[Senate Hearing 116-299]
[From the U.S. Government Publishing Office]
S. Hrg. 116-299
COVID 19 AND U.S. INTERNATIONAL PANDEMIC
PREPAREDNESS, PREVENTION, AND RESPONSE
=======================================================================
HEARINGS
BEFORE THE
COMMITTEE ON FOREIGN RELATIONS
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
JUNE 18 AND JUNE 30, 2020
__________
Printed for the use of the Committee on Foreign Relations
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web:
http://www.govinfo.gov
U.S. GOVERNMENT PUBLISHING OFFICE
42-192 PDF WASHINGTON : 2020
COMMITTEE ON FOREIGN RELATIONS
JAMES E. RISCH, Idaho, Chairman
MARCO RUBIO, Florida ROBERT MENENDEZ, New Jersey
RON JOHNSON, Wisconsin BENJAMIN L. CARDIN, Maryland
CORY GARDNER, Colorado JEANNE SHAHEEN, New Hampshire
MITT ROMNEY, Utah CHRISTOPHER A. COONS, Delaware
LINDSEY GRAHAM, South Carolina TOM UDALL, New Mexico
JOHN BARRASSO, Wyoming CHRISTOPHER MURPHY, Connecticut
ROB PORTMAN, Ohio TIM KAINE, Virginia
RAND PAUL, Kentucky EDWARD J. MARKEY, Massachusetts
TODD YOUNG, Indiana JEFF MERKLEY, Oregon
TED CRUZ, Texas CORY A. BOOKER, New Jersey
DAVID PERDUE, Georgia
Christopher M. Socha, Staff Director
Jessica Lewis, Democratic Staff Director
John Dutton, Chief Clerk
(ii)
C O N T E N T S
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Page
COVID-19 AND U.S. INTERNATIONAL PANDEMIC PREPAREDNESS, PREVENTION, AND
RESPONSE
Part 1: Covid-19 and U.S. International Pandemic Preparedness,
Prevention, and Response --
June 18, 2020
Risch, Hon. James E., U.S. Senator From Idaho.................... 1
Prepared Statement........................................... 3
Menendez, Hon. Robert, U.S. Senator From New Jersey.............. 4
Prepared Statement........................................... 6
Richardson, James L., Director, Office of Foreign Assistance,
U.S. Department of State, Washington, DC....................... 8
Prepared Statement........................................... 10
Milligan, Chris, Counselor, U.S. Agency for International
Development, Washington DC..................................... 13
Prepared Statement........................................... 15
Grigsby, Garrett, Director, Office of Global Affairs, U.S.
Department of Health and Human Services, Washington, DC........ 18
Prepared Statement........................................... 19
Additional Material Submitted for the Record
Responses of James L. Richardson to Questions Submitted by
Senator Robert Menendez........................................ 47
Responses of Chris Milligan to Questions Submitted by Senator
Robert Menendez................................................ 54
Responses of Mr. Garrett Grigsby to Questions Submitted by
Senator Robert Menendez........................................ 62
Responses of James L. Richardson to Questions Submitted by
Senator Ben Cardin............................................. 64
Responses of Mr. Chris Milligan to Questions Submitted by Senator
Ben Cardin..................................................... 69
Responses of Mr. Garrett Grigsby to Questions Submitted by
Senator Ben Cardin............................................. 72
Responses of James L. Richardson to Questions Submitted by
Senator Chris Coons............................................ 73
Responses of Mr. Chris Milligan to Questions Submitted by Senator
Chris Coons.................................................... 74
Responses of Mr. Garrett Grigsby to Questions Submitted by
Senator Chris Coons............................................ 74
----------
(iii)
Part 2: Covid-19 and U.S. International Pandemic Preparedness,
Prevention, and Response: Additional Perspectives --
June 30, 2020
Risch, Hon. James E., U.S. Senator From Idaho.................... 77
Prepared Statement........................................... 80
Menendez, Hon. Robert, U.S. Senator From New Jersey.............. 81
Prepared Statement........................................... 83
Dybul, Hon. Mark, M.D., Co-Director of the Center for Global
Health Practice and Impact and Professor in the Department of
Medicine, Georgetown University Medical Center................. 85
Prepared Statement........................................... 88
Kolker, Hon. Jimmy J., Former Assistant Secretary For Global
Affairs, U.S. Department of Health and Human Services.......... 91
Prepared Statement........................................... 93
Jha, Dr. Ashish K., M.D., Director, Harvard Global Health
Institute, Cambridge, MA....................................... 95
Prepared Statement........................................... 97
Konyndyk, Jeremy, Senior Policy Fellow, Center For Global
Development, Washington, DC.................................... 101
Prepared Statement........................................... 104
Additional Material Submitted for the Record
Responses of The Honorable Mark Dybul, M.D. to Questions
Submitted by Senator Robert Menendez........................... 133
Responses of The Honorable Jimmy J. Kolker to Questions Submitted
by Senator Robert Menendez..................................... 136
The Committee Received No Response From Dr. Ashish K. Jha, M.D.
for the Following Questions by Senator Robert Menendez......... 141
Responses of Jeremy Konyndyk to Questions Submitted by Senator
Robert Menendez................................................ 143
COVID-19 AND U.S. INTERNATIONAL PANDEMIC
PREPAREDNESS, PREVENTION, AND RESPONSE
PART 1: COVID-19 AND U.S. INTERNATIONAL PANDEMIC PREPAREDNESS,
PREVENTION, AND RESPONSE
----------
THURSDAY, JUNE 18, 2020
U.S. Senate,
Committee on Foreign Relations,
Washington, DC.
The committee met, pursuant to notice, at 9:33 a.m., in
room SD-106, Dirksen Senate Office Building, Hon. James E.
Risch, chairman of the committee, presiding.
Present: Senators Risch [presiding], Johnson, Gardner,
Barrasso, Young, Perdue, Menendez, Cardin, Shaheen, Murphy,
Kaine, and Booker.
OPENING STATEMENT OF HON. JAMES E. RISCH,
U.S. SENATOR FROM IDAHO
The Chairman. The committee will come to order.
Morning, everyone. I want to thank all of you who are
attending this important hearing.
Today, we are going to discuss the international response
to the COVID-19 pandemic as well as future pandemic
preparedness, prevention, and response.
The hearing will focus on Senate bill 3829, which Senator
Murphy and I have introduced, the Global Health Security and
Diplomacy Act. It is written on paper, not on stone, which we
will talk about a little bit in the future here. This is an
important endeavor that this committee is going to take up.
Indeed, probably one of the weightiest matters that we will
deal with as we attempt to create a new shield to prevent a
COVID virus-type attack from happening again. The COVID-19
global pandemic has reaffirmed what we have long known, and
that is, infectious diseases, particularly those of viral
nature, do not respect borders; they are a threat, and a threat
anywhere is a threat everywhere. We have been right, here, to
focus on our domestic response to this pandemic, but we ignore
the spread overseas at our own peril, for obvious reasons.
It is essential that we respond now to help our partners
who are not yet experiencing significant spread to get testing,
tracing, and quarantine procedures in place, and to help our
partners who already are under siege avert a worst-case
scenario. We also need to focus on protecting access to food,
livelihoods, water, sanitation, and hygiene.
Protecting existing investments in immunizations, maternal
and child health, and other infectious diseases are important
at this time, also. And we need to work with partner countries
and organizations to ensure that our aid reaches those who need
it most, without aiding and abetting corruption, human rights
violations, and democratic backsliding, which we all know
frequently happens in the world when we start focusing on
something else.
At the same time, we need to figure out how to get ahead of
the next global pandemic. Indeed, that is what the focus of
this hearing is going to be on. And again, the vehicle we are
talking about is Senate bill 3829, but it is for discussion
purposes, and we look for every possible improvement to that
bill that we can make.
This hearing is one of a number that I am going to
undertake as we construct Senate bill 3829 going forward. And
the purpose of it is to, as I said, construct a shield that is
better than the shield that we have. I have repeatedly said
that what we need is a fire station and a fire department ready
and able to put out a fire before it burns the entire world.
Over the years, we have come to expect that the World Health
Organization would play a role. The World Health Organization
has done great work in many respects. It does play a key role
as the guardian of the international health regulations and as
the clearinghouse of global health data and best practices, and
it has done remarkable work in combating polio and eradicating
smallpox. But, its response to fast-moving emergencies, such as
Ebola and COVID-19, has exposed significant weaknesses that the
WHO has. But, we are not here to demean or to criticize or
condemn the WHO. Rather, what we are here to do is to have a
fair analysis of what the response was, and how their structure
is constructed that has caused the weaknesses we have.
Dr. Tedros and his management team were very kind to spend
some time with me early on, and they explained to me what their
objectives were and how they were attempting to achieve them.
They made some very fair points, and it truly is obvious that
they did things that could have been done differently, and they
will be the first to admit that.
In addition to reforming WHO--and, truly, there is some
reform that is needed--and it should be done, as I said,
without demeaning, criticizing, or condemning--but, rather, in
the kindest way possible, to make it work better. We need an
international financing mechanism that will reenergize action
under the Global Health Security Agenda so we can help
countries with a high commitment but low capacity to improve
their pandemic preparedness and response. And we need a long-
term fix to the coordination problems that have long plagued
U.S. country teams operating overseas. We need a single
accountable entity housed at the Department of State to lead
diplomatic efforts and coordinate the efforts of the agencies
implementing global health security assistance overseas. This
accountable entity would not--I repeat, not--replace the
central role of the NSC in coordinating global health security
policy across the whole of government here in Washington.
Alternatively, it would ensure the effectiveness of global
health security programs at the mission level.
We have put these ideas forward in this bipartisan bill,
the Global Health Security and Diplomacy Act, and have invited
all those who wish to participate to do so. This has to be a
bipartisan effort.
It is not too late to get back on track and to restore the
longstanding tradition of bipartisanship that has characterized
every successful U.S. global health program of the past 20
years. It also is not too late to focus our efforts on
addressing the current COVID-19 pandemic overseas in a manner
that saves lives and protects the United States from future
waves of infection. But, let there be no mistake about it, this
bill is designed to look at the future.
There is no doubt this is going to happen again. We have
been told that the bat population, particularly in the Wuhan
area in China, contains about 2,000 viruses. Of course, this
pandemic was caused by one of these viruses jumping from one
species to another, from a bat to a human being. What happened
after that has been greatly debated, but we know what the
result was, and we know that the result was not good, and we
know that there were failures along the line. We know that we
can do better.
There is no other group more qualified than this committee,
the United States Senate Committee on Foreign Relations, to
undertake this proposition. This is something that we owe
America, that we owe the world. We can do this. I am committed
to do that. I would hope that every member on the committee
will help focus on this as one of the most important things
that we do. It will be a legacy that will be incredibly
important for future generations. And we know that the world
cannot withstand much more of what we have seen that we got
from the COVID-19 infection that went through the world.
So, with that, I hope that we, as a committee, do what we
try to do, and that is focus with civility, kindness,
understanding, and tolerance as we hear from everyone. We are
going to have a lot of different ideas. There is going to be a
lot of ideas that people have strong feelings about. I hope
people will do their best to listen carefully to what others
have to say, and listen to defenses that people make as to what
has happened. But, more important, listen carefully to what
people tell us that they have learned that will help us in the
future. In a bipartisan fashion that is done with kindness and
civility, I have every confidence we can develop a bill that
can pass this Congress, be signed by the President, become law,
and really be a tremendous benefit to our fellow human beings
as we go forward.
[The prepared statement of Senator Risch follows:]
Prepared Statement of Senator James E. Risch
Today we meet to discuss the international response to the COVID-19
pandemic and the future of pandemic preparedness, prevention, and
response.
The COVID-19 global pandemic has reaffirmed what we've long known:
infectious diseases do not respect borders. A threat anywhere is a
threat everywhere.
We have been right to focus on the domestic response to this
pandemic. But we ignore the spread overseas at our own peril.
It is essential that we respond now: to help our partners who are
not yet experiencing significant spread to get testing, tracing, and
quarantine procedures in place; and to help our partners who already
are under siege avert worst-case scenarios.
We need to also focus on protecting access to food, livelihoods,
water, sanitation, and hygiene; protecting existing investments in
immunizations, maternal and child health, and other infectious
diseases.
And we need to work with partner countries and organizations to
ensure that our aid reaches those who need it most, without aiding and
abetting corruption, human rights violations, and democratic
backsliding.
At the same time, we need to figure out a way to get ahead of the
next global pandemic.
I repeatedly have said we need a fire station, ready and able to
put out a flame before it burns the whole world down. Over the years,
we have come to expect the WHO to play that role. And we've been
disappointed.
The WHO does play a key role as the guardian of the International
Health Regulations and as the clearinghouse of global health data and
best practices. And it has done remarkable work in combatting polio and
eradicating smallpox. But its response to emergencies, from Ebola to
COVID-19, has exposed significant weaknesses. Reform is essential.
In addition to reforming the WHO, we need an international
financing mechanism that will re-energize action under the Global
Health Security Agenda, so we can help countries with high commitment
but low capacity improve their pandemic preparedness and response.
And we need a long-term fix to the coordination problems that have
long plagued U.S. country teams operating overseas. We need a single
accountable entity, housed at the Department of State, to lead
diplomatic efforts and coordinate the efforts of the agencies
implementing global health security assistance overseas.
This accountable entity would not replace the central role of the
NSC in coordinating global health security policy across the whole-of-
government here in Washington. Alternatively, it would ensure the
effectiveness of global health security programs at the mission-level.
I have put these ideas forward in a bipartisan bill, the Global
Health Security and Diplomacy Act.
I share the frustration expressed by many of our committee members
that it has taken so long to get us all here together, but I am glad
for the opportunity today.
It is not too late to get back on track and to restore the long-
standing tradition of bipartisanship that has characterized every
successful U.S. global health program of the past 20 years.
It is not too late to focus our efforts on addressing the current
COVID-19 pandemic overseas in a manner that saves lives and protects
the United States from future waves of infection.
I thank our witnesses for their efforts to help us get there.
With that, I will ask Ranking Member Menendez if he wishes to make
any opening remarks.
The Chairman. With that, I will turn the time to Senator
Menendez.
STATEMENT OF HON. ROBERT MENENDEZ,
U.S. SENATOR FROM NEW JERSEY
Senator Menendez. Thank you, Mr. Chairman, for convening
today's hearing. As you know, I have been seeking a series of
hearings on COVID for quite some time, and I am pleased that we
are now having one. And I understand you intend to hold more.
And I strongly support that.
But, let me start by speaking to the larger concerns that
the Democratic Minority recently wrote to you about. We must
have serious and sustained focus on U.S. foreign policy, and a
serious oversight agenda. And we want to work with you to make
that happen.
Mr. Chairman, we should be having more public hearings. We
need to tackle some of the major challenges that confront us--
Afghanistan, Venezuela, North Korea, just to mention some. And
we need to ensure the Secretary of State testifies before this
committee. We should all be shocked and, frankly, offended that
the Secretary is refusing to appear, refusing to defend the
Administration's foreign affairs budget. And we should all be
insisting on his appearance. This could be the first time in
over 20 years that a Secretary of State has not testified
before this committee to explain administration priorities.
And, I guess, after Ambassador Bolton's book, we probably will
never see him again.
This lack of engagement fundamentally undermines our work.
Not only does the Secretary of State feel comfortable in
refusing to come before us, that refusal apparently extends to
other Senate-confirmed officials. We have only heard from one
Senate-confirmed official this entire year. And the
Administration has repeatedly ignored oversight inquiries, many
of them that are even bipartisan.
We do not need to rehash the contentious vote on Michael
Pack, but we should all be seriously concerned about what we
have seen in the last 10 days and 24 hours at the U.S. Agency
for Global Media. Mr. Pack has gone on a wholesale firing
spree, removing the heads of the networks, dissolving their
corporate boards, only to replace them with unqualified
political people, fundamentally undermining the mission and
work of the organization. It is now obvious why the White House
wanted Pack so badly, so they can transform the agency into
their own personal mouthpiece. This is a blow from which it may
never recover. Once the credibility is gone, no one will ever
trust a report from Radio Free Europe, Radio Marti, nor trust
the tools of the Open Technology Fund.
So, Mr. Chairman, I would just urge you to respond to the
letter that we sent you and the spirit in which it was offered.
On behalf of myself and all the Democratic members of the
committee, I can tell you that we want to work with you, and we
want to find common ground. We want the State Department to be
successful. And we want this committee to take on serious and
meaningful work that will make an impact on the national and
global stage. So, let us work together to make that happen.
Now, while I thank all of our witnesses for their service,
it is disappointing that the White House would not send a
member of the Coronavirus Task Force or any of the Senate-
confirmed individuals from the State Department, Health and
Human Services, or the United States Agency for International
Development responsible for Administration's response. The
American people deserve to hear from members of the President's
handpicked team to understand what it is doing to address the
worst pandemic the world has faced in 100 years--more than 8
million cases worldwide, more than 115,000 American lives lost.
In my home state of New Jersey, which is the second-largest
state in the nation, in terms of COVID deaths, I am vividly
reminded of this consequence.
This tragedy has assuredly been a wake-up call to those who
question whether we should engage with, and invest in, the rest
of the world. So, I would like to use this hearing to
understand how we got here, what we knew about the virus, and
when, and how we are leveraging our diplomatic relationships
and leadership to best respond and protect the American people.
So far, most of what we have seen is a lot of bluster,
finger-pointing, and retrenchment. Yes, we should examine the
World Health Organization's initial response. I wish we had
someone from the State Department's Bureau of International
Organizations here to do exactly that. But, we also know that
the U.S. was regularly communicating with, and receiving
information from, the WHO, including through U.S. Government
employees embedded at WHO headquarters in Geneva. And, rather
than seriously consider how to best leverage our leadership and
contributions, the President abruptly announced the U.S. would
simply pull out of the organization, threatening not just our
ability to confront COVID-19, but risking decades of progress
on other global health initiatives, including combating Polio
and Ebola.
And yes, China has a lot to answer for. But, the
administration's use of racially stigmatizing language to
describe COVID-19, in direct contradiction to guidance issued
by the Centers for Disease Control and Prevention, has been
deeply hurtful to Americans at home, and utterly
counterproductive in leading an international response. The
Secretary of State's insistence that the rest of the world
agreed to use such language has prevented us from reaching
consensus of the G7 and in the Security Council. And, while the
White House engages in divisive rhetoric, the rest of the world
is stepping up without us.
When Chinese President Xi Jinping addressed the World
Health Assembly in May, he pledged $2 billion over 2 years to
combat COVID-19. In contrast, when Secretary Azar addressed the
Assembly, he attacked the WHO and cast blame on China. The
European Union held a pledging conference on vaccines last
month, at which over $8 billion was raised. The White House
declined the invitation to participate, for reasons that are
beyond me. Is this what the Administration means by ``America
First''? Well, if this EU consortium comes up with a vaccine
before we do, it will mean ``America Last.'' This approach is
not only isolationist, shortsighted, and foolish, it endangers
American lives.
Finally, as the old saying goes, ``An ounce of prevention
is worth a pound of cure.'' I am all for ensuring the U.S.
Government is better organized to prevent, detect, and respond
to future pandemics both here and abroad, but some of the
proposals coming out of the Administration, eerily similar to
those coming from some Members of Congress, are ill-thought,
destructive, and dangerous, insofar that they would cripple
USAID and create a mechanism at the World Bank to which the
Administration could channel all of the funding it is
withholding from the WHO.
So, I look forward to the first of what I hope are many
thorough discussions.
Thank you, Mr. Chairman.
[The prepared statement of Senator Robert Menendez
follows:]
Prepared Statement of Senator Robert Menendez
Mr. Chairman, thank you for convening today's hearing. As you know,
I have been seeking a series of hearings on COVID for quite some time.
I am pleased we are now having one. I understand you intend to hold
more, and I strongly support that.
dem letter and committee prerogatives
But let me start by speaking to the larger concerns that the
Democratic minority recently wrote to you about. We must have serious
and sustained focus on U.S. foreign policy and a serious oversight
agenda . . . and we want to work with you to make that happen.
Mr. Chairman, we should be having more public hearings . . . we
need to tackle the major challenges that confront us . . . Afghanistan,
Venezuela, and North Korea . . . and we need to ensure the Secretary of
State testifies before this Committee.
We should all be shocked and, frankly, offended, that Secretary is
refusing to appear . . . refusing to defend the Administration's
foreign affairs budget; we should all be insisting on his appearance.
This could be the first time in over 20 years that a Secretary of State
has not testified before this Committee to explain an administration's
priorities.
This lack of engagement fundamentally undermines our work. Not only
does the Secretary of State feel comfortable in refusing to come before
us, that refusal apparently extends to other Senate-confirmed
officials--we have heard from only one Senate-confirmed official this
entire year. And the Administration has repeatedly ignored oversight
inquiries--many of them bipartisan.
We do not need to rehash the contentious vote on Michael Pack. But
we should all be seriously concerned about what we've seen in the last
10 days and 24 hours at the U.S. Agency for Global Media.
Mr. Pack has gone on a wholesale firing spree, removing the heads
of the networks, and dissolving their corporate boards only to replace
them with unqualified political people . . . fundamentally undermining
the mission and work of the organization.
It's now obvious why the White House wanted Pack so badly--so they
could transform the Agency into their own personal mouthpiece. This is
a blow from which it may never recover. Once the credibility is gone,
nobody will ever trust a report from Radio Free Europe . . . or Radio
Marti . . . nor trust the tools of the Open Technology Fund.
So Mr. Chairman, I urge you to respond to the letter in the spirit
in which it was offered. On behalf of myself and all of the Democratic
members of the Committee, I can tell you that we want to work with you
. . . we want to find common ground.
We want the State Department to be successful . . . and we want
this Committee to take on serious work and make a meaningful impact on
the national and world stage. Let's work together to make this happen.
covid-19 hearing
Now, while I thank all of our witnesses for their service . . . it
is disappointing the White House would not send a member of the
coronavirus task force, or any of the Senate confirmed individuals from
the State Department, Health and Human Services, or the United States
Agency for International Development responsible for the
Administration's response.
The American people deserve to hear from members of the President's
hand-picked team to understand what it is doing to address the worst
pandemic the world has faced in 100 years . . . more than 8 million
cases worldwide, and more than 115,000 American lives lost.
This tragedy has assuredly been a wake-up call to those who
question whether we should engage with--and invest in--the rest of the
world. So I would like to use this hearing to understand how we got
here--what we knew about the virus and when, and how we are leveraging
our diplomatic relations and leadership to best respond and protect the
American people.
blame game
So far most of what we have seen is a lot of bluster, finger
pointing, and retrenchment.
Yes, we should examine the World Health Organization's initial
response--I wish we had someone from the State Department's Bureau of
International Organizations here to do that--but we also know that the
U.S. was regularly communicating with and receiving information from
the WHO--including through U.S. Government employees embedded at WHO
headquarters in Geneva.
And rather than seriously consider how to best leverage our
leadership and contributions, the President abruptly announced the U.S.
would simply pull out of the organization; threatening not just our
ability to confront COVID-19, but risking decades of progress on other
global health initiatives including to combat Polio and Ebola.
And yes, China has a lot to answer for, but the Administration's
use of racially stigmatizing language to describe COVID-19 in direct
contradiction to guidance issued by the Centers for Disease Control and
Prevention has been deeply hurtful to Americans at home, and utterly
counterproductive in leading an international response.
The Secretary of State's insistence that the rest of the world
agree to use such language has prevented us from reaching consensus at
the G7 and in the Security Council.
loss of leadership
While the White House engages in divisive rhetoric, the rest of the
world is stepping up. Without us. When Chinese President Xi Jinping
addressed the World Health Assembly in May, he pledged $2 billion over
2 years to combat COVID-19.
In contrast, when Secretary Azar addressed the Assembly, he
attacked the WHO and cast blame on China.
The European Union held a pledging conference on vaccines last
month, at which $8.2 billion was raised. The White House declined the
invitation to participate for reasons that are beyond me. Is this what
the Administration means by ``America First''?
Well, if this EU consortium comes up with a vaccine before we do,
it will mean ``America Last.'' This approach is not only isolationist,
shortsighted and foolish--it endangers American lives.
Finally, as the old saying goes, an ounce of prevention is worth a
pound of cure. I'm all for ensuring the U.S. government is better
organized to prevent, detect and respond to future pandemics both here
and abroad, but some of the proposals coming out of the
Administration--eerily similar to those coming from some Members of
Congress--are ill-thought, destructive and dangerous in so far as they
would cripple USAID, and create a mechanism at the World Bank through
which the Administration could channel all of the funding it's
withholding from the WHO.
So I look forward to the first of what I hope are many thorough
discussions. Thank you, Mr. Chairman.
The Chairman. Thank you very much.
We will now proceed to do exactly what I said we were going
to do, and that is examine this with an eye towards
constructing a shield for the future. And, of course, that does
require some discussion of what happened and how we got here.
But, nonetheless, I am hoping we will continue to focus the
discussion, just as Senator Murphy and my bill has done in
Senate bill 3829, and that is: look forward.
So, with that, we have a distinguished panel today,
certainly people with outstanding knowledge in this area and
who can help us understand the task at hand, and how we can
accomplish that task.
So, first of all, we have Mr. James Richardson, who serves
as Director of the Office of Foreign Assistance, where he
coordinates $35 billion in foreign assistance across the
Department of State and the U.S. Agency for International
Development. Prior to this, he coordinated USAID's
Transformation Task Team and served as Assistant to the
Administrator for Policy, Planning, and Learning. He has 20
years of government experience and holds a bachelor's of
science and government, a master's of science and defense and
strategic studies, and is a graduate of the United States Air
Force Command and Staff College.
Mr. Richardson, thank you so much. Give us the benefit of
your wisdom.
STATEMENT OF JAMES L. RICHARDSON, DIRECTOR, OFFICE OF FOREIGN
ASSISTANCE, U.S. DEPARTMENT OF STATE, WASHINGTON, DC
Mr. Richardson. Great. Thank you, Chairman Risch, Ranking
Member Menendez, and members of this committee. Thank you for
inviting me to testify on the international response to the
COVID-19 pandemic.
As a former staffer to a member on this committee, it is
great to be back, and I look forward to having this opportunity
to have a dialogue and answer any of your questions.
First of all, I need to acknowledge the leadership of
President Trump, Vice President Pence, Secretary Pompeo, and,
really, the myriad of teams we have all around the world at
State and USAID who are working together to defeat COVID-19.
For those who may not be familiar, I am the Director of the
Office of Foreign Assistance, which is a joint office between
both State and USAID, and we coordinate foreign assistance on
behalf of the Secretary.
As the Chairman mentioned, prior to that I was at USAID,
where I led the agency's historic transformation, looking for
ways to strengthen the power of development and improve the
institution. As such, I believe deeply in the power of both
development and diplomacy. But, together, I think they can be
unstoppable.
The United States is the world's undisputed leader in
foreign assistance. We have invested $500 billion over the past
20 years; 140 of that in global health, alone. The United
States has built and sustained health systems across the globe,
trained millions of healthcare workers, and saved millions of
lives. COVID has posed a unique challenge to the United States
and the entire world, as you know, impacting both high-income
and developing countries, alike. The numbers speak for
themselves. The State Department has received nearly 1,000
requests from almost every country in the world.
In the face of COVID, the generosity of the American people
has been on full display, with more than 12 billion in
financial, humanitarian, scientific, and technical support to
combat the crisis. Of that total, Congress has appropriated
$1.6 billion to State and USAID for the international response.
First, thank you for that. This money is being well spent. We
have committed, so far, 1.3 billion of that, and our assistance
has gone to 120 countries, and it is making true impact. Of
note, we have obligated over 500 million of that, with a plan
to quickly obligate the rest.
We have provided much-needed ventilators in El Salvador. We
have trained 20,000 front-line workers in India. We have funded
public health service announcements on how to fight the virus
in more than 50 languages. State and USAID has undertaken
unprecedented coordination in the COVID response. That
coordination has not slowed us down, but actually ensured
alignment and effectiveness of our resources, for, when
people's lives are at stake, we need to make sure we get this
right. While the COVID-19 pandemic is certainly not over, I
firmly believe that we need to start thinking about, today,
what systems the U.S. and the world needs to lessen the
likelihood of another outbreak becoming a global pandemic.
When looking across both this pandemic and epidemics and
pandemics of the past, I think we can pull some important
lessons learned, but the bottom line is that, moving forward, I
hope we can all agree that more data, more coordination, and
more response functions are necessary to respond to future
outbreaks and prevent pandemics.
So, the first lesson learned is that pandemics are not just
a development challenge or confined to the developing world.
They are truly global in scope, with the risk of severe health
and economic impact across the globe. For instance, of the
countries with the highest percentage of COVID-related deaths,
almost none of them have U.S. Government bilateral global
health programs. As such, U.S. leadership needs to not just
focus on the development piece, which is critically important,
but has to have a broader scope, focusing on mobilizing
countries' own resources, burden-sharing with like-minded
donors, and building true accountability into the global
system.
The second lesson is that the U.S. Government and the
global system must be prepared to respond internationally in
strength and accountability. Coordination in the U.S.
Government is key. We have to leverage the existing strengths
of each department and agency for maximum impact. As I often
say, true coordination is not about control, it is about
empowerment. We have to unleash the power of our diplomacy, of
our development, of our public health efforts in order to
maximize our impact. We also need to ensure that global
structures can effectively prevent and contain outbreaks from
becoming epidemics and pandemics.
The third lesson is, the world needs more effective early-
warning systems and data-tracking.
And, lastly, we need to think holistically about
preparedness, and be flexible.
We understand that the challenges that we may face can come
in many different forms, and that our response will ultimately
be multifaceted, so we need to start thinking and planning for
all of those inevitabilities today.
In the age of globalization, I fear that the next outbreak
will look more like this one than outbreaks that we have dealt
with in the past, but we have an opportunity to save lives,
promote accountability, and ensure that pandemics are prevented
to the greatest extent possible. We need systems that are
flexible, focused, and truly global. We need to fill the gaps
in the system while coordinating and leveraging the respective
comparative advantages and unique strengths of each aspect of
the U.S. Government. Time and time again, when there is a
global challenge, Americans lead. We are the world's greatest
humanitarians that the world has ever seen, and I am committed
to working with all of you to strengthen this fact.
Thank you for having me today, and I look forward to your
questions in this important conversation.
[The prepared statement of James Richardson follows:]
Prepared Statement of James Richardson
Chairman Risch, Ranking Member Menendez, and Members of the
Committee--thank you for inviting me to testify today on the State
Department and USAID international response to the COVID-19 pandemic.
As a former staffer on this Committee at the beginning of my career, it
is great to be back, and I'm grateful for the opportunity to have this
dialogue and answer your questions. The United States has been a global
leader in responding to the COVID-19 crisis, as we have been in
numerous other health, humanitarian, and complex crises for decades.
As you are fully aware, the COVID-19 pandemic is unique in that it
is causing widespread health and economic devastation across the world:
developed and developing countries alike. Unfortunately, scientists and
the health security community have been clear that we should be
prepared for another outbreak to rise to the level of a global
pandemic. Therefore, even amid our significant response, we must begin
to look to the future in order to analyze the lessons learned, adapt
processes and structures accordingly, and act. Months into the
pandemic, we already have important lessons learned that can help to
inform our future response and ensure that our resources continue to be
aligned with both our national security and international development
goals.
First, I want to acknowledge the leadership of President Trump,
Vice President Pence, Secretary Pompeo, Dr. Birx, and our talented
teams around the world as we work together to defeat COVID-19, both at
home and abroad. The President knows that pandemics like COVID-19 do
not respect national borders, and so our All-of-America response must
also stretch beyond our borders. We can and must both fight pandemics
at home and help our partners overseas.
For those that may be unfamiliar, the Office of Foreign Assistance,
which I lead, is a Bureau staffed with personnel from the State
Department and U.S. Agency for International Development, responsible
for coordinating foreign assistance policy, resources, performance and
strategy across the State Department and USAID. My team has been deeply
involved in the COVID-19 response effort, ensuring foreign assistance
is prioritized and committed to countries in need.
Previous to this role, I was at USAID, where I served as the
Assistant to the Administrator for Policy, Planning and Learning and
worked extensively with your staff as head of the Agency's historic
Transformation. While at USAID, we built several new Bureaus, including
the new Bureau for Humanitarian Assistance, which is operational as of
this week, unifying and strengthening USAID's humanitarian response. We
also created dozens of new policies and strategies, including the
Private Sector Engagement Policy, and worked to empower the diverse and
brilliant workforce, strengthening the Agency from the bottom to the
top. I passionately believe in the power of development and diplomacy
individually, but together they can be unstoppable. I am proud to have
worked at both organizations during this Administration, now serving as
the institutional link between the two.
The United States is the world's undisputed leader in foreign
assistance, with $500 billion invested by American taxpayers in the
21st Century, including over $140 billion in global health, alone. The
United States has built and sustained health systems across the globe,
trained millions of healthcare workers, and saved millions of lives. It
is no surprise that nearly every country in the world has requested
assistance from the United States during this pandemic. They know we
will deliver no-strings attached, high-quality interventions and
equipment that addresses their greatest challenges.
When it comes to COVID-19, it's important to remember, this is not
the first time we've seen an outbreak, and it certainly won't be the
last. The United States has led the global fight against HIV/AIDS,
tuberculosis, malaria, polio, Ebola, and many other infectious disease
health security threats. At nearly $10 billion dollars each year, the
United States provides nearly 40% of worldwide global assistance for
health--nearly five times the next highest donor. Without a doubt, our
foreign assistance investments over time have laid the foundation for
our COVID-19 response today.
We have mobilized as a nation to combat this disease both at home
and abroad. With unprecedented destruction, COVID-19 has posed a unique
challenge to the United States and the entire world in a way that we
haven't seen this generation, affecting both the developed and
developing world alike. When we look at the effects of COVID-19, it's
important to understand the true challenges not just today in this
pandemic, but also for the next pandemic.
In the face of COVID-19, the generosity of the American people has
been on full display. Since the outbreak of COVID-19, the U.S.
government alone has committed more than $12 billion in financial,
humanitarian, technical, and scientific support across many federal
agencies to combat the crisis. As part of this, the State Department,
USAID, HHS, DoD, and others are working together to support health
systems; humanitarian assistance; and economic, security, and
stabilization efforts worldwide with nearly $2.4 billion in emergency
supplemental program funding provided by Congress in March, including
nearly $1.6 billion for State Department and USAID foreign assistance.
The U.S. government has no higher priority than the protection of
American citizens. On top of our foreign assistance efforts, the State
Department has worked to bring more than 100,000 Americans home.
Our efforts are guided by the SAFER package, a comprehensive
interagency strategy to support our international partners in
combatting COVID-19. The SAFER package is part of an All-of-America
approach, leveraging the unique expertise, capacities, and mechanisms
of various U.S. government departments and agencies to rapidly deploy
and deliver essential support when, where, and to whom it is most
critically needed. As part of this package, our foreign assistance
funding is saving lives in more than 120 countries by bolstering
countries' ability to prevent, detect and respond to the virus, support
risk communications, funding water and sanitation services, and
preparing healthcare facilities and staff. That coordination does not
end at a shared strategy, but experts from USAID, State, and CDC are
meeting regularly to ensure that we implement this strategy in a united
way. In addition, thanks to the expertise of American manufacturing,
this effort now includes ventilators, delivering on President Trump's
generous commitment to meet requests from foreign governments now that
we have met our domestic needs for this equipment.
Importantly, our work has made a demonstrable impact, saving lives,
with innovation leading the way. For example, in India, the United
States has virtually trained more than 20,000 people on the frontlines
of COVID-19, leveraging the power of digital technology to help state
leaders prepare local COVID-19 response plans and train frontline
health workers in strategic messaging, screening activities, counseling
of patients, and basic clinical management. The United States has
worked with Thailand to create a mobile application where 80,000 health
volunteers can now track the location of suspected cases, manage home
visits, and deliver relief kits with essential staples such as soap,
rice, fish, and safe drinking water. And in many other places around
the world, the United States has worked to pivot humanitarian
assistance programs to respond to the pandemic, continuing to save
lives through emergency food assistance and cash assistance while
simultaneously providing access to water and soap for handwashing and
critical information on how to stay safe.
While our response has been unprecedented, the COVID-19 pandemic is
far from over, and will certainly not be the last outbreak that
threatens to become a pandemic. We have a moral obligation to lead and
to build a safer system for the next generation. The stakes have never
been higher. With a current death toll above 400,000 and increasing and
estimated economic losses between $6 and $9 trillion, we must seize
this opportunity to prepare for the future, and we know where to start.
COVID-19 has provided the U.S. interagency and international community
a harsh reminder of existing health security gaps and new challenges
that we must face. There are lessons to be learned about the way that
we've responded to this pandemic and about the way we've responded to
previous global health challenges, with great research to pull from
think tanks and oversight bodies. Building on lessons from COVID-19, as
well as previous challenges--Ebola in West Africa, Zika, H1N1, and so
on--various trends emerge time and again. The value of this learning
should be clear--the U.S. government can and should do better. While
the list is much longer, for the sake of brevity, I'll mention four key
lessons learned today.
First, as we have seen with COVID-19, the effects of pandemics are
not limited to the developing world, and are truly global in scope,
with the risk of severe health and economic impacts across the globe.
U.S. leadership must have whole-of-globe reach that focuses on
mobilizing partner countries' own resources and should demand
transparency and accountability in the global system.
Second, the U.S. government must continue to prevent, detect, and
respond internationally to outbreaks. Our historic investments in
global health security have been critical in helping partner countries
respond to COVID-19, and we will continue those investments to build
their national capacities to respond to a variety of disease outbreaks.
However, COVID-19 has had a multifaceted impact, with catastrophic
health, economic, and humanitarian consequences. Coordination is key,
and we must leverage existing strengths of each U.S. government
department and agency for maximum impact. It is clear that global
health structures alone are not able to effectively prevent or contain
outbreaks from becoming epidemics and pandemics.
Third, the world does not have effective early warning systems and
data tracking in-country in order to detect and prevent outbreaks from
spreading. There is uncertainty on when and where outbreaks may occur
at any given time. A robust multisectoral approach and transparent
coordination with Health and other relevant Ministries will be critical
for virus detection and demanding the accountability and transparency
that is imperative to stopping a virus in its tracks. Pandemics don't
know borders--we must take a close look at both domestic and
international systems.
Lastly, we need to think holistically about preparedness, and start
preparing for the next serious outbreak that could turn into a
pandemic, today. As COVID-19 has proven, an outbreak can strike
anywhere at any time. We must ensure our systems are flexible,
accountable and meet the challenge at hand.
While there are many more lessons that could be identified, both
large and small, these initial four provide a starting place. The
question on the table is: how do we use these lessons learned to shape
what do we do next? In the past, the world has faced serious infectious
disease outbreaks such as HIV/AIDS, malaria, and Ebola. Over the past
20 years, for each of these diseases, the United States has stepped up
to lead in response. We have also worked with our allies and partners
to prevent, detect, and respond to a wide variety of other disease
outbreaks. We have a moral obligation and national security imperative
to do the same when it comes to preventing dangerous future outbreaks.
However, as I mentioned, the challenge with COVID-19 is that it's
simply different than outbreaks and pandemics most of us have seen in
our lifetimes. In this age of globalization, I fear the next outbreak
will look more like this one than the ones of the recent past. With
proactive thinking, together, we can prepare the U.S. government and
international system to ensure the world is prepared for the next
outbreak--and work together to prevent a future pandemic.
As we look forward, with history as our guide, we have an
opportunity to save lives, promote accountability, and ensure that
pandemics of this size and scale are prevented to the greatest extent
possible. We need systems that are flexible, focused, and truly global.
We need U.S. Government and international systems organized in a way to
prevent, detect, and respond to future outbreaks, with better tools and
improved whole-of-government coordination. We need to fill the gaps in
our systems, while coordinating, leveraging and respecting the
comparative advantages and unique strengths of each U.S. Government
agency involved in pandemic preparedness, prevention and response. This
does not mean taking away funding or responsibilities from any single
government agency but mobilizing the collective strengths of each in a
way that is truly coordinated and impactful. Lastly, and importantly,
out of respect for the lives and livelihoods of Americans, we need to
ensure effective oversight, accountability and performance mechanisms
to ensure each dollar spent advances our objectives, including
protecting Americans at home and abroad, and meets the challenges at
hand.
Time and again, when there is a global challenge, Americans lead.
We are the world's greatest humanitarians. And our international
response does not detract from our ability to protect the homeland;
rather, it bolsters it. Thank you for having me today for this
important discussion, and I look forward to your questions.
The Chairman. Thanks so much. Great comments.
Mr. Milligan serves as Counselor to USAID. He previously
served as the Acting Mission Director in Madagascar; Mission
Director in Burma; Senior Development Advisor for the first
Quadrennial Diplomatic and Development Review; a Senior Deputy
Assistant Administrator for Policy, Planning, and Learning. He
has a bachelor's degree from Georgetown School of Foreign
Service, a master's degree from Johns Hopkins School of
Advanced International Studies, and is a distinguished graduate
of the National War College.
With that, Mr. Milligan, thank you for coming. We would
like to hear what you have to say.
STATEMENT OF CHRIS MILLIGAN, COUNSELOR, U.S. AGENCY FOR
INTERNATIONAL DEVELOPMENT, WASHINGTON DC
Mr. Milligan. Thank you. Chairman Risch, Ranking Member
Menendez, members of the committee, it is really an honor to be
here today.
And let me begin, first, by thanking you for your
generosity, which has allowed the United States Agency for
International Development to mount a robust response to the
COVID-19 pandemic.
I have been a Foreign Service Officer at USAID for more
than 30 years, and I currently serve as Agency Counselor, which
is the senior-most career official at the agency. And,
throughout my career, I have seen the United States respond to
crises all over the world, and I have led some of those
responses, such as the response to the Haiti earthquake.
I have seen how the United States saves lives, how we
support our partner countries, and how we stand with them when
disaster strikes. The scale of COVID-19 response is
unprecedented, but these core American values are constant. In
the past 10 years, USAID has been on the front line to fight
numerous complex health emergencies, including the outbreaks of
Ebola in West Africa, Zika in Latin America and the Caribbean,
and the pneumonic plague in Madagascar, one I know quite well.
We are continuing to fight Ebola in the DRC, and we are in this
fight for the long term, because that is what we do, and that
is who we are as Americans.
Through these experiences, USAID has developed deep
operational and technical expertise to respond quickly,
rapidly, and appropriately to complex health crises. The United
States Government is strongest when we are agile and flexible
and well-coordinated, particularly at the country level. I know
from my own experience, out-of-control epidemics are a symptom
of multiple complex causes, and health emergencies have
consequences that can rapidly require broader development
assistance to address those deeper root causes of instability
and poor governance. Controlling epidemics requires more than a
standalone effort, and we have seen that, when we do not
address poor governance and conflict, we wipe out the
investments in health and education and other basic social
services.
USAID has development experience to address these issues
and prevent outbreaks from becoming epidemics, but we are
hampered. We are hampered when countries such as the People's
Republic of China and other malign actors do not disclose
information transparently or share pathogen samples, and
instead destroy samples and obfuscate facts, imprison medical
personnel, and silence journalists. In stark contrast, USAID
builds capacity and strengthens healthcare systems and
democratic institutions to enable countries, themselves, to
respond better to global health crises, and that protects us
back home. We appreciate your support for retaining the
independence to make these investments ourselves based on data
and the best available evidence.
Today, faced with COVID-19, the United States is again
demonstrating clear and decisive leadership. USAID is investing
$1.2 billion in emergency supplemental foreign assistance
generously appropriated by Congress to finance healthcare,
humanitarian assistance, economic security, and stabilization
efforts worldwide. This funding is saving lives. It is also
improving public health education and protecting health
workers, strengthening laboratory systems, and supporting
disease surveillance, and boosting rapid response capacity in
over 100 countries around the world.
We are leveraging our development programming to complement
our global efforts, because we recognize that COVID-19 will
have extensive secondary- and tertiary-order impacts. So,
taking health out of a broader development approach and
isolating it will not lead to success. We must empower our
health and development experts to do what they do best in the
field, to respond to dangerous infections, diseases. It is
imperative that we act proactively and address the ways--the
many ways this crisis has not only cost lives, but threatened
development outcomes.
We are very concerned about these secondary and tertiary
impacts. We are concerned about the more than 113 million
people who will need emergency foods assistance in the coming
year, which would be a 25-percent increase. We are seeing a
disturbing trend of a rolling back of democratic reform and
democratic backsliding, closing space for civil society. We are
investing not only in food security, but also in combating this
democratic backsliding. These investments build responsive,
transparent government.
USAID's response to the COVID pandemic contributes to the
United States remaining a trusted and preferred partner in
countries around the world. No other country can match our
unparalleled generosity, our open and collaborative approach,
our long-term commitment to helping--the Journey to Self-
Reliance. So, that is why I greatly appreciate the ability to
be here today and testify in front of this committee.
Thank you very much.
[The prepared statement of Chris Milligan follows:]
Prepared Statement of Chris Milligan
Chairman Risch, Ranking Member Menendez, and Members of the
Committee--Thank you for inviting me to testify today on the
international response to the COVID-19 pandemic. It is an honor and
privilege to testify in front of the Committee, and I look forward to
your questions.
Let me begin by first thanking you for your generosity, which has
allowed the U.S. Agency for International Development (USAID) to mount
a robust response to an unprecedented global crisis that has touched
nearly every person around the world--both at home and overseas.
I have served with USAID as a Foreign Service Officer for more than
30 years in multiple countries, including Burma and the Republics of
Iraq, Madagascar, Ecuador, and Zimbabwe. Throughout my career, I have
seen how the United States rushes to help during times of disaster and
crisis. We bring relief to the affected and hope to the afflicted. We
save lives, support our partners to build systems, and stand with them
if disaster strikes. The scale of the response to COVID-19 might be
unprecedented, but these values--these core American values--are not.
USAID is one of the faces of American compassion and generosity
overseas, and I am proud to be here on behalf of the men and women who
serve and carry out our mission all around the world.
Of course, our assistance goes far beyond relief work. We work with
our partners throughout the U.S. government to strengthen democracies,
drive economic growth, help send children to school, and keep families
healthy.
Our response builds upon these decades of investments in global
health. In just the 21st Century alone, the United States has
contributed more than $140 billion in global health assistance. For
example, over the past 20 years, USAID's funding has helped Gavi, the
Vaccine Alliance, vaccinate more than 760 million children, which has
prevented 13 million deaths. This month, the United States committed
$1.16 billion to Gavi over the next 4 years, with the goal to immunize
300 million additional children by 2025. Since 2005, the U.S.
President's Malaria Initiative (PMI), led by USAID in partnership with
the Centers for Disease Control and Prevention (CDC), has saved more
than 7 million lives and prevented more than 1 billion cases of
malaria. USAID also recognizes that viruses do not respect borders, as
the current pandemic so clearly demonstrates. USAID invests in global
health security to address existing and emerging zoonotic diseases--
which account for more than 70 percent of new infectious-disease
outbreaks. USAID alone has invested $1.1 billion in this critical area
since 2009, in close coordination with other U.S. Government agencies.
In the past 10 years, USAID has been on the front lines to fight
numerous complex health emergencies, including the outbreaks of Ebola
in West Africa and Zika in Latin America and the Caribbean, and the
outbreak of pneumonic plague in Madagascar. Today, even as we
cautiously count down towards the end of the 10th outbreak of Ebola in
the Eastern Democratic Republic of Congo (DRC), we are now scaling up a
response to fight the confirmed 11th outbreak in Northwestern DRC. We
are in this fight for the long term--because that is what we do, and
that is who we are as Americans.
We know that what happens around the world can affect us here at
home. Until now, local authorities, often with U.S. Government support,
brought most of these outbreaks of dangerous pathogens under control.
Our success has come from the ability to act quickly, rapidly and
appropriately. The U.S. Government is at its strongest when we are
agile, flexible, and well-coordinated at the country level.
Throughout the years, we have built up our operational and
technical expertise and learned some hard lessons. Chief among them, is
that we need close partnerships with communities, civil society, non-
governmental organizations (NGOs), and faith-based organizations to
solicit the support and engagement of local communities to ensure an
effective response, as well as the need to collaborate with researchers
and the private sector.
As we continue to learn from this pandemic, we must address the
root causes of these outbreaks and apply the lessons learned from
COVID-19 and epidemics past. We have also learned that outbreaks and
epidemics are directly related to governance, transparency, and
capacity considerations. For example, the robust international response
to the ongoing Ebola outbreak in eastern DRC was notably challenged by
a humanitarian crisis, weak institutions, marginalized and impoverished
communities, and insecurity. Yet thanks to healthcare capacity and
expertise--supported by millions in USAID and U.S. government long-term
investments in the country, the DRC government and international
community was able to contain outbreak spread within DRC borders and
prevent a global pandemic.
From my own experience, controlling epidemics requires more than a
stand-alone effort. And we have seen that when we do not address poor
governance and conflict, we wipe out investments in health, education,
and other basic social services.
More often than not, we have the tools to prevent outbreaks from
becoming epidemics--but we are hampered when countries such as the
People's Republic of China and other malign actors do not disclose
information transparently or share pathogen samples, and instead
destroy samples, obfuscate facts, imprison medical personnel, and
silence journalists.
And we recognize that health emergencies have consequences that can
rapidly require broader development assistance--whether that is support
for orphaned children, protection against sexual exploitation, gender-
based violence, and abuse, buttressing sustainable livelihoods or
addressing the deeper root causes of instability and governance.
When former Administrator Mark Green last testified before this
Committee, he spoke of USAID's overarching mission of helping
communities on their Journey to Self-Reliance. Our investments in
global health throughout the decades are a cornerstone of this
approach. Through USAID, our partners have built capacity and
strengthened healthcare and democratic institutions to enable them to
respond better to global health crises. We appreciate your support for
retaining the independence to make these investments ourselves, based
on data and the best available evidence.
Today, faced with COVID-19, the United States is again
demonstrating clear and decisive leadership. The United States has
mobilized as a nation to combat the virus, both at home and abroad, by
committing more than $12 billion to benefit the global COVID response
overseas. USAID is working with the U.S. Departments of Defense, Health
and Human Services, and State, as part of an All-of-America response.
With $2.3 billion in emergency supplemental funding generously
appropriated by Congress, including nearly $1.7 billion for foreign
assistance implemented by USAID and the State Department, we are
financing health care; humanitarian assistance; and economic, security,
and stabilization efforts worldwide.
This funding is saving lives by improving public health education,
protecting healthcare workers, strengthening laboratory systems,
supporting disease surveillance, and boosting rapid-response capacity
in more than 120 countries around the world. We are providing high-
quality, transparent, and meaningful assistance to support communities
affected by COVID-19 and equip them with the tools needed in their
efforts to combat this pandemic. We are also using funding to support
COVID responses in complex crisis countries and regions and providing
health, water and sanitation, and logistics for humanitarian and crisis
response.
We are forging partnerships with the private sector, NGOs, and
others to help respond. For example, in the State of Israel, USAID has
a long partnership with Hadassah Hospital, and a new one with Pepsi and
SodaStream is underway to invent a high-flow respirator for COVID-19
patients, which would be available for medical centers in Jerusalem
neighborhoods with an especially high incidence of the virus. The open-
source designs can be downloaded for free for assembly anywhere in the
world, and have already been used in the Republics of El Salvador,
Guatemala, and Turkey.
In the Kingdom of Thailand, we have worked with the Thai Red Cross
to create an application called Phonphai, which enables users to report
locations of people infected with COVID-19 and in need of assistance.
Village health volunteers in Thailand are using the app to locate
people in quarantine, conduct basic health screening, and collect vital
information. Working with Makro, Thailand's Costco equivalent and
third-largest retailer, health volunteers have used the app to order
and deliver emergency kits, including essential food and hygiene items,
to more than 115,000 vulnerable people in quarantine throughout the
country.
In the Federal Republic of Nigeria, USAID launched a partnership
with cellphone provider Airtel to reach 1 million citizens a day with
critical information via voice and text messages on physical
distancing, safe hygiene practices, and other preventive measures to
contain the spread of the disease. Now we are able to distribute the
latest public-health messaging instantly to millions.
Looking long term, we understand that COVID-19 will continue to
have an impact around the world in the months and years to come. We
remain committed to helping communities in our partner countries
through this pandemic, and its second- and third-order effects. The
COVID-19 pandemic is not simply a health crisis, and our response
cannot be just a health response. It is an economic one as well.
Because of this reality, USAID is leveraging our development
programming to complement our global health efforts. We are including
other facets of our development programming to complement our health
efforts to mitigate pandemics--because preventing pandemics requires
functioning healthcare in the public and private sectors. And
functioning health institutions require engagement beyond just the
health sector. They require reforms in the gathering of local tax
revenue, private-sector development, as well as engaging with patients
and a broad set of actors. Taking health out of a broader development
approach and isolating it will not lead to success. We recognize that
diplomacy is a critical component of fighting epidemics, and we as a
government should emphasize the importance of full compliance with the
International Health Regulations (2005) in addition to coordinating and
empowering our health and development experts to do what they do best
in the field to respond to dangerous infectious diseases.
Already, the spread of the novel coronavirus and actions to
mitigate COVID-19 have had significant secondary impacts--perhaps none
more devastating than in the areas of food security and nutrition. At
the beginning of 2020, conflict, poor macroeconomic conditions, and
weather shocks were already driving high food assistance needs across
the globe. The Famine Early-Warning System Network (FEWS NET), led by
USAID, estimates 113 million people will be in need of emergency
humanitarian food assistance this year, which represents an increase of
approximately 25 percent in the span of just 1 year. The onset and
progression of the COVID-19 pandemic, and measures taken to suppress
its spread, are likely to increase the magnitude and severity of acute
food-insecurity.
It is imperative that we proactively--and comprehensively--address
the many ways that this crisis has eroded food security and driven
malnutrition worldwide. To that end, USAID is working with the World
Food Programme and NGOs to invest over $165 million of COVID-19
supplemental humanitarian resources to address emergency food needs in
21 countries, including countries such as Afghanistan, Bangladesh,
Colombia, Ecuador, and Lebanon and 15 countries in Africa that already
were experiencing high levels of hunger before the pandemic. In
addition to emergency food assistance, we are addressing disruptions to
agricultural production, trade, and local markets; the loss of
livelihoods; and the deterioration of essential social services, like
water and sanitation, while building longer-term resilience. Each of
these plays an important role in strengthening food security and
nutrition, as well as fostering long-term resilience.
At the same time, we recognize how important democracy and citizen-
responsive governance are in responding to the outbreak, and we are
investing funds accordingly. Unfortunately, we are seeing democratic
backsliding, closing space for civil society, and crackdowns on media
freedom as the pandemic continues to unfold. To counter this trend,
through ongoing USAID programming and supplemental funding, we are
supporting civil-society organizations and independent media outlets,
strengthening the rule of law, working with national electoral
commissions, and combatting disinformation--because we know responsive,
transparent governments are better-equipped to help their populations
address the crisis and eventually help to mitigate the pandemic.
USAID also has begun to think about how we can successfully execute
our mission in the post-COVID-19 world, in a way that is flexible and
agile. To that end, Acting Administrator Barsa is establishing a
temporary Agency Planning Cell and Executive Steering Committee to
guide this effort. While the USAID COVID-19 Task Force manages near-
term challenges arising from the pandemic, the Agency Planning Cell
will perform research, conduct outreach, and prepare analyses around
key strategic questions to help USAID prepare for lasting challenges to
the development and humanitarian landscape in the medium to long term.
It will then provide this information to the Executive Steering
Committee, composed of senior leaders from across the Agency, who will
craft recommendations for the Acting Administrator's consideration.
We are already planning for the medium- and long-term impacts of
COVID-19 because we know the United States will remain a trusted
partner, the preferred partner, in countries across the world. No other
nation can match our unparalleled generosity, our open, collaborative
approach, or our long-term commitment to helping communities on their
Journey to Self-Reliance.
Thank you for the opportunity to represent USAID. I welcome your
questions.
The Chairman. Thank you. It is good information.
Mr. Garrett Grigsby is the Director of the Office of Global
Affairs at the Department of Health and Human Services, which
leads U.S. engagement with the World Health Organization and
its regional offices. He previously served as USAID's Deputy
Assistant Administrator for Democracy, Conflict, and
Humanitarian Assistance, as USAID's Director of Faith-Based and
Community Initiatives, and as Deputy Staff Director for the
Senate Foreign Relations Committee.
With that, Mr. Grigsby, we are anxious to hear what you
have to say about our relationship with the WHO and how we will
move forward.
STATEMENT OF GARRETT GRIGSBY, DIRECTOR, OFFICE OF GLOBAL
AFFAIRS, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
WASHINGTON, DC
Mr. Grigsby. Thank you, sir.
Mr. Chairman, Ranking Member Menendez, and members of the
committee, it is an honor to be with you to discuss the World
Health Organization and the Global Health Security Agenda, or
GHSA.
Last month, Secretary Azar addressed the World Health
Assembly, the WHO's governing body, expressing concerns with
the WHO and member-state response to the COVID-19 outbreak. The
committee is aware of the President's statements and letter
expressing his concerns and his May 29th statement that the
United States is terminating its relationship with the WHO.
With respect to the WHO, allow me to go back even before
the first reporting of the outbreak in Wuhan, China, and
highlight the concerns, and then I will address GHSA.
After the SARS pandemic that also originated in China, the
International Health Regulations, or IHRs, were revised in 2005
to improve transparency and reinforce obligations of countries
to provide accurate, timely, and complete information about
outbreaks. After the 2014 West Africa Ebola crisis, the WHO
Health Emergencies Program was created, and it has had some
success on the ground responding to complex emergencies, but it
has not met the goal, the global challenge of COVID-19.
Fourteen years after SARS, China failed again to provide
accurate, timely, and complete information to the WHO about its
COVID-19 outbreak, and, in fact, withheld information that
could have helped countries take actions earlier to protect
public health. The WHO did not call out the Chinese government,
which we believe exacerbated the pandemic. Early statements
from WHO leadership praised the Chinese government while
criticizing others. When missteps of China and the WHO became
apparent, our team compiled information to identify gaps in the
WHO's outbreak response toolkit. This led to discussions with
partner countries about reform of the WHO.
For example, the WHO's Director General must demand
compliance with IHR obligations. The Director General and the
WHO's Health Emergency Program must be insulated from malign
political pressure. Improvements to the process for declaring a
public health emergency of international concern are overdue,
and linking travel and trade restrictions together must be
reexamined so countries can take proactive measures, like the
U.S. did to protect our citizens, without criticism or
retaliation.
Enacting these reforms, regardless of the United States
relationship with the WHO, would be good for the world. The WHO
will only live up to its mandate with increased transparency
and accountability of all member states.
Switching to the Global Health Security Agenda, 18 months
into phase two, called GHSA 2024, the need for a multi-sectoral
approach to pandemic preparedness is greater now than ever.
GHSA was created in the midst of the 2014 West Africa Ebola
crisis to help countries comply with the IHRs. GHSA is a group
of 67 countries, international organizations, NGOs, and
companies working together to prepare for infectious disease
threats. Under GHSA, nations make concrete commitments to
elevate health security and improve capacities to prevent,
detect, and respond to infectious diseases as a national
priority. GHSA members provide support for implementation
through advocacy, collaboration, information-sharing, and
technical advice.
The U.S. is a leading voice on the GHSA 2024 Steering
Group, as chair of the Accountability and Results Task Force,
ensuring the focus on addressing gaps and challenges in
countries' core capacities. The target is to have more than 100
countries with improved capacities by 2024. It seeks to improve
accountability and tracks partner commitments in a transparent
manner. We also collaborate with partners as chair of the
Sustainable Financing for Preparedness Action Package to
mobilize resources for preparedness.
HHS works with many countries to improve health security
capacities pursuant to GHSA commitments. This includes helping
complete a joint external evaluation to assess preparedness,
developing national action plans, and mobilizing resources.
As GHSA core capacities are based on the International
Health Regulations, both efforts I have discussed, leading GHSA
2024 and forging ahead on WHO reforms focused on strengthening
the IHRs, are mutually reinforcing and will help bring about a
safer world.
Thank you, Mr. Chairman. We look forward to working with
the committee on global health security.
[The prepared statement of Mr. Garrett Grigsby follows:]
Prepared Statement of Mr. Garrett Grigsby
Mr. Chairman, Sen. Menendez, and members of the Committee, it's an
honor to be with you to discuss the World Health Organization (WHO) and
the Global Health Security Agenda, or GHSA.
Last month, Secretary Azar addressed the World Health Assembly,
which is WHO's governing body, expressing concerns with WHO and Member
State response to the COVID-19 outbreak.
The Committee is aware of the President's statements and letter
expressing his concerns, as well as his May 29 statement that the
United States is terminating its relationship with WHO.
With respect to WHO, allow me to go back even before the first
reporting of the outbreak in Wuhan, China and briefly highlight the
concerns of the United States, and then address GHSA.
After the SARS pandemic, which also originated in China, WHO Member
States revised the International Health Regulations, or IHRs, in 2005
to improve transparency and reinforce and expand obligations of
countries to provide accurate, timely and sufficient information
related to outbreaks.
After the 2014 West Africa Ebola crisis, the WHO Health Emergencies
Program was created. The program has had some success on the ground,
responding to complex emergencies, like Ebola in the Democratic
Republic of Congo, but it has not met the global challenge of COVID-19.
Unfortunately, 14 years after SARS, China failed again. We have
grave concerns that China did not provide accurate, timely and
sufficiently detailed information to WHO in accordance with the IHRs
about its COVID-19 outbreak and, in fact, withheld information that
could have helped countries take actions earlier to protect global
public health. China had a responsibility to share this information
with the rest of the world as it was the first to know about the virus.
WHO did not call out the Chinese government on its lack of
transparency and timely information-sharing, and we believe that not
doing so exacerbated the pandemic we are now experiencing. To the
contrary, statements from WHO leadership praised the Chinese
government. while criticizing other nations.
As early as February, when missteps of China and WHO were becoming
apparent, our team was compiling information about the lack of sharing
accurate, timely and sufficiently detailed information for the purpose
of identifying gaps in WHO's outbreak response toolkit. This led to an
intense discussion with partner countries about reform of WHO relating
to outbreak response tools and preparedness programs.
For example, it is critical that WHO's Director-General use his
platform to call for compliance with IHR obligations. The Director-
General and WHO's Health Emergencies Program must be insulated from
political pressure. Improvements to the process for declaring a Public
Health Emergency of International Concern are needed. And the practice
of linking travel restrictions must be reexamined so countries can take
proactive measures, as the U.S. did to protect our citizens, without
criticism or retaliation.
If these reforms are enacted, regardless of the United States'
relationship with WHO, it would be good for the world by enabling WHO
to fulfill its mandate, and increasing transparency and accountability
of all Member States, in particular those with responsibility during
infectious disease outbreaks in their territory.
Switching to the Global Health Security Agenda--18 months into the
second phase of GHSA--called GHSA 2024--the need for a strong, multi-
sectoral approach to pandemic preparedness is greater now than ever.
GHSA was created in the midst of the 2014 West Africa Ebola crisis
to help countries meet their obligations to comply with the
International Health Regulations. GHSA is a voluntary group of 67
countries, as well as international organizations, NGOs and companies
working together to prepare for infectious disease threats. Under GHSA,
nations make concrete commitments to elevate global health security and
improve their capacity to prevent, detect and respond to infectious
diseases as a national priority. GHSA members provide support for
implementation through advocacy, collaboration, information sharing,
and technical advice.
The U.S. is a leading voice on the GHSA 2024 Steering Group, as the
chair of the Accountability and Results Task Force, ensuring that GHSA
continues to focus on addressing gaps and challenges in countries' core
capacities. The GHSA 2024 target is to have more than 100 countries
with improved capacities by 2024. It also seeks to sharpen the focus on
accountability and tracking country and partner commitments in a
transparent manner.
We also collaborate with partners as the chair of the Sustainable
Financing for Preparedness Action Package to use momentum from the
COVID-19 response to mobilize resources to invest in preparedness.
HHS, alongside U.S. Government partners at State Department, USAID,
and beyond, works with many countries to improve their health security
capacities pursuant to GHSA commitments. This includes helping complete
a Joint External Evaluation to assess their current state of
preparedness, developing National Action Plans for Health Security, and
mobilizing resources. Since the launch of GHSA, the United States
Government has invested over $3 billion to strengthen national capacity
in partner countries to prevent, detect, and respond to existing and
emerging-infectious disease threats.
As GHSA core capacities are based on the International Health
Regulations, the two efforts I have discussed--forging ahead on WHO
reforms focused on strengthening the IHRs, and leading in GHSA 2024--
are mutually reinforcing and will help bring about a safer world.
Thank you, Mr. Chairman, for your attention and interest. We look
forward to working with the Committee on global health security in the
future.
The Chairman. Well, thanks, to all of you. It certainly
looks like we have got the right panel here to give us the
information we need to try to go forward.
Mr. Richardson, let me say, first of all, thank you for
reminding us of how critical and pivotal the role of the United
States is in any kind of a global challenge, and, most
importantly, how generous Americans are. The 330 million of us,
compared to the 8 billion in the world, contribute an
incredibly high percentage of need that is given to less
fortunate people.
You made one statement that I would like to focus on a
little bit. And I am going to follow up on this with Mr.
Grigsby, also. But, you said you fear that future pandemics are
going to look a lot more like this COVID-19 than the ones that
we have experienced in the past. Could you drill down on that a
little bit, why you say that and what do you mean by that?
Mr. Richardson. Yes. I appreciate the question, Senator.
I think when we start looking at what is the real
differences with this pandemic--whether it is Ebola or SARS,
both of those were fairly localized in scope. The challenges
that they presented were probably overwhelmingly focused on the
developing world. This pandemic--and, I think, given the
globalization realities that we find, the fact that we can
easily travel around the world, and that is continuing to
accelerate, I fear that that mobility will drive epidemics, the
outbreaks somewhere, to then be able to spread more easily
through the developed world, in addition to the developing
world.
The Chairman. You know, let me stop you there. As I look at
these differences in the viruses--just take Ebola and compare
it to COVID. The transmission mechanism is very different on
the two, it seems. And the contagiousness of the disease seems
to be very different. And with 2,000 viruses kicking around out
there, they are probably all going to have idiosyncrasies that
are different than others. Is that what you are making
reference to?
Mr. Richardson. Yes, absolutely. I think, when you really
look at what the challenge we are presented, the likelihood of
transmission, the globalization of this world, and the ability
for viruses to quickly move outside of a containment area, that
is a game-changer. And again, given the fact that it has been
able to impact high-income countries, like the way it has, I
think, really makes us want to rethink how we approach this.
The Chairman. Yeah, that is what we are trying to do right
here, and that is exactly the focus of what we are doing. And I
think your identification there is important.
In a minute, I am going to ask Mr. Grigsby a little bit
more about that, because of the system we need to put in place.
It seems to me that COVID-19, because of the way it transmitted
and the rapidity at which it transmitted, it is so different
from those other viruses that we have experienced in the past,
and, in the defense of the systems that we are trying to
respond to this, they were not ready for that. They did not
expect it. They expected that it would behave like SARS or like
Ebola or something like that. And what we found out is that it
behaved very differently and required a very different
response. And that did not happen. Is that a correct
characterization?
Mr. Richardson. Absolutely. We are not really sure what the
next outbreak or next virus will look like, or what it will do.
I will leave it to the scientists to talk about, you know, how
it is transmitted or how much more easily it can move. But, I
think our systems are not built for this type of outbreak.
Clearly, it did not work, right? It did not stop the ability
for this to become a global pandemic. So, we really need to
think about what kind of flexible mechanisms, both in the
international system and in the U.S. Government, that we can
put into place now that allows us to be able to respond, both
at an outbreak and at a pandemic level, that is to be able to
say, you know, regardless of what the virus is, or regardless
of where the outbreak starts and where it goes, we need to have
an ability to respond. This idea of a worldwide ability to
respond is incredibly critical.
The Chairman. Well, and that is what Senator Murphy and I
and this committee are focused on, as far as trying to develop
the system, here. And thank you for being part of that.
Mr. Grigsby, you know, in my conversations with Mr. Tedros
and his team, they were defensive in one respect. I think it
was legitimate. And that is, they said they did not have enough
power. And, regardless of our criticism of them, we do have to
realize that they are not a sovereign entity, and they cannot
really tell a sovereign entity what to do. They can certainly
encourage them and try to press them to do the right thing.
But, it struck me that, going along with the conversation I was
just having with Mr. Richardson, that they, as much as the rest
of the world, were taken aback by how COVID-19 reacted,
compared to their dealings with polio or AIDS or Ebola. Is that
a fair assessment of where they were, as far as being taken
aback by what happened?
Mr. Grigsby. Thank you, Mr. Chairman.
You know, it is fair to say, as Jim was alluding to, COVID-
19 is a novel virus, it is one that had not been seen in human
beings before. There is still a lot that we are learning about
it. And, by the way, we would be happy to come up and brief you
or your staff--not myself, but we have leading scientists in
the world at HHS, and they could answer some of these questions
very specifically for you. They are still learning about this.
I think that is a fair comment.
And it is true, and it is a challenge, that the World
Health Organization does not have a police force, it does not
have a standing army to go in and enforce international health
obligations, which is only one of two treaties that are in the
WHO that countries have signed up for and are obliged to comply
with.
But, I think what we all know is that, rather than even
calling China out, what was really going on is that the
leadership of WHO was praising China. This has happened before.
We have been in this movie before. If you go back to the SARS
situation in the early 2000s, the leadership of the WHO was a
little bolder when it was confronting China, in that it did
call China out. There were significant problems that happened
that led, as I mentioned in my statement, to a revision of the
International Health Regulations in 2005. But, there is only so
much that it can do. But, it did not even do the minimum it
could have done, as in calling out what was really going on,
the information that it needed that it was not receiving. That
did not happen at all, unfortunately.
The Chairman. Thank you.
I am going to end here and turn it over to Senator
Menendez.
Before I do, what I want you to think about is. We have
focused quite a bit on what did not happen, and why it did not.
And what I would like to hear when I come back to you is your
thoughts as to what a system would look like if we were
designing it now, which we are, hopefully, for the next
pandemic, whose transmission is rapid and easily as COVID-19.
Because, as we have now, I think, all agreed, this is entirely
different than what we have dealt with in the past. We need a
system entirely different than what we have had in the past. We
want your thoughts on that as to how we would go forward.
Senator Menendez.
Senator Menendez. Thank you, Mr. Chairman.
Mr. Chairman, just a comment. I agree that we need to
continue working on a bipartisan approach. Before the last
business meeting, we were working well on a bipartisan
manager's package. And I, along with all the other Democrats on
the committee, introduced the COVID-19 International Response
and Recovery Act. And I hope we can find a common ground and a
productive path forward. And I look forward to that
opportunity.
Mr. Grigsby, I want to pick off, in your last set of
comments here as well as your testimony, that China did not
share sufficient information about the virus. And you just said
that the WHO's words of praise for China actually exacerbated
the pandemic because it did not pressure China to be more
transparent. But, President Trump, himself, praised China's
response multiple times, in speeches, public statements, in
tweets, quite explicitly. In one tweet, on January 24th, he
wrote, ``China has been working very hard to contain the
coronavirus. The United States greatly appreciates their
efforts on transparency. It will all work out well. In
particular, on behalf of the American people, I want to thank
President Xi,'' close quote.
On February 6th, at the WHO executive board meeting,
Ambassador Bremberg, who represented the United States, was
similarly effusive, saying, quote, ``We deeply appreciate all
that China is doing on behalf of its own people and the world,
and we look forward to continuing to work together as we move
ahead in response to the coronavirus,'' close quotes.
Those are just some of the quotes.
So, was the WHO's praise for China the fatal flaw which
necessitated the U.S. withdrawal from the WHO? And, if so, why
did the United States make similar statements of praise and
support for China at the same time if this was detrimental to
the global pandemic response?
Mr. Grigsby. Thank you, Senator.
The comments you made are absolutely correct. Early on, the
information we were receiving was that China was being
cooperative. We were getting those reports from the World
Health Organization. I remember having conversations early on
at my level and members of WHO telling me how unbelievably
transparent China was being, particularly compared to the SARS
problem in the early 2000s.
What happened was, we received more information later, as
we all have had, and information is going to continue to come
out. And, as that information changed, the tone changed. And
that is just a fair comment.
Last month, the World Health Assembly approved a
resolution. It is cosponsored by--in fact, because it was a
virtual Assembly and much condensed, as opposed to the normal
meetings, they were not able to do a lot of business. They had
one item, and that was a resolution, cosponsored by 140
countries, expressing concern, but also demanding that there be
an independent review of what happened, including about the
origins of the disease and its path to transmission to humans.
So, a lot of countries were saying good things about
China's response early on, but then as more information came
out, and it will continue to come out with these independent
reviews----
Senator Menendez. Well, I look forward to the review, and I
certainly believe it is important, but the President's praise
continued even after the ones I mentioned.
Let me ask you this. You listed several reforms the
Administration would like to see at the WHO, including pressure
for better compliance of international health regulation
obligations and improving the process for declaring public
health emergencies of international concern. That would be good
for the world. But, the Director General is not the person who
decides on those reforms. It is the WHO, which is a member
organization. Member countries make those decisions. How does
the United States expect to influence other members to achieve
reforms of the WHO if it has relinquished its seat at the
table?
Mr. Grigsby. Senator, that is a good question, and I
appreciate it.
The fact of the matter is, the United States is a member of
the World Health Organization now. The President has announced
that that relationship is being terminated and----
Senator Menendez. Well, if I said, ``I am terminating my
relationship with you,'' why should I listen to you? Can you
explain that to me? If you tell me you are terminating your
relationship with me, why should I listen to you about anything
you want to do with the organization that I no longer am going
to have a relationship with?
Mr. Grigsby. Why don't I tell you what we are actually
doing?
Senator Menendez. No, why don't you answer my question.
Mr. Grigsby. I am doing that, sir.
As you know, the United States has the presidency of the G7
this year. That provides us an opportunity to speak with health
ministries. In fact, Secretary Azar has, since early on in the
pandemic, had once-a-week telephone conversations with all
health ministers of the G7. As the situation with COVID-19
became more apparent, there was a focus on reform of the WHO.
Those conversations continue. And some of the countries have
asked us the same question. It is in the interest of the United
States, whether or not we are a member of the WHO, to have a
WHO that performs better.
Senator Menendez. Well, I appreciate your lengthy answer,
which is a non-answer, as far as I am concerned. The reality
is, you have not made it clear to me how you are going to
effect change in the WHO when you have terminated your
relationship.
Let me ask you one other question. If we create a new
Global Trust Fund at the World Bank--as I understand it from
reading Senator Risch's bill that is what it would do--would we
just be going it alone? The rest of the world, they may be
seeking change at the WHO, but they are behind the WHO. So,
help me understand why other countries would now support a new
mechanism at the World Bank. Would this not just create a
parallel mechanism to the World Health Organization?
Mr. Grigsby. Senator, we just received a copy of the bill a
couple of days ago, and I know our team is looking at that. I
do not know that that would be the case. In terms of, for
example, HIV/AIDS, there are multiple organizations that have
been created, and I believe that they very much complement each
other. I assume that the Senator's proposal would be in that
same spirit.
Senator Menendez. Well, we look forward to your further
analysis of the bill, because that is what it seems to me.
Let me close.
Mr. Richardson, I know that you have talked about the
generosity of the United States. I would just say that, if I
look at the President's proposals for global health in fiscal
year 2020, which is more than a 20-percent decrease in the
foreign affairs budget, including a 28 percent cut to global
health programs at AID and the Department of State, and,
similarly, the proposal for FY-2021 includes, by some
estimates, a 34 percent reduction to the State Department and
USAID's global health funding, and the budgets of the President
for the last 3 years, had they been enacted, the U.S. would
have, by some accounts, $7 billion less to spend on
humanitarian assistance in the last 3 years. So, to the extent
that the American people have been generous--and they have--it
has been because the Congress of the United States has put
forward these funds, not because the Administration has
proposed it. And I have serious concerns, which I will wait for
the second round, as it relates to the actual delays in the
obligation of critical humanitarian aid. We have heard, from
many partners, that up to 10 weeks in delay. I do not think
that there is a good reason for that. But, I look forward to
exploring it with you.
Senator Johnson.
Senator Johnson. Thank you, Mr. Chairman.
This is a crisis that is really driven by, and really
defined by, certain data points, certain metrics. Moving
forward, if we are really going to respond properly, I think
there are certain metrics that I think we have to key in on. I
just kind of want to ask some questions about that.
If you look at recent past viruses, different outbreaks--
H1N1, I am not a doctor, but I view that as a flu. Numbers I
have seen, about 60 million Americans were affected by that,
200 million globally, but it was not particularly deadly.
Ebola, I think, all told now, about less than 50,000 people
have been infected with Ebola. It is about a 40-percent
fatality rate. MERS was, I think, about 2500 people, about a 32
percent fatality rate. SARS, less than 10,000 people, and about
a 10 percent fatality rate. Is it safe to say, Mr. Grigsby,
that early on, in December, when this first surfaced in China,
the WHO was looking at this, Dr. Fauci was looking at this, we
were hoping that this type of new virus would be something
similar, on the order of MERS and SARS, where, you know, it
might be pretty deadly, but it was not going to spread that
much? And I think my main point is, is the main metric there
the transmission rate? And how quickly can we really obtain
information on transmission rate in a new virus that we have
never even seen before?
Mr. Grigsby. Well, Senator, I think you have hit upon the
problem. And I sort of wish Dr. Fauci were here to answer your
questions. He is a lot more knowledgeable than I am.
But, again, the point is, is that it was a novel
coronavirus. And there are other coronaviruses that we have
dealt with. SARS is an example. So, that is really the only
thing that you could go back to and look at.
COVID-19 is not SARS. It behaves differently. But, you do
not know that until you get into it. And, frankly, the
scientists are still learning a lot more about it, and will be,
I am sure, for years. That makes it very difficult to respond
to.
Ebola is a scary thing. The mortality rate is high. It is
very difficult to deal with. But, at this point, there has been
a lot of experience in dealing with that. There have been new
tools that have been created, like a vaccine that is effective,
and therapeutics that are effective. But, early on, that was
not the case. But, once you deal with these things, you become
better at it, you learn more about it, and that is what we are
in the process of doing.
Senator Johnson. We have obviously now seen the economic
devastation caused by, you know, global and national shutdowns.
I think we have to take that into effect, the human toll of
that, as well. I think we are starting to understand that, the
devastating human toll of what has happened to our economies.
Early on in these models--for example, the Imperial College
of London, I have read the reports, but the one that really
drove so many of these shutdowns--in the first report, the
introductory summary estimated, without mitigation, 7 billion
people would contract coronavirus. Is that not an
impossibility?
Mr. Grigsby. I confess to you, sir, that I am not an expert
on those models. We have people at CDC and NIH and other places
that are. We would be happy to bring up those folks and talk
with your staff. There is a whole industry that deals with
these models.
Senator Johnson. I guess, my point being is, what models
are we relying on to drive policy? We need to take a serious
look at that, and we need to take a serious look back at what
drove so much of this economic devastation. And, you know,
eventually we will find out what the infection fatality rate
is. Right now, according to the Oxford Center for Evidence-
Based Medicine, they are saying it is going to be somewhere
between 0.1 and 0.41 percent. A bad season of flu is about
0.18. If we are moving forward, in terms of, you know, what our
response is going to be, we need to identify these metrics that
drive the type of policy--first of all, to address the health
situation, but also understand what is happening with our
economy as we employ these shutdowns.
Mr. Grigsby. Right. You are right, Senator. And again, I
would just go back to the fact that this is a novel
coronavirus, something that had not been seen in humans before.
So, some of it is educated guesswork. There is no doubt about
it.
Senator Johnson. Thank you, Mr. Chairman.
Mr. Richardson. Senator, if I may, just----
The Chairman. Go ahead.
Mr. Richardson. I think your point is exactly right, sir,
and I just want to sort of reemphasize that this idea of having
an early-warning tracking system--we have early-warning
tracking systems for families, right? That is an existing
program. It is run out of USAID. It is phenomenal. But, we do
not have effective early-warning systems and data-tracking
systems for outbreaks going into a pandemic. This is a huge
vulnerability and a gap in the strategic system, and it is not
a gap currently filled by the WHO or any other system out
there, and it is something, I think, we certainly need to look
at.
The Chairman. We will take note of that.
Senator Johnson, thank you for bringing this into the area
of the economics. It is certainly something that needs to be
considered as we go forward with the bill and the metrics that
need to be developed to look at that.
Senator Kaine.
Senator Kaine. Thank you, Mr. Chair.
And thank you, to the witnesses.
I want to follow up on Senator Johnson and ask you some
questions about data.
So, on January 21st, the United States and South Korea both
had their first reported case of coronavirus. And, on that day,
the unemployment rate in both nations was fairly similar. It
was 4 percent in South Korea, and it was a 3-and-a-half percent
in the United States. On March 3rd, we had a hearing in this
room, I believe, a HELP Committee hearing, not a Foreign
Relations Committee hearing--with a number of the political
appointees dealing with coronavirus. And on that day, South
Korea had experienced 28 deaths, and the U.S. had experienced 9
deaths, the coronavirus, and the unemployment in both nations
was also, essentially, similar.
Today, South Korea has lost 280 people to coronavirus, and
the United States has lost, now, more than 119,000. The South
Korean unemployment rate has risen to 4.8 percent, while the
U.S. unemployment rate has risen to 13.3 percent.
South Korea has one-sixth of the population of the United
States. Their GDP is one-twelfth that of the United States.
South Korean per-capita income is less than two-thirds of U.S.
per-capita income. South Korea is every bit as much affected by
any missteps of the WHO and every bit--and possibly more
affected by Chinese missteps because of their close proximity
to China and the frequency of travel between China and South
Korea.
Even with vastly greater resources, the United States now
has a COVID-19 death rate per 100,000 population that is 80
times higher--80 times higher--than that in South Korea. I know
four people who have died of coronavirus. And our economy has
been devastated by this crisis in a way that South Korea's has
not.
In a hearing on international response, I think it is
important to look at other nations and ask, what did they get
right that we got so wrong? So, I would like to ask our panel,
how can America and the entire world replicate the more
successful strategy that South Korea or other nations--Japan,
Canada, Germany, Australia, New Zealand, Vietnam--utilized, as
we go forward in fighting COVID-19 and preparing for the next
pandemic?
Mr. Grigsby. Senator, I am happy to start out.
I think that many years are going to be spent taking a look
at lessons learned. The World Health Organization just approved
a resolution to take the first steps to do the first one.
Senator Kaine. Is that a good thing? Does the U.S. support
that?
Mr. Grigsby. Yes, we did. In fact, we negotiated--the EU
sponsored it. We worked very closely with them to ensure that
that language was, in fact, in there and was not weakened by
other states that were seeking to weaken that language. And
there were 140 other cosponsors.
I have no doubt that, in our own country, there will be
countless studies looking at this, and there will be lots of
lessons----
Senator Kaine. Can I ask you, are you guys looking at this?
Are you guys analyzing the experience of nations whose death
tolls are dramatically less than the United States, and asking
yourselves, What do we need to do better right now--not years
of analysis; we are still fighting COVID-19--what do we need to
do better right now, and what do we need to do better to
prepare for the likelihood of future pandemics?
Mr. Grigsby. Yes, sir. I mean, we have folks at the CDC in
Atlanta who do just that. As you mentioned, you know, South
Korea is a very different country than the United States, and,
in fact, even their laws allow the government to----
Senator Kaine. They are also similar to the United States
in a lot of ways.
Mr. Grigsby. Sure.
Senator Kaine. They are an ally; big, messy multiparty
democracy, densely urban, but also fairly rural. Every country
is different than the United States in some ways, but South
Korea is a country that has a lot of similarities to the United
States, including a very close working relationship.
Mr. Grigsby. And I think that all of us are going to have a
lot to learn from the successes and failures of many countries,
including what we have done in the United States. So, that is
going to be happening for years on something like this that has
had this massive of an impact.
Senator Kaine. My time is close to the end, and I do not
want to go over, but, Mr. Chair, I think a hearing on best
practices, in this committee, and maybe a combined hearing
between this committee and HELP would make a lot of sense,
because there are things we have done that we could teach
others, but there is an awful lot of things that other nations
have done that we should learn. To be true to what you say, we
are having this hearing to prepare for the near-certainty of
future epidemics. We should be trying to learn those lessons as
quickly as we can.
The Chairman. Yes. You know, Senator Kaine, I could not
agree with you more. It seems to me, though, that the answer to
the question is relatively straightforward, and that is, how
tough does the government want to be, as far as locking people
up so they cannot spread the disease? That is a debate that is
probably going to be pretty heated, I would think, depending
upon the culture of where you come from. But, it needs to be
explored. There is no question about it. Because the question
is, do you want to go ahead, as Senator Johnson and others have
pointed out, that if you compare this to the flu, we go through
this every year with the flu, and we take hits as a result of
that. What are we willing to do in a pandemic like this? And
that is a very fair discussion----
Senator Kaine. And I think, Mr. Chair, just to respond,
South Korea is not a China or a Vietnam, it is not an
authoritarian state, but a democracy. And so, yes, the
government did some things--early testing, and then, if people
are sick, contact trace, isolate and treat those who are sick.
But, by doing that--and that was heavy government action--they
did not have to shut down the economy.
The Chairman. Yes.
Senator Kaine. So, that is why the unemployment rate went
from 4 percent to 4.8 percent, where ours went from 3.5 to
13.3. So, you have tough government action on the testing and
contact tracing, meant that they needed to do less dramatic
government action on shutting down the economy. And other
nations are going to have other experiences. And then, we have
done things that we can--in, especially, our research
institutions, that we could share with others. But, it makes my
skin crawl to think of--first case on the same day, similar
tiny number of deaths in March, and now 280 deaths in South
Korea--and 120,000 in the United States. And so, I know we can
do better. And this committee, with the Global Health
Subcommittee, together with the HELP Committee, are the places
where we ought to be hashing that out, learning those lessons.
The Chairman. Yes. Fair points, across the board. I think,
also, a person pointed out to me the fact about how important
wearing a mask is in social interaction. And this person also
pointed out that, culturally, around the world, there are
people that are very comfortable wearing a mask. In some
countries--I was told by this person, who is an academic, as
far as these things are concerned--that, in many countries,
people will wear a mask if they have got a cold or if they have
a cough. We never see that in our Western civilization here.
But, yet, in other countries, that is the case. So, you are
right. I mean, these things absolutely do need to be looked at
further.
Dr. Barrasso.
Senator Barrasso. Thank you very much, Mr. Chairman.
Mr. Grigsby, I believe the World Health Organization failed
the American people, failed the world during the coronavirus
crisis, refused to call out China for its disinformation
campaign, lack of transparency, the cover-ups. You made
reference to some of this. From the start, I believe the World
Health Organization blindly accepted China's leaders' false
reporting and understated the threat of the disease. They
repeatedly praised China for transparency and spreading
accurate and misleading information. January 14th, we know they
pushed out a false information that there was no evidence, they
said, of human-to-human transmission of the virus, despite
clear evidence to the contrary.
But, it continues. I mean, just last week, the World Health
Organization announced that asymptomatic spread of the
coronavirus was rare, and then that made the national and the
international news for a day. And then, the next day, they had
to walk back the claim, so they had to change things. Lots of
inconsistencies. But, this is not the first instance of the
World Health Organization's failure to prevent, detect, or
respond to a severe infectious disease crisis. As a doctor, I
always thought that the World Health Organization's
mismanagement of Ebola and the delay in declaring it an
international emergency--and I called them out publicly about
it back in, I think it was 2014.
So, due to the leadership failures and the repeated
mistakes, I think it is time to reconsider the role that the
WHO and its leadership play. I agree with the withdrawing of
the funding. Reforms are needed. I agree that reforms are
needed to ensure the accurate and transparent data-sharing to
members.
So, the question is, how do you do this? Another member of
this committee said, what leverage do you have after you have
withdrawn the funding? I think you have a lot of leverage,
because if you say, ``You want the funding restored, you want
us to come back and reengage, then give us the kind of
credibility and engagement that is necessary.''
Fundamentally, what do you see is the problem with the
World Health Organization? Is it a lack of political
commitment? Is it a lack of capacity or capabilities? Why are
they continuing to fail to implement needed reforms?
Mr. Grigsby. Thank you, Senator.
Maybe if I could just talk a little bit about some of the
reforms that we are discussing with other countries. And it
goes beyond G7 health ministers, as well. As I mentioned
before, this is not the first time. We have experienced this
before with the World Health Organization. And, in fact, I made
mention of the SARS earlier--when there were problems, again,
in the West Africa Ebola crisis, that led to more reforms, the
creation of the Emergencies Program at WHO. The Obama
administration, at the time, actually had to redirect funding
away from the WHO, because the WHO could not get its act
together and even accept the money. So, that went for good work
that was going on in those countries through private
organizations.
So, this sort of thing is not new. There is a big
difference between the COVID-19 pandemic and how that has
impacted the world and the West Africa Ebola crisis, which was
more regionally focused. But, you know, we have had many
encouraging conversations with other countries regarding the
need for reform. I mentioned a few of those in my statement.
And, really, you answered Senator Menendez's question better
than I did. But, the fact remains that if WHO can get its act
together, and can make the reforms, and can prove that it has
independence from China, I am sure there is every possibility
that the relationship that the United States has could be
changed. But, the ball is in their court. And there are a
number of reforms that they need to undertake. And we have,
really, a remarkable amount of agreement and common ground with
other health ministers that we are dealing with on the need for
reform, notwithstanding our relationship with WHO. That is
beside the point. So, the ball is in their court, and we hope
that they will embrace these reform proposals.
Senator Barrasso. Can I ask about the development of a
vaccine? Can you please discuss the steps, Mr. Grigsby, that
the Administration is taking to engage with our global partners
to ensure that the vaccine can be developed and distributed as
quickly as possible?
Mr. Grigsby. Well, yes, sir. You know, we have our own
projects that are going on, Operation Warp Speed, and we are
investing a lot of resources in that. There are other efforts
going on globally. We have collaborations and conversations,
and share lessons learned, and provide technical assistance.
So, really, we are rooting for all of the efforts. We are going
to need more than one vaccine, and we are going to need more
than one company, because we are going to really need
vaccinations for everybody on Earth, ideally, and easy access
to them.
There are a lot of different things in play. We have folks
whose job is to work on these. I am happy to bring up some
folks, technical experts and scientists, who can speak with you
and your staff. We are happy to do that anytime. But, there are
a number of initiatives going on. And our Department and the
White House, as well, they are in discussions with, I am
assuming, all of them.
Senator Barrasso. Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you.
Senator Booker.
Senator Booker. Thank you very much, Mr. Chairman.
It goes without saying this pandemic has hit the United
States of America pretty significantly, and, within that
context, my State of New Jersey has seen the worst of this
pandemic; and the lives lost, the families facing devastating
grief, and the struggles that we have seen have been legion. I
am grateful that it was already said in this committee that we
have a serious problem--at a time that people were calling into
question China's secrecy, we have a President that was praising
China. At a time when people were demanding transparency from
China, this President was coddling them and encouraging them in
numerous public statements, in numerous tweets, and we were
failing--as people in New Jersey were dying, we were failing to
hold them to account for the challenges that were before them.
And so, I continue to be concerned about our policies regarding
China that go beyond tough talk, but to really working to get
results. According to reporting, China appears, during this
crisis, to have nationalized control of domestic production and
international distribution of critical personal protective
equipment. In early 2020, in response to this crisis, including
that of the U.S. companies, such as 3M, which produce PPE, this
is a significant challenge. Under their action of nationalizing
their control, China required factories that make masks on
behalf of American companies in China to produce masks for its
own domestic use. Now, China is currently exporting more masks,
and these exports seem to relate to political calculations,
with the U.S. receiving less priority than other markets.
China's mask diplomacy, or China's distribution of masks and
medical equipment in order to curry favor, has been widely
reported. I would like to really know, how is China, in your
perspective--and maybe address this to Grigsby and Richardson--
how is China prioritizing their exports of PPE? And how is the
U.S., in your view, benefiting or to the detriment of our
country? And, really, the entire world saw the images of our
healthcare professionals working without adequate PPE while we
waited for China to release the supplies of PPE. What have we
learned, as a nation, through the process, in the event that
another surge of the coronavirus hits and we find ourselves
with heightened demands and needs for PPE? I am very concerned
that this problem still is ongoing and that the Chinese
policies are still working at a detriment, at a significant
detriment, to the United States of America, and we are not
doing enough.
So, I would like a response from Mr. Grigsby and Mr.
Richardson, if possible.
Mr. Grigsby. Thank you, Senator. I think your comments are
spot-on. And I do not know that there are many silver linings
to this terrible crisis. But, I think one of them is going to
be, I can assure you, a reexamination of the supply chains. I
believe that everything you mentioned is true, in terms of
that. I can assure you--this is not my office that does this,
but there are a lot of people, not only in HHS, but across our
government, working very hard specifically on the supply-chain
issue. It is a big issue. And thank you for raising that.
Senator Booker. Thank you, Mr. Grigsby.
Mr. Richardson.
Mr. Richardson. Yes, thank you, Senator. I totally agree
with you, and I agree with Garrett.
When you look at China--and I would not just look at it in
the context of COVID--but, if you look at their approach to
foreign assistance generally, they have a really mercantilist,
very strategic approach to what they do. They are looking at
strategic medical--mineral rights. They are looking at
strategic ports. They are looking at, you know, bribing
officials in order to get their companies access to things.
That is really the Chinese approach to foreign assistance, writ
large. And I think it does set up a really great dichotomy
between, you know, if you want to go with China and accept that
type of assistance, you are going to go backsliding on your
governance and your transparency, and it is not ultimately
going to be the most successful for any of our partners.
I think what the U.S. really offers with our donor
partners--offers, really, a different solution of transparency,
no-strings-attached assistance, and those types of things. It
is a critical issue.
Senator Booker. So, I am grateful. And I do not think we
are sounding the alarm enough. We see the authoritarian regime
of China working against our country, from currency
manipulation to corporate espionage and stealing secrets. We
have seen this behavior consistently in how they deal with
foreign relations. But, now, in the nature of a pandemic, it is
chilling to see that their actions and what they are doing is
putting lives in our country at risk in the past, right now,
and especially with the potential for a second wave. I am
grateful you are echoing, Mr. Grigsby, what I have been saying
in this committee, in the Small Business Committee, is the
supply-chain issues are national security issues, and we need
to be acting with bolder, far-greater action to protect our
nation from this menace that seems to be the Chinese intention
to undermine our safety, our health, and our well-being.
I want to ask, very quickly, about wet markets, because I
have great partnerships across the aisle. China CDC announced
it found COVID-19 in samples collected in a wet market in
Wuhan, China, in January. There is a new outbreak right now in
Beijing, but China, yet again, in this outbreak, we see that it
is still linking a lot of the challenges to wet markets. These
live wildlife markets were also linked to the 2003 SARS
outbreak. Scientists studying zoonotic diseases, diseases that
jump between animals and humans, have pointed to the close
proximity of shoppers, vendors in these markets, as they are
being prime locations for the spread of these pathogens. And
so, we know, from SARS, which I mentioned, Ebola, monkeypox,
COVID-19, MERS, and more, jump from animals to humans. It is
clear that wildlife markets that sell wildlife animals for
human consumptions need to be shut down.
Senator Graham and I sent a letter to the heads of
international organizations, urging them to engage in efforts
to shut down these markets. And so, very quickly, and then I
will stop--and love to ask this question to Milligan and
Richardson--is, how should the U.S. work through international
organizations and the international wildlife community to
increase the awareness of this risk and, really, to begin to
take real measures to shut down and ban wildlife markets so
that we do not see this challenge again? I am grateful to be
working with Senator Cornyn, Senator Graham, and others, on
legislation. But, to me, this has got to be an international
priority. And I would love to get your thoughts on that.
Mr. Richardson. Thank you, Senator. I appreciate those
comments.
State and USAID have really robust programs when it comes
to preventing wildlife trafficking, environmental programs. And
we have a fairly broad reach, although a lot of the countries
that are the greatest offenders, like China--we do not have a
lot of those types of programs in some of these countries. So,
I do think we need to expand, not just in the development piece
that Chris will have better insight in, but on the diplomatic
side. I think that we have got to do a one-two punch here. But,
working together, I think we can make real progress.
Mr. Milligan. Thank you. And I think what this shows is
that these issues are all interrelated. You cannot look with
just a simple health focus. It is all interrelated. We have a
tremendous opportunity now to build more commitment behind
preventing wildlife trafficking, by action messaging on CITES,
and by talking to many of the countries that enable this to
happen about the consequences and the downstream effects. So,
this is a tremendous opportunity.
And going back to the whole sanitation issue that you
raised, we are prioritizing many of our investments in water
and sanitation hygiene, particularly for that reason, you know,
that we can prevent the spread of this disease as it goes
forward. So, Senator Booker, your point is well taken that
these issues are all quite interrelated. But, we have an
important ability now to message strongly and show these
connections, which can help have a broader impact on these
important issues, such as countering wildlife trafficking.
Senator Booker. Thank you.
Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you. Thank you, Senator Booker, for
raising the supply-chain issue. That is certainly something
that is critical.
This ties in a little bit with what Senator Kaine was
saying, and that is that one of the things that South Korea
did, it had an all-of-government approach to this thing, and
they shut down their supply chain out. They hung onto
everything that they had. And what has happened in this is,
there has been a real underscoring of the weaknesses that we
have as a result of a lot of our manufacturing going overseas.
And I think some of that manufacturing that is national
security, and certainly a health challenge is a national
security issue, like anything else. I have no doubt we are
going to be looking at that as we go forward. So, thank you for
that.
Senator Murphy.
Senator Murphy. Thank you very much, Mr. Chairman.
In response to a question about global vaccine efforts, Mr.
Grigsby said that we are ``rooting for these efforts.'' And I
will, maybe, direct this question at Mr. Richardson, because it
probably matters more what the Secretary of State thinks about
this than the head of the CDC.
Why should we just be ``rooting'' for these global vaccine
efforts? In fact, we could be a part of these global vaccine
efforts. In particular, there is one that is probably the most
promising. It is CEPI, the Coalition for Epidemic Preparedness
Innovations. All our allies are a part of it. It is, frankly,
doing work, as we speak, with U.S. companies. The legislation
that Senator Risch and I have would authorize the United States
to become a partner with CEPI and put money behind that effort.
So, what is the Administration's specific position on the
wisdom of joining this particular global vaccine effort? It
just seems to be a lot smarter for us to be at the table, so,
if CEPI is the one that produces a vaccine, that we have
something to say about where that vaccine goes and who gets it
first.
Mr. Richardson. Yeah, I appreciate that, Senator.
You know, CEPI plays an important role, certainly. Gavi
also plays an essential role. The Administration just made the
largest pledge ever, for an American government, to Gavi, of
$1.6 billion. So, I think our commitment to the international
effort for vaccines is pretty strong.
I would say that, if you look at what we have done--and a
lot of this actually is on the HHS side--but, $4 and a half
billion of--we have invested through BARDA. We have allocated
$350 million for vaccine efforts, $1.8 billion for rapid
acceleration of diagnostics. I think there is a lot of work
that has already been happening in the U.S. Am I going to say
that we should not coordinate more closely with our partners
and allies around the world? Well, of course we should. That is
a great commonsense approach.
I will say--and I do not know if your question was leading
to the EU Conference before--but, the U.S. has invested private
sector and public dollars, over $12 billion so far into vaccine
development and therapeutics.
Senator Murphy. I do not deny we are spending a lot of
money on vaccines. My question is not whether we are spending
enough money. It is whether we are better off hedging our bets
and making sure that we are not only doing that domestically,
but we are also joining these international efforts. I hope
that the Administration would be open to bipartisan
congressional legislation pushing us towards joining CEPI. I
think there is bipartisan support here.
Mr. Richardson. Happy to look at that.
Senator Murphy. Mr. Grigsby, I did want to turn back to
this question of the WHO. I mean, I do think it is pretty
stunning to hear from the Administration that the problem,
early on, was that the WHO was giving cover for China to
withhold information about the vaccine. And Senator Menendez
covered this, and so we do not need to belabor the point. But,
it was not that the President was simply saying nice things
about China early on. On 40 different occasions, up to and
including the month of April, the President of the United
States was the primary global cheerleader for the Chinese
response to COVID. He went out of his way, over and over and
over again, to say great things about the Chinese response.
Here he is on February 7th. This is far after we all
recognized that China was withholding information. He gets a
direct question at a gaggle, ``Are you concerned that China is
covering up for the full extent of coronavirus?'' February 7th.
He has an opportunity right here to say, ``Yes, I am concerned
about it. They need to give us information.'' His answer is,
``No. China is working very hard.'' And I have got 20 pages of
this from the President.
And so, it just belies reality to suggest that the problem
was the WHO covering up China's response. The president of the
WHO is not more power than the President of the United States.
And we all need to acknowledge that.
My question to you is this. The idea that we are going to
try to affect WHO reform through the G7 is a new one. Can we at
least just stipulate, for the time being, that it is harder for
the United States to impact reform of the WHO if we are not a
part of it, rather than a part of it? It might just be good for
us to stipulate that. Whether or not you are going to try to
pursue reform through the G7, or not, can we at least stipulate
that it is more difficult for us to get the WHO to reform if we
have withdrawn from it?
Mr. Grigsby. Thank you, Senator.
I think, as Senator Menendez or another Senator had
mentioned, WHO is a member-state institution. Our conversations
with the G7 are important, because it really represents the
most significant and influential donors to the World Health
Organization.
I would say that if WHO and other countries do not want to
see the United States leave WHO, there is no doubt about that--
it is important for WHO to embrace these reforms, and at the
appropriate governing bodies, meaning for member states to take
these reforms up and approve them.
Senator Murphy. There is one country that is desperate for
the United States to leave the WHO, and that is China. They are
going to fill this vacuum. They are going to put in the money
that we have withdrawn. And, even if we try to rejoin in 2021,
it is going to be under fundamentally different terms, because
China will be much more influential because of our even
temporary absence from it. And any other construction of
reality is just putting the United States in a very, very
dangerous position.
Thank you, Mr. Chairman.
Mr. Grigsby. Well, I guess I would say to that, sir, that
the U.S. has been the most generous donor to WHO, really, since
the beginning. It has been remarkable, the increase in China's
influence within WHO, really, over a long period of time. That
has been with the United States in WHO and being the most
generous contributor to WHO. So, the President made a bold
decision. There is no doubt about that. Personally, I hope that
it will get the attention of the leadership of the World Health
Organization, and that the scenario you just described would
not come about. That is at least my hope.
Senator Murphy. I would just, finally, note, we were
continuing to fund the WHO for the last 3 years, but we left
our seat on the board vacant. So, it does not take a lot of
imagination to figure out why China was able to get more
influence if we were sending money but not sending anybody to
sit on the governing board. So, we invited--listen, I am not
defending the fact that WHO has gotten closer to China, but, we
essentially invited the Chinese to step in and fill the shoes
of the United States, given the fact that we were not sitting
on that governing board.
Mr. Grigsby. Senator, I actually have something to do with
that, so I would like to respond to that.
I am actually the alternate board member, and I am sure I
do not do as nearly as good a job as a Senate-confirmed person,
but that seat was not vacant, I assure you. And, in fact,
Ambassador Bremberg or his predecessor, the Ambassador in
Geneva, they are always there to fill that seat. And Dr.
Giroir, who is the Assistant Secretary of Health, he was
actually nominated--I think it was 2017. So, he was nominated a
long time ago, and we sure do wish we could have had him
confirmed sooner, but he was just confirmed a couple of weeks
ago. He was nominated last year, and had to be re-nominated
again this year.
Senator Murphy. All right. Well, I will not get into an
argument over whether it is more effective to have Senate-
confirmed positions, or not. I would, obviously, argue that it
is.
I am well over my time. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Murphy.
Mr. Grigsby, I can tell you that I have got contacts with
the WHO, and your suggestion that our talk of withdrawing and
withdrawing funds might get their attention. I can assure it
has gotten their attention. And it has probably been your
experience, too, but it is clearly my experience. So.
In any event, we want to look forward, as opposed to
backward. And we are going to talk about it in a few minutes.
But, before we do that, Senator Cardin.
Senator Cardin. Well, I hope I am looking forward.
Mr. Chairman, thank you very much for holding this hearing.
Let me thank all of our witnesses for their service to our
country.
On global challenges, U.S. leadership is indispensable if
we are going to have the type of outcome that is in the
interest of the United States, in our security interests. And
this committee knows that best. So, that is why I was very
pleased to see that we are holding this hearing.
It is through U.S. leadership that we have a safer world, a
more democratic world, and a healthier world. So, many of us
are very concerned as to how the United States responded to
this global pandemic. We have seen inconsistent information
coming out from the White House--and that is being kind to the
President--on a lot of the things that he has done in regards
to this pandemic. We have not seen the type of preparation or
response to the pandemic that would be used as a model for the
world to respond. I think Senator Kaine pointed out that pretty
clearly in his questioning.
This is not an isolated example of the Trump administration
in regards to global affairs. I could point to the immigration
policy of this country. And I was very proud that the Supreme
Court ruled the President's actions in trying to end the DACA
program were, in their words, ``arbitrary and capricious.''
But, we also could talk about the President's trade agenda that
initially put us at odds with our trading partners, our
traditional trading partners, rather than trying to isolate
China. Or the United States pulling out of the Paris Climate
Agreement--the only country in the world, basically, to pull
away from that. And now the pandemic.
So, my question starts off with the effectiveness of U.S.
global leadership on this pandemic. When other countries look
at what is being done here in the United States, how much
influence do we really have in the behavior of other countries?
Because they look at what is happening in the United States,
they see the President holding a political rally, bringing lots
of people together, against the advice of the public health
officials. So, how can we complain about what is going on in
other countries--and my question is going to deal specifically
with some of our largest countries in our hemisphere who have,
at least publicly reported that their cases of COVID are very
much underreported, and they have not taken the steps that
public health officials believe are necessary in order to
contain the spread of COVID-19? This is our hemisphere, and we
know this is a global pandemic. How much influence do we really
have? And how much are we concerned with what is happening in
our own hemisphere, with other countries that are
underreporting COVID-19 and have not taken the steps that
public health officials believe are necessary in order to
contain this virus?
Mr. Richardson. Yes, Senator, I can start that. I
appreciate that question.
You know, we are really, truly committed to the western
hemisphere. I think we just announced another $250 million to
be turned on for the Northern Triangle countries. Our
commitment to Colombia is unprecedented. Mexico----
Senator Cardin. I am trying to limit this to COVID-19, if I
can.
Mr. Richardson. Sure. Yes.
Senator Cardin. And you might want to also point out that
Congress appropriated almost $2 billion of aid to deal with
COVID-19. Can you tell me how much of that money has actually
been spent, and where it has been spent?
Mr. Richardson. We can go and look exactly at the
obligations by country----
Senator Cardin. Not obligations. How much has been spent?
Mr. Richardson. That is how much has been spent.
Senator Cardin. Spent.
Mr. Richardson. Yes. So----
Senator Cardin. Can you give me a range of that 2 billion,
how much has been spent?
Mr. Richardson. Yes. So, Congress has appropriated $1.6
billion for State and USAID. So, I can speak to that piece. We
have committed about 1.3 billion. Of that, we have committed
almost 200 million for the western hemisphere----
Senator Cardin. And you say ``committed.'' The money is
actually out, and it is being spent?
Mr. Richardson. We have identified which project----
Senator Cardin. I understand you identified. How much of
that has actually been spent?
Mr. Richardson. So, it gets down to the obligation rates,
which--USAID actually does their own obligations. I will turn
to Chris to answer specifically. But, in general, we have
obligated almost over 500----
Senator Cardin. I am not interested--I want to know how
much has been spent. This is a global emergency.
Mr. Richardson. Right. So----
Senator Cardin. Time is critical. How much has actually
been spent?
Mr. Richardson. So, obligation equals spending. It is when
we actually hand over the money to the implementing partner to
do the work. And so, that is the big picture. And then I can
turn it over to Chris, if he has more details on, specifically
for western hemisphere, what the obligation rate is.
I will say, you know, one thing. So, each individual bureau
and an agency handles their own obligations rate. So, I can
speak for the State Department side. State Department has
obligated every dollar that we have identified that we want to
spend on COVID. So, that is happening. AID has a different
mechanism and different approach to this, and so I can let
Chris, sort of, elaborate. But, I think----
Well, let me just do that. Chris, if you want to have this
conversation.
Mr. Milligan. Thank you, Senator.
The easy answer, from our perspective, is that USAID has
put over a billion dollars into the hands of people overseas to
respond to the COVID-19. That includes the portion of the
supplemental that we are still continuing to put in people's
hands.
Senator Cardin. How much of the supplemental has been
spent?
Mr. Milligan. More than 50 percent, sir. Of the portion
that we control. But----
Senator Cardin. And why has not all of it been allocated?
Mr. Milligan. We have been allocating in tranches, because
the virus moves very quickly, and if we--what we need to do is
see where the virus is going, and then move ahead of it and
prepare, and learn as we go.
Senator Cardin. Do you need more money? Are you going to be
requesting more money?
Mr. Milligan. We are busy obligating the money that we
have, and we are very thankful for the generosity of Congress
in this. We are not through this pandemic, and we are learning
a lot.
One of the things I am most concerned about, sir, are the
secondary and tertiary impacts. We are seeing a big rise in
food insecurity. We are seeing a democratic backsliding. We see
1.1 billion children out of school. We are alarmed about
gender-based violence. So, there is a whole set of secondary
and tertiary impacts that we will have to consider, going
forward, sir.
Senator Cardin. I just would ask that you would keep our
committee informed as the money is actually spent, and the
requests for additional funds, as you see the needs.
Mr. Milligan. Yes.
Mr. Richardson. No, absolutely, Senator.
And just to pick up on what Chris mentioned. We have $35
billion that is being spent every year on foreign assistance--
you know, much of it going to western hemisphere. We want to
make sure that every dollar is spent in a COVID-sensitive way.
Right? How do we make sure that our gender-based violence
programming, our education programming, our health programming
takes into effect of what is happening with the virus, right
there, right then? And so, it is a really important
conversation. So, as Chris mentioned, it is not just the
supplemental. We are really trying to bring to bear all of our
foreign assistance in order to help countries overcome this
virus.
Senator Cardin. Thank you.
The Chairman. Let me follow up on Senator Cardin's
question.
On the 50 percent of the supplemental money that has been
put out, has that been spent on the primary effects of COVID,
or is some of it spent on the secondary and tertiary effects
that you have quite properly and considerately brought up?
Mr. Richardson. Yes, it is a mix. So, Congress has
appropriated a certain amount of money for our Economic Support
Fund, which is looking at that tertiary and secondary impacts.
Primarily, most of our resources are coming in the form of both
global health and humanitarian, which do focus more primarily
on the actual virus and providing critical medical supplies,
training healthcare workers, looking at best practices, those
types of things.
The Chairman. Thank you so much.
Senator Shaheen.
Senator Shaheen. Thank you, Mr. Chairman.
And thank you, to our panelists.
I would like to go back to China. There has been a lot of
discussion about China and their role, in the hearing today. We
have seen a concerted effort from China to counter any negative
narrative that may develop in the international media and
within countries on China's role in the pandemic. And I would
say, given the discussion this morning, they have been pretty
successful. They have demonstrated a clear willingness to use
their resources, including the manufacturing of personal
protective equipment, to realign national sentiments in
countries that may otherwise be inclined to critically examine
China's response to the coronavirus. In fact, the Center for
Strategic and International Studies released a report earlier
this month that surveyed political elites across Southeast Asia
and found that China is gaining ground on political influence
and far outstrips the U.S. on economic influence in that
region.
So, I have two questions for you, really. One is, how does
the lack of U.S. leadership on the pandemic response create a
vacuum that allows China to better develop that narrative,
where they are the provider, helping countries with needed
resources and expertise? And, secondly, how does the pandemic
contribute to this dynamic in Southeast Asia in a way that has
a negative impact on the United States and our role?
Mr. Richardson. Yes, I appreciate----
Senator Shaheen. I am happy to have whoever wants to answer
it.
Mr. Richardson. I can start, and then I can pass it on.
I mean, I just totally agree with your premise of your
question. I mean, the reality is, China has used this pandemic
to advance their strategic interests around the world. As I
mentioned earlier, it does need to be seen in the context of
their larger efforts. I think we have a lot of work to do,
especially on the public diplomacy side, to--one, to counter
misinformation, and our Global Engagement Center does a great
job of doing that, and also providing----
Senator Shaheen. Well, let me--I am sorry to interrupt,
but----
Mr. Richardson. Of course.
Senator Shaheen. --let me just ask you, Why do you think
that is? Why have we been slow? Has it been some of the
statements that were read, from the President, that suggest
that we have been slow to recognize what was happening in
China?
Mr. Richardson. No. Actually, I think what you are seeing
is that the United States has outspent China, time and time
again, both in its everyday foreign assistance--right? China
spends 400 million or so on foreign assistance, and we are at
35 billion. I mean, they are just not a significant player when
it comes to what we would consider to be effective foreign
assistance. They spend all of their resources trying to build
up strategic ports and to engage in bribery and other aspects.
And so, I think it is an asymmetrical challenge, from a
development perspective, and we need to develop asymmetrical
responses, accordingly.
And, you know, Congress was really smart in last year's
appropriations bill. They established what is called the
Countering China Incentive Fund, and we are going to be
spending $300 million through a bottom-up process, trying to
develop best practices across the world to say, How can we
effectively counter China in Djibouti and in Malawi and in El
Salvador? This is not a Southeast Asia problem, as you know.
China's influence has dramatically shifted, and the next
battlefield is Africa and western hemisphere. And we want to
position ourselves in order to be able to be, one, the partner
of choice, always; and two, remind people of the everyday
commitment we have been making to countries over the past 40
years. We have been there. We have stood with countries through
thick and thin. As I said, we have invested $500 billion just
over the past 20 years.
Senator Shaheen. Well, I agree with that. But, a lot of
that 500 billion has not been in humanitarian and economic
development aid, is it? And when you are counting that 500
billion, are you not counting the military aid in that, as
well?
Mr. Richardson. Yes. So, about 25 percent of--the way that
our budgets work, about 25 percent of our foreign assistance is
security assistance. And that is not just military, that is
also law enforcement----
Senator Shaheen. Right.
Mr. Richardson. --and those types of things, 25 percent is
global health, 25 percent is humanitarian, and 25 percent is
everything else.
Senator Shaheen. So, given that, why do you think we have
not been more successful and China has been successful?
Mr. Milligan. I would like to, please. I have been working
in development for 30 years, and most of that time I have been
overseas. And yes, we have seen the quick increase in Chinese
influence. But, we are also seeing that China is not now as
successful, in many ways. There is a lot of buyer's remorse and
more understanding that Chinese investments come with strings
attached. The supplemental that we are implementing has a very
important public diplomacy side that really shows American
leadership. And countries overseas are turning to us and to our
embassies for leadership on this issue.
Senator Shaheen. So, can I--I am sorry to interrupt again,
but I am out of time, and I just want to get an answer to the--
what has the pandemic done to allow China to increase its
influence, as opposed to our reaction globally to the pandemic,
which does not seem to have produced a similar response to
American aid?
Mr. Richardson. Yes. I mean, that is a tough question to--
obviously, to answer. And we would have to go country-by-
country to really determine. Every country is unique in how
they approach it and how they think about Chinese assistance.
Most countries are willing to accept face masks, or whatever,
from China. But, to Chris's point, they often then go around to
us and say, ``Hey, is this financing deal from China any
good?'' That we are the trusted partner in choice, even though
we have seen China really accelerate. But, if you look at their
investments, even in COVID, versus what the U.S. has invested,
it pales in comparison. I think they have just really focused
on getting those headlines.
Senator Shaheen. Well, let me just point out that the State
of New Hampshire was able to get personal protective equipment
from China when we could not get it from the United States or
from FEMA. So, I think we need to examine what is happening
there and what we could be doing better in order to address the
fallout from the pandemic.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Shaheen.
Now, the tough questions. If you guys were sitting here,
each of you, one at a time, what would you do to construct a
system for the future? Would it be to rehabilitate WHO, to
reform WHO, to create a new division of WHO, to restructure its
management? Would it be to create a new international agency?
Would it be to use something else, like CDC, or what have you,
to construct a system as we go forward?
I want to say that Senator Menendez raised a very
legitimate question about parallel spending in another
organization. And I think the last thing anybody here wants to
do is to create more bureaucracy, as opposed to an effective,
nimble response to this in the future.
And so, give me your thoughts. I guess we will go right
down the line.
Mr. Richardson, you are up.
Mr. Richardson. Thank you, Chairman.
You know, whenever you deal with these challenges, I always
want to make sure we are thinking about what problem we are
trying to solve and what results that we are looking for. The
solution, and the specifics about the solution, will naturally
come, and that is through the legislative process. The
Administration has yet to finalize its own proposal in this
space. But, let me say that--a couple of things.
You know, first and foremost, having really clear
leadership and coordination function is essential. And, as I
said, coordination does not mean control, it means empowerment.
We should not be--you know, the State Department should not be
doing global health programming. That would be a terrible
duplication of efforts, and really takes away from what CDC and
USAID does. But, the State Department also has global reach, it
has embassies in nearly every country in the world. And it has
a natural coordination function that is essential.
The other gaps into the system that we have seen in both
the domestic and the international systems is data-tracking, is
built-in accountability. How do we create true accountability
into the international system to hold countries accountable for
not meeting minimum standards? How do we make sure that we are
encouraging countries to use their own resources in a
coordinated and systematic way that allows us to better share
data, to be able to create early-warning systems? And how do we
bring the very best of our private sector and the U.S.
Government to work together? So, those are a couple thoughts.
The Chairman. Those are all good questions, but not much of
an answer. What--who--when the fire alarm goes off, who
responds?
Mr. Richardson. The State Department is the functional lead
for foreign policy for the United States.
The Chairman. How about for the world?
Mr. Richardson. For the world, sorry. The CDC is
responsible for outbreaks or for public health emergencies.
USAID leads on complex crises. So, each one of us has our
natural roles or responsibilities. And so, I would guess I
would encourage as how we can pull all of our expertise
together in order to solve the problem.
The Chairman. So, the criticism has been made both in this
committee here, and for a long time, that the WHO fell down on
the job when it was obvious that there was something
developing. Should they be the ones to undertake this in a
fast-moving pandemic like this, or should there be a different
agency that does that, that shines light on it, that attacks
it--that goes and gets it? Who should do that?
Mr. Richardson. I appreciate that. I do not think that--
look, the WHO has failed the world on multiple occasions. The
last Administration saw the same thing with the Ebola crisis.
We have now seen this with the COVID crisis. You know, when
this problem has been brought to us before--this is not the
first time we have had to think about, can the WHO do HIV/AIDS
response?--for instance. I think the world said, ``No.'' It
does what it does, but it is not going to be nimble, dynamic,
respect burden-sharing, bring in private-sector actors, and be
able to respond appropriately, with the highest-levels
accountability. So, last time, the U.S. led to create the
Global Fund in order to do something on the HIV/AIDS side. And
so, I think that looking at where are the strategic gaps in the
multilateral space, and how the U.S. can lead with our friends
and partners and folks around the world in order to
strategically fill those gaps, that will be an essential part
of that conversation.
The Chairman. So, is the Global Fund a model?
Mr. Richardson. I think the Global Fund is a tremendous
model. I think Gavi is also a tremendous model. I think there
are a lot of things to be learned from lots of different
options out there. I think really the key here is having
worldwide reach, focusing on burden-sharing. You know, right
now, the U.S. spends--40 percent of the world's global public
health work comes from the American people. You know, we do not
want to back away from that, but, as we take on this new
challenge, we really need to surge in both private-sector and
other donors into this space. And both the Global Fund and Gavi
have tremendous models about how to do that well.
The Chairman. Do you agree, Mr. Milligan?
Mr. Milligan. Thank you, Senator.
When I think about the future, I think we need to think
about, how do we respond to the next pandemic, and how do we
prevent, also, as well, an epidemic from becoming a pandemic?
And then, how do we structure ourselves to effectively engage
in that effort?
We know that, in order to respond, we have to maintain a
nimble and effective means to do so. We cannot have an
overarching, top-down, bureaucratic bureaucracy engaging in
that.
The Chairman. We have learned that the hard way.
Mr. Milligan. And we need to empower our people in the
field, at the country-team level, because that is where a lot
of the true coordination and expertise comes due. In order----
The Chairman. Do you agree with Mr. Richardson that good
models for the vehicle are the Global Fund and Gavi?
Mr. Milligan. That depends, sir, because it is a model for
what? I do not mean to be cheeky, but a----
The Chairman. No, no. No, I--fair enough.
Mr. Milligan. Because we are--Preventing is very different
than responding. And those are different skillsets and
different attributes. So, when I consider prevention, we know
that a pandemic is not really a health crisis, it is a
governance crisis. We know, where we have epidemics today, we
have them because of state fragility. Where is Ebola today?
Eastern Congo. Why does polio still exist where it exists
today? It exists in fragile states, like parts of Pakistan and
South Sudan. So, many times, an epidemic is really a governance
crisis masquerading as a health crisis. And we need to make
sure that we have an integrated approach.
Senator Booker talked about the link between wildlife
trafficking and zoonotic crossovers. So, when we look at
preventing, there is a level of coordination that needs to take
place. We cannot have a stove-piped, health-alone approach that
creates another layer of bureaucracy. It has to be something
that brings everything together.
When we look at the response side, we have to maintain our
nimbleness and our ability to actually engage in that
international effort at multiple levels.
The Chairman. And what agency, or what system--what do you
recommend in that regard? Again, this is a global--for that
part--when the fire alarm goes off and the fire department
goes, who is the fire department?
Mr. Milligan. Correct. We do not really have the Global
Fund or Gavi set up to be the fire department. The Global Fund
is responding to slow-moving epidemics, not----
The Chairman. So, is there no model, then, that exists for
the fire department?
Mr. Milligan. The only model we currently have is the one
that we are suggesting needs to be reformed. Currently, when
there is a humanitarian assistance crisis--and I have led many
of our interactions in them--we work through the U.N. cluster
system. The U.N. actually sets and organizes the international
parts together. It works well on a--for a regional stage. But,
now we do not have a model for the pandemic stage. But, we have
principles that we need to incorporate: flexibility,
responsiveness, integrated approach, and one that brings the
U.S. Government core capabilities that we share at this table
into that together.
The Chairman. Mr. Grigsby.
Mr. Grigsby. Yes, sir. Thank you.
I think Jim and Chris have stated it quite well. And I just
want to thank Jim and colleagues at U.S. Agency for
International Development. We have worked very closely with
them in the development of these ideas. We appreciate that.
We do support the coordinator concept being in a non-
implementing agency. I would just point out that most of what
we are talking about is sort of foreign-assistance-related. The
CDC, which would be the agency in HHS that would have the most
to do in this area, it is not a foreign-assistance agency. It
really is a technical-assistance agency. It operates
differently than USAID, and, in fact, in different places. It
does have 50 or 60 offices in developing countries. But, it
actually operates in every country on Earth. So, rich
countries, poor countries. It has all sorts of collaborations.
But, we----
The Chairman. Are you suggesting CDC is the model for the
fire department?
Mr. Grigsby. No, not necessarily. It just depends on what
kind of fire that the trucks are going out to address, I guess.
I mean, CDC is on point when it comes to the pandemics and
disease outbreaks. There is no doubt about that. It oftentimes
works very closely with U.S. Agency for International
Development, particularly in the case--in eastern DRC is a
great example--where there is a disease outbreak, and it is
happening in a part of the world where there is a war going on,
and many other problems, and it is, by definition, a complex
emergency. So, we work hand-in-glove with USAID on that.
So, I do not know that there is a one-size-fits-all sort of
answer. Kind of case-by-case.
The Chairman. Well, thanks.
I was hoping to get a clearer answer to the question of,
``Who is the fire department?'' Because that is what we are
trying to do here. I get all the moving parts. I understand
that. But, it seems to me that if there was a telephone number
that somebody could call and say, ``Come and put out the
fire,'' we want that agency. But, right now, what you are
suggesting is, we give them a list of phone numbers to call.
And I am not sure that that response makes sense.
Mr. Richardson. Well, Senator, if I could just be very
clear. There already is a number that countries call when they
have a problem. It is our Ambassador. And that is really where
our worldwide reach is really essential. And then, our
ambassadors and chiefs of mission around the world, they are
naturally lean on the technical expertise, depending on the
challenge. Right? And I think as we start thinking about what
the next pandemic looks like--is it fast-moving? Is it slow-
moving? Does it hit the developing world? Does it hit the high-
income countries? How does it work? What are the responses that
we need to do? We just do not know. And so, making sure that we
have true coordination that can pull the right levers at the
right time in order to get to results, I think is essential.
But, I certainly would not want to move away from the fact that
we do have a worldwide reach today. People know who to call.
And that is our chief of mission at the State Department. And
we want to just look to strengthen that capacity.
Mr. Milligan. And if I could add briefly to that. I would
say that our ambassadors, they are the mayors, and the fireman
is the Office of Foreign Disaster Assistance, which mobilizes
rapidly through DARTS around the world, but currently
responding to very complex humanitarian assistance all around
the world, and complex emergencies. So, from our U.S. point of
view, we have firemen. But, I think your question, sir, is--
should there be, and will there be, an international
fireperson?
The Chairman. That is what we are looking for.
Senator Kaine, anything for the good of the order?
Senator Kaine. Just to follow up, Mr. Chair, on your
comment, and then one additional question.
I will put myself firmly in the camp on this, in that I
think we ought to stay in the WHO and use our leverage to push
reforms. An enormously frustrating organization, like every
international organization. The U.S. chose not--the Senate
actually chose not to put the U.S. into the League of Nations
when President Wilson urged, after World War I, that we do so.
And the organization was ineffective. It was more ineffective
because the U.S. was not involved. But, it was interesting,
during the 1930s, long before World War II, FDR could see the
League of Nations collapse coming, and basically said, ``It has
been ineffective, but if it collapses, we are going to have
recreate it. The world needs it,'' and started planning for a
U.N. Those plans were delayed by World War II, but eventually
Presidents Roosevelt and then Truman carried forward on it,
recognizing the frustrations. The U.S. pulled out of the U.N.
Human Rights Council, for some very legitimate reasons--a
history of anti-Israel bias, and also a more broad history of
hypocrisy. The member nations, you know, were fulminating about
human rights and doing bad things. But, what has happened as a
result of us pulling out--has it gotten better for Israel? No.
And things that the U.S. advocated on the Council that did
become global priorities--for example, fighting against
discrimination against LGBTQ people, that would not have been
part of the global human rights agenda if it were not for the
United States. Those have gone unaddressed or sort of dormant
with the U.S. not there.
I think these organizations are enormously frustrating, but
I think it always goes worse for the world if the U.S. is not
involved. And I think it generally goes worse for us, as well.
And so, I, like the President--whether it is with NATO or
the WHO, lean on them, demand more accountability, more strings
have to be attached. But, it just goes worse for the world if
we are not there. I am so confident that the U.S. always had
such a value-add to any organization that when we back away
from it, (a) they lose the expertise that we uniquely have, and
then, worse actors elevate their profile in ways that is not
good for us or anyone else.
Here is the question I want to ask you quickly, and it
follows up on a conversation I think you were having with
Senator Cardin. There was a New York Times piece in the last
week about on-the-ground agencies feeling frustrated about the
slow pace of the delivery of the March CARES Act and other
money, this 1.6 billion, out into the field. And you have given
us, basically, ``An awful lot of it has been committed, a big
chunk of it has been obligated.'' And I just want to understand
this, and maybe we will follow up in writing. But,
``obligation'' means you put it in the hands of the
organization--you know, the U.S. is writing a check to an
organization. Is that the same thing as getting to the field?
Might some of the complaints of these ground-level--you know,
Church World Services, Save the Children, World Vision--might
their complaints be, the U.S. has written a check to somebody,
but there is a middleman problem, and it is not getting down to
the ground yet? Because this was a recent piece in the New York
Times, with groups named that were really frustrated. What is
the source of their frustration? How can we solve it?
Mr. Milligan. Senator, I think that their source of their
frustration is that they want to act as quickly as we want them
to act, as well. Without getting very bureaucratic, our
different accounts have different abilities to spend money.
Here are these concerns from these NGOs, our important
partners. With the humanitarian assistance funding that we
have, as soon as it is available, they can begin spending it.
We contract directly with them. We do not go through middlemen.
Senator Kaine. Okay.
Mr. Milligan. As soon as it is available--this is a unique
ability we have with these funds. And so, of the $535 million
in humanitarian assistance funding, they can currently spend
267 million, and, by July 17th, they can spend all of it. So,
that is in addition to the--that is part of the overall funding
that we have made available, which is a billion dollars that we
have made available, which it is in their hands to do work now.
We are looking at ways of actually streamlining the process. We
are committed to fully obligate all this humanitarian
assistance by the end of July.
I have to tell you, these are extraordinary times. Previous
to the global pandemic, we were running very large-scale
humanitarian assistance efforts in very difficult places, like
Yemen, Iraq, South Sudan, and Syria. And the global pandemic
has also affected our own workforce, as well. But, we are
adapting, and we are streamlining, and we are meeting the
challenge.
Senator Kaine. Thank you. Appreciate that.
Thanks, Mr. Chair.
The Chairman. Thank you, Senator Kaine.
To our witnesses, thank you so much. You have been very
patient with us. And this is a part of the puzzle that we are
trying to solve, here. We appreciate your thoughts on it. We
hope to hold a number of these hearings to try to get as much
input as we can and then, as a committee, sit down and try to
construct a bill that is going to move us forward and that,
when this happens again--and I think we are all under the
belief that it is going to happen again, hopefully later rather
than soon--that we will be more ready for it. And hopefully we
will have some legislation that will address that.
So, with that, thank you again for your service, and thank
you for attending this hearing.
The committee is adjourned.
[Whereupon, at 11:41 a.m., the hearing was adjourned.]
----------
Additional Material Submitted for the Record
Responses of James L. Richardson to Questions
Submitted by Senator Robert Menendez
Question. The Administration provided a shipment of ventilators to
Russia under emergency authority. Does the Administration remain
committed to sanctions imposed on Russia in response to its election
interference and illegal occupation of Crimea and aggression in Donbas?
Would the State Department be willing to put out a statement towards
that end?
Answer. Our actions have sent a clear message to those who take
part in malign Russian activity: they are on notice. If they continue
to pursue election interference efforts, aggression in Eastern Ukraine
and Crimea, human rights abuses or other threatening activity, they
will suffer consequences. More broadly, the U.S. government has
sanctioned more than 350 individuals and entities for their involvement
in Russia's malign activities since January 2017.
Most recently, the United States Delegation to the Organization for
Cooperation and Security in Europe (OSCE) reiterated on July 2 that the
United States does not, nor will ever recognize Russia's purported
annexation of Crimea and that sanctions will remain in place against
Russia until it fully implements its Minsk commitments and returns full
control of the Crimean peninsula to Ukraine. We will continue to impose
costs until Russia changes course, and sanctions will remain a key part
of that.
Question. A study published in 2016 by Yale University researchers
found that there may have been as many deaths from HIV AIDS, TB and
Malaria during the 2014/2015 Ebola outbreak in Guinea, Liberia and
Sierra Leone as there were from Ebola because the health systems in
those countries were overwhelmed, limiting access to health services.
Recent reports indicate that as the COVID-19 pandemic continues, there
has been a rise in the number of illnesses from preventable illnesses
including polio, cholera and diphtheria. Have we provided funding for
the Global Fund's COVID-19 mechanism?
Answer. One third of the total resources at the Global Fund were
provided by the United States government, as part of our regular
contribution. We have not provided additional resources for the Global
Fund's COVID-19 Response Mechanism (C19RM) beyond our regularly planned
Global Fund amounts. The Global Fund Board, including the United
States, approved up to USD $1 billion originally intended for HIV,
Malaria and TB programs for needed adaptations due to COVID-19
disruptions and for mitigating the COVID-19 pandemic through C19RM. The
mechanism currently has been approved to be funded for up to USD $500
million at this time.
Question. WHO plays a leading role in the provision of vaccines. It
is one of the main partners of Gavi, the Vaccine Alliance, which is the
critical funding agency supporting vaccine programs in the world's
poorest countries where the majority of the world's unimmunized
children live: How is our pulling out of WHO going to affect
vaccinations, and what impact will disruption of vaccine campaigns have
on under five mortality?
Answer. The withdrawal of the United States from the World Health
Organization (WHO) will not have a deleterious impact on the ability of
Gavi, the Vaccine Alliance, to reach children in lower-income countries
with life-saving vaccines. While the U.S. Government (USG) is the
third-largest donor to Gavi, historically none of the USG's funding to
Gavi has gone to the WHO. Under the terms of the funding agreement
between the U.S. Agency for International Development (USAID) and Gavi,
Gavi primarily uses the USG's funding for the procurement and delivery
of vaccines. I refer you to USAID for further details on its financial
and technical support to Gavi and immunization programs globally.
Question. Do the Department and USAID have the resources to help
countries bring the pandemic under control? What does Congress need to
provide in the next supplemental appropriations bill?
Answer. The pandemic of COVID-19 continues to have an extraordinary
impact on the people, countries, and partners that benefit from U.S.
foreign assistance. We are grateful to Congress for the emergency
supplemental funding already appropriated to the U.S. Department of
State and the U.S. Agency for International Development (USAID). The
Department of State and USAID are investing these funds to respond to
COVID-19 effectively. We look forward to working with Congress to
address the significant needs we continue to have to respond to COVID-
19, including the secondary and tertiary impacts of the pandemic.
Question. I would like to better understand whether and how the
Department and USAID's many understandable COVID-related reprogramming
requests are interacting with overall expenditures and obligations,
including the possibility of the unintended creation of significant
unobligated balances. Congress needs to know if and how certain
decisions made by the Administration--such as its decision to withhold
funds to the World Health Organization--may be affecting departmental
budgeting and financial management for the remainder of the fiscal
year. I am also concerned that unforeseen complications related to the
pandemic may create situations in which funds expire at the end of the
fiscal year before they can be obligated, especially FY19 funds, unless
the Department and USAID take action to prevent this from happening.
What is the status of obligations for FY 19 funds?
Answer. The U.S. Department of State and the U.S. Agency for
International Development (USAID) recognize that the pandemic of COVID-
19 currently is affecting, or could affect, the ability to obligate and
expend funds appropriated by Congress for Fiscal Year 2019. Following
normal practice, State and USAID are working with U.S. Embassies and
Missions throughout the world, and Bureaus domestically, to take the
steps necessary to obligate all unobligated expiring resources
prudently prior to the end of the Fiscal Year. Consistent with
statutory provisions, State and USAID are continuing to transmit all
required Congressional Notifications for expiring funds, and are
committed to working to resolve any questions and concerns that the
relevant congressional Committees of jurisdiction raise.
State and USAID both expect to obligate all expiring funds by the
end of the Fiscal Year, and we are monitoring obligations closely.
Question. I would like to better understand whether and how the
Department and USAID's many understandable COVID-related reprogramming
requests are interacting with overall expenditures and obligations,
including the possibility of the unintended creation of significant
unobligated balances. Congress needs to know if and how certain
decisions made by the Administration--such as its decision to withhold
funds to the World Health Organization--may be affecting departmental
budgeting and financial management for the remainder of the fiscal
year. I also concerned that unforeseen complications related to the
pandemic may create situations in which funds expire at the end of the
fiscal year before they can be obligated, especially FY19 funds, unless
the Department and USAID take action to prevent this from happening:
Can the State Department assure me that the Administration will not
seek to pursue a rescission, either by intent or by mismanagement, as
we approach the end of this fiscal year?
Answer. State and USAID plan to prudently obligate expiring funds
for programs that advance U.S. foreign policy objectives. Consistent
with normal practice, State and USAID are working with posts throughout
the world and bureaus domestically to take the steps necessary to
prudently obligate all unobligated expiring resources prior to the end
of the fiscal year.
We remain concerned about being able to obligate expiring
International Military Education and Training (IMET) account funds by
the end of the fiscal year as those funds support in-person training
sessions that likely will not be able to occur due to the threat of
COVID-19. The Department is seeking Congress's support to extend the
availability for expiring IMET funding to ensure they do not expire at
the end of the fiscal year.
Consistent with required congressional notification processes,
State and USAID are continuing to transmit all required congressional
notifications for expiring funds and are committed to working to
resolve questions and concerns raised by the relevant congressional
committees.
Question. On April 7, the President declared he would like to put a
``powerful hold'' on WHO funding and on May 29, the President said the
Administration plans to ``terminate'' the relationship. On April 8,
Sec. Pompeo stated that the World Health Organization has ``to get the
data, they have to share that data with the world's best scientists--
many of which are often located right here in the United States--and
allow that information to be transferred freely so that we can have a
transparent response that will save lives.'' This is an essential
aspect of WHO's work, which has received praise from health experts
here and abroad but would be significantly harmed if the U.S. withheld
funding: In light of this statement, can you explain the guidance you
gave to Sec. Pompeo? Can you detail the implications beyond the COVID-
19 response this hold would have?
Answer. The WHO failed to uphold its responsibilities and grossly
mismanaged the COVID-19 pandemic response. Even after the President's
many public statements and his May 18, 2020 letter, the WHO has done
little to respond to the Administration's serious concerns and repeated
calls for progress and reform. I shared those views and my concerns
about WHO with the Secretary.
The United States accounts for more than 40 percent of total global
health funding, and we have given more than $142 billion since 2001.
Only about 4 percent of our annual global health budget is spent
through the WHO. Our work in global health does not stop because we
have halted funding to the WHO, and we are confident that we will be
able to find qualified implementers for any voluntary assistance that
was planned for WHO programs. Beyond the WHO, we have an extensive
cadre of faith-based organizations, NGOs, contractors, and multilateral
organizations that have the ability to implement health programs--for
COVID-19 response and beyond. The State Department is committed to
ensuring that we find trustworthy, accountable, results-oriented
implementing partners on behalf of the American people, whose taxpayer
dollars fund our foreign assistance programs.
Question. In an April 8 press conference, Sec. Pompeo stated the
need for the World Health Organization to complete ``the work they were
designed to do.'' And yet the Administration has consistently delayed
tens of millions in funding each year that Congress has appropriated to
WHO so it could complete its work. To take one example of many, in
Yemen, these delays coupled with a funding cut-off will mean that over
2 million people assisted by WHO, that no one else is able to do, will
no longer receive essential care support. This represents 25% of the
total population in need to whom WHO has delivered lifesaving services
in the last 2 years:
Answer. Since the 1980s, the U.S. Government has paid annual
assessed contributions to the World Health Organization (WHO) and many
other U.N. specialized and technical agencies for a given calendar year
with funds appropriated to the Contributions to International
Organizations (CIO) account in the subsequent U.S. government fiscal
year. WHO and other U.N. agencies have long since adapted management of
their finances to accommodate this delay. Assessed funding goes
primarily to headquarters operations, not programs and activities in
specific countries such as Yemen. I would refer you to our Bureau of
International Organization Affairs for more information on how funding
for assessed contributions is managed. Congress has not appropriated
any foreign assistance funds specifically for WHO.
The population of the Republic of Yemen is extremely vulnerable to
health threats after years of conflict. As COVID-19 spreads rapidly and
overwhelms the country's collapsing health institutions, we are using
all of the tools and resources we have available to help. We have made
available supplemental funding and resources from the International
Disaster Assistance account from FY 2020 to support the response to
COVID-19 in Yemen. In addition, the U.S. Agency for International
Development (USAID) is financing robust, ongoing programming in health
and nutrition in the country, including through other United Nations
agencies that can adapt as necessary to the pandemic.
The United States remains one of the largest donors of humanitarian
assistance in the Republic of Yemen. For years, the United States has
funded emergency health programs in Yemen, as well as made investments
in water, sanitation, and hygiene that have lasting impacts and help
keep people healthy, stave off disease, and build capacity in health
care. In FY 2019, USAID provided more than $26 million in emergency
health funding, along with nearly $14 million for water, sanitation,
and hygiene in communities affected by Yemen's conflict. These efforts,
which include training health care workers, supporting medical
facilities, and teaching safe hygiene practices, continue to help
communities in Yemen to prepare for disease outbreaks and other health
threats.
Question. Diseases do not recognize borders, so challenges like the
COVID-19 pandemic necessitate a global, collective response. The WHO--
through its high level of technical expertise and international
legitimacy--is uniquely positioned to lead the international response
to public health emergencies like the COVID-19 pandemic. From the
outset of the crisis, WHO has been a critical provider of supplies and
tests, distributing 1.5 million diagnostic kits and millions of items
of PPE to dozens of countries; designed, refined, and distributed
technical guidance for communities, hospitals, frontline clinicians,
private sector partners, and public health authorities around the
world; carried out public awareness campaigns in dozens of languages in
149 countries; and, through its ``Solidarity Trial,'' has been working
to enable rapid and accurate research on the effectiveness of potential
therapeutics. People around the world--including Americans--stand to
benefit from these types of activities:
What effect will ``terminating'' our relationship with the World
Health Organization have on these efforts? How can we hope to protect
Americans from pandemic disease and other health challenges without a
multilateral coordinating authority like the WHO?
Answer. As U.S. leadership demonstrated in the Ebola and MERS
outbreaks, our diplomatic, health security capacity building, and
development efforts enable countries to develop tools for addressing
infectious disease. Through these efforts, we filled gaps created by
the WHO's inaction to prevent, detect, and respond to outbreaks
immediately. The Administration is examining ways to leverage the
expertise of key U.S. Government departments and agencies and the
American private sector to rapidly deploy and deliver this essential
support to other countries to prevent, detect, and respond to
infectious disease outbreaks at their source. During the President's
May 29, 2020 announcement that the United States will be terminating
its relationship with the WHO, President Trump announced that the
United States will be redirecting funding planned for the WHO to other
global health organizations and urgent needs around the world.
While the United States was by far the leading donor to the WHO,
that funding represented a small fraction--just 4 percent--of our total
funding to global health assistance every year. This year, it will
represent just 2 percent of the health assistance the United States
provides worldwide. The United States leads the world in health and
humanitarian aid in an ``All of America'' effort and is committed to
ensuring our generosity directly reaches people around the world. We
account for more than 40 percent of total global health funding. Since
2001, we have given more than $142 billion. Every day, U.S. global
health funding prevents, detects, and treats HIV/AIDS, malaria,
tuberculosis, Ebola, and other diseases. We give an average of $10
billion per year--and this year, it will be double that as we surge to
fight the virus around the world. The United States has allocated more
than $12 billion that will benefit the global COVID-19 pandemic
response; more than $2 billion of this has already been committed.
Question. WHO has been on the frontlines of nearly every global
health challenge over the last 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases, viruses, and
infections. While the world is rightly focused on defeating COVID-19,
other health challenges confronting the world have not disappeared, and
it is not in our interest to neglect them. These include WHO-led
efforts to control and eliminate malaria, implement global disease
surveillance for the polio virus in areas where U.S. government
agencies do not have the capacity to reach, support measles
immunization campaigns, and strengthen the health sector's response to
HIV/AIDS and Tuberculosis. The loss of more than $400 million in annual
U.S. funding threatens to upend these critical activities: What does
our withdrawal from these multilateral initiatives say to our allies
and partners around the world? Given how far-reaching and complex these
challenges are, how can bilateral efforts even hope to begin to make a
dent?
Answer. The President's decision to terminate our relationship with
the WHO in no way diminishes U.S. leadership on global health and
combatting the COVID-19 pandemic. While the United States was by far
the leading contributor to the WHO, those contributions represented a
small fraction of our total funding to global health assistance every
year. This year, it will represent just 2 percent of the global health
assistance the United States provides. We account for more than 40
percent of total global health funding. The United States has allocated
more than $12 billion that will benefit the global COVID-19 pandemic
response; more than $2 billion of this has already been committed. To
fill in gaps in the WHO's handling of the HIV/AIDS pandemic, the United
States set up a far more effective framework for HIV/AIDS called
``PEPFAR''--the program started by President George W. Bush two decades
ago that has saved literally millions of lives across the African
continent and beyond.
Question. With regards to U.S. arrears in our payments to WHO, in a
June report to Congress, the State Department noted a number of
possible impacts, including: ``1. Loss of vote or inability to be a
member of governing bodies; 2. Diminished U.S. standing and diminished
ability to pursue U.S. priorities; 3. Reduced U.S. ability to promote
increased oversight and accountability through reforms that promote
efficiency, cost savings, and improved management practices; 4. Reduced
standing needed to successfully promote qualified U.S. citizens to
assume senior management roles; and 5. Impairments of peacekeeping
missions to operate, including addressing objectives that may directly
impact the national security of the United States:'' Given your
experience working with international organizations like the WHO, do
you stand by these conclusions from your own Department?
Answer. The Administration is examining ways to leverage the
expertise of key U.S. Government departments and agencies and the
American private sector to rapidly deliver essential support to other
countries to prevent, detect, and respond to infectious disease
outbreaks at their source. As the World Health Organization's (WHO)
failed response to COVID-19 has clearly demonstrated, we lack the
international structures to prevent, detect, and respond to infectious
disease outbreaks. Without U.S. global leadership on pandemic
preparedness, prevention, and response, future pandemics will continue
to severely impact public health and the world economy. As U.S.
leadership demonstrated in the Ebola and MERS outbreaks, our efforts
enable countries to develop tools for addressing infectious disease.
Due to these efforts, we filled gaps created by the WHO's inaction to
prevent, detect, and respond to outbreaks immediately.
Question. The U.S. has so far provided only $5M to the West Bank
and no money at all for some of the most COVID-19 vulnerable people
living in Gaza. When will the Trump administration release the full
amount of funding appropriated by Congress for Palestinians, including
$75 M in aid?
Answer. The $5 million is in support of immediate, life-saving
needs for Palestinian hospitals and households in the West Bank. We are
closely monitoring the global response to the U.N.-led Interagency
Response Plan, which, along with Israel, is providing vital support to
Gaza. We continue to engage with partners on the outstanding needs and
ways in which the United States and global community can support.
This decision does not prejudge future decisions about U.S.
assistance in the West Bank and Gaza. We will continue to assess how
U.S. assistance can best be used to advance U.S. foreign policy and
provide value to U.S. taxpayers, consistent with applicable legal
requirements.
Question. How is the State Department prioritizing the needs of
children and youth (access to education, nutrition, continued basic
healthcare) during the pandemic?
Answer. The pandemic of COVID-19 has created serious risks to the
safety and well-being of children and young people on an unprecedented
scale, including secondary health impacts such as worsening nutritional
status; reduced vaccination rates; loss of education; and increased
risks of violence, child marriage, inadequate care, income-insecurity,
and psychosocial distress and trauma.
To mitigate these impacts, the U.S. Government is prioritizing the
well-being of children and youth throughout our response to COVID-19,
which includes working with Ministries of Health and other key
Ministries to provide basic social services to marginalized groups. For
example, in the Republic of Ghana, the U.S. Agency for International
Development (USAID) is working with the Ministry of Gender, Children,
and Social Protection and the Ghana Health Service to develop targeted
child-protection messages and provide referral information within
health facilities for responding to violence against children. Making
this information available during routine visits provides an
opportunity for women and children to talk with trained staff privately
in a safe space in COVID-19 hotspot areas, as well as in underserved
and rural areas.
Globally, the U.S. Department of State has provided $12.46 million
to reduce the transmission of COVID-19 in affected countries and
mitigate the impact of the pandemic on children, youth, and their care-
providers in refugee and migrant settings. This assistance will
strengthen risk-communications and community engagement; provide
critical medical, water, sanitation, and hygiene supplies to prevent
and control infections; support continued access to essential health
care for women, children, and young people; support access to
continuous education, social protection, and resources on gender-based
violence disrupted by the pandemic; and assist with the collection and
analysis of data on the secondary impacts of the pandemic on children
and women.
USAID's Bureau for Global Health is prioritizing the continuity of
essential maternal, newborn, and child health care in the pandemic
context, including by supporting routine immunization and restarting
measles vaccination campaigns; protecting providers to ensure ongoing
health care for children in facilities and the community; increasing
support to improve children's nutrition through community outreach; and
promoting social and behavior-change communications.
Additionally, school closures have affected the education sector
profoundly, which has left nearly 1.2 billion children and young people
out of school as of July 7, 2020.\1\ In response, the United States is
demonstrating global leadership by mobilizing its existing human and
financial resources to mitigate and address the negative education
impacts of COVID-19, from pre-primary through higher education. The
U.S. Government's work in this regard will help governments, faith-
based organizations, public and private educators, learners, parents,
and communities in our partner countries stay safe and continue to
learn during the COVID-19 pandemic and after the crisis subsides.
Question. In what ways are you seeking to expand distance learning
services to populations in need of assistance?
Answer. The scope of the impact of the pandemic of COVID-19 on
education requires rapid mobilization and a strategy to respond to the
shifting needs. In response, the U.S. Government (USG) through the U.S.
Agency for International Development (USAID) is leveraging existing
resources and programs in 20 different countries, to help pivot our
programming during school closures to meet the educational needs of
children and youth. This includes supporting Ministries of Education to
broadcast educational programs over radio and television, adapting
teacher-led curricula to family- or self-led instruction, and
encouraging safe and healthy routines that promote the social and
emotional well-being of learners. For example, in the Democratic
Republic of Congo, USAID has used COVID-19 supplemental funding to
expand distance and alternative education for Congolese children and
young people so they can continue to learn and maintain protective
routines and social connections while schools remain closed across the
country.
The U.S. Government Action Plan to Support the International
Response to COVID-19 addresses the evolving needs of education in the
countries where we provide support and prioritizes that ``all children
and youth access high-quality distance education.'' To do so we have
curated distance-learning materials, which includes the development of
an easy-to-use, centralized resource library for interactive radio and
audio instruction. The library now contains materials for 12 countries,
including in local languages. As we add more, the Inter-Agency Network
for Education in Emergencies (INEE) will formally launch a Global
Distance Learning Hub for our implementing partners. We have also
published a Literature Review on Delivering Distance Learning in
Emergencies, which presents the basic modalities for delivering
learning through radio, television, cell phone, and online methods. It
presents lessons-learned and recommendations for using these tools to
ensure equitable and inclusive continuity of learning through distance
formats even during crisis situations. To increase access to books and
other reading materials, we created the Global Book Alliance, a cross
platform search engine, called FreeLearning, to allow users to find
high-quality books and other reading materials. The platform launched
in June 2020 with more than 300 titles in 100 different languages.
Question. In April of 2018, U.S. Global AIDS Coordinator Ambassador
Deborah Birx announced that PEPFAR would transition 70% of prime awards
to local partners by the end of FY2020. Notably, the definition of
``local partner'' used by PEPFAR does not include locally registered
offices of international non-governmental organizations (INGOs), even
if the local INGO offices are predominantly governed and staffed by
local citizens of that country. The end of FY2020 is just weeks away,
which means that USAID is actively moving funding away from effective,
high-performing international partners in country at a time when we
need established partners--local and international--to quickly adapt
and implement COVID-19 activities in HIV settings (which are often some
of the strongest health care facilities in these countries). In
particular, INGOs can coordinate approaches and share practices across
countries, while also working closely with local partners to ensure
that interventions tailored for specific communities and country
contexts: Does the ``all hands on deck'' effort needed to address the
COVID pandemic necessitate a re-evaluation of the pace and purpose of
PEPFAR's rapid push towards localization? How are you utilizing INGOS
and their decades of experience in HIV to help the U.S. global response
to COVID?
Answer. To sustain epidemic control of HIV, it is critical that the
full range of HIV prevention and treatment services are owned and
operated by local institutions, governments, and community-based and
community-led organizations. The intent of the transitioning to local
partners is to increase the delivery of direct HIV services, along with
non-direct services provided at the site, and establish sufficient
capacity, capability, and durability of these local partners to ensure
successful, long-term, local partner engagement and impact. In line
with USAID's ``Journey to Self-Reliance,'' PEPFAR has set a bold goal
of 70 percent of agency funds directly to local prime partners by the
end of FY 2020 and agencies are well on their way--at the start of FY
2020 CDC had 63 percent of their funding portfolio awarded to local
partners and USAID had 45 percent respectively. On this goal of
localization, PEPFAR has always been somewhat flexible in agencies
achieving this goal, and is especially so in the context of dual
pandemics. However, PEPFAR is not re-evaluating this goal toward
localization. The COVID-19 response has underscored even more how
important local partners are on the ground in providing and continuing
services to clients. International NGOs also continue to be important
in the HIV and COVID responses.
Question. The largest refugee camp in the world is hosting over a
million Rohingya people in Bangladesh right now, where families live in
cramped and squalid conditions, which makes social distancing during
the COVID pandemic impossible. COVID-19 cases have already been
confirmed in the camps despite limited testing. Problematically, the
government of Bangladesh has also imposed telecommunications and mobile
data ban in the camps since September 2019. The ban has hindered
humanitarian response efforts and prevented the Rohingya from being
able to more freely access information and communicate effectively with
their family and friends, all of which are critical in a pandemic. The
ban is a concern not only for the Rohingya, but it also negatively
impacts and increases risks in the neighboring Bangladeshi communities:
How is the State Department prioritizing its response to the dire needs
of the Rohingya refugees in Bangladesh and working to reduce
impediments to the response, including by ensuring that internet and
telecommunications services are restored immediately?
Answer. The Department has placed a high priority on responding to
Rohingya refugees in Bangladesh. In the context of the COVID-19
pandemic, the United States has provided nearly $44 million in
assistance for Bangladesh to include more than $21 million for health
and IDA humanitarian assistance to support case-management,
surveillance activities, the prevention and control of infections in
health facilities, risk communications, water, sanitation, hygiene, and
emergency food assistance, and more than $22 million in MRA
humanitarian assistance to support vulnerable people during the
pandemic, including refugees and host communities. This is in addition
to the nearly $926 million that the United States has contributed to
relief efforts in the Rohingya/Rakhine State crisis since August 2017,
of which more than $776 million has been used in Bangladesh.
The importance of telecommunications to all residents and service
providers in Cox's Bazar District has become more immediate due to the
COVID-19 pandemic. While the Government of Bangladesh has restored 3G
cellular service in the Cox's Bazar area, we share your concern that 4G
service is not yet reliable. We continue to press the government to
improve 4G. We also support the U.N.'s ongoing advocacy with the
Government of Bangladesh to provide Rohingya refugees a means for
legally purchasing SIM cards.
Question. Conditions set up by the Government of Burma in IDP camps
and camp-like settings are prime for rapid and uncontrolled spread of
COVID-19 among vulnerable populations. These conditions include
significant overcrowding, limited access to health care, severe
movement restrictions, internet bans reducing dissemination of real
time information about the virus, and the potential of camp lockdowns
reducing the ability of humanitarians to provide essential services:
What steps is the State Department taking to encourage rolling back
these restrictions so Rohingya populations and other communities living
throughout Rakhine State are adequately protected from COVID-19?
Answer. The United States continues to push for the removal of
restrictions on humanitarian access and freedom of movement in Rakhine
and Chin States, as well as other regions affected by violence. We also
continue to push for the removal of restrictions on mobile data
services, which have curtailed communication and access to information,
including about COVID-19, for as many as 1 million people. These
restrictions cut communities off from life-saving humanitarian
assistance and information. Humanitarian access, freedom of movement,
and access to the Internet and media are fundamental for improving the
lives of people in Rakhine and Chin States, particularly in the face of
the pandemic.
The United States is also working closely with the Burmese
government, health professionals, and civil society actors to contain
the spread of COVID-19 in Burma. We have provided $16.5 million in
health and humanitarian assistance for a range of activities, including
the prevention and control of infections in health facilities, improved
case management, support for laboratories, risk-communications and
community engagement, and water and sanitation supplies for internally
displaced persons and other vulnerable communities.
Question. Additionally, what is the State Department doing to
ensure that COVID-19 is not used as a justification to further restrict
freedom of movement throughout Burma for all ethnic and religious
minorities, and that these marginalized minorities enjoy equitable
access to testing, health care, and that humanitarian aid is maintained
throughout this crisis?
Answer. The State Department is coordinating efforts to deter human
rights abuses in Burma under the pretext of responding to COVID-19. The
Department also is working to ensure all citizens of Burma have access
to COVID-19-related information. In response to Burma's ongoing
Internet shutdown in Rakhine and Chin States, the United States issued
a joint statement with 13 diplomatic missions in Burma and used its
social media presence to call for the Government of Burma to end the
shutdown. Ending the shutdown will give residents of Rakhine and Chin
States easier and more reliable access to information about COVID-19.
The United States continues to work closely with the Burmese
government, health professionals, and civil society actors to contain
the spread of COVID-19 in Burma. We have provided $16.5 million in
health and humanitarian assistance for a range of activities, including
the prevention and control of infections in health facilities, improved
case management, and support for laboratories for internally displaced
persons and other vulnerable ethnic and religious minority communities.
----------------
Notes
\1\ United Nations Educational, Scientific, and Cultural
Organization. COVID-19 Impact on Education. Accessed July 7, 2020.
______
Responses of Chris Milligan to Questions
Submitted by Senator Robert Menendez
Question. In 2017, within 5 months of receiving nearly $1 billion
in emergency appropriations for International Disaster Assistance, the
Trump administration had effectively obligated the bulk of that
funding, and leveraged an additional $1.5 billion from humanitarian
funding accounts to respond to four famines, each of which occurred in
differing, complex, and non-permissive environments. As of late May,
little of $550 million in emergency appropriations from the same
account had been obligated to respond to humanitarian needs related to
COVID-19. These delays undoubtedly have cost lives in countries
severely impacted by the pandemic. What constraints have led to the
extended time to obligate funding in comparison to past crises?
Answer. We are in unprecedented times right now, with a rapidly
evolving situation on the ground in almost every country. We are
working aggressively to obligate all of our resources for COVID-19 as
swiftly and effectively as possible. At the same time, we want to
ensure we are accountable for the effective use of funds for COVID-19
and are good stewards of U.S. taxpayer dollars. USAID is resolving all
the issues and the IDA funds are on track for being obligated by July
30th, 2020.
Question. How has the process within USAID to obligate supplemental
International Disaster Assistance funding changed between this crisis
and the 2017 famines?
Answer. USAID is working to ensure that IDA funds are available to
our partners on the ground as quickly as possible. For example, the
USAID Bureau for Humanitarian Assistance (USAID/BHA) has expedited its
proven systems and procedures to program humanitarian resources to
frontline partners, with supplemental funding being obligated on
average within 37 days from proposal receipt, approximately 40 percent
faster than non-expedited obligation timelines.
Question. When do you anticipate spending down supplemental funds
that Congress has already appropriated for the crisis?
Answer. We intend to obligate the entirety of the $558 million in
COVID-IDA supplemental funds appropriated by Congress by July 31, 2020.
Question. I have seen actions that actively undercuts international
efforts to respond. Mr. Barsa, the Acting Administrator of USAID sent a
letter to U.N. Secretary General Antonio Guterres that offers nothing
by way of support to combat the most deadly pandemic of the last
century, but does internationalize the Administration's ideologically
driven attack on women's reproductive rights. What is USAID doing to
contribute to and support the U.N.'s Global Humanitarian Response Plan?
Answer. The United States is a top donor to the COVID-19 pandemic
response, and has made available $558 million in COVID-19 International
Disaster Assistance (IDA) supplemental funding directed to support
humanitarian interventions. Much of this funding supports the U.N.'s
Global Humanitarian Response Plan (GHRP) that addresses food, health,
protection, and other critical humanitarian needs and has been provided
to U.N. agencies such as the World Food Program and UNICEF.
While some USAID funding goes toward projects not listed in the
appeal, we work closely with in-country teams and partners to ensure
that programming reaches the most vulnerable populations and addresses
critical humanitarian gaps. USAID is also working with partners to
adapt existing programs, as necessary, to address needs that have
arisen due to the COVID-19 pandemic.
USAID coordinates closely with the U.N. Office for the Coordination
of Humanitarian Affairs (OCHA) to advance improvements in the GHRP,
such as prioritizing response activities to address acute needs and
better promoting linkages between humanitarian and development efforts.
Question. In March, Congress appropriated $558 million to the
International Disaster Assistance (IDA) account to address COVID-19
overseas, which is managed by USAID, and $350M to the Migration and
Refugee Assistance account (MRA), overseen by State's Bureau of
Population, Refugees, and Migration (PRM). I understand that a large
portion of these funds have yet to be obligated and expended due to
unusual bureaucratic delays from senior levels. These funds, generally
speaking, are the most nimble at our disposal. By comparison, during
the Ebola response in 2014-15, it typically took between 30-45 days for
humanitarian money to reach partner agencies. How many IDA and MRA
dollars have you obligated to date from the additional appropriations
we provided in March?
Answer. As of June 18th, USAID had obligated $201 million in
International Disaster Assistance to respond to the pandemic. USAID
planned and obligated all $558 million of IDA funding by July 30th,
2020. Regarding MRA funds, I would defer to the Department of State
Bureau for Populations, Refugees, and Migration for the most recent
update on the status of obligations of those funds, as they are
responsible for programming that account.
Question. Why is it taking longer than usual for life-saving
humanitarian funds to reach the ground and prevent the spread of COVID-
19?
Answer. USAID's ability to obligate COVID-19 supplemental funding
effectively and quickly remains our highest priority. Providing our
implementing partners with the necessary resources to support critical
emergency health, WASH, protection, and food assistance programs on the
frontline of the pandemics is at the core of our response strategy.
Several unexpected challenges impacted the ability to obligate funding
quickly.
These challenges included the need to accurately address the policy
on Personal Protective Equipment (PPE) as well as the relationship with
the World Health Organization (WHO). In both cases, USAID worked to
adapt operational responses and collaborate with partners to support
these policies.
In coordination with the Department of State, USAID issued
additional PPE guidance on June 9 that allows USAID implementing
partners to procure PPE for their staff, and to continue critical
programs as long as the PPE is produced locally or regionally and not
intended for the U.S. market.
I assure you that we are working as hard as possible to ensure that
IDA funds are available to our partners on the ground as quickly as
possible.
For example, the USAID Bureau for Humanitarian Assistance (USAID/
BHA) has expedited its proven systems and procedures to program
humanitarian resources to frontline partners, with supplemental funding
being obligated on average within 37 days from proposal receipt,
approximately 40 percent faster than non-expedited obligation
timelines.
Question. What is the USG doing to ensure the money moves in an
expeditious and transparent manner moving forward?
Answer. We understand the concerns about delays in funding, and we
are working to make resources available as quickly as possible. I
assure you that we are working aggressively to obligate COVID-IDA as
swiftly and effectively as we can. At the same time, we want to ensure
we are accountable for the effective use of COVID-19 funds as stewards
of U.S. taxpayer dollars.
To accelerate the pace of processing awards and our obligations,
USAID/BHA is taking concrete actions, including implementing the
following measures:
1. Quicker Turnaround: Impose stricter deadlines on partners to
develop applications, and for USAID to provide technical
approval.
2. Prioritization: Fast-track all COVID-19 proposals for review over
non-COVID applications.
3. All Hands on Deck: Ensure Agency buy-in across the spectrum of
USAID business processes, from USAID/BHA field teams/
headquarters staff, General Counsel, and M/OAA.
Since implementing these measures in early July, obligations have
increased significantly and we expect to obligate the entirety of
COVID-IDA funds by July 31, 2020.
Question. USAID has received explicit instruction from the NSC to
expend funds provided in the CARES Act on ventilators destined for
countries hand selected by the President based on conversations he has
with foreign leaders. What analysis is informing the decisions about
which countries are given ventilators? Are ventilators given to
countries that most need them based on case load?
Answer. President Trump has pledged ventilator assistance to
countries in need across the world. The Head of State or Ministry of
Health in each country that is receiving ventilators has requested this
equipment, and the U.S. Government is offering it as an in-kind
contribution. After pledges to partner countries, USAID mobilizes to
fulfill pledges under direction from the NSC. For additional
information on the decision-making process, we refer you to NSC.
Question. Were health experts at USAID, other agencies or elsewhere
consulted, and did they or do they agree that these are the countries
in most need of ventilators?
Answer. USAID is committed to supporting countries in need around
the world and leading the global COVID-19 response through an All-of-
America approach. This includes coordinating closely as part of the
U.S. Government interagency around all COVID-19 activities, including
ventilators. USAID health experts are closely involved in this process
and are consulted frequently.
Question. What assurances is USAID seeking or requiring from
countries receiving ventilators that they will provide equitable access
to U.S. provided ventilators and that the country is in fact following
proper protocols and implementing health security measures to prevent
the spread of COVID-19?
Answer. USAID is offering ventilators as an in-kind contribution.
Once delivered, USAID transfers the title to the ventilators to the
host government. The host government then distributes ventilators based
on a number of factors including where it determines the greatest need
is to care for the most critically ill patients affected by COVID-19
and which facilities are best-suited to use ventilators. USAID is
coordinating with host country Ministries of Health to assess overall
capacity to provide respiratory care for critically ill patients
suffering from COVID-19, as well as health facilities' capacity to
provide critical care and use ventilators safely and appropriately.
USAID health experts are providing regular input and guidance to
promote the safe and effective use of ventilator donations in recipient
countries. USAID offers targeted technical assistance where needed,
using assessments conducted with ministries of health and implementing
partners to guide this support. In addition, USAID is providing access
to a global distance learning portal and a technical hotline for health
providers to tap into subject matter expertise.
Question. It is my understanding that USAID is procuring nearly all
ventilators, and that the NSC is requiring them to purchase them from
two companies (Zoll and Vyaire). Is USAID competitively bidding this
procurement?
Answer. NSC allocates recipient countries to specific vendors
identified by the U.S. Department of Health and Human Services (HHS)
and the Federal Emergency Management Agency (FEMA) within the U.S.
Department of Homeland Security (DHS). These vendors include Vyaire,
Zoll, and Medtronic. USAID then works with assigned vendors and
countries to coordinate the necessary county-specific customizations
and fulfil assigned ventilator orders. For more details on the bidding
process for these vendors, we refer you to HHS and FEMA.
Question. How many of these orders have been fulfilled?
Answer. As of 18 June 2020, 800 of 8,482 ventilators have been
delivered to El Salvador (250), India (200), Russia (200), and South
Africa (50).
Question. If the decisions on which countries are being given
ventilators are being made by the White House weeks before the
ventilators can be delivered, why is USAID using authorities that allow
it to waive the regular 15 day Congressional notification process on
these procurements?
Answer. USAID has occasionally relied on emergency authority to
obligate funds when we have identified an urgent need to obligate funds
and when notifying these funds to Congress in accordance with the
regular procedures would pose a substantial risk to human health and
welfare. Specifically, funds are needed in advance for the
manufacturers to start production on country-customized ventilators.
Question. Does USAID have adequate resources to help countries
bring the pandemic under control? What does Congress need to provide in
the next supplemental appropriations bill?
Answer. USAID is extremely grateful for the generous supplemental
appropriations from Congress on behalf of the American people. Besides
the immediate health impacts of COVID-19, many countries are also
experiencing an increase in conflict, as well as humanitarian,
economic, and social challenges.
Countries with weak health systems are suffering from a lack of
laboratory systems, infection prevention and control in health
facilities, case management, contact tracing, surveillance, and
behavior change and risk communications. USAID's other global health
programs across areas such as maternal and child health, nutrition,
HIV/AIDS, tuberculosis, malaria, global health security, population and
reproductive health, and neglected tropical diseases are also seeing
additional costs and challenges rise from supply chain delays and
shutdowns, pauses in health services and immunization campaigns,
inability to reach health facilities to pick up medicines, as well as
due to misinformation.
Food insecurity, unemployment, education, and economic shutdowns
have left many already-vulnerable families even more at-risk. Countries
with already volatile and conflict-ridden situations are experiencing
increasing humanitarian challenges. Women, girls, and youth are
particularly at risk from a rise in gender-based violence, and child
abuse as a result of economic pressures, stress, and mental health
challenges resulting from COVID-19.
Malign actors are using the growing economic, social, and health
challenges in many countries to spread disinformation and
misinformation, reverse democratic gains, further violent extremism,
and increase their influence.
USAID is committed to addressing the aforementioned development
challenges to the best of our ability with available resources.
Question. The U.S. has suspended aid to northern Yemen amid a
pandemic. While some ``life-saving'' activities are carved out from the
suspension, other programs key to preventing and treating COVID-19,
including hygiene promotion, public education, basic healthcare,
epidemiological surveillance, and the provision of safe drinking water,
are not. How can the U.S. lay claim to leading the global response when
it is undercutting core prevention and treatment activities in the
world's largest humanitarian crisis?
Answer. The United States remains one of the largest donors of
humanitarian assistance in Yemen despite severe access restraints and
deliberate operational impediments imposed by the Houthis on U.S.
humanitarian partners in northern Yemen. Ongoing interference in
international aid operations by Houthi officials in northern Yemen has
prevented millions of people from receiving the assistance they need to
survive.
Yemen is now confronting what the U.N. says is the country's
``greatest threat in the past 100 years''--COVID-19. The pandemic is
spreading rapidly through the country, where prolonged conflict has
decimated the country's health system and left people malnourished and
extremely vulnerable to disease. Despite this unprecedented crisis, the
Houthis have not only failed to end their longstanding obstruction of
aid, we are hearing reports that, in some cases, they have instituted
even more brazen measures to seize control of international aid
operations. Now more than ever, we need to ensure critical resources
reach those who need them most.
Our priority remains delivering life-saving aid to the most
vulnerable populations in Yemen. While we have reduced certain NGO
programs that have become untenable due to the Houthis' ongoing
interference, we continue to support critical life-saving activities in
northern Yemen, including COVID-19 response activities, and remain
fully operational in the south. These activities--such as providing
safe water at sites for displaced families and treating malnourished
women and children--are helping to keep people healthy and prevent
diseases, such as cholera and COVID-19.
The United States remains one of the largest donors of humanitarian
assistance in Yemen. Given the constrained operating environment in the
north of Yemen, some of our partners have not been able to program at
their anticipated levels. As a result, USAID currently has some Fiscal
Year 20 humanitarian funding available to support new COVID-19 response
efforts without needing to request additional COVID supplemental funds,
and allowing these critical resources to be prioritized for other life-
saving responses. Our Yemen response also has robust ongoing
programming that is able to adapt as necessary to respond to this
outbreak.
We are working to safely and responsibly program all funding in
Yemen funding, and expect to announce new humanitarian assistance that
will support COVID-19 response efforts in Yemen in the coming weeks.
The United States continues to carefully monitor the situation in close
coordination with Yemeni health officials, the United Nations, and
other donors. We also continue to fully support the U.N.'s countrywide
services that underpin the humanitarian response and are critical to
COVID-19 response efforts, including the U.N. Humanitarian Air Service,
Logistics Cluster, and coordination mechanisms. We are also working
with our partners to adapt existing programs, as necessary, to address
additional needs due to COVID-19. Longstanding U.S. health and water,
sanitation, and hygiene programs--which include training healthcare
workers, supporting medical facilities, and teaching safe hygiene
practices--have and continue to help communities to be better prepared
for disease outbreaks and other health threats.
As COVID-19 threatens communities in Yemen that are already
extremely vulnerable, the United States remains committed to providing
humanitarian assistance whenever and wherever conditions permit.
As a donor accountable to U.S. taxpayers, the U.S. cannot
responsibly fund aid operations if our partners are prevented from
monitoring and protecting the humanitarian integrity of these programs.
We must be able to operate without interference in program operations,
including the ability to assess actual needs on the ground and to
protect resources being diverted from the most vulnerable; absent that,
we cannot be sure resources will get to those who need them most. This
suspension was thoughtfully planned with our partners to ensure they
were ready to safely and responsibly adjust their programming. We are
working closely with partners to ensure they resume operations as
quickly as possible once we are confident that they can deliver U.S.-
supported assistance without undue interference.
Question. NOAA's Climate Prediction Center predicts 2020 to have an
above-average number of hurricanes. How is USAID increasing support for
disaster risk reduction and preparing for a compound emergency like
hurricanes during a pandemic?
Answer. USAID's Bureau for Humanitarian Assistance (USAID/BHA) is
actively planning and preparing for an above-normal hurricane season
this year in the Atlantic and eastern Pacific. A key aspect of this
preparation has been adapting USAID's standard operating procedures for
responding to multiple hurricane scenarios, particularly in the Latin
America and Caribbean (LAC) region, while also addressing the operating
constraints of the COVID-19 pandemic.
USAID/BHA and the interagency have conducted table-top exercises to
review response procedures and the added challenges of responding in
the COVID-19 environment. Consultations with U.S. embassies and USAID
missions throughout the LAC region reviewing factors related to staff
deployment, access restrictions, COVID-19 status, as well as
coordination to expedite clearance processes, quarantine, and other
anticipated changes are ongoing. USAID/BHA is also providing a Mission
Disaster Preparedness six-session online learning series geared towards
USAID staff and Mission Disaster Relief Officers (MDRO) and alternates
(A/MDRO) in the Latin America and Caribbean (LAC) region. These
trainings are designed to ensure effective coordination between
Embassies and USAID/BHA during a disaster, and improve access the
appropriate tools and resources.
USAID has strategically pre-positioned disaster experts and
emergency relief supplies throughout the LAC region in preparation for
the 2020 hurricane season. Disaster experts in the region and in
Washington, DC will assess needs and determine whether USAID should
provide humanitarian assistance immediately following hurricanes and
other disasters, even in the event that a Disaster Assistance Response
Team (DART) is not required.
Through its Regional Disaster Assistance Program, USAID/BHA has a
network of disaster risk management specialists (DRMS) in the LAC
region that have provided training and technical assistance to national
disaster management organizations and first responders. There are 29
DRMSs and more than 400 local surge capacity consultants located
throughout the region. This capacity-building effort has increased the
ability of countries in the region to manage disasters without U.S.
assistance. Due to potential COVID-19 access restrictions, USAID/BHA is
expanding communications capacity, including satellite phones, in order
to enhance response efforts using this network.
To facilitate any potential response, USAID/BHA has an email alert
system that provides up-to-date information on entry protocols/
restrictions for response personnel, in addition to storm locations,
development probabilities, and projected trajectories to MDROs and
other relevant U.S. Government (USG) personnel.
USAID/BHA will embed an advisor with Joint Task Force-Bravo (JTF-B)
at Soto Cano Air Base in Honduras this year, from July-November, to
ensure seamless coordination, communication, and information sharing
between USAID/BHA and forward-deployed Department of Defense (DoD)
teams in the LAC region. JTF-B has capacity for rapid response
throughout the region and has responded to major events with USAID in
the past, including Hurricane Matthew in 2016. Additionally, USAID/BHA
has participated in hurricane response coordination activities and
communications in the COVID-19 context with SOUTHCOM and Caribbean
Disaster Management Agency (CDEMA).
Question. Refugee populations, like the Rohingya communities that
have settled in Bangladesh, who are restricted to living in densely
populated internally displaced persons camps or camp-like settings that
restrict health care, movement, access to hygiene materials and
sanitation, do not allow for social distancing or self-isolation, and
provide no clear mechanism for referrals of severe COVID cases. How
does the U.S. COVID action plan account for this vulnerable population
who are forced to live in conditions ripe for COVID to take root?
Answer. According to the Inter-Sector Coordination Group--a Cox's
Bazar coordination body that comprises U.N. agencies and NGOs--health
partners have delivered Infection Prevention and Control (IPC) training
to staff in all clinics and facilities serving the Rohingya camps. In
addition, health partners have trained over 1,500 refugee community
health work volunteers on COVID-19 to conduct household-level health
screenings and referrals, and are working with Imams and local leaders
to disseminate key messages on virus transmission, how refugees can
protect themselves and their families, and symptoms and proper care-
seeking behavior.
Since May, humanitarian organizations have established 14 Severe
Acute Respiratory Infection Isolation and Treatment Centers near camps
to treat both the refugee and host community populations, according to
the Inter-Sector Coordination Group. In addition, all health
organizations working in the camps ensure that water and soap are
readily available by increasing the number of hand-washing facilities
in distribution centers, health points, and nutrition centers. U.N.
agencies and NGOs continue to clean and disinfect communal areas and
neighborhoods throughout the camp, while physical distancing measures
are now required at distribution points, as well as mandatory hand
washing before entering distribution lines.
USAID's Bureau of Humanitarian Assistance (USAID/BHA) continues to
provide support in the camps in coordination with State/PRM. While food
assistance has continued, USAID/BHA partners are adapting measures to
minimize the spread of COVID-19 by providing a full month's food
ration, rather than biweekly, and implementing social distancing
measures at distribution sites. Each sponsored food vendor is required
to have two months of food in stock to prevent shortages and keep
refugees from congregating in markets. In April, IOM, with support from
USAID/BHA, began using pre-positioned USAID plastic sheeting for the
construction of temporary COVID-19 isolation and treatment centers and
upgrades to existing health facilities in host communities and refugee
camps, increasing local capacity to isolate and treat vulnerable
patients exhibiting symptoms of COVID-19.
In addition to ensuring existing programming is COVID-19 sensitive,
USAID/BHA is programming $5 million in COVID-19 International Disaster
Assistance supplemental funding to support vulnerable communities
hosting Rohingya refugees with health; water supply and hygiene; and
protection services. In host-community health facilities, USAID/BHA is
providing critical inputs such as pharmaceuticals, personal protective
equipment (PPE), and handwashing inputs. In addition, USAID/BHA
partners support water, sanitation, and hygiene (WASH) infrastructure
repairs, and training on IPC and case management. Following recent
reports by the U.N. Children's Fund (UNICEF) and other protection
actors, USAID/BHA is also scaling-up programs to combat harmful coping
mechanisms, such as early marriage and domestic violence.
Question. After years of eradicating extreme poverty, the World
Bank is predicting that 71 million to 100 million people will be pushed
into extreme poverty due to COVID-19. What is the U.S. strategy to
mitigate the secondary impacts of COVID-19, especially in fragile and
conflict-affected places?
Answer. The COVID-19 pandemic starkly illustrates the linkage
between public health outcomes and its impact on fragility and
conflict. While immediate international responses are focusing on
medical and humanitarian assistance, these alone will not be
insufficient to meet needs and respond to this crisis.
COVID-19 impacts are being felt across a range of sectors,
including governance, the economy, civilian security, education,
energy, tourism, agriculture, and food security, with both short-term
and long-term repercussions. USAID is working to address urgent COVID-
related conflict prevention and stabilization challenges to preserve
development gains and prevent backsliding in regions critical to U.S.
national security. USAID has prioritized support for citizen-responsive
governance, economic support, and peace and stability. Economic support
funds from the COVID-19 supplemental funding have gone towards
combating misinformation and disinformation, reducing the influence of
malign actors, strengthening economic opportunities, improving
workforce training and development, and enhancing private sector
adaptability and productivity so that populations are better equipped
to respond to the pandemic and not fall into deeper economic and social
vulnerabilities. Funds have also gone towards improving good
governance, ensuring the free flow of media and independent journalism,
countering violent extremism, counter-narcotics efforts, and providing
social support to the most vulnerable populations. These efforts will
help improve stability and peace in conflict-ridden regions.
Where and when violence and conflict do arise, USAID's programs
will aim to not only address the immediate conflict, but also to
prevent longer-term economic, governmental, and social effects of
conflict.
Question. What additional resources will be needed to ensure that
USAID and the State Department can address the secondary impacts of the
crisis?
Answer. USAID is working in close coordination with the State
Department on future programming needs and related budgeting priorities
to ensure they align with U.S. strategic priorities, including our
economic, security, and diplomatic interests.
Question. How will implementation of the Global Fragility Act
support these efforts?
Answer. The Global Fragility Act and subsequent Strategy can serve
as a framework for addressing second order impacts due to COVID. The
Global Fragility Strategy (GFS) aims to strengthen U.S. efforts to
stabilize conflict-affected areas, prevent violence, and address global
fragility, in line with the Global Fragility Act of 2019. It reinforces
the National Security Strategy commitment to strengthen the resilience
of communities and states ``where state weakness or failure would
magnify threats to the American homeland.'' America's prosperity and
security depend on our ability to stabilize conflict-affected areas,
prevent violence, and reduce fragility globally. The interagency sees
the GFS as a framework any USAID mission can utilize to shape their
programs to the changing environment amidst the COVID pandemic, even if
they are not one of the countries selected as part of the GFS.
USAID's transformation elevated many of the issues outlined in the
Global Fragility Act and has begun building a new organizational
structure designed to spearhead this very challenge. For example, the
Bureau for Conflict Prevention and Stabilization (CPS) will engage
dedicated senior leadership within USAID and the interagency for
peacebuilding; preventing conflict and violence; and implementing
programs in political transition and stabilization, while also
conducting civilian-military coordination to support U.S. foreign- and
national-security policy priorities in high-priority countries.
Question. How is USAID prioritizing the needs of children and youth
(access to education, nutrition, continued basic healthcare) during the
pandemic? In what ways are you seeking to expand distance learning
services to populations in need of assistance?
Answer. As a result of the global pandemic, the education sector
has been negatively affected by school closures, leaving more than 1.68
billion children and youth out of school at the height of the pandemic,
equaling more than 91 percent of enrolled learners worldwide. In
response, and to prevent development backsliding, USAID is mobilizing
its existing human and financial resources to mitigate and address the
negative education impacts of COVID-19, from pre-primary through higher
education. USAID's work will help our partner countries, learners, and
communities to stay safe and continue to learn both during the COVID-19
pandemic and once the crisis subsides.
In 20 different countries, USAID is leveraging existing resources
and programs to pivot programming during school closures to meet the
educational needs of children and youth. This includes supporting
ministries of education to broadcast USAID-funded educational programs
over radio and television, adapting teacher-led curricula to family- or
self-led instruction, and encouraging safe and healthy routines that
promote social and emotional wellbeing of learners.
For example, in the Democratic Republic of Congo COVID-19
supplemental funding has enabled USAID to expand distance education and
alternative education for Congolese children and youth so they can
continue to learn and maintain protective routines and social
connections while schools are closed across the country.
USAID is also working with partner countries to adapt approaches to
the context of each country's education system to ensure they are
resilient during future crises. Specifically, USAID is coordinating and
leveraging resources through partnerships with international education
actors. For example:
USAID's commitment to launch a Global Distance Learning Hub
supports governments, schools and parents to keep children and
youth learning during times of crisis.
USAID's support to the Inter-Agency Network for Education in
Emergencies (INEE) enables the curation and global
dissemination of tools, resources, and guidance on education
and COVID-19.
USAID's investment in Education Cannot Wait (ECW) supports
an immediate response to COVID-19 of about $1 million per
country in all 27 existing ECW partner countries. The specific
response will vary by country.
USAID's investment in the Global Partnership for Education
(GPE) supports GPE's phased COVID-19 response, which includes
$8.8 million for contingency and response planning for all 87
GPE member countries and a second phase that includes a $250
million funding window for immediate COVID-19 response.
Question. The Stop TB Partnership has reported a major decrease in
the number of people accessing tuberculosis services globally,
following the emergence of COVID-19, and this risks a major setback in
our efforts to control the disease internationally--and ultimately to
protect the U.S., since TB knows no borders. For instance in India, the
country with the highest number of TB cases, the TB case notification
rate has fallen 80%, indicating a massive drop in diagnosis and
treatment. Similar figures have been reported by Indonesia and South
Africa. How is USAID helping countries rapidly shore up and adapt their
TB programs to help patients get rapidly and properly diagnosed and
stay on their course of treatment, despite lockdown conditions?
Answer. As the spread of COVID-19 was confirmed around the world,
USAID/Washington quickly developed and distributed tuberculosis (TB)
technical guidance on best practices for adapting TB programs and their
platforms to combat COVID-19, especially for TB patients, who are at
high risk. The technical guidance is being updated regularly as the
pandemic evolves and shared with USAID Missions and Advisors embedded
in country National TB Programs (NTP). USAID Missions are working with
NTP and partners to adapt and adopt the guidance developed by USAID/
Washington on continuity of TB services during the COVID-19 pandemic.
Missions are also supporting the NTP to rapidly assess the extent of TB
service disruption and develop appropriate mitigation plans.
For example, USAID/South Africa supported the NTP to conduct a data
analysis and quantification of impact of COVID-19 on the TB program,
including any disruptions in TB drug supply, case finding, and
treatment support. As a result, the Mission is intensifying TB and
COVID-19 case finding in communities and health facilities, including
the development of integrated programs for TB and COVID-19 case
finding, treatment, and infection prevention control. In Uganda, USAID
supported the development of a TB-COVID-19 screening algorithm and the
training of health care workers to screen for both COVID-19 and TB;
developed a remote case finding mentorship for District TB programs to
better support facilities and communities in continuing TB services;
worked with partners and facilities to increase the number of TB
medicines dispensed from weekly to monthly through the Family DOT
practice; and extended the supply of TB medicines to lower-level
facilities (Health Center Level II) to dispense first- and second-line
medicines closer to patients. In Ukraine, USAID scaled-up video-
observed therapy options, allowing patients to stay home and reduce the
number of contacts with medical and social staff.
USAID also commissioned modeling from the STOP TB Partnership to
quantify the impact COVID-19 mitigation efforts could have on TB
activities.
USAID is committed to continuing to monitor programs and adapt our
strategies during the COVID-19 pandemic to address the challenges for
TB program implementation.
Question. USAID's Standards of Conduct state the Agency strives to
foster a ``respectful, diverse, inclusive, and collaborative
environment that promotes professional and personal growth for
everyone,'' and requires employees to ``promote and support a
respectful and inclusive work environment in which all individuals are
treated with dignity at all times. Employees shall ensure that both
their verbal and non-verbal communications comport with this
standard.'' Please explain how publicly-reported comments by Mark Kevin
Lloyd and Merritt Corrigan are consistent with those principles. For
example, Mr. Lloyd has referred to Islam as a ``barbaric cult'' and Ms.
Corrigan referred to the ``tyrannical LGBT agenda.'' As a career USAID
foreign service officer, I understand that you may not be personally
responsible for selecting political appointees for USAID or monitoring
compliance with USAID's Standards of Conduct, but you are the official
that the agency sent to testify before this Committee, so I appreciate
your comments on this matter.
Answer. USAID has long held our employees, regardless of hiring
category, to the highest legal, moral, and ethical standards, and the
Agency will continue to do so.
Question. Given the difficult discussion about racial injustice
taking place in our nation right now and across the world, along with
reports of diplomats and foreign service officers abroad struggling to
represent the United States to the world in the face of ongoing
injustice, do you agree that our international development agencies,
including USAID, have an important role to play in supporting
diversity, speaking out against racial injustice, and supporting those
serving around the world? Please provide all messages and guidance that
senior USAID leadership and Acting Administrator Barsa have provided on
these topics.
Answer. Last year, USAID issued a policy statement on diversity and
inclusion stating that, in accordance with USAID 's core values, we
remain fully committed to the fundamental principles that underpin a
workplace in which all employees are proud of their work; are
encouraged to collaborate, innovate, and learn; are respected for their
uniqueness; and are valued for their different perspectives. To achieve
our mission, one that promotes and demonstrates democratic values
abroad and advances a free, peaceful, and prosperous world, we must
draw from the strength of a workforce that represents these American
values. As such, we strictly prohibit discrimination, harassment, and
retaliation in all employment-related decisions including recruitment,
hiring, promotions, employee development, and retention. I work day in
and day out with my fellow foreign service officers, as well as all
USAID staff, to strengthen our core values as we remain mission focused
and committed to these principles.
______
Responses of Mr. Garrett Grigsby to Questions
Submitted by Senator Robert Menendez
Question. WHO plays a leading role in the provision of vaccines. It
is one of the main partners of Gavi, the Vaccine Alliance which is the
critical funding agency supporting vaccine programs in the world's
poorest countries where the majority of the world's unimmunized
children live. How is our pulling out of WHO going to affect
vaccinations, and what impact will disruption of vaccine campaigns have
on under five mortality?
Answer. The United States continues to be a leader in promoting and
providing vaccines, including through its support of GAVI and other
international partners. The United States will focus on and strengthen
other partnerships on vaccine issues. In addition, we are continuing to
review all collaborations to discover if there are certain activities
that only WHO can undertake and, if this is the case, decisions will be
made about how to deal with this situation.
Question. On April 7, the President declared he would like to put a
``powerful hold'' on WHO funding and on May 29, the President said the
Administration plans to ``terminate'' the relationship. On April 8,
Sec. Pompeo stated that the World Health Organization has ``to get the
data, they have to share that data with the world's best scientists--
many of which are often located right here in the United States--and
allow that information to be transferred freely so that we can have a
transparent response that will save lives.'' This is an essential
aspect of WHO's work, which has received praise from health experts
here and abroad but would be significantly harmed if the U.S. withheld
funding. In light of this statement, can you explain the guidance you
gave to Sec. Pompeo? Can you detail the implications beyond the COVID-
19 response this hold would have?
Answer. HHS works closely with the Department of State and other
interagency partners on global health policy and programs. We continue
to provide input to the interagency and the impact of our activities on
COVID-19.
Question. Diseases do not recognize borders, so challenges like the
COVID-19 pandemic necessitate a global, collective response. The WHO--
through its high level of technical expertise and international
legitimacy--is uniquely positioned to lead the international response
to public health emergencies like the COVID-19 pandemic. From the
outset of the crisis, WHO has been a critical provider of supplies and
tests, distributing 1.5 million diagnostic kits and millions of items
of PPE to dozens of countries; designed, refined, and distributed
technical guidance for communities, hospitals, frontline clinicians,
private sector partners, and public health authorities around the
world; carried out public awareness campaigns in dozens of languages in
149 countries; and, through its ``Solidarity Trial,'' has been working
to enable rapid and accurate research on the effectiveness of potential
therapeutics. People around the world--including Americans--stand to
benefit from these types of activities. What effect will
``terminating'' our relationship with the World Health Organization
have on these efforts? How can we hope to protect Americans from
pandemic disease and other health challenges without a multilateral
coordinating authority like the WHO?
Answer. The United States is, and will continue to be, a leader on
global health issues, whether or not we are a WHO Member State. The
United States is leading on the research and development of vaccines,
diagnostics and therapeutics to combat COVID-19 and will work with our
partners to exchange information and understanding.
Technical collaboration between the United States and WHO through
the Global Influenza Surveillance and Response System (GISRS) has been
used for global virus surveillance and selection of viruses for use in
vaccines to protect Americans from seasonal and pandemic influenza. We
are continuing to review all collaborations to discover if there are
certain activities that only WHO can undertake and, if this is the
case, decisions will be made about how to deal with this situation.
Question. WHO has been on the frontlines of nearly every global
health challenge over the last 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases, viruses, and
infections. While the world is rightly focused on defeating COVID-19,
other health challenges confronting the world have not disappeared, and
it is not in our interest to neglect them. These include WHO-led
efforts to control and eliminate malaria, implement global disease
surveillance for the polio virus in areas where U.S. government
agencies do not have the capacity to reach, support measles
immunization campaigns, and strengthen the health sector's response to
HIV/AIDS and Tuberculosis. The loss of more than $400 million in annual
U.S. funding threatens to upend these critical activities. What does
our withdrawal from these multilateral initiatives say to our allies
and partners around the world? Given how far-reaching and complex these
challenges are, how can bilateral efforts even hope to begin to make a
dent?
Answer. While the United States was by far the leading contributor
to the WHO, those contributions represented a small fraction--just 4
percent--of our total funding of global health assistance every year.
It is important to underscore that the United States continues to
lead on global public health issues and provides generous funding to
initiatives to eliminate malaria, global disease surveillance for
polio, immunization and addressing HIV/AIDS and Tuberculosis. Since
2001, the U.S. has provided more than $142 billion in global health
funding, and an average of approximately $10 billion per year in recent
years. Our global health efforts, whether in concert with the WHO, or
with other partners will continue. There are many important partners
working on global health in addition to the WHO. We plan to communicate
and coordinate, as appropriate, with all stakeholders to continue the
global response.
Question. With regards to U.S. arrears in our payments to WHO, in a
June report to Congress, the State Department noted a number of
possible impacts, including: ``1. Loss of vote or inability to be a
member of governing bodies; 2. Diminished U.S. standing and diminished
ability to pursue U.S. priorities; 3. Reduced U.S. ability to promote
increased oversight and accountability through reforms that promote
efficiency, cost savings, and improved management practices; 4. Reduced
standing needed to successfully promote qualified U.S. citizens to
assume senior management roles; and 5. Impairments of peacekeeping
missions to operate, including addressing objectives that may directly
impact the national security of the United States.'' Given your
experience working with international organizations like the WHO, do
you stand by these conclusions from your own Department?
Answer. We defer to Jim Richardson, the panelist from the
Department of State, to answer the above question about a State
Department report.
______
Responses of James L. Richardson to Questions
Submitted by Senator Ben Cardin
Question. COVID-19 poses a significant threat to low and middle-
income countries. Recognizing this need, Congress appropriated almost
$2 billion for foreign assistance in the emergency supplemental
packages. Nonetheless, we are increasingly hearing from foreign aid
implementers that very little of this assistance has been disbursed to
those who need it most: What is causing these delays?
Answer. Of the nearly $1.7 billion in foreign assistance, State and
USAID have obligated more than $800 million across State and USAID,
with that level increasing every day. The State Department's Bureau for
Population, Refugees, and Migration confirms that nearly all of the
committed State Department humanitarian assistance funding has been
obligated to date. I have also personally committed to responding to
funding allocations and proposals from State Department and USAID
bureaus in 24 hours. We are committed to moving quickly, while still
ensuring every dollar is used wisely, effectively, and strategically.
Question. Of the $1 billion that USAID has pledged, how much has
actually been obligated?
Answer. Across the State Department and USAID, the Secretary has
committed more than $1.3 billion for COVID-19 foreign assistance to
date. Of this total, more than $800 million has been obligated across
both agencies, with that level increasing every day. We refer you to
USAID for further information on USAID obligations.
Question. What are State and USAID doing to ensure funds get
disbursed as quickly as possible?
Answer. I have committed to responding to funding proposals from
State Department and USAID bureaus in 24 hours. Budget should move at
the speed of policy, which is why I've focused on speeding up our
processes in the Office of Foreign Assistance, ensuring every dollar is
coordinated, effective, and efficient.
Question. Are State and USAID concerned with the potential long-
term impacts these delays could cause?
Answer. We are in unprecedented times right now, with a rapidly
evolving situation on the ground in almost every country. The State
Department and USAID are working aggressively to obligate all of our
resources for COVID-19 as swiftly and effectively as possible. At the
same time, we recognize that our agencies are accountable for the
effective use of funds for COVID-19 response, and must be good stewards
of U.S. taxpayer dollars. We refer you to USAID for further information
on obligations.
Question. Is the State Department concerned that a U.S. withdrawal
from the WHO will further strengthen China's role at the organization
and other multilateral bodies?
Answer. In May, Chinese President Xi pledged $2 billion over the
next 2 years to help in the COVID-19 response--he did not say how much
money will be given to the WHO. This pledge is less than what China
borrows every year from the World Bank. China's pledge falls well short
of the U.S. commitment of $10 billion to the COVID-19 response. The
President's decision to terminate our relationship with the WHO in no
way diminishes U.S. leadership on global health and combatting the
COVID-19 pandemic. The United States leads the world in health and
humanitarian aid in an ``All of America'' effort and is committed to
ensuring our generosity directly reaches people around the world. We
account for more than 40 percent of total global health funding. The
United States has allocated more than $12 billion that will benefit the
global COVID-19 pandemic response; more than $2 billion of this has
already been committed.
Question. How can we hope to protect Americans from pandemic
disease and other health challenges without a multilateral coordinating
authority like the WHO?
Answer. As the COVID-19 pandemic and the WHO's failed response have
clearly demonstrated, we lack the international structures to prevent,
detect, and respond to infectious disease outbreaks. As U.S. leadership
demonstrated in the Ebola and MERS outbreaks, our diplomatic and
development efforts enable countries to develop tools for addressing
infectious disease. Due to these efforts, we filled gaps created by the
WHO's inaction to prevent, detect, and respond to outbreaks
immediately. The Administration is examining ways to leverage the
expertise of key U.S. Government departments and agencies and the
American private sector to rapidly deploy and deliver this essential
support to other countries to prevent, detect, and respond to
infectious disease outbreaks at their source. In addition, President
Trump announced on May 29 that the United States will be redirecting
funding planned for the WHO to other global health organizations and
urgent needs around the world.
Question. Do you believe that a bilateral approach to complex and
far-reaching global health crises is the most effective and efficient
way to spend tax payer dollars?
Answer. Achieving global health security remains a foreign policy
priority for the U.S. Government. The U.S. Government implements many
of its capacity building programs at the country level, including our
coordinated whole of government investments in support of the Global
Health Security Agenda (GHSA). U.S. Government investments have and
continue to build foundations to prepare and respond to the current
COVID-19 pandemic, and help countries more broadly prevent, detect, and
respond to infectious disease threats. Building upon decades of
investment in life-saving health and humanitarian assistance, the
American people should be proud of the real results we are achieving
through our help to nations around the world, which also helps protect
the homeland. Stopping outbreaks at their source protects U.S. national
security, and the lifesaving impact of our bilateral efforts remain
fruitful components in our diplomatic relationships.
Question. With the world experiencing the worst public health
disaster in the last 100 years, it is difficult to understand why the
Administration would decide now is the right time to suspend funding
and withdraw from the World Health Organization. While China has been
used as the pretext for this withdraw, this decision will play into
China's hands and possibly strengthen their role at WHO: How does the
Administration plan to allocate funding that would otherwise be
obligated to WHO, particularly in countries like Venezuela and Yemen
that are particularly difficult for U.S. implementers to operate?
Answer. On May 29, 2020, the President announced that the United
States will be terminating its relationship with the WHO and
redirecting WHO-related funding to other deserving and urgent global
health organizations and needs around the world. While the United
States was by far the leading contributor to the WHO, those
contributions represented a small fraction--just four percent--of total
U.S. funding to global health assistance every year. There is a wide
range of excellent implementing partners available to us, partners that
value transparency and are better able to provide value for American
taxpayers. In many cases, our teams in the field and here in Washington
have already identified alternate implementers in challenging
environments, such as World Vision in Afghanistan, the International
Medical Corps in Iraq and the International Rescue Committee in Syria,
and in environments where we do not discuss the names of our partners
due to safety and operational considerations.
Question. How do you assess the role of PAHO in providing support
to Latin America and the Caribbean countries during the pandemic?
Answer. PAHO plays a critical role in the Americas to prevent,
detect, prepare and respond to a COVID-19 outbreak. PAHO has activated
regional and country incident management system teams to provide direct
emergency response to regional Ministries of Health and other national
authorities for surveillance, laboratory capacity, support to health
care services, infection prevention control, clinical management and
risk communication; all aligning with priority lines of action. PAHO
has developed, published, and disseminated evidence-based technical
documents to help guide PAHO Member States' strategies and policies to
manage this pandemic in their territories. PAHO has also been critical
to advancing lab support and detection in the region, including inside
Venezuela and throughout the Caribbean. PAHO is the only Organization
in the region supplying COVID-19 testing kits and supplies.
Question. In light of the pandemic, will the Administration
reconsider its PAHO budget request that would cut funding so
significantly?
Answer. We remain committed to PAHO and understand it plays a
critical role in the Americas to prevent, detect, prepare and respond
to a COVID-19 outbreak. The United States is the largest funder of
PAHO, providing 59.4 percent of assessed contributions to PAHO, in
addition to voluntary funding from USAID and the HHS Centers for
Disease Control (CDC). That said, the United States remains deeply
troubled by the role PAHO played in facilitating the provision of Cuban
doctors for Brazil's Mais Medicos program. This is the basis of a
pending lawsuit filed by several Cuban doctors against PAHO in U.S.
federal district court. The United States must ensure U.S. tax dollars
are in no way contributing to any program that may have involved human
trafficking, as alleged in the lawsuit. At the same time, Secretary of
State Pompeo has approved the continuation of limited U.S. foreign-
assistance health-related funding to PAHO to implement critical health-
related activities in the region, including in Venezuela.
Question. How would a U.S. withdrawal from the WHO impact our
support for PAHO?
Answer. A withdrawal from the WHO does not affect our relationship
with PAHO. The United States remains a member state of PAHO and
supports its unique and important role in the region as the oldest
public health organization of its kind. While PAHO serves as a regional
office of the World Health Organization (WHO), a U.N. Specialized
Agency, PAHO is also an independent organization with its own
Constitution, membership, and legal personality. PAHO is also
recognized by the Organization of American States (OAS) as a
specialized organization of the inter-American system.
Question. I am particularly concerned about the impact of COVID-19
on Venezuela, as the country's health care system was collapsing even
prior to the pandemic. How much U.S. humanitarian assistance may be
required for Venezuela beyond the $12.3 million announced, as of late
May 2020, to address COVID-19?
Answer. The COVID-19 crisis has exacerbated humanitarian needs
among vulnerable populations in the Bolivarian Republic of Venezuela.
As you noted, Senator, health care in Venezuela was already near
collapse prior to the pandemic of COVID-19 because of the emigration of
healthcare workers during the ongoing crisis, interruptions of
electricity and water that have resulted in the deterioration of
hospital infrastructure, and the acute shortage of medicines. Further,
assessing the extent of the impact of COVID-19 in the country is
challenging because of the lack of transparency from the illegitimate
Maduro regime. Venezuelan health actors continue to express concern
that the COVID-19 caseload and death rate are significantly higher than
the numbers officially reported.
A further strain on health care in Venezuela during the pandemic is
the return of more than 80,000 Venezuelans from Colombia and other
neighboring countries since March, many of whom require additional
health, financial, and livelihood support. In addition, the Maduro
regime has enforced mitigation measures on returnees who arrive through
formal border crossings; they must quarantine in overcrowded,
unsanitary makeshift shelters, often operated by the Venezuelan
military, where they face heightened protection risks and cannot follow
proper physical-distancing protocols.
Not only are Venezuelan health institutions ill-equipped to manage
the outbreak, but the ongoing nationwide restrictions imposed by the
Maduro regime have reduced livelihood opportunities and the
availability of food and fuel. Beyond providing direct humanitarian
assistance, the U.S. Government (USG) continues to advocate for
unfettered humanitarian access and improved coordination and
information-sharing.
Since Fiscal Year (FY) 2017, the USG has provided more than $856
million in development and humanitarian assistance for programs inside
Venezuela and across 17 neighboring countries. Since the beginning of
FY 2020, the USG has provided more than $76 million in lifesaving
humanitarian assistance and over $12.3 million in COVID-19 support
inside Venezuela. This includes directly supporting the critical
response to the pandemic, improving water and sanitation in schools and
hospitals, distributing food for children and families, and protecting
vulnerable groups inside Venezuela. The U.S. Agency for International
Development is examining options for providing additional funding for
health-related interventions against COVID-19 inside Venezuela.
While the USG continues to be the largest humanitarian donor in
Venezuela, a significant scale-up in funding and support is required to
mitigate the impact of the pandemic of COVID-19 on the existing
political and economic crisis. On May 26, 2020, the European Union and
the Government of the Kingdom of Spain convened an international
donors' conference to mobilize resources in support of Venezuelan
migrants and refugees. The governments in attendance pledged nearly $3
billion at the conference; the USG announced more than $200 million,
the single largest commitment. The conference largely focused on how
COVID-19 is exacerbating the ongoing humanitarian crisis caused by the
corruption and tyranny of the Maduro regime. The USG continues to
advocate for other donors to increase their financial contributions to
respond to the crisis, especially inside Venezuela.
Question. What is your assessment of the recent shipment of COVID-
19 aid that Iran sent to Venezuela?
Answer. We see the increased Iranian shipments to Venezuela as Iran
acting opportunistically to obtain desperately needed cash, while
marketing the trade as primarily humanitarian in nature. However,
recent shipments of food may have been accompanied by equipment for
Venezuela's failing refinery infrastructure. To pay Iran for its
assistance, the Maduro regime looted nine tons of gold, worth $500
million.
Question. How has COVID-19 impacted the obligation of other
development, humanitarian, and global health funds? Please provide us
with an update on the status of FY19 and FY20 funding.
Answer. The State Department and the U.S. Agency for International
Development (USAID) recognize that the COVID-19 pandemic is currently
affecting, or could affect, the ability to obligate and expend funds
appropriated by Congress for Fiscal Year (FY) 2019 and FY 2020.
Following normal practice, State and USAID are working with posts
throughout the world and Bureaus domestically to take the steps
necessary to obligate all unobligated expiring resources prudently
prior to the end of the Fiscal Year. Consistent with statutory
provisions, State and USAID are continuing to transmit all required
Congressional Notifications for expiring funds, and are committed to
working to resolve any questions and concerns that the relevant
Committees of jurisdiction raise.
State and USAID both expect to obligate all expiring funds by the
end of the Fiscal Year, and we are monitoring obligations closely.
Question. What policy actions does the State Department intend to
take to push back against negative trends in democracy and human rights
that are tied to government responses to COVID-19?
Answer. The United States is committed to the protection of
democracy and human rights in the global response to the COVID-19
pandemic. Strong respect for human rights is a necessary part of the
solution to public health crises. Government responses to the COVID-19
epidemic must focus on protecting public health, rather than using the
disease as a pretext for repression of people or ideas.
As a member of the Freedom Online Coalition, Media Freedom
Coalition, Global Action on Disability network, Community of
Democracies, and Open Government Partnership, the United States, with
its partners, has called upon governments to respect democratic values
and human rights in their responses to COVID-19. The State Department
will continue to lead multi-stakeholder initiatives, as well as
leverage bilateral and multilateral diplomacy and foreign assistance,
to advance democratic norms and combat authoritarian responses to the
COVID-19 pandemic.
Question. Will you commit to the importance of equitable and
affordable vaccines for the whole world regardless if it is developed
for COVID-19?
Answer. In February, the United States pledged $1.16 billion to
Gavi, the Vaccine Alliance, over 4 years. This marks the largest U.S.
commitment to Gavi to date, and reaffirms our commitment to
strengthening global health security and combatting the spread of
infectious diseases through the delivery of safe and effective vaccines
to at-risk populations across the world. On top of investments in Gavi,
the United States supports the work of UNICEF and has invested over $2
billion towards Polio eradication, including through investments in the
Global Polio Eradication Initiative, which seeks to end polio by 2023
through delivery of routine and targeted vaccination campaigns in
endemic and outbreak countries.
lgbtqi rights
This month marks Pride Month--which recognizes people of varying
sexual orientations and gender identities across the world. I am deeply
concerned that the United States has abdicated its historic leadership
role in upholding the human rights of all people. Already facing
stigma, violence, and discrimination in their communities prior to the
pandemic, there have been multiple reports that LGBTQI+ people are
being scapegoated for the spread of the disease. Notably, last month
for the International Day against Homophobia, Biphobia, Intersexism,
and Transphobia, the United States did not sign onto U.N. statements
about the unique risks that LGBTQI+ people face in the context of
COVID-19:
Question. Why did the United States fail to join these statements?
Answer. U.S. policy on LGBTI human rights around the world is
focused on mitigating violence and the decriminalization of LGBTI
conduct. The statements issued by the Core Group included broad
language that went beyond the scope of the Department's policy mandate.
The United States' longstanding commitment to protecting the human
rights and fundamental freedoms of all people, including LGBTI persons,
is well-known. So too is its sovereign interest in ensuring that any
statements it joins are consistent with U.S. law and policy.
In this case, a virtual abbreviated negotiation process for a
lengthy statement made it preferable to release our own statement,
which was posted on the USUN Mission's website and social media
accounts.
Question. How is the United States promoting the human rights of
LGBTQI+ people in the context of COVID-19?
Answer. The State Department and USAID have been at the forefront
of the U.S. Government's response to the impact of the global COVID-19
crisis on democracy and human rights. The Department has established a
COVID-19 Working Group spearheaded by the Bureau of Democracy, Human
Rights, and Labor (DRL) to track foreign governments' autocratic and
abusive responses to COVID and to coordinate and promote democratic and
human rights-respecting responses instead.
Since the launch of our COVID working group on April 9 at a large
NGO virtual roundtable, DRL has hosted more than 50 additional external
consultations with more than 100 NGOs. Our partners have highlighted
COVID-19-related disinformation and other malign influence, growing
authoritarianism, crackdowns on fundamental freedoms, expanded use of
surveillance tools, and targeting of vulnerable groups, including LGBTI
persons.
These consultations have been instrumental in helping the
Department adapt and implement programming in response to the crisis.
We recognize that the LGBTI community is often a target of abuse where
governments conveniently cloak crackdowns on fundamental freedoms as
efforts to respond to the pandemic. The Department is working with our
civil society partners to make current LGBTI programs flexible and
responsive to the impact COVID-19 is having on the human rights of
individuals in this community.
In response to COVID-19, USAID has worked to ensure that existing
funds--both from USAID and bilateral partners such as Canada and
Sweden--can be used flexibly to address the most urgent challenges
facing LGBTI people in developing countries. Additionally, USAID is
working to incorporate LGBTI considerations into broader COVID-19
emergency response efforts.
Question. How is the United States monitoring human rights abuses
against LGBTQI+ people in the context of COVID-19?
Answer. The State Department has established a COVID-19 Working
Group spearheaded by the Bureau of Democracy, Human Rights, and Labor
(DRL) to track foreign governments' autocratic and abusive responses to
COVID. DRL has hosted more than 50 external consultations with more
than 100 NGOs and is documenting cases of COVID-19-related
disinformation and other malign influence, growing authoritarianism,
crackdowns on fundamental freedoms, expanded use of surveillance tools,
and targeting of vulnerable groups, to include LGBTI persons. These
consultations have been instrumental in helping the Department to adapt
and implement LGBTI programs that are flexible and responsive to the
impact COVID-19 is having on the human rights of individuals in this
community.
Question. What steps has the U.S. taken to ensure that our
international assistance, especially with respect to global health
programming, is being carried out in a non-discriminatory and inclusive
manner when other governments may not have protections in place for
vulnerable populations?
Answer. USAID integrates inclusion and nondiscrimination principles
into its policies and programming, and advances inclusion and
nondiscrimination through programs that address the specific needs of
marginalized and vulnerable populations. In all programs, USAID
continues to enforce its nondiscrimination policies for access to
services to beneficiaries, which ensure that no USAID contractor or
grant recipient discriminates against any beneficiary for any reason.
______
Responses of Mr. Chris Milligan to Questions
Submitted by Senator Ben Cardin
ventilators
The administration has touted the distribution of U.S.-made
ventilators to countries overseas as a large success. However, many are
concerned by a lack of details regarding USAID's distribution of
ventilators and the strategy behind it.
Question. To date, how much funding has been spent on these
ventilators? How many countries have received ventilators? And how is
the Administration deciding which countries receive them? Specifically,
can you walk us through the decision to provide 200 ventilators to
Russia? As you know, ventilators are complex medical machines that
require training and maintenance to operate successfully. How are we
ensuring that medical professionals in countries receiving these
ventilators have the proper training to operate and maintain these
machines?
Answer. The total funding spent on ventilators is $195.7 million.
USAID has delivered U.S. manufactured ventilators to ten countries as
of June 18, 2020.
The COVID-19 pandemic is worldwide: Nearly all countries are either
experiencing the effects of the virus or are at risk of shortly
experiencing transmission, morbidity and mortality. Up to 20 percent of
all COVID-19 patients are expected to require at least supplemental
oxygen; the most-critical patients require intensive care and assisted
ventilation. The COVID-19 pandemic has been particularly acute in the
Russian Federation.
A total of 44 countries (with NATO) are receiving ventilator
donations. USAID does not have visibility into the parameters for
country selection within the larger USG ventilator donation program. We
would advise engaging HHS and NSC for this status.
In alignment with Pillar IV of the U.S. Government Action Plan to
Support the International Response to COVID-19, USAID procured U.S.
manufactured plans to use ESF resources to support the Russian
Government to implement an immediate, critical, life-saving response to
COVID-19 by providing 200 ventilators and related commodities and
consumables. The recipient of the equipment is expected to be a Federal
State Budgetary Institution, ``National Medical and Surgical Center
named after N.I. Pirogov'' of the Ministry of Healthcare of the Russian
Federation. In light of the urgent need for this assistance to address
the pandemic in Russia, notifying these funds in accordance with the
regular notification procedures would pose a substantial risk to human
health and welfare.
USAID is coordinating with host country Ministries of Health to
assess overall capacity to provide respiratory care for critically ill
patients suffering from COVID-19, as well as health facilities'
capacity to provide critical care and use ventilators safely and
effectively. USAID is facilitating setup and orientation support for
ventilator deliveries led by manufacturers. USAID is also offering
targeted technical assistance where needed, using assessments conducted
with Ministries of Health and implementing partners to guide this
support. In addition, USAID is providing access to a global distance
learning portal and a technical hotline for health providers to tap
into subject matter expertise.
ppe
I was pleased by the Administration's recent decision to re-allow
U.S. international assistance to be used to purchase PPE, like masks
and gloves, to protect healthcare workers on the frontlines of fighting
COVID-19 overseas. However, the new policy only allows the purchase of
PPE that is regionally produced.
Question. Are essential PPE like N95 masks produced in sub-Saharan
Africa, southern Asia, and the other resource-limited areas? Will
healthcare workers be able to access the PPE they need to protect
themselves and patients under the revised policy, or will they continue
to face challenges?
Answer. This guidance adheres to the White House's guidance to
reduce competition for PPE with the U.S. market, while allowing our
countries and staff a great degree of flexibility and freedom to
protect themselves and continue to implement life-saving programs.
A number of countries throughout the regions where USAID works have
the manufacturing know-how and capacity to produce essential personal
protective equipment, however, which country or region is producing
what types of PPE is highly variable. Many regionally-produced types of
PPE are emerging from countries such as the Middle East, South Asia,
and East Asia, whereas the continent of Africa as a whole may have less
experience in producing complex types of PPE such as respirators. For
this reason, USAID's PPE guidance allows for exceptions on the regional
and locally produced elements. For beneficiaries of USAID programs,
Covered Materials should be procured from local or regionally-
manufactured sources. However, in the case where a country does not
have access to local or regional suppliers, or if they find products
with a better price or higher quality elsewhere, they are permitted to
procure Covered Materials produced in regions other than the region in
which the country itself is located, with written Agreement Officer/
Contracting Officer approval and the understanding that these products
are not, and reasonably could not, be intended for the U.S. market.
Anyone receiving financial compensation from a USAID implementing
partner is considered to be staff, and can therefore procure and use
Covered Materials from any source, not just regional or local sources.
In many situations, government-employed healthcare workers and Ministry
of Health employees are implementing partners of USAID and those
healthcare workers are therefore able to procure and use Covered
Materials from any source. This guidance enables healthcare workers to
access the products and supplies they need to protect themselves and
patients. Furthermore, only the items considered ``Covered Materials''
are under any type of procurement restrictions--other types of PPE,
hand sanitizer, and cleaning suppliers are not under procurement
restrictions.
ebola/who
USAID and other U.S. agencies, including the CDC, worked closely
with WHO in responding to the Ebola outbreak in the Democratic Republic
of the Congo since 2018.
Question. With reports of new cases in the western part of the
country, how will the U.S. continue to provide assistance in the fight
against Ebola outside the WHO framework?
Answer. Historically, USAID's response to outbreaks of Ebola in the
Democratic Republic of Congo (DRC) has been coordinated with WHO and
U.N. leadership, but we always directly fund U.N. and NGO partners to
ensure any gaps in critical response operations are filled.
USAID has more than 20 active United Nations and non-governmental
organization partners responding to Ebola in eastern DRC. These
partners have the flexibility to respond country-wide, supporting
activities to prevent and control infections in health facilities,
enhance disease surveillance, train health-care workers, and educate
and engage communities on health behaviors. Two USAID partners, the
International Medical Corps and the Alliance for International Medical
Action, have already leveraged the geographic flexibility and rapid
response capabilities in their awards and are currently providing case
management support in western Equateur province.
DRC's Minister of Health is leading the response to the Ebola
outbreak in Equateur, while the U.N.'s Humanitarian Coordinator and the
Office for the Coordination of Humanitarian Affairs (OCHA) is providing
critical coordination support to international response actors. USAID
is closely tracking the situation unfolding in northwestern DRC and is
assessing other potential areas of support. Additionally, USAID is
coordinating closely with all response stakeholders, including other
donors, to identify needs and ensure an efficient and effective
response to this new outbreak.
program oversight
In March, the State Department authorized the return to the United
States of high-risk U.S. government personnel from diplomatic or
consular posts abroad. USAID and the Millennium Challenge Corporation
followed State Department guidance, while the Peace Corps suspended all
operations worldwide.
Question. What has been the impact of these evacuations on program
operations, both for existing and new programs? How has reduced staff
capacity in the field affected oversight of programming?
Answer. Following the State Department's Global Authorized
Departure, U.S. employees at high-risk were evacuated to the United
States, where they immediately continued their normal duties by
teleworking. Even with staff evacuating on Global Authorized Departure,
all operating units had U.S. employees, including supervisors,
remaining, with the exception of one small country office. Under the
in-country leadership of these remaining U.S. and host country staff,
and with the support of employees teleworking from the United States,
USAID continues program operations.
USAID has been able to continue operations without reducing program
oversight by using available technology. However, restrictions on
movement imposed by overseas public health authorities have, in some
posts, reduced our ability to engage in-person with beneficiaries,
implementers, and host-government officials. USAID has worked to
overcome these restrictions by advising our Missions on how to
effectively use remote monitoring techniques, including cell-phone
monitoring, accessing data from institutional monitoring systems, and
direct monitoring through satellite data and geospatial information.
USAID has also created an online forum to share monitoring and
evaluation best practices as well as lessons learned during COVID-19.
covid-19 in latin america
The leaders of Brazil, Mexico, and Nicaragua have played down the
threat of COVID-19 and failed to take adequate actions to stem its
spread. There are also concerns that several countries in the region
are undercounting their COVID-19 death tolls.
Question. To what extent do you share these concerns? How might the
United States play a role in convincing governments to adequately
address the spread of COVID-19 and be transparent in reporting COVID-19
cases and deaths?
Answer. Combating the COVID-19 pandemic will require an
unprecedented level of global trust, transparency, and accountability,
particularly in the areas of accurate case and death reporting. With
the generous support of Congress, through the COVID-19 supplemental
funding, USAID has been able to promote these best practices in many
countries around the world. For example, with COVID-19 Supplemental
funding in many conflict-ridden and vulnerable countries, USAID is
supporting activities to counter misinformation and disinformation,
bolster the independent and free flow of media, journalism, and
information, and support citizen-led governance, civil society, and
good governance efforts. Additionally, USAID has advanced efforts to
disseminate in local languages scientific-based risk and behavior
change materials, and supports surveillance, digital methods of
tracking cases, points-of-entry screening, case reporting, and contact
tracing, all of which lead to increased visibility and transparency
into the accurate numbers of COVID-19 cases. By working with Ministries
of Health and other local leaders in our partner countries, USAID can
play a key role in convincing governments and leaders that accurate and
timely reporting of COVID-19 cases is a strength that will allow for
quicker assistance, better communication and messaging to their people,
a reduction in caseload, earlier preparation for infection prevention
and control in facilities, and most importantly, a reduction in
livelihoods and lives lost due to the pandemic.
immunizations
The WHO has reported that the pandemic has disrupted routine
immunization services in at least 68 countries, putting more than 80
million children at risk of becoming infected with polio, measles,
diphtheria and other diseases. The resulting disease burden from
outbreaks of vaccine-preventable illnesses may be devastating for
already weak and stretched healthcare systems in developing countries.
Question. How has the pandemic impacted USAID's immunization
programs, and how will USAID help restore and strengthen immunization
services globally?
Answer. COVID-19 and its global spread has resulted in the
disruption of immunization services worldwide, including the suspension
of campaigns against epidemic-prone diseases, such as polio and
measles. Among the 25 high-burden countries prioritized for USAID
maternal and child health (MCH) efforts, since March 2020, 20 have
experienced or are projected to experience disruptions in campaign
activities for polio, measles, yellow fever, and other vaccine-
preventable diseases. In addition, USAID partners report reduced demand
for immunizations in 14 of 22 MCH priority countries.
To address these challenges, USAID--in partnership with Gavi, the
Vaccine Alliance, and others--is supporting country governments to plan
for catch-up vaccination campaigns and to promote improved infection
prevention and control efforts by immunization service providers to
prevent the spread of COVID-19. USAID and partners are adapting
immunization delivery strategies, developing strategies to track and
follow-up with individuals who missed vaccinations, monitoring
reductions in vaccine coverage, and re-establishing community trust and
demand for vaccination. USAID is committed to continuing support to
minimize the effects of immunization service disruptions, respond
rapidly to outbreaks of vaccine preventable diseases, and protect
health workforces, even as we address the direct effects of the COVID-
19 pandemic.
______
Responses of Mr. Garrett Grigsby to Questions
Submitted by Senator Ben Cardin
who
I believe freezing aid to the WHO and withdrawing the U.S. is
short-sighted and dangerous.
Question. What reforms was the Administration seeking from the WHO?
Answer. The United States is working with other likeminded WHO
member states on a number of areas of concern with WHO's preparedness
and response that have come to light due to the outbreak of COVID-19.
These proposals focus on member state compliance with the International
Health Regulations as well as strengthening WHO's leadership, allowing
them to be more independent and empowered to call out concerns about
member states' failure to comply with the IHRs. Reforming the process
for declaring a Public Health Emergency of International Concern
(PHEIC) is being discussed, as well as delinking travel from trade
restrictions. The President also articulated the specific concerns of
the United States in his May 18, 2020 letter to WHO Director-General
Tedros.
Question. Why did the administration announce the withdraw from the
WHO 10 days after telling the organization it had 30 days to make these
reforms?
Answer. The President announced on May 29, 2020 his determination
that it was in the best interest of the United States to ``terminate
its relationship'' with the WHO. On July 6, the United States deposited
its notice of withdrawal from the WHO with the U.N. Secretary General,
the depositary of the WHO Constitution, effective July 6, 2021.
Question. Which alternative implementers has the interagency review
panel found who can step into the gap while assistance to the WHO is
suspended? Are you worried about a lack of coordination and decreased
effectiveness through using non-WHO implementers?
Answer. The United States collaborates with many partners on global
health. Funding that was previously provided to WHO will, to the extent
permitted by law, be redirected to these partners. We will work to
ensure coordination and effectiveness with these partners, as
appropriate and feasible. The interagency is reviewing all
collaborations to discover if there are certain activities that only
WHO can undertake and, if this is the case, decisions will be made
about how to deal with this situation.
Question. How does the U.S. plan to partner with other countries on
global health initiatives without being a WHO member?
Answer. The United States' partnership with many countries on
global health is not dependent upon our membership in WHO. U.S.
leadership on global health has been uncontested for decades and that
will remain so. In fact, several signature U.S.-led global health
initiatives, such as the President's Emergency Plan for AIDS Relief and
the President's Malaria Initiative , were created, in part, because the
international community, including WHO, were not able to put sufficient
resources toward fighting HIV/AIDS or malaria. The United States
Government is committed to maintaining and even strengthening our
leadership in the field of global health, notwithstanding our
relationship with WHO.
Question. The U.S. has invested heavily in WHO-led polio
eradication efforts, as the WHO is the only global entity with safe
access to polio hotspots in places experiencing conflicts, including
Afghanistan. How will the U.S. continue to be a global leader in polio
eradication efforts without the support WHO provides?
Answer. The interagency is reviewing all collaborations to discover
if there are certain activities that only WHO can undertake and, if
this is the case, decisions will be made about how to deal with this
situation.
solidarity trial
Among other activities, WHO is leveraging its global reach and
convening power to support an unprecedented effort to identify
effective treatments and vaccines for COVID-19. The organization's
``Solidarity Trial,'' in which more than 100 countries are now
participating, could--due to its wide geographic breadth and inclusion
of diverse demographic groups under one umbrella--reduce the time
needed to evaluate the effectiveness of specific treatment regimens by
80%.
Question. Do you think it is important for the U.S. to support
these types of global trials? Why is the United States not joining this
effort when it could help Americans and American companies?
Answer. The United States has contributed significantly to the
establishment of the Solidarity Trial by writing the master clinical
trial protocol used. This is critical because the majority of on- going
clinical trials globally are observational or under-powered and will
not result in data that can be used to support safety and efficacy of
investigational therapeutics. The United States, through leadership at
HHS' National Institutes of Health, has launched a series of robust
clinical trials targeting: (1) the re-purposing of products licensed
for another indication for activity against SARS-CoV-2; (2) novel
therapeutics; (3) convalescent plasma; and (4) neutralizing monoclonal
antibodies targeting the virus. In undertaking these studies directly,
the U.S. has moved out significantly faster in enrolling patients in
robust clinical trials, making determination of investigational
products' efficacy, and sharing these results with the global
community.
operation warp speed
The U.S. is focused on developing a safe and effective COVID-19
vaccine through Operation Warp Speed.
Question. In addition to securing a vaccine for domestic
distribution, will the U.S. also be a partner in the global effort to
develop and distribute a COVID-19 vaccine?
Answer. Although Operation Warp Speed's primary mission is to
advance medical countermeasure development to accelerate the
availability of products for use by Americans, we believe that such
work advances global efforts to develop critical tools to combat COVID-
19 and would expect that our commercial partners would ultimately make
any approved COVID-19 vaccines available globally as well. Moreover,
the Administration is examining ways to leverage the expertise of key
U.S. Government departments and agencies and the American private
sector to rapidly deploy and deliver essential support to other
countries to prevent, detect, and respond to infectious disease
outbreaks at their source.
______
Responses of James L. Richardson to Questions
Submitted by Senator Chris Coons
Question. In December 2019, the U.S. Congress passed the bipartisan
Global Fragility Act (GFA), which calls for a new strategy to address
the root causes of violence fragility around the world. The GFA
requires a dramatic shift from the status quo and requires a
coordinated, proactive, multi-sectoral, locally-driven, and evidence-
based approach.
The Trump administration's current strategy to address to global
consequences of the COVID-19 pandemic prioritizes four pillars,
including: protecting American interests, bolstering health systems,
and addressing complex humanitarian crises. The fourth pillar calls for
preparing for, mitigating, and addressing second-order economic,
civilian security, stabilization, and governance. I am concerned that
this strategy does not adequately address the issues of fragility and
focuses instead on the emergent needs of the pandemic.
Will you advocate for a U.S. Government strategy to combat COVID-19
that includes a focus on fragility and adequately addressing the issues
that will be exacerbated by the global pandemic and contribute to the
increased spread of violence and violent extremism?
Answer. Since the outbreak of COVID-19, the State Department and
USAID have committed more than $1.3 billion in emergency health,
humanitarian, economic and development assistance to help fight the
pandemic. A portion of this assistance helps governments, civil
society, and the private sector to prepare for, mitigate, and address
the second-order economic, civilian-security, stabilization, and
governance effects in fragile states caused by COVID-19. This includes
over $13 million dollars committed thus far to Pillar IV programming in
fragile states and an additional $11 million to peace and security
programming. This work will promote democracy in Libya, support media
and civil society organization-led awareness campaigns in the DRC and
the Central African Republic (CAR), and improve the capacity of host
country governments in the Sahel to communicate COVID-19 prevention,
management, and response messages. The Global Fragility Act and its
associated strategies and plans will be a crucial tool in successfully
addressing COVID-19's impact on conflict and fragility.
Question. How will the State Department seek to develop a Global
Fragility Strategy that addresses the increased risk that COVID-19
presents in fragile states?
Answer. The White House is coordinating an interagency process to
implement the GFA and corresponding Global Fragility Strategy. The
Department of State leads the drafting and execution of the GFS, with a
five-phase approach that includes initial scoping, consultation,
drafting, country and region selection, and country plan development.
The GFS will help identify the underlying causes of fragility,
violence, and conflict; articulate more effectively how to use U.S.
taxpayer dollars; foster greater transparency, accountability, adaptive
and locally-based approaches; and demand measurable and meaningful
outcomes. Underpinning the development of the GFS is a dynamic analytic
approach that can take into account new and evolving developments,
including the impact and risks that COVID-19 will have on fragility and
conflict. By pursuing an innovative, data-driven, consultative approach
through the GFA, the U.S. Government can better mitigate threats to its
core national security interests and more effectively address the
drivers of global conflicts and fragility.
______
Responses of Mr. Chris Milligan to Questions
Submitted by Senator Chris Coons
Question. On April 28, Acting Administrator Barsa released a press
statement on the New Partnerships Initiative where he focused on the
COVID-19 response, saying that ``USAID is pursuing all options for an
effective response, including by working with new or underutilized
partners that can provide innovative, scalable solutions to address the
pandemic.'' What results has the agency achieved in utilizing new and
underutilized partners to date in combatting the consequences of the
global pandemic around the world?
Answer. Throughout our response to the COVID-19 pandemic, USAID is
committed to working with new, underutilized, local, and locally
established partners as defined by our New Partnerships Initiative.
Thus far, just over 4 percent of our total obligations for COVID-19
funds have gone to new and underutilized partners, totaling over $26.4
million. Additionally, many of USAID's prime partners are expanding
their association with local sub-partners to effectively respond to
COVID-19.
______
Responses of Mr. Garrett Grigsby to Questions
Submitted by Senator Chris Coons
Question. Do you believe U.S. based, multinational companies will
be adversely impacted by WHO policy recommendations once the Trump
administration terminates its relationship with the WHO?
Answer. The United States will continue to advocate for U.S.
companies, as appropriate, in multilateral fora directly or in
collaboration with allies. We will work together to ensure that policy
recommendations are based on science and the best available evidence
and do not disadvantage American interests.
Question. Do you believe that the United States has more or less
leverage to advocate for the interests of U.S. based, multinational
companies in the WHO after termination of the U.S. relationship with
the WHO?
Answer. The United States will participate actively and advocate
effectively for its interests, including, as appropriate, the interests
of the U.S. private sector. This is also why the WHO reform package the
U.S. Government is leading on is necessary and why we have proposed
that trade and travel restrictions be delinked when responding to
health emergencies. This particular reform would seek to ensure that
private sector partners can continue to deliver products and produce
needed health supplies and get these goods into the hands of those who
need them.
COVID-19 AND U.S. INTERNATIONAL PANDEMIC PREPAREDNESS, PREVENTION, AND
RESPONSE
PART 2: COVID-19 AND U.S. INTERNATIONAL PANDEMIC PREPAREDNESS,
PREVENTION, AND RESPONSE: ADDITIONAL PERSPECTIVES
----------
TUESDAY, JUNE 30, 2020
U.S. Senate,
Committee on Foreign Relations,
Washington, DC.
The committee met, pursuant to notice, at 10:05 a.m. by
videoconference, Hon. James E. Risch, chairman of the
committee, presiding.
Present: Senators Risch [presiding], Menendez, Cardin,
Shaheen, Gardner, Udall, Murphy, Merkley, Perdue, and Booker.
OPENING STATEMENT OF HON. JAMES E. RISCH,
U.S. SENATOR FROM IDAHO
The Chairman. Well, good morning, everyone. The hour of
10:00 a.m. having arrived, I am going to call this meeting of
the Foreign Relations Committee to order.
And I want to thank all of you for participating. We have
very important business for the committee today, and this is
the second in a series on the international response to the
COVID-19 pandemic and what we can do about it in the future of
prevention, preparedness, and response.
Let me take just a moment to talk about what we are
attempting to do here. You know, around here in the Senate,
exaggeration and hyperbole is kind of the order of the day, and
so I am always reluctant to say this truly could be one of the
most important things we, as members of this committee, do.
What the world is experiencing today, what the United
States of America is facing today, is one of the most
significant challenges that a lot of us will face in our
lifetime.
The bad news, the really bad news, is that it is entirely
possible that it will happen again, and I say this, of course,
because the experts tell us that this virus that made the leap
from one species to another, from bat species to human species,
can very easily happen again and that there are 2,000 of these
viruses out there. We have no idea what they can do when they
get into a human being.
The bat populations, the experts and scientists tell us,
have had identified within their ranks about 2,000 different
viruses.
So having said that, we need to look forward, and I want to
stress what I am trying to do with this and what I hope all of
us will be joining and trying to do is to look forward.
I believe there is a lot of hearings going on. There is a
lot of hyperbole going on. There is a lot of finger pointing
and a lot of blame assignment.
But that is not what I am trying to focus on here and I
hope we would all avoid that. Certainly, a person cannot help
but think about how this happened, who is responsible for this,
who could have done things better.
We do want to see how we could do things better. But I
would hope, I would sincerely hope, that all of us are
committed to the idea that what we are trying to do is to keep
from happening--keep this from happening again, not trying to
tar and feather somebody that should have done things better in
the past.
I mean, there has been a number of criticisms levied
against the World Health Organization. I have spent a
considerable period of time talking to the people at WHO. I
have been impressed with the fact that they themselves
recognize that things should be looked at, and they, like us,
are--would really like to see that things work better in the
future. Heaven help us if this happens again.
In any event, to that end, there has been legislation
prepared. There has been a number of pieces of legislation, and
I am going to urge the committee in the strongest way possible
for everyone to get together and pull the wagon on this to get
to the place where we can have a piece of legislation that will
actually help in the future.
As I said, there is--this future is so important when it
comes to how we react next time. It is going to be very
important, particularly if it turns out to be a worse virus
than what--the world is not going to know probably what we did,
and if we fail they probably will not even know that we made an
effort at it.
But all of us run for these offices because we want to make
a difference, particularly into the future, and this is our
opportunity to do this.
This is my 40th year in a Senate body. I led a Senate body
over two decades. I know good-faith effort when I see it, and I
have seen a lot of good-faith effort here on a bipartisan basis
to develop something as we go forward in the future.
There is--of the 22 members on this committee, there is a
tremendous pool of talent here on both sides of the aisle.
Ranking Member Senator Menendez has spent many, many years
in the service of the United States, dealing with the
challenges, and they are challenges that we face with other
countries. He brings that to the table, and much more.
Across this committee, we have people who are--have been
deeply involved in Committees on Health and Human Services, on
Homeland Security, on Armed Services, Intelligence, and other
committees. Everybody brings something to the table.
What I am hoping is we have a product that will reflect the
best of all of us in bringing the matter into a bill. As I have
said over and over again, the bill that myself and Senator
Murphy have introduced is written on paper. It is not written
on stone.
We want the best possible ideas and the best possible
outcomes as we move forward. And everything is on the table and
there is no pride of authorship here, and I hope everyone can
set aside preconceived notions and move forward when we need,
obviously, a more innovative approach to be brought to this
problem, as it, hopefully, but probably will exist in the
future. Hopefully, it will not, but probably will, exist in the
future.
We are fortunate to have with us a panel of experts with an
impressive range of expertise today for infectious disease
detection and treatment, diplomatic engagement, and emergency
response, and we know that all of these are incredibly
important as we put together a holistic approach to this
problem.
Each of you bring something unique to the table. Thank you
for sharing your insights today. In our last hearing, we
focused on a number of key issues including the need for World
Health Organization reform.
Again, simply because we talk about the World Health
Organization reform we do not want to demonize people who have
made incredible efforts to try to address the problems we have
today.
I am aware of the challenges and differences that several
of our panelists faced when they worked with World Health
Organization during the Ebola outbreak in West Africa, which,
ultimately, led to a number of things that bring us to where we
are here today.
While some structural improvements have been made to the
World Health Organization since the Ebola situation, it appears
we may be repeating history today, though on a much grander and
deadlier scale. After Ebola, of course, the Global Health
Security Agenda was formed and it did not get us where we need
to be either.
Some have suggested that the World Health Organization has
neither the mandate nor the capacity to hold countries
accountable for failing to uphold obligations under the
international health regulations, and that probably can be
fixed.
Indeed, as I talked with the World Health Organization,
they made credible cases as to why they could not do some of
the things that they really wanted to do. Those are things that
we really need to--others have suggested that the World Health
Organization does not have the will. That is a harder fix. But,
again, we need to focus on what we could do about it.
And so it is only appropriate for us to recognize what the
World Health Organization is. It is a convening mechanism, a
guardian of things, and a clearinghouse of norms and best
practices, and we probably out to examine our own consciences
and ask us if we are asking the World Health Organization to be
something that it is not.
I have repeatedly asked what entity to call when an
outbreak begins before it gets out of control. What entity is
the fire department?
Again, I want to especially say that we should avoid
condemning what happened in the past and look forward to the
future. I have repeatedly been disappointed by the response as
to who is the fire department.
One thing is clear. It is not the World Health
Organization, at least not as it exists today. That does not
mean it cannot be fixed.
So what entity is it and what entity responds to the alarm?
The mandate capacity and will do not yet exist to whom and
where should that be vested.
That question is wide open and the answer that we need and
the right answer is not an answer that is dictated by
politically taking sides.
What entity raises the alarm? How can we approve and expand
early warning at a global level so we can get ahead of an
outbreak before it gets out of control?
The Global Health Security Agenda provides a useful and
only a framework for addressing these issues. How can we more
effectively operationalize it?
As I said, our suggestions to point is only for discussion
and written on paper, not stone. And how can we incentivize
countries to prioritize global health security, strengthen
preparedness and response, and share critical global health
data? Is there a way we can better support countries that have
demonstrated will but a low capacity to operationalize?
More importantly, how do we incentivize innovation
including from development, manufacturing, and equitable
deployment of vaccines are a couple of the issues.
These are difficult challenges that require serious
solutions. Though we are rightly focused on the immediate
COVID-19 response, particularly as the Southern Hemisphere
moves into the winter months, we cannot afford to wait.
This is not our first pandemic, and unless we can figure
out some solutions, it will not be our last. We have put a
number of ideas forward in a bipartisan bill, the Global Health
Security and Diplomacy Act.
It is a bill that we hope everyone will take as a starting
point and as a discussion point. I am hopeful that our
discussions today will help us further refine the ideas in that
bill so we can answer these questions, chart a responsible path
forward, save lives, and ultimately protect America from future
waves of infection.
I have been impressed by the way the committee had been
working together. We are taking ideas from everyone. Senator
Murphy and I continue to meet to try to--to try to
operationalize the ideas that we are getting from other members
of the committee.
I thank our witnesses for their contributions to this
inquiry. Yet, I strongly urge that if we are to succeed, and we
must succeed for the future of America and the future of the
world. We work on solutions and not necessarily on focusing of
the failures of the most recent response.
[The prepared statement of Senator James E. Risch follows:]
Prepared Statement of Senator James E. Risch
We will now convene the second hearing in a series on the
international response to the COVID-19 pandemic, and the future of
preparedness, prevention, and response.
We are fortunate to have with us a panel of experts with an
impressive range of expertise--from infectious disease detection and
treatment, to diplomatic engagement and emergency response.
You each bring something unique to the table. Thank you for sharing
your insights today.
During our last hearing, we focused on a number of key issues,
including the need for WHO reform.
I am aware of the difficulties several of our panelists faced when
working with the WHO during the Ebola outbreak in West Africa--which
ultimately led to a decision not to fund the WHO appeal, to request an
interim review of the WHO's performance, and to advance a broader WHO
reform agenda.
While some structural improvements have been made since, it appears
we may be repeating history--though on a much grander and deadlier
scale.
Some have suggested that the WHO has neither the mandate nor the
capacity to hold countries accountable for failing to uphold
obligations under the International Health Regulations. That can
probably be fixed.
Others have suggested that it does not have the will. That's a much
harder fix. And so perhaps it's time for us to recognize what the WHO
is--a convening mechanism, a guardian of the IHR, and a clearinghouse
of norms and best practices--and stop asking it to be something it's
not.
I've repeatedly asked, ``Who do we call when an outbreak begins,
before it gets out of control? Who is the fire department?''
I've repeatedly been disappointed by the response.
One thing is clear--it's not the WHO. At least not today.
So who is it? Who responds to the alarm? If the mandate, capacity,
and will do not yet exist, to whom and where should they be vested?
Who raises the alarm? How can we improve and expand early warning
at a global level, so we can get ahead of an outbreak before it spins
out of control?
The Global Health Security Agenda provides a useful framework for
addressing these issues. How can we more effectively operationalize it?
And how can we incentivize countries to prioritize global health
security, strengthen preparedness and response, and share critical
global health data?
Is there a way we can better support countries with demonstrated
will but low capacity?
And, importantly, how do we incentivize innovation, including for
the development, manufacturing, and equitable deployment of vaccines
and counter-measures?
These are serious challenges that require serious solutions.
While we are rightly focused on the immediate COVID-19 response--
particularly as our friends in the Southern Hemisphere move into the
winter months, and infections accelerate in places like Brazil, India,
and across Africa--we cannot afford to wait.
This is not our first pandemic and, unless we can figure out some
solutions, it won't be the last.
I've put a number of ideas forward in a bipartisan bill, the Global
Health Security and Diplomacy Act. It's a bill that is written on paper
and not on stone, and it continues to evolve.
I am hopeful that our discussion today will help us further refine
the ideas in that bill, so we can answer these questions, chart a
responsible path forward, save lives, and, ultimately, protect America
from future waves of infection.
I thank our witnesses for their contributions to this important
effort.
With that, I will ask Ranking Member Menendez if he wishes to make
any opening remarks.
The Chairman. With that, I thank everyone again for joining
us today. I will urge everyone to work in good faith to try to
actually reach some conclusion. With that said, it is, I think,
one of the most important things we will probably do with our
service here in the United States Senate.
With that, I want to recognize Senator Menendez for his
remarks.
STATEMENT OF HON. ROBERT MENENDEZ,
U.S. SENATOR FROM NEW JERSEY
Senator Menendez. Thank you, Mr. Chairman. Thank you for
convening another hearing on the ongoing COVID-19 pandemic.
As of June 26, 2020, the World Health Organization had
recorded just under 9.5 million confirmed cases of COVID-19 and
more than 484,000 deaths worldwide. More than 2 million of
those cases are right here in the United States.
This disease has claimed more than 120,000 American lives
in the span of 5 months. I know it well because, unfortunately,
at least 14,000 to 15,000 of those are from my home state of
New Jersey.
And it has proven resilient and pernicious, with new spikes
across the United States and China, and alarming increases in
the number of cases in South Africa, India, and Brazil.
This pandemic presents one of the most complex and novel
threats the United States, indeed, the world has faced in
several generations and it is clear that even if we stop the
spread of the disease here, which we certainly have not,
without a serious global effort to understand and confront it,
COVID-19 can and will return to our shores.
If ever there was a need for the United States to be an
active leader in an international coalition to respond to a
common threat, it is now. We simply cannot safeguard American
lives without one.
Unfortunately, the United States has not yet risen to meet
this challenge. We have seen a haphazard response, going so far
as to effectively withdrawing from the very international
institution best poised to respond to this crisis.
We have alienated critical partners and have been absent at
critical convening meetings, all of this at the expense of the
health and safety of the American people.
I believe there is more America can and must do, and that
Congress has a critical role to play. In good faith, as you
referred to, Mr. Chairman, in May all the Democratic members of
this committee introduced comprehensive legislation laying out
concrete actions the United States could take to lead in the
global response.
The COVID-19 International Response and Recovery Act, or
CIRRA, presents a clear strategy to confront the ongoing
pandemic and prepare the United States to deal with the next
and compels the Trump administration to constructively engage
with other countries, international organizations, and
multilateral fora to stop the spread of this deadly pandemic.
Specifically, our bill authorizes an additional $9 billion
in funding to fight the COVID-19 pandemic through contributions
towards vaccine research at the Coalition for Preparedness and
Innovations; a contribution to the Global Fund for AIDS,
Tuberculosis, and Malaria for its COVID-19 response mechanism;
additional funding for emergency overseas humanitarian
assistance in response to the pandemic, ensuring that these
funds are provided both to the U.N. for its global response
plan as well as directly to NGOs working on the front lines;
and a new surge-financing authority at the U.S. International
Development Finance Corporation that would allow the DFC to
expedite decisions and make strategic investments quickly to
aid in COVID-19 reconstruction efforts.
CIRRA also puts in place mechanisms to help us better
prepare for the next pandemic. It requires an annual
intelligence estimate on pandemic threats and establishes a
White House advisor for global health security to coordinate a
whole of government U.S. response to global health security
emergencies aimed at improving both domestic and international
capacity to prevent, respond, and detect epidemic and pandemic
threats.
It clearly delineates the role for the State Department,
USAID, and the Centers for Disease Control and Prevention in
responding to pandemic threats, and it directs the U.S.
executive director to the World Bank to begin negotiations to
establish a trust fund at the World Bank designed not to
compete with or supplant the World Health Organization, but to
work in tandem with the World Health Organization on
incentivizing countries to mobilize their own resources for
epidemic and pandemic preparedness.
Mr. Chairman, more than 700 Americans are dying each day.
Neither the finger pointing blame game, race-baiting statements
linked to the origins of the disease, nor a strategy centered
on denial will win the battle against COVID-19.
It is painfully apparent that Congress will have to lead in
this effort, just as it led in domestic relief and recovery
efforts.
I enjoy, appreciate, and embrace your call for us to
develop a proposal in the committee that boldly and robustly
addresses the current crisis, ensures that we are adequately
prepared for the next one, and aids countries across the globe
with recovery.
Anything less falls short of the legacy created through
initiatives such as the president's emergency plan for AIDS
relief and the Marshall Plan.
So I welcome our witnesses as well and look forward to our
discussion.
[The prepared statement of Senator Robert Menendez
follows:]
Prepared Statement of Senator Robert Menendez
Mr. Chairman, thank you for convening another hearing on the
ongoing COVID-19 pandemic. As of June 26, 2020, the WHO had recorded
just under 9.5 million confirmed cases of COVID-19, and more than
484,000 deaths worldwide. More than 2 million of those cases are right
here in the United States. This disease has claimed more than 120,000
American lives in the span of 5 months. And it has proven resilient and
pernicious, with new spikes across the United States and China, and
alarming increases in the number of cases in South Africa, India and
Brazil.
This pandemic presents one of the most complex and novel threats
the United States--indeed the world--has faced in a generation. And
it's clear that even if we stop the spread of the disease here--which
we certainly have not--without a serious global effort to understand
and confront it--COVID-19 can and will return to our shores. If ever
there was a need for the United States to be an active leader in an
international coalition to respond to a common threat, it is now. We
simply cannot safeguard American lives without one.
Unfortunately, the United States has not yet risen to meeting this
challenge. We have seen a haphazard response . . . going so far as to
effectively withdrawing from the very international institution best
poised to respond to this crisis. We have alienated critical partners,
and have been absent at critical convening meetings. All this at the
expense of the health and safety of the American people.
I believe there is more America can--must--do, and that Congress
has a critical role to play. In May, all the Democratic members of this
Committee introduced comprehensive legislation laying out concrete
actions the United States could take to lead in the global response.
The COVID-19 International Response and Recovery Act, or CIRRA [SEAR-
Ah], presents a clear strategy to confront the ongoing pandemic and
prepare the United States to deal with the next; and compels the Trump
administration to constructively engage with other countries,
international organizations, and multilateral fora to stop the spread
of this deadly pandemic.
Specifically, our bill authorizes:
An additional $9 billion in funding to fight the COVID-19
pandemic through contributions towards vaccine research at the
Coalition for Preparedness and Innovations;
A contribution to the Global Fund for AIDS, Tuberculosis and
Malaria for its COVID-19 response mechanism;
Additional funding for emergency overseas humanitarian
assistance in response to the pandemic, ensuring that these
funds are provided both to the U.N. for its global response
plan as well as directly to NGOs working on the front-lines;
And a new surge financing authority at the U.S.
International Development Finance Corporation (DFC) that would
allow the DFC to expedite decisions and make strategic
investments quickly to aid in COVID-19 reconstruction efforts.
CIRRA [SEAR-ah] also puts in place mechanisms to help us better
prepare for the next pandemic. It requires an annual National
Intelligence Estimate on pandemic threats, and establishes a White
House advisor for global health security to coordinate a whole of
government U.S. response to global health security emergencies, aimed
at improving both domestic and international capacity to prevent,
respond and detect epidemic and pandemic threats.
It clearly delineates the roles for the State Department, USAID and
the Centers for Disease Control and Prevention in responding to
pandemic threats. And it directs the U.S. Executive Director to the
World Bank to begin negotiations to establish a trust fund at the World
Bank designed not to compete with or supplant the World Health
Organization, but to work in tandem with the WHO on incentivizing
countries to mobilize their own resources for epidemic and pandemic
preparedness.
Mr. Chairman, more than 700 Americans a day are dying. Neither the
finger pointing blame game, race-baiting statements linked to the
origins of the disease, nor a strategy centered on denial will win the
battle against COVID-19. It is painfully apparent that Congress will
have to lead in this effort, just as it's led domestic relief and
recovery efforts.
I encourage us to develop a proposal in this Committee that boldly
and robustly addresses the current crisis, ensures that we are
adequately prepared for the next one, and aids countries around the
globe with recovery. Anything less falls short of the legacy created
through initiatives such as the President's Emergency Plan for AIDS
Relief, and the Marshall Plan.
I welcome our witnesses, and look forward to our discussion.
The Chairman. Thank you, Senator Menendez. Well spoken. I
think that your reference to the success that we have in
addressing the AIDS pandemic is appropriate.
When I started out to construct the bill, it was, as I
said, a starting point. I used the successes that PEPFAR had.
Certainly, if we can replicate that for future pandemics, I
think we will all be given a great credit--that is another
issue.
Your remarks about the United States being the leader in
this are absolutely right. We have a moral obligation based on
our standing in the world and we should come together to do
that.
Those ideas--some of the ideas that you have had are novel
to me. Your discussion about an annual threat assessment of the
pandemic I think is appropriate. We have that every year on the
Intelligence Committee.
But, unfortunately, it is mixed with every other threat to
the United States and they are regional, and it gets a nod that
there is a threat of a pandemic it frequently takes the form of
assessing what terrorists would do or malign influences would
do and do not really focus on what a pandemic might look like.
And I think that part of that may be due to the fact that
these pandemics are different. Each one is different. It has
things that they are the same. But each virus has a different
way of acting and reacting in the world.
So it gets short shrift in the Intelligence Committee it
probably ought to be undertaken by either Health and Human
Services or by us or by someone who could spend a little bit of
time with it. So that is a great idea.
So with that, let us move to our panel. We have a very
impressive panel here today, and I must say that the last
panel, I thought, was good. It helped clear up my thinking on
this.
One of the things I learned, I think, from the last panel
about how there just is not a silver bullet, that it is going
to take a coordinated effort by many, many different agencies
and countries, and today we are going to take a little
different approach on that.
But these people have great experience. If we were to go
through each of their accomplishments, we would be here all
day. So with each of their forgiveness I am going to give just
very brief introductions first.
Our first witness is Ambassador Mark Dybul. He is an
accomplished diplomat physician and medical researcher. He
currently serves as a professor in the Department of Medicine
and as co-director of the Center for Global Health Practice and
Impact at Georgetown University.
He previously served as the executive director of the
Global Fund to Fight AIDS, Tuberculosis, and Malaria, and as
the U.S. Global AIDS Coordinator. Certainly an impressive
resume as he joins us today.
So with that, Ambassador Dybul, the floor is yours.
STATEMENT OF HON. MARK DYBUL, M.D., CO-DIRECTOR OF THE CENTER
FOR GLOBAL HEALTH PRACTICE AND IMPACT AND PROFESSOR IN THE
DEPARTMENT OF MEDICINE, GEORGETOWN UNIVERSITY MEDICAL CENTER
Dr. Dybul. Thank you, Chairman Risch, Ranking Member
Menendez, members of the committee. It is a great privilege to
be back before this important body.
I would like to thank the committee, the entire Congress,
for its steadfast bipartisan efforts to ensure the U.S. has
been the ongoing leader in global health for decades.
COVID-19 has made clear that a global pandemic requires a
global response and we are not quite there yet. But there is
good news. What is needed is not rocket scientists.
A number of countries who did well in the early stages of
COVID-19 were not faster at setting up systems. They already
had them. They were prepared. Therefore, they never had to
enforce total lockdowns.
Other countries rapidly put in place test, trace, and
quarantine systems, and as a result they were able to safely
begin reopening within 6 weeks, identifying and containing
additional outbreaks as they occur.
I am very grateful to the chairman as bipartisan co-
sponsors as well as to the ranking member for putting forward
proposals to help ensure the U.S. coordinates international
bilateral programs and to ensure non-duplicative multilateral
institutions.
I listened with great interest to the hearing the committee
held on June 18th. From my experience, I would like to offer
with all humility one perspective on the chairman's question,
who is the fire department; who may we call.
From a bilateral perspective, the proposal to create a
coordinator at the State Department resonates. From the
perspective of legislative oversight, the coordinator would
seem to be the fire department for bilateral engagement.
When PEPFAR was developed, and I was fortunate to be
involved in the creation of the small group that put together
the plan, we struggled with where to house it.
A coordinator at State was, to paraphrase Churchill's quip
on democracy, the worst approach except for everything else.
Multiple parts of the U.S. government must be engaged in global
health, as you noted, including pandemics.
USAID is deeply involved in many aspects of health as well
as those that impact health and, of course, USAID leads on
humanitarian responses.
CDC is the premier government health organization in the
world. It is the only agency in the U.S. government
armamentarium that spans domestic and global engagement,
including pandemics, and is involved with, provides technical
support to, and is looked to and respected by governments and
institutions in high, middle, and low income countries. And as
we know from this pandemic, we must be involved with every
country.
CDC is built for what is most needed for; global and
national pandemic preparedness and response. However, more than
with PEPFAR, the national security apparatus is needed, as you
both noted.
That requirement complicates full coordination from the
Department of State. In that regard, it is important to note
that both of the proposals identify the essential role of the
National Security Council, as has been noted.
Perhaps there is also an opportunity for cross-committee
authorization and preparation legislation, which is now without
some precedent.
From a multilateral perspective, the world has come
together and created the Global Health Security Agenda, or
GHSA, as has been noted.
However, GHSA is not the fire department. GHSA provides an
action plan for every country to have an Emergency Operation
Center, or EOC, capable of mounting a response to an outbreak
within 2 hours.
At least in my view, the EOC must also be responsible for
continual surveillance down to the community level with
systematic reporting to rapidly detect an outbreak.
We need a global EOC as the fire department. The global EOC
should be multi-sectoral and the principal functions of it
would be to learn from the past what has worked and not worked
during previous epidemics and pandemics to conduct regular
simulations of local outbreaks with national, regional, and
global responses to them, rigorously interrogating gaps and
weaknesses, to support regional and national EOCs to be fully
operational, and coordinate with a financing mechanism, what we
will call the fire hydrant, to help ensure optimal use of
resources.
A global effort on pandemics and a global EOC cannot be
effective without the deep engagement of WHO. It is a necessary
although not sufficient player. In my view, WHO has done a good
job under the circumstances and has vastly improved from Ebola.
I have known the director general, Dr. Tedros, since 2004
when he was the newly-installed junior administrator. I watched
him systematically transform one of the worst-performing
ministries of health in the world to one of the best.
He has been a steadfast partner and ally of the U.S. and
global health, and he has taken on a difficult vast task of
reforming WHO and has made significant strides.
As the first African director general, he also has the
unwavering support of African countries, and as the second most
populous continent, Africa's total engagement is essential for
pandemic detection and control.
Finally, I know from experience that the U.S. can best
drive reform when we are fully engaged. You cannot place a bet
if you are not at the table, and if we are not at the table
others are ready to step in and take our place, including China
and Russia.
In my view, a financing facility, the fire hydrant, related
to but organizationally separate from a global EOC, would
create the optimal conditions for success.
One already exists to procure vaccines for low- and middle-
income countries, Gavi, the Vaccine Alliance. However, there is
a great deal of preparedness, detection, and response that
needs to be funded before and after a vaccine becomes available
and for future pandemics.
The principal function of the fire hydrant would be to
finance the priorities identified by the global, regional, and
national EOCs, the fire departments.
I appreciate the discussion of Gavi and the Global Fund
models during the government panel hearing. Of course, the
World Bank houses catalytic and trust funds, as the ranking
member noted, and something could be created new.
All have pros and cons. It seems to me the best approach
would be for the Administration to play a leadership role,
working with key governments and stakeholders in a time bound
way with parameters set by Congress to identify the most likely
mechanism to succeed, now and for the future; succeed in the
tracking funds and implementing pandemic preparedness,
detection, and response.
In the short term, Congress has an important opportunity.
This committee has a long history of supporting both U.S.
leadership and the commitment of significant resources.
Including at least $12 billion in the HEROES Act will save
lives, help protect the U.S. from additional waves of this
pandemic and send an important message abroad as well as here
at home.
And there is no time to lose. You might have seen the
troubling report today of a new swine flu. While there is yet
no reported human-to-human contact, there is reason for concern
the next pandemic might be upon us.
Mr. Chairman, Ranking Member, members of the committee, no
country is safe and no one is safe until everyone is safe.
The good news is that this is one of the most solvable
problems facing the world. Throughout history we have seen that
when we come together and look forward, outward, and with hope,
there is no problem we cannot solve and, in particular, the
U.S. has shown that when we take a leadership role, it is in a
blessing of enlightened self-interest, serving others while
protecting and promoting our interests and our lives.
I thank the committee for what you are doing to lead again.
[The prepared statement of Dr. Dybul follows:]
Prepared Statement of the Honorable Mark Dybul, MD
Chairman Risch, Ranking Member Menendez and members of the
Committee: It is a privilege to be back before this important body. I
would be remiss if I did not thank this Committee and the entire
Congress for its steadfast, bipartisan efforts to ensure that the USA
has been the unquestioned leader in global health for decades.
Most people living in the USA, Europe and many other countries are
experiencing for the first time the devastating impact of a rapidly
spreading and deadly global pandemic. There have been scares--SARS,
MERS, H1N1 Influenza and Zika, among others. Fortunately, those
epidemics were limited in their scope and scale.
COVID-19 has made clear that a global pandemic requires a global
response. While we have the outlines of a global response, it needs to
be strengthened by reforming existing structures and identifying
financing mechanisms that will build on the uneven response to this
crisis. Thank you for taking up the remarkably important issue of
controlling this pandemic and focusing on preparedness for the next
one.
Unfortunately, it is likely this will not be the last pandemic we
will experience. Changes in climate and weather patterns, population
growth, increased contact with animals and a highly mobile global
population create the conditions conducive to pandemics.
The task before the world is to work to ensure that all countries
can respond to the current threat, but also to be ready for the next
one.
But there is good news: what is needed is not rocket science. A
number of countries that did well in the early stages of COVID-19 were
not faster at setting up systems to respond--they already had them.
From the relatively high-tech South Korean to the relatively low-
tech Taiwanese approaches taken, the devastating experiences from SARS
and/or MERS propelled them to develop, establish and maintain effective
systems for sentinel surveillance, testing, contact tracing and
quarantine. They performed simulations of outbreaks to identify and
fill gaps and to stay alert. They stockpiled key commodities. They were
prepared. Therefore, they never had to enforce total lockdowns.
Other countries, for example Germany, rapidly put test, trace and
quarantine systems in place. As a result, they were able to safely
begin reopening within 6 weeks, identifying and containing additional
outbreaks as they occurred--and continue to occur.
I am grateful to the Chairman and his bipartisan co-sponsors, as
well as to the Ranking Member for putting forward proposals to help
ensure the U.S.A. coordinates its international bilateral programs and
to ensure complementary, non-duplicative multilateral institutions so
the world can be prepared and rapidly detect and respond to continued
and new waves of COVID-19, and to future pandemics.
I listened with great interest to the hearing the Committee held on
June 18 with Government witnesses, all good people working hard in
challenging times.
From my experience as one of the principal architects, and then as
the head, of the President's Emergency Plan for AIDS Relief (PEPFAR)
under President George W. Bush, and as someone who has been involved
deeply in multilateral organizations, including as the Executive
Director who led the transformation of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, I would like to offer, with all humility, one
perspective on the Chairman's question: ``Who is the fire department?
Whom do we call?''
For those interested in more detail, please refer to a White Paper
on the need for a Global Response to COVID-19 published with colleagues
from Georgetown University and Dr. Peter Piot.\1\ Please also refer to
the Report of the CSIS Commission on Strengthening America's Health
Security--co-chaired by a former member of this chamber and former
Director of CDC--on which both Ambassador Kolker and I served.\2\
bilateral perspective
Proposals to create a Coordinator at the Department of State
resonate. Perhaps that is not surprising since I served as the U.S.
Global AIDS Coordinator in the State Department. From the perspective
of Legislative oversight, the Coordinator would be the fire department
for bilateral engagement.
When PEPFAR was developed, we struggled with where to house it. A
Coordinator at State was, to paraphrase Churchill's quip on democracy:
the worst approach--except for everything else.
Like COVID-19, the HIV pandemic is caused by a virus that jumped
from animals to humans. Fortunately, unlike HIV, COVID-19 is not yet
wiping out a generation in Sub-Saharan Africa. We knew what this
Committee knows, and what the Government panel verified a few weeks
ago: to be prepared for and combat a global pandemic, multiple parts of
the U.S. Government must be engaged. We also knew from reviewing past
experiences that selecting one implementing agency to receive all of
the funds and then fully embrace, engage and fund other implementing
agencies stretches beyond the bureaucratic breaking point.
USAID is deeply engaged in many aspects of health as well as
overall development efforts that impact health, such as education,
economic security, agriculture and nutrition, water, sanitation and
hygiene (WASH) required for hand-washing to prevent COVID-19 and many
deadly diseases. And of course, USAID leads on humanitarian responses.
CDC is the premier government health organization in the world. It
is the only agency in the U.S. Government armamentarium that spans
domestic and global health and that is engaged with, provides technical
support to and is looked to, and respected by, governments and
institutions in high-, middle- and low-income countries. These unique
characteristics are essential in pandemic preparedness and response. It
leads in sentinel surveillance, testing, laboratory capacity and public
health capacity. It has already supported countries to implement GHSA
that resulted in strong responses to COVID-19. CDC is built for what is
most needed for global and national pandemic preparedness and response.
More than with PEPFAR, the national security apparatus is needed
for other pandemics. While the Department of Defense is a key part of
PEPFAR, it is a relatively small piece of the budget and relates mostly
to work with HIV prevention, care and treatment in foreign militaries.
For global health security, there is a much bigger role including
identification of outbreaks, potential in emergency responses, such as
transportation, logistics and deployment of field hospitals as was done
with Ebola. The need for significant engagement of the national
security departments and agencies complicates full coordination from
the Department of State. In that regard, it is important to note that
both proposed bills identify the essential role of the National
Security Council. Perhaps there is also an opportunity for cross-
Committee Authorization and Appropriation legislation, which is not
without some precedent.
multilateral perspective
The world has come together and created the Global Health Security
Agenda (GSHA), including 67 countries, international organizations, the
private sector, communities and others. It provides a good framework
and sensible ``action packages''. However, GHSA it is not the fire
department.
In the limited time available, I would like to focus on two
organizations that I believe are needed: the fire department and the
fire hydrant.
The Fire Department: A Global Emergency Operations Center
GHSA provides an action plan for every country to have an Emergency
Operations Center (EOC) capable of mounting a multi-sectoral response
to an outbreak within 2 hours. At least in my view, the EOC must also
be responsible for continual surveillance down to the community level
with systematic reporting to rapidly detect an outbreak at the earliest
possible stage.
We need a global EOC as the fire department. This is not a new
concept. Bill Gates, myself and others have been calling for some
version of this--often called a Task-Force--for a number of years. Of
course, there is a lot involved in a global EOC. Managing the many
viewpoints and equities will not be easy. But neither was creating
PEPFAR, Gavi (the Vaccine Alliance) or the Global Fund. It is time to
exert the energy to get it done.
The global EOC should be multi-sectoral, including key
organizations for health, economics, security and include the private
sector and civil society communities, including the faith community. In
the end, everything will work or fall apart at the community level. The
principal functions of the EOC would be similar to national EOCs:
Learn from the past: what has worked and not worked at the
global, regional and national levels during previous epidemics
and pandemics (as South Korea, Taiwan and others did after
their SARS and/or MERS epidemics);
Conduct regular simulations of local outbreaks with
national, regional and global responses to them, rigorously
interrogating gaps and weakness;
Use the knowledge gained from the past and regular
simulations to evolve the global EOC to be maximally effective
and to support regional and national EOCs to be fully
operational; and
Coordinate with a financing mechanism, the fire hydrant, to
help ensure optimal use of resources.
The Central Role OF WHO
It has been said ``If WHO didn't exist, we would create it.''
Perhaps as with the PEPFAR coordinator it is the worst approach--except
for every other option. But a global effort on pandemics, and a global
EOC, cannot be effective without the deep engagement of WHO. It is a
necessary, although not sufficient, player.
In my view, WHO has done a good job under the circumstances. And it
has significantly improved. There is no real comparison between the
deeply flawed response to Ebola and the initially flawed, but overall
improved performance of WHO during COVID-19.
The current Director General, Dr. Tedros Adhanom Ghebreyesus, is a
committed public health servant and diplomat. I have known Tedros since
2004 when he was the newly installed junior Minister of Health and I
was the U.S. Deputy Global AIDS Coordinator. I watched him
systematically transform one of the worst performing ministries of
health in the world to one of the best performers. He has been a
steadfast partner and ally of the U.S.A. in global health. He has taken
on the difficult task of reforming WHO and, only a few years in, has
made significant strides, including reorienting an institution
resistant to change from headquarters to the countries.
As the first African Director General, he also has the unwavering
support of African countries, who for the first time voted in a block
to elect him. As the second most populous continent, Africa's total
engagement is essential for pandemic detection and control.
Finally, as an official of the Bush administration, including
preparation for G7 Summits, and then as Executive Director of the
Global Fund, I know that the U.S.A. can be most effective in reforming
institutions when it is fully engaged. In part because we bring deep
expertise and financial resources, and in part because I know from
experience that you can't place a bet if you aren't in the game. And if
we are not at the table, others are ready to step in and take our seat:
China and Russia.
The Fire Hydrant: A Financing Mechanism
The significant progress on childhood vaccinations, HIV,
Tuberculosis and Malaria has demonstrated that a financing mechanism
separated from normative and deep-bench technical functions can be
highly valuable. In my view, a financing facility related to, buy
organizationally separate from, a global EOC would create the optimal
conditions for success. One already exists to procure vaccines for low-
and low-middle income countries: Gavi, the Vaccine Alliance. It was
wonderful to see the significant pledge made by the U.S.A. at the
recent Gavi replenishment conference.
However, there is a great deal of preparedness, detection and
response that needs to be funded before and after a vaccine becomes
available.
The principal function of the financing mechanism--the fire
hydrant--would be to finance the priorities identified by the global,
regional and national EOCs--the fire departments.
I appreciated the discussion of the Gavi and Global Fund models
during the Government panel hearing. Of course, the World Bank houses
catalytic and trust funds. And something new could be created. All have
pros and cons. Again, similar to the PEPFAR Coordinator, and for that
matter the structure of many organizations, we might have to settle for
the least bad option.
It seems to me that the best approach would be for the
Administration to play a leadership role working with key governments
and stakeholders in a time-bound way and with direction and parameters
set by Congress, to identify the most likely mechanism to succeed now
and for the future in attracting funds and implementing pandemic
preparedness, detection and response. This was the approach taken with
the creation of the Global Fund, in which the U.S. Government was
deeply involved, and Gavi.
short-term opportunity
Global and American partners are looking for a sign that the U.S.
will, once again, demonstrate its commitment to a comprehensive global
response. It is in our national security interest to do so. Investing
in the immediate response now and laying the foundation for the future
will require leadership and resources. This Committee has a long
history of supporting both. Including at least $12 billion in the
Heroes Act before Congress will save lives, help protect the U.S. from
additional waves of the pandemic and send an important message abroad
as well as here at home. A recent poll conducted by the U.S. Global
Leadership Coalition found that 72 percent of Americans support
including $10 to $15 billion for international assistance in the next
emergency package.
conclusion
We know from the massively destructive global pandemics of history
what, sadly, we needed to learn again from COVID-19. No country, and no
one is safe until everyone is safe.
But there is good news. This is one of the most solvable problems
facing the world--as countries who activated systems they built after
their SARS and MERS epidemics, and those who rapidly built those
systems and controlled the outbreak in 6-10 weeks and are now safely
reopening have shown.
Throughout history, we have seen that when we come together and
look forward, outward and with hope there is no problem we cannot
solve. And in particular, the U.S.A. has shown that when we take a
leadership role, it is a blessing of enlightened self-interest serving
others while protecting and promoting our interests--and our lives. I
thank the committee for what you are doing to lead--again.
----------------
Notes
\1\ See https://georgetown.app.box.com/s/
5snwu87gg0szfreu5oaqqdm21qwbs2ty
\2\ See https://healthsecurity.csis.org/final-report/
The Chairman. Well, thank you very much.
First of all, it is good to hear that when you--when
PEPFAR's structure was put together that you struggled with
where to house it because that has certainly been one of the
vexing issues that we have struggled with here and, of course,
have not reached a conclusion on that yet.
You also--I appreciate your remarks about the importance
that we have a place at the table. I think not only have a
place at the table but I think it--because of our unique
standing in the world, we need a very significant voice in how
to construct that.
Thank you. Thank you so much for your remarks.
We are now going to turn to Ambassador Kolker. Before
retiring in 2017, Ambassador Kolker served 30 years in the U.S.
diplomatic service, including as ambassador to Burkina Faso and
Uganda, and as deputy chief of mission in Denmark and Botswana.
He completed his government service as assistant secretary
for global affairs at the U.S. Department of Health and Human
Services where he represented the United States at WHO meetings
and as alternate board member of the Global Fund to Fight AIDS,
Tuberculosis, and Malaria.
With that, Ambassador Kolker, the time is yours.
STATEMENT OF HON. JIMMY J. KOLKER, FORMER ASSISTANT SECRETARY
FOR GLOBAL AFFAIRS, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Mr. Kolker. Thank you. Thank you very much, Chairman Risch,
Ranking Member Menendez, distinguished senators.
I am Jimmy Kolker and am honored to be with you today. I am
very proud to have been a State Department Foreign Service
Officer and with the Department of HHS for 5 years, as you
said.
And in those jobs I help develop and implement both the
President's emergency plan for AIDS relief and the Global
Health Security Agenda in the Obama administration.
These are two exceptional examples of global leadership,
which all Americans should be proud of. Starting with the
Global Health Security Agenda, some people have dismissed its
work because we did not prevent or adequately respond to the
novel coronavirus outbreak.
But five countries took actions because of GHSA with
extraordinary results in combating the novel coronavirus.
After mishandling the MERS outbreak in 2015, South Korea
became one of the most active members of GHSA, reviewing its
own procedures, and when COVID-19 hit it was ready with
surveillance and crisis management capacity developed through
GHSA efforts.
Uganda and Vietnam were the two pilot countries where the
U.S. Centers for Disease Control and Prevention helped develop
comprehensive prevention, detection, and response capacity.
Both have been positive examples in their regions of
controlling coronavirus and did so without extensive outside
help.
Likewise, the Republic of Georgia, through the involvement
of CDC and of the Department of Defense through the Lugar
Center managed coronavirus better than any other country in the
former Soviet Union.
And within the European Union, Finland, the first chair of
GHSA and its most enthusiastic initial backer, did an
exceptional job of preventing and controlling COVID-19.
So GHSA has some solid successes, and despite some
justified criticism, so does the World Health Organization. Its
Health Emergencies Program responded immediately to validate
and distribute a good diagnostic test for COVID-19.
The World Health Organization was the only organization
that could get Chinese approval for independent scientists to
enter China, and WHO, as they always would, included American
government experts in their delegation.
And the WHO also convened the first multi-stakeholder
meeting to look at access to eventual vaccines, treatments, and
countermeasures.
You asked, Mr. Chairman, who is the fire department; who
responds when there is an outbreak that threatens to become an
epidemic. My reply for that question is that there is no
alternative to WHO.
Others will be mobile, such as the CDC through the GOARN,
the Global Outbreak and Response Network, CEPI, the Coalition
for Epidemic Preparedness Innovation, and GISAID, a laboratory
network.
But WHO has to be at the core. After Ebola, with U.S.
leadership I was involved personally and we helped make WHO
more effective and we can do so again. The reforms that need to
be made, I can enumerate some of them later if senators wish.
But let me turn also to strengthening U.S. government's
leadership and capacity. I mentioned my experience with PEPFAR,
initially as ambassador to Uganda.
PEPFAR worked. It worked because it had, one, presidential
engagement and leadership; two, bipartisan support; three,
implementation organized country by country; four, significant
new money, initially, $15 billion over 5 years; and not least,
number five, a State Department coordinator but, I emphasize,
who was empowered because of that new money.
I support the establishment of a senior Global Health
Security and Diplomacy coordinator at State. But I support that
if and only if there is significant new money. Simply
redirecting USAID and CDC appropriations to STATE will result
in gridlock.
Additional new appropriations through State, on the other
hand, can foster innovation and can incentivize both USAID and
CDC to up their game, as PEPFAR did.
So how can experience make U.S. global health leadership
more effective? Here is some criteria I would use to evaluate
any new proposal.
One, as both proposals of Senator Risch and Senator
Menendez do, it should restore White House whole of government
expert leadership through a health security senior director at
the National Security Council.
It should be bipartisan. It should define responsibility
and division of labor for implementation, not just at
headquarters level.
It should recognize the unique role that embassy teams play
in allocating resources to build on the comparative advantages
of USAID, of CDC, and of other parts of the Department of
Health and Human Services.
And most important, any new proposal must request,
authorize, and appropriate through the appropriate committees
enough money for these agencies to do their work.
The proposal of $3 billion over 5 years is not enough. It
is less than the CSIS commission I was a member of
recommended--and I will put the cover there, give an
advertisement--recommended for preparedness even before COVID
hit.
The HELP Committee and HHS appropriators will have to come
up with billions more. And global health money in the HEROES
Act, as Mark mentioned, will--is likely also to be required to
reach health security goals.
Funding should also include more money for the World Health
Organization, a U.S. contribution to the Coalition for Epidemic
Preparedness Innovation, and an incentive fund for low-interest
countries--low-income countries, I am sorry, possibly through
the already created Health Emergency Preparedness Fund at the
World Bank.
I thank you for your attention and I welcome your
questions.
[The prepared statement of Mr. Kolker follows:]
Prepared Statement of Jimmy Kolker
Chairman Risch, Ranking Member Menendez, Distinguished Senators: I
am Jimmy Kolker, honored to be with you today and very proud to have
been a State Department Foreign Service Officer for 30 years and at the
Department of Health and Human Services for 5.
In those jobs, I helped develop and implement both President Bush's
Emergency Plan for AIDS Relief (PEPFAR) and the Global Health Security
Agenda in the Obama administration.
These are two exceptional examples of U.S. global leadership of
which all Americans should be proud.
the global health security agenda (ghsa)
Starting with the Global Health Security Agenda, I have heard
people dismiss its work because we did not prevent or adequately
respond to the novel coronavirus outbreak.
Five countries, however, took actions because of GHSA with
extraordinary results in combatting the novel coronavirus.
After mishandling the MERS outbreak in 2015, South Korea
became one of the most active members of GHSA, reviewing its
own procedures. When COVID-19 hit, it was ready with
surveillance and crisis management capacity developed through
GHSA efforts.
Uganda and Vietnam were the two pilot countries where the
U.S. Centers for Disease Control and Prevention helped develop
comprehensive prevention, detection and response capacity. Both
have been positive examples in their regions of controlling
coronavirus and did so without extensive outside help.
Likewise, the Republic of Georgia, through the involvement
of CDC and of DoD through the Lugar Center, managed coronavirus
better than any other country in the former Soviet Union
And within the European Union, Finland, the first chair of
GHSA and its most enthusiastic initial backer, did an
exceptional job of preventing and controlling COVID-19.
So GHSA has some solid successes.
the world health organization
And despite some justified criticism, so does the World Health
Organization.
Its Health Emergencies Program responded immediately to validate
and distribute a good diagnostic test for COVID 19.
The WHO was the only organization that could get Chinese approval
for independent scientists to enter China, and WHO, as they always
would, included American government experts in their delegation.
The WHO also convened the first multi-stakeholder meeting to look
at access to eventual vaccines, treatments and countermeasures.
who's the fireman
You asked, Mr. Chairman, at the previous hearing ``Who's the Fire
Department?'' Who responds when there is an outbreak that becomes an
epidemic?
My reply to that question is that there is no alternative to the
WHO.
Others will mobilize, such as the CDC through GOARN, the Global
Outbreak and Response Network, CEPI, the Coalition for Epidemic
Preparedness Innovation, and GISAID, a laboratory network. But WHO is
at the core.
After Ebola, with U.S. leadership, we helped make WHO more
effective and we can do so again. There are reforms that need to be
made, and I can enumerate some of them later if Senators wish.
strengthening the u.s. government's leadership and capacity
But let me turn to strengthening the U.S. Government's leadership
and capacity I mentioned my experience with PEPFAR, initially as
Ambassador to Uganda.
PEPFAR worked because it had:
presidential engagement and leadership;
bipartisan support;
implementation country-by-country;
significant new money, $15 Billion over 5 years; and, not
least
a State Department coordinator empowered because of the new
money.
I support the establishment of a senior Global Health Security and
Diplomacy coordinator at State. But if and only if there is significant
new money.
Simply redirecting USAID and CDC appropriations to State will
result in gridlock. Additional new appropriations through State can
foster innovation and incentivize both USAID and CDC to up their game,
as PEPFAR did.
what to look for in new proposals
How can experience make U.S. global health leadership more
effective? Here are some criteria I would use to evaluate any new
proposal.
It should restore White House whole-of-government expert
leadership through a health security senior director at NSC.
It should be bipartisan.
It should define responsibility and division of labor for
implementation.
It should recognize the unique role of embassy teams in
allocating resources to build on the comparative advantages of
USAID, CDC and other parts of HHS.
Most important, it requests, authorizes and appropriates
enough money for them to do the work.
The proposal of $3 Billion over 5 years is not enough. It is less
than the CSIS commission I was a member of recommended for preparedness
even before COVID hit. The HELP committee and the HHS appropriators
will have to come up with billions more. Global Health money in the
HEROES Act will be required to reach health security goals.
Funding should also include more money for WHO, the Coalition for
Epidemic Preparedness Innovation and an incentive fund for low income
countries, possibly through the Health Emergencies Preparedness Fund of
the World Bank.
Thanks for your attention and I welcome your questions.
The Chairman. Ambassador, thank you very much.
I think I appreciate your focus on the structure. That is,
although, not the most exciting thing in the world, it
certainly is one that is absolutely critical here. I think
without a structure we really are going to be lost.
I really appreciate all the other suggestions that you have
made and I would hope that you put those in writing and get
them to us so that as we are discussing this amongst ourselves
we can have this in front of us.
Again, thank you for your--thank you for your experience in
that regard.
Next, we have Dr. Jha. He is a physician, researcher, and
data enthusiast. I am not exactly sure what a data enthusiast
is. I have never met one before. But I am glad to hear we have
one here.
He is the K.T. Li Professor of Global Health at Harvard,
T.H. Chan School of Public Health, and the faculty director of
the Harvard Global Health Institute.
He is a practicing general internist and a professor of
medicine at Harvard Medical School. He holds an M.D. from
Harvard Medical School and an M.P.H. from the Harvard T.H. Chan
School of Public Health.
With that, Dr. Jha, we welcome you and maybe you can start
off by telling us what a data enthusiast is. So thank you for
joining us.
STATEMENT OF DR. ASHISH K. JHA, M.D., DIRECTOR, HARVARD GLOBAL
HEALTH INSTITUTE, CAMBRIDGE, MA
Dr. Jha. Chairman Risch and Ranking Member Menendez, and
members of the committee, it is indeed an honor to be here this
morning.
I do not think I have described myself as a data
enthusiast, but I do believe that data and evidence should
drive our decision making. So maybe that is--maybe that is the
idea.
But let me get to my testimony. We are in the middle of the
greatest global public health crisis in a century. Millions of
people around the world have gotten sick and hundreds of
thousands have died from this disease.
Despite this, our best estimates are that less than 2
percent of the world's population has been infected with this
virus. The global pandemic is just getting started.
And the single biggest obligation that I believe we all
have is to protect the lives and well-being of the American
people and the people around the globe, and this is why I
believe that the Administration's decision to withdraw from WHO
is so deeply unwise.
You know, Chairman Risch, there is some irony in my
testifying today in defense of WHO. You see, for years I have
been widely seen as a critic of WHO and rightly so.
I was one of WHO's harshest critics of its disastrous
handling of the Ebola outbreak in West Africa, and coming out
of that outbreak I co-chaired an international panel that
recommended major changes at WHO.
So did WHO change? In some ways, yes, and in other ways,
no. And WHO's response to COVID-19 has been better but no
perfect. After China informed WHO of a viral pneumonia outbreak
in Wuhan, WHO acted quickly and alerted the world.
And because both Ambassadors Dybul and Kolker have talked
about what the WHO has done well, let me focus for a minute on
what WHO has done poorly.
To me, the single biggest failure of WHO in this outbreak
has been the excessive praise for the Chinese government and
its handling of the outbreak.
The Chinese government's response is not worthy of praise.
They, clearly, hid the virus and silenced doctors and
scientists for weeks if not months. They delayed notifying the
world.
China is a major world power and we should expect better.
So I was disappointed to see WHO's lavish praise for China.
Disappointed, but not surprised, because WHO is a membership
organization and, as such, it has had a long tradition of
showering praise on governments even when those governments are
behaving poorly.
One of the criticisms of WHO has been that it did not stand
up to China, and I have to say I find this puzzling. I have
never understood what that could possibly mean.
WHO has no authority to compel China to do anything, any
more than it has authority to compel our government to act in a
certain way. WHO is a membership organization. It can only be
as effective as its members allow it to be.
And let me be clear in my testimony. I believe WHO can be
more effective. One of the areas where I think WHO can be more
effective is that its mission is too broad. It literally works
on every health-related issue in the world, and I believe WHO
should only do those things that only WHO can do.
So let us come back to how that might apply in this
pandemic. Walking away from WHO at this moment is an
extraordinarily bad idea. It will weaken WHO, which will harm
the world and harm Americans because WHO does critical work
that we all benefit from.
WHO is running the solidarity trial, which has patients
enrolled from 35 countries to find new treatments for COVID-19.
WHO is coordinating the procurement and delivery of vaccines
once they become available, and WHO is working closely with
ministries of health in nearly every low- and middle-income
country around the globe.
It takes visiting any ministry of health to realize the
integral role that WHO plays. WHO is a trusted partner to
ministries around the world, and if other countries struggle to
control the outbreak, it will be bad not just for people of
those nations but for all of us because the one thing we have
learned over and over again is that an outbreak anywhere can
quickly become an outbreak everywhere.
So during this pandemic when we have many, many difficult
months ahead of us, walking away from WHO, I believe, makes
controlling the virus globally harder and makes it harder to
manage the virus here at home.
Walking away from WHO leaves us without a voice at the
table to better manage the disease globally and walking away
from WHO means we will have little influence on how WHO is
shaped and improved when this pandemic eventually comes to an
end.
I believe WHO can and should be more effective. But the
bottom line is WHO is essential, as you have already heard this
morning. There is no substitute.
So for the sake of the health and the well-being of the
world and particularly for the health and well-being of the
American people, I believe it is critical to use America's
leadership to improve WHO's performance in this pandemic and
for future ones.
Thank you very much.
[The prepared statement of Dr. Jha follows:]
Prepared Statement of Dr. Ashish K. Jha, M.D.
We are the middle of the greatest global public health crisis in a
century. The COVID-19 pandemic has wreaked havoc on lives, healthcare
systems, and economies around the globe. In most countries around the
world, cases and deaths are still rising, and an effective, widely
deployed vaccine is likely at least a year away. Yet at this critical
moment in global public health, U.S. leadership is lacking. The most
striking example of this lack of leadership is our Administration's
decision to withdraw the U.S. from the World Health Organization (WHO).
This is a decision that will harm not only the health of people around
the world, but also U.S. leadership and scientific prowess. And
ultimately, the withdrawal from WHO, if it is to be finalized, will
harm the health of the American people at a time when Americans are
getting sick and dying at an unprecedent rate.
WHO has a unique and incomparable ability to coordinate and support
international pandemic response. Now more than ever, we should be
investing in and supporting this organization that is uniquely poised
to tackle COVID-19.
the pandemic is not over
The COVID-19 pandemic is still accelerating. We are continuing to
see record-breaking daily increases in COVID-19 cases, and deaths are
also rising worldwide. The pandemic is still in its early stages in
most parts of the world, with cases still on their first uphill climb
in Latin America, Africa, and large parts of Asia, as well as a
resurgence of cases right here in the U.S.
The Latin American region recently reached 2.2 million cases after
infections doubled over the past 2 months, and its combined death toll
passed 100,000 last week.\1\ Brazil has been described as a ``worst-
case scenario,'' with overflowing hospitals and morgues; \2\ last week,
they saw their largest rise in daily infections and passed 50,000
deaths.\3\ India is now recording record numbers of single-day cases
after easing the strict national lockdown that had been imposed.\4\
Reports of overwhelmed hospitals and lack of access to tests or
treatment reveal the dire state of the pandemic there.\5\ South Africa
is also seeing an uphill trend and new daily records of confirmed
cases.\6\ They are now reporting about 7,000 new cases per day, about
four times the number of daily new cases from a month ago.\7\ Israel
has seen a rise in cases since easing restrictions at the end of May.
During the month of May, they were seeing only dozens of new cases each
day; now, daily cases counts hit 400 and 500.\8\
And these are just a few examples. Globally, we are still early in
the crisis. Most nations are in the middle of an uphill climb in cases,
and some countries that did have some success in battling the virus
early are now seeing second peaks after lifting their lockdowns. While
the scientific community has made remarkable progress on diagnostics,
vaccines, and therapeutics, the disease remains deadly for many. The
pandemic is far from over.
the critical role of who
The World Health Organization's response to the COVID-19 pandemic
has been highly visible and at times, less than ideal. WHO is not
perfect, by any means. I have historically criticized WHO a number of
times, particularly following their leadership failures during the 2014
Ebola outbreak in West Africa.\9\ Then, WHO's response was slow and
diffuse and contributed directly to several thousand preventable
deaths. Indeed, the United Nations even created a new entity to
coordinate the response, typically WHO's prerogative, when it created
the U.N. Mission for Ebola Emergency Response. I co-chaired a
commission that examined the failures of the global community to
respond effectively to Ebola, and our report specifically called out
WHO's shortcomings and failures as a major contributor to the poor
outcomes we saw in West Africa.
While the shortcomings of the global Ebola response went far beyond
WHO, its poor performance was one critical element. To that end, our
commission made a series of recommendations about WHO reforms, many of
which have indeed been taken up and implemented, while others have not.
As a result, WHO's response to the COVID-19 pandemic has been much
stronger than its Ebola response.
But that is still not enough. WHO has made important mistakes in
its response to the COVID-19 pandemic. WHO excessively praised China's
early response to its outbreak, calling it ``transparent'' and
``responsible'' despite early clues that China's response was anything
but that.\10\
Some have argued that WHO should have refused to take China's
claims at face value and done more to independently investigate the
early outbreak. For example, WHO probably should have considered it a
greater possibility that human transmission was already occurring, even
when officials in Wuhan said otherwise.\11\ Although WHO does not have
the power to forcibly investigate their own member states, it may have
been beneficial for them to not have so quickly accepted China's data
and statements as truth.
Furthermore, WHO remained opposed to implementing travel
restrictions until late February. While travel restrictions have not
been proven to stop the spread of disease, some studies have found that
they may delay its spread,\12\ and some have argued that countries
could have bought more time to prepare their response if they had not
been encouraged to keep their borders open.
So yes, WHO's response has been imperfect, but that doesn't mean it
is in our interest--or the world's interest--for the U.S. to leave WHO.
Instead, we should stay involved to encourage improvement of the
organization as an active member. After WHO's failures during the Ebola
crisis--which were far more dismal than any failures related to COVID-
19--the U.S. Government engaged deeply with the organization and helped
implement necessary changes. These changes included establishing a
unified WHO platform for outbreaks and emergencies, creating the WHO
Health Emergencies Programme, and implementing a framework for R&D
preparedness and capacity.\13\ WHO also worked to address shortages in
funding that limited its ability to respond to the outbreak, including
through the establishment of a Contingency Fund for Emergencies.
WHO's role in helping countries, particularly low- and middle-
income countries (LMICs), cannot be overstated. These nations'
ministries of health are heavily dependent on WHO for technical
expertise and guidance on pandemic response. WHO is deeply embedded in
LMICs--whereas local health officials in the U.S. turn to the CDC for
help, health officials in most other countries turn to WHO during an
outbreak. For example, WHO has distributed tests to 126 countries
around the world,\14\ many of which lack the capacity to develop their
own test kit quickly enough and thus rely on WHO's technical expertise.
When countries receive help from non-governmental organizations (NGOs),
it is WHO that helps provide coordination. When countries need access
to scientific expertise to inform policies, conduct disease
surveillance, and acquire necessary resources and supplies, they turn
to WHO. And given the longstanding relationship that local WHO offices
have in many LMICs, they are uniquely able to collect and collate new
data coming out of these countries. WHO is the primary hub of the
knowledge and skills needed to prevent cross-national infectious
disease outbreaks. Now is a time when LMICs are relying on WHO the
most.
The U.S.'s partnership plays an important role in ensuring that WHO
has the capacity to do these things. The U.S. provides about 15% of
WHO's funding.\15\ Ten percent of WHO's collaborating centers for
research and development are hosted in the U.S.\16\ And the U.S. CDC
has played a critical role in facilitating public health emergency
management training events and supporting the deployment of staff and
resources to respond to crises. It's clear that cutting U.S. ties with
WHO significantly hampers WHO's ability to execute on its mission.
leaving who harms the u.s.
The decision to leave WHO doesn't just harm the rest of the world--
it hurts the United States, as well. By ending our relationship with
WHO at this critical moment, the U.S. is removing itself from the most
important decisions surrounding this virus. We are sending a message
that the U.S. is an undependable partner, that we cannot be counted on
for collaboration in a global crisis. And we are leaving a leadership
vacuum within WHO for other countries to fill. Some European countries
are already starting to step up to fill the space the U.S. has left
behind--last week, Germany pledged $560 million and France pledged $100
million to support WHO's work.\17\ And China may also seize the
opportunity to exert more influence over WHO.
Leaving WHO also separates the U.S. from much of the leading
research and development around COVID-19. Scientists from countries
around the world turn to WHO to share samples and collaborate on
quickly building an evidence base. A notable example of this is WHO's
SOLIDARITY Trial, the world's largest clinical trial of COVID-19
therapies.\18\ Over 3,500 patients have already been recruited into
this trial, and WHO is actively supporting 60 countries with ethical
and regulatory approvals, identification of participating hospitals,
training on usage of the online data system, and procurement of
necessary medications. The SOLIDARITY Trial is believed to reduce the
time needed to design and conduct a randomized controlled drug trial by
80%.
WHO is also playing a key role in COVID-19 vaccine development and
manufacturing.\19\ They have created a coalition of 300 scientists,
developers, and funders with the goal of expediting exchange of
scientific results and reducing duplication of research efforts. They
are designing a large international vaccine trial that would ensure
faster turnaround of results--around 3-6 months to determine the
efficacy of each vaccine candidate. An expert group convened by WHO is
working to prioritize the vaccine candidates with the most potential
and develop a protocol for later trial phases that can be used around
the world. WHO also played a role in creating the ACT-Accelerator,
which, in addition to several other goals, is working to ensure that a
vaccine will be manufactured and distributed quickly and equitably once
it is developed.\20\ This level of international scientific cooperation
is critical to allowing us to rapidly develop tools to fight this
virus--but the U.S. will no longer be able to shape or participate in
this work.
In addition to hindering U.S. scientific and global health
leadership, the decision to leave WHO threatens the health of
Americans. As we have so clearly seen during this pandemic, diseases do
not respect borders. We can't keep travel restrictions in place
forever, and until this pandemic is under control globally, we will
continue to be at risk of spread in the U.S. If low- and middle-income
countries continue to have large outbreaks, they will become the
sources of spread of the disease globally. No level of fortified
borders will prevent disease spread from other nations. Unless we shut
off all travel and trade from every other nation in the world, a
physical impossibility, we will continue to import cases from other
countries (and export cases as long as our outbreak remains large).
Importing more cases of COVID-19 from other nations puts Americans'
health at greater risk. If we really want to protect the health of the
American people, a central feature is to control the disease in the
U.S. and help other countries control their outbreaks as well.
These implications don't only apply to this current outbreak, but
also future ones. WHO provides critical information on most major
public health threats, including influenza season and emerging
diseases, and we will no longer have the same access to that
information. We will no longer be able to inform the global scientific
and political response to those outbreaks. Collaborating with other
countries to keep future diseases from entering our own borders will be
more difficult. While COVID-19 is our major concern currently, the
harms to the U.S. of pulling out of WHO are far-reaching.
there is no substitute
There is no substitute for WHO. Its unique position as an
international agency made up of 194 member states gives it an
unparalleled legitimacy and capacity to facilitate collective action
and political will. Because of its international leverage, WHO is
uniquely positioned to set and communicate public health norms and
coordinate critical research and development across countries. It also
has the ability to coordinate with international institutions from
other sectors, like the World Trade Organization or the World Bank--an
important asset for an interdisciplinary field like global health.
The leadership of WHO is chosen by member states. The deep
relationship between individual nations and WHO, as I have outlined
above, makes the organization essential for many countries around the
world. If we were to get rid of WHO today, we would have to recreate a
WHO tomorrow with many of the same features. There is no substitute for
the essential work that WHO does.
A U.S.-based global health organization, or even other
international organizations like the World Bank, are no substitutes for
WHO. There are no other organizations with the same reach into
ministries of health. No other organizations have earned the same level
of trust from healthcare organizations and frontline health workers
here in the U.S. and around the world. WHO's role as a membership
organization made up of nearly every nation in the world makes its
presence accepted and welcomed in many countries in a way that the
presence of a U.S. government organization or even World Bank would not
be, at least not in the health sector. And for global issues, you need
truly global collaboration.
conclusion
The U.S. potentially leaving WHO has dire consequences for both
global health and for the health and well-being of the American people.
WHO plays a critical role in providing support during health
emergencies and accelerating scientific research. It is irreplaceable.
During this pandemic, its response has been extraordinary, although not
without some missteps. Some of the urgent reform efforts laid out in
the post-Ebola period have yet to be completed. But there is no
substitute for WHO. If we were to leave WHO, we would have no
legitimacy or ability to make WHO a stronger organization. Instead, we
should engage with WHO, support its important mission, and work to
improve and strengthen it. Our ability to beat this pandemic--and to
improve the health of people in the U.S. and around world--depends on
it.
----------------
Notes
\1\ Henley J. Global report: India has highest rise in Covid-19
cases as Latin America toll passes 100,000. The Guardian. https://
www.theguardian.com/world/2020/jun/24/global-report-india-has-highest-
rise-in-covid-19-cases-as-latin-america-toll-passes-100000
\2\ Leite J, Preissler Iglesias S, Viotti Beck M, Bronner E. The
pandemic's worst-case scenario is unfolding in Brazil. Bloomberg
Businessweek. https://www.bloomberg.com/news/features/2020-06-24/
coronavirus-pandemic-brazil-faces-worst-case-scenario
\3\ Otte J, Gayle D, Quinn B, Perraudin F, Sullivan H. Bolsonaro
silent as Brazil passes 50,000 deaths; global cases reach 9 million--as
it happened. The Guardian. https://www.theguardian.com/world/live/2020/
jun/22/coronavirus-live-news-covid-19-update-china-us-uk-brazil-latest-
updates
\4\ Henley J. Global report: India has highest rise in Covid-19
cases as Latin America toll passes 100,000. The Guardian. https://
www.theguardian.com/world/2020/jun/24/global-report-india-has-highest-
rise-in-covid-19-cases-as-latin-america-toll-passes-100000
\5\ Dewan A, Woodyatt A. A surge in cases shows the coronavirus
won't go away soon. CNN. https://www.cnn.com/2020/06/23/world/
coronavirus-spikes-after-lockdown-intl/index.html
\6\ Coronavirus in South Africa: Restrictions ease as Covid-19
cases rise rapidly. BBC News. https://www.bbc.com/news/world-africa-
53093832
\7\ Johns Hopkins University Coronavirus Resource Center. https://
coronavirus.jhu.edu/map.html
\8\ Johns Hopkins University Coronavirus Resource Center. https://
coronavirus.jhu.edu/map.html
\9\ Jha AK. A race to restore confidence in the World Health
Organization. Health Affairs Blog. https://www.healthaffairs.org/do/
10.1377/hblog20170406.059519/full/
\10\ Rauhala E. Chinese officials note serious problems in
coronavirus response. The World Health Organization keeps praising
them. Washington Post. https://www.washingtonpost.com/world/asia--
pacific/chinese-officials-note-serious-problems-in-coronavirus-
response-the-world-health-organization-keeps-praising-them/2020/02/08/
b663dd7c-4834-11ea-91ab-ce439aa5c7c1_story.html
\11\ Perez-Pena R, McNeil DG. WHO, now Trump's Scapegoat, warned
about coronavirus early and often. New York Times. https://
www.nytimes.com/2020/04/16/health/WHO-Trump-coronavirus.html
\12\ Narea N. Coronavirus is already here. Blocking travelers won't
prevent its spread. Vox. https://www.vox.com/2020/3/12/21176669/travel-
ban-trump-coronavirus-china-italy-europe
\13\ Chan M. Learning from Ebola: readiness for outbreaks and
emergencies. Bulletin of the World Health Organization. https://
www.who.int/bulletin/volumes/93/12/15-165720/en/
\14\ Rolling updates on coronavirus disease (COVID-19). World
Health Organization. https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/events-as-they-happen
\15\ Joseph A, Branswell H. Trump: U.S. will terminate relationship
with the World Health Organization in wake of Covid-19 pandemic. STAT.
https://www.statnews.com/2020/05/29/trump-us-terminate-who-
relationship/
\16\ The United States of America: Partner in global health. World
Health Organization. https://www.who.int/about/planning-finance-and-
accountability/financing-campaign/us-impact
\17\ Schmitz R. Germany and France promise new financial support to
World Health Organization. NPR. https://www.npr.org/sections/
coronavirus-live-updates/2020/06/25/883302474/germany-and-france-
promise-new-financial-support-to-world-health-organization
\18\ ``Solidarity'' clinical trial for COVID-19 treatments. World
Health Organization. https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/
solidarity-clinical-trial-for-covid-19-treatments
\19\ Accelerating a safe and effective COVID-19 vaccine. World
Health Organization. https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/
accelerating-a-safe-and-effective-covid-19-vaccine
\20\ Access to COVID-19 Tools (ACT) Accelerator. World Health
Organization. https://www.who.int/publications/m/item/access-to-covid-
19-tools-(act)-accelerator
The Chairman. Thank you for those candid and, I think, very
helpful remarks. You, I think, quite clearly and correctly
noted that WHO has no authority over other countries, and as I
discuss this in a robust fashion with Dr. Tedros and with his
management team, they stress that over and over again, wishing
they had that authority.
I think the criticism perhaps is more correctly directed at
the fact that they do have a bully pulpit and, as we all know,
the bully pulpit can be as effective and, indeed, sometimes
more effective than having actual authority over someone.
And I think, from my own personal standpoint, I was
disappointed that--but at the same time understanding--that the
minute you step up on the bully pulpit you are going to find
yourself in an adversarial position with someone or some
country that you are trying to get to cooperate with you. But
that may dissipate. It is a fine line. There is absolutely no
question about that. I thank you for your remarks and I thank
you so much.
We now have Mr. Jeremy Konyndyk and he is a senior policy
fellow at the Center for Global Development. He previously
served as director of USAID's Office of Foreign Disaster
Assistance during which time he led the U.S. humanitarian
response to the 2015-2016 outbreak in West Africa, among other
complex emergencies.
He is a member of WHO's Independent Oversight and Advisory
Committee and previously served on the Independent Advisory
Group and helped design WHO's post-Ebola reports.
Mr. Konyndyk, the floor is yours. I am told that they are
having a little technical difficulty with your--with the audio.
So I hope this works. In any event, the floors is yours.
STATEMENT OF JEREMY KONYNDYK, SENIOR POLICY FELLOW, CENTER FOR
GLOBAL DEVELOPMENT, WASHINGTON, DC
Mr. Konyndyk. Yes. Thank you. Thank you, Chairman Risch
and, thank you, Ranking Member Menendez for the opportunity to
testify.
I apologize that you cannot see me. I had logged in and
then mid-way through Chairman Risch's opening statement, my
internet completely went down and it seems the provider is not
working. But at least we have the phone as a backup.
The Chairman. Would you like me to repeat the second half
of my opening statement?
[Laughter.]
Mr. Konyndyk. No, I heard it--I heard it perfectly clearly
on my phone.
The Chairman. Okay. Thank you.
Mr. Konyndyk. So and I greatly appreciated your remarks,
Senator.
The Chairman. Thank you.
Mr. Konyndyk. I thought you set a wonderful tone.
I want to thank the committee for the opportunity to
testify today on this--on this important topic. The COVID-19
pandemic has made incredibly clear the importance of expanding
U.S. government investments in global pandemic preparedness and
also the linkage between that and our own domestic
preparedness, you know, within our own borders.
Investments like this in global outbreak cooperation are
not just altruistic. They also serve to keep us safe here at
home, and so I commend the many thoughtful ideas that have been
put forward by members of this committee, by some of your
colleagues in the House, and I am encouraged by some aspects of
the plans that are reportedly being developed by the
Administration as well.
Because it is clear that the U.S. now needs to take
advantage of this moment to go really big on a global
partnership for pandemic preparedness, and this means focusing
on a number of things.
It means investing more in surveillance diagnostics and
early warnings so that we can build the same kind of early
warning capacity for infectious disease risks that we currently
have for things like hurricanes, famines, or tsunamis.
It means creating--using that risk awareness to create
clearer triggers for global and country-level action so that we
never again have to see the kind of inconsistent patchwork of
country responses that we have seen in response to COVID-19 and
I think one of the things that the current pandemic really
shows clearly is that that kind of early action is just as
important as the baseline national capacity.
The countries that acted early have done better whether or
not they have the full capacity we might--that they might want
and countries that have waited, even if they had good capacity
on paper, have really struggled. So both capacity and early
action are incredibly important.
It also means things like investing in the readiness and
resilience of medical and public health systems in weak and
low-income countries. It means reinforcing supply chains and
reserves of PPE and essential drugs.
It means collaborating towards the development of
innovative diagnostics, vaccines, and therapeutics on a global
level, and I was encouraged to see in Senator Risch's bill the
U.S. support for CEPI, which I think is incredibly important.
And, of course, all of these things will require robust
U.S. funding behind these priorities, and so I urge Congress to
include pandemic response and preparedness funding in the
HEROES Act and continue supporting this on a more ongoing
reliable basis over time as we have done with things like
PEPFAR.
But that, of course, if we are to do all those things it
raises the natural question of how should we organize ourselves
and how should we organize the global system to deliver on
that, and so I want to lay out a few ideas on that, based on my
own experience with this over the years.
First, within the U.S. government it is incredibly
important to establish a clear interagency division of labor
that is built on each agency's comparative advantages, and this
is something that has been a struggle in PEPFAR. It has been--
it has produced a lot of turf battles over the years between
USAID and CDC.
It is something we did not struggle with so much on Ebola
because we laid out a clear division of labor right at the
outset of the Ebola response and then we budgeted and allocated
funding based on that. So there was, simply, less to fight over
between the agencies. Our roles were clear from the beginning.
And so something like an international response framework
to parallel what we have domestically with the national
response framework could help to clarify and enshrine some of
those roles for institutions like the State Department, USAID,
CDC, DoD, and others.
I was encouraged to see that Senator Menendez's bill
contains some similar language.
Second, the State Department has an incredibly important
role in building diplomatic support for pandemic readiness and
can play a role also in coordinating broader overseas U.S.
engagement.
But I do not believe a heavy PEPFAR style centralized
authority at the State Department over programs and budgets of
interagency partners is the right template for this particular
role.
I believe a lighter approach modeled more on the counter-
ISIL envoy would be more effective. That approach was tasked
similarly with building a global coalition of allies towards,
of course, in that case fighting ISIL, in this case fighting
pandemics.
That is a sweet spot role for the State Department and the
coordination function that the counter-ISIL envoy used was
shared with a senior director at the NSC who could more
effectively coordinate with the interagency and I believe that
that sort of model would be a better partnership here, hinging,
of course, on restoring the White House senior director and
accompanying team for global health security, which is as
crucially important, as some of the other witnesses have
already noted.
Third, as several of these proposals do acknowledge, any
new U.S. initiative must be robustly resourced. The pandemic
has cost trillions of dollars in emergency economic stimulus
and lost productivity and other spending.
So investing in pandemic preparedness on a PEPFAR like
scale, which is to say billions of dollars a year, is an
extremely good return on investment if it can prevent that kind
of economic damage in future pandemics.
Fourth, it is impossible to envision the U.S. succeeding in
this kind of ambitious pandemic preparedness agenda without the
full engagement of the World Health Organization and, frankly,
it is hard to envision the rest of the world working together
with us on this effort if they view it as a U.S. alternative or
competitor rather than a complement and a supporter and partner
to the World Health Organization.
Withdrawing the U.S. from the World Health Organization
will be tragic and it is entirely unjustified. In an earlier
hearing, Senator Risch, you asked a group of administration
witnesses to identify the fire department for global health
emergencies.
I agree with the other witnesses who have noted that such a
thing already exists. It is called the Health Emergencies
Program at the World Health Organization. It was established--
and I and Ambassador Kolker both had a hand in helping to stand
it up--it was established following the failures of the 2014
Ebola outbreak.
It is not perfect. It is still a work in progress. But it
is making great progress and has succeeded in recent years in
addressing several outbreaks like Ebola in the Congo as well as
other outbreaks like cholera in Yemen.
There is no question that WHO continues to need further
reform, and I would echo what Senator Risch said about the
challenges within the limitations that the international health
regulations currently put on WHO.
But we should then focus on those problems. We should not
abandon the organization and our best chance to focus on those
problems is by staying part of the organization despite its
flaws and working to improve it.
Finally, it is a bit painful to say this but I think we
also have to acknowledge that the U.S.'s credibility to lead a
global coalition on pandemic preparedness will really hinge on
our ability to contain our domestic outbreak here at home.
Our credibility globally starts with our competence within
our own borders, and so to rectify this we need to take the
advice that we have given to other countries for many years:
depoliticizing public health, following the evidence,
communicating risk effectively, building public trust, and
deploying competent management structures.
And I think we have to show a degree of humility as well,
recognizing that even a country as well prepared and powerful
and wealthy as the United States can falter when it departs
from these sort of sound public health principles.
With that, I look forward to your questions, and thank you.
[The prepared statement of Mr. Konyndyk follows:]
Prepared Statement of Jeremy Konyndyk
Dear Chairman Risch, Ranking Member Menendez, and distinguished
Senators, thank you for inviting me to testify before you today. This
hearing comes as the COVID-19 pandemic is proving what public health
experts have warned for years: no country in the world is adequately
prepared for a lethal pandemic. Many countries today are failing to
contain the virus, whether through poor management, weak systems, late
action, or all of the above. There is an aphorism that one must never
waste a crisis. So even as we work to defeat the current pandemic, we
must begin learning from the failures to contain it, and prepare
ourselves to be more ready the next time around. We are fortunate that
COVID, while highly transmissible, has a lethality far lower than past
threats like SARS-1, Ebola, or the Spanish flu. A comparably
transmissible virus with a much higher lethality is plausible, and over
time even probable. So we must use this moment to marshal the political
will to be ready for that.
Being ready for the next pandemic must be a global effort: U.S.
readiness at home will be compromised if there are vulnerabilities
overseas. As COVID is teaching us, a lethal pathogen will take
advantage of any weakness in the world's defenses. The Pandemic All
Hazards Preparedness Act, which was reauthorized a year ago, focuses on
domestic pandemic readiness but is nearly silent on international
aspects. This is a moment to rectify that, for our global and our
domestic efforts must be well aligned. We must understand that our
investments in global cooperation are not purely altruistic; the also
keep us safe. And we must connect those efforts directly into our
domestic efforts.
the global outlook
In an earlier hearing of this Committee, Chairman Risch asked a
group of administration witnesses to identify the ``fire department''
for global health emergencies. While none acknowledged it, the world
already has such an institution: the Health Emergencies Programme of
the World Health Organization, guided by the WHO's mandate under the
International Health Regulations to ``prevent, protect against, control
and provide a public health response to the international spread of
disease.'' While WHO is not a perfect institution, it has improved
dramatically since its failings during the 2014 Ebola outbreak, and has
largely served the world well during the present pandemic. U.S.
involvement with WHO is a critical pillar of American and global
pandemic preparedness. Withdrawing the United States from the WHO will
weaken both the WHO and the United States, and put at risk the health
of millions around the world and here at home.
There have been assertions by the Administration, and by some in
Congress, that WHO's performance on COVID has been a repeat of mistakes
it made during the West Africa Ebola outbreak, and that the U.S. is
therefore justified in abandoning the organization as hopeless. This
mis-diagnoses both what went wrong in 2014, and what constrained the
organization during the early phase of this pandemic.
There is no question that the organization badly mishandled the
Ebola outbreak in 2014 during the critical May-August period when the
outbreak accelerated across West Africa. The WHO country offices were
slow to take the risk seriously, WHO HQ in Geneva was slow to sound the
global alarm, and the organization lacked the operational wherewithal
to mount a rapid and effective response. The independent panel tasked
with evaluating WHO's response to that outbreak concluded that the
organization did not ``currently possess the capacity or organizational
culture to deliver a full emergency public health response.'' \1\ And
this glaring gap in the global readiness for complex outbreaks allowed
a virus that had never previously produced more than 425 cases in any
single outbreak to infect 28,616 people and kill 11,310. It forced the
U.S. and other nations to deploy massive civilian and military
operations to contain the outbreak, at a cost of billions of dollars.
At the time, I served at USAID as the director of foreign disaster
assistance, and my team served as the backbone coordinating the U.S.
response in West Africa. Following the outbreak, I was closely involved
in U.S. deliberations over what to do with WHO. The interagency debated
a range of options, up to and including the creation of a new, separate
agency responsible for health emergencies. But we concluded ultimately
that that was neither feasible nor advisable, and that the best
approach was to press for a fundamental overhaul of WHO's role in
health emergencies.
We also recognized, as did other prominent WHO member states, that
part of the responsibility for the failure rested with us. WHO is a
member state-based organization, and its policies and priorities are
not determined in a vacuum: they reflect the guidance and direction
that the WHO secretariat receives from WHO members. And for too long,
member states had pushed WHO leaders to prioritize non-emergency
missions while ignoring the erosion of the organization's emergency
response capacity.
So rather than abandon the organization, the U.S. set out to
strengthen it. We worked with WHO leadership to develop a plan for a
major organizational overhaul; I and a CDC representative sat on the
advisory group that helped design the proposed reforms. We also
mobilized diplomatic efforts to build support among member states for
the emergency reform package, which was passed by the WHO's governing
body in May 2016 with broad support. We provided targeted funding to
help kickstart the reform process, tied to rigorous accountability
requirements to ensure that the organization followed through on reform
implementation. And since 2016 I have had a unique vantage point on the
implementation of these reforms from another perspective, as a member
of the independent oversight board that monitors WHO's Health
Emergencies Programme and reports back to the member states on the
organization's implementation of the post-Ebola reforms.
These reforms have had a real impact. There is perhaps no clearer
contrast between the WHO of 2014 and the WHO of today than the
organization's handling of the extremely complex Ebola outbreak that
finally concluded last week in Eastern Congo. An agency that had been
unable, in 2014, to mobilize a rapid or robust operational Ebola
response in three stable and peaceful countries was able, by 2018, to
mount a massive field operation in one of the most complex conflict
zones on earth. And furthermore, WHO did this without anything like the
kind of massive U.S. and UK personnel deployments that had rolled out
in West Africa. In fact, WHO received far less technical support and
cooperation from CDC and USAID than it customarily would, due to the
State Department's fears about security risks to U.S. personnel. WHO
meanwhile deployed more than 700 personnel, at significant risk, and
lost staff to armed violence. Over the course of the outbreak, WHO and
the Congolese government partnered to build an operation that
vaccinated more than 300,000 people and at its high-water mark was
tracing and monitoring more contacts (in a war zone!) than most U.S.
states are today.\2\
And that in turn is a useful backdrop to understanding WHO's
performance during the ongoing COVID pandemic. The organization today
remains far from perfect but has made huge strides since its nadir in
2014. And while the Trump administration has criticized the WHO for
supposed failures on COVID-19, the main charges do not hold up to
scrutiny--and certainly do not justify withdrawing from the
institution.
The Administration has made three main accusations: that the WHO is
uniquely close and credulous toward China; that it was late to warn the
world about the dangers of the virus, particularly its potential for
human-to-human transmission; and that it opposed President Trump's
imposition of a travel ban on China. Collectively, the Administration
has suggested that different behavior from WHO on these fronts would
have spared the U.S. and the world from the catastrophe that this virus
has wrought.
These accusations are false.
With respect to WHO's supposed closeness to China, it is certainly
true that WHO is highly deferential toward member states--but this is
not unique to China. Like any multilateral, member-state based
organization, WHO is loath to criticize its members in public. This is
by design; WHO's members (the U.S. included) have traditionally steered
it to be highly deferential toward member state prerogatives. WHO also
avoided criticizing shortcomings by the Congolese government, or the
governments of West Africa, during Ebola outbreaks there; all of those
members states have far less global power than China.
This kind of deference is formally enshrined in the International
Health Regulations, the binding treaty negotiated by WHO member states
that guides WHO's authorities in major outbreaks. The IHRs make
explicitly clear that WHO has virtually no authority to second-guess
outbreak reporting by a member state, and can only investigate new
outbreaks with the state's cooperation and consent. Furthermore, the
IHRs grant WHO no authority to sanction or punish states for
inaccurate, late, or incomplete reporting. Again, it is important to
emphasize that this situation was created by the choices of the member
states that negotiated and adopted the IHRs. As for the notion that
China has outsized influence in the WHO, U.S. citizens occupy two
senior leadership positions in the organization while only one is
occupied by a Chinese national.
The idea that WHO was unjustifiably late in warning the world about
COVID-19 also ignores the evidence. China confirmed the outbreak to WHO
on December 31 2019. Within days, WHO had released an extensive set of
resources and technical guidance on the virus, and on January 12
(unprecedentedly fast compared to previous outbreaks) WHO shared the
virus' genetic sequence with the world, with detailed guidance for
diagnostic testing released on January 13.\3\ With respect to human-to-
human transmission, WHO stated in a press conference on January 14 that
human-to-human spread was a possibility (albeit yet unproven).\4\ WHO
subsequently confirmed human-to-human spread was occurring on January
22, a day after WHO staff returned from the first trip that the Chinese
government had permitted them to make to Wuhan. Another day later, on
January 23, Director General Tedros convened the WHO Emergency
Committee (and advisory body composed of outside experts, including a
senior U.S. CDC official) to review emerging information from China and
advise on declaration of a public health emergency of international
concern. The PHEIC is the highest level of alert that WHO is authorized
to sound under the IHRs.
The emergency committee was split at that time on declaring a
PHEIC; there were fewer than 600 cases officially reported. Nonetheless
the WHO's summary of the committee deliberations provided a picture of
the virus that was deeply alarming: a novel respiratory coronavirus
that was spreading uncontained in the community; had a severity rate of
25% and a preliminary fatality rate of 4%; and had a reproduction
number of up to 2.5 \5\, making it significantly more transmissible
than seasonal flu. In the infectious disease world, this is a highly
worrying collection of characteristics. A week later, after China had
begun shutting down Wuhan and other major cities, the Emergency
Committee reconvened and advised declaring a PHEIC, which Director
General Tedros did. At the time, fewer than 100 cases had been detected
outside China, and only 5 in the United States.
With respect to on the travel ban controversy, WHO's posture was
grounded in the widely held view in public health literature that
travel bans are a highly disruptive measure that provides limited real
protection against the spread of a respiratory virus. Most research on
travel bans has found that in a large and open country like the United
States, such bans can at best modestly delay the acceleration of an
outbreak by a few weeks. They cannot shield a country from the eventual
arrival of a virus, as is now obvious. There was good reason to
therefore be wary of such bans, for fear that they foster a false sense
of complacency that deters emphasis on true readiness for the arrival
of the outbreak--which indeed is precisely what happened here. And in
fact WHO did not actively oppose such bans; it sent a circular notice
to member states on February 6 noting that such bans could be justified
if they were used to allow time for countries to implement sustained
preparedness and response measures.
Put together then, these accusations have little merit and there is
no reason to believe that different behavior from WHO would have
produced a different readiness posture by the U.S. Government. The
failure of the U.S. to be ready for the pandemic now battering our
country is not result of listening to WHO, but rather a result of not
listening. China was slow to release information on the virus; but WHO
had no authority under the IHRs to compel different behavior. Once WHO
verified updated and more accurate information it relayed that evidence
to the world, at a time when there was still a sufficient window for
preparedness. And it noted that travel bans, if implemented, should be
used to buy time for domestic preparedness, advice that the U.S.
ignored.
The U.S. withdrawal from WHO is absurd on the merits and will be
tragic in its consequences. WHO is a crucial reporting hub for every
country in the world, and there are numerous USG secondees working for
the organization. Membership provides access to important policy and
research bodies; walking away from WHO leaves the U.S. less informed in
COVID-19 and future pandemics. The U.S. has also invested heavily over
the years in WHO's ability to lead the fight against infectious
diseases so that we don't need to carry that burden alone. Global
polio, for example, is close to full eradication due to WHO's U.S.-
backed vaccination efforts. Withdrawing from WHO will leave the U.S.
isolated in global health efforts and unilaterally surrender U.S.
influence.
Instead of withdrawing, the United States should focus its efforts
on continuing to advance WHO reform. While great progress has been
made, much more is needed. The United States' ability to promote those
reforms will evaporate with our departure from the institution. The
U.S. should focus as well on the bigger weakness that this pandemic has
revealed: glaring shortcomings in the International Health Regulations.
If we want to see greater country transparency and accountability in
outbreaks, the IHRs' tepid handling of those dimensions is the place to
start. We should also explore updating the PHEIC mechanism, whose
binary structure undermines its usefulness as a true alarm bell for
health emergencies. A far better approach would be to rethink the PHEIC
as an escalating scale of pandemic risks, with different global and
national readiness triggers tied to gradations of risk. These kinds of
reforms would make the U.S. and world meaningfully safer in future
emergencies; by leaving WHO, we lose the ability to accomplish this.
organizing the u.s. government
As the U.S. focuses on adapting the international system to the
lesson of COVID-19, we must also rethink how the U.S. Government itself
works to advance global pandemic readiness. I am very heartened to see
a flurry of proposals to bolster U.S. Government focus, operations, and
financing toward this critically important objective. We must seize
this moment to begin building a stronger U.S. and global architecture
for health security, just as we did after 9-11 for counter-terror
cooperation (although hopefully with greater regard for human rights
and civil liberties).
And so I welcome and commend the spirit of the proposals that have
emerged--the Risch/Murphy/Cardin bill and the Menendez bill in the
Senate; the Connolly bill in the House; and elements of the emerging
proposals being formulated by the Administration. However, I have real
concerns about the design of some of these proposals. Global health
security and pandemic preparedness are whole-of-government functions
that must be effectively organized within the U.S. Government and well
aligned with our multilateral partners, particularly the WHO. I do not
believe that modeling the new initiatives on PEPFAR, as some of these
proposals envision, is the best approach. While PEPFAR's robust budget
and long-term political commitment are both characteristics we want to
emulate here, other aspects of that initiative are poorly suited to
pandemic preparedness. I will outline several elements that I believe
USG-focused reforms must incorporate.
First, it is important to establish a clear division of labor
across the interagency, building on each agency's comparative
advantages.
This was not enough of a focus during PEPFAR's inception, and that
lay the groundwork for years of interagency friction that continues to
plague the USAID-CDC relationship. Due to initial ambiguity over the
division of tasks and expertise, each agency built parallel capacities
and programs in different countries. Even now it is not uncommon for
CDC to lead program areas in one country that USAID leads next door,
and vice versa.
In developing the Ebola response in West Africa, my team at USAID
and our counterparts at CDC instead sought to explicitly avoid this
kind of ambiguity. We defined each agency's roles clearly at the
outset, based on our respective comparative advantages--and then OMB
developed budget proposals that reflected that pre-arranged division of
labor. This led to a much smoother partnership, because we each
obtained the resources we needed and had little reason to compete with
the other agency for turf. I would urge that as Congress considers how
best to authorize a new USG initiative, it establishes up front the
respective roles of CDC, USAID, State, and other USG institutions (I
was encouraged to see this reflected in the Menendez bill). This will
reduce the potential for interagency friction and the need for a heavy
coordination infrastructure.
Second, the coordinator role at the State Department should
accordingly be a lighter structure modeled on the Counter-ISIL envoy,
rather than the heavy and directive model of the PEPFAR Coordinator.
The PEPFAR Coordinator role centers expansive authority over
program priorities, evaluation, and most importantly budgetary
oversight at the State Department. This centering of interagency
authority at State was arguably necessary for two reasons; the
Coordinator's role in refereeing the aforementioned interagency turf
battles, and to give the Coordinator leverage for interagency
coordination. Repeating that model for pandemic readiness would have
real downsides. It would prompt resistance from USAID and CDC, who are
skeptical of the need for an added budgetary and program layer for
initiatives that in many cases they have been investing in for years.
And it would put a huge amount of program control in a Department that,
outside of the PEPFAR office, has a weak institutional track record on
global health.
While PEPFAR has worked well overall, the State Department has
struggled with other global health efforts over the years. The Obama-
era ``Global Health Initiative'' launched in 2009 was an earlier
attempt by the State Department to improve interagency coherence across
the U.S. Government's global health programs. But, as my CGD colleagues
wrote at the time, it was ``plagued by infighting, leadership
questions, and general confusion since its launch'' and was quietly
shuttered in 2012.\6\ A few years later, during the Ebola outbreak, the
State Department performed some tasks extremely well--such as
organizing medevac services and providing Embassy-level support to
outbreak response in the affected countries. But Main State in
Washington struggled with interagency coordination, because the issue
had no clear institutional home in the department. Eventually the
Secretary recalled retired ambassadors to manage an ad-hoc Ebola
Coordination Unit to manage State's contributions and represent in
interagency deliberations. It is quite a leap to go from this track
record to overseeing and leading the full range of programmatic,
strategic, diplomatic, and budgetary functions envisioned in some of
these proposals, and in the reported State Department vision.
A lighter approach modeled on the Counter-ISIL envoy would have a
higher chance of success. The Counter-ISIL envoy role has numerous
parallels to what is needed for pandemics. It emerged from a
recognition that protecting the U.S. homeland from ISIL would depend on
both a well-aligned U.S. interagency response, and a major global
diplomatic mobilization. The U.S. Special Envoy role was established in
the State Department and tasked with building a coalition of allies--a
classic State Department function. The Envoy's office also co-led the
U.S. interagency planning, in close partnership with the National
Security Council at the White House. This produced an effective and
expansive coordination model, that gave government departments and
agencies appropriate space to manage their operations while ensuring
alignment and mutual visibility. Like the counter-ISIL campaign, a
pandemic readiness initiative must mobilize a surge in global
diplomatic outreach alongside agency-level programs and operations. The
same kind of decentralized alignment--rather than concentrated
bureaucratic power--is what the U.S. government needs for its global
pandemic readiness efforts. Lastly, there is simply no substitute for
White House leadership. A signature U.S. pandemic initiative needs
visible Presidential backing and White House coordination in order to
deliver on the ambitious scale that this challenge requires.
Third, as many of the proposals have acknowledged, any new U.S.
initiative must be robustly resourced. The pandemic has stripped
trillions of dollars from global economic productivity, and cost
trillions more in emergency economic stimulus and safety net spending.
Investing on a PEPFAR-like scale--which is to say several billion
dollars a year--to build the capacity to prevent a recurrence of this
kind of catastrophe is an extremely good return on investment.
Whatever the bureaucratic shape of this initiative, its priorities
are clear. It must build a global partnership that advances the world's
ability rapidly detect and contain future pandemic threats. This means
investing in surveillance, diagnostics, and early warning--building the
same capacities for infectious disease risks that we have built for
hurricanes, droughts, and tsunamis. It means creating clearer triggers
for global and country-level preparedness, so that we never again see
the kind of inconsistent patchwork of country response that we have
seen on COVID-19. It means investing in the readiness and resilience of
medical and public health systems in weak and low-income countries, so
that those states can contain disease threats that might reach us here.
It means reinforcing critical supply chains of PPE and drugs. It means
collaborating toward development of innovative diagnostics, vaccines,
and therapeutics as global public goods.
conclusion
All of these priorities will cost money, and all will require
multilateral cooperation. To state it plainly, it is impossible to
envision the U.S. advancing this kind of agenda without the full
engagement of the World Health Organization. And it is hard to envision
the rest of the world collaborating with us in this effort if they
perceive it as an alternative--rather than a complement--to the WHO.
Finally, it is painful to say this but it must be candidly said:
the U.S.' credibility to lead a global coalition on pandemic
preparedness will also fall short unless and until we also get serious
about containing our domestic outbreak. Our credibility globally starts
with our competence at home, yet we are presently a prime example of
how not to handle this pandemic. To rectify this, and to be able to
credibly reassert our global health leadership, we must start taking
the advice we have long provided to other countries: depoliticizing
public health, following the evidence, communicating risk effectively,
building public trust, and deploying competent management structures.
And as we engage with the world going forward, we must show a degree of
humility, in recognition that even a country as nominally well-prepared
as the United States can falter when it departs from sound public
health principles.
----------------
Notes
\1\ https://www.who.int/csr/resources/publications/ebola/report-by-
panel.pdf?ua=1
\2\ https://www.who.int/news-room/detail/25-06-2020-10th-ebola-
outbreak-in-the-democratic-republic-of-the-congo-declared-over-
vigilance-against-flare-ups-and-support-for-survivors-must-continue
\3\ https://www.who.int/news-room/detail/29-06-2020-covidtimeline
\4\ https://twitter.com/UNGeneva/status/1217146107957932032
\5\ https://www.who.int/news-room/detail/23-01-2020-statement-on-
the-meeting-of-the-international-health-regulations-(2005)-emergency-
committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
\6\ https://www.cgdev.org/blog/failure-launch-post-mortem-ghi-10
The Chairman. Well, thank you very much. First of all, that
is a good point, the last point made about if we are going to
be the leader in this we need to have things at home covered.
I want to say I have sat through a lot of panels on the
Foreign Relations Committee over the years. This is probably
the best one that has been put together.
I would like to take full credit for it but, unfortunately,
I am going to have to concede that the staff, both the majority
staff and the minority staff, had a great hand in this and,
clearly, picked out the best possible people on this topic.
I really appreciate the tone of the panel as far as trying
to move forward and not being in a condemning mode. I think
that one thing that has come clear to all of us and has been
evident by all of you is the fact that this is going to take
more dollars.
For those of us that are--have a difficult time spending
money, other people's money, this is a real challenge. But,
obviously, there are things--you do not have any trouble with
us most of the time but when it comes to defense spending.
But this is going to fall in the category of defense
spending because without it, the consequences are phenomenal.
All you have to do is look at what we just do with the wall at
$2.8 trillion, half of the annual budget, to address this one
single problem.
And that indicates that we are going to have to be spending
more to avoid having to do this again in the future. So I think
coming to that realization is difficult. It is painful. But it
is the reality.
The Emergency Health Program within the WHO is probably one
we are going to have to take a really serious look at. I think
if--one thing that has come clear here is as I have tried to
identify the fire department there is no fire department, but
if there is one it is the Emergency Health Program but they act
more like a volunteer fire department than the real deal when
you pick up the phone and want the fire department.
Maybe we could go around, just very quickly, and get each
of you, give me your brief thoughts on the Emergency Health
Program, how we ought to look at it, what it needs to be, and
if you would go, please, in the same order from where we
started. Then I am going to turn it over to others for comment
and questions.
With that, we will start with Mark Dybul. Mark, are you
there?
Dr. Dybul. I am. Thank you, Mr. Chairman.
So within that response there is something called the
Strategic Health Operation Center, or SHOC, which is similar to
what an EOC, which I put forward in the testimony, we need.
However, it is not funded sufficiently and there will be
limitations for some of the reasons that have been discussed
that WHO does not have authority to compel countries to act
nor, really, would anyone else.
There are limitations that are involved in the private
sector. And so, I think, you know, WHO absolutely needs to be
involved, likely should host, and SHOC could be the central
point of that.
But we would need to supplement the authorities. I think
you need to involve heads of state, the private sector, civil
society including faith communities, so that we are ready to
go.
And then a key piece, and this worked in South Korea,
Taiwan, and other countries, they have to do regular
simulations, and the national security apparatus, the
apparatuses of the world.
The private sector is exquisitely good at these
simulations. You identify where your gaps are. So, for example,
that SHOC or whatever the EOC would be would literally pick up
the phone and call a country and say, you have an outbreak, and
then the whole system would kick in and you would see how it
worked, whether it worked.
You would have stockpiles, and then you would start to see
how to support regional and national EOCs so that they can be
ready at the same time.
So I totally agree that WHO has to be central to that and
would be a driving force. But I think there is some
supplemental things that would need to be done to make it
totally effective with national security, private sector, civil
society, and other groups, and to have those simulations, which
WHO can manage and should run.
But and this would be, I think, a conversation we have to
have globally to put together the right pieces.
The Chairman. Thank you.
Let us see. Ambassador Kolker.
Mr. Kolker. Thank you very much. I agree with Mark, and
there does need--the WHO's budget for the entire operation with
all of the mandates that they have is one-third of the state of
Maryland Department of Health budget every year. So we need
to--we need to go quantum levels more to let them be anything
but a volunteer fire department.
And in that regard, the dependence of the Health
Emergencies Program on the overall budget of WHO, the small
amount of assessed contributions for which the U.S. is
traditionally in arrears--not just now but we are now more than
ever in arrears--and the voluntary contributions makes it
always dependent on an aspirational budget to do its work.
It has to respond and then raise the money to pay for what
it just did, borrowing from other WHO programs.
So I used to work for UNICEF, which has a tremendous
ability to raise money from individuals, from foundations, from
the private sector, in a way that the WHO does not.
The Red Cross also takes huge advantage of emergencies when
people, Americans in particular, really want to respond and
donate money.
WHO has just set up a foundation that can scratch that
surface. But I think we really need to look at the UNICEF and
World Food Program models and look at a way that the World
Health Organization can raise money widely from individuals and
from organizations that now do not contribute because it is a
number of state organizations with assessed contributions, not
a funded program like UNICEF and WFPR.
In addition, I think we need to look at the international
health regulations, which are the basis on which countries need
to cooperate with the Health Emergencies Program.
I think they need to be strengthened maybe through a review
conference or through member state effort like we reviewed the
Health Outbreaks and Emergencies Program after the Ebola
outbreak at WHO.
But there should be a stronger right of international
inspection. The International Atomic Energy Agency can require
that countries let them inspect facilities if they think
something has gone wrong. This will be harder in the health
context but I think it is something we need to look at.
And we need more options for declaring levels of public
health emergency. We need to be able to prepare a proportionate
response, for instance, having to do with travel regulations,
for instance, having to do with laboratory requirements so that
right now it is either an outbreak or it is a Public Health
Emergency of International Concern, which triggers a number of
different other requirements for states.
We need to have a traffic light system in which there are
more moderate levels of public health emergency that would
galvanize states to take action earlier before this Public
Health Emergency of International Concern take place.
And I fully endorse what Mark said and others have, that
WHO's inability to deal effectively with the private sector,
which civil society, and even with finding a way in which
other--many other multilateral organizations have to engage
Taiwan, all of these are factors that can be addressed and need
to be addressed by WHO in order to make the multilateral
response more effective.
The Chairman. Thank you very much. I appreciate those
remarks and I am particularly interested in your comparison
to--on inspections to the nuclear inspections.
I would respectfully disagree that these may be more
difficult than the nuclear inspections would be. You have a
lot--you have a lot of experience with that, particularly with
Iran and North Korea are probably the poster children for that.
But what we have found is an international agency can use
the bully pulpit really to shame countries into doing what
needs to be done.
And so I am not so sure that it is more of a challenge. But
that is an interesting idea and a novel idea that I had not
heard. That is one of the biggest complaints WHO has about
their lack of authority is that they cannot go in on these
things.
That is really worth taking a look at. Excellent thoughts.
Let us see. Dr. Jha.
Dr. Jha. Yeah. So, Chairman Risch, I am going to just be
very brief and echo a few of the points that Ambassadors Dybul
and Kolker have made because I agree, largely, with their
points, and let me emphasize maybe three.
So, first of all, I do think the Health Emergencies Program
is, clearly, underfunded. One of the reasons why it feels like
a volunteer fire department is because in some ways it is. It
is a little bit of a ragtag.
They do not have--they are always out there asking for
money, and if we are going to use them as one of the key
pillars of our global response they need sustained and adequate
financing.
So I think whatever mechanism we use, that, I think, has to
be essential.
Second is on the public health emergency declaration. One
of the calls that we had from our report in 2014 was that you
do need a graded system because it cannot be an all or none
because what that does is it raises the threshold for calling
out a problem until it becomes much worse than it needs to be.
And so we called for essentially a version of what the
Department of Homeland Security does--you know, kind of green,
yellow, orange, red--and I think that would be very, very
helpful. It will probably require some looking at IHR and what
can be done there.
Last is one of my broader frustrations with WHO, which does
come up here again and has been mentioned both by Ambassadors
Dybul and Kolker but let me emphasize because I think this is
extraordinarily important, is the difficulty WHO has engaging
with nongovernment actors, nonstate actors.
It has a framework that it uses. But, largely, WHO really
struggles and one of the things that we have learned is that a
global response to a pandemic is not just about government
action. It is about private sector. It is about civil society
organizations.
And so that is a broader and, I think, deeper discussion
with WHO, not just about the Health Emergencies Program.
But I would like to see a WHO that is more deeply engaged,
that is more favorable, that is more welcoming of nonstate
actors, because I think that is something that hinders WHO's
effectiveness.
[Pause.]
The Chairman. Excuse me. Great thoughts.
Lastly, Mr. Konyndyk, you are up.
Mr. Konyndyk. Thank you, and hopefully you can all see me
again. My internet has returned.
So I agree with--I agree with everything that my other
colleagues here have said. I think that, Senator Risch, you are
framing that it is a fire department but it is a volunteer fire
department is a really nice shorthand for the challenges that
the World Health Organization's emergency program continues to
face.
They have made great strides. They are now at a point where
I think the proof of concepts has been demonstrated and now we
need to really invest in strengthening and institutionalizing
their emergency capacity, and that means more consistent
funding.
I have watched them from my perch on their Independent
Oversight Committee for the last few years. I have watched them
struggle constantly with tradeoffs, of trying to cover all the
things that they have to cover within their mandate despite not
receiving enough resources to do so. And, you know, they are--
they are trying to contend with everything the world throws at
them with a budget smaller than most U.S. hospital systems.
Tied to that, they need greater staffing but they also, as
other witnesses have said, they need to invest more in
partnerships.
And so, you know, WHO should not have to do everything
alone and they have made progress, I think, overcoming some of
the cultural challenges within WHO around partnership with
nongovernmental actors. I think that is an area that needs to--
that needs to continue.
And then, finally, it is very, very important to take a
look, as Ambassador Kolker said, at the international health
regulations and some of the authorities that WHO has to operate
under that really do tie their hands and their ability to be
more forward leaning and more assertive.
And, in particular, looking fresh at the Public Health
Emergency of International Concern mechanism, which right now
is a binary mechanism--it either is or it is not--we need to
build in more gradations because there is a huge difference
between something like the COVID-19 pandemic and the Ebola
outbreak that has just finished in eastern Congo.
But within the existing construct of the emergency
declaration mechanism that cannot be acknowledged, so a more
gradated mechanism that looks perhaps more like what we do
within the humanitarian sector with famine declarations and
famine prediction I think could be very helpful in triggering
early action and differentiating between different levels of
risk.
Thank you.
The Chairman. Thank you very much for those remarks, and
just let me close. I am going to turn it over to Senator
Menendez.
Again, I want to stress that for every member of this
committee, the Foreign Relations Committee, and their staffs we
are going to be meeting as we have been regularly and talking
about ways of moving forward and getting things into the bill
that people can embrace so everyone--there is no closed secret
meetings.
Everyone is invited to these. Senator Murphy are going to
meet with our staffs briefly at noon today to talk about next
steps forward. So I want to invite everyone to participate and
so we can try to pull this wagon together.
With that, Senator Menendez.
Senator Menendez. Thank you, Mr. Chairman, and thank you
all for some very thoughtful testimony.
Dr. Dybul, in your written statement you mention that,
quote, ``Global and American partners are looking for a sign
that the United States will once again demonstrate its
commitment to a comprehensive global response. Investing in the
immediate response now, laying the foundation for the future,
will require leadership and resources.''
So do you or any of the witnesses testifying today believe
that the Administration's response has been commensurate with
the scope and nature of the COVID-19 pandemic, domestically or
abroad?
Dr. Dybul. Thank you, Senator Menendez.
I think the only honest answer to that is no, we are not
quite there yet. I would say we have some of the best people,
and I think we all know all of them, in the Administration and
in our civil service capable of mounting a strong engagement
internationally, as you saw from the government panel a few
weeks ago.
But we do have room to make up in terms of being engaged,
our leadership, joining CEPI, which both of your bills called
for, and participating there, engaging with WHO, supporting
WHO's reform and engaging with international partners which, as
I point out, I think is necessary to establish that fire
hydrant.
I know you have put the World Bank trust fund in and maybe
that is the best mechanism. But until we talk to the rest of
the world and know where they would put money, it is difficult
to know that.
So I do think we have the right people. We have got a great
team that can do the work. But we have some ground to make up
and I really thank the Congress and this committee for the
leadership and stressing it because people do look to Congress,
not just the Administration, and when they see leadership
coming from--and I know this from PEPFAR and the Global Fund--
leadership from Congress actually makes a big difference in the
world, took and I think we are positioned well to be able to
engage and to see this through.
And I would just point out, again, that swine flu report
today is very disturbing. I mean, if we have at the same time
new waves of the coronavirus, the potential for a bad flu
season or swine flu, it is a catastrophic future we could face,
and I really thank all of you and the people in the
Administration doing the work. But we have some work to do.
Senator Menendez. So let me ask you all, what lessons
should we learn from watching other countries who have
successfully responded to the COVID-19 pandemic?
I open that up to anyone who wants to give any insights.
Dr. Jha. Well, Senator Menendez, maybe I can--this is
Ashish Jha. Maybe I can begin.
There are lots of lessons, but the single most important
one is countries that have taken the virus seriously and have
moved aggressively have done better. This is a virus that is
unforgiving if you fall behind and, unfortunately, for much of
the time that we have been battling this virus I think we have
been behind and we have been playing catch up.
But, certainly, South Korea, New Zealand, Germany, and
Taiwan, Hong Kong, Singapore, there is a list of countries.
They have not all done the exact same thing. Some of them have
pushed more in testing and tracing, others sort of more
aggressive lock down.
But they all took it much more seriously than we have and
that has been the single biggest difference, in my opinion,
between countries that have done well and countries like ours
that have really struggled.
Mr. Konyndyk. Senator, this is Jeremy Konyndyk. Quick
thoughts on those two questions.
First, I would agree with Dr. Jha. The countries that have
done the best are the countries that have acted the earliest
had have been the most robust in using public health
engagement, that they have used upstream public health
capacity, testing, tracing, and strong public health systems to
prevent overwhelming their hospitals.
We have a weak public health system in the United States
compared to most other developed countries and that is an area
that needs more focus. But we also just have to act early and
be guided by evidence and I think it is clear we waited too
long and that has really hurt us.
On the international scene, you know, you asked if it has
been commensurate to the scope of the pandemic. I do not think
our engagement has.
We have been uncharacteristically absent from international
leadership on this pandemic and I look at the contrast with the
Ebola outbreak a few years ago or past outbreaks under the Bush
administration where, you know, the U.S. is really showing
leadership, engaging with the world, trying to convene and
bring the world along with us around a common vision.
We do not see anything like that here. Instead, we see the
Administration attacking WHO, moving very slowly to disburse
the aid funds that Congress has appropriated to it and going it
alone on things like vaccine development where the rest of the
world is collaborating.
So I think we really do need to step up into the customary
leadership role that we have shown in past outbreaks.
Senator Menendez. Well, thank you.
Now, moving into what this should look like then, recent
articles in Devex and Politico reported that the Trump
administration is proposing an initiative as called the
President's Response to Outbreaks, which would consolidate
international pandemic preparedness under a new State
Department coordinator and establish a new central fund to
fight pandemics, using money out of the COVID supplemental.
And let me go back to you, Mr. Konyndyk. You state clearly
in your testimony that you do not believe that modeling a new
initiative on PEPFAR as proposed by the Administration or as
the chairman's bill envisions is a good approach.
Would taking budgetary authority and programs from USAID
and moving them to the State Department at all improve the
ability of USAID or the U.S. in general to respond to epidemics
and pandemics?
What impact would further stove piping pandemic response
funding for prevention and response efforts have on global
health programs and the relief to development continuum?
Mr. Konyndyk. Thanks for that question, Senator.
Yeah, I do not think that creating a PEPFAR style highly
empowered centralized coordinator at the State Department is
the right model for what we need to do here.
I think that the--something like the counter-ISIL
coordinator is more the sort of function that we need here, and
that was a lighter touch structure.
It has some coordination authority but it led that in close
conjunction with the White House and it left the budgetary and
program decision making and line management to the agency
themselves, and I think that that is a much better way to go as
long as right from the outset we clearly define who is on the
hook to do what across the interagency.
And that was one of the challenges within PEPFAR and one of
the reasons the PEPFAR coordinator has had to be so empowered
is because that was kind of a free for all in the early years
of PEPFAR between USAID and CDC and it set the foundation for a
long--many years of turf battles between those two agencies and
forced the PEPFAR coordinator role to be more of kind of
referee for some of those interagency fights.
But if we design it well up front, I do not think we need
quite that heavy structure and that will be--you know, in the
Ebola outbreak when we did that it worked very well and we got
along because we did not have that much to fight over.
If we leave them a lot to fight over by not outlining roles
clearly, that is when you need that kind of heavy-handed
coordination function.
Senator Menendez. Very good.
And then, finally, Dr. Jha, on May 18th, President Trump
called for WHO reform within 30 days. Eleven days later he
announced that the United States withdraw from the WHO.
Former Deputy Secretary of State Bill Burns, one of
America's preeminent diplomats who served for 33 years,
commented that, quote, ``You do not reform the fire brigade
when the fire is raging out of control.''
So as someone who has both been a severe critic of the WHO
but today's testimony balances with some of the realities, what
is your assessment of the Trump administration's efforts to
reform the WHO, have they been effective, and what lessons can
we learn now from the United States efforts to work with and
reform the WHO during and following the 2014 Ebola outbreak?
Dr. Jha. So, Senator Menendez, thank you for that question.
To stick with Chairman Risch's analogy of a fire brigade, a
fire department--a fire department that, let us say, is
struggling to manage a blaze that is engulfing our
neighborhood, it is important to look at how that fire brigade
is doing and assess its performance. But to distract it in the
middle of fighting the fire is probably not ideal.
And so I believe that we have to do a very thorough and
careful examination of what did WHO do well, what did it do
badly, and how we make it better.
Interim assessments as have been proposed may be reasonable
as long as they are not hugely distracting. I believe at this
moment all of us have one job and one job only, which is to try
to manage this pandemic and try to bring it to a close as
quickly as possible. Anything that helps is a good thing to do
and anything that distracts is a bad thing to do.
I believe at the end of this pandemic, which I hope will be
within a year with vaccines that are widely available or at
least, let us say, controlling the pandemic by then, I think
there will be plenty of opportunity to do a very deep dive on
what WHO did well, badly, what reforms are needed.
Again, after Ebola it took both independent commissions and
U.S. leadership to make those changes, and I suspect that we
will need both of those, both independent assessments as well
as U.S. leadership to make the necessary reforms to make WHO a
more effective organization yet.
Senator Menendez. All right. Thank you. I have a lot of
questions I am going to submit for the record. I would love to
have your expertise on it, all of you.
And with that, Mr. Chairman, I turn it back to you.
The Chairman. Thank you, Senator Menendez. I think we all
have questions we will be submitting for the record and I think
those will be helpful as we try to put a path forward.
Unfortunately, technology has not helped me know who is on
the line here. So I am just going to go--I am going to do this
on seniority and I am going to move as quickly as I can through
these until we--so we can get through these.
Senator Rubio, are you on?
[No response.]
The Chairman. Senator Johnson.
[No response.]
The Chairman. Senator Gardner.
[No response.]
The Chairman. Senator Romney.
[No response.]
The Chairman. Senator Graham.
[No response.]
The Chairman. Senator Barrasso.
[No response.]
The Chairman. Senator Portman.
[No response.]
The Chairman. Senator Paul.
[No response.]
The Chairman. Senator Young.
[No response.]
The Chairman. Senator Cruz.
[No response.]
The Chairman. Senator Perdue.
[No response.]
The Chairman. Senator Cardin.
Senator Cardin. I am here, Mr. Chairman.
The Chairman. Oh, thank you. Senator Cardin, thank you for
being on, number one. Number two, thank you for your work on
this. Your work has been very helpful, very instrumental in
moving the entire issue forward.
Both yours and Senator Portman's work in that regard is
greatly appreciated and, again, on a bipartisan fashion I hope
we could all move forward to get a bill, whatever that bill may
look like, that would move the ball downfield.
So thank you, Senator Cardin. The floor is yours.
Senator Cardin. Thank you, Mr. Chairman, and I agree with
your assessment. I think this panel has been an excellent panel
and I thank each of them for their contribution.
A couple of observations, then I am going to ask a specific
question on what we should be doing in the United States
Congress.
Observations, as you have all said, that if you are in a
country, you are not going to be safe unless all countries are
safe to be in because it will spread; that U.S. leadership is
indispensable; and that the United States pulling out of WHO
during the middle of this pandemic made no sense whatsoever,
recognizing that the WHO definitely needed to be reformed.
We also recognize that the United States must lead by
example, and when we live in a country where we have the
continuation of the first wave and the escalating number of
cases, we are not the example that the world is going to look
to as the best way to handle this pandemic.
All of that are facts we have to deal with. The Senate
Foreign Relations Committee has a strong record of the
independence of the Congress in leading our nation. And yes,
you have all mentioned the fact that we need to provide greater
resources and I could not agree with you more. We do need to
provide the resources and Congress has the responsibility to
provide the resources.
But we can do more than just provide resources, and that is
my question to you, is what should the United States Congress
do? By example, during the previous Administration, we
disagreed with the policies in regards to Iran. We passed the
bill to be much stronger against the regime of Iran.
In this Administration, we disagreed with the
Administration's policy in regards to Russia. We passed a
strong bill to stand up to Russian aggression.
We acted independently. Now, we may have some different
views, but I believe that the President has been very
inconsistent--that is being kind--but has not given the
leadership we need for the global community in order to
effectively deal with this pandemic.
What should Congress do? What concrete steps should we take
in order to exercise U.S. global leadership to protect the
health of not just the global community but, clearly, the
health of Americans?
What action would you like to see come out of Congress?
Mr. Kolker. Senator, this is Jimmy Kolker. I would like to
take a first stab at that. Is that----
Senator Cardin. Sure.
Mr. Kolker. Okay. Sure. First of all, many people said, oh,
the U.S. was the best prepared country in the world, and in
another book, the Nuclear Threat Initiative, Johns Hopkins, and
the Economist published a study in which we did get the highest
score, 83 out of 100, which is not an A grade.
But if you look at the--if you look at the areas in which
we failed, we got a grade of 60 or less in three of the 34
indicators in that study, Global Health Security Index.
One was in the preparedness of our clinics and hospitals
for a pandemic outbreak in terms of supplies, training,
personnel, and all those things. We got a score of 60.
We got a score of 23 out of 100, a phenomenally bad grade,
in terms of health care access; how easy is it for the most
vulnerable populations to get access to health care in the
United States. A low score.
And we got an even lower score in exercising our team, and
we have seen that all three of these that we did not have a
team in place that was used to working with each other on
outbreaks and emergencies.
We did not have access for the most vulnerable populations
and our hospitals have been struggling to meet the demands that
had been placed on them.
So, domestically, Congress needs to look at this
holistically. But I also want to make one other point about
China. It is absolutely true China was not wholly transparent
or cooperative in the way they looked at this.
But, historically, the United States is not reliant and has
not been reliant on Chinese government official statements or
even on World Health Organization information about China.
After the SARS outbreak in 2003, China systematically set
up the CDC model on their own CDC. We had CDC people co-located
in China and in 2016 there were 47 of them on the campus of the
Chinese CDC in daily contact with their counterparts about
outbreaks and epidemics training, sharing information.
In 2013, with H7N9, bird flu outbreak, which many people
thought was going to be an epidemic, we surged 40 CDC people to
China to help the Chinese epidemiologists control that epidemic
and they did.
But two things happened. One is the post-Benghazi move of
all U.S. government personnel onto embassy compounds, which at
HHS or during the Obama administration I actually fought saying
this was not in the interests of our public health
preparedness, and indeed, in China we have moved all of CDC off
of the Chinese CDC campus into the embassy compound.
Then the Trump administration talked about reducing our
footprint of health presence in China and those 47 people have
been reduced to 14, of who only three are Americans.
So when we had this outbreak, we had--we had none of the
three protocols. We did not use any of the three protocols that
we could have used to engage China in direct bilateral
collaboration, and the last one of those three, I have to say,
which is an emerging infectious disease protocol, expires
today.
June 2020 is the expiration date. But emerging infectious
disease protocol, we have not convened a meeting under that
protocol since 2017.
So we have a protocol which would have facilitated the
sharing of information directly to us. We have not used those
authorities.
Senator Cardin. I have limited time. Let me just see if any
of the others want to respond.
Dr. Dybul. Senator Cardin, if I could.
As a constituent, I live in Kent County.
Senator Cardin. Sure--you first.
[Laughter.]
Dr. Dybul. I would say your direct question on what can
Congress do is very pointed and I would say what you are doing.
One is to link domestic and global much more clearly, which
would mean working across committees.
And that is one thing I would emphasize because this
crosses CDC in our domestic response. It crosses, you know, our
international activity, both at the State Department and in
Defense. It becomes complicated and it is very important to
work across those committees as I know you have begun to do.
The second thing is to do precisely what you are doing with
the legislation that has been proposed. Put forward how the
U.S. government can lead in both a bilateral and a multilateral
way, and open that up for discussion and then ultimately pass
the legislation and work with the appropriators to ensure it
gets funded.
But I do believe this committee is actually taking the
steps that are necessary and, again, there are people in the
Administration who can work with what you can do.
But if it is clear that Congress is acting I can tell you
that matters both here but abroad because people understand our
system of government, and clear action from Congress on
financing structure, activity, what you want to see done, makes
a big difference in terms of how the rest of the world views
the U.S. response.
So I thank this committee for initiating that process. The
key is to drive it forward, get it done, and then it can make a
big difference.
Senator Cardin. Considering you just complimented the
committee, I am sure the chairman did not mind I ran over a
little bit of time.
Thank you, Mr. Chairman.
The Chairman. If that had not been so complimentary I would
be very angry about your going over time. But thank you for
those remarks and I want to underscore again this is a--this is
a full committee response to this.
With that, Senator Shaheen, are you on?
[No response.]
The Chairman. I know she was with us earlier.
Senator Coons.
[No response.]
The Chairman. Well, Senator Coons is not here but I can see
Senator Udall sitting in front of a beautiful New Mexico state
flag and the mountains behind him reminds me of home.
Senator Udall. --you can hear me, I take it, right?
The Chairman. I can.
Senator Udall. Great.
Ambassador Kolker, first, I would like to thank you for
your previous work as HHS's chief health diplomat. The COVID-19
pandemic demonstrates how crucial it is for us to engage early
on with our international allies and neighbors to address
emerging public health issues. Only with open communication and
focused coordination can we effectively take on this virus.
The U.S.-Mexico Border Health Commission has a tradition of
working bilaterally to tackle shared public health challenges.
That is why I introduced bipartisan legislation with Senator
Cornyn and others, the Border Health Security Act, to better
coordinate our public health response along the northern and
southern borders by increasing emergency preparedness,
developing stronger health surveillance, and strengthening our
public health infrastructure by providing additional resources,
as the chairman has talked about.
Our bill uses the recommendations of the commission to help
effectively guide resources along with input from the
Administration.
Ambassador Kolker, in your opinion, will providing
additional resources to build public health infrastructure or
better coordinate early warning infectious disease surveillance
at our borders, which my bill does, improve our ability to
combat COVID-19 and future pandemics?
Mr. Kolker. Senator, thanks for your question and, of
course, the answer is yes. I did represent the secretary of
Health and Human Services and was co-chair with the Mexican
minister of health to lead these sessions of the U.S.-Mexico
Border Health Commission when I worked at HHS.
And it is a little known operation but it--when we think
about border security it is really important also to think
about border cooperation, and this is a great example of where
the four U.S. border states and the five Mexican border states
meet regularly to exchange information about health threats
with a direct involvement of the populations that live across
the border and the state departments of health.
And in that capacity we were able in the past to give small
grants, a total of only about $2 million a year, to state
health departments to enable them to leverage state support and
to support state and local efforts to do things like
surveillance, TB control, which is especially difficult across
the border, and looking for infections and outbreaks.
And this, unfortunately, with the reduction in budget for
the secretary's office at HHS, these grants to the states have
ended. So your efforts to--earmarks of money to do something
that I really saw good results from, especially in this time
when health security is national security, I really appreciate.
Senator Udall. Great. Well, I hope I can persuade Chairman
Risch and Senator Menendez to put this border health security
package into the next COVID relief package that we are going to
be working on because I think it would make a real difference,
as you have said, on all of the issues that impact us on the
northern border and the southern border.
Dr. Jha, in your opening remarks you said that the Latin
American region recently reached 2.2 million cases after
infections doubled over the last 2 months and its combined
death toll passed 100,000 last week.
Yet, the Trump administration has repeatedly cut funding to
the Latin American region. Furthermore, instead of helping our
neighbors in Cuba, the Administration has cut off communication
to family support networks. These cuts simply were not prudent
in light of the current pandemic.
What impact will these cuts have on our effectiveness in
dealing with the pandemic here at home and across Latin
America?
Dr. Jha. So, Senator, thank you for your question and your
comment.
You know, Latin America is our neighbor. These are our
neighbors, in Mexico and Cuba and, certainly, across the entire
Americas.
And when I look across the entire globe, Senator, I see
what is happening in Mexico and Peru and Brazil and Chile but
other countries as well as incredibly concerning. These have
really become, along with the United States, the hotspots of
the world.
And so if you think of this as a fire raging across an
entire city, and these are our neighbors, we have got to work
with our neighbors to put the fire out, because if there is a
fire, a raging fire, in our neighbor's home, there is nothing
we can do to protect our home that will not require us also
working with our neighbor.
So I believe deeply in American engagement globally but I
believe particularly in our engagement locally in our own
neighborhood. It is a good thing to do. It is in tradition with
what America has always done and it helps protect the American
people.
Senator Udall. Thank you, Chairman Risch, very much for
this hearing.
The Chairman. Thank you, Senator Udall. Appreciate that.
Senator Murphy, are you with us?
Senator Merkley. Yes, I sure am.
The Chairman. Senator Merkley, the floor is yours.
Senator Merkley. Mr. Chairman, were you calling on Chris
Murphy or Senator Merkley?
The Chairman. I am sorry. Chris Murphy.
Senator Merkley. That is not me. This is Senator Merkley
speaking.
The Chairman. I am sorry.
Senator Murphy, are you with us?
[No response.]
The Chairman. Senator Kaine.
[No response.]
The Chairman. Senator Markey.
[No response.]
The Chairman. Looks like you are going to get your chance
after all, Senator Merkley. You are up.
Senator Merkley. Okay. Very good, Mr. Chairman. Thank you
very much.
I want to start by asking for some thoughts on some of the
secondary impacts that we are facing, and perhaps Mr. Konyndyk,
I will address this to you at the Center for Global
Development.
One of the secondary impacts is a potential massive
increase in food insecurity, an estimated doubling of severe
food insecurity, an estimated 150 million more people driven
into extreme poverty.
Is this an area where America could really show some
international leadership and take that on?
Mr. Konyndyk. Thank you, Senator, for that question.
I think you raised a really important point, which is that
the--you know, the full impact of a pandemic like this is not
simply the infections that it causes. It is also the second
order impact so things like the economic damage, the food
security damage.
And, you know, we are seeing increasing reports of food
security impacts, particularly, you know, in countries that
have resorted to lockdown tactics without having the ability to
cushion the economic impact of that the way that a wealthy
country like the U.S. or the European countries have been able
to.
So I am particularly concerned about what that will mean
for much of the developing world as they try to contain this
virus and we need to then--we need to support them not just
with--not just with fighting the pandemic but we also need to
provide more comprehensive support.
And, you know, one of the areas where I have been
concerned, and I wrote a piece about this last week, is that
not much aid funding, whether from the U.S. or from other
donors, is reaching NGOs and front line local organizations in
developing countries and they have a very important role in
cushioning those impacts.
So, you know, I would urge the U.S. and other global donors
to focus on getting money really as expeditiously as possible
to those front line local partners who play such an important
role while also supporting organizations like the World Food
Program, which have an enormously important responsibility on
the kind of macro side of the food impact.
Senator Merkley. Thank you.
I wanted to turn to another aspect, and Dr. Jha, perhaps I
will direct this your way, which is there was reports that
international refugee camps are starting to show the signs of
outbreaks that could move very quickly.
I have been in some of those refugee camps around the world
where people are densely populated, most recently in Cox's
Bazar, and is that an area where the United States could really
help focus world attention and resources on the refugee camps?
Dr. Jha. Yes. So, Senator Merkley, thank you for that
question, and absolutely. You know, refugee camps--we have more
people displaced in the world right now than we have ever had
since World War II, about 70 million around the world, and
refugee camps are breeding grounds for large outbreaks of this
virus because it is, obviously, very difficult to socially
distance.
They do not have strong health infrastructure and you have
a very mobile population, often people with a lot of chronic
illness.
So I think this is an area of extreme concern to me as a
public health person and an area that I think has gotten very
little attention globally. And so U.S. leadership in this area,
I think, would be very helpful.
We are not talking about a small group of individuals--70
million people around the world who are internally or
externally displaced--and we really do need a concerted effort
to make sure that we manage disease outbreaks in those
communities.
Senator Merkley. Thank you. I think about how in Oregon we
are looking at the high-risk areas--farm worker camps, old
folks centers, prisons, and so forth, and how our committee--
our Foreign Relations Committee could be looking at those high-
risk areas around the--around the globe.
Let me turn to another piece of the puzzle, and perhaps,
Mr. Dybul, I will ask you to respond to this, and that is
vaccine strategy.
There is some hundred groups pursuing a vaccine. There has
been a conversation about if a United States organization
develops a vaccine that is approved whether we should insist
on, essentially, all the vaccine being available in the United
States first before it can be exported, or whether it should be
available to be developed or reproduced in, I guess, in
factories--drug factories around the world to quickly spread
it.
And so in terms of vaccine strategy, what is the--assuming
we get an effective approved vaccine what is the best way to
pursue the production and distribution of that vaccine?
Dr. Dybul. That is an excellent question, Senator Merkley,
and I do not think any of us would agree that we should just
give it to the U.S. first before we give it to anyone else
because that does not make us safe. If other countries have
widespread virus worst and we do not, we are stuck here. You
need vaccination across the world.
What is happening actually here is very exciting. In the
research world, the international collaboration is very strong
across the private sector.
We have three candidates that are moving, and there is a
significant investment both by the United States government
through NIH, BARDA, and other mechanisms, and also through the
Gates Foundation, through CEPI, which, unfortunately, the U.S.
did not participate in, to actually basically put bets on seven
vaccines, and we do not know if they are going to work but
begin creating the production facilities now.
The hope is that we would have more than one approach. For
example, there is about three major approaches that are being
taken to vaccine development.
You cannot just switch one factory from one type to other,
and so people are investing billions of dollars, including the
Gates Foundation, and Bill said, ``I am going to lose a couple
billion dollars'' because he is going to actually create the
production capacity now for those vaccines should they become
available so he can mass produce.
So there is great work being done there and I think support
from the U.S. Government, including financially, in addition to
NIH, which is hugely important, but to CEPI and others, which
both bills call for, will be important.
And secondly, to understand that just waiting until we get
to every last person in the United States is not the best way
to protect us from the virus. We actually need the world to
have the vaccinations so that we can have the open global
economy that we need if our economies are going to grow.
And the last thing I would say to that, which is something
I actually said to Senator Cardin, it is important that the WHO
be at the table, and so something Congress can do is make sure
we do not withdraw from WHO.
Senator Merkley. Thank you very much. Thank you, Mr.
Chairman.
The Chairman. Thank you, Senator Merkley.
We have got less than 15 minutes left but we have had a
couple of members join us who want to participate.
And we will do that starting with Senator Shaheen.
Senator Shaheen, you are up.
Senator Shaheen. --but I had to leave for a few minutes,
and I very much appreciate the thoughtful discussion and all of
our panelists' testimony this morning.
Dr. Jha, I want to begin with you because one of the things
you talked about was that you have been critical of the World
Health Organization for the way they praised China's response
to the coronavirus.
Given what has been said about the lack of carrots and
sticks that the WHO actually has, what do you think they should
have done in response to the way China behaved?
Dr. Jha. Yeah. Senator Shaheen, this is a very difficult
question because WHO--you know, people have often said, well,
WHO should have chastised China, and I think, well, I am sure
that would have worked out well in terms of WHO's ability to
get in and do things.
So I think the balancing act, as Chairman Risch brought up,
would have been, one, to acknowledge the information, demand
that China let WHO investigators in. But they did not have to
go as far as to praise China as the model.
I remember listening to those early WHO press conferences
and being struck by what I thought was an excessive level of
praise.
I suspect it was done with the motivation of getting the
Chinese government to then be more open to WHO's engagement,
and so I think the motivation was probably good.
But it also, I think, led a lot of people to be less
suspicious of the data coming out of China than probably should
have been. So I think it had costs, and it is always easy to
armchair quarterback but I do think they went too far and I
wish they had not.
Senator Shaheen. And could the international community,
could the United States, have done more at the time to
criticize and demand that China provide accurate data?
Dr. Jha. Yeah. You know, I always believe that direct
engagement by global leaders on issues like this and moments
like this is really important.
Harsh criticism may not work so well with the Chinese
government, just as it would not work with our government if
another government or WHO criticized us harshly. I am not sure
we would be amenable to working closely.
But I think direct engagement and more of a demand for
accountability and sharing of information coming from the
United States, coming from other European leaders, would have
been helpful.
The Chinese government, I think, responds to pressure when
it is done respectfully, as I think most organizations and
governments do, and I think that could have been done more
effectively than it was.
Senator Shaheen. Thank you.
One of the questions that I asked at the last hearing that
we had about the current pandemic was what opening the United
States withdrawal from the global stage has provided to China
to extend their influence in other parts of the world as they
respond as the country that is there to provide materials, to
provide medicine, to provide guidance based on their
experience.
Can any of you comment on the opening that you see that
that has given China and what the United States has sacrificed
in our not being the leader on the global stage right now?
Dr. Dybul. Well, Senator Shaheen, this is Mark Dybul, and
having run an international organization I can tell you it is
significant. And it is not just China. It is actually Russia,
too.
They have both been, over the last 3 or 4 years, been
increasing their footprint in global health significantly and
particularly in Africa.
And this is a real risk, I think, to the United States.
There should be a balance. We need China involved. They have
got lots of resources and they have got a lot to offer.
We cannot just open up the door to them, and wherever we
have stepped back, they have stepped in, and not just in the
WHO but in other areas.
And so we are at great risk around the world if we do not
stay actively engaged and at the table, and I would just
emphasize it is not just China. Russia has also been increasing
their footprint in the multilateral and in specific countries
in terms of health because they know countries value health,
and the U.S. has been the preeminent leader unquestioned in
global health and we need to maintain that role for many
reasons, including who are going to be our trading partners in
the future, and we need--we want to have those relationships
maintained not only for health but for many reasons that are
important to our security and our economic strength.
Mr. Kolker. This is Jimmy Kolker. If I can just reinforce
what Mark said.
You know, I was in the Foreign Service for 30 years, and
the U.S. is the aspirational nation. People in many, many
countries, especially in Africa, where I served for 14 years,
look to the U.S.
How do you solve that problem in the U.S.? How can we get
U.S. partners, U.S. expertise, and U.S. energy, involved in our
projects? And that is especially true with health.
And it seems to me that if we see this as mercantilist, if
it is zero sum, we miss opportunities that we took advantage of
working with China, for instance, on the Ebola response in
Liberia where there is a Chinese facility and ours worked
together with the African CDC, which was set up after Ebola and
has responded well.
So there are opportunities bilaterally with China but,
particularly, in the WHO and the rest of the world. People look
to us for expertise, guidance. We are the best prepared
delegation. We have the resources they want. If we are not
there, they are going to find somebody else and China,
certainly, is eager to play that role.
Senator Shaheen. Well, thank you very much.
Mr. Konyndyk, do you want to add to that?
Mr. Konyndyk. Yeah. I agree with everything the other
witnesses have said. I would just say as well I think that the
U.S. posture globally has been a real coup for China on this
because, you know, what the world has seen over the past few
months is China, because they controlled their outbreak
fairly--you know, relatively quickly, has been able to go
around the world distributing PPE and other supplies to
developing countries while for most of that period the U.S.,
rather than providing aid as we customarily would, has actually
been competing with a lot of these same countries for scarce
supplies or testing materials and PPE, and it is only recently
that that has begun to reverse.
You know, so what the world has seen is they are competing
with the U.S. that they are usually accustomed to partnering
with and instead they are getting help from China, and China
has been very happy to step into that gap and they have made a
lot of hay in terms of the public diplomacy, about really
playing that up.
I think that, you know, that is something we need to be
very wary of and the sooner we get our outbreak domestically
under control the sooner we can return to that customary role
of supporting the rest of the world.
Senator Shaheen. Well, thank you all very much. It seems to
me that as we talk about the importance of health around the
world, it is something that some of us in Congress seem to have
missed because it is also a huge issue here at home, and we
need to make sure that we are also looking towards the health
of the American people as well as globally.
Thank you all very much.
The Chairman. Thank you, Senator Shaheen.
We are down to about 5 minutes, and I have Senator Kaine
and Senator Booker, particularly Senator Booker, who has been
with us the entire meeting.
But, Senator Kaine, you are first in seniority so have at
it.
Senator Booker. Seniority and looks, by the way.
The Chairman. Yeah. Right.
Senator Kaine, are you with us?
[No response.]
The Chairman. Looks like, Senator Booker, you are up.
Senator Booker. I am grateful. Make sure somebody tells
Senator Kaine that I was saying nice things about him behind
his back.
The Chairman. Oh, I will. Believe me.
[Laughter.]
Senator Booker. All right.
I want to thank everyone on the panel for being here. It
has been a really substantive discussion and dialogue. I want
to get real quick to Mr. Konyndyk, and just ask you, you were
also a member of the CSIS Task Force that Senator Young and I
co-chaired just last year, and your expertise in producing the
report was really invaluable, frankly, and I just thank you for
your engagement and your commitment to easing suffering around
the world. It was a great experience for me and my team, quite
frankly.
I would like to ask you just some quick questions and,
hopefully, getting succinct answers, knowing that we have a
time limit.
Understanding that we really need global coordination and
information sharing to bring COVID-19 and other pandemics under
control, what would be less costly to the American taxpayer?
And that is something, I think, is a good lens with which to
look for.
Is it less costly to remain in the WHO, in your opinion, or
setting up a whole new international global health
organization?
Mr. Konyndyk. Thanks. That is a very easy question that I
can answer quickly. It is much cheaper and easier to stay in
the WHO and try to fix it than to set up something new.
And we--you know, when I served in the last Administration
we looked very hard at this question, as Ambassador Kolker will
remember, trying to figure out what to do with WHO after it
really dropped the ball badly on Ebola in 2014.
And we gave serious consideration to a range of options and
what we came back to was both the--kind of the least expensive
but also the most effective solution was to try and make WHO
work and that prompted the creation of the Health Emergencies
Program, which over the last 2 years, I think, has proven--has
proven the concept.
I would point most to the Ebola outbreak in Congo over the
last 2 years, an incredibly complex outbreak which WHO was able
to handle, you know, largely, without the kind of intensive
support it got from the U.S. and UK during the West Africa
outbreak.
You know, there was no deployment of 3,000 U.S. military
personnel. There was no deployment of hundreds of CDC and USAID
civilian personnel, and WHO still got the job done and the U.S.
spent far less--contributed far less to the Congo outbreak than
we had to do in the billions of dollars that we spent
containing the West Africa outbreak.
So I think there is very good return on investment in
working to make WHO work.
Senator Booker. Well, let me ask you the same kind of
balance sheet cost benefit analysis. What would demand less
resources from the State Department, working through the
existing system to reform the WHO or corralling the entire
international community to join a new organization to do what
the WHO already does?
Mr. Konyndyk. Yeah, of course, it is the same answer, and I
would add I think the rest of the world is not as upset with
WHO as the Trump administration is. You know, we are not seeing
other countries threaten to abandon WHO or even lodge criticism
towards WHO the way the U.S. has.
So I do not think there is any appetite for that. The U.S.
would really be, you know, banging its head against a brick
wall if we are trying to create a new organization without
consensus from the rest of the world on that.
Senator Booker. But it is more than just banging your head
against the wall. You know, it is so resource intensive,
correct, to try to go out and develop relationships----
Mr. Konyndyk. Absolutely.
Senator Booker. --with every health minister in every
country in the world as opposed to just tapping into the
relationships that the WHO has already developed over decades
and where its presence, frankly, is already accepted and
welcomed when some of the countries our presence,
understandably, with a lot of state of the globe right now
would not be welcomed. Is that correct?
Mr. Konyndyk. That is very well stated. You know, one thing
I have seen in my years doing this work is that the WHO is
almost an extension of the health ministry in many developing
countries, and that is not a--you know, that is not a role that
a new organization could just take over.
We need to capitalize--that is a huge advantage for WHO. It
is one that they could capitalize on better with their
emergency work and they are beginning to do so.
But I do not think you could just create something new and
expect to have that same sort of deep relationship and trust
that WHO has with the health ministries that need to be
partners on it.
Senator Booker. And in terms of just making America less
safe, is it--you know, trying to replicate the WHO's solidarity
trial, which is, you know, the world's largest clinical trial
of COVID-19 therapies, coalition of 300 scientists exchanging
scientific results as they test vaccines, we are really being
sort of isolating going at it to determine the efficacy of
vaccines ourselves. That does not seem a wise way to go.
Mr. Konyndyk. Yeah. We should be spreading our bets when it
comes to vaccines. I mean, I am glad to see the Warp Speed
program that the Administration has launched. We need that.
But we should not be putting all our eggs just in that
basket, and if there are other mechanisms that might pay off
sooner, you know, we do not know which of these things
ultimately is going to hit first. So we want to have a hand in
all of them.
Senator Booker. Yeah, and that is the challenges. I hear
this idea of using taxpayer dollars wisely, and it just seems
on a lot of levels just so deeply unwise, not to mention wildly
fiscally irresponsible to try to remove ourselves from the WHO
and then think that we are going to be able to replicate that
without extreme expense, putting ourselves in jeopardy, putting
American health and well-being at risk.
And so I just, really quickly, in the last seconds I have
remaining I want to go to Dr. Jha. I do not--I am not sure if
Americans really know the role that WHO plays in just the
seasonal flu vaccine, for example, and ending our involvement
in the WHO will, for the first time, cut the government--U.S.
government, rather--out of the development of the seasonal
influenza vaccine from the Southern Hemisphere, which is a
process that is actually coordinated by the WHO in partnership
with the United States.
So just really quickly, do we know for sure how or if U.S.
would maintain access to the most up-to-date information needed
to develop a vaccine?
How important it is--is it for the U.S. and for Americans,
in your opinion, to take the flu shot every year and what would
be the consequences for the world of not sharing and
coordinating information and the processes themselves for the
development of the seasonal flu vaccine?
If you could just give me a window on that and then I will
yield back to the chairman.
Dr. Jha. Senator Booker, thank you.
A couple of very quick remarks on that. Yes, we develop a
new flu vaccine, the world does, every year. Ten institutions
from around the world come together to collaborate, including
American institutions, and it is all done under the aegis of
the WHO.
I have no idea whether we would continue to be able to be
engaged and have a hand. But what I know is that if we could
not access that information and if we had to go it alone, our
ability to make the right bets, create the right vaccine every
year would be substantially diminished.
And that would--as you know, the flu, while, you know,
nothing like the current coronavirus, is still a deadly virus
and especially affects older Americans, and a vaccine is
incredibly helpful.
And if our vaccines became far less effective the main
people who would suffer from that are the American people.
So there are a lot of questions about what we would be able
to continue to engage in. Walking away from WHO, in my mind, it
is a no-brainer. It would leave the American people much worse
off and the influenza vaccine is just one example of how the
American people would be hurt by this decision.
Senator Booker. I am grateful for that, and thank you, Mr.
Chairman. I will yield back.
The Chairman. Thank you. Thank you, Senator Booker, and
thank you for being with us for this entire hearing.
We are past time, but Senator Murphy has joined us. I know
he is supposed to be in a very important meeting with a
distinguished member of the body right now. But we will
certainly welcome him and give him a shot at this.
So, Senator Murphy?
Senator Murphy. Thank you very much, Mr. Chairman, and I
will just ask one question. I know I am a little late to the
party here.
But there is one topic that we have not covered that I
think might be important to hear from at least Ambassador Dybul
on, and that is the status of global health infrastructure.
What we learned in combating viruses in West Africa is that
fragile local public health infrastructure makes it very, very
difficult to respond to new and evolving diseases.
And I know, Ambassador, you were involved in the creation
of the Global Fund for AIDS, Tuberculosis, and Malaria, which
has been a huge success in tackling those diseases. But the
mandate of the fund is really limited to those diseases.
Right now, there is not a robust global financing mechanism
by which we can muster partners together to go and just help
build and rebuild local public health infrastructure and then
also partner with nations to try to prompt reforms in the way
that they govern their public health infrastructure space.
So one of the things we have talked about across the aisle
is whether there is a need for the United States to stand up
that kind of capacity with other partners and on a nondisease-
specific basis go in and work with nations where we know there
is vulnerabilities and we know there is likely going to be
future viruses and pandemics and just use some basic building
block work of public health infrastructure where it is lacking.
So I just wanted your thoughts, quickly, on, you know, how
we go about doing that work, whether that can be done at the
Global Fund or whether we need to do that kind of work through
another entity, the WHO, new authority prompted by
congressional action.
Your thoughts?
Dr. Dybul. Thank you, Senator Murphy, and it is an
extraordinarily important question, especially right now.
A couple of quick points. From a technical perspective,
technical support, WHO plays a critical role. As was mentioned,
often the WHO is an extension of the ministries of health in
countries.
So they do play a critical role on the technical side, but
not on the financing side and so the financing piece is a
little bit different.
The Global Fund would have the capacity, certainly, with
new money now to scale up support to countries for
infrastructure, for procurement, for the pieces that are
necessary to respond to COVID right now.
I think for the longer term, it would be an open question
where the best international facility is, and we had a little
discussion about that a little bit earlier.
I would also point out that, you know, there are different
approaches, and we saw this, right. Taiwan had a relatively
low-tech approach versus South Korea's relatively high-tech
approach.
Because of the investments the U.S. and others have made in
HIV, TB, malaria vaccination, maternal and child health, South
Africa has fielded 28,000 community health workers to go out
and do contact tracing. Sierra Leone has 9,000.
In the Ebola crisis, it was those workers that went around,
that were repurposed, in a sense, from what had gone into the
institution building.
But we absolutely need more laboratory capacity. We need
more structure, and this is where the complementary
opportunities for CDC and which does this all the time, and
GHSA, USAID, bilaterally but then multilaterally.
Without a financing institution to complement the technical
institutions, we will not be able to get there, and I believe--
and I am a little biased, having run the Global Fund, but I
also ran PEPFAR so I have both perspectives--they could do--
they could absorb money now while the conversation is going on
for what it would do for the future.
Senator Murphy. Thank you, Mr. Chairman. I appreciate the
time.
The Chairman. Thank you, Senator Murphy.
That pretty much runs us out of time.
But, Senator Menendez, did you want to--first of all, let
me thank the panelists. This has been an incredibly frank and
good-faith honest broker exchange of ideas, and we really
appreciate that.
On behalf of the committee, I want to thank each and every
one of you for spending----
Senator Menendez, did you want to add anything----
Senator Menendez. Mr. Chairman, with your indulgence, if I
could ask Mr. Konyndyk one quick question just so I could----
The Chairman. Sure.
Senator Menendez. --devise responses to what you are trying
to do, and then with my thanks to everybody because it has
been--I echo the chairman's remarks--been extraordinarily
helpful and insightful.
Mr. Konyndyk, you mentioned in your testimony that your
team at USAID and the counterparts at CDC define each agency's
roles clearly at the outset of the response to the Ebola
outbreak in West Africa based on each institution's respective
comparative advantages.
A provision that we have in the legislation that we drafted
clearly spells out the roles of State, USAID, and CDC in the
pandemic response.
Is such a provision useful, in your view, and if so, why?
And, secondly, another provision creates a special advisor at
the White House rather than the State Department.
What is your view on having a coordination function at the
White House?
Mr. Konyndyk. Thank you, Senator. I will be very brief.
I would say that defining----
Senator Menendez. Unmute yourself because I cannot hear
you.
Mr. Konyndyk. How about now? Are you able to hear me now?
The Chairman. This is Jim Risch. I can hear you. Go ahead.
Mr. Konyndyk. Okay. I will try this again.
So I think that it is not just helpful, I think it is
essential to define each agency's comparative advantages up
front and I think the provision in your bill is--you know, it
is on the right path there.
You know, when it is clear what each agency is supposed to
do there is far less to fight over. There is far less turf
battling that I saw during the Ebola outbreak.
On the--on the White House piece, I would not say that you
need the White House coordinating instead of the State
Department. I think, you know, one of the helpful things with
the counter-ISIL model was the--it was a sort of partnership.
I spoke earlier this week with Brett McGurk, who served in
the envoy role, just to pick his brain a little bit on how that
worked in preparing for this hearing.
You know, and he talked about the partnership he had in his
team with the NSC, because the NSC has coordination leverage
that, frankly, the State Department just does not have vis-a-
vis other agencies.
So I think that you need both. I think a coordinator based
at the State Department synced with a restored global health
security director and an empowered senior director at the White
House is probably the best structure.
Senator Menendez. Well, thank you. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Menendez, and again, thank
you to our panel. I think we have all learned a lot that is
going to help us move the ball down the field and try to get to
a place that will make the world a better place and America a
better place.
Thank you all, and with that, the hearing is adjourned.
[Whereupon, at 12:10 p.m., the hearing was adjourned.]
----------
Additional Material Submitted for the Record
Responses of The Honorable Mark Dybul, M.D. to Questions
Submitted by Senator Robert Menendez
the u.s. international response
On June 7, The New York Times published an article which revealed
weeks of delays in getting emergency funding appropriated in the CARES
Act to fund our international response out the door to our partners.
Implementing partners themselves report waiting up to 10 weeks as
opposed to our usual 3 and a half weeks. And more than $200 million in
COVID aid is being spent on ventilators for countries handpicked by the
President with little to no examination as to whether this was the best
use of funds, and whether countries have the facilities and medical
personnel to put the ventilators to use.
Question. Did these types of funding delays happen while you were
in government? To your knowledge, what accounts for the current delays
in pushing funding out the door?
Answer. There can be delays following appropriation of funds even
when the executive functions are fully staffed. COVID itself could be
slowing use of funds.
Question. Based on your knowledge of the capacity constraints of
healthcare systems in developing countries, would healthcare facilities
serving rural or underserved communities in a given develop country
have the technical capacity or medical staff to safely and successfully
employ a ventilator?
Answer. Rural communities would not likely be able to manage
ventilators. However, this is true for many more advanced services,
e.g. c-sections, drugs needed to treat women during complications
during pregnancy, PCR for HIV or drug resistant TB, etc. For this
reason, health services in low income settings--including in the
U.S.A.--are designed with a ``hub and spoke'' approach. Several
countries in Africa have fewer than 10 ventilators. There is no
question they are desperately needed. However, many other less
expensive commodities and services are also needed. Oxygen, which can
save many lives and prevent progression requiring ventilators, is
relatively inexpensive and can be provided in many settings. It is
important to prioritize in a pandemic crisis and to ensure that
countries with the highest risk of an explosive epidemic and most in
need rapidly receive support for commodities and services, e.g. support
for testing, contact tracing and quarantine. In addition, there has
been a long standing, bipartisan agreement that politics and political
issues should not come into play for humanitarian relief.
Question. Is the expenditure of more than $200 million on a few
thousand ventilators for a select set of countries the best investment
for protecting the most lives and preventing the spread of COVID-19?
Answer. As noted above, ventilators are definitely needed. As are
many other commodities and services. The prices per unit of a
ventilator, and any other commodity or service, should, of course, be
reasonable and within standards and procurement procedures.
Question. What assurances on equitable access to care, when it
comes to U.S. supported response activities, should USAID seek from
host country governments?
Answer. In general, because much of the programming by USG
bilateral funding, and in particular USAID funding, is performed
through implementing organizations, e.g. non-governmental organizations
(NGOs), the USG can directly set standards and requirements for equity,
including where and to whom services should be provided. International
organizations, e.g. the U.N. family, the Global Fund to Fight AIDS,
Tuberculosis and Malaria (the Global Fund), Gavi (the Vaccine Alliance)
have strong equity provisions as part of their mission. Regarding
direct support to governments, the U.S. is often successful at
negotiating agreement on funding to ensure equity consistent with
national priorities and plans. CDC works closely with ministries of
health around the world and is a trusted partner and source of
technical support welcomed by countries. CDC also plays an important
role in ensuring equitable access to care.
It is important that U.S. support through NGOs and international
organizations also fit within national priorities and plans wherever
feasible.
Question. What else should we be doing to help end the pandemic--
are there programs and activities that the Administration should be
funding that it currently is not?
Answer. The legislation introduced by the Chairman with his
bipartisan co-sponsors and the Ranking member advance the two areas
that require coordination and funding--better coordination for U.S.
bilateral support and for international efforts. The Administration
seems to have similar approaches. The Center for Strategic and
International Studies Commission on Strengthening America's Global
Health Security, for which Ambassador Kolker and I serve as
Commissioners, issued and important report with additional
recommendations which can be accessed at: https://
healthsecurity.csis.org/final-report/.
More specifically, an effective pandemic response requires
coordinated and effective efforts to: 1) control spread, including
testing, tracing and quarantine and implementation of social distancing
and masks, and; 2) care and treatment for those who progress with
symptoms. Both control and care and treatment requires trained
personnel and varying degrees of personal protective equipment. In
addition, because it is likely that the pandemic will continue,
potentially with a second large wave beginning between August and
October, it is important for the U.S. to support efforts to understand
the global movement of the virus and genetic drift so that we, and the
rest of the world can be better prepared for the future. For a more
complete analysis, please see the White Paper published by Georgetown
University: https://gumc.georgetown.edu/covid-19-a-global-pandemic-
demands-a-global-response/
global reach of the who
The WHO has been on the frontlines of nearly every global health
challenge over the past 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases. The WHO serves
as both a repository of global expertise as well as a critical
implementation partner for local health ministries and organizations on
the ground. In many places with weak health systems, the WHO's role is
indispensable in ensuring the delivery of adequate health services and
responses.
Question. From your perspective, what makes the WHO a critical, or
even indispensable, partner?
Answer. There is remarkably wide agreement on the indispensable
role of WHO in pandemic preparedness, detection and response. Many have
come together to summarize the key strategic values of WHO as
summarized below:
Preeminent Technical Guidance--With a presence in over 150
countries and the trust of governments around the world, WHO is
uniquely positioned to both collect new evidence emerging from anywhere
in the world and use it to develop, refine and disseminate technical
and normative guidance essential to battling COVID-19.
Global Clinical Trials--WHO is the only agency in the world capable
of coordinating unprecedented global trials on therapeutics and
vaccines, including the groundbreaking scope of the ``Solidarity Trial
(https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-
trial-for-covid-19-treatments),'' with more than 100 countries
participating. As important, the Solidarity trial will reduce the
amount of time it normally takes for a drug trial to determine
effectiveness by 80%.
Communication--WHO is the only organization with the technical
expertise and capacity, global membership, credibility, access and--
most important of all--trust, to launch pandemic awareness campaigns
throughout the world. Billions of people have access to WHO's evidence-
based information in dozens of languages.
Distribution--At least 133 countries are relying on WHO to globally
procure millions of pieces of personal protective equipment (PPE) and
other vital health commodities like tests and testing supplies,
including more than 4.5 million items of vital PPE.
Equity and Access--Only WHO is working to pre-position
manufacturing capacity and distribution channels to ensure countries
will have access to COVID-19 vaccines and treatments as quickly as
possible and at a fair price.
Developing world engagement--The WHO has a particularly important
role to play in helping poorer countries fight COVID-19. Out-of-control
outbreaks in the developing world will threaten the United States and
could spark second waves of disease.
Question. What challenges do we face in responding to a global
pandemic without the WHO as a partner?
Answer. The challenges would be insurmountable given the key roles
WHO plays, and must play, as noted in the previous question. In
addition, the risk to the world--and the U.S.--for future pandemic
preparedness and response would be significant.
Every agency can always do better, and no doubt mistakes have been
made by WHO and every organization involved in COVID-19. However,
overall the WHO has done a very good job in challenging circumstances.
Action was taken from January 1 onward. And WHO has significantly
improved under the leadership of the Director General, who was elected
on a reform platform. The responses to the recent Ebola outbreak in the
Democratic Republic of Congo and to COVID-19 have been substantially
better than the response to the Ebola epidemic in West Africa several
years ago.
Question. What barriers will the United States face in trying to
set up an effective alternative to the WHO?
Answer. There is no effective alternative to WHO as a global
normative, guidance, technical agency. No other organization would have
the credibility, access, network of country offices or authority
needed.
I have not seen any proposals by the Administration to establish an
alternative, perhaps understanding that any attempt to create an
alternative would be technically and politically impossible. However,
WHO is not ordinarily an implementing or financing agency (In unusual
circumstances it can fill a vacuum, for example during Ebola Congo when
it got too dangerous and the NGO's left Butembo). Those key pieces must
be established as discussed in the hearing and as noted in the
legislation put forward.
international cooperation
In addition to efforts to combat COVID-19 at the WHO, there have
been a number of other international efforts to combat the virus,
including the European Commission's Coronavirus Global Response Summit
on vaccines, which the United States conspicuously did not join. In
fact, since the start of the pandemic the United States has failed to
lead the international efforts to respond. We blocked consensus on a
statement from the Security Council, and from the G7 by insisting on
using divisive racially inflammatory rhetoric to describe the
infection. The President himself used offensive terms to describe the
disease at a political rally in Tulsa.
Question. What kind of international engagement is necessary for
the United States to be best prepared to combat COVID-19?
Answer. As discussed at the hearing, and addressed in proposed
legislation and, it seems, being considered by the Administration, a
coordinated U.S. Government bilateral effort combined with a global
fire department--a multi-sectoral global Task Force or Emergency
Operations Center--and a separate financing agency (the fire hydrant)
are needed. The U.S. has been the unquestioned leader in global health
with strong bipartisan support for two decades. It is important that
the U.S. play a strong leadership role again.
For more detail, please refer to the White Paper released by
Georgetown University: https://gumc.georgetown.edu/covid-19-a-global-
pandemic-demands-a-global-response/.
Question. How can we use our international relationships to improve
the situation for U.S. citizens as well as our partners?
[No Response Received]
western hemisphere
Over the past few months, there have been multiple reports
documenting that the Trump administration has deported dozens of
Guatemalan, Mexican, and Haitian nationals who tested positive for
COVID-19 upon arrival in their home countries. Just this week, it was
reported that despite an agreement to deport only those with medical
certificates showing a negative test, Guatemalan authorities say that
at least 28 deportees have tested positive since early May. Thirteen of
my colleagues and I sent a letter to the State Department and
Department of Homeland Security highlighting this very issue, though we
have yet to receive a response. This question is for any of our
panelists:
Question. How, in your view, does deporting COVID-19 positive
individuals to countries with weak or limited health system capacity
affect our strategic interests in the hemisphere?
Answer. The most sound scientific and medical approach is to
quarantine and care for and treat anyone who is positive for SARS-CoV-
2, and to conduct rigorous contact tracing and testing related to the
sentinel person. Deportation of someone who is actively positive for
the virus risks further spread in the region and damages our
reputation.
Question. What policy approach would you recommend regarding
removals during a pandemic? How have U.S. Government policies relating
to deportation addressed previous epidemics, such as the Ebola crisis?
Answer. There is no scientific or medical basis for deportations of
any kind.
Question. What is the scientific or medical evidence supporting the
Trump administration's closure of U.S. borders to asylum seekers, but
not other ``essential'' travelers such as truck drivers and family
members?
Answer. There is no scientific or medical basis for such a
restriction.
impact on other global health priorities
A study published in 2016 by Yale University researchers found that
there may have been as many deaths from HIV AIDS, TB and Malaria during
the 2014/2015 Ebola outbreak in Guinea, Liberia and Sierra Leone as
there were from Ebola because the health systems in those countries
were overwhelmed, limiting access to health services. Recent reports
indicate that as the COVID-19 pandemic continues, there has been a rise
in the number of illnesses from preventable illnesses including polio,
cholera and diphtheria. This question is for any of our panelists:
Question. What should we be doing to prevent the disruption of
health services, including service for those affected by HIV/AIDS, TB
and Malaria?
Answer. The reality is that until there is pandemic control, other
health services will suffer. As during the Ebola crisis, pandemics can
lead to significant disruptions to health services including HIV, TB
and malaria, vaccinations, etc. There is fear among health providers
and those at risk, leading to decreased availability of health
services. There are reports of 70 percent declines in, for example,
identification of new cases of tuberculosis. Because virtually every
country has been effected by COVID-19, it has also been reported that
COVID-19 could wipe out the significant gains the world has made
against the HIV, TB and malaria pandemics, with strong leadership and
bipartisan support of the U.S.
However, it is also important that the U.S. do what she can to
minimize the collateral damage by supporting bilateral and multilateral
organizations and efforts to ensure as many HIV, tuberculosis and
malaria services are provided, including through PEPFAR, PMI, other
health programs supported by USAID, the Global Fund to Fight HIV,
Tuberculosis and Malaria, Stop TB, Roll Back Malaria, Gavi, and
importantly, as noted above, WHO.
The most important and effective approach the U.S. can take is lead
global efforts to control the global pandemic and to lead in preparing
for the next one. With population growth, changes in climate and
temperature patterns, and increased proximity to animals, another
pandemic in the near- to mid-term is highly likely.
Question. Should the U.S., provide funding for the Global Fund to
Fight AIDS Tuberculosis and Malaria's COVID-19 mechanism?
Answer. Yes. The Global Fund consistently receives high marks for
results, transparency and accountability. It has the capacity and
mechanisms to rapidly support national responses including procurement
and supply chain, laboratory and human capacity, data collection and
analysis and other key aspects of efforts to control the pandemic and
provide care and treatment to those who become infected. It also can
support countries to maintain and even strengthen their HIV,
tuberculosis and malaria responses, helping to protect massive and
highly successful U.S. investments over the past two decades. In that
regard, during the West African Ebola epidemic, the Global Fund
supported a community-led national malaria bed net campaign in Liberia
and, with WHO leading the normative, guidance and technical aspects,
the presumptive treatment of malaria at the height of the epidemic.
______
Responses of The Honorable Jimmy J. Kolker to Questions
Submitted by Senator Robert Menendez
the u.s. international response
On June 7, The New York Times published an article which revealed
weeks of delays in getting emergency funding appropriated in the CARES
Act to fund our international response out the door to our partners.
Implementing partners themselves report waiting up to 10 weeks as
opposed to our usual 3 and a half weeks. And more than $200 million in
COVID aid is being spent on ventilators for countries handpicked by the
President with little to no examination as to whether this was the best
use of funds, and whether countries have the facilities and medical
personnel to put the ventilators to use.
Question. Did these types of funding delays happen while you were
in government? To your knowledge, what accounts for the current delays
in pushing funding out the door?
Answer. The June 7 NYT article refers mostly to USAID, where I did
not personally work, and, needless to say, every crisis and every
appropriation has some unique features which make comparison difficult.
I nonetheless understand the frustration that urgently needed funds are
not getting to their intended beneficiaries.
In the current case, the differences include that we are facing the
same public health crisis at home as other countries are experiencing,
that most U.S. government employees and most NGO partner staff are
working from home, that embassies overseas are working with reduced
staff, including the local staff who are essential in the response, and
that the demands are truly global, not centered on one country or
region, thus requiring more clearances and trade-offs in setting
priorities. Each of these factors probably resulted in some delays in
moving funds to many overseas partners and American implementers
working overseas.
In addition, I have a concern, maybe specific to my time as
ambassador and with HHS, when I hear ``pushing funds out the door.''
The emergency supplemental Ebola funds, that were appropriated for a 5
year period, are an example. USAID was able to obligate a large
percentage of those funds during the first weeks and months because 1)
OFDA has lots of ``notwithstanding'' authority which CDC, for instance,
does not have, and 2) USAID works primarily through grants and
contracts, where all of the money is ``obligated'' and thus ``out the
door'' up front, but expenditure and implementation may not start
immediately and is phased over many months or years. HHS, by contrast,
does most of its work through USG employees. The salaries and expenses
of these people cannot be sent ``out the door'' all at once, but we had
a very accurate idea of what the multi-year costs would be. and this
was in a clear multi-year budget. However, when Congress (and some in
the Administration) looked at 2014 Ebola emergency funds as a source
for reducing the Administration's request for Zika funds in 2016, the
USAID 5-year money was mostly ``spent'' while the HHS money was deemed
``unspent'' even though progress on actual programs in the field was
comparable.
That said, the groups quoted in the article, Catholic Relief
Services and International Rescue Committee, are essential partners and
responsible actors in emergency situations. If they experienced
procedures, timetables or motivations different from the imperfect
systems we had in past USG administrations for ``moving money out the
door,'' the comparison is instructive--and disappointing if harmful to
getting results.
Question. Is the expenditure of more than $200 million on a few
thousand ventilators for a select set of countries the best investment
for protecting the most lives and preventing the spread of COVID-19?
Answer. Not in my opinion.
It is hard to recognize any public health strategy, needs
assessment or realistic logistics plan in selection of partner
countries and ventilator destinations within those countries. Equipment
that can only be used in tertiary hospitals with specialist medical
supervision raises questions of access for the poorest, most vulnerable
and the greatest numbers, who rightly are the target beneficiaries of
most U.S. global health programs.
Question. What assurances on equitable access to care, when it
comes to U.S. supported response activities, should USAID seek from
host country governments?
Answer. Such assurances, naturally, depend on the circumstances,
partner and resources provided. My experience is that we sometimes
worked through non-government, including faith-based, organizations or
multilaterals, such as UNICEF or UNHCR, because they could reach target
populations more directly than governments could, so the analysis needs
to extend beyond host country government ``assurances.''
Nonetheless, with the novel coronavirus affecting everyone,
everywhere, serious thought at all levels of government and among non-
government actors to allocation of supplies, access to prevention,
testing and treatment and to disparities is essential. We in the U.S.
are in a precarious position to make demands on others because our
domestic response has been so weak in this area. Tellingly, the
indicator for access to care and treatment in the 2019 Global Health
Security Index for the United States was 23 out of 100, a poorer score
than many African countries. The consequence has been dramatic racial,
ethnic, income and social disparities in our own outbreak and the
outcomes for patients.
The message both at home and abroad needs to be: collect the data
on who has access and who does not, look at what it tells you; address
inequities and keep in mind that social determinants of health are not
abstract. They determine how well the health system can respond. This
is a role the World Health Organization often plays well in countries.
We might not need to do this work bilaterally if we cooperate with the
WHO to see that it is done.
Question. What else should we be doing to help end the pandemic--
are there programs and activities that the Administration should be
funding that it currently is not?
Answer. As Jeremy Konyndyk said in the hearing, we are recommending
that others around the world listen to experts whose advice we are not
following at home. Paying closer attention to the science and
scientists in our response at home will help end the pandemic.
We should contribute to the Coalition for Epidemic Preparedness
Innovation and look at setting some better guidelines for public
benefits in terms of cost, availability or other benefit from USG
investment in research which leads to blockbuster drug development by
private sector firms which develop, patent, manufacture and market
these discoveries.
I also support Senator Udall's effort to fund Covid-relevant
activities through the U.S.-Mexico Border Health Commission. The
Administration has discontinued using discretionary funds to support
the border areas' health needs.
global reach of the who
The WHO has been on the frontlines of nearly every global health
challenge over the past 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases. The WHO serves
as both a repository of global expertise as well as a critical
implementation partner for local health ministries and organizations on
the ground. In many places with weak health systems, the WHO's role is
indispensable in ensuring the delivery of adequate health services and
responses.
Question. From your perspective, what makes the WHO a critical, or
even indispensable, partner?
Answer. It is the pre-eminent global health normative and
consultative agency, with a broad mandate and near universal
membership. It has been effective in getting countries to work together
on priorities (smallpox, polio, childhood immunization) and has helped
the United States leverage our resources, expertise and soft power to
make health a priority and to base interventions on evidence.
WHO processes are cumbersome, its budget far below what is needed
to cover its responsibilities and its structure, antiquated, But these
are solvable problems, and considerable progress was made 2015-16
improving processes that proved problematic in the Ebola response.
WHO's was the first specialized agency of the United Nations and
the premier example of how the U.S. helped create a rules-based,
science-based order for addressing trans-national problems. That should
remain the cornerstone of our international engagement, even as the
structures of WHO are updated and the funding increased to meet 21st
century challenges, including health issues far beyond infectious
diseases.
Question. What challenges do we face in responding to a global
pandemic without the WHO as a partner?
Answer. There are many, but I will highlight three.
The biggest challenge in my view is that we are not working with
WHO and the broad international community that it convened to consider
equitable access to and allocation of vaccines, treatments and cures
for COVID-19 that are under development.
The U.S. public and private sector systems for research do not
align with the WHO's focus on global health equity priorities. Market
forces can be at odds with WHO's desire to assure vaccine and treatment
affordability for low and middle income countries. In the past, the
U.S. has taken a ``problem-solving'' approach to discussing these
situations and working together to share information, define roles and
reach accommodations, so that divergent interests are recognized, even
if never fully satisfied.
By boycotting the WHO meeting that set up the Access to Coronavirus
Tools (ACT) Accelerator and the subsequent European Commission and UK-
led conference to collaborate on practical solutions, we missed the
chance to have our priorities taken into account as well as to benefit
from the conclusions reached for vaccine deployment. If the U.S. is the
first to develop a safe and effective vaccine, our monopolization of
the supply will be seen as illegitimate by other nations. If we are not
the first, we will have reduced leverage to meet our domestic needs
equitably, as we were not at the table.
Second, experts from the U.S. have always in the past been included
in WHO panels and delegations, reviewing public health emergency
responses, gathering key data or recommending remedial actions. Not
being included in these groups will inhibit our ability to gather and
analyze the data, bring our perspective to the discussion and influence
the recommendations. An example is the expert group that will go to
China to review their handling of the novel coronavirus outbreak. The
WHO has the authority to organize the delegation and report on results.
This knowledge is important, but we may be getting it second-hand.
Third and related, is that there are many collaborative activities,
such as development of a seasonal flu vaccine (cited by Senator Booker
in the hearing) that are jointly convened and acted upon by the WHO and
by, in this case, the U.S. CDC. Relinquishing our role as co-convener
and lead vaccine developer may severely handicap our deploying the most
effective possible flu vaccine at exactly the time the dual threat of
seasonal flu and COVID-19 may have the most devastating effect on our
population and health systems.
Question. What barriers will the United States face in trying to
set up an effective alternative to the WHO?
Answer. We have a lot of allies wanting to improve the World Health
Organization. We have no allies on abandoning it. There is no support
by other major countries for an alternative to WHO, although it is
clear to all that WHO alone is not adequate to address the world's
response to a pandemic, given its social, economic and political
facets.
As we look at existing and potentially new structures that can add
value and impact to the domestic and international capacity, it is
essential that these be seen as supplements to or reinforcing WHO, not
as alternatives. Numerous studies looking into WHO's weaknesses and
missteps, for instance in the initial Ebola response, all concluded
that there is no multilateral alternative that could assume or
duplicate the WHO's mandate, reach and embedded collaborations. Their
conclusion, which I think is even more pertinent today, is that trying
to create a global health structure as a replacement for WHO would be
politically impossible to negotiate. It is especially important to
recognize that any alternative proposed unilaterally by the U.S.
Government has no chance of winning wide support.
I advocated in my testimony for a review conference or revision
meeting to update the International Health Regulations. I think this
would be the best place to start if we are looking for more effective
multilateral platforms for dealing with outbreaks, epidemics and member
state obligations when they occur. Any new or improved arrangements
would also depend on robust and sustainable financing, with the U.S.
government as a core guarantor.
international cooperation
In addition to efforts to combat COVID-19 at the WHO, there have
been a number of other international efforts to combat the virus,
including the European Commission's Coronavirus Global Response Summit
on vaccines, which the United States conspicuously did not join. In
fact, since the start of the pandemic the United States has failed to
lead the international efforts to respond. We blocked consensus on a
statement from the Security Council, and from the G7 by insisting on
using divisive racially inflammatory rhetoric to describe the
infection. The President himself used offensive terms to describe the
disease at a political rally in Tulsa.
Question. What kind of international engagement is necessary for
the United States to be best prepared to combat COVID-19?
[See response to next question below.]
Question. How can we use our international relationships to improve
the situation for U.S. citizens as well as our partners?
Answer. I will reply to the two questions together.
COVID-19 struck first and has had its most widespread consequences
in countries with advanced health systems. This reality reinforces my
belief that we must approach global health and international health
engagement as a technical partner and not as a ``donor''. I mentioned
in a previous reply the importance of U.S. participation in discussions
and decisions about vaccine access, and I am in favor of pro-active
U.S. leadership on health in the U.N. Security Council, G7, G20 and the
many other fora that can shape world opinion and national action.
But I also advocated in my testimony a stronger role for the State
Department, with a permanent senior coordinator for health security and
diplomacy. My foreign service experience is that we have phenomenal
resources in our embassies and missions overseas, which are often under
appreciated and underused for health goals.
This is not a suggestion that State should take over health work
done by USAID or anyone else. It is a recognition that traditional
diplomatic skills and attention can greatly expand our influence and
ability to deal with health challenges. We have underappreciated the
value of health and scientific partnerships as a priority in bilateral
relations as well as multilateral. Our ambassadors and embassy teams
can gather information, alert our own and foreign governments to health
conditions and needs, find counterparts in civil society, academia and
the private sector, recognize best practices and build coalitions to
respond, nationally, regionally and globally.
It was of course important to address the needs of American
citizens in our initial coronavirus response activity around the world,
But as we devoted priority embassy resources to evacuations of American
employees and their families and of private citizens, I don't believe
we paid enough attention to the diplomatic priority Coronavirus had
become and remains. In China, for example, the health attache and all
American FDA and NIH staff were evacuated. Shouldn't these have been
considered essential, even ``emergency'' employees to protect our
national security? Where was the Office of Global Health Diplomacy in
instructing embassies, analyzing information and leading the diplomatic
response to coronavirus? Lodging this Office within the Office of the
Global AIDS Coordinator has severely limited its responsibility and
potential influence.
Furthermore, cutbacks in funding and staff required CDC and, to a
lesser extent, USAID, to cut back health security staff and programs in
partner countries. This now seems very short-sighted, and we need to
look holistically at health diplomacy as a component of U.S. interests
in most countries around the world and reinforce both traditional
diplomacy and soft-power expeditionary diplomacy to promote and protect
those interests.
western hemisphere
Over the past few months, there have been multiple reports
documenting that the Trump administration has deported dozens of
Guatemalan, Mexican, and Haitian nationals who tested positive for
COVID-19 upon arrival in their home countries. Just this week, it was
reported that despite an agreement to deport only those with medical
certificates showing a negative test, Guatemalan authorities say that
at least 28 deportees have tested positive since early May. Thirteen of
my colleagues and I sent a letter to the State Department and
Department of Homeland Security highlighting this very issue, though we
have yet to receive a response. This question is for any of our
panelists:
Question. How, in your view, does deporting COVID-19 positive
individuals to countries with weak or limited health system capacity
affect our strategic interests in the hemisphere?
Answer. Any non-emergency, non-therapeutic transport of people who
have an active contagious disease is a questionable public health
practice and almost inevitably a source of tension between sending and
receiving countries. Even if the deportation legality and mechanisms
are established and mutually agreed (which may or may not be the case
here), these need to be re-examined in the current circumstances of
high U.S. infection levels and many international travel restrictions.
Question. What policy approach would you recommend regarding
removals during a pandemic? How have U.S. government policies relating
to deportation addressed previous epidemics, such as the Ebola crisis?
Answer. The precedents of the Ebola crisis are not very relevant
because travelers from the affected countries could not reach the U.S.
overland, and the transmissibility of the pathogen was different. To my
knowledge, there were no Ebola-specific deportations or instances of
individuals who contracted Ebola in or en route to the U.S. who were
deported, nor any deportations to the three West African countries
during the Ebola epidemic. (We strongly advised Nigeria not to put the
arriving Ebola-stricken Liberian airline passenger back on a flight to
Liberia, which was their original intention). The system of screening
passengers for fever and visible symptoms at airports of departure in
Liberia, Sierra Leone and Guinea and then monitoring arrivals through
state health department check-ins when they reached the U.S. worked
well--better, in fact, than we had anticipated within the
Administration.
Question. What is the scientific or medical evidence supporting the
Trump administration's closure of U.S. borders to asylum seekers, but
not other ``essential'' travelers such as truck drivers and family
members?
[No Response Received]
impact on other global health priorities
A study published in 2016 by Yale University researchers found that
there may have been as many deaths from HIV AIDS, TB and Malaria during
the 2014/2015 Ebola outbreak in Guinea, Liberia and Sierra Leone as
there were from Ebola because the health systems in those countries
were overwhelmed, limiting access to health services. Recent reports
indicate that as the COVID-19 pandemic continues, there has been a rise
in the number of illnesses from preventable illnesses including polio,
cholera and diphtheria. This question is for any of our panelists:
Question. What should we be doing to prevent the disruption of
health services, including service for those affected by HIV/AIDS, TB
and Malaria?
Answer. One of the advantages of the standing, funding and track
record of the U.S. PEPFAR program and the Global Fund to Fight AIDS, TB
and Malaria is that we have resources and partnerships that can be and
are being directed to this priority.
U.S. leadership, through financial commitment, consultation with
front-line partners and UNAIDS and WHO guidance and policies, can
contribute substantially to keeping these diseases on governments' and
communities' agendas and assuring the supply chain and health facility
capacity to minimize disruptions due to COVID-19. The AIDS 2020
conference this month provided a broad platform for innovative ideas
toward this goal.
The increase in illness and death due to other causes while West
African states were fighting Ebola in 2014-15 is well documented, but
it is not evident that we learned the necessary lessons. It was because
of the Ebola outbreak that I recognized the success of Last Mile
Health, an organization supporting community health workers in some
parts of Liberia, which uniformly had better Ebola and non-Ebola health
outcomes than the rest of the country. That model is being used in
Liberia and some nations now to maintain routine health services, and
should be expanded. [Disclaimer: I am a member of the Last Mile Health
Advisory Board].
Question. Should the U.S., provide funding for the Global Fund to
Fight AIDS Tuberculosis and Malaria's COVID-19 mechanism?
Answer. Yes.
______
The Committee Received No Response From Dr. Ashish K. Jha, M.D. for the
Following Questions by Senator Robert Menendez
the u.s. international response
On June 7, The New York Times published an article which revealed
weeks of delays in getting emergency funding appropriated in the CARES
Act to fund our international response out the door to our partners.
Implementing partners themselves report waiting up to 10 weeks as
opposed to our usual 3 and a half weeks. And more than $200 million in
COVID aid is being spent on ventilators for countries handpicked by the
President with little to no examination as to whether this was the best
use of funds, and whether countries have the facilities and medical
personnel to put the ventilators to use.
Question. Based on your knowledge of the capacity constraints of
healthcare systems in developing countries, would healthcare facilities
serving rural or underserved communities in a given develop country
have the technical capacity or medical staff to safely and successfully
employ a ventilator?
[No Response Received]
Question. Is the expenditure of more than $200 million on a few
thousand ventilators for a select set of countries the best investment
for protecting the most lives and preventing the spread of COVID-19?
[No Response Received]
Question. What assurances on equitable access to care, when it
comes to U.S. supported response activities, should USAID seek from
host country governments?
[No Response Received]
Question. What else should we be doing to help end the pandemic--
are there programs and activities that the Administration should be
funding that it currently is not?
[No Response Received]
global reach of the who
The WHO has been on the frontlines of nearly every global health
challenge over the past 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases. The WHO serves
as both a repository of global expertise as well as a critical
implementation partner for local health ministries and organizations on
the ground. In many places with weak health systems, the WHO's role is
indispensable in ensuring the delivery of adequate health services and
responses.
Question. From your perspective, what makes the WHO a critical, or
even indispensable, partner?
[No Response Received]
Question. What challenges do we face in responding to a global
pandemic without the WHO as a partner?
[No Response Received]
Question. What barriers will the United States face in trying to
set up an effective alternative to the WHO?
[No Response Received]
international cooperation
In addition to efforts to combat COVID-19 at the WHO, there have
been a number of other international efforts to combat the virus,
including the European Commission's Coronavirus Global Response Summit
on vaccines, which the United States conspicuously did not join. In
fact, since the start of the pandemic the United States has failed to
lead the international efforts to respond. We blocked consensus on a
statement from the Security Council, and from the G7 by insisting on
using divisive racially inflammatory rhetoric to describe the
infection. The President himself used offensive terms to describe the
disease at a political rally in Tulsa.
Question. What kind of international engagement is necessary for
the United States to be best prepared to combat COVID-19?
[No Response Received]
Question. How can we use our international relationships to improve
the situation for U.S. citizens as well as our partners?
[No Response Received]
western hemisphere
Over the past few months, there have been multiple reports
documenting that the Trump administration has deported dozens of
Guatemalan, Mexican, and Haitian nationals who tested positive for
COVID-19 upon arrival in their home countries. Just this week, it was
reported that despite an agreement to deport only those with medical
certificates showing a negative test, Guatemalan authorities say that
at least 28 deportees have tested positive since early May. Thirteen of
my colleagues and I sent a letter to the State Department and
Department of Homeland Security highlighting this very issue, though we
have yet to receive a response. This question is for any of our
panelists:
Question. How, in your view, does deporting COVID-19 positive
individuals to countries with weak or limited health system capacity
affect our strategic interests in the hemisphere?
[No Response Received]
Question. What policy approach would you recommend regarding
removals during a pandemic? How have U.S. government policies relating
to deportation addressed previous epidemics, such as the Ebola crisis?
[No Response Received]
Question. What is the scientific or medical evidence supporting the
Trump administration's closure of U.S. borders to asylum seekers, but
not other ``essential'' travelers such as truck drivers and family
members?
[No Response Received]
impact on other global health priorities
A study published in 2016 by Yale University researchers found that
there may have been as many deaths from HIV AIDS, TB and Malaria during
the 2014/2015 Ebola outbreak in Guinea, Liberia and Sierra Leone as
there were from Ebola because the health systems in those countries
were overwhelmed, limiting access to health services. Recent reports
indicate that as the COVID-19 pandemic continues, there has been a rise
in the number of illnesses from preventable illnesses including polio,
cholera and diphtheria. This question is for any of our panelists:
Question. What should we be doing to prevent the disruption of
health services, including service for those affected by HIV/AIDS, TB
and Malaria?
[No Response Received]
Question. Should the U.S., provide funding for the Global Fund to
Fight AIDS Tuberculosis and Malaria's COVID-19 mechanism?
[No Response Received]
______
Responses of Jeremy Konyndyk to Questions
Submitted by Senator Robert Menendez
state usaid reorganization
Question. How will doing taking budgetary authority and programs
from USAID and moving them to State Department impact development
outcomes in global health? Will doing so at all assist with health
systems strengthening?
Answer. I have grave reservations about shifting program and budget
authority from USAID (and potentially CDC) into the State Department.
As I noted in my testimony, the State Department does have an important
role in promoting global health security and pandemic preparedness, but
it is mainly centered on diplomatic engagement to mobilized aligned
global action around these issues. That is quite different from
asserting State as the overall lead for the initiative; a role that
would require greater subject matter expertise at the institutional
level than the State Department possesses.
I fear that this approach would increase friction between State,
USAID, and CDC, thus weakening programs and undermining health security
outcomes. It would also be inimical to health system strengthening,
which would be better supported by keeping these programs housed at
USAID and CDC, both of which support broader health system
interventions. Shifting pandemic authorities to State would turn those
into more of a vertical intervention (similar to the PEPFAR model) that
can be narrowly useful toward a specific disease or threat but will
struggle to align with horizontal system strengthening interventions. A
vertical structure would be, in my view, a poor design for this
initiative because pandemic preparedness is inherently cross-cutting--
it touches on many different structures and capacities across a
government, health system, and society.
the u.s. international response
On June 7, The New York Times published an article which revealed
weeks of delays in getting emergency funding appropriated in the CARES
Act to fund our international response out the door to our partners.
Implementing partners themselves report waiting up to 10 weeks as
opposed to our usual 3 and a half weeks. And more than $200 million in
COVID aid is being spent on ventilators for countries handpicked by the
President with little to no examination as to whether this was the best
use of funds, and whether countries have the facilities and medical
personnel to put the ventilators to use.
Question. Did these types of funding delays happen while you were
at USAID? To your knowledge, what accounts for the current delays in
pushing funding out the door?
Answer. These kinds of delays in funding emergency appropriations
did not happen during my tenure at USAID. In fact, during the 2014
Ebola outbreak, we did nearly the inverse of what the Trump
administration has done on COVID. We felt an extreme sense of urgency
to roll out programs and interventions quickly that we began doing so
using regular annual appropriation money even before the emergency
supplemental funds cam through. We knew that waiting to roll out
programs until we had a special appropriation would mean letting the
outbreak spread exponentially further before we acted. So at the
direction of the Administrator, my office spent down nearly the
totality of our non-OCO appropriation to cover our cash flow needs for
Ebola even before the supplemental came through. We then used the
supplemental funding to backfill our normal budget and to continue
extending our Ebola programs.
By the time the Ebola emergency appropriation passed in December
2014, the U.S. government had spent over $750 million on Ebola efforts,
of which 362.8 million had been spent through my team in the USAID
Office of U.S. Foreign Disaster Assistance (OFDA).\1\ This was roughly
4 months after the deployment of the Disaster Assistance Response Team
(DART) and corresponding activation of USAID's Response Management Team
(RMT) and Agency Task Force. During the COVID-19 response, USAID
activated their agency Task Force in early March and their RMT in mid-
March, likewise roughly 4 months ago. Over that period, they have
announced public obligations of only $214 million, of which only $8
million is through the Disaster Assistance account.\2\ They have
announced over $1 billion in ``pledged'' funding, with few details
provided. Pledged funding typically means funding that remains on the
agency's books and has not yet determined a specific intended recipient
(``committed'') or been disbursed to that recipient (obligated).
I do not have full awareness of the reasons for these delays.
However, my understanding both from public report and from
conversations with USAID partners is that politicization of PPE funding
has been among the major bottlenecks between USAID and the White House.
The White House was reportedly very wary of allowing aid partners to
use U.S. fund to supply PPE to low-income countries while U.S.
hospitals remained under-supplied, and so issued a soft prohibition on
such usage of funds. However this made it functionally impossible for
partners to move ahead with responsible programs, because PPE is a
vital component of such interventions (during my time at USAID I
directed my team to develop a USAID PPE reserve stock for situations
like this; my understanding is that those reserves were diverted for
domestic use).
Question. Is the expenditure of more than $200 million on a few
thousand ventilators for a select set of countries the best investment
for protecting the most lives and preventing the spread of COVID-19?
Answer. With respect to ventilator donations, I find a number of
puzzling dimensions. It is difficult to assess whether USAID has
applied consistent criteria to distributing these because there does
not appear to be a publicly stated set of criteria for the selection of
countries or the proposed volumes of ventilators to each recipient.
Meanwhile, USAID documents (as reported by ProPublica) make explicit
that some of these donations to middle and high income countries are
being made for political purposes. It is not otherwise clear to me why
a wealthy country like Malaysia needs 250 U.S.-donated ventilators.
Question. What assurances on equitable access to care, when it
comes to U.S. supported response activities, should USAID seek from
host country governments?
Answer. The U.S. should allocate its COVID funding based on an
evaluation of the degree of need, and of the gaps in country capacity
and preparedness. This should include an analysis of whether U.S. aid
and health resources more generally are accessible to the population in
an equitable manner. In some countries--such as conflict affected
states--this may be particularly difficult, and the U.S. should seek to
work through partners that can complement or work around government
obstructions, where those may exist.
Question. What else should we be doing to help end the pandemic--
are there programs and activities that the Administration should be
funding that it currently is not?
Answer. This is a challenging question to answer given how little
funding has so far been disbursed. But I would broadly see several
priorities for U.S. global aid funding on COVID-19:
Reinforcing fragile health systems.
Community engagement, communication, and behavior change.
Logistics and supplies.
Macroeconomic support to countries taking major economic
hits.
Safety net and livelihood support at household level.
Supporting frontline aid and civil society organizations.
global reach of the who
The WHO has been on the frontlines of nearly every global health
challenge over the past 70 years, combatting, containing, and
eradicating some of the planet's most deadly diseases. The WHO serves
as both a repository of global expertise as well as a critical
implementation partner for local health ministries and organizations on
the ground. In many places with weak health systems, the WHO's role is
indispensable in ensuring the delivery of adequate health services and
responses.
Question. What makes the WHO a critical, or even indispensable,
partner?
Answer. The Trump administration's decision to withdraw the United
States from the World Health Organization is reckless and entirely
unjustified. The Administration's accusations against WHO do not stand
up to scrutiny, and certainly do not rise to the level of abandoning
the organization as the worst pandemic in a century sweeps around the
world and hammers the United States. WHO's handling of the pandemic has
not been perfect, but has been more than good enough to provide ample
early warning and actionable guidance to countries that were paying
attention.
The U.S. withdrawal will have damaging consequences both for the
U.S. and the world at large. WHO makes vital contributions to the
health of Americans, including through vaccine and therapeutic research
and coordinating annual flu vaccines. It advances U.S. interests by
countering global health threats like Ebola and cholera, carrying the
frontline burden in places like Eastern Congo and Yemen where USG
personnel cannot safely operate. It has partnered successfully with the
U.S. on global vaccine programs and disease eradication efforts. Global
polio eradication, which has for years been a U.S. priority, will be
imperiled by this decision, as will numerous other longstanding U.S.
health investments. And weakening WHO will also reverberate across the
developing world, where health ministries rely heavily on WHO technical
guidance. WHO covers these and numerous other functions on a budget
that is less than the annual budget of a U.S. hospital system, and just
a fraction of the annual spending of the CDC and NIH.
Question. What challenges do we face in responding to a global
pandemic without the WHO as a partner?
Answer. Despite the Trump administration's claim that it can easily
route WHO funds to other equally capable partners, the reality is that
WHO's role is unique and there are no viable substitutes for many of
its functions. WHO has the ability to mobilize and deploy large teams
of public health experts to any country in the world, usually with the
eager consent of the host government. That is a critical capability in
a global pandemic, and not one that exists within the NGO community or
elsewhere in the U.N. WHO's longstanding relationships with health
ministries enable its personnel, in many countries, to function as de
facto extensions of the health ministry and play a central role in
shaping policy and strategy. Again, there is no other institution in
the world that could readily step into such a role--and in any case,
those national ministries would continue looking to WHO rather than to
a U.S. contractor or non-profit.
Question. What barriers will the United States face in trying to
set up an effective alternative to the WHO?
Answer. The best way to rectify weaknesses in WHO and in wider
global health governance is by remaining engaged and outlining a
constructive vision for reform. Past Administrations have responded to
previous outbreaks by doing exactly that: after SARS the Bush
administration worked to develop the 2005 International Health
Regulations, and after Ebola in West Africa the Obama administration
led member states to approve sweeping reform and reorganization of
WHO's emergency programs. Withdrawing now, particularly on such
specious grounds, will destroy U.S. credibility and diminish U.S.
influence over the reforms that will inevitably follow the present
outbreak.
Withdrawing will also likely sound a death knell for the emerging
U.S. proposals for new global pandemic response mechanisms. It will be
hard for other countries to align with U.S. efforts if those efforts
serve as an alternative or competitor to WHO. Plainly put, other
countries expect WHO to play a central role in any future pandemic
architecture, and U.S. efforts will fail if they ignore this reality.
international cooperation
In addition to efforts to combat COVID-19 at the WHO, there have
been a number of other international efforts to combat the virus,
including the European Commission's Coronavirus Global Response Summit
on vaccines, which the United States conspicuously did not join. In
fact, since the start of the pandemic the United States has failed to
lead the international efforts to respond. We blocked consensus on a
statement from the Security Council, and from the G7 by insisting on
using divisive racially inflammatory rhetoric to describe the
infection. The President himself used offensive terms to describe the
disease at a political rally in Tulsa.
Question. What kind of international engagement is necessary for
the United States to be best prepared to combat COVID-19?
Answer. To fully protect Americans, this virus must be contained
both within the United States and well beyond our borders. As every
country has learned, travel restrictions are not an effective long-term
protection against the virus. And in any case, the U.S. and global
economies will suffer greatly if long-term travel disruption remains in
effect. The fight against the virus in the U.S. cannot be siloed from
the global fight.
A globally engaged U.S. COVID policy should cover multiple
dimensions:
Leadership and convening: The absence of U.S. presence and
leadership in global fora has been palpable throughout this
response. Where past Presidents like Obama and Bush put the
U.S. at the forefront of global efforts against threats like
Ebola and pandemic influenza, the U.S. has been largely absent
under President Trump. It makes it hard for global institutions
to function effectively when the U.S. is absent from or opposed
to efforts to drive international collaboration on the
pandemic.
Support to poor and fragile countries: The impact of COVID-
19 on low-income and fragile countries will be devastating and
will resonate for years. The U.S. should be helping to organize
and lead global support, both financial and technical, to
enable low-income countries to fight the virus without
jeopardizing decades of development progress.
Research collaboration: The U.S. ``Warp Speed'' vaccine
initiative is prioritizing only 5 vaccine candidates. Meanwhile
there are currently more than 140 coronavirus vaccine
candidates (see https://www.who.int/publications/m/item/draft-
landscape-of-covid-19-candidate-vaccines ) being tracked by
WHO. There is no way to predict which of these will first prove
effective, nor which will eventually prove most effective. It
is strongly in the U.S. interest to spread our bets--pursuing
our own vaccine candidates while collaborating with a wide
range of other vaccine options, so that we are positioned to
benefit from whichever one(s) prove effective. The global
vaccine trial partnership--led by WHO--may also prove more
effective and efficient in identifying a safe and effective
vaccine. A large multi-country, multi-population trial can
evaluate a large number of vaccines against a common placebo
group, enabling a wide range of candidates to be simultaneously
evaluated, increasing the prospects of rapidly identifying a
viable vaccine.
Supply chain: U.S. supply chains for items like PPE,
pharmaceuticals, and testing supplies all depend on global
producers and suppliers. This will likely hold for vaccine
production as well. The U.S. will need cooperation on vaccine
production--as we've seen with PPE, we cannot produce
everything that is needed solely within our own borders. The
U.S. drug supply chain is heavily dependent on global
suppliers, and an antagonistic or uncooperative posture towards
other countries could harm U.S. access to needed materials.
Question. How can we use our international relationships to improve
the situation for U.S. citizens as well as our partners?
Answer. The United States' global reputation as taken a heavy hit.
Perceptions of American competence have eroded as the U.S. struggles to
control the virus as well as other high-income and even middle-income
countries. But perceptions of U.S. benevolence have suffered as well.
Much of the developing world has encountered the U.S. not as a partner
on COVID, but as a competitor. The failure to contain case counts in
the U.S., combined with the lack of PPE production capacity
domestically and the failure to mandate it under the DPA, put the U.S.
in a position of outbidding other nations for global PPE supply. The
image of the U.S. pricing developing countries out of the PPE market,
while China happily provided PPE donations to those same countries,
will not soon be forgotten. The U.S. must begin to rebuild credibility
by:
Controlling our domestic outbreak.
Providing rapid and effective support to nations being hit
hard by COVID.
Re-engaging in global collaboration around COVID
containment, including the joint vaccine initiative.
Revoking our withdrawal from the World Health Organization.
western hemisphere
Over the past few months, there have been multiple reports
documenting that the Trump administration has deported dozens of
Guatemalan, Mexican, and Haitian nationals who tested positive for
COVID-19 upon arrival in their home countries. Just this week, it was
reported that despite an agreement to deport only those with medical
certificates showing a negative test, Guatemalan authorities say that
at least 28 deportees have tested positive since early May. Thirteen of
my colleagues and I sent a letter to the State Department and
Department of Homeland Security highlighting this very issue, though we
have yet to receive a response. This question is for any of our
panelists:
Question. How, in your view, does deporting COVID-19 positive
individuals to countries with weak or limited health system capacity
affect our strategic interests in the hemisphere?
Answer. Deporting COVID-positive individuals to countries with weak
health systems will place further strain on those systems; a particular
concern as the outbreaks in South and Central America worsen.
Question. What policy approach would you recommend regarding
removals during a pandemic? How have U.S. government policies relating
to deportation addressed previous epidemics, such as the Ebola crisis?
Answer. During the Ebola outbreak in West Africa, the Department of
Homeland Security authorized Temporary Protected Status (TPS) for
citizens of the three principally affected countries. I believe that a
similar measure would be appropriate for COVID, in instances where the
individual's home country is suffering a major outbreak of COVID-19
and/or lacks the domestic capacity to appropriately quarantine,
isolate, and treat cases of the virus.
Question. What is the scientific or medical evidence supporting the
Trump administration's closure of U.S. borders to asylum seekers, but
not other ``essential'' travelers such as truck drivers and family
members?
Answer. To my knowledge there are no scientific grounds for
considering asylum seekers to pose higher risks of the virus than other
categories of migrants or travelers.
food security
USAID has determine that in addition to the pandemic's exacerbation
of economic decline across the developing world, the pandemic also
stands to drastically increase food insecurity and risk major
backsliding in countries that the U.S. has worked hard and invested
significantly to improve food security and agricultural based economic
opportunities.
Question. USAID's analysis on food insecurity risks is incredibly
important and informative, and USAID has a model food security program
in Feed the Future, but in light of the pandemic's compounding effects
on food security and nutrition, does USAID have adequate resources to
prevent food insecurity backsliding related to the impacts of the
pandemic?
Answer. We are still formulating an accurate picture of how the
pandemic will affected global food insecurity. I find the projections
by FEWSNET to be broadly credible, and consistent with the wider
picture of economic damage that the pandemic will cause in the
developing world. It is impossible to separate the food insecurity
challenge from the wider economic impact, and I believe USAID and other
aid donors should be focusing heavily on broad-based livelihoods
support to enable vulnerable populations to continue to afford
sufficient food. Per FEWSNET, global food supply remains around normal
levels, although prices have risen somewhat. The combination of
sufficient supply with increased prices and reduced household income is
concerning, and would indicate that household cash grants and
government safety net programs are likely the best tool to use, rather
than provision of in-kind food aid. But without question, substantial
further resources--both through USAID and the World Bank--will be
needed to avert damaging impacts on food security.
Question. Feed the Future is great, but are there additional
programmatic needs and considerations USAID should make as it related
to preserving food security in regions, countries and communities
hardest hit by the pandemic? Are there modifications that USAID needs
to make to its food security programs to address pandemic specific
impacts on food security (like, strengthening supply chains)?
Answer. As noted above traditional in-kind food aid programs are
not likely to be the most appropriate tool. Instead--somewhat as we
have done domestically in the U.S.--aid programs should focus on
shoring up livelihood support among vulnerable populations to ensure
that they can continue meeting their own needs through market
mechanisms.
impact on other global health priorities
A study published in 2016 by Yale University researchers found that
there may have been as many deaths from HIV AIDS, TB and Malaria during
the 2014/2015 Ebola outbreak in Guinea, Liberia and Sierra Leone as
there were from Ebola because the health systems in those countries
were overwhelmed, limiting access to health services. Recent reports
indicate that as the COVID-19 pandemic continues, there has been a rise
in the number of illnesses from preventable illnesses including polio,
cholera and diphtheria. This question is for any of our panelists:
Question. What should we be doing to prevent the disruption of
health services, including service for those affected by HIV/AIDS, TB
and Malaria?
Answer. It will be critically important to ensure that health
systems in low-income countries remain solvent, have the technical
support that they need, and can provide sufficient protection to their
frontline personnel. Most COVID services will be delivered through
health ministries and health systems, not through aid organizations.
The U.S. should work with the World Bank to ensure that health
ministries can access the resources needed to maintain adequate health
budgets, and provide top-up funding where needed (the U.S. provided
salary support to the Liberian health ministry during the Ebola
outbreak, for example). U.S. support to WHO is critical to ensure that
health ministries in low-income countries can draw on technical support
related to COVID while also managing other health priorities. And U.S.
aid funds should prioritize supply of PPE and sanitation support to
frontline health facilities, to prevent outbreaks among health
personnel and ensure continuity of normal health services.
Question. Should the U.S., provide funding for the Global Fund to
Fight AIDS Tuberculosis and Malaria's COVID-19 mechanism?
Answer. The U.S. should consider support to any funding mechanism
that demonstrates it can quickly route money to frontline needs.
----------------
Notes
\1\ https://www.usaid.gov/sites/default/files/documents/1864/
12.10.14%20-
%20USG%20West%20Africa%20Ebola%20Outbreak%20Fact%20Sheet%20%2311.pdf
\2\ https://www.usaid.gov/sites/default/files/documents/1860/
05.05.20_-_USAID_COVID-19_Global_Response_Fact_Sheet_2.pdf