[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                        A GLOBAL CRISIS NEEDS A
                    GLOBAL SOLUTION: THE URGENT NEED
                       TO ACCELERATE VACCINATIONS
                            AROUND THE WORLD

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

                                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

                               __________

                           DECEMBER 14, 2021

                               __________

                           Serial No. 117-58

                               __________

      Printed for the use of the Committee on Oversight and Reform

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                       Available on: govinfo.gov,
                         oversight.house.gov or
                             docs.house.gov
                             
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
46-490 PDF                 WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------                             
                             
                             
                             
                   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                Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia         Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois        Glenn Grothman, Wisconsin
Jamie Raskin, Maryland               Michael Cloud, Texas
Ro Khanna, California                Bob Gibbs, Ohio
Kweisi Mfume, Maryland               Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York   Ralph Norman, South Carolina
Rashida Tlaib, Michigan              Pete Sessions, Texas
Katie Porter, California             Fred Keller, Pennsylvania
Cori Bush, Missouri                  Andy Biggs, Arizona
Shontel M. Brown, Ohio               Andrew Clyde, Georgia
Danny K. Davis, Illinois             Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida    Scott Franklin, Florida
Peter Welch, Vermont                 Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr.,      Pat Fallon, Texas
    Georgia                          Yvette Herrell, New Mexico
John P. Sarbanes, Maryland           Byron Donalds, Florida
Jackie Speier, California            Vacancy
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts

         Jenifer Gaspar, Deputy Staff Director & Chief Counsel
                         Beth Mueller, 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

                              ----------                              
                                                                   Page
Hearing held on December 14, 2021................................     1

                               Witnesses

Dr. Ali Khan, Dean, College of Public Health, Professor, 
  Department of Epidemiology, University of Nebraska Medical 
  Center
Oral Statement...................................................     6
Katheryn Russ, Ph.D., Professor, Department of Economics, 
  University of California, Davis
Oral Statement...................................................     8
Dr. Martin Makary, M.D., M.P.H., Professor of Surgery, Johns 
  Hopkins School of Medicine
Oral Statement...................................................     9
Dr. Krishna Udayakumar, Associate Director for Innovation, Duke 
  Global Health Institute, Associate Professor of Global Health 
  and Medicine, Duke University School of Medicine, Director, 
  Duke Global Health Innovation Center
Oral Statement...................................................    12
Sebnem Kalemli-Ozcan, Ph.D., Professor of Economics, University 
  of Maryland
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

                              ----------                              

No additional documents were entered into the record for this 
  hearing.


 
                        A GLOBAL CRISIS NEEDS A
                    GLOBAL SOLUTION: THE URGENT NEED
                       TO ACCELERATE VACCINATIONS
                            AROUND THE WORLD

                              ----------                              


                       Tuesday, December 14, 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 2:10 p.m., via 
Zoom; Hon. James E. Clyburn (chairman of the subcommittee) 
presiding.
    Present: Representatives Clyburn, Waters, Maloney, 
Velazquez, Foster, Krishnamoorthi, Scalise, Jordan, 
Malliotakis, 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.
    Tragically, in the two years since the coronavirus emerged, 
there have been more than 270 million infections and over 5.3 
million deaths worldwide.
    Even more tragically, more than a third of these deaths 
have occurred since life-saving vaccines became widely 
available to those of us in the United States and most other 
highly developed nations.
    Nearly 40 percent of people around the world have not yet 
received even a single dose of a coronavirus vaccine. That's 
three billion people who remain at far higher risk than they 
should be.
    Some of these three billion are those who have been 
unwilling to get the vaccine. The Select Subcommittee held a 
hearing of vaccine hesitancy earlier this year, and we continue 
to examine its causes and seek solutions to increase vaccine 
uptake.
    Many others, who remain unvaccinated, however, have been 
among those who have been unable to get the vaccine because it 
is unavailable in the countries where they live.
    Many poor countries around the world have received only a 
fraction of those in the United States and elsewhere in the 
Western half.
    Fifty-six countries, largely in Africa and the Middle East, 
have not been able to vaccinate even 10 percent of their 
populations. In some of the world's poorest countries, such as 
Haiti, that figure is below one percent.
    This inequitable access to coronavirus vaccines is causing 
unnecessary death and suffering, and we have a moral obligation 
to save lives by expanding vaccine access.
    But ensuring that vaccines are available around the world 
is not just the right thing to do, it is necessary to protect 
our own health and our economy.
    Experts say that variants are 6 to 8 times more likely to 
emerge from less developed countries where a lag in vaccination 
rates create opportunities for the virus to mutate.
    The more that new virus develop, the greater the risk that 
there will be more infections, more deadly, and that they will 
be resistant to the current life-saving vaccines.
    We have learned from this pandemic just how difficult it is 
to prevent new variants from reaching our shores once they 
emerge.
    The best protection is, therefore, to make sure they do not 
develop in the first place. By increasing access to vaccines 
around the globe, we can save lives and protect public health 
at home.
    Helping other countries vaccinate their citizens is also 
the right thing to do for our economy. The American economy, 
like the economies of all nations in the 21st century, relies 
on international trade to reach its full potential.
    Many goods we manufacture here depend on materials sourced 
elsewhere. Other goods made in the United States are exported 
and sold to other countries. Outbreaks in these countries hurt 
American businesses and workers.
    Coronavirus surges in southeast Asia this summer illustrate 
how connected our economy is to global public health. In 
Malaysia semiconductor plants shut down because of coronavirus 
outbreaks, American car companies like Ford and General Motors 
could not produce new cars.
    They were, therefore, forced to suspend work in factories 
here at home. American workers and American consumers feel 
these consequences. As a result of the shutdowns in Malaysia, 
General Motors was forced to cut production by an estimated 
100,000 fewer vehicles in the second half of this year.
    Outbreaks in Vietnam have similarly hurt the supply of 
clothing, footwear, and cell phones manufactured by American 
companies. Global vaccination will help us avoid empty shelves 
and higher prices here at home.
    A fully vaccinated world is critical to the American 
recovery. In fact, a report commissioned by the Gates 
Foundation found that high-income countries like the United 
States could reap economic benefits from global vaccination 
that are more than 12 times the cost of funding those mass 
vaccination efforts.
    For all these reasons, I applaud the Biden administration 
for its leadership and ensuring vaccines are available around 
the world. As reflected in this chart, the United States has 
donated nearly 300 million vaccine doses and has committed to 
donate over 800 million more, more than every other country 
combined.
    President Biden recently reaffirmed his commitment to help 
vaccinate the globe, pledging an additional $400 million to 
help low-income countries administer vaccines on top of the 
$1.2 billion previous dedicated to global vaccination efforts.
    As we face another new coronavirus variant, we call on 
other countries around the world to step up and follow 
America's example.
    I would like to thank today's witnesses for being with us 
today. I look forward to hearing more about the importance of 
increasing global vaccinations for both public health and 
economic strength.
    I now recognize the ranking member for his opening 
statement.
    Mr. Scalise. Thank you, Mr. Chairman, and appreciate you 
having this hearing. Appreciate our witnesses who are before us 
today.
    It is a true testament to President Trump's Operation Warp 
Speed that anyone in America who wants the COVID vaccine can 
get that vaccine and its fully paid for. I've been proud to 
support President Trump's Operation Warp Speed, an amazing 
public-private partnership that led to the development of three 
different vaccines, which, by the way, only took less than a 
year to produce when many were saying it would be years to 
produce that.
    But in addition to that, produced, manufactured and 
distributed enough vaccines to give shots to every single 
American who wants one.
    America has also donated millions of doses to countries 
around the world, as the chairman just showed. I believe there 
is bipartisan agreement on this subcommittee, the vaccines have 
helped us reopen our economy, helped people get back to work, 
and helped people to live their lives again. There's no doubt 
about it, they have saved millions of lives.
    But they have been around for about a year now, and widely 
available for more than six months. Yet about 1,300 people are 
still dying each day in the United States. Sadly, there have 
been more COVID deaths this year than last year.
    Though there's still plenty left to learn about COVID, one 
thing we know for sure at this point is that vaccinations are 
not a panacea against preventing the spread of the virus.
    Despite these facts, after nearly a year in office, 
President Biden still has no real strategy to protect American 
families from COVID.
    The same administration that promised to shut down the 
virus still does not have an FDA commissioner. It took 
President Biden almost a year to finally get a nominee to lead 
the FDA, and he's just having his confirmation hearing in the 
Senate today.
    There's been no hearing or investigation into the origins 
of COVID, which we, in the minority, have continued to push 
for.
    The only strategy they seem wedded to is one that increases 
government control over people's lives with more illegal 
mandates.
    The Biden administration ignores naturally acquired 
immunity and won't dedicate much attention to therapeutics, but 
they want to mandate vaccines in any setting they can think of. 
They want to bully and shame Americans into thinking like they 
do or else face termination from their jobs.
    The Biden administration has tried to apply unlawful 
vaccine mandates to private companies with over 100 employees, 
to healthcare workers, to Federal contractors, and even Federal 
employees.
    President Biden has dedicated more time trying to get 
healthcare workers fired if they don't get vaccinated than he 
has spent on alternatives like therapeutics to keep families 
safe.
    Fortunately, for Americans, the Biden administration is 
losing big time in the courts. The Federal courts have struck 
down, halted, or delayed most of President Biden's unlawful 
mandates.
    This slide actually shows all of the different mandates 
that have been blocked. The OSHA mandate, for example, that 
President Biden issued for Federal--for private employers was 
blocked by the Fifth Circuit Court of Appeals last month.
    The CMS mandate that healthcare workers had to be at least 
partially vaccinated by December 6 of this year or face 
termination, that after a preliminary injunction issued by a 
Federal district court in Missouri, which applied to ten 
states, the healthcare workers mandate was finally blocked 
nationally just two weeks ago.
    The unlawful mandates for Federal contractors and 
subcontractors was blocked last week as well after a Federal 
district court in Georgia found it exceeded executive 
authority.
    Finally, under executive order 14043, virtually all Federal 
employees had to get vaccinated or risk losing their job. Sound 
familiar?
    On November 29 of this year, leadership in the Office of 
Management and Budget and the Office of Personnel Management 
encouraged Federal agencies to delay enforcement of yet another 
Federal mandate.
    This is a dismal record of failure and rejection of 
President Biden's unlawful mandates.
    With healthcare systems still treating COVID patients and 
facing staffing shortages, I warned months ago that the Biden 
administration's proposed vaccine mandate on healthcare workers 
would exasperate the shortage and could harm patient care.
    But the Biden administration pushed for it anyway. They 
continued to offer nonsensical solutions that don't solve the 
purported problem but rather create serious problems of their 
own.
    What is this twisted infatuation President Biden has with 
firing millions of hardworking families right before Christmas 
and especially at a time when most employers can't find 
workers?
    It seems like all President Biden wants to do is threaten 
people, bully people, and try to get them fired from their jobs 
when the courts are saying it's illegal for the President to do 
this.
    They want to do the same thing on global vaccinations. To 
increase the vaccine supply worldwide, the Biden administration 
wants to force the American developers of COVID-19 vaccines to 
give away their intellectual property, to give away those 
rights.
    That's right, for years we all spoke out against China 
trying to steal America's intellectual property. Now we have 
the American President trying to give our intellectual property 
away to China and other countries for free.
    If President Biden gets his way, imagine the chilling 
effect this would have on the ability to develop more life-
saving drugs in the future.
    On a bipartisan basis for more than 25 years, the U.S. 
trade representative made protection of U.S. intellectual 
property a cornerstone of our trade agreements. When America's 
ingenuity is protected and able to flourish, America can 
compete and win.
    American pharmaceutical companies have led the world in 
both research and development and introduced more life-saving 
drugs. The COVID vaccines are a great example of this. We're 
the world's leader because we have strong IP protections, and 
because we prohibit the U.S. Government from setting prices, 
like the socialized healthcare systems abroad.
    Now President Biden wants to take a sledge hammer to 
innovation by removing protections for U.S. intellectual 
property. Stripping innovators of their constitutionally 
protected patents will undermine innovation, weaken our 
international competitiveness, and only help communist China, 
the country that spread the pandemic in the first place.
    Even if the U.S. Government was successful in forcing the 
companies to give away their vaccine recipe, it would take the 
manufacturing process years to build those facilities, to 
source the materials that are needed to safely produce these 
complex vaccines.
    This would not yield more safe and effective shots in arms 
across the world. It's yet another illegal attempt to undermine 
American competitiveness. As I've said before, we should 
protect IP. We should contract with U.S. manufacturers and help 
distribute the vaccine to countries who need it.
    It is a quicker and smarter and safer strategy. There would 
be more shots administered, and we wouldn't have to knee-cap 
future innovations to do that.
    It seems like some people just want to use COVID as an 
excuse to exert control over Americans and expand the powers of 
big government socialists even when it makes no sense. 
Americans are sick of this.
    Thankfully, and finally Mr. Chairman, people are coming 
around to the idea that these shutdowns and mandates must end. 
Quote, the emergency is over. That was a quote from Democrat 
Governor and former colleague of ours from Colorado, Jared 
Polis.
    The New York Times editorial page had an article just this 
Sunday titled, COVID isn't going anywhere, it's time we started 
acting like it. We need to stop living in a state of emergency. 
It's time to figure out a way to both protect people and their 
freedoms while doing a better job of handling COVID. The Biden 
administration must finally lead on this. First, they need to 
clean up their mixed messaging on public health that has left 
Americans confused and frustrated, and then they need to start 
following the science on schools, masks, and vaccines. 
Americans have had enough.
    Thank you, Mr. Chairman. I yield back.
    Chairman Clyburn [continuing]. Mr. Scalise. I am pleased to 
welcome today's witnesses. I would first like to welcome Dr. 
Ali Khan, a practicing physician and dean of the College of 
Public Health at the University of Nebraska Medical Center. Dr. 
Khan previously served as the director of Office the Public 
Health, Preparedness, and Response at the Centers for Disease 
Control and Prevention, where he led our responses to numerous 
domestic and international public health emergencies.
    I would next like to welcome Dr. Katheryn Russ, a professor 
of economics at UC Davis. Dr. Russ is an expert in open 
economy, microeconomics, and international trade policy, a 
research associate at the National Bureau of Economic Research, 
and a senior fellow at the Peterson Institute for International 
Economics.
    She previously served as senior economist for international 
trade and finance for the White House Council of Economic 
Advisers.
    Next, I would like to welcome Dr. Martin Makary, a 
professor of surgery at Johns Hopkins School of Medicine.
    I would like also to welcome Dr. Krishna Udayakumar--I'm 
going to have problems with a few of these names, but I hope I 
get them OK--the founding director of the Duke Global Health 
Innovation Center and associate professor of medicine and an 
associate professor of the practice of global health at Duke 
University.
    Finally, I would like to welcome Dr. Sebnem Kalemli-Ozcan--
is that Ookan? Whatever it is, I'm going to let you tell us 
when you speak--she's a Neil Moskowitz professor of economics 
at the University of Maryland, a research associate at the 
National Bureau of Economic Research and a research fellow at 
the Center for Economic Policy Research.
    She co-authored a leading study commissioned by the 
International Chamber of Commerce Research Foundation that 
analyzed the economic value of global coronavirus vaccinations.
    Will the witnesses please raise their right hands? Do you 
swear or affirm that the testimony you're about to give is the 
truth, the whole truth, and nothing but the truth so help you 
God?
    Let the record show that the witnesses answered in the 
affirmative.
    Without objection, your written statements will be made 
part of the record.
    Dr. Khan, you are recognized for five minutes for your 
opening statement.

  STATEMENT OF DR. ALI KHAN, DEAN, COLLEGE OF PUBLIC HEALTH, 
 PROFESSOR, DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF NEBRASKA 
                         MEDICAL CENTER

    Dr. Khan. Good afternoon, and thank you, Chairman Clyburn 
and Ranking Member Scalise and distinguished members of the 
Select Subcommittee on the Coronavirus Crisis. As you just 
heard, I'm Ali Khan, a physician, scientist, former assistant 
Surgeon General, former director of preparedness at CDC, and 
currently the dean of the College of Public Health at the 
University of Nebraska Medical Center.
    With the emergence of the Omicron variant, I'm pleased to 
be here today to offer testimony to support an improved 
strategy that will allow us to defeat COVID and end this 
pandemic.
    In September of this year, COVID-19 surpassed the 1918 
Spanish influenza pandemic death toll and is now the deadliest 
disease event in our Nation's history. This is despite the 
scientific advancements we have made since the early 1900's.
    And yet 800,000 Americans have lost their lives from a 
preventable disease with 5.3 million deaths globally.
    Over the years, many have claimed the mantle of the great 
pandemic or Black Death, including plague, smallpox, influenza, 
HIV, SARS, and now COVID.
    And we have repeatedly addressed these pandemics with 
better and better tools, technologies, and transformational 
public health solutions.
    Now, undoubtedly, we are in a much better position than we 
were a year ago. So, two years later, why do we still say we're 
in a pandemic? Well, because COVID is still disrupting critical 
healthcare, social, and economic functions in our communities.
    In the U.S., we still see almost 65,000 hospitalizations a 
day and healthcare rationing going on in America, in addition 
to supply chain disruptions and outbreaks closing schools, 
businesses and sports.
    And the emergence of a new variant like Omicron has sent 
capital markets into a tailspin, but the rise of the Omicron 
variant may or may not draw out this pandemic. We are at risk 
of more infections and deadly variants until we fully address 
this pandemic globally.
    Now thanks to American ingenuity, I'm happy to tell you 
that we already have all the tools we need to beat COVID and 
transition to a post-COVID world that still has some ongoing 
cases.
    We have vaccines that are safe and effective, developed by 
President Trump, we have quarantine, self-isolation, masks, 
proven effective control methods, and we're seeing new and 
cutting-edge antivirals emerge, free COVID testing across the 
Nation and increasingly in our homes.
    But the end of the pandemic no longer depends just on good 
public health science. It depends on action, and it depends on 
rebuilding citizen trust in their government that has been 
eroded by the politization of this response and rampant 
misinformation.
    So how do we balance our right to freedom, personal 
autonomy, and responsibilities with the right of everyone to be 
protected from infection and death? How do we remember that 
sacrificing for the common good is how communities are built. 
And it's how wars are won, including wars on microbes.
    It all starts, I think, with the admission that we're 
stalled and need a new and different strategy to end this 
pandemic. In the U.S., we need new public health officials and 
voices, and we need new national and local political leaders to 
help restore trust to those who are skeptical about the vaccine 
and even skeptical about the disease itself.
    We need to increase vaccine confidence. The 60 percent 
vaccination rate nationally is clearly not enough to return our 
lives to something resembling normal even with those who have 
natural immunity.
    We need better solutions to increase coverage to at least 
85 percent or more through vaccine mandates, incentives, or 
non-mandate approaches that are people-centered and community-
based.
    And for the skeptical, we do need standardized tests to 
recognize the duration of natural and acquired immunity. We 
also desperately need public-private partnerships to support 
collection of realtime COVID data in the U.S., so we stop 
relying on foreign countries for our data, to decide what to do 
with vaccines, et cetera.
    And to fully protect us from new variants, we need to 
increase global vaccination supply, access, and confidence. So, 
globally as you said, Mr. Chairman, only 7.1 percent of 
residents of low-income countries have had a single dose yet. 
And remember, individuals may require two, potentially three 
doses to be protected.
    So, immediate actions include the U.S. must share its 
Moderna patent with the global community and announce temporary 
waivers on other intellectual property and licenses, actively 
share technology and know-how, remove export controls for 
critical materials, and continue to fulfill our 1.2 billion 
vaccine donation.
    We learned this lesson with the HIV pandemic, that in the 
time of deadly pandemics, profits will never outweigh lives 
anywhere in this world. We need to solicit more partners in the 
U.S. vax logistic efforts to make vaccines become--to have 
vaccines become vaccinations. Can't have vaccines sitting on 
tarmacs as we see happening.
    And finally, we need global standardization for strategies 
and triggers to help fight misinformation and help fight the 
global anxiety, as people know what's going to happen and when 
and why. And we saw this recently with the trigger for travel 
bans again.
    So, as somebody with 30 years of experience responding to 
outbreaks all over the world, I want to assure the American 
people that there's hope and there's a light at the end of the 
pandemic tunnel. And so I will leave you with a simple 
message--get vaccinated, get tested, and mask on, America.
    Chairman Clyburn. Thank you, Dr. Khan.
    Dr. Khan. Thank you, sir.
    Chairman Clyburn. We will now hear from Dr. Russ. Dr. Russ, 
you are recognized for five minutes.

   STATEMENT OF DR. KATHERYN RUSS, PROFESSOR, DEPARTMENT OF 
           ECONOMICS, UNIVERSITY OF CALIFORNIA, DAVIS

    Dr. Russ. Good afternoon, honorable Chair Clyburn and 
members of the Select Subcommittee. Thank you for the 
opportunity to testify that, in addition to the humanitarian 
urgency, ensuring vaccination against COVID-19 globally and 
with the most effective vaccines available is critical to the 
U.S. economy. I'll tell you four reasons why.
    First, leaving large pools of people unvaccinated overseas 
increases the risk that new variants will sweep through the 
U.S. work force. As we saw this fall, each new wave has a 
direct and serious impact throughout our economy, including the 
services sector.
    Second, failing to vaccinate the world as a whole creates a 
host of supply chain problems. The lack of availability of 
effective vaccines overseas has worsened some of the biggest 
hang-ups that American businesses and consumers are 
experiencing now.
    Perhaps the most visible example is the one the chair 
mentioned--the plight of the U.S. auto industry in the third 
quarter of this year. A COVID-19 outbreak in Malaysia triggered 
public health restrictions that curtailed the already short 
supply of semiconductors for U.S. auto makers.
    The acute shortage forced massive shutdowns at U.S. auto 
plants. Monthly domestic auto production dropped below a 
hundred thousand units by September, the only time on record 
this has happened in the last 28 years, other than our 
lockdowns in spring 2020.
    These shutdowns helped keep prices elevated in domestic car 
markets which is a key driver of the overall inflation facing 
American consumers over the last few months.
    Malaysia's vaccination rate has reached 80 percent, but the 
first 15 million shots they got were a vaccine that is much 
less effective at preventing infection than the ones you and I 
have received.
    Countries across southeast Asia and throughout the world 
have had to use vaccines from China and Russia, which are much 
less effective than our mRNA vaccines. This increases the 
chance of outbreaks that can cause supply chain disruptions.
    Other examples are the COVID-related shutdowns affecting 
two major ports in China over the summer--Yantian and Ningbo. 
China is quick to resort to lockdowns to prevent the spread of 
the virus, partly because the vaccines there are not as 
effective as vaccines in the U.S.
    These two ports are so large that the closures generated 
prolonged shipping delays for a wide array of products headed 
for the U.S. and other countries. The closures were also a 
reminder that shutdowns could suddenly interrupt the supply of 
many of the products that the U.S. sources from China.
    Third, failing to ensure global delivery of vaccines can 
lead to labor market shortages, causing additional supply 
problems for the U.S. economy. Because there are large pools of 
people who have not been vaccinated, some countries have 
resorted to restrictions on workers' movement to reduce spread.
    Resulting labor shortages are affecting production in a 
broad array of agricultural and manufacturing industries 
worldwide, like footwear and textiles in Vietnam, wine and 
other agricultural products in Europe.
    These restrictive measures might be mitigated or avoided 
were all workers properly vaccinated and tested.
    Finally, due partly to lack of access to vaccines, emerging 
markets in low-income countries are unlikely to return to the 
growth path that they were on pre-pandemic for some time.
    This lower growth abroad threatens jobs and U.S. export 
industries. More than ten million American jobs depend on 
exports of goods and services to the rest of the world.
    Close to half of these exports are purchased by developing 
countries, where the most effective COVID-19 vaccines are 
harder to come by than they are here.
    Risks of lockdown-induced slowdowns also loom in many high-
income, U.S. trading partners where vaccination is incomplete, 
including Australia, Austria, and Germany.
    We must wage a global war on COVID-19, due foremost to the 
immense humanitarian need but also to reduce economic 
volatility and uncertainty for American businesses and 
consumers.
    Whether it is $50 billion or double that, it would be a 
bargain compared to the cumulative injury to the U.S. economy 
and our influence abroad were we to delay any longer. Thank 
you.
    Chairman Clyburn. Thank you, Dr. Russ.
    We will now hear from Dr. Makary. Dr. Makary, you are 
recognized for five minutes.

  STATEMENT OF DR. MARTIN MAKARY, PROFESSOR OF SURGERY, JOHNS 
                   HOPKINS SCHOOL OF MEDICINE

    Dr. Makary. Chairman Clyburn, thank you, Ranking Member 
Scalise, members of the committee, thank you for the 
opportunity to testify. My name is Marty Makary. I'm a public 
health researcher at Johns Hopkins.
    By way of background, I studied epidemiology at the Harvard 
School of Public Health where I received a master's in public 
health and have served on the faculty of the Johns Hopkins 
School of Public Health for the past 16 years.
    I also take care of surgical patients, including 
immunocompromised patients.
    I would like to personally ask you to consider new 
scientific data that tells us that some COVID policies have 
become too extreme, too rigid, and are no longer driven by 
clinical data.
    Take for example, boosters in children who already had 
COVID. When pharma announced on Wednesday that they did a lab 
experiment that shows that boosters raise antibody levels 
against Omicron, without releasing the underlying scientific 
data, the CDC immediately urged everyone 16 and 17 years old to 
get a booster.
    Is this what we've come to? Pharma tells people what to do 
in a press release and the CDC just falls in line?
    Meanwhile, Germany just reported that no healthy child, 5 
through 17, has ever died of COVID in the first 15 months of 
their pandemic, with nearly all of those children unvaccinated.
    The CDC has never told us if any U.S. COVID deaths in 
children have been in healthy children.
    And Germany, France, and other countries now restrict the 
Moderna vaccine from people under age 30 because of concerns of 
heart complications.
    Now, I'm very pro vaccine, I've been vaccinated, but we 
have a modern-day McCarthyism, if somebody asks a question 
about boosters in young people. Remember, just 12 weeks ago, 
the FDA external experts voted against boosters for everybody 
by a 16-2 vote, and for good reasons.
    But weeks after that vote, the FDA made another internal 
push to ream through boosters for all. But this time they 
inexplicably did not convene their experts, their external 
experts. The CDC did the same.
    As a result, they got their broad booster recommendation by 
circumventing their external experts who opposed it. Public 
health officials justified it, pointing to declining antibody 
titers, but they ignore, and continue to ignore, the powerful 
T-cell immunity, which a study just last week, done by the NIH 
itself, found to be highly effective against Omicron.
    Vaccine doses are now being used to boost young people 
without any supporting clinical data. Those vaccinated--those 
vaccine doses to boost young people should be going to the 93 
percent of the population of the world in low-income countries 
who have received no vaccine.
    Let me be clear, there is nothing that represents American 
waste, excess, and global arrogance more than requiring a 
young, healthy, low-risk student, who had the infection in the 
past and already has natural immunity, to get a booster.
    Yet dozens of colleges and universities have already 
announced this as a requirement.
    I believe in mammograms, and I believe they save lives, but 
I don't recommend them universally for men or children. We need 
precise medical guidance, not blanket medical guidance that's 
good for marketing departments.
    If the U.S. wants to help struggling countries ration their 
limited vaccine supply in the midst of an epidemic, tell them 
to recognize natural immunity and have those who had COVID step 
aside of the vaccine line to protect those who are vulnerable 
faster with the live-saving vaccine. That's what we should have 
done.
    Over 20 scientifically sound studies have demonstrated that 
natural immunity is as good or better than vaccinated immunity. 
Yet our public health officials continue to ignore it. In fact, 
they never talk about it.
    Why don't they just do their own study of people who had 
the COVID infection 20 months ago in New York, test their 
bloods and interview them? Why have they never done that study 
with their gigantic budgets? Instead they say it's unknown. 
Well, my research team is doing that study because the 
government has failed to do it.
    Teachers, nurses, soldiers, they have circulating 
antibodies from prior COVID infection, they have antibodies 
that neutralize the COVID virus, but they are antibodies that 
the government does not recognize. As a result, careers have 
been destroyed and medical privacy is essentially dead.
    The U.S. can also show leadership with medications. 
Fluvoxamine and inhaled budesonide, a steroid inhaler, both 
have been around for years, both are inexpensive, both have 
impressive, randomized control trial data that show they 
dramatically reduce COVID deaths.
    Why do we never hear our public health leaders talk about 
them? These are not medications with the controversies of 
hydroxy and ivermectin. These are solid, randomized, 
controlled, trial-supported interventions.
    Paxlovid cut COVID deaths and hospitalizations by 91 
percent. The application has been sitting at the FDA for four 
weeks as Americans die every day.
    Molnupiravir had its up vote by the external experts two 
weeks ago. What is the FDA doing two weeks after the experts 
vote to authorize the medication?
    Finally, anyone in the world getting vaccinated today with 
an mRNA vaccine should space it out to at least three months. 
That data is in.
    Many of us begged U.S. policymakers to do this. The U.K. 
actually did it as a broad policy. Makes sense. Why would you 
give two life preservers to people in an ocean when some are 
drowning with none?
    The data are now in. The experiment is over. The U.K. did 
it right. We did it wrong.
    Yet Uganda has had approximately one percent of its 
population vaccinated when the President announced that they 
will use a new shipment of almost 700,000 vaccines for second 
doses, following U.S. guidance.
    As the world rations a scarce vaccine supply, they should 
learn from our mistakes, not repeat them. Thank you, Mr. 
Chairman.
    Chairman Clyburn. Thank you, Dr. Makary. We will now hear 
from Dr. Udayakumar.

  STATEMENT OF DR. KRISHNA UDAYAKUMAR, ASSOCIATE DIRECTOR FOR 
 INNOVATION, DUKE GLOBAL HEALTH INSTITUTE, ASSOCIATE PROFESSOR 
   OF GLOBAL HEALTH AND MEDICINE, DUKE UNIVERSITY SCHOOL OF 
    MEDICINE, DIRECTOR, DUKE GLOBAL HEALTH INNOVATION CENTER

    Dr. Udayakumar. Chairman Clyburn, Ranking Member Scalise, 
and members of the House Select Subcommittee on the Coronavirus 
Crisis, it's an honor to be with you today. My name is Krishna 
Udayakumar, and I'm an internal medicine physician and global 
health and policy researcher at Duke University.
    Through the nonpartisan COVID Global Accountability 
Platform, led by Duke and COVID collaborative, we're generating 
actionable insights to accelerate an effective, equitable, 
global-pandemic response.
    We know that the COVID-19 pandemic continues to evolve in a 
highly dynamic manner around the world. We are in a global war 
against a virus that doesn't respect borders and rapidly 
advances across continents.
    But global leaders have yet to use the full arsenal of 
tools available to fight this war. Unprecedented scientific 
achievements, begun under the Trump administration and 
continued under President Biden, have led to the development of 
highly effective and safe vaccines, promising therapies, and 
other critical interventions, including diagnostics.
    But the world has been unable to marshal a coordinated, 
effective, and equitable response. The widening gap between 
vaccine haves and have-nots around the world has prolonged the 
pandemic, worsened inequity, and increased the risk of the 
emergence of additional variants that could pierce vaccine 
immunity.
    Indeed, we are witnessing the consequences of a failed 
global response with Delta variant-driven surges in many parts 
of the world, including the U.S., while the Omicron variant 
spreads rapidly with worrying signs of increased 
transmissibility and immune evasion.
    Based on current vaccination rates, nearly all low-income 
countries, including most African countries, are not on track 
to reach the globally agreed upon 40 percent vaccination target 
for the end of this month.
    Our recent analysis identified three urgent actions to 
accelerate global vaccination. First, improve transparency of 
vaccine production, supply, and allocation, to drive stronger 
accountability and more effective vaccination planning and 
implementation.
    Second, allocate a rapidly increasing supply of vaccines 
much more equitably and urgently.
    And third, strengthen country-level capabilities and 
capacity to ensure effective and efficient vaccination.
    As overall global vaccine supply continues to increase 
significantly, now with over a billion doses produced each 
month, challenges in allocation, distribution, and delivery in 
low-and middle-income countries are becoming more urgent.
    Strong, bipartisan, American leadership has been critical 
to address major global health crises over decades. From the 
eradication of smallpox, to increasing global access to 
treatments for HIV and AIDS, to managing recent Ebola 
outbreaks, such American leadership is needed again to 
effectively address the COVID-19 pandemic.
    The best way to prevent further domestic and global 
catastrophe is to dramatically decrease cases and slow 
transmission of the virus through widespread global 
vaccination, combined with other public health measures.
    Thankfully, there is significant progress and U.S. 
leadership from which to build. The U.S. and G7 allies have 
taken important but still modest steps to close the global 
vaccination gap, including accelerating large-scale production 
and delivery of high-quality vaccines, increasing financial 
supports to COVAX and other entities, and supporting the share 
of over 1.6 billion doses.
    The U.S. has now donated over 317 million vaccine doses, as 
you noted, Mr. Chairman, more than every other country 
combined.
    President Biden also hosted a global COVID-19 Summit in 
September to further galvanize global coordination and 
response. The recently announced initiative for global vaccine 
access, or GlobalVax, is also a step in the right direction.
    While commendable, these actions still fall far short of 
the true scale and urgency required. Much more needs to be done 
to provide high quality vaccines more quickly and to build 
countries' vaccine distribution and delivery and capacity which 
is rapidly becoming the key constraint in the race between 
vaccines and variants.
    The $315 million allocated to support global vaccine 
delivery in GlobalVax is substantially inadequate in the 
context of the billions of dollars that will be needed to 
support successful vaccinations around the world.
    In fact, we have proposed, with the endorsement by a 
bipartisan group of experts, a bold U.S. emergency plan for 
global COVID-19 relief.
    Mr. Chairman and members of the subcommittee, the global 
COVID-19 pandemic is both an international, humanitarian crisis 
and also a threat to our own Nation's security, health, and 
economic interests.
    We can impose travel restrictions, promote vaccines and 
boosters, recommend masking and distancing, but those steps 
will not keep Americans completely safe because we cannot stay 
isolated from the rest of the world.
    Building from significant efforts to date, we must further 
unleash unparalleled American resources and capabilities and 
provide bold American leadership to address the global 
pandemic. Such an effort will reflect both our ideals as a 
people and our interest as a Nation.
    By galvanizing global efforts to vaccinate the populations 
of the world's poorest, most afflicted countries, we can 
accelerate the end of the pandemic here and everywhere. Thank 
you for the opportunity to testify.
    Chairman Clyburn. Thank you very much, Dr. Udayakumar.
    The chair will now hear from Dr. Kalemli-Ozcan--or is that 
Ozcan? Dr. Ozcan, you're recognized for five minutes.

STATEMENT OF DR. SEBNEM KALEMLI-OZCAN, PROFESSOR OF ECONOMICS, 
                     UNIVERSITY OF MARYLAND

    Dr. Kalemli-Ozcan. Good afternoon, Chairman Clyburn, 
Ranking Member Scalise, and other members of the Select 
Subcommittee. Thank you for the opportunity to appear before 
you to discuss the economic case for global vaccinations.
    My name is Sebnem Kalemli-Ozcan, a professor of economics 
and finance at the University of Maryland College Park, with 
specialty in international macroeconomics, finance, and 
globalization.
    Rolling out a vaccine to stop the spread of a global 
pandemic doesn't come cheap. Already billions of dollars have 
been spent developing drugs and putting place in programs to 
get those drugs into people's arms.
    However, given the uneven distribution of vaccine, with 
poorer countries lagging far behind richer nations, the 
question is simply, what is the economic cost of not 
vaccinating everyone?
    My work, joint with my colleagues, calculates these 
economic costs of uneven global vaccinations and how much of 
these costs will be borne out by which countries such as the 
United States.
    Back in January 2021, with the projected progression of the 
pandemic at that time, we have estimated $4 trillion global 
cost at the end of 2021 under the scenario of rich countries 
vaccinating all of their citizens while poor countries only 
inoculating half of their populations.
    Forty-nine percent of this $4 trillion global cost is going 
to be borne out by the rich countries composed of United 
States, Canada, Japan, and Europe. For United States, the cost 
is three percent of its 2019 gross domestic product, $671 
billion.
    As of now, the reality of the vaccinations turn out to be 
much worse than our initial assumption as rich countries were 
not able to vaccinate all their citizens and poor countries are 
nowhere near vaccinating half of their population as we just 
heard.
    With the ongoing pandemic, if we do not achieve global 
vaccination, the economic costs that we have estimated will 
only grow exponentially in 2022 and 2023.
    To arrive at our economic estimates, we analyzed 35 
industries, such as services and manufacturing in 65 countries 
and studied how these sectors linked economically in 2019 
before the pandemic.
    For example, construction sector in the U.S. relies on 
steel imported from Brazil, American auto manufacturer need 
glass and tires that come from countries in Asia and so forth.
    Then we used data on COVID infections in each country to 
demonstrate how coronavirus crisis can disrupt supply chains, 
curbing and delaying shipments, providing a very early and 
inevitable possible global supply chain disruption.
    In our economic epidemiological model, the more a sector 
relies on people working in close proximity to produce goods, 
the more disruptions we're going to be because of high 
infections. As sectors link globally, domestic supply chain 
disruptions become global.
    With that model, how vaccinations can solve this problem by 
smoothing the disruptions as healthy and immune work force is 
able to produce and deliver parts in time, increasing output.
    Widespread vaccination in rich countries will certainly 
help domestic businesses such as restaurant and services, but 
industries such as auto, construction, wholesale, and retail 
that depend on other countries for labor, materials, parts and 
supplies, will continue to suffer if vaccines are not made 
available worldwide.
    In addition, people in other countries, if they remain out 
of work because of repeated lockdowns required to control the 
spread of the virus, then they will have less money to spend on 
the sales of exports in North America and Europe.
    Our work estimates the economic costs arising from supply 
chain disruptions, where a key reason for this disruption is 
the ongoing pandemic. How can we predict the economic costs of 
supply chain disruptions that we are living through today 10 
months ago before they became evident that they are widespread 
and now known as the container crisis and the great disruption?
    This is because our economic estimates take into full 
account of the full complexity of the entire global trade and 
production network data.
    Our research shows that vaccinating the other nations is 
not an act of charity but an act of economic rationality with a 
high return on investing in global vaccinations. We have 
calculated a return to such investments 166 times.
    The number is calculated by deriving the cost of not 
vaccinating the rest of the world, on rich countries, by cost 
of vaccinating as put out by----
    If United States alone wants to close this gap, it implies 
a return to investment to United States of 24 times in 
investing in global vaccinations.
    As Chairman Powell has stated to this committee recently, 
economic activity remains low pre-pandemic level in United 
States, according to our model, in the absence of global 
vaccinations, 2021 United States gross domestic product will be 
3.1 percent lower than what could have been, showing the heavy 
economic toll of not vaccinating the world for the United 
States.
    As shown by the new Omicron variant, we know that no one is 
safe until everyone is safe, because if we wait longer on 
global vaccinations, new variants are going to emerge.
    Our work is an economic counterpart to this because no 
economy is an island and rogue economies are interdependent to 
each other. So, full economic global recovery will come only 
when every economy recovers from the pandemic. Thank you.
    Chairman Clyburn. Thank you, Dr. Ozcan.
    Now, I do not see the ranking member at this point. We are 
to go into questions. I see the ranking member has returned.
    Mr. Scalise. Hey, Mr. Chairman. Yes, I'm voting on this one 
too, so I'm not sure if you voted on the----
    Chairman Clyburn. I have not. I have not. I'm going to 
yield to you for five minutes of questions while I go vote, and 
I'll take my five minutes when I get back.
    Mr. Scalise. OK. Well, thank you, Mr. Chairman. And 
obviously when you look at what we opened with, the mandates 
have been thrown out by courts over and over again. We've had 
three different court cases on mandates.
    All three have said that the President doesn't have the 
legal authority to fire people, whether it's Federal workers, 
subcontractors, or healthcare workers. Yet it seems like that's 
the administration's main focus.
    I think if you go to Mr. Makary's opening statement, I 
think you touched on some things that a lot of us would like to 
see explored more. I've talked to a lot of medical 
professionals that have said it seems like the Biden 
administration is really underplaying the importance of things 
like natural immunity, of some of the other therapeutics that 
are out there.
    And we've had, you know, obviously we mourn the lives of 
the hundreds of thousands of Americans who have died, but we 
also know that we've had millions of Americans who have 
contracted COVID and then came through it and lived.
    Some had really, really tough experiences, some had very 
mild symptoms. That fact, by the way, is before and after the 
vaccine. Vaccinated and unvaccinated people have gotten COVID, 
who have experienced different degrees of difficulty going 
through it, and again, some that have had no problems, but 
they've tested positive and now they have immunities.
    And it seems like there is a missing gap in the science on 
what these immunities do, how it protects people going forward. 
And I think you touched on it with children, but if you could, 
Dr. Makary, talk about what Congress should be looking at more, 
what should the scientific community in Washington be doing 
that it's not doing to study more about what natural immunity 
really means?
    If you could unmute.
    Dr. Makary. Thank you, Ranking Member Scalise. You raise a 
really important point because the original sin of this 
pandemic was that when this virus hit the United States we had 
a complete paralysis of research at the NIH.
    With over $42 billion, they could not pivot any of those 
dollars quickly to answer the most basic questions that the 
American people were asking, all of us in healthcare--how does 
it spread, do masks work, how long do I need to quarantine for, 
when is the peak day of viral shedding in the course of 
illness.
    We could not answer those questions with any solid evidence 
because the NIH was unable to pivot their funding. We just did 
a study of NIH funding last year, the year of the pandemic. 
They spent five percent of their budget last year on COVID 
research. They spent twice as much on aging research.
    The average time for them to give research dollars to a 
group of researchers, like my team, was five months in a health 
emergency.
    They had 278 research grants on social determinants of 
health, an important topic, but about four on how the virus 
spreads. And so you had this very popular group think, led by 
our top public health officials that it was surface 
transmission--wash your hands for 20 seconds, pour a gallon of 
alcohol gel on your grocery bag.
    We had a vacuum of scientific data and what filled that 
vacuum is political opinions. That is the original sin of this 
politicalization. It was the inability of the bureaucracy of 
the NIH to pivot their funding to answer the practical, 
clinical questions that we needed answered.
    And today, we can't do this--we seem unable to do any 
followup on the therapeutics--fluvoxamine, budesonide, 
hypertonic saline spray. I mean, none of these things have 
gotten the research dollars to this day. We've basically been 
unifocused on vaccines, an important intervention, but it's 
come at a heavy exclusion.
    So, when we talk about helping the world, we are not doing 
them a service if we're only telling them about one of several 
important ways to reduce death and mortality.
    Mr. Scalise. Well, I appreciate that, and clearly as we 
continue to promote the vaccine and its safety and 
effectiveness--again, the President only talking about 
mandating vaccines or else somebody is going to get fired. The 
courts aren't even allowing that. So, at some point you would 
think the President would move on and come up with other 
alternatives including natural immunity, which many medical 
professionals are starting to look into and recognizing that 
there's a dearth of studies being done to show how that helps 
keep people safe.
    All this focus should be on helping keeping people safe, 
not only one-size-fits-all approach.
    Let me finally ask you about schools. We've seen a lot of 
studies that have shown kids ought to be in school, and it 
actually hurts them not to be. Have you seen any research on 
that as well?
    Dr. Makary. Brown University has a good study showing that 
kids who have been in school during the pandemic, compared to 
kids who have been in school before the pandemic, have more 
cognitive, motor, and learning deficits. This is a tragedy. 
It's uncharted territory.
    We're going to appreciate the down side of this far into 
the future. Young women have had a 51 percent increase in 
emergency room visits for self-inflicted harm, and so the list 
goes on and on, substance abuse. Opioid deaths are up 300--
30,000 this year. So, anyway that is the American tragedy that 
will be----
    Mr. Scalise. I know I'm out of time, but we'll try to get 
that Brown study to all the members. I appreciate that 
feedback. With that, Mr. Chairman, yield back.
    Chairman Clyburn. Thank you very much, Mr. Ranking Member. 
Dr. Khan, I'm going to ask you, under the Biden administration, 
the United States has led the global coronavirus vaccination 
campaign to combat the pandemic with more than $1.6 billion 
committed, nearly 300 million vaccine doses donated, and more 
than 800 million additional doses pledged.
    Our country leads all others by a significant margin in all 
of these metrics, and we have called on our international 
partners to do more to address vaccine inequity.
    Dr. Khan, what would you say are the benefit of America's 
leading contributions to global vaccination efforts?
    Dr. Khan. Mr. Chairman, as we heard very eloquently from 
our economic speakers also, there's no doubt that in the United 
States, because of the failure to get this pandemic under 
control, we still have healthcare rationing going on, we have 
schools, businesses, et cetera, disrupted supply chain, but 
that-plays out globally also.
    And until--if we want to protect people, we have to protect 
everyone. Otherwise, we will continue to have new variants 
emerge and make their ways onto our shores and force us into 
another cycle of aggressive prevention strategies.
    So yes, the U.S. is taking the global role, which is 
necessary because then that allows us to work with other 
partners to say other countries need to step up also and 
continue these efforts to increase both vaccine supply, vaccine 
access, and to address the misinformation that's rampant in the 
United States.
    We see it all the time here in the U.S., unfortunately, and 
it's now made its way worldwide, with increasing vaccine 
hesitancy.
    So, we need to address all three of those issues, and as I 
said during my testimony, we answered this question with the 
HIV pandemic when we said profit will not trump lives. And 
those were the decisions we made then to make sure that HIV 
treatment was available to everybody worldwide.
    It's a simple decision for us to make now. The U.S. owns 
the Moderna patent, and it can clearly make it available to the 
global community. The global--WHO has set up an mRNA technology 
hub that's ready to make this happen. So, it's not a matter as 
if countries could not scale up if they were not issued these 
license and assistance with know-how.
    They clearly can scale up. We can have national hubs that 
are producing vaccine, get us closer to getting a global 
community vaccinated and get to a post-pandemic phase.
    Chairman Clyburn. Thank you very much for that.
    I know that we are going to be a bit convoluted as we go 
through this today.
    So, is Mr. Jordan--I don't see him.
    I want to go to Ms. Malliotakis. Is she with us?
    Ms. Malliotakis. I'm here, Mr. Chairman. Would you like me 
to go next?
    Chairman Clyburn. Yes, please.
    Ms. Malliotakis. OK. Thank you.
    I want to thank you all for your testimony and thank you to 
the chairman for having this hearing today.
    I'm actually a member also of the Foreign Affairs Committee 
and we definitely talk about vaccine diplomacy, the importance 
of it, particularly as it impacts our supply chains.
    So, my first question would be, I guess, be for our 
economics professors here. Just if you could touch on the 
impact that vaccine diplomacy has on alleviating the supply 
chain issues we are experiencing today. Some of it is on 
vaccine mandates as well right here in the United States, and 
that's impacting the supply chain.
    So, can you just talk a little bit about both of those 
dynamics?
    Dr. Russ. Sebnem, would you like to go first?
    Dr. Kalemli-Ozcan. Sure. I mean, basically the United 
States is doing the right thing here because we do have to 
increase the supply of global vaccines.
    I just want to be very clear here. This is not about, you 
know, allocating. So, this is not about let's just not, you 
know, give all the available vaccines in my country but, you 
know, like ration. Beyond that, as we heard from Dr. Khan, to 
increase the vaccine production and the vaccine supply to other 
countries, and the United States leadership so far has been 
very good, and it is definitely helping, but it is not enough.
    The supply chain issues are going to be sorted out when we 
do this globally. If you look at the very complex spider web 
looking figure of the global supply chains in my written 
testimony, you will understand that this is not just about some 
chips or some lumber issue. So, all of these sectors are 
intrinsically linked to each other with different countries 
having different exposures. I mean, without really doing it at 
the global scale, you wouldn't be able to solve all supply 
chain issues. But the stimulus, the fiscal stimulus now that 
skyrocketed the demand is making the supply chains work.
    So, in that respect, it is very urgent that we need to do a 
lot with the vaccine----
    Ms. Malliotakis. Thank you.
    Dr. Makary, if you could comment, though, because, on one 
hand, what the prior individual said is somewhat true, but also 
the vaccine mandates are having a tremendous impact on our 
economy.
    New York City was--the New York Times today has slowest 
recovery rate than the rest of the Nation. Unemployment is 
double the national average. I believe a lot of that is due to 
a lot of the mandates, the vaccine passports, and other 
restrictions that have been put in place.
    If Dr. Makary can please comment on the concerns that you 
have regarding some of the mandates, I would appreciate that as 
well.
    Dr. Makary. Representative Malliotakis, we can't get 
Abraxane chemotherapy in parts of the United States because of 
our supply chain prices, bleomycin to treat Hodgkin's lymphoma.
    There are downstream effects, not to mention the many 
careers destroyed and up to one in five people leaving 
healthcare. The real story in New York that we are not hearing 
about is that they are having significant staffing issues, and 
they are asking for a partial halt or a plan to halt elective 
surgery to so-called get ahead of Omicron. But the real story 
is they are having significant staffing issues.
    Now, all of these problems, our massive chemotherapy supply 
chain problems, halting elective surgery, they could have all 
been avoided with a flexible immunity mandate; in other words, 
recognizing natural immunity, allowing for more medical 
exemptions, not require immunization for healthcare workers 
that are not on the frontlines, that is, patient facing, we 
would have avoided so many of these problems.
    Ms. Malliotakis. One last question to followup. Regarding 
the mandates, how much should we be focusing on these mandates 
as opposed to looking for, you know, treatments and 
therapeutics? You mentioned natural immunity, but what about 
treatment and therapeutics, making that more of a priority?
    Dr. Makary. Representative, no one should be dying of COVID 
right now, with rare exceptions. With best practices of 
budesonide, Fluvoxamine, the hypertonic saline spray, 
immunization, two drugs sitting at the FDA, their applications 
are sitting on someone's desk as we wait for these two drugs 
that have cut COVID deaths to zero or near zero in both of 
their phase III trials, no one should be dying of COVID right 
now. We never hear about therapeutics from our public health 
leaders, only this intense focus on vaccinations. We can do 
both.
    Ms. Malliotakis. I appreciate that. I think it's a balance 
that is required here, and I appreciate all of your testimony 
today.
    And thank you, Mr. Chairman. I yield back.
    Dr. Kalemli-Ozcan. Mr. Chairman, can I clarify a point 
here? Because I think it's very important in terms of the 
immunity from getting sick and not----
    Chairman Clyburn. Yes.
    Dr. Kalemli-Ozcan. OK. The economic cost estimates are 
short term. So, the costs are going to come from every single 
threat. In our model, we have an economy epidemiological model, 
nobody dies. But the minute you get sick, there are going to be 
an economic cost of it. Natural immunity is going to take time.
    So, this is very important. And with the price pressure, 
that cost is going to get bigger. So, in that sense the costs 
are really becoming from being sick and not able to be 
productive two weeks, wait until we have this setup out there, 
as long as you are sick a week or two weeks, you can go back to 
work force later with your natural immunity. But that two weeks 
is going to add to the economic cost with the price pressure.
    That's all.
    Chairman Clyburn. Thank you very much.
    The chair now recognizes Ms. Waters for five minutes.
    Ms. Waters. Thank you very much, Chair Clyburn.
    This is a very, very needed hearing that you are doing 
today because there's so much information out there, a lot of 
it sometimes conflicting, and so I have a few questions that I 
really want to ask.
    First of all, let me thank Dr. Khan for his caution about 
CDC accepting information that they get from press releases. I 
have often wondered why they could adopt certain things so 
quickly and wondered whether or not the testing and the 
research had been done before they start to advise about five-
year olds, et cetera, et cetera, et cetera. So, I want to learn 
a lot more about that, but I thank him for opening up that 
discussion.
    Second, I want to get to the global problem that we have, 
and I want to ask Mr. Udayakumar whether or not we are 
assisting in any way to help other nations to develop their own 
vaccines. As I understand it, there is something in terms of 
international law that may be stopping them from being able to 
do it. Some of them want to do it.
    What do you know about that?
    Dr. Udayakumar. Sure. Representative Waters, thank you for 
that question.
    The U.S. is assisting several organizations around the 
world in trying to stand up vaccine manufacturing capacity. The 
format that has been used to date has included U.S. public 
sector investment from the International Development Finance 
Corporation, as well as working with U.S. manufacturers.
    So, examples of that would include what was announced at 
the Quad Vaccine Partnership. So, Johnson & Johnson partnered 
with Biological E. in India with investment from the DFC and 
others to enable the production of a billion doses of vaccine 
over the coming year.
    We have also seen vaccines, in terms of licensing, 
especially for fill/finish capacity. We've seen announcements 
of Pfizer BioNTech enter into such a partnership in South 
Africa. We have heard that Johnson & Johnson may allow 
manufacturing in its entirety.
    So, the work that's happened to date has included voluntary 
licensing from our private sector manufacturers in partnership 
with the public sector being able to help support everything 
beyond intellectual property, the know-how, the access to 
supply chains, the regulatory advice, and oversight access to 
financial capital. And it's really that type of model that we 
need to continue to see.
    We most definitely need to increase the vaccine 
manufacturing capacity across low-and middle-income countries. 
And we have seen significant progress, including through a 
partnership for African vaccine manufacturing, that's also 
underway. This is a space that is going to take some time, 
months to years, to stand up, given the complexity; but there's 
significant progress that's already being made.
    Ms. Waters. Well, thank you so very much.
    And I would like to know--well, at one point the Caribbean 
was begging the United States to help with the vaccines. Now, 
that was early on. Do we have that problem anymore? Because 
they had the money to purchase, but they did not have access, 
despite the fact that the United States had a memorandum of 
understanding with both Canada and Mexico.
    Now, are we in a position now where we can help others 
really and not do what--allow to happen what happened with the 
Caribbean?
    Dr. Udayakumar. Yes. Thank you, ma'am.
    We are in a much better position than we have been in the 
past and the best position we've ever been in. As I mentioned, 
we see global output of more than a billion doses of high-
quality vaccines each month that will allow us in the U.S. to 
make sure that we are following the science in terms of primary 
vaccination and boosters. We are not in a position of having to 
sacrifice any of that.
    But, in addition to boosters as warranted, the U.S., as 
well as primary vaccination, we do have enough. We continue to 
send tens to hundreds of millions of doses internationally, and 
we need to continue to do that.
    Recent analysis shows that if you look at the G7 and 
European countries, by the end of this year, in addition to 
everything that they might need for domestic needs, they will 
likely have more than 500 million doses of excess vaccines. And 
those are the ones that absolutely have to reach low-and 
middle-income countries as soon as possible.
    Ms. Waters. Thank you so much.
    We have another problem I want to mention just quickly, and 
that is in Haiti we got vaccines to them and they could not 
distribute them. And so we had to make sure that we retrieved 
them before they expire. And we just need to come up with some 
ways of helping countries like Haiti.
    With that, I have used up all of my time. And I thank you 
very much.
    Chairman Clyburn. Thank you very much, Ms. Waters.
    The chair now recognizes Mr. Jordan if he is with us? I 
don't see him.
    Mr. Jordan?
    How about Dr. Miller-Meeks?
    The chair now recognizes Ms. Velazquez for five minutes.
    Ms. Velazquez. Thank you, Mr. Chairman. Thank you for the 
timing of this important hearing.
    Dr. Kalemli-Ozcan, you called for a study to model the cost 
of incomplete global vaccination. What did your study conclude 
about the costs of failing to achieve global vaccination to 
advanced economies like the United States?
    Dr. Kalemli-Ozcan. Yes. So, the study shows that the 
overall cost to the United States, Canada, Japan, and Europe 
will be $4 trillion. For the United States, it will be $671 
billion, which is two percent of the United States 2019 gross 
domestic product.
    And this is assuming, by the way, that the United States 
and other rich nations vaccinate everyone in their own country 
and the rest of the world at least reaches the 40 to 50 percent 
of vaccination in their countries. So, our estimates are lower 
than that.
    So, since the vaccinations were way worse than what we 
assume, the cost, the true costs are much higher than that, and 
it's going to get higher in the next year and year after if we 
really don't take the global vaccinations seriously.
    Ms. Velazquez. Thank you.
    And so, Doctor, what does your research show about the 
potential economic benefits of donating vaccines to developing 
and less wealthy nations?
    Dr. Kalemli-Ozcan. Huge. We calculate the return of 
investment over the Unites States of 24 times. The richest 
countries overall is going to get a return of investment over a 
hundred times. The return of investment for countries like 
France, Germany is going to be 20 times.
    So, there's no question of just, you know, sending these 
vaccines. And now we hear from Dr. Udayakumar and Dr. Khan 
that, you know, we can easily do this. We are in a position of 
producing billions, so it is a no-brainer. I mean, this is a 
rounding error compared to the money we spend in fiscal 
spending domestically in rich countries.
    Thank you.
    Ms. Velazquez. Thank you.
    And Dr.--Professor Russ, COVID outbreaks in Malaysia and 
Vietnam have contributed to supply chain issues, such as the 
slowing of the production of component parts for American car 
manufacturers, unfinished goods sold in the U.S.
    Dr. Russ, can you tell us about how the outbreaks in 
Southeast Asia earlier this year affected the U.S. economy?
    Dr. Russ. Sure. So, if we take just the example of the 
semiconductors causing the auto plant shutdowns, so car prices 
have been rising the last few months. So, the White House 
Council of Economic Advisors just stated that about 1.4 
percentage points of the 6.8 overall inflation that consumers 
faced in November compared to the last year was due to auto-
related items.
    So, those shutdowns helped keep those prices for autos 
high, and that means that it contributes to the overall 
increase in prices that consumers are facing.
    And it's not just autos. I mean, that's a really visible, 
you know, big, big shock, but also--and the chair mentioned----
    I was muted. Sorry.
    So, not just autos, but also clothing, textiles, so many 
different products.
    And if we want to think about active pharmaceutical 
ingredients, important for diabetes or chemotherapy, many of 
these come from China. And so China is really quick to move to 
lockdowns because their vaccines are not super effective. We 
saw the port lockdowns that caused major shipping disruptions 
globally, but including for the United States.
    So, the normal time for shipments to get to the United 
States from China is 40 days by sea, and in the fall it peaked 
at 73 days. So, that's an extra 33 days that we have to wait 
for, say, medical supplies to come when we are sourcing those 
active pharmaceutical ingredients.
    So, it's really widespread this impact that it can have on 
the U.S. economy.
    Ms. Velazquez. So, we can say that vaccinated people around 
the globe will help mitigate economic disruption in the United 
States?
    Dr. Russ. Yes, absolutely, including inflation.
    Ms. Velazquez. Thank you.
    I yield back, Mr. Chairman.
    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. Makary, how many--well, let me start with this.
    What's the budget at CDC? Do you happen to know that?
    Dr. Makary. CDC, it's about $9 billion, sir.
    Mr. Jordan. How about at NIAID, what's the budget there?
    Dr. Makary. $6 billion.
    Mr. Jordan. $6 billion. $9 billion CDC, $6 billion NIAID. 
What about NIH? What's the budget there?
    Dr. Makary. Between $42 and $43 billion.
    Mr. Jordan. Forty-two and 43, so if I do the quick math, 
that's like $57, $58 billion. That's annual, right?
    Dr. Makary. Annual.
    Mr. Jordan. And do you know how many people work at CDC?
    Dr. Makary. CDC and NIH together, about 30,000 people.
    Mr. Jordan. Thirty-thousand. What about if you add in 
NIAID? Do you know how many that is? Or they are part of NIH as 
well? Right? So 30--what was that number?
    Dr. Makary. That's right. That's right. Thirty-one people 
between CDC and NIH.
    Mr. Jordan. Thirty-one thousand people spending $58 billion 
a year. Why hasn't our government done a study on natural 
immunity?
    Dr. Makary. If I can be honest, Representative Jordan, I 
don't think they want to know the answer. It would undermine 
the indiscriminate vaccine--vaccination policy for every single 
human being, including extremely low-risk people.
    Mr. Jordan. So, how many Americans have got COVID since 
we've had this virus, do you know?
    Dr. Makary. North of half of Americans based on the 
Columbia University study that showed one in three had COVID at 
the end of last year, a year ago.
    Mr. Jordan. So, there's certainly a sufficient sample size 
to do a study. And there's $57 to $58 billion somewhere--I 
mean, you could use some of that money to do a study. And then, 
of course, you know, you've got 30-some thousand people who 
could conceivably do a study on a pretty fundamental question.
    Now, I think I saw in your opening statement that you are 
actually doing a study on natural immunity. Is that right?
    Dr. Makary. That's right. With private funding, Johns 
Hopkins, my research team, is doing a study.
    Mr. Jordan. OK. So, there's no grant money coming from CDC, 
NIH, nothing like that?
    Dr. Makary. No, sir.
    Mr. Jordan. And are any of these 30-some thousand employees 
helping you with your study?
    Dr. Makary. No, sir.
    Mr. Jordan. Now, other countries, if I understand--I think 
this was in your opening statement as well. Other countries 
have done this study. Is that correct?
    Dr. Makary. Most of our learning has come from Israel and 
other countries, yes, sir.
    Mr. Jordan. And what have they found? Let's start with the 
Israel study, if you could just refresh my memory. What did 
Israel find?
    Dr. Makary. The Israel study is the largest study done 
worldwide, and it found that natural immunity, adjusted for age 
and comorbidity, is 27 times more effective than vaccinated 
immunity. And they just put out December 5 another study, a 
followup study, again, affirming similar results, that natural 
immunity is stronger than vaccinated immunity.
    Mr. Jordan. But are--the scientists in our government at 
the CDC and NIH, they don't account for that? They don't talk 
about that? What do they say about that study, or do they say 
anything?
    Dr. Makary. They never talk about it unless asked. But I 
would say that they are doing worse than being absent on the 
topic. They are undermining natural immunity through two 
studies that the CDC did that are so flawed, that are so poorly 
put together, honestly, they would not qualify for a seventh 
grade science fair. The results cannot be derived from the 
data, and it's a disgrace that those two studies were put out 
because it undermines the larger body of science.
    Mr. Jordan. So, they won't talk about international studies 
that conclude natural immunity is 27 times better than the 
vaccine, but they will do some bogus, in your word, some 
seventh grade science studies using some of those 30,000 
employees and using some of that $58 billion of American 
taxpayer money, they will do that? Is that fair?
    Dr. Makary. That's fair. I will say that the intention is 
noble, but just very paternalistic. That is, they believe in 
private conversations that if they acknowledge natural 
immunity, some people may avoid vaccination and think I'll just 
get the infection. We don't want people to do that, but we can 
be honest with the data and encourage vaccination at the same 
time.
    Mr. Jordan. Well, I think the American people, particularly 
the ones paying--this is their money, they expect honesty and 
transparency from our government. They don't expect to be 
deceived.
    So, I mean, this is what gets me. We can spend money, some 
of that $58 billion, and some of the resources at NIH and CDC 
can be used to fund gain of function research and give a grant 
to EcoHealth, who then sends some of that money to a lab in 
Wuhan China, that's just fine. But we can't find any resources 
to deal with a fundamental question about natural immunity, and 
so much so that you have to go out and get private funding to 
do it yourself?
    Dr. Makary. That's right. The NIH spent twice as much money 
on aging research last year, the year of COVID, more than they 
spent on COVID researcher.
    Mr. Jordan. This would be laughable if it wasn't so 
serious. And the implications, when you think about these 
mandates and everything else that's happening, what it's doing 
to our economy, not to mention just being honest with the 
American people who, after all, it's their money. But we have 
the head guy, Mr. Fauci, Dr. Fauci saying, I represent science, 
but he is afraid to actually do the science and do the studies 
that need to be done to answer this question. And we have to 
rely on international studies and your private study to get the 
truth to the American people.
    Dr. Makary. We've subjected 72 million children to intense 
restrictions for two years, yet we don't have the most basic 
research. We've never had an NIH-funded study on masks on kids, 
and we've never had any information revealed by the CDC on 
whether or not any healthy child has died of COVID.
    Mr. Jordan. So, doctor, it's either they know the answer 
and don't want the American people--they know the answer and 
don't want the American people to know, or they do know the 
answer and are trying to hide it. I mean, it's like they know 
the answer or they are not sure of the answer--Mr. Clyburn. The 
gentleman's time is----
    Mr. Jordan [continuing]. I should say, or they know the 
answer and are trying to hide it from the American people. It's 
one of those two.
    Chairman Clyburn. Thank you. Your time has expired.
    Mr. Jordan. Thank you, Mr. Chairman.
    Chairman Clyburn. Thank you.
    The chair now recognizes Mrs. Maloney for five minutes or 
Mr. Foster.
    Mrs. Maloney. I'm here.
    Chairman Clyburn. Mrs. Maloney is there.
    Mrs. Maloney. Thank you.
    Well, thank you, Mr. Chairman, on this important hearing.
    Even as we are working to keep and increase vaccination 
rates in the United States, we don't have to--we have to really 
focus also on the fact that we need to vaccinate the rest of 
the world, and helping vaccinate people in lower income 
countries is not only the right thing to do, from a 
humanitarian and diplomatic standpoint, but it also helps 
protect the health and safety of Americans.
    And as long as the coronavirus continues to circulate 
widely across the globe, new variants will arise and Americans 
are going to be at risk. We are already on another new variant.
    So, I would like to ask, Dr. Udayakumar, how does a failure 
to bring the coronavirus under control around the world put 
Americans at risk?
    Dr. Udayakumar. Thank you, Representative Maloney.
    I think we continue to put Americans at significant risk so 
long as we don't have a global plan of attack against the 
pandemic that leads to a global recovery. First and foremost, 
we put the health and lives of Americans at risk as we saw with 
the Delta variant, as we are seeing with the Omicron variant 
that have both emerged in other parts of the world where 
infections were raging and vaccine were underutilized and 
underavailable.
    We can't isolate ourselves from the rest of the world, so 
we are prone to anything that happens elsewhere. So, 
fundamentally, to protect Americans, we need to make sure 
there's a global response.
    Second, our economy, as we've heard from colleagues today, 
is intertwined with the rest of the world. We will not see as 
strong a global economic growth and recovery or global trade or 
global travel so long as the pandemic continues.
    Third, as you started off rightly by saying, it's also the 
right thing to do. It is a way for the American people to 
express our values as a people to the rest of the world and 
lead in a way that brings strong American values in helping 
those that are most in need. And, of course, it's also the 
ability to influence the future decades of diplomatic relations 
in the world.
    So, I think we have every incentive that could be possibly 
aligned to do the right thing and do it quickly.
    Mrs. Maloney. Thank you.
    The new variants have been devastating. We've seen the 
problems brought on by the Delta variant now which happens to 
be even more contagious. It's really going through New York 
very--infecting a lot of people. It's very, very contagious, 
twice as likely to result in hospitalization in our city than 
other strands.
    And so I would like to ask, Dr. Khan, what does our 
experience with the Delta variant tell us about the potential 
threat posed by not only Delta but other new variants that seem 
to be arriving?
    Dr. Khan?
    Dr. Khan. Thank you for that question, Representative 
Maloney.
    Correct. Our 1,300 deaths a day and 65,000 hospitalizations 
are due to the failure to adequately respond to this pandemic 
with vaccinations. And each of these variants have arrived 
overseas, and until we have a global response--a global 
vaccination campaign, layered with other public health 
measures--you know, there's masks, there's testing, 
quarantining, isolation, treatment--you layer them altogether, 
we need to do this globally, otherwise we will be at risk for 
yet another variant. It may not be Omicron. Obviously, between 
Delta and Omicron, there were a lot of numbers that went 
through there that didn't turn out to be a big issue for us, 
but it could be whatever the next variant is.
    So, we must make sure that we have a global response to 
this pandemic if we want to protect Americans and go into this 
post-pandemic phase.
    Mrs. Maloney. Dr. Khan, how would temporarily waiving 
patent rights on certain vaccines help accelerate global 
vaccination efforts, given the fact that we have to be as 
concerned about other countries as our own?
    Dr. Khan. It would allow many of these hubs that are being 
stood up to use those patents immediately, including, as I 
said, the U.S. owns the Moderna, critical Moderna patent on the 
spike protein formulation. So, having--and the WHO has already 
set up a facility that's ready to do that work. The companies 
don't want to work with them, unfortunately, because profit for 
them outweighs lives. But the U.S. has the ability to be paid 
for these vaccines. The American people paid for these 
vaccines, and they can demand that these companies work with 
these other countries and make sure that we get everybody 
vaccinated.
    That's the solution. We need to get more sites that are 
vaccinating, in addition to, as I said, access issues, the 
logistics issues and to address the vaccine hesitancy that we 
also seem to be exporting.
    Mrs. Maloney. You mentioned the Moderna vaccine. Scientists 
at the National Institute of Health played a critical role in 
developing these vaccines, and the Federal Government, I 
believe, should have a say in how it's licensed this vaccine 
abroad.
    Dr. Khan, can you put this into the context of the global 
vaccination effort? Why is it important for the Federal 
Government to be involved in making these decisions abroad?
    Chairman Clyburn. The gentlelady's time has expired.
    Mrs. Maloney. My time has expired.
    Dr. Khan. Can I answer? No?
    Chairman Clyburn. Quickly.
    Dr. Khan. We need to get everybody vaccinated as fast as 
possible, and everything we do to increase that speed will 
increase our transition to post-pandemic and move us back to a 
better new normal and take care of these trade issues and all 
of these social and political and economic disruptions, and 
healthcare disruptions.
    Chairman Clyburn. Thank you, Dr. Khan.
    The chair now recognizes Mrs. Miller-Meeks for five 
minutes.
    Mrs. Miller-Meeks. Thank you, Mr. Chair.
    And, you know, it's interesting listening to the panel, and 
I agree that this is a global pandemic. So, all of our 
panelists would agree this is a global pandemic? They can just 
voice yes.
    All of them agree that we need to have immunity, and we 
know that we can acquire immunity through two different 
sources; one through vaccination, and the second way that they 
can acquire immunity is through infection-acquired immunity, 
which we have heard discussed already.
    It's frustrating to me to hear that the response from some 
of our panelists is that if the United States forces U.S. 
companies to give up intellectual property rights and patent 
protections to allow more dosages to be developed, one is that, 
are there facilities that can develop vaccines immediately and 
with the safety requirements? And then, two, is there a public 
health infrastructure in order to deliver vaccines? And, three, 
while we are waiting for this, individuals are developing 
COVID-19 and developing immunity. So, perhaps talking about 
immunity would be extraordinarily helpful.
    And one of the greatest problems today that we see and I 
see, I have been told for over a year to listen to the science, 
and I listened to the science, but I see that there's a lack of 
evidence-based decisionmaking from the Biden administration.
    And one example of this is what's happening in schools. 
President Biden promised to support a return to the safe 
learning as quickly as possible. Yet, even as the teachers were 
prioritized for vaccines, they refused to turn to in-person 
instruction. Students' learning loss due to remote or hybrid 
learning is astronomical, and we just had another publication 
about that this week. Failing grades are rising, and child 
suicide rates are surging, and yet some schools remain remote 
or hybrid despite no scientific basis for this decision. And we 
heard again this week that schools in certain states are going 
back to hybrid learning because of the Omicron variant, which 
to this point has had very little fatalities.
    In addition to which, when I was touring in some areas of 
my district yesterday, I learned that one of the school systems 
in a rural area closed down for a week for mental health 
reasons for the faculty, not for the students. And that put a 
burden then on those individual childcare providers and parents 
who were in that school system.
    So, for even those schools that are in person, many are 
forcing children to wear masks, even though there is no study 
that shows masks on their own provide any additional protection 
for children.
    Dr. Makary, do you have any studies which show the efficacy 
of masking children in school?
    Dr. Makary. No. The topic of masking children has not been 
studied with any formal randomized control trial. The data that 
we are relying on are really from adults, and that's--the 
largest custom randomized control trial was conducted by 
researchers at Stanford University, and they found that 
basically a cloth mask had almost a negligible benefit. A 
surgical mask had a roughly 11 percent reduction in 
transmission, and higher quality masks were higher.
    Now, I don't love that study design, but it's all we have 
to work on. And basically we've imposed the covering of faces 
of 52 million school aged children with very weak data.
    Mrs. Miller-Meeks. And are there some evidence-based 
consequences of masking children in schools?
    Dr. Makary. Certainly if you talk to those who are speech 
pathologists, guidance counselors, if you look at mental health 
disorders in kids, it's got to play a factor.
    And the Brown University study that showed that 
developmental aspects of childhood are being significantlly 
hindered in those who have gone to school during the era of 
masks being worn in school. That was very validating to many 
frontline people who have had concerns.
    Some kids do great with masks. Some kids struggle. A 
quarter of kids wear glasses, and it fogs up the glasses many 
times. So, it's easy to say my kid does well with the mask and, 
therefore, everyone should wear it. Come to inner city 
Baltimore and take a look at the kids who are not in school or 
in school wearing a mask and trying to learn on an iPad with 
glasses on. It's an entirely different situation than somebody 
who has got private tutors for their kids in the Hamptons with 
a $10,000 Zoom suite.
    Mrs. Miller-Meeks. And, you know, Dr. Makary, like you and 
like our other panelists, I'm fully vaccinated. I've given 
vaccines in all 24 of the counties in my congressional 
district. But I think we've brought up a very important point 
in this hearing is that I have asked Dr. Fauci and Dr. Walensky 
on hearings of this subcommittee, we had five public health 
experts just recently in this hearing ask them about infection-
acquired immunity, asked them about the Israeli study, and all 
of them were less than supportive of evidence-based data that 
has come out about infection-acquired immunity.
    I put forward a bill to mandate all insurance, both private 
and Federal, cover for serology testing for human antibodies 
and also T-cell antibodies because we know the T-cell immunity 
is stronger and lasts longer. But, yet, as you are indicating, 
when we are talking about trying to globally vaccinating 
countries, we are vaccinating now children 16 to 17 and 
recommending boosters for individuals who may already have 
immunity rather than recommending testing for that.
    We don't know in children because the CDC--and I've asked 
this of Dr. Walensky, you know, for those children who have 
died of COVID 19, what were their risk factors? What were their 
vulnerabilities? That's information we should know before 
recommending that every child be vaccinated from the ages of 5 
to 12 or 5 to 11 and then recommending boosters. Because, as I 
think you indicated, would you agree those boosters could be 
doses that could go overseas to other countries in order to 
increase the rates of immunization?
    Chairman Clyburn. The gentlelady's time has expired.
    The chair now recognizes Mr. Foster for five minutes.
    Mr. Foster. Thank you.
    Am I audible and visible here, Mr. Chair?
    Chairman Clyburn. Yes.
    Mr. Foster. Thank you.
    So, Dr. Khan, we've heard a lot of speculations about how 
maybe we would be better off with a national response that 
focused on natural immunity rather than vaccination.
    And so if we had adopted that sort of approach, which is 
pretty much what Third World countries are forced to do because 
they don't have access to vaccine, if we had adopted that 
approach, what would it have meant in terms of patient overflow 
in emergency rooms and ICUs? What would it have meant in terms 
of the burnout of medical personnel?
    Dr. Khan. Thank you, Representative Foster.
    We did adopt this strategy. This is the Great Barrington 
Death Declaration, Scott Atlas Strategy of Natural Immunity.
    There's a reason in the English language we say, ``Avoid it 
like the plague,'' because in no other plague have we ever 
said, Let's go out and get infected. Yes. So, the trouble with 
natural immunity is you have to get infected to get natural 
immunity, which makes you either dead or have long COVID or 
other complications, causing orphans causes often, et cetera, 
overwhelms healthcare systems.
    But let me step back, Representative. I'm big fan of 
immunity, innate immunity, natural immunity, acquired immunity. 
Love all of them; love B cells, T cells, probably have some 
love for dendritic cells too. But what really beats all of 
those is hybrid immunity, and the data is unequivocal with 
hybrid immunity. Right? Nice. CDC study in Kentucky, May and 
June of last--of this year. Two-point-three percent less likely 
to get infected if you were previously infected and vaccinated 
versus just previously infected.
    And even Israel that we like to talk about, I think they 
only give you 3 to 6 months before they say, sorry, you have to 
get vaccinated. With the Omicron variant, we are seeing the 
data has clearly coming out with the Omicron variant. Natural 
immunity is not as good with the Omicron variant and overcomes 
very easily. So, that 3 to 6 months will probably go away also.
    So, what's better is hybrid immunity. So if you have been 
naturally infected, get infected. I may also add--and I want to 
thank Dr. Makary for the data. So, over half of Americans have 
already probably been infected in some way, shape, or form. You 
add in 200 million people who have at least been fully 
vaccinated, so essentially everybody in America has some 
version of fully vaccinated or natural immunity, In which case 
why do we have any cases anymore? We should have zero disease 
in America if you have combination of vaccinated and natural 
immunity.
    So, this continued misinformation and false god of natural 
immunity is one of the reasons why we have the military 
deployed to hospitals across America to say, Please help us. 
It's why we have healthcare burnout. And institutions are in 
trouble not because of the interventions of vaccination, 
masking, social distancing, isolation, and quarantine. 
Institutions are in trouble because of the disease which we 
respond to with good better public health measures.
    Mr. Foster. Yes. Thank you. And----
    Dr. Khan. So, we need to get people vaccinated.
    Mr. Foster. Thank you.
    Now, we've also heard that masking may be as small as 11 
percent effective. OK. Now, that sounds like maybe a small 
number, but that means that this virus, first off, has to find 
a new victim or die every week or two. OK.
    So, now that means if it's 11 percent effective, then you 
have only 89 percent of the virus that will be transmitted in 
the next generation. One generation it will be 89 percent 
squared, the next one cubed, and on and on and on. After ten 
generations, 10 weeks afterwards, you will find that 70 percent 
of the virus has been wiped out by masking, which is why you 
see at the country comparison level masking is so effective and 
as a general public health precaution.
    So, 11 percent, even if the number is that low, is nothing 
to be sneezed at in terms of the public health impact.
    Now, also we've heard the claim made that somehow the 
administration is not interested in natural immunity, and I can 
tell you they are very focused on it, particularly in terms of 
the Omicron and what that will mean.
    Now, the multiplication factor seems to be about every 
three days, the doubling time, every three days. That means 
that if it's every three days, after one month, it's a factor 
of a thousand. So, one case will turn into a thousand cases; 
after two months, a million cases; after three months, a 
billion cases. The likelihood is that within the next three 
months, most of humanity will be expected by this. And it is a 
matter of crucial concern that I can tell you from the very--
from the top of the administration and understanding why 
whether that will provide some level of cost immunity to the 
Delta variant, which is apparently the lethal version of it.
    And so I just want to put that out there, that there is no 
shortage of interest in the implications of cross-immunity to 
the Omicron virus in the administration. It is going to be a 
crucial issue and officials at the highest level are working on 
it.
    I guess my time is up at this point, and I yield back.
    Chairman Clyburn. Thank you.
    Mr. Foster. OK.
    Chairman Clyburn. Thank you for yielding back.
    The chair now recognizes Mr. Krishnamoorthi for five 
minutes.
    Mr. Krishnamoorthi. Can you hear me now?
    Chairman Clyburn. Yes, I hear you now.
    Mr. Krishnamoorthi. OK. Great. Thank you, Mr. Chair.
    I'm the cochair of the Global Vaccination Caucus in 
Congress, so this is a very important hearing.
    Let me first ask Professor Russ, Dr. Russ, it's correct 
that vaccinations abroad could relieve supply chain 
disruptions? Correct?
    Dr. Russ. Yes; in two ways.
    Mr. Krishnamoorthi. Let me--I want to just build on this 
question.
    And reducing supply side disruptions will in part tamp down 
price inflation? Correct?
    Dr. Russ. Yes.
    Mr. Krishnamoorthi. And, therefore, global vaccinations 
would help fight inflation? Right?
    Dr. Russ. Yes.
    Mr. Krishnamoorthi. Do you have an estimate of how much 
inflation would go down because of global vaccinations?
    Dr. Russ. No.
    Mr. Krishnamoorthi. Would it be a substantial portion of 
the inflation that we see?
    Dr. Russ. It's hard to tell. The relationship between the 
price of imports and the impact on our domestic inflation is 
not linear. So, if you think about the contribution of the 
shortage in semiconductors, it generated these shutdowns in 
U.S. auto production that contributed to keeping prices high on 
autos in the United States.
    Right now autos contribute to one-fifth of the inflation 
that we are seeing. That's not all because of the vaccine-
related supply disruptions.
    Mr. Krishnamoorthi. I understand, I understand.
    Dr. Udayakumar, a new study came out from South Africa 
today suggesting that the Omicron variant may cause less severe 
disease, and they found a 29 percent lower risk of 
hospitalization. However, they also found that in the U.K. 
members of the same household were three times more likely to 
pass on Omicron than Delta.
    So, if we have 29 percent fewer hospitalizations but three 
times more people infected, that would produce more 
hospitalizations overall and would potentially overwhelm 
hospitals in this country, would it not?
    Dr. Udayakumar. Yes, Representative Krishnamoorthi, it's 
exactly right. We like to think about transmissibility, immune 
evasion, and severity as different variables that impact, and 
certainly the significant increase in transmissibility is quite 
worrisome.
    Mr. Krishnamoorthi. So, since the Delta variant became the 
dominant variant in the U.S. in July, almost 200,000 people 
have died from COVID-19 in this country. Given that the two-
dose vaccine regimen is less effective against Omicron and 
natural immunity is less protective against reinfection with 
Omicron and it's significantly more transmissible--yes or no 
question--are we likely to see tens of thousands of deaths in 
the U.S. alone because of Omicron?
    Dr. Udayakumar. I would say it's probably too early to tell 
because we don't really know the questions around severity, but 
it is likely that we will see that level of deaths in the U.S. 
over the coming months.
    Mr. Krishnamoorthi. So, one of the things that I'm pushing, 
along with my co chairs of the Global Vaccination Caucus, is 
$17 billion more in Fiscal Year 2022 appropriations for the 
scaling up of manufacturing capacity of vaccines.
    And what I wanted to ask you is, would you agree that this 
additional $17 billion for the purchase of vaccines, as well as 
the scaling up of vaccine capacity, is needed right now to 
combat the lack of vaccinations globally?
    Dr. Udayakumar. Yes, Representative Krishnamoorthi, we are 
still tens of billions of dollars short in the global response.
    I would just note, in addition to vaccine manufacturing and 
purchases, the additional bottleneck going into 2022 is really 
going to be on the delivery side. So, country level readiness 
is also something we need to invest significantly in, in the 
billions of dollars.
    Mr. Krishnamoorthi. I'm glad you brought that up. So, I 
have introduced legislation called NOVID. It's a play on words; 
no more COVID. One-hundred of my colleagues and I urge that 
this be adopted as part of our legislative process going 
forward to help make sure that we combat the problem of a lack 
of vaccines abroad.
    Let me--Dr. Ali Khan, you know, I read in a recent piece by 
Dr. Makary that back in the spring of last year natural 
immunity apparently had reached a very high level. And he said, 
quote, I expect COVID will be mostly gone by April 2021.
    That wasn't the case, was it?
    Dr. Khan. No, it wasn't. And anybody who was a field 
epidemiologist, public health expert would have known that.
    Mr. Krishnamoorthi. Thank you.
    I yield back.
    Chairman Clyburn. I thank the gentleman for yielding back.
    I do not see any others here. Am I missing somebody?
    It is now time for me to yield to the ranking member for 
whatever closing statement he may want to make. Is the ranking 
member available for his closing statement?
    Mr. Scalise. Like on queue, Mr. Chairman. I appreciate 
that.
    Between votes we were able to pull this hearing off too. 
So, I appreciate all of the witnesses for bearing with us and 
for bringing your different viewpoints to mind; you as well, 
Mr. Chairman.
    And, obviously, when we look at where we are on COVID with 
yet another variant that's come, we've seen different 
approaches by different states, and I think some states have 
shown the way for how you can confront the virus while also 
maintaining people's own rights and freedoms and the ability 
for people to live their lives, to keep their businesses open, 
to keep their jobs.
    And, unfortunately, I think one of the things that we've 
been very frustrated by is that it seems, coming out of the 
Biden administration, it has been more of a one-size-fits-all 
approach and more of a top down kind of bullying, shaming 
approach just on vaccine mandates.
    And, again, to show the President, has tried and been 
blocked by courts all across this country on these mandates. 
The courts have said you can't fire people in the healthcare 
industry, for example, if they don't get a vaccine. You can't 
fire people that work for a company with over 100 employees if 
they don't get the vaccine
    You can't fire someone who's a government contractor.
    But it's just alarming that President Biden's main focus 
seems to be trying to get people fired from their jobs as 
opposed to putting more time and effort into some of these 
alternatives. And I'm glad we've started to discuss them. You 
know, what do immunities really provide you? For how long do 
those immunities really last? And for someone who says they 
don't want to get a vaccine, I'm vaccinated. I think most of 
our members are vaccinated and have encouraged other people to 
get vaccinated.
    But we also see that there are segments of our country that 
don't want to get vaccinated, and it's not all Trump 
supporters. It's people in every community, in African-American 
communities, in Hispanic communities, across the political 
spectrum. It's not a political issue. It's a personal choice. 
And people are making that personal choice with the facts.
    You know, let's first get them the facts and let's trust 
the science. But it seems like science is getting thrown out 
the window when it doesn't meet a narrative. And we really 
should be putting more time into looking into those questions. 
You know, what are alternative therapies that aren't being 
researched right now that could help protect and keep people 
safer while also maintaining their freedoms, the ability for 
people to go about their lives again?
    You know, this idea that some states just want to shut 
everything down is not--it's not realistic, and it ignores 
where many people are in their lives. Like, let's look at the 
models of places where it's worked well. Many states have done 
it much better than other states.
    Those are the kind of discussions we ought to be having. 
Bring in scientists that have different viewpoints so that we 
can hear how we can put more ideas on the table. I don't see 
enough of that happening. And, once again, I will say we ought 
to have a hearing to investigate the origin of COVID-19 to see 
what really happened, why the world wasn't told the truth, how 
many lives could have been saved, and how we can prevent 
something like this from happening again.
    So, I appreciate the testimony we've had.
    Mr. Chairman, I'll see you on the floor in a little while.
    With that, I yield back the balance of my time.
    Chairman Clyburn. I thank the ranking member for yielding 
back. Thank you so much.
    Let me thank all of you for being with us today, all of the 
witnesses today. In closing, I want to say that we appreciate 
your insight, your expertise, and your advice on the urgent 
need to accelerate vaccinations around the world.
    I often quote Dr. Martin Luther King, Jr.'s letter from the 
Birmingham City Jail for various reasons. Today I wish to quote 
his statement that ``Injustice anywhere is a threat to justice 
everywhere. We are caught in an inescapable network of 
neutrality, tied in a single garment of destiny. Whatever 
affects one directly, affects all indirectly.''
    On no subject is that statement more clearly true than the 
subject of vaccinating the world against the coronavirus. The 
injustice facing those who still lack access to a vaccine is a 
threat to justice everywhere in the world, including here in 
the United States. It's a threat to health justice, and it's a 
threat to economic justice.
    As we have heard from today's witnesses, the only way to 
end this crisis once and for all, for all everywhere, is to 
make sure that the United States continues to support global 
vaccination efforts so the virus cannot spread unchecked 
anywhere.
    We have the tools to end this pandemic. Vaccines and 
boosters are highly effective at preventing hospitalization and 
death and curbing the spread of the virus. But it will only 
work if people can have access to them. As we continue urging 
fellow Americans to take advantage of these lifesaving 
vaccines, we must dedicate the necessary resources to allow 
everybody in the world to access them. Their lives and 
livelihoods depend on our efforts. The American lives and 
livelihoods depend on our efforts.
    To protect the lives and livelihoods of all of us caught in 
the escapable network of neutrality, tied in a single garment 
of desolate, we must achieve a global solution to this global 
problem by accelerating vaccinations across the world.
    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 4:04 p.m., the committee was adjourned.]

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