[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
UPGRADING PUBLIC HEALTH
INFRASTRUCTURE: THE NEED TO
PROTECT, REBUILD, AND STRENGTHEN
STATE AND LOCAL PUBLIC HEALTH
DEPARTMENTS
=======================================================================
HEARING
BEFORE THE
SELECT SUBCOMMITTEE ON THE CORONAVIRUS CRISIS
OF THE
COMMITTEE ON OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 29, 2021
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Serial No. 117-43
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Printed for the use of the Committee on Oversight and Reform
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available at: govinfo.gov,
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
45-880 PDF WASHINGTON : 2021
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COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Stephen F. Lynch, Massachusetts Jim Jordan, Ohio
Jim Cooper, Tennessee Paul A. Gosar, Arizona
Gerald E. Connolly, Virginia Virginia Foxx, North Carolina
Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia
Jamie Raskin, Maryland Glenn Grothman, Wisconsin
Ro Khanna, California Michael Cloud, Texas
Kweisi Mfume, Maryland Bob Gibbs, Ohio
Alexandria Ocasio-Cortez, New York Clay Higgins, Louisiana
Rashida Tlaib, Michigan Ralph Norman, South Carolina
Katie Porter, California Pete Sessions, Texas
Cori Bush, Missouri Fred Keller, Pennsylvania
Danny K. Davis, Illinois Andy Biggs, Arizona
Debbie Wasserman Schultz, Florida Andrew Clyde, Georgia
Peter Welch, Vermont Nancy Mace, South Carolina
Henry C. ``Hank'' Johnson, Jr., Scott Franklin, Florida
Georgia Jake LaTurner, Kansas
John P. Sarbanes, Maryland Pat Fallon, Texas
Jackie Speier, California Yvette Herrell, New Mexico
Robin L. Kelly, Illinois Byron Donalds, Florida
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Mike Quigley, Illinois
Jenifer Gaspar, Deputy Staff Director & Chief Counsel
Beth Mueller, Michael Huggins, and Peter Rechter Counsel
Yusra Abdelmeguid, Clerk
Contact Number: 202-225-5051
Mark Marin, Minority Staff Director
Select Subcommittee On The Coronavirus Crisis
James E. Clyburn, South Carolina, Chairman
Maxine Waters, California Steve Scalise, Louisiana, Ranking
Carolyn B. Maloney, New York Minority Member
Nydia M. Velazquez, New York Jim Jordan, Ohio
Bill Foster, Illinois Mark E. Green, Tennessee
Jamie Raskin, Maryland Nicole Malliotakis, New York
Raja Krishnamoorthi, Illinois Mariannette Miller-Meeks, Iowa
C O N T E N T S
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Page
Hearing held on September 29, 2021............................... 1
Witnesses
Dr. Jennifer Bacani McKenney, Health Officer, Wilson County
Health Department (Kansas)
Oral Statement................................................... 7
Dr. Mysheika Roberts, Health Commissioner, Columbus Public Health
(Ohio)
Oral Statement................................................... 9
Dr. Joseph Kanter, State Health Officer and Medical Director
Louisiana Department of Health
Oral Statement................................................... 11
Dr. Beth Resnick, Assistant Dean for Practice and Training,
Senior Scientist, Bloomberg School of Public Health, Johns
Hopkins University
Oral Statement................................................... 13
Written opening statements and the written statements of the
witnesses are available on the U.S. House of Representatives
Document Repository at: docs.house.gov.
Index of Documents
----------
Documents entered into the record during this hearing are listed
below.
* Letters - from the National Association of County and City
Health Officials, American Public Health Association, Big
Cities Health Coalition, and Network for Public Health Law;
submitted by Chairman Clyburn.
Documents are available at: docs.house.gov.
UPGRADING PUBLIC HEALTH
INFRASTRUCTURE: THE NEED TO
PROTECT, REBUILD, AND STRENGTHEN
STATE AND LOCAL PUBLIC HEALTH
DEPARTMENTS
----------
Wednesday, September 29, 2021
House of Representatives
Committee on Oversight and Reform
Select Subcommittee on the Coronavirus Crisis
Washington, D.C.
The subcommittee met, pursuant to notice, at 2:17 p.m., in
room 2154, Rayburn House Office Building, and over Zoom; Hon.
James E. Clyburn (chairman of the subcommittee) presiding.
Present: Representatives Clyburn, Waters, Velazquez,
Foster, Krishnamoorthi, Scalise, Jordan, Green, and Miller-
Meeks.
Chairman Clyburn. Good afternoon. The committee will come
to order.
Without objection, the chair is authorized to declare a
recess of the committee at any time.
I now recognize myself for an opening statement.
For decades, state and local public health departments have
been chronically underfunded and understaffed. Throughout the
pandemic, we have seen firsthand how our under resourced public
health system was ill-equipped for such a large-scale
emergency, with limited disease monitoring and surveillance
capabilities, testing and reporting deficiencies, and outdated
technology hampering the response.
The response was also impacted by significant cuts in the
public health work force over many years. As this chart
reflects, in the past decade, at least 37,000 state and local
public health jobs were eliminated, leaving a skeletal work
force that was stretched thin even before the coronavirus first
reached our shores.
This persistent underinvestment in our public health system
hasn't just hampered our response to this pandemic. It also
limits our ability to reduce and manage chronic illnesses,
implement prevention and preparedness programs, and promote
good health behaviors, which research has shown can reduce
overall health spending.
It is clearly long past time we commit to investing
sustainably in state and local public health departments.
While many of the challenges facing public health agencies
are longstanding, since the start of the coronavirus pandemic,
we have observed a potentially even more dangerous trend: the
reckless politicization of public health.
Since the pandemic began, public health officials have
faced unprecedented levels of harassment, threats, and attacks
from members of the public, particularly in response to their
attempts to adopt proven mitigation measures, such as masks and
social distancing guidelines, after they were recklessly
politicized by the past President and his anti-science allies.
One local health official was repeatedly threatened for
issuing public health orders by a man with ties to the far-
right who was found with more than 130 firearms and explosive
materials when police arrested him for stalking and threatening
the official.
Another official's family home was surrounded by anti-
science protesters who used bullhorns and sirens to amplify
their hostile rants against her every Sunday for multiple
weeks.
These are just a few of many similar stories. It is
abhorrent that public health officials and their families have
received death threats, had their homes vandalized, and faced
other malicious attacks for following the science and taking
steps to save American lives.
Alarmingly, this dangerous movement to politicize public
health has extended to elected officials across the country.
At least 26 states have enacted laws during the pandemic
permanently weakening public health authorities.
At least 16 states, including Ohio and Kansas, the home
states of two of our witnesses here today, have passed laws
limiting public health officials' authority to issue mask
requirements or quarantine and isolation orders not just during
the coronavirus pandemic, but in any future infectious disease
outbreak.
Republican Governors like Florida Governor Ron DeSantis and
Texas Governor Greg Abbott have also sidelined public health
experts by issuing executive orders to prohibit localities from
implementing commonsense protective measures.
Experts warn that these actions recklessly inject politics
into public health decision-making, resulting in more cases and
deaths from the coronavirus, undermining public health
officials' ability to combat future disease outbreaks, and
threatening any effort to improve the health of the American
people.
Amid this dangerous movement to politicize public health,
more than 300 state and local public health leaders have left
their jobs during the pandemic, marking the largest exodus of
public health officials in United States history.
Let me be clear. Any effort to undermine the longstanding
authority of public health officials to keep Americans safe is
shortsighted and dangerous. To do so for political purposes is
simply unconscionable.
We must stand up for our public health leaders and reject
attempts to sideline public health experts.
Fortunately, the Biden administration has taken bold action
to protect, rebuild, and strengthen the Nation's public health
infrastructure.
Using funding Democrats in Congress provided in the
American Rescue Plan, the Biden administration is investing
billions of dollars to help states and localities expand their
public health departments and prepare for future pandemics.
This includes investments in programs to teach and recruit
students from historically Black colleges and universities and
other minority-serving institutions to be the next generation
of public health leaders.
I commend President Biden's historic efforts to revitalize
our public health system. We must keep building on this
progress to ensure our public health work force consistently
receives the resources it needs over the long term.
I want to thank our witnesses for being with us here today.
I look forward to learning more about the challenges you have
experienced working on the front lines of the pandemic response
and how we can better support and strengthen our state and
local public health infrastructure.
I now yield to the ranking member for his opening
statement.
Mr. Scalise. Thank you, Mr. Chairman, for yielding and for
holding today's hearing.
I want to welcome all of our witnesses today, but
especially Dr. Kanter from the Louisiana Department of Health.
How are you doing, Dr. Kanter?
Louisiana has endured three brutally COVID waves, and,
unfortunately, we were one of the first states to really feel
the crush of the Delta variant.
But there are several things that Louisiana has done well,
particularly as it relates to getting kids back in school.
We've had a number of hearings on that important issue, so
many scientists, including Dr. Fauci, who testified that the
science is very clear that all kids should be in school and, in
fact, it hurts kids to keep them out of school. Not every
school system has done that, but Louisiana has done that very
well.
We were one of the first states to reopen schools for in-
person learning, and I'm proud of that and hope that it can
serve as a model for other states who still haven't gotten to
that point.
It's important that we hear from local and state public
health officials about their experiences and ways for the
Federal Government to do a better job of confronting this
latest outbreak. We have a lot of work to do, not only to
overcome this pandemic, but to better prepare for others that
might come.
That's why it's so hard to understand why the majority has
not used the authority provided to the subcommittee to perform
oversight into areas like the nursing home debacle in New York.
Former Governor Cuomo's ``must admit'' order, which went
against the recommendation of the CDC, led to thousands of
unnecessary deaths. He then engaged in a coverup of massive
proportions.
And yet, this subcommittee never held a hearing to uncover
the truth that Governor Cuomo hid from the thousands of victims
and their families. They still want and deserve answers. We
could get those answers.
On top of that, the subcommittee has ignored the question
of where the coronavirus actually came from, and the Democrat
majority does not want to investigate whether the United States
funded research at the Wuhan lab in China that is the likely
source of this virus.
Many medical experts have suggested that the virus
absolutely did start in that lab in Wuhan and was genetically
engineered, it was not a natural virus that was created from
bats, transferred through animals to humans. We need to have a
hearing on that question.
There are several big open questions about reports that the
Biden administration interfered with the FDA, political
interference that I would argue has created serious confusion
on vaccine booster shots.
I know most people would agree that the public health
messaging from the Biden administration has been disastrously
unclear.
These are major public health mistakes that we should
investigate, but the majority refuses to do so.
I'm very concerned with the path the Biden administration
has taken to politicize the pandemic and try shaming and
bullying Americans that don't think exactly the way that they
do.
The vaccines are excellent. Proud to have been vaccinated.
But vaccines are not enough. The Biden administration has
failed to adequately develop more therapeutic options to
protect Americans who fall ill. The fact that 2,000 people a
day are still dying should be clear evidence of this epic
failure.
I don't think vaccine mandates are the best way to
accomplish our shared goal of ending this pandemic, and I'm
very concerned about what mandates are doing right now to
undermine staffing levels at hospitals, for healthcare, and for
other frontline workers that are already facing burnout and
staffing challenges.
We're already seeing the negative effects that these
mandates are having in states that have imposed their own.
Dozens of state troopers are now quitting in the state of
Massachusetts.
About 90 percent of San Diego police officers surveyed said
they oppose COVID-19 vaccine mandates, and 65 percent of all
San Diego police officers said they would consider quitting the
police force if the city were to impose a mandate requirement.
In New York state, hospitals and nursing homes are bracing
for mass staffing shortages that have been sparked by the
state's vaccine mandate.
According to The New York Times, as of September 22, state
data shows around 84 percent of New York's 450,000 hospital
workers and 83 percent of its 145,000 nursing home employees
have been fully vaccinated. That means that tens of thousands
of people likely will not have gotten the shot by the September
27 deadline that New York set, risking their jobs and
livelihoods.
One hospital, the Lewis County General Hospital in
Lowville, New York, has announced that it is pausing maternity
services because dozens of staff members quit rather than
getting COVID-19 vaccines. The hospital is, quote, ``unable to
safely staff its maternity department and newborn nursery.''
Other departments in the hospital are at risk as well if
more workers don't want to get vaccinated and end up getting
fired for that.
A hospital system in North Carolina announced just
yesterday that about 175 employees were terminated because they
didn't comply with the hospital's mandate.
Imagine, hospitals that are running short on staffing on
employees to care for people are firing nurses who won't get
vaccinated, firing them, making those hospitals less able to
safely take care of patients. This is nuts.
Many fear that this will continue to happen all across the
country if the Biden administration's vaccine mandate on
healthcare workers and employers goes into effect.
Mr. Chairman, this committee should hold a hearing into the
real-world implications that a big government mandate will have
on our Nation's hospitals, our healthcare workers, and on our
first responders. We're already seeing this play out in many
states across this country.
Unfortunately, I'm not sure the Biden administration cares
about those negative consequences or the public health
implications of their counterproductive mandates. Their plan
appears to be just shame and bully millions of Americans into
submission.
Last week, the Secretary of Health and Human Services, our
former colleague, Xavier Becerra, referred to the people who
are hesitant about the vaccines as, quote, ``flat earthers.''
This isn't one monolithic group of people. It represents every
spectrum of our society, Black, White, Asian, Hispanic, all.
We've seen different segments of our population that have
expressed some hesitancy.
We should be encouraging people to get vaccinated, let's be
clear about that, but we want more Americans to make their own
decision to get vaccinated. This idea that you can just bully
people and shame people is not working.
And the idea that they're going to continue doing it,
leading to people getting fired, healthcare workers getting
fired, when we need more healthcare workers, police officers
getting fired, when we need our frontline first responders to
keep our communities safe.
Trying to shame and bully people for their personal medical
decisions is disgraceful, and it needs to stop. If you want to
get vaccinated, it is safe, it's effective, it's free, and it's
readily available. That should be the message that we all send.
I believe one way to give people more confidence and more
of a feeling of control over their own decisions is to let them
know that this is their decision. So let's give folks who are
hesitant the reassurance that they are not going to be forced
by the Federal Government to do something against their will or
face termination from their jobs and their livelihoods.
Vaccines are not the only answer. Millions of Americans
have contracted COVID-19, and they have the antibodies. Testing
should be easy to use and widely available, and we should
encourage the FDA to continue to work on finding therapeutics
to treat COVID.
Maybe this isn't happening because President Biden still
has failed to appoint a head of the FDA, nine months into his
presidency. He's yet to even put a name forward to head the
FDA, which some people have referred to as a rudderless ship on
major, major health decisions that are not being made by the
FDA.
Maybe we should have a hearing, Mr. Chairman, on why the
President hasn't appointed a head of the FDA, nine months into
a pandemic that was already in place.
We need a multipronged approach to fight back against the
COVID-19 virus, not a one-size-fits-all solution that is
forcing millions of Americans to lose their job or face
termination.
With that, I look forward to hearing from our witnesses,
and I yield back the balance of my time.
Chairman Clyburn. I thank the ranking member for his
statement, but I'm sure he's aware that vaccinations are
nothing new. I've still got my polio scar. I still remember the
little drop of serum on a lump of sugar. I'm very grateful for
it, because we virtually eliminated polio from this country,
and I think that these vaccinations are going to do the same
thing in this country.
In fact, United Airlines, I'm sure you're aware, they
mandated it and they're up to 97 percent. And I think that just
because people don't know what's good for them, sometimes we
have to encourage them along.
Mr. Scalise. We know there's still breakthrough cases, too,
Mr. Chairman. And as we continue to develop the science, as we
continue to help people confront whatever their concerns are,
this should be a question we direct people to go talk to their
doctor about.
If they have valid questions or hesitations, clearly,
shaming them and threatening them is not working because people
are getting fired. They're losing their jobs. We're losing
healthcare workers when we need more healthcare workers.
And so while government thinks it knows what's best for
people, if people still make that choice, ultimately those of
us that choose to get vaccinated have made that educated
choice. If someone knowing the facts chooses not to, should it
really be something that forces the termination from their
career and their livelihoods?
Chairman Clyburn. I agree, and I wish that all of our
citizens had physicians that they could go to. And that's one
of the things we're trying to do with some of the legislation
that's before the floor now. You have a physician, I've got
several, but we've got health insurance to pay for it.
So, if we can get health insurance to everybody, maybe
they'll be able to consult their physicians.
Mr. Scalise. We could have a hearing on that, too.
Chairman Clyburn. With that, I'm pleased to welcome today's
witnesses.
Dr. Jennifer Bacani McKenney serves as Wilson County Health
Officer, as well as the Fredonia City Health Officer in Kansas.
She's also the associate dean of the Office of Rural Medical
Education at the University of Kansas Medical Center and serves
on the board of directors for the Kansas Health Foundation. Dr.
McKenney is a family physician practicing in her hometown of
Fredonia.
Dr. Mysheika Roberts serves as the Health Commissioner of
Columbus Public Health in Ohio where she leads an organization
of more than 500 public health professionals. Dr. Roberts has
spent 20 years working in public health, including at the CDC,
where she investigated disease outbreaks. She also serves as
the chair-elect of the Big Cities Health Coalition, an
organization of leaders from the country's largest metropolitan
health departments.
Dr. Joseph Kanter serves as the state Health Officer and
Medical Director of the Louisiana Department of Health where he
consults on a variety of issues, including emergency
preparedness, infection control, and health equity.
Prior to joining the Louisiana Department of Health, Dr.
Kanter served as the Director of Health for the city of New
Orleans and was the Health Director of the Healthcare for the
Homeless Clinic.
Dr. Kanter is a practicing emergency physician and a
clinical assistant professor of Medicine at the LSU Health
Services Center and Tulane School of Medicine.
Dr. Beth Resnick is a senior scientist and assistant dean
for the Public Health Practice at the Johns Hopkins School of
Public Health. Her research and practice interests include
assessing and improving the public health infrastructure,
enhancing knowledge of potential health connections, and
developing effective public health policies.
Prior to joining the Johns Hopkins faculty, Dr. Resnick
worked at the National Association of County and City Health
Officials where she provided technical assistance and support
to the Nation's local health departments.
Thank you all for taking the time to testify today. I look
forward to hearing from our witnesses on ways we can strengthen
our public health infrastructure.
Now will the witnesses please rise and raise your right
hands?
Do you swear or affirm that the testimony you are about to
give is the truth, whole truth, and nothing but the truth, so
help you, God?
You may be seated.
Let the record show that the witnesses answered in the
affirmative.
Without objection, your written statements will be made
part of the record.
Dr. McKenney, you are recognized for five minutes for your
opening statement.
STATEMENT OF JENNIFER BACANI MCKENNEY, HEALTH OFFICER, WILSON
COUNTY HEALTH DEPARTMENT (KANSAS)
Dr. McKenney. Thank you. Good afternoon, Chairman Clyburn,
Congressman Scalise, and members of the subcommittee. My name
is Dr. Jennifer McKenney, and I've been the Local Health
Officer for Wilson County in southeast Kansas since 2011.
I'm also a family physician in my hometown of Fredonia,
Kansas, a community of 2,500 people, where I've been practicing
medicine for the last 12 years with my 77-year-old father, who
has served our community for 42 years. I am the mom of an 8-
year-old son and a 10-year-old daughter.
I also serve as the president of the Kansas Academy of
Family Physicians and as the associate dean for rural medical
education for the University of Kansas School of Medicine.
I will be speaking on behalf of myself, someone on the
front line, with multiple roles that give me a unique
perspective on public health and healthcare.
In rural communities, we are feeling immense strain. My
health department has four full-time employees and serves a
county of about 9,000 people. Our team has worked days, nights,
and weekends to detect COVID cases, do contact tracing, educate
the public, and vaccinate, all the while still attempting to
provide the high-quality services we have provided for years.
Unfortunately, we have now had turnover of three of our
four employees employed at the start of the pandemic. We are in
the process of hiring a new health department administrator, as
the last two have resigned in the last six months.
There is no doubt we need national pipeline programs in
place to support the training and retention of public health
professionals. Otherwise, we will see continued attrition, and
we'll be ill-prepared for the future.
In addition to staff shortages, our overall public health
and medical resources are extremely limited. Recently, I had to
call 40 hospitals in our region to find a bed for a critically
ill COVID patient.
This is a common story these days, unfortunately, because
public health guidance and recommendations are not being
followed by many in our communities.
We rural healthcare workers have managed patients on
ventilators without ICUs. We struggle for hours to get our
patients the critical care they need while they struggle to
breathe.
Never before have we seen how much our rural and urban
communities are interconnected. Never before have we seen them
so overwhelmed.
While the majority of the people in my community are
supportive of my healthcare work, some individuals, the same
ones we are working so hard to protect, distrust the
government, as well as science and public health. Even though
the virus is the enemy, their anger and frustrations are often
directed toward public health officials like me.
Kansas has seen one of the highest rates of public health
leadership turnover in the Nation. Many of my colleagues have
experienced worse harassment than me by the general public and
elected officials. But some have not been able to speak up for
fear of retaliation, so I share some challenges during the
pandemic to give a voice to those who are unable.
For example, after our public mask mandate hearing, a local
sheriff's deputy asked if he could escort me to my car because
he was worried about the angry people in the crowd who spoke up
against masks.
And I've been a member of our local school board for the
last six years and a former president. Despite presenting
scientific evidence for masking in schools, our school board,
like many others, still voted against keeping kids masked.
The same science that we teach children in schools is being
ignored by those making decisions for them.
Because the Kansas state legislators passed legislation
restricting public health powers during the pandemic, county
commissioners, most of whom have no medical or public health
training, are now the ones who make COVID-related decisions as
the Board of Health. They have been told that consulting with
health officials is optional.
I, myself, was informed that my job would be opened up for
applications last fall because I focused too much on health and
science and not enough on business.
We need support, more support, from local, state, and
Federal leaders. We are being asked to work longer and harder
in a much more difficult and controversial work environment.
My colleagues and I have worked thousands of unpaid hours
because we have promised to protect our friends, families, and
neighbors. But this is not realistic for everyone in public
health.
Funding needs to be sustained over time. It should support
training for those with an interest in public health careers,
and it must also provide these workers the tools they need to
succeed.
Healthy communities are good for everyone. The COVID-19
pandemic has challenged the entire Nation. It has produced
miraculously effective vaccines as well as producing resistance
to time-proven public health strategies. We have seen heroic
altruism, and we've seen extreme selfishness.
We need to do something now. With the support of this
Congress, we can have the human capital and resources we need
to point public health in the right direction for all
communities.
Thank you so much for your attention. I'll be happy to
answer any questions.
Chairman Clyburn. Thank you, Dr. McKenney.
We will now hear from Dr. Roberts.
Dr. Roberts, you are recognized for five minutes.
STATEMENT OF MYSHEIKA ROBERTS, HEALTH COMMISSIONER, COLUMBUS
PUBLIC HEALTH (OHIO)
Dr. Roberts. Thank you so much and good afternoon, Chairman
Clyburn, Ranking Member Scalise, and members of the
subcommittee. I am Dr. Mysheika Roberts, the Health
Commissioner here at Columbus Public Health, which serves the
cities of Columbus and Worthington in the great state of Ohio.
Over the past 20 months, my colleagues and I have worked
tirelessly to keep our community safe during this once-in-a-
lifetime pandemic. Local health departments like mine are the
boots on the ground, tasked with bringing this pandemic to an
end in partnership with our state and Federal partners.
The experience we bring to the table is unique. How public
health is responding to this pandemic is no different than how
we respond to other infectious diseases. While the scale is
much larger, the work we do to mitigate and to protect the
health is not new. Public health has been doing this work for
nearly a century.
Public health is essential to a thriving community. We need
support to be successful, not only during this pandemic, but
the new normal that lies beyond. We must be allowed to do what
we do best, which is to protect our community's health using
every public health tool at our disposal.
After months of working really long hours on COVID-19
testing, tracing, and vaccinating to protect the health of our
community, my staff is burned out, overworked, and underpaid.
Some are leaving the field entirely, unable to contribute any
more to the work they once loved. Simply put, their tank is
empty.
The pandemic has taken its toll on all Americans, but its
impact on public health is often overlooked, undervalued, and
left in the shadows.
Nearly all of my staff have been called to our COVID-19
response. Many of them have jobs that have nothing to do with
the infectious disease containment and mitigation of COVID-19.
Yet, they are now on the front lines of this pandemic.
Local health department staff are also combating
unprecedented levels of disinformation that divides
communities, it allows the virus to flourish, and it erodes the
trust in the public health system.
Public health officials also have been physically
threatened and politically scapegoated, causing them to leave
when they are needed the most.
This is the largest health crisis of our lifetime, and it
has created an unprecedented challenge for public health. We
need the support of our lawmakers now more than ever.
Yet, lawmakers in many states are actively working against
proven public health practices and our authority to protect the
health and safety of the communities we serve.
Laws that challenge and undermine public health authority
have been proposed in all 50 states, with 26 states passing
laws that hinder our response to COVID-19--laws prohibiting
mask mandates, banning the use of quarantine for those exposed
to COVID-19, setting arbitrary time limits on emergency orders,
and giving unilateral power to legislatures.
These are health decisions, not political ones. Local
health officials make decisions based on science to protect the
public's health, whether popular or not. Public health has been
doing this work for nearly a century. It should be no different
today.
As was mentioned, in the Ohio General Assembly they
recently passed a law that undermines the science of infectious
disease containment, which public health has long successfully
practiced.
These things are not new or unique to COVID-19. I can only
issue orders for those diagnosed with the disease, not for case
contacts, which demonstrates the ignorance of the basic
underlying science of infectious diseases. And sadly, this
change was made despite the protests of hundreds of medical and
public health experts.
Public health professionals are leaving the field due to
fatigue, some early retirement, challenges to our public health
authority, and harassment from the public. These vacancies,
plus years of disinvestment in public health, have made our
COVID response even more challenging.
According to NACCHO, local health departments began the
pandemic with fewer dollars and people compared to a decade
ago. At Columbus Public Health, our general fund per capita was
$24 in 2020 compared to an average in Ohio of $37 per capita in
2018.
Budget reductions directly impact the people needed to do
this work, which is critical to pulling out us of this pandemic
and building a strong public health infrastructure.
We need your sustained, predictable, and robust investment
in public health, not just disease-specific program lines to
support the infrastructure of our communities' needs. We must
invest in public health to keep our communities thriving.
We must do more to recruit and retain a skilled work force.
Local health departments are unable to be competitive in
today's job market. Salaries often fall significantly short of
the healthcare sector and make it difficult to attract
graduates.
Public health needs a work force loan repayment program
modeled after the National Health Services Corps to help
recruit and retain talent.
Boom and bust funding cycles to tackle this crisis and
others that will follow place Americans' lives at risk. Short-
term solutions to the pandemic will not ensure long-term
readiness of our Nation. But with your help, we can enhance our
public health system and get through the pandemic, and be
prepared for whatever comes next.
I thank you all for your time this afternoon, and I'm happy
to answer any questions.
Chairman Clyburn. Thank you very much, Dr. Roberts.
We now will hear from Dr. Kanter.
Dr. Kanter, you're recognized for five minutes.
STATEMENT OF JOSEPH KANTER, STATE HEALTH OFFICER AND MEDICAL
DIRECTOR, LOUISIANA DEPARTMENT OF HEALTH
Dr. Kanter. Good afternoon, Chairman Clyburn, Ranking
Member Scalise, members of the subcommittee. I serve as state
Health Officer and Medical Director for the Louisiana
Department of Health. I'm also a member of the Association of
State and Territorial Health Officials, an organization which
has provided crucial support and coordination throughout the
pandemic.
On behalf of the Louisiana Department of Health and the
state of Louisiana, we thank you for your attention and
dedication to these pressing issues.
I must note that as I speak to you today, many communities
in Louisiana continue to struggle in the aftermath of Hurricane
Ida. We are appreciative of the Federal Government's continued
partnership on this front as many families in the affected
areas still need our help.
Yet, despite these struggles, the COVID-19 storm continues
to rage even if it is not as immediately visible.
Hurricane Ida has taken the lives of 30 Louisianans. In
that same time period, since Ida made landfall, our department
has unfortunately reported an additional 1,541 new COVID-19
deaths.
Our fatality count, as high as it is, would undoubtedly be
higher if not for the expertise, commitment, and selflessness
of our public health work force. Under the leadership of
Governor John Bel Edwards and Secretary Courtney Phillips, we
have brought a science-and compassion-based approach to this
crisis.
It often falls to our public health work force to
operationalize the response, and this work force, a critical
piece of our health infrastructure, is in danger of crumbling.
Much like physical infrastructure, routine maintenance and
sustained investment are needed to prevent collapse.
Let us be frank. Stress fractures in our human public
health infrastructure have been visible for years. In many
departments across the country, these fractures have become
gaping holes. State and local health departments need help
shoring up their work forces before they buckle under the
weight of a now 19-month-long pandemic.
I do not in any way intend to discount the heroics of the
clinical healthcare workers. As a practicing ER physician, I am
one myself, and I can tell you, my colleagues in the clinical
sphere have performed with true grit and honor. The Nation
remains indebted and thankful.
But it is public health professionals who provide the
bedrock of how we as a community and as a Nation respond to and
ultimately overcome this pandemic.
My department, like others across the Nation, is staffed by
high-performing health advocates who can handle the workload
and weight of the moment. Like a clutch ballplayer in the
playoffs, this is precisely what they're trained for.
However, as with any well-trained and valuable
professional, they are sought after, and they have options. We
need to be able to provide competitive salaries, opportunities
for professional advancement, and the ability to surge
resources when need arises. And to do this, we need greater
flexibility in funding.
The emergency supplemental funding provided by Congress
during the pandemic has been instrumental in our ability to
mount an appropriate response, and we remain deeply thankful
for the resources.
Unfortunately, the usual grants that provide the bulk of
health department funding tend to be overly prescriptive and
unnecessarily complicated.
More importantly, they are too short-lived. Departments
like mine are built on a perpetual stream of short-term, high-
maintenance grants. It's no way to do business. You can never
build for the future if your funding is limited to the
priorities of yesterday's appropriations.
To recruit and retain the work force that is needed to keep
America healthy, our health departments need funding mechanisms
that allow for strategic investment and longer-term planning,
mechanisms like longer spending durations for routine grants,
capacity-building grants, specific funding allocations for
professional development, educational loan forgiveness programs
for public health professionals, and incentive programs to
recruit public health professionals who come from the
communities they intend to serve.
The pandemic has showed us how interdependent we all are.
Outbreak waves of the virus have spread across the country,
bleeding from one state into another.
As state Health Officer of Louisiana, it matters a great
deal to me that Texas, Arkansas, and Mississippi have strong
health departments. Threats to the health of their constituents
will quickly become threats to the health of mine.
There is a clear national interest, indeed, a national
security interest, in bolstering all public health work forces.
Mr. Chairman, thank you for your time and attention. And to
the subcommittee, I look forward to our continued partnership.
Chairman Clyburn. Thank you very much, Dr. Kanter.
Finally, we will hear from Dr. Resnick.
Dr. Resnick, you are recognized for five minutes.
STATEMENT OF BETH RESNICK, ASSISTANT DEAN FOR PRACTICE AND
TRAINING, SENIOR SCIENTIST, BLOOMBERG SCHOOL OF PUBLIC HEALTH,
JOHNS HOPKINS UNIVERSITY
Ms. Resnick. Thank you. Good afternoon, Chairman Clyburn,
Ranking Member Scalise, and members of the subcommittee. Let me
also thank the other panelists that are here with us today.
I am a senior scientist at the Johns Hopkins Bloomberg
School of Public Health. I'm honored to come before this
committee today.
Now, more than ever, the United States needs a robust
public health system. My testimony today will address three
urgent tasks. First, stop harassment and attacks against the
public health work force. Next, protect the statutory authority
of public health. And third, rebuild the public health system.
Stop harassment and attacks against the public health work
force. It is the job of public health agencies to protect the
health of their communities.
In a democracy, dialog is necessary. Disagreement is
inevitable. But there is no place for attacks and harassment
against public health workers.
We identified at least 1,500 incidents of attacks and
harassment against workers in health departments across the
country, and half of this local health department survey
reported at least one incident of attack or harassment. From
death threats to protests, intimidation, even shots fired at
their homes, public health workers and their families continue
to be the focus of attacks and harassment.
Public health officials joined their professions to save
lives. Now, in the wake of these attacks and harassment, many
are leaving just when we need them the most.
Since the pandemic began, over 300 state and local public
health leaders have left their jobs, resulting in one in five
Americans losing their public health leader. Therefore, we
recommend two immediate actions to protect the public health
work force.
First, CDC should establish a national reporting system for
incidents of violence and harassment against state and local
public health workers for performing their official duties.
Second, the Federal Government should provide legal
protections for public health workers facing harassment and
violence. The U.S. Department of Justice should support state
and local prosecutors and law enforcement in their use of
existing laws and other legal protections to prosecute those
who threaten or commit violence against state and local public
health workers.
Protect the statutory authority of public health. Public
health emergency authority is an essential component of a well
functioning government. Throughout our Nation's history, the
use of public health authority, such as imposing quarantines,
abating nuisances, and administering vaccines, has saved lives.
Without public health powers, we would still have smallpox. We
would still have polio.
Public health powers are not absolute. There must be checks
and balances. But if we unilaterally disarm against public
health threats, we put ourselves in peril.
Yet, state legislatures in over 20 states have passed at
least one law to undermine public health authority. Imagine if
a legislature passed a law prohibiting the fire department from
using hoses.
Clearly, this makes no sense, yet such senselessness is
exactly what is happening across the country as state
legislatures work to strip emergency authority away from public
health officials.
We need to fix this. Therefore, we recommend the Federal
Government implement legal strategies and funding incentives to
support effective public health authority at the state and
local levels.
Rebuild the public health system. The pandemic arrived
after a decade of neglect of state and local public health.
Over 40,000 jobs eliminated, 15 to 20 percent of the total work
force lost.
Such neglect has consequences. We are all now facing those
consequences as our Nation struggles with our COVID response,
hobbled by a paucity of data, inadequate testing, and contact
tracing, struggling vaccine efforts, and insufficient outreach
to marginalized communities.
We can never be this unprepared again. Therefore, we offer
three recommendations for the Federal Government to rebuild the
public health system.
First, guarantee multi-year funding for state and local
public health infrastructure so that our improvements are
sustainable and that funding reaches all state, tribal, and
local public health agencies and their communities.
Next, sustain Federal investment in the work force. Build
on the short-term Federal investments in the work force with
sustained scholarships, loan repayment programs, and training
to assure a diverse and prepared public health work force to
protect communities across our Nation.
Third, modernize the public health data systems. Provide
full funding to upgrade systems and technology for electronic
data transmission and exchange across Federal, tribal, state,
and local agencies.
In closing, nearly 700,000 Americans have lost their lives
from COVID. To quote the late Baltimore Congressman Elijah
Cummings, we are better than this. By stopping attacks and
harassment against public health officials, protecting public
health statutory authority, and assuring sustained funding to
rebuild the public health infrastructure, we will be better
than this.
Thank you for the testimony, and I look forward to your
questions.
Chairman Clyburn. Thank you very much, Dr. Resnick.
Each member will now have five minutes for questions.
The chair now recognizes himself for five minutes.
For decades, public health departments around the country
have been underfunded. Overall, public spending for state and
local public health departments has dropped more than 15
percent since 2010, with more than three-quarters of Americans
living in states that spend less than $100 per person annually
on public health.
I am concerned that this figure to invest in public health
is putting American lives in jeopardy and has hampered our
country's ability to mount an effective response to the
coronavirus.
Dr. Roberts, how has underfunding impacted your
department's ability to provide core public health services in
Columbus, Ohio, both over the long term and in response to this
pandemic?
Dr. Roberts. Thank you for the question, Chair Clyburn. And
you're absolutely right, public health funding is essential to
a thriving community.
Our health department has an emergency response team that
was sufficiently funded when it started in 2001, shortly after
9/11. But over the course of the last 20 years, that funding
has dwindled down.
To put things in perspective to you, at one point in time
that office staffed about 20 individuals. But by the time the
pandemic hit in the spring of 2020, we had five individuals
funded on our emergency preparedness grant.
That reduction in staffing left a hole in how we could
adequately respond and gear up to this once-in-a-lifetime
pandemic.
So funding, stable funding, is essential to a successful
health department and to the response of a successful health
department.
Chairman Clyburn. Dr. Kanter, how about Louisiana?
Dr. Kanter. Thanks, Mr. Chair.
I feel very similar. The way that a lot of health
departments are funding, certainly my health department, is the
overwhelming majority of the operating revenue is coming from
program-specific Federal grants, CDC grants, SAMHSA grants,
HRSA grants that are tied very narrowly to a specific program
and are oftentimes very short-lived. A couple years is a common
duration.
And it's just very challenging to do anything substantial,
anything long-term, anything that builds capacity when you're
hamstrung with that.
We find that departments can do exactly what they're funded
to do, which is what was important a year prior when that
funding came down, but they can't do much to build for the
future.
So in looking back through this pandemic, and I'm proud of
how Louisiana responded and my department, but I don't feel
well prepared for the next thing because the next thing is
going to be a little bit different, and I don't anticipate
having a lot of resources that have the type of flexibility
that we're going to need to build what we have to build to do
that.
Chairman Clyburn. My district is largely rural, and I am
concerned about the chronically underfunded public health
departments that serve rural communities.
Dr. McKenney, why is it so important to ensure that public
health departments have adequate funding?
Dr. McKenney. Thank you for this great question.
Really, I would say that rural communities and urban
communities are so intimately intertwined. So what happens in
our rural communities affects urban communities and vice versa.
So when I talk about my small health department that only
has four full-time employees, if we lose one, we lose two, I
mean, really, we're not able to do the things that we need to
do every day to take care of moms and babies, to do routine
childhood vaccinations, to take care of the public in general
and do that type of education.
One lost employee is a huge hit on a health department the
size of ours in our rural community.
So funding, stable funding, as we talked about, is such an
important thing so that we can continue to plan for the future
so that we know what we have to work with, so that we can
actually stay open. We want to keep our doors open because
every rural citizen deserves as much of the services and the
public health education as any urban community, and we want to
keep that going within every community.
Chairman Clyburn. Well, thank you very much for that. I
suspect that we won't be able to get another question in, in 15
seconds. So in the absence of the ranking member, the chair is
pleased to recognize Dr. Miller-Meeks.
Mrs.Miller-Meeks. Thank you so much, Mr. Chair.
And I want to thank all of our witnesses here for their
testimony. As a former Director of the Iowa Department of
Public Health, I'm deeply appreciative for the work that all of
you do. So not only a physician but a former Director.
And, in fact, I spoke on the floor of Congress in criticism
of the latest COVID relief bill that passed because less than
one half of 1 percent of the total $1.9 trillion funding went
to public health work force, and it could have gone to public
health work force in non-competitive grants to local public
health work force, of which in Iowa there are 101 local public
health work forces, county departments, who did amazing work
during the pandemic.
As we all know, the coronavirus crisis presented a unique
and profound challenge for our healthcare communities. The
impact of the economic lockdowns and school closures had on our
economy and general well-being cannot be understated as well.
In fact, the World Health Organization found that
government imposed lockdowns can have a profound impact on
individuals, communities, and societies by bringing social and
economic life to a near stop, and this is especially true for
our already vulnerable groups.
Last April, I wrote an article about the impact that the
lockdowns would have on excess deaths from cardiovascular
events, from untreated cancers, undetected cancers, cancers
that were not continuing on their treatment use, from increased
drug use, addiction, and overdose, and from increased anxiety,
depression, and, unfortunately, suicide.
The United Nations Children's Fund has estimated that these
lockdowns the increased childhood poverty rate by 15 percent.
Additionally, mental health problems are up 31 percent.
Drug use and addiction resulting in overdose have exploded.
The San Francisco Chronicle relayed in January of this year,
published that deaths in the 18-to 45-year-old age group by
drug overdoses far exceeded deaths in that age group from
COVID-19.
And children as young as nine have committed suicide.
How we have responded to reopening our economy and getting
back to normal is also troublesome to me and presents a
challenge for the healthcare sector specifically.
Dr. McKenney, Dr. Roberts, and Dr. Kanter, all three of you
mentioned in your written testimony issues with turnover and
the struggle to recruit and retain healthcare workers.
Meanwhile, we see an administration pushing for vaccine
mandates among these very populations.
These are the brave men and women who worked tirelessly,
and many of you in your local departments have worked
tirelessly over a year through the pandemic with no vaccine to
care for our country.
This seems a little bit hypocritical to me that these
healthcare professionals receive a vaccine after fighting this
virus for 18 months and have the wherewithal and knowledge to
understand and make an informed decision.
So I'd like to ask all of you, do you believe that we
should be recognizing immunity as the broad base of immunity
that we know in public health, which is immunity either
acquired from an infection or from a vaccine?
So if you would each keep your answers brief. Do we
acknowledge that and recognize that there is immunity? Should
we be talking about immunity, and immunity, whether it's
acquired through infection or natural immunity or acquired
through vaccine?
Chairman Clyburn. Dr. Resnick?
Ms. Resnick. I'm not a virologist, but I do want to offer a
statement, a quote from Dr. David Thomas, chief of the Hopkins
Division of Infectious Diseases, who stated that, ``I would
advise persons previously infected to consider adding
vaccination if they haven't already received it. SARs-CoV-2
infection can kill and produce long-term side effects that no
one wants. Vaccination remains the best way to be protected
without experiencing the risk of infection.''
Mrs. Miller-Meeks. Well, I would say those recent studies
that have come out from Israel do, in fact, highlight the broad
based immunity of naturalized infection. No one is suggesting
that people go out and get infected or have a COVID-19 party
like chickenpox.
So, Dr. McKenney, yes or no?
Dr. McKenney. Yes. I would be happy to answer.
In response to the Israel study, we are all very anxious to
see more data come out in various studies.
With that, the risk of getting natural immunity, like you
mentioned, is so high. We've seen the consequences of COVID.
And so----
Mrs. Miller-Meeks. Again, I'm not asking about the risk.
Dr. McKenney. Yes.
Mrs. Miller-Meeks. I'm asking, should we be talking about
immunity as a broad based immunity like we do for any other
infectious diseases? None of us want people to go out and
deliberately get infected.
So thank you for that.
Dr. Roberts?
Dr. Roberts. Thank you for the question.
I would just add, as you mentioned before, that vaccine
mandates are very common in the healthcare sector, and for many
of those, we do allow a natural immunity as an option if they
can prove that.
Mrs. Miller-Meeks. Thank you so much. And I, in fact, have
a bill that asks that we mandate insurance coverage for testing
for antibodies and T-cell antibodies so we can show proof of
immunity.
And then, Dr. Kanter?
Dr. Kanter. Yes. Thanks, Rep. Miller-Meeks. I respect you
as a colleague, both as a doc and a state health officer, a
former Health Officer.
I agree. I think there needs to be more discussion. The
data out there is somewhat inconclusive. The Maccabi data, I
think, has some selection bias issues.
There's compelling data from Kentucky and Alabama that
shows that natural protection from an infection is somewhat
unpredictable. About a third of people that get natural
infection might not mount an antibody response.
There are also other viruses that we still vaccinate people
for after they have an infection, like varicella.
So I think it's complex. But I advise my patients who had
COVID-19 infection that they get more protection if they go and
get vaccinated after that.
Mrs. Miller-Meeks. So I think testing for the immune
response would be a very valuable piece of information in that
data.
So thank you, and I yield back my time.
Chairman Clyburn. Thank you very much.
The chair now recognizes for five minutes, Ms. Waters.
Ms. Waters. Thank you very much, Mr. Chairman. I'm very
appreciative for you holding this hearing. I think it's so very
important.
First, let me say, of course, I'm in Los Angeles County,
and we have the Director of Los Angeles County Public Health,
Dr. Barbara Ferrer, and she is absolutely wonderful. She works
long hours. Not only is she managing that department, but she
does public appearances. She responds to requests from
legislators and others on town hall meetings, virtual meetings,
on and on and on. And this department works very hard.
And I am always amazed that we have so many entities in
L.A. County who are following the advice. I have been tested at
least six or seven times for every event, public event that
I've gone to. Those entities in L.A. County have required that
you have recent testing. They're taking temperatures, and
they're asking for proof of vaccination. They're following the
leadership of Dr. Ferrer in L.A. County, and they're doing a
good job.
But I know they're overworked. And without even talking
about funding, it is just absolutely necessary that they have
the staffing, that they have the funding that's needed to do
the kind of work that they're doing and provide the kind of
protection that they're providing.
Given that we have our health departments, our public
health departments who are struggling because many of them, not
only are they under attack, as has been testified to here
today, they are basically dealing with these contradictions
that I just don't understand.
And I want to ask any and all of our witnesses here today,
how do we reconcile that we have so many people who are
unvaccinated? As I understand it, we have 70 million eligible
Americans who remain unvaccinated.
And a recent CDC study found that unvaccinated people are
29 times more likely to be hospitalized with severe
coronavirus. More than 97 percent of recent coronavirus deaths
are among the unvaccinated persons.
Can you help me to understand how we could have our
legislators or anybody else who believes that the unvaccinated
personnel should be taking care of people who are very ill and
being hospitalized because of the coronavirus?
Dr. Resnick, how does this work? Does that make good sense?
I mean, how is it we could say that there are workers who
should not be mandated to be vaccinated themselves who are
taking care of unvaccinated people who are crowding our
hospitals?
Ms. Resnick. So, good question, Congresswoman. I might
yield to my physicians to give more specific examples.
But I do know that the evidence has shown that vaccine
mandates that are crafted well are effective in terms of having
us well staffed and well protected. And, obviously, as we know,
vaccination does remain the best way to be protected without
experiencing risk of infection.
Ms. Waters. And so, I don't know if it's proper for me to
ask you, having stated what you've stated, that do you believe
that mandating vaccinations throughout our society would help
to defeat this coronavirus that we're confronted with, this
pandemic?
Ms. Resnick. So from a personal standpoint, I feel like it
is a complicated question, and oftentimes individual
communities have their own needs. But I think a key point of
this hearing here is that we need a strong public health
infrastructure to start.
So having better information, being able to start out ahead
of the game, knowing what's going on, having testing and
information and data, could help inform our decisions to then,
first of all, get out ahead of it, hopefully; and, second of
all, be able to make informed decisions that might be
appropriate for each individual place. For example, a nursing
home is going to be different than a bowling alley, different
than a hospital.
Ms. Waters. Dr. Roberts, what do you think about that?
Should we have more mandates?
Dr. Roberts. Well, thank you for the question,
Congresswoman Waters.
I would just add that we have had vaccine mandates in our
country for many years. It is something common that kids have
to be vaccinated to go to school. It is very common that
healthcare workers have to be vaccinated against certain
infectious diseases.
This is not new. Our response to this pandemic is no
different than how public health has been working for the last
100 years.
I do think we need to educate our public and our healthcare
work force about the vaccine. I've spent lots of time and
effort educating our community, educating agencies about the
safety and effectiveness of the vaccine.
But the final decision is up to the individual. And I think
that vaccine mandates, again, have worked in the past. We know
the vaccine is safe and effective.
And we know that individuals in the front lines, whether
you are in public health, healthcare, or working in the front
lines as a law enforcement officer, you are at increased risk
to being exposed to this virus.
Ms. Waters. Thank you. I yield back.
Chairman Clyburn. Thank you very much.
The chair now recognizes Dr. Green for five minutes.
Mr. Green. Thank you, Mr. Chairman. I appreciate having the
hearing. And of course Ranking Member Scalise.
I want to thank our witnesses for being here today.
During the last hearing, I just want to clarify some
testimony that I provided. I think it was misunderstood by Mr.
Raskin. I've spoken to Mr. Raskin, but I want to make sure that
it's on the record.
When I spoke about natural immunity and the study out of
Israel with a sample size of 700,000 people showing that
natural immunity was 27 times better than the vaccine, I was
not arguing that the vaccine was not effective. For people who
are at risk for bad outcomes for COVID, the vaccine is a great
choice.
So I want to make sure that's clear. And I did clarify. I
caught Mr. Raskin offline and we spoke about it.
But I just want to make sure everybody understood what I
was talking about was this natural immunity that is showing
itself to be better than the vaccine. And yet, we're not
considering natural immunity with vaccine mandates. And we're
firing people, we're kicking people out of the military who
might very well have a better answer than the vaccine.
So that was my point with the testimony last week. I wanted
to clarify that. And thank you very much.
Chairman Clyburn. Very good. Thank you.
Mr. Green. My biggest concern with our committee has been--
and I think y'all have heard me say this many times--what we're
not talking about.
And a quick example. I just flew back from Brazil. I went
down to Brazil to meet with leadership down there, to talk to
their military about joint military stuff, and all this as a
part of my responsibilities on Foreign Affairs and as the
ranking Republican on Western Hemisphere.
When I came back, I had to have a negative COVID test. Yet,
thousands and thousands of migrants are coming across our
southern border, they are not getting COVID tested, and our
government is sending them all over the United States.
It's as if we're seeding COVID all over the country and
we're not talking about that in this committee. We should talk
about that in this committee. That's a big, big deal.
And of course the heavy-handed lockdowns, I'd love to spend
some time talking on that. I think that those government
officials created an unmitigated disaster with consequences
that are going to be felt for years, small businesses forced
into bankruptcies, unemployment.
As a physician, I'm very concerned about the long-term
effects of delayed cancer screenings and preventative care.
I think most people here know that I had colon cancer. And
I went to combat, too. I don't have survivor guilt from the
war, but I do have some survivor guilt from the cancer ward.
And when you're sitting in a chemo chair getting chemo and you
become friends with the person who comes every other Tuesday
with you in the chair next to you and they die, you have to
live with the question of, why wasn't it me that died?
Yet, here we are with all our lockdowns. There weren't
cancer screenings for months. Thousands of undiagnosed cancers
will kill Americans. We didn't consider the ratio. We won't
look at the numbers. We won't talk about this.
And even today--I talked to my oncologist this week--30
percent below our pre-COVID levels of colon and breast cancer
screening. We are still scaring people to death literally,
because they're afraid to go get their cancer screening.
School closures forced millions of students to substitute
screens for classrooms, and it has led to a massive setback in
our educational progress for those students, not to mention the
very well-documented toll on social isolation and mental
health.
As an ER physician, I would see people all the time coming
in with suicidal ideation, with suicidal attempts. And when it
is a young person, it rips your heart out. Yet we're not
talking about that.
In fact, while we know for a fact that there's been a 30
percent increase in ER visits for mental health issues amongst
teenagers, and a 50 percent increase for women, the CDC hasn't
released the suicide data for the last year.
Why? Well, we ought to know that in the midst of this
pandemic. If we're going to balance out how many we lost to the
virus, well, how many did we wind up harming, killing with the
bad lockdowns?
I mean, we should look at that data. Why aren't we talking
about those things?
I'm a clinician and I'm also an ER physician, so I think
very practically.
I have so much more to talk about, Mr. Chairman, but I'm
running out of time.
But I'm concerned about what we're not talking about in
this committee. Last week I talked about the origins of the
virus. We haven't yet talked about that.
I'm out of time, but I yield, and thank you.
Chairman Clyburn. I assure the gentleman that the ranking
member did talk about that, as you can imagine.
Mr. Green. I bet he did.
Chairman Clyburn. The chair now recognizes Ms. Velazquez
for five minutes.
Ms. Velazquez. Thank you, Mr. Chairman, for this important
hearing.
And I want to take this opportunity to thank all the
witnesses.
Dr. Kanter, there continues to be a significant amount of
misinformation regarding miracle cures for COVID. First, it was
hydroxychloroquine, and now the miracle drug is the horse
dewormer Ivermectin.
Dr. Kanter, how is this misinformation and junk science
impacting people in your state?
Dr. Kanter. Thank you for the question, Representative
Velazquez. And thanks for your work in this area, too.
It's been incredibly harmful. And there is a long history
of snake oil and snake oil salesmen in this country. And it is
not just for this, COVID, it's not just hydroxychloroquine and
Ivermectin. Talk about an antacid like Pepcid. I've seen people
talk about gargling hydrogen peroxide, and all types of other
things that do nothing to help prevent or treat COVID.
I'll tell you, what I've seen clinically and what I've
heard from other clinicians is patients coming in sick with
COVID and shocked and angry that the Ivermectin they were
taking didn't help them, or the hydroxychloroquine they were
taking didn't help them, and realizing too late that what they
were listening to was not accurate.
I think the essence here is we all wish that there was a
silver bullet. I can't tell you how much I wish that there was
a silver bullet that would be easy, one pill to make you
immune. I wish that was true, and most doctors do. It's just
not the case.
And while some of these medicines might not hurt the person
immediately, the harm they cause is in giving a false sense of
security when there are other things, like vaccination, that
would really protect them more.
Ms. Velazquez. Thank you.
There are people that know better. And when public
officials do not immediately condemn the spread of
misinformation or junk science, does it make your job harder to
have the public follow public health guidance? And how does
your agency try to combat misinformation?
Dr. Kanter. It does. It makes the job more harder. But more
important than that, it hurts people.
I talk to a lot of individuals who have seen this
misinformation on Facebook and social media, and believe it.
And I would never fault anyone for that, because everything
with COVID has been so fast paced and confusing, and that's
understandable, and I have a lot of empathy for that.
It's hard to have empathy for people that know better and
are trying to spread this because God knows why. But they are
trying to spread it. And there are real people and real
families that get hurt on the other end of it. That's tough to
stomach.
Ms. Velazquez. Thank you.
Dr. McKenney, I have been appalled by the hate and abuse
experienced by public officials who are doing their best to
protect us during this pandemic.
Can you please describe for us the backlash you faced when
you advocated for the use of proven mitigation measures, such
as masks?
Dr. McKenney. Yes, absolutely. Thank you for this question.
For me, it has been a very personal experience. If you can
imagine, I'm in my hometown where I grew up with all of these
people, and I've been caring for them for over a decade.
And those same people, as you mentioned about the
misinformation and everything, these same people are ones that
do attack and ask for your termination or your resignation. And
these are people I've known for my whole life.
So these are the things that truly hurt a community as a
whole. It's not just the virus anymore, it's not just
infection, it's not just physical health. But this leads to
mental health problems, the misinformation, the problems when
people are fighting in your community, when your community
before the pandemic was so tight knit.
And so, absolutely, not just in rural communities, we all
have communities, whether it is urban, or our church community,
or whatever it is. But all the misinformation, all the attacks
on people just trying to help other people have really broken
our society apart in so many ways that are beyond the virus and
beyond infection.
Ms. Velazquez. Just the previous colleague was talking
about mental health and how we need to study it.
Again, what toll have these threats and harassment had on
you and your coworkers?
Dr. McKenney. This is why we see people leaving public
health now. It is not because we've been asking them to be
vaccinated, truly. It's because every day they have to endure
things like people lying to them about their close contacts or
when their symptoms started.
It is truly the personal effect, the way they're putting
their whole heart into everything that they're doing to help
people, only to get other people to, again, lie or yell or
attack or shame them in public for just trying to do their job.
And that's such a strain and truly is a reason why we've seen
so many people quit public health.
Ms. Velazquez. Thank you for your service.
Mr. Chairman, I yield back.
Chairman Clyburn. I thank the gentlelady for yielding back.
The chair now recognizes Mr. Jordan for five minutes.
Mr. Jordan. Thank you, Mr. Chairman.
Dr. Resnick, in your testimony, your written testimony, you
stress that public health emergency authority is essential, and
the power of public health officials, state and local public
health officials, in making decisions.
Should there be limits on the emergency powers of public
health officials?
Ms. Resnick. Yes. Thank you for the question, Congressman.
As I said in my testimony, yes, there should absolutely be
checks and balances in thinking these things through.
Mr. Jordan. Tell me what those checks and balances should
be.
Ms. Resnick. Well, actually, Lawrence Gostin, a law
professor of global health at Georgetown University, has some
criteria that he thinks we can think about for individual
rights:
Is there scientific evidence that the policymakes sense?
Is the intervention the least restrictive possible to
achieve our public health goal?
Are the measures used likely to gain the public's support
and confidence?
Does the person have access to due process to challenge the
intervention?
And is the measure arbitrary or discriminatory?
Mr. Jordan. Those don't sound like checks and balances.
Those sound like guidelines and just good common sense. Checks
and balances means someone else has power, some other authority
has power to actually check and balance the decision made by
the public health official.
What should those checks and balances be?
Ms. Resnick. Well, again, I think, keeping these guidelines
in mind--and you're right, these aren't checks and balances,
they're guidelines--but thinking that through carefully before
you even propose the intervention, and then, obviously, having
to balance those risks. And, again, yes, the public health
officials shouldn't make the decision----
Mr. Jordan. Public health official makes an emergency
decision, emergency authority, and says, ``This is going to
happen.'' What should be the--should there be a time limit on
that?
Ms. Resnick. So those are good questions. But when we think
about the illness and the situation that we're facing, so if
you have smallpox, you have some kind of very contagious
disease, there should immediately be able to put that into
place, yes.
Mr. Jordan. So are you agreeing with me, there should be a
time limit?
Ms. Resnick. No. I think it depends on the circumstances. I
don't think there could be a set--one set moment that----
Mr. Jordan. Well, let's back up a second.
Who should be able to check the decision of the public
health official?
Ms. Resnick. So you have the local boards of health. You
have the elected officials.
Mr. Jordan. Well, now we're talking, yes. It seems to me it
should be the elected officials. That's how our system works.
People who put their names on the ballots should make decisions
for the people they represent, not someone who's unelected.
So the checks should come from the elected body. And I'm
asking what would be--for example, in the state of Ohio I know
what our legislature did. They said, the public health order
from the governor's office, from the state health director,
there should be a time limit on how long that is in effect
before the legislature--a limited amount of time they can take
that decision.
But at some point the legislature gets to weigh in and say
whether that's appropriate or not. Do you agree with that?
Ms. Resnick. So, again, I think it depends on the
circumstances. So, again, if you have a very contagious
disease, no, I do not. But if it's a longer-term thing, yes.
Mr. Jordan. You don't think the elected official should be
able to overrule at some point the length of time of a public
health decision emergency authority? A public health emergency
authority decision, I should say. You don't think the elected
official should be able to overrule that?
Ms. Resnick. At some point, maybe. But I'm saying in an
immediate emergency----
Mr. Jordan. Maybe?
Ms. Resnick [continuing]. in an immediate emergency where
you have life and death.
Mr. Jordan. I'm not arguing with that. I'm saying at some
point--to your point, at some point--it seems to me at some
point, of course, the elected officials can overrule that.
Ms. Resnick. OK. I wouldn't disagree with that. But I guess
the question is, at what time point and when that would be?
Mr. Jordan. Yes.
Ms. Resnick. Again, I think that would depend on the
circumstances that you're facing, and there would be
questions----
Mr. Jordan. I think that depends on the decision the
elected officials make, not the unelected official.
Ms. Resnick. But would you think that you'd need public
health guidance and information and knowledge to inform those
decisions?
Mr. Jordan. We take guidance, that's why we have hearings.
We take testimony from people. That's why you're here today,
we're getting information. Of course, that's always part of the
process.
But in the end you don't get to decide, the public health
official doesn't get to decide. The people whose names are on
the ballot elected to the state legislature, they get to
decide. That's how it works in our system.
Have public health officials ever been wrong, state and
local public health officials ever been wrong on orders they
do?
Ms. Resnick. I don't know for sure. I'm sure there's been
cases, yes.
Mr. Jordan. How about the recent one in New York, the state
and local public health officials who said we should put COVID-
positive patients back in the nursing homes? It seems like that
was probably wrong.
It would have been nice maybe if the legislature got to
weigh in on that and change that decision. People's lives might
have been saved. We've got all kinds of examples of where
that's wrong. Of course, we need the check and balance of the
elected officials to make these decisions.
Do you agree?
Ms. Resnick. I also think there's emergency situations
where they would have to act in immediacy.
Mr. Jordan. No one disagrees with that. That's why the
legislature gave them emergency authority for a limited amount
of time. But at some point the elected officials get to weigh
in.
I see I'm out of time. I yield back.
Chairman Clyburn. I thank the gentleman for yielding back.
The chair now recognizes Mr. Foster for five minutes.
Mr. Foster. Thank you.
Maybe I'll start with just a simple question to Drs.
Kanter, McKenney, and Roberts.
Do you have any doubt that if everyone in your state had
been promptly vaccinated as soon as it became available then
the ICUs and the rest of your medical system would not be under
stress today?
Dr. Kanter. Thanks, Representative Foster.
I don't. I have absolutely no doubt that if that had
happened, we would have averted the situation we did. And we're
coming out from our Delta surge right now. It was the largest
surge to date. And we stressed our hospitals absolutely to the
brink. We avoided catastrophe, but we came awfully, awfully
close.
Mr. Foster. And do you ever think about what the situation
would be if in some parallel universe everyone had taken the
vaccine as soon as it became available? It must kind of break
your heart and contribute to the burnout.
Dr. McKenney?
Dr. McKenney. Yes, I would agree. And thank you for asking.
I agree with Dr. Kanter that I have no doubt that if we did
come out and have everybody vaccinated from the beginning, then
we would be in a much different place right now.
I don't even think we need an alternate universe. We saw
that with polio and we saw that in history. And so, we have
that luxury of being able to look back, and that is our
research and that is our proof.
So I wish that that had been the case early on for all of
us. A lot of lives would have been saved.
Mr. Foster. Dr. Roberts?
Dr. Roberts. I agree with my colleagues. I have no doubt
whatsoever that we'd be in a very different position now had
more of our community been vaccinated. Our hospitals are seeing
rates comparable to what they saw in December 2020, which was
before we even had a vaccine.
And so, this Delta surge, which is still ongoing in Ohio,
is hitting our urban areas and our rural areas very hard. And
with only about 52 percent of the state's population being
vaccinated, I am very confident that if we had a higher
vaccination rate we would not be experiencing what we are
seeing now in our hospitals.
Mr. Foster. And so, when you hear our Republican colleague,
the ranking member, state that, well, we know that there are
breakthrough cases and therefore somehow it's OK if people
remain unvaccinated, what's your reaction to that line of
logic, that the vaccines aren't perfect, therefore people
shouldn't have to take them?
Dr. Roberts. Well, first of all, nothing in life is
perfect. The vaccines are very effective. And from talking to
my hospital colleagues about our breakthrough cases, the vast
majority of our breakthrough cases are found in our elderly
population and those with underlying health conditions, which
are the same population that have now been eligible for a third
or a booster dose of a vaccine to give them that extra level of
protection.
So I would say the vaccines are very effective. And for the
average healthy adult and child, if they are vaccinated, they
are six times less likely to be hospitalized and to die from a
COVID-19 infection.
Mr. Foster. And as a scientist, I will be paying very
careful attention to the experiment we are seeing in real time,
where countries like Italy, I believe, which are implementing a
nationwide vaccine mandate, to see if they see a different
course of COVID than we will see in our country, where we
believe it's a--some of us seem to believe it's a matter of
individual choice to do something that puts your fellow
American at risk.
Dr. Resnick, you emphasized modernizing electronic health
data systems, which I think all of us were sort of shocked at
how little information we had early in the pandemic, even
elementary things like ICU occupancy, the number--the fraction
of people sick with COVID, the testing reporting system.
I want to make two quick points.
First, the Congress has actually done something on this--
and the Senate, of course, is sitting on it--which is to remove
the Federal law against having a unique patient identifier.
This is simply a system that patients can opt into to have a
unique identifier for all the electronic health records. And we
passed that unanimously through the U.S. House. For the last 25
years it's been illegal for the electronic health record
systems to do that, to develop such a system.
And so, can you comment on if we had a rational way for a
patient to have a health record where you could collect the
testing status, the vaccination status, other relevant aspects
in a single location, how that might have transformed the
response?
Ms. Resnick. Yes. So I think, obviously, these are
complicated issues with privacy and other questions. But I
think the key point is that they have to be interoperable so
that people can share. And right now what we're facing is, as
we saw with COVID, you can't even share information between
state, local, tribal agencies.
And so, having an ability to do that--and, again, I'm not
an expert on all the privacy rules, so I think you'd have to
have lots of discussion around it--but the key point would be
that you'd have to be able to share that information across
governmental levels would be super important.
Mr. Foster. And so, yes. Israel, for example, has multiple
competing providers, but they have a unique identifier so that
you can pull in all of the health data for one patient when
they opt into the system.
Anyway, so I urge everyone to continue thinking about
putting pressure on the Senate to do the right thing and save
tens of thousands American lives a year.
Thank you. I yield back.
Chairman Clyburn. Thank you very much, Mr. Foster.
The chair now recognizes Mr. Krishnamoorthi for five
minutes.
Mr. Krishnamoorthi. Thank you Mr. Chair, for allowing me to
participate virtually.
I've been reading these articles about threats to public
health officials, and they are very startling. I just read an
article detailing how in Kent County, Michigan, just last
month, a man, a public health official, whose public health
department issued a mask mandate, said that a woman driving
more than 70 miles an hour tried to run him off the road twice
in one night. He said someone also called him an expletive and
then yelled, quote, ``I hope someone abuses your kids and
forces you to watch.''
In another incident, this time in Colorado, in Jefferson
County, Colorado, someone threw live fireworks into a tent of
public health workers administering vaccines.
And then, in Ohio, someone actually went up to a former
public health official's home and shot into their home, in a
suburb that's not otherwise known for gun violence.
Dr. McKenney, let me start with you for a moment. You've
seen this backlash, and you talked about it a little bit. I
also saw that you told NBC News that it might have something to
do with your race.
Can you talk to us a little bit about that? As an Asian
American, I'd by curious about your observations there.
Dr. McKenney. Yes. Thank you so much for asking.
I do believe that there is a lot more that has to do with
race within the pandemic that we haven't talked about, and that
might be the hate against Asians that we've seen out there.
It also might be the discrepancies in the care that people
have gotten because of their various races or socioeconomic
status.
So there is so much more to it, I think, than we have
really even able to dive into at this point.
As a Filipino-American woman in a small town in Kansas, you
can imagine I'm not exactly what everybody looks like here. My
benefit is that I've grown up here, so they know me, and I've
built trust over the years.
But even with that, you still hear the comments about how
this an Asian or a Chinese disease, and you feel the fingers
being pointed.
There's no denying that there have been racial issues
throughout this entire pandemic. And it's so unfortunate,
because, again, that is not what we're trying to fight. We
don't need to be fighting each other. We need to be fighting
this virus. And somewhere along the way people decided----
Mr. Krishnamoorthi. May I jump in for a second?
Dr. McKenney. Yes, please.
Mr. Krishnamoorthi. Did any officials or public figures
exacerbate that particular situation for you in the way that
they talked about the public health threat?
Dr. McKenney. I did not personally have anyone that was an
elected official say that directly to me.
Mr. Krishnamoorthi. OK.
I think that this is something that we have to tamp down,
which is anti-Asian-American bias, and, of course, anti-Asian
hate crimes. And, unfortunately, it's manifesting itself
everywhere, including toward public health officials where you
see a disproportionate number of people of Asian-American
heritage represented.
Dr. Kanter, I understand that you recently spoke at an
assembly where you were talking about the efficacy of mask
wearing, and somebody said you were, quote, ``complicit in
genocide'' for making people take these vaccines. So I guess
you also talked about the effectiveness of vaccines.
How dangerous is it when people believe that public health
officials such as yourself are complicit in, quote/unquote,
``genocide''?
Dr. Kanter. Thanks. I appreciate the question. As the
grandson of Holocaust survivors, that was a particularly stingy
comment to make.
I just wish people would tone it down. And I think we can
have a discussion about what the prudent public health response
is. And there is room for that discussion without taking it to
the level of personal attacks, without even assuming that
people are doing things because they're trying to be a
``tyrant,'' quote/unquote.
But there's been a lot of these high-level accusations,
there's memes with Nazi imagery. And it just needs to be taken
down, because the things that Dr. McKenney described are real
and people are going to get hurt and the people that are
trying----
Mr. Krishnamoorthi. Let me just jump in and summarize. I
think that the anti-Asian or anti-Semitic tropes that kind of
are coursing through social media generally and in the White
supremacist movement are also being directed at public health
officials now. And this is deeply dangerous. And we have to
combat it wherever it rears its ugly head.
Thank you so much.
Chairman Clyburn. I thank the gentleman.
And I thank all the witnesses here today.
Before we close--I don't see anybody else to be
recognized--before we close, I would like to enter into the
record letters the committee has received from the National
Association of County and City Health Officials, American
Public Health Association, Big Cities Health Coalition, and
Network for Public Health Law, with respect to some of the
challenges facing state and local public health officials.
I ask unanimous consent that these letters be entered into
the official record. So ordered.
Chairman Clyburn. In closing, I want to thank Dr. McKenney,
Dr. Roberts, Dr. Kanter, and Dr. Resnick for testifying before
the Select Subcommittee today. We appreciate your personal
stories, your expertise, and your continued leadership in the
face of multiple challenges.
I often quote Dr. Martin Luther King, Jr.'s statement
issued at a healthcare conference back in 1966, and I quote:
``Of all the forms of inequality, injustice in health is the
most shocking and the most inhumane because it often results in
physical death.'' End of quote.
Dr. King is often misquoted to have said ``injustice in
healthcare.'' And healthcare is obviously critically important
for health. But he said, ``Injustice in health is shocking and
inhumane because it is often results in physical death.''
State and local health departments do far more for the
health of their communities than provide healthcare. They
promote healthy lifestyles, conduct health education, stop the
spread of disease, and so much more. Their services are
particularly important for vulnerable communities who have long
suffered health disparities and inequity.
The neglect of these public health agencies has caused
injustice in health that has, particularly during the
coronavirus pandemic, resulted in physical death of far too
many Americans.
We must end this shocking and inhumane injustice by
investing sustainably in state and local public health
departments. We must revitalize the public health work force,
which is facing high burnout rates and rapid turnover. These
investments will result in better health outcomes and can lead
to less overall health spending.
Fortunately, the Biden administration is already making
historic investments to upgrade our public health
infrastructure, ensuring that state and local public health
departments have the resources they need to combat the
coronavirus, be better prepared for the next pandemic, and
improve the overall health of the people in their communities.
I look forward to continuing to work with President Biden
to rebuild and strengthen state and local public health
departments and the entirety of our public health
infrastructure moving forward.
As we heard today, longstanding public health funding and
work force challenges are significant. But we are also facing
more acute problems.
The unprecedented level of harassment, threats, and attacks
against public health workers during the pandemic, fueled by an
alarming anti-science movement, must be addressed head on. We
cannot allow our public health officials to be subjected to
such outrageous behavior simply for doing their jobs to keep
Americans safe and healthy.
We must also reject attempts to undermine public health
authorities for political purposes. Public health decisions
must be made by experts based on the best available science,
not politics.
Underinvestment in public health has consequences.
Politicalization of public health has consequences. Attacking
public health workers has consequences.
Nearly 700,000 Americans have now died from the
coronavirus. To prevent this level of unjust physical death in
the future we must protect, rebuild, and strengthen our public
health infrastructure, starting with the state and local public
health departments and the dedicated Americans who have devoted
or will devote their careers to protecting the health of their
communities.
I look forward to working with today's witnesses, my
colleagues here in the Congress, and the Biden administration
to do just that.
And with that, without objection, all members will have
five legislative days within which to submit additional written
questions for the witnesses to the chair, which will be
forwarded to the witnesses for their response.
This hearing is adjourned.
[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]
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