Demangone, when the H5N1 virus surfaced as a possible
agent of the next pandemic, many small businesses pushed for
information. They prioritized job functions, worked to educate
employees, and stockpiled personal protective equipment. For
many, the initial pandemic scare seriously drained some of the
firms' resources. Among small businesses, what challenges do
you see with pandemic preparedness?
Mr. Demangone. Thank you for that question. I agree that
there was a little bit of pandemic planning fatigue that had
taken place. The H5N1 virus--and there is only so many times
you can hear about that. Some of the challenges, though, have
been abated by the fact that the H1N1 virus has materialized
and actually has led to fatalities here and in other regions of
the world. For that reason, some of the stockpiles of the
preventative personal protective equipment, masks, hand
sanitizers, will still be okay.
And a lot of that planning, I would actually say the fact
that we were planning for H5N1 actually was a hidden blessing
because, at that time, no one was to know whether that was
going to lead to the pandemic. And it was ironic, just 2 years
ago, there was an industrywide exercise, and then 2 years
later, those lessons could be used for this particular
pandemic.
But the challenges, of course, are, for Federal credit
unions as well as other financial firms, budgets are a little
tighter this year, and there is some strain. It is still
finding the ability to procure resources to use them
effectively to protect not only your employee but your
membership in the community.
Chairwoman Velazquez. Thank you.
Dr. Tayloe, if a pandemic emergency would compromise the
ability of local and regional health care systems to deliver
basic health services to children, if the H1N1 outbreak is
severe, how would pediatric practices be affected and what will
providers need to do to maintain existing levels of care? I
know that you touched on that, but if you could be more
specific.
Dr. Tayloe. It will depend directly upon the size of the
practice. In other words, if you have got three physicians and
seven staff, and half your staff is sick and one of your
physicians is sick, it is going to cripple you.
Our office is 14 pediatricians and 8 nurse practitioners,
physician assistants. And we operate four offices, kind of a
health care system and since, as Dr. King said, this looks like
a relatively mild flu that doesn't last quite as long as the
seasonal flu, large practices will be able to shift people
around and survive. We will probably end up doing a lot of
telephone medicine, and there are triage protocols that have
already been on the Internet as to how you talk with families
about this problem.
So I think it will just depend on the size of the practice.
But we will be trying really hard to do things right. We have
really perfected the medical home concept, particularly in our
North Carolina Medicaid program, where I think we will be okay.
But it is going to be a rough--it has already started. It is a
rough season.
Chairwoman Velazquez. Do you see foresee some part of the
country more vulnerable than others in terms of the resources
that are available?
Dr. Tayloe. Well, you would have to say, what will happen
in rural areas--I note during an H1N1 flare in northern Canada
this past year, they had so much sickness, they ran out of
respirators, and they were flying sick patients in to other
parts of Canada and the United States. So I think the further
you are from a tertiary hospital with those metropolitan
resources, the more trouble you are going to have.
Chairwoman Velazquez. Let me ask you. On payment for child
vaccination, do you see a difference in payment?
Dr. Tayloe. Most assuredly. And again, I am sorry I ran out
of time on my testimony. But when Congress established Vaccines
For Children in 1993, the Federal Government recommended
vaccine administration fees for each State based on Medicare
economics, that kind of thing. Only about five States followed
that recommendation, and those fees have never been upgraded by
CMS.
Several years ago, Medicare established vaccine
administration fees. And so where the average fee for
pediatricians to give a vaccine is less than $10 from Medicaid,
which is Vaccines For Children, Medicare pays $21. So our
members feel like it is much more difficult to do our
immunizations. We have to convince the parent to let the child
receive the vaccine. That takes forever with all the autism
hype. Then you have to hold a screaming child and give the
vaccine. And then children just have more fears and things
after vaccines. So the fact that we get less than half the
money to do this makes my members tell me, you need to tell
Congress that if pediatricians are going to bear the brunt of
this vaccination program, our vaccine administration fees need
to be at least equal to those of Medicare because we have got
to value our children. And this is seen as just not valuing our
children.
Chairwoman Velazquez. Mr. Jackson, how has your business
prepared to protect staff and maintain operations if a moderate
to severe pandemic outbreak was to present itself?
Mr. Jackson. Obviously that is a significant concern.
Buffalo Supply, as many other small businesses, is operating
alone very slim staff if everything goes well. So we take the
steps that we mentioned in here in trying to keep people
healthy, offering the flu shots and clean stations and all
those sorts of things. As a small business, we have always
stressed cross-training of employees, but we have stressed it
even more recently, and what it probably means is some of the
people that travel stay home and do the job of the day-to-day
office until we can get the operation and all the people back
from being sick.
Chairwoman Velazquez. And I would like Mr. Jackson to
answer this question, but also I would like any other member of
the panel to answer as well. Have you offered any sort of
flexible leave policies for any of your employees, particularly
those with children that are part of the most at-risk
population?
Mr. Jackson. Yes, we do. We treat our employees like they
are family. A lot of them are family in a small business. But
we try to work with each individual that has an issue to come
up with a resolution. I would rather do that than writing a
policy that kind of ties our hands in the future. But we have
flex time that we offer. We allow people to take a day off if
it is to take care of a sick child or if they are not feeling
well themselves. Interestingly enough, we offer the flu shots
at no cost to the employees, but I give a stipulation. If you
decline to take the flu shot, I don't pay you for your time
off. If you take it, I will pay you for your time off.
Chairwoman Velazquez. Any other member wish--Dr. King.
Dr. King. Well, of course, in the practice, you have got to
take into consideration, flu season is our busiest season. So
we have more people that want to come in and be seen, and they
have more problems. So giving time off, flex time--we think
"patient first" naturally. So we want to expand our hours so
patients can get in, those things can be done.
But we do, of course, offer flu shots to all of our
employees. But you have got to understand, that is one of the
things that makes this particular flu epidemic different from
the seasonal flu epidemics we have; we don't have a vaccine
yet. So all the health care providers that are seeing patients
now that have the flu have not been vaccinated. In years past,
we always get our vaccine in ample time, and we get taken care
of. That is the reason there is a greater risk of health care
providers getting this type of flu.
And even though they are going to have the vaccine
available in the middle of October, realize it is going to take
time to get it distributed, out to the State, get it out to the
practices, and then you have got two weeks before you develop
any type of immunity from that vaccine, it is going to be well
into November before anyone has really got any immunity to
begin with.
Chairwoman Velazquez. Ms. Thatcher, we discussed that there
is no correlation between swine and pork and the H1N1. And
since the declaration of four intergovernmental agencies,
organizations and the Federal Government that stated that H1N1
virus cannot be contracted from consuming pork product, have
you seen--has your business continued to decline?
Ms. Thatcher. We believe that we have made progress
domestically and that the vast majority of people in the U.S.
now understand it. I wouldn't say we are back to exactly where
we were in sales, but we still believe our biggest problem is
in the export markets. And it is always hard to ascertain--we
think that the survey that meat export folks did that shows
that one out of five people in China are concerned is very bad
news. But we also know that countries like China tend to use
whatever they can as a trade barrier against us. So there may
be some of that playing into the situation, too.
Chairwoman Velazquez. Mr. Graves? Thank you.
Mr. Graves. Thanks, Madam Chairwoman.
Ms. Thatcher, how much pushback are you getting from the
business community, or health care providers, in trying to
change the paradigm between the term swine flu and the fact
that it doesn't have anything to do with H1N1?
Ms. Thatcher. Mr. Graves, I don't know that we are getting
pushback; I am just not sure we are getting as much help. And
you know, it is easy for all of us to slip and call it the
other name instead of H1N1. And so we have worked with those
folks, and again, I applaud what this administration has done.
It is just that we have to keep it up because we have too many
people I think in the business community who say, well, if I
call it H1N1, people won't know what it is; but if I call it
swine flu, they get it. So it is a real change in mindset that
we have to continue to--
Mr. Graves. Okay.
Chairwoman Velazquez. Mr. Luetkemeyer.
Mr. Luetkemeyer. Thank you, Madam Chair. Just to follow up
again with Ms. Thatcher and Congressman Grave's comment here.
Did you hear that--Mr. McGaw's comment a while ago when I
was discussing it with him, to the effect that they were going
to monitor the media and how they represented the H1N1, and
while that is fine, to monitor is fine, but I think you need to
act on what you find, and I didn't hear him making a
commitment. Are you working with the Homeland Security folks,
so if they do have--they do find that there is a continued
misnaming of this flu, that there is going to be some follow-
up?
Ms. Thatcher. We have done more working through USDA
especially and somewhat through USTR in trying to get them to
help us carry their message at very high levels and have it
done that way. But certainly we have worked with every
department we can think of so far.
Mr. Luetkemeyer. Okay. Well, I was just thinking if there
needs to be some interaction there and some cooperation and
some oversight to make sure that there is some pressure, and I
realize we can't do a whole lot perhaps with the folks from
other countries, but I would think we should be able to sort of
minimize the effect here in this country once the information
gets out of what is really going on here.
Very quickly, Dr. King and Dr. Tayloe, depending on which
one wants to answer, maybe both, what is the effectiveness of
the vaccine? I know we are talking about the shots here. What
is the effectiveness? Is it as effective as most other
vaccines, or is it less effective, because it is being
promoted?
Dr. King. It is being studied. Like I said, we don't get
the flu vaccine out until--we don't know numbers yet for this
particular vaccine that I know of.
Dr. Tayloe. They began the trials in--around the first of
August. I know Duke has a site--
Mr. Luetkemeyer. So we are all--
Dr. Tayloe. They haven't published any data yet that we
could go on because we are hoping the immunity will be good
enough that we can get by with just one injection. But with the
traditional flu vaccine, we have had to give two the first year
to all children under the age of 9 years. And that is going to
create more of a problem. And then the question is, will they
have a nasal vaccine, too? It is rumored that one of the
companies will have a nasal vaccine, which will make much
easier to do this.
Mr. Luetkemeyer. My follow up to that, maybe you won't be
able to answer it, have you seen any reactions to the shot, any
negative things that come out with people who have taken it?
You alluded to autism a while ago. I don't think this is a
problem with this particular thing, but is there some other
sort of side effects or some other negatives that come with
this shot that we need to be aware of or people need to be
informed of?
Dr. Tayloe. I am not aware of any new developments in the
way of the downside to receiving the flu vaccine. The flu
vaccine will contain thimerosal, the mercury preservative--
ethyl mercury preservative that got so much press in the late
1990s, that was removed from most vaccines by going to single
dose viles. But this vaccine is going to come in multiple dose
viles, so it will have thimerosal in it as a preservative. So
it does not bother us because we are not aware of any problems
with human beings as far as the trace amounts of the thimerosal
that is used as preservative in these vaccines. But the
patients that come in the office all want to talk about it. So
the media has just done a number on the public health system
here, and it is a shame. And anything you can do to help us--
Mr. Luetkemeyer. You have got a forum right now. Let it
rip.
Dr. Tayloe. Help us educate the general public about the
really good, solid safety system we have in place for vaccines,
the fact that it takes forever for a vaccine to make it through
the FDA to come to market as a rule. This is a special
situation where this vaccine is made like other flu vaccines
and it will be treated like other flu vaccines and not treated
as a brand new vaccine. But as a rule, it takes forever to get
to market. Then it goes into hundreds of thousands of patients
as a tracking population by the CDC through the Vaccine Data
Link System, and that is how we pulled a couple of vaccines
that looked okay in the thousands of people it was tried on
before release, but as soon as it got out to hundreds of
thousands of people, we knew there was a problem and was
pulled.
So I think our system is a very good system, and I
personally am in a practice where we do over 100,000 counters a
year, and our practice is a really big practice; we have never
referred a single child to the Vaccine Injury Compensation
Program for any chronic or permanent injury from a childhood
vaccine. So I think it is extremely rare. We have a
compensation system in place. And we need the help of the
government in getting the right message to the public.
Mr. Luetkemeyer. Thank you, Madam Chair.
Chairwoman Velazquez. Mr. Graves, another question?
Well, let me take this opportunity to thank all of you for
being here and providing the important information, and we will
continue to work with the Federal Government and the respective
agencies to make sure that there is not only a coordinated
effort but a proactive effort and that we keep in mind that if
we deal with a pandemic, the impact that it could have in the
economy, but particularly on small businesses.
So, with that, I ask unanimous consent that members will
have 5 days to submit a statement and supporting materials for
the record. Without objection, so ordered.
This hearing is now adjourned.
[Whereupon, at 3:41 p.m., the committee was adjourned.]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]