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


                    OVERSIGHT OF THE TRUMP ADMINISTRATION'S 
                     RESPONSE TO THE COVID-19 PANDEMIC

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

                                HEARING

                               BEFORE THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                              JUNE 23, 2020

                               __________

                           Serial No. 116-115
                           
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      Printed for the use of the Committee on Energy and Commerce

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                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              GREG WALDEN, Oregon
ANNA G. ESHOO, California              Ranking Member
ELIOT L. ENGEL, New York             FRED UPTON, Michigan
DIANA DeGETTE, Colorado              JOHN SHIMKUS, Illinois
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          CATHY McMORRIS RODGERS, Washington
KATHY CASTOR, Florida                BRETT GUTHRIE, Kentucky
JOHN P. SARBANES, Maryland           PETE OLSON, Texas
JERRY McNERNEY, California           DAVID B. McKINLEY, West Virginia
PETER WELCH, Vermont                 ADAM KINZINGER, Illinois
BEN RAY LUJAN, New Mexico            H. MORGAN GRIFFITH, Virginia
PAUL TONKO, New York                 GUS M. BILIRAKIS, Florida
YVETTE D. CLARKE, New York, Vice     BILL JOHNSON, Ohio
    Chair                            BILLY LONG, Missouri
DAVID LOEBSACK, Iowa                 LARRY BUCSHON, Indiana
KURT SCHRADER, Oregon                BILL FLORES, Texas
JOSEPH P. KENNEDY III,               SUSAN W. BROOKS, Indiana
    Massachusetts                    MARKWAYNE MULLIN, Oklahoma
TONY CARDENAS, California            RICHARD HUDSON, North Carolina
RAUL RUIZ, California                TIM WALBERG, Michigan
SCOTT H. PETERS, California          EARL L. ``BUDDY'' CARTER, Georgia
DEBBIE DINGELL, Michigan             JEFF DUNCAN, South Carolina
MARC A. VEASEY, Texas                GREG GIANFORTE, Montana
ANN M. KUSTER, New Hampshire
ROBIN L. KELLY, Illinois
NANETTE DIAZ BARRAGAN, California
A. DONALD McEACHIN, Virginia
LISA BLUNT ROCHESTER, Delaware
DARREN SOTO, Florida
TOM O'HALLERAN, Arizona
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     2
    Prepared statement...........................................     4
Hon. Greg Walden, a Representative in Congress from the State of 
  Oregon, opening statement......................................     7
    Prepared statement...........................................     9

                               Witnesses

Robert R. Redfield, M.D., Director, Centers for Disease Control 
  and Prevention.................................................    10
Prepared statement \1\
    Answers to submitted questions...............................   156
Anthony S. Fauci, M.D., Director, National Institute of Allergy 
  and Infectious Diseases, National Institutes of Health.........    12
Prepared statement \1\
    Answers to submitted questions...............................   180
Admiral Brett P. Giroir, M.D., Assistant Secretary for Health, 
  U.S. Department of Health and Human Services...................    14
Prepared statement \1\
    Answers to submitted questions...............................   196
Stephen M. Hahn, M.D., Commissioner, FDA.........................    15
Prepared statement \1\
    Answers to submitted questions...............................   208

                           Submitted Material

Statement of June 23, 2020, from the American Society of 
  Microbiology, submitted by Mr. Pallone.........................   135
Statement of June 23, 2020, from the Alzheimer's Association, 
  submitted by Mr. Pallone.......................................   137
Letter of June 23, 2020, to Mr. Pallone, by Scott Frey, Director 
  of Federal Government Affairs, America Federation of State, 
  County and Municipal Employees, submitted by Mr. Pallone.......   141
Letter of June 23, 2020, to Mr. Pallone and Mr. Walden, from the 
  American Society of Hermatology, submitted by Mr. Pallone......   144
Graph on COVID-19 cases in the Houston region, from Rep. Olson, 
  submitted by Mr. Pallone.......................................   148
Statement of June 23, 2020, from Rep. Burgess, submitted by Mr. 
  Pallone........................................................   149
Letter of June 23, 2020, to Mr. Pallone, from Mr. Walden, 
  submitteed by Mr. Pallone......................................   155

----------
\1\ The information has been retained in committee files and also 
  is available at https://docs.house.gov/meetings/IF/IF00/
  20200623/110829/HHRG-116-IF00-Wstate-RedfieldR-20200623.pdf.

 
   OVERSIGHT OF THE TRUMP ADMINISTRATION'S RESPONSE TO THE COVID-19 
                                PANDEMIC

                              ----------                              


                         TUESDAY, JUNE 23, 2020

                          House of Representatives,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The committee met, pursuant to call, at 11:00 a.m., in the 
John D. Dingell Room 2123, Rayburn House Office Building, Hon. 
Frank Pallone (chairman of the committee) presiding.
    Members present: Pallone, Rush, Eshoo, DeGette, Doyle, 
Schakowsky, Butterfield, Matsui, Castor, Sarbanes, McNerney, 
Welch, Lujan, Tonko, Loebsack, Schrader, Kennedy, Cardenas, 
Ruiz, Peters, Dingell, Veasey, Kuster, Kelly, Barragan, Blunt 
Rochester, Soto, O'Halleran, Walden (ranking member), Upton, 
Burgess, Latta, Rodgers, Guthrie, Olson, McKinley, Kinzinger, 
Griffith, Bilirakis, Johnson, Long, Bucshon, Flores, Brooks, 
Hudson, Walberg, Carter, Duncan, and Gianforte.
    Staff present: Joe Banez, Professional Staff Member; Kevin 
Barstow, Chief Oversight Counsel; Billy Benjamin, Systems 
Administrator; Jacquelyn Bolen, Counsel; Jesseca Boyer, 
Professional Staff Member; Jeffrey C. Carroll, Staff Director; 
Sharon Davis, Chief Clerk; Kimberlee Espinosa, Professional 
Staff; Austin Flack, Staff Assistant; Waverly Gordon, Deputy 
Chief Counsel; Tiffany Guarascio, Deputy Staff Director; 
Stephen Holland, Health Counsel; Zach Kahan, Outreach and 
Member Service Coordinator; Saha Khaterzai, Professional Staff 
Member; Chris Knauer, Oversight Staff Director; Una Lee, Chief 
Health Counsel; Kevin McAloon, Professional Staff Member; 
Aisling McDonough, Policy Coordinator; Meghan Mullon, Staff 
Assistant; Joe Orlando, Staff Assistant; Kaitlyn Peel, Digital 
Director; Alivia Roberts, Press Assistant; Tim Robinson, Chief 
Counsel; Samantha Satchell, Professional Staff Member; Andrew 
Souvall, Director of Communications, Outreach and Member 
Services; Benjamin Tabor, Policy Analyst; Kimberlee Trzeciak, 
Chief Health Advisor; C.J. Young, Press Secretary; Nolan Ahern, 
Minority Professional Staff, Health; Jennifer Barblan, Minority 
Chief Counsel, Oversight and Investigations; Mike Bloomquist, 
Minority Staff Director; S.K. Bowen, Minority Press Secretary; 
William Clutterbuck, Minority Staff Assistant; Diane Cutler, 
Minority Detailee, Oversight and Investigations; Molly Jenkins, 
Minority Press Secretary; Caleb Graff, Minority Professional 
Staff Member, Health; Tyler Greenberg, Minority Staff 
Assistant; Tiffany Haverly, Minority Communications Director; 
Brittany Havens, Minority Professional Staff, Oversight and 
Investigations; Peter Kielty, Minority General Counsel; Bijan 
Koohmaraie, Minority Counsel, Consumer Protection and Commerce; 
Ryan Long, Minority Deputy Staff Director; Mary Martin, 
Minority Chief Counsel, Energy and Environment and Climate 
Change; James Paluskiewicz, Minority Chief Counsel, Health; 
Brannon Rains, Minority Policy Analyst; Kristin Seum, Minority 
Counsel, Health; Kristen Shatynski, Minority Professional Staff 
Member, Health; Alan Slobodin, Minority Chief Investigative 
Counsel, Oversight and Investigations; Natalie Sohn, Minority 
Counsel, Oversight and Investigations; and Everett Winnick, 
Minority Director of Information Technology.
    Mr. Pallone. [presiding]. The Committee on Energy and 
Commerce will now come to order.
    Today, the Committee is holding a hearing entitled, 
``Oversight of the Trump Administration's Response to the 
COVID-19 Pandemic.'' Due to the COVID-19 public health 
emergency, members can participate in today's hearing either in 
person or remotely via video conferencing.
    As part of this hearing, the microphones of members 
participating remotely will be set on mute for the purpose of 
eliminating inadvertent background noise. Members participating 
remotely will need to unmute your microphone each time you wish 
to speak.
    For members and witnesses participating in person, I 
encourage you to wear your mask whenever you are not speaking. 
Dr. Monahan stressed in the updated attending physician's 
COVID-19 guidelines that the use of face coverings is meant to 
protect other people in case the wearer is unknowingly 
infected, but does not have symptoms. By wearing our masks when 
we are not speaking, each of us is playing a vital role in 
protecting all members and staff who are in attendance, as well 
as the leaders of the administration's COVID-19 response who 
will be testifying before the committee today.
    Due to the anticipated length of this hearing, the 
committee will take a 15-minute recess at 1:30 p.m. to provide 
witnesses a restroom break.
    And finally, documents for the record can be sent to 
Benjamin Tabor at the email address we provided to staff. All 
documents will be entered into the record at the conclusion of 
the hearing.
    And now, I recognize myself for 5 minutes for an opening 
statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Today, the Energy and Commerce Committee continues its 
important work overseeing the administration's response to the 
COVID-19 pandemic. It is difficult to overstate this disease's 
devastating impact. To date, more than 2.2 million Americans 
have contracted COVID-19 and, tragically, more than 120,000 
have died. At the same time, more than 45 million Americans 
have filed for unemployment over the last three months. COVID-
19 has wreaked havoc on this country's physical, mental, and 
economic well-being.
    And the pandemic has been especially brutal to people of 
color and low-income communities. Thousands of families can 
tell stories of losing a relative without being allowed to 
visit them in their final days or the social isolation felt by 
seniors and others in long-term care facilities. Millions more 
could tell us about losing their jobs or being forced to close 
a small business.
    On top of the raw devastation of this disease, this 
committee must confront the fact that, had it not been for a 
sluggish initial response from the Trump administration, and a 
President in my opinion putting political considerations over 
public health, we could have done much more to mitigate the 
destructive impact of COVID-19. And we must learn from and 
correct the administration's mistakes, so that we are prepared 
to combat this disease as more outbreaks flare up this summer 
and the potential second wave comes in the fall.
    Now, testing has been a problem since the beginning, and 
while it has improved, we are still falling far short of the 
900,000 daily tests public health experts believe we need. We 
are also hampered by the administration's refusal to develop 
and implement a national testing and contact tracing strategy. 
This cannot continue. I think we need federal public health 
experts to take more of a leadership role, and this 
administration is failing to allow that.
    Public health must also be our first consideration as we 
accelerate research into a vaccine and treatments for COVID-19. 
We all want a vaccine to be developed as soon as possible. 
Before any vaccine or treatment is distributed, our public 
health experts must ensure that it is safe, effective, and 
accessible.
    And we must also take action to prepare our supply chain 
with sufficient quantities of vials, needles, syringes, and 
other products necessary to administer a vaccine. We also need 
to improve testing supply and our supply of personal protective 
equipment, or PPE, for our frontline workers and others 
throughout the economy. And while our supply of some PPE has 
improved, governors have told us that we are still far from 
where we need to be.
    Fortunately, last month the House passed the Heroes Act, 
which provides our public health agencies with the mandate and 
the resources to ensure we are prepared going forward. The bill 
requires that HHS finally develop a national testing and 
contact tracing plan and provides $75 billion to carry it out. 
It also provides billions more to strengthen the Strategic 
National Stockpile and to increase research, development, and 
manufacturing of vaccines and treatments. And it ensures that 
all Americans will be able to receive free coverage of 
treatment, drugs, and an eventual vaccine with no cost-sharing. 
This legislation is needed today, but the Senate has failed to 
act and the Trump administration has threatened to veto it 
without putting forward any policy vision of their own.
    Now President Trump refuses to even acknowledge the 
challenges we face and the difficult work that must be done to 
prevent further destruction. Just this weekend, as outbreaks 
flared up and public health leaders continued to urge social 
distancing, the President put Americans at risk, in my opinion, 
by holding a political rally in Oklahoma. And at the rally, he 
suggested that his staff slow down testing to mask the true 
level of infection across the country. In fact, this morning 
the President said he wasn't kidding when he made those 
comments. And I think this was extremely reckless, and 
unfortunately, it continues the President's pattern of ignoring 
the advice of his own public health experts and it also sends a 
horrible message to some Americans that they, too, can ignore 
public health experts.
    As this vicious disease continues to harm our country, it 
is extremely dangerous that the President, the Vice President, 
and others in this administration continue to downplay the risk 
we continue to face. All around the country, warning bells are 
going off, with hospitals struggling to keep up with the rate 
of hospitalizations and ICU beds filling up and emerging COVID 
hot spots. And the administration's unwillingness to face these 
hard truths I think is going to lead more deaths and more 
needless suffering.
    So, I am pleased that we have our nation's public health 
officials with us today. Thank you all for coming. I have 
admired your role and what you have done over the last few 
months. I think you can help us answer questions about what has 
gone wrong, what is improving, and how we can be prepared going 
forward. And I look forward to your testimony.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today, the Energy and Commerce Committee continues its 
important work overseeing the Administration's response to the 
COVID-19 pandemic. It is difficult to overstate this disease's 
devastating impact. To date, more than 2.2 million Americans 
have contracted COVID-19, and tragically 120,000 have died. At 
the same time, more than 45 million Americans have filed for 
unemployment over the last three months. COVID-19 has wreaked 
havoc on the country's physical, mental, and economic 
wellbeing.
    And the pandemic has been especially brutal to people of 
color and low-income communities. Thousands of families can 
tell stories of losing a relative without being allowed to 
visit them in their final days, or the social isolation felt by 
seniors and others in long-term care facilities. Millions more 
could tell us about losing their job or being forced to close a 
small business.
    On top of the raw devastation of this disease, this 
Committee must confront the fact that had it not been for a 
sluggish initial response from the Trump Administration, and a 
President putting political considerations over public health, 
we could have done much more to mitigate the destructive impact 
of COVID-19. We must learn from and correct the 
Administration's mistakes so that we are prepared to combat 
this disease as more outbreaks flare up this summer and a 
potential second wave comes in the fall.
    Testing has been a problem since the beginning, and while 
it's improved, we are still falling far short of the 900,000 
daily tests public health experts believe we need. We are also 
hampered by the Administration's refusal to develop and 
implement a national testing and contact tracing strategy. This 
cannot continue - we need federal public health experts to take 
more of a leadership role, and this Administration is failing 
to allow that.
    Public health must also be our first consideration as we 
accelerate research into a vaccine and treatments for COVID-19. 
We all want a vaccine to be developed as soon as possible, but 
before any vaccine or treatment is distributed, our public 
health experts must ensure that it is safe, effective, and 
accessible. We must also take action to prepare our supply 
chain with sufficient quantities of vials, needles, syringes, 
and other products necessary to administer a vaccine.
    We also need to improve testing supplies and our supply of 
personal protective equipment, or PPE, for our frontline 
workers and others throughout the economy. While our supply of 
some PPE has improved, governors have told us that we are still 
far from where we need to be.
    Fortunately, last month the House passed the Heroes Act, 
which provides our public health agencies with the mandate and 
the resources to ensure we are prepared going forward. The bill 
requires that the Department of Health and Human Services (HHS) 
finally develop a national testing and contact tracing plan and 
provides $75 billion to carry it out. It provides billions more 
to strengthen the Strategic National Stockpile and to increase 
research, development, and manufacturing of vaccines and 
treatments. And it ensures that all Americans will be able to 
receive free coverage of treatments, drugs and an eventual 
vaccine with no cost-sharing. This legislation is needed today, 
but the Senate has failed to act, and the Administration has 
threatened to veto it without putting forward any policy vision 
of their own.
    President Trump refuses to even acknowledge the challenge 
we face and the difficult work that must be done to prevent 
further destruction. Just this weekend, as outbreaks flared up 
and public health leaders continued to urge social distancing, 
the President put Americans at risk by holding a political 
rally in Oklahoma. At the rally he suggested that his staff 
slow down testing to mask the true level of infection across 
the country. This was an extremely reckless action, and 
unfortunately it continues the President's pattern of ignoring 
the advice of his own public health experts. It also sends a 
horrible message to some Americans that they too can ignore 
public health experts.
    As this vicious disease continues to harm our country, it's 
also extremely dangerous that the President, the Vice 
President, and others in this Administration continue to 
downplay the risks we continue to face today. All around the 
country warning bells are going off, with hospitals struggling 
to keep up with the rate of hospitalizations and ICU beds 
filling up in emerging COVID hotspots. The Administration's 
unwillingness to face these hard truths I think will lead to 
more deaths and more needless suffering.
    I am pleased we have our nation's public health officials 
with us today who can help us answer questions about what has 
gone wrong, what is improving, and how we can be prepared going 
forward. I look forward to their testimony and I now recognize 
the Ranking Member for 5 minutes for his opening statement.

    I now recognize our ranking member for 5 minutes for an 
opening statement.
    Mr. Walden. Thank you, Mr. Chairman.
    Before I begin, I have a parliamentary inquiry.
    Mr. Pallone. Yes.
    Mr. Walden. Mr. Chairman, Committee Rule 9(b)(1) says that, 
``At full committee hearings, the chairman and ranking minority 
member shall be limited to 5 minutes each for an opening 
statement, and may designate other members to give an opening 
statement of not more than 5 minutes.'' And pursuant to this 
rule, I designated Dr. Burgess to give an opening statement. 
And I raise this because I know in the past at times only the 
chairman and ranking member have given opening statements. At 
other times, we have allowed the minority--and you have I 
believe as well--to designate another member for 5 minutes.
    Given the importance of this hearing, I would hope that we 
could work this out where the subcommittee chairmen and rankers 
could also comment. And I wonder if you would be willing to 
allow that.
    Mr. Pallone. Well, I appreciate your comments, Mr. Walden, 
but the answer is no. I mean, first, let me remind members 
that, pursuant to committee rules, all Members' written opening 
statements will be made a part of the record. But, according to 
our rules, only the full committee chair and ranking member 
must be provided 5 minutes for an opening statement at a full 
committee hearing.
    Now, you know, we don't have too many of these because, in 
the tradition of the Energy and Commerce Committee, we try to 
do all the hearings at the subcommittee level. But the problem 
with doing that today is that I thought this was important 
enough for a full committee hearing, but, plus, these witnesses 
are going to be testifying in areas that cross the boundaries 
of various subcommittees. And so, if we let the Health 
Subcommittee ranking members, we would have to let the ranking 
members of all the subcommittees, including Oversight and 
Investigations, and that is just going to drag things on too 
long. So, I decided that we would just have it for the full 
committee members.
    And I would point out--I don't want to go into it--I could 
give you all the record about how, when you were chair when we 
had full committee hearings, we just had it limited to the two 
full committee members. And I know you are not saying that we 
have to do it. You are just asking that we do it. But, given 
the fact that I would have to open it up to all the 
subcommittee chairs, and we would be here another hour, I 
think, I have decided to just proceed with the two of us.
    Mr. Walden. Sure. Reclaiming my--I guess I can reclaim the 
time on a parliamentary inquiry.
    But I know in the past we would even be willing to divide 
that simple 5 minutes among both Mr. Guthrie and Dr. Burgess. I 
would suggest you could do the same on that side and limit it 
to 10 minutes.
    Mr. Pallone. Do you want to use your time for them?
    Mr. Walden. No, I would yield it, as allowed for under our 
rules, the additional 5 minutes. Each side would have 10 
minutes total.
    Mr. Pallone. No, because you see my point. My point is, if 
you just have the subcommittee chairs--and nobody is prepared 
to do that at this point. So, let's just leave it the way it is 
and you use your 5.
    Mr. Griffith. Mr. Chairman, parliamentary inquiry.
    Mr. Pallone. Yes.
    Mr. Griffith. What part of Rule 9(b) do you think does not 
give the ranking minority member the opportunity to delegate 
another member to give an opening statement of not more than 5 
minutes? When I read this language, it is pretty clear, it is 
not a decision of the chair. It is, in fact, built into the 
rules that that is a decision of the ranking member, the 
ranking minority member, if he chooses to do so.
    And as Jefferson's Manual opens up with very clearly--and I 
didn't bring my copy down with me today--but the rules are 
designed to protect the rights of the minority because the 
majority can do whatever it wants to whenever it wants to. And 
the rules that we adopted just at the beginning of this 
congressional session reiterated the fact that the minority 
ranking member not only gets his 5 minutes, or her 5 minutes, 
but that they may designate another member to give an opening 
statement of not more than 5 minutes.
    So, while we have waived that in the past, I don't see 
anything in here that actually gives that decision to the 
chair. And while we are all friends--and I know you do the best 
you can, Mr. Chairman; I am not criticizing that personally--I 
am just saying the rules are pretty clear that the ranking 
minority member gets to designate somebody, and it is not----
    Mr. Pallone. Well, that is not the way I read it. According 
to the rules, only the full committee chair and ranking member 
must be provided the 5 minutes for an opening statement at a 
full committee hearing. Anything else is discretionary with the 
Chair and is ``may.''
    Now, again, this interpretation is not unique to my term as 
chairman. At the first full committee hearing during the 
ranking member's term as chairman of the full committee, on 
October 25th, 2017, a hearing entitled, ``Federal Efforts to 
Combat the Opioid Crisis,'' then-Chairman Walden announced, 
``At the conclusion of my opening statement, we now go to our 
witnesses.'' Full committee hearing, only the chairman and 
ranking member give opening statements just for our committee's 
benefit. So now, we go to our witnesses.
    And then, in the 116th Congress, we continued the same 
practice of only providing the full committee chair and ranking 
member with 5 minutes each for opening statements at full 
committee hearings.
    At both the May 22nd, 2019 full committee hearing entitled, 
``Lift America: Modernizing our Infrastructure for the 
Future,'' and the July 25th, 2019 full committee hearing 
entitled, ``Member Day,'' only the full committee chair and 
ranking member were provided time for an opening statement.
    So, I am just continuing the same practice today that 
existed both under Mr. Walden's chairmanship and mine, and it 
is clearly discretionary. But the reason I am exercising 
discretion to not do it beyond the 5 minutes for each of the 
full committee chairs and rankers is because of the time 
limits. I mean, I guess now we are wasting time. But, I mean, 
look, I don't want to tell you what to do, but I am going to 
insist on that.
    And I would rather proceed and hear from everybody.
    All right, you are recognized, Mr. Walden, for 5 minutes.

  OPENING STATEMENT OF HON. GREG WALDEN, A REPRESENTATIVE IN 
               CONGRESS FROM THE STATE OF OREGON

    Mr. Walden. Well, Mr. Chairman, I am frustrated by that. I 
know members on both sides, and in the past back to 2011 and 
2013, chairs and rankers did work this out and did have others 
participate.
    So, I will move on to my opening statement at this point.
    I want to thank our distinguished panel of witnesses who 
are still working around the clock to understand this deadly 
virus and to develop public health standards to confront it, 
medicines to treat it, and a vaccine to end it.
    COVID-19 laid bare how vulnerable we are and how much more 
we need to do as a government. I comment the work of my 
colleagues, Anna Eshoo and Susan Brooks, to modernize the 
Pandemic and All-Hazards Preparedness Act. And I acknowledge 
the incredible efforts of Fred Upton and Diana DeGette who 
wrote the 21st Century Cures legislation.
    But, even with all of that work, COVID-19 hit the world 
like a tsunami, quick and deadly, leaving unprecedented 
destruction and disruption. Our distinguished speakers are like 
co-captains of America's rescue plane, a plane we are building 
while we fly. Congress has supported those efforts with 
historic levels of funding, resources, and flexibility.
    Early on, President Trump stopped flights from China, and 
then, Europe. He tightened up our borders, established a 
presidential task force to coordinate efforts, and invoked 
executive authority seldom used except in times of emergency or 
war, including the Stafford Act and the Defense Production Act, 
and harnessed the power of American innovation through projects 
like Operation Warp Speed.
    During this unprecedented response, the administration had 
to operate with very limited, often conflicting, data. Even 
with CDC guidance in hand, some governors chose to ignore that 
guidance, and they actually forced sick nursing home patients 
back to the nursing homes, committing the deadliness mistake of 
the pandemic.
    Meanwhile, backward-looking critics with unfair advantage 
of 20/20 hindsight attacked you and the men and women who 
worked alongside of each of you. I commend our witnesses today 
for keeping focused on the challenges at hand and for doing 
everything possible to beat this virus.
    Six months ago, we had barely heard of this virus. During 
our briefings, most thought that, like SARS and MERS before it, 
we would get past this beast, which didn't even have a name 
back then. We quickly went from knowing little about this virus 
to creating a test for it and testing more than 25 million 
samples, with recent averages of more than 500,000 tests a day. 
But we all know there is more to be done.
    Dr. Giroir is a distinguished admiral who became a self-
proclaimed ``swab guy,'' quote-unquote, because that is what 
America needed. We discovered there were only two nasal swab 
manufacturers in the world, one in Maine and one in Italy. And 
the President invoked the DPA ordering Puritan to make the 
swabs we needed, and then, provided funds made available 
through Congress to dramatically increase production in a new 
facility in Maine.
    Meanwhile, the President launched Project Airbridge to fly 
military planes to Italy to pick up swabs and to search the 
globe for other supplies that we found in complete limited 
supply here.
    The State Department helped 101,386 Americans abroad get 
back home, often on government-chartered planes when commercial 
transportation was shut down.
    With a potential increase of illnesses in the fall when 
coupled with the flu season, I asked my team to research every 
aspect of this health crisis and provide recommendations to 
improve our preparedness going forward. Mitigating a second 
wave of infections is critical, given the impact this virus has 
had not only on public health, but also on people's livelihoods 
and America's economy. We released the first recommendations on 
testing and surveillance three weeks ago and are preparing to 
release recommendations on therapeutics and vaccines very soon.
    In less than six months, the United States has conducted 
millions of tests, manufactured medical equipment in car 
factories, used 3D printers to make personal protective 
equipment, developed multiple vaccine candidates, authorized 
use of more than 100 medical devices and drugs for emergency 
use, weighing the known and potential benefits and risks at the 
time--all at unprecedented speeds. These innovations have the 
ability to serve us well and far beyond this pandemic.
    We have seen remarkable coordination, flexibility, and 
cooperation between the executive branch, private sector, faith 
groups, volunteers, and lawmakers. America is strongest when we 
work together to achieve common goals.
    We are constantly learning how to improve our preparedness. 
We must adjust our response based off of facts at hand and 
focus on how to best move forward. We must unite in a common 
fight against this virus.
    Just as America mobilized in World War II to do whatever it 
took, today our distinguished panelists have mobilized 
America's finest scientists, logisticians, and entrepreneurs to 
beat this deadly, microscopic enemy. Thank you for your 
leadership, for your years of public service, and for your 
dedication to this lifesaving mission.
    Mr. Chairman, I yield back the balance of my time.
    [The prepared statement of Mr. Walden follows:]

                 Prepared Statement of Hon. Greg Walden

    I want to thank our distinguished witnesses who are still 
working around the clock to understand this deadly virus and to 
develop public health standards to confront it; medicines to 
treat it; and a vaccine to end it.
    COVID-19 laid bare how vulnerable we are and how much more 
we need to do as a government. I commend the work of my 
colleagues, Anna Eshoo and Susan Brooks to modernize the 
Pandemic All Hazards Preparedness Act. And I acknowledge the 
incredible efforts of Fred Upton and Diana DeGette who wrote 
the 21st Century Cures legislation.
    But even with all of that work, COVID-19 hit the world like 
a tsunami: quick and deadly, leaving unprecedented destruction 
and disruption.
    Our distinguished speakers are like co-captains of 
America's rescue plane -a plane we are building while we fly. 
Congress has supported those efforts with historic levels of 
funding, resources, and flexiblility.
    Early on, President Trump stopped flights from China and 
then Europe, tightened up our borders, established a 
presidential task force to coordinate efforts, and invoked 
executive authorities seldom used, except in times of war, 
including the Stafford Act and the Defense Production Act, and 
harnessed the power of American innovation through projects 
like Operation Warp Speed.
    During this unprecedented response, the Administration had 
to operate with very limited, often conflicting, data. Even 
with CDC guidance in hand, some governors chose to ignore 
guidance and forced sick nursing home patients back to the 
nursing home, committing the deadliest mistake of the pandemic.
    Meanwhile backward-looking critics with the unfair 
advantage of 20-20 hindsight attack you and the men and women 
who work alongside you. I commend our witnesses today for 
keeping focused on the challenges at hand and for doing 
everything possible to beat this virus.
    Six months ago, we'd barely heard of this virus. During our 
briefings, most thought that like SARS and MERS before it, we'd 
get past this beast--which didn't even have a name back then. 
We quickly went from knowing little about this virus to 
creating a test for it and testing more than 25 million 
samples, with recent averages of more than 500,000 tests a day.
    Dr. Giroir (JER--WA), is a distinguished Admiral who became 
a self-proclaimed "swab guy" because that is what America 
needed. We discovered there were only two nasal swab 
manufacturers in the world: one in Maine and one in Italy. The 
President invoked the DPA ordering Puritan to make the swabs we 
needed and provided funds to dramatically increase production 
in a new facility.
    Meanwhile, the President launched Project Air Bridge to fly 
military planes to Italy to pick up swabs, and to search the 
globe for other supplies that were in limited supply here. The 
State Department helped 101,386 Americans abroad get back home, 
often on government chartered planes after commercial 
transportation was shut down.
    With a potential increase of illness in the fall when 
coupled with the flu season, I asked my team to research every 
aspect of this health crisis and provide recommendations to 
improve our preparedness. Mitigating a second wave of 
infections is critical given the impact this virus has had on 
not only public health, but also on peoples' livelihoods and 
the economy. We released the first recommendations on testing 
andsurveillance three weeks ago, and are preparing to release 
recommendations on therapeutics and vaccines very soon.
    In less than six months, the United States has conducted 
millions of tests, manufactured medical equipment in car 
factories, used 3-D printers to make personal protective 
equipment, developed multiple vaccine candidates, authorized 
use of more than 100 medical devices and drugs for emergency 
use, weighing the known and potential benefits and risks at the 
time, all with unprecedented speed. These innovations have the 
ability to serve us well and far beyond this pandemic.
    We have seen remarkable coordination, flexibility and 
cooperation between the executive branch, private sector, faith 
groups,volunteers, and lawmakers. America is strongest when we 
work together to achieve common goals.
    We are constantly learning how to improve our preparedness. 
We must adjust our response based off the facts at hand and 
focus on how to best move forward. We must unite in a common 
fight against this virus.
    Just as America mobilized in World War II to do whatever it 
took, today, our distinguished panelists have mobilized 
America's finest scientists, logisticians and entreprenuers to 
beat this deadly, Microscopic Enemy. Thank you for your 
leadership, for your years of public service, and for your 
dedication to this life-saving mission.

    Mr. Pallone. Thank you. I want to thank the ranking member.
    And I would like to now introduce our witnesses for today's 
hearing. I keep calling it the White House Task Force on 
Coronavirus, but I don't actually know whether that is still in 
existence or whether you are all Members of it anymore.
    So, first, we have Dr. Robert Redfield, the Director of the 
Centers for Disease Control and Prevention. We have Dr. Anthony 
Fauci, Director of the National Institute of Allergy and 
Infectious Diseases at the National Institutes of Health. We 
have Admiral Brett Giroir, Assistant Secretary for Health, U.S. 
Department of Health and Human Services, who is probably tired 
of hearing from me since I am call him all the time. And Dr. 
Stephen Hahn, who is the Commissioner of the U.S. Food and Drug 
Administration.
    Thank you all for being here today, and I know it is going 
to be worthwhile.
    At this time, the chair is going to recognize each witness 
for 5 minutes to provide their opening statement. Before we 
begin, I would like to explain the lighting system.
    In front of you is a series of lights. The light will 
initially be green at the start of your opening statement. The 
light will turn yellow when you have 1-minute remaining. And, 
of course, you should try to wrap up your testimony at that 
point. And the light will turn red when your time expires. You 
probably know this already, but I will mention it again.
    So, we are going to start with Dr. Redfield. You are 
recognized for 5 minutes. Thank you.

STATEMENTS OF ROBERT R. REDFIELD, DIRECTOR, CENTERS FOR DISEASE 
 CONTROL AND PREVENTION; ANTHONY S. FAUCI, DIRECTOR, NATIONAL 
    INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL 
   INSTITUTES OF HEALTH; ADMIRAL BRETT P. GIROIR, ASSISTANT 
   SECRETARY FOR HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN 
SERVICES, AND STEPHEN M. HAHN, COMMISSIONER, U.S. FOOD AND DRUG 
                         ADMINISTRATION

                STATEMENT OF ROBERT R. REDFIELD

    Dr. Redfield. Good morning, Chairman Pallone, Ranking 
Member Walden, and distinguished members of the committee. 
Thank you for the opportunity to testify before you with my HHS 
colleagues.
    Today, the COVID-19 pandemic continues in the United States 
and around the world. This pandemic is the greatest public 
health crisis our nation and our world have confronted in more 
than a century.
    While overall case counts are going down, several 
communities are seeing increased cases driven by multiple 
factors, including increased testing, outbreaks, and evidence 
of community transmission.
     Right now, the most powerful weapon against this disease 
are social distancing, face coverings, and hand hygiene. These 
actions will help us contain transmission, along with readily 
available testing; comprehensive, timely contact tracing; 
timely isolation of known cases, and self-quarantine to break 
the chains of transmission.
    Once again, I call on the American people to remain 
vigilant in our collective obligation to protect those who may 
be at risk for severe complications of COVID-19 due to age or 
underlying medical conditions. We must also lessen the burden 
of COVID-19 among racial and ethnic groups disproportionately 
impacted.
    The CDC continues to improve its data collection of 
comprehensive data of each case, race, and ethnicity from our 
state, local, tribal, and territorial partners. Reporting from 
hospital surveillance sites, for example, has increased in 
completeness on race and ethnicity from 30 percent to now more 
than 80 percent. CDC is also receiving more complete data from 
our public health partners.
    The recent CDC study examined more than 1.3 million COVID-
19 cases and found that the most underlying health conditions 
were cardiovascular, diabetes, obesity, and chronic lung 
disease. Hospitalizations were six times higher for these 
individuals and death 12 times higher of those reporting these 
conditions compared to those without.
    The CDC is working to ensure the equity and health outcomes 
and the social determinates are being addressed through the 
COVID-19 response. CDC continues to provide communities with 
technical expertise, tools, and information to confront the 
virus.
    The CDC has created more than 1500 specialized resource and 
guidance documents that would have been consulted more than 1.5 
billion times on the CDC website.
    We have deployed over 5,000 personnel in the response. We 
have more than 40 rapid response teams on the ground now 
providing local health departments and health officials with 
expertise in epidemiology, surveillance, infection control, 
laboratory science, and community mitigation.
    We are enormously grateful to the heroes of the response. 
That is the public health and healthcare professionals, the 
first responders, the critical infrastructure workers who have 
served and sacrificed too much.
    CDC and our nation's public health partners are actively 
working on the front lines of this pandemic to remedy the 
shortcomings in a public health system that has been 
underresourced for decades. With your support, CDC has been 
able to award nearly $12 billion to states, territories, 
tribes, and localities to enhance their response capabilities.
    When confronted by any disease threats, CDC and public 
health departments must make real-time decisions based on real-
time data. Data is the backbone of any disease threat response.
    With the resources that Congress has provided, data 
modernization is underway. We also must ensure that our 
laboratories have resilience. Advanced technology, personnel, 
expertise, and supplies are being sourced.
    Our public health workforce must grow exponentially to 
address COVID-19 and future public health threats. Thousands of 
contact tracers are onboard and being recruited by public 
health departments across our nation. The bottom line: 
sustained investment in the public health system is an 
investment in the health and prosperity of our nation.
    Last, CDC has begun to prepare for the months ahead when 
the next season's influenza illness will occur simultaneously 
potentially with COVID-19, increasing the challenges on 
hospitals, healthcare professionals, and the public. This fall, 
before the seasonal circulation of influenza increases, I 
encourage the American people to be prepared and to embrace flu 
vaccination with confidence for yourself, your families, and 
the communities. This single act will save lives.
    Thank you, and I look forward to your questions.
    [The combined statement of Dr. Redfield appears at the 
conclusion of the hearing.]
    Mr. Pallone. Thank you, Dr. Redfield.
    Dr. Fauci?

                 STATEMENT OF ANTHONY S. FAUCI

    Dr. Fauci. Thank you very much, Mr. Chairman, Ranking 
Member Walden. Thank you all for giving me the opportunity to 
discuss with you today the role of the National Institutes of 
Health in research addressing COVID-19.
    The approach to the NIH is very similar to what we do with 
other emerging infections. It is a four-pronged approach. 
First, to study the fundamental knowledge of the virus itself, 
as well as the host response to the virus. The second is to 
help develop diagnostics and assays. The third is to 
characterize and test therapeutics, and the fourth is to 
develop safe and effective vaccines.
    Speaking of the first, fundamental knowledge of the virus 
and what the virus is capable of doing, we have done a number 
of studies now that have informed how we are approaching 
therapeutics and vaccines. For example, the precise molecular 
structure of the spike protein, which is that part of the virus 
which actually gives it its name, coronavirus, because of these 
spikes that stick out from the virus, that is the way the virus 
binds to cells in the body. This has been precisely delineated 
by NIH scientists and those that we fund. Second, the 
demonstration of the precise receptors where by the virus binds 
to cells in the body, allowing it to enter and cause disease. 
In addition, we develop animal models. We do natural history 
studies, such as understanding the virus in different 
demographic groups.
    Second is the development diagnostics and assays. We need, 
and we will get within a reasonable period of time, based on a 
major investment in the RADx program, diagnostics that are 
point-of-care, simple, precise, sensitive, and specific. We 
hope by the end of the fall and into the early winter we will 
have these for wide distribution.
    Third, the development and characterization of drugs. You 
have all heard of the first successful randomized, placebo-
controlled trial of a drug called remdesivir, which was used in 
hospitalized patients with lung disease. It showed a 
statistically significant, but modest impact on decreasing the 
time to release from the hospital; namely, faster recovery. In 
addition, this drug is now being used in combination with 
another drug that blocks the inflammatory response, 
baricitinib. We are also looking at a variety of others: 
convalescent plasma, hyperimmune globulin, other drugs, 
monoclonal antibodies, as well as other immune-based therapies.
    Fourth, the development of safe and effective vaccines, the 
hallmark of all really defining responses that we have to virus 
diseases. If you look at the history of viral diseases, it is 
generally vaccines that put the nail in the coffin of these 
types. We are now mounting a major effort in which we are 
collaborating with industry in public-private partnerships to 
get vaccine trials that are developed that harmonize with each 
other. In other words, they have multiple trials in which we 
have common questions that are being asked, common laboratories 
that are being looked at, common data and safety monitoring 
board, and common primary, secondary, and tertiary endpoints, 
so that the data can be compared from one to another.
    You have probably heard that one of those vaccines--and 
there are more than one; there are several that are moving 
along at various paces--one of them will enter phase 3 study in 
July. This is one that has already shown in preliminary studies 
some very favorable responses in the animal models that were 
developed. There will be others that will follow one month, two 
months, three months later.
    Although you can never guarantee at all the safety and 
efficacy of a vaccine until you actually test it in the field, 
we feel cautiously optimistic, based on the concerted effort 
and the fact that we are taking financial risks, not risks to 
safety, not risks to the integrity of the science, but 
financial risks to be able to be ahead of the game, so that 
when--and I believe it will be when and not if--we get 
favorable candidates with good results, we will be able to make 
them available to the American public, as I said to this 
committee months ago, within a year from when we started, which 
would put us at the end of this calendar year and the beginning 
of 2021.
    I will stop there, Mr. Chairman, and be happy to answer 
questions later. Thank you.
    [The combined statement of Dr. Fauci appears at the 
conclusion of the hearing.]
    Mr. Pallone. Thank you, Dr. Fauci, and thanks for all your 
contributions to fighting this pandemic. And I will say the 
same about Admiral Giroir, who I bother the most.
    You are recognized for 5 minutes, Admiral.

                  STATEMENT OF BRETT P. GIROIR

    Mr. Giroir. Thank you, Chairman Pallone, and I always enjoy 
our conversations. You call me anytime.
    Ranking Member Walden, distinguished members of the 
committee, on March 12th, Secretary Azar requested that I lead 
the coordination of COVID-19 testing efforts within the 
Department of Health and Human Services. And I would like to be 
clear that, although I am no longer full -time deployed to 
FEMA, I am maintaining my role of coordinating testing.
    To date, the nation has performed over 27 million COVID-19 
tests, now averaging about 500,000 tests per day. Even without 
any major technical advances, I estimate the nation will have 
the capacity to perform between 40 to 50 million tests per 
month by fall.
    To address the public health challenges over the past 
months, we implemented a phased approach to meet the testing 
needs at each stage of the pandemic, especially now during 
reopening when the need for testing is the greatest. In early 
March, HHS and FEMA developed and implemented 41 community-
based drive-through testing sites in locations prioritized by 
the CDC in collaboration with our state and local partners. 
These sites have tested nearly 300,000 high-risk individuals 
and served as prototypes that have been duplicated multifold.
    Next, we leveraged trusted pharmacies to further implement 
community testing, especially for minorities and the 
underserved. This federal program is now providing testing at 
611 locations in 47 states and the District, 70 percent of 
which are in communities with moderate to high social 
vulnerability. This program has tested over 688,000 
individuals.
    Federally Qualified Health Centers serve over 29 million 
people across the nation. They provide care to 1 in 5 of those 
uninsured, 1 in 5 rural Americans, 1 in 3 living in poverty, 
and 1.3 million homeless. Again, to ensure we reach these most 
vulnerable among us, 93 percent of FQHCs offer COVID-19 
testing.
    To further expand access, we authorized all licensed 
pharmacists to order and administer COVID-19 testing under the 
Public Readiness and Emergency Preparedness, or PREP, Act. Over 
90 percent of Americans live within 5 miles of a pharmacy, 
again assuring widespread availability.
    On June 4th, using authorities provided to the Secretary 
under CARES, HHS released new mandatory laboratory reporting 
guidance, so that we can confirm that all groups are 
benefitting equitably from COVID-19 testing. Lab reports must 
include demographic information like race, ethnicity, age, and 
gender.
    And today, I am pleased to announce the selection of 
Morehouse School of Medicine as the awardee for a new $40 
million initiative to fight COVID-19 among racial and ethnic 
minorities, as well as rural and other socially vulnerable 
communities. This cooperative agreement with the Office of the 
Assistant Secretary for Health's Office of Minority Health and 
Morehouse School of Medicine will develop and implement a 
strategic network of national, state, territorial, tribal, and 
local organizations to deliver COVID-19-related information to 
communities hardest hit by the pandemic. In the first year of 
this agreement, Morehouse School of Medicine will receive $15 
million.
    This massive expansion of testing resulted in unprecedented 
demand for supplies, reagents, and laboratory platforms. To 
meet this demand, we secured the global supply chain through a 
military airbridge. We worked directly with manufacturers to 
increase domestic production. We collaborated with external 
partners to validate new technologies. We secured and 
prioritized scarce point-of-care tests for state public health 
laboratories, the Indian Health Service, and other critical 
needs. Finally, we used Title III of the Defense Production Act 
to further invest in domestic manufacturing. These actions and 
others have enabled our current efforts with states, 
territories, and tribes to implement evidence-based diagnostic 
and surveillance plans.
    I would like to close by recognizing my fellow officers in 
the United States Public Health Service Commissioned Corps, the 
uniformed service that I lead. Four thousand four hundred and 
eighty-two officers have deployed to support the pandemic 
response, including to the Diamond Princess cruise ship in 
Japan, to our military bases repatriating Americans, to our 
community-based testing sites, to FEMA and task forces directly 
inside nursing homes, and to field hospitals across our nation, 
exemplifying the care and compassion that all of us feel for 
those who have suffered during this pandemic.
    I thank each and every one of these officers and their 
families, and on their behalf, I would like to thank all of you 
in Congress for supporting our training needs and the 
establishment of a ready reserve corps to supplement our ranks 
during inevitable future national emergencies.
    Thank you again for the opportunity to provide these 
remarks.
    [The combined statement of Dr. Giroir appears at the 
conclusion of the hearing.]
    Mr. Pallone. Thank you, Admiral, and thank you for 
mentioning the--both military and civilians who are out front 
and helping us during this crisis. We really appreciate all 
that they do and we have to make sure that we help them as much 
as possible.
    So last, but certainly not least, because the FDA is just 
as important, is Dr. Hahn, or Commissioner Hahn.

                  STATEMENT OF STEPHEN M. HAHN

    Dr. Hahn. Chairman Pallone, Ranking Member Walden, and 
distinguished members of the committee, thank you for inviting 
me here today.
    First, I would like to start by thanking all of you for 
your support of the agency and U.S. government with the laws 
that you've passed that become have law of the land. It has 
helped a great deal in our response.
    FDA has a critical role in the federal government's 
response to the COVID-19 pandemic. We remain focused on our 
mission of protecting and promoting the health and safety of 
Americans.
    President Trump has requested and we have provided 
appropriate regulatory flexibilities to assure that the 
American public have access to critical medical products, safe 
foods, and the confidence that the government is taking 
measures to address important public health issues.
    FDA has used our emergency authority since the beginning of 
this pandemic. We have issued more than a hundred emergency use 
authorizations for diagnostics, personal protective equipment, 
ventilators, and other devices, as well as for drug products.
    Since the public health emergency was declared, we issued 
more than 50 guidance documents to help ensure the continuity 
of healthcare and safe food supply, and we put into place new 
initiatives to accelerate the development of needed products.
    Additionally, we have kept the American public up to date 
on what they need to do to protect themselves and to contain 
the virus from spreading.
    We are now preparing for the next phase of addressing this 
evolving crisis. It is mission-critical that the agency 
continue to be diligent, assuring the safety of the products 
that we regulate, and that we also put in place processes 
needed to assure the protections that the public will need.
    There are a number of experiences we have gained over the 
past few months that will inform our plans. We recognize that 
we must be bold in our decision-making and advance effective 
solutions to achieve challenging public health objectives.
    Therefore, we have begun a comprehensive real-time review 
and assessment of our actions to date to address the COVID-19 
pandemic.
    The objective is to identify and address potential 
organizational and programmatic changes that should be 
implemented without delay to advance the ongoing response to 
COVID-19.
    We need to assure that we leverage what is working well 
while at the same time review our framework and policies to be 
positioned to effectively identify and respond to quickly 
evolving public health situations.
    A major focus of this effort will be to identify what 
regulatory policies should be continued and accelerate it 
consistent with Executive Order 13294, signed by the president.
    Durable policy, organizational and programmatic changes 
will be consistent with advancing the agency's public health 
mission and will inform our strategic priorities moving 
forward.
    One of the challenges facing FDA during the COVID-19 
pandemic is how to assure the timely review of medical product 
applications despite an incredible surge in volume and 
constraints on our ability to conduct onsite inspections.
    I am pleased to announce today that FDA has maintained the 
same pace of meeting its goals on applications for medical 
products for the last six months it has maintained in recent 
years.
    We are on target to meet our user fee goals for the drugs 
this year by reviewing and taking timely action on at least 90 
percent of brand, generic, and biosimilar drug applications, 
even during the pandemic. Additionally, this work has continued 
at a time when the number of applications received in some 
centers is substantially higher than the pre-COVID-19 times.
    I want to thank the more than 17,000 employees of the FDA 
for their incredible efforts, one that reflects the remarkable 
dedication and commitment to the public health of all 
Americans.
    Finally, I would like to discuss what is top of mind for 
all Americans, namely, the work that FDA is doing to facilitate 
the development of safe vaccines and therapeutics. FDA launched 
an emergency review and development program called the 
Coronavirus Treatment Accelerated Program, or CTAP, and we 
continue to work night and day to provide guidance and to 
review proposals from companies, scientists, and researchers 
who are developing therapies.
    Let me be clear that data and science will dictate when we 
will have safe and effective treatments and vaccines for COVID-
19, as Dr. Fauci just mentioned. Toward that end, FDA is using 
every available authority and applying every appropriate 
regulatory flexibility to facilitate the development and 
testing.
    We have not lost sight of our solemn responsibility to the 
American people to ensure our decisions related to all medical 
products are based on science and data, and that is a 
commitment that the American public can have confidence in. And 
I assure you that the FDA will provide leadership, expertise, 
guidance, information, and whatever else is needed as we 
continue to address this unprecedented challenge.
    Thank you, and I look forward to your questions.
    [The combined statement of Dr. Hahn appears at the 
conclusion of the hearing.]
    Mr. Pallone. Thank you, Commissioner Hahn.
    That concludes our openings from the witnesses, and so now 
we will move to member questions. Each member will have 5 
minutes to ask questions of our witnesses and I will start by 
recognizing myself for 5 minutes.
    Now, you know that I am very critical of the president for 
a lack of leadership from the start of this pandemic, which I 
think continues. And, of course, it is difficult because you 
work, in theory, for the president and I feel that many of you 
on many occasions actually wanted to take more leadership and 
be, as Dr. Hahn mentioned, or Commissioner Hahn, fully 
cognizant of the data and the science.
    So it is difficult because I am going to ask you questions 
about the president's lack of leadership, and I know it is hard 
for you to answer those. So we will see.
    But I do believe the president is encouraging behaviors 
that are not consistent with good public health such as 
encouraging thousands to attend a rally and not mandate the 
wearing of masks, and I can't imagine that NIH or CDC would 
suggest this as a best practice in the face of this pandemic.
    So it is sort of like there are two versions of reality 
here. One is the president's and one is, hopefully, yours, 
based on data and science. But I want to hear from the experts. 
So let me start with Dr. Fauci. You are a trusted voice and 
have always been candid with us and the American public.
    Give us an unvarnished view of where we are at our fight 
against COVID-19, quickly if you can.
    Dr. Fauci. Thank you very much for that question, Mr. 
Chairman.
    It really is a mixed bag. We have a very large country, 
very heterogeneous, major differences, for example, between the 
New York metropolitan area and Casper, Wyoming.
    If you look at how we have been hit, we have been hit 
badly. I mean, anybody who looks at the numbers we have had now 
over 120,000 deaths and we have had two and a half million 
infections. So it is a serious situation.
    In some respects, we have done very well. Right now, for 
example, the New York metropolitan area, which has been hit 
extraordinarily hard, has done very well in bringing the cases 
down and using the guidelines that we have very carefully put 
together in a step-wise fashion to try and carefully reopen 
their city and their state.
    However, in other areas of the country, we are now seeing a 
disturbing surge of infections that looks like it is a 
combination. But one of the things is an increase in the 
community spread, and that is something that I am really quite 
concerned about that and you know that.
    This has been something that has been in the press over the 
past couple of days. We were going down from 30,000 to 25,000 
to 20,000, and now we sort of stayed about flat and now we are 
going up. A couple of days ago there were 30,000 new 
infections.
    That is very troublesome to me. The way you address that, 
and I have said this over and over again, is you have to have 
the manpower, the system, the testing to identify, isolate, and 
contact trace in an effective way so that when you see those 
increases you can understand where they are coming from and you 
can do something about them.
    Right now, the next couple of weeks are going to be 
critical in our ability to address those surgings that we are 
seeing in Florida, in Texas, in Arizona, and in other states. 
They are not the only ones that are having the difficulty.
    Bottom line, Mr. Chairman, it is a mixed bag, some good and 
some now we have a problem with.
    Mr. Pallone. All right. Now, I am going to have to ask 
about the president because you talked about testing and how 
important it is, and I--you know, Admiral Giroir and I know how 
important it is.
    At his rally over the weekend the president said, and I 
quote, ``When you do testing to that extent you are going to 
find more people. You are going to find more cases. So I said 
to my people, `Slow the testing down, please,' '' unquote, and 
this morning he said he meant this.
    So, Dr. Fauci, do you agree with that? Does it make sense 
that to safely open our economy we should be limiting the 
number of tests rather than ensuring that anyone who needs a 
test can get one? And you don't have to mention the president. 
I did. But tell us about the testing.
    Dr. Fauci. I, as a member of the task force----
    Mr. Pallone. Your microphone is on?
    Dr. Fauci. Sorry. I, as a member of the task force, and my 
colleagues on the task force, to my knowledge--I know for sure 
that to my knowledge none of us have ever been told to slow 
down on testing. That just is a fact.
    In fact, we will be doing more testing. As you have heard 
from Admiral Giroir, not only testing to specifically identify 
people in the identify, isolate, and contact trace, but also 
much more surveillance if you want to get your arms around and 
understand exactly what is going on in community spread.
    So it is the opposite. We are going to be doing more 
testing, not less.
    Mr. Pallone. And then let me just ask the same question of 
Dr. Redfield. Do you agree with the president on this? Do you 
think we should be testing more people? If you don't want to 
talk about the president, just tell us if you think we should 
be testing more people.
    Dr. Redfield. As Dr. Fauci said, all of us have been and 
continue to be committed to increasing readily timely access to 
testing. We have made a marked improvement. We still have a 
ways to go.
    One of the key things, as Tony mentioned, is surveillance, 
expanding surveillance because of the asymptomatic nature of 
this infection, and in doing so we are looking at ways that can 
really substantially enhance testing by potentially pooling 
samples.
    So right now, as Giroir said, we are doing 500,000, 600,000 
tests a day. If we can pool samples five to one, that would 
bring it to 3 million tests a day.
    So we are continuing to try to enhance testing. It is a 
critical underpinning of our response.
    Mr. Pallone. Thank you, Dr. Redfield.
    I recognize Mr. Walden now for 5 minutes.
    Mr. Walden. Thank you, Mr. Chairman.
    Let me--let me go straight to the question that my 
colleague asked, and I will just ask each of you for a yes or 
no answer.
    Has President Trump ever directed you to slow down testing 
for COVID-19 in the United States?
    Dr. Redfield?
    Dr. Redfield. No.
    Admiral Giroir. No, sir.
    Dr. Hahn. No, Congressman.
    Mr. Walden. Thank you.
    All right. Let us go to some other issues here.
    Dr. Hahn, you created a website, I believe, on the FDA site 
dealing with convalescent plasma and antibody-rich 
investigational therapies that may help fight the virus.
    What is the status of the research into the effectiveness 
of convalescent plasma in fighting COVID-19? What do we know 
right now?
    Dr. Hahn. Thank you, Congressman Walden.
    A really important question from a therapeutic point of 
view. As everyone here knows, convalescent plasma is where you 
take the natural immunity from a person who has recovered from 
COVID-19--those antibodies--and then administer to a person who 
is sick.
    So we have partnered with BARDA and HHS as well as the Mayo 
Clinic to develop what is called an expanded access program. We 
have safety data from over 20,000 patients that show this is a 
very safe therapy, and our preliminary assessment of the 
effectiveness of this plasma is quite encouraging.
    We continue to look at the information. If those data hold, 
we will have potentially another weapon in the armamentarium 
against COVID-19, pending those final results. This will also 
allow us to have information that will feed the development of 
monoclonal antibodies and something else called a hyperimmune 
globulin, which we can pool that plasma and actually give it as 
an injection to people.
    So I think it's a good news story right now. We have to 
wait for the final data to come in and we should know very 
shortly about that.
    There are also several randomized trials looking at this as 
well that are ongoing across the country.
    Mr. Walden. All right. Thank you very much.
    Dr. Redfield, CDC has developed a new test to 
simultaneously detect two strains of influenza and the COVID-19 
and is seeking an emergency use authority.
    How does the CDC envision its combined tests to be used?
    Dr. Redfield. I think it is very important. As I mentioned, 
as we get to the fall, we are going to have influenza and COVID 
at the same time, and CDC is developing that test for the 
public health system. But in parallel, the private sector now 
has also got advanced development.
    Maybe Dr. Hahn wants to comment on similar tests in the 
private sector. So to facilitate timely diagnosis of these two 
co-circulating pathogens.
    Mr. Walden. Dr. Hahn, do you want to comment on that for 20 
seconds?
    Dr. Hahn. Yes, sir. In cooperation with Admiral Giroir, we 
have been working with companies to actually look at that. 
Admiral Giroir has been at the forefront of this. It has been a 
great relationship.
    Mr. Walden. Admiral?
    Admiral Giroir. I would just agree with my colleagues. We 
are all concerned about the possibly of co-circulation of 
influenza A and B as well as COVID-19 when it comes to flu 
season.
    So we want to do everything we can to simplify the 
diagnosis, and you can have a--if you have a single test and we 
are working with multiple manufacturers. As is usual, the CDC 
is usually in the lead. But there are multiple manufacturers 
both at point of care and laboratory who will have this type of 
test available.
    Mr. Walden. All right. Excellent.
    You all have been subject to a lot of criticism, as has the 
president. Often that is leveled after we know facts we didn't 
know at the time when things started, and so it is really great 
if you have hindsight and 20/20 vision you can look back and 
say you should have done that then.
    I want to look forward. What is it you need from Congress 
that you do not have now to have America ready for the fall? 
What should we be preparing for now for the fall?
    I don't care who wants to start but I am down to a minute 
to answer. So Dr. Redfield?
    Dr. Redfield. I think, first, I want to just express our 
appreciation to Congress for the supplemental funding. I think 
it is of note that CDC has been able already to disburse $12 
billion to the states to help prepare their COVID responses 
and, really, that is an unprecedented amount of resources.
    I would only ask that we look to how to make this a 
sustainable investment as opposed to a sporadic investment to 
this particular challenge we have right now.
    Mr. Walden. All right. Dr. Fauci, what do we need to worry 
about? What don't you have?
    Dr. Fauci. Well, just to reiterate what Dr. Redfield said, 
we are extraordinarily grateful for the--you know, the 
unprecedented amount of supplementary funded that the Congress 
gave to us, which really make it totally possible for us to do 
the kinds of things we need to do on an emergency basis.
    But, again, to mention what Dr. Redfield said, we have to 
establish some corporate memory. I have said to this committee, 
literally, many times over the many years that we forget things 
when we get distant from them.
    We are going through a terrible ordeal right now. We need 
to have in place the stable type of support for preparedness 
for outbreaks.
    We will get through this. This will end, hopefully, sooner 
rather than later. But we need to establish a system so that we 
are prepared for future outbreaks.
    Mr. Walden. Thank you.
    Mr. Chair, could the other two just answer that question 
quickly?
    Admiral, what do you need you don't have? What should we be 
worrying about?
    Admiral Giroir. I want to express my thanks again----
    Mr. Walden. Right.
    Admiral Giroir [continue]. To the committee. But let me get 
to the point.
    I think sustainability and commitment are very important. I 
was involved in Ebola in 2015 in Dallas trying to lead some of 
the policy options during that time, and you see over a five-
year period we sort of forgot all the lessons that we were 
trying to get implemented, including PPE and other stockpiles.
    I would say some of the biggest limitations, and I know 
everyone is working on this, is the national data 
infrastructure we need.
    When we started out, I am calling up a hundred hospitals a 
day trying to understand who is on an ICU bed, who is not, who 
has a ventilator, how much you have left. And we got through 
this early not by systems but by people working 24/7.
    The third thing is--I am just going to pound it--the 
vaccine infrastructure in this country, to promote vaccination, 
to promote vaccine confidence, to make sure that people have 
the right information about safety and efficacy, that we order 
enough flu vaccine, because we really need to get everybody 
vaccinated this winter.
    One thing that minimizes our problems is if we get 
everybody a flu vaccine. That is one less virus that could kill 
20,000, 30,000, 50,000, 70,000 and, potentially, even be a co-
infection with COVID.
    Mr. Walden. Dr. Hahn?
    Dr. Hahn. Thank you. Again, thank you for the support.
    One big point I want to make here is that what we have 
learned during this epidemic is what Admiral Giroir said, is 
that we have an access to information issue.
    We have learned that we need to collect real-world evidence 
in real time during an emergency, just like a doctor would do 
during an emergency, to inform decisions and how we could 
change them, moving forward.
    So your support for real-world evidence generation would be 
incredibly helpful.
    Mr. Pallone. So now we are going to move to our members, 
based on seniority, and I think our next few are virtual. So I 
will just remind you to unmute. If you don't do so on your own 
I will just keep reminding you.
    So next we have Mr. Rush from Illinois.
    Mr. Rush. I want to thank you, Mr. Chairman, for holding 
this important hearing.
    Last week, the Health Subcommittee held an informative 
hearing on the racial and ethnic health disparities being 
highlighted by the coronavirus.
    The distinction of all of these disparities are very 
troubling, even extremely outrageous. A Scientific American 
article published earlier this month found that if Black people 
were dying at the same rate as white Americans, at least 13,000 
mothers, fathers, daughters, sons, and other loved ones would 
still be alive.
    Even more shocking is that among those 35 to 44, Black men 
and women die from the coronavirus at least nine times the rate 
of white Americans.
    Dr. Fauci, wouldn't it become apparent that institutional 
racism and structural discrimination are playing a part in why 
certain racial and ethnic communities are suffering more than 
white communities?
    Dr. Fauci. I think I know what the--I didn't hear it quite 
as clear as I want but I think I know what the Congressman is 
referring to.
    So when you are looking at the African American community 
and the minority community in general as a demographic group, 
there are two elements that make it much more difficult for 
them and why they are suffering disproportionately.
    One is the risk of infection. Because of economic and other 
considerations, the jobs that the majority of them would find 
themselves in does not allow them to protect themselves by 
looking into a computer and doing telework. Most of them are 
essential, on the outside, having to mingle in a society in 
which the virus is circulating.
    So right at the get-go, they have a greater risk of getting 
infected. And then we know from a lot of experience now that 
the situation regarding whether or not you have serious 
consequences, hospitalizations, intubation, complications, and 
death relate very strongly to the prevalence and incidence of 
underlying comorbid conditions, which are, clearly, 
disproportionately more expressed in the African American 
population than in the rest of the population and that 
particularly includes hypertension, diabetes, obesity, chronic 
lung disease, and kidney disease.
    So, unfortunately, we have a situation where it is sort of 
a double whammy of a negative capability of them to respond 
through no fault of their own because of underlying conditions 
and the conditions in which they find themselves with.
    Mr. Rush. Dr. Fauci, would you consider racism itself as 
being one of the stresses that certainly impacts the African 
American community more in an extraordinary way that 
contributes to these comorbidities?
    Dr. Fauci. I think the question was would I consider 
institutional racism as contributing. I don't think there is--
--
    Mr. Rush. Yes.
    Dr. Fauci. Yes. Thank you, Congressman.
    Well, I mean, obviously, the African American community has 
suffered from racism for a very, very long period of time and I 
cannot imagine that that has not contributed to the conditions 
that they find themselves in economically and otherwise.
    So the answer, Congressman, is yes.
    Mr. Rush. Admiral Giroir, I applaud your announcement that 
provides for $100 million--I mean, for $40 million to go into 
the Morehouse College of Medicine for contact tracing and 
testing.
    I have introduced a bill, the TRACE Act, which calls for a 
$100 million for testing and contact tracing. Shouldn't we be 
seeing a larger amount, $100 million or more, for contact 
tracing and for testing?
    Admiral Giroir. Thank you, Congressman.
    For testing and contact tracing, we are going to need 
billions of dollars. I mean, that is the amount of investment 
that we are doing partially through CDC.
    This specific award is to have Morehouse lead a consortium 
of organizations like 100 Black Men, UnidosUS, the National 
Association of Community Health Workers, the National Council 
of Urban Indian Health, et cetera, et cetera, to really focus 
on the specific educational testing and linkage to the care 
needs of underserved minorities and some of those also in the 
rural population.
    My personal opinion is $40 million is a start. It is going 
to need to be a lot more than that in order to reach the people 
that we need to reach.
    Mr. Pallone. Thank you, Bobby. Thank you, Admiral.
    Next is Mr. Upton from Michigan.
    Mr. Upton. Thanks very much, Mr. Chairman, and I really 
appreciate the testimony that we have heard thus far and the 
interaction that we will have between all of our----
    I guess the first question I have, Dr. Fauci--good friend, 
thank you for your service for sure--in recent weeks, of 
course, you made the statement [audio malfunction in hearing 
room] have as many as a 100 million doses of [audio malfunction 
in hearing room] vaccine before the [audio malfunction in 
hearing room] year.
    I have heard from a number of companies just in recent days 
AstraZeneca, Pfizer [audio malfunction in hearing room] hopes 
to have, perhaps, a billion doses before the end of next year, 
calendar year '21.
    So as [audio malfunction in hearing room] move through the 
Phase II process [audio malfunction in hearing room] maybe even 
get into some production, a little bit later by somewhat early 
August. Not the approvals yet but [audio malfunction in hearing 
room] the promise of getting it to the marketplace and, really, 
saving the world. Let's face it.
    What is your thought as to how early we may see an EUA, an 
emergency use authorization, approved for any of these 
vaccines, based on what you know today and under the scenarios 
that we may see something in the next number of months in terms 
of an approval? Lay out what you think is a real distinct 
possibility where we might end up being.
    Dr. Fauci. OK. Thank you for that. I didn't hear----
    Mr. Upton. And Dr. Hahn as well.
    Dr. Fauci. I didn't hear everything you said but I think I 
got enough of it to answer your question, at least the last 
part that I think is very important and I welcome the 
opportunity to address this.
    The idea about the doses that would be available, you know, 
a couple of hundred million doses in the beginning of the year, 
some companies saying that in a couple of years, a year or two, 
they will have as many as a billion doses, I think that is 
real.
    Most people would raise their eyebrows and think that how 
is that going to happen, and it is because things are being 
done at risk. People--companies are starting to plan to make 
doses even before you know the vaccine works.
    So the risk of the speed is not risk to safety. It is not 
risk to scientific integrity. It is risk to money. So put that 
aside.
    The point that Congressman Upton made I think is very 
important. We need to be careful that we don't jump because of 
our need to get vaccines for those who need it that we do not 
definitively prove safety and efficacy before we make decisions 
about distribution.
    We have heard a lot about emergency use authorization. An 
emergency use authorization is important, but it has to be done 
in a situation where you fulfill the criteria for the emergency 
use authorization.
    I would be very disappointed if we jumped to a conclusion 
before we knew that a vaccine was truly safe and truly 
effective because I wouldn't want the perpetual ambiguity of 
not knowing whether or not it is truly safe and truly 
effective.
    That is the reason why we are doing several randomized 
placebo-controlled trials with power enough that could give us 
that answer.
    I hope that answers your question, Fred.
    Mr. Upton. Well, just one quick. What would be the earliest 
that you think, under the best scenario, that we might be able 
to see an EUA issued by [audio malfunction in hearing room] 
along with--I guess it would actually be the FDA, right, that 
would actually issue that?
    Dr. Fauci. Yes. The answer is yes.
    Let me just quickly answer that and hand it over to Steve 
because he may want to answer that.
    We are going into the first Phase I--Phase III efficacy 
trial in July. It takes at least a month to get to the second 
dose because it is a prime boost.
    It will take another couple of months to accrue or enroll 
enough people that if there is viral activity in the community, 
and we have our sites not only in the United States but all 
over the world, in Brazil and in South Africa.
    So if we get an efficacy signal, you are going to get an 
efficacy signal more quickly the more cases there are. Now, if 
it turns out that there are not a lot of cases, it may take 
longer and that is the reason why you can't give an accurate 
prediction of when you are going to get those data.
    Steve, do you want to take it from here?
    Dr. Hahn. Yes, thanks, Dr. Fauci.
    So just a couple of issues to your point, Congressman 
Upton. One is we are--we are working with the sponsors across 
the board--private industry, Operation Warp Speed, et cetera--
those who are developing vaccines, and we are providing 
technical assistance regarding clinical trial design, the 
number of participants in the clinical trials, as well as the 
endpoints that we want to see to make an adjudication about 
safety and effectiveness.
    And I want to emphasize what Dr. Fauci said and that is the 
acceleration is really around taking financial risk around the 
development process. The acceleration is not cutting corners 
with respect to the assessment of safety and effectiveness.
    The American people can rely upon the fact that FDA has 
many experts in the vaccine area. We have been doing this for 
years, and we will rely upon the science and data when it is 
available to us to make that adjudication and decision 
regarding an EUA. I cannot prejudge when that will happen.
    Mr. Pallone. Thank you. Thank you, Fred.
    Next, we have the gentlewoman from California, Ms. Eshoo.
    Ms. Eshoo. Thank you, Mr. Chairman. And morning, everyone. 
I would like to start with Dr. Redfield.
    Doctor, we had a conversation over the weekend, and I 
expressed to you, really, my pain, my disappointment about you 
as CDC director, the most prestigious institution in the world, 
infectious disease intervention.
    The United States today is number one--number one in the 
world in infections and in deaths. This is not anything that 
any of us can be proud of. The American people are in pain. 
They are grieving. There is a great deal of struggle in 
communities. There is confusion because for many reasons, and I 
urged you as head of CDC to speak directly to the American 
people.
    I know the agencies are talking to each other. I consider 
that a whisper because the American people are not hearing you 
speak out. They deserve to hear the truth. We have heard Dr. 
Fauci time and time again putting out pertinent information to 
the American people. The American people are divided on this 
issue of the virus. Imagine that.
    So I continue to urge you to speak out. You are a doctor. 
Put your white jacket on and speak weekly to the American 
people. They want to know what is coming, what is ahead. My 
constituents ask me on a consistent basis, what is next? What 
is our government doing? That is a haunting question. And so 
while we are doing the nice back and forth this morning, good 
questions on the part of members, I really remain dismayed and 
deeply disappointed.
    We need leadership coming out of the CDC, real leadership. 
It was an outrage that there was a gathering in Tulsa. Six of 
the President's advanced people were infected and it is my 
understanding that two Secret Service agents were. How can the 
CDC allow this pandemic, this virus to be something political? 
You have to push back. You are a scientist. You are a doctor.
    Now to Dr. Hahn, I am sure you have read several articles 
regarding hydroxychloroquine. Every study states it doesn't 
work in any setting. In fact, it has known side effects, 
cardiac issues being one, so there is a danger in terms of the 
side effects. As Commissioner you see all the data. Are you 
going to inform the American people, doctors across the 
country, about these facts?
    Dr. Hahn. Thank you, Congresswoman, for that question. And 
indeed, we are. I can refer the committee to several documents 
that we have put out over the last several weeks regarding 
hydroxychloroquine. With respect to the issues, we issued a 
safety alert, particularly around the combination of 
hydroxychloroquine within other drugs that might affect the 
heart. And as you know we have taken recent action regarding--
--
    Ms. Eshoo. Have you specifically spoken directly to the 
American people so isn't this notion about hydroxychloroquine?
    Dr. Hahn. Yes, ma'am. There is an FDA Voices piece that is 
authored by me as well as a piece that is directly to the 
American people about the status of hydroxychloroquine.
    Ms. Eshoo. This isn't paper. I want to know if you have 
spoken out verbally to the American people, to doctors across 
the country. People don't hear paper, with all due respect.
    Dr. Hahn. Yes, ma'am, and I appreciate the question. But 
every opportunity I have had to be in the media I have been 
asked that question and I have communicated that same 
information about the current status----
    Ms. Eshoo. You aren't answering the question, Dr. Hahn. 
There have been several disturbing articles expressing concerns 
related to political pressure being placed on the FDA by the 
President. Can you state unequivocally that if any political 
pressure is applied to you and the FDA that you will 
immediately report that to this committee?
    Dr. Hahn. I will certainly unequivocally state that if I 
receive political pressure I will report to this committee. I 
can tell you that I have not felt political pressure nor has 
the FDA to make any decisions in any specific direction.
    Mr. Pallone. Thank you.
    Ms. Eshoo. Well, it is not about decisions, it is about a 
direct political pressure. So thank you for your response and I 
yield back.
    Mr. Pallone. Thank you, Ms. Eshoo.
    Next is Mr. Latta from Ohio.
    Mr. Latta. Well, thank you, Mr. Chairman. And thanks to our 
witnesses and all the hard work that you have been doing over 
the last several months for not only the United States but for 
individuals from around the world. I really appreciate it.
    Dr. Fauci, if I could start my questions with you. And I 
know that our leader, Mr. Walden, had brought some of this 
stuff. Would you further explain how an infected individual 
develops antibodies and how long those antibodies remain 
effective in fighting off the virus and are you seeing 
different levels of antibodies in people who have been infected 
and what that means in terms of immunity?
    Dr. Fauci. Thank you very much for that question, 
Congressman Latta. So we need to start off by saying that we 
want to assume that you are dealing with an antibody test that 
has been validated by the FDA or by the NIH. That is important 
because a lot of the confusion out there. There are tests that 
are not validated. But let's assume you have a good test.
    Whenever the body gets confronted with a virus and 
recovers, even when they don't recover, the body is stimulated 
to make antibodies. In general, for viruses that we have a lot 
of experience with, those antibodies serve to protect you 
against exposure and infection after you are exposed to the 
same virus. So that is what we call immunological memory and 
these proteins block the virus.
    The one thing we do not know yet with COVID-19 is the 
relationship between the type of antibody, because the best 
antibody is called neutralizing antibody, namely if this were 
the virus and this is where the virus binds to the cell, the 
neutralizing antibody blocks the virus from binding to the 
cell. There are antibodies against other parts of the virus 
that are called binding antibodies; they don't mean much. So 
you have got to make sure you get the right antibody.
    The second thing is, what we still don't know is what the 
relationship between the titer of the antibody is, namely the 
level of the antibody and the degree of protection. The third 
thing we don't know is how long or what the duration of that 
antibody is going to be. We are going to find these things out 
as we study these individuals over months and a year or more, 
but remember, we are only a few months into this.
    So, A, we know they make antibody; B, it is likely they are 
protected for some period of time, but we don't know how long 
that is going to be. So the question I always get asked, which 
is a subtext, does that mean if you are exposed and you have 
antibody that you are protected? Likely you are, but we don't 
know how long you are protected.
    Mr. Latta. All right, thank you.
    Dr. Redfield, when a vaccine or treatment is developed, how 
will it be distributed to Americans?
    Dr. Redfield. Thank you for the question. It is a critical 
issue that is currently under discussion within the team to 
look at what the appropriate prioritization for distribution. I 
want to just comment that it may be very dependent on what the 
product is. Each of these vaccine products that are currently 
being developed may in fact, have differential utilization for 
different populations.
    So there are serious considerations to try to develop those 
prioritizations and it is going to be important to develop them 
dependent upon the product that they are going to applied to.
    Mr. Latta. Thank you.
    Dr. Hahn, and thanks very much for all your work and thanks 
for taking my calls especially on Friday nights and on 
Saturdays. I appreciate it. The FDA provided an emergency use 
authorization for remdesivir. Do you expect or envision the FDA 
to issue anymore EUAs for potential treatments in the fall?
    Dr. Hahn. Congressman, for potential therapies? Is that 
what you asked, sir?
    Mr. Latta. Right.
    Dr. Hahn. Yes. Yes, sir. So we are working very closely 
with sponsors regarding the development of therapeutics 
including with Operation Warp Speed. A hundred and thirty one 
clinical trials ongoing right now. I anticipate that we will 
receive data regarding several therapies in the future, plasma 
being one of them that we just discussed with Congressman 
Walden, and potentially also with some anti-inflammatory agents 
as well as for monoclonal antibodies. Those are being 
accelerated through the pipeline and then on potential 
therapeutics as well as prophylaxis moving forward.
    Again, can't prejudge the EUA process because we have to 
see the data. But I do anticipate that we will be receiving 
data.
    Mr. Latta. Thank you very much.
    Mr. Chairman, my time has expired and I yield back.
    Mr. Pallone. Thank you.
    Next we have Ms. DeGette from Colorado.
    Ms. DeGette. Thank you so much, Mr. Chairman.
    I want to thank the panel and welcome all of you. Many of 
you have appeared in front of my subcommittee, the Oversight 
and Investigation Subcommittee, a number of times. And just to 
let you know, the Oversight and Investigations Subcommittee is 
going to be continuing its investigations both about how we 
responded to this and where we go in the future, so you can 
expect to hear from us.
    I have some brief questions for each witness and I would 
like to start with you Admiral Giroir. The Chairman talked 
about comments last weekend saying that double testing because 
when you do testing, quote, you are going to find more people. 
And then again this morning, the President tweeted cases are 
going up U.S. as we are testing far more than any other country 
and ever-expanding. With smaller testing we show further cases.
    This is what he says and he also said this morning that he 
doesn't talk about it. So I know the chairman asked Dr. Fauci 
and Dr. Redfield they have been expected to test less, I am 
going to ask you since you are now in charge of overseeing the 
tests, has the President asked you to do fewer tests?
    Admiral Giroir. Thank you. And again I want to clarify that 
neither the----
    Ms. DeGette. Yes or no will work. Yes or no will work, 
Admiral. Has the President asked you to do fewer tests?
    Admiral Giroir. No, the President--neither the President 
nor anyone in the administration has instructed that we should 
do less testing, have said that to me, and we are proceeding in 
just the opposite.
    We want to do more testing----
    Ms. DeGette. OK.
    Admiral Giroir [continue]. Of higher quality.
    Ms. DeGette. I want to ask--so I want to ask you, Admiral, 
do you think that it is a good or a bad idea to do less testing 
so it will look like fewer cases?
    Admiral Giroir. My purpose in leading is to increase the 
number of testing. The only way that we will be able to 
understand who has the disease, who is infected and can pass 
it, and to do appropriate contact tracing is to test 
appropriately, smartly, and as many people as we can.
    Ms. DeGette. Thank you so much.
    Dr. Fauci, I wanted to ask you, I have seen some data the 
last few days that while cases are going up in this country, 
deaths are going down. And I have seen some reporting in the 
media that in part that is because younger people who tend not 
to die from COVID are the ones being infected. Should we see 
this as a positive sign or should we still be worried?
    Dr. Fauci. I think it is too early to make that kind of 
link, Congresswoman. Deaths always lag considerably behind 
cases. You might remember that at the time that New York was in 
their worst situation where the deaths were going up and yet 
the cases were starting to go down, the deaths only came down 
multiple weeks later.
    So you are seeing more cases now while the deaths are going 
down. The concern is if those cases then infect people who wind 
up getting sick and go to the hospital, it is conceivable you 
may see the deaths going up. So I think it is too early to say 
because the deaths are going down.
    Ms. DeGette. Thank you, Doctor. And I have another 
question, Dr. Fauci, for you. We have seen--and I think you and 
I have talked about this. Most vaccines take years, if not 
decades, to be approved and to be proved efficacious and 
sometimes we don't find a vaccine at all. I have two questions 
for you.
    Number one, do you believe that we will find a vaccine for 
the coronavirus; and number two, do you still stand by the 
prediction you gave us some months ago that we could actually 
have a vaccine by early 2021?
    Dr. Fauci. I feel cautiously optimistic, Congresswoman, 
that we will be successful in getting a vaccine. There is never 
a guarantee of that, but the early data that we are seeing 
regarding the immunogenicity and the induction of good 
responses makes me cautiously optimistic, always knowing that 
there is never a guarantee. You remember I told your committee 
a few months ago that a vaccine would be available from a year 
to 18 months. I said that in January of 2019--2020. A year from 
January to December. I still think there is a reasonably good 
chance that by the very beginning of 2021 that if we are going 
to have a vaccine that we will have it by then.
    Ms. DeGette. Thank you very much, Doctor.
    Mr. Chairman, I will yield back.
    Mr. Pallone. I thank the gentlewoman.
    Next we have Mrs. Rodgers from Washington State.
    I hope.
    Mrs. McMorris Rodgers. I am coming. Cathy McMorris-Rodgers 
is here. Am I here?
    Mr. Pallone. You are recognized for 5 minutes.
    Mrs. McMorris-Rodgers. Thank you, Mr. Chairman. I want to 
thank the Chair and the ranking member for holding this hearing 
and appreciate our witnesses for testifying today.
    COVID-19 is the challenge of the century as others have 
said. It is a health and economic crisis of our lifetime. We 
mourn the deaths of over a hundred thousand Americans and we 
must remember that we are not out of the woods yet. I want to 
especially express my heartfelt gratitude for the healthcare 
workers, the first responders, the emergency and essential 
workers who have been working around the clock to fight this 
virus, save lives, and keep our families safe. As our experts 
work tirelessly to develop a vaccine and treatment, I am 
confident that there is no country in the world who is better 
equipped to lead for a medical breakthrough than America. We 
can't trust China to lead.
    And that is why the Trump administration has created 
programs like Operation Warp Speed for bringing together the 
very best in the public and private sector to develop 
countermeasures that will fight the virus. We are leveraging 
the power of artificial intelligence, super-computing, and 
machine learning to speed up discoveries and enhance our 
knowledge base of the virus. In Washington State we have top 
researchers as well as biotech and pharmaceutical innovators 
who continue to be at the forefront of these breakthroughs.
    I look forward to learning more and appreciate all of you 
being here to help us understand what the administration is 
continuing to do to lead in the development of these tests and 
treatments that America needs so that we can usher in a new era 
of innovation and healthcare cures. To win the future, keep our 
families healthy and save lives, and to ensure our economy 
booms again, we must get this right.
    Dr. Fauci, as you know, adjuvants maximize the 
effectiveness of vaccines. Would you just explain a little bit 
further what an adjuvant is and are there any novel synthetic 
adjuvants in the pipeline and, if so, how will they play a role 
in the administration's pursuit of a COVID-19 vaccine?
    Dr. Fauci. Thank you very much for that question, 
Congresswoman. An adjuvant is a product distinct from the 
vaccine itself, but when given in conjunction with the vaccine 
it enhances the power of the immune response, so if you have a 
vaccine that gives a level of response that here when you get 
an adjuvant together with it you often boost it to a much 
higher level.
    We use adjuvants in several vaccines. The NIH has a major 
program in the pursuit and development of novel adjuvants of 
all different types. And, in fact, that is part of the program 
right now, to accelerate our vaccine development capability. So 
it is a good question but it is a very important part of what 
we do. Thank you.
    Mrs. McMorri-Rodgers. Thank you. Thank you for that.
    Dr. Hahn, as you know, FDA's decentralization of diagnostic 
test oversight has been very helpful in expanding the 
availability of diagnostic tests for COVID-19 but it is 
temporary. Would you just speak to how this flexibility has 
benefited the general public and how you think it would be 
helpful in the future for outbreaks or novel viruses?
    Dr. Hahn. Thank you very much, Congresswoman, appreciate 
the question. As you have pointed out, the flexibilities have 
allowed us to work with test developers. This has been 
throughout the COVID pandemic with all of our medical products 
a balance between the oversight so that we have tests that are 
valid, reproducible, accurate, but at the same time allow the 
developers the ability to have the freedom to develop those 
tests.
    And we have developed this partnership that I think has 
been very fruitful moving forward. I particularly like it with 
respect to the flexibility given the states, your state in 
particular which has excellent public health laboratories, as 
well as the University of Washington, and New York State is 
another example of this.
    Those are the sort of things that we are looking at now as 
we talk about how we want to move forward that we could 
potentially put in place on a permanent basis to facilitate 
test development. Hopefully, we will never be in a position 
again where we have to develop tests over such a short period 
of time like we have remarkably done during this time. But we 
really do need to talk about how these flexibilities could 
stimulate innovation and development of tests.
    Mrs. McMorris-Rodgers. Great. Well, thank you all. Thank 
you all for your leadership, your commitment during this time, 
the long hours, and I especially appreciate the way that we are 
looking forward to make sure that we are prepared in the future 
for whatever we may face. Thank you. Good to be with you.
    Mr. Pallone. Thank you.
    Now we go to Mr. Doyle coming to us from Pittsburgh.
    Mr. Doyle? Is Mr. Doyle----
    Mr. Doyle. Sorry, Mr. Chairman. I forgot to unmute.
    Mr. Pallone. Thank you.
    Mr. Doyle. Can you hear me now?
    Mr. Pallone. Yes. You are recognized for 5 minutes.
    Mr. Doyle. Thank you, Mr. Chairman, for holding this 
hearing and to the ranking member also and to our witnesses for 
your service on behalf of the American people.
    This committee has continued to conduct oversight of the 
Trump administration's shortcomings related to procuring and 
distributing personal protective equipment, or PPE. When states 
and hospitals were faced with critical shortages of PPE such as 
masks and gowns, President Trump passed the buck and said the 
federal government was, quote, not a shipping clerk. We saw the 
result of a failure of leadership.
    Without a national strategy, states have had to fend for 
themselves and even compete against each other for critical 
supplies. It has become so desperate out there that one former 
U.S. disaster official referred to this scramble as, quote, 
Lord of the Flies: PPE Edition. At a recent hearing before the 
Oversight and Investigation Subcommittee, Michigan Governor 
Gretchen Whitmer testified, quote, the lack of centralized 
coordination at the federal level created a counterproductive 
competition between the states and federal government to secure 
limited supplies, driving up prices, and exacerbating the 
existing shortages.
    Admiral Giroir, let me ask you. Do we have enough PPE for 
every front-line worker who needs it whether they be healthcare 
workers, first responders, or thousands of others whose job 
puts them at risk? Are people still having to reuse N95 masks, 
for example, and if we don't have enough, why hasn't the 
administration invoked DPA to greatly expand the manufacturing 
of these supplies?
    Admiral Giroir. Well, thank you for the question and I will 
do my best to answer that. Admiral Polowczyk is certainly 
running the supply chain with also Dr. Kadlec from ASPR. But 
being a member of the Unified Coordination Group at FEMA for 
the past three months, I am pretty familiar with this.
    I think as Admiral Polowczyk testified before and I think 
we all know is that there was an absolute shortage of 
everything when this started. Everyone in the world was looking 
for the same supplies and we tried to manage that both from 
increasing the supplies and using the DPA multiple times. For 
example, there were three investments, DPA Title 1 for N95s--
3M, Honeywell, and Owens & Minor--to improve production.
    We estimate that the country in the fall, if there were a 
COVID outbreak to this degree, would need about a 140 million 
N95s per month. We should have 180 million per month being 
produced domestically by that time. This was not available when 
we started in March. The industry was not here. This was all 
offshored.
    And I will just say, cumulatively, between March 1st and 
June 19th, the government distributed or enabled the commercial 
distribution through the air bridge of 160 million N95 masks, 
638 million surgical and procedural masks, 281 million gowns, 
and over 16 billion pairs of gloves. So this was really an 
enormous effort.
    We need to better prepared. This all needs to be onshore. 
We are working with S&S 2.0 to have a 60- to 90-day supply. We 
talked to governors in every state. Many of the states are also 
doing their own supplies for 60 to 90 days. So I am confident 
moving from here on as we ramp domestic manufacturing that we 
are going to be in a much better position than we were three 
months ago.
    Mr. Doyle. Thank you, Admiral.
    Dr. Hahn, let me ask you. Since demand for PPE increased 
this spring, we have seen many actors with little previous 
experience in the supply field enter the market. Reports have 
indicated that some are selling counterfeit or low-quality 
products that don't meet safety requirements or are unable to 
fill agreements. What steps is the FDA taking to ensure that 
companies are not circumventing federal oversight and injecting 
potentially substandard PPE into the United States market?
    Dr. Hahn. Thank you, Congressman. This is a really 
important issue. During the height of this epidemic and the 
increased demand, we provided regulatory flexibility for 
companies but insisted that they provide certification, often 
foreign FDAs, if you will, certification that the PPE met the 
requirements that we have in place and that the foreign 
governments had in place.
    But we did something else with respect to that and that is 
we also partnered with CDC and NIOSH, for example, with N95s to 
test, to verify that in fact that self-certification over the 
validity of the efficacy of the PPE was in place. And you have 
correctly identified that for a variety of reasons subsequent 
product that was shipped into the country did not meet those 
specifications.
    We immediately took action to make sure that those were off 
of the market and continue to do that and monitor it very 
closely.
    Mr. Doyle. Thank you, Mr. Chairman. I see my time has 
expired. I yield back.
    Mr. Pallone. Thank you, Mr. Doyle.
    Next we have Mr. Guthrie coming to us from Kentucky.
    Are you muted? Do you want to unmute?
    Mr. Guthrie. I thought I did that. I apologize.
    Hi. Brett Guthrie. I apologize.
    I Dr. Hahn, I am interested in the COVID-19 counterfeit 
testing. And I have a bill that would bring--it's called the 
Safeguarding Therapeutics Act that would assure FDA has the 
authority to destroy the counterfeit testing devices. And I 
will follow up with a question with this.
    What I am interested in, and what the people that I talk to 
every day are interested in, is what is going on in the future? 
How are we going to protect ourselves moving forward?
    We need the lessons learned from the past. We need to look 
forward. And Dr. Hahn kind of answered on--I mean, excuse me, 
Dr.--Admiral Giroir answered on the PPE kind of moving forward. 
But if I can just go with Dr. Redfield, Dr. Fauci, and then Dr. 
Hahn, if you will talk about pool testing and how that might be 
effective.
    What--the people that I've talked to want to know what is 
it going to look like in March--I mean, excuse me, what is it 
going to look like in August? Are kids going to be getting back 
in school? Are our nursing homes going to be safe? That is what 
people are looking for.
    So, Dr. Redfield, I know we are going to have flu, we are 
going to have COVID. What is the testing going to be like? Dr. 
Fauci, what do we need to be looking for? And Dr. Hahn, pool 
testing?
    And I will just open it up for you three to talk about, 
what is it going to look like in August, and are our kids going 
to be able to go back to school.
    Thank you. And I will start with Dr. Redfield.
    Dr. Redfield. Thank you, Congressman. I think, first and 
foremost, it is really important that we continue to take this 
time to continue to accelerate our capacity to diagnose, 
obviously, readily available, timely test results. Build that 
capacity for isolation and contact tracing, and self-
quarantine.
    That is fundamental. We are working hard to do that. As I 
mentioned in January, we had about 6,000 contact tracers in 
this country. The beginning of June it was up to around 27, 
28,000. It needs to continue to increase in my view towards 
100,000, if we get that operationally functional. That is going 
to be critical for what we're doing.
    Secondly, we do have to reinforce in the American public 
the importance of the social distancing interventions that we 
have discussed, particularly face coverings, six feet 
distancing, and hand washing.
    I anticipate that the states will begin to open up higher 
education and K through 12. It is going to be on a 
jurisdiction-to-jurisdiction decision. CDC will be issuing 
additional guidance on this topic in the days ahead as we 
continue to try to work and to give guidance on how to open up 
these, particularly the school systems, how to open them up 
safely.
    I will end with nursing homes. I think we have made 
enormous progress in the long-term care facilities, enhancing 
infection control. Admiral Giroir may want to comment about the 
commitment that FEMA made to provide all nursing homes with 
protective equipment for a period of time.
    And we are continuing, I think, to have aggressive 
surveillance in the nursing homes across this country where we 
have recommended that all residents get tested so that we can 
start with a clean baseline of understanding where the epidemic 
is.
    I will just end with the fact that although they only make 
up 0.6 percent of our population, nursing home residents have 
made up more than 35 percent of our mortality.
    Dr. Fauci. Let me very briefly----
    Mr. Guthrie. Thank you, Dr. Redfield.
    Dr. Fauci.
    Dr. Fauci. Yes, let me briefly address the question you 
asked about schools, because we get asked that all the time.
    I think the important thing to point out is that, as you 
well know, we live in a very big country that is certainly not 
a unidimensional country. It is very, very different whether 
you are in a New York metropolitan area or Casper, Wyoming. So, 
when you are asking about schools, you have to say where are 
you talking about, because we have different regions, different 
states, different cities, towns, and countries.
    So, some counties may have such a low level of infection 
that schools can open in a way that is exactly like normal. 
Others may be in a situation where it isn't really bad where 
you want to close the school, but you might want to make some 
modifications, alterations of scheduling, things like morning/
afternoon, one day or another day.
    So, it is up to the local officials to evaluate where you 
are in the particular region, what the recommendations that we 
really very carefully put out about the guidance of opening 
schools.
    So, you don't want to make one-size-fits-all for the United 
States. You want to tailor it to the degree of viral dynamics 
in the particular location that you are talking about.
    Mr. Guthrie. So, looking forward, we are really only going 
to know when we get closer to that point so we can make those 
decisions. That is unfortunate, but obviously that is the 
reality.
    I am about out of time, Dr. Hahn. I will submit a question 
for the record for pool--for pool sampling.
    Thank you very much. And I yield back.
    Mr. Pallone. Thank you, Mr. Guthrie. It sounded like there 
was a monster that was going to envelop you at some point 
there.
    Next we have Ms. Schakowsky from Illinois.
    Ms. Schakowsky. Thank you, Mr. Chairman. And I want to 
thank the witnesses.
    I have to disagree with you, Dr. Redfield. I think nowhere 
has the Trump administration's lack of leadership been more 
apparent than in our nation's nursing homes and long-term care 
facilities where we have lost 50,000 residents and workers to 
COVID-19.
    So, let's review some of the deadly failures.
    You delayed data collection on cases and deaths in nursing 
homes.
    You have not required--required--states to conduct testing.
    You are not giving workers adequate PPE--and I agree with 
Congressman Doyle on that--to protect themselves.
    You are allowing facilities to literally kick residents out 
of--out onto the street if there is a more profitable COVID 
patient to take their place.
    And since CMS Administrator Verma who is responsible for 
the safety of our nursing home residents has declined Chairman 
Pallone's invitation to speak, let me refer then to Dr. 
Redfield.
    The CDC website explains that your mission is to save lives 
by providing health information that protects our nation. So, 
why didn't you require nursing homes to report any data on 
COVID-19 cases and deaths until May, four months after--you may 
remember, you told me about the first case in Illinois--January 
30th? And to report the case of human-to-human transfer.
    On July 4th--on June 4th, you testified before the House 
Appropriations Committee and apologized for CDC's inadequate--I 
quote--response to COVID-19 race and ethnicity data. Yet, the 
same day CMS and CDC finally published COVID-19 data from 
nursing homes, and failed to include race and ethnicity 
information.
    So, when--when my office asked CMS about the exclusion, we 
were told to ask the CDC.
    So, will you promise to include race and ethnicity 
information moving forward so that we can identify the 
address--and address the racial disparities in nursing home 
COVID-19 cases?
    Dr. Redfield. Thank you, Congresswoman, for your question.
    First, I want to stress that since the early beginning of 
the pandemic that we have initially encouraged all nursing 
homes to report the cases through their health departments and 
through our National Healthcare Safety Network as of May 8th.
    Ms. Schakowsky. If I--if I could--if I could just briefly 
interrupt on the word encouraged. That, I think, is a problem, 
that there has been guidance, there has been encouragement, but 
what about mandating?
    Dr. Redfield. As I said, that as of May 8th now it is a 
requirement that this be reported in through CDC, as CMS has 
made that required. And we are working to make sure this 
reporting is comprehensive to include ethnic and racial data.
    As well as I would argue--put forth that we have worked 
hard to really accelerate training and retraining of infection 
control procedures in these nursing homes to, to try to 
mitigate the situation that, unfortunately, we did experience, 
as you pointed out, where the nursing home residents have taken 
a high burden of this initial outbreak.
    We will continue to work to get this reporting. This 
reporting is going to be forward-facing. CDC will forward the 
data to CMS. CMS will forward face it so families can make 
decisions based on their understanding of how different nursing 
homes are performing.
    We have recommended that the nursing homes, as you 
mentioned, that they screen all residents. And we have 
recommended that they screen all workers in nursing homes on a 
weekly basis because we do believe this is an important area 
that we have to do more as a nation to protect infections.
    Ms. Schakowsky. Let me just say, this kind of suggesting 
and recommending has clearly not been enough, in my view. This 
is the view of many observers, families, workers, that there is 
a crisis in our nursing homes that persists, and that we insist 
that the government do more to help.
    And I yield back.
    Mr. Pallone. Thank you, Ms. Schakowsky.
    Mr. Olson of Texas.
    Mr. Olson. Thank you, Chairman Pallone and lead Republican 
member Greg Walden for having this very important hearing. 
Welcome to our four expert witnesses. You all have been on the 
frontlines fighting the COVID-19 virus for about half a year 
now. We greatly appreciate all your efforts to make our country 
safer.
    And a special howdy to a former Rice Owl like myself, 
Commissioner Hahn. Go Owls.
    First of all, all of you know that Texas and Greater 
Houston have seen a spike in COVID-19 cases over the last week. 
Our state is at stage 3 of reopening and the trend is not good. 
To Dr. Tony Fauci of Houston, of Texas, Dr. Steve--Peter Hotez 
put out a tweet, and I quote what he said, if this trajectory 
persists, Houston will be the worst affected city in the United 
States, maybe rival what we are seeing right now in Brazil, end 
quote. And that is damn scary.
    The spike in the Greater Houston region is due to one 
country, Harris County, which is the county--the third largest 
county in America in the county seat of Harris County--I am 
sorry, Harris County and Houston, county seat of Houston, the 
fourth largest city.
    Mr. Chairman, I would like to have a graph added for the 
record about the spikes in Houston, in Harris County, and Fort 
Bend County.
    Mr. Pallone. Without objection, so ordered.
    [The information follows:]
    Mr. Olson. Thank you.
    There are many factors why we have this spike right now in 
Texas and in Houston. But what scares me the most is the 
increase in infectious cases in people aged 20 to 39, the so-
called youngsters. In the last week they are one-third of the 
new cases in my hometown of Sugarland, in my own county of Fort 
Bend, in the Greater Houston region. This is because of their 
attitude.
    To sum up their attitude my former boss Phil Graham said it 
best about these people, how they've--how they view this 
crisis. Bending the COVID-19 curve and ending the pandemic is 
like going to heaven: everyone wants to go there but fewer and 
fewer want to do the hard work to make it happen. I call this 
the bad attitude curve.
    And, Dr. Fauci, if you were king for a day, how could we 
change this bad attitude curve and make these people address 
this issue for the threat it truly is?
    Dr. Fauci. Well, Congressman, you bring up a very good 
point. One of the very perplexing things about COVID-19--and I, 
as some of you know, have been dealing with viral outbreaks for 
the last 40 years--I have never seen a single virus that is one 
pathogen have a range from 20 to 40 percent of the people have 
no symptoms, to some get mild symptoms, to some get symptoms 
enough to put them at home for a few days, some are in bed for 
weeks and have symptoms even after they recover, others go to 
the hospital. Some require oxygen. Some require intensive care. 
Some get intubated, and some die.
    So, you have a situation that is very confusing to people 
because some people think it is trivial, it doesn't bother me; 
who cares? And that is one of the reasons why what we do have 
is a lack of appreciation, that you have a dual responsibility. 
You have a responsibility to yourself, because I think thinking 
that young people have no deleterious consequences is not true. 
We're seeing more and more complications in young people.
    But even though the majority--the overwhelming majority of 
them do well, what you can't forget is that if you get infected 
and spread the infection, even though you do not get sick, you 
are part of the process of the dynamics of an outbreak. And 
what you might be propagating inadvertently, perhaps 
innocently, is infecting someone who then infects someone who 
then is someone who is vulnerable. That could be your 
grandmother, your grandfather, your sick uncle, or whom have 
you who ends up dying.
    So, it is a very difficult messaging when people say, I am 
young, I am healthy; who cares? You should care, not only for 
yourself but for the impact that you might have on the dynamics 
of the outbreak.
    Mr. Olson. The bad attitude syndrome.
    I am out of time. I have a question for the record for Dr. 
Redfield about hurricane evacuation of COVID-19 people from 
nursing homes.
    I yield back. Thank you very much.
    Mr. Pallone. Thank you, Mr. Olson.
    Next we go to Mr. Butterfield from North Carolina.
    You might have to unmute, G.K.
    Mr. Butterfield. Thank you, Mr. Chairman. I made a note to 
do that and failed to do it, yes.
    But thank you, Mr. Chairman, and thank you to all of our 
witnesses today.
    Mr. Chairman, in response to COVID-19, Congress has 
appropriated significant funding through the CARES Act. And it 
looks like some of that money is finally getting into 
underserved communities. The Congressional Black Caucus Health 
Braintrust, led by Congresswoman Robin Kelly, has met with some 
or all of you. And we've written you to urge funding for 
minority institutions and communities to fight the pandemic.
    Admiral, Mr. Secretary, you announced this morning that HHS 
has formed a partnership with the Morehouse School of Medicine. 
That's good. A partnership to coordinate a strategic network of 
organizations to deliver COVID-19--related information to 
minority communities hardest hit by the pandemic.
    Does the Morehouse funding give the medical school 
discretion to engage in aggressive contact tracing and other 
testing and education? We need more than information. What is 
their mandate?
    Admiral Giroir. So, thank you for that question, sir.
    The intent of this award is really not to empower Morehouse 
to physically do contact tracing themselves but to be a lead 
institution to build partnerships throughout the nation so that 
public health organizations, et cetera, can use the well over 
$11 billion that the CDC sent out.
    So, we are not funding Morehouse to be the boots on the 
ground, we are funding them to be the brains behind the 
operation, to really extend our network throughout the minority 
and underserved----
    Mr. Butterfield. Yes. Thank you for that. But how broad is 
their discretion, or are they restricted?
    Admiral Giroir. They--I would be happy to get into this, 
but they--they assembled really a remarkable group of partners 
using digital technologies, all types of network technologies. 
They have very broad discretion. This is out of my office----
    Mr. Butterfield. That's what---that's what---
    Admiral Giroir. And look, what I want to do--I want to do 
is make sure that the underserved get the information, get 
testing, and get links to care.
    Mr. Butterfield. Yes. You're saying broad discretion. Yes. 
That is what I wanted to hear, broad discretion.
    Dr. Fauci, the Washington Post reported this morning that 
Arizona is seeing a troubling spike, the State of Arizona. And 
as we all know, President Trump is in Phoenix today for a 
campaign rally at Dream City Church. And I suspect he will not 
be wearing a mask. I know that will disappoint you. It will 
certainly disappoint me.
    The Washington Post also reported that Arizona got its 
positive rate down to seven percent, but now it is up to 20 
percent after a 3-week rise.
    In my state of North Carolina we had got it down to seven 
percent. And now in North Carolina, it is up to ten percent.
    So, ten percent in North Carolina, up from seven; and 20 
percent in Arizona. What is the Administration specifically 
doing to slow the spread in states like Arizona and North 
Carolina that are seeing a rise? It can't--it just can't be 
explained away by more testing.
    Dr. Fauci. Well, Congressman, the percentages that you are 
speaking of are clearly indications that there are additional 
infections that are responsible for those increases. Because 
when you get an increase in the percentage of your tests that 
are positive, that is an indication that you do have additional 
infections.
    So, one of the issues that we have spoken about that is 
very clear is that when you have those kinds of increases, you 
must implement on the ground as effectively as possible the 
manpower, the system, the tests to do identification, 
isolation, and contact tracing to try and blunt that surge of 
cases in the two states that you are speaking of. Hopefully, 
that will be successful in the blunting of those cases because, 
if not, then you have the danger of having a gradual insidious 
increase in community spread, which will be much more difficult 
to contain as the community spread amplifies itself.
    Mr. Butterfield. Well, it just seems to me in closing, Dr. 
Fauci--and you don't need to respond to this--but it seems to 
me that the President seems to think that COVID is over and he 
can just push it all to the states.
    The data that is coming out of the states shows the 
necessity, the absolute necessity for a national strategy. 
Because while the virus may seem contained in some areas, it is 
conceivable that we can see a resurgence everywhere. This 
frightens me and should frighten the American people.
    Thank you, Mr. Chairman. I yield back.
    Mr. Pallone. Thank you, Mr. Butterfield.
    So, now Dr. Burgess is here, and we will recognize him for 
5 minutes.
    Mr. Burgess. Thank you, Mr. Chairman. In fact, I was with 
you virtually earlier, so I heard all of the discussion back 
and forth. And I would ask unanimous consent that my opening 
statement be made part of the record.
    [The information appears at the conclusion of the hearing.]
    Mr. Burgess. And I do want to thank our panelists for being 
here today. Outside of a tiny little bit that we tacked onto a 
budget hearing on February 27th, we really have not heard from 
this group enough in this committee, and certainly the Health 
Subcommittee. So, I want to thank you for your willingness to 
be here today and testify.
    I would also observe that we are about the one-year 
anniversary of the passage and signing of the Pandemic and All-
Hazards Preparedness Act. We had a wonderful opportunity in 
January, February, perhaps early March of this year to do some 
real-time introspection as to whether or not that bill had 
gotten things right. Did we do what we--was it performing as 
intended? Was it going as expected? And for whatever reason, we 
chose to talk about flavored tobacco, horse racing, and ticket 
stubs instead.
    So, we can be critical of the Administration, Mr. Chairman, 
but this committee--this committee bears some of that 
responsibility as well.
    Since we have been talking about community spread and 
increase in community spread, I also, Dr. Fauci, have been 
talking to some of my counterparts, physicians in the Lower Rio 
Grande Valley. And spread in that part near the border of 
Mexico--community spread has been apparently significant over 
the last week to ten days.
    I guess a question I would have for you and for Admiral 
Giroir is since we recognize community spread is increasing, 
and we recognize that there is still going to be the 
vulnerabilities of congregate living facilities, what are we 
doing to make certain that the appropriate amount of personal 
protective equipment is available to our congregate living 
facilities, extended care facilities, and nursing homes, not 
just in the Valley but any place where we see this community 
spread increasing?
    Admiral Giroir. So, thank you, Dr. Burgess. Good to see you 
again.
    Mr. Burgess. Good to see you.
    Admiral Giroir. Again, I am familiar with the PPE situation 
from my work on the UCG at FEMA. And I think you--I think you 
know that it was decided by the UCG very early that when we 
were able to secure the PPE, we would send directly to every--
and we are sending PPE directly to fifteen thousand--I believe 
the number is four hundred--nursing homes. And the numbers are 
really staggering. Millions of face shields, masks. Thirteen 
million pairs of gloves are already there.
    So, that is being distributed right now. And there are 
going to be multiple tranches of that.
    Again, Admiral Polowczyk is running this through the Supply 
Chain Task Force. I've got all the swabs and all the tests. He 
runs the PPE, and we interact a lot. So that is going to be 
going all the way through August and September, through all 
15,400 nursing homes, with multiple shipments of that.
    Mr. Burgess. Do you agree that that is on the immediate 
horizon ahead, that is one of the big vulnerabilities, 
community spread is increasing in some places, but we also know 
we have got areas where there is congregate living people with 
multiple risk factors?
    Admiral Giroir. So, I think as has maybe been said by the 
colleagues, we are clearly seeing community spread in a number 
of areas. If you look at counties, I think Dr. Birx detailed 
yesterday, there are about 110 counties of real concern 
throughout the country.
    Mr. Burgess. Well, I guess, Admiral--excuse me for 
interrupting, but my time is short. I guess what I am really 
asking is are we preparing and do our administrators and 
executives in nursing facilities--nursing home facilities know 
how to access the vast amounts of personal protective equipment 
that is being made available through Airbridge and through the 
work that you have done? Because if we don't get it to the end 
user, then it is a vulnerability and it will affect all of us.
    Admiral Giroir. Very briefly because I know the time, I am 
going to say the answer is yes, because we decided to ship door 
to door because we couldn't necessarily rely on the state 
distribution systems, you know, because you just can't get that 
deep. So, the only way to do it is get the address and ship it.
    And then, secondly, the testing regimens that are now 
mandated through CMS, recommended by CDC, are pretty excellent. 
Right? Every nursing home resident gets tested. Every worker 
gets tested every week. This is a very robust testing regimen--
--
    Mr. Burgess. Sure.
    Admiral Giroir [continue]. That we think is going to put 
high protection.
    Mr. Burgess. Certainly has been in Texas.
    Dr. Redfield, in just the very brief amount of time I have 
remaining, let me just ask you a question.
    I heard some things, and of course people are concerned 
about--about China, the impact that China has had on our 
ability to fight this virus. Are there people working in the 
CDC in Atlanta who are Chinese nationalists? Do you have such 
people on loan from Chinese labs in the agency?
    Dr. Redfield. Well, CDC does have an office--CDC has an 
office in Beijing that is right next to the China CDC, and we 
work collaboratively on a series of things, particularly 
respiratory viruses and particularly influenza.
    We haven't been brought in into the overall Chinese 
investigation of this current coronavirus epidemic. That's 
something I requested back on January 3rd and then formally on 
January 6th.
    Mr. Burgess. I want to be helpful to you on that, so I will 
follow up with you. And I have some ideas of some other things 
that we might think about as well. But I think that is a 
critical part of our discussion going forward and being 
prepared into the future.
    Thank you all. Thank you to the panelists.
    Mr. Pallone. Thank you, Dr. Burgess.
    Next we go to Ms. Matsui from California. You may have to 
unmute.
    Ms. Matsui. Thank you. I have unmuted. Thank you, Mr. 
Chairman. I want to also thank the witnesses for being here 
today. You have been on the clock 24/7, and we really 
appreciate it.
    Now, while a lot of our questions today have focused on how 
we found ourselves in the midst of this pandemic, I would like 
to focus my questions on the future and how we are preparing 
for the coming weeks and months and the possibility for another 
dramatic surge in cases of a second wave this fall, 
particularly during flu season.
    Dr. Fauci, it's nice to see you there. You have said that 
we are still in the first wave, and I understand that it's 
difficult to predict what a second wave would look like while 
we are still seeing high counts, high case counts and deaths 
currently. However, we must effectively prepare our 
communities, our healthcare workforce, and constituents for 
what could come as we make decisions about returning to work, 
going to school, and trying to readjust to what we consider 
somewhat normal life.
    Dr. Fauci, I want you to put your kind of prognosticator 
cap on right now. What are the projected infection mortality 
rates for the second half of 2020 and for early 2021?
    Dr. Fauci. Thank you for the question, Congresswoman. It is 
really impossible to give any projection about what the 
fatality rate or case rates are going to be. It's going to 
depend on so many factors. I think you alluded to that in the 
beginning of your question.
    When people talk about second waves--and I have said 
multiple times publicly that we are still in the middle of the 
first wave. So, before you start talking about what a second 
wave is, what we'd like to do is to get this outbreak under 
control over the next couple of months, so that when we enter 
into the fall, early/late, and then early winter, that we have 
such a low baseline that when you do have the inevitable 
situation of cases appearing as you try to gradually reopen the 
country, which we are all trying to do to varying degrees, 
depending upon what state, city, town, or county you are in, 
that if you get a level that's very low, when you get new 
cases, you can contain.
    And contain means identify, isolate, and contact trace, 
rather than have such a high level that when you get increases 
you have to mitigate right from the beginning. So that really, 
as you can imagine, complicates the situation and makes it 
impossible to predict what the case or fatality rate is going 
to be until you know where you are.
    Do you get down to baseline? And, if so, can you keep it 
there as you enter into the complicating situation that will 
inevitably occur when we get into the winter and inevitably we 
will have a flu season? And that is the reason why we are 
saying, all of us, why it is so important to really get as many 
people vaccinated with influenza as you possibly can, so that 
you can at least take off the table, for many people, one of 
the confounding issues that we are going to face this winter of 
two respiratory-borne infections simultaneously confounding 
each other.
    Ms. Matsui. And what would you say, Dr. Fauci, 
understanding that we don't know yet, but we have a sense that 
we are going to have a second wave, what should the public know 
so they can be prepared for this? And what, as a country, can 
we all do to reduce the potential for this second wave and 
somehow or another manage it? Because I think that all of us 
believe something is going to be happening, and we need to know 
what we can do now.
    Dr. Fauci. Thank you for that second part of the question. 
There are a lot of things that can be done. We know what the 
failings were early on: a lack of enough PPE, a lack of enough 
N95s, hospital bed issues, ventilator issues. All of that is 
right now being stored up in the Strategic National Stockpile 
in preparation for what we hope never occurs, but which very 
well might occur.
    So, it's the preparation. Also, as Admiral Giroir had 
mentioned, as we go into the fall, we likely will have the 
capability of doing 40 to 50 million tests per month, which 
means we can get a much better grasp of what the situation is 
of the dynamics of virus in the community. So, hopefully, we 
will be much better prepared if, in fact, we do get this second 
surge than we were months ago.
    Ms. Matsui. OK. Thank you very much, Dr. Fauci. And I yield 
back.
    Mr. Pallone. I thank the gentlewoman.
    Next we move to Mr. McKinley.
    Mr. McKinley. Thank you, Mr. Chairman. I'm going to direct 
my first question to Dr. Fauci. The New York Times, CNN, and 
The Washington Post have relentlessly criticized President 
Trump's response to COVID-19, calling it a failure. You heard 
today, a lack of leadership. But, wait. As you know, nearly 
750,000 people have died in America from drug overdose, and we 
still don't have a solution. AIDS has killed over 700,000 
people in America, and we don't have a cure for that either.
    But, look, the first case of COVID was diagnosed in America 
just 155 days ago. And, according to testimony we had earlier 
this spring, the pharmaceutical experts say that we could have 
a treatment by fall and a vaccine by January, keeping in mind 
it took almost ten years to come up with a vaccine for the 
influenza and four years for mumps. Nevertheless, the media and 
the left simply can't help but criticize President Trump.
    So my question to you is: do you think that President Trump 
is being judged fairly?
    Dr. Fauci. Actually, that's an unfair question, because you 
are asking me to pass judgment on the press's treating of the 
President of the United States. That's----
    Mr. McKinley. It may be unfair, but you've had--numerous 
times you've commented and criticized--or contradicted what the 
President said. So do you think he is being judged fairly?
    Dr. Fauci. Well, it depends on what you mean. I mean, I 
work in the White House, and I believe that everyone there is 
doing everything they possibly can----
    Mr. McKinley. Thank you.
    Dr. Fauci [continue]. To do what they need to do.
    Mr. McKinley. That's it. So, Dr. Fauci, you said as late--
and I've got a newspaper article here--that as late as March 
31st, there was no consensus on wearing masks. And the 
President, as you know, relies on your expertise. Do you now 
regret not advising people more forcefully to wear masks 
earlier?
    Dr. Fauci. OK, we're going to play that game. Let me 
explain to you what happened back then.
    Mr. McKinley. It should be a yes or a no.
    Dr. Fauci. No, there's more than a yes or no, by the tone 
of your question. I don't regret that, because let me explain 
to you what happened. At that time, there was a paucity of 
equipment that our healthcare providers needed, who put 
themselves daily in harm's way of taking care of people who are 
ill. We did not want to divert masks and PPE away from them to 
be used by the people.
    Mr. McKinley. OK. I have----
    Dr. Fauci. Now that we have enough, we recommend----
    Mr. McKinley. Reclaiming my time, I've got two more 
questions. So, thank you for that, Dr. Fauci.
    So, Dr. Redfield, I am going to be directing this to you. 
Nursing homes, as we've talked about here earlier, make up 
nearly 40 percent of all of the COVID deaths. And the CDC 
issued guidance on proper protocol for these facilities, yet 
states like Michigan, New York, New Jersey, and California 
apparently--apparently disregarded that guidance. So, Dr. 
Redfield, do you think the decisions of these governors led to 
unnecessary deaths in these nursing homes?
    Dr. Redfield. Thank you for your question. I think the 
critical issue here is--two things. One, our guidance is just 
that: guidance. Two, areas that we could impact the nursing 
homes, particularly infection control, working together with 
CMS, very aggressively early on, after the Seattle outbreak was 
recognized in that nursing home, really rechanneled energy into 
looking at the effectiveness of infection control in those 
nursing homes, then restricted visitors to make sure----
    Mr. McKinley. Do you think that the decisions led to 
unnecessary deaths by not--by allowing infected residents to 
come back into the nursing home?
    Dr. Redfield. I think, again, all of these decisions that 
have been made in the early days are subject to hindsight. We 
gave clear guidance on how people should be handled if they 
come into these nursing homes.
    Mr. McKinley. OK. Now, the third question--back again to 
you, Dr. Redfield--we know in the foreseeable future that we're 
not going to have a zero risk of transmission. We're not going 
to get to that. So if we want our economy to recover, we know 
our schools have to reopen. So, going back to the school 
question, in addition to tracing, distancing, wearing masks, 
what rate of infection is needed, in your mind-set, for 
children to go back to school? What's the rate of infection? 
One percent?
    Dr. Redfield. Yes, I'm not prepared to give you that 
definitive answer. I am prepared to say that one of the most 
important things we need to look at is not the number of 
infections but the consequences of these infections. And there 
are two really big consequences. One is hospitalization and 
mortality, and the other is our economy, right?
    And I think we are clearly seeing that, in many parts of 
our nation, that one can open our economy safely, but it is 
going to require more vigilance than some of us see right now 
with the social distancing. We're going to continue to try to 
emphasize the importance of social distancing, face masks, and 
hand-washing as we continue to do it.
    It's my expectation that many jurisdictions will be opening 
schools. We're going to try to give the guidance to help them 
do it safely. I think you're right, as Dr. Fauci alluded to 
before, it is going to be influenced by the kinetics of the 
outbreak in the jurisdiction at the time. I'm not prepared to 
give you that number, but I think we're going to see 
progressive jurisdictions move to open schools in the fall.
    Mr. McKinley. I yield back. My time's up.
    Mr. Pallone. We now go to Ms. Castor, the gentlewoman from 
Florida. I'd ask everybody to unmute before they begin.
    Ms. Castor. Great. Thank you so much. Thank you to our 
witnesses today.
    When you compare the number of confirmed cases and the 
number of deaths in the United States with countries across the 
globe, it's really shocking. And it makes me angry and it makes 
me sad at the same time. We have 2.3 million confirmed cases. 
We have just over 120,000 Americans who have lost their lives 
just in a few months' time. And it appears that other countries 
have done a better job controlling the spread. They've done a 
better job on testing and tracing. Every advantage that the 
United States of America has with our scientists, our public 
health experts, something has gone wrong here, and I think it 
starts at the top. I think the President's behavior and 
comments have undermined our public health professionals every 
step of the way.
    Dr. Redfield, I would like to know, how often do you 
interact with the President and talk to him about public health 
guidelines and bringing all of your expertise to bear? How 
often do you interact with the President?
    Dr. Redfield. Well, I have regular interactions as part of 
the White House Task Force, as a member to it, and participate 
in each and every one of the task force meetings. And as 
relates to my interactions directly with the President, I'm 
going to keep those between myself and the President.
    Ms. Castor. Well, you know, every time the President 
contradicts scientists, every time he contradicts our public 
health experts, whether it's the wearing of masks or mass 
gatherings or drinking bleach or taking hydroxychloroquine, it 
costs lives. And I agree with my colleagues that we really 
expect you to be more outspoken when it comes to these public 
health advisories. It will cost lives, it has cost lives, and--
but I'll change direction now.
    For Dr. Fauci, you know, Floridians are very concerned with 
the latest spike in cases. The Florida Department of Health 
announced, just a little while ago, we've got another 3,300 
cases and 64 deaths just since what was announced yesterday. 
Twenty-five percent of the total cases in Florida have been 
confirmed in just the past ten days, and we have a positivity 
rate of now up to 13 percent in the past week.
    So, what message do you have for the State of Florida, and 
other hot spots across the country, as we have so many more 
young people who feel invincible that are testing positive and 
our economy is opened up? What is your advice to Floridians and 
others in hot spots?
    Dr. Fauci. You know, my advice to the Floridians is the 
advice I would give to anyone and everyone: to follow the 
guidelines that we have very carefully thought out and put out 
on how one can reopen or open America again. And that is to 
stay within the framework of the particular phase of reopening 
you are in and to not throw caution to the wind.
    I think what happens, related to the comment I made a 
little while ago about the confusion there must be, 
particularly among young people who have a pent-up urge to go 
out, which is understandable, but what they need to appreciate 
is that they are part of a process of the dynamics of an 
outbreak. And although they themselves may perceive that they 
are at very low risk for something that would be deleterious to 
them, by propagating the process of the outbreak they may be 
indirectly hurting people by infecting someone, who then 
infects someone, who then infects someone who is vulnerable.
    So they need to understand that. If we could get that 
message across, that it is not an all-or-none phenomenon; 
getting back to normality is going to be a gradual step-by-step 
process, and not throwing caution to the wind.
    Ms. Castor. And what about masks for young people? There's 
a lot of--you know, they look at national leaders who are not 
modeling your advice and your behavior. What do you say? 
Because you're a trusted scientist and expert. What do you say 
directly about wearing masks and mass gathering?
    Dr. Fauci. I will be very consistent, and I will say it yet 
again, that you should not congregate in crowds. You should 
keep your distance. And even though many people, for a variety 
of reasons, do not listen to the--not suggestion, but plea to 
not congregate in crowds, some people are going to do that 
anyway.
    If you do, please wear a mask. And as you wear a mask, and 
you are in a situation where you are getting animated, in a 
demonstration or in a rally or wherever you are, avoid as best 
as possible the urge to pull your mask down and shout.
    So, Plan A, don't go in a crowd. Plan B, if you do, make 
sure you wear a mask.
    Mr. Pallone. Thank you, Ms. Castor.
    Ms. Castor. Thank you, Dr. Fauci. I yield back.
    Mr. Pallone. Next, we go to Mr. Kinzinger in Illinois. And 
unmute.
    Mr. Kinzinger. Thank you, Mr. Chairman. I'm unmuted. Thank 
you, Mr. Chairman, and thank you to all of the guests for being 
here. It's a weird time, and very important, so thank you.
    I think, you know, one of the discussions is this 
communication's important. So, whether it's between Federal 
Government, state governments, local governments, nonprofits, 
businesses, but also international governments. And I think we 
need a lot more information, eventually, on what the Chinese 
Communist Party knew, what they withheld, and what real impact 
they had, and I look forward to that being more investigated.
    We have all seen the stories about people who are testing 
positive for the virus and they show no symptoms at all. And, 
in some cases, it was able to spread through entire communities 
of people without ever knowing that they have been infected. 
So, Dr. Fauci, let me ask you, given the significant rate of 
these asymptomatic infections, how can antibody tests improve 
our understanding of the transmission of COVID-19 and to help 
identify populations at risk?
    Dr. Fauci. Well, one of the things that we need to do, and 
I think that's very important, related to a previous question 
about getting the kinds of surveillance studies that allow you 
to get a much better handle on, A, the real percentage of 
asymptomatic carriers; B, the rate at which they infect others; 
and a variety of other things, I mean, things that are really 
important questions.
    We learned, interestingly--actually, to my surprise, 
Congressman--that when you look at asymptomatic individuals and 
people who are symptomatic, the level of virus in their 
nasopharynx is almost the same, which is almost 
counterintuitive, but it is a fact which tells you that the 
danger of transmissibility is such that it is very important to 
understand the penetrance of asymptomatic infected people.
    And when you do get them, you need to identify them, 
isolate, and contact tracing. And questions that were asked, I 
don't know, an hour or so ago to the testing issue, we need to 
do much, much more surveillance testing. And so the 40 to 50 
million tests per month that would be available as we get into 
the late summer and early fall are going to be able to ask some 
of the questions you're appropriately asking.
    Mr. Kinzinger. Thank you. And----
    Admiral Giroir. If I could just build on that for a second. 
The 40 to 50 million tests I said assume no advances in 
technology, and that's not even including pooling. I do say 
pooling because the FDA just put up standards for validating 
pooling. So we would expect, based on preliminary data we have, 
that on many tests we can at least pull 5 to 1, and maybe up to 
10 to 1.
    So when you do that math that I think will be validated 
very quickly by academic institutions and by large 
organizations, that number of 50 million is going to go up by 
five-fold, at least, per month.
    Mr. Kinzinger. Great. Thank you. And that's what's amazing, 
frankly, is American ingenuity, when we put our minds to it and 
seeing the advances and hopefully when we get to a vaccine.
    So, at the beginning of the pandemic, both my wife and I 
actually experienced what we thought were symptoms of COVID-19, 
and we recently decided that we would go in and get an antibody 
test. I had that done, and I found out that I was actually 
negative for the antibody.
    So, Dr. Redfield, in your testimony, you stated that, at 
this point, we don't know whether the presence of antibodies 
provides immunity to the virus. So, with this in mind, how does 
antibody testing help, if we don't know if it provides immunity 
to the virus? And what are the benefits of an antibody test 
from an individual patient's perspective?
    Dr. Redfield. Thank you very much for the question, 
Congressman. I think right now, at this stage, I think 
important at the individual patient level, we don't know what 
it means, particularly, in terms of immunity, as Dr. Fauci said 
earlier. What it does mean--again, assuming it is a reliable, 
approved-FDA test--that you have been infected in the past. We 
don't know, though, what that means in terms of immunity.
    Its value to us at CDC is its surveillance advantage. Right 
now, we continue to do surveillance throughout the United 
States through a variety of different systematic collections we 
are doing, and it allows us to see the full extent of the 
infection.
    Right now, the data at a national level suggest that for 
every documented infection that we have as a case report, 
there's actually about ten other individuals that actually had 
been infected. That data will continue to be refined as we 
continue to expand our antibody testing, but I really think its 
major role right now is an important surveillance tool.
    Mr. Kinzinger. Thank you. And I'll just add another 
question, I'll submit it for the record, about this virus 
lasting on surfaces.
    But, with that, I will yield back. Thank you.
    Mr. Pallone. Thank you. And, thanks, I remind everyone that 
you can submit questions for the record, to the task force and 
the witnesses, and that all opening statements will be entered 
into the record.
    So, next we go to Mr. Sarbanes from Maryland.
    Mr. Sarbanes. Thank you, Mr. Chairman. Can you hear me?
    Mr. Pallone. We can.
    Mr. Sarbanes. Terrific. I want to thank the panel. Last 
month, the Trump Administration announced the launch of 
Operation Warp Speed to support rapid research and development 
of COVID-19 vaccines, therapeutics, diagnostics, and so forth. 
It's a project that is supposed to coordinate efforts across 
the Federal Government and engage the private sector, including 
at least five pharmaceutical companies that are developing 
vaccines.
    So, I'm trying to understand a little bit better how that 
works. First off, there's been some concerns raised about the 
venture, including potential conflicts among its leadership, 
conflicts of interest.
    Dr. Fauci, you have had decades of experience leading 
public-private partnerships with pharmaceutical companies to 
develop the vaccines. Transparency is important, is it not, in 
these collaborations?
    Dr. Fauci. Thank you for the question. The Operation Warp 
Speed is an endeavor that is a Department of Defense/HHS, led 
by Secretary Esper and Secretary Azar, to try and get 
diagnostics, therapeutics, and vaccines done in a way that is 
coordinated, with the maximum speed possible without 
sacrificing scientific integrity.
    It is divided up into three groups. The leader of this is 
Moncef Slaoui, a person with great experience in industry; as 
well as General Perna, who is an Army General who is very well 
versed and very experienced in supply chain processes of 
getting vaccines, when we do get it, to be produced to the 
level that is needed, as well as to be distributed equitably 
throughout our society.
    So it's a----
    Mr. Sarbanes. Let me ask--let me jump in, because I wanted 
to ask Dr. Hahn. I understand that a senior FDA official was 
initially tapped to lead the vaccine development under 
Operation Warp Speed, but then left the project out of concerns 
about political pressures to approve vaccines.
    I assume you agree that the role FDA plays in this has to 
be one that's not impacted by political pressure, and that your 
agency is ready to adopt the highest standards in approving any 
vaccine that's developed under this initiative?
    Dr. Hahn. Congressman, thank you for the question. Your 
point is very well taken, and I can assure you that we will 
retain our regulatory independence. We will use the science and 
data that come to us, and we will use our high standards to 
assess the safety and efficacy of a vaccine. We have world-
class experts who will continue to maintain that.
    One point I do want to make clear, sir, is that we drew a 
very bright line between Operation Warp Speed and all of our 
sponsors. We do not engage in decisionmaking, neither I nor Dr. 
Marks nor Dr. Cavazzoni, with respect to those decisions. We 
provide technical assistance, as we do to all sponsors, but 
we've made it clear that we do not participate in those 
decisions because we absolutely must maintain regulatory 
independence and make the right decision for the American 
people based upon science and data.
    Mr. Sarbanes. Thank you. And, again, I'm trying to 
understand sort of the boundaries or reach of the Operation 
Warp Speed effort. So, my initial sense is that it was focused 
on these five selected companies that are pursuing vaccine 
candidates. I'm not entirely clear--and maybe that's not 
right--but I'm not entirely clear on what this means for 
vaccine exploration/development beyond that.
    For instance, I've been reading just over the last week or 
ten days or so about this oral polio vaccine opportunity, maybe 
that it has promise, maybe it doesn't, but some inquiry there, 
I guess, may be warranted.
    I'd like to get the panel's perspective on whether you 
consider those kinds of inquiries outside of Operation Warp 
Speed, or is Operation Warp Speed broad enough to accommodate 
those kinds of things in addition to whatever is happening with 
the five companies? And sort of from where your different 
agencies sit, what's your perspective and understanding of 
that?
    So let me just, I guess, go down the line. Dr. Redfield, 
why don't we start with you, and then Dr. Fauci, and I guess 
Commissioner Hahn would be the other one.
    Mr. Pallone. Brief responses, gentlemen, because his time 
is up.
    Dr. Redfield. Yes, very quick. The only thing I would say 
is it's intriguing in terms of the potential, what we call 
viral interference with these live-virus vaccines, whether it's 
polio or measles, that they may impact another RNA virus from 
being able to establish infection. So, really, that's the 
hypothetical. I think it's intriguing, not for just this 
pathogen, but for other RNA viruses.
    Dr. Fauci. Yes. Very quickly, I think your question was, is 
there room for other vaccines? The answer is yes, through 
multiple mechanisms. Anything is on the table. It could be 
through Operation Warp Speed. It could be through a number of 
mechanisms that we have in our research institution at NIH. So, 
I can understand your concern, but the doors are not closed to 
other candidates. You can be assured of that, sir.
    Dr. Hahn. Congressman, from FDA's perspective, we 
absolutely--the doors are open there as well. We are working 
with multiple different sponsors, pharmaceutical companies, as 
well as Operation Warp Speed. We will look at all data that 
comes across the door. We will provide technical assistance to 
all who want to develop a vaccine and therapeutics.
    Mr. Sarbanes. Thank you.
    Mr. Pallone. Thank you. Mr. Griffith?
    Mr. Griffith. Thank you very much, Mr. Chairman. I greatly 
appreciate it.
    Dr. Fauci, and then Dr. Redfield, I'm going to put you all 
a little bit on the spot, because I want to talk about schools. 
And as you might imagine, a lot of constituents are very 
concerned about what's happening in the schools.
    And, Dr. Fauci, you earlier made some statements which led 
me to believe that you believe that, not only nationally, but 
even within a state the size of Virginia, we probably ought to 
be looking regionally, and maybe even locally, as to how we do 
it and how we go forward. Did I understand that correctly?
    Dr. Fauci. You understood me correctly, Congressman. And 
that's the point I want to make, because it's really a source 
of confusion. It's not one-size-fits-all. I think you have to 
look at it at the local level, the county level, the regional 
level, the city level, the state level.
    So, we often say, in America, should you or should you not 
be open? I mean, that is almost a non-question, because we're 
such a large country, and so heterogeneous, and such a range of 
involvement of this virus in different parts of the country.
    Mr. Griffith. And, Dr. Redfield, I'll move to you because 
in the Commonwealth of Virginia they often are citing, and for 
various things related to schools and others, they cite the 
CDC. Do you agree with Dr. Fauci in his assessment?
    Dr. Redfield. Yes. It needs to be a very targeted, 
jurisdictional decision.
    Mr. Griffith. And I greatly appreciate that, because my 
district is four hours from D.C., even though people often 
think I am right next door. And then the district stretches 
from the very edge of it, which is four hours away, another 
four-and-a-half hours, so that it ends up going further west 
than Detroit, Michigan. And the district, just my district, is 
larger than the State of New Jersey. So, even within the 
district, we may need to have some additional regional 
approaches. Would you all agree with that?
    Dr. Redfield. Yes.
    Mr. Griffith. And Dr. Fauci indicates that, as well.
    All right. Commissioner Hahn, in a statement on March 30th, 
2020, you recognized the importance of facilitating access to 
viral samples in order to speed up the development of tests. 
You noted that, in the future, making virus samples available 
earlier to commercial developers will be crucial to deploying 
tests quickly.
    This certainly will not be the last time we face a rapidly 
spreading novel virus strain. How can the process for obtaining 
viral samples, especially inactivated viral samples, be 
improved in the future for quicker access?
    Dr. Hahn. Congressman, thank you for that question. And I 
think that is one of the lessons learned from this situation 
with COVID-19, is that access to those samples is very 
important. We would work with NIH, with academics, with the 
CDC, to make sure that those are available.
    And just to make a point, we, for serology tests, have made 
a reference panel now available to developers to actually 
facilitate that. That's an example of what U.S. government, 
FDA, NIH, and CDC could do.
    Mr. Griffith. I thank you. And I apologize, Admiral Giroir? 
Did I say it close to correct?
    Admiral Giroir. That's good enough.
    Mr. Griffith. All right. Earlier this year you informed 
this committee that enough testing supplies would be 
distributed so that the states could test the recommended two 
percent of their populations per month. Yet, according to Johns 
Hopkins coronavirus testing trend tracking center data, only 
about 20 percent of the states are testing the recommended two 
percent of their population per month, while another 20 percent 
are testing less than one percent of their population per 
month.
    Has the Administration been distributing supplies to 
states? And, if so, why do you believe some states that have 
testing supplies are not testing more of their population?
    Admiral Giroir. So, thank you for that. Again, before the 
full state plans were just received--and this was part of the 
PPP funding that we've reviewed, and we've reviewed them 
extensively with the CDC--we set preliminary targets for every 
state by phone calls with every single state, every single 
state health officer, epidemiologist.
    Overall, in May, the target was about 12.9 million tests 
throughout the country and about 12 million were done. This is, 
really, very good considering many of the states try to do 
three or four times as many tests as they had done cumulatively 
during that time.
    Mr. Griffith. So you think we are on track.
    Admiral Giroir. I think we're really on track right now. It 
looks very good. Some states have underperformed, especially in 
May. Most of them have improved their performance in June. And 
our preliminary view of all of the state plans, the great 
majority of them, I mean, the overwhelming majority, were very 
good to excellent. So, everyone is getting the message, and I 
look forward to that.
    Mr. Griffith. I thank you. And, Dr. Fauci, if I can come 
back to you. When we first started this, you know, we knew it 
was going to be tough, and that we were probably never going to 
get rid of this particular virus, but we talked about bending 
the curve and making sure our hospitals were ready. Based on 
your comments on PPE and face masks and so forth, I believe 
that you think that we're probably ready, maybe not perfect, 
but we're ready. And have we not bent the curve?
    I understand it's not over. It's not going to be over 
anytime soon. We've got to wear our masks and do what we're 
supposed to do, but don't you think we've bent the curve and 
that our hospitals are now ready? Is your mic on?
    Dr. Fauci. Sorry, sir. Yes. We've been through a terrible 
ordeal. We've learned a lot. The preparedness now is clearly 
logarithmically different than it was in the beginning.
    Mr. Griffith. And so we've bent the curve and our hospitals 
are ready.
    Dr. Fauci. Right.
    Mr. Griffith. I yield back.
    Mr. Pallone. Thank you. Next we go to Mr. McNerney, coming 
from California. Would you unmute?
    Mr. McNerney. I thank the Chairman, and I thank the 
witnesses for your work and your expertise. Are you able to 
hear me there, Chairman?
    Participant. We can hear you.
    Mr. McNerney. OK. Thank you. So, I am deeply concerned 
about President Trump's decision to terminate the United 
States' relationship with the World Health Organization. And 
I'm not alone in this concern. The head of the American Medical 
Association has called the President's move a senseless action 
that will have significant harmful repercussions now and far 
beyond this perilous moment. It appears that the President is 
not acting on sound public guidance, but is instead 
scapegoating the WHO to deflect from his Administration's 
failure in responding to the COVID-19 pandemic.
    According to a report in Vanity Fair, key U.S. agencies 
that work with the WHO on critical public health programs were 
not consulted or asked for an impact analysis before the 
President's decision to withdraw.
    Dr. Fauci, were you consulted about the potential public 
health impact of the United States withdrawing from the WHO? 
And, if so, what were your recommendations?
    Mr. Pallone. Jerry, I apologize. We said we were going to 
take a break at 1:30 so everyone can go to the restroom or 
whatever for 15 minutes, and Dr. Fauci had to step out.
    So I'm going to ask you to start over again. We will take a 
15-minute break so everybody can use the restrooms, and then 
we'll start again with Jerry and you'll have to repeat your 
question.
    This committee stands adjourned for 15 minutes.
    [Recess.]
    Mr. Pallone. All right. The committee will reconvene. We 
will try to go as quickly as we can. And I appreciate everybody 
bearing with us. And if you have to step out, please come back.
    And we left off with Congressman McNerney. Jerry, you are 
going to have to repeat your question, and unmute.
    Mr. McNerney. OK. Thank you, Mr. Chairman. I am assuming I 
am live now.
    I want to remind the chairman that your video from the 
committee is coming in and out, so I am not sure if I am in 
sync or not.
    But I am truly concerned by President Trump's decision to 
terminate the United States' relationship with the World Health 
Organization. And I am not alone in that concern. The American 
Medical Association, for example, has called the President's 
move a senseless action that will have significant harmful 
repercussions now and far beyond this perilous moment.
    It does appear that the President is not acting on sound 
public health guidance, but is instead scapegoating the WHO to 
deflect from his administration's failure in responding to the 
pandemic. Again, according to the Vanity Fair, key U.S. 
agencies that work with the WHO on critical public health 
programs were not consulted or asked for impact analysis before 
the President's decision to withdraw.
    Dr. Fauci, were you consulted about the potential public 
health impact of the United States withdrawing from the WHO? 
And, if so, what were your recommendations?
    Dr. Fauci. Thank you, for the question, sir. I was not 
specifically consulted about the withdrawal or the attempt to 
withdraw.
    The situation with many of us is that we have longstanding 
relationships with the WHO. The NIAID is a collaborating 
center. I have a memorandum of understanding with Dr. Tedros. 
Many of our bits of information that we get, Dr. Redfield and I 
are on a weekly call that is supervised by the WHO where we get 
the opportunity to speak to the medical leaders in the various 
countries.
    So, with regard to what policy comes from the White House 
is not--I have not been consulted on. And it hasn't really 
impacted the kind of interaction----
    Mr. McNerney. I am going to interrupt you, Dr. Fauci. I 
can't--it's like watching--listening to a cell phone that is 
coming in and out. So I am going to go to my next question, 
which is really the same question for Dr. Redfield.
    Were you consulted about the potential public impact of the 
U.S. withdrawing from the WHO? And if so, what were your 
recommendations?
    Dr. Redfield. As with Dr. Fauci, no, not directly.
    CDC has a long history with working with WHO. We continue 
that collaboration. We are working on both polio eradication, 
the Ebola outbreaks in the DRC, influenza surveillance across 
the world. So, we continue working at the technical scientist-
to-scientist level. And so, we continue to do that.
    Mr. McNerney. Again, I couldn't hear the response, and I 
hope the Committee improves the situation.
    According to Dr. Ashish K. Jha, Faculty Director of the 
Harvard Global Health Institute, pulling this critical global 
health investment while the world is in the middle of battling 
a pandemic will have outsized consequences, and it will 
certainly make all of us less safe. And this will put more of 
lives at risk, not only globally but here in the United States.
    Dr. Fauci, do you have concerns with the President's 
decision to withdraw from the WHO?
    Dr. Fauci. Yes, I do. And that is the reason why I am sorry 
that you did not hear my explanation.
    What I was saying is that despite any policy issues that 
come from higher up in the White House, we at the operational 
level continue to interact with the WHO in a very meaningful 
way, literally on a day-by-day basis.
    Mr. McNerney. Thank you.
    Dr. Redfield, if the United States formally withdraws from 
the WHO, how will that impact the CDC's ability to protect 
Americans?
    Dr. Redfield. Yes. We will--as I said, we are continuing to 
work with WHO in our public health efforts in a number of 
different programs. And, again, the implication will become, 
you know, where there is colleagues and able to collaborate, 
clearly there can be limitations on our ability to provide 
direct funding to the WHO, but we have the ability to provide 
funding to the operations through different mechanisms, so we 
continue the public health work that we need to get done.
    Mr. McNerney. Thank you, Dr. Redfield.
    Well, as a member of Congress with a science background, I 
am concerned that science is being ignored for political 
purposes. We must be certain that consequential decision, like 
withdrawing from the WHO, are based on sound public health 
guidance and not on pursuit of a scapegoat. Science must have a 
voice at the table. Whether it is regarding treatments for the 
current and future pandemics, climate change, or other issues 
of public concern, we must include science in decision-making. 
Ignoring science is dangerous and a disservice to the American 
public.
    Mr. Chairman, I yield back.
    Mr. Pallone. Thank you, Mr. McNerney.
    Next, Mr. Bilirakis.
    Mr. Bilirakis. Thank you, Mr. Chairman, I appreciate it. 
And I want to thank the presenters for their testimony today 
and all the work you do on behalf of our constituents.
    Dr. Fauci and Dr. Hahn, in the scientific community's 
COVID-19 responses, we have seen unprecedented scientific 
collaborations and research information sharing at a pace 
unlike anything before in history. Clinical trials are approved 
in record time, while laser focus remains intent on patient 
safety.
    Regulators and drug manufacturers are learning from each 
other from joining together in the critical fight against 
COVID-19.
    In line with that innovation, is the COVID-19 Evidence 
Accelerator, which is a public/private partnership initiative 
launched by the Reagan-Udall Foundation for the FDA, in 
collaboration with Friends of Cancer Research, to advance 
understanding of COVID-19 through focus on analysis of real-
world diagnostic and clinical data.
    Question: do you believe these scientific collaborations 
will lead to lasting changes in how we innovate for drugs and 
vaccines--for drugs and vaccines? How will the innovation 
changes affect research into diseases like ALS and Alzheimer's 
disease?
    Dr. Fauci, if you--OK. All right, Commissioner Hahn.
    Dr. Hahn. Congressman, thank you for highlighting this 
really important endeavor and partnership with the Reagan-Udall 
Foundation and the Friends of Cancer Research. This effort is 
an attempt to really accelerate, as the name implies, the use 
of real-world evidence in our decision-making from a 
development and a research point of view.
    A couple of points I would like to make, sir. And I do 
thank you. One is, we have to be really careful that we do this 
in a robust and careful way because the gold standard remains 
clinical trials, randomized clinical trials. That is important 
that we understand that level of evidence.
    However, in a rapidly moving situation like we have now 
with COVID-19, where we make decisions based on the data that 
is available to us at the time, having additional data 
afterwards, as those decisions play out, as we gather evidence 
of how tests work in the real world, about how treatments are 
administered, very pragmatic data that allow us to then go back 
and revisit the decision, to me there is nothing wrong with 
that, that is actually a really good thing. As the doctors in 
the room know, when you are taking care of a patient and you 
get more data, you bring that back to the table. In fact, you 
must incorporate that in your decision-making.
    Mr. Bilirakis. Absolutely.
    Dr. Hahn. So, I think this is a great opportunity. I would 
love to see us do more. But as I mentioned earlier when asked 
that question, I would love to continue the conversation with 
Congress.
    Mr. Bilirakis. Very good.
    Dr. Fauci, would you like to respond?
    Dr. Fauci. Yes. I totally agree. I think that what Dr. Hahn 
has mentioned is something that spills over into what we do at 
NIH and NIAID, is the clinical trial process, which is really 
the gold standard of those types of decisions.
    Mr. Bilirakis. Very good. Thank you.
    The next question is for Dr. Redfield. Has CDC coordinated 
with agencies, such as the Administration on Community Living, 
to improve efforts to protect the elderly?
    What steps has CDC taken to foster increased collaboration 
between the public health sector, and aging services sector, to 
meet the needs of older adults during this pandemic?
    Dr. Redfield. Thank you, Congressman.
    Mr. Bilirakis. Thank you.
    Dr. Redfield. CDC has a long, established relationship with 
the ACL to continue to work on health and well-being, 
particularly the elderly, but also people with disabilities. We 
work together in trying to cross-clear information from other 
agencies, and their materials.
    Also, CDC has reached out to, obviously, AARP to help to 
provide tools for older adults that we can get out and take 
advantage of their distribution. And we will continue to do 
that.
    Obviously it is a critical group. It was highlighted in 
terms of the morbidity and mortality in this particular 
pandemic, as you know. So, again, I think we will continue to 
cross-collaborate with the ACL and try to help facilitate their 
mission.
    Mr. Bilirakis. Excellent.
    Next question, again Dr. Redfield. Given the fact that we 
continue to learn about the virus in real-time, how often is 
CDC updating its testing guidelines?
    Dr. Redfield. Well, it is intermittent. We recently posted 
our updated testing guidelines last Friday. And I know, as 
we've gotten some feedback from the states, there's an interim 
week posting that is going to come to clarify a few issues this 
week probably.
    And then, on top of that basic guideline, we are posting 
specific guidelines for specific situations. So, we did 
infrastructure, critical infrastructure, we did nursing homes, 
we did medical. This week I suspect we are going to do K 
through 12 and higher universities. And then I suspect shortly 
thereafter we are going to do non-critical infrastructure, 
businesses.
    So, we are trying to add specific testing guidelines to 
specific situations. And, obviously, when there is new science 
and new situations we update them in that setting. But I think 
you will see there is going to be a series of targeted testing 
guidelines for unique situations that will be posted over the 
next several weeks.
    Mr. Bilirakis. Very good. I appreciate that.
    I yield back, Mr. Chairman. Thank you.
    Mr. Pallone. Thank you.
    Next member is the gentleman from Vermont, Mr. Welch.
    Unmute, please.
    Mr. Welch. Thank you very much. Thank you very much, Mr. 
Chairman and our Ranking Member Walden. Thank you for your 
patience and for your extraordinarily good work.
    I think it is fair to say that not a single member of this 
committee, Republican or Democrat, as of December of last year, 
or even January or February, had any notions that there was 
this emerging threat from the coronavirus. But, on the other 
hand, my understanding is that public health officials always 
anticipate, and there are two things that are essential to be 
ready. One is preparation, and two is communication.
    I want to ask a few questions about preparation. My 
understanding is that the National Security Council had a 
playbook for early response to high-consequence emerging 
infectious diseases. And that indicated that we should, in 
preparation, move swiftly to fully detect outbreaks, procure 
PPE, secure supplemental funding, use the Defense Production 
Act.
    Are any of the witnesses aware of that report having been 
followed in 2019, or January or February of 2020? Just a yes or 
no.
    It sounds like the answer is no.
    Dr. Fauci. No, I am not exactly sure what you are referring 
to. I think you are referring to a document that was put out 
prior to the outbreak about what the response should be.
    Mr. Welch. Right.
    Dr. Fauci. Yes. You know, if you look substantively, much 
of what is put--that was in that document, actually was 
implemented with the exception, as I think you are alluding to, 
is that the amount of stockpiled PPE and other items that were 
needed were not at the level that we were able to respond in as 
efficient way as possible.
    Mr. Welch. Right.
    Dr. Fauci. Right.
    Mr. Welch. And there was a real delay in the use of the 
Defense Production Act.
    Also, there had been a White House Global Pandemic Response 
Team that was eliminated in May of 2018. Anyone think that that 
was a good decision, to eliminate that?
    I am not there to see your responses. I take it the answer 
is no.
    In the travel ban that the President did implemented 
January 31, as I understand it, that only applied to foreign 
nationals coming from Wuhan, but it did not include permanent 
residents or family members or nationalized American citizens. 
Did that significantly limit the benefit of that travel ban?
    Dr. Redfield. Thank you for the question, Mr. Congressman. 
This is Redfield, CDC.
    Mr. Welch. Yes. Very briefly, if you would, because I don't 
have more time.
    Dr. Redfield. Yes, those individuals, those individuals as 
American citizens were qualified to come into America when 
allowed. They went into 14-day quarantine.
    Mr. Welch. But the quarantine wasn't enforced, is my 
understanding.
    Let me ask a few other questions about communication. I am 
sure that every one of you, who is very careful about your 
communications, knows how important that is. When the President 
said on February 23, 2020, that the stock market is starting to 
look very good, and the coronavirus looks very much under 
control, if any one of you agrees with that, can you raise your 
hand?
    And on February 27th----
    ADM Giroir. I am sorry, we didn't, none of us heard that 
question. Could you just repeat that?
    Mr. Pallone. Peter, could you repeat the question again?
    Mr. Welch. What I said is that communication is extremely 
important. And we have before us extremely good and careful 
communicators, for which I thank them.
    On February 23, 2020, President Trump indicated that the 
stock market is, quote, starting to look very good, and the 
coronavirus is, quote, very much under control.
    Does anyone at the table agree with that statement? If so, 
raise your hand.
    And another statement was that----
    Mr. Pallone. Peter. Peter, listen to me.
    Mr. Welch. Yes.
    Mr. Pallone. You have got to give them a chance to respond, 
because you are not here.
    Did you hear his question? If you don't want to respond, 
that is fine. But I just ----
    Dr. Redfield. He asked us to raise our hands.
    Mr. Pallone. Oh, I see.
    Dr. Fauci. Nobody raised their hand.
    Mr. Pallone. OK. So nobody raised their hands. OK.
    Next.
    Mr. Welch. All right. On February 27th President Trump said 
that COVID-19 will disappear like a miracle. Do any of you--did 
any of you agree with that statement by President Trump at that 
time? If so, raise your hand.
    Mr. Pallone. OK. No hands were raised, Peter.
    Next.
    Mr. Welch. And, finally, President Trump indicated on March 
9 that COVID was comparable to the common flu. I heard your 
testimony, Dr. Fauci, and you are fearful about the flu making 
the situation worse. But do you agree that there is any 
comparison between COVID and the common flu? That is for Dr. 
Fauci.
    Mr. Pallone. You have to put your mike on, Dr. Fauci.
    Dr. Fauci. Sorry.
    It is not the common flu.
    Mr. Welch. OK, thank you. I see my time is up. I yield 
back.
    Mr. Pallone. All right, thanks a lot.
    Mr. Johnson of Ohio is recognized for 5 minutes.
    Mr. Johnson. Well, thank you, Mr. Chairman and Ranking 
Member Walden, and to our witnesses. Especially our witnesses, 
for taking your critical time. The work that you are doing is 
so very important. Obviously we are not out of the woods with 
this virus yet, so you are still on the front lines of it.
    You know, I want to shift gears a little bit and talk about 
something I don't think I have heard anybody else talk about. 
You know, during this COVID-19 pandemic and the associated 
lockdowns and distancing orders, many vulnerable Americans, for 
the first time, became isolated and, in many cases, too fearful 
or unable to get essential healthcare.
    In eastern and southeastern Ohio where I live, and across 
rural America, unfortunately this can be the reality even in 
normal times. A specialist could be a three-hour-plus drive 
away, or a symptom could go unchecked for days because an 
elderly person might not have a loved one close by to drive 
them to their doctor.
    Increased use of telehealth could help alleviate this 
problem. Telehealth has been a priority of mine for a long 
time, and it has taken on a new sense of urgency with so many 
elderly and medically-compromised people finding it potentially 
hazardous to leave their homes due to COVID-19.
    I am really pleased that President Trump and his 
administration used the emergency authority that Congress gave 
them to remove the regulations and red tape that had previously 
hindered robust deployment of telehealth. And as a result, 
countless vulnerable Americans now have access to their doctors 
from the safety of their home, ensuring continuity for 
essential medical care.
    I have heard patient after patient, and provider after 
provider, who have taken advantage of these safe, new services. 
They love the convenience of it and the immediate access to 
care. They tell me they don't want to go back to the way that 
it was before.
    It is time for Congress to make robust access to telehealth 
permanent for all Americans, especially the most vulnerable 
among us.
    So, Dr. Fauci, I would like to start with you.
    Do you believe that telehealth practices, virtual doctor 
visits, could be an effective tool in helping to promote--or, 
protect vulnerable individuals in the event of a second wave of 
COVID-19, or even in a future infectious disease pandemic?
    Dr. Fauci. Yes, I do, sir. I believe that telemedicine is a 
very important component. It should have been even more 
implemented. But as we look forward in the future, I think you 
are going to see a lot more of that, not only for the reasons 
that you bring out, given the specific situation we are in now, 
but for a variety of other situations.
    And I think Admiral Giroir has a very keen interest in 
this.
    ADM Giroir. Thank you. I would just like to emphasize that, 
as well, is that I think we have learned tremendous lessons 
about the utility of telemedicine, lessons that most of us 
thought that would be there.
    But for example, just to understand the uptake, the week of 
January 15th there were only 500 telehealth visits by Medicare. 
The week of April 15th, there was 150,000 of them. We have seen 
telehealth visits be instrumental in combating our burgeoning 
SUD issues, particularly with opioid use disorder, 
teleprescribing, increasing access to buprenorphine.
    So, I think all of us with M.D.s behind our name understand 
that the whole key is getting healthcare to people where they 
are, and not making them come to a major tertiary or quaternary 
center, unless they really need to be there. So, we are all 
very anxious to increase the use of telemedicine going forward.
    Mr. Johnson. OK. Well, Dr. Redfield, you know, during the 
last several months we have seen situations where at risk, 
elderly, and isolated individuals have missed regular doctor 
appointments and preventative health screenings. As one of 
America's leading public health experts, can you speak briefly 
to the dangers to public health if patients looking to continue 
mental health treatment, to check in with their specialists, or 
even to consult with their doctor, are not able to do so over 
an extended period of time?
    Dr. Redfield. Thank you very much, Congressman.
    I think it is important to emphasize that, you know, as we 
did limit healthcare, largely the purpose was to keep certain 
jurisdictions from overwhelming their health systems when we 
were working towards the peak.
     Unfortunately, with healthcare being broadly limited 
across the nation, as you point out, there were real health 
consequences. Clearly, an individual's mental health services, 
individual's substance abuse services, but also, you know, 
individuals, we have a marked decline in childhood 
immunization. Many people missed their preventative medicine 
visits for mammograms or pap smears or colonoscopies.
    So, it is really important that we get the health system 
back and operational. And I do think the introduction of 
telemedicine is a critical component and something that needs 
to stay as part of the innovation, as we work more and more to 
move from a disease-based system to a health system. So, I 
think it is critical.
    We have seen an increase in suicides. We have seen an 
increase, obviously, in drug use disorder. It is important to 
get these health services back and operational in a manner 
which the American public can access.
    Mr. Johnson. Well, thank you very much.
    And my time has expired. So, Mr. Chairman, I yield back.
    Mr. Pallone. Thank you, sir.
    Next is the gentleman from New Mexico, Mr. Lujan.
    Unmute your connection, there.
    Mr. Lujan. Thank you, Mr. Chairman.
    Dr. Redfield, under federal statute the CDC is required to 
treat tribal epidemiology centers as public health authorities, 
and share all data and data sets. Dr. Redfield, last week your 
staff indicated in writing that the data sharing issue--what is 
that, Mr. Chairman?
    Mr. Pallone. Commenting on your artwork. I apologize.
    Mr. Lujan. Oh.
    Dr. Redfield, last week your staff indicated in writing 
that the data sharing issues reported in Politico were merely a 
miscommunication with a single tribal epidemiology center. But 
that isn't true.
    My office has confirmed that this problem goes beyond a 
single center and the center's report that they have 
encountered problems obtaining other data sets from CDC, beyond 
COVID-19.
    Dr. Redfield, do I have your commitment to work with each 
of the 12 tribal epidemiology centers to sure they get access 
to all the data they are entitled to under law?
    Dr. Redfield. Yes. The initial episode that you brought up 
was obviously a significant miscommunication. But you are 
right, that there is still issues to be worked out. Our team is 
currently working with the tribal epidemiology center, and we 
are committed to correcting that for all tribes.
    Mr. Lujan. So, Dr. Redfield, you could direct your staff 
right here and now to release that data. Is that something you 
are prepared to do?
    Dr. Redfield. I didn't hear. I'm sorry, I didn't hear the 
question.
    Mr. Lujan. Dr. Redfield, you could direct your staff right 
here and now to release that data to the tribal epidemiology 
centers. Is that something you are prepared to do?
    Dr. Redfield. We are working with them as we speak. One of 
the keys, Congressman, is to make sure that we have secure data 
systems to transport the data. And that is in fact, what our 
teams are working to--to finalize that. And as soon as that is 
finalized, to maintain the security of the data, it will be 
transferred.
    I have been told that that is going to be completed, 
hopefully, this week or within the next one to two weeks for 
all 12 tech directors.
    Mr. Lujan. Thank you, Dr. Redfield. And please report to 
the Committee when that is done. Thank you.
    The Trump administration failed to bring COVID-19 testing 
to scale in the early months of the pandemic. Even now, five 
months later, testing capacity is nowhere near where America 
needs it to be.
    On January 31st, Secretary Azar declared COVID-19 a public 
health emergency. Five weeks later, on March 6th, President 
Trump infamously declared that, quote, anybody that needs a 
test can have a test. They are all set. They have them out 
there, close quote. Yet, on the same date, fewer than 3,300 
tests were completed in the United States.
    On April 28th, President Trump said testing in the United 
States would surpass five million per day.
    Admiral Giroir, yes or no, are we currently in the United 
States conducting five million tests per day?
    ADM Giroir. No, we are not. We are doing about 500,000 
single tests per day.
    Mr. Lujan. That's my understand, about half a million 
tests.
    Now, nearly every leading public health expert agrees that 
the centerpiece of reopening the country is robust testing, 
tracing, and isolation strategy. One public health expert has 
said, quote, the lack of testing has been not only a public 
health catastrophe in the U.S., but is also a direct cause of 
our economic suffering, close quote.
    Admiral Giroir, we have been hearing both proclamations and 
promises on increased testing for months now, and every time 
they come up short. What is going to be different moving 
forward? And how does the United States get to the 50 million 
tests promised, particularly in light of the President's 
evident lack of concern over the need for testing?
    ADM Giroir. Thank you, Congressman, but I disagree with 
your question. I don't believe we have come up short every time 
we have said something. Since March 12th I have been very 
forthright about what we are going to provide, what the 
imitations are, what some of the constraints are, and that we 
are doing everything possible to increase that.
    Right now we are doing about 15 million tests per month. 
Although we have need for more testing, our national positivity 
rate is about 6.5 percent, so we are certainly getting in the 
range. Right now six or seven states are above ten percent. We 
have to really surge into those areas.
    When I tell you 40 to 50 million tests that is because I 
know every single lab producer, what they are doing, when they 
are providing it, how they are going to distribute it, and how 
many swabs are going to be there. So, the capacity will be 
there for 40 to 50 million tests, at least, in the fall. And I 
have that provider by provider, material by material.
    And, hopefully, it will be much greater than that when we 
have pooling, and hopefully some of the new technologies from 
the NIH, from BARDA, that we can move into that realm.
    Mr. Lujan. Thank you, Admiral Giroir. And I appreciate your 
leadership and respect you very much.
    The one area where I disagree though, is that President 
Trump promised 5 million tests per day very soon, on April 
28th, and we are still at only half a million tests each day. 
That appears that we have fallen short. So, I continue to look 
forward to working with you.
    And with that, I yield back, Mr. Chairman.
    Mr. Pallone. Thank you, Mr. Lujan.
    Next we have Mr. Long, from Missouri.
    Mr. Long. Thank you, Mr. Chairman.
    And, Dr. Hahn, there are a number of initiatives between 
the federal agencies and private industry to accelerate the 
entire process for the development, manufacture, and 
distribution of COVID-19 therapeutics. The administration 
recently established Operation Warp Speed, and FDA has set up a 
Coronavirus Treatment Acceleration Program, or CTAP, as they 
call it.
    Could you talk about the FDA's role in the development of 
therapeutics under Operation Warp Speed? And how does the FDA 
integrate its work and its own initiatives, like CTAP, with 
Warp Speed?
    Dr. Hahn. Thank you, Congressman, for the question.
    Approximately ten weeks ago, FDA stood up what we call 
CTAP, Coronavirus Treatment Acceleration Program, as you 
mentioned, and that was for a variety of reasons. One is we 
indeed wanted to accelerate the development of therapeutics on 
behalf of the American people but do it in a very robust way 
that looked at the science and data.
    We also, because we had gotten a significant number of 
applications and at this point our best estimate is double the 
normal of applications that we have during a regular time pre-
COVID, because of that we had to prioritize applications based 
upon science and the highest priorities of science. So across 
the spectrum of our medical products CTAP allowed us to 
prioritize the science and then address those applications, 
because what we wanted to do is make sure that we in real-time 
with those applications address any questions that developers 
had.
    I think the other important point here is that we had 
people come to the FDA who had never before applied to the FDA 
for an application of any sort, whether it be an emergency use 
authorization or an IND, and so we really had to hold hands 
with industry, with sponsors, with academia, to try to help get 
through the process.
    I think a great example of what can be done is the work we 
did within IND to get the remdesivir protocol up and running 
and the speed with which I think it was completed that 
ultimately led to a EUA. We are working with all sponsors, sir, 
not just Operation Warp Speed, but we are providing all 
sponsors, but and including Operation Warp Speed technical 
assistance.
    What are the trials that we think need to be done, what are 
the end points that need to be looked at, how can we accelerate 
those clinical trials and the design, and we will continue to 
do that as we continue to go through this pandemic.
    Mr. Long. OK, thank you.
    And Dr. Fauci, could you speak to the HHS's role as part of 
the Warp Speed and its efforts to accelerating manufacturing 
capacity and ensuring the manufacturers can invest early and 
aggressively in vaccine and therapeutic development?
    Dr. Fauci. Thank you very much for that question, a very 
important question. Congressman, and that was one of the things 
I refer to earlier on in the discussion. That as part of the 
process of developing the vaccines in Operation Warp Speed that 
there is employment of contracting organizations to already 
start scaling up development of vaccines, particularly the 
first one that I mentioned that will go into a Phase 3 trial in 
July has already had contracted through HHS and BARDA, for the 
production by a contracting organization of hundreds of 
millions doses, ultimately, the first group of which would be 
delivered at the end of the year and the rest in the first 
quarter of 2021.
    Mr. Long. OK, yes. Thank you. I was a little confused in 
your opening remarks. Of course, we have been here a long time 
today and I can't remember exactly everything that I have 
heard, but I was wondering about that so thank you for 
clarifying.
    And, Dr. Hahn, I will go back to you. Looking long term, 
what do you think the FDA and Congress could do to promote 
domestic manufacturing of drug therapy?
    Dr. Hahn. Congressman, this is a very important issue and I 
appreciate you bringing it up. We have seen across the medical 
products that we regulate issues related to redundancy in 
manufacturing and our dependence particularly in the foreign 
sphere where during a public health emergency we might have a 
lot of difficulty given the increased demand of having access 
to those supplies, both precursor products such as 
pharmaceutical precursors as well as final finished form of the 
drugs and PPE.
    So very much we have been working on our technical 
assistance because manufacturers depend upon our technical 
assistance to help them develop the manufacturing procedures 
that lead to a quality product. We very much are leaning in on 
this. It is one of our major initiatives for advanced 
manufacturing but also domestic manufacturing. It would be very 
good to work with Congress further on this.
    I think this is a particularly important lesson learned and 
the more we can bring manufacturing home and provide that 
redundancy to the supply chain, I think the better off we will 
be in the future. Thank you.
    Mr. Long. OK. I am getting the red light so I do yield 
back. Thank you all.
    Mr. Pallone. Thank you, Billy.
    Mr. Tonko of New York. Unmute.
    Mr. Tonko, are you muted?
    Mr. Tonko. Can you hear me?
    Mr. Pallone. Yes. Now we can.
    Mr. Tonko. OK. Hey, thank you, Mr. Chairman, and thank you 
to our panelists for all the information exchange.
    Last week, while participating in a telephone town hall 
with my constituents, I got a simple question from Ruby in 
Schenectady for which I had no good answer. She asked me 
straightforwardly, if the government is telling everyone to 
wear a mask in public, why does President Trump refuses to wear 
one?
    So, Dr. Fauci, please help us set the record straight. What 
does the evidence tells us about the benefits of face masks or 
face coverings when it comes to transmitting or contracting 
COVID-19?
    Dr. Fauci. Thank you for the question, Congressman. So 
although we don't know the exact percentage; we can say very 
clearly that wearing a mask is definitely helpful in preventing 
acquisition as well as transmission. The data for your wearing 
a mask and if you are inadvertently not knowing you are 
infected, protecting you from infecting someone else, is 
stronger data than the data that says that you will be 
protected.
    However, everyone agrees in the public health sector that 
wearing of masks is beneficial. It may not be perfect, as we 
often say wear it and don't let the perfect be the enemy of the 
good, it is always better to have a mask on than to not have a 
mask on both for acquisition and for transmission.
    Mr. Tonko. Thank you. And I listened earlier in the hearing 
to my friends and colleagues talk about this spike in numbers 
in Texas, and I couldn't help but think that precautionary 
efforts come to prime importance. They can be defined and 
written or they can be shared by example. And so I, 
unfortunately, witness as the President seems to believe he is 
above this evidence-based recommendation you just described and 
has rejected, or injected, rather, politics into public health. 
Not only as he refused to be seen on camera wearing a face 
mask, but last week he claimed that some Americans are wearing 
masks as a way to signal disapproval of him.
    Now I think that, you know, leadership as a form of 
precautionary instruction is required of the President and any 
of us in elected office. We should be setting the right 
example. Does the President's refusal, Dr. Fauci, to wear a 
face covering and his efforts to politicize the wearing of face 
masks send the wrong message about the advice coming from 
public health experts like yourself and others who are at that 
expert table?
    Dr. Fauci. No, I don't think I can comment on what the 
President, the multiple factors that go into the President not 
wearing a mask. Certainly, I wear a mask in public all the time 
not only because I want to protect others and to protect 
myself, but also to set an example. So I guess that answers 
your question.
    Mr. Tonko. Yes. And have you had any time to advise the 
President to wear a mask in public? If so, what was the 
response that you received?
    Dr. Fauci. I have not directly recommended to the President 
to wear a mask, but I think it is very clear to anybody in the 
country, because I talk about it so often, of the importance of 
having physical distance with a mask and if you are going to be 
either beyond your control or by your own choice in a crowd 
that it is imperative to wear a mask at all times.
    Mr. Tonko. Thank you.
    And, Dr. Redfield, let me turn to you. On April 3rd, I 
believe, CDC released guidance recommending the use of face 
masks or face coverings in public settings such as grocery 
stores, and more recently CDC issued recommendations suggesting 
that employees that were [audio malfunction in hearing room] 
face covering as well as promoting their use when someone is 
likely to raise his or her voice such as at a protest for 
racial justice or at a political rally.
    So what prompted the need for these recommendations and 
what does the American public need to know about the use of 
face masks and whether and when they should wear them?
    Dr. Redfield. Thank you very much for the question, 
Congressman. I want to echo the comments Dr. Fauci made. You 
know, our recommendations are clear. One of the most powerful 
weapons we have against this virus remains as it was before and 
that is social distancing, face coverings, and our ability to 
practice rigorous hand hygiene.
    Clearly, when we recognize that asymptomatic transmission 
or pre-symptomatic transmission was significant, that is when 
it was clear that we wanted to recommend that all individuals 
wear a face covering in order to, you know, protect other 
individuals in case they were asymptomatically infected. We 
continue to recommend that. Our recent guidance on mass 
gatherings, we again tried to illustrate the importance of 
trying to maintain social distancing and to wear face 
coverings.
    And as Dr. Fauci said, in the event that you are not going 
to maintain that distance, it is critical that you wear a face 
covering.
    Mr. Tonko. Well, I think it is unfortunate that like so 
much of the administration's response, the message coming from 
the White House undermines the message coming from public 
health experts [audio malfunction in hearing room] support the 
health of the American people.
    With that I yield back, Mr. Chair, the balance of my time.
    Mr. Pallone. Thank you, Mr. Tonko.
    Next is Mr. Flores from Texas.
    Mr. Flores. Thank you, Mr. Chairman. I want to thank each 
of our witnesses for appearing today. My internet access is a 
little bit spotty today, so hopefully you will be able to hear 
me.
    I want to brag on the Trump administration and the team 
witnesses that are here today for the response to the SARS-CoV-
2 spread. First of all, we have several new therapeutics 
underway. We have several vaccines under development. We have 
had a huge expansion in the supply of testing materials, PPE, 
ventilators. The regulatory response to deal with clearing out 
the roadblocks that would typically impede the development of 
these items has been impressive.
    The great example is the huge expansion in telemedicine 
which has happened just in the last few weeks despite some of 
us trying to promote that for years. Dr. Fauci made a pretty 
pointed statement earlier in this hearing talking about the 
reason that things are different region by region, and I would 
like to talk a little bit about the responses that were done 
region by region, so here are some state level statistics on 
COVID-19 as of yesterday.
    New York State has six percent of the population, but it 
has twenty-two percent of the total U.S. deaths. Michigan has 
three percent of the U.S. population but it has about five 
percent of the total U.S. deaths. If you look at my home state 
of Texas, we have nine percent of the population but only two 
percent of the deaths.
    Now, again, these are all spot values as of yesterday. Of 
the top seven states that represent sixty percent of the 
deaths, all of those are led by Democratic governors. When you 
look at the cases' number of deaths, New York State's fatality 
rate is six percent and Michigan's is nine percent, whereas 
Texas is three percent.
    So what concerns me are the stark differences in fatality 
rates and some states' percentage of deaths compared to their 
percent of the population. It is obvious that some governors 
made big mistakes, but we are not hearing much about that today 
in addressing the spread of SARS-CoV-2. It is interesting that 
while those governors were complaining about President Trump, 
they were ignoring their own populations.
    So, specifically, I think we ought to talk about our 
elderly at-risk population who contracted COVID-19 and let's 
start with these stats. In Michigan, 1,947 patients in long-
term care facilities died from COVID-19. In New York that 
number was 6,200. In Florida that number is only 1,637 and this 
is despite the fact that Florida has a long-term care 
population that is far higher than both Michigan's and New 
York's.
    In Michigan, state officials declined a proposal to use 
new, vacant, unlicensed facilities to house patients who tested 
positive for COVID-19. Instead, Michigan put those patients in 
nursing homes with other uninfected patients. And as we have 
heard previously in this hearing, in New York the health 
department ordered nursing homes and rehab centers to accept 
COVID-19 patients who were discharged from hospitals. This led 
to more than 4,500 patients who tested positive for COVID-19 
being put back into long-term care facilities.
    Now compare these policies to Florida where state officials 
set up isolation centers that focused on treating patients with 
COVID-19.
    So my questions for Dr. Fauci and Dr. Redfield are as 
follows: As I noted, there have been fewer deaths reported in 
Florida's long-term care facilities compared to either 
Michigan's or New York's despite the long-term care population 
of Florida being significantly higher. So can you talk 
specifically about these approaches to elderly care and whether 
putting COVID-19-positive patients in nursing homes with non-
infected patients was good policy and were the decisions in the 
best interest of our seniors?
    So, Dr. Fauci?
    Dr. Fauci. Well, obviously, if you put someone who is a 
potentially infected patient into a nursing home there is a 
risk of their being spread. I think you gave a lot of data and 
a lot of situations in which there really was a moving target 
and whether or not there really was a facility to put 
individuals in, so I really feel uncomfortable in commenting 
about that because I was having trouble following each and 
every one of the data points that you were giving.
     But, Bob, do you have any further insight into that one?
    Dr. Redfield. Thank you very much, Congressman. Two points. 
First, and we are working to try to understand the 
multivariance, as you have pointed out, that at least on the 
cases there has been differential mortality both in different 
jurisdictions as well as within the long-term care facilities 
in different jurisdictions and really looking at the 
multifactors to see that if they are controlled for whether 
there is any difference and that we really don't know at this 
point, but we are looking at it.
    Mr. Flores. I want to ask you and Dr. Fauci a simple 
question. Which state had a better approach to dealing with 
elderly patients, Florida or New York?
    Dr. Fauci?
    Dr. Redfield. He wants to know which state had the----
    Dr. Fauci. I don't think I am in a position to evaluate 
that. That is not in my purview of anything that I am 
responsible for.
    Mr. Flores. Dr. Redfield?
    Dr. Redfield. I would just say that, clearly, Congressman, 
if you look at, as I have said before, consequences and impact, 
for me, consequences and impact is obviously morbidity and 
mortality. And as you pointed out that the mortality rates in 
nursing homes were clearly better in Florida than opposed to 
New York, but the causation is what I am not willing to 
speculate on, and without doing controlling for the different 
variables that we have individuals with the same extent of 
comorbidities in those two nursing home settings.
    So I think that investigation will be complete and we will 
get an understanding of why there is differential mortality in 
nursing homes as well as why there is differential mortality in 
different jurisdictions as you pointed out.
    Mr. Pallone. Thank you, Mr. Flores. Thank you.
    Mr. Flores. I ask you to provide that information 
subsequently. Thank you. I yield back.
    Mr. Pallone. Now we go to Iowa, Mr. Loebsack. Unmute.
    Mr. Loebsack. All right, thank you. I should be unmuted. Am 
I unmuted?
    Mr. Pallone. Yes. You are good.
    Mr. Loebsack. OK, thank you. Thank you, Chairman Pallone 
and Ranking Member Walden, for this important hearing today and 
I want to thank all these witnesses for their expert testimony. 
I know it has been a tough several months here for you folks 
trying to lead the way through this.
    I had hoped also that Administrator Verma would be here 
today willing to join the panels. I believe that Congress needs 
a fuller understanding of how the administration is meeting the 
resource needs of hospitals and nursing homes, but since she is 
not here, I do have a few questions for Admiral Giroir as the 
Assistant Secretary for Health.
    I think that Dr. Fauci kind of answered this question 
already, very briefly, but Admiral Giroir, do you believe that 
our healthcare providers that are serving on the front line 
within our hospitals have the personal protective equipment, 
the supplies, the resources that they need today at this 
particular moment?
    Admiral Giroir. Today at this particular moment, I do 
believe they have the supplies that they need. And let me tell 
you, when we get a report of a nursing home or another facility 
that says they don't have the supplies, literally, we call 
those places individually to understand what their needs are. 
So at this point in time, I think we are meeting those needs.
    Again, the challenge is if the first wave gets worse or we 
have a second wave, are we going to be able to meet those 
challenges and that is what the S&S 2.0 is, to make sure we 
have at least 90 days. Yes, sir.
    Mr. Loebsack. No, that is--no. Thanks, I appreciate that.
    I want to move on to the future, if you will, but before I 
do that I do want to ask every one of the panelists whether he 
agrees that it is likely that we will, in fact, see a second 
wave. I know there is a lot of controversy, right, as to 
whether we are still in the first wave, if you will, and it is 
sort of disproportionately--the different regions are kind of 
dealing with it in just in different ways and are feeling 
different effects as well. But if I could just go down the 
panel beginning with Dr. Redfield and truly a simple yes or no 
answer, do you believe that it is likely that we will see a 
second wave in the fall or the winter?
    Dr. Redfield, you first.
    Dr. Redfield. Yes, it is simple. I am not sure I would call 
it a wave, but I want to make it clear we are going to 
experience significant coronavirus infection in the fall and 
winter of 2020 and 2021.
    Mr. Loebsack. OK. Thank you.
    Dr. Fauci?
    Dr. Fauci. Yes, certainly there will be coronavirus 
infections in the fall and winter because the virus is not 
going to disappear. It is too----
    Mr. Loebsack. OK, thank you. I appreciate that.
    Dr. Hahn?
    Dr. Hahn. Congressman, I agree with Drs. Fauci and 
Redfield.
    Mr. Loebsack. Thank you.
    And I left you to last, Dr. Giroir. I am a little bit out 
of place there, I apologize, because I do want to ask you about 
going forward and in particular what steps is the Department 
taking to help hospitals and healthcare providers prepare for a 
potential or perhaps likely, if you will, second wave of 
surging cases in the coming months?
    Dr. Giroir?
    Admiral Giroir. OK, thank you. I don't want to take up all 
your time because it is really everything from understanding 
what the needs are to understanding the supply chains down to 
the individual hospital levels. Because, like I said, when we 
started out it was impossible to know what supplies were being 
used objectively, what ventilators were being used objectively.
    We have gone through that--all the way to the therapeutics 
that Dr. Fauci has talked about and Dr. Hahn, of course--
remdesivir, steroids, hopefully plasma--all these things and 
everything in between. It is really all hands on deck and all 
our task forces are still operational including the Hospital 
Resilience Task Force, that is not only dealing with COVID, but 
if this happens again, we don't want our immunization rates to 
plummet. We don't want our mammograms to plummet. We don't want 
our colon cancer screenings to plummet.
    All of these things were really victims of the COVID 
response just like COVID patients were, so we need to fix all 
of that.
    Mr. Loebsack. All right.
    OK, one last question, Dr. Giroir. As you know, hospitals 
have struggled dramatically, financially, through all this, 
especially when they could no longer perform elective surgeries 
because they had to be ready for the COVID patients. And we did 
pass legislation here in Congress, obviously, to provide $175 
million in direct funding to providers for expenses and lost 
revenue.
    What is the status, Dr. Giroir, of the next allocations of 
the remaining funding that is yet to be distributed from the 
provider fund?
    Admiral Giroir. Yes. I am sorry. I am going to have to take 
that one for the record because the Secretary and the people on 
that side are really controlling that but we will be happy to 
supply that answer to you from----
    Mr. Loebsack. I look forward to that. My time has expired, 
anyway, but thank you all. Thank you, Dr. Giroir, and thank 
you, Chairman Pallone, and I yield back.
    Mr. Walden. Mr. Chairman, before you proceed----
    Mr. Pallone. Yes.
    Mr. Walden [continue]. There is quite an uproar on social 
media about the fact Dr. Fauci has changed face masks and the 
implications thereof. Do you have any comment?
    Dr. Fauci. I am an avid Washington National fan, so I 
thought I would break up this a little bit by putting on my 
Washington National face mask.
    Mr. Pallone. OK. Thank you.
    Next we have Mrs. Brooks.
    Mrs. Brooks. Thank you, Mr. Chairman, and thank you all so 
very much. We got going thinking about the Nats a little bit. 
We miss all of them playing baseball.
    I would like to talk a little bit about what you all 
suggested with respect to sustainability of funding. Dr. 
Redfield, I think for decades we have underinvested in our 
nation's public health infrastructure. Can you tell us what is 
it we need to do? You all mentioned sustainability, but if you 
could, you know, talk with us about what steps would be 
necessary. Not just federal government, state and local, what 
do we need to do to really think about our public health 
infrastructure in this country?
    Dr. Redfield. Thank you very much, Congresswoman. It is so 
important and I have said this that this now is the time, 
because for decades we have underinvested in what I call the 
core capabilities of public health, day-to-day analytics that 
have predicted data analysis, laboratory resilience, public 
health workforce, emergency response form, and then our global 
health security around the world.
    Mrs. Brooks. And those are all the different things that 
you think everyone--state, local, and federal--ought to be 
investing in at higher levels.
    Dr. Redfield. And we need to do it. And when you look at 
it, if you didn't quite palpate it before we are going to 
probably spend close to seven trillion dollars, all right, 
because of one little virus that came which we recognized very 
early. We used the capacity that we have and, you know, I said, 
you know, the critics will be there, but we will do the 
postmortem when we are done.
    We have all done the best that we can do to tackle this 
virus and the reality is it brought this nation to its knees. 
And I would say now is the time. It requires a sustained 
investment in terms of the core capability. Many of you may not 
know the nuances of, say, funding for the agency I run, CDC, 
but there is no core funding. It is all through different PPAs 
that are provided by Congress.
    We need core public health funding and many people don't 
know that CDC provides up to 70 percent of the public health 
funding for every state, local, territory, and tribal health 
department in this nation. So we have got to invest in that in 
a sustainable way with a purpose that that is core-based 
funding.
    Mrs. Brooks. And might the states also invest at higher 
levels and local governments as well.
    Dr. Redfield. I think you said it right there. This needs 
to be a partnership.
    Mrs. Brooks. Right.
    Dr. Redfield. It is not all the burden of the federal 
government to invest in public health at the local level. And 
the reality, if the public, if your funding of CDC was to go 
away tomorrow public health infrastructure across this nation 
would just crash. We are right now the backbone of it and it 
should be a partnership.
    Mrs. Brooks. Thank you.
    I want to talk, Dr. Hahn, a little bit about Operation Warp 
Speed. It really sounds like an exciting effort. It is a great 
project. We are, the United States is the global leader in 
vaccine development. But I have to tell you, because we are 
working at warp speed and your companies that you are working 
with and all of the government agencies and everyone is working 
at warp speed, there are many who have concerns about vaccine 
safety and efficacy.
    And when we get to that point which hopefully is at the end 
of this year or early next year where one of these products 
breaks through and gets there, what do you want to tell the 
American people and the world in many ways about the safety and 
the efficacy and the steps that we are taking to make sure that 
when that vaccine does break through that it, you know, it will 
be safe for everyone to use?
    Dr. Hahn. Thank you, Congresswoman Brooks. I really 
appreciate the question. And Dr. Fauci, certainly, as a world's 
expert can speak to vaccine development, I can tell you from 
the regulatory perspective of FDA we have world-leading experts 
in the assessment of vaccine safety and efficacy. The world 
looks to FDA. The world looks to the U.S. to actually make 
those assessments. What I can promise the American people, we 
will work with companies. We will work with Operation Warp 
Speed to provide the assistance so the right studies are done 
with the right information.
    But we will independently look at those data and we will 
make a decision in the best interest of the American people 
with respect to safety and efficacy. We will use science and 
data to do that.
    Mrs. Brooks. So, Dr. Fauci, maybe I should have started 
with you before going to the regulatory side. So what would you 
like to say to the American people?
    Dr. Fauci. Yes. I think that Dr. Hahn said it very well. 
But I just want to emphasize, you know, I think there were some 
good intentions about using the word ``Warp Speed,'' but I, 
myself, flinched a little because I know that people might 
think it is reckless because it is warp speed. It isn't. There 
are risks, but the risks are all financial risks and that is 
what people need to understand.
    They are not compromising the safety at all nor is there 
compromise of scientific integrity. When you do a vaccine under 
non-emergent conditions there are various steps. And because 
companies make investments in this, what they do is they don't 
make an investment in this step until they are pretty sure this 
step works, and then they go to the next step. And one of the 
most important steps is when you start, you know, gearing up to 
make many, many doses. You are not going to make an investment 
of a half a billion or more dollars to produce doses unless you 
know it works.
    So what this particular program says, we are going to 
assume it is going to work so we are going to put investment in 
preparing the sites for Phase 3 even before we knew that the 
Phase 1 was successful. We are going to be making doses even 
before we know it is effective. So what you are doing is you 
are cutting down on time but you are not cutting down on the 
process of safety and science, so if you lose, the only thing 
you lose is a lot of money.
    Now nobody likes to lose a lot of money, but we feel we 
would rather lose a lot of money and gain 4, 5, 6, 7 months 
than have a result and have to wait 4, 5, 6, 7 months to get 
the vaccine.
    Mrs. Brooks. Thank you. Thank you. I yield back.
    Mr. Pallone. Thank you, Mrs. Brooks.
    And now we go to Mr. Schrader from Oregon.
    Mr. Schrader. Thank you, Mr. Chairman.
    I want to thank everybody here for all the hard work you 
are doing.
    But I am concerned, very concerned, that the American 
people are laboring under some gross misapprehensions as a 
result of some of the information that is out there.
    Dr. Fauci, what is the average time to develop a vaccine?
    Dr. Fauci. It depends on the vaccine and the situation in 
which you are doing it. If you are developing a vaccine in the 
middle of an outbreak----
    Mr. Schrader. I am just asking, what is the average?
    Dr. Fauci. About seven years.
    Mr. Schrader. All right. And what was the fastest we have 
ever done? What is the quickest a vaccine has been developed to 
date?
    Dr. Fauci. Well, it is probably, I think, the Zika vaccine, 
which we developed, was about a year and a half, but it was 
never brought to full fruition because Zika kind of 
disappeared.
    Mr. Schrader. And say there is a vaccine. What is the 
probability that a vaccine comes to market actually?
    Dr. Fauci. Oh, if it is successful, it is a high 
probability.
    Mr. Schrader. Well, I am just saying, all these vaccines we 
have got out there being developed, what is the probability 
they are going to make market entry?
    Dr. Fauci. There are more failures than there are 
successes.
    Mr. Schrader. It is about six percent.
    Dr. Fauci. Right.
    Mr. Schrader. What is the chance that, even with a vaccine, 
this virus will be eradicated? And I would look to flu for a 
little bit of an example, influenza. How effective is that 
vaccine?
    Dr. Fauci. The influenza vaccine is variable because the 
virus changes rapidly.
    Mr. Schrader. Much like this virus?
    Dr. Fauci. We don't know that yet.
    Mr. Schrader. Well, we already know it has mutated, right?
    Dr. Fauci. Yes. That doesn't make any difference. All RNA 
viruses mutate. That doesn't mean they change.
    Mr. Schrader. If I was a mother, or a hard-working American 
citizen, and I am trying to bank on my family's future, how 
long do I wait? I am very worried that many, many Americans are 
waiting until there is a vaccine, maybe a year and a half at 
best, out there, and that is going to be the panacea, and they 
are all going to be OK. I think that is a terrible 
miscalculation. I am not blaming anybody here, but it is a 
terrible miscalculation on the part of many Americans. So, I am 
going to stay home, not go to work, not send my kid to school, 
and I am going to hunker down and I am going to be OK. I will 
just wait for that vaccine. I think we have to start talking in 
terms of vaccine as one of many tools in the toolbox, so we 
don't end up in particular problems. Dr. Redfield----
    Dr. Fauci. I agree with you completely.
    Mr. Schrader. Well, that needs to get out there a little 
bit more.
    Dr. Redfield, to that end, I am very concerned with the 
school year coming up. The CDC never recommended closing 
schools this spring. And yet, many, many, many school districts 
across the country closed. Right now, the CDC guidance talks 
about different considerations. How likely is it that a second-
grader or, frankly, even a teenager, is going to maintain 
social distancing of six feet all the time?
    Dr. Redfield. I think you know the answer to that, 
Congressman.
    Mr. Schrader. All right. Thank you. That is a rhetorical 
question. I appreciate that.
    How about a school bus where you are supposed to have one 
child per row? School districts maybe in some states, are much 
more flush with money than mine. We can barely afford the 
school buses we have now. What is the chance of having three 
foot or less----
    Dr. Redfield. Yes, I mean, I think you raise the reality. 
As we look at----
    Mr. Schrader. I am just concerned--I am sorry to interrupt; 
I have limited time. And some of these are rhetorical. But I am 
just worried that we are making all these pie-in-the-sky public 
health perfection recommendations that have no chance in hell 
of actually happening at the local level. They don't have the 
money. They are dealing with human nature, especially children. 
Look, adults aren't much better, from what we can see around 
the country. But for children, we have to have recommendations, 
I think, that are realistic.
    What is the incidence rate of this disease in children?
    Dr. Redfield. We still don't know the infection rate in 
children, but we do know, when you say ``disease''----
    Mr. Schrader. Well, we do know internationally it is less 
than two percent.
    Dr. Redfield. When you say ``disease''----
    Mr. Schrader. And Dr. Fauci makes a correct comment that, 
oh, but they can infect others.
    It would seem to me a smart use of our precious dollars--I 
mean, you talk $7 trillion. We don't have $7 trillion, Doctor. 
We spent over $3 trillion, which is twice what we spend in a 
year, and we did that in one bloody month, for good reason. And 
you guys are showing us good results, and I appreciate that.
    But we need to make sure that citizens out there aren't 
withholding Johnny and Suzie from going to school because they 
think this is all going to be over in a month and a half or two 
months. That is what the President tells--that is what we are 
telling them, or they are getting that impression. That is 
wrong. And if we have kids not going to school, we run the huge 
risk of the wealthy kids get a great education online with 
their nice moms and dads; the lower-income kids get no 
education.
    Dr. Redfield. The comment I would like to make is that--it 
is so important--the inference of what you are saying is, we 
need to use the knowledge that we have now, which we didn't 
have then. As you know, CDC did not recommend closing schools. 
OK?
    Mr. Schrader. Yes, sir. Thank you for that.
    Dr. Redfield. And we didn't recommend it because we didn't 
think it was a one-size-fits-all. We close schools jurisdiction 
by jurisdiction when we see issues in the schools.
    So, I do think we have to focus, as we move forward in the 
fall. And now--what I said before, on the consequences of this 
virus, and those consequences are mortality and hospitalization 
and the economy. Right? And I think when you see that, you will 
see that different recommendations for the jurisdictions will 
come to rise. And as you said, I am pretty confident we are 
going to be opening our schools. And your comments are true; we 
need to open our schools with the reality of how we expect 
those schools to act, based on the consequences of what we 
think this virus is going to pay for those individuals in 
school. That doesn't mean we don't have to be vigilant about 
protecting the vulnerable. We need to work on that in those 
families, but no longer does that mean we have to shut down 
schools, shut down the economy. It means we have to focus on 
how to prevent the consequences of this virus.
    Mr. Schrader. Thank you very much. I am sorry for the line 
of my questioning.
    Mr. Pallone. Thank you.
    Mr. Schrader. I yield back.
    Mr. Pallone. All right. Now we go to North Carolina, Mr. 
Hudson.
    Mr. Hudson. Thank you, Mr. Chairman. Thank you for holding 
this hearing today and for convening such an esteemed witness 
panel.
    Admiral Giroir, it is a pleasure to see you. I appreciate 
all the work we have done together, particularly on the opioid 
epidemic. I want to thank you and all of the distinguished 
witnesses for taking time out of your very busy schedules to be 
with us here today.
    I, first, want to give a lot of credit on our coronavirus 
response to President Donald Trump and to the individuals on 
this panel who worked tirelessly to get us to where we are. The 
Trump administration has taken decisive action early and often 
to combat this virus and keep us safe. Eleven days after the 
first confirmed case in the United States, President Trump 
declared a health emergency and restricted travel from China 
and any foreign national who posed a risk of infection. And a 
little less than two months after the first confirmed case, 
President Trump declared a national emergency.
    The same goes for our testing capacity. The Trump 
administration has gone from a few thousand tests a day in 
March to close to half a million tests a day in June, and 
anticipates being able to perform 40 to 50 million tests a 
month by September. That is a staggering improvement for a 
virus we knew nothing about last year. This is not to mention 
the Herculean efforts made on PPE with Project Airbridge and 
ventilators with all the public-private partnerships to grow 
our capacity.
    As we all have grappled with the coronavirus outbreak, we 
have all had to acknowledge how little was known about it. Even 
months after its arrival, we are still grappling with questions 
such as how and if it will mutate, if our immune system can 
develop appropriate antibodies, and what, if anything, our 
genetic makeup says about our vulnerability to the virus.
    What has become clear, though, through all this 
uncertainty, is our need for data. Getting the full picture 
from the data is important to my district because of racial 
disparities. If you look at cases reported by race in 
Cumberland County in my district, there were 71 white 
individuals, 202 African American individuals, but, then, 638 
unknown. I noted in our health hearing last week the disparity 
in COVID-19 cases in my district. Fifty-seven percent of the 
COVID-19 cases at Cape Fear Valley Hospital in Fayetteville are 
in African Americans, despite being just 34.9 percent of the 
county population. It is paramount that we have as much data as 
possible, so that we can address this issue.
    Congress recently required new reporting requirements under 
the Paycheck Protection Program and Healthcare Enhancement Act. 
Labs are required to submit data to the CDC on a number of 
factors to help us understand how and where the virus is 
spreading, such as race, ethnicity, age, sex, geographic 
region, and other relevant factors. It is important to note, 
though, that in most cases lab employees are not actually 
interacting with the patient. This makes it important to ensure 
that all providers are fully engaged on collecting this data to 
obtain the most complete demographic information.
    Admiral Giroir, what actions can we take so that all 
providers, including those in physician offices and hospitals, 
know to collect all of this demographic data?
    Admiral Giroir. Yes, we feel very comfortable, but we are 
going to continue our efforts to make sure that everyone does 
know this. It was guidance that was put out. And again, as you 
said, it is essential.
    One thing--although the PPP did authorize the Secretary to 
make this, there were no enforcement mechanisms in PPP. So we 
are enforcing this through emergency use authorization 
enforcements of the laboratory tests. So, I just want to put 
that just for your information.
    But, yes, I am absolutely committed to aggressively getting 
this information. It is not only African Americans. African 
Americans have suffered horribly with this disease. Latino 
Americans are also at very high risk, and the highest risk are 
Native Americans and Alaska Natives who suffer even higher 
rates. So all these are critically important to us.
    Mr. Hudson. Yes, sir. Thank you.
    As I noted earlier, the Trump administration has greatly 
increased our testing capacity. One area that has had 
uncertainty, though, is the serology testing, something that 
could help us tremendously as we reopen the economy and people 
move back to work.
    Commissioner Hahn, in recent months, we have seen a large 
number of serology tests enter the market, some decisively not 
as accurate as others. The FDA has since taken action to remove 
several of these. How is the FDA ensuring that only high-
performance serology tests are available in the U.S. market?
    Dr. Hahn. Congressman, thank you for the question. As I 
think you know, when we issued our original regulatory 
flexibility around serology testing, it was not known 
completely how these tests would be used and what the operating 
characteristics of them were. Our guidance allowed these to be 
used in a real-world setting. At that time, we required the 
manufacturers to certify that the tests had been validated. We 
found that in some cases that certification was not correct. 
And so we developed a partnership with the National Institutes 
of Health, NCI, to actually do a U.S. Government independent 
validation. And as you probably know, sir, over 20 of those 
tests have been taken off the market. We have subsequently 
required that all manufacturers provide us with that 
manufacturing data, and if they don't, they have to be removed 
from the market. We continue to look into that, and we will 
continue to follow that policy, sir.
    Mr. Hudson. Thank you.
    Mr. Chairman, I see my time has expired. So, I will yield 
back.
    Mr. Pallone. Thank you.
    Next, we go to Mr. Kennedy in Massachusetts. Joe, are you 
there? Did you unmute? Joe, you have to unmute. I think he is 
there, but you are still muted, Joe. Mr. Kennedy, you are 
speaking, but we can't hear you. Are you there?
    All right. We are going to go on. We will come back to Mr. 
Kennedy.
    Next is Mr. Cardenas. Mr. Cardenas, unmute. Maybe there is 
a technical problem; I don't know.
    Mr. Cardenas. Can you hear me now?
    Mr. Pallone. Yes. You are recognized for 5 minutes.
    Mr. Cardenas. OK Thank you so much. Thank you, Chairman 
Pallone and Ranking Member Walden, for holding this important 
hearing.
    And thank you to the expert witnesses that we have before 
us, and we all appreciate all the work that you are able to do 
when you are allowed to do it.
    This February, there has been a steady flow of reports of 
the Centers for Disease Control and Prevention, otherwise known 
as the CDC, being sidelined. Its experts have been overruled. 
And in the midst of a pandemic, this is unacceptable.
    Dr. Redfield, earlier this month you expressed concern that 
the CDC's public health messages on COVID-19 weren't resonating 
with the public. Dr. Redfield, why hasn't the CDC held regular 
media briefings during the pandemic, as the CDC has done during 
past public crises, where it can provide clear evidence-based 
information directly to the public and where the media can ask 
questions? Is it possible the lack of regular and direct 
communication from CDC has been contributing to the public's 
confusion about how to best protect themselves in this health 
pandemic crisis?
    Dr. Redfield. Thank you very much, Mr. Congressman.
    The CDC has communicated in different ways. Clearly, first 
and foremost, we have put out over 1500 guidances or----
    Mr. Cardenas. Excuse me, Doctor. Dr. Redfield, the 
President has proven very, very clearly that when you get in 
front of a podium and you actually have a press conference, you 
have a higher likelihood that you are going to reach more 
people.
    My specific question is, why aren't you having more of 
those press conferences like the CDC has done previously?
    Dr. Redfield. And I was trying to add that, through our 
things, we have had about or we have reached 1.5 billion people 
so far. We have regular conferences with the local, state, 
territorial, tribal health departments every week almost, and 
every day we have special conferences reaching out to special 
interest groups, whether it is business, faith communities, et 
cetera. We have also had conferences, as you know, and we have 
re-instituted our now biweekly press conference with the open 
press. And so, I do think that CDC does continue to 
communicate, but more at the local level than, let's say, at 
the national level.
    Mr. Cardenas. Thank you, Dr. Redfield. You actually 
answered my question, and I appreciate all the local work you 
have been doing. But in the past, the CDC has been more of a 
national presence and a voice in previous issues where we have 
had health crises. And I hope that you are able to change that 
and continue doing your local, but actually be more present on 
the national, as the biggest voice on the national stage has 
been President Trump. And there is no question that he has 
misled the public, certainly with his actions and his words, by 
not wearing masks and refusing to do so, and actually telling 
the public that he is not going to do that.
    In February, Dr. Messonnier with the CDC warned us that the 
virus could possibly cause severe disruption to our everyday 
life. She was right. Yet, she was contradicted by both the 
President and Secretary Azar. And in April, Dr. Redfield, you 
confirmed that a second wave of the virus in the fall could be 
difficult, and President Trump immediately contradicted you in 
real-time. And I will quote him. The President said, ``You may 
not even have corona coming back.'' End quote.
    Dr. Redfield, do you believe the public would have been 
better prepared, and state and local public health officials 
better supported to face this pandemic, had CDC and other 
public health experts not been ignored or contradicted at the 
national level, like the President contradicted you in real-
time?
    Dr. Redfield. Well, I think, Congressman, obviously, we 
continue to try to get our message out. And I thought Dr. 
Messonnier obviously did a service in sharing her perspectives 
at that time, in letting people understand what could be on the 
horizon, which obviously eventually was on the horizon. I have 
tried to do the same in making the American public prepared 
that this fall and winter is going to be difficult and we need 
to be prepared for it.
    Mr. Cardenas. Thank you, Dr. Redfield, and thank you for 
complimenting Dr. Messonnier for her bravery and her 
willingness to speak up at the moments as necessary.
    I am concerned, gentlemen, that we have a problem right 
now, that over 120,000 lives have been lost in the United 
States due to COVID-19. And yet, the public is still not on the 
same page as they should be when it comes to how to protect 
themselves, and they are getting mixed messages at the national 
level from our leaders. So what I hope and pray is that the CDC 
make its presence more aware and more clear with evidence-based 
advice to the American people.
    And then, also, I have got to hope and pray that--and I am 
going to ask some questions to be forwarded back to the 
committee as to the misleading statements such as touting the 
fact that PPEs have been provided to the American people to the 
tune of a few million here and there, when, in fact, some of 
you have actually reported that, ideally, we should be in the 
billions of PPEs. And I am going to ask those specific 
questions, so that the full public can hear the answers and we 
can have it on the record of this committee.
    My time has expired. I yield back. Thank you.
    Mr. Pallone. Thank you.
    Next, we go to Mr. Walberg from Michigan.
    Mr. Walberg. Thank you, Mr. Chairman.
    And thanks to the panel for sticking with us for this 
lengthy period of time. And thank you for your work. Whether we 
agree or disagree, we are kind of learning this all together, 
aren't we, and building it on the fly to some degree.
    As we have discussed already, and as you know, there were a 
handful, five states to be exact, including my State of 
Michigan, where my governor ordered, required through an 
executive order, nursing homes to admit COVID-19--positive 
patients back into their facilities. This proved to be a 
terrible policy, as we found out, with the consequences for our 
seniors, with almost 2,000 nursing home residents in Michigan 
having died. That is accounting for one-third of our State's 
COVID-19 deaths.
    Dr. Redfield, some officials in the five states that issued 
these executive orders have indicated they were following 
guidance from the administration. What guidance? And you used 
that term expressly earlier on, and I appreciate that, because 
I do think that is what we do give at the federal level when we 
talk to the states. But what guidance did HHS and CDC release 
as it relates to admitting COVID patients in the nursing homes? 
And secondly, what obligations are states under to follow that 
guidance?
    Dr. Redfield. Thank you very much, Congressman, for the 
question, an important question.
    CDC did, in fact--and does, in fact--have guidance for 
nursing homes. The guidance that you are referring to was 
guidance that was grounded in the fact that there were some 
situations where the nursing homes were refusing to take any 
COVID patients at the time. So, CDC did issue a series of 
important prerequisites that the nursing home had to have in 
place in order to accept these patients that they had admitted 
to the hospital back, when they came back.
    Fundamental to that was that they had the appropriate 
facilities to isolate that individual; they had the appropriate 
infection control capacity to maintain that. So, it really was 
not saying you have to take somebody back. It is that you have 
to be open to taking care of COVID patients, provided that you 
have the capacity to do it correctly.
    Mr. Walberg. And correctly is the key thing?
    Dr. Redfield. And correctly--and so that that patient 
doesn't spread the infection to other individuals. And I think 
some of the speeches that we have heard in the press fail to 
understand that it is to do it correctly. As you know, over 
half of the nursing homes in this nation right now, over 7,000 
nursing homes in this nation, have a COVID patient in them. The 
question is how to do it correctly and safely.
    Mr. Walberg. And save the lives, yes.
    Dr. Redfield. And save the lives.
    Mr. Walberg. Well, it gets down to data as well. So, let me 
ask you, what are the obstacles to collecting and reporting the 
data that you are now requiring--and my governor has finally 
started to put out--what are the obstacles to collecting and 
reporting this data, particularly among seniors living in 
nursing homes? And what steps has CDC already taken to improve 
data collection from the states?
    Dr. Redfield. CMS says now required. As you know, the 
nursing homes are reporting their data, and they report it to 
CDC, and then, CDC reports it on to CMS. And CMS has it as 
actionable.
    Right as we sit here today, a majority, over 90 percent of 
nursing homes--I think it is north of 80; I think we are 
between 80 and 90 percent--are actively reporting through our 
system already since that request was required a couple of 
weeks ago. And we are working to get all 100 percent of the 
nursing homes to be reporting, as required by CMS.
    And that data also is complemented--I mentioned earlier 
about the ethnic groups and data. That data actually comes in 
originally with now all testing. You all have helped us in 
that. Now any test that is done for COVID has to come and has a 
series of key data points, to include ethnicity and race, so 
that we can maintain that for all cases across the country, 
independent of if they are a nursing home or not.
    Mr. Walberg. Thank you. We hope it helps.
    Dr. Fauci, three questions that I have for you relative to 
yesterday--the University of Michigan announced its plans for 
the fall semester, to consist of a mixture of in-person and 
remote classes. As schools prepare for the fall semester, what 
factors should they be considering? And I am thinking of higher 
education here. What do we know about the transmission of COVID 
in young adults that would help inform the decision to reopen 
colleges and universities? And thirdly, should reopening look 
different for a school like the University of Michigan versus a 
school like Hillsdale College in my district with 1500 students 
in a rural community?
    Dr. Fauci. Yes, all good points. Again, one answer could 
probably spill over into each of the questions. You really have 
to consider what the state of the epidemic is in the particular 
place that you are at. Now, if you have very, very few cases, 
like in a small college in a county, I think you can be really 
very liberal in the opening.
    What schools are doing--and they are doing it in a very 
creative way--is to try to make sure that there is separation 
enough that you have situations, where, first of all, masks 
should be done at all times without exception. You have got to 
protect the vulnerables. You have got to allow both faculty as 
well as students who are in that category of underlying 
conditions to be able to have the capability of either teaching 
or learning online. You have to have the capability of, when 
you get an infected student, which you invariably will, no 
doubt, to be able to remove that student to a safe, comfortable 
place for the period of time until they can go back. If you 
leave them in the community, you are going to wind up having a 
situation that could make the whole thing fall apart. That is 
just a few of the things we need to do. But, importantly, you 
have got to look at what the status is in your particular 
situation.
    The other thing is, people who work with the students--
namely, people who feed them, people who clean--they need to be 
also paid attention to, because often, be it in a cruise ship 
or be it in a nursing home, it is the staff who might bring in 
an infection, and then infect the individuals who are in a much 
larger group.
    Mr. Walberg. Thank you. I yield back.
    Mr. Pallone. Thank you.
    We are going to go back now to Mr. Kennedy.
    Mr. Kennedy. Hopefully this time it works. There you go.
    Mr. Pallone. We can hear you.
    Mr. Kennedy. All set, Frank? Beautiful.
    Mr. Chairman, thank you. Apologies for the interruption 
beforehand.
    I want to thank our witnesses for being here. And Chairman, 
thank you for calling this hearing. And to the witnesses, thank 
you for your service and your willingness to stay so long into 
the afternoon.
    I want to start--this is now about a month ago. I had been 
in Chelsea, Massachusetts, a community just outside of Boston 
that has a rate of infection roughly six times higher than the 
State average. And I was delivering meals at a nonprofit, local 
nonprofit there, with food lines longer than I have ever seen 
anywhere in the world.
    On my way out of the community, I called one of the heads 
of the local community health center and I asked what else they 
needed for help. The individual I spoke with said that they had 
recently received some mapping software and they were looking 
for cool spots in the community. I asked him, why cool spots? 
Aren't you looking for the hot spots? And he said, no, we know 
that everybody is being exposed. What those cool spots will 
tell us is where we haven't been testing. You know what the 
biggest cold spot was? The public housing facility where, in a 
population of 900 people, four had been tested--four.
    This administration has failed so completely to prepare our 
nation for this pandemic that working communities largely made 
up of people that our government and our society have deemed to 
be essential, that we require to be essential, they were left 
in their wake with no help and nobody.
    Just days ago, President Trump stood up before the American 
public and told us that he asked his administration to slow the 
tests down because what they were viewing was that tests were 
accelerating and it was instrumental to his political survival. 
And I know that we received testimony today that his statements 
here were not true, although the President has also 
contradicted that again, saying he does not joke.
    But to my people in Massachusetts and our people in 
Chelsea--maybe they are predominantly Black and brown, men, 
women, and children--this administration's failure to test was 
no joke. It has been deadly.
    We have nearly 120,000 people that have died, over 2 
million that are sick, and 45 million Americans that are out of 
work. We are four months into this crisis, and the 
administration's best plan to confront the racial inequities 
that we are talking about is collecting long-overdue 
demographic data. Yes, we need that data.
    We know that Black and brown people across this country are 
more than twice as likely to die as those who are white from 
this virus, and more than six times as likely if you are Black 
and in Washington, D.C. In Massachusetts, the positive rate 
among Black and brown residents is three times higher than for 
white residents.
    So, yes, we need more data, but only because the 
administration spent months ignoring what advocates had tried 
to warn us about in those first months. So, let's talk about 
the actions that this administration is taking to confront 
these inequities.
    Dr. Redfield, I will start with you. The CDC finally 
released guidance requiring demographic data from commercial 
testing companies earlier this month, but it does not take full 
effect until August 1st. Do you believe that that lag time is 
acceptable, as thousands are diagnosed still every day?
    Dr. Redfield. Thank you very much, Congressman, for your 
question.
    I can say that we are committed to making sure that we get 
comprehensive data, particularly on race and ethnicity, as well 
as data on these underlying comorbidities, so we can better 
understand----
    Mr. Kennedy. I appreciate that. Doctor, we are talking 
about collecting it on August 1st for a virus that arrived on 
our shores in January and February. I have limited time, but 
that wait seems to be quite substantial.
    I want to move on because there is news that I think broke 
today that indicates that the federal government is going to 
stop supporting testing sites in Texas and other states. We see 
skyrocketing numbers of cases. Actually just stopping this 
federal support for those testing sites, is that going to be 
effective at helping to mitigate the spread of the virus?
    Admiral Giroir. So, I will take that question. Thank you 
very much.
    So, the first set of testing sites were 41 sites that were 
completely federally run under federal contracts. The retail 
sites have now been over 600, and then, the retail sites on 
their own are over 1400. There are tens of thousands of testing 
sites. The only sites that we sunsetted, with the full 
agreement of the governors because I spoke to all of them, were 
13 remaining sites, seven that were in Texas that were the 1.0 
variety that were ready to go, because there were so many other 
sites around them. We matched each site to FQHCs surrounding 
them, to retail sites. So we are not withdrawing the support 
for well over 2,000 sites. We are just transitioning those 13.
    Mr. Kennedy. And very quickly, briefly, because I don't 
have much time here, but we have seen 45 million Americans lose 
their jobs. Yet, we have an administration that continues to 
push the need for work requirements for individuals on 
Medicaid.
    Yes or no? I will go down the list, starting with Dr. 
Fauci. Do you believe that implementing work requirements is 
going to be an effective measure to stop the spread of 
coronavirus?
    Mr. Pallone. We are going to have to just limit you to the 
response, Dr. Fauci.
    Dr. Fauci. I didn't get the question. I am sorry.
    Mr. Pallone. He asked about work requirements.
    Mr. Kennedy. Now that 45 million Americans have lost their 
jobs, is implementing work requirements an effective way to 
stop the spread of coronavirus?
    Dr. Fauci. I am not sure I am qualified to answer that 
question. I really have not been involved in that.
    Mr. Kennedy. I believe you are very qualified to answer 
that question, Doctor, respectfully.
    Dr. Fauci. I didn't even hear--sir, I am sorry, but I 
really didn't even hear the question or understand it. So I am 
not trying to evade.
    Mr. Kennedy. No, no, no, no. OK. Let me clarify, if the 
Chairman would give me one minute.
    Given that 45 million people have lost their jobs, and the 
administration still continues to move forward in trying to 
implement work requirements, will the implementation of work 
requirements be helpful at stopping the spread of coronavirus?
    Dr. Fauci. Right, yes, I think that would be a problem. I 
agree with you.
    Mr. Pallone. All right. Your microphone wasn't on, but you 
said it would be a problem.
    Mr. Kennedy. Thank you. Thank you, Doctor.
    Mr. Pallone. All right. We are going to go now from 
Massachusetts to Savannah. Mr. Carter?
    Mr. Carter. Thank you, Mr. Chairman. And thank all of you 
for being here. I appreciate it.
    The administration has done an exceptional job, in my 
opinion, of increasing testing capacity over the past several 
months. And I know that it is our desire and our goal to get 
testing to 40 to 50 million tests per month by September. And 
in order to do that, we greatly need to expand testing.
    I have said that, in order to roll out our economy, we need 
two things. First of all, we need robust testing. Secondly, we 
need personal responsibility. That is, following the advice of 
members of the Coronavirus Task Force in making sure we are 
washing our hands, wearing masks, et cetera, et cetera.
    Admiral Giroir, earlier you said that 90 percent of 
Americans live within 5 miles of a pharmacy or a pharmacist. 
And I don't mean to correct you, but it is actually 95 percent 
of Americans live within 5 miles of a pharmacist, making them 
the most accessible healthcare professionals out there.
    I wanted to ask you--and, Admiral Giroir, you and I have 
talked about this many times before--do you think the 
administration should utilize the pharmacy personnel and the 
profession for expanded testing, especially community 
pharmacists who can help rural and medically underserved 
communities? I know that we have made it to where pharmacists 
can provide these tests, but not all pharmacists. And what I am 
getting at is if we could get to where in the rural and the 
medically underserved communities, the pharmacists there would 
be able to do it as well.
    Admiral Giroir. So, thank you, Congressman.
    Mr. Carter. Admiral, can you respond?
    Admiral Giroir. Yes. Thank you, Congressman.
    And you know how I feel about this. I think pharmacists are 
one of the most underutilized professions in the country, for 
their training and their expertise, and also their trust from 
the population. And I would just like to put an exclamation 
point behind everything you have said.
    In order to work with the independent pharmacist even more 
than the retail pharmacist--and I am sorry, I know this is your 
world--but there is an organization that is sort of an 
intermediary between that, that we are working with to make 
sure that we could bring more and more of the independent 
pharmacists under contract through our community-based testing 
program.
    But I am all onboard. Whether it is telehealth, 
pharmacists, community health workers, we need to get health 
into the community, and pharmacists are a great way to do that.
    Mr. Carter. Thank you, Admiral.
    And I actually have submitted bill text that would do just 
this, that all the pharmacists are onboard with. And it is over 
at HHS right now. And I would just like to ask all of the 
members here of the task force, if you could help me to get 
that review completed, so we can move forward, I would 
appreciate it.
    Also, I wanted to talk--you know, I have been sitting here 
listening to colleagues on the other side of the aisle who have 
been saying that the administration and this task force has not 
done enough to save lives. And as you know, we have talked 
about the fact that 42 percent of the COVID have been from .6 
percent of the population, and that has been nursing home 
residents.
    Now I do not in any way consider myself to have more 
expertise on communicable diseases than any of the four of you 
who are sitting here today. However, I will tell you that, in 
my professional career as a pharmacist, I was a consultant 
pharmacist and I worked in nursing homes. I spent almost 30 
years in nursing homes. So I do know nursing homes, and I know 
that is the last place that you want a positive patient to be 
at.
    And I just want to point out, in fact, I can remember 
servicing a 100-bed facility years ago that, for whatever 
reason, did not get the flu vaccine, and we lost almost 20 
percent of our population in that nursing home as a result of 
the flu outbreak, because we didn't get the flu vaccine that 
year. So, I have seen this firsthand and I have experienced it.
    And that is what upsets me so much about the decision of 
some of these governors to put these patients in the nursing 
home, which would have been the worst place they could have put 
them in. Now I say all of that to say that, you know, I still 
believe in humanity, and I don't think any of those governors 
who made that decision did it intentionally. And I don't think 
they would have done it if they had known what it would have 
resulted in.
    And I say that to point out to all of us on this committee 
and to everyone in Congress that I think the administration has 
done an outstanding job, and I think they have saved us. Well, 
have they done everything right? No. No, they haven't. And 
would they do things differently if they could? Yes. And I 
believe that these governors would have done things differently 
if they could. But to point fingers and say that no one cared 
about saving lives, I think that is despicable, and I don't 
think that is fair whatsoever.
    Dr. Redfield, I know that you seem to have had a bullseye 
on your chest today, for whatever reason. But I know that the 
CDC has done some great things and made some great, positive 
comments. Can you just tell us some of the useful materials 
that you have released from the CDC?
    Dr. Redfield. Well, we have put out the guidances really in 
a variety of different areas, as you know, and obviously, 
focusing on nursing homes; focusing on obviously individual 
mitigation steps to limit the spread; focusing on first 
responders, healthcare settings.
    I will say something about the nursing homes that I really 
hope we consider. As we are looking to the fall, I think there 
needs to be more serious consideration in jurisdictions that 
have multiple nursing homes to look at whether certain nursing 
homes are prioritized for COVID patients, just because of the 
situation we went through before.
    But we continue to put guidance out on them, but going back 
to school, going to camp, daycare centers, K through 12--
wherever the American public seems to have a need for guidance, 
we either put out a guidance document or we put out what we 
call a consideration document, which gives people some better 
understanding of the impact of COVID and how they can protect 
themselves safely in those particular environments.
    Mr. Pallone. Thank you. Thank you, everybody.
    Mr. Carter. Thank you, and thank all of you.
    And I yield back, Mr. Chairman.
    Mr. Pallone. And I just want you to know we have got ten 
left. So hopefully, if you have to take a restroom break or 
something just go out and come back.
    Are you going to be able to stay with us for these ten? We 
will try to make it brief.
    All right. Mr. Peters of California is next.
    You want to unmute, Scott?
    Mr. Peters. Yes. I was just getting it.
    Thank you, Mr. Chairman. I appreciate the witnesses coming 
today. You know, the monumental challenge that our country is 
facing has come in large part due to the failure to develop and 
deploy sufficient diagnostic testing in time to monitor and 
control the spread of the virus.
    In February, on the 29th after it became clear that CDC's 
tests would not be able to perform, FDA began authorizing the 
emergency use of molecular diagnostic tests, and since then FDA 
has authorized more than 110 emergency use authorizations--has 
issued more than 110 authorizations for diagnostic tests, and 
that has done a lot to increase our overall testing capacity.
    Unfortunately, we still don't know much about the accuracy 
of these tests, and while we might typically expect the tests 
to undergo large patient studies to determine the level of 
accuracy, the emergency use authorizations require a much lower 
standard, so only a small number of validation steps.
    While most screening tests will never be 100 percent 
accurate, false negatives can lead to devastating consequences. 
For example, there have been reports that the White House tests 
that they use to screen individuals before they visit the Oval 
Office may produce false negatives 20 percent of the time.
    So, Dr. Hahn, FDA has said that it has asked test 
manufacturers to conduct follow-up accuracy studies on tests 
that have received emergency use authorization.
    Can you tell us how many of these tests--how many of these 
tests have you requested follow-up accuracy testing on and of 
that number how many have been shown to be accurate?
    Dr. Hahn. Thank you, Congressman, for that question, and I 
just want to emphasize the point that you made, which is that 
in an emergency situation our EUA authorities allow us to look 
at the risk benefit, and early on in a pandemic with limited 
numbers of supplies on our--or not supplies, but reagents to 
test the actual diagnostic accuracy, we rely upon a certain set 
of data to make that decision initially.
    We have actually required in the post-marketing setting the 
collection of data for a number of companies and they have come 
back to us with those data, and we have made adjustments to the 
EUAs for those tests.
    But even in those situations where we haven't required a 
formal post-marketing assessment of the tests, we have 
collected on our own and with the companies and with academics 
real-world data.
    We incorporate all those data into our assessment of the 
tests. And I will just take, sir, for a moment, serology tests 
where we have taken over 20 off the market based upon our own 
independent evaluation in U.S. government.
    We will continue to make those efforts and we will continue 
to look at those data and adjust our recommendations and tell 
end users, be very transparent about the operating 
characteristics of the tests so that they can use them in the 
best way possible.
    Mr. Peters. About how many adverse events reports have you 
received on diagnostic tests so far?
    Dr. Hahn. Sir, I will have to get back to you with the 
exact number. We have received a number, and I mean double-
digit numbers, of reports about all of these tests. But I would 
be glad to get those data for you, sir.
    Mr. Peters. OK. And just to confirm, if a follow-up 
accuracy study comes back and it is shown to be inaccurate, you 
have moved and you will continue to move to take those tests 
off the market?
    Dr. Hahn. Absolutely, sir, and we promise to be transparent 
and post that on our website.
    Mr. Peters. Thank you very much.
    I want to ask Dr. Redfield a question about digital contact 
tracing. Do you agree that digital contact tracing tools can 
enhance our traditional contact tracing efforts, particularly 
proximity tracking tools that use Bluetooth technology to 
identify people at risk of COVID-19 infection?
    Dr. Redfield. Thank you very much for the question.
    Clearly, these new digital technologies that are--have been 
developed for contact tracing are important to be evaluated and 
to see how they will contribute.
    I want to emphasize, though, that first and foremost, the 
most important component we believe of contact tracing is the 
human capacity to do that, and this is why we are working to 
aggressively increase the number of contact tracers.
    But we currently are in the process of evaluating it to see 
if it is value added.
    Mr. Peters. Dr. Redfield, let me just--let me just point 
out, because I only have 45 seconds.
    Dr. Redfield, let me just point out, I would really think 
it would be a shame if we took the technology from the 1980s 
and didn't employ the technology that we have today.
    Bluetooth technology can tell you who you have been around 
within a certain proximity with great accuracy and with great 
speed. It can be anonymized so that no one knows who the 
particular person is.
    But if you have your Bluetooth on, you don't have to know 
who you were standing next to at the protest or in the 
restaurant or in the bar. If the person's test is positive, it 
can go into a system. And Google and Apple, MIT, UCSD are 
working on these things.
    So, in fact, you could be automatically almost in real-time 
warned that you have been in proximity to someone who has 
tested positive, and can behave accordingly.
    For speed and for accuracy, I hope you will give a good 
look to Bluetooth technology because it could be private and it 
is certainly more accurate and certainly faster than the 
technologies we used back in the 1980s.
    We can do better, and I yield back.
    Dr. Redfield. Yes. I just want to just emphasize, 
Congressman, that we are aggressively evaluating that 
technology with Google, Facebook, to actually see how it 
impacts it.
    So I agree with you, it is really important. We have 
programs evaluating each of it in partnership with Google and 
Facebook right now, and we will continue.
    The question is just to see exactly the best way for this 
technology to be used. It is not a question of not seeing it as 
something that potentially could be very important.
    Mr. Peters. Thank you.
    Mr. Pallone. Thank you.
    We are going to go to Montana now, Mr. Gianforte.
    Unmute, please.
     Mr. Gianforte. Thank you, Mr. Chairman. I appreciate the 
recognition.
    I want to thank all the witnesses for their time today. The 
people of Montana appreciate you and all the health 
professionals who are working so hard to keep us safe and deal 
with this virus.
    As we mourn the lives of those lost to COVID-19, we must 
also think about how to continue to safely reopen our nation. 
Testing is critically important to both help limit the spread 
and restore confidence to the public.
    Montana has seen an uptick in positive test results but not 
a large uptick in hospitalizations. This could be seen as 
indicating that increased testing is finding more mild and 
asymptomatic cases.
    I have heard from hospitals and private labs across Montana 
that they would like to provide their own testing services to 
help their communities and provide certainty to large employers 
as well as rapid response capability for tourists that are 
coming to see our national parks and great public lands in 
Montana.
    Admiral Giroir, there has been an enormous increase in 
availability of diagnostic testing since the early stages of 
the pandemic. Test manufacturers rapidly scaled up their 
production capacity to meet the unprecedented need for testing.
    Could you describe for us the administration's 
collaboration with the private industry in establishing this 
massive diagnostic and serological testing infrastructure and 
the availability of supplies for state health agencies as well 
as the commercial supply chains?
    Adm. Giroir. So thank you, and I will try to be brief 
because I know your time is limited.
    It has really spanned--as you said, it is a public-private 
partnership and we have been working very tightly with FDA as 
well because innovation has been key to that.
    Just to give you an example, when we opened our first 41 
testing sites using nasopharyngeal swabs, which would require a 
full PPE and full PPE changes, if we ran those 41 sites full-
blown we would have exhausted 80 percent of the stockpile for 
PPE within the first week.
    So it was really vital that the FDA was able to work with 
sponsors to validate other types of equipment to span our--to 
expand our supplies.
    Let me just say that the public-private partnership, 
whether it is working with the ACLA labs--that is the Quest, 
LabCorp, Mayo, BioReference--they have done over half the tests 
in the country to date. It has been absolutely critical.
    Every laboratory manufacturer that supplies test kits for 
these laboratories are working with us. We have a relationship 
manager with every one so we know what their limitations are, 
can we get around it with the DPA, can we help them with their 
supplies, what can we do to maximize the number of tests, 
moving forward.
    And, again, I will just say with Montana it has been a real 
special case because although we have lots and millions and 
millions and millions of tests, there are only a few that are 
really geared to rural areas and they are in very short supply.
    So we have been working very closely to get, for example, 
the Sofia test and the point of care to Montana, because you 
are not in the middle of New York City where you have the 
umpteen million-dollar machines. You are really in a rural area 
like in Alaska.
    So it's not just the numbers. It's the type and it is mixed 
with innovation.
    Mr. Gianforte. Great. Thank you, sir. And it sounds like 
the public-private partnerships have really been central to 
your strategy to scale up testing capacity.
    What efforts are ongoing in that area to further develop 
public-private partnerships?
    Adm. Giroir. They really have been critical because the 
public health laboratories are an essential first line of 
defense. But as of now, they have only done about 7.5 percent 
of the overall testing. So the majority--you know, overall, it 
is the hospitals and academic institutions and about half with 
the commercial sector.
    The swabs--you've jested about swabs--when I dropped into 
this on March 12th I thought we had ten manufacturers, 12 
manufacturers.
    There was one in Italy and one in Maine, and everybody 
repackaged the same product and it, you know, was the most--is 
the hardest to make, most difficult to get was the only one 
that was authorized.
    I never thought I would send a C-17 over to Italy, to pack 
a C-17 full of swabs. But that is what we needed to do. So the 
public-private partnerships, whether it is the manufacturers, 
the retailers, and the pharmacists, have been absolutely 
essential.
    It is really the only way to scale what we need. If you 
have a small outbreak you could do it within the traditional 
infrastructure. But like in World War II, you know----
    Mr. Gianforte. Thank you, sir.
    Adm. Giroir [continue]. Everybody has to participate.
    Mr. Gianforte. Yes. Thank you, sir.
    Commissioner Hahn, in the limited time I have here, a 
health professional in Montana wanted me to ask if you have 
confidence in the accuracy of the antibody test currently 
available, and what steps are being taken to ensure we avoid a 
supply crunch for those tests as well?
    Dr. Hahn. Thank you, Congressman.
    We have authorized over 20 serology tests. My 
recommendation to users across the country in, particularly, 
public health, is to use those tests that are authorized under 
the EUA process with the FDA.
    We are undergoing an independent validation of data that 
manufacturers have sent to us to ensure that we can actually 
corroborate what the manufacturers have sent.
    If we are not able to do that, we are asking those and 
taking those off the market. We are being very transparent on 
our website, and I am very happy to have a conversation with 
the health professionals in your state, sir.
    Mr. Gianforte. Thank you.
    Mr. Pallone. Thank you.
    Mr. Gianforte. Mr. Chairman, I yield back.
    Mr. Pallone. Thank you.
    We are going to go now to Michigan, Mrs. Dingell. We are 
coming to you from the Dingell Room there.
    Mrs. Dingell. Thank you. Thank you, Mr. Chairman, and I 
want to thank all of our witnesses for being here today and 
your patience in dealing with all of us.
    Believe it or not, there is widespread agreement on 
something, which is that we are not going to be able to safely 
return to anything resembling what we once knew as normal until 
we have a safe and effective vaccine.
    In Congress we have moved quickly to facilitate development 
of such a vaccine, investing billions of dollars of funding in 
BARDA and NIH.
    Public and private researchers have taken those resources 
and run with them, speeding through the Phase I and Phase II 
trials, clinical trials, with multiple companies now announcing 
that they are about to begin Phase III trials as soon as next 
month or soon after.
    This speed is unprecedented, and I want to be very clear as 
I ask these questions I am not an anti-vaxxer. Vaccines have 
eliminated disease and expanded life spans--extended life 
spans.
    But as members of this committee have been told many times, 
Phase III trials are where the rubber meets the road in 
developing a new drug.
    It is where you test a new drug in human patients on a wide 
scale, evaluating constantly for side effects and, ultimately, 
determining the effectiveness of a vaccine.
    One of the vaccine candidates which is working with NIH has 
announced that their Phase III clinical trial will enroll 
30,000 patients and another Operation Warp Speed candidate 
company has said it will enroll 8,000 patients.
    These are much lower than historical vaccine trials, which 
have enrolled 60,000 to 70,000 patients in the past. And I know 
that there can be consequences.
    I was one of those unlucky people that got Guillain-Barre 
after the swine flu shot decades ago. But to this day, I know 
the benefits of the swine flu shot far outweighed the risks and 
that we must develop this vaccine.
    But we have got to talk about important issues so people 
believe in this vaccine.
    Dr. Fauci, will you explain the importance of testing 
larger populations in Phase III clinical trials?
    Dr. Fauci. Yes. Thank you very much for that very important 
question.
    The size of the trial is calculated, really, on a 
statistical basis of the number of infections that you might 
need to get a certain percentage of efficacy.
    So you figure out do you need this level of efficacy or 
this level, and how many hits or how many events do you need in 
the trial, and it was based on that that the statisticians came 
up with a 30,000-person.
    I want to point out something that I think you were hinting 
at, and I agree with you completely. You want to make sure, 
particularly when you have a new vaccine for a brand new 
disease, that not only can you get a signal of efficacy but you 
really feel good about safety.
    And the more people you get in the trial before you release 
that vaccine to the public, the more confident you are in the 
safety. We are going to have a different kind of an approach, 
Congresswoman Dingell, to the Phase III trial.
    We are going to have subsets of that that will be looked at 
much more carefully for safety, particularly for the concept 
and the phenomenon of enhancement, because that is one of the 
things we are concerned about that, paradoxically, if you get a 
suboptimal response to the vaccine and you do get infected, you 
could actually have an enhancement.
    So I hear you very, very loud and clear. Safety is a very 
important issue and we are going to be paying very close 
attention.
    You may not have heard, or not, my comment earlier on in 
the hearing when I said I wanted to make sure that before we 
let a vaccine out to the general public, we are as confident as 
to the efficacy as we are of the safety. And I promise you that 
I will be an advocate for that very, very strongly.
    Mrs. Dingell. I did hear you, and I do trust you. But I 
still had to ask the question.
    I want to ask Dr. Hahn a question, very quickly. A number 
of observers have said that we won't know the vaccine's long-
term safety and effectiveness if we move forward with these too 
quickly.
    I hear what Dr. Fauci is saying and I know the importance, 
but what steps will FDA take to ensure effectiveness in 
evaluating data from the clinical trial and will you commit to 
receiving that full effectiveness data from Phase III before we 
authorize or approve the vaccine?
    Dr. Hahn. Congresswoman, thank you very much for the 
question, and I just want to reiterate one thing I said earlier 
and that is that the science and the data will guide our 
decisions.
    We have world-class experts at the FDA. We are working on 
right now guidance for sponsors and developers of vaccines to 
exactly address the question that you are asking.
    We will be transparent about that guidance and forward 
leaning, and we will work with the sponsors to ensure that the 
data we need to make those decisions are available.
    And I promise you, ma'am, that we will wait for the data 
that we need to make that adjudication around safety and 
efficacy.
    Mr. Pallone. Thank you, Mrs. Dingell.
    Mrs. Dingell. Thank you both.
    Mr. Pallone. OK. Now we are going to move to Mr. Veasey of 
Texas. Unmute, please.
    Marc, are you there?
    Mr. Veasey. Can you hear me?
    Mr. Pallone. Yes. You are recognized for 5 minutes.
    Mr. Veasey. OK. Mr. Chair, thank you very much.
    I wanted to ask a question about something disturbing that 
I saw in Politico this morning, and it is concerning the data 
collections that are underway at CDC.
    It was implied in the article that there were attempts to 
downplay true statistics, and I was wondering how is CDC 
determining the death count that is updated daily?
    If you could touch on that, Dr. Redfield, that would be--I 
would sure appreciate it.
    Dr. Redfield. Thank you very much, Congressman.
    There was a report. There was--cases are reported to CDC 
from state and territorial local health departments either as 
confirmed cases or probable cases.
    They come in through different data streams and then they 
are verified to get the final numbers. There was a coding 
glitch on June 19th from the State of New York where there was 
approximately 5,000 cases that were probable cases that the 
coding glitch assumed that they were counted in the confirmed 
case list.
    So that one day there was a 5,000 confirmed case 
undercounting, which was--it occurred on the 19th of June. It 
was identified on the 19th of June and it was corrected. And 
there were no coding glitches that affected deaths.
    Mr. Veasey. So let me ask you, so if a patient that--if a 
patient has COVID and they die of sepsis, is that still a 
COVID-related death? Are you still going to count that as a 
COVID-related death?
    Dr. Redfield. It depends on how it is coded by the state 
health department or the city health department or the county 
health department, whoever has jurisdiction for that, because 
it is coded at the local level.
    Mr. Veasey. So then--so the death count could be a lot 
higher than what we are seeing right now on the news?
    Dr. Redfield. Yes, I think each coder--each physician tries 
to understand on the death certificate what the primary cause 
of death was.
    Was it COVID that then caused complications that leads to 
sepsis, or is it somebody who had an asymptomatic COVID 
infection who got hospitalized for, say, a contaminated 
infection in their arm and led to sepsis.
    So these are individual clinical decisions that are made on 
the death certificate.
    Mr. Veasey. So based on that, what do you think the actual 
COVID death rate is? Would you have the--would you have----
    Dr. Redfield. I would continue--yes, I would continue to 
rely on the data that we have that is basically reported 
through the current reporting system where it is then based on 
the death certificate--the actual death certificate that is 
defined by the clinician responsible for making that 
determination, and that is the numbers that we use.
    Mr. Veasey. OK. Thank you very much.
    And I wanted to ask Dr. Fauci a quick question with my 
remaining time.
    Dr. Fauci, there was a grant that was--it was a 
coronavirus-related grant that was not renewed and I wanted to 
talk with you to make sure that we just get the facts straight 
about this because I was really concerned about this.
    Does the--do you know why this grant was canceled or if 
anyone at the White House or HHS pressured your colleagues to 
do so and, specifically, I wanted to talk with you about the 
National Institutes of Health.
    There was a decision made by the Trump administration to 
cancel research on a grant that was specifically focused on 
coronavirus emergence while we are in the midst of this 
coronavirus pandemic, and it just didn't make any sense to me 
why this grant would be canceled.
    Dr. Fauci. Is the question you are asking, why was it 
cancelled?
    Mr. Veasey. Yes. Why was this--why was this grant cancelled 
when we are in the middle of this pandemic? It seems like it 
would have been very helpful for us to have this research, 
considering we know very little about COVID-19.
    Dr. Fauci. Right. OK. It was canceled because the NIH was 
told to cancel it.
    Mr. Veasey. And why were they told to cancel it?
    Dr. Fauci. I don't know the reason. But we were told to 
cancel it.
    Mr. Veasey. OK. Thank you very much, Mr. Chairman. I have 
no further questions.
    Mr. Pallone. Thank you.
    We are going to now go to New Hampshire.
    Ms. Kuster, unmute please.
    Ann, you got to unmute. Ann, are you there?
    Ms. Kuster. I am, and I did unmute, Frank. Can you hear me?
    Mr. Pallone. Yes, we can. You are recognized for 5 minutes.
    Ms. Kuster. It is so embarrassing. I am sorry. I had 
already unmuted and started.
    So thank you, Chairman Pallone, for holding this hearing, 
and to all our witnesses for your patience today.
    In addition to efforts related to the research, 
development, and manufacturing of a COVID-19 vaccine, there 
will also be work needed to ensure that the vaccine is widely 
adopted and equitably distributed, specifically, decisions 
about the allocation of the vaccine, efforts to support 
provider training, public education, and coverage 
considerations to ensure that the vaccine is not only available 
but available to everyone in every community, including 
communities of color, among immigrants and refugees, those 
living in rural areas, and of course, our elders.
    In the absence of a vaccine plan from the administration, I 
am concerned that attention to this necessary work is being 
overlooked and we will repeat the errors and mistakes that were 
made earlier in the pandemic.
    Admiral Giroir, the framework and documents HHS has 
released do not address these details and other factors that 
will be critical to reaching COVID vaccination rate goals.
    Could you comment on that and the bipartisan letter that 
this committee called on the administration to create a 
national COVID-19 vaccine plan?
    Adm. Giroir. Thank you, ma'am. A very important question.
    I am not on that work group. That is Dr. Redfield and, I 
believe, Dr. Fauci, and they can answer that question for you.
    Ms. Kuster. Great. Thank you. I would appreciate it.
    Dr. Redfield. Thank you very much, Congresswoman.
    This is a critical area. Just as Dr. Fauci has commented 
how important it is that we have begun to take the financial 
risk to have these companies be able to start manufacturing----
    Ms. Kuster. And I am sorry to interrupt. Our time is short 
and the day is long.
    Admiral Giroir, what I am asking about is not the creation 
of the vaccine. It is a national vaccine plan to equitably 
distribute the vaccine.
    Dr. Redfield. Right. I was----
    Ms. Kuster. I have legislation to require the 
administration to create a plan on the equitable distribution. 
That is the focus of my question.
    Dr. Redfield. Yes. The quick answer is that is part of the 
overall working plan and it is in development.
    Ms. Kuster. It is not available at this time? When can we 
expect it will be available?
    Dr. Redfield. I will have to defer that to the Secretary of 
Health and the Secretary of Defense that are in charge.
    But I can tell you that is an essential part of the current 
plan to develop the distribution strategy that will also 
address the equitability issue.
    Ms. Kuster. My understanding from when Dr. Eric Wright came 
before our committee is that it could take up to a couple of 
years to manufacture the materials to administer the vaccine 
and that those plans had not developed. Do you know about the 
manufacturing of the supplies to deliver the vaccine?
    Dr. Fauci. That is currently a plan that is under the 
purview of a combination of General Gustave Perna, who is one 
of the co-leaders of the Operation Warp Speed.
    He has been specifically brought in by the Secretary of 
Defense to work with the Department of Health and Human 
Services to make sure that not only the vaccine itself is 
equitably distributed but also that all of the material that is 
needed for the proper distribution.
    So this falls under his purview and he was specifically 
brought in by the Department of Defense to address that issue.
    Ms. Kuster. And do you know if there is a plan to promote 
public health messaging----
    Dr. Fauci. Yes.
    Ms. Kuster [continue]. And materials to counter vaccine 
hesitations in the country?
    Dr. Fauci. Yes. That is a very good question. I am glad you 
asked it and I have the opportunity to answer it.
    What we are doing is a combination of a couple of things. 
We are employing our community activist groups that we had 
originally put together during the days when we had the HIV 
group and they are now an important part of all of our clinical 
trials networks.
    So we are going to employ the community outreach mechanisms 
that we already have. But also the CDC traditionally over the 
years has been very heavily involved in making the 
prioritization which usually is the most vulnerable people 
first.
    But I will let Bob talk about that since----
    Dr. Redfield. I will just say, very quickly, that we are 
very involved in the critical area you brought up in developing 
the communication strategy.
    It is going to be fundamentally critical, as well as I 
mentioned already we are working on developing the distribution 
strategy for--but the communication strategy is very important 
and it needs to--it will be beginning to be operationalized 
soon, just like we are getting ahead on the manufacturing.
    Mr. Pallone. Thank you, Ann.
    Ms. Kuster. Thank you. My time is up and I yield back.
    Thank you, Mr. Chair.
    Mr. Pallone. Thank you.
    Now we go to Illinois, Ms. Kelly--Robin Kelly. Please 
unmute.
    Ms. Kelly. Thank you. Yes, I am. Thank you, Mr. Chair, and 
thank you to the witnesses for all their patience.
    I also wanted to thank Dr. Redfield and Dr. Fauci for the 
extra meetings with the CBC and the Tribal Caucus.
    As we have heard, data has been revealed across the 
country, including in my district and in the city of Chicago, 
minority communities shoulder a disproportionate burden of 
COVID-19 cases and fatalities.
    The virus has exposed centuries of health inequities 
stemming from historically racist policies affecting the social 
determinants of health.
    As chair of the Congressional Black Caucus Health Brain 
Trust, I am concerned by this tragic reality. The most recent 
CDC data showed that American Indians and Alaska Natives have a 
hospitalization rate approximately five times that of whites.
    Black people are hospitalized at four and a half times the 
rate of whites, and those who are Hispanic or Latino are 
admitted to the hospital approximately four times more often 
than white people.
    Despite these disparities, CDC's racial and ethnic 
demographic data is still extremely lacking. It is my 
understanding that 52 percent of reported coronavirus cases in 
the U.S. are still missing information on race or ethnicity.
    That is why we included a number of requirements in the 
HEROES Act that the House passed in May that would require the 
federal government to better track and publicly report COVID-19 
racial, ethnic, age, sex, and gender data as well as require 
the various federal agencies to modernize their data collection 
methods to account for inequities.
    Dr. Redfield, you have admitted publicly that the 
Administration's four-page COVID-19 demographic report was 
inadequate, and while you announced that CDC will require all 
lab tests to include information about a patient's race, 
ethnicity, age, and zip code, the most recent report from CDC 
shows that more than half of the data you have is missing 
racial and ethnic information.
    Consequently, I worry that this is a little too late, and 
this new rule lacks a clear enforcement mechanism. What further 
actions is CDC taking to address these data gaps? How is the 
CDC working with state, local, territorial, and tribal public 
health departments and labs to support their efforts to collect 
this information across the country?
    Dr. Redfield. Yes. Thank you very much, Congresswoman. As 
we discussed I think last week, we are continuing to make 
progressive progress and to ensure that the requirement to 
include the race and ethnicity issue on all tests submitted for 
COVID is completed.
    There is a progressive improvement, as you--I think you 
have noticed. The same with the hospitalizations. I think we 
are up to 80 percent now. That is still not where we need to 
be. We are working to get to 100 percent, and we are going to 
just continue to work with our state, local, territorial, 
tribal leaders to get that accomplished, as well as the 
laboratories and the hospitals and the long-term care 
facilities, because it is critical that we do have that 
information, as you point out.
    Ms. Kelly. Thank you.
    And, Admiral Giroir, what steps is the Administration 
taking to gather missing data, including data for minority 
neighborhoods and congregate facilities like nursing homes, 
jails, and prisons?
    Admiral Giroir. I think I caught about half of that, ma'am. 
But let me just say that I am sorry. It is the internet 
connection.
    Mr. Pallone. Robin, repeat it.
    Ms. Kelly. What steps is the Administration taking to 
gather missing data, including data for minority neighborhoods 
and congregate facilities like nursing homes, jails, and 
prisons?
    Admiral Giroir. So all kind of different very, very 
important subgroups that we are working with. I don't think it 
is possible on the testing data to reconstruct what the racial 
and ethnic makeup is of the tests that were done in March and 
April and May. I don't think that is a possibility. Looking 
forward, we are absolutely going to mandate that.
    On the enforcement mechanisms that you talked about, we 
might want some help with that because the authorization did 
not have an enforcement mechanism. So we looked very deeply to 
do that. We were not able to do criminal/civil monetary 
penalties, et cetera, but we are working through the EUA 
mechanism.
    And I don't want to put too fine a point on it, but I would 
like to turn the switch and have this tomorrow. I would have 
liked to have had it two months ago, because it really is 
critically necessary. We are targeting our resources to those 
areas, but not getting all of the feedback of the numbers that 
we need.
    But one thing, for example, the major reference 
laboratories, just to give you an idea of the complexity, they 
have done over half the tests. They don't collect any of those 
tests. That comes from tens of thousands of individual 
physicians, pharmacists, others. So we are working with this 
very complex system to make sure each of those tens or hundreds 
of thousands of people provide that data, so we can get it.
    But you have my personal commitment as a person whose job--
my day job is working on health disparities to make sure we get 
this as quickly and as accurately as possible.
    Ms. Kelly. Thank you. And my office will be in touch, so we 
can work together and we can give you the help that you need. 
Thank you so much.
    And I yield back.
    Mr. Pallone. Thank you.
    Ms. Barragan is here. You are recognized for 5 minutes.
    Ms. Barragan. Thank you. Thank you, Mr. Chairman, for 
having this hearing.
    This pandemic is still raging. Over 119,000 Americans have 
died, and cases are still rising in 29 states, with over 20,000 
new infections per day. In fact, 12 states set records for the 
most daily cases in the past week, and we know that Black, 
Latinx, and Native Americans are bearing a disproportionate 
burden of the Administration's failures to address this 
pandemic.
    Meanwhile, the Trump Administration seems to have moved on. 
The last time the White House task force held a full press 
briefing was April 27, and the task force is now winding down. 
Admiral Giroir is stepping down as the Administration's testing 
czar, despite the fact that we still need to greatly expand 
testing.
    We still don't have enough tests. We still don't have 
enough PPE. We don't have a vaccine, and this fall, we could 
see another wave of infections, yet President Trump last month 
declared, and I quote, ``We have met the moment, and we have 
prevailed.''
    Dr. Fauci, do you believe we have prevailed? Has the fight 
against COVID-19 been won?
    Dr. Fauci. I wouldn't use the word ``prevail.'' I would say 
that we are still in the middle of a serious outbreak. There is 
no doubt about that.
    Ms. Barragan. Instead of devoting his time and effort to 
taking this pandemic seriously, President Trump is hosting 
campaign rallies, packing thousands of people tightly together 
without masks, in direct opposition to the guidance of all 
public health experts, just so that he can hear the crowds 
chant his name.
    Clearly, this President has decided the best strategy to 
deal with the greatest threat against this country during his 
presidency is to bury his head in the sand and wish it went 
away.
    Dr. Redfield, as the director of the CDC, your advice to 
the President is important now more than ever. Dr. Redfield, 
when was the last time you spoke to the President about the 
country's response to this pandemic?
    Dr. Redfield. Thank you, Congresswoman. As I mentioned 
before, the interactions and discussions I had with the 
President I will keep to myself. But I do meet with the task 
force every----
    Ms. Barragan. Dr. Redfield, I am not asking for the content 
of your conversation. I am asking when you talked to him last. 
Has it been a week? A day? A month?
    Dr. Redfield. Again, I am going to stay with my same 
answer, that I continue to talk with the task force whenever 
the task force meets. And I think----
    Ms. Barragan. Thank you, Dr. Redfield. I think the fact 
that you won't tell this committee when the last time you spoke 
to him, whether it was days or months ago, is a real concern.
    Dr. Fauci, when is the last time you spoke to the 
President?
    Dr. Fauci. About two and a half weeks ago.
    Ms. Barragan. Thank you, Dr. Fauci.
    Admiral Giroir, when is the last time you spoke to the 
President?
    Admiral Giroir. It was about two and a half weeks ago as 
well, maybe three weeks ago. If you don't mind just me 
clarifying, because I do think it is really important. I am 
remaining the testing lead. A lot got misconstrued because I 
said I was not going to be 100 percent of the time at FEMA, 
because my current position also works on ending HIV, substance 
use.
    So I am still going to maintain the testing lead, but I am 
also integrating back into some of my other office functions.
    Ms. Barragan. Thank you for clarifying that.
    Honorable Hahn, when is the last time you spoke to the 
President about the pandemic and the response?
    Dr. Hahn. It has been some time since I spoke about the 
pandemic response. I did have a conversation in the last couple 
of weeks.
    Ms. Barragan. Would you say that it had been more than a 
month ago?
    Dr. Hahn. No, ma'am.
    Ms. Barragan. OK. Dr. Fauci, you have been candid in the 
past about the shortcomings of the Federal Government's 
response and what more is needed. Dr. Fauci, as painful as 
these spring shutdowns have been, if we don't put in the effort 
now--expand testing, prepare for a second wave, develop 
national strategies for contact tracing and vaccinations--could 
we see our progress reverse? And could we be forced to shut 
down again if cases again get out of control?
    Dr. Fauci. In describing what is going on, it is a very 
complicated situation and a mixed bag. There are certain parts 
of the country, certain areas, cities, states, that have 
actually done very well and are following the guidelines that 
we put together--the gateway, phase 1, phase 2, phase 3. New 
York City is one of them. Actually, Washington, DC., is 
another.
    There are other areas, other states, other cities, that 
have not done so well. I have a considerable concern about 
those because I want to make sure that we get everything under 
control. It is not there yet. I hope as the weeks and months go 
by we will be able to do what you are referring to and mobilize 
the identification, isolation, and contact tracing in those 
states, the ones that have recently been in the news--Florida, 
Arizona, Texas--and those states that are now having a serious 
problem.
    So it really is a mixed bag. We have some doing really well 
and some really in trouble.
    Ms. Barragan. Right. But, Dr. Fauci, just to clarify, in 
the areas where it may get out of control--and we certainly 
know there are states that are doing that now--would you say 
that we might have to go backwards and some of the progress may 
be taken away and we may have to shut down?
    Dr. Fauci. Yes. I wouldn't necessarily--first of all, I 
agree with what you are saying. I wouldn't necessarily say an 
absolute shutdown/lockdown.
    Ms. Barragan. Right.
    Dr. Fauci. But if someone is going from gateway to phase 1 
to phase 2, and they get into trouble in phase 2, they may need 
to go back to phase 1. I don't think they necessarily need to 
go back to lockdown.
    Ms. Barragan. Thank you. Thank you all.
    With that, I yield back.
    Mr. Pallone. Thank you.
    Now we go to Delaware, Ms. Blunt Rochester. Please unmute.
    Ms. Blunt Rochester. Thank you, Mr. Chairman. And thank you 
so much to the panel. We know that under normal circumstances 
uninsurance, health insurance, the lack of that, as well as the 
underinsurance of individuals, is a big problem for our 
country. But right now with the current pandemic and the high 
unemployment rate, it is an absolute crisis.
    I don't want to turn this into a debate about the 
Affordable Care Act or Medicaid expansion or any other policy 
disputes that we may have. The fact remains that millions of 
people in our country are either without health insurance or 
they can't afford to use it. And they are especially vulnerable 
right now.
    There are close to 30 million people without health 
insurance in this country. And for those people, it will 
undoubtedly be harder to receive testing and treatment. And 
when a vaccine is developed, they will likely struggle to 
access that vaccine.
    Dr. Fauci, as a matter of public health, would you agree 
that during a pandemic such as COVID-19 it is in everyone's 
interest for people to be quickly tested, treated, and 
ultimately vaccinated?
    Dr. Fauci. I agree.
    Ms. Blunt Rochester. And, Dr. Fauci, if approximately 30 
million people in this country can't easily access treatment 
and vaccines because they lack health coverage, doesn't that 
present a public health risk?
    Dr. Fauci. I feel as a physician, a scientist, and a public 
health official that everyone should have access to the kinds 
of things that we are talking about--testing, as well as 
accessibility to a vaccine and healthcare.
    Ms. Blunt Rochester. Admiral Giroir, the Administration has 
suggested that money from the Provider Relief Fund, which is 
supposed to help struggling providers, is how it will pay for 
care for the uninsured. When can we expect a comprehensive plan 
from this Administration for how it plans to provide treatment 
and vaccines to people regardless of insurance status?
    Admiral Giroir. The vaccine plan I think is currently 
underway, as you heard Dr. Redfield do that. There are--I work 
very closely with HRSA on making sure that everyone can get 
free testing. That program is underway, and the claims 
reimbursement for treatment is up to about $186 million now. So 
I know that is ongoing and would be glad to have HRSA or anyone 
else answer any specific more questions that you would have.
    But I do agree with the premise again that it is absolutely 
critical, not only in a pandemic but under any other times, 
that people who need testing get the testing, that they get the 
healthcare that they need, and most importantly there are no 
impediments whatsoever to getting vaccinated.
    Ms. Blunt Rochester. I don't know if anyone on the panel 
could answer this question, but were there conversations about 
expanding Medicaid or opening up enrollment for the ACA to 
actually mitigate the risks?
    Admiral Giroir. So I am just going to say that I am not a 
member of the task force but am at most of the meetings as an 
invited guest for obvious reasons. And I think there were 
discussions across the board about all options. All options 
were looked at and discussed in order to make--it was clear 
that the objective needed to be that no one should be waiting 
at home in need of care because of a lack of coverage.
    And I would say that every option was really looked at, and 
the leadership of the Administration at the White House decided 
on this way to move forward.
    Ms. Blunt Rochester. I will reserve my comment to just say 
that I think those options would have been no-brainers.
    I championed legislation included in the Heroes Act that 
would require insurers to cover COVID-19 treatment with no 
cost-sharing, and the Heroes Act also included a provision that 
would provide coverage of COVID-19 treatment and vaccines 
through Medicaid for everyone who is uninsured.
    I sincerely hope our colleagues in the Senate will take up 
the Heroes Act, so that we can make sure that everyone in this 
country can access the treatment and vaccines they need.
    I yield back the balance of my time.
    Mr. Pallone. Thank you.
    Next is Mr. Soto of Florida. Please unmute.
    Mr. Soto. Thank you, Chairman. I want to go through a 
little bit of a timeline. On January 23 through 28, President 
Trump received two intelligence briefings on the coronavirus 
according to White House officials. From early January well 
into mid-March, President Trump deliberately misled the 
American people into believing the coronavirus was, quote, 
``well under control.'' He declared on several occasions, 
quote, ``It will disappear.'' And as late as March 12, he 
stated, quote, ``It is going to go away.''
    The very next day, on March 13, he finally declares the 
national emergency. Approximately 50 days passed from the time 
President Trump received his first coronavirus intelligence 
briefings until he finally declared the national emergency.
    Add in six weeks we lost in ramping up testing at the CDC 
due to contamination and the results of President Trump's 
disastrous response have been deadly, the United States has 
more COVID-19 deaths and more cases than any country in the 
world. Over 120,000 Americans are dead, 2.4 million Americans 
contracted the virus, and the economic fallout has left 43 
million Americans out of work.
    To argue that President Trump's response has somehow been a 
success is really quite astounding. It is our job to conduct 
oversight and hold the Administration accountable, regardless 
of the American--regardless of your party.
    So moving forward, Dr. Fauci, the House has already passed 
the Heroes Act, which includes $75 billion in additional 
coronavirus testing, contact tracing, and isolation measures. 
How important is this funding to our continued efforts to 
combat COVID-19 in the United States?
    Dr. Fauci. Thank you for that question, Congressman. As we 
have said throughout this hearing, clearly testing, even more 
widespread testing on a surveillance basis, is absolutely 
essential for us to really get a full understanding of the 
penetrance of this, particularly among individuals who are 
asymptomatic.
    So the short answer to your question: it is very important.
    Mr. Soto. Thank you. And, Dr. Fauci, how important is this 
additional funding to stop recent increases in COVID-19 cases 
as seen in my home State of Florida?
    Dr. Fauci. Again, in attune with what I just mentioned, the 
more that you understand the dynamics of the infection, the 
more that you understand the distribution, the more chance you 
have of better control for identifying, isolating, contact 
tracing, and concentrating the resources in those areas where 
you have the most problems. You won't know that unless you know 
exactly what the penetrance is in your community.
    Mr. Soto. Thank you.
    Commissioner Hahn, there is a shortage of remdesivir in 
Central Florida in and around my district. Will the FDA be able 
to assist us with this shortage? And have we seen other 
shortages of remdesivir across the country?
    Dr. Hahn. Congressman, really appreciate the question. We 
are working closely with HHS, as well as the White House 
Coronavirus Task Force, who are responsible for the 
distribution of the remdesivir. We do know that we have a 
supply in this country, and I am very happy to work with you 
and with others.
    So I would be glad to have our folks get in touch with 
yours to make sure that there is adequate supply for Central 
Florida.
    Mr. Soto. Thank you, Commissioner Hahn.
    Dr. Redfield, we saw after the [audio malfunction in 
hearing room] we lost [audio malfunction in hearing room] in 
ramping up testing. And now do you think that the United 
States' relationship with the World Health Organization is 
important to the future of combating the coronavirus, both in 
the United States and worldwide?
    Dr. Redfield. Thank you very much, Congressman. We continue 
to have an important public health relationship with the WHO. 
We have had a long history of partnership with them. We are 
currently involved in a number of very important public health 
efforts--the eradication of polio, responding to the Ebola 
outbreak in the DRC, developing our influenza surveillance 
system across the Nation, so we continue that partnership at 
the scientific and public health level.
    Mr. Soto. Thank you, Dr. Redfield. And so it is going to be 
very important not to defund the World Health Organization, 
since it so important to our national interest.
    And with that, I yield back.
    Mr. Pallone. Thank you.
    And last but certainly not least is Mr. O'Halleran.
    Mr. O'Halleran. That always bring a smile to everybody's 
face, Mr. Chairman.
    Members of the panel, thank you for being here today.
    I am going to start out with the forest fire. I have been 
at three of them the last week, because my district has eight 
going on right now. And when I get to an incident control 
meeting, the commander of that incident control team is there, 
and then the division managers for that fire are all there, 
too, or on the phone and being able to address the issue, as 
are all of the community organizations--police, fire, emergency 
response groups.
    They are all on those meetings, and there are multiple 
meetings during the course of the week with the citizens of 
those communities at risk. And now I am in a process where I am 
trying to figure out how this whole process is working from the 
standpoint of we are here now. What has happened happened; we 
can't change that. But going forward, how are we going to 
address that we have enough of the testing equipment and 
training--not training--equipment, the tracing equipment, in 
order to address the issues potentially in October, November, 
and into the winter?
    How are we going to, or will we have, a command and control 
system that doesn't include 50 people doing whatever they want 
to do, and not any ability to react to hot spots as they occur 
as quickly as they should maybe? And are we going to be ready?
    Hot spots--Navajo is my district. I have White Mountain 
Apache in my district. White Mountain Apache, over 1,500 have 
gotten the virus. That is out of 12,000 people. Navajo--the 
whole Nation knows what happened on Navajo. It took us weeks to 
get enough help up there to be able to address that problem, 
and White Mountain Apache is still calling me all the time 
saying, ``Where is this? And where is that?''
    So it is obvious that we have a shortage right now. How can 
we be guaranteed that we are going to have the necessary 
equipment and materials to be able to address it coming up 
during a flu season and the pandemic at the same time?
    And then transparency and accountability. I don't know how 
right now you trace transparency and accountability in the 
system because it is almost impossible, because nobody takes--
nobody says, ``That was my fault.''
    So, and I think every one of your groups has done an 
outstanding job. I just can't find out what you are doing on a 
regular basis. I hear something on the news, but that doesn't 
mean that I really end up knowing what it is.
    And so, Dr. Fauci, could you explain to me where we are at 
now and how are we going to attack these hot spots and address 
all of the issues I just talked about by the fall? And will we 
be prepared?
    And I guess most of all, is the entire process of--how do 
we educate the public that has different ideas and concepts 
right now to be able to understand the complicated nature that 
all of you have addressed here today and the overwhelming need 
to cooperate with one another as America always has?
    Dr. Fauci?
    Dr. Fauci. You asked a lot there. I will try to be succinct 
in my answer. So where we are now, as I mentioned a little bit 
ago, that it really is a mixed bag. It is a big country, it is 
very heterogeneous, and you can't have essentially a 
unidimensional approach to the difference between Arizona and 
the things you are responsible for and New York City 
metropolitan area.
    Some areas have done very well, are well controlled; they 
are going through the guidelines to open America. Others that 
we have discussed in detail today are doing poorly, and we are 
very concerned about them. So you are talking about what about 
as we get into the fall, into winter?
    The first thing that we would need to do is to try as best 
as possible to get the complete outbreak under control, so that 
everything is at such a low level that when there are cases 
that come up, you can contain them as opposed to mitigating, 
where you are essentially chasing after a forest fire that you 
just mentioned. Hopefully, we will get that under control soon.
    The other thing we need to do is to get the material, which 
we are doing--and Admiral Giroir, I am sure, will comment on 
that because he has done a phenomenal job of doing that--
getting the PPE, getting the ventilators, getting the equipment 
that we need, and have them in store, so that if--and I hope it 
is if and not when--but if we ever need them, we will have them 
and not be in the situation that we were in in February and 
March.
    Mr. O'Halleran. Will we have them by October and November?
    Dr. Fauci. I believe we will. We certainly will have the 
testing that we did not have early on. We will have it by 
October.
    With regard to the other things, the PPEs and the others, 
perhaps Admiral Giroir can help you with that.
    Mr. O'Halleran. Thank you.
    Admiral Giroir. Thank you. And, again, this is what we 
spend all of our time working on under the cooperation with 
Department of Defense, FEMA, HHS. We have already talked about 
testing. And if you want a person with accountability, it is 
me. If we don't have it, you look at me, it is my problem.
    But the whole testing infrastructure is really working 
together. The laboratory supplies, the laboratory testing, the 
NIH program, the BARDA program are all working in synergy, and 
I am coordinating all of that to make sure it happens.
    In terms of PPE, we have a long--we had a long way to go 
because almost nothing was made in the United States. I mean, 
literally, almost nothing was made in the United States. I 
mentioned earlier that a good example would be the N95 masks, 
and Admiral Polowczyk tells me as a result of everything we are 
going to have about 180 million per month made in the United 
States by the fall. That is ramping up very quickly, so we feel 
pretty good about that.
    And ventilators were just a good success story. I worked a 
lot on the ventilator problem early on. I am an intensive care 
physician. That is probably the only thing I do best is work 
with children on ventilators. But we were very concerned about 
that, and by July we will have about 50,000 in the stockpile. 
We only had 19,000 to begin with, but we will have 50,000. So 
we think--we know we are going to be in good shape for that.
    And I am going to use a word of Dr. Fauci. I am cautiously 
optimistic, but I am very cautious, and I still don't sleep 
well at night because we have a long way to go.
    And I just want to make the point that everyone has made. 
It is not like this is all going to happen to us. The American 
people have a lot to say about this, and we want to emphasize 
following the guidelines, following the phases, avoiding mass 
gatherings, wearing these things, using hand hygiene.
    We have a lot to say about where this is going to go, but 
we all need to continue to work together to make that happen.
    Mr. O'Halleran. Thank you, Admiral.
    And I yield.
    Mr. Pallone. Thank you. Let me thank all of you for bearing 
with us for six hours I guess, and a really thorough analysis 
of what is going on. So I want to emphasize again, we really 
appreciate your being here and your thoughtful responses to 
everything. Thank you so much.
    And I am going to let you go because I have a long list 
here of documents to read for the record, so you don't have to 
stay for that, but thank you again.
    I want to remind members that, pursuant to committee rules, 
they have ten business days to submit additional questions for 
the record to be answered by the witnesses who have appeared. 
And I ask each witness to respond promptly to any such 
questions that you may receive.
    And we would like to insert in the record by unanimous 
consent the following documents: a letter from the American 
Society of Microbiology to the committee dated June 23, 2020; a 
letter from the Alzheimer's Association to the committee dated 
June 23, 2020; a letter from AFSME to the chairman dated June 
23, 2020; a letter from the American Society of Hematology 
dated June 23, 2020; graph from Representative Olson on COVID-
19 cases in the Houston area; a statement from Representative 
Burgess dated June 23, 2020; and a letter from Ranking Member 
Walden on Committee Rule 9(b)(1) dated June 23, 2020.
    [The information appears at the conclusion of the hearing.]
    Mr. Pallone. And I will repeat again that any member that 
wishes to submit an opening statement for the record is 
certainly encouraged to do so.
    And with that, at this time, the committee is adjourned. 
Thank you to everyone.
    [Whereupon, at 4:47 p.m., the committee was adjourned.]
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