[Senate Hearing 116-630]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 116-630

                     THE LOGISTICS OF TRANSPORTING 
                           A COVID-19 VACCINE

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

                                HEARING

                               BEFORE THE

               SUBCOMMITTEE ON TRANSPORTATION AND SAFETY

                                 OF THE

                         COMMITTEE ON COMMERCE,
                      SCIENCE, AND TRANSPORTATION
                          UNITED STATES SENATE

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                           DECEMBER 10, 2020

                               __________

    Printed for the use of the Committee on Commerce, Science, and 
                             Transportation
                             
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                             


                Available online: http://www.govinfo.gov
                
                               __________
             
                                
                    U.S. GOVERNMENT PUBLISHING OFFICE                    
52-857 PDF                  WASHINGTON : 2023                    
          
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       SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                  ROGER WICKER, Mississippi, Chairman
JOHN THUNE, South Dakota             MARIA CANTWELL, Washington, 
ROY BLUNT, Missouri                      Ranking
TED CRUZ, Texas                      AMY KLOBUCHAR, Minnesota
DEB FISCHER, Nebraska                RICHARD BLUMENTHAL, Connecticut
JERRY MORAN, Kansas                  BRIAN SCHATZ, Hawaii
DAN SULLIVAN, Alaska                 EDWARD MARKEY, Massachusetts
CORY GARDNER, Colorado               TOM UDALL, New Mexico
MARSHA BLACKBURN, Tennessee          GARY PETERS, Michigan
SHELLEY MOORE CAPITO, West Virginia  TAMMY BALDWIN, Wisconsin
MIKE LEE, Utah                       TAMMY DUCKWORTH, Illinois
RON JOHNSON, Wisconsin               JON TESTER, Montana
TODD YOUNG, Indiana                  KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida                  JACKY ROSEN, Nevada
                       John Keast, Staff Director
                  Crystal Tully, Deputy Staff Director
                      Steven Wall, General Counsel
                 Kim Lipsky, Democratic Staff Director
              Chris Day, Democratic Deputy Staff Director
                      Renae Black, Senior Counsel
                                 ------                                

               SUBCOMMITTEE ON TRANSPORTATION AND SAFETY

DEB FISCHER, Nebraska, Chairman      TAMMY DUCKWORTH, Illinois, Ranking
JOHN THUNE, South Dakota             AMY KLOBUCHAR, Minnesota
ROY BLUNT, Missouri                  RICHARD BLUMENTHAL, Connecticut
JERRY MORAN, Kansas                  EDWARD MARKEY, Massachusetts
CORY GARDNER, Colorado               TOM UDALL, New Mexico
SHELLEY MOORE CAPITO, West Virginia  GARY PETERS, Michigan
TODD YOUNG, Indiana                  TAMMY BALDWIN, Wisconsin
RICK SCOTT, Florida
                           
                           
                           C O N T E N T S

                              ----------                              
                                                                   Page
Hearing held on December 10, 2020................................     1
Statement of Senator Fischer.....................................     1
    Letter dated December 10, 2020 to Hon. Deb Fischer and Hon. 
      Tammy Duckworth from Pete Slone, Senior Vice President, 
      Public Affairs, McKesson Corporation.......................    39
    Statement from Shawn Seamans, President, RxCrossroads, 
      Executive Sponsor Enterprise COVID Vaccine Program, 
      McKesson Corporation.......................................    40
    Letter dated December 8, 2020 to Hon. Deb Fischer and Hon. 
      Tammy Duckworth from Anne Reinke, President and CEO, 
      Transportation Intermediaries Association..................    42
    Letter dated December 9, 2020 to Hon. Deb Fischer and Hon. 
      Tammy Duckworth from Advocates for Highway and Auto Safety, 
      Citizens for Reliable and Safe Highways, Consumer 
      Federation of America, Consumers for Auto Reliability and 
      Safety, KidsAndCars.org, National Consumers League, Parents 
      Against Tired Truckers, Public Citizen, Trauma Foundation, 
      and Truck Safety Coalition.................................    43
    Article dated December 1, 2020 by Thomas Pallini from the 
      Business Insider entitled, ``How United Airlines overcame 
      one of the largest limitations to transporting Pfizer's 
      COVID-19 vaccine to the US''...............................    45
    Letter dated December 9, 2020 to Hon. Roger Wicker, Hon. 
      Maria Cantwell, Hon. Deb Fischer and Hon. Tammy Duckworth 
      from Joseph G. DePete, President, Air Line Pilots 
      Association, International.................................    46
Statement of Senator Duckworth...................................     2
Statement of Senator Wicker......................................     4
Statement of Senator Klobuchar...................................    19
Statement of Senator Thune.......................................    22
Statement of Senator Peters......................................    24
Statement of Senator Capito......................................    25
Statement of Senator Baldwin.....................................    28
Statement of Senator Tester......................................    30
Statement of Senator Blumenthal..................................    33
Statement of Senator Cantwell....................................    37

                               Witnesses

Rachel L. Levine, MD, Secretary and State Health Official, 
  Pennsylvania Department of Health; and President, Association 
  of State and Territorial Health Officials......................     5
    Prepared statement...........................................     7
Richard W. Smith, Regional President, Americas and Executive Vice 
  President, Global Support, FedEx Express.......................    11
    Prepared statement...........................................    13
Wesley Wheeler, President, Global Healthcare, United Parcel 
  Service........................................................    14
    Prepared statement...........................................    16

                                Appendix

Response to written questions submitted to Rachel L. Levine, MD 
  by:
    Hon. Dan Sullivan............................................    49
    Hon. Maria Cantwell..........................................    50
    Hon. Tammy Duckworth.........................................    52
    Hon. Gary Peters.............................................    52
    Hon. Kyrsten Sinema..........................................    53
Response to written questions submitted to Richard W. Smith by:
    Hon. Dan Sullivan............................................    53
    Hon. Rick Scott..............................................    54
    Hon. Maria Cantwell..........................................    54
    Hon. Jon Tester..............................................    55
    Hon. Gary Peters.............................................    56
    Hon. Kyrsten Sinema..........................................    56
Response to written questions submitted to Wesley Wheeler by:
    Hon. Maria Cantwell..........................................    57
    Hon. Jon Tester..............................................    57
    Hon. Gary Peters.............................................    58
    Hon. Kyrsten Sinema..........................................    58

 
                     THE LOGISTICS OF TRANSPORTING 
                           A COVID-19 VACCINE

                              ----------                              


                      THURSDAY, DECEMBER 10, 2020

                               U.S. Senate,
         Subcommittee on Transportation and Safety,
        Committee on Commerce, Science, and Transportation,
                                                    Washington, DC.
    The Subcommittee met, pursuant to notice, at 9:31 a.m., in 
room SR-253, Russell Senate Office Building, Hon. Deb Fischer, 
Chairman of the Subcommittee, presiding.
    Present: Senators Fischer [presiding], Wicker, Thune, 
Capito, Duckworth, Cantwell, Klobuchar, Blumenthal, Peters, 
Baldwin, and Tester.

            OPENING STATEMENT OF HON. DEB FISCHER, 
                   U.S. SENATOR FROM NEBRASKA

    Senator Fischer. The hearing will come to order. Good 
morning. I am pleased to convene today's hearing as Chairman of 
the Senate Subcommittee on Transportation and Safety.
    Since the beginning of the pandemic, over 280,000 of our 
family members, friends, and fellow citizens have died from 
COVID-19. Many more have had the disease and, in some cases, 
with severe symptoms and potential long-term impacts. Even more 
have felt the economic impacts, either through losing a job, 
facing shorter work hours, or being forced to close businesses. 
And all of us have adjusted to what we modestly call a new 
normal, which has kept us apart from family, friends, and 
colleagues. It has kept us from celebrating holidays together, 
engaging in our favorite pastimes, and enjoying each other's 
company in person.
    So when we all heard news that vaccines may soon be 
available, we were impressed with the science and the hard work 
that went into developing them and relieved that we may be 
nearing the beginning of the end to this pandemic. We must all 
remember that until vaccines are widely available and people 
are vaccinated, we need to continue to wear masks, social 
distance, and wash our hands.
    Once the vaccines are vetted and approved, we will again 
rely on the transportation sector, as we have throughout this 
year, to complete what has been one of the biggest logistics 
challenges in recent history. Today, we have an opportunity to 
hear about the ongoing preparation to ensure the quick, safe, 
and efficient transportation of a vaccine to its destination--
from the manufacturer to State-designated providers.
    First, I want to thank the administration, Operation Warp 
Speed, participating agencies, scientists, and vaccine 
manufacturers for all of their dedication and ingenuity to 
getting us where we are today. We must also remember all of the 
frontline workers who have given so much this past year.
    The CDC says its goal is for everyone who wants to get a 
vaccine to be able to get one as soon as possible. HHS and DOD, 
as part of Operation Warp Speed, aim to procure and assemble 
enough supply kits to support administering 660 million vaccine 
doses. UPS and FedEx will play a critical role in ensuring 
these vaccines are delivered to providers identified by the 
states. States will then ensure the vaccine is either 
administered or redistributed, as necessary.
    Each of the witnesses here today will provide insight into 
the planning that has already gone into transporting and 
distributing a vaccine, the anticipated challenges, and what 
Congress and the public should expect from this process.
    One of the more notable challenges will be maintaining the 
cold chain, meaning that the vaccine does not experience a 
warmer temperature during transportation and storage than it 
can handle without spoilage. The Pfizer vaccine must be kept at 
-70 degrees Celsius, or -94 degrees Fahrenheit. The Moderna 
vaccine must be maintained at -20 degrees Celsius, or -4 
degrees Fahrenheit. We want to hear about the transportation 
network's capacity to ship a vaccine.
    More people were already using e-commerce as a result of 
the pandemic, and even more will want to ship gifts for the 
holidays. So how will the vaccine transportation fit into this 
demand for shipping?
    We also want to know if the witnesses have the necessary 
Federal guidance and resources to transport the vaccine, 
particularly following the Department of Transportation's 
notice last week that the necessary guidance and waivers were 
in place for the vaccine transport.
    Finally, we want to hear about near-and long-term plans to 
transport an increasing number of vaccine doses through the 
spring and summer of 2021.
    I look forward to your testimony, and I would now like to 
invite my colleague and the Ranking Member, Senator Duckworth, 
to offer her opening remarks. And I believe Senator Duckworth 
is speaking to us remotely.

              STATEMENT OF HON. TAMMY DUCKWORTH, 
                   U.S. SENATOR FROM ILLINOIS

    Senator Duckworth. Thank you, Madam Chair. Thank you for 
holding this very important hearing. As this is likely our last 
subcommittee hearing of the 116th Congress, I want to take a 
moment to thank you for your leadership and for your 
partnership in working with me to address pressing 
transportation and safety issues that are facing our Nation.
    In our very first meeting as Chair and Ranking Member in 
early 2019, we discussed issues of mutual interest and agreed 
to work collaboratively on critical legislative matters, such 
as passing a bipartisan pipeline safety reauthorization, and 
today, we are extremely close to finalizing that important 
safety legislation. I hope we are able to complete that journey 
with our House counterparts over the next few days.
    Luck has been in short supply for so many this year, but 
should we both be fortunate to find ourselves in these seats 
again in the 117th Congress, I look forward to continuing our 
productive, bipartisan collaboration.
    And to our witnesses, thank you for your participation 
today. Unfortunately, millions of our friends and neighbors are 
grieving the loss of a family member or loved one this holiday 
season. This tragedy has been repeatedly exacerbated by 
President Trump's refusal to take this pandemic seriously.
    To say that I am disappointed with the President's 
coronavirus response is a depressing understatement of epic 
proportions. From the onset of COVID-19, the President has 
renounced his responsibilities and abandoned logic, civility, 
and expert advice, while prioritizing self-promotion and blame 
shifting. But for the hard work of many dedicated career public 
servants, health officials, and frontline workers, COVID-19 may 
very well have stolen twice as many American lives than the 
more than 290,000 souls who have already perished.
    If committee staff could please bring up the graphic. In 
October, the President once again dismissed the pandemic as a 
media hoax by suggesting that after Election Day, and if you 
look at this graphic, I quote, ``We won't be hearing much about 
it anymore.'' Well, Mr. President, since Election Day, an 
additional 55,000 Americans have died, and COVID-19 infections 
and hospitalizations have spiked to record highs across this 
Nation.
    In the past week and a half, the President has held 
potential super spreader holiday parties at the White House, 
despite the advice of his own health experts. He has held a 
self-congratulatory vaccine summit and issued an executive 
order so meaningless that he did not even bother to inform the 
top scientists for Operation Warp Speed.
    As is often the case with this administration, others must 
plan, others must prepare, and others must implement, in the 
absence of Presidential leadership. Fortunately, industry 
appears confident, particularly FedEx and UPS, that they 
already operate a massive logistics network capable of 
distributing all types of vaccines nationwide.
    Perhaps most importantly, the shippers testifying before us 
today appear to be confident that their respective network of 
freezers that already exists for transporting perishables, 
medical goods, and supplies will be up to the task of safely 
shipping vaccines. Of course, this subcommittee does not exist 
to simply accept confident predictions at face value. After 
all, in 2020, it is prudent to prepare for and expect things to 
go terribly wrong.
    Accordingly, I hope today we will learn more about what 
evidence underlies the confidence of our witnesses. Have 
shippers stress-tested their capacity to handle the massive 
holiday shipping boom and the distribution of a lifesaving 
vaccine, or multiple vaccines with different storage 
requirements, for example? Have companies taken the steps to 
proactively secure supplies, like dry ice, in anticipation of 
shortages resulting from a spike in global demand?
    While the President has undermined America's scientists, 
public health experts, and logistics professionals at every 
turn, our longstanding history of public-private partnerships 
and developing medical countermeasures has enabled us to 
develop vaccines in record time. Until the Oval Office returns 
next month to patient and practiced hands, our Nation is 
depending on the private sector and State and local governments 
to execute what may be one of the most complex logistical 
challenges our country has ever faced.
    This won't be easy. Our country has lost significant 
ground. However, I am cautiously optimistic about the outcome 
because of actions taken thus far by many public and private 
sector stakeholders to develop and implement a strategic road 
map needed to ensure the safe, efficient, and equitable 
distribution of vaccines to Americans as quickly as possible.
    Again, thank you to our witnesses for participating. Thank 
you, Madam Chair, for holding today's hearing.
    I am going to be turning off my camera because, as you can 
see, I am at home. I am doing my daughter's distance education, 
and it is a little crazy here. Nobody needs to see this. But 
thank you, everyone, and I look forward to today's hearing.
    Senator Fischer. Thank you, Senator Duckworth. It has been 
a pleasure to work with you on the issues that we agree with 
each other on, and it is always a joy to be able to work out 
differences, so that we can pass good legislation for the 
people of this country. Thank you, Senator.
    Next, I would like to recognize Senator Roger Wicker. 
Chairman Wicker, you are recognized for an opening statement. I 
believe you are also at a remote location.

                STATEMENT OF HON. ROGER WICKER, 
                 U.S. SENATOR FROM MISSISSIPPI

    The Chairman. Right. I am at a remote location in the 
Dirksen Building. Can you hear me, Madam Chair?
    Senator Fischer. I can. I see you are in your office, sir. 
Good to see you.
    The Chairman. OK. And my office does not compare to Senator 
Duckworth's kitchen--hers is much--her location is much neater 
and tidier than my desk, but here we are. And thank you, 
Senator Fischer, for your leadership and holding this hearing.
    I just checked. We just hit over 290,000 deaths in the 
United States because of the COVID-19 pandemic, and that is--it 
is tragic in every way. But really, today is a day of good 
news. I anticipate the FDA will give approval today to one of 
the vaccines. I certainly hope so.
    And also, it is just a time to celebrate the great success 
of Operation Warp Speed. It is breathtaking how our scientists 
have really exceeded expectations and performed miracles. And 
here we are, where vaccines are now being given globally and 
will soon be given in the United States. So there is good news 
amidst the tragedy.
    Today's hearing will inform the Committee about the 
logistics of distributing the vaccines across the country. 
These newly developed vaccines were produced at record pace 
because of Operation Warp Speed, a public-private partnership 
devised by the Trump administration. There is just no way 
around that. Congress passed legislation to invest in this. It 
has been bipartisan, and it makes me feel good, as an American 
and as a member of the U.S. Senate and a member of this 
committee.
    Efforts to ship and deliver vaccines will begin 
immediately, once the FDA issues emergency authorization. So we 
will be looking for news today. Our Nation's transportation 
network has been critical in helping sustain our economy during 
this pandemic, and it will be just as critical in enabling us 
to defeat the virus in the months ahead. I know there is much 
left to do, but we are turning the corner. And as we turn the 
page on a new year, I think things are really looking up, and 
thank goodness for that.
    I look forward to hearing today from our witnesses about 
their roles in ensuring the vaccines are distributed safely and 
efficiently. We will be asking about adequate communication 
between Federal, State, and local officials
    [inaudible] vaccines with the rest of what we are looking 
for, and then we will be wanting to hear from witnesses about 
any cyber threats that we might have.
    So thank you very much. Glad to be part of this. Thank you 
much to our witnesses, and I yield back to you, Madam Chair.
    Senator Fischer. Thank you, Chairman Wicker.
    Next, I would like to introduce our witnesses for their 
opening statements. Let us begin with Dr. Rachel Levine, 
Secretary of Health for the Commonwealth of Pennsylvania. Dr. 
Levine is also here today as President of the Association of 
State and Territorial Health Officials.
    Welcome, Dr. Levine.

 STATEMENT OF RACHEL L. LEVINE, MD, SECRETARY AND STATE HEALTH 
  OFFICIAL, PENNSYLVANIA DEPARTMENT OF HEALTH; AND PRESIDENT, 
     ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS

    Dr. Levine. Well, good morning. Thank you very much.
    And so, I would like to thank Chairman Senator Wicker, 
Ranking Member Senator Cantwell, Subcommittee Chair Senator 
Fischer, Subcommittee Ranking Member Senator Duckworth, and all 
of the distinguished members of the Senate Commerce, Science, 
and Transportation Committee for the opportunity to appear 
before you to discuss the challenges facing states like 
Pennsylvania due to the COVID-19 pandemic.
    As you kindly stated, my name is Dr. Rachel Levine. I am 
the Secretary of Health for the Commonwealth of Pennsylvania, 
and I am currently the President of the Association of State 
and Territorial Health Officials. I joined the Wolf 
administration in January 2015, after approximately 20 years at 
the Penn State Hershey Medical Center and Penn State College of 
Medicine. As the Physician General of the Commonwealth, I was 
named Acting Secretary in July 2017 and then confirmed in 2018.
    During this time, public health preparedness has always 
been one of my absolute priorities. And what I would always say 
is the thing that would keep me up at night would be the risk 
of a global pandemic, or what the CDC has called Disease X, and 
unfortunately, that has come to pass.
    From a public health perspective, there are three ways to 
address a pandemic such as COVID-19. You can work on 
containment, which includes testing and contact tracing, with 
appropriate isolation and quarantine. You can work on 
mitigation, such as wearing a mask, washing your hands, social 
distancing, avoiding large and small gatherings, and other 
necessary mitigation factors that have been implemented by 
states. And then, there is a vaccination. We continue to apply 
containment, mitigation measures to control the spread of 
COVID-19, and we have seen success, and we have seen 
challenges. But as has been mentioned, the only way to truly 
end this pandemic is through widespread vaccination, and this 
will be our biggest challenge yet.
    As has been stated, there are two vaccines currently that 
we anticipate will be available in the next several weeks, the 
Pfizer vaccine and the Moderna vaccine. And I also applaud the 
success of Operation Warp Speed in terms of the development of 
these vaccines. These are two vaccines based on novel 
technology using genetic material called messenger RNA to 
induce an immune response. It has never been done before. It is 
really a tremendous achievement.
    Each vaccine needs different methods of containment, 
transportation, and distribution. In Pennsylvania, we have 
collaborated with public health officials from across the 
country to solve these logistical challenges. However, the 
challenges of this essential mission do go beyond getting the 
vaccine from point A to point B.
    We are facing challenges in coordination and in 
communication in such a massive mission between Federal, State, 
and local health agencies. We are facing challenges--and I must 
say that states had little or no involvement in any key policy 
decisions or discussions. We are facing challenge in terms of 
the development of a coordinated communication strategy to 
promote confidence in the public in the safety and efficacy of 
the COVID-19 vaccines and to be able to counter vaccine 
hesitancy. And finally, we are facing challenges in finding 
sufficient funding to execute a timely, comprehensive, and 
equitable vaccine campaign over the long haul.
    But despite this, we are confident in our ability to carry 
out this mission because running vaccination programs is really 
fundamental to our work in public health. We do have experience 
in vaccinations, and we have detailed plans to meet the 
challenge of this historic moment.
    But I emphasize this will not be a short-term operation, 
and the $300 million allocated to states, territories, and big 
cities is simply insufficient. If you break it down, there are 
about 330 million people in the United States. So that is a 
little over $1 per person in the United States to mount an 
immunization enterprise that is unparalleled in scale and 
complication, and it is insufficient.
    The Association of State and Territorial Health Officials, 
of which I am President, has partnered with the Association for 
Immunization Managers, and we are requesting that Congress 
provide $8.4 billion in emergency supplemental funding for this 
ongoing mass vaccination campaign. That will include funding 
for work force, for infrastructure, for outreach to priority 
populations, communications, and educational efforts to 
increase vaccine confidence and combat misinformation.
    At the Pennsylvania Department of Health, our vision is a 
healthy Pennsylvania for all, and we are laser focused in 
moving toward that mission and ensuring all people have access 
to the COVID-19 vaccines. I am so proud of the immense public 
health work we have done in Pennsylvania, and across the 
country, that has worked to slow the spread of this virus and 
save lives. But one thing this pandemic has reinforced is the 
need for continued investment in public health and place a 
spotlight on the need for additional funding to support our 
efforts to vaccinate the entire country to bring this pandemic 
under control.
    Thank you so much for the opportunity to offer this 
testimony and for all of your partnership, and I am pleased to 
answer any questions.
    [The prepared statement of Dr. Levine follows:]

Prepared Statement of Rachel L. Levine, MD, Secretary and State Health 
Official, Pennsylvania Department of Health; and President, Association 
               of State and Territorial Health Officials
    Chairman Wicker, Ranking Member Cantwell, Subcommittee Chair 
Fischer, and Subcommittee Ranking Member Duckworth and distinguished 
committee members of the Senate Commerce, Science, and Transportation 
Committee, thank you for the opportunity to appear before the committee 
today to discuss the challenges presented by the biggest public health 
crisis facing this country in the last century, the COVID-19 pandemic. 
As the United States experiences an exponential increase in new 
infections of COVID-19 nationwide, we must redouble our efforts to 
combat the pandemic through a comprehensive and multi-faceted approach. 
As public health officials and indeed as a nation we have and must 
continue to apply strong containment and mitigation efforts to combat 
the virus. These efforts include but are not limited to case 
investigation, contact tracing, capacity and event limits, encouraging 
mask usage, and more.
    The introduction of safe and effective COVID-19 vaccines will be a 
critical tool to combat the rampant viral spread in the United States. 
However, distributing the COVID-19 vaccine along with administrating it 
is a herculean effort, one that our Nation has never experienced. 
Currently, there are two vaccines under consideration by the Food and 
Drug Administration (FDA) for an Emergency Use Authorization (EUA); and 
most likely to be the first product that states receive, is the Pfizer 
vaccine which requires ultra-cold storage capacity and ships quantities 
of 975 doses that cannot be broken down into smaller allotments. The 
second product likely to receive an EUA is from Moderna. The Moderna 
vaccine does not have the same logistical constraints that Pfizer's 
product requires. The Moderna vaccine can be stored and handled much 
like other vaccines that providers use daily.
    While we along with public health officials throughout the country 
spent countless hours preparing this mission is fraught with 
significant challenges that go well beyond just transporting the 
vaccine from point a to point b. The challenges to this effort include 
sufficient funding to rapidly execute a timely, comprehensive, and 
equitable vaccination campaign; coordination and communication between 
federal, state, and local health agencies; minimal state or local 
governmental public health pre-decisional involvement in key policy 
decisions such as the use of private sector pharmacy providers, 
including chain pharmacies, by the Federal government to administer 
vaccines, all confounded by the lack of a coordinated communication 
strategy to promote confidence in the safety and efficacy of COVID-19 
vaccines.
    At the Pennsylvania Department of Health, our vision is a healthy 
Pennsylvania for all. Right now, we are laser focused in moving towards 
that vision by ensuring all people have access to the lifesaving COVID-
19 vaccinations. It will take very careful orchestration to get the 
right vaccine into the right arm at the right time. However, 
Pennsylvania, and many other of my state health official colleagues are 
committed to this task. Running vaccination programs is foundational to 
our work in public health. We learned a lot through our collective 
experience during H1N1 and we have detailed plans to meet the challenge 
of this historic moment; however it will take a comprehensive national 
approach to ensure its success, making coordinated adjustments along 
the way, and bring an end to the pandemic.
    Pennsylvania is a large and geographically diverse state with 
population density varying from fewer than 15.0 people per square mile 
in our most rural counties to 64,263.1 people per square mile in our 
most urban counties, according to the 2010 U.S. Census.\1\ 
Additionally, there are about 250 hospitals across the Commonwealth 
that vary in size from small critical access hospitals to health 
systems offering quaternary care. These geographic, resource, and 
jurisdictional issues present unique challenges and planning 
considerations to our statewide COVID-19 vaccine distribution efforts. 
These challenges are not only presented in Pennsylvania, but across the 
Nation's states and territories.
---------------------------------------------------------------------------
    \1\ 2010 Census: Pennsylvania Profile https://www2.census.gov/geo/
maps/dc10_thematic/2010
_Profile/2010_Profile_Map_Pennsylvania.pdf.
---------------------------------------------------------------------------
COVID-19 Vaccine Logistics
    The logistics of the vaccine distribution are complicated and the 
degree of coordination among federal, state, and local levels of 
government (and commercial and nonprofit entities) required for this 
enormous undertaking is unprecedented. The direction and pace of each 
state's vaccine distribution plan is determined by the individual 
jurisdictional characteristics, vaccine type, amount, and availability. 
Transport of COVID-19 vaccines to the states will be the sole 
responsibility of Operation Warp Speed (OWS), and the Centers for 
Disease Control and Prevention (CDC) in partnership with federal, 
state, local, tribal and territorial health departments. The Pfizer 
vaccine, which requires ultracold storage, will be delivered directly 
from Pfizer, as arranged by OWS, to pre-identified large health systems 
with existing ultracold storage capabilities. Other vaccines, including 
Moderna, will be distributed to states through McKesson Distribution. 
Proper, swift, and reliable transportation, of not only the vaccine but 
the ancillary supplies that are needed to provide the vaccination, will 
be absolutely key in getting COVID 19 vaccines into the hands of 
providers standing ready to administer the vaccine.
    Given the differences in the logistical requirements of the Pfizer 
and Moderna vaccines and the anticipated limited supply of vaccine in 
the early months of the vaccination efforts, each state and local 
department have had to develop plans taking into account their own 
jurisdictional characteristics (geography, storage capabilities, among 
others) and healthcare system capability to develop a strategy to most 
effectively use the two vaccine products as they become available. Due 
to the less than optimal logistical constraints of the Pfizer vaccine, 
Pennsylvania intends to direct the Pfizer vaccine to go to large health 
systems that have ultracold storage capacity and the ability to 
vaccinate many adults in a short period of time meeting the storage and 
administration requirements. Pennsylvania intends to use the Moderna 
product in more rural settings (hospitals and providers) who may not 
have the ability to store an ultracold vaccine and may have smaller 
numbers of staff and patients to vaccine at once.
    In addition to the complexities around transportation and storage 
of both vaccines, each vaccine requires a second does in a specific 
timeframe. At this time, both vaccines have been shown to have some 
side-effects which may prompt some people to be more hesitant to 
receive a second dose. Disadvantaged and marginalized communities will 
face more hurdles to achieve their access to care.
    States and territorial public health departments are responsible 
for identifying the health systems, hospitals, and providers to receive 
vaccines and coordinating with CVS and Walgreens regarding their access 
to long term care facilities.
    COVID-19 vaccine providers are required to sign a specific provider 
agreement; which notes that the site is responsible for documentation, 
storage, and administration of the COVID-19 vaccine. The sites are also 
responsible for security of the vaccine while in their possession. Any 
additional transferring or moving of vaccine is at the discretion of 
the facility as long as the provider agreement is being adhered to.
    Like most states, Pennsylvania's COVID-19 vaccine plan is broken 
into three phases, with Phase 1 divided to protect the highest risk or 
most critical workforce. In Phase 1a, when limited doses are expected 
initially, Pennsylvania will align with the recommendation of the 
Centers for Disease Control and Prevention's Advisory Committee on 
Immunization Practices in identifying the priority populations of 
health care personnel in hospitals and skilled nursing facilities and 
residents of skilled nursing facilities as the first groups to be 
vaccinated.
    Ten large health systems distributed across the Commonwealth will 
be responsible for immunizing their providers, as well as providers 
from nearby hospitals. Pennsylvania has opted into the Pharmacy 
Partnership with CVS and Walgreens. Under this partnership, those 
organizations will send personnel into skilled nursing and assisted 
living facilities and personal care homes to vaccinate residents and 
staff.
    Phase 1b will include health care personnel who were not vaccinated 
in 1a and utilize partnerships with pharmacies and Federally Qualified 
Health Centers to reach our rural settings. Additionally, the Emergency 
Management agencies located in each of the 66 counties will be 
essential in coordinating community-based vaccination in those 
counties.
    At the same time, Pennsylvania will shift focus to other congregate 
settings, correctional facilities, businesses, critical workers, 
colleges, and universities. This will be done through partnerships and 
unprecedented collaboration with providers and pharmacies who know 
their communities best.
    In late spring or early summer, we will hold mass vaccination 
clinics in communities across the Commonwealth to ensure accessibility 
to all who desire to be immunized. Pennsylvania specifically focused 
our COVID-19 vaccine plan with deliberate intent to reach individuals 
of rural, ethnic, religious, homeless, differently abled, immigrant, 
refugee and LBGTQ populations. These efforts will be executed in close 
partnership with our Office of Heath Equity and already established 
community partners through our COVID-19 testing initiatives.
Health Equity
    As with other communicable and chronic diseases, COVID-19 has 
disproportionately impacted communities of color, people living with 
disabilities, and those living in rural and frontier areas. Immediate 
policy changes that support investments in social and environmental 
health factors and address these disparities head on are needed to 
reduce COVID-19 illness and death in all populations, especially in 
communities of color, settings where individuals with disabilities live 
and rural and frontier communities. This focus on equitable access to 
the COVID-19 vaccine and addressing health disparities is a key tenet 
of Governor Wolf's administration. Pennsylvania's COVID-19 vaccine plan 
was developed through a departmental health equity lens, heavily 
influenced by the Secretary's Vaccine Crisis Committee, a group of 
hospital specialists including vaccinology, gerontology, and medical 
ethics, as well as representation from the pharmacist association, 
federally qualified health centers, business, and aging, which 
developed our ethical allocation strategy, and was informed by our 
departmental Health Equity Workgroup.
    When we talk about vaccinating ``healthcare workers,'' we're not 
just talking about physicians and nurses. We intend to prioritize all 
personnel who work in healthcare settings in that top tier of need for 
early vaccination. This includes all paid and unpaid persons serving in 
healthcare settings who have potential for direct or indirect exposure 
to patients or infectious material. These healthcare workers could 
include emergency medical service personnel, nurses, nursing 
assistants, students and trainees, environmental services, laundry, and 
volunteer personnel.
Communications
    According to a recent poll conducted by the Kaiser Family 
Foundation, the share of adults who trust CDC to provide reliable 
information has decreased by 16 percent since April.1 Moreover, public 
health experts and institutions have been attacked, threatened, and 
intimated by the public. To date, there has been little clarity on a 
CDC and HHS plan to raise public confidence in COVID-19 vaccine safety. 
We believe this communications strategy is imperative and must be 
tailored state-by-state to address our Nation's diversity, as well as 
local concerns that may not apply nationwide. This pandemic has 
reinforced the value of consistent and coordinated communication 
between the Federal government, state and territorial government 
entities, and stakeholders. In this case, it is key for state 
government entities to have a clear understanding of their anticipated 
vaccine allotments, and the absence of that information can and has 
presented challenges in vaccine planning operations and logistics. It 
is important to emphasize that distribution including transportation of 
the COVID-19 vaccine is just one component of this mission.
    The incoming administration should execute a robust communications 
strategy across the entire Federal government, and ``flow down'' 
throughout all levels, including state, local, and tribal governments. 
A robust scientific evidence base should be utilized devoid of 
political interference. This communications strategy ensures a unified 
approach to combatting COVID-19 without sending confusing mixed 
messages. Communications about COVID-19 should leverage the expertise 
of local leadership, celebrities, and businesses to target hard-to 
reach-populations. The information should be shared in a culturally 
competent way for multiple audiences
    Among all Pennsylvanians and especially with our underserved 
communities, appropriate and effective communication strategies will be 
vital. We have been working hard to deliver key health messages related 
to prevention of COVID-19 and increase access to testing to all 
Pennsylvanians through multiple channels. We have been relying on 
community partners on COVID-19 education and testing access and will be 
leveraging those relationships when the time is available to do 
community-based vaccinations.
    There is a baseline level of governmental distrust among 
Pennsylvanians, and a historic national distrust of the medical 
enterprise among our black and indigenous people of color that could 
significantly negatively impact vaccine uptake in the Commonwealth. 
Combatting this vaccine hesitancy and building trust in these 
communities a is a cornerstone of the Commonwealth's vaccine plan. In 
addition, given the unprecedented speed these vaccines have gone from 
concept to production has caused a level of distrust among the American 
people that will need to be addressed with accessible, actionable, and 
coordinated messaging. My communications team, along with other state's 
communications teams, have a host of creative ideas and concepts they 
would love to bring to fruition.
Challenges
    Unfortunately, states and territories do not have the adequate 
funding to support communication campaigns to promote the safe and 
effective vaccines, recruit and train the necessary workforce to reach 
communities of color and other vulnerable populations, stand up 
federally supported supplemental vaccination sites and promote new 
strategies for mass vaccination, enhance existing public health 
infrastructure and strengthen vaccine confidence. The $340 million 
allocated for states, territories and big cities to date is simply not 
enough. If you break it down, that's about $1 per American to mount an 
immunization enterprise that is unparalleled in scale and complication. 
The Association of State and Territorial Health Officials along with 
our partners at the Association for Immunization Managers are 
requesting that Congress provide $8.4 billion in emergency supplemental 
funding for a mass vaccination campaign which will include funding for 
workforce, infrastructure, cold supply chain management and outreach to 
priority populations, communications, and educational efforts to 
increase vaccine confidence and combat misinformation.
    This will not be a short-term operation. We expect this operation 
will take months to vaccinate all the citizens across the states and 
territories. This task will be undertaken by a public health and 
healthcare system that is already strained and stressed by the current 
and ongoing response to COVID-19. The resource challenges--monetary and 
personnel--are enormous. Although vaccination will be accomplished 
through many healthcare partnerships; states and territories understand 
that some portion of this will fall on public health and public health 
nurses, who are already overtasked with case investigation and general 
public health response. The public health infrastructure and investment 
in this country has been systematically stripped away over decades. 
What we have seen is that this pandemic has revealed the devastating 
impacts of that reality, along with the disconnect between public 
health and medicine.
    In recent mock shipments of vaccine to train and test the 
transportation/logistics planning that has been done by OWS, there have 
been varying levels of success. While the authorization of a vaccine, 
is a great step towards the ending the pandemic, it is critical that 
vaccine and ancillary supplies arrive in a timely manner to the 
appropriate location. In approximately \1/4\ of states, at least one 
significant issue arose during the mock shipment that requires 
attention prior to shipping actual vaccine. States experienced vaccine 
arrivals with a 2-day lag in the arrival of ancillary supplies. Vaccine 
that arrives without the ancillary supplies required to administer it 
will delay the vaccination of key prioritized populations.
    Lastly, following a successful rollout of vaccination, states and 
territories will need to continue to work with CDC, Health and Human 
Services (HHS), and Centers for Medicare and Medicaid Services (CMS) as 
to how the vaccination will impact those who have already had COVID, 
and how this will impact CMS guidance on frequency of staff and 
resident testing which are real operational and funding initiatives 
that we would be better able to plan for if we understand where things 
are going. Continuing these multi-level discussions will be key to a 
coordinated nationwide plan.
Conclusion
    Despite these challenges I outlined today, I am proud of the 
immense amount of public health work that have led in the mitigation 
and containment of the virus not only in Pennsylvania, but throughout 
the Nation. This pandemic has reinforced the need for investment in 
public health, collaboration among public and private partnerships, and 
public health education.
    There is a grave need for additional funding to support additional 
personnel and the creation of an impactful communication campaign to 
ensure that we can achieve the life-saving goal of vaccinating everyone 
who wants it in order to bring the COVID-19 pandemic under control.
    Thank you for the opportunity to offer this testimony and for all 
your partnership. I am pleased to take any questions you may have.

    Senator Fischer. Thank you, Dr. Levine.
    Next, I would like to introduce Richard Smith. Mr. Smith is 
the Regional President of the Americas and Executive Vice 
President of Global Support for FedEx Express. In this role, he 
oversees operations in the United States domestic market, 
Canada, Latin America, and the Caribbean. Welcome.

STATEMENT OF RICHARD W. SMITH, REGIONAL PRESIDENT, AMERICAS AND 
               EXECUTIVE VICE PRESIDENT, GLOBAL 
                     SUPPORT, FEDEX EXPRESS

    Mr. Smith. Thank you. Chairman Fischer, Ranking Member 
Duckworth, and members of the Committee, thank you for inviting 
me, representing FedEx and UPS, here today to speak about our 
efforts to support the upcoming distribution of vaccines to 
combat the spread of COVID-19. We recognize that this is 
complex and critical work and appreciate the Subcommittee's 
focus on this mission.
    Before I begin, I would like to express my sincere 
appreciation for the courageous work of our more than 600,000 
FedEx Global team members who have been on the front lines 
since the start of this pandemic, providing essential 
transportation services and keeping critical supply chains 
moving. As a result of their dedication and commitment to the 
communities we serve, we have delivered over 2 billion face and 
surgical masks, 55 kilotons of personal protective equipment, 
and over 9,600 discrete humanitarian aid shipments to support 
the global response to COVID-19, to date.
    Earlier this year, when the pandemic reached the United 
States, we worked quickly to support over 40 community testing 
sites, spanning across 10 states, delivering test kits and 
samples for analysis. I am very proud of the significant, 
positive impact the FedEx team's work has had on the response 
to this pandemic and will continue to have as we enter this 
next critical phase. I am grateful for and humbled by their 
continued, unrelenting commitment to service, which we refer to 
at FedEx as ``delivering the Purple Promise.''
    Forty-seven years ago, FedEx was created for the exact 
purpose and service required for today's mission--fast, 
reliable delivery of time-sensitive, high-priority goods. As 
the largest global express transportation provider, FedEx has 
an unparalleled worldwide network serving over 220 countries 
and territories, connecting more than 99 percent of the world's 
gross domestic product. Within the United States, we can 
deliver to every zip code. With the largest fleet of cargo 
airplanes, over 670, and over 180,000 motorized ground 
vehicles, we deliver more than 17 million packages on an 
average day.
    Every day at FedEx, we focus on what we can control and 
prepare for the things we cannot. We invest in our team members 
and innovative technologies, all in preparation to serve the 
needs of our customers and communities. FedEx has a long 
history of supporting critical relief efforts around the world, 
and we are ready for the challenge ahead.
    For the past several months, we have been working closely 
with our healthcare customers, both the vaccine manufacturers 
and distributors, as well as the Federal Government on vaccine 
distribution plans. We have years of experience in this area, 
shipping flu vaccines every flu season and moving vaccines 
globally for decades, as well as transporting over 80 million 
vaccine doses to combat H1N1 in 2009.
    We also regularly carry vaccines for commercial and 
government organizations, both domestic and international. Our 
healthcare team has been able to leverage this experience, flex 
our comprehensive network, and work with various stakeholders 
to build customized solutions to achieve our collective goal--
moving COVID-19 vaccine shipments as safely, securely, and 
quickly as possible. This is who we are and what we do.
    Once the vaccines are approved and ready for distribution, 
vaccine and related healthcare shipments will be the top 
priority for FedEx Express' network. Our Priority Alert team 
will actively monitor and track vaccine shipments for our 
healthcare customers using a suite of advanced tracking and 
monitoring tools, including SenseAware ID, which uses FedEx 
patented technology, as well as our FedEx Surround platform, 
providing predictive analytics. These technologies provide 
increased visibility and real-time updates on sensitive 
packages, enabling us to intervene and intercept a shipment, if 
necessary. Long ago, we recognized that information about the 
package was just as important as the package itself. We 
invested in these innovative solutions for this exact purpose.
    We have also made significant investments in our cold chain 
infrastructure over the years, including our packaging, 
aircraft, motorized vehicles, and facilities. At present, we 
have more than 90 temp-controlled facilities across 5 
continents, with plans to open additional facilities in the 
coming years. We are also expanding our network of ultra-low 
temperature freezers at some of our major hubs. As demonstrated 
by these actions, we have planned for the various contingencies 
required for missions like this and are prepared to respond as 
needed.
    Finally, maintaining the health and safety of our essential 
frontline workers will remain our top priority throughout this 
effort. To date, we have spent over $225 million in personal 
protective equipment and cleaning services to keep our 
employees safe. We will continue to invest in our employee 
health, safety, and monitoring programs, providing safety 
equipment, regularly cleaning our facilities, and ensuring that 
our employees have access to COVID-19 testing. Their health and 
fitness are vital to this effort.
    From day one of our operation, FedEx has taken the 
necessary steps and is well positioned to respond, both here 
and abroad. This concludes my statement. I appreciate your time 
today and look forward to answering any questions you may have.
    [The prepared statement of Mr. Smith follows:]

 Prepared Statement of Richard W. Smith, Regional President, Americas 
      and Executive Vice President, Global Support, FedEx Express
    Chairman Fischer, Ranking Member Duckworth, and Members of the 
Committee:

    Thank you for inviting me here today to speak about our efforts to 
support the upcoming distribution of vaccines to combat the spread of 
COVID-19. We recognize that this is complex and critical work and 
appreciate the Subcommittee's focus on this mission. Before I begin, I 
would like to express my sincere appreciation for the courageous work 
of our more than 600,000 FedEx global team members who have been on the 
frontlines since the start of this pandemic providing essential 
transportation services and keeping critical supply chains moving. As a 
result of their dedication and commitment to the communities we serve, 
we have delivered over two billion face and surgical masks, 55 kilotons 
of personal protective equipment, and over 9,600 humanitarian aid 
shipments to support the global response to COVID-19 to date. Earlier 
this year when the pandemic reached the United States, we worked 
quickly to support over forty community testing sites, spanning across 
ten states, delivering test kits and samples for analysis. I am very 
proud of the significant, positive impact the FedEx team's work has had 
on the response to this pandemic and will continue to have as we enter 
this next critical phase. I am grateful for and humbled by their 
continued, unrelenting commitment to service, which we refer to at 
FedEx as delivering the Purple Promise.
    Forty-seven years ago, FedEx was created for the exact purpose and 
service required for today's mission: fast, reliable delivery of time-
sensitive, high priority goods. As the largest global express 
transportation provider, FedEx has an unparalleled world-wide network 
serving over 220 countries and territories, connecting more than 99 
percent of the world's gross domestic product. Within the U.S., we can 
deliver to every ZIP code. With the largest fleet of cargo airplanes 
(over 670), and over 180,000 motorized ground vehicles, we deliver more 
than 17 million packages a day. Every day at FedEx, we focus on what we 
can control and prepare for the things we cannot. We invest in our team 
members and innovative technologies, all in preparation to serve the 
needs of our customers and communities. FedEx has a long history of 
supporting critical relief efforts around the world and we are ready 
for the challenge ahead.
    For the past several months, we have been working closely with our 
healthcare customers, both the vaccine manufacturers and distributors, 
as well as the Centers for Disease Control and Prevention, U.S. 
Department of Health and Human Services, U.S. Department of Defense, 
U.S. Department of Transportation, and U.S. Department of Homeland 
Security on vaccine distribution plans. We have years of experience in 
this area, shipping flu vaccines every flu season and moving vaccines 
globally for decades, as well as transporting over 80 million vaccine 
doses to combat H1N1 in 2009. We also regularly carry vaccines for 
commercial and government organizations, both domestic and 
international, including Defense Logistics Agency Troop Support and 
Logistics Health, a U.S. Army contractor. Our dedicated, experienced 
healthcare team has been able to leverage this experience, flex our 
comprehensive network, and work with various stakeholders to build 
customized solutions to achieve our collective goal: moving COVID-19 
vaccine shipments as safely, securely, and quickly as possible. This is 
who we are and what we do.
    Once the vaccines are approved and ready for distribution, vaccine 
and related healthcare shipments will be the top priority for the FedEx 
Express network, with support provided by our FedEx Logistics and 
Custom Critical teams. Our established FedEx Priority Alert team will 
actively monitor and track vaccine shipments for our healthcare 
customers using a suite of advanced tracking and monitoring tools to 
ensure the integrity of the shipments as they move through the system, 
including SenseAware ID (which uses FedEx patented technology), as well 
as our FedEx Surround platform. These technologies provide increased 
visibility and near realtime updates on sensitive packages. Our FedEx 
Priority Alert teams and healthcare customers will have access to this 
information, enabling us to intervene and intercept a shipment if 
necessary. Long ago, we recognized that information about the package 
was just as important as the package itself and invested in these 
innovative tracking and monitoring solutions for this exact purpose.
    In addition to our tracking and monitoring technologies, we have 
made significant investments in our infrastructure over the years to 
develop temperature-control solutions throughout the network, including 
our packaging, aircraft, motorized vehicles, and facilities. At 
present, we have more than 90 cold chain facilities across five 
continents, with plans to open additional facilities in the coming 
years. In 2016, we opened the Cold Chain Center at our world 
headquarters in Memphis, Tennessee, creating over 20,000 square feet 
dedicated to temperaturecontrolled storage. This facility incorporates 
the latest temperature control solutions, allowing us to maintain 
packages at frozen, refrigerated, and room temperatures in the event of 
unforeseen delays. We are also expanding our network of ultra-low 
temperature freezers, capable of maintaining temperatures as low as -
94+to -112+F. As demonstrated by these investments, we have planned for 
the various contingencies required for missions like this and are 
prepared to respond as needed.
    Finally, maintaining the health and safety of our essential 
frontline workers will remain our top priority throughout this effort. 
To date, we have invested over $225 million in personal protective 
equipment and cleaning services to keep our employees safe. We will 
continue to invest in our employee health safety and monitoring 
programs, providing the recommended health safety equipment, cleaning 
our facilities regularly, and ensuring that our employees have access 
to COVID-19 testing, if needed. We encourage our team members to take 
any signs of illness seriously and seek medical attention as needed. 
Their health and fitness remain vital to this effort and we will follow 
and promote the health safety guidance issued by the leading health 
organizations to ensure their safety.
    As evidenced by the above, from day one of our operation, FedEx has 
taken the necessary steps and is well-positioned to respond on a 
domestic and global level to events like we currently face. We will 
continue to support our healthcare customers throughout this effort, 
and work with the various Federal and state agencies as necessary to 
ensure a coordinated, safe, secure, and efficient vaccine distribution 
effort.
    This concludes my statement. I appreciate your time today and look 
forward to answering any questions you may have.

    Senator Fischer. Thank you, Mr. Smith.
    Next, I would like to introduce Wesley Wheeler. Mr. Wheeler 
is the President of Global Healthcare at UPS. In this role, he 
oversees UPS' work related to pharmaceuticals and medical 
device transportation, wholesalers, retail distributors, and 
customers of regulated healthcare products. Welcome, sir.

  STATEMENT OF WESLEY WHEELER, PRESIDENT, GLOBAL HEALTHCARE, 
                     UNITED PARCEL SERVICE

    Mr. Wheeler. Good morning, Chairwoman Fischer, Ranking 
Member Duckworth, and members of the Subcommittee. My name is 
Wes Wheeler. I am the President of UPS Healthcare, the 
company's Healthcare and Life Sciences Division. Thank you for 
the opportunity to appear before you this morning and discuss 
our involvement in COVID-19.
    I will focus my testimony today on our capabilities, our 
involvement in Operation Warp Speed, and the solutions we are 
implementing to ensure the safe and effective delivery of 
vaccines upon approval. I trust that my testimony today will 
clarify our involvement, and I look forward to your responses 
and questions.
    While UPS is known primarily for its brown trucks and 
drivers, members of the Subcommittee may not be aware that UPS 
is also a longstanding provider of supply chain services for 
the many healthcare companies around the world. We handle 
medicines in more than 10 million square feet of facilities in 
more than 30 countries. Our regulated facilities are designed 
to handle biologically derived drugs, such as vaccines, at any 
temperature. We also offer end-to-end cold chain transportation 
service by air, ground, or ocean, and we deliver, on average, 
more than 25 million packages per day.
    UPS has been on the front lines of COVID-19, as FedEx has, 
since February of this year. We supported FEMA and Project 
Airbridge by moving more than 24 million pounds of PPE and 
opened up our facilities to the National Strategic Stockpile 
Program. We also supported 32 states by distributing millions 
of diagnostic test kits and biologic samples for COVID-19.
    We are also involved in clinical trials. Our UPS Healthcare 
group was proud to be the logistics partner for the Pfizer 
COVID-19 vaccine clinical trial. In fact, we are providing 
logistics support for 8 of the 10 leading vaccines in clinical 
trials today. Our experience with these trials helps us to 
prepare for vaccines when they come to market.
    UPS is a proud partner of Operation Warp Speed, and we were 
delighted to present at the Vaccine Summit this week for the 
President, and we are in daily contact at all levels with the 
team. And just last week, General Perna and Dr. Slaoui visited 
one of our newest healthcare facilities in Louisville, 
Kentucky, where we reviewed our supply chain planning and the 
preparations we have in place. We discussed how we will handle 
ultra-low temperature shipments and, in particular, how our dry 
ice replenishment program will be managed. I believe they left 
feeling confident with our degree of readiness.
    Let me elaborate further on the transportation security and 
temperature issues, which I believe the Subcommittee is 
interested in. Please understand that UPS has spent many weeks 
designing the supply routes and expected data flows for these 
vaccines. Capacity has been reserved in our air network, our 
operating hubs, and our ground operations. Our 3,000 U.S.-based 
pilots will know that they are carrying vaccines. Our trailers 
will have escorts.
    We will monitor all vaccine shipments in a newly dedicated 
24/7 command center, which collects data from all sources 
including GPS and temperature monitors. Each package will also 
carry a UPS exclusive active tag, which provides visibility in 
our network. Command center staff have been trained to monitor 
and, if required, intervene and recover a vaccine package. UPS 
has also designed software which can detect network disruptions 
before they occur.
    On the issue of temperature control, UPS has extensive 
experience handling shipments at any temperature. However, it 
is important to note that in the case of these vaccines, the 
temperature in transit will be maintained by its packaging, 
which is designed to keep its internal temperature at 
temperature for several days. Pfizer and McKesson have chosen 
appropriate, validated, and environmentally friendly packaging 
for these two vaccines, and we have extensively tested both.
    UPS has also invested in dry ice manufacturing capacity for 
replenishment at dosing sites, where required. UPS will produce 
over 24,000 pounds of dry ice per day in Louisville, and we 
will ship 40 pounds of dry ice to all Pfizer dosing locations 1 
day after the vaccine arrives. UPS is also nearing completion 
of two very large coolers and freezers in the same facility for 
storage of future vaccines in the pipeline. And we offer a 
program to supply ultra-low temperature freezers for dosing 
sites where dry ice may not be available.
    We are ready. I would like to take a moment to thank the 
thousands of UPSers who are poised and ready to deliver the 
greatest contribution to this country we could possibly 
imagine. Together, without General Perna and our colleagues at 
Operation Warp Speed, none of this would be possible.
    Thank you very much, Chairwoman Fischer. I will take your 
questions.
    [The prepared statement of Mr. Wheeler follows:]

  Prepared Statement of Wesley Wheeler, President, Global Healthcare, 
                         United Parcel Service
    Good Afternoon Chairwoman Fischer, Ranking Member Duckworth, and 
members of the Subcommittee. My name is Wes Wheeler, and I am the 
President of UPS Healthcare, the company's healthcare and life sciences 
division. Thank you for the opportunity to appear before you to discuss 
our involvement in COVID-19 vaccine distribution. I will focus my 
testimony on our capabilities, our involvement in Operation Warp Speed 
and the solutions we are implementing to ensure the safe and effective 
delivery of vaccines upon approval. I trust that my testimony today 
will clarify UPS's involvement in this effort and I look forward to 
answering your questions.
    While UPS is known primarily for its network of brown trucks and 
drivers, members of the subcommittee may not be aware that UPS is also 
a longstanding provider of supply chain services for many healthcare 
companies. We handle regulated medicines in more than 10 million square 
feet of facilities in 32 countries. Our temperature controlled 
facilities are designed to handle biologically derived drugs such as 
vaccines at any temperature. We also offer an end-to-end cold chain 
transportation service by air, ground or ocean and we deliver 50,000 
shipments per day of lifesaving medicines.
    UPS has been at the forefront of the COVID-19 fight since February 
of this year. We supported FEMA and Project Air Bridge by moving over 
24 million pounds of PPE and we opened up our facilities to the 
National Stockpile program. We also supported 32 states in distributing 
millions of diagnostic test kits and biologic samples for COVID-19.
    We are also involved on the clinical side. UPS Healthcare was proud 
to be the logistics partner for Pfizer's COVID-19 vaccine clinical 
trial. In fact, we are providing logistics support for eight of the ten 
leading vaccines in clinical trials today. Our experience with these 
trials is helping us prepare for the vaccines when they come to market.
    UPS is proud to be a partner in Operation Warp Speed. We are in 
daily contact with each member company and the OWS team itself. Just 
last week, General Perna and Dr. Slaoui visited one of our newest 
healthcare facilities in Louisville, KY. We reviewed our supply lane 
plans and the preparations we have in place with their guidance. We 
discussed how we will handle ultra-low temperature shipments and in 
particular, how our dry ice replenishment program will be managed. I 
believe they left feeling confident with our degree of readiness.
    Let me elaborate on the subjects of transportation security and 
temperature-controlled shipping, as I understand these are areas of 
interest for the subcommittee.
    Please understand that UPS has spent many weeks designing the 
supply routes and expected data flows for these vaccines. Capacity has 
been reserved in our air network, operating hubs and ground operations. 
Our pilots and drivers will know they are carrying vaccines. We will 
monitor all vaccine shipments in a newly dedicated 24/7 command center 
which collects data from all sources including our client's temperature 
recorders. Each package will also carry a UPS-exclusive active tag 
which provides visibility in our network. Command center staff have 
been trained to monitor and, if required, recover any vaccine package. 
UPS has also designed software that can detect network disruptions 
before they occur, and then recommend counter-measures in real time.
    On the issue of temperature control, allow me to correct any 
misperceptions about our ability to deliver vaccines at ultra-low 
temperatures. UPS has extensive experience with storage and transport 
of any material at any temperature. However it is important to note 
that, in the case of these vaccines, the temperature-in-transit will be 
maintained by its packaging, which is designed to keep its internal 
temperature--at temperature--for several days. Pfizer and McKesson have 
chosen appropriate, validated and environmentally-friendly packaging 
for the first two vaccines, and we have prior experience handling them.
    UPS has also invested in dry ice manufacturing capacity for 
replenishment at dosing sites where needed. UPS will produce over 
24,000 pounds of dry ice per day in our Louisville facility and we will 
ship a box with 40 pounds of dry ice to all Pfizer dosing locations a 
day after the vaccine arrives. UPS is also nearing completion of very 
large coolers and freezers in the same facility for storage of future 
vaccines in the pipeline. We have also invested in a `freezer farm' for 
-80C storage and we offer a program to supply portable ultra-low 
temperature freezers for dosing sites where dry ice may not be 
available.
    I'd like to take a moment to thank the thousands of UPSers who have 
devoted their time and energy into making sure our network is prepared 
for the challenges ahead. Without their dedication, none of this would 
be possible.
    Thank you for the opportunity to testify, and I look forward to 
answering your questions.

    Senator Fischer. Thank you, Mr. Wheeler, and thank you to 
all of our panel.
    I would like to begin the first round of questions. Mr. 
Wheeler and Mr. Smith, as you know, we are in the midst of peak 
shipping season, when transport capacity is expected to be 
tight. At the same time, tens of millions of vaccine doses are 
likely to be available today. Once vaccines are approved, will 
UPS and FedEx ensure capacity is available in your network for 
COVID-19 vaccines, and if so, how will you ensure that capacity 
is available? Mr. Smith?
    Mr. Smith. Well, we begin planning for peak in January of 
that year. So we recognized early on this would be a record 
peak season, and of course, throughout the months, as the COVID 
picture changed and we saw all of the folks ordering things at 
home and the volume spike, we adjust our plans accordingly. So 
we have even taken to calling this peak ``the ship-a-thon'' 
months ago because we knew it was going to be a record peak.
    But just as my esteemed competitor here said about their 
network, we also knew the vaccines would be coming when we 
started planning for this with Operation Warp Speed and our 
healthcare customers, the manufacturers and distributors who 
would play a role in this. So we started reserving capacity for 
that.
    We have been preparing for months, working with all of our 
customers, as I said, to match network capacity with the demand 
we expect to see, just as we do for any surge event. Whether it 
is peak season, a new iPhone release, or any new product 
introduction, we have been planning for this for some time. We 
have also hired 70,000 more team members across the FedEx 
enterprise to support all of our needs this season. And again, 
as I said before, this is who we are and what we do. This is 
what we were built for, and we plan for things like this 
regularly. Maybe not on this scale, with all of the ins and 
outs, but we are well versed in this type of planning.
    Also, I will point out for FedEx, we run--we have different 
operating companies that focus on different things. You may 
note that you will see a FedEx Ground truck on the road, and 
sometimes you will see a FedEx Express truck. The FedEx Ground 
system, which we have been investing in tremendously, will 
handle the bulk of the surging online retail orders, all of 
your Christmas presents. And the Express network focuses more 
on time-definite critical deliveries, like vaccines. That is 
the company that will be focused on delivering your mission-
critical vaccines.
    Thank you.
    Senator Fischer. Mr. Wheeler?
    Mr. Wheeler. Thank you. I am an engineer. About 2 or 3 
months ago, we started building a forecasting model trying to 
predict, as best we could, how many vaccine companies would be 
approved this year and next year, where the manufacturing 
locations were. So we had the origins. We started to think 
about how many doses per shipment, and we built a very detailed 
forecasting model, which would allow us to predict--sorry--
which would allow us to predict how much we would be having to 
reserve in our capacity.
    During peak, of course, we are now above our 25 million per 
day. We are at 34 million, I think, a couple of days ago. We 
have reserved plenty of capacity in all the lanes, from all the 
manufacturing locations, even for the vaccines that are still 
in development. So we have talked to all the companies, 
including Novavax, AstraZeneca, J&J, to find out just how much 
volume may come through the pipeline at the first of the year, 
or beyond.
    So we have reserved plenty of capacity in all the lanes. We 
are ready now. We have the dry ice capacity to start with a 
large number of Pfizer vaccine shipments, starting next week, 
we hope, and we are very much looking forward to that.
    Senator Fischer. So if I am understanding you both 
correctly, you knew this was going to be a peak season anyway, 
and now you put COVID on top of it and the challenges that we 
face there, just in our daily lives, with people becoming ill 
and having to take time off and having those people replaced. 
So you hire more people. You use different delivery systems, 
whether it is for regular shipping, compared to the shipping we 
are going to see now with the vaccines.
    When you--do you foresee a need that the vaccines are going 
to have to become a priority because of the--if the development 
of the vaccine increases at a higher capacity, at a faster 
capacity, have you planned for that? And then, how do you plan 
to get that out? Do you plan to follow a model of hiring more 
people, getting the resources you need, whether it is finding 
other shipping companies, air freight, and then the freezing 
capacity and getting it delivered throughout the United States?
    Mr. Smith. Well, we have said throughout this that there 
will be no higher priority shipments in our network than these 
vaccine shipments. So they will have the highest priority of 
anything we carry in all of our FedEx networks, but certainly 
in the FedEx Express system that will be carrying them.
    We will be using new technologies, and I am sure someone 
will get to a question on that. So I will not go into too much 
detail about our respective monitoring and tracking 
technologies that will allow us to have positive control of 
these shipments at all times, know where they are, give them 
that highest priority in our network, and make sure they are 
delivered, intercede if there are any unforeseen delays, 
weather related, on road traffic delays. We will have eyes on 
them. We will be able to jump into action. But make----
    Senator Fischer. Do you--I am going to interrupt you.
    Mr. Smith. Yep.
    Senator Fischer. Do you have a good working relationship 
with airports, for example----
    Mr. Smith. Absolutely.
    Senator Fischer.--that you will move into priority lanes 
there? Do you transport by rail, trucking?
    Mr. Smith. These shipments will move in our integrated air-
ground system, the Express network, but we are working closely 
with the FAA, and we have great relationships with the 
airports. But we are working with the FAA to identify the 
flights that will have these shipments. So they will get the 
highest priority.
    To your question on staffing, so as I said, we staff up, 
just like UPS does, for peak. We hire a lot of new team members 
during peak. We know that as these vaccines come on and ramp 
up, we will continue operating at elevated levels post peak. 
But we are confident we have the team members in place and will 
maintain a lot of those team members that we have staffed up 
for peak to continue with this vaccine distribution beyond.
    Senator Fischer. Thank you. Mr. Wheeler, did you have any--
--
    Mr. Wheeler. Very similar. So, every year, we plan on peak. 
We have added 100,000 temporary workers to get us through. This 
was going to be our biggest peak ever. I believe that is 
probably the same for my colleague here. So planning for the 
capacity is something we do every year, and we have done this 
now for several months. It turns out that the volume is there. 
We are seeing that.
    In terms of the vaccines, similar to what Richard was 
showing is we have a UPS Premier gold service. This is--there 
is four radios in this label. This label will go on every 
single vaccine package and every dry ice package. This allows 
us to see the package as soon as it arrives in any of our 
locations. So as soon as it arrives in any hub, any airport, 
and even some of our ancillary supply areas, we will see the 
package. It will get priority. It goes on the plane first. It 
comes off the plane first. And so, that gives us the ability to 
see the package.
    We have triple redundancy. So when the packages leave 
Kalamazoo, Michigan, or one of the locations of the vaccine 
manufacturers, the trucks will have a sensory device. This is a 
GPS tracker that also gives temperature, that gives light 
exposure, and motion. So it gives us a lot of data. And Pfizer 
is also providing data from their own packages. So we have 
three ways of looking at the package through the system. And 
all that data streams into our command center, and we transmit 
that data to Operation Warp Speed.
    So we are all watching the packages all day long. And we 
have very, very high confidence that we will see all the 
packages running through the network.
    Senator Fischer. Thank you, sir. Senator Klobuchar.

               STATEMENT OF HON. AMY KLOBUCHAR, 
                  U.S. SENATOR FROM MINNESOTA

    Senator Klobuchar. Thank you very much, and thank you to 
all the witnesses here. I think we all know that this vaccine--
or the vaccines are going to be critical to getting our economy 
moving again in such a big way. And while states, including my 
own state of Minnesota, are making the decisions about exactly 
their own plans for distribution, I think we all know they 
can't do it alone. So that is why this time is so critical, as 
we are in this hearing room. And I want to thank the Chair and 
the Ranking Member for holding this important hearing at this 
time.
    We have got to make sure that our resources are there for 
the states and locals. And so, I guess I would start with a 
quick question there of Dr. Levine, and that is that could you 
explain, Dr. Levine--and thank you for your good work--why it 
is so important to get some Federal help in getting the vaccine 
distribution going?
    Dr. Levine. Well, thank you very much, Senator, for that 
question. So, you know, the states and the territories as well 
as the big cities chosen for this mission stand ready to 
accomplish it and to immunize everyone in the United States 
that will accept the vaccine. But that is a critical point. It 
is absolutely essential that we have proper communication and 
education messages from the CDC, but also from each state, 
territory, and city, to be able to educate people about the 
safety and effectiveness of the vaccine, and to educate people, 
and to dispel misconceptions about the vaccine, as well as work 
past vaccine hesitancy. We currently have no funding to 
accomplish that part of our mission.
    So, again, $340 million to all of the states. 
Pennsylvania's share of that is approximately $14.6 million, 
and that is going to give us a start as we work to distribute 
and administer the vaccine, hopefully starting next week and 
then through December and into January. But this is a long 
mission----
    Senator Klobuchar. Agreed.
    Dr. Levine.--and it is going to take much more funding.
    Senator Klobuchar. OK.
    Dr. Levine. And we have no money for the communication.
    Senator Klobuchar. OK, thank you.
    Dr. Smith and--Mr. Smith--you feel like everyone is 
becoming doctors now--and Mr. Wheeler, thank you for the work, 
and also of your employees right now. I left my apartment 
building in Washington and saw all the packages and people 
working hard, including Postal Service employees, your 
employees, and so many people every single day are on the front 
lines. So I want to thank them, through you, for that. Make no 
complaints about package deliveries. That is not--everything 
has been going well.
    But I was concerned about how these vaccines are going to 
get to the rural areas, because they are not just going to be 
parachuted in the middle of Laverne, Minnesota, or to one of 
the communities in Nebraska, for Senator Fischer. So could you 
talk about how you are paying attention to that?
    Mr. Smith. Sure, of course. As I mentioned in my remarks, 
we have the capability to serve every zip code in the United 
States of America. We do it every day. We have over 1.7 billion 
zip code service combinations. So, with this network capacity, 
whether you live in Chicago, Illinois, or Murdo, South Dakota, 
we are able to ensure time-definite deliveries of these 
shipments, and we feel very confident in our capabilities in 
this regard. This is what our network was built to do.
    Senator Klobuchar. OK. And then could I add, Mr. Wheeler, 
just because time is limited here, pharmaceutical companies 
have reported that about 5 to 20 percent of vaccines spoil 
during distribution. Not your fault, it is just a fact since 
they are highly perishable products. We don't have an unlimited 
supply. More than ever, it is really, really important that 
they not do that. And I assume this tracking technology that 
you both were talking about is part of that. So, in addition to 
talking about rural, could you get at that?
    Mr. Wheeler. If I understand the question, Senator 
Klobuchar, it is about the protection of the product?
    Senator Klobuchar. Mm-hmm.
    Mr. Wheeler. OK. Well, this is the product. This is a 2-mL 
vial.
    Senator Klobuchar. Mm-hmm.
    Mr. Wheeler. So this is the Pfizer vaccine. Five--not the 
actual vaccine----
    Senator Klobuchar. OK, that is good to know.
    Mr. Wheeler.--salt water. Five doses from this, when they 
dilute it. With the packaging that Pfizer has developed, and 
exclusive to Pfizer, we presented that to the President's 
vaccine summit this week. Very, very highly complex, it has dry 
ice in the bottom. It has the payload in the middle. It has 
what we call ``pizza trays'' where they can put up to 195 of 
these small vials in the tray. And then they are packed with 
more dry ice, and then there is a tracking device on top.
    I can assure you that I have never seen packaging quite 
that complicated before, and they have been very proud to 
develop that, and we are the first to show that out this week. 
I am pretty confident, aside from real big damage, that we are 
going to have a lot less spoilage than you think.
    Senator Klobuchar. Mm-hmm. And my last question is just the 
dry ice that I think, Mr. Wheeler, you talked about how--I know 
UPS Healthcare announced increased dry ice production capacity, 
producing something like 1,200 pounds of dry ice per hour? Is 
that right?
    Mr. Wheeler. Twenty-four thousand per day.
    Senator Klobuchar. Can any of that dry--OK. Can any of that 
dry ice be made available for hospitals and clinics that need 
extra cold storage? And how is supply for necessary 
transportation and storage materials kept up with this 
increased demand? I am trying to look at this as, you know, the 
entire supply chain here as we get this vaccine out.
    Mr. Wheeler. Well, I am sure we both agree on the same, 
that there is plenty of third-party supply for dry ice, and we 
are both prepared to do that. We have that now, and we are fine 
with the first several months of dry ice. But to top that off, 
we actually built a dry ice manufacturing plant in Kentucky. So 
we now have the contingency dry ice, and we are able, if we 
have extra dry ice--and I am sure we will--we can provide that 
to independent hospitals and clinics around the world--around 
the country.
    Senator Klobuchar. Very good. You want to add anything, Mr. 
Smith?
    Mr. Smith. No, I think he covered it well. We have talked 
to a number of vendors we use across the country--across the 
world on dry ice, in terms of dry ice replenishment or top-off 
for packages when they experience a delay, particularly an 
international package with a prolonged delay, where you may be 
asked by the customer to top it off. We are not being asked in 
this instance to do that while it is in transit.
    Post delivery, there may be some dry ice top-off that 
certain specialty couriers and vendors--Marken, which UPS 
acquired and is part of their healthcare business, which Mr. 
Wheeler ran, will be providing some of those services where 
they top off post delivery. But in talking to all these vendors 
out there, they do not believe that this talk of a dry ice 
shortage is real. They think there is plenty of dry ice out 
there.
    Senator Klobuchar. OK, good. Thank you, both of you, and 
thank you, Dr. Levine, as well.
    Senator Fischer. Thank you, Senator Klobuchar. I appreciate 
your comments on how to get things out to rural America. I live 
an hour and a half south of Murdo, South Dakota. And with that, 
I would like to recognize Senator John Thune.

                 STATEMENT OF HON. JOHN THUNE, 
                 U.S. SENATOR FROM SOUTH DAKOTA

    Senator Thune. Thank you, Chairman Fischer, for holding 
this important hearing in the midst of such a challenging year. 
We are excited about the high level of innovation and ingenuity 
that went into developing these vaccines, and it is going to 
take a high level of ingenuity and innovation and coordination, 
obviously, to get the vaccines distributed across the country. 
And I also will echo what my Chair from Nebraska and my 
colleague from Minnesota said about getting it to rural areas, 
particularly places like Murdo, and so, I appreciate your focus 
on that.
    And I want to know--there is a--obviously, it is going to 
take a sophisticated, multimodal supply chain at this scale. 
And that is going to require logistical coordination not only 
within the individual organizations, but between them. At least 
two vaccines, each with its own set of considerations and 
methods for distribution, are likely to be authorized in the 
near future. Could you speak, Mr. Smith and Mr. Wheeler, to how 
are you preparing to simultaneously distribute these vaccines 
at scale in a safe and rapid manner? And does the potential 
authorization of additional vaccines add further complexity to 
that challenge?
    Mr. Smith. Well, there are two models currently with the 
vaccines that we are talking about here, the Pfizer and the 
Moderna vaccine. Moderna has opted to use McKesson to put 
together the full package, if you will, to do the kitting of 
the vaccine with the syringes, needles, alcohol wipes, and if 
vaccines require a diluent or an adjuvant, they will do all of 
that at the distributor's site, ship it out at once.
    Pfizer's model is a little different. The actual vaccine 
will come from the Pfizer manufacturing site, and it will marry 
up with the kitting, which will come from McKesson, at the 
administrationsite.
    Having said that, as I alluded to earlier, when I talked 
about the discrete--just in the U.S., the discrete origin-
destination pairs we can connect with our network and a network 
like UPS, that is not really a challenge. We can--as more 
vaccines come on--this is what we do every single day.
    They are asking us to transport them rapidly and reliably 
from point A to point B, to get them from either the 
manufacturer or the distributor site to tens of thousands of 
administration sites. We do that every single day. And the 
packaging, as Mr. Wheeler alluded to, the onus of protecting 
the product is mostly on the packaging in transit, unless there 
is some sort of unforeseen delay.
    Mr. Wheeler. I think Richard said it well. I will just add 
to this. There is a complex difference between the two. The 
Pfizer vaccine does require a diluent and the diluent is going 
with the McKesson shipment, with the kits and the PPE and the 
syringes that are necessary.
    The good thing about that process is that those kits are 
going out from UPS a day before the vaccines arrive. It gives 
us good visibility of where the vaccines will be delivered. So 
if there are any errors at all in the addresses, we will know 
that. So when the kits arrive at the dosing sites, then the 
vaccine the next day, and then we top it up with dry ice. That 
is the Pfizer.
    Moderna is a little different, just as Richard said. All 
the whole package is going together from McKesson. Makes it a 
little bit easier, that we are picking up from the McKessonsite 
in Shepherdsville, Kentucky, and then taking it to all 
destinations that we are assigned.
    Senator Thune. So, in addition to the work that you all are 
doing, there are some passenger carriers, including United, 
American, and Delta, that are preparing also to rapidly 
distribute some of the vaccines. Can you describe how your 
companies plan to coordinate with other carriers in that 
distribution?
    Mr. Smith. Well, I think in the domestic United States, we 
don't have a need to collaborate with any passenger carriers. 
As I mentioned, we run the largest all cargo airline in the 
world. Our esteemed competitor here runs a pretty substantial 
airline themselves, and we have plenty of capacity for this in 
our own system, particularly in the domestic United States, but 
we think worldwide.
    Senator Thune. As you know, the U.S. Department of 
Transportation is committed to providing the regulatory 
flexibility that is necessary for rapid vaccine distribution. 
Beyond the actions that have been taken by the Department so 
far, do you have any suggestions for regulatory relief that 
would improve the ability of supply chains to adequately meet 
the task? Are you getting what you need from the Transportation 
Department?
    Mr. Smith. I mean, in our view, the Federal Government has 
been highly supportive in helping essential service providers 
to continue to operate during these difficult times. As one 
example, the DOT has been proactive, issuing guidance and 
providing relief on expiring driver's and pilot's licenses, 
medical certifications, facilitating alternative methods of 
training where appropriate, developing guidance on employee 
health safety practices, and working with states and foreign 
governments on policies that allow our team members to continue 
to work. So we have been getting a lot of great support.
    Senator Thune. OK. Mr. Wheeler?
    Mr. Wheeler. I will just add one thing that was mentioned 
earlier. We are working with the FAA. They have actually asked 
us to send them a file every day of where the flights are 
landing. So, in the event that they have difficulties or backup 
landing aircraft in a certain airport, they will know that 
vaccines are coming and will give priority to those shipments 
coming in.
    Senator Thune. Good. I am pleased to hear that.
    Madam Chair, I think that the willingness of the DOT to 
make this as easy as possible, given obviously all the 
regulations that you all live by on a daily basis, it is really 
important to expedite it, and get it out there as quickly as 
possible in a safe way. So, thank you, we appreciate you being 
here.
    Senator Fischer. Thank you, Senator Thune. Next, we have 
Senator Peters, please.

                STATEMENT OF HON. GARY PETERS, 
                   U.S. SENATOR FROM MICHIGAN

    Senator Peters. Thank you, Madam Chair.
    Good morning, gentlemen. Good to have both of you here, and 
a third via the online here.
    Dr. Levine, a question for you. I think it is a similar 
question that was asked of Mr. Smith, but it think it is 
important for me to get a sense from your state because 
Pennsylvania is a lot like Michigan. Michigan is the home of a 
significant number of rural communities. In fact, two-thirds of 
our state is classified as rural, and about 30 percent of those 
residents in those areas are over 60, who, as you know, are 
high priority for receiving the vaccine.
    But given the number--limited number of medical facilities 
and infrastructure in these communities, give me a sense of how 
you are preparing to make sure these vaccines remain stable and 
at the temperature that they need. It is a significant 
challenge, and we have got to get a sense of what you are doing 
in Pennsylvania, and it may help us as we are thinking through 
our issues.
    Dr. Levine. Well, thank you very much for that question, 
Senator.
    So, yes, Pennsylvania is a very rural state. So, for the 
first vaccine, the Pfizer vaccine, we have approximately 100 
hospitals that will be served as the first stage of the vaccine 
to be able to immunize healthcare workers for that first part 
of the mission. Those are hospitals that have the ability to do 
two things. One is to have the cold chain storage and the 
refrigeration capacity at their hospital. And the second is to 
do a widespread vaccination of at least 975 doses with the 
first trays, as our colleagues talked about.
    After that, we are anticipating that the Moderna vaccine 
will come out, hopefully within several weeks. That is the 
vaccine that will be distributed to the rural hospitals, much 
of whom do not have the capacity to be able to store the Pfizer 
vaccine. And we will be accomplishing the mission of immunizing 
healthcare workers in those rural areas with a hub-and-spokes 
method.
    In terms of long-term care living facilities, both vaccines 
will be going to distribution centers for our pharmacy 
partners, CVS and Walgreens, and then they have hired 
significant personnel to go out to nursing homes and other 
facilities to accomplish those immunizations.
    Senator Peters. Does your state or other states have 
resources to implement perhaps a mobile vaccination clinic to 
reach some of these areas rurally?
    Dr. Levine. Yes, we will. That will come into play with 
future phases of the vaccine, particularly Phase 2 and Phase 3, 
where actually the Department of Health is coordinating much of 
the vaccination through vaccine clinics, through FQHCs, and 
through something like mobile vans. For Phase 1, it really is 
going to be the hospitals that will be immunizing most of the 
healthcare workers, and again, CVS and Walgreens, our pharmacy 
partners, going directly to long-term care facilities to 
accomplish those immunizations.
    Senator Peters. All right. Well, thank you.
    Question for Mr. Smith and Mr. Wheeler. You know, IBM 
recently released a very disturbing report detailing cyber 
attacks on COVID-19 vaccine distribution infrastructure. And 
just last month, a cold chain storage company also reported 
that they were the target of a cyber attack. So my question to 
both of you is, what specific steps have you taken to ensure 
hackers are not able to disrupt the distribution networks for 
the vaccines through your companies?
    Mr. Smith. Thank you, Senator, appreciate this question. I 
know you understand the sensitivity of this type of information 
that we are dealing with. We certainly do at FedEx, and we are 
engaged with all of the relevant agencies and stakeholders on 
this issue. We are taking all of the necessary precautions, 
using the latest technology, as we pointed out, to safely and 
securely support these vaccines.
    We also have a tremendously strong information security 
group, Infosec we call it, at FedEx. It is not my area. I run 
operations and network planning and engineering for the 
Americas, but we can certainly follow up with you with more 
specifics on all the things we have done. They do a fantastic 
job hardening our network and protecting us from attacks.
    Senator Peters. All right, thank you. Mr. Wheeler?
    Mr. Wheeler. Just to add to that, I think a good way to 
answer the question is Pfizer and McKesson, the two primary 
distributors coming up soon, are longstanding clients of ours, 
and I am sure FedEx works with them as well. So the data 
movement between these companies and UPS is well, well trodden. 
It is a path that we have been walking for a very long time.
    Those data feeds are well protected. We have firewalls. We 
have all the necessary security measures. And we actually 
presented this yesterday at the Operation Warp Speed 
headquarters, here at HHS, to give them the assurance that we 
have the right security measures in place.
    Senator Peters. Right. Thank you.
    Senator Fischer. Thank you, Senator Peters. Next, we have 
Senator Capito.

            STATEMENT OF HON. SHELLEY MOORE CAPITO, 
                U.S. SENATOR FROM WEST VIRGINIA

    Senator Capito. Thank you, Madam Chair, and thank you all 
for being here. Can you see me here?
    Senator Fischer. Yes, we see you.
    Senator Capito. OK, we got it.
    Senator Fischer. We hear you, as well.
    Senator Capito. Great. Great. Thank you for having this 
hearing, and thank you, all three of you, for being here. As 
you can imagine, this is very much top of mind of many, many 
people, certainly in the State of West Virginia, but all across 
the country, and the logistics of this, I think, are 
exceedingly important.
    So, Dr. Levine, I would like to ask you the first question. 
In your neighboring state of Pennsylvania, you might have 
noticed our state of West Virginia. We have really relied on 
our National Guard to serve as the supply chain, to do PPE for 
our schools. They have done a lot of testing and have really 
filled in an enormous gap for us, as a state, and have really 
been the frontline workers, and the Governor has relied quite a 
bit on them. Is there any plan in Pennsylvania to use that 
supply chain, or that knowledge that the Guard has accumulated 
over the last 8 to 9 months, to be a part of this distribution 
once you secure the vaccine?
    Dr. Levine. So I know that other states do plan to utilize 
the National Guard for that mission. Right now, in 
Pennsylvania, we do not. Our National Guard members, who also 
have been integral to our response, are actually working 
primarily in nursing homes and long-term care living 
facilities. And so, we have used medical personnel extensively 
as strike teams, to go into challenged nursing homes to provide 
direct care to patients and to--who have specific--in nursing 
homes that have particular staffing issues because their staff 
either have COVID-19, or they are in quarantine.
    In addition, if we have to open alternative care sites for 
hospitalized patients, then we would use National Guard for 
that purpose. So we have not used the Guard in our planning.
    Senator Capito. OK. Second question is on the dosages. Let 
me ask a simple question. If you get the Pfizer first dose, is 
the amount of the first dose the same as the amount of the 
Pfizer second dose? In other words, are they alike? Yes?
    Dr. Levine. Yes.
    Senator Capito. OK. On tracking that, I think this going to 
be a potential problem, particularly in rural America. How do 
you track who has gotten the first one? How do you retrack if 
you don't have connectivity for certain areas?
    Who has the responsibility of that? Do you, as the Chief 
Medical Officer? Does Pfizer have that responsibility? Where 
does that responsibility lie, and where is the recheck going to 
be on this? Because my understanding is that second dose is 
very critical.
    Dr. Levine. So you are correct. The second dose is critical 
to produce the appropriate immune response so that the 
individual will have a really good chance of being immune to 
COVID-19. It is primarily our responsibility to track when the 
first dose is given and the second dose is given. We will be, 
of course, working with the healthcare providers themselves, 
who have to input into our system that those doses are given. 
And both the healthcare providers and the Department of Health 
have recall mechanisms to contact patients who don't come for 
their second dose.
    Senator Capito. So do you have the systems already 
available to you that would be perfect for inputting this data 
so that you can follow up quickly and all that? That system, I 
am going to assume, exists now? It is not something you have to 
build?
    Dr. Levine. No, the system exists now. We did have to 
update our current immunization system and make it much more 
robust, with redundancies for this mission, which is much 
bigger than other immunization campaigns we have had. But we 
have those systems present now.
    Senator Capito. OK. Mr. Smith and Mr. Wheeler, let me ask 
you this question in terms of last house. My understanding is 
that, in some cases, the last house delivery from UPS or from 
FedEx may be from the U.S. Postal Service. Is that a correct 
assumption? Am I right there?
    Mr. Smith. You want to take it? We both have services where 
we utilize the United States Postal Service for final mile 
delivery, primarily of lightweight, low-value, e-commerce 
items.
    Senator Capito. Would the--OK, would the vaccine fall into 
this, or would that be something that you----
    Mr. Smith. Absolutely not. The vaccine will be delivered by 
FedEx Express, by a FedEx Express courier to these 
administration sites.
    Senator Capito. And is that the same with UPS?
    Mr. Wheeler. Exactly the same with UPS. We are a 100 
percent UPS network. And as you know----
    Senator Capito. OK, good.
    Mr. Wheeler.--all the employees are UPS employees.
    Senator Capito. Good. Well, I would imagine, I mean, 
utilization of that--however many--the fewer hands between----
    Mr. Wheeler. We agree.
    Senator Capito.--the vaccine and the person who actually 
receives it obviously eliminates any kind of room for error 
there. So I am pleased to hear that.
    Mr. Wheeler. Agree 100 percent.
    Senator Capito. Good. And then I was interested to hear, 
too, that there have been some relaxations of certain 
regulations, times of service. I heard expired licenses of 
pilots--or extension of pilot licenses and other things. I 
understand that is going to be very helpful to both of you to 
make sure that you have got full capacity to be able to move 
forward. Do you have anything to add on that aspect, where you 
might need some other flexibilities?
    Mr. Wheeler. We are actively testing all of our pilots on a 
regular basis to make sure that we can rotate the pilots 
efficiently. We have 3,000 pilots in the U.S., and we are 
testing them all.
    Mr. Smith. We are doing the same. Our pilots are being 
tested before they fly on a mission, particularly 
internationally. So, same.
    Senator Capito. OK. But then, let us say--let us go to your 
trucks, same thing? I mean, there are hours of service 
restrictions on those, too. Do those come into play for you, or 
not----
    Mr. Smith. We think we can----
    Senator Capito.--in this instance?
    Mr. Smith. We can manage those, and we don't have any 
additional asks in that regard here.
    Senator Capito. OK.
    Mr. Wheeler. I will just add, we said before that we are 
giving priority to all the vaccine shipments. So as soon as 
they arrive in the destination location, our sort facilities or 
our hub facilities, the drivers will know exactly that they are 
moving vaccines. So it is a priority for them. They will put 
those packages on their trucks first, and the others will 
follow.
    Senator Capito. OK, final question for both of you. 
Obviously, getting a vaccine--I saw you with the little vial of 
the fake Pfizer vaccine. Obviously, you need swabs. You need 
injection devices. Are you in contact with those manufacturers, 
too, to make sure that--are you a part of that whole stream of 
logistics that are going to be important to delivering this 
vaccine? Mr. Wheeler?
    Mr. Wheeler. Yes, UPS moves everything. So we are moving 
ancillary supplies to our customers. We are moving glass 
vials----
    Senator Capito. But I mean, is that something that you are 
making special considerations for, as you are for the vaccine 
itself?
    Mr. Wheeler. Of course.
    Senator Capito. Yes.
    Mr. Smith. We are planning for everything.
    Senator Capito. OK. Mr. Smith?
    Mr. Smith. Yes, same. We are planning for everything, 
anything that we are asked to move from a distributor like 
McKesson or directly from a manufacturer like Pfizer. In terms 
of just shipping vaccine or whether we are shipping vaccine and 
kitting, we are same as UPS. We are prepared for it and ready 
and planning that with them.
    Senator Capito. OK, thank you.
    Senator Fischer. Thank you, Senator Capito. Senator 
Baldwin, you are recognized.

               STATEMENT OF HON. TAMMY BALDWIN, 
                  U.S. SENATOR FROM WISCONSIN

    Senator Baldwin. Thank you, Madam Chairwoman.
    Like so many of my colleagues, we are very much looking 
forward to hearing from the FDA later today, but we all know 
that we have a lot of work to do. We still need to wear our 
masks. We still need to limit our gatherings, until at least 70 
percent of Americans are vaccinated. And to get there, our 
states are going to need support.
    I want to share that in hearing from Wisconsin officials, 
they have been working overtime to provide care to patients 
with COVID-19, reduce the spread, and prepare for the vaccine 
distribution. But the state estimates that they will need an 
additional $10 million for vaccine infrastructure readiness 
over the months to come.
    States are doing as much as they can to get ready, but they 
can't do this work alone, as we all know. And I am concerned 
about the potential for breakdown in coordination between the 
Federal Government, states, and partners of the private sector. 
We have got to get this right from the very start.
    So, Mr. Wheeler and Mr. Smith, given your roles in the 
distribution process, can you describe which points in the 
distribution coordination will be the most critical and where 
you see the potential for breakdowns? What do we need to do to 
ensure better coordination at these various points?
    Mr. Wheeler. I think what I would ask is that the State 
jurisdictions that are working with Operation Warp Speed come 
up with a very good forecasting model. As soon as we can see 
the volume coming through the pipeline and through the system, 
the better. We--I think that is probably the best way to answer 
it. We are taking orders from McKesson and Pfizer for these two 
vaccines that come straight in. We have embedded employees at 
their locations, so we are scanning everything from the origin 
to the final destination. And Operation Warp Speed is really 
driving the train here. They are the ones giving us the orders 
to move.
    Mr. Smith. Yes, and I would just second that. I mean, we 
feel very confident, as I know UPS does, about our role in 
this, particularly the transport from point A to point B. You 
know, we don't decide where the vaccines go, how much is 
allocated to each state, how it is allocated within the state. 
We are the transportation provider, and our mission is to get 
it there rapidly and reliably, safely and securely.
    But we are very confident about it in our system. There are 
certainly things before it enters our system that are outside 
of our control. There are things after we deliver it that are 
outside of our control. But I am confident about it when it is 
within our control, and I will just echo what Wes----
    Mr. Wheeler. I might add that it is very useful to have CVS 
and Walgreens signed up as really the primary destinations, at 
least for these first few months. That is very helpful because 
both companies know CVS and Walgreens very well. We have all 
the addresses. We deliver every day for all sorts of things. So 
having that focus is very, very important to the supply chain, 
I believe.
    Senator Baldwin. Thank you.
    Dr. Levine, I would like to ask you about dry ice, 
especially given its essential role in delivering the Pfizer 
vaccine doses. Pfizer has developed plans to secure access to 
dry ice for their initial shipments. But I am wondering about 
the second phase of dry ice demand, when Pfizer's shipping 
containers are replenished with dry ice, at the State and local 
level. I understand that it is State and local health leaders, 
or whoever receives the shipment within the state, who are 
responsible for ensuring their supply at that point.
    This is all happening at a time of heightened demand for 
dry ice around the holidays, and in an industry that operates 
in a just-in-time basis, given the short window to use dry ice 
after it is manufactured. Do State and local leaders who 
anticipate receiving a shipment of Pfizer vaccines have clear 
and robust information about how and where to source dry ice 
that is needed for the replenishment and adequate cooling of 
the supplies they are likely to receive?
    Dr. Levine. So, yes. The Pennsylvania Department of Health, 
working with PEMA--the Pennsylvania Emergency Management 
Agency--would be able to obtain dry ice, if necessary. For the 
first stages, we actually don't anticipate it will be necessary 
because, again, the Pfizer vaccine will be going to hospitals. 
And particularly, that vaccine will be going to hospitals that 
have, themselves, the refrigeration capacity to be able to keep 
it at the ultra-cold storage temperature that is necessary. And 
then, for the long-term care facilities, as was mentioned, it 
is going to distribution centers at CVS and Walgreens, and 
those centers also have the refrigeration capacity to be able 
to keep it at an ultra-cold temperature.
    Now, with future distributions, as it goes more out to 
FQHCs, and et cetera, you know, we are going to be able to 
really try to work that they can be administered, you know, 
right when the box is opened, and we can administer that amount 
of vaccine. I think the Moderna vaccine, which has less 
requirements, will be much easier to distribute, as I 
mentioned, to rural Pennsylvania and other parts of 
Pennsylvania that will not really have access to those 
refrigeration capacities.
    Senator Baldwin. Is there any information that you would 
like to be made available, by the Federal Government or through 
cooperation of the industry, to ensure that local health 
officials have a clear direction on dry ice sourcing protocols 
or alternative sourcing plans, if needed, and pricing? Any sort 
of dashboard that should be required?
    Dr. Levine. Absolutely. I think what we have shown is that 
it is really challenging when the states are almost competing 
with each other for needed resources, and that occurred in the 
spring, particularly for personal protective equipment. Since, 
you know, we know that every state in the country is going to 
need this material for the eventual distribution, as time goes 
by, of the Pfizer product, it would be helpful if the Federal 
Government coordinated that, and we didn't have to bid against 
our sister States.
    Senator Baldwin. Thank you.
    Senator Fischer. Thank you, Senator Baldwin. Senator 
Tester, you are recognized.

                 STATEMENT OF HON. JON TESTER, 
                   U.S. SENATOR FROM MONTANA

    Senator Tester. Well, thank you, Chairman Fischer. I want 
to thank you and the Ranking Member for holding this hearing. 
It is one of the reasons--I don't normally sit on this 
Subcommittee, but it is a critically important area, and I want 
to thank you guys for doing this. And I want to thank all the 
folks who have testified.
    Now, this is for Mr. Smith and Mr. Wheeler. We have got 
about 10,000 doses coming into Montana in this first round. 
They are all going to be allocated to hospitals that are in the 
seven major cities in Montana. I hope there is going to be no 
problem there, and I don't think there will be a problem. It 
sounds like you guys have planned for that. They have access to 
things that a lot of the rural and frontier towns that have 
hospitals in them do not. I think if this vaccine is going to 
be distributed throughout the country, and I think Chairman 
Fischer knows this as well as anybody, the rural areas are 
really going to, I think, pose some issues.
    And so, the first question I had, for either or both of you 
is, and I know it depends on location, but how long to the 
furthest location out there, do you think it will take to get 
from the distribution center, where you pick the vaccine up, to 
its final location, assuming that it is more than just those 
seven major cities in Montana--assuming it is a town like 
Chester, Montana; or Harlowton, Montana, that have much smaller 
populations, that are a ways away from these more populated 
areas in the State of Montana?
    Mr. Smith. I have to take this one because I can't resist. 
In the United States, as our old tagline used to say, 
absolutely, positively, overnight.
    Senator Tester. OK, good. Mr. Wheeler?
    Mr. Wheeler. We are planning on a next day, 10:30 a.m. 
arrival anywhere in the--anywhere that we are assigned. So, of 
course, FedEx and UPS have split the country into two. We know 
exactly what states we have, and they know what states they 
have. We are guaranteeing overnight, from the time that it 
leaves the Pfizer location or the McKesson location until it 
arrives the next morning at 10:30.
    And of course, remember that the dry ice packaging with 
Pfizer is a 10-day package. So it is good for 10 days, and then 
they will have additional 40 pounds of dry ice to replenish, 
which gives you more life.
    Senator Tester. No, I think that is good. I think the key 
is to get the vaccine into the bodies of the people who need 
it.
    Has Pfizer or Moderna or anybody--CDC or anybody--told you 
guys what the protocol is going to be to let you know when you 
are going to pick it up so that the hospital knows? I mean, you 
guys are going to deliver it overnight or within--by 10:30 the 
next day. That hospital has to be ready for it. They have to 
let their patients know it is available and probably 
individually call the patients who are most susceptible.
    What is going to--have they told you what the protocol is 
going to be to letting people know that, you know, this vaccine 
is coming to X town in Montana?
    Mr. Wheeler. Not really, but we have some--we have an idea 
how they want to do this. Pfizer has very, very specific 
protocol for how the package is handled, how many times a day 
it can be opened, how many vials can be withdrawn.
    I think the best answer to the question is the states and 
the jurisdictions and all the dosing centers have to have their 
patients lined up, lined up so they don't waste any vials. Once 
you take the vials out of the box and they thaw, you can't 
refreeze them.
    Senator Tester. Got you.
    Mr. Smith. Yes. I will just echo my colleague here that, 
you know, they have those processes they are working on. When 
it is tendered to us, we are told to transport it to the 
administrationsite overnight, and as Wes pointed out, we also 
deliver it by 10:30. We have the same commit time for our 
priority overnight shipments to business locations by 10:30. 
Like good competitors, we keep each other--one another on our 
toes, and we have the same commitment.
    Senator Tester. We like competition. So this isn't on you 
guys, but I certainly hope somebody out there. We are going to 
distribute these vaccines in the winter. I mean, truthfully, 
some will be done in the spring, too, but primarily in the 
winter. And you guys know, because you deal with this stuff, if 
they are going to get a hold of the patients, get them there so 
we don't waste the vaccine, it is going to take some planning. 
And I hope somebody is listening to this hearing that has some 
stroke in that because, quite frankly, you get a blizzard that 
blows through, and it is going to screw stuff up. And so, it is 
important.
    Mr. Smith, I want to touch base with you, and this is a 
question that Senator Thune asked, and it didn't go to Wheeler. 
But very, very quickly, he talked about Delta and American and 
the airlines--the commercial airlines, potentially carrying 
this, and his question was how are you going to work with them? 
And you said, ``We got the capacity. Don't worry about it.''
    Well, let us say that whoever is the king maker out there 
says, ``Well, you know what? I don't care if UPS or FedEx has 
the capacity, we are using Delta,'' for whatever reason it 
might be. Do you guys have that relationship to be able to work 
with those commercial airlines, in case it isn't on your ship?
    Mr. Smith. Sure. We work with them in the international 
environment, both our companies do, with what the industry 
calls freight forwarding, where we will use passenger 
underbelly lift to move deferred air cargo point to point, 
airport to airport, as we say. But in the United States, we 
have plenty of capacity, as I pointed out, that decision to use 
a commercial airline I don't think would make a lot of sense 
because they don't have the infrastructure to connect all those 
origin-destination pairs that I talked about, right, the 1.7 
billion zip code combinations we connect. Because it is not 
just about moving it from airport to airport. You have got to 
move it from the ramp at the airport to the station and then 
get it out into the field. So they don't have the 
infrastructure ability to do that----
    Senator Tester. I got it.
    Mr. Smith.--and connect the country on such a widespread 
basis. So I don't think that would happen in the U.S., but we 
would certainly work with them if they were brought in.
    Senator Tester. OK, that is fine. That is good. Thank you 
very much.
    And once again, Madam Chair and Ranking Member Duckworth, I 
just want to thank you guys for doing this hearing. I 
appreciate all the witnesses. Thank you.
    Senator Fischer. Thank you, Senator Tester. While we are 
waiting for a couple more Senators to come, I am going to ask a 
couple more questions here, please.
    Dr. Levine, you noted in your testimony that during mock 
vaccine shipments, a quarter of the states experienced a lag in 
receiving the ancillary supply kits. Could you elaborate on 
what the challenge was, and have you noticed any corrective 
action that is being taken to address it?
    Dr. Levine. Well, as you have stated, through ASTHO, you 
know, we keep in touch with all of the State health officials, 
and there was a dry run. In Pennsylvania, we did receive the 
mock shipment and the mock kitting that was discussed that will 
be shipped separately for the Pfizer product. But in 
significant number of states, they did not all come at the same 
time. So, as was mentioned, you are going to have three 
different components--the vaccine itself, the diluent, and the 
kitting--and it all needs to arrive at the exact same place at 
the right time so that the vaccine can be administered.
    Now we don't transport that. I mean, that is being 
transported, you know, through our partners here, the other 
testifiers, as well as, you know, under the jurisdiction of 
Operation Warp Speed. And so, when the ball comes to us, and 
all of it is present, and then our supervision comes in and we 
work with the hospitals and then with the pharmaceutical 
partners to administer the vaccine.
    So all of that was relayed to Operation Warp Speed about 
the challenges that some of the states had. And so, hopefully, 
those difficulties will be ironed out, and everything will 
arrive at the correct time next week, when the Pfizer product, 
hopefully, will ship.
    Senator Fischer. Thank you. And Mr. Smith or Mr. Wheeler, 
is FedEx or UPS planning to be involved in the shipping of the 
ancillary supply kits? And how are you ensuring those shipments 
are timed to arrive with the vaccines doses that are arriving?
    Mr. Wheeler. I was going to mention that this week when we 
presented to the vaccine task force, McKesson basically said 
that they have built 150 million test kits already. So they 
have stockpiled the ancillary supplies. Moderna and Pfizer are 
both being built now. So they are ready to go. That has the 
syringe, the diluent, the PPE, the instructions to the dosing 
sites, the mixing vials as well.
    All that is ready to go. UPS will be supplying 100 percent 
of all the kits to the country. FedEx and UPS will then follow 
with the vaccine shipments, and then we will follow all 100 
percent of the sites with dry ice.
    Senator Fischer. OK, thank you.
    Mr. Smith. So, in some respects, just to point out how 
profound this is, you have two fierce rivals here and 
competitors in FedEx and UPS, who literally are teaming up to 
get this delivered. And in some cases, that relationship is 
interdependent, with them shipping the kitting and us shipping 
the vaccine to certain states. So we are relying on one 
another. It is almost like, and I hope Senator Wicker is still 
watching, but it is almost like two rival college football 
teams--say, Ole Miss, Hotty Toddy, and Mississippi State--
coming together on the same NFL team to play as teammates.
    Senator Fischer. OK, thank you. Senator Blumenthal, you are 
recognized.

             STATEMENT OF HON. RICHARD BLUMENTHAL, 
                 U.S. SENATOR FROM CONNECTICUT

    Senator Blumenthal. Thanks, Mr. Chairman, and thank you 
both for being here. Thanks for your cooperation. I don't know 
whether football is a perfect analogy, but on this issue, I am 
glad you are on the same team and that you are working together 
because the American people really need that kind of 
cooperation.
    And we are on the cusp of historic approval of the Pfizer 
vaccine, hopefully next week the Moderna vaccine, and as you 
know, there are challenges in shipping it. I am proud to say 
that a number of efforts by manufacturers are innovating in 
this area on cold storage and transport.
    In fact, I attended a virtual demonstration of the Bozrah-
based Gilman Brothers vaccine transport system, demonstrating 
their capability for vaccine transportation. And I think that 
kind of innovation and invention can help in the massive--and I 
emphasize massive--challenge of distribution. People expect 
that it will arrive at their local CVS tomorrow because that is 
the way American enterprise works, but I recognize you have 
great challenges ahead.
    I want to emphasize one particular aspect of this 
challenge, which actually arose yesterday in a hearing of the 
Veterans' Affairs Committee. The head of the Veterans Affairs 
health system indicated that they are facing obstacles and 
challenges to deliver the vaccine to their health facilities. 
That is veterans health facilities. Could you address what 
specific steps you are taking to provide this vaccine to our 
veterans, which is so important?
    They are in the age group that is most vulnerable. Many of 
them are veterans of wars of decades ago, and they need this 
vaccine, and they need it right away. They are going to get it, 
hopefully, through their veterans facilities, like the West 
Haven facility in Connecticut, which, right now, is apparently 
not on the list to receive it because of these logistical 
obstacles. So maybe you can address that aspect of the issue.
    Mr. Smith. I am not aware of any logistical obstacles that 
prevent us from delivering to the veterans. We were founded by 
a proud veteran of the Marine Corps, Vietnam veteran, who did 
two tours of duty in Vietnam. So we live to serve our veterans. 
We employ a lot of veterans.
    We don't have any control over where the vaccine goes. We 
are told where to deliver it. We are simply the transportation 
provider here. So I am not aware of any logistics challenges 
that would prevent us from delivering to the VA hospitals or to 
getting it to our veterans. Certainly willing to look into 
that, anything you have heard on the logistics side, because I 
have not heard that.
    Mr. Wheeler. Senator Blumenthal, I think Connecticut is 
assigned to UPS, so we will be delivering to Connecticut. We 
don't have the addresses yet. I was on the phone with General 
Perna yesterday, and we are waiting for the addresses any day 
now. We have sent the kits out. So the kits have gone. They are 
arriving this morning. We will look at the addresses and make 
sure we get them.
    Senator Blumenthal. I am so glad to hear that because I 
think our veterans will expect it, and I would like to work 
with both of you, have my staff perhaps contact you and work 
with the VA to make sure that there are no difficulties. I am 
not attributing any of those obstacles to you, I should 
emphasize, but I just want to make sure that we focus on 
getting the job done.
    As you know, onsite cold storage is as critical to vaccine 
efficacy and effectiveness as storage during transportation. 
What challenges do you anticipate providers may face after 
receiving those vaccine shipments?
    Mr. Wheeler. Yes, we have talked a lot about--I mean, 
Moderna and Pfizer are a little bit different. So, Moderna is 
at -20, typical freezer temperature. So, in terms of storage at 
the sites, there is probably more of that available at most of 
these sites.
    Pfizer, recognizing that, has built this amazing package 
that can keep that -70 for 10 days, and we are providing 
additional dry ice to keep it longer. And beyond that, we have 
offered to many sites--in fact, we already have 100 orders of 
portable freezers that you plug into your outlet, at -70 
degrees, and it maintains temperature forever. So we have 
offered that as well.
    Senator Blumenthal. Thank you.
    Mr. Smith. We have talked to some of the big pharmacies 
like Walgreens, who is our customer, and they are acquiring 
some of these freezer units as well to stage the product and 
keep it ultra-cold after delivery.
    Senator Blumenthal. Thank you. Thank you both.
    My time has expired, but this topic is top of mind, I 
think, for all of us, and your being here today, along with Dr. 
Levine of Pennsylvania is very welcome, and I am sure we will 
be hearing from you again. Thanks so much.
    Senator Fischer. Thank you, Senator Blumenthal.
    As we wait for the Ranking Member, Senator Cantwell, to 
come ask questions, I have a couple more questions that I would 
like to ask.
    Dr. Levine, the CDC, and Operation Warp Speed planning 
documents, indicate that the jurisdictions will be responsible 
for any redistribution of vaccines after the doses are shipped 
to the identified provider. Do you anticipate jurisdictions 
redistributing many vaccine doses after those have been 
received by the providers, and if so, can you outline what 
those redistribution procedures may look like?
    Dr. Levine. Well, so as the Moderna product is going out--
particularly because it doesn't require the ultra-cold chain--
to hospitals, we will distribute some of those, for instance, 
to federally Qualified Health Centers because we want to think 
of healthcare providers extremely broadly. It is not just 
hospital providers. It really has to be anybody that is on the 
front lines, seeing patients with COVID-19, for instance, 
including EMS providers. So we do anticipate some 
redistribution, particularly of the Moderna, to accomplish 
that.
    Senator Fischer. Thank you. And for the entire panel, given 
the magnitude of transporting so many vaccine doses, I 
anticipate flexibility among all stakeholders is going to be 
extremely important. How are each of you planning to 
incorporate changes into your logistics or planning as the 
vaccination effort progresses?
    Dr. Levine, would you like to start, please?
    Dr. Levine. Sure. So, you know, all of the vaccine plans 
that we have, really, I consider drafts for our state and for 
all of the states because there are many different factors that 
are going to come up as this mission proceeds. For example, we 
don't yet know what recommendations the FDA might state about 
the Pfizer and then the Moderna product, which would change our 
vaccine plans, as well as when it goes to the Advisory 
Committee on Immunization Practice from the CDC, which might 
have some specific recommendations about administration, which 
would then change our plans. That would be true of the Moderna 
product as well.
    Of course, as the time is going and we are immunizing 
according to the three phases of the CDC, things are going to 
change in terms of the spread of the virus and which groups 
might be most impacted. And so, I think that it will be very 
important for the States, territories, and cities involved to 
be very nimble and flexible with their plans going forward, 
just to make sure that we are able to immunize the members of 
the public, as is necessary.
    Senator Fischer. Thank you. Mr. Smith?
    Mr. Smith. Sure. There is an old saying I am very fond of. 
Men make plans--or men and women make plans, and the gods 
laugh. We deal with the unforeseen every day--weather, traffic, 
you name it. For international shipments, regulatory holds, 
customs delays, and that sort or thing. So our plans have to be 
flexible every single day. And it is customer specific, often.
    I mentioned a new product introduction, like a new iPhone 
or a new medicine that is being brought to market. I mean, 
those things require tremendous planning, and sometimes the 
forecasting is wrong, so you have to adjust. So we do this 
every day, adjust to changes on the battlefield, as we say. And 
we are well versed in it, and we don't expect anything that we 
won't be able to handle in that regard.
    Mr. Wheeler. The beauty of our network is that all of these 
vaccine shipments are going from--for the first couple of 
months anyway until we get the next vaccine approved, will come 
from three locations into our Louisville Worldport facility. 
Every day, we have 400 flights landing and 400 flights taking 
off to reach destinations around the country the next morning.
    Every time a vaccine shipment is sourced, it comes with the 
tag, the tag gives it priority, and as soon as we have a change 
in addresses or change in priority or change in volume, we can 
immediately pivot to make sure that those vaccines arrive the 
next day at whatever location is required. We are taking 
direction from General Perna and his team, and we are very 
flexible, both companies.
    Mr. Smith. Yes, I should add that both of these networks 
have tremendous redundancy built into them. So we have our 
Express super hub in Memphis, Tennessee. We have our other 
major inland sort location in Indianapolis. We also have hubs 
in Newark, Greensboro, Miami, Dallas-Fort Worth, Oakland, and 
Anchorage, Alaska, just in the United States alone. So we have 
redundancy in the event of weather events or other unforeseen 
things.
    Senator Fischer. OK. And I would like to go back to follow 
up a little bit on Senator Peters' question about the IBM 
report on the cyber attacks. IBM specifically identified 
phishing e-mail attacks in its report. What also are you doing 
to ensure employees have the appropriate cybersecurity training 
to ward off these attacks?
    Mr. Smith. Yes, we battle those every day. As I mentioned, 
our Infosec, information security department, is extremely 
good. We can certainly follow up with more information about 
all of the things they are doing, in cooperation with Federal 
agencies and internally, to battle this.
    We have regular training and communications that go out to 
employees. We mark any e-mail that doesn't come from within the 
FedEx system behind the firewalls as external, so they know 
that it is an external e-mail. We tell them not to open links, 
not to open the e-mail. We constantly train them and refresh 
that training. So we do a number of things to harden our 
systems, but also to educate our employees about what to look 
out for.
    Senator Fischer. I imagine you both face hundreds of 
thousands of attacks every single day. In this public setting, 
can you give us any information on if you have been 
specifically targeted by any type of cyber attack, and if it 
was to your administration, or was it to an employee? Can you 
tell us any of that in this setting?
    Mr. Wheeler. We are not in a position to say that today, 
but we have attacks every day, and we have information security 
and cybersecurity. We work with CISA on best practices. 
Whatever comes up in the industry that is new, that is better 
than we have, we adopt those things. But we have incredibly 
tight e-mail systems and systems around the country. And as I 
said earlier, Pfizer and McKesson, the data flows between 
Pfizer and McKesson and UPS and Operation Warp Speed are well 
established and have been for quite some time.
    Senator Fischer. OK. Thank you very much. Senator Cantwell.

               STATEMENT OF HON. MARIA CANTWELL, 
                  U.S. SENATOR FROM WASHINGTON

    Senator Cantwell. Thank you, Madam Chair, and thank you and 
Senator Duckworth for holding this important hearing. I have 
had to be in and out because Small Business is also talking 
about PPP, so we are really trying to pay attention to what we 
need to help people dealing with this unbelievable COVID 
pandemic that is increasing in impact right now at a very 
critical moment.
    So I wanted to ask a question about what we are doing to 
help states and municipalities on the delivery system. I have 
heard from my mayors in my state. I have heard from my state's 
health officials. This is a very intense operation on the 
ground, and they are going to need help and resources in the 
delivery system.
    And I want to make sure that we are thinking about how to 
give equitable access. I heard some of the discussion about 
nursing homes and I definitely agree about that distribution, 
but I want to make sure that we are getting equitable 
distribution to very challenged and hard to serve communities. 
We, in the State of Washington, have 29 tribes and a big 
geographic area and delivering to Native Americans, and I am 
sure I could give other examples of hard to serve communities.
    And then I just want, one more time, to ask the question 
that Senator Capito was trying to get at. With major layoffs in 
the aviation sector, are we sure that there is nothing we need 
to do there, to make sure that both pilots and equipment are 
ready on the rotation side? When you lay people off they 
obviously have to then requalify. And when you have equipment 
that has been out of service, it needs to be--I don't know what 
the right word is--reevaluated and put back into service in a 
new way.
    So I just want--if you can answer those questions or 
address those issues which are, what do we need to do to help 
State and local governments on the distribution side? What do 
we need to make sure to do to be equitable for minority 
communities? And are you sure we have this figured out on the 
workforce and equipment side?
    Mr. Smith. Let me answer those in reverse order. We are 
very confident, and I believe that Wes would say the same, that 
we have the assets, we have the crews, we have the 
infrastructure to support this mission. We have----
    Senator Cantwell. And is that--just if I could, because 
nobody in the rest of the larger aviation sector will be called 
on or will there be some transport over our general carriers? 
Because they are in the carrier business, too. So, is there 
nothing that they are going to be impacted on?
    Mr. Smith. We don't believe, at this point in time, in the 
United States, to deliver this we are going to need to rely on 
the passenger airline sector at all. Again, they could fly it 
airport to airport. We have plenty of capacity for that, plenty 
of well-trained, excellent pilots and crew members who fly our 
missions every day. I know UPS is the same. We have plenty of 
capacity in the United States.
    But also, the ability with these networks we operate, there 
are only two companies in the United States of America that 
have the networks to connect all those O&D pairs that I talked 
about on an overnight basis, and they are both represented at 
this table. So the reason we are both here and we are both 
doing this is because we are the only ones that can. So that is 
the answer to the last question.
    On the second, in terms of equitable distribution, we have 
no say in how this is being distributed. We are simply the 
transportation arm, and our job is to get it from point A to 
point B, rapidly and reliably, safely and securely. That is 
just not a decision that we make. We are told where to take the 
vaccines on a daily basis, and that is what we do.
    And then getting it out to rural areas, as I mentioned, we 
service every zip code in the United States of America. So does 
UPS. And we do that every day, on an overnight basis, by 10:30 
the next day.
    Mr. Wheeler. A lot of what he said, but just to add to 
that. The beauty of our network is that it works only as a 
network. So we are planning 100 percent with the UPS aircraft, 
UPS package cars, and drivers and trucks. But we also have a 
very extensive courier network. So if we get into trouble 
anywhere and we have to get a vaccine overnight on a commercial 
aircraft, we have relationships with all of them, and charter 
aircraft. And we are actually working with a lot of the 
manufacturers to move active ingredient and bulk product into 
the United States from overseas on charter aircraft. So we have 
that ability.
    To go back to the question about helping states. We got 
pretty good at this with test kits. So when we started testing 
and moving laboratory samples from patients to lab companies, 
we got very, very familiar with the State governments, the 
State jurisdictions, and the health authorities there. And we 
were helping a lot of the states to do that, and we still are, 
and that allows us to give you help wherever you need it.
    Senator Cantwell. Yes, Madam Chair, thank you again. It is 
so great that you had this hearing, but we need to figure out 
whether it is us or someone else that has to have the rest of 
this conversation. It reminds me a lot of what happened with 
the hurricanes in Puerto Rico, where there was a lot of 
undistributed cargo on the docks.
    And I know you have equipment that can get you into 
communities, but we still have this big question of who are you 
delivering the vaccine to, and what do they have set up? And we 
see the complexity on TV, of what it takes to actually 
administer the vaccine. So the question is, who is going to do 
that?
    And my sense is that states, cities, and public health 
districts need resources, and we need to make sure they have 
them. Otherwise, you are going to do a really great job, and we 
are still going to have a roadblock.
    So, thank you so much. This is helpful.
    Mr. Smith. I will just add, I am very familiar with the 
situation in Puerto Rico because we flew a ton of that cargo 
into Puerto Rico. A lot of the issue there on the ground was 
the infrastructure being wiped out, so----
    Senator Cantwell. Well, we--you have to have the 
infrastructure to deliver the vaccine. So, anyway, we will get 
to this question, but again, thank you, Madam Chair, and thank 
you for working around the clock to help us on this pandemic.
    Senator Fischer. Thank you, Senator Cantwell.
    At this time, I ask consent to enter several letters into 
the record--a statement from McKesson, regarding their role in 
the vaccine distribution process; a letter from the 
Transportation Intermediaries Association regarding third-party 
logistics providers' role in the distribution process; letters 
from transportation industry and labor associations regarding 
vaccine prioritization; and a letter from the transportation 
safety associations regarding the safe transportation of 
vaccines.
    Without objection, so ordered.
    [The information referred to follows:]

    
    
Testimony of Shawn Seamans, President, RxCrossroads; Executive Sponsor 
         Enterprise COVID Vaccine Program, McKesson Corporation
    Chairman Fischer, Ranking Member Duckworth and Members of the 
Subcommittee on Transportation and Safety. On behalf of the 80,000 
employees of McKesson Corporation, I am pleased to share with the 
Committee our effort to distribute COVID-19 vaccines and supply kits to 
the American People. In a highly integrated plan with government and 
private sector partners, we are proud to play an important role in 
helping to address the needs of the healthcare community during this 
global health crisis.
Our mission
    For over 185 years, McKesson has led the industry in the delivery 
of medicines and healthcare products. As one of the world's largest and 
oldest healthcare companies, we are at the forefront of supply chain 
innovation; delivering vital medicines and supplies that touch the 
lives of over 100 million patients in healthcare settings.
    McKesson is a mission driven company, focused on our vision to 
improve healthcare in every setting--one product, one partner, one 
patient at a time. We believe the patient comes first.
Vaccine Distribution
    Our leadership and experience in managing complex logistics extends 
to vaccine solutions and cold chain handling. McKesson is the largest 
seasonal flu vaccine distributor, delivering millions of doses annually 
to all settings of care including public health clinics, hospitals, 
physician offices, nursing homes and other long-term care facilities. 
We also deliver many millions of other refrigerated non-flu vaccines 
every year.
    For the last 13 years, McKesson has been the central distributor 
for the Centers for Disease Control (the ``CDC'') Vaccines for Children 
program. The Vaccines for Children program, including the CDC's Vaccine 
Tracking System (``VTrckS''), is also the backbone to the distribution 
of COVID-19 vaccines. Each year we work at the direction of the CDC to 
distribute 75 million doses of over 60 different vaccines to 44,000 
locations across the U.S. In addition, we delivered millions of vaccine 
doses, meeting critical logistical needs, during the 2009 H1N1 
outbreak. As the CDC's central distributor, we delivered 127 million 
H1N1 vaccines to 90,000 locations. At the time, this was the Federal 
government's largest public health initiative. As you can see, McKesson 
has deep experience and a track record of successfully moving vaccines 
and medical supplies at scale.
COVID-19 Response
    McKesson has been steadfast in our support of Federal and state 
response efforts to the COVID-19 public health crisis. We have played a 
critical role supporting the U.S. Department of Health and Human 
Services and the Federal Emergency Management Agency in their sourcing 
and distribution efforts, contributing our advanced understanding of 
the supply chain.
    As a participant in Project Airbridge, we coordinated closely with 
Federal and state agencies to move products to the front lines. Our 
Health Mart pharmacies have leveraged their significant footprint in 
rural and medically underserved communities to expand the reach of 
community based COVID testing to patients nationwide. These pharmacy 
locations are prepared to join the many other administration sites 
being marshaled to deliver hundreds of millions of COVID vaccine doses 
to patients.
    Our commitment to the COVID-19 response extends to Operation Warp 
Speed. McKesson is the CDC's central distributor of COVID-19 vaccines 
(except Pfizer) and ancillary supply kits for all vaccines, including 
Pfizer. Now that two COVID-19 vaccines are near Emergency Use 
Authorization by the Food and Drug Administration, we are prepared to 
meet this moment for our Nation. Our best-in-class practices make 
McKesson well-positioned to assist the government in getting the right 
vaccines and supplies needed for administration to the right place at 
the right time.
    I would like to discuss in greater detail the operational steps 
McKesson is tasked with in furtherance of the largest mass vaccination 
initiative in the history of the United States. Our program is designed 
to ease the burden on the states by allowing them to focus on 
administration itself.
    McKesson is today operating dedicated distribution centers for both 
the vaccines and ancillary supply kits in close proximity to hub 
operations of FedEx and UPS in Memphis, Tennessee and Louisville, 
Kentucky.
    Safety, security, and accuracy are our highest priorities at every 
step of the process.
    McKesson will distribute the Moderna vaccine--and other future 
vaccines that would require refrigeration or frozen storage, as well as 
any that can be maintained at ambient temperatures. Pfizer has 
maintained responsibility for distributing its vaccine, directly 
through FedEx and UPS, which requires ultra-frozen storage and 
distribution. We, however, will distribute supply kits that are needed 
to administer all vaccines, including Pfizer's vaccine.
    We have a superior cold chain process to maintain the right 
temperature throughout the transportation process. McKesson will accept 
Moderna's vaccine at its manufacturing site, bring vaccine doses to 
McKesson distribution centers, verify via temperature sensors that 
proper temperature was maintained while in transit, and finally, store 
the vaccine doses in pharmaceutical grade freezers until a fulfillment 
order is placed by the Federal Government.
    The Federal government--in coordination with state governments--
will determine where, when, and how many doses McKesson will 
distribute. Once an order is received, McKesson will package the 
vaccines into a specially designed shipping container with cold packs 
that are designed to maintain the product within the manufacturer's 
required temperature range during transit from our distribution center 
to the administration site. Each package will include a temperature 
monitor so the administration site can confirm upon receipt of shipment 
that vaccines remained within the appropriate temperature range. Our 
carrier partners, FedEx and UPS, will retrieve the vaccine shipments 
from our distribution centers and deliver them to administration sites, 
typically within 24 hours. Those carriers will use their highest 
priority shipping method and will embed Bluetooth technology to track 
each package.
    McKesson has already pre-assembled ancillary supply kits (including 
syringes, needles, alcohol wipes and face shields) to support 
administration of more than 150 million doses. Supply kits for Pfizer's 
vaccine also include diluent to reconstitute the vaccine to its proper 
dosage. The ancillary supply kits are also shipped by FedEx or UPS and 
are intended to arrive prior to or at the same time as the vaccine 
shipments.
    Safety for our employees is equally important. McKesson takes very 
seriously compliance with Federal and state public health COVID 
guidelines and protocols. We are proud of the thousands of associates 
across the United States who are working tirelessly to deliver 
vaccines, supply kits and other critical personal protective equipment 
such as masks, gloves, and gowns during this pandemic.
    While McKesson will be instrumental in the distribution of COVID 
vaccines and supply kits, all decisions regarding allocation and 
prioritization will be made by the Federal government, in consultations 
with the states. State governments will determine how vaccines will be 
received, stored, and where administered. Agreements between government 
agencies and pharmacy chains or independent pharmacy networks allow for 
vaccines to be shipped directly to their site locations. CVS and 
Walgreens, for example, have agreements to administer vaccinations at 
long-term care facilities.
    Centralized distribution for COVID vaccine delivery leverages the 
strength of all stakeholders. This model is important for the current 
pandemic and future pandemic preparedness. McKesson believes that 
public-private partnerships can help ensure that our country deploys an 
integrated set of solutions, informed by experience and careful 
consideration of the ways in which future crises could differ from the 
one at hand. A comprehensive pandemic response plan should include 
material preparedness; supply chain resiliency; data sharing and highly 
integrated communication and coordination. These elements are built 
into the COVID vaccine and kit distribution plan.
    We look forward to working with the Congress and the states, along 
with our private sector partners on maintaining an integrated supply 
chain to support efficient procurement, inventory management, and 
deployment of essential vaccines, medical supplies, therapeutics, and 
medicines.
    Together we will alter the trajectory of this pandemic.
                                 ______
                                 
                                ADDENDUM
               THE CENTRALIZED VACCINE DISTRIBUTION MODEL
   The Federal government utilizes its buying power to procure 
        the vaccines and develops an overarching strategy for 
        administration.

   The state governments leverage their local resources--public 
        health entities and private sector providers--to facilitate 
        administration.

   The Federal Government purchases vaccines and ancillary 
        supplies. Over one and one-half million supply kits, supporting 
        more than 150 million vaccine doses, have been assembled and 
        ready for shipment. Supply kits include syringe, needle, 
        alcohol wipe, and face shield. Supply kits for the Pfizer 
        vaccine will also include diluent to reconstitute the vaccine 
        to its proper dosage.

   Manufacturers ship to the central distributor, where product 
        is inventoried and stored.

   Health and Human Services has ownership of the Pfizer 
        vaccine stock. The Centers for Disease Control has ownership of 
        the Moderna vaccine stock and supply kits. Each Federal entity 
        allocates product to the states (factoring in population size, 
        needs of prioritized groups, as well as other national health 
        imperatives and criteria).

   McKesson, as central distributor, then distributes vaccines 
        and ancillary supplies at the CDC's direction. States can 
        designate a redistribution site or have products shipped 
        directly to end administration sites.

   States are responsible for overseeing vaccines 
        administration and coordinating the local healthcare response.
                                 ______
                                 
                  Transportation Intermediaries Association
                                   Alexandria, VA, December 8, 2020

Hon. Deb Fischer,
Chairwoman,
Subcommittee on Transportation and Safety,
Committee on Commerce, Science, and Transportation,
United States Senate,
Washington, DC.

Hon. Tammy Duckworth,
Ranking Member,
Subcommittee on Transportation and Safety,
Committee on Commerce, Science, and Transportation,
United States Senate,
Washington, DC.

Dear Senator Fischer and Duckworth:

    I am writing on behalf of the almost 1,800 members of the 
Transportation Intermediaries Association (TIA) to voice our 
willingness to be a part of both the discussion and operations for 
delivering a vaccine to all 50 states in a timely manner. Thank you for 
having this important oversight hearing entitled ``The Logistics of 
Transporting a COVID-19 Vaccine.'' As you know, our industry 
facilitates the movement of freight from a shipper to the actual 
carrier of record. The distribution of the COVID-19 vaccine could be 
the largest logistics operations in the country's history and our 
members are eager to be on forefront of this monumental task. Moving 
pharmaceuticals, and vaccines, is among the highest maintenance, time 
sensitive and sophisticated freight that exists. TIA members have 
experience moving these types of goods.
    Transportation intermediaries or third-party logistics 
professionals act somewhat as the ``travel agents'' for freight; 
however, given the wide varieties of freight, specific needs of each 
shipper the diverse issues applicable to anyone load, third-party 
logistics professionals must have expertise far beyond what a 
traditional ``travel agent'' must possess. They serve tens of thousands 
of shippers and carriers, bringing together the transportation needs of 
the cargo interests with the corresponding capacity and special 
equipment offered by rail, motor, air, and ocean carriers.
    I urge Congress and the incoming and outgoing administrations to 
utilize the 3PL industry as a resource both for information and for the 
physical movement of the vaccine. I have heard directly from our 
members who are eager to serve their country. Just like these companies 
did earlier this year during the economic shutdowns, TIA members will 
step up and do what it takes to ensure that this important vaccine is 
distributed safely and efficiently. Thank you again for this important 
oversight hearing.
            Sincerely,
                                               Anne Reinke,
                                                   President & CEO,
                                                                   TIA.
                                 ______
                                 
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                                 ______
                                 

                            Business Insider

                               12/01/2020

    How United Airlines overcame one of the largest limitations to 
            transporting Pfizer's COVID-19 vaccine to the US

                         Author: Thomas Pallini

To read this story on the web, please click:

https://www.businessinsider.com/how-united-airlines-overcame-major-
limitation-to-fly-pfizer-vaccine-2020-11

    Pfizer has tasked United Airlines with transporting the first doses 
of its vaccine to the U.S., the Wall Street Journal reported on Friday, 
in preparation for an expected emergency authorization from the Food 
and Drug Administration scheduled to come in the upcoming weeks.
    A chartered Boeing 777-200 aircraft filled with the pandemic-ending 
drugs first flew on Friday, the Journal reported, traveling from 
Brussels, Belgium to Chicago, a United hub. Unlike the daily United 
passenger flight between the two cities, Pfizer would have likely had 
the entire plane to itself as a dedicated charter.
    United set up a vaccine task force earlier this year for this very 
possibility and had crafted standard operating procedures for each 
vaccine as it wasn't initially clear which one would cross the finish 
line first. In November, it became clear that the two leading 
contenders would be Pfizer and Moderna.But transporting Pfizer's 
vaccine came with a problem: its below-freezing storage temperature 
requirement of -94 degrees Fahrenheit. Drugs with requirements that far 
below-freezing are packed with dry ice to keep them at temperature, 
presenting a problem for airlines tasked with flying them.
    Dry ice is classified as a dangerous good in aviation as it 
sublimates from a solid to gaseous carbon dioxide, which can 
incapacitate the flight crew and passengers. Regulators limit how much 
dry ice can be flown on cargo and passenger planes but given the unique 
circumstances, carriers have request exemptions to these limits in 
order to fly more vaccine doses in the upcoming airlift to transport 
doses around the world.
    The Federal Aviation Administration granted United an exemption to 
the dry ice limitation, according to the Journal, allowing the airline 
to fly more of the drug than it normally would have. As the flight was 
a charter, no other passengers were onboard, and only essential crew 
were looking after the aircraft during the flight.
    ``The FAA is working with manufacturers, air carriers, and airport 
authorities to provide guidance on implementing current regulatory 
requirements for safely transporting large quantities of dry ice in air 
cargo,'' the regulator said in a statement e-mailed to Business 
Insider.
    United is now allowed to fly up to 15,000 pounds of dry ice on the 
Boeing 777-200, according to the Journal, five times the previously 
allowed limit for the wide-body aircraft. The shipping containers 
carrying Pfizer's vaccine have around 23 kilograms, or around 50 
pounds, of dry ice packed inside of them, according to Julian Sutch, 
Emirates SkyCargo's global manager for pharma, in a previous interview 
with Business Insider.
    Although operating cargo-only flights with no passengers, the 
Chicago-based airline still has to comply with regulations for 
passenger airliners such as the Boeing 777-200, according to Chris 
Busch, managing director for United Cargo in the Americas, in a 
previous interview with Business Insider. And even without passengers, 
all freight flown by United flies in the belly cargo hold and not the 
passenger cabin.
    Most, if not all major airlines with pharmaceutical-carrying 
capabilities are gearing up to potentially participate in the life-
saving airlift as more vaccine candidates enter the authorization 
process. But unlike the first mass transport of COVID-19 supplies that 
saw anybody with a plane transport personal protective equipment from 
China, aircraft operators will face hurdles including adequate storage 
and limited onboard space thanks to the dry ice limitations of each 
aircraft.
    Pfizer taking the steps to move around the vaccine before its 
authorization shows the confidence the drug-maker has in the product. 
Chartering a Boeing 777 can quite easily cost tens of thousands of 
dollars per hour and multi-day international trips can easily add up, 
especially as cargo space is now yielding a premium during the 
pandemic.
    Now that it's in the U.S., Pfizer will rely on over-the-road trucks 
for regional transportation to its storage facilities until the Food 
and Drug Administration passes down an approval that will see immediate 
distribution as the U.S. begins the long journey to herd 
immunity.Trucks can better deal with transporting a frozen vaccine as 
they have higher dry ice limitations than aircraft. From Chicago or one 
of Pfizer's storage facilities, the vaccine can be on either coast in a 
matter of days using team-truck driving.
    The Food and Drug Administration is expected to grant Pfizer's 
emergency authorization request as early as December 10, with Moderna 
set to file for emergency authorization on Monday.
                                 ______
                                 
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    Senator Fischer. The hearing record will remain open for 
two weeks. During this time, Senators are asked to submit 
questions for the record. Upon receipt, the witnesses are 
requested to submit their written answers to the Committee as 
soon as possible.
    I would like to thank all of our panel today for a very 
informative hearing that we had. I appreciate the work that you 
and the people you represent do every single day to keep this 
country moving and keep us being able to receive what we need, 
when we need it, so that it is effective.
    So, thank you very, very much. Thank you, Dr. Levine, 
remotely. We appreciate your comments, as well.
    With that, the hearing is adjourned.
    [Whereupon, at 11:12 a.m., the hearing was adjourned.]

                            A P P E N D I X

    Response to Written Questions Submitted by Hon. Dan Sullivan to 
                          Rachel L. Levine, MD
    Background: On average, rural populations are older, poorer, and 
sicker than their urban counterparts. These populations are more 
severely impacted by a coronavirus infection. To make matters worse, 
nationally, 61 percent of rural hospitals do not have an Intensive Care 
Unit (ICU)-and that is when a rural area has a hospital. It is 
imperative that we immunize rural populations according the CDC 
guidelines at the very same time as their urban counterparts. A delay 
will allow COVID-19 to continue to severely overwhelm rural health 
systems, like hospitals, clinics and the emergency medical systems that 
support rural communities.

    Question 1. As Congress continues to discuss what should be 
included in the next COVID relief package, what should we prioritize to 
ensure equitable access to the COVID-19 vaccine to all individuals in 
each population group, regardless of their zip code, rural or urban?
    Answer. Investment into communication campaigns is important. 
Reaching our most vulnerable populations who may speak another 
language, not understand how to access electronic media, or be part of 
the digital divide can be difficult. Additionally, states have 
different populations that speak different languages. Reaching these 
populations through proper language translations and different mediums 
is important to improve messenger services to help combat vaccine 
hesitancy. Additional flexible support for equitable vaccine 
distribution methods and evaluation is also important--mainly state 
logistic resources and data and system collection improvements for 
reaching and understanding vulnerable populations and those in rural 
areas.

    Background: COVID-19 deaths are on the rise in rural America. For 
the fifth straight week, the number of rural deaths due to COVID-19 set 
records. Last week, there were more than 3,000 rural deaths due to the 
virus. Alaska has personal experience with this type of rural tragedy. 
The 1918 pandemic decimated our rural regions, which are largely made 
up of predominantly Alaska Native communities. The fear and historical 
trauma of that pandemic is still felt today. HHS has allocated vaccines 
specifically for tribes, which has been incredibly helpful.

    Question 2. Do you think that states and IHS are equipped to 
distribute vaccines across challenging geographies that ensure 
equitable access to the Covid-19 vaccine for every population, 
including Alaskan Natives and other Native American populations? Are 
there ways to better support our states as they endeavor to take on 
this responsibility and to ensure that high-risk populations do not 
fall through the cracks?
    Answer. HIS has a well laid plan to describe vaccine availability, 
prioritization, distribution and ordering, administration, safety, and 
communications. Although Pennsylvania is not one of the states with 
tribal territories, it has a population of more than 51,000 American 
Indians or Alaskan Americans. Pennsylvania's goals are to prioritize 
persons, while the vaccine supply remains limited, who receive the 
vaccine to maximize benefits and minimize harms caused by the virus, 
promote justice, mitigate health inequities, and promote transparency. 
Pennsylvania has worked throughout the pandemic to address disparities 
within racial and ethnic minority groups.
    Addressing COVID-19 through a health equity lens is just as 
critical for the administration of vaccines. Providing vaccines to 
American Indians or Alaskan Americans is essential to creating a 
healthy Pennsylvania for all. Investment into communication campaigns 
and additional vaccine dosages to increase coverage is important. 
Support to improve trusted messenger services to help combat vaccine 
hesitancy would be of great assistance.
                                 ______
                                 
   Response to Written Questions Submitted by Hon. Maria Cantwell to 
                          Rachel L. Levine, MD
    State Funding. States and local communities have been on the 
frontlines fighting the COVID-19 virus from the beginning of this 
pandemic. Healthcare workers have been battling this virus around the 
clock since it first came to our Nation despite being underfunded and 
undersupplied. Now they are being tasked with the herculean effort of 
distributing and administering a vaccine to millions of people on an 
accelerated timetable. In September, CDC Director Robert Redfield 
testified before Congress and said that states will need $6 billion for 
vaccine distribution. The Association for State and Territorial Health 
Officials puts that number closer to $8.4 billion. Yet so far, less 
than $340 million has been allocated to states to help plan for and 
distribute a vaccine. Facing a national emergency and a vaccine 
campaign of unprecedented proportions, that amount is simply 
unacceptable.

    Question 1. What are the most critical elements for ensuring a 
successful vaccination campaign at the state and local level?
    Answer. Use of multiple partnerships for planning and 
operationalizing. Ability to pivot planning and operational needs to 
adjust to the vaccine availability, phase and timing and the engagement 
of traditional and non-traditional vaccination partners.

    Question 2. What are the public health consequences that will 
result if states and localities do not receive more financial support?
    Answer. It will take longer to get all Pennsylvanians vaccinated 
who want to be. The greater the delay in vaccination of large numbers 
of Pennsylvanians, the longer it will take to achieve herd immunity, 
the longer people will suffer the consequences of the COVID-19 
pandemic, including the disproportionate effects on vulnerable 
communities.

    Strain on the Healthcare System. The U.S. healthcare system is 
under severe strain. Our healthcare workers have been working nonstop 
to treat this virus and to keep people safe. However, there are not an 
unlimited number of healthcare workers, and that number is further 
strained as we deal with a surge in COVID-19 cases. Additionally, with 
mass vaccine distribution underway, those healthcare systems need 
infrastructure and inventory management systems that can ensure extreme 
temperature requirements are maintained for the COVID-19 vaccine.

    Question 3. Are you concerned about the healthcare system's ability 
to handle a mass vaccination campaign while also managing the recent 
surge in COVID-19 cases? If so, what are the most critical pressure 
points in the healthcare system that must be bolstered?
    Answer. Yes. We have been relying on our health system partners to 
vaccinate not only their own staff but also non-affiliated healthcare 
personnel--in addition to managing surging COVID-19 admissions. 
Additional Federal funding would enable us to hire a contractor or 
contractors to conduct mass vaccination clinics that would allow the 
health systems to focus on their primary mission and increase the rate 
of vaccination across the Commonwealth.

    Question 4. How are states addressing the distribution needs of 
rural or remote areas that may not have cold-chain storage to support 
some of the vaccines?
    Answer. We are utilizing the Moderna vaccine which does not have 
the ultra-cold chain requirements of the Pfizer-BioNTech vaccine for 
our hospitals and providers in rural and remote areas. Our Federally 
Qualified Health Centers (FQHCs) and enrolled local pharmacies are key 
partners in this effort. We also anticipate that the Retail Pharmacy 
Partnership (PA has chosen Rite Aid and Topco) will also be important 
and we will be choosing locations in parts of the state with limited 
existing vaccine providers.

    Vaccine Equity. COVID-19 has disproportionately impacted 
communities of color, people living with disabilities, and those living 
in rural and frontier areas. Minority communities have faced higher 
cases rates, hospitalization rates, and death rates than white 
Americans. There are also concerns about distributing the vaccine 
equitably to communities that speak different languages or are 
difficult to reach, especially when supply is limited.

    Question 5. How are states ensuring that the vaccine is distributed 
equitably, and are there any specific shortages of personal protective 
equipment or infrastructure that may impact equitable distribution of 
the vaccine across the country? Where are those shortages likely to 
occur?
    Answer. Public health crises have the potential to affect all 
populations but typically have more severe impacts on underserved 
populations, making those populations more vulnerable to severe illness 
and death. A first step in developing an equitable vaccine distribution 
plan is to understand and identify populations most at risk of 
contracting COVID-19 and severe illness. We have worked across state 
agencies and with external partners to identify vulnerable populations 
for whom receiving the COVID-19 vaccine is especially critical. 
Estimates of the number of these identified vulnerable populations are 
derived from the 2019 U.S. Census, the Behavioral Risk Factor 
Surveillance System (BRFSS), State Health Assessment, and health 
systems patient databases (Medicaid, IBX), and Tiberius. We have also 
developed a vulnerability index to look at social factors, 
demographics, and health risks to identify potential areas that are 
most in need of the vaccine.
    Currently, the vaccine distribution is not affected by lack of PPE. 
However, we are cognizant that the PPE supply chain is still strained, 
and that any disruption in supply (or significant increase in demand) 
is likely to impact the ability to procure PPE necessary for an 
effective vaccination campaign.

    Question 6. What do states and local governments need from the 
Federal Government to ensure equitable vaccine distribution?
    Answer. The Commonwealth's approach for Pennsylvania's COVID-19 
Interim Vaccination Plan utilized a health equity lens to proactively 
mitigate the disparities in the risks associated with COVID-19 with no 
new resources for health equity assessment. We have been relying on our 
limited health equity staff to collect data and assess social risks and 
health statuses associated with severe outcomes from COVID-19. 
Additional Federal funding would enable us to hire a contractor or 
contractors to conduct assessments and lead interventions to addresses 
health disparities associated with COVID-19.

    Question 7. What social and environmental investments are needed to 
address the disproportionate impact on certain communities in the 
future?
    Answer. Interventions to address the digital divide across 
different geographies and socioeconomic statuses; trusted messenger 
strategies and centralized approaches to sharing evidence, mitigation 
standards, and vaccine planning; information technology platform 
readiness, specific to demographic race and ethnicity reporting 
capabilities and exercising mandates to create corporate support for 
the collection of actionable public health data; funding and 
implementation support for vaccine strategies and pharmacy partnership 
programs specific to underserved communities.

    Security. In late 2020 we saw reports that cyber criminals and 
foreign adversaries had attacked companies involved with the storage 
and transport of the vaccine in Europe. Additionally, it has come to 
light that Russia was likely behind one of the largest cyber-attacks 
against the United States. I am concerned that entities critical to the 
distribution of the vaccine may not have the cyber expertise needed to 
deal with these new threats.
    There have also been reports of some individuals intentionally 
sabotaging vaccines once they have been received by healthcare 
facilities by removing them from the appropriate storage containers.

    Question 8. What are the top threats to vaccine viability that 
state and local healthcare facilities and providers must deal with, and 
what is needed from the Federal government to bolster state and local 
responses to those threats?
    Answer. Anecdotally, we have heard that the largest challenge to 
vaccine viability at the facility level is ``vaccine shopping'' by 
eligible individuals, who may make appointments with or seek vaccine 
from multiple providers; this leaves a vaccine provider with 
reconstituted vaccine but without a patient to vaccinate. We have not 
heard of any credible external threats, such as tampering or theft, 
from any partners.

    Question 9. Are you aware of any impacts the recent SolarWind 
cyber-attack or other cyber security threats have had on the Nation's 
healthcare infrastructure or the COVID vaccine supply chain?
    Answer. We are not aware of any impacts.

    COVID Vaccine Distribution Delays. It has been reported that states 
are seeing a reduction in the number of vaccines allocated to them 
through the end of the year. On December 17, 2020, Pfizer released a 
statement stating that they have had no production issues and that 
millions of vaccines are waiting in storage waiting on shipping 
instructions from the Federal government.

    Question 10. Has the Federal government provided states with an 
explanation for the reduction in vaccine allocation?
    Answer. We have been advised to use the numbers initially given for 
planning purposes only. We have also been advised that it would take 
several weeks to establish a cadence for the amount of vaccine 
allocations.

    Question 11. Are you aware of, or have you experienced delays in 
vaccine delivery?
    Answer. Delays have been due to incorrect addresses in the vaccine 
tracking system which prevents delivery of vaccine until the address is 
confirmed.
                                 ______
                                 
  Response to Written Questions Submitted by Hon. Tammy Duckworth to 
                          Rachel L. Levine, MD
    Temperature Requirements. Preserving cold chain and temperature 
requirements for bulk distribution.

    Question 1. In review of the COVID-19 Distribution Plan established 
by Operation Warp Speed, it is clear that steps have been taken to 
preserve the cold chain and temperature requirements for the bulk 
distribution of the vaccines to each State under the supervision of 
state health departments. This addresses some key risks during these 
early steps of the cold-chain process. However, it is still important 
to promote public confidence that the vaccine is effective when 
administered to the patient.
    What percentage of COVID-19 vaccines do you estimate will be lost 
in transit, due to temperature, or other issues? What precautions are 
you taking to minimize this?
    Answer. The vaccine is delivered either directly to the site from 
the manufacturer or to the site through the distributor. The state is 
not involved in this transport.

    Question 2. What measures is your state taking to mitigate the 
risks during the ``Last Mile'' administration of the vaccine?
    Answer. The Commonwealth is not directly involved with the last 
mile; we have provided storage and handling training to providers 
receiving the vaccine.

    Question 3. As containers, pallets and boxes of vaccine are broken 
down to be distributed throughout each state, will temperature 
technology on the individual vials of vaccine be utilized and requested 
by the state health departments to ensure the vaccine vials remain at 
the required temperature range and are safe and effective for the 
patient receiving these doses?
    Answer. The Commonwealth is not redistributing the vaccine. The 
Pfizer-BioNTech vaccine does arrive with a tracker for temperature 
monitoring due to the ultracold requirements. There are no additional 
requirements by the state outside the routine temperature monitoring by 
each site.
                                 ______
                                 
    Response to Written Questions Submitted by Hon. Gary Peters to 
                          Rachel L. Levine, MD
    FEMA and Healthcare Distribution. As Ranking Member of the Senate 
Homeland Security and Governmental Affairs Committee, I have been 
conducting oversight of FEMA's role in the Federal COVID-19 response. 
FEMA played a large part in the distribution of personal protective 
equipment (PPE) throughout this pandemic and we unfortunately continue 
to hear reports of shortages.

    Question 1. From your perspective as Secretary of Health for 
Pennsylvania as well as President of ASTHO, how has the PPE 
distribution process with FEMA gone, and what can be learned from that 
experience as the Federal government executes a similar distribution 
effort of vaccines and ancillary supplies?
    Answer. FEMA and other Federal partners (such as HHS) have provided 
significant quantities of PPE to the commonwealth over the last 11 
months. One of the largest challenges to the order and receipt of 
Federal assets throughout has been the change in process and 
eligibility requirements--to date, we have had at least 2 request 
process changes (between HHS and FEMA) and one major revision to 
eligibility. These changes, especially at the incipient phase of the 
response created challenges to the timely procurement of PPE through 
Federal partners. However, recently, we have not had any challenges in 
procuring PPE.

    Question 2. Is a lack of PPE in your state affecting vaccine 
distribution plans?
    Answer. Currently, the vaccine distribution is not affected by lack 
of PPE. However, we are cognizant that the PPE supply chain is still 
strained, and that any disruption in supply (or significant increase in 
demand) is likely to impact the ability to procure PPE necessary for an 
effective vaccination campaign.
    All parties involved in the distribution of COVID-19 vaccines must 
be closely coordinated to ensure successful and safe vaccine delivery. 
I am concerned by recent reports of miscommunication regarding vaccine 
allocations to states. States must receive accurate, timely information 
about vaccine deliveries from the Federal government, so they can plan 
accordingly.

    Question 3. Has your state received clear communication from the 
Administration on vaccine allocations, including visibility into the 
number of COVID-19 vaccines you expect to receive and when you expect 
to receive them?
    Answer. The vaccine allocations are uploaded weekly. Vaccines are 
tracked through the vaccine tracking system. There are daily reports 
sent to states as to the delivery of vaccines.

    Question 4. What can be improved in the communication between 
states and the Federal government regarding COVID-19 vaccine allocation 
and distribution?
    Answer. Communication between states and the Federal government 
would be improved by the provision of a longer time frame for expected 
allocations rather than weekly.

    Question 5. What are the most pressing unanswered questions that 
states have regarding the vaccine distribution process?
    Answer. When will the allocations increase to meet the demand of 
vaccination needs?

    Question 6. Vaccine distribution efforts will be a costly 
undertaking for the states. Has your state received adequate guidance 
from FEMA on what vaccine distribution costs will be reimbursable under 
this national emergency?
    Answer. Our state emergency management agency has taken the lead 
for Federal reimbursement through the Stafford Act/FEMA process. This 
partnership has ensured that we have the relevant information to seek 
appropriate reimbursement for costs not covered under other HHS Federal 
funding steams.

    Question 7. What further information does your state need to 
understand what costs can be covered by the Federal government, whether 
FEMA or another Federal agency?
    Answer. Both HHS and FEMA have provided adequate guidance and 
continuing consultation on the eligibility of Federal reimbursement of 
costs incurred under this response.
                                 ______
                                 
   Response to Written Question Submitted by Hon. Kyrsten Sinema to 
                          Rachel L. Levine, MD
    Vaccine Security. Vaccine security is an important issue that must 
be addressed as part of the logistics process for vaccine distribution. 
Earlier this month, Interpol issued a global warning alerting its 
members that organized crime networks could attempt to steal doses of 
the vaccine.

    Question. Are there any particular considerations related to 
vaccine security that smaller regional hospitals must consider as they 
receive the vaccine?
    Answer. Since the shipments of vaccine are going directly to the 
providers without the commonwealth as a logistics intermediary, 
security and responsibility for the vaccine is within the purview of 
the receiving site
                                 ______
                                 
    Response to Written Questions Submitted by Hon. Dan Sullivan to 
                            Richard W. Smith
    Background: On average, rural populations are older, poorer, and 
sicker than their urban counterparts. These populations are more 
severely impacted by a coronavirus infection. To make matters worse, 
nationally, 61 percent of rural hospitals do not have an Intensive Care 
Unit (ICU)-and that is when a rural area has a hospital. It is 
imperative that we immunize rural populations according the CDC 
guidelines at the very same time as their urban counterparts. A delay 
will allow COVID-19 to continue to severely overwhelm rural health 
systems, like hospitals, clinics and the emergency medical systems that 
support rural communities.

    Question 1. As Congress continues to discuss what should be 
included in the next COVID relief package, what should we prioritize to 
ensure equitable access to the COVID-19 vaccine to all individuals in 
each population group, regardless of their zip code, rural or urban?
    Answer. Our role in this effort has been focused on providing rapid 
and reliable transportation to the administration sites across the 
Nation using our robust air and ground network. This is a complex task 
and there are only a few companies in the world that can do we what we 
do, connecting an incredible number of origin-destination pairs across 
countries and continents via the vast networks we operate, including 
rural communities across the U.S. FedEx has the ability to service 
every ZIP code in the U.S. As the U.S. moves forward in this effort, it 
is critical that we continue to work closely with our healthcare 
customers, as well as federal, state and local officials, on plans for 
transporting the vaccines as soon as they become available to ensure 
they reach their destination as determined by the Federal and state 
authorities.

    Background: We all know the story of Balto, the lead sled dog who 
helped deliver the diphtheria vaccine to Nome, Alaska in 1925. The 
weather was so cold that planes would not start, but Nome needed that 
vaccine. Over 20 mushers took part in a race to get the vaccine to 
Nome-in a negative 23-degree blizzard. Balto and his team safety 
delivered the vaccine, resulting in many lives saved. The point of this 
story is that Alaska has many barriers that other states do not have. 
We have ultra-rural, sometimes referred to as frontier regions, 
communities off the road system, communities without water, blizzards 
that shut down entire communities. Recently, a 37-year old tragically 
died in a rural community off the road system in Alaska because he was 
unable to get to the nearest hospital, and helicopters and planes were 
unable to get to him because of severe weather. This is a rural 
problem, most acute in Alaska.

    Question 2. The CDC Advisory Committee on Immunization Practices 
appropriately outlined vaccine priorities based on population groups. 
While states are leading the distribution effort, many rural states, 
including Alaska, will have geographic challenges. How will you work 
with states to ensure equitable access for high-risk populations in 
rural areas? For example, will a frontline health care worker in 
Bethel, Alaska get the vaccine at the same time as a health care worker 
in Anchorage?
    Answer. The FedEx network was created for the exact purpose and 
service required for today's mission. FedEx is the world's largest 
express transportation provider, with an unparalleled global network of 
more than 680 aircraft, including a wide range of aircraft types that 
can serve both large metropolitan areas and smaller, rural communities 
alike, and with more than 200,000 vehicles. We have made significant 
investments in our people, infrastructure, and assets that allow us to 
serve every ZIP code in the U.S., including facilities on Tribal lands 
and those in rural communities. For example, we have a hub at Ted 
Stevens International Airport and more than a thousand Alaskan team 
members who understand the unique needs of the communities they serve. 
We have been working closely with Federal and state government 
officials since the start of this effort to ensure that as soon as 
vaccines are available, they are delivered to the destinations as 
determined by the government authorities.
                                 ______
                                 
     Response to Written Question Submitted by Hon. Rick Scott to 
                            Richard W. Smith
    Background: Recently, the U.S. Department of Transportation 
announced that it had taken all regulatory measures to provide 
flexibility for companies to transport the vaccine. The CDC also 
requested that states provide a plan for how they will operationalize 
the vaccine response within their jurisdictions.

    Question. Do you feel the Federal government and states have 
provided clear plans and guidance for vaccine distribution?
    Answer. FedEx has been working closely over the past several months 
with our healthcare customers, as well as federal, state and local 
officials, on plans for transporting the vaccines as soon as they are 
approved and become available to ensure they reach their destination as 
determined by the government authorities. This is a complex task that 
requires close coordination. It is essential that as we move forward in 
this effort, the collaboration with these stakeholders continues.
                                 ______
                                 
   Response to Written Questions Submitted by Hon. Maria Cantwell to 
                            Richard W. Smith
    Cyber Security. In late 2020 we saw reports that cyber criminals 
and foreign adversaries are attacking companies involved with the 
storage and transport of the vaccine in Europe. Additionally, it has 
come to light that Russia was likely behind one of the largest cyber-
attacks against the United States.

    Question 1. What is FedEx doing to ensure the security of the 
vaccines from both virtual and physical threats?
    Answer. In addition to complying with regulatory obligations set 
forth by the Transportation Security Administration, FedEx operates 
under a high level of physical and virtual security awareness at all 
times and has robust policies and procedures designed to protect our 
employees, equipment, packages and customers. In preparation to support 
this effort, we conducted targeted risk analyses and physical security 
audits and enhanced threat monitoring capabilities. As an added 
safeguard, we have developed protocols to enable our team to react 
immediately to any potential vaccine shipment anomalies.
    To combat potential threats from cyber adversaries, FedEx relies on 
multiple layers of security defense mechanisms using the latest 
technologies and network monitoring 24 hours a day, 365 days a year.
    Regarding the physical security of the vaccines, FedEx and our 
customers are using the latest technology to monitor the shipments in 
real-time. This includes the use of FedEx-patented technology, 
SenseAware ID device, that can precisely track a package's location. 
FedEx Priority Alert teams have been engaged from the beginning, 
monitoring, tracking and tracing these shipments from the moment they 
enter our network until they are delivered to our customers, leveraging 
our FedEx Surround platform, that uses predictive analytics to alert 
our agents of potential exception events such as weather or traffic 
before a failure occurs so they can proactively intercede.

    Question 2. Are you aware of any impacts the recent SolarWind 
cyber-attack have had on your infrastructure or the COVID vaccine 
supply chain?
    Answer. Neither the FedEx infrastructure nor our COVID-19 vaccine 
distribution have had any impacts from the recent SolarWinds cyber-
attack.

    COVID Vaccine Distribution Delays. It has been reported that states 
are seeing a reduction in the number of vaccines allocated to them 
through the end of the year. On December 17, 2020, Pfizer released a 
statement stating that they have had no production issues and that 
millions of vaccines are waiting in storage waiting on shipping 
instructions from the Federal government.

    Question 3. Are you aware of, or have you experienced, delays in 
distribution of the vaccine? If so, what have been the causes of those 
delays?
    Answer. Vaccine shipments remain the top priority for the FedEx 
Express network. At this time, we have not experienced any delays in 
distribution based on factors within our control.

    Question 4. Specifically, are you aware of or have you experienced 
delays in the distribution of the vaccine as a result of lack of 
instruction from the Federal government?
    Answer. FedEx has not experienced any delays in distribution based 
on factors within our control and continues to work closely with the 
U.S. government task force to ensure timely distribution.
                                 ______
                                 
     Response to Written Questions Submitted by Hon. Jon Tester to 
                            Richard W. Smith
    Question 1. COVID has disproportionately impacted minority 
communities, and in Montana, this pandemic has significantly impacted 
our Native communities. As we discuss the distribution of a vaccine, it 
is absolutely critical that we consider the unique challenges of 
reaching the remote communities where many Native folks live. What 
steps are you taking to make sure that remote facilities like those on 
Tribal lands receive vaccines in a safe and timely manner?
    Answer. FedEx was created for the exact purpose and service 
required for today's mission: fast, reliable delivery of time-
sensitive, high priority goods. Over the years, we have invested in our 
people, infrastructure, and assets, to ensure we have solutions that 
meet the needs of the communities we serve. As a result of these 
investments, within the U.S., we can deliver to every ZIP code, 
including facilities on Tribal lands, and are committed to ensuring 
timely vaccine distribution to the communities we serve at the 
direction of federal, state and local officials.

    Question 2. At the beginning of the pandemic my office heard from a 
number of businesses in rural Montana that they either were not 
receiving shipments or they took much longer than usual. When there are 
major disruptions in the supply chain, rural America often faces the 
brunt of those changes. What precautions are you putting in place to 
ensure a stable supply chain to our rural communities?
    Answer. FedEx has been on the frontlines since the start of this 
pandemic providing essential transportation services and keeping 
critical supply chains moving across the U.S and the world. In the 
U.S., we have continued to serve rural communities without disruption 
and will continue to do so. The FedEx network was designed for today's 
mission and we remain committed to serving communities across the U.S. 
and the world.
                                 ______
                                 
    Response to Written Questions Submitted by Hon. Gary Peters to 
                            Richard W. Smith
    Cybersecurity. Cyber-attacks are a real threat as our Nation ramps 
up efforts to distribute millions of COVID-19 vaccines. In 2017, the 
largest container ship company was hit by the NotPetya cyber-attack, 
which compromised the company's operations for months. Just this month, 
the U.S. government experienced troubling cyber-attacks from foreign 
adversaries. At the hearing, I asked you about the security measures 
your company has in place to ensure vaccine distribution networks are 
protected from bad actors.

    Question 1. Please detail the specific security measures that are 
currently in place, including contingency plans, and whether these 
plans include cooperation with Federal agencies and commercial 
competition to ensure the safe delivery of vaccines.
    Answer. FedEx and our customers are using the latest technology to 
monitor vaccine shipments in real-time. FedEx operates under a high 
level of physical and virtual security awareness at all times and has 
robust policies and procedures designed to protect our employees, 
equipment, packages and customers. To combat potential threats from 
cyber adversaries, FedEx relies on multiple layers of security defense 
mechanisms using the latest technologies, and we constantly monitor our 
networks for illicit activity via a dedicated global cybersecurity 
operations center operating 24 hours a day, 365 days a year.
    FedEx Express is CTPAT certified and has a Transportation Security 
Administration compliant security program. Beyond compliance with 
Federal regulations intended to secure and deny unauthorized access to 
air cargo shipments, FedEx has conducted targeted risk analyses and 
physical security audits in preparation for vaccine transportation and 
has enhanced our threat monitoring capabilities. As an added safeguard, 
we have developed protocols to enable our team to react immediately to 
any potential vaccine shipment anomalies.
    FedEx is actively engaged with the U.S. government task force and 
has robust security relationships with Federal agencies, as well as 
with major distributors and manufacturers globally. Contingency and 
crisis management capabilities are in place to address potential 
business interruption scenarios.

    Question 2. Have you received sufficient support and guidance from 
the Department of Homeland Security's Cybersecurity and Infrastructure 
Security Agency?
    Answer. FedEx engages with CISA via multiple information sharing 
platforms and has open channels of communication with the Agency at 
both the headquarters and regional levels.
                                 ______
                                 
   Response to Written Question Submitted by Hon. Kyrsten Sinema to 
                            Richard W. Smith
    Rural and Tribal Communities. As you know, Arizona is a vast 
state--the sixth largest state by area. Arizona is home to Phoenix, one 
of the largest cities in the country, and is also home to many smaller, 
rural, and tribal communities across the state. Unfortunately, many of 
these smaller, rural, and tribal communities have been particularly 
impacted by the COVID-19 pandemic.

    Question 1. What are the challenges associated with vaccine 
distribution to rural and tribal communities, as compared to larger 
urban areas and what has your company done to address those challenges?
    Answer. The FedEx network was created for the exact purpose and 
service required for today's mission. FedEx is the largest global 
express transportation provider, with an unparalleled global network of 
more than 680 aircraft, including aircraft capable of serving large 
metropolitan areas and smaller, rural communities, and more than 
200,000 vehicles. We have made significant investments in our people, 
infrastructure, and assets that allow us to serve every ZIP code in the 
U.S., including facilities on Tribal lands, and will continue to do so 
to ensure continued connectivity to the communities we serve.

    Vaccine Security. Vaccine security is an important issue that must 
be addressed as part of the logistics process for vaccine distribution. 
Earlier this month, Interpol issued a global warning alerting its 
members that organized crime networks could attempt to steal doses of 
the vaccine.

    Question 2. What security and tracking measures are in place for 
vaccine shipments to ensure that vaccine shipments reach their 
destination?
    Answer. FedEx has a robust suite of tools and technology we are 
deploying to ensure the safety, security, and integrity of vaccine 
shipments. This includes the FedEx SenseAware ID device, our sensor-
based technology that can precisely track a package's location, and 
FedEx Surround platform, which uses data and predictive analytics to 
alert our agents of potential exception events before a failure occurs 
so they can proactively intercede if needed. These tools are monitored 
by our Priority Alert teams who have been engaged from the beginning, 
monitoring, tracking and tracing these shipments from the moment they 
enter our system until they are delivered to our customers.
                                 ______
                                 
   Response to Written Questions Submitted by Hon. Maria Cantwell to 
                             Wesley Wheeler
    Cyber Security. In late 2020 we saw reports that cyber criminals 
and foreign adversaries are attacking companies involved with the 
storage and transport of the vaccine in Europe. Additionally, it has 
come to light that Russia was likely behind one of the largest cyber-
attacks against the United States.

    Question 1. What is UPS doing to ensure the security of the 
vaccines from both virtual and physical threats?
    Answer. UPS leverages secure escorts (US Marshals and/or local law 
enforcement on moves into Louisville. Internal UPS Security and UPS's 
Command Center monitor each vaccine shipment with UPS Premier, which 
includes real-time monitoring in the UPS network. UPS networks are 
secure and protected by threat (we offer our best practices to CISA on 
a regular basis). Vaccine tracking information is secured behind UPS 
firewalls and only shared in protected transactions to vaccine 
partners.

    Question 2. Are you aware of any impacts the recent SolarWind 
cyber-attack have had on your infrastructure or the COVID vaccine 
supply chain?
    Answer. UPS has not been impacted by SolarWind cyber threats and 
vaccine delivery specifically has not been impacted.

    COVID Vaccine Distribution Delays. It has been reported that states 
are seeing a reduction in the number of vaccine's allocated to them 
through the end of the year. On December 17, 2020, Pfizer released a 
statement stating that they have had no production issues and that 
millions of vaccines are waiting in storage waiting on shipping 
instructions from the Federal Government.

    Question 3. Are you aware of, or have you experienced, delays in 
distribution of the vaccine? If so, what have been the causes of those 
delays?
    Answer. No. UPS delivered 100 percent vaccines by scheduled day in 
December and near perfect in January. Since the start of vaccine 
shipments UPS is running 99.98 percent on time by day and 99.9 percent 
on time by 10:30 AM commit times.

    Question 4. Specifically, are you aware of or have you experienced 
delays in the distribution of the vaccine as a result of lack of 
instruction from the Federal government?
    Answer. UPS is not aware of any delays related to the lack of 
instruction from the Federal Government.
                                 ______
                                 
     Response to Written Questions Submitted by Hon. Jon Tester to 
                             Wesley Wheeler
    Question 1. COVID has disproportionately impacted minority 
communities, and in Montana, this pandemic has significantly impacted 
our Native communities. As we discuss the distribution of a vaccine, it 
is absolutely critical that we consider the unique challenges of 
reaching the remote communities where many Native folks live. What 
steps are you taking to make sure that remote facilities like those on 
Tribal lands receive vaccines in a safe and timely manner?
    Answer. These remote territories are serviced by UPS with next day 
service. Time commitments may be later within the day, but UPS will 
deliver the next business day as with urban areas. UPS has experienced 
severe weather in some of these areas since the vaccine distribution 
began, but extraordinary efforts have been made by our people to ensure 
vaccines were delivered on the proper day.

    Question 2. At the beginning of the pandemic my office heard from a 
number of businesses in rural Montana that they either were not 
receiving shipments or they took much longer than usual. When there are 
major disruptions in the supply chain, rural America often faces the 
brunt of those changes. What precautions are you putting in place to 
ensure a stable supply chain to our rural communities?
    Answer. This has not been an issue for UPS. Our service rate has 
been 99.98 percent on time by day for vaccines since the start of 
vaccine shipments in mid-December. If weather or other events delayed 
movements of vaccines into these territories, UPS has contingent 
support in these locations to receive later aircraft and ensure same 
day deliveries. If needed, UPS can leverage support from our Marken/
Express Critical groups for same day ground or air movements. UPS is 
prepared to leverage charters as well if needed in case of significant 
circumstances, which has not been required to date.
                                 ______
                                 
    Response to Written Questions Submitted by Hon. Gary Peters to 
                             Wesley Wheeler
    Cybersecurity. Cyber-attacks are a real threat as our Nation ramps 
up efforts to distribute millions of COVID-19 vaccines. In 2017, the 
largest container ship company was hit by the NotPetya cyber-attack, 
which compromised the company's operations for months. Just this month, 
the U.S. government experienced troubling cyber-attacks from foreign 
adversaries. At the hearing, I asked you about the security measures 
your company has in place to ensure vaccine distribution networks are 
protected from bad actors.

    Question 1. Please detail the specific security measures that are 
currently in place, including contingency plans, and whether these 
plans include cooperation with Federal agencies and commercial 
competition to ensure the safe delivery of vaccines.
    Answer. UPS takes extensive actions to ensure our networks are 
protected from cyber-attacks. This includes regular training for our 
employees on threats. UPS regularly interfaces with CISA and other 
security support groups to share best practices. In terms of physical 
security, UPS leverages U.S. Marshals and local law enforcement escorts 
for bulk ground moves as well as private security when vaccines are on 
UPS property. Real-time tracking is used and monitored by UPS's Command 
Center and internal UPS security. Contingency plans are a way of life 
at UPS. We have late aircraft plans by specific location to ensure 
timely delivery, hot spare aircraft, and same day capabilities with our 
Express Critical and Marken business units. UPS does collaborate with 
commercial airlines and other logistics providers to enable this 
contingency support.

    Question 2. Have you received sufficient support and guidance from 
the Department of Homeland Security's Cybersecurity and Infrastructure 
Security Agency?
    Answer. Yes, UPS has regularly meets with these agencies and 
receives ample support. The CISA team met with UPS in December of 2020 
to specifically discuss security with vaccine rollout.
                                 ______
                                 
   Response to Written Question Submitted by Hon. Kyrsten Sinema to 
                             Wesley Wheeler
    Rural and Tribal Communities. As you know, Arizona is a vast 
state--the sixth largest state by area. Arizona is home to Phoenix, one 
of the largest cities in the country, and is also home to many smaller, 
rural, and tribal communities across the state. Unfortunately, many of 
these smaller, rural, and tribal communities have been particularly 
impacted by the COVID-19 pandemic.

    Question 1. What are the challenges associated with vaccine 
distribution to rural and tribal communities, as compared to larger 
urban areas and what has your company done to address those challenges?
    Answer. The greatest challenge posed for rural deliveries is 
related to weather threats. Rural communities are delivered next 
business day, as with urban deliveries. At times, weather can impact 
the small feeder aircraft used to reach these areas, which is an 
additional challenge. In addition, longer driver and road conditions 
when storms hit can be a difficult factor. UPS is proud to say that we 
have worked to overcome these factors in the handful of winter storms 
experienced so far this year. UPS was 100 percent on time by day in 
December and 99.96+ in January for on time by day.

    Vaccine Security. Vaccine security is an important issue that must 
be addressed as part of the logistics process for vaccine distribution. 
Earlier this month, Interpol issued a global warning alerting its 
members that organized crime networks could attempt to steal doses of 
the vaccine.

    Question 2. What security and tracking measures are in place for 
vaccine shipments to ensure that vaccine shipments reach their 
destination?
    Answer. A number of both physical and technical security measures 
are in place for vaccines. Security escorts are leveraged for ground 
movements to our air hubs. Private armed security is used when vaccines 
are on UPS property for longer durations. UPS monitors each movement of 
the vaccines using our Sentry devices, which provides real-time GPS 
tracking. We have separate devices for temperature and other discrete 
data points. These asset/network tracking tools are used by UPS's 
Command Center. Each vaccine delivery is forecasted in advance down to 
the specific driver making the delivery. The UPS Command Center 
monitors the progress and close out of each vaccine shipment daily. UPS 
has eyes on these shipments at various levels through the entire chain 
of custody.

                                  [all]