[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
CONFRONTING THE CORONAVIRUS: PERSPECTIVES
ON THE COVID 19 PANDEMIC ONE YEAR LATER
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
FEBRUARY 24, 2021
__________
Serial No. 117-3
__________
Printed for the use of the Committee on Homeland Security
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-393 PDF WASHINGTON : 2021
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COMMITTEE ON HOMELAND SECURITY
Bennie G. Thompson, Mississippi, Chairman
Sheila Jackson Lee, Texas John Katko, New York
James R. Langevin, Rhode Island Michael T. McCaul, Texas
Donald M. Payne, Jr., New Jersey Clay Higgins, Louisiana
J. Luis Correa, California Michael Guest, Mississippi
Elissa Slotkin, Michigan Dan Bishop, North Carolina
Emanuel Cleaver, Missouri Jefferson Van Drew, New Jersey
Al Green, Texas Ralph Norman, South Carolina
Yvette D. Clarke, New York Mariannette Miller-Meeks, Iowa
Eric Swalwell, California Diana Harshbarger, Tennessee
Dina Titus, Nevada Andrew S. Clyde, Georgia
Bonnie Watson Coleman, New Jersey Carlos A. Gimenez, Florida
Kathleen M. Rice, New York Jake LaTurner, Kansas
Val Butler Demings, Florida Peter Meijer, Michigan
Nanette Diaz Barragan, California Kat Cammack, Florida
Josh Gottheimer, New Jersey August Pfluger, Texas
Elaine G. Luria, Virginia Andrew R. Garbarino, New York
Tom Malinowski, New Jersey
Ritchie Torres, New York
Hope Goins, Staff Director
Daniel Kroese, Minority Staff Director
Natalie Nixon, Clerk
C O N T E N T S
----------
Page
Statements
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Oral Statement................................................. 1
Prepared Statement............................................. 3
The Honorable John Katko, a Representative in Congress From the
State of New York, and Ranking Member, Committee on Homeland
Security:
Oral Statement................................................. 3
Prepared Statement............................................. 5
The Honorable Andrew S. Clyde, a Representative in Congress From
the State of Georgia:
Prepared Statement............................................. 6
Witnesses
Ms. A. Nicole Clowers, Managing Director, Health Care Team, U.S.
Government Accountability Office (GAO):
Oral Statement................................................. 8
Prepared Statement............................................. 9
Ms. Crystal R. Watson, DrPH, Senior Scholar, Johns Hopkins Center
for Health Security, and Assistant Professor, Department of
Environmental Health and Engineering, Johns Hopkins Bloomberg
School of Public Health:
Oral Statement................................................. 19
Prepared Statement............................................. 20
Dr. Ngozi O. Ezike, MD, Director, Illinois Department of Public
Health:
Oral Statement................................................. 25
Prepared Statement............................................. 27
Mr. J. Ryan McMahon, II, County Executive, Onondaga County, New
York:
Oral Statement................................................. 31
Prepared Statement............................................. 33
For the Record
The Honorable Sheila Jackson Lee, a Representative in Congress
From the State of Texas:
Bill........................................................... 41
The Honorable Andrew S. Clyde, a Representative in Congress From
the State of Georgia:
Letter, February 19, 2021...................................... 65
The Honorable Val Butler Demings, a Representative in Congress
From the State of Florida:
Letter, February 23, 2021...................................... 83
Appendix I
The Honorable Diana Harshbarger, a Representative in Congress
From the State of Tennessee:
Statement of Matthew J. Rowan, President and CEO, Health
Industry Distributors Association............................ 99
Appendix II
Questions From Chairman Bennie G. Thompson for A. Nicole Clowers. 113
Questions From Chairman Bennie G. Thompson for Crystal R. Watson. 115
Question From Honorable Michael Guest for Crystal R. Watson...... 116
Questions From Honorable Michael Guest for Ngozi Ezike........... 116
CONFRONTING THE CORONAVIRUS: PERSPECTIVES ON THE COVID-19 PANDEMIC ONE
YEAR LATER
----------
Wednesday, February 24, 2021
U.S. House of Representatives,
Committee on Homeland Security,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., via
Webex. Hon. Bennie G. Thompson [Chairman of the committee]
presiding.
Present: Representatives Thompson, Jackson Lee, Langevin,
Payne, Correa, Slotkin, Cleaver, Green, Clarke, Swalwell,
Titus, Watson Coleman, Demings, Barragan, Gottheimer, Torres,
Katko, Higgins, Guest, Bishop, Van Drew, Norman, Miller-Meeks,
Harshbarger, Clyde, Gimenez, LaTurner, Meijer, Cammack,
Pfluger, and Garbarino.
Chairman Thompson. Good morning. Our Ranking Member will be
joining us shortly.
The Committee on Homeland Security will come to order. The
committee is meeting today to receive testimony on confronting
coronavirus perspectives on the COVID-19 pandemic 1 year later.
Without objection the Chair has authorized to declare the
committee in recess at any point.
This gentlelady from Florida, Ms. Demings, shall assume the
duty of the Chair in the event that I run into technical
difficulties.
With that, I recognize myself for an opening statement.
Almost 1 year ago, on March 4, 2020, the Committee on
Homeland Security held a first Congressional hearing to examine
the novel coronavirus that had begun spreading around the
world. A week later, on March 11, 2020, the World Health
Organization declared COVID-19 a global pandemic. Since then,
over half a million Americans have died from the virus, a
tragic, catastrophic loss of life. In remembrance of those who
have lost their lives to COVID-19, I ask the committee to
observe a moment of silence.
Thank you.
The committee is meeting today to examine perspectives on
the COVID-19 pandemic 1 year later. We are fortunate to be
joined today by witnesses representing 2 of the same
organizations that came before the committee at our March 2020
hearing, and I look forward to resuming our discussion.
Examining the failures in the Federal responses so far and
applying lessons learned are essential to ending the pandemic
and keeping Americans safe.
Unfortunately, President Trump ignored intelligence on
COVID-19, made States compete for PPE and testing supplies,
rejected science on masking and distancing, silenced medical
and scientific experts in his own administration, and failed to
develop a comprehensive plan for testing and vaccine
distribution. The American people have paid dearly for those
failures and continue to do so today, in some cases with their
lives.
Late last month, the Government Accountability Office
released a scathing report on the Trump administration's
persistent failure to address critical problems in the COVID-19
response. Nearly 90 percent of GAO's recommendations remain
unimplemented as President Trump left office, leaving the
normally reserved Government watch dog agency deeply troubled.
Among the most significant failures identified was the lack of
a comprehensive plan for COVID vaccine distribution. According
to GAO, without a plan each State was left to create its own
plan for locally distributing the shots and launching programs
for getting them into people's arms. We all know how that is
going. I doubt to say that every Member on this committee has
received calls from constituents asking how and when can I get
a shot. Long waits for appointments at under-resourced local
public health departments, older people trying to navigate a
patchwork of overwhelmed private pharmacy websites to get a
shot, and minority and underserved communities being left
behind, despite suffering disproportionate illness and death
from the virus.
This is a situation the Biden administration was handed by
its predecessor. President Biden has taken aggressive action to
try to rectify these failures and bring the pandemic under
control, but it will not be an easy task. Executing the
National strategy for the COVID-19 response and pandemic
preparedness will take a coordinated effort along Federal,
State, local, Tribal, and territorial governments and private-
sector partners.
I hope to hear from our witnesses today how Congress can be
helpful in that endeavor. Getting the pandemic under control
will also take addressing the disproportionate toll COVID-19
has taken on minority and underserved communities. The risk of
dying from COVID is nearly 7 times higher in Hispanics and 5\1/
2\ times higher in African Americans than others, yet minority
and underserved communities are having trouble accessing life-
saving COVID vaccines. In my State of Mississippi, only 20
percent of the vaccines have gone to African Americans, even
though African Americans comprise 38 percent of the State's
population. In one Mississippi county, less than 9 percent of
vaccines have gone to African Americans even though 26 percent
of residents are African American.
President Biden's Executive order and task force on COVID-
19 health equity are a good start. But more needs to be done to
ensure equitable vaccine access and outcomes.
I was heartened to hear of the creation of a civil rights
advisory group within FEMA that will be working on this issue
and Americans can be assured this committee will be conducting
close oversight of their work and supporting their efforts. The
Federal Government is paying for these vaccines with taxpayers'
money and it must ensure that all Americans have equitable
access to them.
I thank the witnesses for joining us and Members for their
participation and look forward to a robust discussion.
[The statement of Chairman Thompson follows:]
Statement of Chairman Bennie G. Thompson
February 24, 2021
Almost 1 year ago, on March 4, 2020, the Committee on Homeland
Security held the first Congressional hearing to examine the novel
coronavirus that had begun spreading around the world. A week later, on
March 11, 2020, the World Health Organization declared COVID-19 a
global pandemic. Since then, over half a million Americans have died
from the virus--a tragic, catastrophic loss of life.
In remembrance of those we have lost to COVID-19, I ask the
committee to observe a moment of silence. Thank you.
The committee is meeting today to examine ``Perspectives on the
COVID-19 Pandemic One Year Later.'' We are fortunate to be joined today
by witnesses representing two of the same organizations that came
before this committee at our March 2020 hearing, and I look forward to
resuming our discussion. Examining the failures in the Federal
responses so far and applying lessons learned is essential to ending
the pandemic and keeping Americans safe.
Unfortunately, President Trump ignored intelligence on COVID-19,
made States compete for PPE and testing supplies, rejected science on
masking and distancing, silenced medical and scientific experts in his
own administration, and failed to develop comprehensive plans for
testing and vaccine distribution. The American people have paid dearly
for those failures and continue to do so today, in some cases with
their lives.
Late last month, the Government Accountability Office released a
scathing report on the Trump administration's persistent failure to
address critical problems in its COVID-19 response. Nearly 90 percent
of GAO's recommendations remained unimplemented as President Trump left
office, leaving the normally reserved Government watchdog agency
``deeply troubled.''
Among the most significant failures identified was the lack of a
comprehensive plan for COVID vaccine distribution. According to GAO,
without a plan each State was left to create its own plan for ``locally
distributing the shots and launching programs for getting them into
people's arms.'' We all know how that has gone.
Long waits for appointments at under-resourced local public health
departments, older people trying to navigate a patchwork of overwhelmed
private pharmacy websites to get a shot, and minority and underserved
communities being left behind despite suffering disproportionate
illness and deaths from the virus. This is the situation the Biden
administration was handed by its predecessor.
President Biden is taking aggressive action to try to rectify these
failures and bring the pandemic under control, but it will be no easy
task. Executing his National Strategy for the COVID-19 Response and
Pandemic Preparedness will take a coordinated effort among Federal,
State, local, Tribal, and territorial governments and private-sector
partners.
I hope to hear from our witnesses today about how Congress can be
helpful in that critical endeavor. Getting the pandemic under control
will also take addressing the disproportionate toll COVID-19 has taken
on minority and underserved communities. The risk of dying from COVID
is nearly 7 times higher for Hispanics and 5\1/2\ times higher for
African Americans than for others. Yet, minority and underserved
communities are having trouble accessing life-saving COVID vaccines.
In my State of Mississippi, only 20 percent of vaccines have gone
to African Americans, even though African Americans comprise 38 percent
of the State's population. In one Mississippi county, less than 9
percent of vaccines have gone to African Americans even though 26
percent of residents are African American. President Biden's Executive
Order and Task Force on COVID-19 Health Equity are a good start, but
more needs to be done to ensure equitable vaccine access and outcomes.
I was heartened to hear of the creation of a Civil Rights Advisory
Group within FEMA that will be working on this issue, and Americans can
be assured this committee will be conducting close oversight of their
work and supporting their efforts. The Federal Government is paying for
these vaccines with taxpayer money, and it must ensure that all
Americans have equitable access to them.
Chairman Thompson. With that, I recognize the Ranking
Member, the gentleman from New York, Mr. Katko, for an opening
statement.
You are going to have to unmute yourself.
Mr. Katko. You had to me unmute me first, Mr. Chairman. I
appreciate your comments.
Thank you for holding this necessary hearing today as well.
I appreciate you tackling this topic so early in the
proceedings. The mere fact that this hearing is being held
virtually demonstrates the degree to which the COVID-19
pandemic has interrupted our daily lives. Like very few things
during my lifetime, the COVID-19 pandemic has impacted every
American in some way. It has had a crippling effect on our
economy, forcing small businesses to shutter their doors, it
has threatened the financial stability of millions of families,
and it has taken a significant toll on the mental health of
countless Americans, including our school children.
We need to do everything we can to support those suffering,
including by taking appropriate steps to get our kids back in
the classrooms as quickly and as safely as possible.
Not to mention the horrific number of deaths that have
occurred. I saw media reports just last week that life
expectancy in the United States fell by a full year in the
first 6 months of 2020 resulting from the pandemic, with racial
minorities, as you noted, suffering even greater declines. This
is the largest drop since World War II and it is absolutely
tragic. My thoughts and prayers go out to everyone who has
suffered through this pandemic, especially those who have lost
loved ones.
Sadly, a year later, when many of us thought we would have
returned to a semblance of normalcy, we are still deep in the
throes of this pandemic. Although it is a positive sign that
cases and deaths may be trending down, at the moment the
numbers are still way too high. Many have become numb to the
news on any given day in the United States that thousands more
of our fellow Americans have lost their lives to this
devastating virus. Just last week alone we lost more than
10,000 Americans to COVID, and in the last few days surpassed
500,000 deaths totally. Luckily, the vaccines have given us
some much-needed hope, but we are still a long way from the
end. We need to do absolutely everything we can to get as many
Americans vaccinated as quickly as possible.
Most of the news in 2020 surrounding the pandemic was
awful, but I would be remiss for not mentioning that we saw
enumerable feats of courage and perseverance. As we know, Mr.
Chairman, the American people under the most horrendous
conditions throughout history have always stepped up to defy
the odds. Throughout the 2020 year, and continuing to this day,
we see tremendous courage from health care workers and first
responders on the front lines who continue to put their lives
on the line to help their fellow Americans. I commend them for
that.
Although the media tends to focus on the largest cities
where the cases are higher, I would like to use this
opportunity to highlight that the pandemic is everywhere. In
districts like yours in Mississippi, Mr. Chairman, in mine in
central New York. I would argue that the pandemic has had an
even equal or even larger impact on our smaller cities and more
rural communities.
I want to urge all those working on the response to the
pandemic not to forget about the impact this deadly virus is
having on communities in my district, such as Syracuse, New
York, Auburn, New York, and Oswego, New York, and many, many
others. In central New York we have seen the pandemic
contribute to rising rates of mental illness, substance use
disorders, and nearly doubling the overdose stats for heroin.
My witness today will highlight some of those challenges.
In my Congressional district we have seen north of 45,000 COVID
cases and more than 800 deaths.
Even though the country has been given a ray of hope with
the vaccine, there is much left to do, including--and I hate to
say it because I hope it never happens--plan for the next
pandemic. Now that we know first-hand that something like this
is possible, we need to compile lessons learned and best
practices to ensure we build an effective and aggressive
strategy to respond to public health crises of this magnitude.
Pandemic preparedness is a critical part of the Homeland
Security mission. We must ensure that the Federal, State,
local, and Tribal governments have diligent plans in place for
a public health response to this and future pandemics.
Longer-term, we need to engage in a study about medical and
pandemic response supply chains to identify where we are overly
beholden to foreign nation-states, like China, that don't share
our interests. I believe the Department can play a critical
role in this work. Mr. Chairman, I see great opportunity, as
always for bipartisan collaboration. We always accomplish the
most when we work collaboratively across the aisle to address
the needs of the American public.
Again, Mr. Chairman, thank you for holding this most
important hearing today. I look forward to the testimony of our
witnesses.
With that, I yield back.
[The statement of Ranking Member Katko follows:]
Statement of Ranking Member John Katko
Thank you for holding this necessary hearing today. I appreciate
your commitment to tackling this topic so early in the Congress. The
mere fact that this hearing is being held virtually demonstrates the
degree to which the COVID-19 pandemic has interrupted our daily lives.
Like very few things during my lifetime, the COVID-19 pandemic has
impacted every American in some way--it has had a crippling effect on
our economy forcing small businesses to shutter their doors, it has
threatened the financial stability of millions of families, and it has
taken a significant toll on the mental health of countless Americans,
including our school children.
We need to do everything we can to support those suffering,
including by taking appropriate steps to get our kids back in the
classroom, as quickly and safely as possible!
Not to mention the horrific number of deaths that have occurred. I
saw media reports just last week that life expectancy in the United
States fell by a full year in the first 6 months of 2020 resulting from
the pandemic, with racial minorities suffering even greater declines.
This is the largest drop since World War II--and it's absolutely
tragic. My thoughts and prayers go out to everyone who has suffered
through this pandemic, especially those who have lost loved ones.
Sadly, a year later, when many of us thought we would have returned
to a semblance of normalcy, we are still deep in the throes of this
pandemic. Although it is a positive sign that cases and deaths may be
trending down at the moment, the numbers are still way too high.
Many have become numb to the news on any given day in the United
States, that thousands more of our fellow Americans have lost their
lives to this devastating virus. Just last week alone, we lost more
than 10,000 Americans to COVID and in the last few days surpassed
500,000 deaths total. Luckily, the vaccines have given us some much-
needed hope, but we are still a long way from the end. We need to do
absolutely everything we can to get as many Americans vaccinated as
quickly as possible.
Most of the news in 2020 surrounding the pandemic was horrible, but
I would be remiss without mentioning that we saw innumerable feats of
courage and perseverance. As we know, Mr. Chairman, the American
people, under the most horrendous conditions throughout history, have
always stepped up to defy the odds.
Throughout 2020 and continuing to this day, we see tremendous
courage from health care workers and first responders on the front
lines who continue to put their lives on the line to help their fellow
Americans. I commend them for that.
Although the media tends to focus on the larger cities where the
cases are higher, I would like to use this opportunity to highlight
that the pandemic is everywhere--in districts like your district in
Mississippi, Mr. Chairman, and mine in Central New York.
I would argue that the pandemic has had an equal or even larger
impact on our smaller cities and more rural communities.
I want to urge all those working on the response to the pandemic
not to forget about the impact this deadly virus is having on
communities such as Syracuse, Auburn, Oswego, and many, many others. In
Central New York, we have seen the pandemic contribute to rising rates
of mental illness, substance use disorders, and overdose deaths.
My witness today will highlight some of those challenges. In my
Congressional district, we have seen north of 45,000 cases and more
than 800 deaths.
Even though the country has been given a ray of hope with the
vaccine, there is much left to do--including, and I hate to say it,
plan for the next pandemic.
Now that we know first-hand that something like this is possible,
we need to compile lessons learned and best practices to ensure we
build an effective and aggressive strategy to respond to public health
crises of this magnitude. Pandemic preparedness is a critical part of
the homeland security mission. We must ensure that Federal, State,
local, and Tribal governments have diligent plans in place for a public
health response to this and future pandemics.
Longer-term, we need to engage in a study of our medical and
pandemic response supply chains to identify where we are overly
beholden to foreign nation-states--like China--that don't share our
interests. I believe the Department can play a critical role in this
work, and Mr. Chairman, I see great opportunity for bipartisan
collaboration on this.
We always accomplish the most when we work collaboratively, across
the aisle to address the needs of the American people.
Again, Mr. Chairman, thank you for holding this hearing today. I
look forward to the testimony of our witnesses.
Chairman Thompson. Other Members of the committee are
reminded that under committee rules opening statements may be
submitted for the record.
[The statement of Hon. Clyde follows:]
Statement of Hon. Andrew S. Clyde
February 24, 2021
Thank you, Chairman Thompson.
I would like to take this opportunity to address my grave concern
with the Biden administration's decision to eliminate the Migrant
Protection Protocols. This reckless decision will have the dual effect
of putting Americans at risk of exposure to the coronavirus and
creating conditions that mirror the 2019 border crisis.
The increasing number of unaccompanied minors and families
illegally crossing the border in the middle of a global pandemic is
creating a recipe for disaster. President Biden's Executive actions
have the potential to cause mass outbreaks at facilities and ports of
entry, which would lead to temporary closures that could have a
significant impact on commerce and further handicap our economic
recovery efforts. A mass outbreak would also jeopardize the health and
safety of our men and women who serve on the front lines protecting our
Nation's borders. Finally, these Executive actions and a surge at the
border have forced CBP officials to return to the dangerous policy of
catch and release. This policy releases migrants who have not been
properly vetted or sufficiently tested for coronavirus into our
communities, putting the health and well-being of Americans at risk.
The Biden administration's actions are unacceptable and serve as
distractions from what this committee should be focusing on, which is
how we can secure our borders and prevent our constituents from being
exposed to the COVID-19 virus. I would like to submit for the record a
letter my colleagues and I on the House Oversight and Reform Committee
sent to Secretary Mayorkas highlighting these concerns. With that Mr.
Chairman, I yield back my time.
Chairman Thompson. Members are also reminded that the
committee will operate according to the guidelines laid out by
the Chairman and Ranking Member in our February 3 colloquy
regarding remote procedures.
Now, I welcome our witnesses.
Ms. Nicole Clowers serves as the managing director of the
Healthcare Team at the Government Accountability Office. She
has been with GAO since 1998 and is one of the people leading
GAO's reporting on the Federal Government's COVID-19 response.
Dr. Crystal Watson is a senior associate at John Hopkins
Center for Health Security and assistant professor in the
Department of Environmental Health and Engineering. Her policy
research focuses on public health, risk assessment, prices, and
risk-based decision making regarding preparedness and response,
biodefense, and emerging infectious diseases.
Dr. Ngozi Ezike is the director of Illinois Department of
Public Health. She is a board-certified internist and
pediatrician and the testimony she provided to the committee 1
year ago was invaluable to our understanding of a difficult
road ahead. I thank her for agreeing to return today.
I would now like to recognize the Ranking Member for the
purposes of introducing our fourth witness.
Mr. Katko. Thank you, Mr. Chairman.
My witness' name is a little bit easier. His name is Ryan
McMahon. I am proud to introduce a constituent by Mr. Ryan
McMahon. Ryan is an Onondaga County executive and has been so
since 2018. He started his career in public service as Syracuse
city counselor in 2005 after being elected at the ripe old age
of 25. He was reelected in 2007 for a second term and quickly
distinguished himself as a bipartisan problem solver.
In 2011 County Executive McMahon was elected to the 15th
District of the county legislature of Onondago, which includes
portions of the city of Syracuse, the Town of Geddes, and the
Town of Onondaga. Ryan was subsequently elected chairman of the
county leg in 2012 by his fellow legislators, becoming the
youngest chairman in county history.
Upon taking office as county executive, Ryan McMahon has
placed a focus on 3 main initiatives, poverty, infrastructure,
and economic development. Obviously, Mr. Chairman, Ryan's main
focus now is COVID. He has done a remarkable job leading us
through this pandemic in central New York and saw daily
briefings that have been superb. I commend him for his
leadership in that regard.
I have enjoyed working with Mr. McMahon during my life in
the House and I am thrilled that he is able to testify with us
today.
With that, Mr. Chairman, I yield back.
Chairman Thompson. Thank you. Without objection, the
witnesses' full statements will be inserted in the record.
I now ask Ms. Clowers to summarize her statement for 5
minutes.
STATEMENT OF A. NICOLE CLOWERS, MANAGING DIRECTOR, HEALTH CARE
TEAM, U.S. GOVERNMENT ACCOUNTABILITY OFFICE (GAO)
Ms. Clowers. Thank you, Chairman Thompson, Ranking Member
Katko, and Members of the committee. Thank you for the
opportunity to discuss the Federal Government's on-going
response to COVID-19.
Through the CARES Act Congress directed GAO to provide on-
going real time oversight of the Federal Government's response
to the pandemic. As of January we have issued 5 reports
containing 44 recommendations. About a third of those
recommendations were directed in the following public health
areas, COVID testing, vaccine distribution, medical supply
chain, COVID health disparities, and COVID data. My written
statement details each of those recommendations. We believe
each, if fully implemented, would improve the on-going Federal
response.
In my comments this morning I would like to focus on 3 of
those areas, vaccine distribution, the medical supply chain,
and COVID disparities.
First, the topic that is on everyone's mind, vaccine
distribution. As you know, as of today 2 vaccines have been
authorized for emergency use and are being distributed. The
emergency use authorization request for a third vaccine
candidate is pending before the FDA. The rapid development of
these vaccines is an achievement. But as we and others have
reported, the distribution of the vaccines had not met
expectations through January. While the distribution pace has
recently increased, challenges continue to be reported.
Distribution of authorized vaccines across the Nation is a
daunting, complicated logistical endeavor in part because of
the number of entities involved across all levels of the
Government and the private and non-profit sectors. This is why
we recommended in September 2020 that HHS, as part of a
National plan for distributing and administering the vaccine,
outline an approach for how efforts would be coordinated across
Federal and non-Federal partners. To date this recommendation
has not been fully implemented and we maintain doing so,
especially ensuring local officials are part of the planning
efforts, would improve the Nation's distribution efforts.
The second topic that I would like to highlight is the
medical supply chain. The pandemic has highlighted
vulnerabilities in the Nation's medical supply chain, which
includes personal protective equipment and other supplies
necessary to treat individuals with COVID and to vaccinate
people. Providing medical supplies to meet the continuing needs
has been a persistent challenge.
We have made multiple recommendations to improve the
Federal Government's management of the medical supply chain.
For example, we recommended that HHS should develop plans
outlining specific actions the Federal Government would take to
mitigate medical supply gaps for the duration of the pandemic.
We also recommended that HHS work with Federal and non-Federal
stakeholders to helps States enhance their ability to track the
status of supply requests. Implementing both of these
recommendations would help address the supply challenges.
Finally, I want to highlight the health care disparities
related to COVID-19. Available data from CDC and others show
communities of color bear a disproportional burden of COVID-19,
to include cases, hospitalizations, and death. For example,
available data show that the rate of COVID-19 hospitalizations
for Native Americans is almost 4 times the rate for White
Americans.
While CDC collects race and ethnicity data on indicators of
COVID-19, we found gaps in the data. For example, data on race
and ethnicity for COVID-19 vaccine recipients were missing for
almost half of the recipients who received at least one dose.
The lack of complete race and ethnicity data hinders the
Government's ability to take corrective actions.
In conclusion, over the past 2 weeks case counts and deaths
have thankfully slowed since peaking in January, but public
health officials caution that we should not become complacent
in our efforts as new variants emerge. Until the country better
contains the spread of the virus, the pandemic will continue to
lay bare the fragmented nature of the public health sector, the
fragility of the medical supply chain, and long-standing
disparities in health care access, treatment, and outcomes.
Chairman Thompson, Ranking Member Katko, and Members of the
committee, this concludes my prepared statement. I would be
happy to answer questions at the appropriate time.
Thank you.
[The prepared statement of Ms. Clowers follows:]
Prepared Statement of A. Nicole Clowers
February 24, 2021
highlights
Highlights of GAO-21-396T, a testimony before the Committee on
Homeland Security, House of Representatives.
Why GAO Did This Study
As of February 17, 2021, the United States had about 27 million
cumulative reported cases of COVID-19 and more than 486,000 reported
deaths, according to the Centers for Disease Control and Prevention.
The country also continues to experience serious economic
repercussions.
Five relief laws, including the CARES Act, have appropriated $3.1
trillion to address the public health and economic threats posed by
COVID-19. The CARES Act also includes a provision for GAO to report on
its on-going monitoring and oversight efforts related to COVID-19.
This testimony summarizes GAO's insights from its oversight of the
Federal Government's pandemic response in a series of comprehensive
reports issued from June 2020 through January 2021. In particular, the
statement focuses on the public health response, including testing,
vaccines and therapeutics, medical supply chain, health disparities,
and health data.
GAO reviewed data, documents, and guidance from Federal agencies
about their activities and interviewed Federal and State officials and
stakeholders for the series of reports on which this testimony is
based. See https://www.gao.gov/coronavi- rus/.
What GAO Recommends
GAO has made 44 recommendations for agencies and 4 matters for
Congressional consideration in its comprehensive series of bimonthly
reports on the Federal response to COVID-19 over the last year. GAO
will issue its next report in this series in March 2021.
covid-19.--key insights from gao's oversight of the federal public
health response
What GAO Found
More than a year after the United States declared COVID-19 a public
health emergency, the pandemic continues to result in catastrophic loss
of life and substantial damage to the economy. It also continues to lay
bare the fragmented nature of our public health sector, the fragility
of the Nation's medical supply chain, and long-standing disparities in
health care access, treatment, and outcomes.
GAO has made 44 recommendations to Federal agencies. Of these
recommendations, 16 relate to the following public health topics:
COVID-19 Testing.--GAO has made 2 recommendations to date to
improve the Federal Government's efforts in diagnostic testing for
COVID-19, critical to controlling the spread of the virus. In January
2021, GAO recommended that the Department of Health and Human Services
(HHS) develop and make publicly available a comprehensive National
COVID-19 testing strategy.
Vaccines and Therapeutics.--GAO has made 2 recommendations to
improve transparency, communication, and coordination around the
Government's efforts to develop, manufacture, and distribute vaccines
and therapeutics to prevent and treat COVID-19. For example, in
September 2020, GAO recommended that HHS establish a time frame for a
National vaccine distribution and administration plan that follows best
practices, with Federal and non-Federal coordination.
Medical Supply Chain.--GAO has made 7 recommendations for the
Federal Government to respond to vulnerabilities highlighted by the
pandemic in the Nation's medical supply chain, including limitations in
personal protective equipment and other supplies necessary to treat
individuals with COVID-19. In January 2021, GAO recommended that HHS
establish a process for regularly engaging with Congress and non-
Federal stakeholders as the agency refines and implements its supply
chain strategy for pandemic preparedness, to include the role of the
Strategic National Stockpile.
COVID-19 Health Disparities.--GAO has made 3 recommendations to
improve COVID-19 data by race and ethnicity, as available data show
communities of color bear a disproportionate burden of COVID-19
positive tests, cases, hospitalizations, and deaths. In September 2020,
GAO recommended that the Centers for Disease Control and Prevention
involve key stakeholders to help ensure the complete and consistent
collection of demographic data.
COVID-19 Data.--GAO has made 2 recommendations to improve the
collection of data needed to respond to COVID-19 and prepare for future
pandemics. GAO recommended in January 2021 that HHS establish an expert
committee to help systematically define and ensure the collection of
standardized data across the relevant Federal agencies and related
stakeholders; the absence of such data hinders the ability of the
Government to respond to COVID-19, communicate the status of the
pandemic with citizens, or prepare for future pandemics.
Although the responsible agencies generally agreed with the
majority of the 16 recommendations, only 1 has been fully implemented.
GAO maintains that implementing these recommendations will improve the
Federal Government's public health response and ability to recover as a
Nation.
Chairman Thompson, Ranking Member Katko, and Members of the
committee: Thank you for the opportunity to discuss the Federal
Government's on-going response to Coronavirus Disease 2019 (COVID-19).
The pandemic has resulted in catastrophic loss of life and substantial
damage to the global economy, and to the stability and security of our
Nation. As of February 17, 2021, the United States had more than 27
million reported cases and 486,000 reported deaths, according to the
Centers for Disease Control and Prevention (CDC).
The country also continues to experience serious economic
repercussions. In January 2021, there were more than 10.1 million
unemployed individuals, compared to nearly 5.8 million individuals in
January 2020.
Over the past 2 weeks, case counts and deaths have slowed since
peaking in January 2021. But public health officials warn that we
should not become complacent in our efforts, as new variants of virus
appear across the country. Until the country better contains the spread
of the virus, the pandemic will continue to lay bare the fragmented
nature of our public health sector, the fragility of our medical supply
chain, and long-standing disparities in health care access, treatment,
and outcomes, as well as impeding a more robust economic recovery.
In response to this on-going public health emergency, and the
resulting economic challenges, Congress and the administration have
taken a series of actions to protect the health and well-being of
Americans. Notably, in March 2020, Congress passed, and the President
signed into law, the CARES Act, which provided over $2 trillion in
emergency assistance and health care response for individuals,
families, and businesses affected by COVID-19.\1\ To date, the 5
enacted COVID-19 relief laws, including the CARES Act, have
appropriated $3.1 trillion.
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\1\ Pub. L. No. 116-136, 134 Stat. 281 (2020). As of January 1,
2021, 4 other relief laws were also enacted in response to the COVID-19
pandemic: The Consolidated Appropriations Act, 2021, Pub. L. No. 116-
260, 134 Stat. 1182 (2020); Paycheck Protection Program and Health Care
Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); Families
First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178
(2020); and the Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146. We refer
to these 5 laws, each of which was enacted as of January 1, 2021, and
provides appropriations for the COVID-19 response, as ``COVID-19 relief
laws,'' and the funding appropriated by these laws as ``COVID-19 relief
funds.'' In January 2020, the novel coronavirus was declared a public
health emergency.
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The CARES Act includes a provision for us to conduct monitoring and
oversight of the Federal Government's efforts to prepare for, respond
to, and recover from the COVID-19 pandemic, including issuance of bi-
monthly reports to Congress.\2\ We are to report on, among other
things, the effect of the pandemic on public health and the economy. To
date, our work in response to this provision includes 5 comprehensive
issued reports from June 2020 through January 2021; we will issue our
next Government-wide report on the Federal response to the COVID-19
pandemic at the end of March.
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\2\ Pub. L. No. 116-136, 19010, 134 Stat. at 579-81.
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In our 5 reports we have made 44 recommendations to Federal
agencies, and raised 4 matters for Congressional consideration to
improve the Federal Government's response efforts.\3\ Our
recommendations are tailored to specific Federal programs and
initiatives, and, if implemented, will strengthen the efficiency,
effectiveness, and accountability of these Federal efforts. We urge the
new Congress and administration to consider these recommendations as
well as the principles of an effective Federal response that we have
previously identified.
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\3\ See https://www.gao.gov/coronavirus/ for our comprehensive
reports and other COVID-19-related reports.
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My comments today will summarize the key findings and
recommendations from our oversight of the Federal Government's
continued efforts to respond to and recover from the COVID-19 pandemic.
I will focus my comments on our findings related to the public health
response, including COVID-19 testing, vaccines and therapeutics, the
medical supply chain, COVID-19 health disparities, and COVID-19 health
data.
We conducted the work on which this statement is based, which was
completed on January 15, 2021, with updates to Federal agency data, as
available, in accordance with generally accepted Government auditing
standards.\4\ Those standards require that we plan and perform the
audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
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\4\ We reviewed data, documents, and guidance from Federal agencies
about their activities and interviewed Federal and State officials and
stakeholders for the series of reports on which this testimony is
based.
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key insights from gao's oversight of the federal response to covid-19
In February 2020, at the outset of the COVID-19 pandemic, we
identified key principles that are essential for an effective Federal
response.\5\ Specifically, based on our prior work examining responses
to large-scale catastrophic disasters or public health emergencies, we
emphasized the need for Federal agencies to coordinate, establish, and
define roles and responsibilities among those responding to the crisis,
and to provide clear, consistent communication. In June 2020, we
reinforced the importance of these key principles and also emphasized
the need to collect and analyze data to inform decision making and
future preparedness; establish clear goals; establish mechanisms for
accountability and transparency to help ensure program integrity; and
address fraud risks. Incorporating these principles into on-going or
new COVID-19-related programs and policies will improve the
effectiveness of the Federal Government's response.
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\5\ A. Nicole Clowers, Managing Director of GAO's Health Care team,
Roundtable: Are We Prepared? Protecting the U.S. from Global Pandemics,
testimony before the Senate Committee on Homeland Security and
Governmental Affairs. 116th Cong., 2d sess., Feb. 12, 2020.
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Of the 44 recommendations we have made to date, 16 fall into one of
the following public health areas: COVID-19 testing, vaccines and
therapeutics, medical supply chain, COVID-19 health disparities, and
COVID-19 health data.
COVID-19 Testing
Diagnostic testing for COVID-19 is critical to controlling the
spread of the virus, according to CDC. We have made 2 recommendations
to improve the Federal Government's COVID-19 testing efforts, as shown
in table 1. Most recently, in January 2021, we found that the
Department of Health and Human Services (HHS) had not issued a
comprehensive and publicly available National testing strategy. For
example, stakeholders involved in the response efforts told us that
they either were unaware of the National strategy or did not have a
clear understanding of it. Without a comprehensive, publicly-available
National strategy, HHS is at risk of key stakeholders and the public
lacking crucial information to support an informed and coordinated
testing response.
In January 2021, we recommended that HHS develop and make publicly
available a comprehensive National COVID-19 testing strategy that
incorporates all 6 characteristics of an effective National strategy.
Such a strategy could build upon existing strategy documents that HHS
has produced for the public and Congress to allow for a more
coordinated pandemic testing approach. (See table 1.)
TABLE 1: GAO'S RECOMMENDATIONS RELATED TO COVID-19 TESTING
------------------------------------------------------------------------
Recommendation Status
------------------------------------------------------------------------
The Secretary of Health and Human Services Open. HHS partially
(HHS) should develop and make publicly concurred with our
available a comprehensive National COVID- recommendation. HHS agreed
19 testing strategy that incorporates all that the Department should
6 characteristics of an effective take steps to more directly
National strategy. Such a strategy could incorporate some of the
build upon existing strategy documents elements of an effective
that HHS has produced for the public and National strategy, but
Congress to allow for a more coordinated expressed concern that
pandemic testing approach (January 2021 producing such a strategy
report). at this time could be
overly burdensome on the
Federal, State, and local
entities that are
responding to the pandemic,
and that a plan would be
outdated by the time it was
finalized or potentially
rendered obsolete by the
rate of technological
advancement.
The Secretary of Health and Human Services Open. HHS concurred with our
should ensure that the director of the recommendation, noting that
Centers for Disease Control and CDC officials typically
Prevention (CDC) clearly discloses the consult with scientific
scientific rationale for any change to stakeholders when issuing
testing guidelines at the time the change guidance and that HHS will
is made (November 2020 report). continue to evaluate its
processes in this area.
------------------------------------------------------------------------
Source GAO/GAO-21-396T.
Vaccines and Therapeutics
Multiple Federal agencies support the development and
manufacturing, and now distribution, of vaccines and therapeutics to
prevent and treat COVID-19. Agencies involved in the Federal
partnership (formerly called Operation Warp Speed) include the
Department of Defense (DOD) and HHS, including HHS's Biomedical
Advanced Research and Development Authority (BARDA), Food and Drug
Administration (FDA), CDC, and the National Institutes of Health (NIH).
DOD is supporting HHS in Nation-wide distribution efforts of any
licensed or authorized vaccine. As of February 18, 2021, 2 of the 6
Operation Warp Speed vaccine candidates had been authorized by FDA for
emergency use, and vaccine distribution and vaccine administration
began in December 2020. A third company submitted a request for
emergency use authorization for its vaccine to FDA on February 4, 2021.
In addition, the Federal Emergency Management Agency (FEMA)
provides funding to States (including the District of Columbia), Tribes
and territories, for expenses related to COVID-19 vaccination. In
accordance with a January 21, 2021, Presidential memorandum, FEMA will
reimburse States, territorial, local, and Tribal governments for costs
associated with vaccine distribution and administration through the
Disaster Relief Fund, which had a balance of more than $12.2 billion,
as of February 7, 2021, according to FEMA.\6\ The agency has also
deployed staff across the Nation to support vaccine centers with
Federal personnel and technical assistance.
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\6\ White House, Memorandum to Extend Federal Support to Governors'
Use of the National Guard to Respond to COVID-19 and to Increase
Reimbursement and Other Assistance Provided to States, (Washington, DC:
Jan. 21, 2021), accessed on February 4, 2021, https://
www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/
extend-federal-support-to-governors-use-of-national-guard-to-respond-
to-covid-19-and-to-increase-reimbursement-and-other-assistance-
provided-to-states/. According to FEMA, as of February 7, 2021, it had
provided more than $2.29 billion to 32 States, the District of
Columbia, 3 territories, and 2 Tribes for expenses related to COVID-19
vaccination efforts.
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As shown in table 2, we have made 2 recommendations to improve the
Government's efforts related to vaccines and therapeutics. In
particular, in September 2020, we reported that clarity on the Federal
Government's plans for distributing and administering vaccine, as well
as timely, clear, and consistent communication to stakeholders and the
public about those plans, is essential. In September 2020, we
recommended that HHS, with the support of DOD, establish a time frame
for documenting and sharing a National plan for distributing and
administering COVID-19 vaccines that, among other things, outlines an
approach for how efforts would be coordinated across Federal agencies
and non-Federal entities.
In our January 2021 report, we noted that vaccine distribution and
administration had, as of January, fallen short of expectations. We
reiterated the importance of fully implementing our September 2020
recommendation. (See table 2.)
TABLE 2: GAO'S RECOMMENDATIONS RELATED TO COVID-19 VACCINES AND
THERAPEUTICS
------------------------------------------------------------------------
Recommendation Status
------------------------------------------------------------------------
The Secretary of Health and Human Services Closed. FDA developed a
should direct the Commissioner of the process for working with
Food and Drug Administration (FDA) to drug sponsors to disclose
identify ways to uniformly disclose to its scientific review
the public the information from FDA's documents for therapeutic
scientific review of safety and EUAs and has released this
effectiveness data--similar to the public information for the EUAs it
disclosure of the summary safety and has already issued. For
effectiveness data supporting the vaccine EUAs, FDA is
approval of new drugs and biologics--when holding public Vaccines and
issuing emergency use authorizations Related Biological Products
(EUA) for therapeutics and vaccines, and, Advisory Committee
if necessary, seek the authority to meetings, through which FDA
publicly disclose such information and sponsors are making
(November 2020 report on vaccine and information from scientific
therapeutics). reviews publicly available.
The agency also released
decision memos with
detailed information about
the agency's review of
safety and effectiveness
data for the 2 vaccines
authorized to date.
The Secretary of Health and Human Open. The Department of
Services, with support from the Secretary Health and Human Services
of Defense, should establish a time frame (HHS) neither agreed nor
for documenting and sharing a National disagreed with our
plan for distributing and administering a recommendation. In November
COVID-19 vaccine and, in developing such 2020, we reported that HHS
a plan, ensure that it is consistent with and the Department of
best practices for project planning and Defense had released
scheduling and outlines an approach for initial planning documents
how efforts will be coordinated across for the distribution and
Federal agencies and non-Federal entities administration of potential
(September 2020 report). COVID-19 vaccines, but also
reported that stakeholders
indicated that they would
like to see additional
information as planning
continued.
------------------------------------------------------------------------
Source GAO Analysis/GAO-21-396T.
Medical Supply Chain
The pandemic has highlighted vulnerabilities in the Nation's
medical supply chain, which includes personal protective equipment and
other supplies necessary to treat individuals with COVID-19. Ensuring
the availability of medical supplies to meet the continuing needs of
State, local, Tribal, and territorial governments, as well as point-of-
care providers, such as nursing homes, has been a persistent challenge
for Federal agencies. Continued supply chain constraints may also
hamper HHS's goal of building a 90-day supply of certain key items in
the Strategic National Stockpile (SNS).
Multiple Federal agencies have responsibility for coordinating and
managing the medical supply chain, and HHS and FEMA lead the Federal
response through the Unified Coordination Group.\7\ HHS is designated
as the lead agency to address the public health and medical portion of
the response and FEMA is designated as the lead agency for coordinating
the overall Federal response. The agencies are responsible for
supporting and informing decisions made by the Unified Coordination
Group regarding the allocation, distribution, and procurement of COVID-
related supplies (see fig. 1).
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\7\ The Unified Coordination Group (UCG) is the primary field
entity for the Federal response. The group integrates diverse Federal
authorities and capabilities and coordinates Federal response and
recovery operations. The UCG is jointly led by the administrator of
FEMA, the assistant secretary for preparedness and response, and a
representative of CDC.
We have made 7 recommendations to improve the Federal Government's
efforts to address medical supply challenges highlighted by the
pandemic (see table 3.) In our January 2021 report, we focused on the
role of the SNS, which is an important piece of HHS's strategy to
improve the medical supply chain to enhance pandemic response
capabilities and was being finalized during the course of our review.
However, the Department has yet to develop a process for engaging about
the strategy with key non-Federal stakeholders that have a shared role
for providing supplies during a pandemic, such as State and territorial
governments and the private sector. Our work has noted the importance
of directly and continuously involving key stakeholders, including
Congress, in the development of successful agency reforms and in
helping to harness ideas, expertise, and resources.
In January 2021, we recommended that HHS establish a process for
regularly engaging with Congress and non-Federal stakeholders--
including State, local, Tribal, and territorial governments and private
industry--as the agency refines and implements its supply chain
strategy for pandemic preparedness, to include the role of the SNS.
TABLE 3: GAO RECOMMENDATIONS RELATED TO MEDICAL SUPPLY CHAIN CHALLENGES
------------------------------------------------------------------------
Recommendation Status
------------------------------------------------------------------------
To improve the Nation's response to and Open. HHS generally
preparedness for pandemics, the assistant concurred with our
secretary for preparedness and response recommendation, and added
should establish a process for regularly that improving the pandemic
engaging with Congress and non-Federal response capabilities of
stakeholders--including State, local, State, local, Tribal, and
Tribal, and territorial governments and territorial governments is
private industry--as the Department of a priority.
Health and Human Services (HHS) refines
and implements a supply chain strategy
for pandemic preparedness, to include the
role of the Strategic National Stockpile
(January 2021 report).
The assistant secretary for preparedness Open. HHS concurred with our
and response, in coordination with the recommendation and stated
appropriate offices within HHS, should that it has taken steps to
accurately report data in the Federal manually identify its other
procurement database system and provide transaction agreements in
information that would allow the public its contract writing system
to distinguish between spending on other to allow the public to
transaction agreements and procurement distinguish between
contracts (January 2021 report). spending on agreements and
procurement contracts in
the Federal Procurement
Data System--Next
Generation. HHS also plans
to update its contract
writing system.
The Commissioner of the Food and Drug Open. HHS neither agreed nor
Administration (FDA) should, as the disagreed with our
agency makes changes to its collection of recommendation. In HHS's
drug manufacturing data, ensure the response, FDA said that as
information obtained is complete and the agency continues
accessible to help it identify and efforts to enhance relevant
mitigate supply chain vulnerabilities, authorities and close data
including by working with manufacturers gaps, it will consider
and other Federal agencies (e.g., the GAO's recommendation.
Departments of Defense and Veterans
Affairs), and, if necessary, seek
authority to obtain complete and
accessible information (January 2021
report).
The Secretary of Health and Human Open. HHS disagreed with our
Services, in coordination with the recommendation at the time
administrator of the Federal Emergency the report was issued and
Management Agency (FEMA)--who head noted, among other things,
agencies leading the COVID-19 response the work that the
through the Unified Coordination Group-- Department had done to
should immediately document roles and manage the medical supply
responsibilities for supply chain chain and increase supply
management functions transitioning to the availability.
Department of Health and Human Services,
including continued support from other
Federal partners, to ensure sufficient
resources exist to sustain and make the
necessary progress in stabilizing the
supply chain, and address emergent supply
issues for the duration of the COVID-19
pandemic (September 2020 report).
The Secretary of Health and Human Services Open. HHS disagreed with our
in coordination with the administrator of recommendation at the time
FEMA--who head agencies leading the COVID- the report was issued and
19 response through the Unified noted, among other things,
Coordination Group--should further the work that the
develop and communicate to stakeholders Department had done to
plans outlining specific actions the manage the medical supply
Federal Government will take to help chain and increase supply
mitigate remaining medical supply gaps availability.
necessary to respond to the remainder of
the pandemic, including through the use
of Defense Production Act authorities
(September 2020 report).
The Secretary of Health and Human Open. HHS disagreed with our
Services--who heads one of the agencies recommendation at the time
leading the COVID-19 response through the the report was issued and
Unified Coordination Group--consistent noted, among other things,
with the Department's roles and the work that the
responsibilities, should work with Department had done to
relevant Federal, State, territorial, and manage the medical supply
Tribal stakeholders to devise interim chain and increase supply
solutions, such as systems and guidance availability.
and dissemination of best practices, to
help States enhance their ability to
track the status of supply requests and
plan for supply needs for the remainder
of the COVID-19 pandemic response
(September 2020 report).
The administrator of FEMA--who heads one Open. The Department of
of the agencies leading the COVID-19 Homeland Security, on
response through the Unified Coordination behalf of FEMA, disagreed
Group--consistent with the Department's with our recommendation at
roles and responsibilities, should work the time the report was
with relevant Federal, State, issued and noted, among
territorial, and Tribal stakeholders to other things, the work that
devise interim solutions, such as systems the Department had done to
and guidance and dissemination of best manage the medical supply
practices, to help States enhance their chain and increase supply
ability to track the status of supply availability
requests and plan for supply needs for
the remainder of the COVID-19 pandemic
response (September 2020 report).
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Source GAO/GAO-21-396T.
COVID-19 Health Disparities
Available data from CDC and others demonstrate disparities in
COVID-19 indicators by race and ethnicity, with communities of color
bearing a disproportionate burden of COVID-19 cases, hospitalizations,
and deaths. For example, the available data on COVID-19
hospitalizations show that as of February 12, 2021, the rate of COVID-
19-associated hospitalizations for non-Hispanic American Indian/Alaska
Native persons is 3.7 times the rate for non-Hispanic White persons,
when adjusting for age.\8\ Available data from CDC on the percentage of
positive COVID-19 tests and on recipients of COVID-19 vaccinations also
demonstrate racial and ethnic disparities.
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\8\ Hospitalization data through January 30, 2021, are from CDC's
COVID-19-Associated Hospitalization Surveillance Network (COVID-NET),
which collects data on COVID-19 hospitalizations that are confirmed by
laboratory testing from select counties in 14 States, representing 10
percent of the U.S. population. It includes data from hospitals in
select counties in California, Colorado, Connecticut, Georgia, Iowa,
Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon,
Tennessee, and Utah. American Indian/Alaska Native, Asian, and Black,
and White persons were non-Hispanic. Hispanic or Latino persons might
be of any race.
Age-adjusted case, hospitalization, and death rates were
standardized to the 2019 U.S. intercensal population. Age-adjusted
rates, which hold constant the age distributions between different
population groups, allow researchers to focus analyses on other
demographics, such as race and ethnicity, without being concerned about
differences that are due to different age distributions of the racial
and ethnic groups. Age-adjusted rates are particularly important to
consider for indicators of COVID-19 because persons in older age groups
are more likely to experience hospitalizations and racial and ethnic
groups have different age distributions in the U.S. population.
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Testing.--As of January 7, 2021, among COVID-19 diagnostic test
results reported to CDC from laboratories in 48 jurisdictions,
the percent of tests that were positive by each racial and
ethnic group was: 17.9 percent for Hispanic or Latino persons,
13.2 percent for non-Hispanic Native Hawaiian or Other Pacific
Islander persons, 12.4 percent for non-Hispanic American
Indian/Alaska Native, and 11.2 percent for non-Hispanic Black
persons, compared to 9.5 percent for non-Hispanic White
persons.\9\
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\9\ Department of Health and Human Services, Centers for Disease
Control and Prevention. Report to Congress on Paycheck Protection
Program and Health Care Enhancement Act Disaggregated Data on U.S.
Coronavirus Disease 2019 (COVID-19) Testing, 8th 30-Day Update (January
2021). CDC data represent viral COVID-19 laboratory test results from
laboratories in the United States, including commercial laboratories,
public health laboratories, and other testing locations from 48
jurisdictions. The data represent total laboratory tests, not
individual people, and exclude antibody and antigen tests.
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Vaccinations.--Data showed disparities by race and ethnicity in
vaccine recipients who received at least one dose whose race
and ethnicity was known as of February 8, 2021:
62.9 percent were non-Hispanic White (compared to 60.1
percent of the U.S. population),
8.9 percent were Hispanic or Latino (compared to 18.5
percent of the U.S. population), and
5.9 percent were non-Hispanic Black (compared to 13.4
percent of the U.S. population).\10\
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\10\ CDC COVID Data Tracker, https://covid.cdc.gov/covid-data-
tracker/#vaccination-demographic, accessed February 9, 2021.
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While CDC collects and makes race and ethnicity data on indicators
of COVID-19 available to the public, we found gaps in the data for
COVID-19 indicators. For example, as of February 2, 2021, race and
ethnicity was missing for 48.8 percent of COVID-19 cases with case
report forms received by CDC, or 61.5 percent of total cases
reported.\11\ Additionally, as of February 8, 2021, data collected from
States and jurisdictions on race and ethnicity for COVID-19 vaccine
recipients were missing for almost half (45.6 percent) of recipients
who received at least 1 dose.
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\11\ CDC officials reported that the number of cases with case
report forms received by CDC is less than the total number of reported
cases because there is generally a 2-week lag from when total cases are
reported by State and jurisdictional health departments to when CDC
receives the case report forms. Total cases reported by CDC include
both probable and confirmed cases as reported by States or
jurisdictions. A probable case does not have confirmatory laboratory
evidence, but meets certain other criteria.
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We made 3 recommendations to address the gaps in race and ethnicity
data (see table 4). CDC agreed with the recommendations.
TABLE 4: GAO'S RECOMMENDATIONS RELATED TO COVID-19 HEALTH DISPARITIES
------------------------------------------------------------------------
Recommendation Status
------------------------------------------------------------------------
As the Center for Disease Control and Open. CDC agreed with our
Prevention (CDC) implements its COVID-19 recommendation. In response
Response Health Equity Strategy, the to our recommendation, CDC
director of CDC should determine whether stated in January 2021 that
having the authority to require States the agency is committed to
and jurisdictions to report race and having discussions, both
ethnicity information for COVID-19 cases, internally and with
hospitalizations, and deaths is necessary stakeholders, to assess
for ensuring more complete data and, if whether having and
so, seek such authority from Congress implementing authority to
(September 2020 report). require States and
jurisdictions to report
race and ethnicity
information for COVID-19
cases would result in
improved reporting.
As CDC implements its COVID-19 Response Open. CDC agreed with our
Health Equity Strategy, the director of recommendation. In response
CDC should involve key stakeholders to to our recommendation, CDC
help ensure the complete and consistent stated in January 2021 that
collection of demographic data (September the agency is working with
2020 report). State and local health
departments, in addition to
other stakeholders, to
accelerate the reporting of
demographic data and
improve data quality,
including for information
on race and ethnicity.
As CDC implements its COVID-19 Response Open. CDC agreed with our
Health Equity Strategy, the director of recommendation. In response
CDC should take steps to help ensure to our recommendation, CDC
CDC's ability to comprehensively assess noted in October 2020 that
the long-term health outcomes of persons the agency is convening a
with COVID-19, including by race and team to develop a plan to
ethnicity (September 2020 report). monitor the long-term
health outcomes of persons
with COVID-19 by
identifying health care
surveillance systems that
can electronically report
health conditions to State
and local health
departments.
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Source GAO/GAO-21-396T.
COVID-19 Data Collection and Standardization
The Federal Government does not have a process to help
systematically define and ensure the collection of standardized data
across relevant Federal agencies and related stakeholders to help
respond to COVID-19, communicate the status of the pandemic with
citizens, or prepare for future pandemics. As a result, COVID-19
information that is collected and reported by States and other entities
to the Federal Government is often incomplete and inconsistent.
The lack of complete and consistent data limits HHS's and others'
ability to monitor trends in the burden of the pandemic across States
and regions, make informed comparisons between such areas, and assess
the impact of public health actions to prevent and mitigate the spread
of COVID-19. Further, incomplete and inconsistent data have limited
HHS's and others' ability to prioritize the allocation of health
resources in specific geographic areas or among certain populations
most affected by the pandemic. For example, HHS's data on COVID-19 in
nursing homes do not capture the first 4 months of the pandemic,
because the agency did not require nursing homes to report until May 8,
2020. The gaps in reporting limits the usefulness of data in helping to
understand the effects of COVID-19 in nursing homes. GAO has made 2
recommendations to improve the collection of data needed to respond to
COVID-19 and prepare for future pandemics.
In January 2021, we recommended that HHS immediately establish an
expert committee comprised of knowledgeable health care professionals
from the public and private sectors, academia, and nonprofits or use an
existing one to systematically review and inform the alignment of on-
going data collection and reporting standards for key health
indicators.
In addition, in September 2020, we recommended that HHS, in
consultation with CMS and CDC, develop a strategy to capture more
complete data on COVID-19 cases and deaths in nursing homes
retroactively back to January 1, 2020.
In conclusion, we have made 16 recommendations to improve the
Government's pandemic response in the areas of COVID-19 testing,
vaccines and therapeutics, medical supply chain, COVID-19 health
disparities, and COVID-19 health data. Most of the recommendations have
not been implemented. We maintain that doing so would improve the
Government's response. We will continue to monitor the implementation
of our past recommendations as part of our on-going oversight of the
Government's COVID-19 response and recovery efforts on behalf of
Congress.
Chairman Thompson, Ranking Member Katko, and Members of the
committee, this concludes my prepared statement. I would be pleased to
respond to any questions that you may have at this time.
Chairman Thompson. Thank you very much.
Now I ask Dr. Watson to summarize her statement for 5
minutes.
STATEMENT OF CRYSTAL R. WATSON, DR PH, SENIOR SCHOLAR, JOHNS
HOPKINS CENTER FOR HEALTH SECURITY, AND ASSISTANT PROFESSOR,
DEPARTMENT OF ENVIRONMENTAL HEALTH AND ENGINEERING, JOHNS
HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
Ms. Watson. Mr. Chairman, Ranking Member Katko, and Members
of the committee, thank you very much for the opportunity to
testify to you today.
One year ago the director of our center, Dr. Tom Inglesby,
testified to this committee about the grave threat of COVID-19
and the need for a robust response. There was significant
uncertainty at that time about how the pandemic would play out.
Today we have answers to many of the early unknowns and are
now vaccinating millions of Americans per day, but on balance
our National response has not met its potential and many
thousands of deaths have occurred unnecessarily as a result.
As has been said, we have just reached a terrible total of
half a million deaths Nation-wide. More Americans have now died
from COVID-19 than in all 20th Century wars combined. Despite
having only 4 percent of the world's population, our country
has contributed 25 percent of the global total of cases and 21
percent of reported deaths. These are just the officially
reported statistics. The true burden of COVID-19 is unknown,
but is estimated to be much higher than what is recorded.
As has been stated already, the consequences of the
pandemic have been appalling unequal. When adjusted for age,
people of color and indigenous people have been over twice as
likely to die from COVID.
Yet while the last year has been a nightmare, there are now
some glimmers of hope. The number of U.S. cases,
hospitalizations, and deaths are all dropping rapidly from the
winter peak. I expect that this trend will continue due to a
combination of mitigation measures and vaccinations. While the
vaccine roll-out has been anything but smooth, it is improving.
The emergence of consequential SARS-CoV variants of concern are
troubling, but I am hopeful that vaccination and current
mitigation measures will prevent a severe resurgence in the
United States this spring. However, it is something that we
obviously have to watch very closely.
Vaccination is the centerpiece of the current U.S.
response, but it is also important to note that low- and
middle-income countries are mostly still waiting for a vaccine.
This is a humanitarian crisis for those countries, and it also
represents a significant risk for the world because it could
prolong the pandemic.
Now, I would like to take a few moments to briefly
highlight some of the successes and failure of the U.S.
response over the last year. First, the successes. It is so
important to recognize that the response represents collective
work from tens of thousands of people across the country. We
should be truly thankful for the heroic efforts of those who
have worked to reduce the [inaudible]. Of course, the biggest
and most visible success over the past year has been the
development of multiple highly safe and effective vaccines and
therapeutics. I can't emphasis enough what a technical feat
this is.
Now, to the challenges. Over the last year health officials
and experts who tried to follow the evidence and protect the
public's health, including implementing masking, contact
tracing, and business restrictions, have faced harassment and
political pressure and have at times been stripped of or
resigned their positions. In addition, risk communication has
been severely challenging in the face of high-level denial of
the severity of the pandemic and overt politicization of public
health measures intended to keep people safe. These failings
have allowed the virus to flourish.
Historically, our public health agencies have not been
sufficiently resourced to respond to a crisis of this
magnitude. As just one example, during this response only $200
million was provided to States to support distribution and
administration of vaccines during the largest max vaccination
campaign in our Nation's history.
Support for our health care response has been similarly
dismal. States often had to go it alone when procuring
important things like ventilators, testing supplies, and PPE
for front-line health workers.
Finally, the withdrawal from the WHO and withholding of
contributions from COVAX both weakened our position as a global
health security leader and limited global vaccination efforts.
With the new administration and Congress in place I am
hopeful that our response to the rest of the pandemic will be
much more evidence-based, coordinated, and effective. The
American Rescue Plan currently being considered by Congress
would provide significant support for the response, as well as
authorization for new programs that will begin our investment
in future preparedness. I look forward to the passage of this
bill and better days ahead.
This concludes my testimony. I am grateful to the committee
for inviting me and would be happy to take questions.
Thank you.
[The prepared statement of Ms. Watson follows:]
Prepared Statement of Crystal R. Watson
February 24, 2021
Chairman Thompson, Ranking Member Katko, and Members of the
committee, thank you for the opportunity to speak with you today about
the COVID-19 pandemic.
My name is Crystal Watson. I am a senior scholar at the Johns
Hopkins Center for Health Security and an assistant professor in the
Johns Hopkins Bloomberg School of Public Health. The opinions expressed
herein are my own and do not necessarily reflect the views of The Johns
Hopkins University. Today, I will provide comments on the status of the
COVID-19 pandemic and the U.S. Government's response efforts to date,
as well as the major successes and failures of the last year, and what
we should look forward to, and prepare for in the coming weeks and
months.
the covid-19 pandemic: a retrospective
One year ago, the director of our Center, Dr. Tom Inglesby,
testified to this committee about the grave threat of COVID-19 and the
need for a robust Federal, State, and local response. Dr. Inglesby's
warning about the need for resources and coordination was made amidst
significant uncertainty about how the pandemic would play out. At that
time, there were only 100 recognized cases of COVID-19 and 6 deaths
reported here in the United States. We did not know how severe the
pandemic would be, what mitigation measures would be most effective at
reducing transmission, whether we would be able to develop vaccines in
time to prevent illness and save lives, and whether masks would be a
significant and socially accepted means of limiting transmission, among
other unknowns. What we did have at the time was a strong sense that
the COVID-19 pandemic could be a once in a generation event, and that
great attention and effort would be needed to prevent the worst-case
outcomes.
One year later, thanks to the efforts of scientific and public
health leaders, we have answers to many of the open questions of early
2020 and are beginning to vaccinate Americans in large numbers.
Significantly though, we also have evidence that our National response
did not meet its potential and that many thousands of unnecessary
deaths have occurred as a result.
As of February 21, 2021, the world has now surpassed 111 million
reported cases and 2.4 million reported deaths. In the United States
alone, we have just reached a terrible cumulative total of half a
million deaths Nation-wide and about 30 million cases.\1\ More
Americans have now died from COVID-19 than in WWI, WWII, Vietnam,
Korea, and Gulf wars combined.\2\
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\1\ Johns Hopkins Coronavirus Resource Center. https://
coronavirus.jhu.edu/map.html.
\2\ Hedges C. What every person should know about war. The New York
Times. July 6, 2003. https://www.nytimes.com/2003/07/06/books/chapters/
what-every-person-should-know-about-
war.html#:?:text=In%20the%20twentieth%20century%2C%20approximately,148%2
0in%20the%20- Gulf%20War.
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For the last year, the United States has held the dubious
distinction of leading the world in COVID-19 cases. Despite having only
4 percent of the world's population, our country has contributed 25
percent of the total number of reported cases and 21 percent of
reported deaths.\3\ We are also 8th in the world in terms of deaths per
100,000 population despite having significant success in improved
treatment for COVID-19 patients. For those who might suggest that our
case numbers are merely a result of more robust testing and
surveillance capacity, it should be noted as an example that our
Canadian neighbors, who are doing excellent surveillance, have 1/3 as
many deaths, with only 58 per 100,000 population compared to our 152
per 100,000.\4\
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\3\ Andrew S. The U.S. has 4 percent of the world's population but
25 percent of its coronavirus cases. June 30, 2020. https://
www.cnn.com/2020/06/30/health/us-coronavirus-toll-in-numbers-june-trnd/
index.html.
\4\ Johns Hopkins Coronavirus Resource Center. Mortality Analysis.
https://coronavirus.jhu.edu/data/mortality.
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And these are just the officially reported statistics. The true
burden of COVID-19 is unknown but is estimated to be much higher than
what is recorded. For example, the U.S. Centers for Disease Control and
Prevention (CDC) estimates that there are actually between 4 and 5.4
times as many infections than what we have recognized.\5\
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\5\ U.S. Centers for Disease Control and Prevention. Estimated
Disease Burden of COVID-19. Updated January 19, 2021. https://
www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html.
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beyond the numbers
All of these numbers are so large that they are difficult to
comprehend. The real toll of this last year cannot be captured in the
facts and figures alone. Many of those lost to the pandemic had family,
loved ones, friends, and coworkers whose lives have been irreparably
altered by their passing.
There are many also who live with the aftereffects of this disease
even if their symptoms were initially mild. Recent findings in JAMA
show that on the order of 30 percent of people may have ``post-COVID
syndrome'' with persistent symptoms such as fatigue, loss of taste and
smell, memory problems, shortness of breath, and chest pain, which
affect the ability to perform everyday activities like household chores
or exercise.\6\
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\6\ Gupta S. Almost a third of people with `mild' COVID-19 still
battle symptoms months later, study finds. CNN Health. February 19,
2021. https://www.cnn.com/2021/02/19/health/post-covid-syndrome-long-
haulers-gupta-wellness/index.html.
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Many of us have experienced loss during this last year. Every death
witnessed by a health care worker has taken a toll. People have lost
their jobs, livelihoods, been evicted, suffered from isolation and
loneliness, and faced extreme burnout from the prolonged intensity of
this crisis.
Children have lost a year of in-person school and connection with
peers, and families with young children are facing incredible pressures
without adequate child care.
The consequences of COVID-19 have been appallingly inequitable.
People of color and indigenous people have been disproportionately
affected by this virus. When adjusted for age, Black, Pacific Islander,
Latino/x, and Indigenous people have all been over twice as likely to
die from COVID-19 than White people.\7\
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\7\ APM Research Lab. COVID-19 Deaths by Race and Ethnicity in the
U.S. February 4, 2021. https://www.apmresearchlab.org/covid/deaths-by-
race.
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The reason for this inequity is multifaceted, but we know that it
stems from deeply-rooted problems that long pre-dated the COVID-19
pandemic. First, there are imbedded and long-established disparities in
access to health care, so getting quality treatment is a challenge. We
also know that a history of abuses has resulted in loss of trust in
Government and the health care system, which translates to lower care-
seeking behavior and vaccine acceptance among these populations.
Furthermore, underlying health problems including diabetes and heart
disease, which are more prevalent in minority populations because of
systemic inequities and racism, also increase the risk for severe
disease and death from COVID-19.
where we are right now in the united states
While the last year has been a nightmare, in the past few weeks
there are now glimmers of hope. The number of U.S. cases,
hospitalizations, and deaths are all dropping rapidly from the winter
peak, which was the highest of the pandemic. Daily case numbers have
fallen from a high of over 295,000 reported on January 8 to about
72,000 as of February 20. Similarly, hospitalizations have come down
dramatically from a National 7-day average of about 130,000 to about
63,000; and deaths are following, having dropped from a 7-day average
of over 3,500 per day to around 2,000 per day. This is still far too
many deaths, but the trend is in the right direction.\8\ Ideally, we
will need to reduce daily incidence of COVID-19 to under 10 cases per
day per 100,000 population to truly get back to a place where we can
effectively contact trace and manage individual cases. If we can do
that, we will continue to drive infections down and hopefully prevent
future surges.
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\8\ The COVID Tracking Project. The Data. https://
covidtracking.com/data#summary-charts. Accessed February 21, 2021.
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I hope and expect that we will continue to see cases decrease to a
much lower and more manageable level due to a combination of personal
and public health mitigation measures like masking, social distancing,
business restrictions, and contact tracing; and an increase in
population immunity from vaccination and prior COVID infections. As of
February 21, about 12.9 percent of the U.S. population has been
vaccinated,\9\ and more people in the United States have now received
at least one dose of vaccine than the number of people reported to have
had COVID.\10\
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\9\ Huang P, Carlsen A. How is the COVID-19 vaccination campaign
going in your state? NPR Shots. February 21, 2021. https://www.npr.org/
sections/health-shots/2021/01/28/960901166/how-is-the-covid-19-
vaccination-campaign-going-in-your-state.
\10\ U.S. Centers for Disease Control and Prevention. COVID Data
Tracker. https://covid.cdc.gov/covid-data-tracker/#vaccinations.
Accessed February 21, 2021.
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This is great news, and while the vaccine rollout has been far from
easy or smooth, it continues to improve. I expect that vaccination
rates will continue to increase as manufacturers deliver supplies and
other vaccines become available for use in the near future.
My optimism here is somewhat tempered by the emergence of SARS-CoV-
2 variants of concern. For example, the B.1.1.7 variant that has been
shown to be more transmissible, and the B.1.351 and P.1 variants that
have been shown to have some level of immune escape rendering
vaccination and natural immune defenses less protective. Currently, the
variant of most immediate concern in the United States is B.1.1.7
because our surveillance shows that it is already in at least 42 States
and is outcompeting other variants, but it is still unclear whether
this will result in yet another surge in U.S. cases. In the United
Kingdom, B.1.1.7 necessitated National stay-at-home orders because of
the steep increase of cases. But the United Kingdom surge also
coincided with the winter holidays and occurred before mass vaccination
had started in earnest, which was the worst possible timing. I am
tentatively hopeful that vaccination and current limitations on
business occupancy and travel will prevent a similar resurgence in the
United States. However, it is something we must watch closely.
Variants with mutations that escape our immune defenses like P.1.
and B.1.351 may yet become a greater threat, particularly in the fall
and winter of 2021. If we are to avoid a resurgence of cases at that
time, we need to make sure that our vaccines are as protective as
possible, which may require a third dose or vaccine booster. Vaccine
manufacturers, scientists, and Government officials are currently
working hard to plan for this possibility, but it is a significant
scientific and logistical challenge that remains for the country.
current global picture
I am focusing largely on the U.S. response in today's testimony but
would be remiss if I didn't at least touch on the global status of the
pandemic and vaccine rollout.
There are a handful of countries that have been so successful at
keeping the SARS-CoV-2 virus out and quenching any introductions before
they can turn into epidemics, that they are virtually virus-free. In
these parts of the world, citizens are able to live largely apart from
the pandemic and go about their normal lives. There are also countries
with virtually zero capacity to respond to COVID-19, and in those
places, we do not have enough disease surveillance to know how people
are affected.
Vaccination has been the center piece of the response in the United
States and other high-income countries since December, while low- and
middle-income countries still wait for vaccine. The international
leader in vaccination thus far is Israel, which has over 30 percent of
its population fully vaccinated. The good news from Israel is that
preliminary data seems to show that vaccination there has provided both
significant protection from infection and from severe disease and
death, even in the face of the B.1.1.7 variant as the dominant variant
in the country.\11\
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\11\ Mitnick J, Regalado A. A leaked report shows Pfizer's vaccine
is conquering COVID-19 in its largest real-world test. MIT Technology
Review. February 19, 2021. https://www.technologyreview.com/2021/02/19/
1019264/a-leaked-report-pfizers-vaccine-conquering-covid-19-in-its-
largest-real-world-test/.
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While this is heartening, the success of Israel is in sharp
contrast to low-income countries that have not even begun vaccinating
their health care workers, much less the general population, and will
likely not have sufficient vaccine for many months to come. This global
inequity is resulting in a humanitarian crisis for low- and middle-
income countries, and it also represents a significant risk for the
entire world; the longer this virus circulates at high levels, the
greater the risk of new mutations that could result in dangerous
variants which are resistant to vaccines and could prolong the
pandemic.\12\
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\12\ Shah S, Steinhauser G, Solomon F. Vaccine delays in developing
nations risk prolonging pandemic. The Wall Street Journal. https://
www.wsj.com/articles/faltering-covid-19-vaccine-drive-in-developing-
world-risks-prolonging-pandemic-11613557801.
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successes of the u.s. pandemic response
Next, I would like to take a few moments to highlight some of the
successes and failures of the U.S. response over the last year.
First, the successes. It is so important to recognize that the U.S.
response represents collective work of tens of thousands of people
across the country, as well as millions of Americans who had to
sacrifice tremendously to take protective actions. People working
collectively and non-stop over the past year in Federal agencies;
State, territorial, Tribal, and local governments; hospitals and Dr.
offices; mental health organizations; universities; laboratories;
mortuaries, and many other organizations. It has been a year of
constant and extreme stress, and life-and-death decisions. Many lives
have been saved by the actions of our responders, and we should be
truly thankful for the heroic efforts of those who have worked to
reduce COVID-19's impact.
We also owe a great debt of gratitude to essential workers who have
kept our society functioning, our supply chains moving, our shelves
stocked, and our power running. People have shown great courage in the
face of the virus and have maintained continuity of critical societal
functions, allowing us to be more resilient than we might have
imagined.
Finally, the biggest and most visible success of the past year is
the development of multiple highly safe and effective COVID-19 vaccines
in under a year. I cannot emphasize enough what a technical feat this
is. The reasons for this success are many, but it is anchored in
planning, capabilities, and science that have been developed over time
by the U.S. Government, international partners, industry, and academia.
This experience should shape our medical countermeasures development
planning and investment for the future. There are additional lessons
and new technologies that we can harness to be ready for the next
pandemic. The COVID-19 pandemic has taught us that we cannot simply
plan for known viral threats and limit ourselves to a list-based
approach to medical countermeasure development. The Department of
Health and Human Services and the Department of Defense should also
invest in pathogen-agnostic platform technologies with the goal of
quickly developing new medical countermeasures against novel viruses.
failures of the u.s. pandemic response
My time to testify here does not adequately allow for a full
reckoning for the failures of the U.S. response over the last year, but
there are some that I want to make sure to highlight for this
committee.
Over the last year, public health leaders, scientists, and many
others who have spoken out in defense of scientific fact and truth
about the pandemic have suffered retribution and terrible treatment.
Health officials and experts who have implemented or recommended
evidence-based interventions including masking, contact tracing, and
business restrictions, have been threatened both verbally and
physically. They have been harassed on-line and had threatening
packages mailed to their homes. They have faced political pressure and
backlash from elected officials from the top of Government on down and
have at times been stripped of or resigned their position in the midst
of the pandemic. More than 27 health officers in 13 States have
resigned or been fired in the last year, leaving our public health
agencies even less equipped to respond. This is unacceptable and
dangerous.\13\
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\13\ Mello M, Greene JA, Sharfstein JM. Attacks on public health
officials during COVID-19. JAMA. August 5, 2020. https://
jamanetwork.com/journals/jama/fullarticle/2769291.
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As colleagues eloquently stated in a recent JAMA commentary,
``Instead of attacking their health officials, elected leaders should
provide them with protection from illegal harassment, assault, and
violence.''\13\ They should also be turning to their health officers
for public health advice and providing them with the resources that
will make their jobs more successful.
This leads me into a second and related failing of this response:
The politically-driven failure to heed expert advice, silencing or
sidelining of Federal experts, and censoring or cherry-picking of data.
As examples, the previous administration reportedly sought on several
occasions to withhold important data from the public about the
impending crisis. And, on multiple occasions in 2020, political
appointees altered CDC's Morbidity and Mortality Weekly Report
publications and other reports that did not align with the White
House's messaging about pandemic risk or preferred courses of
action.\14\
---------------------------------------------------------------------------
\14\ Viglione G. Four ways Trump has meddled in pandemic science--
and why it matters. Nature News. November 3, 2020. https://
www.nature.com/articles/d41586-020-03035-4.
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High-level denial of the severity of the pandemic and
disempowerment of scientists and public health experts led both to
under-resourcing of the response and significant confusion for the
public. Furthermore, overt politicization of the public health measures
intended to keep people safe allowed the virus to flourish as people
were convinced that wearing a mask was weak, that public health
officials were trying to steal their identities when conducting contact
tracing, and that restrictions on businesses were scientifically
unfounded. This is why we have so many more cases and deaths than other
countries.
Within the response itself, there are a few significant issues that
should be highlighted. Our public health agencies have been underfunded
and overburdened long before COVID-19, through multiple Republican and
Democratic administrations, but they were also not sufficiently
resourced or supported by the Federal Government during this response.
While funds from the Cares Act did go to health departments, it was not
enough.
Support for State, territorial, and Tribal vaccination planning is
a particularly damaging failure. While the U.S. Government has
understandably spent billions of dollars on vaccine development, only
$200 million was provided to States for the actual distribution and
administration of vaccine in the largest mass vaccination effort that
our country has ever undertaken. This is despite pleas from public
health experts for additional funding and guidance.\15\
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\15\ Florko N. Trump officials actively lobbied to deny States
money for vaccine rollout last fall. Stat News. January 31, 2021.
https://www.statnews.com/2021/01/31/trump-officials-lobbied-to-deny-
states-money-for-vaccine-rollout/.
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Support for our health care response has been similarly dismal.
States often had to `go it alone' in ensuring supply chains for
important things like ventilators, testing supplies, and personal
protective equipment for front-line health workers.
Last, but certainly not least, the United States' withdrawal from
the World Health Organization and the withholding of contributions to
COVAX both weakened our position as a global health security leader and
limited burgeoning global vaccination efforts. I am encouraged to see
that the United Stated has reversed these positions and has pledged
significant support to COVAX.
new administration priorities and continued progress
With the new Biden administration and this Congress in place, I am
hopeful that our response to the remainder of the COVID-19 pandemic
will be much more evidence-based, coordinated, and effective.
Recent decisions to support acquisition of additional vaccine and
enable health and scientific experts to communicate directly and
honestly with the American people are already paying dividends.
The administration should continue to prioritize strong leadership
for the response in Federal agencies, including by appointing an
Assistant Secretary for Preparedness and Response (ASPR) within the
Department of Health and Human Services as soon as possible; ensuring
that sufficient Federal support and resources are being provided to
enable equitable access to vaccine; and making every investment
necessary to prepare for the possibility of updating vaccines to
protect against immune escape variants.
Finally, I am glad to see that the American Rescue Plan legislation
currently being considered by Congress provides significant support for
the on-going response as well as funding and authorization for new
programs that will begin our investment in our future preparedness. I
look forward to the passage of this bill and better days ahead.
That concludes my testimony. I am grateful to the committee for
inviting me to contribute to the hearing and would be happy to take any
questions.
Chairman Thompson. Thank you. Thank you very much.
I now ask Dr. Ezike to summarize her statement for 5
minutes. I apologize if I mispronounced the word. Charge it to
my hearing, not my heart.
STATEMENT OF NGOZI O. EZIKE, MD, DIRECTOR, ILLINOIS DEPARTMENT
OF PUBLIC HEALTH
Dr. Ezike. No problem, sir. Thank you. Chairman Thompson,
Ranking Member Katko, and distinguished Members of the
committee, thank you for inviting me here to speak today about
Illinois' response to the coronavirus pandemic.
We have had more than 1.1 million cases of COVID-19 in
Illinois and, even more deplorable, over 20,000 parents,
grandparents, and children who have succumbed to this baleful
disease. From the outset of the pandemic our response has been
guided by a focus on data, science, and equity. 2020
mitigations necessary to curb infection transmission and
protect health care capacity still left an indelible mark on
the State of Illinois and the lives of our residents.
As a State we have made significant investments in testing
and contact tracing. Our State lab was the first in the country
to validate and run in-house the CDC's PCR test and we are
proud to rank fifth among States for a total number of COVID
tests run.
As vaccines are distributed, the benefit of vaccination
will depend on: (1) How rapidly and broadly we can turn vaccine
into vaccination and (2) how effectively we limit viral
replication, thus limiting the creation of new variants of
concern. In Illinois more than 2.3 million doses have been
administered. Currently we have administered 90 percent of all
delivered doses outside of the long-term care pharmacy
partnership program. We currently rank fifth among States in
total vaccines administered.
The Department of Public Health has been intentional about
engaging disproportionately-impacted communities. From the
beginning of our response, we created a health equity work
group that was embedded into all aspects of the response. We
assembled a diverse speakers bureau to support multilingual
virtual town halls for cultural groups, work groups, faith
communities, and other special groups. Our Ambassador program
enlists nearly 1,000 Illinois residents to share information
via personal social medial channels to their friends and family
and peers on prevention, testing locations, treatments, and
vaccines. We aim to create confidence and trust in the
available vaccines through education and culturally appropriate
respectful engagement. Our hope is that when people get the
facts, then they will get the vax.
When I testified before this committee a year ago, one of
our primary concerns was a lack of PPE for health care workers
and first responders. Today, we are in a much better position
as production and demand have equalized. Even so, we learned a
very valuable lesson about the global supply of medical
products that must inform our future planning for Strategic
National Stockpile and domestic production.
One of the biggest hurdles to a successful response over
the past year has been a lack of clear and consistent
communication and modeled messaging from the highest levels of
government on down. While we appreciate the increased planning,
transparency, invocation of the Defense Production Act for
vaccine supplies and PPE and the securing of 600 million doses
by July, today we still have to contend with the good trouble
of having more rolled-up sleeves than vaccine-filled syringes.
We are seeing increases in our vaccine supply and welcoming
the strong commitment from the Federal Government to augment
the States' vaccination efforts. The promise of a 3-week lead
time on vaccine allocation has been welcome news both to the
States and to all of our local partners. Last month Governor
Pritzker announced the activation of the Illinois National
Guard to assist local health departments in administering
vaccines. To date, 44 teams have been deployed with the plan to
reach 100 total Guard teams in the coming weeks.
FEMA is another great partner in our efforts and the 100
percent Federal cost coverage allows us to support additional
high-priority areas. We have also discussed mass vaccination
centers and are hopeful that this Federal-State partnership
will come to fruition.
To bring this pandemic to an end we need to stay focused on
the multi-layered approach of masking, social distancing,
testing, genomic sequencing, contact tracing, in addition to
vaccination. To maintain all these efforts States need
consistent resources, but also expertise and National guidance.
Yes, National strategies have a clear role and function in
battling pandemic because State borders do not keep out the
virus. Yes, our National strategy has to include control of the
virus in other countries, especially developing countries,
because as we have also learned, no one is truly safe until all
of us are safe and viruses are only as far as away as the
furthest flight or the furthest cruise voyage.
I look forward to continued collaboration with Congress and
the administration to see the other side of this pandemic,
where pandemic fatigue, frustration, and fear is replaced with
the post-pandemic side of relief.
Thank you.
[The prepared statement of Dr. Ezike follows:]
Prepared Statement of Ngozi O. Ezike
February 24, 2021
Chairman Thompson, Ranking Member Katko, and distinguished Members
of the committee, thank you for inviting me here today to speak about
Illinois' response to the coronavirus pandemic. Over the past year in
Illinois, we have had more than 1.1 million cases of COVID-19 and,
unfortunately, more than 20,000 of our people have succumbed to this
baleful disease.
From the outset of the pandemic, our response has been guided by a
focus on data, science, and equity. The year 2020 was marked by
mitigations necessary to curb infection transmission and protect health
care capacity, but they also left an indelible mark on the State of
Illinois and the lives of our residents.
As a State we have made huge investments in testing and contact
tracing and are proud to rank 5th among States and territories for the
number of COVID tests administered. Illinois was the first State in the
country to validate the Centers for Disease Control and Prevention's
(CDC) COVID-19 PCR test and all 3 of our State laboratories began
running samples early in the pandemic. These 3 laboratories began
State-wide sentinel surveillance testing almost a year ago, enabling
Illinois to determine how COVID-19 was circulating in our communities.
So, it is with great hope that we embrace the advent of vaccines
that are a pathway to ending this calamitous period in our State and
National history. Through efficient and effective distribution of the
vaccine, we can suppress the spread of the virus and save many lives.
The Illinois Department of Public Health (IDPH) has been working in
close partnership with our 97 local health departments, hospitals,
retail pharmacies, Federally-qualified health centers (FQHCs), and many
other partners across the State to ensure vaccination occurs with both
velocity and equity. To date we have enrolled hundreds of new providers
to receive and administer COVID vaccines. We have also expanded scopes
of practice to allow more health care providers to administer vaccines,
such as dentists, pharmacists, and EMTs above the basic level.
In Illinois, vaccines are currently distributed according to the
population of each county, adjusted to ensure health equity using the
COVID-19 Community Vulnerability Index (CCVI), a measure of
vulnerability to COVID-19 at the State, county, or census tract level
that combines health determinants such as epidemiology of underlying
chronic conditions and access to care with the CDC Social Vulnerability
Index.\1\ Due to the initial limited supply of vaccine and the
established priority groups, we directed our allocations of vaccine to
local health departments (with subsequent distribution to hospitals)
and our large retail pharmacy partners. As vaccine availability
continues to increase, we will allocate across a growing, more
expansive provider network throughout the State.
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\1\ Surgo Ventures. (2020, December). COVID-19 Community
Vulnerability Index (CCVI) methodology. https://covid-static-
assets.s3.amazonaws.com/US-CCVI/COVID-19+Community+-
Vulnerability+Index+(CCVI)+Methodology.pdf.
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The ultimate benefits of vaccination against COVID-19 will depend
on how well we are controlling the spread of the virus and how swiftly
and broadly we can implement the vaccine.\2\ In Illinois, 1,779,143
people have received their first dose of vaccine as of February 21,
2021.\3\ We are doing everything we can to vaccinate our share of the
more than 200 million people necessary to achieve herd immunity against
COVID-19.\4\
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\2\ Paltiel, A.D., Schwartz, J.L., Zheng, A., & Walensky, R.P.
(2020). Clinical outcomes of a COVID-19 vaccine: Implementation over
efficacy. Health Affairs, 40(1). https://doi.org/10.1377/
hlthaff.2020.02054.
\3\ Centers for Disease Control and Prevention. (2021, January 31).
Number of people receiving 1 or more doses reported to the CDC by
State/territory and for selected Federal entities per 100,000 [Data
set]. Retrieved from https://covid.cdc.gov/covid-data-tracker/
#vaccinations.
\4\ Randolph, H.E., & Barreiro, L.B. (2020). Herd immunity:
Understanding COVID-19. Immunity, 52(5), 737-741. https://dx.doi.org/
10.1016/j.immuni.2020.04.012.
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In order to reach populations that have been disproportionately
impacted by COVID, IDPH has been intentional about engaging hard-hit
communities across the State with the most up-to-date information,
answering questions and addressing any concerns people may have,
particularly around vaccine hesitancy and distrust. False narratives
abound--especially in our communities of color--and we must come
together to create confidence and trust in the available vaccines. To
this end we created a COVID-19 Ambassador program to support State
efforts to stop the spread of COVID-19 by enlisting individuals to
promote and share information among their friends, family, peers, and
neighbors on prevention measures, testing resources, vaccines and other
relevant information.
While we await additional vaccine supply and the approval of new
vaccines by the Food and Drug Administration (FDA), we must continue
the public health measures that will control the spread of the virus:
Masking, testing, and social distancing. A multi-pronged approach
supported by the Federal Government that includes the following could
improve the effectiveness of nonpharmaceutical interventions in
Illinois and across the country:
An aggressive expansion of genomic sequencing infrastructure
to assess the threat of new variants, including the ability to
analyze higher numbers of COVID-19 samples and easily transfer
data between the CDC, State-run labs, and public health
practitioners to inform mitigation efforts.
Continuation of paid sick leave as required by the now-
expired Families First Coronavirus Response Act (FFCRA), which
one study found led to more than 400 fewer reported cases of
COVID-19 per State per day compared to the pre-FFCRA period and
to States that had already enacted paid sick leave.\5\
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\5\ Pichler, S., Wen, K., & Ziebarth, N.R. (2020). COVID-19
emergency sick leave has helped flatten the curve in the United States.
Health Affairs, 39(12). https://doi.org/10.1377/hlthaff.2020.00863
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Support for wide-spread molecular testing and isolation,\6\
especially for high-priority populations, and rapid point-of-
care testing in high-priority settings, including schools and
workplaces.
---------------------------------------------------------------------------
\6\ Rannan-Eliya, R.P., Wijemunige, N., Gunawardana, J.R.N.A.,
Amarasinghe, S.N., Sivagnanam, I., Fonseka, S., Kapuge, Y., & Sigera,
C.P. (2020). Increased intensity of PCR testing reduced COVID-19
transmission within countries during the first pandemic wave. Health
Affairs, 40(1). https://doi.org/10.1377/hlthaff.2020.01409.
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Additional direct payments to individuals to encourage
compliance with public health guidance for quarantine,
isolation, and stay-at-home orders,\7\ especially in
economically marginalized communities.\8\
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\7\ Wright, A.L., Sonin, K., Driscoll, J., & Wilson, J. (2020).
Poverty and economic dislocation reduce compliance with COVID-19
shelter-in-place protocols. Journal of Economic Behavior &
Organization, 180, 544-554. https://dx.doi.org/10.1016/
j.jebo.2020.10.008.
\8\ Chang, S., Pierson, E., Koh, P.W., Gerardin, J., Redbird, B.,
Grusky, D., & Leskovec, J. (2020). Mobility network models of COVID-19
explain inequities and inform reopening. Nature, 589, 82-87. https://
doi.org/10.1038/s41586-020-2923-3.
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Distribution of masks, preferably medical-grade,\9\ to every
person to enable universal masking.\10\
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\9\ Tufekci, Z., & Howard, J. (2021, January 13). Why aren't we
wearing better masks? The Atlantic. https://www.theatlantic.com/health/
archive/2021/01/why-arent-we-wearing-better-masks/617656/.
\10\ Howard, J., Huang, A., Li, Z., Tufekci, Z., Zdimal, V., van
der Westhuizen, H., von Delft, A., Price, A., Fridman, L., Tang, L.,
Tang, V., Watson, G.L., Bax, C.E., Shaikh, R., Questier, F., Hernandez,
D., Chu, L.F., Ramirez, C.M., & Rimoin, A.W. (2021). An evidence review
of face masks against COVID-19. Proceedings of the National Academy of
Sciences of the United States of America, 118(4). https://doi.org/
10.1073/pnas.2014564118.
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Grants to improve indoor air ventilation \11\ in high-
priority settings, including schools and long-term care
facilities.
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\11\ Noorimotlagh, Z., Jaafarzadeh, N., Martinez, S.S., & Mirzaee,
S.A. (2020). A systematic review of possible airborne transmission of
the COVID-19 virus (SARS-CoV-2) in the indoor air environment.
Environmental Research, 193, 110612. https://doi.org/10.1016/
j.envres.2020.110612.
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Promulgation of National standards and practices for contact
tracing, especially for data collection.
Workforce expansion strategies for vaccinators and other
public health personnel, including deployment of Federal
personnel to Illinois as a force multiplier to our already
substantial but inadequate immunization resources.
Intentional community engagement and education strategies to
promote vaccine science as a preventive method to thwart
vaccine misinformation and distrust for any future campaigns.
Much has transpired over the past year; we have endured unthinkable
loss and mounted a forceful response to contain the spread of this
disease, save lives and rollout a massive effort to vaccinate our
population.
One of the biggest hurdles to a successful response over the past
year has been a lack of communication and muddled messaging from the
highest levels of government. Though it is still early, the Biden
administration has already demonstrated a strong desire to better
engage the States and this is a major improvement from where we were a
year ago. In concert with improved communication, we are seeing
increases within our vaccine supply chain and commitment from the
Federal Government to augment what States have already implemented. The
promise of a 3-week lead time on vaccine allocation projections has
been welcome news to States and our partners on the ground. In
Illinois, as may be the case in other States, addressing the large
number of second doses due to the public and its impact on available
first doses has been challenging. An informative and transparent
discussion on vaccine allocation to the States on the part of the
Federal Government could go a long way to helping States like Illinois
address the angst felt by local governments who receive small
quantities of doses.
While we appreciate the increased planning and transparency, this
has not eliminated the need for additional vaccine supply. In testimony
I made a few weeks ago to the House Energy and Commerce Committee, I
urged the Federal Government to leverage all resources and powers at
their disposal to ramp up the manufacturing and purchase of additional
vaccine and associated supplies. I applaud news that the Biden
administration has invoked the Defense Production Act to increase
production of vaccines, at-home coronavirus tests and additional
personal protective equipment (PPE); as we know, the advent of vaccines
does not eliminate the need for PPE or testing. With production
increases and the pending approval of an additional vaccine on the
market, we are hoping to see significant increases to vaccine
allocations in the next few weeks. Our local health departments, FQHCs,
hospitals and other partners are standing ready to ramp up
exponentially.
Looking back to where we were last year and the difficulty we faced
in procuring PPE, I am grateful for how far we have come. When I
testified before this committee a year ago, our largest concern was the
lack of PPE for health care workers and for our residents. I discussed
our challenges in supplying local health departments and hospitals with
required PPE and the State's extraordinary efforts to source common
products like masks and gloves. Today we are in a much better position
as production and demand have equalized. Even so we learned a valuable
lesson about the global supply of medical products that must inform our
future planning for strategic stockpiles and domestic production. We
trust the Federal Government is acknowledging that lived experience and
look forward to discussions with you to harden our systems against
future crises.
Being a National leader in COVID-19 testing comes with a commitment
to maintaining and increasing testing levels. Illinois began its COVID-
19 testing mission in its 3 State laboratories with very small supplies
of reagents, viral transport media (VTM) and consumables required to
run tests. Further, a year ago we did not have a comprehensive network
of public laboratories capable of rapidly scaling to meet a demand such
as COVID-19. Like today's vaccine crunch, IDPH with assistance from the
Federal Government went about resourcing needed supplies to not only
maintain but increase by orders of magnitude the availability of
testing. Not leaving our fate in the hands of others, IDPH developed
its own recipes for VTM and reagents. We optimized our PCR processes to
reduce time and resource consumption. Automation and high-throughput
equipment allowed the State health department labs to go from
processing hundreds to thousands of samples per day.
Going forward Illinois acknowledges the need for a robust and
enduring public health lab infrastructure, we ask the Federal
Government to join with us in building increased education
opportunities for people interested in becoming laboratorians and
researchers. This must be accomplished by investing in public
universities and colleges, both for increasing degrees as well as by
providing laboratory infrastructure that serves as a training platform
in good times and back up lab capacity in troubled times.
Public health infrastructure was again critical as Illinois
approached vaccine delivery. Long before COVID-19, IDPH along with
Federal and local partners developed medical countermeasure plans for
mass vaccination in Illinois. Even so, in September 2020, IDPH
organized its COVID-19 vaccination plan with an understanding that
unlike other crises, this potential antidote would come in small
quantities to start and with significant handling challenges. A
different approach involving local and National providers, focused on
equity and compassion for those people most ravaged by this disease
would be required.
Notwithstanding our planning, Illinois has experienced the same
difficulties as other States. Vaccination efforts in Illinois were
hampered by conflicting Federal messaging a lack of consistent
information on vaccine deliveries. Operation Warp Speed's many unmet
promises left Illinois holding the bag as our people sought reliable
answers to when they could expect to be vaccinated. Reduced or
postponed allocations and outright cancellations left Illinois
receiving far fewer doses than advertised. We have taken great
satisfaction in the improvements made in both communication and actual
doses delivered since late January and stretch forth our hands in
anticipation of even higher allocations of vaccine to shortly come.
We have distributed vaccine with equity garnishing our every
thought. We have also focused on speed, partnering with those who could
vaccinate the population the fastest, while working with others to
improve their delivery of services, such as the activation of the
National Guard to increase capacity and support local operations across
the State. Illinois is ready for more vaccine and we will not delay in
its use.
On January 25, 2021, the State moved into Phase 1B of our vaccine
rollout.\4\ Initial advice from the CDC Advisory Committee on
Immunization Practices (ACIP) targeted front-line workers and adults
aged 75 years and older for Phase 1B.\12\ In keeping with our
commitment to equity and understanding the disparities in life
expectancy, generally, and age at death from COVID-19 in Illinois
specifically,\5\ IDPH chose to expand our priority populations for 1B
to include adults aged 65 years and older. In doing so, Illinois sought
to save lives in a truly equitable manner, recognizing that
longstanding inequities, as well as institutional racism has reduced
access to care, caused higher rates of environmental and social risk,
and increased co-morbidities for people of color. After taking into
account the expectation of increased vaccine supply in the coming
weeks, Governor JB Pritzker announced that on February 25 the State
will expand Phase 1B eligibility to include people aged 16 to 64 years
with co-morbidities and underlying conditions associated with increased
risk for more severe COVID-19 as defined by the CDC,\13\ along with
individuals with disabilities.
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\12\ Dooling, K., Marin, M., Wallace, M., McClung, N., Chamberland,
M., Lee, G.M., Talbot, H.K., Romero, J.R., Bell, B.P., & Oliver, S.E.
(2020, December 22). The Advisory Committee on Immunization Practices'
updated interim recommendation for allocation of COVID-19 vaccine--
United States, December 2020. Morbidity and Mortality Weekly Report,
69(5152), 1657-1660. http://dx.doi.org/10.15585/mmwr.mm695152e2.
\13\ Centers for Disease Control and Prevention. (2021, February
3). People with certain medical conditions. https://www.cdc.gov/
coronavirus/2019-ncov/need-extra-precautions/people-with-medical-
conditions.html.
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In late January, Governor Pritzker also announced the activation of
the Illinois National Guard to assist local health departments in
administering vaccinations; a move that was made possible by the Biden
administration approving 100 percent Federal coverage of the cost. To
date 44 teams have been deployed across the State and over the course
of February more than 50 total National Guard teams will be deployed to
expand access to vaccines in high-need areas across the State, in
concert with clinics hosted by local health departments, hospitals, and
pharmacies. The Federal Emergency Management Agency (FEMA) has been a
great partner in our efforts and the increase to 100 percent (up from
75 percent initially) Federal cost coverage of these sites has allowed
us to support more high-priority areas in the State than we initially
expected.
Finally, in order to expeditiously administer vaccinations I have
urged the Federal Government to assist State efforts by partnering with
us to establish Federally-run mass vaccination centers. Since then, we
have discussed the idea of such mass vaccination centers in Illinois
with the Federal Government and are hopeful that this Federal/State
partnership will come to fruition.
In order to bring this pandemic to an end, States need continued,
consistent support and resources from the Federal Government. New,
highly-contagious variants are threatening our progress and we need our
Federal partners to align their efforts with ours to help solve
practical, operational issues; thankfully we seem to be moving in this
direction.
Thank you for the opportunity to share Illinois' experience over
this past year. We will continue to let data, science, and equity guide
our approach and I look forward to working with Congress and the
administration to see the other side of this pandemic.
Chairman Thompson. Thank you very much.
I now ask Mr. McMahon to summarize his statement for 5
minutes.
STATEMENT OF J. RYAN MC MAHON, II, COUNTY EXECUTIVE, ONONDAGA
COUNTY, NEW YORK
Mr. McMahon. Thank you. Chairman Thompson, Ranking Member
Katko, Members of the committee, it is an honor and a privilege
to be here today to tell the story from the local government
perspective. Our story isn't unique to our community, but to
local governments throughout this pandemic. The reality is it
is important when we tell this story that people understand
what we do.
Our county government does different things in each State.
That has been part of the challenge in the global pandemic at
the local level. In our county in New York State--and I know
there are Members from New York State on this panel as well
that know this--in New York City--New York City is actually a
county as well--in New York State, the rest of the counties, we
take care of our community's most vulnerable. We have the
children and family service departments to watch our children,
we have the adult long-term care departments to take care of
our elderly, we have our economic security departments to take
care of our poor, and we have our local health departments that
help deal with health equity and public health, day in and day
out. During a pandemic everybody is vulnerable. We were the
local government on the front lines of this. When we look at
what we do and what we had to do, reliving the last year and
our responses, is actually a traumatizing experience if we
think about all we have been through together collectively in
this country.
We went from planning, when we learned of this virus, to
preparing to having to do mitigation at the local level,
canceling community gatherings, canceling parades, before we
even had a case. Then we went to response to a pandemic at the
local level. In our community--we are in central New York--
our--in New York City, in Long Island, and the Hudson Valley
was ground zero for this pandemic. We had a 2-week head start
to implement mitigation, implement our plans, and prepare for a
response.
What is response? We got very familiar very quickly with
terms like contact tracing, testing for a virus, competing for
tests throughout the committee, quarantine. These are all
things that we never thought we would have to do at this point
in time. We then went into a situation where we are focused in
on shutdowns to help mitigate the spread of the virus
throughout the State. We then we through a restart process
where we started to reopen our economy, where our government
were now responsible for regulating social distancing, physical
distancing, capacity amongst businesses, things we never
thought we would be.
As we restart the economies, the Operation Warp Speed and
the vaccination came to fruition. We are now in the process of
vaccinating, developing distributing, underutilized
infrastructure, how do we get to specific communities within
our community that are underserved intentionally. That is
something that we have focused on in Onondaga County. We will
be the front line leaders in recovery as well.
One thing I do really want to highlight is that once we are
done vaccinating, and we will at some point, this emergency is
not over whatsoever. The reality is the victims of this
pandemic are far more than just those who become COVID-
positive. We have had 31,000 COVID-positive residents in my
county, we have had over 650 people in my county die, but it is
becoming clearer and clearer every day the crisis of mental
health, opioid overdoses, where we have seen increases between
40 to potentially 70 percent in our county. What we are seeing
what is happening to our children as hybrid learning schedules
are not meeting the needs of our children for school.
But this is the macro level. What are some of the unique
experiences that we had that I think bring value to you as you
form policy. In the beginning we were not prepared for PPE. We
were scrambling for test kits. Every night we were looking for
test kits throughout our community to get people just tested
for this virus on March 16 when the virus came to our
community. We were scrambling for masks, for gowns, for gloves
with all of our partners. We were competing not only against
other local governments and hospitals, but States and the
Federal Government as well. It is abundantly clear that there
needs to be a supply chain repatriotization to our country to
address this moving forward.
We communicated daily at the local level, as other did at
the Federal level and State level. That helped provide comfort
and calm to our community, but we had new challenges. Everyone
was vulnerable. We had to implement continuity of food
operations, we had to implement continuity of care operations
for our essential workers where they had free day care. Things
that were never in the traditional response to an emergency,
but now local governments were fronting these costs to make
sure that we had nurses going into hospitals, to make sure that
we had other essential workers going on so society moved on.
We did this all at a point where we were the largest
community in the country to receive no direct CARES Act
support. CARES Act funding flowed through the States. There was
money earmarked for local governments. Not all States passed
that money onto the local governments. This led to a huge
economic challenge for us in Onondaga County, a community of
462,000 people that would have normally received $80+ million
if we had over half a million people. We received no direct
CARES Act funding for response because of the way the emergency
aid flowed.
We quickly utilized and worked with our partners at up-
State hospitals, Syracuse University, to implement great
testing strategies. We implemented these testing strategies to
help restart both Pre-K through 12 education, but also higher
education. We continue to asymptomatically test in our schools
and the positive rates are phenomenal because of this. We took
the strategy that we should not be embarrassed to identify the
virus anywhere because the only way we get our arms around this
virus and end this pandemic is to identify it everywhere. We
test and we test and we test today. Because of that our
positive rate in our community today, after a surge from
Halloween through Christmas, is at 1 percent for a 7-day
average. Our active caseload on January 3 was 6,000 cases,
today it is 660 cases.
We are now in the process of vaccinating and vaccinating is
something that counties do. The Federal Government funds us to
actually put together mass vaccination plans. We put together
these plans, we are ready for this process. To date we feel we
have been underutilized. The supply we know is an issue and we
know it is getting better. But specifically, to intentionally
get to the hard-to-reach communities, our new American
communities, our minority communities, nobody is better served
to do that than county governments. We have the human service
partners. These are our clients day in and day out. We can get
the job done. We need to be brought into the game in a larger
aspect.
Thank you, Mr. Chairman. I am prepared to take questions
when appropriate.
[The prepared statement of Mr. McMahon follows:]
Prepared Statement of J. Ryan McMahon, II
Good morning Chairman Thompson, Ranking Member Katko, and the rest
of the House Homeland Security Committee. Thank you for the opportunity
to address you today regarding our community's efforts to confront the
Coronavirus pandemic and the perspective gained 1 year later.
Located nearly 250 miles from the epicenter of COVID-19 in New York
State, Onondaga County had the benefit of understanding how COVID-19
affected our neighbors in the Hudson Valley and New York City before
the virus reached our community. The devastation would be undeniable
and we moved quickly to activate our plan to mitigate loss and keep
people safe.
Our first confirmed case of COVID-19 in Onondaga County occurred on
March 16, but our teams in Emergency Management and the Health
Department had been preparing for months. As you probably know, it is
the local governments who are on the front lines fighting any pandemic
and COVID-19 is no different. With a State of Emergency already
declared and an aggressive campaign under way encouraging people to
practice physical distancing, we quickly moved to bring together all of
our community partners including hospitals, local governments,
epidemiologists, and others to ensure we could take decisive action as
the data merited.
We partnered with a local Health Center and set up community
testing. Just as important, we made efforts to ensure that our
neighbors who lived in communities often hardest-hit by public health
emergencies had easy access to the resources they needed to stay safe.
Schools also were shut down, but not before ensuring every district
had a plan to take care of their most vulnerable. We know that for many
children, school is the only place they receive at least 2 meals a day
and we worked tirelessly to make sure those children continued to
receive the meals they needed. We also partnered with Childcare
Solutions to arrange for our first responders, essential employees,
doctors, nurses, and nursing-home staff to have child care. If these
folks could not get to work during a global health pandemic, then the
entire system collapses.
Acquiring personal-protective equipment was--let's say--
challenging. The PPE chain was the Wild, Wild West. Masks that you
could get for under a dollar were now $8 or $9. People reached out to
us who miraculously had contacts in Singapore, China, and Taiwan for a
small advance of $500,000. Legitimate governments, however, do not make
these deals. We pressed on, qualifying different supply chains, and
finally bought PPE at decent prices. We even secured ventilators in the
event we needed to transform the Manley Field House at Syracuse
University into a hospital.
At the heart of our response to COVID-19 was our communication with
the public. We held briefings twice a day, once via Facebook Live at
noon and another briefing with the press at 3. These briefings were
televised across northern and Central New York and we took the
opportunity to emphasize that we are all in this together and it would
take everyone doing their part to ensure our community emerges stronger
than before. As New York State continued to shut things down and we
asked people to modify their social behavior, I was heartened at the
number of people tuning in, listening, and buying in to these
sacrifices they were being asked to make, as scary as they were. We
spoke about testing, quarantines, the number of cases, food security,
day care, and mental-health programs; anything and everything that was
relevant to the well-being of the public. Our job was to tell the truth
without the slant of politics. We were asking people to sacrifice, and
they had to know why. I never Monday-morning quarter-backed the
decisions at the Federal or State level. I just talked about how they
impacted us, and I believe people appreciated our straight-forward
approach.
Emotionally, the loss of life was overwhelming, but I knew the
unintended consequences of these shut-downs would be severe. Whether it
was individuals unable to identify or report domestic violence or child
abuse to the rising cases in opioid overdoses or just the sheer
devastation of our local economy, the human toll of this virus extended
beyond what anyone could have imagined.
Over the last year, there has been a significant increase in the
number of fatal opioid overdoses in Onondaga County. From January
through September 2020 there was a 40 percent increase in opioid
overdose deaths compared to the same time period in 2019 (121 deaths vs
86 deaths, respectively). The pandemic has exacerbated the opioid
epidemic, through risk factors such as high unemployment rates, social
isolation, and despair, as well as the disruption of available
treatment and harm reduction support services that individuals with
substance use may depend on.
We were shut down for months and lost millions of dollars in sales
tax not to mention our room-occupancy tax essentially evaporated. We
had to cut county government and execute rigorous austerity measures.
Twice we offered retirement incentives, but still had to implement
furloughs, voluntary and involuntary. We were facing a $70 to $80
million shortfall as we prepared our next budget. Adding salt to the
wound, our population is 461,000, just shy of the half a million
Federal requirement to receive direct Federal aid which would have
totaled at least $100 million from CARES Act funding. The current
funding formula resulted in the Federal Government sending our money to
the State, but it was never redirected to us. This means that we have
funded, and continue to fund, every aspect of this fight using whatever
resources we could muster at the local level. Everything from testing,
contact tracing, purchasing PPE and setting up vaccination clinics was
done without one single dollar from any other either the Federal or
State government. To be clear, we have had some success in receiving
reimbursement from FEMA, but this required our Government to upfront
the cost. While we were fortunate enough to be able to do this, there
is no doubt that Onondaga County would have more greatly benefited if
we had received the same direct allocation that our neighbors in Monroe
or Erie counties had received.
So there we were, in the middle of a pandemic, with no additional
money, forced to let go of staff while enforcing a host of new rules
and policies including mask-wearing and physical distancing, necessary
to keep our community safe. No upside to this, really, except that when
businesses were finally able to reopen, they understood what was at
stake. We did institute a system for residents to send concerns or
complaints about establishments not following safety guidelines and we
teamed up our legal, probation, and health departments to investigate
them. State agencies would eventually also lean on us about complaints
they received, asking us to investigate. More often than not, we
learned our business owners simply did not understand or know all of
the new rules they were being required to follow and after empowering
them with the necessary information, they quickly and gladly complied.
At the end of the day I am proud to say that our local restaurant
industry quickly and willingly agreed to be our partners when it came
to following and enforcing the rules. Neither we nor the restaurant
owners had any interest in seeing them closed again and we worked
together to make sure that didn't happen.
As difficult as this past year has been, as a county we have many
things of which to be proud. On top of the list is how the community
came together, everyone pulling in the same direction. We planned and
prepared for the needs of our residents, and we acted. There was no
paralysis. Whatever the obstacle, we figured out a way to get it done.
We were especially aggressive about testing--symptomatic and
asymptomatic--which is one reason why we saw our positive infection
rates drop as we began our restart. We were intent on finding those
hidden asymptomatic cases because we saw what the virus was doing to
our seniors. Therefore, we tested in assisted living facilities and
independent living facilities to box in the virus. We were equally
aggressive in our schools. We deployed county personnel to perform
saliva-pool testing for teachers to start the school year and
asymptomatic testing for the entire student body, teachers, and staff
beginning in November. Simultaneously, we were building up the
infrastructure every day so that we could quickly pivot once the
vaccine arrived.
Syracuse University was also planning on using the UpState Saliva
Test to bring their students back in August, an effort which would
provide a desperately-needed boost to our local economy. However, it
had yet to get emergency approval from the State or the FDA. Two weeks
before school started, they had a decision to make. We were telling
them they needed to test the students before they came back and we knew
it was a big ask because it was going to cost them $2 million. Syracuse
University proved once again their commitment to our community and
spent the money doing the right thing for public health. Testing kits
were mailed to the student's home, they self-administered the test,
sent them back and were subsequently sent the results. Our community
then knew which students were positive before they returned and
required them to stay home and isolate. Those with a negative test were
allowed to return, but our efforts did not end there. When the kids got
to campus, they were tested again and thanks to this impressive
undertaking, Syracuse had a great start to the school year
We were also able to give some relief to small businesses,
especially our hard-hit restaurants which are an important source of
pleasure for our residents and tax money for the county. The Industrial
Development Agency appropriated $500,000 to cover the cost of COVID-
related expenses--tents, heaters, fire pits, and more, so that outdoor
dining could be more comfortable and compensate for the loss of
capacity indoors.
While nothing has made me sadder than the hundreds of people we
have lost to COVID-19, nothing makes me happier than to start quickly
dispensing the vaccine so we can begin to reclaim our lives and move
forward, together. Our community spent months planning, preparing, and
mitigating; now our focus has shifted to equitably distributing the
vaccine.
Onondaga County has proven to be the best among the big counties in
New York State in distributing the vaccine and doing so quickly. I
think that is worth repeating, Onondaga County, with no additional
dollars or resources, is the best among the big counties in New York
State for distributing the vaccine and doing so quickly. In the past 2
months our POD has administered more than 20,000 first doses. While we
are proud of this effort, we have the ability to ramp up to 18,000
shots a week. We just need supply. As I said earlier, it is local
governments who are responsible for being on the front lines fighting
this pandemic. It is literally the job of your local health and
emergency management departments to plan, prepare, and train for such
events as this. We are on the ground, doing the work, day in and day
out to keep our community safe and eventually reclaim our lives.
I want to conclude by taking this opportunity, with this audience,
to thank the amazing team working for Onondaga County. They have worked
countless hours, had many sleepless nights, and sacrificed a great deal
for the good of our community and I am eternally grateful to be able to
lead such an amazing and dedicated team. To Chairman Thompson, Ranking
Member Katko, and the rest of the committee, thank you again for the
opportunity to share my community's story and I am happy to answer any
questions.
Chairman Thompson. Thank you very much. I thank the witness
for his testimony.
I remind each Member that he or she will have 5 minutes to
question the witnesses.
I will now recognize myself for questions.
Dr. Ezike, a year later in this pandemic, what more can the
Federal Government do to help States like Illinois deliver
vital medical care to those hospitalized by the virus and
support State vaccination efforts?
Dr. Ezike. Thank you for that question.
So there is a plethora of needs that can be coordinated at
the Federal level. Of course, as I mentioned in comments, we
need Federal strategies that help unify the effort of the
cities, which in turn unifies the efforts at the local level.
We know that in terms of the variants, we need a very organized
system of surveillance to identify ahead of time variants
mutations as they come on board. We need to be able to collect
all the different variants that are identified throughout the
State in a very robust library to be able to track that.
We need data. We need a comprehensive data technology
upgrade such that we can have our systems, or State registries
give the important information to the Federal Government so
that we can see exactly what is happening across the country.
We know that people live and work in different States and so
being able to have a more seamless connection between our
partners is also necessary. But the technology solutions are
one of our biggest needs, the technology solutions to make sure
that we can collate all this important information.
Chairman Thompson. Thank you very much.
Dr. Watson, based on your research, can you explain how
America ended up with the highest number of COVID-19 cases and
deaths in the world? What should have been done differently and
what must be done now to overcome these mistakes?
Ms. Watson. Thank you for that question, Chairman.
I think it is obviously a combination of factors. But I do
think high-level communication about the pandemic was very
muddled, sometimes it undermined the advice of public health
experts, and it did not help people to take the protections
that they needed to take to keep themselves safe from becoming
infected. So we have really seen this virus thrive in that type
of communication environment.
We have also seen support for public health agencies has
not be enough. They do not have the resources they need to do
testing at a level they needed to help keep people to stay home
when they have been infected or have been exposed to the virus,
to do contact tracing at a high-enough level to keep up with
cases and contact. All of these things need to improve. We are
seeing more direct and clear communication to the public now,
but that must continue. We need to be able to back fill health
departments who have been going into the red to try and conduct
this response. Obviously that is also needed for vaccination
efforts, which are still under-supported and need to ramp over
the next month.
Chairman Thompson. Thank you very much.
I would like to hear from Mr. McMahon. As you know, FEMA is
paying for 100 percent reimbursement for the costs associated
with this pandemic. Are you current in your reimbursement
requests? Or explain how that process is working for local
government.
Mr. McMahon. Thank you, Mr. Chairman for the question.
Recently we were approved for our FEMA reimbursement for 75
percent. Essentially President Biden I believe--whether it was
an Executive Order--pushed us to potentially be eligible for
100 percent reimbursement for our expenses that were spent in
2020. I think one of the challenges, if you think about the way
we budget in local government, in 2020 we never budgeted for
COVID-19 pandemic response. We then had economic shut-downs. In
New York State for local governments our largest driver of
revenue is sales tax. So when our economies were shut down, we
lost up to 40 percent of sales tax for that period of time. So
we never budgeted for these expenses to begin with, so there
was never revenue behind it. We then lost the flexible revenue
and had to make cuts, mid-year cuts to our budgets.
So even though now we may be receiving some response from
FEMA at this point, the model is challenging in the middle of a
pandemic to cash-flow expenses. Governments had to borrow at
times to cover expenses due to the model of reimbursement. So
certainly something that should be considered moving forward.
Chairman Thompson. Thank you very much.
The Chair recognizes the Ranking Member of the full
committee, the gentleman from New York, Mr. Katko, for
questions.
Mr. Katko. Thank you, Mr. Chairman, and thank you to all
the witnesses for the testimony. This is obviously vitally
important to getting an understanding of what we can do better.
County Executive McMahon, we have had many conversations
over the past year and many meetings over the past year about
some of the things you touched upon in your testimony, which I
would like to highlight.
The overarching observation from me from all those
conversations and meetings is that there is a question of
equitable distribution of supplies, equitable distribution of
vaccines, and equitable distribution of funding that we have
provided. You have highlighted a little bit about the CARES Act
funding that went to New York State, but since you were just
under the threshold of 500,000, you didn't get the funding
directly like your neighbors to the west of you did, Rochester,
and that had a dramatically negative impact on your budget.
So you have touched on that, but I want to talk about
FEMA's role in this equitable distribution. It seems to me like
FEMA is somewhat hamstrung in their ability to equitably
distribute the vaccination, equitably distribute the PPE
because the New York State--goes to Albany and they decide who
gets what and when and how much. I think a lot more of it went
down-State than it should have. So, from an equitable
distribution standpoint, could you tell us some of the
shortcomings you have experienced and what you have had to do
to try and overcome them?
Mr. McMahon. Yes. So it is difficult, too, if you think
about the beginning part of the pandemic when you have PPE and
test kits were the big need. The challenge in our State was
that New York City and down-State, Long Island, Hudson Valley,
was really under siege at a greater level, so the State's
attention went to that--appropriately went to those regions,
but we still had challenges where were so. So the model of--in
an emergency, in a pandemic, of just flowing things through the
State doesn't necessarily mean it gets to every part of the
State. We saw that with the CARES Act funding. Again, I know
there are Members of the committee who represent Nassau County.
Imagine if Nassau County didn't receive direct aid in the CARES
Act because you would have received from my counterparts. We
were the largest community in the country that didn't. So we
had to mid-year budget cuts of $40 million in the middle of a
pandemic response because we didn't get the help other
communities got throughout the country.
When you look at vaccine distribution, our frustration
isn't at the point the speed, supply is an issue everywhere, it
is that for everything and every curve ball we have been thrown
during this pandemic, the one thing county governments were
prepared to do was vaccinate. We plan and we prepare for that,
whether it was Ebola or whether it was SARS, this is what we
do. We get Federal funding to plan and prepare. We believe we
should have taken a larger role in that, and we still think we
can. Especially we think we should, specifically to the idea
that we know how to vaccinate our most vulnerable communities
better than anyone else because we work with them every day.
So with vaccinations--I use sports analogies a lot--we are
in the second quarter of a four-quarter game here. We can learn
from what didn't work well in the first quarter and adapt and
adjust and pivot to have great success.
Mr. Katko. OK. To follow up on that a little more, FEMA
doesn't have the discretion with respect to PPE or with respect
to vaccinations, in at New York State at least, to decide where
they go. To kind-of think about Chairman Thompson's point, I
think because of that sometimes minority populations do suffer
because of the lack of equitable distribution of the PPE and
the vaccinations.
So would it be fair to say that if FEMA had a little more
discretion when an emergency declaration is declared with
respect to equitably distributing the products? A better
mechanism for that would help communities like yours? The
smaller ones in New York State?
Mr. McMahon. Yes. The intention is to get supply directly
to us from the Federal level. The clearest path to do that is
to give it to us. I understand the challenge of there are 50
States and there are thousands of local governments with health
departments. I appreciate that challenge, but logistically in a
pandemic I think it is different from regular course of
business funding models.
Mr. Katko. Right. Just to put a little finer point on that,
FEMA is dealing with its first--I think first--National
disaster declaration. It means Nationally they are in charge of
getting the stuff out to the front lines, the vaccinations, the
PPE, and everything. It seems to me that given that model the
communities like yours and communities like--Chairman Thompson
talked about Mississippi--they should have more discretion
instead of being held to the whims of a Governor or a
legislature that may not be as competent at doing that.
Then from a fundamental sense of fairness, teams should
have more role in deciding how things get distributed in the
State. Is that fair to say?
Mr. McMahon. I think it would beneficial during the
pandemic, from my experience. Not suggesting--we may do some
things differently. Whether they are better than the State will
do then, history will judge us all on that. I just think the
reality is local health departments, these are our
professionals. We have epidemiologists on staff. Our local
health commissioner and their team, they are the best in the
business in my opinion. We know how to get things done. This is
our community.
I am a county executive. I am accountable to every member
of the public here. We have certain powers in a public health
crisis that have even been somewhat challenged through the
State emergency orders.
So the intention of the Federal Government is to get
funding to local health departments in an emergency. The
easiest way to do that is to get the funding to us. There is no
guarantee if it doesn't go to us that the intention from the
Federal Government, that will is going to actually happen.
Mr. Katko. Thank you very much, Mr. McMahon. I appreciate
all you have done during this pandemic.
Now, Mr. Chairman, I yield back. Thank you.
Chairman Thompson. Thank you very much.
The Chair will now recognize other Members for questions
they may wish to ask the witnesses. I will recognize Members in
order of seniority, alternating between Majority and Minority.
Members are reminded to unmute themselves when recognized for
questioning and to then mute themselves once they have finished
speaking and to leave their cameras on so they are visible to
the chair.
The Chair now recognizes for 5 minutes the gentlelady from
Texas, Ms. Jackson Lee.
Ms. Jackson Lee. Thank you very much and good morning.
Thank you to all of the witnesses for your very important
testimony.
Texas remains a hot spot in the landscape of COVID-19
cases. It is a State of almost 29 million persons and we have
had 41,000 deaths and we continue to be a hot spot for
infection and of course we are challenged as it relates to the
hard-to-reach communities and people of color.
So this is a very important hearing because we are not
ending, we are beginning. I think this committee has to be very
pivotal in that role.
Let me ask Ms. Clowers of the GAO, regarding the issue of
testing, just the memory lane, very briefly, if I might, where
we went wrong in the testing protocol when COVID-19 first
started. You had recommendations of GAO reporting regarding
testing and where they were implemented. What were your
recommendations, very briefly, and are they valid today?
Ms. Clowers. Yes, they remain valid. One of the key
recommendations that we made was for a National strategy. You
have heard the other panel members talk about this need as
well. There has been different testing strategy documents that
have been put out, but not an overarching strategy that would
contain all the information that you would expect from a
comprehensive strategy, where it defines the goals and the
problems and the risk and the benchmarks, as well as how are we
going to fund this, what resources are needed. Defining the
roles and responsibilities. Then, importantly, making that
strategy publicly available.
One of the things we found in our work in talking to non-
Federal stakeholders is that sometimes they weren't clear about
their role in a National strategy and that is, you know, ripe
for causing confusion and gaps. That is what you can't have
during a public health emergency.
Ms. Jackson Lee. If I might, the failure in the
administration not having a testing protocol provided for the
surge in COVID-positive cases.
Ms. Clowers. The lack----
Ms. Jackson Lee. No protocol, no--that----
Ms. Clowers. I am sorry to interrupt. The lack of the
strategy has certainly compounded the problems that we were
seeing. As you know, from the start, the testing in our country
had challenges with the roll-out of the test equipment from CDC
that caused some inaccuracies and to the slow ramp-up, and then
we got into the supply chain. So it was a snowballing effect.
Ms. Jackson Lee. Thank you, thank you very much.
Ms. Clowers. Mm-hmm.
Ms. Jackson Lee. Mr. McMahon, I was moved, impressed by
your testimony. You are obviously boots on the ground and we
thank you for that.
I introduced H.R. 936, delivering COVID-19 vaccinations to
all regions in vulnerable communities, which really was to
emphasize FEMA working directly with local counties and cities
where you are managing your own health department.
Can you dig a little deeper on how that would work, rather
than waiting with hat in hand, as you had to do for PPE, as you
had to do for testing test kits, and now vaccines. Would that
help save lives? We failed to do that with the Trump
administration. We saw that as Members of the Congress, but
you, how do you see the idea of getting direct collaboration
with the Federal Government through FEMA and reaching these
hard-to-serve communities, vulnerable communities?
Mr. McMahon. Thank you for the question and thank you for
your service.
I believe the reality is that we could be partners at the
local level with the Federal Government. I have colleagues that
we communicate throughout the country and they may be called
county judges in different parts of the country or different
things, but I have spoken to the Harris County executive or
county judge about the challenges via our network that we have.
We have the local health departments, the experts. My health
commissioner is a graduate of Johns Hopkins. She is well
renowned. We have followed the data in this process. We have
looked at testing as the tool to identify and box in the virus,
the risk to our community. Getting us the vaccine directly will
certainly help us get to the communities that need to get it
that are not participating at the right levels.
Ms. Jackson Lee. Thank you.
Mr. McMahon. Thank you, ma'am.
Ms. Jackson Lee. Thank you.
Dr. Watson, are we sicker now because we did not have
protocols dealing with COVID-19 early on? Is America sicker
now, lost more lives because of that?
Ms. Watson. I think there is no question of that,
representative, that we have experienced a lot of illness and
death, not just from COVID but also from loss of access to
health care for other diseases that are critical. Absolutely.
Ms. Jackson Lee. Thank you. Mr. Chairman, may I submit into
the record Delivering COVID-19 Vaccinations to All Regions and
Vulnerable Communities Act? I ask unanimous consent.
Chairman Thompson. Without objection.
[The information follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. Jackson Lee. Thank you.
I yield back, Mr. Chairman. Thank you.
Chairman Thompson. Thank you.
The Chair recognizes the gentleman from Louisiana, Mr.
Higgins, for 5 minutes.
Mr. Higgins. Thank you, Mr. Chairman, Mr. Ranking Member.
We have shut down the world's economy and destroyed
millions of American families' lives over a virus. Far beyond
health concerns of the virus, 100 million American adults
having difficulties covering their household expenses, millions
of children are missing out on critical in-person education.
The economic consequences of Government action in response to
this virus is going to last a generation. Viruses come and go.
There is a certain cycle, new virus impacts the world, the
world responds. We are in the 21st Century now, we have
unbelievable medical skills and technologies, we are responding
very quickly, and yet we shut down the world's economies.
Despite Americans being told to stay home--let me tie this
together with what is going on at the border--America is being
told to stay home and shut down their businesses, deny their
children an education, but our newly-inaugurated President is
right now allowing scores of thousands of migrants, illegal
immigrants, who had been held in Mexico and attempted to enter
our country illegally, allowing them access into America. We
are a Nation of immigrants, a Nation of compassion, and I am
willing to have that conversation about immigration laws with
my colleagues, but I find it highly ironic that Americans are
being asked to live under continued repressive COVID
restrictions while the Biden administration has relaxed our
borders in a way that will result in a mass migration of people
from Central and South America. Nobody is talking about COVID
there.
We expect illegal immigrants to enter America relatively
freely, then we should let American citizens ourselves live
free.
Families have been restricted from the death beds of their
loved ones. It is an unbelievable emotional impact. At any
other time my colleagues were talking about the--be talking
about the emotional stress and the pain and the burden of
anything imaginable, but no one is talking about this. It has
been abhorrent the oppression of freedoms and the impact on
American families. My colleagues and the respected panelists
that mention statistics, statistics stating that the United
States is worst in the world, statistics are very commonly
lies. Compared to who? China? Seriously? Does anyone believe
that any COVID data coming out of China is accurate? It is
intellectually unsound.
What is next, Mr. Chairman? What virus is next? What level
of Government oppression is next? Many, many Americans believe
that their Government does not want them to wear masks and
tolerate un-Constitutional restriction of freedoms until the
end of COVID, many Americans believe that governments wants us
to wear masks and tolerate oppression until the end of time.
We grow weary.
Mr. McMahon, let us talk about our kids please.
Mr. McMahon. Yes, sir.
Mr. Higgins. Let us talk about the schools. Students have
the highest risk of long-term negative effects due to
Government actions in response to COVID. Parents unable to go
back to work because their kids are not allowed to go back to
school.
Give us your opinion, share with America, how do we get our
kids back in school? You mentioned in your opening statement
regarding Syracuse University. Share some of that formula----
Mr. McMahon. Sure.
Mr. Higgins [continuing]. And how we can get our kids back
in school please.
Mr. McMahon. Thank you. Thank you for your service as well.
The reality is that throughout the pandemic response on
every issue we follow the data. The more data we can get, you
can make better decisions and you find the appropriate balance
at the appropriate time during the pandemic response. Certainly
we are at a position now when we--over--getting, for example,
higher education back into the community. We worked with
Syracuse University to send test kits to every student
throughout the country. They were tested. Those who tested
positive needed to quarantine at home. The students then came
back to the community that were negative. They were then tested
again. Now we do weekly testing for higher ed so that these
students can have an in-person experience.
When you look at our Pre-K-12, in our community we have
been going to school. Some of our smaller rural districts, due
to the regulations set forth by the State, can meet in person 5
days a week because of the physical space. Some of the larger
districts have hybrid models where they are going in person 2
days. Some in our urban districts, the model changed from a
remote model to a hybrid model. We are very concerned about the
hybrid models. We know our children are falling behind. We know
that we have rising cases of child abuse. Our eyes and ears on
our children are our educators, day in and day out. We need
them in the game. Our kids need to be learning.
So we look at the data. Like I said before, what we did
before our Pre-K-12 started in the fall, we tested all the
faculty going back. We have done random asymptomatic saliva
testing in the school buildings to look for that asymptomatic
carrier. Now we have been using the Binax antigen test on a
weekly basis with our county teams going in with our schools to
test asymptomatic students. Mind you, a symptomatic student is
not allowed in the building. So our positivity rates in the
schools, from the month of January 2021 to present, even though
we were experiencing surges in the community, our positivity
rates in the schools is really about a 0.2 percent, trending
down.
So we believe testing is the tool to keep schools open. You
give the data to the public so the public feels comfortable
about doing more in-person learning.
Mr. Higgins. Thank you, sir.
Chairman Thompson. The gentleman's time has expired.
Let me caution the Members, if you speak for 4 minutes and
ask a question that takes 3 minutes, you are not being fair to
the next Member of the committee. So I am going to hold us to
the 5-minute mark because we have a lot of Members, because we
are in a full committee, who need to get a chance to ask their
question.
So the Chair will now recognize the gentleman from Rhode
Island, Mr. Langevin, for 5 minutes.
Mr. Langevin. Thank you, Mr. Chairman. I want to thank our
witnesses for their testimony today.
I want to turn our attention to how the disabilities
community has been impacted by COVID in particular.
Unfortunately, many of the 500,000 people that we have lost to
COVID belong to the disability community. Reporting by, for
example, NPR, shows that people with intellectual disabilities
and autism dying from COVID-19 at higher rates than the general
population. In early numbers from the United Kingdom show that
people with disabilities accounted for nearly 60 percent of all
COVID-19 deaths last year. A very sobering statistic indeed.
As we continue working to provide an equitable response to
the pandemic, I believe it is essential that we include the
disability community in our conversation.
So, Ms. Clowers, if I could start with you, in your
testimony you discussed CDC data that illuminate the disparity
in COVID-19 in cases, hospitalizations, and deaths when
examined by race and ethnicity. Would standardized COVID-19
data broken down by disability status also be useful in
ensuring an equitable pandemic response?
Ms. Clowers. Yes, sir, it would. We need better, more
granular data on a variety of fronts, whether it is with the
disabled population, different racial or ethnic groups. Without
that data it limits our ability to take needed corrective
action to monitor trends, to see where we are maybe
experiencing problems and then attack those----
Mr. Langevin. Thank you. Are you aware of any CDC data or
reporting efforts that examine COVID-19 cases,
hospitalizations, or death by disability status?
Ms. Clowers. I have not seen that, but I will ask my team.
We will comb through the data again and get back to you if we
find it.
Mr. Langevin. OK. I would appreciate that.
Ms. Clowers. Mm-hmm.
Mr. Langevin. I think that would be very helpful. I will
say that the American Community Survey conducted by the U.S.
Census Bureau examines difficulties in 6 categories, hearing,
vision, cognitive, ambulatory, self care, and independent
living. I wanted to mention that.
Dr. Ezike, if I could, has the Illinois Department of
Public Health been tracking data on the prevalence of COVID-19
cases, infections in the disability community? Why did the
State feel it was important to prioritize vaccination for
individuals with disabilities?
Dr. Ezike. Yes, sir. Thank you.
So we absolutely thought that this was an important group
that needed special attention beyond individuals who are in a
congregate care facility. So that is why we intentionally moved
the group of differently abled or disabled population into our
1D category. With our forms of registrations for vaccination,
we will be able to select--people will have to designate their
eligibility for vaccination, so they will be able to check if
disability is the eligibility criteria that they need. So we
will be able to grow some information and data around that.
That eligibility population begins tomorrow.
Mr. Langevin. OK. That is helpful information. Hopefully I
will get some--we will look to that going forward.
Let me ask you this, it has also been reported that roughly
a third of Americans--military personnel are declining to
receive coronavirus vaccines when they are offered, which is
certainly above the civilian population.
Dr. Watson, if I could ask you, from a public health
perspective, what could we do to ensure that our troops
understand the importance of receiving a COVID-19 vaccine and
feel comfortable about its safety and efficacy? This is also
important given the fact that we are using the National Guard,
for example, to help implement and assist with the COVID-19
response, but also administering the vaccine.
Ms. Watson. Thank you for that question.
Yes, I think it is all about clear and consistent
communication. It is also about speaking with individuals who
have familiarity with groups that we want to reach who are
trusted by those communities. So we need to reach out to
community leaders and give them the information that they can
pass on and have conversation with people to try and understand
their hesitancy. Then give them data and information that can
show them how safe and effective these vaccines are and why it
is important for them to be vaccinated.
Mr. Langevin. Yes. Very important. Especially as it could
impact readiness and response.
So I know my time has expired. Thank you, Mr. Chairman. I
yield back.
Chairman Thompson. Thank you.
The Chair recognizes the gentleman from Mississippi for 5
minutes, Mr. Guest.
You need to unmute yourself.
Mr. Guest. Thank you.
Dr. Watson, in your testimony, on page 3 of your written
testimony that you submitted, you have a paragraph that says
what we are doing right now in the United States, and you talk
about some of our recent successes. It says the number of U.S.
cases, hospitalizations, and deaths are all dropping rapidly
from a winter peak, which was the highest of the pandemic.
Daily numbers have fallen from a high of 295,000 reported on
January 8 to about 72,000 as of January 20. Similarly,
hospitalizations came down from a dramatic National average of
about 130,000 to 63,000. Deaths are following, having dropped
from a 7-day average of about 3,500 a day to about 2,000 per
day.
You also go on in the following paragraph to talk about an
increase in population immunity from vaccination and prior
infections. You say as of February 20 about 12.9 percent of the
United States population has been vaccinated and more people in
the United States have now received at least one dose in the
vaccine in number of people reported to have had COVID.
Recent media reports as it relates to school reopenings,
the Wall Street Journal said parents and officials in favor of
reopening in-person education say their own experiences
confirmed research that children are being harmed academically,
emotionally, physically by the isolation of remote learning.
Kids, they argue, need to be back in the classroom as soon as
possible. They point to the U.S. Center for Disease Control and
Prevention recent urging of schools to reopen under new safety
guidelines and research that shows low transmission in schools
where safety protocols are followed.
ABC News reported that the Nation's top health agency said
that in-person school learning can resume safely with masks,
social distancing, and other strategies and vaccination of
teachers, while important, is not a prerequisite to reopening
schools.
In my home State of Mississippi, the Chairman's home State
of Mississippi, my son's high school, we have been successfully
implementing in-person learning since August. So August,
September, October, November, December, January, February, now
heading in to March--for 8 months in the State of Mississippi
we have been able to successfully implement in-person learning.
Congress has appropriated $70 billion for K-12 schools to
implement and to educate our children during this pandemic.
So my question is, in light of the recent successes that
you listed in your report, in light of the new CDC guidelines,
in light of the fact that Congress has appropriated $70
billion, why are we still unable to reopen our schools in many
parts of the country?
Ms. Watson. That is a good question. Thank you very much.
I think that we still have very high incidents of this
virus in our communities, and so as incidents continue to
drop--it is not low yet, but as it continues to drop, it makes
in-person learning much safer. I agree with you that when
schools follow the CDC guidelines, when they are testing
frequently, and especially now that we have vaccines, when
adults can become vaccinated in schools, that in-person
learning will become much more viable and much safer.
So I think we are definitely headed on the path to resuming
in-person learning for most schools across the country, but we
have to do it safely. That is through following the CDC
guidelines.
Mr. Guest. But do you agree that children that are educated
remotely, that they suffer harm academically, emotionally, and
physically because of the remoteness? Would you also agree that
there are many children who learn much better in in-person
classroom settings than they do remotely?
Ms. Watson. I think that there is no doubt that in-person
learning is what we are all striving for and what kids need. We
just have to make sure that we are getting back to it safely,
and I think we are on the path to that.
Mr. Guest. Well, then why are schools, such as the schools
in Mississippi, again where my son has been enrolled in-person
learning since August, why are some schools able to be very
successful in that and other schools are even reluctant to try
in-person learning? Because it seems like, from the recent CDC
guidelines and the new research that we are getting, that
schools can reopen safety, but is it reluctance on the behalf
of many of the educators, many of the school boards to force
schools to reopen and to educate our children as we are
required to do?
Ms. Watson. The guidance is also dependent on lower levels
of transmission in the community, as well as comfort by
teachers and other adults who have to be in the room, as well
as parents in sending their kids to those schools. So it has to
be a conversation with people. We can't force people to come
back in person if they are not comfortable.
Mr. Guest. Thank you, Mr. Chairman. My time is up, I yield
back.
Chairman Thompson. Thank you very much.
Chair recognizes the gentleman from New Jersey for 5
minutes, Mr. Payne.
Mr. Payne. Thank you, Mr. Chairman.
Listening to my colleague, I would be remiss if I didn't
mention that had the 45th President taken seriously this
pandemic, we could potentially not be in this condition:
505,000 people have succumbed to this disease. The 44th
President met with the 45th President's administration and laid
out 3 different incidents of disaster that could happen in the
country. One was a pandemic scenario. But it was never taken
seriously by the 45th President, and here we are.
So my question is for Dr. Ezike and Dr. Watson. To get our
children back into school is critical, but we must do it
safely, obviously. President Trump pushed schools to reopen,
but without funding States and local governments need to ensure
distancing in schools and enough PPE for students and
educators. He would not even reimburse State and local
government for the costs necessary to operate school safely,
such as masks or disinfectant.
My piece of legislation, the Masks for Students Act, which
passed the House unanimously last Congress, and a part of FEMA
Assistance Relief Act, will require FEMA to reimburse school
districts for the cost of masks. I am pleased that President
Biden has followed our lead and directed FEMA to reimburse
schools for these operating costs.
Dr. Ezike and Dr. Watson, can you explain to the committee
why it is important for the Federal Government to help schools
pay for mitigation measures like masks and disinfectant
supplies?
Dr. Ezike. Thank you, Representative.
This is an important measure that is needed because all
school districts are not created equally. We know we have
school districts in high socioeconomic areas versus very low
socioeconomic areas. So the ability to have these supplies up
and ready without the assistance is very varied. We know that
class sizes, classroom size, the ability to do testing, a lot
of those measures have been able to be done in higher economic
areas, which causes the increased disparities.
So we do agree that resources should be deployed so that is
not another defining division to be making students have
opportunities to be in person learning versus others, because
we do all agree that that is where we want our kids to be.
Mr. Payne. Thank you.
Dr. Watson.
Ms. Watson. Thank you very much.
I completely agree with my colleague. I also think that we
need to give consistent guidance to school districts across the
country that is coming from the Federal level, which I believe
we now have, but also from the State and local level, which has
been quite variable. So if we can make clear our expectations
of the steps that schools can take to keep their students safe,
and then of course have the resources to do that, I think that
will be very helpful.
Mr. Payne. Thank you.
Mr. Chairman, I yield back.
Chairman Thompson. Thank you. The gentleman yields back.
The Chair recognizes the gentleman from North Carolina, Mr.
Bishop, for 5 minutes.
Mr. Bishop. Thank you, Mr. Chairman.
Dr. Watson, your testimony happened to be first in my
packet and I read it with care. On the first page you say that
significantly though we have offered up evidence that our
National response did not meet its potential and that many
thousands of unnecessary deaths have occurred as a result. I
read with care specifically those parts of your testimony that
spoke about successes and failures.
I note I guess the--is this paragraph on page 5, you say
finally--and I think this is--everybody pretty much agrees on
this--finally the biggest and most visible success of the past
year is the development of multiple, highly safe, and effective
COVID-19 vaccines in under a year. I cannot emphasize enough
what a technical feat this is. In fact, you have said also
otherwise in your report that cases are dropping sharply and
hospitalizations are at this point. Is that right?
Ms. Watson. Yes, that is correct.
Mr. Bishop. So by historical standards, I mean that is
kind-of an unprecedented success, wouldn't you say?
Ms. Watson. I think the development of the vaccines is
absolutely an unprecedented success, yes.
Mr. Bishop. Now, on the parts about the failures of the
U.S. pandemic response, I read that and it is hard for me to
condense some of it. I mean it is about the--you said that
public health officials suffered retribution and bad treatment,
that elected leaders didn't adequately protect and support
them, that there was a politically-driven failure to heed
expert advice.
I think this is the best summary sentence maybe. It says
high-level denial of the severity of the pandemic and
disempowerment of scientists and public health experts led to
both under-resourcing of the response and significant confusion
of the public.
So when you get past that sort-of section on just sort-of
the generalities of that, you get into this paragraph that says
within the response itself there are a few significant issues
that should be highlighted. You say that public health agencies
were overburdened and underfunded, and then you come to a
specific. You say support for State, territorial, and Tribal
vaccination planning is a particularly damaging failure. While
the U.S. Government has understandably spent billions of
dollars on vaccine development, only $200 million was provided
to States for the actual distribution and administration of the
vaccine. Is that in fact your testimony? You cite an article,
but is that your testimony before the committee, that only $200
million was spent for that?
Ms. Watson. Was specifically made available for the
planning and for mass distribution of the vaccine yes.
Mr. Bishop. Well, I looked up the article that you cited
and it says that that $200 million was released by CDC in
September. In fact, there was a September 23 release to that
effect. But at the end of the article it goes on to say
Congress eventually did allocate $4.5 billion to State
governments, but the money only began to flow to the States
earlier this month.
So is the figure $200 million or $4.5 billion?
Ms. Watson. Two hundred million dollars was in reference to
the planning phase for mass vaccination back in the fall.
Mr. Bishop. At the time--I mean if that was only released
in September, so the debate that this newspaper article refers
to is what was happening in October, right?
Ms. Watson. Yes, sir.
Mr. Bishop. I think what caught my attention about it is
when I was reading Ms. Flowers' testimony, over on page 5, it
says that FEMA, as of February 7, had provided more than $2.29
billion to 32 States, the District of Columbia, 3 territories,
and 2 Tribes for expenses related to COVID-19 vaccination
efforts.
So there is another--is that an additional $2.29 billion
that--because it didn't come from CDC, but FEMA?
Ms. Watson. I defer to my colleague, Ms. Flowers, on that.
That is a big issue. I would have to go back and look, sir.
Mr. Bishop. When you were testifying that only $200 million
had been given to help distribution efforts, you were intending
of course to rely on that information. I assumed you researched
it carefully, didn't you?
Ms. Watson. Yes, sir. That was the funding that came to CDC
to States and local--to State health departments to prepare for
vaccination efforts, yes.
Mr. Bishop. Well, I would say that from what I read in your
own article and from Ms. Flowers' testimony, that seems to be a
misleading figure. I would think, in light of the degree to
which you anticipate and expect that rely on you as the expert,
that you would be more careful about reporting such a
disparity.
I mean we are talking about probably 100 times misnumber or
mistake in terms of the amount there.
I notice that--or I point out, I am sure you are aware that
in New York State Attorney General Letitia James released a
report on the nursing home response there and that a larger
number had died than had been reported, that there were
suppressions of information by the State government there,
because for political reasons that the number of deaths
connected to New York nursing homes were about 15,000, up in
the--this has ballooned up to that, from 12,743 in late
January. So it is an on-going problem. I would think that it
would be very important for maintaining trust that accurate and
non-partisan, non-slanted information come forward from public
health officials in order to justify the confidence and the
reliance that you are saying should customarily reported.
Thank you, Mr. Chairman. I yield back.
Chairman Thompson. Thank you very much.
Chair recognized the gentleman from California for 5
minutes, Mr. Correa.
Mr. Correa. Thank you. Thank you, Mr. Chairman, for holding
this most important hearing.
Last year, as you know, the first Member of this committee
to call for expert testimony about this emerging threat called
the coronavirus today, and this committee, thank you very much,
sir, was one of the first to hold a committee hearing on the
subject matter. A lot has happened in almost a year, a lot of
loss, a lot of our friends and neighbors that passed on.
Ms. Clowers, in a GAO report on our COVID response you
noted that the previous administration had not acted on
recommendations to more fully address critical gaps in the
medical supply chain. Lessons learned. Where did the prior
administration fall short, what do we do today to fix that?
Ms. Clowers. We made several recommendations in the area of
medical supply chain, and I will highlight a few where I think
if we took some action it would help improve on-going response.
First, clarifying the roles and responsibilities of the
number of actors involved. At times there has been a lot of
maybe phonetic activity in trying to get the supplies and
address the gaps that we are seeing, but they always have not
been coordinated, leading to confusion and frustration.
Mr. Correa. Let me interrupt you there.
Ms. Clowers. Sure.
Mr. Correa. Very quickly. You bring up a good point.
Mr. McMahon, you are a county individual where the rubber
meets the road. One of the issues that I see on every weekend
that I am not with my county employees trying to vaccinate our
communities is, you said, Ms. Clowers, confusion. I am seeing
some of the change in the administration's response. This
administration to use Federally-qualified health care centers
to better communicate, distribute vaccines directly from the
Federal Government, those people that are actually giving out
the vaccinations. There are too many middle men right now.
There are too many different agencies, State, local, counties
involved. This is creating all kinds of confusion.
So my question to both of you is can we--how fast can we
get the Federal Government to streamline the system, use FQHCs,
maybe go directly to those, you know, doctors at the corner
that really treat the patients on the day-to-day basis? How can
we execute more effectively right now and not have to wait
another few weeks to get to an execution that is satisfactory
to our community?
You can answer that very quick, Ms. Clowers and Mr.
McMahon.
Thank you very much.
Ms. Clowers. OK. I will go first if you want and I will
just say really quickly it is involving local officials, like
Mr. McMahon, in these efforts. To date, a lot of the plans have
been developed maybe at the Federal or State levels and not
always involving the locals, and the locals are the ones that
know their community and can get that message out and help the
distribution going.
So I will turn it to my colleague now.
Mr. McMahon. I would agree, sir. The reality is our local
FQHC has been a great partner of ours. We had the first mobile
testing site with them before we had a case. The challenge they
would have is capacity. So we at the local level have the
capacity, we have the human service relationships in the
neighborhoods. The State of New York is working with us
potentially on more vaccine supply to address this issue, but
we are the ones that have the existing infrastructure that we
can build off of, we have the relationships. These are our
clients that we work with on a day in and day out in other
departments, so really at the local levels the best way and the
best strategy to get to our hard-to-reach communities.
Mr. Correa. Ms. Clowers, we keep talking, we keep reading
about these millions of vaccines that are coming our way, yet
this last weekend I was at home. Megacenters shutting down
because the vaccines were not there. How fast can we ramp up to
really take care of this issue? I don't want the blame game, I
just want to say how fast can we get the vaccines to main
street?
Ms. Clowers. Well, I think we heard very positive news out
of testimony yesterday from the vaccine development companies
in terms of getting to 3 billion in the next month or so. So
the supply is growing, the supply is going to be there. It is
really going to come down to these logistics of taking what the
supply there and quickly it into the shots and into the arms of
Americans. So that is going to involve our local officials, but
also importantly the communication. It needs to be very clear
and consistent.
As you have heard from fellow panel members in terms of
both educating the public on the safety of the vaccine, how to
get the vaccine, as well as educating providers and encouraging
them to help understand and promote that message as well.
Mr. Correa. Thank you very much.
Mr. Chairman, I am out of time. I yield.
Chairman Thompson. Thank you very much.
The Chair recognizes the gentleman from South Carolina for
5 minutes.
Mr. Norman. Thank you, Chairman, and Ranking Member Katko.
Thanks for holding this hearing.
I guess my question concerns the vaccine roll-out. Let me
remind my colleagues on the--my friends on the left, that had
it not been for Operation Warp Speed to produce this vaccine,
there would be no vaccine. So other than the 7-year turnaround,
which is normal, to have it within 12 months is really an
accomplishment that the 45th President made happen. I just
wanted to alert everyone to that.
Let me ask the question as far as the roll-out. We have got
right at 3,000 immigrants a day coming across that border due
to the Biden administration. I have heard all through this
testimony about shortages of vaccines among the minority,
shortages among Americans, what are we doing as the 3,000 come
across the border who will be entering our school systems, who
will be entering our towns? What is our game plan to vaccinate
them? Are we using masks? What is happening with that? Because
if you look at the statistics--and I am one that follows the
data. I think that is a good thing. The new cases domestically,
according to the CDC's website, are 67,437. Internationally
they are 384,448. You look at the new deaths domestically,
2,356. This is as of February 19. Internationally 10,471. So 5
times the numbers domestically.
So in order to protect America--and, Ms. Clowers, I will
address this to you--what is the game plan that you see to fund
it for both the illegals coming across the border, and how are
we going to deal with this?
Ms. Clowers. Well, certainly as we roll out with our
vaccine efforts and we are focusing on the United States, as
one of the panel members mentioned earlier, this is a global
crisis. As long as the pandemic, as the virus is spreading
throughout other countries, that poses a security risk and a
health and safety risk to us as well. So it is something that
we are going to have to watch and participate in.
I know there has been funding that is provided to State and
other efforts to help control and mitigate the spread in other
countries. It is work that we have on-going and happy to report
back to you on this.
Mr. Norman. So, specifically, are they being vaccinated as
they come across or are they being tested, are they--I mean
give me some--I know you say generally we are looking at it,
what are the specifics?
Ms. Clowers. Sir, at this point I don't have those details
at my ready in terms of what we are doing at the border, but I
can certainly get back to you and your staff on that.
Mr. Norman. If we could, because it affects every American,
it affects--this isn't a Democrat or a Republican issue, this
is an American issue. So if you can get back with us on
specifically what is being done all across the borders that are
now pretty much open for anybody to come across, I would like
to see the game plan that you have and others have before it
gets to the pandemic--worsens the pandemic that we have here.
Ms. Clowers. Yes, sir.
Mr. Norman. Now, as we try to get a handle on the funding
on how the COVID relief is being spent, was your team at GAO,
Ms. Clowers, able to assemble the information that we need to
track how the COVID-19 relief funds were actually spent? How
was that done?
Ms. Clowers. We are doing that--in the process of doing
that. As new relief bills have been passed we have been
updating our information. As of now about $3.1 trillion has
been appropriated and that has gone across the Government, a
variety of sectors. HHS has been one of the largest recipients
of that given their responsibilities for the public health. We
have been tracking that down through the obligations that have
been made, as well as expenditures and trying to track that
down, all the way down to the State and local governments in
some cases.
Mr. Norman. On the unspent funds, do you know the amount of
unspent funds and when that is going to be released?
Ms. Clowers. In terms of--I can give you some information
on that in terms of the amount that has been obligated. Just as
a little bit of data, because we are still updating the
information, but as of November 30, so far at that point $2.7
trillion had been appropriated, about $1.9 trillion had been
obligated, and $1.7 had been expended. We will be updating that
with new release consolidated act numbers that were passed at
the end of December.
Mr. Norman. OK. Well, I would ask if you could get this.
When do you think you would have this information?
Ms. Clowers. Yes, sir, we will be reporting out again in
March. Congress directed us to report on a regular basis and
our next report will have the latest spending figures in it. We
will make sure to get that to you and happy to brief you and
your staff on it as well.
Mr. Norman. On the actual plans on the treating the
illegals, will that be to us?
Ms. Clowers. Yes. I can get that to you as soon as I get
back to my team and get some specifics in terms of what the
agencies are doing and I will follow up with your staff.
Mr. Norman. Great. Thank you so much.
I yield back.
Chairman Thompson. Thank you very much.
Ms. Watson, I did not give you time to respond to the
testimony referencing the CDC expenditure for the vaccine. If
you would like to respond to that, I will yield back to you.
Ms. Watson. Thank you very much, Chairman.
Yes, I specifically worked on the funding that went to
State health departments to prepare for the vaccine roll out.
So at that time it was a very small amount compared to what had
been spent on vaccine development. That development was
obviously very important. I am not taking away from that, but
we did not adequately reimburse our health departments to
undertake the unprecedented roll out of vaccine, certainly.
Chairman Thompson. Thank you very much.
Chair recognizes the gentlelady from Michigan, Ms. Slotkin,
for 5 minutes.
Ms. Slotkin. Thank you, Mr. Chairman, and thanks for the
witnesses for being here.
My question is related to this supply chain issue. I am
sure everyone on this screen went through the experience back
in, you know, April, March, where were just desperately trying
to get ahold of masks and gowns and gloves and very basic
things. I remember very clearly being on the phone with Chinese
middle-men in the middle of the night just trying to get some
KN95 masks for our health care workers who were using things
like scuba equipment in order to protect themselves as they
intubated patients and whatnot.
Then I remember very clearly when we got our portion of the
Strategic National Stockpile, it was a lot less than what we
thought. We opened it up, it was moldy and expired. For us in
Michigan I feel like we have been talking about how when you
outsource supply chains, particularly on sensitive issues, on
sensitive items, like it is going to come back to bite you, and
I feel like it bit us.
So the question is we have the President at the White House
today announcing a new kind of made-in-America supply chain
review.
For Ms. Clowers, can you go through in specific terms what
additional steps we need to take to if not bring back some of
that supply chain to the United States, at least regionalize it
so we are not dependent on countries we have sometimes a mixed
relationship with, like China? What can the Defense Production
Act and Buy American Requirements and the Government do to
actually bring those supply chains home and make us less
vulnerable?
Ms. Clowers. Yes. This is an issue that we have been
tracking for about 9 months now because, as you note, it has
been a persistent challenge from right at the beginning from
the lack of supplies. What we saw was that domestically there
was an insufficient amount of supplies on hand, or in some
cases they were outdated, the supplies were unusable.
In terms of what can we do going forward, you know, we have
called for a few things, including better clarifying the roles
and responsibilities of all the different players. Again, we
saw that confusion in terms of who was going to be providing
what and how to get the supplies that were needed.
I should note that this isn't surprising, because in the
fall of 2019 the Government conducted a pandemic exercise and
through that exercise they found--some of the key findings was
that we had insufficient supplies and that we were going to
have confusion and that it was going to lead to needed gaps.
In terms of going forward, so we have called for clarifying
the roles, assessing what gaps exist now, but also looking
ahead to try to get ahead of this a little bit, you know, 6-12
months, and also looking into the next pandemic. We do want to
be looking at all the tools that are being used from the
Defense Protection Act and other tools that we might be able to
bring to bear in terms of financial incentives.
Two other quick points I will make on the financial
incentives. Especially in the area of medical countermeasures,
we have been--as we have noted, the vaccine development, we
were successful this time in terms of getting a vaccine
developed within a year, but that is an inherently risk process
that is very costly. Most medical countermeasures actually
fail. So we need to incentivize companies to work in this area,
conduct the R&D necessary.
Then, finally, really examine the role of the Strategic
National Stockpile. Is it to be a front line defense or a
backstop? People need to have an understanding of what they can
count on from this Strategic National Stockpile so State and
local can plan.
Ms. Slotkin. Yes. I mean I think the truth is Democrats and
Republicans all talk about this, right. It is like a really
common message that people are saying after the year that we
have lived through. But what I fail to see is actual action,
right. We all know we have to look at gaps, we have to
coordinate better. But what are we going to do actually
incentivize that production to be made here? That is going to
take breaking some china for how our system works.
Mr. Chairman, I would offer we could do maybe a bipartisan
letter or something, particularly to DHS to talk about our
concern about this and urge them forward so we get beyond this
idea that we are all concerned and we actually start seeing
changes in how the procure at places like DHS.
With that, I yield back the rest of my time.
Chairman Thompson. Well, staff will get with the gentlelady
from Michigan and we will start drafting language for such a
letter as you are talking about.
The Chair recognizes the gentlelady from Tennessee, Ms.
Harshbarger.
Ms. Harshbarger. Thank you, Mr. Chairman.
I have several questions. The first is for Dr. Watson. I
have been a pharmacist for 34 years and I absolutely understand
the vaccination process and the manufacturing supply chain. You
know, I was looking at the testimony from Ms. Clowers and what
it says is that in nursing homes they did not capture for the
first 4 months of the pandemic because they weren't required
until May 2020.
My question to Dr. Watson is how important is accurate data
collection as we continue to respond to this pandemic? The
second part is how do we ensure that that data collection is
consistent from State to State? What kind of parameters are in
place to make sure that happens? Because this has to be data-
driven. You know, there can't be any gaps in this.
Ms. Watson. Thank you very much.
Yes, I completely agree with you. That should be a
priority. As my colleagues have already stated, in order to
make changes and to recognize where our response falls down, we
need the data to drive that. So I think accurate data
collection is very important. How we do that is in part having
very consistent guidelines and guidance from the Federal
Government, from the CDC in particular. That is really
important to standardize how our data is collected.
Thank you.
Ms. Harshbarger. That is great.
I do agree with my colleague, Ms. Slotkin, because I have
been talking for 25 years that we need to do something about
the supply chain, us being able to have a domestic supply chain
for finished pharmaceuticals as well chemicals to produce those
domestically. You know, it is imperative we do that. Maybe it
is about time, I don't know.
But, you know, what we did learn, and Mr. Norman touched on
this, Warp Speed did provide us a vaccine in record time, and
that really shows that these drug companies can get vaccines
out from now on in a more timely fashion. It is not just that,
it is other things as well. There is a lot of scrutiny when it
comes to getting things to market.
But Congresswoman Jackson Lee asked you is our society
sicker now than it was before and you said yes. Now, I have
read in your testimony that the post-COVID syndrome, there are
certain things that we have to worry about with that. I
understand that that is things like loss of taste and smell,
fatigue, that type of thing. I have read some articles that say
that lasts 8.9 days and then 98 percent of people are cleared
up within 28 days.
So in your testimony too, really 28 million reported cases
of COVID what work is being done to understand those long-term
effects of the virus? In my opinion, the long-term side effects
are things like the school closures. You know, when are they
going to do studies about what this detriment has done to the
children in their learning capabilities. It put us back 10
years. You know, the closures are shuttering small businesses
completely. These are things that I look at, but what are you
doing--how are we going to study the long-term impacts of this
virus?
Ms. Watson. I think certainly we need to study all of the
long-term impacts of this pandemic, and that includes societal
impacts from the pandemic itself and from the efforts we have
had to take to control it. But in terms of the long-term
impacts of COVID and post-COVID syndrome, I know that there are
a number of studies on-going. They are actually trying to
understand what those effects are and how we can help people to
recover more effectively from this virus.
But recent data has shown that many people months after
they have recovered from the acute phase of COVID do have at
least one of these symptoms and it is affecting their lives. So
I think that is a really important thing that we need to look
at.
Ms. Harshbarger. You also spoke about different variants of
this COVID-19 virus. Do you know how many have been identified
or how bad those strains are going to be? I was on another
conference call and they talked about those different strains.
What have you learned about that and what should we know about
that?
Ms. Watson. I think we are trying to increase our
surveillance across the country for these variants of concern.
That is a really important effort that there is funding in the
American Rescue Plan for additional surveillance capabilities.
I think that is very critical.
Some of the variants are very concerning right now,
particularly B117, which has been shown to be much more
transmissible. We are watching that to see if that will cause
another spike in cases in the spring. I am hopeful that it
won't because we have mitigation measures in place. But there
are other variants that also escape our response that we need
to watch carefully and then plan our update to a vaccination in
line with those.
Ms. Harshbarger. OK.
Chairman Thompson. The gentlelady's time has expired.
Ms. Harshbarger. I yield back.
Chairman Thompson. The Chair recognizes the gentleman from
Missouri for 5 minutes, Mr. Cleaver.
Mr. Cleaver. Thank you, Mr. Chairman. Thank you for having
this hearing.
You know, one of the worst things that is going in this
country, and I--you know, I have fear for my children and their
children over the direction we are going. We try to politicize
everything. It almost made me throw up to just hear the--you
know, we have to politicize a pandemic. We politicize wearing
masks, we politicize whether we drink bottled water or make a
cup out of our hand, drink out of the faucet, drink out of a
well. Whatever, it doesn't matter. We figured out how to
politicize it and create some kind of a social battle on it. We
have done it here. It just troubles me.
But what I would like a guest, those who are testifying, to
help me understand, is that, you know, last March, the
President said, you know, we want to be back in church by
Easter. In my real life, last year was the first time I wasn't
in church on Easter in my whole life. I am usually there 52
Sundays a year. Then he said it is going to be a great
experience. I think when we start giving out false information
it does damage.
My question to you is, is there a system that we need to
put in place? Can you help me at least, figure out a way
something we can put in place that will allow the Government,
you know, to take a back seat because of the system we put in
place? I know we are going to need the President's leadership
on things like this, but maybe there is something I am
overlooking. I have been trying to--now what could we have done
to prevent what was done that has in fact probably cost us
lives? Can any of you help me create this and get the Nobel
Peace Prize?
Ms. Clowers. Well, sir, I would offer, you know, as we have
looked back over the last year in terms of our work from
lessons learned that have emerged--and actually these were
lessons we also offered actually last February. I testified for
a Senate panel as we were learning about COVID-19. Looking back
through our work on H1N1, as well as responses to other public
health emergencies, several things were clear about what we
needed to be doing. I have mentioned some of them already, but
we needed plans in place in terms of clarifying roles and
responsibilities. Everyone needed to know what they were
responsible for and who they should be working with.
We needed clear and consistent communication in terms of
messaging about where we were with the pandemic, what we were
doing, and importantly, what steps we needed the public to
take, because in a public health emergency you are asking the
public to take certain steps. So you need to make sure that you
are informing them in a clear and consistent way.
The same thing in terms of using data to drive decisions
was another lesson learned. Making that data as readily
available and understandable to the public so they understand
why we are asking them to take certain measures. Then, finally
with transparency and being as transparent with our actions as
possible. So when the Government is making decisions, whether
it is around testing guidance or improving emergency use
authorization, the public understands and it can increase the
confidence level in the actions that the Government is taking.
Mr. Cleaver. Thank you. Thank you very much.
Mr. Chairman, I yield back.
Chairman Thompson. Thank you very much.
Chair recognizes the gentleman from Georgia for 5 minutes,
Mr. Clyde.
Mr. Clyde. Thank you, Chairman Thompson.
I would like to take this opportunity to address my grave
concern with the Biden administration's decision to eliminate
the migrant protection protocols. This reckless decision will
have the dual effect of putting Americans at risk of exposure
to the coronavirus and creating conditions that mirror the 2019
border crisis. Increasing number of unaccompanied minors and
families illegally crossing the border in the middle of a
global pandemic is creating a recipe for disaster.
President Biden's Executive actions have the potential to
cause mass outbreaks at facilities and ports of entry which
would lead to their temporary closure that could have a
significant impact on commerce and further handicap our
economic recovery efforts. A mass outbreak would also
jeopardize the health and safety of our men and women who serve
on the front lines protecting our Nation's borders.
Finally, these Executive actions and a surge at the border
have forced Customs and Border Patrol officials to return to
the dangerous policy of catch-and-release. This policy releases
migrants who have not been properly vetted or sufficient tested
for coronavirus into our communities, putting the health and
well-being of Americans at risk.
The Biden administration's actions are unacceptable and
serve as distractions from what this committee should be
focusing on, which is how we can secure our borders and prevent
our constituents from being exposed to the COVID-19 virus.
I would like to submit for the record a letter that my
colleagues and I on the House Oversight and Reform Committee
send to Secretary Mayorkas highlighting these concerns. The
letter is dated February 19.
With that, Mr. Chairman, I yield back my time.
Chairman Thompson. Thank you very much.
Without objection, the letter will be included in the
record.
[The information follows:]
Chairman Thompson. Chair recognizes the gentleman from
Texas for 5 minutes, Mr. Green.
Mr. Green. Thank you very much, Mr. Chairman. I am honored
to have this opportunity to ask questions.
Let me lay the predicate. President Trump led three-
quarters of the 69 press events during the first 13 weeks of
the pandemic.
First question, how important it is it for the
professionals to give professional advice at the inception of a
pandemic, in its nascency? Dr. Watson, would you kindly
respond?
Ms. Watson. Yes, sir. The professionals, the public health
experts, the scientific experts need to be able to provide
their expert judgment on the pandemic situation. It is not
always totally clear-cut what the situation is, but they need
to be able to weigh in with their experience and education and
their related judgment. When they are prevented from doing that
or when political pressures are put on them to say something
that contradicts that experience and that judgment, that is
where we run into trouble.
Mr. Green. I think it is fair to say that--and I mean no
disrespect--but that some of the advice that was given by the
President, some of that advice proved to be harmful to some
members of the public. I can recall persons taking certain
chemicals to their bodies that were harmful to them.
Is this the kind of thing that you can avoid if you allow
the professionals to lead?
Ms. Watson. Yes, sir. Good risk communication will tell
people what they can expect in terms of risk, what actions they
should take to protect themselves, and answer the questions
they have, but won't lead them to do things that are more
dangerous.
Mr. Green. Now, on the other hand, juxtaposing the Biden
administration to the previous administration, we have the
Biden administration with a commitment to put shots in arms. In
fact, in my Congressional district, the Biden administration is
setting up a super site, 6,000 shots in arms per day, to have a
total of 126,000 people vaccinated. This is coming from the
Federal Government in concert with the State, the county
government, and the city. This is a collaborative effort.
Is this the kind of effort that you need in a pandemic so
as to thwart the pandemic as quickly as possible?
Ms. Watson. My colleagues and I like to say that the
pandemic breaks systems. So what we need is people to come
together at all levels of government to address this
unprecedented challenge. Yes, that is the type of coordination
that we need.
Thank you.
Mr. Green. Finally, minority communities are especially
vulnerable--a multiplicity of reasons why, but it appears to me
that we have to do more in terms of assuring minority
communities that they will get the vaccine. But, on the other
hand, we also have to assure minority communities that this
vaccine is going to be safe. There are good reasons for
minority communities to have consternation about injecting
vaccines into their arms given the history that they have
suffered in this country.
What would you say to the minority community in my city
that may be watching now? Because of certain circumstances that
have occurred, what would you say them to encourage them to
please get these vaccinations?
Ms. Watson. I would say that I understand that there is a
history of abuses that have made it difficult to trust both
Government and health care systems, but I would encourage
individuals in your community to listen to their local leaders,
to try and understand the facts about the vaccine in particular
and to judge for themselves how safe and effective it is.
I hope that that will give them the information they need
to make a good decision.
Mr. Green. Thank you, Mr. Chairman, I yield back.
Chairman Thompson. Thank you very much. The gentleman
yields back.
The Chair recognizes the gentleman from Florida, Mr.
Gimenez, for 5 minutes.
Mr. Gimenez. Thank you, Mr. Chairman. I appreciate it. Dr.
Watson, a couple of questions for you. You state in your
testimony that certain countries were very effectively keeping
the virus out. What are those countries? Which countries were
they?
Ms. Watson. There are a number, but the ones that I have in
mind are particularly New Zealand and Australia right now.
Those are the ones that I have kind-of held at the top of mind,
yes.
Mr. Gimenez. What do you account that? How do you account
for that? Why were they able to keep it up?
Ms. Watson. Yes, there were a number of factors early on.
They took very quick action to prevent cases from coming in, to
identify cases early, and then to take the public health
actions to prevent those cases from turning into epidemics by
finding every case as much as possible. Then doing contact
tracing and ensuring that the transmission didn't continue.
Mr. Gimenez. They were able to return to basically a normal
kind of existence, normal kind of life in those countries?
Ms. Watson. Yes. In some cases, the life looks--has looked
pretty normal over the last several months. With the exception
of if there is an introduction of a case, then those countries
often take pretty rapid action to shut things down to prevent
epidemics, but then they are able to return again to more
normalcy.
Mr. Gimenez. Are they open to the world or are they shut
off from the rest of the world?
Ms. Watson. I don't know. I don't have the facts fully on
that, but I think mostly that things have slowed like with the
rest of the world. Transportation has slowed and so, it looks
largely like the rest of the world in that way.
Mr. Gimenez. Do you know if we test the migrants coming on
the Southern Border, do we test them for COVID-19?
Ms. Watson. Like my colleague, I don't have that
information, but I am happy to get back to you on that.
Mr. Gimenez. Does anybody on this call have that
information? OK. Also, do you know if we are testing,--I guess
nobody has the answer to that--if there is a different variant
that they are bringing in from the south? Because I understand
that the Brazilian--the Brazilian variant of COVID-19 is very
similar to the South African variant, which is resistive to the
vaccine?
Ms. Watson. I think that the data on that is still a little
unclear about the P.1 variant. But what we do know is that
these variants are already here in the United States, and they
have been identified in many States already.
Mr. Gimenez. OK. I think final question is do we know the
percentage of Americans that are refusing to get vaccinated?
Ms. Watson. I am not up on the current number on that. I
think there have been some significant polling, but I am not
sure what the most recent number is.
Mr. Gimenez. What number would that be that would make the
vaccination--the vaccination program less effective, let's say,
to getting back to a normal life?
Ms. Watson. I think we need to aim for a high number of
vaccinations around the country. In our very vulnerable
populations, we should aim very high in the 80th, 80 percent
range. In the general population, it is hard to pinpoint an
exact number, but I think we need to reach at least 60 percent
of people vaccinated. That should be our goal. But there is no
hard and fast number to say that it will be a success or a
failure.
Mr. Gimenez. OK. Do we have--again I know that I heard
somewhere else, I guess, in another hearing that there is a
variant. The variant from South Africa is resistive to the--is
resistive to the vaccine, but if you do get vaccinated and you
get sick with that variant, that you won't die and it will be a
much milder effect. Have you heard that also? Have you heard
also that?
Ms. Watson. The data we have seen so far shows that
vaccines have been highly protective against hospitalization
and death against many of these variants. So, that is a hopeful
sign.
Mr. Gimenez. Is there any variant that you are afraid of?
Ms. Watson. I am afraid of those variants that escape our
immune responses, whether it is natural immunity or
vaccination. So, I think we need to track them very carefully
and we need to plan for the future of the pandemic in this
country. We may need to update our vaccines to respond to these
threats.
Mr. Gimenez. OK. Thank you very much. I appreciate it. I
yield back my time.
Chairman Thompson. Thank you. The gentleman yields back.
The Chair recognizes the gentlelady from New York for 5
minutes, Ms. Clarke.
Ms. Clarke. I thank you, Mr. Chairman. I thank our Ranking
Member. Approximately 1 year ago, life as we knew it came to a
screeching halt. Within that year, COVID-19 has claimed more
than half a million lives. This many deaths did not have to
happen. For decades to come, we will look back at the previous
administration's handling of this crisis as a textbook case
study of how not to handle a pandemic. Fortunately, President
Biden has made it clear that going forward, we will let
science, not politics, guide our response. I happen to
represent a district that has been particularly hard hit by
COVID-19 as part of the epicenter of the outbreak of the
pandemic. We all know that communities of color have borne the
brunt of the pandemic. Brooklyn is one of those areas. It is
also home to countless essential workers, many of whom are
immigrants. They are the heroic front line, the lifeline, and
most vulnerable, all at the same time in this pandemic. They
are a significantly crucial segment of the population of our
communities in New York City who have faced some of the highest
infection rates in the Nation.
We must rapidly address the inequities in public health and
eliminate the disparities from our COVID-19 response. Having
said that, I want to turn your attention to Project Airbridge.
I have to tell you, living in New York when we had to scramble,
outbid, and do everything we could without the help of the
Trump administration because the States were handling it.
Project Airbridge to see Robert Kraft's airplane land at JFK
with a New England Patriots sign on it and not a B-59, or
whatever the plane is from our National Guard or our military,
was such a slap in the face to Americans.
Over the past year, when it came to securing PPE for front-
line medical workers, I certainly know why New York had
significant struggles. The Trump administration repeatedly
touted Project Airbridge as a success story in accelerating the
importation of critical PPE. FEMA indicated that at least 50
percent of its supplies were directed to hot spot areas. But
there was a serious lack of transparency to confirm this
occurred. As a matter of fact, it looked like a rewarding of
some friends, i.e., New England Patriots.
Despite repeated requests, we never received information on
where the supplies went and other basic details. I raised this
at the committee's July 14 hearing. Dr. Ezike, when it comes to
securing PPE, could you share with us your thoughts on how
States were forced to compete to secure PPE and what Governor
Pritzker told the committee was akin to the Hunger Games and
the degree to which Project Airbridge was effective in meeting
Illinois' supply needs?
Dr. Ezike. Yes, thank you, Congresswoman. Significant
challenges in the securing of PPE, as I think another
representative who was in the struggle last year, we were
talking to middle men in various countries, in China, you know,
I got a guy, I got a guy.
Ms. Clarke. Mm-hmm.
Dr. Ezike. We were sometimes outbidding trying to bid or
outbid other States. In one situation where we did have an
arrangement to have a large shipment, we then got outbid. Our
order was canceled as the Federal Government was outcompeting
us. We had to at one point, actually take State police to the
airport to make sure that there wouldn't be any interception--
--
Ms. Clarke. Mm-hmm.
Dr. Ezike [continuing]. Of a shipment that was coming in.
So, very uncharacteristic moves were undertaken to secure this
life-saving PPE for the pandemic.
Ms. Clarke. I thank you, Dr. Ezike. Let me just say that
that was a disgrace. We need to really unpack what happened
with Airbridge and make sure it never happens again. With that,
Mr. Chairman, I yield back the balance of my time.
Chairman Thompson. Thank you very much. The gentlelady
yields back. The Chair recognizes the gentlelady from Iowa, Ms.
Miller-Meeks, for 5 minutes.
Ms. Miller-Meeks. Thank you very much. I was trying to
unmute myself. I appreciate it, Chair. If I could, I have a
couple of very quick questions and then a more lengthy
question. So, Mr. McMahon, you mentioned the local public
health and local public health funding. Both as a physician and
the former director of the Iowa Department of Public Health, I
am wondering--and this is one of the things I advocate for--is
that rather than money that is allocated to the States and then
the State decides, could there not be funding go directly to
CDC and then go to local public health grants, which would then
go to our local public health agencies? Would that not be a
pathway----
Mr. McMahon. Yes.
Ms. Miller-Meeks [continuing]. For us to get funding to
local public health agencies so they both have adequate PPE and
can vaccinate?
Mr. McMahon. Yes, I think any time if the intention is to
get us the funding, finding a way to get us directly,
guarantees you get us the funding. We have great relationships
with our State partners. But certainly, there are times where
funding goes to the States and it doesn't flow back to the
local governments.
Ms. Miller-Meeks. Yes, I had that same conversation with my
local public health agencies. Then, Dr. Ezike, can you--do you
know what the number of non-COVID-related excess deaths are in
the United States due to the pandemic? I ask that because in
San Francisco published in January of this year--I have
referred to this pandemic as life versus life. In January this
year, San Francisco Chronicle published that there were 699
deaths from overdose. It would have been much more than that
had it not been for dispensation of Narcan. This was 57 percent
greater than in 2019. So, vastly outstripping. The number of
COVID deaths in San Francisco at that time were 121. So, do you
know the number of non-COVID-related excess deaths in the
United States during the past year?
Dr. Ezike. Doctor, we have that number. I don't have it at
my fingertips, but our team can get that back to you. But I
think we had at least, it was at least 20 or 30 percent on top
of the known COVID deaths. So, we would say that those may have
been some missed COVID deaths as well as other non-COVID deaths
within that number.
Ms. Miller-Meeks. Yes, so, over the summer I had found a
figure of approaching 98,000 at the end of summer. My next
question and this can be to Ms. Clowers or any of the panel
members. But, again, as a physician and former director of the
Iowa Department of Public Health, one of the most concerning
things to me at the start of the COVID-19 pandemic, was the
issues of our country had with supply chain of pharmaceuticals
and PPE. Given my time in the military, the supply chain is
very concerning to me. In particular, I was concerned about our
country's ability itself to produce medical supplies
domestically.
As you know, last spring the Chinese Communist Party issued
threats to cut off the supply of medicine to the United States
just as the virus was beginning to spread widely in our
country. Thankfully, the Chinese Communist Party did not act on
that threat. But it exposed the vulnerability of our medical
supply chain when we rely on foreign countries and foreign
nations for these critical supplies. Some of the supplies that
some countries received were inadequate or deficient.
So, Ms. Clowers, in your testimony you discussed several
recommendations for addressing supply chain challenges. I
appreciate those recommendations. What I am asking is that what
lessons can we apply to further pandemic preparedness efforts?
Are there steps that we as a Nation can take to ensure that we
have critical medical supplies that are available domestically,
rather than enacting the Defense Production Act to get those
supplies produced here?
Ms. Clowers. Yes, in addition to the recommendations that
you mentioned, we do need to go back and look at our domestic
supply chain as a Nation in terms of how we can make it more
robust. Because what the pandemic illustrated when it started,
we had inadequate supply of supplies on hand. The supply chain
is made up of a number of players and a number of entities. So,
we need to have a better understanding of what everyone has and
what their capabilities are. Including in that is the Strategic
National Stockpile.
Ms. Miller-Meeks. Right.
Ms. Clowers. Understanding what is the role that that is
going to play and how we would stock that stockpile and how we
are going to manage it. Those are important policy decisions
for the Congress to consider. You also mentioned in terms of
the supply chain that also we often think about PPE right now,
but it is the drugs too. Most of our generic drugs are
manufactured overseas, particularly in China and India. That
creates a vulnerability for us as a Nation as well.
Ms. Miller-Meeks. Thank you so much. Both drugs, PPE, and
pharmaceuticals in the Strategic National Stockpile. Thank you
so much. I yield back my time, Mr. Chair.
Chairman Thompson. Thank you very much. The gentlelady
yields back. The Chair recognizes the gentleman from
California, Mr. Swalwell, for 5 minutes.
Mr. Swalwell. Thank you, Chairman. Thank you to the
panelists. Many of us gathered last evening on the Capitol
steps, House Members and Senators. We remembered the 500,000
COVID victims that we have lost. As sad as it was to do that, a
lingering thought I had was will we be back here shortly to
remember 1 million lost? I think what we do as leaders on this
committee and with our neighbors and people in the community
will determine that.
I want to turn to Dr. Watson and ask you a question, Dr.
Watson, about misinformation. Because what we learn and how we
act on that certainly will dictate future loss. We have seen
harmless misinformation like mouthwash can stop COVID. We have
seen harmful misinformation like ingesting bleach or
disinfectants can stop COVID. We have seen reports of people
showing up at emergency rooms because they have done this. So,
what can we do to combat what is called infodemic? How deadly
is infodemic to our ability to take this on?
Ms. Watson. Thank you for that question. We have seen that
misinformation, I think, on balance has had a very significant
impact on public health and in the pandemic. As you mentioned
from people taking treatments that are unsupported by science
to not believing in the virus itself up until the point of
death in some cases. So, I think this is a large factor in
shaping how the pandemic evolved in this country.
The WHO has proposed a research and policy agenda for
combating misinformation, which really includes a combination
of limiting its prevalence on-line and improving the reach of
high-quality information that is health protective. But more
research is needed into how we can effectively manage this. I
also think that the United States needs a plan to combat mis-
and disinformation especially as it relates to health.
Mr. Swalwell. Thank you, Dr. Watson. Also, on the topic of
communication, the National Biodefense Strategy lays out the
importance of coordination between the Federal and State and
local governments while responding to a pandemic like COVID-19.
Last year, Governors reported that they had limited information
from the Federal Government about when vaccines would become
available. They only would learn a week ahead of time as to the
number of vaccines they would receive, leaving many States
scrambling to implement distribution strategies.
President Biden has sought to increase coordination and
communication with the States, especially to get the vaccine
and numbers up earlier than just a week out. So, what other
steps can the Federal Government do to coordinate with State
and local governments? I will open this one up to any panelist.
Dr. Ezike. This is from the Illinois response. We can say
that we have really enjoyed in the last month communication,
and if there is such a thing as overcommunication, from the
COVID response team with this new administration. We are very
grateful for the 3-week lead time in terms of allocations,
which allows for appropriate planning at the State level and,
of course, for our local partners who can determine the numbers
of vaccine appointments that can be made based on knowing 3-
week allocations.
We are really grateful to hear their priorities and then
their plans for supporting us in implementing those National
strategies and priorities. So, we are really grateful for on-
going communication and we see that as an important measure to
getting on the other side of the pandemic. We have also seen
responsiveness to issues from the boots on the ground. So, as
we share concerns, those are taken back, acted on, and then
brought back and collaborative decisions are made.
Mr. Swalwell. Great. Thank you to the panelists. Thank you
to the Chairman, and I yield back.
Chairman Thompson. Thank you very much. The gentleman
yields back. The Chair recognizes the gentlelady from--the
gentleman from Kansas, Mr. LaTurner, for 5 minutes.
Mr. LaTurner. Thank you, Mr. Chairman, and thank you to
Ranking Member Katko, and to all the panelists. Mr. McMahon, in
your written testimony, you addressed Syracuse University's
opening in August. You talk about testing and as we know, the
science tells us that college-age students are more susceptible
to the coronavirus. They will spread it more easily than
elementary students will. So, talk a little bit about that
process.
Mr. McMahon. Yes, and so, essentially the testing--the
testing before the student actually comes into the community
was done. Then when they got literally physically on campus, we
tested them again. Then Syracuse University is doing a
tremendous job implementing what is now-weekly testing. They
have actually even invested into their own lab on campus so
that they can meet the State restrictions related to positivity
rates now. Before they were being held to a 2-week period of
time, where to remain in-person learning, they could only have
100 cases on a campus of 15,000 students. It is a pretty tough
threshold.
So, testing has been the key to our success in central New
York related to our positivity rate. It has allowed us to
rebalance the public health decisions we are making related to
whether it is in-person learning for our pre-K-12, or
certainly, our higher ed as well.
Mr. LaTurner. Just to be clear, this is months before a
vaccine that Syracuse was able to open. Tell me this, did
they--you mention testing--did they have to spend millions of
dollars upgrading ventilation systems or reconstructing spaces
to accommodate social distancing?
Mr. McMahon. They did. They spent money, obviously, on the
testing infrastructure, right? That is a business decision the
university makes to get their students back on campus.
Certainly, they did look at updating and investing in
ventilation systems, distancing, mask wearing. They were very
strict related to, as we all know, the college experience
brings different social aspects to it. We would have hiccups
where you would have parties that would lead to cases. The
university responded and responded quickly.
But because of that and the management of that, to your
point before the vaccine was ready, and again, at this point,
students aren't even eligible to get the vaccine in this
process now. We have had the spring semester has started and
things are going quite well. The positive rate if they were
their own State at Syracuse University's campus, they would be
the best State in the country with the positive rate that they
have.
Mr. LaTurner. Thank you very much. Thank you, Mr. Chairman.
I yield back my time.
Chairman Thompson. Thank you very much. The gentleman
yields back. The Chair recognizes the gentlelady from Nevada,
Ms. Titus, for 5 minutes.
Ms. Titus. Thank you, Mr. Chairman. Thank you for holding
this hearing. You know, we have heard a lot from some Members
across the aisle about the folks who are at the border and the
immigrants at the border. But we haven't really heard much
discussion about the 11 million undocumented people who are
already in this country. So, I would like to ask the panel, and
maybe starting with Dr. Ezike, how the policies of the former
President, including the public charge rule, have affected the
undocumented community in terms of getting the virus, getting
good information, dealing--I mean, getting the vaccine, getting
good information, and dealing with the virus. You know, so many
are distrustful of Government. They are fearful of being
deported. They are worried that it will harm their chances of
gaining permanent status.
So, if you all could discuss how it has been a problem, how
we can address it, how it makes it more difficult to deal with
the broader community if you have a large segment like in my
district of folks who aren't vaccinated or aren't willing to
kind-of put themselves out there to get the information or get
the shot in the arm.
Dr. Ezike. Thank you for that question. So, as I started in
my opening remarks, we understand that no one is safe if
everyone isn't safe. When we have individuals living in our
communities who have the virus, the virus doesn't care what
color your passport is. It will spread to any individuals
around. So, understanding that everyone needs to be tested,
needs to be vaccinated, is the only way that the whole
community will be able to move forward.
We have heard on virtual town halls and community meetings
that there is a hesitancy to come forward for fear of being
reported, for fear of having information being turned over. So,
we just understand that all of these individuals who form the
fabric of our communities who care for children, who work in
essential roles that are often engaging with the public in high
numbers, they will go on to infect other people if, you know,
if the infections and the infection transmission is not
contained by either aggressive testing and/or vaccination. So,
again, we just have to understand the basics of infectious
disease spread that we have to control the spread by testing,
contact tracing, and vaccination. We have to take care of all
of the people in our midst to get beyond to the other side of
the pandemic.
Ms. Titus. Anybody else want to address that? Well, what
you say, Doctor, is certainly true in my district because a lot
of these folks work back of the house in gaming, back of the
house in restaurants. They are in service positions where they
could be spreading the virus.
Also, we have the problem of multi-status families. In one
family, one person is a citizen, one person is a dreamer, one
person is on TPS, one person doesn't even know what they are,
you know. So, if one person is afraid to come forward, then you
have got a whole family that will be affected.
Well, I think we need to figure out how to do a better job
of getting information, not just into minority communities, but
into these undocumented communities to try to reassure people
and get the best health and science information to them to make
them realize this is something in their own interest and not
something that is going to come back to bite them like public
charge.
Dr. Ezike. Yes, ma'am. We have been trying to message
directly in the native language in Spanish. Making documents
available in Spanish and working with community-based
organizations that already have a leg in those communities to
make sure that they have trusted messengers telling them that
it is OK, that there is no charge, that they should take
advantage of testing and vaccination.
Ms. Titus. Well, thank you. Thank you, Mr. Chairman, I
yield back.
Chairman Thompson. Thank you very much. The gentlelady
yields back. The Chair recognizes the gentleman from New
Jersey, Mr. Van Drew, for 5 minutes.
Mr. Van Drew. Thank you, Chairman Thompson and Ranking
Member Katko. The coronavirus pandemic has had a devastating
impact on our Nation with over 27 million confirmed cases and
half a million deaths in the United States alone. This is a
tragedy. In addition to the high death toll, our economy has
suffered due to oppressive lockdowns, which have exacerbated
the hardship experienced by so many people. States and cities
across our Nation have seen record unemployment numbers.
Atlantic City, New Jersey one of the most populous cities in my
district, had the Nation's highest unemployment rate, 34
percent, last summer.
Not allowing people to safety and responsibly resume work
is not the answer. Restaurants, gyms, and other essential
businesses and industries have been decimated by the
coronavirus. My district's economy heavily relies on summer
tourism. Those summer months are what drive the regionals'
economic success. But because of restrictive lockdowns, many
businesses had to permanently close their doors forcing
thousands of people out of work.
Fortunately, there is light at the end of the tunnel.
Thanks to the previous administration's steadfast initiatives
like Operation Warp Speed, we now have multiple vaccines that
are being distributed and administered every minute of the day.
We must continue to focus on how we can safely reopen
businesses and our schools and continue to get America
vaccinated. America needs to get moving again. I look forward
to that with my colleagues on the committee on how we, on how
we can best facilitate moving forward again.
I have a couple of questions for Nicole. For Nicole
Clowers, what changes to regulations pertaining to the
Strategic National Stockpile should be changed to ensure that
we are better prepared for future disease outbreaks?
Ms. Clowers. Well, one of the things that--first, thank you
for the question. One of the things we have called for is as
the administration continues to reexamine the supply chain,
which is an effort that is on-going, that they include the
Strategic National Stockpile. Because what the pandemic has
demonstrated is there is not a good understanding of the role
that it plays in terms of should it be the sort-of front-line
defense? Or is it more of a backstop? What type of supplies
should be in it? Should it be for high probability, but low
consequence? Or the reverse? These are the discussions that
need to happen. What we have encouraged is for the
administration to reach out to the Congress, as well as non-
Federal stakeholders to have this conversation to make those
decisions, because it affects multiple players in all levels of
the government.
Mr. Van Drew. Thank you. For Crystal Watson, how do we
ensure that the data collection is consistent from State to
State?
Ms. Watson. I think that the best way to ensure that is to
provide consistent Federal guidance to States about how and
what data they should be collecting. Then giving them support
to do that data collection.
Mr. Van Drew. Are we working in that direction?
Ms. Watson. I believe that CDC is working in that
direction, yes.
Mr. Van Drew. OK. So, your sense is that we are improving
in that area from what you know and understand of it.
Ms. Watson. Yes, sir.
Mr. Van Drew. OK, thank you. Mr. Chairman, I yield back.
Chairman Thompson. The gentleman yields back. The Chair
recognizes the gentlelady from New Jersey also, Ms. Watson
Coleman.
Ms. Watson Coleman. Thank you, Mr. Chairman. Thank you for
this briefing to each of those who have participated here. I
have got a quick question for Ms. Clowers. It is my
understanding that the Biden administration is trying to track
down this so-called 20 million doses of vaccine that were
released by the Trump administration, however, no one knows
where it is or who received it. Do you have any information on
this?
Ms. Clowers. We are looking at these issues as well. We
have on-going work looking at vaccine distribution. What we are
finding is there has been miscommunication about the number of
doses that were available and delivered and allocated. It is a
issue that the administration is working on now to try to
improve the data. Certainly, we have heard from the National
Governors as well about concerns about the reporting of the
data and the doses that are coming to them, as well as the
number of shots that are being given. So, I think it is a
communication issue as well as a data issue. But we have on-
going work and are looking at that, and we will be happy to
brief you----
Ms. Watson Coleman. Thank you.
Ms. Clowers [continuing]. When we have our report.
Ms. Watson Coleman. Appreciate that. With all due respect,
I think that there is an honesty, lack of transparency,
incompetence issue that was at play in this former
administration. Had we had more honesty, transparency, a
recognition respect of the science, as well as competence, we
wouldn't have to have this briefing today at this level.
This question is for Dr. Ezike and Dr. Watson. Although
there is a big focus on vaccines these days, it is important to
remember what other mitigation measures like wearing a mask are
proving to work. Over the past year, instead of setting an
example for the country by wearing a mask, President Trump
downplayed the virus and even mocked wearing masks for months.
In fact, Trump berated Biden for wearing a mask. Even after
contracting the virus himself, hosted campaign events which
were subsequently considered super spreaders. Dr. Ezike and Dr.
Watson, do you believe having our elected officials act as
leaders and promote science-based mitigation measures is
important in fighting this COVID-19? If this were done since
the beginning of the knowledge of the pandemic, would we not
have saved more lives?
Dr. Ezike. Thank you for that question. We have seen that
the example of our leaders carries significant clout. We have
individuals that decide to vaccinate or not based on people
that they trust getting vaccinated. Likewise, we had people
turn against masking because there was a culture of anti-
masking or that masking wasn't necessary. So, absolutely, that
is important.
Ms. Watson Coleman. Thank you. Dr. Ezike, did you
experience any problems with constituents in your State
thinking that it would be safe to ingest bleach and other
chemicals as a way of preventing the virus? If so, to what
extent was that an issue for you?
Dr. Ezike. Yes, ma'am. We did have several reports to our
poison control center of individuals that were asking about the
dangers associated with ingesting bleach after that--after that
announcement.
Ms. Watson Coleman. Thank you. Dr. Watson, do you have
anything to add to this?
Ms. Watson. I agree with my colleague, Dr. Ezike. I think
there is no substitute for effective leadership in this type of
a crisis. So, I think it is critically important.
Ms. Watson Coleman. Do you agree that had we had that
leadership or response in a timely manner when we first
encountered the knowledge of this virus that we would not have
the severe loss of life and infectious rate that we have in
this country?
Ms. Watson. I think that improved leadership and better
communication would definitely have saved lives and I think
people have died unnecessarily in this pandemic, certainly.
Ms. Watson Coleman. Thank you to all 3 of you. Mr.
Chairman, I yield back.
Chairman Thompson. Thank you very much. The gentlelady
yields back. The Chair recognizes the gentleman from Michigan,
Mr. Meijer, for 5 minutes.
Mr. Meijer. Thank you, Chairman Thompson, and Ranking
Member Katko, and to our guests who are here today. I want to
circle back to a topic that both my colleagues, Representative
Mariannette Miller-Meeks and Representative Slotkin mentioned
around PPE and, specifically, domestic production and how that
factors into not only the Strategic National Stockpile, also
State-level stockpiles.
I guess, I first want to start with Dr. Ezike. Can you, I
guess, from your vantage point and your experience at the
Illinois Department of Public Health, you know, thinking not
just in the moment we are in right now, but once now that we
have a little bit more light at the end of the tunnel, and we
have the Johnson & Johnson emergency use authorization out,
what can the Federal Government do to best provide States with
the resources, with the guidance necessary so that those State-
level stockpiles cannot only be built back, but also adequately
maintained so we don't experience the out-of-date or expired
material issues that we saw on both the State-level stockpiles
and the Strategic National Stockpile?
Dr. Ezike. Yes, thank you for that question. So, I think it
might be helpful just to establish National benchmarks.
National benchmark in terms of levels that would be considered
adequate. We had to dispense PPE not only to our 97 different
local health departments, but also first responders, and also,
long-term care facilities. I mean, the needs and the requests
came from every direction. So, being able to have established
benchmarks and protocols in terms of numbers and levels of
storage, being able to have back-up at the Strategic National
Stockpile, being able to have plans in terms of when those
products would be able to be reviewed that with on-going
frequency, we would be able to determine whether things that
had reached their expiration date could still be tested and
still be determined to be effective for use versus needing to
be removed. That kind of organization might be very helpful
for, unfortunately, the next pandemic.
Mr. Meijer. Doctor, just kind-of building on that. I know,
you know, the analogy in a home especially if might be
approaching a--or just from a disaster preparedness standpoint,
is every product in your home has a shelf life, right? So, you
get a little bit more than you need, you know, put the newest
in the back. Take the oldest from the front. You know, do you
think it is feasible to have a similar sort of paradigm at the
State stockpile level where it is not just, you know, we have a
mass purchase and we leave it there to sit. Then after a
certain point, it expires, we have to throw it out and buy
more. But have more of an evolving stockpile where hospitals
aren't just relying on that sort-of just-in-time delivery, but
there is that kind of deeper batch in material as well?
Dr. Ezike. No, eventually that would the goal that we would
get to. But as we think about replenishing all our stock now,
everything that we would get now would all have the same
expiration date. So, you would have to go through multiple
evolutions before you would have that graduated expiration
time.
Mr. Meijer. Thank you, Doctor. I guess, quickly for Ms.
Clowers. I know, and again, I just wanted to--Representative
Slotkin's desire to have to really hit home on this issue of
making sure that either onshoring or, frankly, an issue that I
want to kind-of get your thoughts on, the issue around some of
the domestic manufacturers who have spun-up their production
capability since the start of the pandemic. You know, some
existing manufacturers like 3M but others and Prestige
Ameritech, but other kind-of smaller entities have also spun-up
to meet that, but are having issues accessing, frankly, markets
for their products even while we do have PPE shortages because
of legacy supply chain dynamics of either large hospital
systems or State-based purchasing efforts. Can you share a
little bit more on how we can, frankly, keep some of those
domestic manufacturers that have risen to the challenge to meet
this need in the pandemic, how we can make sure that we not
only are finding markets for them today, but also retaining
that domestic capability around PPE manufacturing so we are not
experiencing the supply chain risks and the shortages that we
saw at the beginning of the pandemic.
Ms. Clowers. Absolutely. This is an area that we have on-
going work looking at the medical supply chain. I would be
happy to as we get further along in the work, to brief you in
terms of what we are finding. But you are hitting on the key
issues. It is both incentivizing the companies to do the
necessary research and development for the medical
countermeasures, for example. But then also, helping them find
those markets. I think there are lessons that we can learn from
existing programs. BARDA within HHS has a program that is
designed to do this. It has not been utilized as much as it
maybe will be going in the future, given the current pandemic.
But there are other financial incentives the Government could
bring to bear. Again, we are looking at all those issues and we
will be happy to brief you when we have that work ready.
Mr. Meijer. Thank you, Ms. Clowers. Mr. Chairman, I yield
back.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentlelady from Florida, Ms. Demings, for 5
minutes.
Ms. Demings. Thank you so much, Mr. Chairman. Thank you so
much for your leadership on this very important topic and
important committee. You know, my friend and colleague from
South Carolina said earlier that I am one that follows the
data. That is a good thing. What we do know on this committee,
every Member, is that Black and Brown communities have been
hardest hit by contracting the virus, by hospitalizations, and
by deaths. Black and Brown communities have been left behind in
testing and now in vaccine distributions. The statistics that
we have quoted several times earlier today that life expectancy
has changed by 1 year, but for African American communities, it
is by 3 years. That is the data.
To identify and address equity gaps in vaccine
distribution, the CDC requires all States to submit demographic
data on those who receive vaccines. I am troubled though that
today, only 34 States are doing it. Only 34 States think the
data is important. This is why I have joined the Chairman in
writing to FEMA to urge FEMA to double-down, redouble its
efforts to secure such data from the States. Facts in Florida
are also troubling, my home State, where 10 percent of White
Floridians have been vaccinated, while 4 percent of African
Americans and 4 percent of Hispanics have been vaccinated. I
ask unanimous consent to submit that letter, Mr. Chairman,
dated February 23 into the record.
Chairman Thompson. Without objection, so ordered.
[The information follows:]
Ms. Demings. You know, we are a Nation where we always go
where the need is greatest. So, I have to ask the question,
what is going on now? For a Nation who always goes where the
need is greatest, but we see the data. So, Dr. Watson, I would
like to start off with you because we are not doing well going
into the areas where the need is greatest. Could you just talk
a little bit about President Biden's Health Equity Task Force
and how it can help us at this particular area?
Ms. Watson. This is an excellent point. I think,
unfortunately, going where the need is greatest sometimes is
also the hardest thing to do, because we don't have established
connections. We haven't prioritized reaching the most
vulnerable populations in the past. So, what we need now is to
make that a top priority to provide States with the resources
to do that. To connect with community organizations in
populations that we want to reach and to ensure that we are
getting vaccination, we are getting testing, and we are getting
access to health care in all these vulnerable populations.
Ms. Demings. So, Dr. Watson, those are some of the lessons
learned, as we come out of this public health pandemic and
prepare, unfortunately, for the next one, those are some of the
vulnerabilities that we as a response--the Nation that
responds, suffers from. Is that what you are basically saying?
Ms. Watson. Certainly. There are underlying factors that
have been present long before COVID-19 that we need to address
more systemically. But in this response, specifically, it will
also take concerted effort to reach the people who we want to
be vaccinated and protect.
Ms. Demings. So, and we know better because we like to say
this that we are supposed to do better. That is what we say.
Ms. Clowers, in cases where States have not adequately made
vaccinations available in Black and Brown communities, what are
FEMA's thoughts in making trusted venues like churches,
community centers, and senior centers designated sites?
Ms. Clowers. That is exactly what the different agencies
are working on right now, Representative. CDC, FEMA, and others
looking at putting sites in places where people have better
access to that are more familiar, but also places of trust as
you mentioned. It is not only the location of those facilities,
but it is also the messengers. Enlisting the community leaders
that people trust and having them help educate everyone about
the importance of the vaccine, for example.
Ms. Demings. OK, thank you so very much. You say that is
what they are currently working on. How would you assess those
efforts because people are dying as we well know, everyday?
Ms. Clowers. I would say it is very early. Unfortunately,
it goes back to what Dr. Watson was saying. You know, we are
building off historic health disparities in this country.
Disparities and systematic biases that have been built into the
system over years, and what the pandemic is revealing those to
us. So, we need to undo those as we go forward. Hopefully not
only with this pandemic, but in the future moving beyond.
Ms. Demings. Part of our job as elected officials is to
address those systematic biases. Thank you very much. Mr.
Chairman, I yield back.
Chairman Thompson. Thank you very much. The gentlelady
yields back. The Chair recognizes the other gentlelady from
Florida, Ms. Cammack, for 5 minutes.
Ms. Cammack. Well, thank you, Mr. Chairman. Thank you too
Ranking Member Katko. Also, thank you to our witnesses for
appearing before the committee today. There is absolutely no
question that COVID highlighted the vulnerabilities in the U.S.
domestic supply chain that had plagued us for decades from PPE
to our domestic food supply. The United States relies heavily
on China as a large source of components that are critical to
our Nation's supply chain that are vital to U.S. operations and
National security. I know that many of my colleagues share the
same concerns on both sides of the aisle. It is crucial that we
prioritize domestic production of these supplies that are
critical to the National security, where possible. We need to
diversify our sourcing elsewhere.
Now, this question is specifically for Ms. Clowers. We have
heard a lot today about supply chain concerns, but I want to
dig in a little bit more on the sourcing of raw materials, for
example. We saw major supply shortages that proved incredibly
challenging in the beginning stages of the pandemic and
highlighted our overdependence. But much of the materials
required to manufacture critical PPE are produced overseas in
loosely or non-regulated environments like China. Materials
like polypropylene, which are melted down and sprayed to make
the nonwoven medical masks, for example. My question to you is
given the regulatory environment that we are facing in this new
administration, how would you recommend bringing these critical
base materials and raw materials back to the United States,
given that this administration has stated that they are going
to increase the red tape in regulatory environment?
Ms. Clowers. Regarding the domestic supply chain as well as
looking at how that fits into the global supply chain, you
highlighted examples of the raw materials for devices of PPE. I
would add that also affects drugs as well, as much of the
active pharmaceutical ingredients that are used for drug
manufacturing are overseas. As I mentioned earlier, a lot of
that production occurs in countries like China and India. So,
when there is a pandemic or other type of incident that affects
the supply chain, it could have an immediate negative effect on
the health care system as we saw now.
I know that the current administration has announced plans
to assess the supply chain and identify gaps and what measures
are needed to be taken. That is something we will be monitoring
and we will report on that progress and any challenges that we
see in future reporting.
Ms. Cammack. As a follow-up to that, what is the time line
on that?
Ms. Clowers. We have on-going reporting. We will be issuing
our next report in March. Then we have specific looks looking
at the supply chain and as it relates to specifically API that
will be coming out later this year. I could get you those exact
time frames. We are happy to, as that report is coming out,
brief you and your staff on it.
Ms. Cammack. I appreciate that. Thank you. My next question
is addressing one of my top issues that I have here in
Congress, which is access to broadband. One of my major
priorities is increasing access and affordability to broadband,
specifically, in rural and underserved communities. In a
pandemic like we have been facing, access to real-time reliable
information is especially important. So, with so many people
lacking reliable internet access, especially in these rural and
urban communities that are underserved, how can the Federal and
State government ensure that everyone has knowledge of and
access to COVID information and vaccine availability? I am
opening this up to anyone on the panel who would like to answer
this.
Dr. Ezike. Thank you for this important issue. So, we have
seen that that digital divide affects individuals in
educational settings. It affects adults who may be trying to
get information about COVID. So, we have expanded call centers,
increased the number of operators so that people have the
option to just call if, you know, searching through internet is
not an option. That people can talk to a live person who can
assist with getting vaccination, especially are trying to focus
on our over-65 population. In Illinois, which is consistent
with what is happening across the country, 85 percent of the
deaths for COVID have occurred in individuals over 65. So, it
is really a priority to make sure that those individuals have
access to the vaccine, whether they have access to the internet
or not.
Mr. McMahon. I would add, as well, that the digital divide
has been real throughout the pandemic. Broadband is something
as a country we have to address immediately. But specifically,
to vaccine rollout, our seniors are confused by the multiple
distribution points. So, to date, what we have done locally as
well, is we have created call centers. We have created waiting
lists where seniors can call the call center and then we are
logging in their waiting lists so that they--and then we are
calling the seniors, not just emailing the seniors when they
have appointment times. So, you really have to adapt and meet
the need all hands on deck with this divide that we have right
now.
Ms. Cammack. OK, thank you so much. With that I yield back.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentlelady from California, Ms. Barragan, for 5
minutes.
Ms. Barragan. Thank you, Mr. Chairman, for holding this
very important hearing. I have heard a lot of discussion about
the Biden administration's effort to restore asylum processing
at the Southwest Border. Let me be clear. No one in the MPP
program tested positive, and testing is happening aggressively.
I was just there. So, so disturbed to hear some of the
commentary and make we get accurate information.
Now, FEMA recently opened 2 managed vaccination sites in my
home State of California, each with the capacity to vaccinate
6,000 people a day. This is an amazingly great development. But
more FEMA sites need to be added, especially in districts like
mine where I have a district that is almost 90 percent Latino,
African American, the fourth-poorest in California, and has
been hit especially hard during this pandemic. Dr. Ezike, what
are the benefits of having the Federal Government run vaccine
centers to augment State capabilities?
Dr. Ezike. Thank you for that question. So, of course, this
pandemic has stretched every public health department well
beyond their natural abilities. So, in addition to vaccination,
of course, there is testing. There is contact tracing. There is
genomic sequencing. Of course, on top of the normal work of
public health, looking out for lead, STIs, tuberculosis. So,
being able to have that Federal support in terms of FEMA with
these very productive high-throughput sites, that allows us to
shift energy on harder-to-reach populations that may not be
able to get to the vaccination sites sponsored by FEMA, but
need mobile teams that the health department can focus on
getting those very hard-to-reach communities as well. So, we
just need that coordinated large-scale effort to make sure that
all of this important work gets done.
Ms. Barragan. Great, thank you. Ms. Clowers and Dr. Watson,
as I said earlier, I support FEMA aggressively making
vaccination efforts. It is important that the location
selection prioritize availability to those at greatest risk.
This includes underserved communities and communities of color,
like in communities--communities very much like my very
district that have been hit very hard. Due to the----
Chairman Thompson. I think we lost your connection,
Congresswoman. Can you hear me?
Ms. Barragan [continuing]. As FEMA considers supporting
sites.
Ms. Clowers. I'm sorry, Representative, I missed the
question.
Ms. Barragan. Sure.
Chairman Thompson. We had some technical difficulties. I
will yield back to the lady an additional minute to get her
questions through.
Ms. Barragan. Great. Dr. Watson, back to FEMA aggressive--I
support FEMA aggressively helping vaccination efforts including
serving underserved communities. What are your thoughts on how
vaccine equity can be addressed as FEMA considers supporting
sites?
Ms. Watson. So, I think that is a very good question.
Obviously, making these vaccination sites accessible by
communities of color, in particular, but also other underserved
communities. Then also working directly with health departments
who know their communities very well to understand how to do
some more microtargeting of communities to help them understand
about vaccination. To get them appointments for a vaccination
and get them access. So, it is a combination of these large
sites, which FEMA is well-placed to help with. But then also
working with established networks through public health and
other parts of your State to really understand how to target
vaccination more specifically.
Ms. Barragan. Thank you. Ms. Clowers, is there anything you
would like to add?
Ms. Clowers. In addition to what my panel member mentioned,
I do know that FEMA is also conducting a pilot program with
vaccination sites including in California. Where they are going
to be using CDC data on using the vulnerability index, as well
as other census data to help locate where those sites should
be. I think that is a positive development. We will monitor
closely how that pilot runs.
Ms. Barragan. Great, thank you. One of the outbreaks in my
district and we have seen is the complex ports. It is the ports
of Los Angeles and Long Beach. There have been serious COVID-19
outbreaks. My concern is of a possible shutdown and what the
implications can be to National security if something were to
happen to the ports and, you know, the serious outbreak. But,
Dr. Watson, given how vital ports are to this country
especially the largest by container volume in my very district,
are to the economy, should COVID-19 outbreaks at these
facilities be treated as a serious threat to National security?
Ms. Watson. I think it is really important to maintain our
infrastructure and as you said, ports are very important to our
National security. So, fortunately, there are public health
mitigation measures including frequent testing and contact
tracing and supporting people to stay home when they are sick,
and if they have to quarantine because of a significant
exposure. So, all of these measures are things we can do for
the broader population. But if they are a little bit more
targeted, then we can help prevent these big outbreaks at
ports.
Ms. Barragan. Great, thank you. I just want to thank you
again, Mr. Chairman, for having this hearing. We know that we
have a new administration who has come in and is taking this
seriously. Who has put forward the American Rescue Plan and has
involved the Federal Government in being a partner and now
getting these FEMA sites up, which are great, and getting
mobile units out. With that, Mr. Chairman, I yield back.
Chairman Thompson. The gentlelady yields back. The Chair
recognizes the gentleman from Texas for 5 minutes, Mr. Pfluger.
Mr. Pfluger. Mr. Chair, thank you. Panelists, thank you
very much. I appreciate the discussion. Ms. Watson--Dr.
Watson--my apologies--the strategy that the President has
outlined, are you in agreement with that as being a strategy
that can work for our country to halt this pandemic and fight
back against it?
Ms. Watson. I think in broad strokes, yes, I am in
agreement with the current trajectory, yes.
Mr. Pfluger. OK. What areas do you disagree with?
Ms. Watson. I don't have any specific disagreements off the
top of my head. But broadly, I am in agreement.
Mr. Pfluger. OK. One question I want to ask you. When it
comes to, you know, there was a couple of Executive Orders that
were issued promoting COVID-19 safety in domestic and
international travel, and also in the equitable response and
recovery. How do we make those decisions? A lot of my
colleagues have previously stated today that their districts
are being hit particularly hard in underserved districts and in
populations who may not have that access. How do we pick and
choose who is going to get the vaccines? As I understand it 60
million have been distributed so far.
Ms. Watson. So, not being in Government and part of those
conversations, it is hard for me to comment specifically. But I
know there are, I think, it is population-based allocation
primarily. But then also risk-based decision making also
occurs.
Mr. Pfluger. So, as I understand it and from your
perspective, would you say that we have limited resources at
this point in time to cover our whole population in a timely
manner at this second?
Ms. Watson. Yes, I don't think the supply that we have
right at this moment meets the demand for vaccine.
Mr. Pfluger. So, diverting supply away from the areas that
need it the most would not be a good plan for us?
Ms. Watson. I think we need to assess where we need
vaccination the most, but we need broad coverage across the
country. There has been considered planning in terms of who
should be vaccinated and in what order. So, we need to
continually reassess that to ensure that it is going in the way
that we want it to.
Mr. Pfluger. Do you believe it is going in the way you said
in broad strokes you agree with the plan?
Ms. Watson. Yes, I think the sequenced rollout of vaccine
is reasonable. Obviously, I think we have some underserved
populations that are not being reached at this moment. So, we
need to reassess how we can get vaccine to be more equitably
distributed. But I think the general plan is reasonable for the
country.
Mr. Pfluger. Thank you very much. Dr. Ezike, do you also
believe that, you know, the limited resources that we have in
this country should be applied, you know, I think it is, you
know, broad strokes, you know, throughout the country, but also
to places that need it the most?
Dr. Ezike. Yes, sir. I believe that we have to get as much
vaccine out as quickly as possible, but it needs to--that plan
has to be infused with equity to prevent additional disparity.
Mr. Pfluger. What would you say about the rural areas,
underserved rural areas?
Dr. Ezike. I think that is an area that needs particular
attention. That there is geographic equity that needs to be
considered as well. We also know that, at least in the State of
Illinois, we have rural areas, southern regions of the State,
that have some of the worst health outcomes. So, those are
high-risk settings that have higher risks that actually need
concerted attention and efforts.
Mr. Pfluger. So glad to hear you say that. Ms. Clowers, do
you also agree that those rural areas need help as do urban
areas, underserved areas?
Ms. Clowers. Yes. We documented that in our work as well in
terms of rural access and how access to health care facilities
and treatment can affect those populations.
Mr. Pfluger. Very good. I appreciate you-all's discussion
on that. My main concern right now, Mr. Chairman, is the fact
that any diversion of any of our resources away from those in
this country who need it the most, is a tragedy. Whether it is
rural, or urban, or underserved, or any population in the
country that needs to get access to vaccines. My district is
incredibly rural and we have a very difficult time with the
access to that. So, when it comes to folks that need it the
most, we need to make sure that they are getting that.
Specifically, in my case, a rural district. So, I have a very
hard time understanding how the President's plan does not take
into account a strategy when it comes to international travel,
especially overturning immigration policy that would put us
further at risk and not get those resources and vaccines to
those who actually need it the most, as all of our witnesses
have just agreed to. With that, Mr. Chairman, I yield back.
Thank you very much.
Chairman Thompson. Thank you very much. The gentleman
yields back. The Chair recognizes the gentleman from New
Jersey, Mr. Gottheimer, for 5 minutes.
Mr. Gottheimer. Thank you, Mr. Chairman. COVID-19 has taken
an immense toll on communities I represent in northern New
Jersey, where we were hit early, unfortunately, and found
ourselves in the eye of the COVID-19 storm. Almost a year
later, we are still working hard to get through the pandemic. I
recently visited vaccine sites across northern New Jersey,
including in Teaneck at Barada Community Center run by Holy
Name Medical Center, at Bergen's New Bridge Medical Center, at
the Sussex County Fairgrounds, and the Meadowlands. Thanks to
our front-line personnel who have done such a great job of
setting those up and running them. As you know, many of the
vaccine distribution systems are still being set up and we are
working hard to expand vaccine availability. I was very
encouraged by the President when he recently announced that
there will be an increased flow of vaccine doses headed to the
States----
Chairman Thompson. I think the gentleman from New Jersey is
having some challenges. We will work through those challenges.
Mr. Torres, if you are ready. We will yield to you at this
time. Mr. Torres, if you can get on, we will go to you while we
work out the challenges with Mr. Gottheimer. Well, it must be a
New York, New Jersey thing. We will go to the other gentleman
from New Jersey.
Mr. Torres. Mr. Chair, I'm sorry. Did you call? Mr. Chair,
I'm sorry. I see Josh is back.
Mr. Gottheimer. I'm sorry, Mr. Chairman. It appears I had
internet problems.
Chairman Thompson. Well, it looks like everybody's having
problems. Mr. Garbarino, are you available to talk? We are
still not able to hear any of our last 3 members. Must be a
system adjustment. Well, we are not really sure what it is. Mr.
Torres, can you hear me?
Mr. Torres. I can hear you, Mr. Chair.
Chairman Thompson. Well, if you could hear me, please go
ahead with your 5 minutes.
Mr. Torres. OK. Thank you, Mr. Chair. It is refreshing to
have a new President who is committed to crushing the virus
rather than crushing our democracy. When it comes to pandemic
response, timing is a matter of life and death. Delay is
deadly. The longer the delay, the higher the death toll. If the
Trump administration had put in place social distancing
restrictions at the beginning of March, it would have cut the
death rate by as much as 90 percent. We as a Nation have paid a
heavy price and the lives of a half a million Americans for the
lethal incompetence of the Trump administration.
My first question is about the way forward. There is no
return to normality without population immunity. What is the
time line for achieving a population immunity? Are we confident
that population immunity can be achieved given the systematic
failure to sufficiently vaccinate communities of color?
Communities of color like mine are often the first to be hit
the hardest and the last to be vaccinated. This question is for
the Government Accountability Office.
Ms. Clowers. In terms of when we will reach societal
immunity, I think it is a question to be determined. I have
seen some suggest it could be earlier this spring. To some,
that it will be much later into the year. Certainly, a number
of factors would drive that. One is the how well we do with the
vaccinations over the next several months. Are we able to get
the supplies that we need in terms of doses and get them out
and into the arms of Americans? That is really going to drive
in terms of how quickly maybe we can get back to somewhat
normal life.
But in terms of--we have also heard the experts talk about
that we will be continuing to need to utilize public health
measures such as social distancing and masking for the
foreseeable future because of hard-to-reach communities and
making sure that everyone in the United States is vaccinated to
the extent that they can be. But also, we live in a global
society and until we are--see the containment of the virus
across the world, all of us are at risk. So, it will be many
months, but it is something that we will be watching very
closely.
Mr. Torres. Is there a concern that we might fail to
achieve population immunity before the emergence of new strains
that render the vaccines ineffective? Is that a concern?
Ms. Clowers. Well, that is certainly--it is certainly a
concern among the public health community and my colleagues
might want to address that. But it is a race with the
vaccination against new variants. Viruses are constantly
mutating. A lot of those mutations don't prove effective for
them, so, they die out. But certainly, as long as there is host
in order for them to continue to mutate, that is a problem.
That is why we want to get as many people vaccinated as quickly
as we can.
Mr. Torres. I do have a question for Dr. Watson about the
future of SARS-CoV-2. You know, some viruses like SARS-CoV-1
and MERS get eradicated. Some viruses like influenza remain
endemic. Is COVID likely to remain with us in a post-COVID
world? Knowing influenza kills tens of thousands of people
every year, is COVID going to kill tens of thousands of
Americans in a post-COVID world?
Ms. Watson. I am not a virologist and so, and I don't even
think my colleagues who are virologists know the answer to this
yet. But I do think we are seeing increasing information that
makes it more likely that COVID, SARS-CoV-2 will remain with us
not just in this pandemic, but beyond. It maybe something that
we face on an annual basis. So, we need to gather more data and
try to understand what that looks like. But then also pay close
attention to our vaccination efforts and determine whether we
need to update vaccinations over time and people need to be
revaccinated. But there are so many unknowns with this right
now.
Mr. Torres. My final question is what can be done to
bolster the rates of vaccination within communities of color? I
just find the rates to be alarmingly low. It is going to
undermine our ability to achieve some semblance of normalcy.
So, any thoughts of what can be done to bolster vaccination
within communities of color?
Dr. Ezike. I can take that. I think there is hope. You are
correct that our communities of color have lower acceptance
rates of the vaccine. But all of the individuals that have said
no--many people who have been offered the vaccine and said no,
they do fall into different buckets. There are individuals that
are simply not first. They weren't ready to get it when it was
first offered. They didn't want to be amongst the first
individuals to get it. As other people have gotten it, as the
tincture of time has passed, they have come around and have
come maybe on a second and third visit, third offering, have
not taken it.
We have some people that were just not sure and so, they
still needed to gather more information. They needed to seek
reassurance from trusted messengers whether it is in the faith
community or medical providers that are trusted. Then there are
some that are, you know, not ever. So, you know, I think the
not ever are a smaller group.
So, there is still lots of work to be done in terms of
community engagement and working with trusted messengers.
Giving out culturally appropriate messages, virtual town halls.
Using venues and people that can be trusted to share the
message. We have had lots of physicians and medical individuals
of color who have been documenting their COVID vaccine journey,
and I think that has helped. We have lots of, you know,
personalities that have come out to share their COVID journey.
I think with time as people see the safety and the efficacy of
this vaccine, you will have more of those individuals come. So,
but we have to continue the engagement.
Mr. Torres. Thank you.
Mr. McMahon. Congressman, if could add on that, I think
method of distribution matters. With our success, we have had
within our minority populations, we have worked with credible
messengers. We have worked with churches. We have had pop-up
clinics at housing authorities. We have worked into our--
looking at library systems in the neighborhoods with pop-up
clinic models. We have not had as much participation with new
American communities in the traditional mass vaccination sites.
Even though one of our mass vaccination sites is in the heart
of a neighborhood in our downtown right next to one of our
poorest neighborhoods. So, I think method of distribution
really matters as well with credible messengers.
Chairman Thompson. Absolutely. The Chair recognizes the
gentleman from New York, Mr. Garbarino, for 5 minutes.
Mr. Garbarino. Thank you, Mr. Chair. Is it working?
Chairman Thompson. Yes, you're working.
Mr. Garbarino. Wonderful, all right. Thank you very much. I
just have a quick I think follow-up, a few questions. Dr.
Ezike, you spoke about getting the vaccine out there as much as
possible to all different sorts of groups. The Biden
administration launched the first phase of the Federal Retail
Pharmacy Program allowing pharmacies to distribute vaccine
doses. Has this initiative been successful so far in Illinois?
Dr. Ezike. Well, I think as with the entire vaccine
rollout, with these very complicated vaccines, there are been a
steady increase. Steady increase in the throughput, steady
increase in the comfort of getting it done. So, I think we
have--we are very excited that all of our long-term care
facilities that were enrolled in the program, and we had many.
We had over 1,400 facilities that were enrolled. But I think we
have had all of our skilled nursing facilities have at least
one visit. We expect all of them to be done in the coming
weeks. We have already moved on to our long-term care
facilities and other congregate care settings. So, you know,
everything has been a learning curve, but we have been--we have
had great partnership with our CVS and Walgreens partners. We
have been working on the phone every week, multiple times a
week to make sure that we iron out kinks. When we hear about
long-term care facilities that have a complaint or an issue, we
have been able to take that back to make sure that we keep
correcting and improving the process as we go along.
Mr. Garbarino. But so, the pharmacy--so far what you have
seen with the pharmacy program with this like you said CVS and
the Walgreens, it has been a positive? It is increasing, or is
it--it is increasing the doses that are being administered?
Would you say that?
Dr. Ezike. Yes, it is helping us get more vaccinations in
arms. So, we are grateful for the partnership. We need many
different partners for this effort.
Mr. Garbarino. Great. I appreciate that. Thank you. I just
want to move on, Ms. Clowers. Hopefully, I got that right.
There are 2 questions I had. No. 1, you talked about in your
testimony you mentioned that HHS data on COVID-19 in nursing
homes is incomplete because they didn't require the first--in
the first 4 months of the pandemic to report data. Has there
been any--and I apologize if this has been asked. But has HHS
done anything to go back and get that data or anything to try
to recap that data so we have a full picture?
Ms. Clowers. They have not. We continue to believe that is
a really important step for them to take. As you may know, that
until May of last year, nursing homes did not have to report
cases and deaths to CMS. In May, CMS put out information to
them and said you are going to start at this point reporting
that information to us going forward. But they didn't have the
nursing homes go back to the beginning of the pandemic and
report that information.
We think it is really important that that information is
captured because that is information that could help us better
understand the spread. Especially during that period through
that vulnerable population. I can give you a quick example of
how this data affects and the types of data that we are
missing.
As you might remember, it was about this time last year one
of the first sites of spread was in the Kirkland Nursing Home
in Washington. If you look at the HHS data, it will show during
that there were zero cases and zero deaths in the beginning
months of the pandemic for that site. Well, of course, we know
there was over 100 cases and unfortunately about 23 deaths in
that nursing home. So, that is just one example of a piece of
data that is missing. We think all that data needs to be
collected. We think it can be done in a fairly non-burdensome
way for nursing homes to report that information so we have
better insight in terms of what was going on during that time
period.
Mr. Garbarino. That is great. That was my next question,
whether or not we could get enough good data that it would
actually make it because that is great. I agree with you, I
think we should get that. As you know, my State of New York we
have had quite a--this has been in the news quite a bunch
lately. It is something I dealt with when I was in the assembly
last year on the health committee. So, I think it is very
important we get that information.
Just another question, you know, a lot of documents have
been, strategy documents have been issued in the last several
years that may encompass a portion of the COVID response. You
know, in 2005, HHS developed a pandemic influenza plan. The
Biden administration just recently released the National
Strategy for COVID-19 Response Epidemic Preparedness. Are there
anything in these plans that--these strategic plans are
missing? Is there something that are in these plans in your
opinion that--or that are not in these plans, but should be?
Ms. Clowers. In terms of the past plans that we have
reviewed, we did find elements were missing. Everything from
very clearly stating what the risks are, what our goals were.
What would be benchmarks for success, consistent definitions,
as well as the resources that are needed. The new
administration has put out the response plan. We are currently
evaluating that. We are also waiting for additional plans that
are to be forthcoming that were required by Congress, the
additional testing strategy that should be coming out at the
end of March, and we will review that to see to make sure that
it contains all the information that is necessary for an
effective strategy. I will note, then it is really important
that these strategies are publicly available so that everyone
understands those roles and responsibilities.
Mr. Garbarino. OK. I appreciate that and look forward to
hearing more about it. Thank you. Last, Mr. McMahon, I just
wanted to say my friend, Bill Barkley, says hello.
Chairman Thompson. The gentleman's time has expired. The
gentleman's time has expired. The Chair is going to recognize,
again, the gentleman from New Jersey, Mr. Gottheimer.
Mr. Gottheimer. Thank you, Mr. Chairman. Is this better?
Chairman Thompson. Much better.
Mr. Gottheimer. Sorry, about that. As I was saying last
time, COVID-19 has taken an immense toll on northern New Jersey
where I represent. We got hit early and very hard and found
ourselves in the eye of the COVID-19 storm. Almost a year
later, we are still working hard to get through the pandemic. I
have recently visited vaccine sites across my district in
northern New Jersey and Teaneck at a center run by Holy Name
Medical Center, at Bergen New Bridge Medical Center, at the
Sussex County Fairgrounds, and at the Meadowlands to thank our
front-line personnel for helping distribute the vaccines.
As you know, many of the vaccine distribution systems are
still being set up and we are working hard to expand
availability. I was deeply encouraged when the President
recently announced that there will be an increased flow of
vaccine doses headed to States and communities like ours. The
administration also announced plans to buy 100 million
additional doses of the Moderna and Pfizer vaccines and the
Food and Drug Administration today endorsed the emergency
authorization request from J&J, a great New Jersey company, for
their new COVID vaccine. With the final authorization hopefully
coming later this week. We need to keep up the pressure until
we can fully deploy vaccines across the country to help us
safely reopen. Dr. Watson, how can we help accelerate the
production and deployment of vaccines? What sort of role can
FEMA play in that effort?
Ms. Watson. I think the Government is working really hard
to accelerate the production. I don't have any specific
comments on that although I think there are lessons that we can
learn for the next pandemic there in improving production
capacity in the United States. But in terms of roll-out, I
think FEMA is an excellent partner as was discussed briefly
earlier in setting up vaccination sites and helping States
coordinate vaccination efforts. As long as it is being
coordinated with the health department, I think that can be a
great asset. So, it is one thing I think we need to look back
at our previous plans and maybe reassess in the future what is
FEMA's role in these types of public health emergencies because
I think they haven't formally been engaged in our plans to the
extent that we realized they have been needed in this response.
So, I think that is a good thing for our after-action reviews.
Mr. Gottheimer. Thanks, Doctor. Do you agree we should
deploy these pop-up vaccine sites in every Congressional
district including in rural areas to make sure we reach those
underserved populations?
Ms. Watson. Yes, I think as my colleague, said, every
connection, every partner in this effort for vaccination is
probably appreciated.
Mr. Gottheimer. Thank you so much. I appreciate that. Mr.
McMahon, as a county executive, you have experienced first-hand
the immense challenges faced by our local counties, towns, and
municipalities during the COVID-19 pandemic. Across Jersey, our
communities have been hit hard. Some of them facing unfortunate
tasks of having to lay off essential and front-line workers or
making painful budget cuts to essential programs and services.
Can you discuss how this is a bipartisan issue for States like
New York and New Jersey and what the grim outlook is for our
communities if we in Congress fail to provide robust aid to our
State and local governments as part of our next relief package?
Mr. McMahon. Yes, I really do see this as a bipartisan
issue. Essentially, in New York what was unique with our
situation is we didn't receive direct aid in the CARES Act,
like many communities under half a million in their population.
Because of that we had to make mid-year budget cuts in 2020. We
had to incorporate those cuts into 2021 for my community. We
are a $1.3 billion budget. In 2021, we made $84 million worth
of cuts. We had retirement incentives. We had furloughs. We had
layoffs. We want to bring back some of these people. I have
people in my adult and long-term care department doing contact
tracing. My social services doing contact tracing.
There are other elements in the pandemic. I referenced
earlier that the human services side of this pandemic is going
to be glaring next year and later in 2021, when we are done
vaccinating. So, the aid is important if we want to shore up
our efforts. When you look at recovery efforts, we are large
employers. We are large spenders. We buy capital. We pave
roads. All these budgets got cut drastically in 2020 and `21.
Mr. Gottheimer. Thank you so much. I yield back, Mr.
Chairman. Thanks again for coming back to me despite the
technological issues here.
Chairman Thompson. Thank you very much. Well, given the
level of Member participation in this hearing, obviously there
has been great interest and impact more importantly in their
respective areas. Let me thank the witnesses for their
testimony and the Members for their questions. The Members on
the committee may have additional questions for the witnesses.
We ask that you respond expeditiously in writing to those
questions.
I don't want to underemphasize rural underserved
communities. I have 26 counties in my district. Thirteen of
those counties we don't have a Walmart. We don't have a
Walgreens and we don't have a CVS. But we have churches. We
have schools that have buildings and other things. So, I am
working trying to get people to go beyond just what the printed
paper requires in order to get people vaccinated. So, I really
thank our witnesses for helping the committee. You have gotten
us to a good point where we can work with this administration
on overcoming this pandemic. Collectively we can do this. Your
testimony adds immensely to getting us there.
Without objection, the committee record shall be kept open
for 10 days. Hearing no further business, the committee stands
adjourned.
[Whereupon, at 12:59 p.m., the committee was adjourned.]
A P P E N D I X I
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A P P E N D I X I I
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Questions From Chairman Bennie G. Thompson for A. Nicole Clowers
Question 1. In January, GAO released a report documenting the Trump
administration's inaction and failure to develop a clear and
comprehensive vaccine distribution and communication plan. The report
concluded that during the final months of the Trump administration, GAO
remained ``deeply troubled by the lack of sufficient Federal action on
critical gaps identified and by the lack of clear plans to address
these gaps.'' Explain how the Trump administration's failure to produce
a clear and comprehensive vaccine distribution strategy led to problems
with our Nation's ability to vaccinate Americans.
Answer. Informed by our past work reviewing the Federal response to
H1N1 flu vaccine and our examination of the Federal efforts to prepare
for the allocation, distribution, and administration of COVID-19
vaccines, we reported early on in the pandemic about the importance of
having and communicating a National vaccination plan. It is
particularly important because of the scope and magnitude of the COVID-
19 pandemic. Multiple Federal agencies, commercial partners, and
jurisdictions all have roles in implementing any COVID-19 vaccination
program, which encompasses identifying priority groups for vaccination
as well as allocating, distributing, and administering available
vaccine. We found that clear and publicly-available National
vaccination plan did not exist.
The lack of a clear and timely National vaccination plan is an
obstacle to effective coordination and communication among the Federal
agencies, commercial partners, jurisdictions, and providers regarding
COVID-19 vaccine distribution and administration. Further, without
clear communication, including information about the availability of
vaccines, it is difficult to manage public expectations about the
progress and availability of vaccines. Clarity to manage public
expectations was particularly important with a relatively limited
initial vaccine supply.
In September 2020, we recommended that HHS, with the support of
DOD, establish a time frame for documenting and sharing a National plan
for distributing and administering COVID-19 vaccines that, among other
things, outlines an approach for how efforts would be coordinated
across Federal agencies and non-Federal entities. To date, this
recommendation has not been fully implemented. We maintain doing so
would improve the Nation's vaccine distribution and administration
efforts.
Question 2. For months, we heard harrowing stories of health care
workers having to perform their jobs without adequate protective
equipment because the Strategic National Stockpile was not properly
maintained and there was no Federal strategy to procure critical
supplies, such as N-95 masks. Reports indicate that some hospitals are
still rationing N-95 masks for doctors and nurses even though supply
has stabilized and stockpiles of these masks are growing. From your
work, do you have any thoughts on what the Federal Government do to
build trust in the PPE supply chain?
Answer. The COVID-19 Pandemic highlighted the fragility of the U.S.
medical supply chain. We and other entities have documented persistent
and evolving supply chain challenges throughout the pandemic. Based on
our work examining medical supply chain and Federal efforts to manage
it, we identified several issues that need Federal attention to improve
the supply chain and help Federal, State, territorial, and Tribal
stakeholders during the pandemic. Actions at the Federal level can
facilitate improvements and build trust in the supply chain for
remainder of the pandemic and also trust in preparedness for future
pandemics.
Actions needed to improve the medical supply chain and support
stakeholders for the remainder of the pandemic include improved
communication and coordination. For example, we recommended that the
Department of Health and Human Services (HHS), in coordination with the
Federal Emergency Management Agency (FEMA) should:
develop and communicate to stakeholders plans outlining
specific Federal Government actions that will be taken to help
mitigate supply gaps for the remainder of the COVID-19
pandemic,
document roles and responsibilities for supply chain
management functions transitioning to HHS, and
work with relevant stakeholders to devise interim solutions
to help States enhance their ability to track the status of
supply requests and plan for supply needs.
While Federal agencies are taking steps to improve future
preparedness by reassessing the medical supply management and
strengthening the domestic medical supply, our work has identified
areas where additional actions are needed. For example, as HHS develops
a strategy to improve the medical supply chain to enhance pandemic
preparedness, including re-thinking supply management, we recommended
that the agency should regularly engage with Congress and non-Federal
stakeholders as it refines and implements its supply chain strategy,
including the role of the Strategic National Stockpile.
Question 3. GAO has issued 44 recommendations to improve the
Federal response to COVID-19--most originating from GAO's review of the
Trump administration's execution of the CARES Act. Our understanding is
that when the Biden administration began, only a few of the
recommendations had been addressed by the prior administration. As
President Biden intensifies efforts to combat COVID-19, which of the
recommendations warrant the most urgent action?
Answer. With the publication of our sixth comprehensive report on
March 31, 2021, GAO has made 72 recommendations to Federal agencies,
and raised 4 matters for Congressional consideration to improve the
Federal Government's response efforts.\1\
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\1\ See https://www.gao.gov/coronavirus/ for our comprehensive
reports and other COVID-19-related reports.
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Throughout our reporting on the Federal response to the COVID-19
pandemic, we have made recommendations that align with key principles
that are essential for an effective Federal response. While we maintain
that all of the recommendations, if effectively and timely implemented,
would improve the Government's public health response, we would
highlight the importance of the following:
Supply Chain.--We recommended that HHS in coordination with
FEMA document roles and responsibilities for supply chain
management functions transitioning to HHS and further develop
and communicate to stakeholders plans outlining specific
actions the Federal Government will take to help mitigate
remaining medical supply gaps. In addition, HHS should work
with relevant Federal, State, territorial, and Tribal
stakeholders to devise interim solutions, to help States
enhance their ability to track the status of supply requests
and plan for supply needs for the remainder of the COVID-19
pandemic response.
Vaccine Plan.--We recommend that HHS, with support from the
Department of Defense, should establish a time frame for
documenting and sharing a National plan for distributing and
administering a COVID-19 vaccine and ensure it is consistent
with best practices for project planning and scheduling, and
outlines an approach for how efforts will be coordinated across
Federal agencies and non-Federal entities.
Testing Strategy.--We recommend that HHS develop and make
publicly available a comprehensive National COVID-19 testing
strategy that incorporates all the characteristics of an
effective National strategy.
COVID-19 Data.--To improve COVID-19 data, we recommend that
HHS make its different sources of publicly-available COVID-19
data accessible from a centralized internet location and take
steps to ensure the complete reporting of race and ethnicity
information for recipients of COVID-19 vaccinations. In
addition, we recommend HHS immediately establish an expert
committee or use an existing one to systematically review and
inform the alignment of on-going data collection and reporting
standards for key health indicators.
Nursing Homes.--To improve the monitoring and transparency
of nursing home vaccination efforts, we recommend that HHS
collect data specific to COVID-19 vaccination rates in nursing
homes and make these data publicly available. In addition, we
recommend that HHS require nursing homes to offer COVID-19
vaccinations to residents and staff and design and implement
associated quality measures. HHS, in consultation with CMS and
CDC, should develop a strategy to capture more complete data on
confirmed COVID-19 cases and deaths in nursing homes
retroactively back to January 1, 2020, and to clarify the
extent to which nursing homes have reported data before May 8,
2020.
For the full list of recommendations in the March CARES Act report
and the status of previous recommendations, see https://files.gao.gov/
reports/GAO-21-387/index.html#Recommendations and https://
files.gao.gov/reports/GAO-21-387/index.html#appendix49.
Question 4. What recommendations does GAO have for how Federal
agencies, like the CDC and FEMA, can construct and maintain robust and
equitable COVID-19 vaccination operations?
Answer. Based on our past work, including our review of the Federal
response to the H1N1 pandemic, and our review of the on-going COVID-19
pandemic, we have identified a National vaccination plan that is clear,
timely, and communicated to the public and data that are complete and
accurate as key elements to an effective and equitable COVID-19
vaccination program.
Vaccination Plan.--Coordination and communication among multiple
Federal agencies, commercial partners, State and local jurisdictions is
critical to effective deployment of vaccines and managing public
expectations. While ensuring a continued supply of COVID-19 vaccine is
key, it is also critical that all those involved in a vaccination
program coordinate and communicate on the allocation, distribution, and
administration of vaccines. This includes communicating changes in the
expected supply of COVID-19 vaccines. In September 2020, we recommended
that HHS, with the support of DOD, establish a time frame for
documenting and sharing a National plan for distributing and
administering COVID-19 vaccines that, among other things, outlines an
approach for how efforts would be coordinated across Federal agencies
and non-Federal entities.
Data.--Complete, accurate, and consistent data is needed to inform
decision making for the COVID-19 pandemic response, monitor for changes
in trends in COVID-19 cases, communicate the status of the pandemic
with citizens, and identify areas and populations that are experiencing
a disproportionate burden from COVID-19. However, we have found that
COVID-19 data being collected by the Federal Government is not complete
or is inconsistently reported. Further, data collected and made
available by the Centers for Disease Control and Prevention (CDC)
suggest a disproportionate burden of COVID-19 cases, hospitalizations,
and deaths exists among racial and ethnic minority groups, we found
that data reporting is incomplete.
The lack of complete and consistent data limits HHS's and others'
ability to prioritize the allocation of health resources in specific
geographic areas or among certain populations most affected by the
pandemic. Further, lack of data limits the ability of HHS and others to
monitor trends in the burden of the pandemic across States and regions,
make informed comparisons between such areas, and assess the impact of
public health actions to prevent and mitigate the spread of COVID-19.
We have made 4 recommendations to HHS to improve the collection of
complete and standardized data on COVID-19 health indicators data. See
the Health Care Indicators enclosure (https://files.gao.gov/reports/
GAO-21-387/index.html#appen- dix2) and the Nursing Homes enclosure
(https://files.gao.gov/reports/GAO-21-387/index.html#appendix5) in our
March 2021 bi-monthly report. In addition, we have made 5
recommendations to improve the collection of data on race and ethnicity
on COVID-19 burden (cases, hospitalizations, and death) and
vaccinations administered. See the Health Disparities enclosure in our
March 2021 bi-monthly report (https://files.gao.gov/reports/GAO-21-387/
index.html#appendix18).
Questions From Chairman Bennie G. Thompson for Crystal R. Watson
Question 1. Many Americans are hearing and seeing a lot of
misinformation in their social circles and on social media about
vaccines and how they might be causing adverse reactions. Could you
speak about vaccine hesitancy and share any recommendations on what can
be done to counter such misinformation?
Answer. Response was not received at the time of publication.
Question 2. During this committee's hearing last year, your
colleague, Dr. Inglesby, stressed the importance of developing a means
to mass manufacture vaccine candidates before they were approved, due
to the massive amount of demand in the United States and world-wide.
Did the United States do enough to prepare for the mass manufacturing
of vaccine candidates over the past year?
Answer. Response was not received at the time of publication.
Question 3. Looking down the road, what can Americans expect to see
from the pandemic in the coming months, and what lessons can Congress
and the Federal Government take from its experience with COVID-19 to
better prepare for future public health threats?
Answer. Response was not received at the time of publication.
Question From Honorable Michael Guest for Crystal R. Watson
Question. The University of Mississippi Medical Center is one of
only 2 Nationally-designated HHS Centers of Excellence in telehealth.
Despite their decades-long history of providing care through
technology, they have seen an unprecedented increase in the use of
telehealth in the State. More clinicians are using it and patients
report a very favorable experience. As we look to the post-pandemic
future, what role do you see telehealth playing in addressing public
health? How can Government support the continued and expanded use of
telehealth to reach rural populations and provide critical specialty
care?
Answer. Response was not received at the time of publication.
Question From Honorable Michael Guest for Ngozi Ezike
Question. The University of Mississippi Medical Center is 1 of only
2 Nationally-designated HHS Centers of Excellence in telehealth.
Despite their decades-long history of providing care through
technology, they have seen an unprecedented increase in the use of
telehealth in the State. More clinicians are using it and patients
report a very favorable experience. As we look to the post-pandemic
future, what role do you see telehealth playing in addressing public
health? How can Government support the continued and expanded use of
telehealth to reach rural populations and provide critical specialty
care?
Answer. Telehealth can play an important role in addressing public
health, specifically in addressing health disparities. Telehealth can
increase access to health care in rural and underserved communities and
has the potential to reduce health care costs while improving outcomes.
Reaching that potential will likely require facilitating utilization
beyond the relatively few patients who used telehealth services and
providers who furnished telehealth services prior to the COVID-19
pandemic. Medicare Payment Advisory Commission (MedPAC) analysis of
calendar year 2014 Medicare claims data showed only 0.2 percent of
Medicare Part B fee-for-service beneficiaries (roughly 68,000
individuals) accessed services using telehealth while 10 percent of
distant site providers accounted for 69 percent of Medicare telehealth
claims.\1\ Use expanded greatly during the pandemic. Telehealth
accounted for 16 percent of total charges for physician services in
April 2020 compared to 0.1 percent in April 2019.\2\ Regarding
Medicaid, all 50 States and DC reimburse for some type of live
telehealth services.\3\ Illinois officials reported to the U.S.
Government Accountability Office that telehealth represented a very
small portion of the overall Medicaid budget--less than $500,000 of the
State's $20 billion spending in State fiscal year 2015--and was used
primarily to provide psychiatric services.\4\
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\1\ Medicare Payment Advisory Commission. (2016, June). Report to
the Congress: Medicare and the health care delivery system. Washington,
DC: Author. http://www.medpac.gov/docs/default-source/reports/june-
2016-report-to-the-congress-medicare-and-the-health-care-delivery-
system.pdf.
\2\ Medicare Payment Advisory Commission. (2021, March). Report to
the Congress: Medicare payment policy. Washington, DC: Author. http://
www.medpac.gov/docs/default-source/reports/
mar21_medpac_report_to_the_congress_sec.pdf?sfvrsn=0.
\3\ Center for Connected Health Policy. (2020). State telehealth
laws & reimbursement policies. West Sacramento, CA: Author. https://
www.cchpca.org/sites/default/files/2020-10/
CCHP%2050%20STATE%20REPORT%20FALL%202020%20FINAL.pdf.
\4\ U.S. Government Accountability Office. (2017, April). Health
care: Telehealth and remote patient monitoring use in Medicare and
selected Federal programs [GAO-17-365]. Washington, DC: Author. https:/
/www.gao.gov/products/gao-17-365.
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In order to increase access to telehealth in the future, the
Federal Government can do the following:
1. Improve reimbursement for telehealth.--In response to COVID-19,
the Centers for Medicare & Medicaid Services (CMS) issued
multiple waivers related to telehealth (offering flexibility in
geographic location for example) and also granted payment
parity between telehealth and in-person care for the Medicare
program. Even before the pandemic, providers and patient groups
identified inadequate payment for telehealth as a significant
barrier to use.\5\ Continuing payment parity with in-person
care after the pandemic subsides, could be a huge boon for
uptake of telehealth.
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\5\ GAO, 2017: https://www.gao.gov/products/gao-17-365.
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2. Improve service coverage.--CMS paid for 81 telehealth services
in the Medicare program as of 2016.\6\ In response to the
COVID-19 public health emergency, CMS temporarily added over
140 services to the list of covered telehealth services for
Medicare.\7\ As recommended by MedPAC, CMS should maintain the
telehealth expansions for a limited duration to gather more
evidence about the impact of telehealth on access, quality, and
cost, and use that evidence to inform any permanent changes.\8\
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\6\ GAO, 2017: https://www.gao.gov/products/gao-17-365.
\7\ MedPAC, 2021: http://www.medpac.gov/docs/default-source/
reports/mar21_medpac_re- port_to_the_congress_sec.pdf?sfvrsn=0.
\8\ MedPAC, 2021: http://www.medpac.gov/docs/default-source/
reports/mar21_medpac_re- port_to_the_congress_sec.pdf?sfvrsn=0.
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3. Increase access to broadband.--Increased access to telehealth
requires increased access to high-quality broadband services,
especially in rural parts of the country.\9\
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\9\ GAO, 2017: https://www.gao.gov/products/gao-17-365.
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