[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]




 
                         THE WUHAN CORONAVIRUS:
                        ASSESSING THE OUTBREAK,
                       THE RESPONSE, AND REGIONAL
                              IMPLICATIONS

=======================================================================

                                HEARING

                               BEFORE THE

         SUBCOMMITTEE ON ASIA, THE PACIFIC AND NONPROLIFERATION

                                 OF THE

                      COMMITTEE ON FOREIGN AFFAIRS
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                            FEBRUARY 5, 2020

                               __________

                           Serial No. 116-100

                               __________

        Printed for the use of the Committee on Foreign Affairs
        
        
        
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       Available:  http://www.foreignaffairs.house.gov/, http://
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             U.S. GOVERNMENT PUBLISHING OFFICE 
39-674PDF           WASHINGTON : 2022 

                      
                       
                       
                       
                       
                       
                       
                       
                      COMMITTEE ON FOREIGN AFFAIRS

                   ELIOT L. ENGEL, New York, Chairman

BRAD SHERMAN, California             MICHAEL T. McCAUL, Texas, Ranking 
GREGORY W. MEEKS, New York               Member
ALBIO SIRES, New Jersey              CHRISTOPHER H. SMITH, New Jersey
GERALD E. CONNOLLY, Virginia         STEVE CHABOT, Ohio
THEODORE E. DEUTCH, Florida          JOE WILSON, South Carolina
KAREN BASS, California               SCOTT PERRY, Pennsylvania
WILLIAM KEATING, Massachusetts       TED S. YOHO, Florida
DAVID CICILLINE, Rhode Island        ADAM KINZINGER, Illinois
AMI BERA, California                 LEE ZELDIN, New York
JOAQUIN CASTRO, Texas                JIM SENSENBRENNER, Wisconsin
DINA TITUS, Nevada                   ANN WAGNER, Missouri
ADRIANO ESPAILLAT, New York          BRIAN MAST, Florida
TED LIEU, California                 FRANCIS ROONEY, Florida
SUSAN WILD, Pennsylvania             BRIAN FITZPATRICK, Pennsylvania
DEAN PHILLIPS, Minnesota             JOHN CURTIS, Utah
ILHAN OMAR, Minnesota                KEN BUCK, Colorado
COLIN ALLRED, Texas                  RON WRIGHT, Texas
ANDY LEVIN, Michigan                 GUY RESCHENTHALER, Pennsylvania
ABIGAIL SPANBERGER, Virginia         TIM BURCHETT, Tennessee
CHRISSY HOULAHAN, Pennsylvania       GREG PENCE, Indiana
TOM MALINOWSKI, New Jersey           STEVE WATKINS, Kansas
DAVID TRONE, Maryland                MIKE GUEST, Mississippi
JIM COSTA, California
JUAN VARGAS, California
VICENTE GONZALEZ, Texas

                                     
                      Jason Steinbaum, Staff Director
               Brendan Shields, Republican Staff Director
                                 ------                                

         Subcommittee on Asia, the Pacific and Nonproliferation

                  BRAD SHERMAN, California, Chairman,

DINA TITUS, Nevada                   TED YOHO, Florida, Ranking Member
CHRISSY HOULAHAN, Pennsylvania       SCOTT PERRY, Pennsylvania
GERALD CONNOLLY, Virginia            ANN WAGNER, Missouri
AMI BERA, California                 BRIAN MAST, Florida
ANDY LEVIN. Michigan                 JOHN CURTIS, Utah
ABIGAIL SPANBERGER, Virginia

                                     
                

                     Don MacDonald, Staff Director
                     
                            C O N T E N T S

                              ----------                              
                                                                   Page

                               WITNESSES

Nuzzo, Dr. Jennifer, Associate Professor and Senior Scholar, 
  Center For Health Security, Johns Hopkins University...........     8
Bouey, Dr. Jennifer, Senior Policy Researcher and Tang Chair in 
  China Policy Studies, Rand Corporation.........................    21
Klain, Mr. Ron, Former White House Ebola Response Coordinator, 
  2014-2015......................................................    39

                                APPENDIX

Hearing Notice...................................................    76
Hearing Minutes..................................................    77
Hearing Attendance...............................................    78

                  OPENING STATEMENT FROM CHAIRMAN BERA

Opening statement from Chairman Bera.............................    79


   THE WUHAN CORONAVIRUS: ASSESSING THE OUTBREAK, THE RESPONSE, AND 
                         REGIONAL IMPLICATIONS

                      Wednesday, February 5, 2020

                        House of Representatives

                 Subcommittee on Asia, the Pacific and

                            Nonproliferation

                      Committee on Foreign Affairs

                                     Washington, DC

    The subcommittee met, pursuant to notice, at 2:02 p.m., in 
room 2172 Rayburn House Office Building, Hon. Ami Bera 
(chairman of the subcommittee) presiding.
    Mr. Bera. The subcommittee will come to order.
    We meet today for Congress' first hearing on the 2019 novel 
coronavirus. Without objection, all members will have 5 days to 
submit statements, questions, extraneous materials for the 
record, subject to the length limitations in the rules.
    I will now make my opening statement and then turn it over 
to the ranking member for his opening statement.
    First-off, I want to thank the witnesses for joining us 
today. This is the first hearing on coronavirus, and for many 
Americans as well as Members of Congress, this is on our mind 
right now. Before kind of diving into things, I do want to make 
note that we did ask the Administration to come up and brief 
us. And, unfortunately, they did not send folks.
    This is not a partisan issue, this is an issue of how we 
work together as Democrats and Republicans, Congress along with 
the Administration, to get ahead of a public health emergency.
    I would note that they did give Members of Congress a 
bipartisan unclassified hearing earlier today with Acting Chief 
of Staff Mick Mulvaney, Secretary of HHS Alex Azar, Deputy 
Secretary of State Steve Biegun, Acting Deputy Secretary of 
Homeland Security Ken Cucinelli, the Director of the CDC Robert 
Redfield, the Director of National Institutes of Allergy and 
Infectious Disease Dr. Tony Fauci, and Assistant Secretary for 
Preparedness and Response, Dr. Robert Kadlec.
    That was not televised. That was not open to the public but 
it was unclassified. And I would make the request of the 
Administration to provide their opening statements to this 
committee so we can add that to the public record because we do 
believe the public's concerns here. The more the Administration 
can speak directly to the public and answer those questions, 
the better off we would all be.
    Again, the Administration has an open door to come before 
this committee or the full committee to show what they are 
learning in the rapidly fluid situation. We look to work with 
the Administration to support the response.
    You know, I look at this as a physician and someone who has 
worked in public health, was Chief Medical Officer for 
Sacramento County, and who has worked overseas internationally. 
This is quite concerning right now. We have many questions. 
When I think about the three objectives of this hearing, but 
also of how we respond as a nation but also a globe, how is the 
U.S. Government coordinating the response both domestically and 
internationally?
    Do we have the right tools and resources in place to help 
get ahead of this outbreak?
    And what I mean by that is if we think about one of the 
most urgent things we could do, CDC has the best 
epidemiologists in the world. We have some of the best 
personnel. I know we have been getting conflicting reports. We 
have had some folks in country that now would be a time for us 
to collaborate with the Chinese to get our best epidemiologists 
to the epicenter so we could actually answer some of the health 
questions that are there.
    How easily is this transmitted human to human?
    How are people infectious when they are asymptomatic?
    Are people infectious when they do not exhibit symptoms, or 
is it only when they are symptomatic?
    We have had conflicting reports of what the incubation 
period is. At times we are told it is up to 14 days. Then we 
were told it was 5 to 7 days. Then we were told it is 3 to 5 
days. All of these are incredibly important questions for our 
staff. So, we cannot just help the Chinese as well as the rest 
of the world internationally, but we can also plan our response 
here.
    A second important point that we learned post-Ebola and 
post-other pandemics is the importance of having an individual 
or small group of individuals who can coordinate across the 
interagency process. To date we do not have that single 
individual that has sole responsibility of that coordination.
    We have Secretary Azar, extremely capable individual, but 
he runs Health and Human Services. If this broadens here 
locally, Health and Human Services are going to have their 
hands full responding and supporting our public health efforts 
here.
    We have a great CDC director, but they have a specific 
role.
    The DoD can do logistics, and they have a specific role.
    Homeland Security, you know, has a specific role.
    One of the recommendations was at the national security 
level we really do need to have a single individual who can 
coordinate the whole interagency process. Mr. Klain, I know you 
were instrumental in that role, and certainly look forward to 
hearing your thoughts about why that is such an important role.
    No. 3, in the era that we live in the misinformation that 
is out there is going to be really important as the public, you 
know, should this spread in the United States. What is the 
right information that should get out to the public? And how do 
we combat disinformation? That is a very difficult scenario, 
but it is incredibly important, not just here but also, you 
know, internationally.
    I look forward to hearing from the witnesses on their 
thoughts and ideas.
    Out of an abundance of caution, we did see the 
Administration institute a travel ban and increase screening of 
folks that are returning from China and the region.
    You know, there are discussions taking place backward and 
forwards as to whether that actually will help us get a handle 
on this or if the travel ban will actually potentially make 
things worse. And, again, I would be curious for the 
perspective of some of the witnesses on how that is being 
implemented and the impact of that.
    Lastly, part of the reason why I really did want the 
Administration here is we do not see this as an adversarial 
role. A lot of things in Washington, DC. are partisan. This is 
not partisan. We, as Congress, understand how rapidly this is 
moving. We also understand that we want to make sure the 
Administration has all the tools and resources that they need.
    Right now, we are guessing at what they might need in the 
emergency supplemental. I would invite the Administration to 
work with us. Tell us what you need and then we will work to 
try to get that available to you as quickly as possible. We are 
on the same team here. This, you know, novel coronavirus does 
not see Republicans or Democrats, it sees human beings. And 
let's get ahead of this. Let's learn from this.
    And then let's also plan so we are not constantly 
responding to the latest outbreak but we are actually thinking 
about how to prevent the next pandemic.
    Those are a few things that I have on my mind. And, again, 
I want to thank the witnesses for being here. And we really do 
have great personnel at CDC, HHS, State Department. And they 
are working overtime. And, again, I commend those men and women 
that are spending quite a bit of time working on this just to 
keep us safe. We look forward to working with them.
    This is an open door if they ever want to come to this 
subcommittee. And I think any of the members here, we are here 
to help support the Administration.
    With that, let me turn it over to the ranking member for 
his opening statement.
    Mr. Yoho. Well, thank you, Mr. Chairman, and good morning. 
I would like to thank Chairman Bera for holding this hearing on 
global spread of novel coronavirus from China.
    And I want to comment on what you said, the hysteria and 
misinformation. We saw that when Zika happened. And it was--it 
turned into a political fight, it was politicized. And we do 
not want to do this. And I commend everybody that is working on 
this to this point; it hasn't happened. And I hope we go 
forward.
    And then you have an M.D. and a veterinarian, and so we are 
both used to having quarantines and dealing with outbreaks.
    I would like to welcome Dr. Jennifer Nuzzo from the Johns 
Hopkins University, Dr. Jennifer Bouey from RAND, and Mr. Ron 
Klain. I look forward to hearing from each of you about recent 
developments and paths forward to coronavirus and related 
global diseases.
    As of today, 20,630 people in 24 countries around the world 
have been infected with coronavirus that we know of. The virus 
has killed 425 people so far, as we know, or that is all we 
know of, the vast majority of which have occurred within China. 
I extend my sympathies to the people in China who have lost 
family members or remain quarantined by the Chinese authorities 
in an unprecedented look-down of millions of people. I do not 
think we have ever seen this before.
    However, despite the severity and infectiousness of this 
virus, the Chinese Government has so far refused to fully 
cooperate with the global community. And, again, this is 
something we hope does not become politicized. Viruses know no 
borders and they do not really care what your politics are.
    Although Chinese scientists were able to share the sequence 
of the strain with international partners, they were only able 
to do so after bypassing government censors. So far, China has 
spurned the help of CDC and refused to provide biological 
samples to the United States. And to date, if we look back, 
whether it was the MERS or SARS epidemic, that was a worldwide 
collaboration. And other countries, even Taiwan, needs to be 
involved in this because they were the ones that helped solve 
the SARS epidemic.
    The slow-walking of information and assessments not only 
hurts the credibility of China, but also hinders our ability as 
an international community to prevent the further loss of life 
and spread of the disease. Further, in the middle of the 
unprecedented crisis the CCP continues to endanger people 
through Asia by using the World Health Organization to advance 
its political agenda through the exclusion of Taiwan.
    Taiwan has also forbidden the evacuation of Taiwanese 
citizens from the mainland, directly threatening the safety and 
sovereignty of their citizens. This cannot stand. And, again, 
viruses really do not care what your politics are.
    The United States should be better prepared to face future 
threats as well, which is why I supported multiple efforts in 
Congress to promote the One Health framework which we are going 
to talk a little it about, because this coordinates 
departments, activities, and programs that will prepare to 
protect the U.S. food and feed supplies in the event of a 
zoonotic disease outbreak. So, this is a cooperation between 
USDA and HHS.
    As we know, six to seven out of ten diseases that we get 
originate in the animal world. And the coronavirus is a perfect 
example.
    The recent outbreak of coronavirus stemming from Wuhan, 
China, is a perfect example why managing the spread of the 
animal-to-person spread to prevent person-to-person spread is 
so important. Thankfully, the CDC has repeatedly assured the 
American people that the risk to our residents remains low. 
This, thanks in large part to the actions taken by the 
Administration in organizing targeted quarantines, travel 
advisories, research into treatments and vaccines, in addition 
to the daily calls our staffs get and Members of Congress get 
on this issue.
    However, questions remain regarding potential paths 
forward. What can we do in the future to prevent not just 
China, but China, any country from hiding the spread of a 
deadly virus, of which they are repeat offenders?
    How can we balance long-term pandemic preparedness with the 
billions of dollars our government spends in short-term 
responses to emerging threats?
    Congress must continue to enable our agencies to respond 
effectively to infectious diseases and encourage our Government 
to collaborate with all of our international partners in global 
health.
    I look forward to hearing from the panel on response to the 
spread of the coronavirus in the U.S., and what we can do 
better to prepare ourselves for the arrival of not just this 
one but future pandemics from foreign countries.
    Thank you, and I yield back.
    Mr. Bera. Thank you to the ranking member.
    And my staff was just updating numbers. It is now 492 
deaths. So, obviously, rapidly flowing and constantly being 
updated.
    I should have noted that it is my pleasure to have had the 
gavel passed over toward me from the former chair of this 
committee. And I would like to recognize you for a 1-minute 
opening statement, Mr. Sherman.
    Mr. Sherman. Thank you, Mr. Chairman. You are to be 
commended for having the first public hearing on this disease 
outbreak of either house of Congress.
    We did get a private briefing from the Administration. And 
let me say that I was impressed by the team that made that 
presentation to us. That is, I hope, particularly noteworthy 
because I am not a leader when it comes to complimenting the 
Trump administration. I am also not a leader in complimenting 
the government in Beijing.
    But, I think the entire world is impressed when they build 
a new hospital and put it in service in 8 days. Which is why I 
am surprised that the Chinese Government has taken offense that 
we have chosen to limit travel, because the Chinese Government 
has limited travel internally in China. And, of course, Hong 
Kong has limited travel from the Chinese mainland. What we do 
to protect our own citizens should not be regarded by the 
Chinese as an insult but, rather, as part of a collective 
effort to control this disease.
    We need Chinese cooperation to start clinical trials. There 
are a variety of possible medicines that might be helpful, but 
we will not know. One of the good things about this disease is 
that it looks like the mortality rate is 1 to 2 percent. That 
is much lower than other outbreaks. I realize some people may 
have slightly different definitions, but it is a lower 
mortality rate than, say, Ebola, that Mr. Klain is familiar 
with.
    And so it means that without a clinical trial you do not 
know whether a particular medicine is successful. Because if 
you take 20 people with Ebola and you try something out and 
they all live, that is a good treatment. If you take 20 people 
with this disease and give them a treatment and they all live, 
that may have proved nothing at all.
    So, we need double-blind clinical trials, we need 
cooperation with China. And I look forward to getting there.
    I yield back.
    Mr. Bera. Thank you, Mr. Sherman.
    Now I am very pleased to welcome our witnesses to today's 
hearing. We are joined by Dr. Jennifer Nuzzo, a Senior Scholar 
at the Johns Hopkins Center for Health Security.
    She will be followed by Dr. Jennifer Bouey, the Tang Chair 
in China Policy Studies at the RAND Corporation. Both are 
trained epidemiologists.
    And, finally, we are joined by Mr. Ron Klain, who 
coordinated the response to West African Ebola epidemic in 2014 
and 2015.
    Please summarize your written statements to 5 minutes. And 
without objection, your prepared written statements will be 
made a part of the record.
    Dr. Nuzzo, if you could begin.

STATEMENT OF DR. JENNIFER NUZZO, ASSOCIATE PROFESSOR AND SENIOR 
 SCHOLAR, CENTER FOR HEALTH SECURITY, JOHNS HOPKINS UNIVERSITY

    Dr. Nuzzo. Good afternoon. Chairman Bera, Ranking Member 
Yoho, and members of the committee, thank you for allowing me 
to appear before you today to discuss the emerging global 
spread of the 2019 novel coronavirus.
    In the last 2 months since this virus was first identified 
we have learned several important things, such as its potential 
to spread between people, and its capacity to cause a spectrum 
of disease ranging from mild to severe. These discoveries have 
changed our perceptions of the global risks the virus poses, 
but there are still critical unknowns for which we urgently 
need more information.
    Though more and more cases are reported each day, we do not 
yet know the true size and geographic scope of this epidemic. 
And many countries are not capable of actively searching for 
cases. And most countries that have implemented surveillance 
are likely missing cases, perhaps large numbers of them.
    Severity of this disease is another key unknown. Because of 
biases in the way we look for cases, it is difficult for us to 
estimate from the case numbers how much severe illness and 
death we may expect to see as this epidemic grows. That said, 
even though we cannot get a precise estimate, there are some 
emerging signs that this virus may be less severe than we 
initially feared. If these trends continue we will ultimately--
we may ultimately downgrade our concerns about this virus. But, 
for now these uncertainties leave important gaps in our 
response planning.
    Though the ultimate trajectory of this epidemic is hard to 
predict with certainty, evidence is mounting each day that it 
may not be possible to contain this virus. What this means is 
that if it is not possible to completely stop disease 
transmission, we must plan for how we will mitigate the impact 
of the virus as it spreads.
    To do this, I recommend three priority actions:
    First, we need to seriously reexamine the current policy of 
banning travel from China and quarantining returning travelers. 
All of the evidence we have indicates that travel restrictions 
and quarantines directed at individual countries are unlikely 
to keep the virus out of our borders. These measures may 
exacerbate the epidemic's social and economic tolls and can 
make us less safe.
    Simply put, this virus is spreading too quickly and too 
silently, and our surveillance is too limited for us to truly 
know which countries have active transmission and which do not. 
The virus could enter the U.S. from other parts of the world 
not on our restricted list, and it may already be circulating 
here.
    The U.S. was a target of travel bans and quarantines during 
the 2009 flu pandemic. It did not work to stop the spread and 
it hurt our country. I am concerned that by our singling out 
China for travel bans we are effectively penalizing it for 
reporting cases. This may diminish its willingness to further 
share data and chill other countries' willingness to be 
transparent about their own outbreaks.
    Travel bans and quarantines will make us less safe if they 
divert attention and resources from higher-priority disease 
mitigation approaches that we know are needed to respond to 
cases within the United States. Caring for and monitoring even 
a small number of quarantined individuals will be highly 
challenging for health departments and may siphon attention 
from other more important response work.
    And we are already hearing stories about chaos in the 
States as they are trying to implement these recent policies.
    Second, rather than penalize China, we should try to assist 
it in responding to the epidemic. Helping China is in our best 
interests. It is a risk of the drastic actions that China is 
taking to control the epidemic could lead to disruptions in 
U.S. supplies of essential medical resources such as personal 
protective equipment and critical medicines. We need to examine 
this possibility and identify ways to ensure that the epidemic 
or the U.S. response to it does not interrupt medical supply 
chains.
    Third, we should focus on health response efforts that we 
know will help to lessen the impacts of the virus within U.S. 
communities. We need to ensure that Federal, State, and local 
health agencies, and hospitals and health clinics have the 
resources they need to diagnose, isolate, and safely treat 
cases, and to promote feasible approaches to disease mitigation 
that are most likely to reduce disease spread, minimize 
disruption, and protect those most likely to experience severe 
illness and death.
    For this, we need leadership and additional investment, 
possibly in the form of emergency funding such as was 
appropriated during the 2009 pandemic.
    Government leadership is also needed to facilitate the 
development of medical countermeasures, including infectious 
disease diagnostics.
    The points I have raised today hopefully paint a picture of 
a epidemic that is in many ways complex and evolving, but for 
which we are increasingly gaining clarity. One thing is 
certain, international collaboration will be essential for us 
to monitor, for continued monitoring and learning about the 
virus and to inform our own response plans. That we know 
anything about this virus is due in large part to information 
contributed by China, Thailand, Vietnam, the other countries 
that have worked hard to improve their surveillance, in part 
with U.S. help. And we will likely need their help going 
forward.
    We should recognize these successes as they demonstrate the 
value of our investments and the need for continued 
international engagement. Though our instincts may be to 
isolate ourselves to try to keep the virus out of our borders, 
this approach may only weaken our preparedness.
    Thank you.
    [The prepared statement of Dr. Nuzzo follows:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]     

        Mr. Bera. Thank you, Dr. Nuzzo.
    Dr. Bouey.

 STATEMENT OF DR. JENNIFER BOUEY, SENIOR POLICY RESEARCHER AND 
      TANG CHAIR IN CHINA POLICY STUDIES, RAND CORPORATION

    Dr. Bouey. Thank you. Chairman Bera, Ranking Member Yoho, 
and members of subcommittee, thank you for inviting me to 
testify for this coronavirus outbreak. My testimony will start 
with laying out the context of this outbreak by looking at 
China's public health development after SARS. Then I will 
examine China's current response to this outbreak. And I will 
end with some recommendations.
    Seventeen years ago SARS emerged from southern China and 
caused a global outbreak and infecting over 8,000 people, and 
killing more than 700. SARS prompted China to radically rethink 
its public health system. The country invested heavily in the 
Centers for Disease Control, surveillance networks, and a 
National Influenza Center. SARS also spurred China to 
strengthen its relationship with United States and the wider 
international community around public health concerns.
    The U.S. helped China in both public health infrastructure 
and capacity building. Public health professionals from both 
countries collaborated on HIV/AIDS, avian flu, swine flu, H7N9, 
and Ebola. In the last couple years, however, this relationship 
has faltered due to tensions between the U.S.-China 
relationship.
    Compared to SARS, the time taken for the Chinese Government 
and global health communities to respond to the first cases of 
coronavirus are much shorter. So, there were about 4 weeks from 
the first noticed case to the public announcement of the 
outbreak, and then 12 days to the time when virus was 
identified, and then 9 more days until the national case report 
system was triggered.
    The credit for this progress can be tied to the 
availability of the latest genomic sequencing technology and 
the global data networks. Because of the rapid identification 
of the virus, many countries, including U.S. and China, can now 
quickly develop a testing kit, monitor the genetic mutation, 
and have better understanding of the transmission. All 
countries can link their cases to the current outbreaks now.
    Further, the wide use of social media and China's progress 
on globalization has pushed the government to be more 
transparent. However, there are remaining similarities to the 
SARS response. Given the Chinese Government values stability 
most, an outbreak by its nature is disruptive. The government's 
hesitation to announce the public health threat was reflected 
in the long review process and the regulations that prohibited 
local officials and the members of the public to discuss the 
outbreak before the approval from the central government.
    The downplay of the severity of the outbreak also has 
happened again. From January 3d to the 20th, the expert 
investigation team assured the public that there was limited 
person-to-person transmission. And after closing the animal 
markets associated with the first group of cases, the epidemic 
was under control.
    It was not until cases outside China appeared and the 
second team was sent and they confirmed the communal 
transmission, then the government announced a public health 
emergency and triggered the national case reporting system.
    Finally, as with SARS, the government uses mass quarantine 
as the primary intervention. Resources have been mobilized 
nationally to support a health care system in the crisis areas, 
and even new hospitals were built for the outbreak. The 
quarantine and the health care system strengthening are 
important strategies, but we do not know, do not know yet if 
such intervention can contain this epidemic, nor do we know 
about the social, cultural, economic, and the political 
implication and impacts.
    I will highlight three recommendations here:
    First, USG should consider having a concerted and 
comprehensive plan to contain the domestic outbreak. In 
addition to the social distancing action we just mentioned, we 
should consider the strategies to reduce the spread of rumors 
and the stigma associated with the outbreak.
    Second, public health and humanitarian assistance should be 
sent at a time when China is bearing the principal burden of 
the outbreak. Currently, 99 percent of the cases are in China, 
and 97 percent of the deaths in Hubei province. Public health 
expertise, medical supplies, and even supporting language can 
help the people who are suffering there.
    And, last, given the continued spread of the outbreak, USG 
should consider working with WHO and China CDC to provide 
strategic and capacity building for other countries that are in 
danger of the epidemic.
    Thank you.
    [The prepared statement of Dr. Bouey follows:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]     

    
    
    Mr. Bera. Thank you, Dr. Bouey.
    Mr. Klain.

 STATEMENT OF MR. RON KLAIN, FORMER WHITE HOUSE EBOLA RESPONSE 
                     COORDINATOR, 2014-2015

    Mr. Klain. Chairman Bera, Ranking Member Yoho, other 
members of the subcommittee, thanks for having me. I move you--
I commend you for moving quickly to hold this hearing.
    At the outset I want to make two preliminary points:
    First, while scientists are working at unprecedented speed 
to learn more about this virus, we still know less about the 
coronavirus today than we did about Ebola in 2014. There are 
many important gaps to be filled in.
    Second, I want to say a word about partisanship. I am a 
political partisan, that is well known, but I testify today the 
same way I approached serving as Ebola Response Coordinator, 
putting politics aside. Epidemic response should not be a 
partisan issue. The coronavirus will certainly not ask anyone's 
political affiliation before infecting them.
    With that introduction, I want to turn to the lessons from 
the Ebola response. That response was not without problems, and 
particularly early on. But, ultimately, President Obama 
launched a whole-of-government effort, he appointed me to lead 
a team at the White House to coordinate it. The president 
ordered the first ever deployment of U.S. troops to combat an 
epidemic. He implemented innovative policies and travel 
screening and monitoring, and worked with this body to pass a 
$5.4 billion bipartisan emergency response package.
    This response improved preparedness at home, and put over 
10,000 people, civilians and soldiers, government employees, 
contractors, and NGO members on the ground in Africa to help; a 
gargantuan effort. The epidemic was tragic, a loss of 11,000 
lives or more, but experts had forecast a death toll of more 
than 1 million. Thus, as part of a global response, with 
Africans playing the largest part, America helped save hundreds 
of thousand of lives.
    Here at home, after some initial missteps in Dallas, no one 
contracted Ebola on U.S. soil. And the evacuation of Americans 
from Africa with Ebola saved lives and resulted in no spread of 
the disease here.
    And the benefits of this response continues to this day. 
With Congress' support we stood up a national network of 
medical facilities that remain prepared now to respond to cases 
of dangerous infectious disease. Nothing like that existed 
before. The response helped develop an effective Ebola vaccine 
being used now in Central Africa. And new therapeutics have 
dramatically reduced the mortality rate of Ebola.
    Tom Friedman recently wrote that the Ebola response was 
``President Obama's most significant foreign policy achievement 
for which he got little credit precisely because it worked, 
demonstrating that without America as quarterback, important 
things that save lives and advance freedom often do not 
happen.''
    Now, the challenges we face now from the novel coronavirus 
have many differences from those that Ebola posed, but also 
some key similarities. And I want to try to quickly run through 
seven lessons from the Ebola response that should be applied 
today.
    First, in a scenario like this one there is no substitute 
for White House leadership. There should be a single high-level 
official inside the National Security Counsel overseeing the 
response. At the end of my tenure as Ebola Response 
Coordinator, President Obama accepted my recommendation to 
create a permanent pandemic preparedness and response 
directorate inside the NSC.
    President Trump initially continued this structure. But, 
unfortunately, in July 2018 he disbanded this unit. The gap 
that created for this response is significant.
    Now, last week's decision to create a task force to oversee 
the coronavirus response is a valuable step, but I think it is 
insufficient. That is not a criticism of its chair, Secretary 
Azar, for whom I have a great respect, but reflects the 
fundamentals of bureaucratic behavior, the realities of the 
competing demands on a cabinet secretary's time, and the need 
to ensure foreign engagement at a high level. This response 
should be lead by a full-time senior appointee at the White 
House.
    Second, the U.S. must lean forward to fight this epidemic 
overseas. Unlike West Africa in 2014, China said they would not 
accept thousands of U.S. responders on the ground. But that 
does not mean our focus is limited to the homeland. Nations 
poorer than China may see outbreaks and need direct help. Our 
diplomats should be engaged around the globe.
    The best way to keep Americans safe is to eschew 
isolationism and help other nations combat the virus.
    Third, this Administration must ensure that science and 
expertise guide our actions. There are going to be many hard 
decisions in the days ahead. The American people are fortunate 
to have the world's leading experts on infectious disease 
working in this government, experts who have served Democratic 
and Republican presidents alike. This expertise should be 
paramount in decisionmaking.
    Fourth, the Administration should quickly transmit to 
Congress an emergency funding package to respond to the 
coronavirus challenge. Federal agencies, State and local 
governments, hospitals testing and treating patients will need 
assistance. Research and deployment of new therapeutics and 
vaccine need government support.
    While the response has benefited from the new emergency 
fund that Congress created on a bipartisan basis last year, 
that probably will not suffice. The Trump administration should 
send an appropriate funding request to this body.
    Fifth, the Congress must do its job in dealing with the 
coronavirus. It needs to act on any such request quickly and 
should, perhaps, work now to be ready for it.
    In addition, hearings like today's are very important. The 
emergency fund needs to be increased and paired with a fund to 
support the development of therapeutics and vaccines on public/
private partnerships.
    And, finally, Congress must renew funding for the full 
network of Ebola and special pathogen hospitals created in 2014 
that is set to expire in May.
    Six, this should be a wake-up call to finish the work we 
need on pandemic preparedness. Recently we marked the 100th 
anniversary of the single largest mortality event in American 
history, the Spanish flu epidemic. At present it seems very 
unlikely that the coronavirus poses a similar threat. But even 
if this epidemic is not the big one, as Representative Yoho 
said, it is a reminder that the danger lurks and it will come.
    The global health security agenda, bipartisan commissions 
and reports, and my own writing have set forth detailed agendas 
of what we need to do to prepare for this event that have 
largely been ignored. The time to act is now.
    And seventh, finally, all of us need to be on the watch for 
discrimination against Chinese Americans and speak out strongly 
against it. The coronavirus strikes humans, not people of any 
particular race or ethnicity. Chinese Americans and Chinese 
immigrants in America are no more likely to get this disease or 
transmit it than anyone else. It is critical to speak out 
against discrimination. Americans need to pull together to 
fight the disease, not pull apart to fight one another.
    Thank you again for having. And I am ready to answer your 
questions.
    [The prepared statement of Mr. Klain follows:]
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]     

        
    Mr. Bera. Thank you, Mr. Klain. And thank you to all the 
witnesses.
    I will now recognize myself for opening questions, and then 
I will recognize the ranking member and other members for 5 
minutes for the purpose of questioning our witnesses.
    Let's touch on a couple areas that I think each of you 
touched on in your opening statement. I understand the initial 
reaction to say, you know, let's try to contain this virus at 
the epicenter in China. That, you know, just given the 
worldwide spread of these cases how little we know about the 
transmission at this juncture.
    It seems as though, you know, we are beyond the point of, 
you know, trying to contain this at the epicenter.
    Maybe starting with you, Dr. Nuzzo, and, you know, just 
going down the line, how effective is this travel ban? And you 
touched on it that it actually may worsen, worsen things right 
now in concentrate.
    Dr. Nuzzo. Thank you, Chairman Bera.
    I, as I mentioned, am worried about the implications of the 
travel ban. We often see when we have emerging disease 
outbreaks out first instinct is to try to lock down travel to 
prevent the introduction of virus to our country. And that is a 
completely understandable instinct.
    I have never seen instances in which that has worked when 
we are talking about a virus at this scale. Respiratory viruses 
like this one, and like others, they just move quickly. They 
are hard to spot because they look like many other diseases. It 
is very difficult to interrupt them at borders. You would need 
to have complete surveillance in order to do that, and we 
simply do not have that.
    In China we are looking for largely sick people. I mean, 
other countries we are only looking for people from China. So, 
we are going to miss transmission elsewhere.
    So, for that and other reasons I do not believe that it 
will be able to keep the virus out of our border.
    I am, though, very worried about the potential diversion of 
resources because this was apparently, it was a decision that 
caught many public health folks off guard. And they are now 
trying to figure out what to do. And so, I talked to one health 
department who has 31 staff working around the clock supporting 
two quarantined individuals. And I just think, as this epidemic 
grows that is not likely to scale.
    So, I am worried about that. And then I am also worried 
about the chilling effect that attends the potential to erode, 
well, our relationship with China that we are critically 
dependent on right now for the supplies of the things that we 
need to be able to manage our own cases. But, also, we just 
need more information.
    And as you mentioned in your opening remarks, China will be 
the source for that information in large part.
    Mr. Bera. Right.
    You know, maybe, Mr. Klain, Dr. Nuzzo touched on the supply 
chains and the interconnectedness of it. How concerned should 
we be about those supply chains? And, you know, obviously they 
are global supply chains as well, and the medical supply 
potentially needed here but also in China?
    Mr. Klain. Yes, Congressman. We do not have a travel ban, 
we have a travel band-aid right now.
    First, before it was imposed, 300,000 people came here from 
China in the previous month. So, that horse is out of the barn.
    Second, what we have restricted is not travel to or from 
China but passports to and from China. There is no restriction 
on Americans going back and forth. There are warnings. People 
should abide by those warnings. But today 30 planes will land 
in Los Angeles that either originated in Beijing or came here 
on one stops. Thirty in San Francisco, 25 in New York City. OK?
    So, unless we think that the color of the passport someone 
carries is a meaningful public health restriction we have not 
placed a meaningful public health restriction.
    And then to get to your question, exempt from the 
President's travel restriction, of course, is the import of 
goods from China and, of course, the people who fly the planes 
and drive the boats that bring those goods from China. We 
couldn't ban that activity. We vitally need that. 90 percent of 
the antibiotics in this country come from China. All kinds of 
vital medical supplies. Dr. Nuzzo mentioned the PPP--PPE we 
will use to treat people.
    So, travel bans, even putting aside Dr. Nuzzo's concerns, 
that is not what we are imposing, that is not what exists. What 
we should be focused on is monitoring the people who are here 
who have been in China in the past 14 days. That is 
complicated. That is hard. We built a path-breaking system to 
do that in the Ebola response. This is much larger and more 
complicated.
    And I do not think we have heard answers--I hope Congress 
will get them--but what the Administration is doing on that, 
which really should be our public health priority.
    Mr. Bera. And maybe in the limited time I have left, Dr. 
Bouey, you have a unique perspective having trained in China. 
And, you know, from your perspective, how best can we assist 
the Chinese? And, again, from the congressional perspective we 
are not looking at this as adversarially, we are looking at 
this as collaboratively.
    Dr. Bouey. Thank you. I agree wholeheartedly with Dr. Nuzzo 
and Mr. Klain that the travel ban does not cause--does not help 
that much in this, the current situation.
    I want everyone to understand that China, Chinese 
scientists look up to the American scientists highly. The 
United States has helped China to build a public health system, 
and has helped with capacity building after SARS.
    So, they are always looking at the U.S. as a leader in this 
field and for U.S. to make this decision. So, I think that is 
why China is a little bit surprised and also feel hurt.
    And I also, my own feeling is that with the travel ban that 
should come with other policies. It should not be the only 
policy that U.S. announced to China. Humanitarian aid, the 
public health assistance should, and the other support should 
be in place at the same time as the travel ban.
    Mr. Bera. Great. I am out of time.
    Let me go and recognize Ranking Member Mr. Yoho from 
Florida.
    Mr. Yoho. Thank you, Mr. Chairman.
    Great testimony. I really, really appreciate it. I have a 
ton of questions let me go through.
    Dr. Nuzzo, you said we should look to help China versus 
blocking them out. What kind of help would you recommend other 
than what we have done?
    Keep in mind if China will not accept our offer to help 
with the CDC, what else can we do? I would like to hear from 
you.
    Dr. Nuzzo. Yes, thank you, Ranking Member Yoho, for that 
question.
    First of all, I want to make clear that I think one of the 
concerns that I have about our----
    Mr. Bera. Dr. Nuzzo, could you speak into the microphone, 
please.
    Dr. Nuzzo. Excuse me. Sorry.
    I want to make clear one of the concerns that I have 
pertains to not just our response to this virus but also how 
China is responding. And the disruptions that I spoke to 
earlier I believe will be exacerbated by the lock-downs that 
China is taking in an attempt to control the virus.
    Since those lock-downs have been announced, every single 
province in China is reporting cases. So, I am increasingly not 
convinced that those measures are helping. And I am really 
worried that they are going to cause disruptions.
    And so, I think it is essential that we encourage China, 
pressure China, whatever the negotiations that we do, to pursue 
strategies for controlling the virus that are not going to be 
disruptive, that will not suspend the production of critical 
medical supplies because people cannot get to their jobs.
    Mr. Yoho. Let me interrupt you right there because that is 
something I want to talk about.
    Dr. Nuzzo. Right.
    Mr. Yoho. You know, does the fact that China did a massive 
quarantine--our reports are 50 to 58 million people have been 
quarantined--does that concern you in addition to the rapid 
construction of the 1,000-bed hospital, which was a monumental 
feat, and they have another 1,500 going in--so China is putting 
a stellar effort into this--that alone would be a concern for 
all of us if they are that concerned about it, yet the 
information coming out is, well, we have it kind of under 
control. And then the furloughing of workers, I have heard up 
to some, they are told not to come back till sometime in March.
    I think this is a big concern that we need to look at. And 
I am all for quarantine if it is done properly but, as Dr. 
Bouey said, it cannot be the only thing. You have to have a 
systematic way of doing it. I mean, we do that with equines 
with influenza outbreaks in shows.
    And it is not--somebody asked me, well, do you care more 
about horses than people, or do you want to treat people like 
horses? I am, like, no. But do we put more emphasis on our 
animals than we do our people?
    This is a national security thing and we cannot afford it. 
And if the economic impact that China is going to feel I think 
that is something that we need to look at very seriously that 
this has the potential.
    And I want to bring up, does anybody know the duplication 
rate of this virus compared to the influenza or SARS?
    Dr. Nuzzo. I completely agree with your concerns about the 
internal response. I do not believe that the massive lock-downs 
in China will lead to a cessation of transmission of the virus. 
I think that it is already causing a tremendous amount of 
disruption.
    When you hear stories about people having to walk to the 
hospital, sick people having to walk to the hospital because 
transportation has been shut down, that is really what raises 
warning flags in terms of the public health benefits of these 
measures.
    Mr. Yoho. But does not that also show you the severe threat 
that the Chinese see themselves?
    Dr. Nuzzo. I think that everybody is viewing this severely. 
I will tell you that many of these tendencies we saw during 
SARS as well, and we often see when there is an emerging 
infectious disease outbreak like this.
    Mr. Yoho. All right. I want to go to Mr. Klain because he 
is jumping over there.
    Mr. Klain. Yes. Thank you. I appreciate that, Congressman.
    Look, I think that there are two points, or three. One, I 
agree that there are a lot of signs that this has been more 
severe in China than has been reported. And I have no doubt 
that the actionable cases is significantly higher.
    Mr. Yoho. Well, let me tell you what I heard yesterday from 
reliable sources. It is over 100,000 people have been exposed.
    Mr. Klain. Yes. Yes, I----
    Mr. Yoho. What we have heard. And the duplication rate with 
influenza was about 1.3 percent. That means one person can 
affect about 1.3 people. And that was the same with SARS, a 
little bit higher for SARS.
    This one they are estimating right now between 2.5 to 3. 
So, that means one person is affecting 2.5 to 3 people. And 
that is not being reported. And if that is true and the Chinese 
know that, they need to let that--us know because that shows 
you the virulence of that and the rapid spread.
    Mr. Klain. Yes, I agree. We do not really know what the R-
nought is, we do not know a lot of these facts. We need to get 
this information, I agree.
    The last thing I want to say is about this Chinese internal 
quarantine. Just to put a finer point on what Dr. Nuzzo said, I 
am highly skeptical that this is effective.
    You know, I think we all saw that picture of all the 
bridges out of Wuhan with no one leaving. But if you look at 
that picture, on the other side were literally thousands of 
trucks on their way into Wuhan.
    Who drove those trucks? And what happened after they 
unloaded them?
    Think about trying to quarantine a city the size of New 
York City in the United States, and imagine that no one would 
come in and no one would go out. How would you feed those 
people? Who would run the power plants and all these things.
    Mr. Yoho. That is going to be found out in the future.
    Mr. Klain. Yes. And so what I am willing to bet right now 
is that people are coming and going from Wuhan every day. And 
it is just a practical reality of the size and the scope of 
what we are talking about.
    Mr. Yoho. I am out of time. Thank you.
    Mr. Bera. Thank you, Mr. Yoho.
    Mr. Sherman from California.
    Mr. Sherman. First, this outbreak shows the 
wrongheadedness, almost immorality of the Chinese Government 
excluding Taiwan from the World Health Organization. We have to 
be on Team Human, not on Team Disease.
    You know, whenever something new like this happens we 
react. Almost always it is an overreaction until there is that 
one case where the reaction is not an overreaction. We are in a 
race to develop vaccines and cures. And that can happen only 
with cooperation between the United States and China.
    We look back at November 2002 when it took months for the 
scale of Chinese SARS crisis to be exposed. This time, as the 
New York Times reported, at critical moments in the first 7 
weeks between the appearance of the first symptoms in early 
December and today, the government's decision--between when the 
first appearance and the government's decision to lock down the 
city officials chose to put secrecy and order ahead of openly 
confronting the growing crisis.
    So, I will ask each of our witnesses, are the Chinese being 
honest as to the extent of the epidemic?
    Does the World Health organization have sufficient access 
to facilities and to patients? Doctor?
    Dr. Nuzzo. I cannot speak to intention. I think there have 
been critical information gaps.
    Mr. Sherman. Uh-huh.
    Dr. Nuzzo. The one that I am particularly interested in 
learning more about and think we should have more information 
about is about the severity of cases.
    You know, to the point about how--is the situation more 
severe than they are letting us know? Are there more deaths or 
dying that we are not hearing about?
    Mr. Sherman. OK.
    Dr. Nuzzo. One puzzling feature so far is that the cases 
that we have seen outside of China have been far more mild than 
what is going on in China. So, we need to understand why that 
is. And for that we need access to more data.
    I have been encouraged that there have been a number of 
scientific publications that have come out already about this 
with Chinese and others, scientists from elsewhere on those 
publications. But I, as an academic, cannot even justify 
waiting for a publication to learn about these things.
    So, I absolutely believe that more information is critical.
    Mr. Sherman. OK. I do have limited time.
    The Chinese have reported 24,000 cases and 490 deaths. Dr. 
Bouey, what----
    Dr. Bouey. My observations----
    Mr. Sherman [continuing]. What do you think the number is?
    Dr. Bouey. Right. My observation is that there was delay of 
case reporting for sure before January 19th. After January 
19th, the government triggered a public health emergency. And 
that triggers the national case reporting system.
    That case system was implemented after SARS. And as we know 
SARS better, well, then you know that at the end of the SARS 
when they set up this system they said, they put in a law that 
if anyone cannot report accurate numbers then they will be 
punished.
    Mr. Sherman. I have to go to the other----
    Dr. Bouey. I think that is very well. But the problem is--
--
    Mr. Sherman. Excuse me. I have limited time.
    The Chinese have not involved the United States' experts to 
the degree they should. Are they, do we have sufficient numbers 
of people from Europe, Japan, and the World Health Organization 
on the ground to get us the information and to see that we are 
doing all we can to look for cures and vaccines? Mr. Klain.
    Mr. Klain. I do not think so, Congressman. And, again, this 
is one reason why I think we need a high-level coordinator at 
the White House who can be in touch with foreign governments at 
other high levels. Again, Secretary Azar is competent and 
skilled, but this is an active diplomacy, not just health 
diplomacy but high-level diplomacy.
    Our President should be on the phone with President Xi. You 
know, we should be engaging these other countries at a very 
high level. That is what we did during the Ebola response, very 
high level from the White House. And I think we need to do that 
here to get more American eyes on the ground there.
    Mr. Sherman. And, again, I was asking not just about the 
U.S. Do any of our witnesses know the level of WHO, European, 
and Japanese experts on the ground in China? And is that 
sufficient?
    Is China cooperating with any of the other advanced health 
organizations in the world?
    Dr. Bouey. My source is the news. And I know that the WHO 
has announced that they will--they have a team on ground. And I 
thought----
    Mr. Sherman. They have a what?
    Dr. Bouey. They have an emergency team in Beijing.
    Mr. Sherman. Uh-huh.
    Dr. Bouey. And I think the Director of the WHO was in 
Beijing I think since January 27th.
    Mr. Sherman. My time has expired.
    Mr. Bera. I recognize Mr. Perry for 5 minutes.
    Mr. Perry. I thank the Chairman, thank the witnesses.
    We have ample evidence that China has undue influence over 
many U.N. organizations, including the WHO. The WHO continues 
to exclude Taiwan, that is an important player in this and many 
other things.
    Do you, do all of you think that we can just unilaterally 
trust the World Health Organization to give an impartial 
assessment of China's response to the coronavirus?
    Mr. Klain. I will start. I certainly do not think so, 
Congressman Perry. I think the WHO is performing better now 
than it was during the Ebola response 5 years ago. I think new 
leadership has helped.
    But I think the delay in declaring a public health 
emergency international concern reflected Chinese influence 
there.
    And think that, you know, the WHO is just one aspect of 
this response. They aren't going to treat people. They aren't 
doing research. They are important. The U.S. should support the 
WHO. But we need to be involved directly on our own in China 
and with our allies.
    Mr. Perry. OK, so that is fair. They have been 
complimentary of China's response but critical of other 
nations. I mean, do you take pause when you hear that?
    Or, Mr. Klain, just for example, you are I guess a self-
described expert having your involvement with Ebola, have you 
been critical of China's response?
    Mr. Klain. Yes, I have, sir. I have published. And 
everything I have written about this so far that the Chinese 
have failed the test of transparency and cooperation, and that 
they, they definitely need to do better.
    We should be very concerned about that. And we should be, 
as I just said a moment ago, engaging the Chinese Government at 
the highest levels to press the issue.
    Mr. Perry. Do you know----
    Mr. Klain. This should be at the top of our agenda----
    Mr. Perry. Mr. Klain.
    Mr. Perry [continuing]. In our relations with China, sir.
    Mr. Perry. I understand.
    Do you know if President Trump has or has not talked to the 
President of China about this?
    Mr. Klain. I do not, sir.
    Mr. Perry. You do not know?
    Mr. Klain. I do not.
    Mr. Perry. I mean, you would admit it is a little unfair to 
criticize it here when you just said you do not know if he--
maybe he has, maybe he hasn't, I do not know. But you are 
making the claim here that he should have done it or should be 
doing it.
    Mr. Klain. My claim is that he should have done it or 
should be doing it. I will say he hasn't said that he has done 
it. And the officials reiterate that the Chinese aren't 
cooperating yet.
    Mr. Perry. Mr. Klain, you worked on the Ebola virus 
outbreak in Sierra Leone, Guinea, and Liberia, is that, West 
Africa; is that about right?
    Mr. Klain. Yes, sir.
    Mr. Perry. Yes. Are any of those nations communist nations?
    Mr. Klain. Not to the best of my knowledge, sir.
    Mr. Perry. No. Right.
    Are any of those nations seeking worldwide dominance over 
the United States of America, stealing somewhere between $300 
and $600 billion in intellectual property annually, including 
medical technology?
    Mr. Klain. No, sir. As I said, I am not here to defend 
China or its response to this virus. In fact, I have been 
critical of China and its response to this virus in virtually 
every answer I have given to the subcommittee today.
    Mr. Perry. So, in your view, what is the first 
responsibility of the U.S. Government regarding a pandemic, the 
coronavirus, Ebola? What is the first responsibility of the 
United States Government?
    Mr. Klain. The first responsibility of this government is 
to keep the American people safe. And the best way----
    Mr. Perry. To keep the American people safe. That is right.
    Mr. Klain. Yes, sir. And the best way to do that, as we did 
with Ebola, as we do with other things, is be engaged globally 
in helping nations fight these diseases overseas so they do not 
come here, sir.
    Mr. Perry. So, are you, are you advocating for a travel ban 
outright to China or from China? I am trying to get that from 
your initial testimony and I couldn't tell where you were. You 
were critical of the current situation but you did not offer 
your solution set as an expert, so to speak.
    Mr. Klain. Sir, I did offer my solution set. It was that we 
monitor carefully everyone who has come to this country from 
China recently.
    Mr. Perry. How many people travel from China to the United 
States every single day, sir?
    Mr. Klain. Well, before this outbreak it was about 8,000 a 
day.
    Mr. Perry. Eight thousand a day?
    Mr. Klain. Yes, sir.
    Mr. Perry. And it is your studied opinion that we should 
let that happen unencumbered, unimpeded, under all 
circumstances and monitor those 8,000 people a day's 
whereabouts should this continue to progress and we found an 
outbreak in the United States of America?
    Mr. Klain. Congressman, it is my studied opinion that we 
will never reduce that to zero due to trade and due to travel 
of Americans and Americans' family members. In fact, the 
President's order exempts 11 different categories of people 
from going back and forth to China, as well as hundreds of 
people a day bringing goods here.
    Mr. Perry. So, it is----
    Mr. Klain. And so given that hundreds----
    Mr. Perry [continuing]. Zero or all?
    Mr. Klain. No, sir. Given that hundreds of people, 
thousands of people will come here every day, I take it, sir, 
it is not your position that American citizens in China should 
be stranded there and unable to come back. And, given that, 
then the only practical thing we can do is to monitor those who 
are coming here to this country, who are bringing medicines to 
this country, who are bringing goods.
    Mr. Perry. May I close with the time I have, Mr. Chairman.
    Mr. Klain. That seems like the only practical solution.
    Mr. Perry. Mr. Klain, we appreciate your experience, we do, 
and your expertise because you have done this to a certain 
extent, but I do not think that you have operated in the same 
realm with the Chinese Communist Government and their actions 
toward the United States. So, things are a little different.
    And the other thing is, is that while you had a certain 
experience, it might not be the only way of doing things. And 
so while it is great to throw partisan shots, I mean, when you 
talk about bringing--I read your piece in The Atlantic, sir--I 
mean, you are talking about bringing countries and the United 
States together and not being paranoid. All you did was offer 
criticism and really no help. And that is not helpful at all.
    And I yield back.
    Mr. Klain. Well, Congressman, that piece included praise 
for Secretary Azar for the other aspects of the response, 
praise for the Administration's response, to a limited extent, 
in Congo to Ebola we have seen there.
    I opened by saying this isn't a partisan issue, and I 
reiterate that this is not a partisan issue. What I do believe, 
though, is that if we do not engage globally--and, again, I 
have been very critical of the Chinese--we cannot keep America 
safe, sir.
    Mr. Perry. And I would agree with you. But instead of 
blaming America, you ought to look more toward the Chinese.
    And I yield.
    Mr. Bera. Great. And, again, the goal here is we want to be 
supportive of the Administration. Congress wants to be on the 
same page with the Administration. And we want to work with the 
Chinese to get ahead of this because this is a global issue.
    With that, let me recognize Ms. Houlahan.
    Ms. Houlahan. Thank you, Mr. Chair. Thank you all for 
coming today.
    I am actually really intrigued by, Dr. Nuzzo and Dr. Bouey, 
your initial conversations about the fact that the travel bans 
and quarantines weren't necessarily the solution. I guess I am 
really struggling trying to understand, based on my limited 
understanding of biology, and I am a mere engineer, why is 
quarantining not appropriate? Why is it something that is not 
useful to this case?
    How do we know what cases it is useful?
    And because my limited understanding of biology is 
quarantining works, is there ever a situation where that would 
be something that would be useful? And when do we know when it 
is before it is too late?
    Dr. Nuzzo. Thank you so much. I will start with answering 
that question.
    The challenge here is that we are talking about a 
respiratory virus that potentially has--and I take the earlier 
points, there are still some uncertainties about the incubation 
period--but potentially can spread between people quite 
quickly. So, it is very difficult to know where the disease is 
spreading because we just simply cannot get a hold of it, ahead 
of it in terms of your surveillance.
    So, those sorts of circumstances makes quarantine 
challenging because we do not know who we should be 
quarantining fully. We may decide just based on the numbers of 
cases in China that we should quarantine travelers from China. 
But we do not actually know if travelers from other countries 
have the virus.
    We also do not know if it is already here because we are 
only testing people who have a connection to China. So that 
makes it challenging.
    Quarantine is actually not something that we routinely use 
in public health. Despite what you may have heard, it is 
actually something that we only use in very rare circumstances. 
We, in public health, when we talk about quarantine we mean 
restricting the movement of people that are not yet sick. We 
very frequently isolate people that we know are sick. It is a 
very routine and well-studied process. But quarantine is not 
something we routinely do. It is usually reserved for 
circumstances in which you have a small group of people, 
perhaps in a measles outbreak in a vaccine-hesitant community.
    Ms. Houlahan. So, is this a situation where you will know 
it when you see it? You will know that this is a quarantine 
situation and an effective one, and this just does not happen 
to be one? Or we are just speculating?
    Dr. Nuzzo. In this situation this definitely does not 
happen to be one.
    Ms. Houlahan. And, Dr. Bouey?
    Dr. Bouey. My sense of a quarantine it is a primary 
prevention. So it is basically separating those who are sick 
versus those who are not sick.
    So, without the vaccine, without the treatment usually we 
have to rely on quarantine on paper, on paperwork. But in 
reality, it often only slows the transmission, not prevents.
    Ms. Houlahan. So, I am sorry to interrupt, because I do 
have very limited time I just want to talk about the vaccine or 
treatment.
    Is there anything that we can do in the short-term with 
this particular situation with vaccinations or treatment from a 
congressional standpoint? Is there anything that we should be 
able to do for the forward-looking perspective because this may 
not be as bad as it seems to have been, at least initially. But 
at some point it will be, something will be.
    I guess this is probably for Mr. Klain. Can you talk to 
anything, you mentioned maybe emergency supplemental funding?
    Can you identify what programs specifically or what 
accounts would be useful, not just for this particular 
situation but for future situations as well?
    Mr. Klain. Yes, Congresswoman. I think it is very--I think 
Congress last year expanded the public health emergency fund, 
considered but did not adopt a proposal to create a special 
fund to help seed public/private partnerships to accelerate the 
development of vaccines and therapeutics. And I think while 
that would probably be too late to really help with this 
epidemic, it might not be. And certainly it will be very 
helpful going forward.
    I think, you know, that means putting more money also into 
BARDA, which plays an important part in turning this research 
and bringing it to the marketplace. We are always underfunded 
and always a little bit behind. But I think, you know, whatever 
Congress can do to supplement public/private partnerhips in 
this regard would be very useful for keeping the American 
people safe.
    Ms. Houlahan. Thank you. And with the last minute of my 
time, Dr. Bouey, I was wondering, you did comment on the fact 
that there would be potential social, cultural, political, and 
economic implications to our current strategy. But you kind of 
left it at that.
    Can you elaborate on what those--I know you said we do not 
know what they are--but could you speculate?
    Dr. Bouey. I was referring to the quarantine measures in 
China. Certainly economic concern is huge. And I think even 
China's government probably is considering, you know, how long 
this quarantine can actuate without harming the economy too 
much.
    And of course it has social and cultural issues. People who 
are being quarantined are worried. They are nervous. And 
especially for the hospitals within Wuhan, they are 
overwhelmed. Certainly the new hospital will help a little bit, 
and the mobilization of resources help a little bit. But for 
people under quarantine it is a tremendous stress.
    Politically, of course, there are lots of distrust, a lot 
of questions within China now. And, again, quarantine to lock 
down a whole city usually is not the best practice.
    Ms. Houlahan. Thank you. I have run out of time.
    I yield back.
    Mr. Bera. Great. Thank you.
    Let me recognize Mr. Mast from Florida for 5 minutes.
    Mr. Mast. Thank you, Mr. Chairman.
    I want to take a step back and ask that we all recall we 
have districts back home. And while we deal with national 
policy, the questions that we ask on this matter to 
individuals, individuals with children, individuals that go to 
work, individuals that are exposed to people that travel. We 
will all travel presumably Friday or Saturday back to our home 
districts. We are in a very international city here.
    And I think, I feel as though the sense that I am getting 
from you all about quarantine not being the right path does not 
pass the test of common sense. But I do not want to dwell on 
that right at this moment.
    What I want to ask first, No. 1, in the aim of speaking 
about people that we represent back home, if you were in Wuhan 
right now, any one of you, you all have experience with this, 
what would be your first or second or third line of defense?
    How would you protect your family? How would you protect 
yourself? Would you wear a mask? Would you wash your hands? 
Does that not work? Would you not touch your eyes or your nose? 
Would you prevent your kids from going to school? What would 
you do?
    Dr. Bouey. Can I start with I think there are many other 
primary prevention methods. Health education is one. I think if 
people understand what is going on, and they understand the 
severity of the issue, and you let them know that how can they 
protect themselves and their families and their children----
    Mr. Mast. That is the question I asked. If you could answer 
that for me it would be fantastic.
    Mr. Klain. That would be through social media, through any 
channel we can have.
    Mr. Mast. Social media is not protecting anybody in Wuhan.
    Dr. Bouey. The knowledge. The knowledge they can.
    Mr. Mast. What do they do to protect themselves?
    So, if there are people that come to our country because 
there is no quarantine on them because of this academic 
approach instead of common sense approach, what do people do to 
protect themselves when they are exposed to others?
    Dr. Nuzzo. I think what confused me about your question 
initially is the if you were in Wuhan. And I cannot speculate. 
I do not know what the situation is happening in Wuhan.
    As I mentioned before, one of the great unknowns about this 
virus is the apparent discrepancy in what we are hearing about 
in terms of severity and illness in China versus the more close 
to 150 cases that have been reported outside of China. The 
majority of the cases that have been reported outside of China 
have largely been mild disease, like other respiratory 
illnesses----
    Mr. Mast. I apologize for cutting you off. But none of you 
are answering a very straightforward question.
    Mr. Klain, you are presumably the expert on this panel. If 
you were there at ground zero, maybe you are not in a full-on 
TAP suit, but what would you do if your family was going to be 
in an area that was exposed to it? How would you protect your 
family from this? What is defense one?
    Mr. Klain. Yes. So, Congressman, I think this goes back to 
your initial point, which is defense one would be get out. And 
the problem I think for this issue of travel bans and 
quarantines is that probably hundreds of thousands or millions 
of people have.
    Mr. Mast. OK. No. 1, get out.
    Mr. Klain. Right.
    Mr. Mast. No. 2?
    Mr. Klain. No. 2 would be, would be----
    Mr. Mast. If you cannot get out of there, No. 2, what would 
you do?
    Mr. Klain. Would be social distancing. Would be trying to 
have fewer interactions with people, yes.
    But keeping your children home from school? We found in the 
past is when that happens, people's children leave the house 
and go to shopping malls and other places where they have 
contact with people.
    So, you know, it is a tricky thing.
    Mr. Mast. How would you physically protect yourself?
    Mr. Klain. The only real way I think to physically protect 
yourself is to try to stay away from other people. I think if 
you are going to have exposure to other people, as we all do, 
you know, washing your hands, doing things to minimize the 
spread of the virus is good.
    But, you know, get out of where the virus is, stay away 
from other people, and then engage in standard, you know, 
public health kind of practices, wash your hands, whatever.
    Mr. Mast. I mean, we do not say whatever, this is a serious 
question.
    Mr. Klain. Yes.
    Mr. Mast. I mean, washing your hands might be a simple act, 
but it is a very serious thing when you are looking at a 
pandemic like this.
    Dr. Bouey, one of your last comments that you made was 
about quarantine perhaps only slowing the transmission. Is 
there at this point a vaccine?
    Dr. Bouey. No.
    Mr. Mast. So, would slowing the transmission be a victory?
    Dr. Bouey. Well, it is a victory for other cities, other 
countries.
    Mr. Mast. Is it a victory for the United States of America?
    Dr. Bouey. It is a victory for human beings.
    Mr. Mast. So, it is a victory to slow that. That being 
something that comes from----
    Dr. Bouey. I think so.
    Mr. Mast [continuing]. Some point.
    Dr. Bouey. I am not all against the quarantine. I am just 
saying the quarantine policy should be evaluated very often. 
Now, every 7 days, every month, you know, it should be 
evaluated.
    Mr. Klain. Congressman, my concerns about the travel policy 
is not an academic concern, it is that as a practical matter 
people are coming here from China every day. Every day. And we 
couldn't stop that unless your district does not want 
antibiotics and protection, and all the things that come from 
China every single day.
    And so, we need to be honest about the American people, 
with the American people about the fact that we cannot keep 
people coming here from China. We are not going to keep 
Americans from coming home, for goodness' sakes, and there is 
no reason to think that a foreign national or an American 
anymore is likely to transmit the disease. In fact, we think 
they aren't.
    So, I think reducing the number of amount of travel from 
China here is a, is a good thing. But I also think we need to 
be honest with people about the fact that we will always be at 
risk for this disease coming here because we will never turn 
off the supply of people, and planes, and ships altogether 
coming here from China given the interconnectedness of our 
world, interconnectedness of vital traffic back and forth.
    Dr. Nuzzo. Can I----
    Mr. Mast. My time has expired.
    Dr. Nuzzo. I would just like to add that this has been 
worked out in a number of circumstances, including the lead-up 
prior to the 2009 influenza pandemic. And, essentially, the 
best evidence suggests that a lock-down of travel will at most 
prevent an introduction for perhaps weeks.
    That is not meaningful in the context of developing a 
vaccine. A vaccine could take a year or more. It is not like 
flu where we have an exiting platform that we can use toe 
create a new version of a flu vaccine for the use in a 
pandemic.
    So, I do not disagree that slowing is a good idea if it a 
meaningful amount of time that it can be slowed, and if the 
consequences do not, do not--aren't worse than the disease 
itself.
    Mr. Mast. Right.
    Mr. Bera. I appreciate the point that my colleague from 
Florida is making. I just want to emphasize one piece that, you 
know, we certainly have emphasized to the Administration is the 
best thing we can do right now is get the smartest people, our 
smartest epidemiologists and everyone working side-by-side with 
the Chinese and the global community to figure out as much as 
we can about infectiousness, incubation, transmission, et 
cetera.
    And, again, the best thing we can do is get those folks 
into China. And the President may be working on this every day 
with phone calls, et cetera. But, again, we are here to help. 
And I do think we can then better answer a lot of those 
questions if we can get our folks into China to help answer 
some of those questions.
    I am going to go to the chairman of the full committee, Mr. 
Engel. Mr. Engel, you are recognized for 5 minutes.
    The Chairman. Thank you, Mr. Chairman. Thank you for 
calling this important hearing on the coronavirus outbreak. It 
is one of the reasons why I love this committee, we are really 
right in the center of things, and quickly as well.
    So, I want to start by expressing my sympathy and 
condolences to everyone who has been impacted by the outbreak, 
including the people of China, other affected countries, and 
those here in the United States. It is hard to imagine how 
painful and scary these past weeks have been for these 
families.
    Here on the Foreign Affairs Committee we know that global 
health is critical to our national security. We held a hearing 
on women's health this morning. The rapid spread of the 
coronavirus over the past month shows this all too clearly. Our 
country needs substantial resources to strengthen our ability 
to prepare for and respond to public health crises like this. 
But instead of building up that capacity, the Trump 
administration has scaled down some of our most critical public 
health institutions.
    Over the past 3 years, the Administration has slashed the 
budget for the Centers for Disease Control and Prevention, 
known as CDC, National Center for Emerging and Zoonotic 
Infections Diseases, and the CDC's Global Health Security 
Agenda, making it much harder for the agency to respond to 
outbreaks overseas.
    And here in the U.S., our own response capabilities are 
diminished. State and local health departments, our first line 
of defense in public health emergencies, are short staffed, 
down tens of thousands of health workers compared to where we 
were just in 2008. This Fiscal Year President Trump is 
proposing a nearly 20 percent cut to the CDC's budget--and you 
heard that right. Just as we are confronting the coronavirus, 
the President wants to cut the very agency on the front lines 
of fighting the disease.
    I think Americans from all corners of the Nation will find 
that extremely unwise, if not crazy. And I hope all my 
colleagues will join me in opposing this dangerous plan and 
committing to support the CDC's important work.
    Rather, building up our institutions is critical. So is 
working hand-in-hand with other countries and investing in 
international bodies like the World Health Organization, WHO. 
In order for us to effectively fight this virus, we need to 
respond with evidence-based practices, transparency, 
collaboration, and communication.
    To that end, I am glad that the Chinese authorities have 
been more cooperative partners with the United States and 
others in the international community in handling the 
coronavirus than they were during 2003 SARS outbreak. Maybe we 
learned something from that.
    But the way the Chinese Communist Party has treated its 
citizens in response to this outbreak is horrifying: crackdowns 
on transparency and information, brave doctors and ordinary 
citizens facing draconian punishments merely for speaking about 
the outbreak. It is unacceptable and must come to an end.
    And in our own country we need to approach this outbreak 
with a scientific, fact-based approach. The United States and 
other countries around the world have put in place 
unprecedented travel restrictions in response to the virus. 
These measures are not proven to improve public health 
outcomes, rather, they tend to cause economic harm and to stoke 
racist and discriminatory responses to this epidemic.
    Now I will turn to ask questions of all witnesses. I must 
note I am profoundly disappointed that the Trump Administration 
would not agree to send any government officials to testify 
today. I understand that there was some kind of briefing today, 
but this hearing was set for a long time and we did not get any 
cooperation from the Administration. I personally asked the 
Administration to send a witness to the hearing. The American 
people deserve to hear firsthand what the Government is doing 
to protect them in this situation.
    Nonetheless, I am pleased that we have such a distinguished 
panel of experts before us today.
    So, thank you, Mr. Chairman, for holding this important 
hearing. And with that, I will move to my questions.
    Over the past 3 years we have seen reductions in funding 
for epidemic prevention efforts abroad, attempted cuts to 
foreign assistance, including global health security funding, 
as well as the elimination of the NSC Global Health Security 
and Biothreats Directorate. How would you assess our Nation's 
current capacity to address epidemics, both here in our own 
country and in terms of offering our expertise to help other 
countries around the world?
    Anyone who would care to answer that I would be happy.
    Dr. Nuzzo. Thank you. I would like to point out that this 
is not the only emergency that our scientists at the Centers 
for Disease Control are managing. They are also still trying to 
end an Ebola epidemic in the DRC. There are other important 
transmissions of polio in the world. This past year has been 
unprecedented in terms of measles cases.
    So, I think what this points to is the need for continued 
support and increased support for the CDC and for their other 
health partners.
    The Chairman. Anybody else?
    Dr. Bouey. Can I add?
    The Chairman. Yes.
    Dr. Bouey. In the last 17 years, U.S. CDC has been working 
with China CDC hand-in-hand in every single pandemic or 
epidemic in China. And the current difficulty I feel as relates 
to your comments is the reduction of collaborations in the last 
2, you know, 2 to 3 years.
    The NSF, National Science Foundation office was closed in 
Beijing last--in 2018. The GAP program, the Global AIDS Program 
was closed last year. The NIH and CDC programs all reduced in 
size in Beijing.
    So, when we talk about the influence, U.S. had a huge 
influence on Chinese public health a few years ago. But the 
problem is the interruption in the last few years.
    Mr. Klain. Congressman, I would just reiterate what I said 
before you arrived. The best way to keep the American people 
safe is to engage globally and to help fight diseases overseas. 
President Obama made a big point of creating a, helping to 
create a CDC in Africa so that we could help fight disease 
there.
    Global health security is American security, and we need to 
continue to support and invest in that.
    The Chairman. Let me--thank you very much--let me ask one 
final question. And if it was asked and answered, please let me 
know. And that is how would you rate the response to this 
epidemic by the Chinese Government and by WHO and other U.N. 
specialized agencies so far?
    What has been the impact of Taiwan's exclusion from the WHO 
and other U.N. specialized agencies given its proximity to the 
Chinese mainland, its status as a transit and trade hub, and 
the handful of cases reported there as well?
    Dr. Nuzzo. I study outbreaks, and epidemics, and pandemics 
in various different settings. And in every situation that we 
have looked at there have always been challenges, there have 
always been missteps, and there have always been mistakes.
    I have not personally seen yet a mistake that I haven't 
also seen in other places. And so, while I think that there is 
an important gap in our knowledge and for which I think it is 
incredibly urgent that we gain additional data in order to 
answer some of these questions that we still have, I also have 
to imagine that any country dealing with tens of thousands, or 
essentially tens of thousands of cases now would be hard 
pressed to handle all that it needs to do, including managing 
the patients, standing up enhanced laboratory surveillance, 
rolling it out to all of the hospital clinics, making sure the 
hospitals have all the personal protective equipment that they 
need.
    So, I am very reluctant to criticize anybody at this point.
    In terms of the World Health Organization, they are limited 
by their member States. The international health regulations 
were established to define the maximum efforts that countries 
should take in the name of disease control. They are inherently 
looking at international issues and not what individual 
countries do within their own borders so long as it does not 
spill across their borders.
    What we have seen from the WHO is that they have been very 
reluctant to call out countries, all countries, not just China. 
And there was questions earlier about whether they were unduly 
influenced by China.
    Just looking at the Ebola outbreak in the DRC, there was a 
long period for which many individuals thought that they should 
have declared a public health emergency of international 
concern, and they did not want to. And I believe, and the 
director-general said, and I believe him at his word, that one 
of his deep concerns was that in doing so it would encourage 
countries to take non-evidence based actions like banning 
travel and trade, et cetera. Very much mindful of what happened 
in Ebola in 2014.
    This was, again, reiterated as a concern about declaring a 
public health emergency of international concerns with this 
current outbreak. And what we saw was that countries even 
before the declaration, but certainly after the declaration did 
just that.
    So, I believe that WHO is in a very difficult position of, 
one, not having enough resources itself. It is still very much 
on the ground in essentially a war zone in the DRC, trying to 
stop the spread of Ebola, and now also managing this and many 
other outbreaks in insecure settings in the world.
    Mr. Bera. I want to be conscious of each of the member's 
times. If you have anything to add to that otherwise, go ahead.
    The Chairman. Thank you.
    Mr. Bera. With that, let me recognize Ms. Wagner from 
Missouri.
    Mrs. Wagner. I thank the Chair very much, certainly for 
organizing this timely hearing. I want to thank all of our 
witnesses for being here today.
    I represent the St. Louis area and greater metropolitan 
region, and many, many of my constituents do business, they 
study, and travel in China. And I appreciate the opportunity to 
learn more about the rapidly changing coronavirus outbreak so I 
can share best practices and up-to-date information with other 
St. Louisians in Missouri's 2d congressional District 
specifically.
    And I would like to just say this, contrary to some of the 
things that are being represented here today, I have had a 
number of briefings. I probably attended at least three myself. 
My staff has had daily briefings from the NIH, CDA--or CDC, 
Health and Human Services, the Administration. So, I want to 
applaud the Trump administration for an amazing amount of 
information, transparency, and trying to keep us up to date on 
things that are really very frightening I think globally, and 
certainly here at home.
    I also would like to thank Representatives Connolly and 
Chabot for introducing the bipartisan Global Health Security 
Act to establish a permanent official responsible for epidemic 
and pandemic preparedness. I am proud to be an original co-
sponsor of the bill. And I urge my colleague to support it.
    Health systems across the developing world lack the 
capacity to control the spread of the novel coronavirus. Mr. 
Klain, how is--I will ask the question and then I want to put a 
context on it--I want to know how the U.S., and it sounds 
broad, but how is the U.S. helping these partners to prepare?
    I know for a fact that the CDC and the NIH here in the 
United States of America have been begging in very early 
January China to come in, help, be there on the ground. And it 
took them 3 weeks, it wasn't until about the 28th or 29th of 
January before they finally said, oh, please, rush on over. We 
could use the help and the assistance.
    And we are there on the ground in a very big presence and 
way.
    So, what else are we doing to help, help these partners 
prepare? What more needs to be done?
    Mr. Klain. Well, thank you, Congresswoman. And I was 
waiting for either Mr. Connolly or Mr. Chabot to show up here 
to praise their bill that you are the co-sponsor of.
    Mrs. Wagner. Yes.
    Mr. Klain. I think H.R. 2166----
    Mrs. Wagner. Yes.
    Mr. Klain [continuing]. Is vital legislation. I hope this 
committee and the Congress will act on it, bipartisan as well, 
as it should be.
    What I would say is, and this is why I have been a little 
perhaps more critical of the Chinese than Dr. Nuzzo, I think 
this delay of a month of getting our people on the ground there 
in China is hard to explain and hard to justify. And I think it 
is good that we have some people there. We should have more 
experts there.
    We have the best experts in the world here working for our 
government. Having them on the ground I think would be of use.
    Mrs. Wagner. And we were trying for over a month to get----
    Mr. Klain. Yes. Yes, ma'am.
    Mrs. Wagner [continuing]. Get there. And we will come up 
with a cure and the vaccine. Now, sadly, it will take months 
and months to probably do that, but.
    Mr. Klain. Yes, ma'am.
    The other thing I would say is we also needed to work with 
the nations around China; right? We are going to see spread of 
this virus certainly through the region, probably globally, but 
certainly first and foremost through the region. Other nations 
in the neighborhood have less advanced health care systems than 
China, less resources, less ability to manage this than even 
the Chinese do. So, we ought to be reaching out to them to see 
what we can do to help them. They may need more direct 
assistance from us in terms of the response.
    And, of course, we need to be beefing up our own 
preparedness for cases here.
    Mrs. Wagner. Well, I think we are doing that. I think we 
are very much on top of that. That is certainly what the 
briefings have been telling, telling me.
    Dr. Nuzzo, what challenges does the U.S. face in deploying 
testing services?
    Dr. Nuzzo. Thank you. That is an area that I am 
particularly concerned about. There seems to be a testing lag 
right now for individuals here in the United States. That is in 
part because the CDC has been doing all of the testing. And I 
know that they plan to roll test kits out to the State 
laboratories, which I think will be essentially important. And 
it is essential that States think about how they are going to 
be doing the testing and what the plan is for that.
    But we do not just need it at public health labs, we also 
need it at hospitals and health clinics so that doctors can use 
it to guide treatment and isolate patients.
    Mrs. Wagner. Well, and in addition, given that respirators 
and other medical equipment are largely produced and shipped 
from China, how can we best address supply chain issues--I keep 
hearing this over and over again--supply chain issues that 
could become critical if the coronavirus were to spread more 
widely in the U.S.?
    I mean, I talked about some of the medical equipment and 
respirators that are mainly sourced, being produced in China. 
But it is also masks, it is so many things. So, can you speak 
to that, please?
    Dr. Nuzzo. Yes. So, we need to assessing the medical supply 
chain and see where there are potential vulnerabilities. That 
is, I know, work that has been ongoing. And I have been 
encouraged to hear that the agencies have been working on that. 
But it also needs to be addressed at the political strategy 
level in China because the decisions that they are making 
internally could impact that beyond just our own assessment of 
what country is producing where, and can we get it from 
somewhere else.
    This summer, the U.S. experienced critical shortages in the 
drug Heparin, which is a blood thinner.
    Mrs. Wagner. Right.
    Dr. Nuzzo. This shortage was in part due to China's efforts 
to control the spread of African swine fever, which is not a 
human disease, it is a pig disease. They were culling pigs. You 
need the pigs to make the Heparin.
    So, we have already seen the impact of how decisions made 
in the name of controlling a disease can affect health and 
health care here in the U.S.
    Mrs. Wagner. I have a lot of other questions. I will go 
ahead and submit them.
    I appreciate the chair's indulgence. And I will yield back. 
Thank you, all, for being here.
    Mr. Bera. Great. Thank you. I appreciate my colleagues. 
And, again, a compliment to the Administration that the 
briefings that they have been giving us, their experts, et 
cetera, on a regular basis, as well as to our staff. That said, 
we would love for those experts to come before our committee in 
a public setting to answer those questions.
    And what we are really asking for is how can we be of 
assistance? You know, what do they need from Congress in terms 
of appropriations, et cetera? And, again, these experts ought 
to be talking to the public and not just Members of Congress.
    With that, let me recognize Ms. Spanberger from Virginia.
    Ms. Spanberger. Thank you very much, Mr. Chairman. And to 
our witnesses today, thank you very much for what has been a 
very interesting conversation focused on the epidemiology of 
this disease and how it is spreading, and also a policy 
discussion related to what we can do as Members of Congress.
    And, Mr. Klain, I would also like to thank you for your 
very specific 7-point plan and recommendations of things that 
we should see from a Federal perspective out of Washington to 
help with this and future, future viruses and future outbreaks.
    And you have talked about the need for high-level diplomacy 
to address threats on the ground. And so, I would like to 
briefly just talk about that from this committee's perspective. 
Looking long-term, I have deep concerns about the fact that we 
have vacancies at State Department and other agencies, we have 
individuals who continue to work in acting positions not fully 
confirmed.
    And reflecting back on your experiences working with other 
outbreaks, looking forward toward what we are dealing with now, 
could you just tell me briefly what your day to day experiences 
were, how much you were interacting with diplomats and with 
civil servants, and how some of these staffing challenges might 
be impacting our ability to react currently?
    Mr. Klain. Yes, thank you, Congresswoman.
    My job in coordinating the Ebola response was really to 
oversee the all-of-government response that President Obama 
summoned. And that means daily interactions with key people at 
the agencies at all levels, some at the cabinet level, some 
below that.
    I think the good news is many really high-quality people 
remain in key posts. Tony Fauci is a national icon and hero. 
Dr. Schuchat at the CDC, others throughout the government. We 
have great people, Ambassador Green at USAID for example.
    But I do worry about some of the gaps, particularly at DHS. 
You know, Congressman Perry was saying how could you possibly 
screen all these people coming here, and so on and so forth? 
That is a DHS function. It will require great skill and 
organization to do that. I worry about the vacancies there.
    I worry about the loss of institutional capacity for 
highest levels of the State Department, which has to manage so 
much of the logistics of an international response.
    So, there are gaps. We have some great people in our 
government. We have some gaps in our government. And we are 
going to need to manage all that.
    And last, as I said, I think someone at the White House 
really needs to be running this every day to help fill those 
gaps, but also to be interacting with other countries. I had 
daily calls with people in Liberia, Sierra Leone, Guinea, 
weekly calls with my counterparts in the U.K. and France. These 
are high-level interactions that really are needed to make a 
global response like this effective.
    Ms. Spanberger. Thank you very much.
    And, Dr. Nuzzo, as we are looking at contagious outbreaks, 
and in this case there is a contagious outbreak that is 
happening on the other side of the world. And all of us 
represent districts here in the United States. My question for 
you is how could or how should the Federal Government work in 
ensuring that medical providers across the United States can 
deal with some of the concerns, have the information they need, 
have the resources that they need? And that is one part of it.
    And then the other part of it would be how can we help as 
Members of Congress to ensure that the information is getting 
out there and that these physicians and hospitals have what 
they need?
    And do you anticipate that there are specific resources 
that will need to be mobilized to support clinicians across the 
country if we do see increased spread here at home?
    Dr. Nuzzo. Yes, thank you.
    I had said earlier that although we have a perception of 
this as an epidemic that is happening across the world, we 
actually do not have enough information to say for sure where 
it is happening. We are only testing around people's 
connections with China.
    Ms. Spanberger. Does that mean that are you asserting that 
it could be elsewhere and we are not yet attuned to that?
    Dr. Nuzzo. Yes.
    Ms. Spanberger. OK. Thank you.
    Dr. Nuzzo. And that is what other countries are doing as 
well. I mean, it could very well already be here.
    And I think an important thing for us to all consider in 
thinking about this is it is not just about how many cases we 
have in the world but our level of concern should be tiered to 
what our perception of the severity is. And I continue to be 
encouraged by the fact that we are seeing many, many more mild 
cases than we initially thought were possible, particularly 
outside of China.
    As I said earlier, we need to understand what is going on 
in China about those severe cases and deaths to know if they 
are in the people that we would expect to have severe illness 
and death regardless of what pathogen, what respiratory virus 
they have.
    It seems like some of the death reports that that is the 
case, the elderly and people with underlying medical 
conditions.
    Ms. Spanberger. Uh-huh.
    Dr. Nuzzo. And if you walk into any hospital in the United 
States and just look for people suffering from respiratory 
viruses you would see disturbing things.
    I think the critical thing that we need here in the United 
States is enhanced diagnostic capabilities. We are moving test 
kits to the State labs, which will be important for 
supplementing our understanding of the virus and where it is, 
and potentially to think about expanding the categories of 
people that we test. But we also need this in health care 
clinics so that they do not have to wait a day or more to get a 
test result for a patient to make a decision about whether or 
not to isolate somebody, how they should treat them, et cetera.
    And although we have heard a lot attention on medicines and 
vaccines, there is less attention to diagnostics. And so, I 
think that is where a funding opportunity as well as funding 
for State health departments and hospitals who are going to be 
on the front lines of this.
    Ms. Spanberger. And just a followup point quickly on that. 
So, in the absence of those diagnostic tools in clinics and 
with health providers across the country, the alternative then 
is what?
    Dr. Nuzzo. The alternative is you do not get tested for 
coronavirus. I mean, we are only at this point testing absent 
the people who are traveling. But in the United States you have 
to have a lower respiratory infection and have traveled to 
Wuhan specifically.
    Ms. Spanberger. Uh-huh.
    Dr. Nuzzo. Or, if you have traveled to China, broader China 
you have to be hospitalized for your infection.
    So, we are only looking at a very small number of people. 
And so your earlier point about people's level of concern, et 
cetera, I think having diagnostic tools to help know what 
people's illnesses are will be useful.
    Ms. Spanberger. And in the absence of that testing, from 
your perspective and your role, how does that contribute to the 
spread of disease at a faster, slower?
    Dr. Nuzzo. It absolutely contributes to the spread oft he 
disease because we do not know where it is. We do not know who 
to stop from coming, and we do not know who to isolate.
    But I continue to be encouraged by the appearance of mild 
symptoms because it is important to recognize that we live with 
a whole lot of respiratory viruses that do not, we do not have 
hearings about.
    Ms. Spanberger. Thank you. I have gone well over time. 
Thank you very much, Mr. Chairman. I yield back.
    Mr. Bera. Thank you.
    I recognize Ms. Titus from Nevada for 5 minutes.
    Ms. Titus. Thank you, Mr. Chairman.
    Dr. Bouey, do you need to finish that conversation?
    Dr. Bouey. If I could. I would, because Dr. Nuzzo mentioned 
several times that the cases outside China are milder, I, you 
know, no one--I agree with her question, but some hypotheses 
or, you know, potential answers are in China, especially in 
Wuhan, within China there are different, we see different 
percentage of fatality. Wuhan is the highest.
    So, I wonder if Wuhan they, only hospitals have noticed 
people who have the most symptoms. So there is a, it is a 
reflection of a lack of resources medically.
    Ms. Titus. Well, thank you.
    Ms. Spanberger, you got that? OK, thank you.
    Well, now I would like to ask you something. In your 
remarks you said that in 2003 the industries hurt most by SARS 
were tourism, retail, and entertainment. And at that point 
those industries made up 43 percent of China's GDP. They now 
account for 54 percent. And China contributes a much larger 
share to the world's economy.
    I serve as the co-chair of the Travel and Tourism Caucus, 
and I recognize the huge impact of tourism on local economies. 
Also, China has expressed concern about travel restrictions 
that have been announced by the White House and noted correctly 
that the World Health Organization advises against the 
application of restrictions of international traffic, based on 
the information that is currently available.
    Could you address how we might balance U.S. security 
precautions with the negative impact that these restrictions on 
travel have had on travel and tourism here in the U.S., and on 
international commercial activities? And then either one of you 
could also weigh in.
    Dr. Bouey. So, if I can say quickly, that I think both 
quarantines and travel bans, all of these social distancing 
measures can harm the economy. So, it is always a--so, often I 
tell people, I am a public health researcher, a public health 
worker, then I am all for social distancing. But usually it is 
not just me talking, it is the economy is also talking.
    So, as you mentioned that in my report I provided some 
statistics that it is going to harm China's GDP. And how much, 
it depends how long the quarantine will be on, how long the 
travel ban will be on. So, I urge all the policymakers to think 
about these measures as temporary measures and certainly 
balance the economic loss versus health care concerns.
    Ms. Titus. Mr. Klain?
    Mr. Klain. Congresswoman, I would just add we live in a 
global economy, interconnected economy. It is impossible, 
impossible to cutoff the flow of people from China to the 
United States. They are needed to bring vital goods to the 
United States by boat and by plane.
    We have Americans coming back, to and from, back from 
China, family members, so on and so forth.
    So, my point about travel bans is beyond the effectiveness 
issue that Dr. Nuzzo has raised, as a practical matter we do 
not have one, we will never have one. And, therefore, what we 
need to do is to monitor the people who have been in China 
recently who are here in the U.S. and pose public health 
measures on a very large scale. This is a complicated, it is a 
hard problem to detect if those people get sick, to isolate 
them, and to treat them.
    This isn't about academics, it is the only practical 
solution on the facts we face here.
    Ms. Titus. Dr. Nuzzo?
    Dr. Nuzzo. I was just reacting to the notion of monitoring. 
And I agree that it is a preferable approach than the 
restriction of travel and the quarantine. I am less optimistic 
about the impact of those measures. And just reflecting on 
Ebola, that we monitored 30,000 individuals and found not a 
single case of Ebola. And, yet, those programs that were 
essentially necessarily set up overnight, in many respects 
diverted resources from, I think, more important work.
    So, I, I used to be a public health practitioner, so I am 
thinking from the field and what it means for them. You know, 
these measures are only as effective as people believe in their 
utility. There was an important paper where a bunch of 
clinicians were monitored for their symptoms for Ebola upon 
returning. And a large, surprisingly large percentage of them 
reported that they lied about their temperatures because they 
did not believe that they should be monitored.
    So, nothing is perfect. And if that is where we need to go 
I, truthfully, from an epidemiological perspective think that 
those approaches are more about politics than public health. 
But if that is what is needed to be done to provide assurances 
and to make people feel better, then I, in my view it is 
potentially less resource intensive than some of what I have 
also heard proposed.
    Ms. Titus. Well, not only does a travel ban, or 
restrictions, or monitoring impact the economy, does not it 
also make it more difficult to share information so that we can 
address the outbreaks quickly or get international cooperation 
from others addressing the problem?
    Dr. Nuzzo. So, I am deeply concerned about penalizing 
countries that report cases. And when you implement travel bans 
and trade restrictions, that is a penalty.
    China may be able to handle it, but other countries around 
the world are watching who haven't yet reported any cases. And 
I can imagine they are seeing what is playing out and thinking 
is it in their best interest to tell, to even look for cases 
first of all. So, that is something that I am particularly 
concerned about.
    I also agree with all the statements that have been made 
about the importance of gaining access to data in China. I 
particularly think China understands that severity is a matter 
of priority. And I do not truthfully understand what the rate-
limiting step is. I am not sure that they do not have the right 
epidemiologists or scientists. I think China is actually quite 
capable, the fact that they have pumped out many Lancet and New 
England Journal of Medicine papers does not signal to me a lack 
of expertise.
    I wouldn't be surprised if we see a paper next week that 
tells us more than we already know. But I think that this is 
critically important, and we should do everything in our power 
to make sure we continue to incentivize the flow of 
information.
    Ms. Titus. So, it affects, negatively affects the economy, 
travel and tourism; negatively affects our ability to get 
information; negatively affects our ability to cooperate with 
other countries. And, finally, we have in the past sent health 
care workers to other countries where these outbreaks occur, 
like Ebola. But now with this new approach of bringing people 
home, that cuts off that assistance as well, does not it?
    Dr. Nuzzo. And just to add to that, what happened in Ebola, 
even with threats of quarantine for health care workers, 
actually put a chilling effect on the number of doctors and 
nurses who were willing to go volunteer, essentially put their 
lives on the line to fight a deadly virus. Just the prospect of 
coming back and having to, in addition to the time away from 
their families and their jobs, then we put into quarantine, 
that is another concern that I have.
    Mr. Klain. If I could just very quickly. I think it is 
important that public health and scientific analysis drive 
these decisions, not politics. So, the same day that we 
quarantined a charter plane of Americans coming from Wuhan, 
that same day planes landed at airports all over this country 
bringing people from China to airports all over this country. 
OK?
    And so, you know, I just think that these policies on 
travel restrictions and quarantines, which I understand why 
they are politically compelling, I understand why one of the 
members earlier said it kind of, like, passes the common sense 
test. But policies that are kind of filled with Swiss cheese 
and exceptions and unevenly applied do not keep us safe, and 
raise the kinds of concerns about cooperation and effectiveness 
that Dr. Nuzzo raised.
    So, whatever we do, I think we need to be candid about what 
we are doing and what we are not doing, and let science drive 
those decisions.
    Mr. Bera. Great. Let me take the chair's liberty here and 
give each of the witnesses a minute or two, if there is 
anything we did not ask that we should have been asking or 
thinking about, or that would be in the public's interest of 
asking. Maybe we will start with you, Mr. Klain. Again, a 
minute or two just.
    Mr. Klain. Yes. What I would say just very briefly is 
Congressman Sherman said before he left that we have a tendency 
to overreact to these things. And what I would say is it is 
actually more complicated than that.
    We have a tendency to overreact in the short term and then 
underreact in the long term. After the 2001 anthrax attacks 
this body appropriated billions of dollars to prepare for a 
potential pandemic. And most of those investments were 
frittered away because they weren't followed up. Most of that 
was gone when I took over the Ebola response in 2014.
    This body then put billions of dollars into responding to 
Ebola very effectively. And, yet, before the coronavirus 
outbreak we were set to see the national hospital network that 
protects us from these infectious diseases expire in May 
without being renewed.
    So, what I would say is we should address this crisis or 
this challenge immediately, but also make the consistent long-
term investments in pandemic preparedness and response that are 
vital to keep this Nation safe over the long run. Again, I 
think the Connolly Chabot bill is a good start on that. There 
are many other proposals. But I think it is consistent focus 
that really keeps this country safe.
    Mr. Bera. Great.
    Dr. Bouey, if there is anything that you would like to add 
or we should have asked?
    Dr. Bouey. I will focus, I will emphasize that it is a 
battle between human and the virus. It is not between persons 
to person, and it is not between party to party, it is not 
between country to country.
    I really hope that global health should be a area for 
research for health care collaborations that is beyond all the 
conflict. It think it needs a long-term investment, not only in 
the infrastructure but also in collaboration, in capacity 
building.
    And I hope, no matter what happens between the two 
countries, between the two parties, that this area can be 
protected because this is critical for every country, for all 
the human beings. So, this should be more than just pointing 
fingers. But this is a time for collaboration.
    Mr. Bera. Thank you, Dr. Bouey.
    Dr. Nuzzo.
    Dr. Nuzzo. As I mentioned in my remarks, I am increasingly 
of the belief that this virus is not something that we can stop 
at borders, that we cannot contain it, that we should be 
probably shifting our focus to one more of trying to mitigate 
its spread and mitigate the impacts. And as I look at th 
situation it is, of course, evolving and complex, but it is 
increasing to me--increasingly to me looking like what we saw 
in 2009 with the influenza pandemic.
    And we have a number of things that we learned during 2009. 
So, we learned that the travel restrictions and the quarantines 
did not stop the spread. Within months the virus was 
everywhere. And that is because we had more capability to do 
surveillance for flu than we have for novel coronavirus right 
now. So, I wouldn't be surprised if we had those capabilities 
if we saw a very similar map to what we saw in 2009.
    So, I really think we should be thinking about it in the 
context of that and asking, if this were flu would we be doing 
these things?
    Obviously, there are still questions about severity. But 
increasingly, and my, my perspective is that we will find more 
cases and our perception of severity will decline.
    The other thing I want to point out is that I actually see 
some optimism here. Just looking at what we have learned in the 
amount of time that we have learned from countries who have 
previously had difficulties, like for instance South Korea, in 
2015 it had a very bad MERS outbreak that caught it off guard, 
they really struggled with, and their information and their 
ability to do surveillance. And an epi investigation of the 
case, the novel coronavirus cases to me is the symbol of what 
our goals are when we make investments and we work with 
countries to improve their capacities. And we are the direct 
benefits of that.
    So, I just want to stress that it is we need more 
information from other countries. The fact that they are able 
to get this information is likely because of our help and 
assistance in many places. We should continue those efforts, 
not just as I mentioned in China, but in other countries that 
we expect to struggle. And I think that we should continue to 
assess our plans based on the information that we have coming 
in and, crucially, in my mind not so much the number of cases 
but the severity.
    Mr. Bera. Great. Thank you.
    Let me allow the ranking member to make a closing statement 
and I will make one myself.
    Mr. Yoho. Well, I appreciate everybody being here. And, Mr. 
Klain, I have this article here and you are saying we need to 
keep politics out of it and need to be factual based. But just 
the title of this, ``Coronavirus Is Coming and Trump Isn't 
Ready.`` And I read it, and there is a lot of politics in that 
article. That is all I am going to say.
    Dr. Nuzzo and Dr. Bouey, you are both epidemiologists. We 
know that the epicenter is supposedly the Wuhan area, the fish 
market and the wet market. Correct?
    Dr. Bouey. Yes.
    Mr. Yoho. Do you feel it was sufficiently studied to get 
the possible original outbreak of where it came from? Do you 
feel that? Do you have any indication?
    Dr. Nuzzo. The answer is no. One of the concerns----
    Mr. Yoho. You said no, you do not think it was?
    Dr. Nuzzo. No, I do not think it was sufficiently studied.
    Mr. Yoho. OK.
    Dr. Nuzzo. And I know that I have heard not just WHO, but 
also some of the major philanthropies are putting money toward 
enhancing the study of that, trying----
    Mr. Yoho. Yet the Chinese Government destroyed it 
completely, the way I understand it. Is that correct?
    Dr. Nuzzo. I do not, I do not have any information about 
that.
    Mr. Yoho. Dr. Bouey, do you know?
    Dr. Bouey. I know they, after they announced the outbreak 
they closed the animal, the wet market the next day. They 
thought it was the sources. We do not know.
    We do not know whether there is a person working there had 
the first case and transmitted to other people or the animal 
source was there. We do not know that.
    Mr. Yoho. But that supposedly was where it was reported 
where it came from. But then we have heard it was completely 
demolished and destroyed. And that, there again that creates a 
cloud of confusion. You know, what is their intent.
    And if we are going to work on this collaboratively 
together between countries, politics needs to go away and it 
needs to be based on science because this is something that we 
are all in threat of. And I think you brought up over and over 
again how it does not seem to be as virulent in other 
countries. And let's hope it maintains that way.
    But I worry about countries like in Africa where there is 
large Chinese population in the Belt Road Initiative, and their 
inability to check with diagnostic equipment.
    So, this is something that is going to be fluid, we are 
going to watch, and we want to make----
    Dr. Bouey. I think it is to everyone's advantage to know 
where it comes from.
    Mr. Yoho. Right.
    Dr. Bouey. So, I do not think it is Americans or Chinese, 
it is everyone wants to know that.
    Mr. Yoho. Sure. We are all here together.
    Thank you all. Appreciate it. Mr. Chairman, thank you.
    Mr. Bera. Great. Thank you.
    And just in close, first-off I want to thank each of you 
for taking the time to come here as well as your service to 
both science as well as to our country and the global 
community.
    You know, again, the message to the Administration here is 
we are here to work as Congress. We are all on the same page 
here. And to the global community and to the Chinese, you know, 
let's get ahead of this. And it will take all of our resources 
to learn as much as we can.
    You know, I think I cannot speak for the CDC, but in my 
conversations with the CDC, with Dr. Fauci and others, we want 
to get there and work with you side by side. And if there is 
one thing that we can do it is that second thing is really put 
someone in control of this.
    This isn't the last time we are going to see a pandemic. 
This isn't the last time we are going to be dealing with a 
viral outbreak. And as we get ahead of this let's not--Mr. 
Klain, you talked about this as let's stop just responding to 
crisis after crisis, let's actually make this part of our 
national security agenda.
    And I had the privilege of being a commission member for 
CSIS. They just came out with a recommendation on what we could 
be doing with regards to global health security. And in a 
bipartisan way it was a great commission, great Members of 
Congress on there, but also, you know, working closely with the 
Administration and others to come up with recommendations.
    And I would say let's deal with the situation that we have 
in front of us right now, but then let's take some of those 
recommendations and act on them.
    So, you know, again I thank the witnesses and all the 
members for being here today. And with that, the committee is 
adjourned.
    [Whereupon, at 3:54 p.m., the subcommittee was adjourned.]

                                APPENDIX
                                
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                  OPENING STATEMENT FROM CHAIRMAN BERA
                  
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