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

                                                            S. Hrg. 117-17

                     VACCINATIONS AND THE ECONOMIC RECOVERY

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

                                VIRTUAL HEARING

                                   BEFORE THE

                            JOINT ECONOMIC COMMITTEE

                                     OF THE

                         CONGRESS OF THE UNITED STATES

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 APRIL 14, 2021

                                   __________

              Printed for the use of the Joint Economic Committee

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    44-730                      WASHINGTON : 2021

    -----------------------------------------------------------------------------------

                            JOINT ECONOMIC COMMITTEE

        [Created pursuant to Sec. 5(a) of Public Law 304, 79th Congress]

    HOUSE OF REPRESENTATIVES             SENATE
    Donald S. Beyer Jr., Virginia,       Martin Heinrich, New Mexico, Vice
        Chairman                             Chairman
    David Trone, Maryland                Amy Klobuchar, Minnesota
    Joyce Beatty, Ohio                   Margaret Wood Hassan, New
    Mark Pocan, Wisconsin                    Hampshire
    Scott Peters, California             Mark Kelly, Arizona
    Sharice L. Davids, Kansas            Raphael G. Warnock, Georgia
    David Schweikert, Arizona            Mike Lee, Utah, Ranking Member
    Jaime Herrera Beutler, Washington    Tom Cotton, Arkansas
    Jodey C. Arrington, Texas            Rob Portman, Ohio
    Ron Estes, Kansas                    Bill Cassidy, M.D., Louisiana
                                         Ted Cruz, Texas

                    James Whitney, Democratic Senior Advisor
                Vanessa Brown Calder, Republican Staff Director
                      Colleen J. Healy, Financial Director

                                C O N T E N T S

                                  ----------

                         Opening Statements of Members

    Hon. Donald S. Beyer Jr., Chairman, a U.S. Representative from
      the Commonwealth of Virginia...................................     1
    Hon. Mike Lee, Ranking Member, a U.S. Senator from Utah..........     3

                                   Witnesses

    Dr. Celine Gounder, M.D., ScM, FIDSA Clinical Assistant,
      Professor of Medicine & Infectious Diseases, NYU School of
      Medicine & Bellevue Hospital CEO of Just Human Productions New
      York, NY.......................................................     6
    Dr. Paul Romer, Nobel Prize Winning Economist and NYU Professor,
      New York, NY...................................................     7
    Dr. Belinda Archibong, Assistant Professor, Economics, Barnard
      College, Columbia University, New York, NY.....................     9
    Dr. Alexander Tabarrok, Bartley J. Madden Chair in Economics at
      the Mercatus Center and Professor of Economics, George Mason
      University Fairfax, VA.........................................    11

                           Submissions for the Record

    Prepared statement of Hon. Donald S. Beyer Jr., Chairman, a U.S.
      Representative from the Commonwealth of Virginia...............    40
    Prepared statement of Hon. Mike Lee, Ranking Member, a U.S.
      Senator from Utah..............................................    41
    Prepared statement of Dr. Celine Gounder, M.D., ScM, FIDSA
      Clinical Assistant, Professor of Medicine & Infectious
      Diseases, NYU School of Medicine & Bellevue Hospital CEO of
      Just Human Productions New York, NY............................    43
    Prepared statement of Dr. Paul Romer, Nobel Prize Winning
      Economist and NYU Professor, New York, NY......................    80
    Prepared statement of Dr. Belinda Archibong, Assistant Professor,
      Economics, Barnard College, Columbia University, New York, NY..    82
    Prepared statement of Dr. Alexander Tabarrok, Bartley J. Madden
      Chair in Economics at the Mercatus Center and Professor of
      Economics, George Mason University Fairfax, VA.................    97
    Response from Dr. Gounder to Questions for the Record Submitted
      by Representative Herrera Beutler..............................   101
    Response from Dr. Gounder to Questions for the Record Submitted
      by Senator Cruz................................................   101
    Response from Dr. Gounder to Question for the Record Submitted by
      Senator Kelly..................................................   104
    Response from Dr. Romer to Questions for the Record Submitted by
      Representative Herrera Beutler.................................   104
    Response from Dr. Romer to Questions for the Record Submitted by
      Senator Cruz...................................................   105
    Response from Dr. Romer to Questions for the Record Submitted by
      Senator Kelly..................................................   107
    Response from Dr. Archibong to Question for the Record Submitted
      by Representative Herrera Beutler..............................   108
    Response from Dr. Archibong to Question for the Record Submitted
      by Senator Cruz................................................   108
    Response from Dr. Archibong to Question for the Record Submitted
      by Senator Kelly...............................................   108
    Response from Dr. Tabarrok to Questions for the Record Submitted
      by Representative Herrera Beutler..............................   109
    Response from Dr. Tabarrok to Question for the Record Submitted
      by Senator Cruz................................................   109
    Articles submitted to Senator Cruz from Dr. Gounder..............   110
    Dr. Tabarrok--Submissions for the Record from Senator Lee........   110
    Article for the Record Submitted by Representative Schweikert....   110

                     VACCINATIONS AND THE ECONOMIC RECOVERY

                                  ----------

                           WEDNESDAY, APRIL 14, 2021

                        United States Congress,
                              Joint Economic Committee,
                                                        Washington, DC.
        The WebEx virtual hearing was convened, pursuant to notice,
    at 2:30 p.m., before the Joint Economic Committee, Hon. Donald
    S. Beyer Jr., Chairman, presiding.
        Representatives present: Beyer, Estes, Schweikert, Pocan,
    Arrington, Beatty, Peters, and Trone.
        Senators present: Lee, Heinrich, Warnock, Cruz, and
    Klobuchar.
        Staff present: Vanessa Brown Calder, Barry Dexter, Colleen
    J. Healy, Jeremy Johnson, Christina King, Nita Somasundaram,
    Kyle Treasure, Jackie Varas, Emily Volk, Jim Whitney, and
    Ismael Cid-Martinez.

     OPENING STATEMENT OF HON. DONALD BEYER JR., CHAIRMAN, A U.S.
            REPRESENTATIVE FROM THE COMMONWEALTH OF VIRGINIA

        Chairman Beyer. So this hearing will come to order. I would
    like to welcome everyone to the first Joint Economic Hearing of
    the 117th Congress. So welcome back, and welcome to all the new
    members.
        I really look forward to working with Vice Chairman
    Heinrich, Senate and Ranking Member Mike Lee, who chaired this
    in the last Congress, House senior Republican David Schweikert,
    and all of our committee members, as we examine the many
    economic challenges and opportunities in our country.
        I want to thank each of our distinguished witnesses for
    sharing their expertise today. Now, my brief opening statement.
        The end is in sight. The pandemic and its tragic health and
    economic consequences have dominated our lives for the last
    year. After more than a year of physical distancing and mask
    wearing, of fearing for our health and the health of our loved
    ones, of widespread unequal economic hardship, the potential
    returning to a sense of normalcy is finally within sight. The
    pandemic will leave no shortage of tragedy in its wake. More
    than 560,000 people have died in the United States, many
    isolated in hospital rooms without their family's last comfort.
        Thirty-one million, that we know of, have been infected
    with the coronavirus, and many of them continue to live with
    the disease's debilitating symptoms. Communities of color,
    particularly Black, Latino, and American Indian communities,
    have been hit especially hard, experiencing the highest rates
    of COVID-19 infections, hospitalizations, and deaths.
        Economic damage persists, as well. After job gains of more
    than 900,000 last month, still close to 10 million workers
    remain unemployed. One-quarter have been jobless for a year or
    longer. Another four million people have simply left the labor
    force since the pandemic began.
        Thankfully, the economy is beginning to recover. Much of
    that recovery is due to the remarkable vaccination efforts
    unfolding in our country and throughout the world right now.
    Millions of shots are going into arms every single day.
        More than 190 million doses have been administered in the
    United States. More than one in three people in the U.S. have
    received at least one shot. One in five Americans has been
    fully vaccinated. At the current rate, we can vaccinate all
    adults in the United States by the end of the summer.
        And then, perhaps our lives will begin to approach a new
    normal where we can see loved ones, we no longer have to choose
    between going to work and keeping the family safe, where we can
    enjoy a meal inside the restaurant, or a trip to the movies.
        There is a profound consensus among economists that
    vaccinations will shape the course of the economic recovery.
    Forecasts call for economic growth. Goldman Sachs may be the
    most optimistic, suggesting 8 percent in 2021. In an interview
    this past weekend, Fed Chair Jay Powell said the economy and
    job creation are poised for faster growth, and the principal
    risk is that, quote, ``We will reopen too quickly. People will
    too quickly return to their old practices, and we will see
    another spike.''
        Although the trajectory of the pandemic recovery is headed
    in the right direction, it remains precarious and can be
    derailed by hasty reopenings, new variants, anti-vaccine
    sentiment, and world access to vaccines. This means that our
    economic recovery is precarious, as well.
        Public health experts warn that state efforts to roll back
    mask mandates and physical distancing requirements can
    backfire, especially in light of highly transmissible and
    deadlier variants.
        Michigan's recent experience makes clear that we cannot
    rely on vaccines alone as our only way out of the pandemic. We
    have seen recent spikes in cases as the more contagious V117
    variant has now become the most common strain of the virus in
    the United States.
        Young adults and children are comprising an ever-larger
    share of the new infectants, and if we cannot bring the
    pandemic under control globally, new variants might become
    resistant to our current treatments of vaccines, creating a
    need for adjusted vaccine products, further delaying the
    recovery efforts.
        CDC Director Rochelle Walensky has said repeatedly that
    because of these concerns we cannot let our guard down and must
    continue to practice mask wearing and physical distancing until
    we reach herd immunity.
        There is also profound inequity in access to vaccines.
    Vaccination rates for people of color, especially Blacks and
    Latinos, lag far behind the rates for Whites. As a result,
    pandemic recovery efforts in communities of color may fall
    behind recovery to White communities. The reality is even worse
    abroad.
        While wealthy countries have purchased enough vaccine to
    cover two and sometimes even three times their populations,
    low- and middle-income countries, which account for 81 percent
    of the world's adult population, have collectively purchased
    only 33 percent of vaccines.
        As Treasury Secretary Yellen laid out last week, some low-
    income countries do not expect to be able to fully vaccinate
    the population until 2023 or 2024, which should be unacceptable
    and dangerous to all of us.
        To end this pandemic for good, the battle against the
    coronavirus must be won globally. So while we have made
    progress in the last few months, we are not out of the woods
    yet. And I really look forward to hearing from our witnesses
    about the state of our recovery, where it is going, and what we
    are going to do to ensure things stay on track.
        So let me turn this over to Senator Lee for his opening
    statement. Senator Lee is with us? Mike?
        [The prepared statement of Chairman Beyer appears in the
    Submissions for the Record on page 40.]

      OPENING STATEMENT OF HON. MIKE LEE, RANKING MEMBER, A U.S.
                           SENATOR FROM UTAH

        Senator Lee. Yes. Thanks so much, Mr. Chairman. Thanks for
    convening today's hearing.
        After a long COVID winter, one that included some
    unprecedented strains on our economy and on public health, the
    Spring has brought some welcome signs of life and of hope.
    Businesses are beginning to reopen. Schools are starting to
    reconvene in person, and friends and family members are finally
    starting to reunite.
        Perhaps what is most encouraging, and what has helped
    support the beginning of our return to normal, has been the
    development and distribution of vaccines. But there is still a
    long way to go. Many Americans still have not returned to the
    in-person experiences of the entertainment and travel
    industries, for example, and our economy has suffered in order
    for people to feel safe, to return to in-person interactions
    that support economic activity.
        We must continue to improve vaccine distribution. As we
    consider how best to move forward, it is worth reflecting on
    our trajectory so far, both the strategies that have helped,
    and those that have hindered our progress.
        Though vaccine production has had some supply chain
    setbacks, such as the difficulty in finding vaccine components
    like reagents and other chemicals that have led to
    manufacturing bottlenecks, it has overall exceeded
    expectations.
        Operation Warp Speed, an initiative begun by the Trump
    Administration, sped the development and the production of
    several vaccines, including Moderna, Pfizer, and Johnson &
    Johnson, by purchasing vaccines in development and directing
    resources toward vaccine manufacturing capacity.
        In total, through advance purchase agreements and grants,
    the Trump Administration purchased more than 800 million doses
    through the end of July 2022. The Council of Economic Advisers
    previously estimated that accelerated vaccine development and
    distribution by OWS could result in as much as $2.4 trillion in
    economic benefit, if there was a viable vaccine by January 1st,
    2021.
        The effort actually outpaced that timeline with first doses
    of the Pfizer vaccine being made available on December 14th,
    2020. And the CEA noted that its own estimate might even
    underestimate the full economic benefit of accelerated vaccine
    development.
        In terms of vaccine distribution, there are worthwhile
    policy proposals to increase the number of people with some
    protection during that time period in which vaccine supplies
    are still somewhat scarce. We should be open to creative
    solutions that can help get people protected more quickly by
    strengthening the limited supply as far as we possibly can, and
    moving the doses that we have as quickly as possible to as many
    people as possible.
        Our main priority should be to extend at least some
    protection to as many people as we possibly can. States also
    have an important role to play in distribution. In some cases,
    we have seen that restrictive Federal guidelines and rigid,
    complex eligibility requirements have impeded states' progress,
    leaving many vaccine doses to being wasted or administered to
    unintended populations.
        Lack of health resources at the final stage of local
    distribution have also presented some problems for many areas.
    On the other hand, successful states have implemented simple
    eligibility criteria, and used technology to accelerate the
    distribution. Some have developed systems where patients can
    register online. Others have used online event hosting software
    to schedule appointments. And they have also partnered with
    local businesses and pharmacies.
        Despite all of the challenges that we have faced, the U.S.
    has vaccinated more people per capita than most other countries
    in the world--nearly 190 million doses have been administered
    as of April 13th. More American citizens have received a COVID-
    19 vaccine than tested positive for the virus since the
    beginning of the pandemic. And nearly a third of the adult U.S.
    population is now fully vaccinated.
        There is reason for hope in our economic outlook, as well.
    Expectations are set for a stronger economic response in the
    second half of the year. The CBO expects real GDP to return to
    its pre-pandemic level by 2021, and the labor force is expected
    to return to its pre-pandemic size by 2022.
        But in order to accelerate our economic recovery, we should
    look for opportunities to improve vaccine distribution policy.
    The sooner the U.S. reaches herd immunity through vaccinations,
    the sooner businesses can reopen to full capacity, and students
    can return fully to schools, and industries can come back to
    life, and Americans can return to work and social life without
    fear.
        So I look forward to hearing our panelists' contributions
    today, and their insights into how we can do just that. But
    before I do, I would like to ask Chairman Beyer for permission
    to submit five articles, or studies from our witness, Dr.
    Tabarrok, for the record.
        Chairman Beyer. Without objection, they are admitted.
        [The five articles referred to by Senator Lee appear in the
    Submissions for the Record on page 111.]
        Senator Lee. Thank you.
        [The prepared statement of Senator Lee appears in the
    Submissions for the Record on page 41.]
        Chairman Beyer. Senator Lee, thank you very much for your
    statement.
        I would now like to introduce our four distinguished
    witnesses.
        Dr. Celine Gounder is Clinical Assistant Professor of
    Medicine and Infectious Diseases at the NYU School of Medicine
    & Bellevue Hospital. An infectious disease specialist and
    epidemiologist, Dr. Gounder served on the Biden-Harris COVID-19
    Advisory Board. She is also the CEO of Just Human Productions,
    which works to build awareness around issues of health
    disparity. Dr. Gounder is a CNN Medical Analyst, and has
    written several publications.
        She holds a B.A. in Molecular Biology from Princeton
    University, a Master of Science in Epidemiology from Johns
    Hopkins University of Public Health, and her M.D. from the
    University of Washington.
        Dr. Paul Romer is the University Professor of Economics at
    NYU. In 2018, he received the Nobel Prize in Economic Sciences
    for his work integrating technological innovations--for
    economic analysis.
        Dr. Romer is a frequent commentator on the COVID-19
    pandemic, and has been a strong proponent of large-scale COVID-
    19 testing as a means of restarting the economy. In fact, about
    a year ago, Dr. Romer spent an hour with the Joint Economic
    Committee team talking about how we can use testing to protect
    the United States.
        In his career at the intersects of economics and invasive
    technology and urbanization, working to speed up human
    progress.
        Dr. Romer previously served as the Chief Economist for the
    World Bank, and he earned his B.S. in Mathematics with the
    University of Chicago, and a Ph.D. also in Economics from the
    University of Chicago.
        Dr. Belinda Archibong is an Assistant Professor of
    Economics at Barnard College, Columbia University. She has done
    research on the economics of epidemics and vaccinations, and
    her broader research areas include developing economics,
    political economy, economic history, and environmental
    economics with an African regional focus.
        Some of Dr. Archibong's research investigated historical
    institutions such as environment and unequal access to public
    services in the development of human capital. This research
    includes the effects of epidemics on gender gaps in human
    capital investment. She received her B.A. in Economics,
    Philosophy, and a Ph.D. in Sustainable Development both from
    Columbia University. And my mom was a 1948 Barnard graduate.
        Then finally, Dr. Alexander Tabarrok, who is the Bartley J.
    Madden Chair in Economics at the Mercatus Center, and is
    Professor of Economics at our own George Mason University.
        Dr. Tabarrok has advocated for policies to speed up the
    rate of vaccinations, including delaying second doses and
    fractional doses. Dr. Tabarrok is the co-author of
    FDAReview.Org, which is the website that scrutinizes the FDA's
    regulatory and authority and performance.
        Dr. Tabarrok is a Senior Fellow and former Research
    Director of the Independent Institute. He was a co-founder of
    the online educational platform ``Marginal Revolution
    University,'' and co-author of the textbook Modern Principles
    of Economics.
        Dr. Tabarrok has a Ph.D. in Economics from George Mason
    University.
        So, Dr. Gounder, I will offer you the floor for your
    testimony, and then we will continue in the order each of you
    was introduced. Dr. Gounder, the floor is yours.

      STATEMENT OF DR. CELINE GOUNDER, M.D., ScM, FIDSA, CLINICAL
      ASSISTANT PROFESSOR OF MEDICINE & INFECTIOUS DISEASES, NYU
       SCHOOL OF MEDICINE & BELLEVUE HOSPITAL, CEO OF JUST HUMAN
                       PRODUCTIONS, NEW YORK, NY

        Dr. Gounder. Thank you.
        Chairman Beyer, Vice Chair Heinrich, Ranking Member Lee,
    and Members of the Committee, thank you for the opportunity to
    discuss with you today the role of vaccination in our pandemic
    and economic recovery.
        It is important to give credit where credit is due. The
    prior administration helped accelerate vaccine development
    safely, scientifically, and in record time. The current
    Administration is helping to scale up manufacturing and speed
    up distribution of vaccines.
        We are currently vaccinating an average of 3 million people
    per day. And according to the CDC's latest data, 37 percent of
    the total population has received at least one dose of vaccine,
    and 23 percent of the total population has been fully
    vaccinated.
        Despite recent setbacks involving production and safety
    concerns with the Johnson & Johnson vaccine, we remain on track
    to have enough vaccine supply for every adult in the United
    States by the end of May.
        Assuming we can continue vaccinating at the same pace of 3
    to 3.5 million vaccine doses per day, we could vaccinate all
    adults well before the end of August. Vaccination rates reflect
    vaccine supply, access to vaccines, and demand for vaccines.
    Our supply is solid. We have done a lot of work to improve
    distribution and access, and yet we still have room to do
    better. But, importantly, we are about to see a big drop in
    demand. And this is going to have a big impact on our daily
    rate of vaccination.
        Supply is already outstripping demand in several states.
    There is a spectrum of vaccine hesitancy, vaccine confidence,
    and vaccine seeking. The good news is that the share of
    Americans who want to, quote, ``wait and see,'' what we call
    the moveable middle, shrank from 39 percent in December to 17
    percent in March. So we made a lot of progress among
    communities of color, and persons for whom issues of access are
    the greatest barriers to vaccinations.
        The bad news is that 20 percent of Americans say they will
    only get vaccinated if required or will definitely not get
    vaccinated. Our daily COVID vaccination rates could drop
    significantly within the coming months as a result of dropping
    demand.
        With 20 percent of Americans currently unlikely to get
    vaccinated, and another 25 percent of the population who are
    children, we will not be reaching herd immunity for quite
    sometime yet.
        It is also important to understand that vaccine rollout is
    necessary but not sufficient for pandemic recovery. And I think
    of pandemic recovery in four phases: ending the emergency,
    relaxing mitigation measures, getting to herd immunity, and
    long-term control.
        To end the emergency, we have to vaccinate the highest risk
    persons who are most likely to develop severe COVID, most
    likely to be hospitalized, and most likely to die. That means
    vaccinating older adults and people with chronic medical
    conditions, and we must also pay special attention to the
    hardest hit, most vulnerable communities, including communities
    of color and front-line essential workers. We cannot end the
    emergency phase of the pandemic by relying only on vaccination,
    without risking another surge in cases, hospitalizations, and
    death.
        I think of the pandemic a bit like a speeding car. Lifting
    mitigation measures too soon is like taking your foot off the
    brake before putting the car into park. With the emergence of
    more infectious variants, the virus is hitting the gas at the
    same time. Vaccination is like a parking brake. It works well
    once the car is in park, but not nearly as well when you're
    racing down a highway.
        We are likely facing a prolonged interim period when we can
    safely lift mitigation measures, because the most at-risk have
    been shielded by vaccinations, but before we have reached herd
    immunity. And this means that, even once restrictions are
    lifted, we are unlikely to get back to business as usual right
    away.
        While COVID credentials may not be mandated by the
    government, the private sector is forging ahead. The purpose of
    COVID credentials, what some mislabel ``COVID passports,'' is
    to demonstrate that when individuals engage in certain
    activities, they pose minimal infectious risk to others. COVID
    credentials may take the form of COVID test results, as well as
    COVID vaccination status. COVID credentials are not COVID
    vaccination mandates.
        Finally, our pandemic recovery plans must address chronic
    underfunding of the CDC and state and local health departments,
    for building a strong modern public health infrastructure. We
    need a professional public health corps and 21st Century
    bioinformatics and laboratory systems. Our financial and
    political investment in preparedness for epidemics and
    pandemics should reflect the serious health, economic, and
    national security triple threat they pose.
        We must re-engage on the global health stage, as this
    pandemic has shown us the emergence of a new virus halfway
    around the world poses a very real and present danger to us
    all.
        [The prepared statement of Dr. Gounder appears in the
    Submissions for the Record on page 43.]
        Chairman Beyer. Dr. Gounder, thank you very much.
        I now recognize Dr. Romer for his testimony.

    STATEMENT OF DR. PAUL ROMER, NOBEL PRIZE WINNING ECONOMIST AND
                      NYU PROFESSOR, NEW YORK, NY

        Dr. Romer. Yes, Chairman, Vice Chairman, Ranking Member,
    other Members, thank you for the chance to speak with you
    today.
        As all of the speakers have emphasized so far, we are
    benefiting from some dramatic successes right now--the success
    in developing the vaccines, and then the very difficult
    logistical challenge but one we have successfully met, of
    getting these vaccines into the arms of the American people.
    Now in the context of these two dramatic successes, I want to
    offer two notes of caution.
        The first is to remind everyone that the damage to the
    economy and to livelihoods has been very significant, and we
    need to have an economic recovery that gets everyone who was
    working before in 2019 back into some kind of employment
    opportunity--and, only decide that we have recovered when we
    reach that point.
        But yet we should go even farther. We should not just get
    back to the employment-to-population ratio we had in 2019. We
    should aim for the employment-to-population ratio that we had
    in 1999, 20 years ago, which was one percentage point higher.
        We have tolerated over the last 20 years a steady reduction
    in the employment-to-population ratio, which has not been
    visible in our unemployment rate because the employment-to-
    population ratio falls when people become so discouraged they
    stop even trying to find a job.
        So we need a goal for recovery that is not just to get back
    to the kind of low unemployment rates we saw in 2019, we want
    to get back to the very hot labor market conditions of 1999
    where more people could work, and where wages for the lowest
    skilled members of the workforce were rising because of the
    demand for these workers. So we cannot lose track of the right
    measure of recovery, and we cannot give up on recovery until we
    get back to full recovery.
        The second cautionary note is that we run--even though the
    vaccines can with certainty end this pandemic by the fall, we
    run a non-trivial risk of--we face a non-trivial risk of a
    third wave of infections and deaths in the spring and the
    spring and summer. This is because we have got a race right now
    between a new variant, which is spreading rapidly, which is
    more aggressive. So control measures that worked for the old
    variant will not work for the new variant. So we have got a new
    variant, which is spreading rapidly, and then the opposing
    advantage we are getting is we are vaccinating more and more
    people.
        There is a race between those two effects, and it is
    complicated because there is also a tendency for people to see
    deaths are going down, at least for now, vaccinations are going
    forward, so social distance measures are being withdrawn. And
    this means that, at least temporarily during the spring and
    summer, the relaxed social distancing measures and the more
    aggressive variant could lead to one more wave of infections
    and deaths.
        What we are seeing in Michigan is a kind of an early
    warning signal of what we could see throughout the economy. If
    this happens, we need to not panic. We need to understand we
    will get to the end of this by the fall. We need to not be too
    obsessed about who to blame, who is at fault. We do need to
    think about what we can do.
        And Dr. Gounder, if you read her recent op ed, makes this
    very important point, that accelerating vaccinations, which
    would be good across the country, is not the right spot
    treatment effect when we do see this new wave emerge.
        We need things that act more quickly. And the kind of thing
    that could act quickly is to get tests into the hands of people
    who might be infected. And if they can test and find out
    quickly that they are infected, they will tend to isolate
    themselves. They will try to protect the people around them.
        So my advice on Michigan is the kind of advice I gave a
    year ago for the country, which is to make these tests
    available. I would be carpet-bombing Michigan right now with
    these at-home tests that people could take. Do not worry about
    whether they get recorded in the data. Do not worry about
    anything but let people take these tests, find out if they are
    infected, and isolate themselves right away. And they can go
    get a confirming test from some official source, but this is
    the kind of measure that could help us during the spring and
    summer. And of course social distance will save lives during
    this period, but we have got to be realistic that it is going
    to be hard to keep people sticking to these social distance
    measures when they are seeing, at least for a time, so many
    signals that look optimistic.
        So to conclude, if we work hard enough, we can recover not
    just to where we were in 2019, or 2009, but--2007, but all the
    way back to 1999. That is the kind of recovery we should aim
    for, and we will get through what could be a little bit of a
    troubling period in the next few months.
        Thank you.
        [The prepared statement of Dr. Romer appears in the
    Submissions for the Record on page 80.]
        Chairman Beyer. Great. Thank you, Dr. Romer, very much.
        Dr. Archibong, the floor is yours.

      STATEMENT OF DR. BELINDA ARCHIBONG, ASSISTANT PROFESSOR OF
    ECONOMICS AT BERNARD COLLEGE, COLUMBIA UNIVERSITY, NEW YORK, NY

        Dr. Archibong. Great. Thank you very much, Chairman Beyer,
    Vice Chairman Heinrich, and Ranking Member Lee, and committee
    members for the opportunity to testify today.
        So I just wanted to highlight three key points around this,
    being that any effect of economic policy needs to focus on
    equitable recovery. So as far as highlighting the differential
    risks and disparities of economic recovery that have been faced
    by Black communities during the pandemic.
        Second, assessing the role of vaccination in economic
    recovery, especially addressing the disparities that my
    colleagues have mentioned in access and also in vaccine
    compliance.
        And third, highlighting four main policies for more
    equitable post-pandemic recovery.
        So on this first point, so we knew early on that Black
    communities, and Black populations were disproportionately
    being infected, and also the case mortality rates were higher
    among Black communities, at the start of the pandemic. Part of
    the reason for this was that Black workers were more highly
    represented related to their population shares in the kind of
    essential service sector. And why is this? This has been due to
    the history of racial discrimination in labor markets in the
    United States.
        So that said, despite the fact that Black communities have
    been disproportionately negatively affected during the
    pandemic, we have seen that the kind of pandemic response in
    the economic recovery has been unequal and uneven.
        So we have all seen the unemployment statistics that came
    out last month, so 6 percent unemployment rates were kind of
    improved from last year. But if you look at the unemployment
    rates by race, you will notice that the Black unemployment rate
    is still twice the rate of White workers. It is still around
    9.6 percent compared to 5.4 percent for White workers.
        We also know that Black business owners faced much higher
    employment losses at the start of the pandemic. They lost about
    41 percent of employment between February and April of last
    year, compared to 17 percent loss in employment for White
    business owners.
        Now despite these losses, Black business owners, especially
    Black women business owners, were less likely to receive loans
    from the Paycheck Protection Program due to poor targeting and
    also partly due to discrimination.
        Second, on vaccination, we know that vaccination is a key
    part of the economic recovery, but as has been mentioned
    earlier, there are disparities in access to vaccines. We need
    to target the 85 percent vaccination rate to public health
    experts to get the positive benefits of reduced diseases from
    the pandemic. We are currently at 22 percent fully vaccinated,
    but if you look at it again, the kind of Black/White difference
    in vaccination rates, the vaccination rates among the White
    population are around 28 percent--so it is about two times
    higher than vaccination rates for Black and Hispanic
    populations, which are about 17 and 16 percent currently.
        So we definitely need more equitable distribution that
    focuses on improving access in Black and Hispanic
    neighborhoods, especially different--and again, these
    populations are relatively over-represented in these essential
    service workers, and we know the key sector, the necessary
    sector, for the economic recovery.
        So lastly, just on these four policies for a more equitable
    post-pandemic recovery, so one definitely we need much better
    targeting of grants of credit to Black neighborhoods, to
    industries where you have higher concentrations of Black
    business owners. More regulation and monitoring is also needed
    to reduce discrimination.
        Second, we need to address the disparities in vaccine
    access. We all know that people who study the history of
    vaccine compliance, we know that there is a history of racism
    in medicine in the United States that has led to the mistrust
    we have seen among the Black population today when it comes to
    the vaccine issue. So really working with trusted community
    partners in Black neighborhoods to disseminate information
    about vaccines, and improve access through local communities in
    Black neighborhoods is essential, again, to get--close the
    disparity in vaccination and get us to this 85 percent
    coverage.
        Thirdly, we know that the pandemic has widened racial and
    gender disparities in employment, in health and wealth. These
    effects will last for a long time, except we have real
    concerted policies, everything around universal health care,
    and thinking about government-funded savings accounts for low-
    income families, thinking about, you know, support for and
    protection for labor in these essential service sectors, as
    well.
        And then lastly, you know, thinking forward. Right? We
    expect that we might see more of these pandemics in the future.
    This is what our environmental health policies are predicting.
    So we need to strengthen environmental regulation around, for
    example, clean air quality, to reduce the health and
    environmental vulnerability faced by the Black populations from
    these pandemics.
        So to conclude, any aspect of pandemic economic recovery
    needs to focus on an equitable recovery. It needs to be aimed
    especially at improving the lives of Black communities, or
    communities of color, and women within these communities that
    have been disproportionately harmed by the pandemic.
        Thank you.
        [The prepared statement of Dr. Archibong appears in the
    Submissions for the Record on page 82.]
        Chairman Beyer. Thank you, Dr. Archibong. Thank you, very
    much.
        Finally, we will hear from Dr. Tabarrok. Dr. Tabarrok, the
    floor is yours.

    STATEMENT OF DR. ALEXANDER TABARROK, BARTLEY J. MADDEN CHAIR IN
     ECONOMICS AT THE MERCATUS CENTER AND PROFESSOR OF ECONOMICS,
                  GEORGE MASON UNIVERSITY, FAIRFAX, VA

        Dr. Tabarrok. Thank you, Chairman, Vice Chairman. It is an
    honor to be here.
        About a year ago, a Nobel Prize winner, Michael Kramer, and
    I were asked by the Domestic Policy Council of the White House
    to write a report on using incentives to accelerate vaccines.
    Joined by a number of other top economists, we wrote a report
    advocating spending on the world scale of approximately $150
    billion to invest in 18 vaccine candidates.
        We wrote similar reports for the British Government, and
    also came to later advise the World Bank and other
    organizations around the world.
        The world did not go as big as we wanted. Operation Warp
    Speed, however, was by far the best. These fed about $15
    billion and were tremendously successful. In a recent paper in
    Science, we calculate that if we get 3 billion courses of
    vaccine this year, which is a conservative estimate, that will
    be worth $17.4 trillion--Trillion--to the world economy. And
    Operation Warp Speed should be credited with the significant
    fraction--certainly not all--but with a significant fraction of
    that success.
        Moreover, it is not too late to do more. We calculate that
    if we could get an additional one billion courses of capacity
    online this year, that will be worth 500 billion to one
    trillion for the world economy, depending upon how quickly it
    can be brought online.
        Now is it possible to get more doses this year? Yes, it is.
    The Biden Administration spent $269 million, giving that to
    Merck, to increase the capacity to produce the Johnson &
    Johnson vaccine. That was a smart investment, and continues to
    be a smart investment.
        Another smart investment which we could make is to invest
    in nasal vaccines. The next big hurdle is going to be vaccine
    hesitancy. And a significant fraction of vaccine hesitancy is
    fear of needles. Adults do not like to say that they are afraid
    of needles, or that they do not want to get a shot because of
    needle fear, but that is in fact the case.
        A needle--excuse me, a nasal vaccine would have advantages,
    not only in reducing vaccine hesitancy but a nasal vaccine
    stimulates the mucosal immune system, which is where the virus
    attacks. So they also have medical benefits, as well.
        Moreover, a nasal vaccine or an oral vaccine is going to be
    important to vaccinate children. And that also is going to help
    us to get to herd immunity. After we vaccinate the next--after
    we vaccinate the United States--our next big job is to
    vaccinate the world. And there are health, economic, and
    political reasons to do so.
        The unvaccinated are the biggest risks that we face for
    generating new variants and mutations. You have heard, no
    doubt, about the South African and Brazilian variants. Well,
    the best way to protect your constituents from South African
    and Brazilian variants, and others, is to vaccinate South
    Africans and Brazilians.
        Moreover, economics. Even after the United States and other
    high-income countries are vaccinated, the United States is
    still going to face economic costs from reduced exports,
    reduced imports, and supply chain disruptions due to COVID
    elsewhere in the world. So there are sound economic reasons for
    vaccinating the world. And an additional $4 billion donation to
    COVAX would go a very long way to getting that last mile,
    getting those last people vaccinated.
        Finally, political reasons. We can have an American plan to
    vaccinate the world, or a Chinese plan. I would prefer that we
    have an American plan. Next, as we vaccinate the world, we need
    to think about dose stretching. We know from the clinical
    trials that both the Moderna and Pfizer vaccines, the first
    dose is about 80 percent effective. And in my view, it is
    better to bring more people from zero percent to 80 percent
    protected, than to bring one person from zero percent to 80
    percent and then boost them to 95 percent.
        Speaking loosely, the first dose protects you from being
    killed, from dying. The second dose protects you from getting
    the sniffles. Related to this, we should investigate fractional
    dosing. The phase one and phase two clinical trials indicate
    that half-dosing would be also potentially very, very
    effective. And if one thinks about this half-dosing, that would
    be equivalent to doubling the number of Pfizer and Moderna
    factories. So that would be extremely valuable if we could do
    that. Great Britain and Canada have moved to delaying the
    second dose, and other countries will soon follow suit.
        So summing up, it is not too late to do more. We should
    invest in nasal vaccines. We should vaccinate the world. We
    should stretch doses through fractional dosing and delaying the
    second dose. And this is going to be important to vaccinate the
    world quickly.
        Thank you, very much.
        [The prepared statement of Dr. Tabarrok appears in the
    Submissions for the Record on page 97.]
        Chairman Beyer. Thank you, Dr. Tabarrok. Thank you, very
    much.
        We will now begin the first round of questions. I will
    lead. So, Dr. Gounder, let me start with you. In your
    testimony, you wrote that most scientists believe that SARS-
    CoV-2 is here to stay; that this virus will become endemic and
    will be around with us for years and years to come.
        What are the implications of that understanding?
        Dr. Gounder. So first of all, the reason that this is not a
    virus that we can eradicate is because it does infect other
    species. There are very few viruses that can be eradicated.
    Smallpox is one of the few that which we have successfully
    eradicated, and we are hopefully going to be eradicating polio
    in the coming years. But I think the fact that we have been
    working so long at this with polio speaks to the fact that this
    is a very difficult thing to do, even when it is not a virus
    that infects other species.
        So we do realize that there are going to be pockets of
    people, whether it is in the United States or overseas, who
    will choose not to be vaccinated, who cannot be vaccinated, who
    do not have access, and then others who may be vaccinated but
    who have for whatever reason either waning immunity or just do
    not mount an immune response.
        And so we are going to see ongoing transmission, and that
    means we cannot only rely on vaccination. We need to anticipate
    the needs for testing to make sure that we can assess if
    somebody is infected so we can triage and isolate as
    appropriate. We also need much better therapeutics for COVID.
        Right now, really the best therapeutic we have is
    dexamethasone, which is an old steroid. We have monoclonal
    antibodies, which have a lot of tradeoff in terms of risk,
    especially as we see the rise of these new mutant variants. And
    then we have a number of old drugs that we are trying to
    repurpose and study for their use in COVID. But we really do
    not have a slam-dunk here. And so that is one area we really do
    need to be looking at.
        I think you are also looking at a lot of people who will be
    COVID survivors. And how do you even accurately assess who was
    a COVID survivor, and then be prepared to manage all of the
    health and disability rehabilitation needs that those people
    are going to have? So I think we need to be anticipating and
    preparing on all those fronts, as well.
        Chairman Beyer. Thank you very much.
        Dr. Romer, when we spoke a year ago you were thinking then
    about testing the entire population every two weeks. I would
    love to know why the past tests have not hit the way we had
    hoped. And also, the one percent higher employment-to-
    population ratio of 22 years ago. What should we be doing right
    now, from an economic policy standpoint, to move it back? What
    are the hurdles like child care affordability?
        Dr. Romer. So I think it is an interesting question, why we
    did not make the same kind of push on testing as we made on
    vaccines. And I think there are at least two possible
    contributing factors.
        I think one is that, you know, the health care community
    has been hesitant about testing when there is low prevalence of
    a condition. And in clinical care, it does not make sense to
    just test people with no other indication that they are stick.
        But screening is a very different use of testing. And I
    think people have been a little bit slow to appreciate the
    potential power of screening.
        The other factor I think, which you cannot deny, is that we
    had an administration that had a very explicit policy of trying
    to reduce the number of tests, because it did not want more
    tested confirmed cases as a sign of the seriousness of the
    pandemic.
        So I think both bad administration policy and hesitancy
    contributed to the failure to use the tests. But just as Dr.
    Tabarrok said, it is not too late here. We have a really
    serious question to address about how do we help places like
    Michigan that are getting hit so hard?
        And I think these new at-home tests that are like little
    cards, we should be giving those out to everybody in Michigan,
    everybody who is willing to do one of these tests, and just
    assume and understand that they will isolate themselves if they
    get a test that the test results signal that they are positive.
        Now on how we get back to the kind of labor market
    conditions of the 1990s, I think the most important thing is we
    agree on that is the goal, and we agree on this metric of the
    fraction of adults who are employed.
        Once we agree on that, then we can take the stance of
    trying many different things. Stimulus like we are doing right
    now, aggressive stimulus, will be part of this. And
    infrastructure build could be part of this. But there could be
    other things we could do. We could look at things like targeted
    subsidies for employment, or for new jobs, or for hiring. You
    know, there are many things that we could do.
        But we have got to get away from unemployment rates as our
    metric of success, and get to the more important measure of
    employment rates. And we should remember that by that measure,
    the employment rate, the United States now lags far behind
    other nations that it used to do better than--Canada, Great
    Britain, Germany, Sweden, Australia.
        So we really have kind of failed repeatedly to recover and
    achieve the kind of employment, and the widespread benefits
    from work, and we really need as a Nation to commit to doing
    whatever it takes to get back to that point.
        Chairman Beyer. Thank you, Doctor, very much.
        I recognize Senator Lee for his questions.
        Senator Lee. Thanks so much, Mr. Chairman.
        Dr. Tabarrok, let's talk about the $1.9 trillion American
    rescue plan for a moment. This $1.9 trillion bill was a massive
    economic stimulus. And it was sold as a COVID Relief Package,
    even though less than 7 percent of it was actually allocated to
    COVID testing and vaccines.
        So, Dr. Tabarrok, given that massive economic spending
    today imposes consequences on future generations, does it make
    sense to focus spending on activities necessary for recovery?
    Specifically, those that help us reduce the incidence of COVID?
        Dr. Tabarrok. So I think there is no recovery until COVID
    is defeated. We are close to that. We should have spent more on
    vaccines. I think that is clearer today. We should still be
    spending, as I suggested, on nasal vaccines and oral vaccines.
        I agree entirely with Dr. Romer that testing was
    underdeveloped and could still be used today. Denmark is
    testing 8 percent of their population every single day, about
    50 percent a week. So Denmark is getting close to what Paul
    Romer originally argued for a year ago. And rapid tests I think
    would be very useful in Michigan, as Dr. Romer said.
        The rest of the stimulus budget I think just has to be
    evaluated on its own ground, not as a stimulus, not as COVID
    fighting; you just simply have to ask do we want this
    particular investment? Does it face a cost/benefit test?
        Some of what we spend on vaccines and testing has a
    tremendous multiplier effect. Everything else is much, much
    smaller. Much, much smaller. So I think those other investments
    need to be evaluated on their own grounds.
        Senator Lee. You know, that makes sense. And I tend to
    agree. In looking at that, we have got to remember that one of
    the strengths of our system of government, which is rooted in
    federalism, is a system in which sovereignty and decision-
    making authority are shared. They are divided between Federal
    and state governments.
        But during the COVID-19 pandemic, states were often
    dependent on the Federal Government for both financial
    assistance and guidance. So I have a couple of questions
    related to that.
        In what ways do you think states' reliance on Federal
    support might have inhibited an effective innovative pandemic
    response?
        And what lessons can we learn from state-level
    experimentation where it did occur? And just show us how we can
    support a decentralized type of innovation for future crises.
        Dr. Tabarrok. I was disappointed by the reactions of many
    states and local governments. Let me give you a few examples.
        The states and local governments were told months and
    months in advance, the vaccines are coming. The vaccines are
    coming. The vaccines are coming. And yet when the vaccines
    arrived on their doorstep, they said, ``We do not have enough
    money. We do not have enough money to set up clinics,'' which
    was total nonsense.
        The states and the local governments have spent trillions
    of dollars. You are telling me they could not find a way of
    reducing their budgets, with this huge, incredible benefit of
    getting the vaccination clinics available? No.
        So that was a very poor response, and it slowed us down in
    the early weeks.
        I do think that a lot of energy has been drained through
    the Presidential system to the Executive. I would have liked
    for there to be more experimentation at the state level. As far
    as I know, for example, a state could have introduced, could
    have required going with first doses first, delaying the second
    dose. No state did that.
        So I would have liked to have seen more experimentation and
    a more federalist system. It is one of the United States' great
    strengths, and I think we are losing it by focusing too much on
    what is going on with the Federal Government.
        Senator Lee. Yeah. You know, and I very much agree. I am
    also concerned about the fact that with the recent virus
    mutations that we have seen arising in Spain, the UK, South
    Africa, and Brazil, we have got mutations that could threaten
    the efficacy of our domestic vaccination process as these new
    strains appear in the United States.
        Can you talk to us a little bit about the importance of
    administering more first doses, especially in light of this?
    And would you describe some of the economic and societal
    tradeoffs of not pursuing the first doses first policy.
        Dr. Tabarrok. Right. So the first dose appears to have
    protected about 80 percent. That is very good for the
    individual. But in addition, when you protect two people at 80
    percent, rather than one person at 95 percent, you reduce the
    transmission rate of the virus. To reduce the transmission, it
    is much better to protect more people.
        It also looks like protecting more people, vaccinating more
    people, which you can do by delaying the second dose, it looks
    like that will also reduce mutations. We do not know that for
    sure, but that is what the epidemiologists are now thinking.
        So by protecting more people, we reduce transmission, we
    reduce mutations, we get more people vaccinated sooner. And
    then finally, I would just like to reiterate that another way,
    in addition to this, we need to do this for the entire world.
    Because the best way to protect against South African,
    Brazilian variants is to protect South Africans and Brazilians.
    And so we have an economic, medical, as well as a political and
    ethical responsibility to vaccinate the entire world. And the
    United States is only one of the very few countries that can
    credibly do this. And this is a good opportunity to show our
    entrepreneurship and our power in the world, and our benefit to
    the world.
        Dr. Romer. Senator Lee, if I could, I would like to
    reinforce the point that you were pointing to. It is a
    discussion we need to have.
        If you think back to the 19th Century, the way the United
    States built the best university system in the world was not by
    saying we are going to have this national university, which is
    this shining light for the world. We said we are going to have
    universities in every one of the 50 states. And so the Morrill
    Act, which created the Land Grant Universities, built this very
    robust system.
        Now fast-forward to the most recent period. When we think
    about the capacity of the CDC, or the FDA, we have done the
    opposite. We have said let's build this enormous capacity that
    is centralized under the control of the Federal Government, and
    make all of the states dependent on those organizations. And
    they have sometimes erred and they have left us with what the
    engineers call a single point of failure.
        I think we need to think hard about investing more in
    public health and regulation, but perhaps going back to the
    methods of the Land Grant approach and invest in that capacity
    in the states rather than creating these Federal single points
    of failure.
        Senator Lee. That is fantastic. I am pleased to hear about
    your enthusiasm for federalism, and let's bring back the
    Morrill Act.
        Chairman Beyer. Thank all of you very much. Let me now
    recognize the senior Senator from New Mexico, Senator Heinrich.
        Senator Heinrich. I thank you, Chairman. And I want to
    start with Dr. Gounder on an issue that has been very much in
    the news in just the last couple of days.
        Yesterday alone COVID claimed 987 lives in the United
    States, 9 of those in my home State of New Mexico, that I am
    proud to say is at the forefront of trying to develop herd
    immunity.
        Meanwhile, out of over 6.8 million doses received of the
    Johnson & Johnson vaccine nationwide, 6 people have developed a
    rare and serious form of blood clots.
        So from what the CDC and the FDA and Johnson & Johnson have
    stated publicly, those six individuals also had a very--had a
    known and defined risk profile with respect to blood clots.
        So how can we properly weigh the relative risk of COVID
    versus the Johnson & Johnson COVID vaccine to ensure that we
    are saving as many lives as possible?
        Dr. Gounder. Thank you for that question. I think it is
    really important to understand that the FDA has not pulled the
    Johnson & Johnson vaccine from the market; that the Emergency
    Use Authorization still stands. This is just a pause, a time-
    out for the scientists to step back and review the data.
        And I think that is really important. Because when you look
    at what our biggest obstacles are in the coming months, it is
    really around vaccine demand, or hesitancy, or confidence,
    whichever word you want to use. And one of the biggest drivers,
    especially in those who are most recalcitrant, most resistant
    to getting vaccinated, it really comes down to either a lack of
    trust in health systems, or a lack of trust in the government.
        And so it is absolutely essential that the CDC and the FDA
    behave in a way that is transparent, honest, above-board, and
    that they show they are doing their due diligence, because that
    is really what is going to predict in the longer term whether
    people feel comfortable getting vaccinated. They need to trust
    in the government, in the CDC, in the FDA. And by doing this
    review that is going on--actually, I think as we speak today--I
    think that is what is going to get us there.
        We have seen, as you mentioned, six of these severe side
    effects. They are all in women who are between the ages of 18
    and 48, and they have had other predisposing conditions. And I
    think there is quite a good possibility that what you will see
    happen, and we have seen something similar happen with the
    AstraZenica vaccine in Europe, is that the CDC and FDA will
    recommend potentially restricting access, or restricting use of
    this vaccine for certain populations.
        We have not seen any of these severe side effects here with
    J&J among men, for example. We have not seen that side effect
    with older people. And so it may just be that they step back
    and say maybe this is not the best option for younger women of
    reproductive age, but for the rest of the population this
    continues to be a great option.
        You know, I think as physicians we err on the side of doing
    no harm, and so I think it is really important that we abide by
    that. And I think it is really important that this message got
    out there as soon as possible so that doctors and patients know
    what to look for.
        The most common treatment we use for blood clots, heparin,
    is actually dangerous for this particular kind of blood clot
    and can be deadly. So it was really essential to get the
    message out there as soon as possible, so that if me, for
    example, as a provider, I have had patients who got the J&J
    vaccine. If I see one of those patients back, I know what to be
    looking for and what to do.
        Senator Heinrich. Thank you, Dr. Gounder. What you outlined
    there in terms of changing the target population is exactly
    what I was discussing with the White House just minutes ago.
    And so I am hopeful that we can be absolutely transparent in
    this process, look at the data, and then hopefully get this
    very efficacious vaccine back into the places where it is
    appropriate. Because it is our best tool in some of the hardest
    to reach communities.
        Fractional dosing, is that something, Dr. Gounder, that you
    would agree with Dr. Tabarrok on? And should we view looking at
    vaccinating the entire country with the first dose, for
    example, and then coming back and prioritizing second doses for
    the most immune-compromised and having that same sort of phased
    approach that we have used in New Mexico to really get ahead of
    most of the rest of the country in terms of developing herd
    immunity?
        Dr. Gounder. I think you need to be very careful in how you
    interpret the data about 80 percent effectiveness after a first
    dose, and over 90 percent after a second dose. I think the
    problem is that immunity is not ``on or off.'' It is a range or
    a spectrum.
        And so you may be immune after one dose to the most
    prevalent original strains, but now we have also seen the rise
    of the B.1.1.7 variant, and also, as you mentioned earlier, as
    we have mentioned earlier, the variants out of South Africa and
    Brazil. And we have several studies now that indicate that
    after one dose you still have break-through infections with
    both the B.1.351 from South Africa, and the B.1.1.7 from the
    UK.
        So there is a very real risk that you would be creating
    this prolonged window where you would be selecting for, putting
    immune pressure for more of these variants to emerge. That
    said, I think the fractional dosing strategy is something that
    should be studied. It can be done pretty quickly, and it is
    something that we should go ahead and evaluate. And if that
    proves to be as effective in terms of the immune response
    solicited as the current full dose, that is something we should
    absolutely be doing.
        Senator Heinrich. Thank you very much. Thank you, Chairman.
        Chairman Beyer. Thank you, Senator, very much. And I
    recognize my fellow Ways and Means classmate, the gentleman
    from Wichita, Mr. Estes.
        Representative Estes. Well thank you, Chairman Beyer.
        From the beginning of the health crisis, we were told that
    vaccines and herd immunity were the keys to reopening the
    economy. Now we have multiple vaccines, and two more in Phase
    III trials. We are moving forward with that. And having 180
    million people, Americans that have already received at least
    one dose of the vaccine, and a vaccination rate of 78 percent
    of those over 65.
        What I hear in my District in Kansas is, you know, when we
    get back to life? A lot of businesses have suffered. Children
    are falling behind in school. And a lot of people have lost
    their jobs.
        We have done a mixed review, or mixed results maybe in
    terms of vaccinations within the state. Specifically, we have
    done a good job of vaccinating seniors, and now of
    vaccinating--reaching out to all adults. But we rate 35 in the
    country of swiftly administering the vaccinations that have
    been given to us.
        The operational speed, as mentioned earlier, and some smart
    investments, the United States were able to develop this
    vaccine in record time. And your Trump Administration purchased
    over 800 million doses, which just set things up now, at the
    end of the Trump Administration and with the current
    Administration, for success.
        Although experts repeatedly said we would not have the
    vaccine by the end of 2020, they were wrong. Tomorrow, 26
    states will expand vaccine eligibility to all adults, and by
    May 1st all states will have open eligibility.
        But instead of focusing on COVID relief to help get the
    economy going, some of the discussions in some of the bills
    like the Rescue Plan have very little funding for vaccine
    distribution efforts, and, instead, spend a lot of money
    bailing out states, again taking away the federalism mindset.
    Even Politifact, which is not known for a conservative point of
    view, has admitted that the COVID-19, the American Rescue Plan,
    is not a COVID-19 package. And I quote that at the end, direct
    COVID-19 spending is about 8\1/2\ percent of the bill's $1.9
    trillion cost.
        Instead of backing big government spending initiatives, we
    should focus on crushing the virus, kick starting the economy,
    and getting Americans back to work by implementing pro-growth
    policies to help American businesses such as R&D expensing,
    which is going to be expiring this year. We need to make it
    permanent in order to make some of the jobs back in America.
        I do want to ask a couple of questions of Dr. Tabarrok.
    Through Operation Warp Speed, the vaccine testing and
    production was able to be conducted in tandem and in a more
    streamlined manner. How can we formalize or codify this process
    to help make sure that we minimize such severe economic impacts
    in the future?
        Dr. Tabarrok. So I think one of the silver linings to the
    crisis is that it has shown that FDA delay can also be very,
    very costly. So people are seeing for the first time that the
    longer the FDA takes to approve, whether it is a vaccine or a
    drug or something like that, can have a real consequence in
    terms of people dying of COVID or some other disease.
        This is also true for cancer. This is also true for heart
    disease. This is true for all of the products that go through
    the FDA. And it now costs over a billion dollars to get the
    typical new drug approved.
        We need to find some way of reducing that to have more
    experimentation and more new drugs. Because new drugs
    absolutely do save lives. So if we can find a way of using our
    experience from COVID to accelerate FDA approvals across the
    range, I think that would be tremendously beneficial to
    American patients.
        Representative Estes. Great. That kind of leads into
    another thought I had around the breakthrough that we and with
    mRNA technology that really did allow us to develop the vaccine
    very quickly.
        Are there things that we can do, incentives such as
    improving R&D expensing, or genius prizes, some of those so-
    called genius prizes that would help us make breakthroughs in
    the future?
        Dr. Tabarrok. Yeah, so two points. Going back to one of the
    earlier questions which was asked--what about if COVID becomes
    endemic--well, one consequence of that is that every investment
    we make now is going to have a very long payoff. So that is
    great. So this increases our incentive to invest in mRNA
    technology, which is capable of not just producing a vaccine,
    but is also capable of producing drugs to treat cancer and
    heart disease, and so forth.
        So I think all of these things are a great way to invest.
    R&D expensing may be certainly a part of that. And, prizes,
    yeah, I do think that prizes should be looked at more. The pre-
    market purchases, the advance-market commitments which we made
    for Pfizer, saying we are going to buy hundreds of millions of
    these doses, that is very similar to a prize. And that worked
    very well in incentivizing Pfizer to invest billions of dollars
    in factories, which is now paying off now.
        Representative Estes. Thank you very much. And, Mr.
    Chairman, I yield back.
        Chairman Beyer. Thank you. Thank you, Mr. Estes. I now
    recognize who I believe is the senior Senator from Georgia,
    Senator Warnock.
        Senator Warnock. Well thank you so very much, Chairman
    Beyer, for that promotion. Senator Ossoff, who is my colleague
    and friend, will be glad to know that I am now the senior
    Senator. He is actually the senior Senator. Let me note this
    only because ``O'' comes before ``W.'' I have been suffering my
    whole life having my last name Warnock. It is the only reason
    he is the senior Senator, because he is Ossoff and I am
    Warnock.
        [Laughter.]
        Chairman Beyer. There is no fairness. You got more votes
    than he did.
        Senator Warnock. Go figure. Well, I did not say all of
    that. You said those things. But we both won.
        Listen, thank you so much. It is an honor to be here at my
    first Joint Economic Committee hearing, and I look forward to
    working under your leadership, and working with all of my
    colleagues to discuss issues and propose solutions that will
    allow for a robust economic recovery.
        As has already been discussed in this committee hearing,
    the COVID-19 pandemic, while it has impacted all of us, some
    communities have experienced a profound disproportionate
    impact. And I am speaking in this instance about women in
    general, particularly low-income women, and women of color who
    are not only experiencing the steepest job declines, but also
    severely lagging in the overall jobs recovery.
        It took until 2018 for the rate of employment among Black
    women to recover from the last financial crisis, almost a full
    decade later. And now, almost all of those hard-won gains have
    been erased due to this economic downturn created by a once-in-
    a-century pandemic. And so I would like to ask Dr. Archibong,
    based on your experience studying how pandemics affect
    economies, what should we expect about our own economic
    recovery, if past is prologue? Should we expect that economic
    prospects for women, especially women of color, to continue to
    lag behind? And what can we do to avoid that from happening?
        Dr. Archibong. Thank you very much, Senator Warnock, Rev.
    Warnock. I do not know if you remember that we met sometime
    ago, but it is nice to see you again. And it is nice to see you
    again.
        It is a very, very important question. It is something that
    I have been studying, the effects of the pandemics on gender
    inequality. We are seeing that women generally,
    disproportionately are involved in home production. So a lot of
    women dropped out of the labor force to take care of families,
    to take care of children. And one of the things that the
    official statistics might decide on kind of the workforce
    statistics, the unemployment statistics, by gender, is that we
    might be missing a lot of women who have just dropped out of
    the workforce altogether, that are no longer looking for jobs,
    which would not be reflected in the unemployment statistics.
        So that is incredibly worrying. This is something that in
    other contexts that I have looked at we see that these widening
    gender gaps are in human capital investment, in the labor
    market, in educational attainment, and these have existed for a
    number of years, except we have, again, a policy that is not
    just a blanket policy about pandemics, but a policy that says
    we are going to take very seriously the fact that certain
    populations, as you said, are disproportionately being harmed.
    Women are disproportionately being harmed by the pandemic. They
    are dropping out of the labor market almost entirely.
        How do we get them back to pre-pandemic levels? And even, I
    would say, better than pre-pandemic levels especially if we are
    looking at women of color, Black women who in pre-pandemic
    times were much, much strained when it comes to unemployment
    rates.
        So what does this mean? This means like thinking about--
    when we think about stimulus and cash grants, thinking about
    incentives that are targeted by gender, thinking about
    incentives that are targeted toward households where women are
    living and doing a lot of unpaid care work, and really being
    very deliberate about the kind of policy, and thinking about
    gender and racial implications of the policies that we are
    passing.
        So I think that is important. And I just wanted to add,
    just to respond, I have been listening to the very interesting
    conversations and responding to Dr. Romer's point earlier, I
    think actually where you really need centralized authority. So
    the CDC is important. The WHO in my experience is very
    important in terms of coordinating these efforts. And also
    coordinating efforts that again to think very carefully about
    the gender and racial disparities that come about from the
    effects of these. So thank you very much for the question.
        Senator Warnock. Thank you so much. And I have got a few
    seconds. So we passed the American Rescue Plan, which is, you
    know, a step in addressing some of the disparities that you
    talked about exacerbated by the pandemic. We are now focused on
    infrastructure, the American Jobs Plan. And we think about
    women, and child care, and a whole range of issues.
        What kinds of things should we be thinking about as we put
    together an infrastructure program to take seriously the need
    to address these disparities as we think about jobs and the
    economy?
        Dr. Archibong. Right. So one thing that my colleagues have
    studied and mentioned and thinking about are subsidies for
    child care. So that is something that, again, women are
    disproportionately dropping out of the labor market to take
    care of children, a lot of women, to take care of household
    members that were sick. And so thinking about the necessity for
    child care, and thinking about, you know, whether it is kind of
    easily accessible work retraining programs to get women back
    into the workforce, these are the types of policies that I
    think would be very effective and have worked in other contexts
    in closing these gender gaps as a result of pandemics.
        Senator Warnock. Thank you so very much.
        Chairman Beyer. Thank you, Senator, very much. I now
    recognize the Senator from Texas, Senator Cruz.
        Senator Cruz. Well thank you very much, Mr. Chairman, and
    welcome to each of the witnesses. Thank you for your testimony.
        Dr. Tabarrok, I want to start with you and address a topic
    that is of significant concern to me. And that is the topic of
    vaccine passports, where there has been a lot of discussion
    about requiring vaccine passports, either the Federal
    Government requiring vaccine passports, or individual private
    companies requiring vaccine passports to be able to utilize
    transportation, to be able to utilize essential infrastructure.
        I have deep concerns about any mandated vaccine passports.
    My concerns include concerns about protecting patient privacy
    rights. What personally identifiable information would be
    shared? Who maintains the information? Whether patients that
    have provided informed consent on the use of this information,
    can the information be shared or exploited by governments or
    businesses? What are the risks of hacking this information by
    foreign nations and criminals? And also the significant
    potential for discrimination against individuals who either
    make the choice not to get the vaccine, or for various medical
    reasons are not suitable candidates to receive the vaccine,
    whether they will face discrimination in terms of public
    carriers, discrimination in terms of being able to stay in a
    hotel, discrimination in terms of being able to eat at a
    restaurant. And in my experience, I think a lot of Americans,
    certainly a lot of Texans, are very concerned about this.
        Recently, White House Press Secretary Jen Psaki said,
    ``There will be no Federal vaccinations database and no Federal
    mandate requiring everyone to obtain a single vaccination
    credential. America's privacy and rights should be protected so
    that these systems are not used against people unfairly.''
        I was encouraged by those comments. I am not sure I believe
    that is where the administration will end up, but I liked at
    least that they were saying that. I think that was a step in
    the right direction.
        Dr. Tabarrok, do you agree that the Federal Government
    should not establish a Federal vaccine mandate?
        Dr. Tabarrok. Yes, I agree with that. I do have mixed
    feelings on so-called vaccine passports. I am not particularly
    against universities, for example, requiring their students to
    be vaccinated, as a number of universities already have
    suggested they will.
        So I think private employers should be allowed to say that
    we want our employees to be vaccinated. I do think the
    following is maybe some way of finding some compromise, and
    that is: Look, this is going to be a very temporary problem. I
    believe that we will quickly, with more vaccinations we will
    quickly get back to normality, even as early as the summer, the
    late summer. I think these issues will begin to fade away at
    that time, particularly as most people will be vaccinated just
    because it is the smart thing to do, it is the rational thing
    to do. And as death rates fall, as the infections fall, I think
    some of these calls will go away.
        Many countries, however, will require a vaccination to get
    into their country. So literally you will require to be
    vaccinated if you want to visit a lot of foreign countries. I,
    myself, am eager to travel again, and many countries already
    require a yellow fever vaccination. And so I think that is
    going to become fairly common, whether one wants it or not.
        I am against the Federal mandate but, as I said, I think if
    we can make vaccines easier to get, at low cost, then people
    are going to be vaccinated, and this problem will fade away
    very quickly.
        Senator Cruz. Well, look, I agree that vaccines should be
    widely available. I have been vaccinated. My wife has been
    vaccinated. Both my parents have been vaccinated. That being
    said, our children, who are 10 and 13, have not been
    vaccinated. And in terms of the cost/benefit analysis, I think
    it is quite different for an adult, or for a senior, than it is
    for the young child.
        Are you concerned about the civil rights implications of a
    vaccine passport? You suggested universities requiring students
    to be, or faculty members to be vaccinated. Right now, women
    who are pregnant or trying to get pregnant are not recommended
    to take the vaccine. Would you be troubled by the
    discrimination effects of a university that in effect excluded
    women who were pregnant or trying to get pregnant from
    attending university? Are you troubled by airlines saying
    children who have not been vaccinated are not allowed on the
    plane and cannot travel anywhere? Does that raise concerns that
    should give us pause?
        Dr. Tabarrok. So first of all, I think the recommendation
    actually is that pregnant women are--should be vaccinated.
    Second, yes, of course I would be concerned if that were to
    happen.
        However, I think this is a case where there is going to be
    loss of opt-outs. It is going to be possible to say, you know,
    children are excluded. You know, if you have a good reason, you
    do not need the vaccine.
        Basically, once we get to herd immunity, these problems are
    going to fade away. So I do not think--although I would
    certainly be worried if the things which you describe were to
    happen, I do not think they are going to happen. And the way to
    prevent them from happening, ironically enough, is through,
    look, everyone get vaccinated. Make it cheap, make it easily
    available. It needs to be rolled out in all kinds of
    communities.
        One of the reasons--one of the good things we have been
    doing lately is getting the vaccines into the pharmacies. The
    pharmacies have much greater ability to reach low-income
    minority communities. They are trusted. And so we need to use
    the pharmacies even more than we have been. And if we get it
    out widely so that you can just walk into a pharmacy, which is
    going to be happening--Texas, by the way, has led the way. So
    Texas should be applauded for leading the way on making it easy
    for anybody to get a vaccine. Texas has done great in that way.
    We should all be following the Texas model for the entire
    country.
        Senator Cruz. Dr. Gounder, I saw you shaking your head when
    I was asking the question, and I would welcome your views. You
    seemed to be disagreeing with the proposition that women who
    were pregnant or trying to get pregnant should not take the
    vaccine. So I guess I would ask, what are your views on that?
    And what are the scientific data that back up those views?
        Dr. Gounder. Sure. It is always that great----
        Senator Cruz. Dr. Gounder, if you could do that quickly so
    we can move on?
        Dr. Gounder. Sure. Sure. It is always great to speak to
    another Princetonian alum, Senator. There is data that
    demonstrates that, one, if a woman gets COVID during pregnancy,
    similar to what we see with the flu, she can have a much more
    severe case. It is deadly for the mother. It is deadly for the
    child. She is much more likely to have a pre-term delivery. And
    we have also seen that women can be safely vaccinated during
    pregnancy, when they are trying to get pregnant, and when they
    are breast feeding. And it is the best way to protect her
    pregnancy and the unborn child.
        Senator Cruz. Are there any data or empirical studies you
    can point to on that, that it is safe for pregnant women? I
    know there are a lot of women who are concerned about that.
        Dr. Gounder. Yes. And I am happy to share some of those
    after the hearing.
        Senator Cruz. I would ask you to share that with the
    committee members. I think there would be widespread interest.
        Thank you, very much.
        Chairman Beyer. Thank you very much. I now recognize the
    Senator from Minnesota, Senator Klobuchar.
        Senator Klobuchar. Thank you very much, Chair Beyer, and
    congratulations to Senator Lee on his work as well on the
    committee in his new position. And thank you for taking on this
    really important topic.
        I look at this in terms of the vaccine in a few ways. The
    first is, I have to start at home. I did a number of events on
    misinformation, starting with at the Mayo Clinic. I made the
    point that 95 percent of their doctors got the vaccine. And we
    still are having issues. I was in a campaign in my
    neighborhood, and one of the workers there told me that his
    mother-in-law would not get it because she read on the internet
    that a microchip would be planted in her if she took the
    vaccine.
        So I wondered if, Dr. Gounder, you could talk about what is
    going on, and speak to how the misinformation can undermine our
    efforts, and what we should do about it. I have some strong
    views about the tech companies, but I am not going to go there
    today or I will use up all my time. Okay, thank you.
        Dr. Gounder. I think it is a really important question.
    There are really two main groups of people who have hesitancy
    about getting vaccinated. You have people who we would call
    them ``movable middle'' who are just straight-up concerned
    about safety and effectiveness. And there has certainly been
    misinformation whether the vaccines are safe and effective--and
    to be clear, they are.
        And then you have people who just do not trust government,
    do not trust public health officials, do not trust the health
    system, and that is a much more difficult one to overcome.
        What we have seen with respect to disinformation is that
    there is a lot of incorrect information that is circulating
    online. This has been looked at and studied, and there are
    actually--and I have this in the written testimony--some 12
    people who are responsible for the vast majority of that. And
    they have remained on the social media platforms. They have not
    been deplatformed, and that would be a highly effective way of
    dramatically reducing the amount of disinformation.
        Because essentially what is happening is those are the
    sources that then get amplified.
        Senator Klobuchar. Oh, I know. Well it's rare that someone
    is so practical in their answer--no, I do not mean that to the
    other witnesses, but so thank you. Maybe we can try to do
    something about these 12 people.
        Dr. Gounder. Yeah, and it is interesting, having spoken to
    a number of the social media companies, very often you get this
    answer: Well, it is a really hard problem. We are trying--but
    there are some very practical, easy things they could do here.
    But I think that is one.
        Senator Klobuchar. Yes.
        Dr. Gounder. I think it is not just social media. It is
    also the mainstream media, television, other outlets that are
    responsible for this. For example, any time there has been
    supposedly a side effect related to vaccination, you will get
    all of the headlines initially reporting that. And then when
    you have the follow-up data as to what really happened, that
    does not get covered. That is not the catchy story, right?
        And then finally, the other thing that we are seeing in
    this relates to what Dr. Tabarrok was saying earlier about, you
    know, he would rather see this global vaccination effort be led
    by the Americans, not the Chinese. I think you are also seeing
    very intentional efforts by the Russians to smear Western
    vaccines to make their vaccine look better. And, unfortunately,
    that is permeating what is online, and some of what the
    mainstream media is even picking up now.
        Senator Klobuchar. Exactly. Okay. Well, thank you. That was
    a very thorough answer.
        Dr. Archibong, throughout the pandemic women, especially
    moms, have been disproportionately affected by job losses. And
    I came up with this Marshall Plan for Moms to combine a lot of
    the things that we have learned during the pandemic about child
    care, and schools, and the help that they need.
        It is interesting, because the last downturn
    disproportionately affected men, and construction jobs, and the
    like. And this has sent tons of women out of the job market
    because of the kind of jobs that they lost, but also because
    they were home with their kids. And now a number of them are
    starting to come back, but there is not child care.
        Your research has shown that epidemics can contribute
    significantly to worsening gender inequality. Can you talk
    about the policies that would work to address it?
        Dr. Archibong. Thank you, Senator Klobuchar. And just as I
    mentioned to Senator Warnock, this is something where you need
    any policy--be it cash grants, stimulus, subsidies to
    households--to think about the composition of households to
    say, look, if there are more in the households, maybe you want
    to direct more of these subsidies for child care toward those
    households.
        So having policies that are very gender conscious in how
    they are implemented is something that has worked in other
    contexts to try and include these gender gaps that happen after
    these pandemics.
        So I mentioned, again, households, thinking about how do
    you get women back into the labor market, right? So in the
    post-pandemic economy. So this might involve like work
    retraining programs, investing in outreach and work retraining
    that is focused on women. And so that is something that, you
    know, again has worked in other countries and I think it will
    be very important to do here.
        Senator Klobuchar. Alright, thank you. Thank you to all of
    you.
        Chairman Beyer. Thank you, Senator, very much. I now
    recognize the senior House Republican on the Joint Economic
    Committee, Congressman Schweikert.
        Representative Schweikert. Thank you, Chairman Beyer. And
    actually a couple of things.
        One--and this is more for you--and I would like to submit
    this one for the record, it is an Atlantic article in regards
    to mRNA Technology and the fact that we have just leaped almost
    a decade in our technology for almost the biofoundry that we--
    actually, you and I talked about a couple of years ago, as
    being a health care cost disrupter. So I would like to submit
    that for the record. I think you have to say ``yes.''
        Chairman Beyer. Without objection, it is accepted.
        [The URL for the article referred to appears in the
    Submissions for the Record on page 110.]
        Representative Schweikert. And to Dr. Romer, I would love
    to try to work with you to encourage Chairman Beyer to do a
    discussion in regards to labor force participation, where we
    are in the demographic curve. We actually had a conversation in
    Joint Economic a couple of years ago in regards to everything
    from barriers to what was happening out there, to--and it was
    surprising what we learned from some of the testimony of things
    we thought were barriers were not, and things we would have
    never thought of as encouragements to come back into the labor
    force to get back up to that type of participation.
        Mr. Chairman, and this is sort of--I am going to take
    advantage of having a freaky smart group of witnesses here. We
    have been looking in our office at some of the health care
    outcomes, some of the populations that had very uncomfortable
    mortality statistics, who got sickest, who--these sorts of
    things. In my part of the country, being from the Phoenix,
    Scottsdale area, it is Native Americans.
        I represent a couple of Tribal communities. One of those
    Tribal communities may have the second highest diabetes, type 2
    diabetes, population in the country. And they had some pretty
    rough numbers in regards to COVID.
        So as we have this discussion of getting a vaccine rolled
    out, and efficacies in different parts of the country, and
    different populations, I am wondering if we should actually
    have a somewhat different conversation as the Joint Economic
    Committee. Are we ready to maybe discuss a real disruption?
    And, look, Chairman Beyer knows this, a number of my charts
    show I have a fixation on charts, and I am not going to show
    all of them--but health care turns out to be the primary driver
    of U.S. sovereign debt over the next three decades.
        I have a factoid over here that for Medicare--Medicare is
    the primary driver of U.S. sovereign debt over the next three
    decades--Medicate beneficiaries with diabetes account for about
    30 percent of medicare spending. Would it be one of the most
    elementary and very difficult things we could promote as a
    committee to help minority communities, my Native American
    communities, that suffer from diabetes, at the same time being
    able to make an argument that this is one of the most powerful
    things we could do for future debt and spending, but also
    differential health care outcomes?
        Maybe it is time for an Operation Warp Speed/Diabetes. And
    could technology such as the mRNA, or other things--and, look,
    it is tough. Because on one side we have an autoimmune; the
    other side we have some lifestyle issues. I would love some
    input from the panel, with what we have experienced this last
    year on concentrating resources, moving technology, could we
    now take on one of the most expensive diseases in our society?
        And I would love to start with Professor Romer. Give me
    your thoughts. Am I being a big Utopian?
        Dr. Romer. Well, thank you. I think, no, you are not being
    Utopian at all. I think our consistent failure is that we lack
    imagination and ambition. Because when we try and do something
    audacious--let's go to the moon! Let's build an interstate
    highway system that links the whole country. When we set a big
    ambition and then go for it, this Nation can do it.
        So I think, no, we should be setting that kind of a target.
    And in terms of how we get there, I understand Professor
    Archibong's hesitancy about my suggestion about just kind of
    involving the states. I think this is the conversation that we
    should have, though, when thinking about a mixed system.
        If you think about, for example, like Professor Tabarrok's
    point that we are not running tests to see if lower doses could
    actually work with the current vaccine, if we had a system
    where we really relied on the states as the laboratories of
    democracy, we could have some states that take the lead in
    trying to say through the fractionated doses, or a state that
    could be particularly interested in diabetes and say we are
    going to make an aggressive push in trying to treat this.
        I think what we need is something which is kind of parallel
    to the universities. We have a wonder system of universities
    across the United States. But you need these organizations that
    really focus on the transition from the academic research into
    the public policy goals. And, you know, the mechanisms that can
    do like what we did with, you know, the BRDA commitments on
    mRNA vaccines. I think more competition, more ambition would be
    great.
        Representative Schweikert. I am up against the tyranny of
    the clock, but it is actually something I would be elated to
    have input from the panel, but even from my fellow members.
    Maybe it is time we come together, because this one could be
    bipartisan, and do an Operation Warp Speed Diabetes, and bring
    those goods to all of society.
        So thank you, and thank you, Don, for your patience.
        Chairman Beyer. You gave us the lead. Twenty-five percent
    of Medicare is just end-stage renal disease right now. So let
    me recognize my dear friend, the dear Congressman from Madison
    Wisconsin, Mr. Pocan.
        Representative Pocan. Thank you very much, Mr. Chairman,
    and thank you to the witnesses. I am one of the new Dems on the
    committee, so very glad to be with everyone today. Also, a 33-
    year owner of a very small business, under 20 employees. I
    guess these days people call them micro businesses. I
    personally hate that term. But, you know, a very small
    business.
        And it seems like, you know, when we had the 2008 economic
    crisis, there was a little more, from memory, general malaise.
    This time there are real almost winners and losers, right.
    There are some deep industry hits--you know, restaurants and
    bars, travel industry, meeting industry. And I have a few
    questions related to that.
        I would like to get to a few subjects, so I will try to be
    quick for answers. Dr. Romer, you talked about getting more
    testing out there. That is one of the solutions.
        Let me ask this, because I have had a lot of talks with my
    state about this. Should we also keep up, or intensify contact
    tracing as part of that answer, as well?
        I think you are on mute.
        Dr. Romer. This is a very good question. And I should say
    that reasonable people will disagree on this one. I think in
    general people think that when you have got a low level of
    prevalence, then contact tracing is a very good way to try and
    respond and keep it low.
        The problem is that, once the prevalence gets too high, the
    tracing system is just overwhelmed. So we need to have a system
    that works like the kind of screening testing when you get to
    high prevalence, but also emphasize contact tracing at low
    levels.
        The other thing, just to be completely honest here, public
    attitudes are changing. And I wish they were not changing, but
    they are. People are a lot less willing to answer the phone. If
    they answer the phone, a lot less willing to answer a specific
    question. Like the yield rate, where you have got somebody who
    is a known positive, and then you try and trace back and find
    contacts. The yield rates are very low right now.
        So I wish it were not so, but it may be that we have to
    accept that this is the new world we are dealing with, and then
    try and find some other mechanisms where we can try and address
    this. And if I can make like a tip of the hat to Senator
    Klobuchar, I think part of why people are so suspicious and so
    mistrusting is they have had their trust abused repeatedly by
    these big tech firms.
        And so, unfortunately, it is the government which is now
    being distrusted because of repeated abuses of trust in the
    private sector. So I wish we could do something about that.
        Representative Pocan. Thank you. Just to make sure I get my
    two more questions, I am going to throw them both out there,
    and whoever wants to take them, because you specifically
    mentioned testing and I wanted to follow up on contact tracing.
        The second one is, it was mentioned that, you know, if you
    get one shot you might just get the sniffles, with two shots--
    or, yeah, you will not die with one shot, but you might get the
    sniffles.
        The question of long haulers are now what you call post-
    acute, whatever the new term we are using. Do we know anything
    about people, if you still get it now after you have been
    vaccinated, does it still have the same potential effect around
    long-haulers? That is the first question.
        And then the second question is, what is the realistic
    expectations around summer? I happen to, in my small business
    we work very closely with the meeting industry, and it has been
    devastated. People are completely out of work, because you
    cannot have the virtual meeting in the normal way, and with the
    jobs that are there.
        Someone is looking at a convention of 1,500 people in late
    August. Is that realistic? Or is any number like that
    realistic? What are we honestly looking at, assuming that
    people keep getting vaccinated and we are keeping the rates
    down. So sniffles, long-term--long-hauler issues, realistic
    expectations around things like meetings and conventions.
        Dr. Gounder. Yeah, I can comment on some of that. So with
    respect to sniffles versus severe disease, what you see is you
    have higher neutralizing antibody levels after a second dose of
    vaccine versus just a dose of vaccine. So that is going to
    correlate to some degree with disease severity.
        But it also--again, it is important to understand that you
    may have breakthrough infections, especially with the variants,
    after just one dose.
        With respect to long-haulers, the COVID vaccines may
    actually function as therapeutic for those groups. There are a
    couple of different hypotheses as to why long-haulers have the
    symptoms they do. But by giving them a dose of vaccine, you are
    priming their immune system to respond to perhaps what may be a
    latent, ongoing low-level virus infection. Maybe you have
    remnants of the virus. But it is causing your immune system to
    respond to that. And a lot of people are reporting improvement
    in symptoms.
        So this is something that is being actively studied right
    now. If we are able to maintain the same pace of vaccinations,
    we will be in a much better place by the end of the summer. We
    could be reaching, at least among the adults, you know, the 80
    percent plus range. Of course, you still do not have kids
    vaccinated. But it really will depend on what happens, whether
    we can keep up that same pace.
        Dr. Romer. Yeah, if I can just weigh in. I think we have
    got to admit that there is some real uncertainty about what
    happens this summer. If I were responsible for organizing a
    meeting, I would set it for September or October.
        If it were July, I would cancel it. August, you are just a
    little bit on the edge. And it could be that things turn out
    fine, but there is just a lot of uncertainty about how this
    will play out.
        And as I said about Dr. Gounder's point before, it takes
    about a month after somebody gets their vaccinations to be
    fully immune. So it is wonderful that we are going to have
    everybody--essentially everybody vaccinated by August, but, you
    know, we are still going to be in this kind of vulnerable
    period until we really get into the fall.
        Representative Pocan. Thank you, Mr. Chairman.
        Chairman Beyer. Thank you, Mr. Pocan, very much. Now I
    would like to welcome another of my Ways and Means members to
    the Joint Economic Committee, the gentleman from Texas, Mr.
    Arrington, the floor is yours.
        Representative Arrington. Chairman Beyer, good to be with
    you, and great to join the Joint Economic Committee, and this
    great group of thinkers, and patriots. And as we formulate
    together advice and counsel economic policies to get our
    country back to the pre-COVID prosperity. I am looking forward
    to working with you, sir, and my other colleagues in both
    chambers, also recognizing Ranking Member Lee for his
    leadership.
        I represent rural--a big swath of rural America in West
    Texas. We have our unique challenges, and we have some unique
    benefits to being rural. But I am very proud of what our State
    has done, Texas, to balance the various factors that are
    important, like the spread of COVID, obviously, but also the
    long-term effects of being isolated, and kids being not in
    school in that very important support system. And whether
    substance abuse, or deferred screenings and treatments, there
    are some major consequences to not getting back and reopening
    our country, going to work and obviously having children in
    school.
        So no doubt having vaccines widely distributed, and the
    effectiveness and the development of new therapeutics are
    absolutely key to that. But I have got a question first for Dr.
    Gounder about the big drop, you said, in demand in terms of
    taking the vaccines.
        Explain to me the reasons for the drop with respect to the
    hesitancy factor. What are some of the reasons within the
    different demographics--women, men, rural, urban, older,
    younger. I would like to understand that whole dynamic of
    hesitancy as it cuts across the different demographics.
        Dr. Gounder. So if you look at the demographics and how
    that correlates with the type of vaccine hesitancy, what we see
    among communities of color, and among younger Americans, it is
    much more questions of access, of not being able to navigate
    the system, of getting to a vaccination site. Maybe they are
    not able to take time off work because they are an hourly wage
    worker.
        There are some historic reasons for lack of trust. Everyone
    always points to that Tuskegee study, but that is actually a
    drop in the bucket. There is a whole history of this, even
    ongoing up to the present day.
        And I think this is where colleagues of mine, like Rhea
    Boyd, Uche Blackstock, a lot of Black doctors have really done
    a tremendous job of reaching out, and we have seen the impacts
    already in terms of increased trust, increased confidence in
    the vaccines that has not been done with younger people yet.
    But I think those two groups are a bit easier to get to because
    in general their concerns tend to be pretty practical in terms
    of access, the costs, and so on.
        Then you also have other groups, which include more rural
    Americans, more conservative Americans, who just do not like to
    be told by the government what to do. They do not trust the
    health system, or public health officials, or the government.
    And so----
        Representative Arrington. Some of my constituents?
        Dr. Gounder. Excuse me?
        Representative Arrington. You must have been talking to my
    constituents.
        [Laughter.]
        Dr. Gounder. That is funny. I actually spoke to somebody
    from Bedias, Texas, which is between College Station and
    Houston, a different rural area, but also rural in Texas and,
    sometimes this is also cultural. People want the freedom to do
    what everybody else like them is doing.
        And so if it is not what people in their community are
    doing, they are just going to be resistant. They are not always
    going to be able to explain exactly why, but we really need to
    be reaching out through the people who are credible in those
    communities, who they trust. And very often that is local
    health care providers, their primary care provider, who can
    really get through here.
        Representative Arrington. Thank you very much. In my
    remaining seconds here, Dr. Tabarrok, I know a lot of employers
    that want to respect the personal freedom to choose whether to
    take the vaccine or not, notwithstanding the fact that we need
    to be better communicating the benefits of that to that person
    and their family in the community. But I think there would be
    some legal liability issues and concerns if employers mandate
    that with their employees. There may be major lawsuits to bear.
        Talk about legal liability protections as an important
    factor in all this. And I yield back.
        Dr. Tabarrok. I think that is an interesting question. I
    prefer to leave that to a lawyer to answer the details of that.
    If I could, I just want to say one thing about if vaccine has
    not been see. Some of it actually is people who have already
    had COVID. And that is less of a concern.
        Some people, they do not want to be the first person to get
    it, but they are okay being the second person to get it. So I
    think some of it is going away over time.
        And let me just say one thing about vaccines. I do not like
    to be told what to do by the government, either, but I love
    vaccines. I love vaccines. To me, it is like a super power,
    right, because a vaccine gives you the super power of immunity.
    And if we could get the super power of being immune to bullets,
    who would not want to be immune to bullets? Well viruses have
    killed a lot more people this year than have bullets.
        So I am very, very happy to have the immunity to viruses.
    It is a great super power to have. Everybody should have it.
        Representative Arrington. Thank you very much. Thank you,
    Chairman.
        Chairman Beyer. Thank you very much, Mr. Arrington. I now
    recognize the chairman of the Congressional Black Caucus, my
    dear friend from Ohio, Congresswoman Beatty.
        Representative Beatty. Thank you so much to Chairman Beyer
    for this very academic, educational, and healthy dialogue. Let
    me say to all of our panelists, thank you for your remarks. I
    have had time to go through your presentations, and I want to
    thank you for that.
        Let me just say to you, Dr. Gounder, being the physician. I
    have been telling people, you listen to the medical profession,
    and you listen to our scientists. A lot of good information
    here. Thank you for telling us to meet people where they are.
        To Dr. Archibong, let me just say thank you for looking at
    the total picture. Now obviously, as the Chairman said, I am
    the Chair of the Congressional Black Caucus. I represent the
    largest number of people in Congress in a caucus. It is our
    50th anniversary.
        And when we look at the disparities which you outlined so
    eloquently, and I would suggest that everybody on this panel
    read her presentation, because it is real. It talks about the
    real issues that many times we skate around in hearings like
    this.
        Black people are dying disproportionately. There is
    systemic racism in this country that we have underinsured, or
    not insured. I am so glad that diabetes came up. My colleague
    is so right. Again, Black Americans have the highest mortality
    rate in dying from diabetes.
        So with that, there are so many disparities, but when I
    look at--the question is to anyone on the panel who can jump in
    with this. Do you believe that our economy can get back to
    normal, or at least to pre-pandemic levels, without getting to
    herd immunity?
        And the second part, if we cannot get to herd immunity
    because of vaccine--and I am going to add some stuff--not only
    hesitancy, but the unequal distribution of it, the lack of the
    vaccine in communities. What kind of effect will that have on
    our economy?
        And to be fair, I asked the same question to the Federal
    Reserve Chair. Anyone? Do you want me to call you by name?
        Dr. Romer. Let me respond. I think we absolutely have to
    get to the point where this pandemic is not a cloud that is
    hanging over the economy, if we want the economy to recover.
        I think we should remember that incentives matter. Costs
    matter. A lot of the costs for getting vaccinated is the time
    to go find a place, and to get there, and to get vaccinated. So
    I think we should be investing aggressively in things like the
    suggestion to use the Dollar Stores as an outlet, in parallel
    with the pharmacies, where it is easier for people to get to
    one and get vaccinated.
        I think accessibility should be a huge focus. We should
    make it as easy as possible for everybody to get vaccinated.
    And even if people are a little bit hesitant, if you make it a
    little bit easier you may be able to get them to go along. So
    we just need to push as hard as we can on that.
        Representative Beatty. Thank you. And I like the analogy of
    putting it, I am going to say, in community centers. The Dollar
    Store may work, but in health centers, churches, schools, post
    offices, et cetera.
        To the issue about state government, if we had, somebody
    used the word ``democracy,'' well if we had fairness in our
    democracy at the state level, you know, maybe I would support
    that fully. But right now, when we look at many of the states
    across this United States, there was a lot of unfairness with
    what some of our governors said about things that we know were
    fair, whether it was the election, whether it was Medicaid
    expansion. Until we do more work there, I think that is very
    dangerous, or could be dangerous.
        The last question in my time I have, and maybe Dr.
    Archibong or Dr. Gounder you can answer this. There have
    already been reports that some states around the country are
    not able to fill the appointment of Blacks for the vaccine.
    Some reports are projecting that the supply will outstrip the
    demand nationwide as early as the end of the month.
        What steps should we be taking in the Federal Government,
    or even in the states, to target populations with lower vaccine
    rates?
        Dr. Archibong. I will just say, very briefly, thank you
    very much Congresswoman Beatty. One of the things that we
    mentioned before was saying that, given the disparities by race
    in vaccination rates, it was very, very important to direct
    vaccines toward--within Black communities, within Hispanic
    communities, communities of color. This where I know--let me
    talk about the federalism--this is where I think a coordinated
    effort from the Federal Government with the states would be
    very, very efficient. But I am going to stop there.
        Dr. Gounder. Yeah, I think we are out of time but, I think
    this is what the retail pharmacies, the FEMA vaccination sites,
    the community health center strategy is really all about,
    trying to focus the vaccination resources access in communities
    of color, in the CDC highest social vulnerability index zip
    code to try to really bring vaccines to where people are.
        Representative Beatty. Thank you. And, Mr. Chairman, if I
    could have ten seconds to say the Congressional Black Caucus--
    may I have 10 seconds, please, I'm sorry.
        Chairman Beyer. Yes. Please proceed.
        Representative Beatty. The Congressional Black Caucus
    announced yesterday at the White House, with the President of
    the United States, that we are going to have Congressional
    Black Caucus Vaccination Week, just like in parallel--and Day,
    like Voting Day, Early Vote, because we are indoctrinated, but
    that is something our leaders tell us to do, and that we do.
        And the last thing is--you do not have to answer, but could
    someone send me more on this oral vaccination that I hear you
    talking about at the beginning, if that is an option? Nobody is
    talking about that in the Congress, or in our communities, that
    there is an option--all we are hearing is that either Pfizer or
    Moderna, and that is by injection. So that would be very
    helpful if that is real and out there.
        Thank you, Mr. Chairman, so much for an incredible hearing.
        Chairman Beyer. And, Ms. Beatty, we will ask the Joint
    Economic Committee staff to run down the research on both oral
    and nasal vaccine.
        Representative Beatty. Thank you.
        Chairman Beyer. Thank you. I now recognize the policy
    leader--and much else.
        Representative Peters. Thank you, Mr. Chairman.
        Dr. Romer, your past statements, I remember you talking
    about the need for widespread testing--so that people can stay
    at home and isolate if they test positive.
        I even remember what your academic research says. I just
    know that you are the rapid testing guy. You have been known
    for that. And I think that in the context of a lack of trust,
    that empowering people to be their own actors, and their own
    diagnosers, and their own treaters, if you will, makes a lot of
    sense. It could be a game changer.
        But what about the capabilities? I think only two home
    tests have been approved by the FDA. You described some of the
    benefit of this, but does the FDA have the testing capabilities
    in the pipeline for approval to do the carpet bombing that you
    described?
        Dr. Romer. This is an area where I think one has to take a
    nuanced approach. I think, for example, it is important for the
    FDA to be extremely rigorous, and demanding, and cautious about
    vaccine safety.
        So I think jumping in actively when the first signs of the
    J&J problems emerged was the right thing to do. This is very
    important for kind of sustaining this broad social consensus
    that vaccines are something that we should all take.
        But on the other extreme, on the process for approving
    tests, I think the FDA has been a huge bottleneck. And really
    just a tragic bottleneck, very concerned about small issues,
    and not attentive to the huge benefits that could come from
    just trusting people at home with a little bit more information
    about their own health conditions.
        Now there are reasons why the FDA kind of historically came
    to the position here it is, but they need to be quicker to
    update and say things have changed and we have got to be able
    to respond more quickly.
        So to be honest, I think, no, the FDA is still going to get
    in the way if we try to carpet bomb Michigan with these kind of
    home rapid tests. I think the Governor of Michigan ought to
    just say, I do not care what the FDA says you can do with these
    tests. I am going to say we are going to send it to peoples'
    homes and they can use them, and then the FDA can come after me
    if they do not like it.
        Dr. Gounder. One thing I would add Dr. Romer's comment on
    the mass testing, I think that works if people are able to stay
    home. This is something I see all the time, as someone who
    discharges patients from the hospital who had COVID, and we ask
    them to isolate afterwards until they are fully out of the
    infectious window, and they are not able to because they have
    to get back to work.
        And so for this to work, you need to allow--you need to
    make it so that people can stay home.
        Representative Peters. That is two problems, though, is it
    not? I mean the first problem is still empowering patients to
    know what they are up to. And then giving them the autonomy to
    act based on that information.
        And I think, you know, the notion that we should be in the
    way of this really flies in the face of the trend toward
    patient empowerment and responsibility for your own health,
    which I think is inevitable and it is coming----
        Dr. Romer. If I could just say, if you want to think about
    how this system could work, you could have people doing these
    at-home tests. If they test positive, they might then have the
    option to go and get an official MPCR confirmation. Then, if
    they get a confirmation, the government could pay them their
    lost wages to stay home.
        Not that many people are positive. It would not be that
    expensive. We could do this.
        Representative Peters. It could be tailored. Let me ask a
    question about something else, about confidence in the vaccine.
    There has been a decision made to shelve the J&J vaccine
    because of very, very few, but admittedly serious consequences.
        I was in local government. I know people do not analyze
    risks the way that you do. I think that is the end of the J&J
    vaccine in terms of acceptance. I am interested in hearing Dr.
    Gounder and maybe Dr. Romer, what is your reaction to that? And
    how do we inspire confidence in the face of what I think may be
    an over-reaction?
        Dr. Gounder. Well, you know, I think it is important that
    we maintain confidence in our vaccines more generally. The
    Pfizer and Moderna vaccines are highly effective, highly safe.
        The fact is----
        Representative Peters. Well that is just J&J, right? I
    mean, J&J is also highly effective.
        Dr. Gounder. Well, it is highly effective, but we are still
    evaluating as you said, very rare but serious complications.
    The fact is, our vaccination supply, we have enough vaccine to
    vaccinate our American adults even without the J&J, number one.
        Number two, there have been manufacturing issues, as you
    are probably aware, at the Emergent BioSolution Manufacturing
    Plant in Baltimore. And so we were anticipating already that
    supply of the Johnson & Johnson vaccine would really slow down
    over the next couple of months.
        So I do not think this is going to have a huge impact,
    frankly, for most of our vaccination efforts. It is really
    going to have the greatest impact on certain hard-to-reach
    communities in this country, and on the global vaccine supply.
        Representative Peters. Alright. Well thank you, Mr.
    Chairman, my time has expired. I yield back.
        Chairman Beyer. Thank you. Thank you, Mr. Peters, for
    making the interesting psychological argument about what
    happens when you challenge the efficacy rebuilding of that
    trust.
        And we wrap up with Congressman David Trone from Maryland,
    who is one of the most successful business people I have ever
    known.
        David.
        Representative Trone. Very generous. Thank you, Mr.
    Chairman.
        Dr. Gounder, as we continue to recover from COVID, one
    issue on many, many families' minds is their kids returning to
    school. Having all adults eligible by April 19th is a great
    first step, but the reality is many children will not receive a
    vaccine. Recently I hosted a Q&A live with Dr. Fauci, and my
    chat box was blown out by constituents asking when will a
    vaccine be safe for my kids? And when will it be safe for my
    kids to return to school?
        So how difficult is it going to be to reach herd immunity
    until we get the vaccine approved for children of all ages?
        Dr. Gounder. Pfizer has submitted their vaccines to the FDA
    for Emergency Use Authorization for kids 12 and up. And I
    anticipate that that will come through pretty quickly here. And
    so that actually will help us, especially if we start to see
    the demand for vaccines among adults slow down. Then you might
    actually see adolescents picking up and taking some of those
    empty vaccination slots in the coming months. And I do not
    think that would be a bad thing, if we can expand vaccine
    coverage that way.
        With respect to schools, I think that we have learned a lot
    in the past year. It has really been a crash course in this
    virus. And in the beginning we thought this virus was largely
    transmitted through droplets and through contact--skin-to-skin
    contact, or contact with contaminated surfaces--and what we
    have learned over the past year is that aerosol, airborne
    spread is probably the more significant driver.
        And so what that means is that your mitigation measures,
    your infection control measures in the school may be different.
    If you are talking about surface contact, you are cleaning
    surfaces and hand washing. If you are talking about droplets,
    it is a combination of wearing masks and being six feet apart.
    But if it is aerosol, airborne, then it is masks and
    ventilation that become the most critical thing here. And you
    do not want to have a high density of people in that room, but
    they can be at closer distances together as long as you do not
    have high density.
        So what we have learned is, you can reopen schools safely
    as long as you have the masking, the ventilation, reasonable
    classroom density, testing, as Dr. Romer would advocate for.
    And the other thing we have learned is, when you see a
    transmission in schools, it is largely adult to adult. It is
    not children to adults. And when children transmit, it is
    usually in the setting of play dates, or sports team activities
    outside of the classroom, not in the classroom.
        So based on what we have learned, we really can reopen
    schools safely as long as you can continue with those
    mitigation measures--the masks, ventilation, ideally testing,
    even if you do not have mass vaccination of the students yet.
        Dr. Romer. If I could just weigh in on this, too. Of course
    I approve testing. But one of the things I wish we had
    committed to in this new infrastructure bill was a massive
    upgrade in the quality of the ventilation and the air quality
    in schools. This could help with the current COVID pandemic,
    but with future viruses. And even other health issues related
    to particulates.
        So if we made the right investments, we could have much
    cleaner air and a lot of good would come of that, of much
    cleaner air in schools.
        Representative Trone. I completely agree with you on that
    100 percent. I sit on a bunch of school boards and could not
    agree more.
        Dr. Gounder, again quickly, with the J&J problem coming up,
    the AstraZenica challenges on their vaccine also, I mean we
    have got to figure how to get the COVID vaccine out to the
    entire globe. And, you know, with the poorest 19 countries
    getting unequal access to a safe and effective vaccine. Could
    you speak a little bit about what efforts we are trying to help
    these other countries on the poor side acquire a vaccine, and
    they take issues now with AZ and J&J that this is complicating
    it.
        Dr. Gounder. What is great about both of those vaccines is
    they are cheap. They do not have the same strict cold-storage
    requirements that you have with Pfizer and Moderna. And so we
    were really counting on AstraZenica and Johnson & Johnson for
    our global vaccine supply. And the Merck-Johnson & Johnson
    collaboration, Merck assisting Johnson & Johnson, which is
    really an astounding feat that is happening, but the idea that
    they would help scale up supply was really intended for the
    world.
        And the other vaccines that are being used, say the Sputnik
    Vaccine, the CanSino vaccine out of China, these are also
    adenovirus vector vaccines that may have some of the same
    complications. We do not yet know. But I think what I am most
    concerned about with respect to, you know, how this all pans
    out is what will this mean for vaccinating the world?
        Dr. Romer. If I could just weigh in as the former World
    Bank Chief Economist, the World Bank is saying somebody else
    needs to go donate a bunch of money to help vaccinate the
    world.
        We have got to remember that that was the job of the World
    Bank, is to help poor countries. They are spending a lot of
    money, including their concessionary aid, on things with a very
    low bang per buck. And as Dr. Tabarrok has shown, the bank per
    buck on these vaccines is extraordinarily high.
        So we should be putting a lot more pressure on the Bank to
    not just engage in business as usual, but go out and pay for
    the vaccinations that people need in the developing world.
        Dr. Archibong. Can I just add something? I have expertise
    in African countries. I would highly encourage investment in
    GAVI, the vaccine alliance. There definitely need to be more
    funds accorded to them because they are doing really, really
    good work in African countries, just to highlight that there.
        Dr. Tabarrok. And with that, for the rest of the world I
    think it is important to underline: It is more important to get
    vaccinated now. Use the AstraZenica, use the Johnson & Johnson
    when the pause is over. It is much, much more important to get
    an early vaccination. Do not wait for Moderna and Pfizer. It is
    going to take too long.
        Take the vaccine, whatever you can get now. The Russian
    vaccine is actually pretty good. Use the vaccines that you can
    get access to, and start your vaccination early. That is the
    message to take to the rest of the world.
        The U.S. is very fortunate. We have Moderna and Pfizer. The
    rest of the world: vaccine early and vaccinate often. That is
    the route to health and to wealth.
        Chairman Beyer. And the message I have to give to you guys
    is that the vote is going to close in three minutes. And since
    I am carrying proxies for a number of other people, I have to
    go. But I want to thank you very, very much. This was a
    fascinating hearing. You managed to keep Senators and
    Congressmen here for two-and-a-half hours, which is a wonderful
    thing. I am very grateful.
        This record will be open for three days. This is recorded.
    I am sure tens of thousands of people across the country will
    watch what you offer. So thank you very much. We hope to work
    with you again in the years to come.
        And with that, the hearing is concluded. Thank you.
        [Whereupon, at 4:32 p.m., Wednesday, April 14, 2021, the
    hearing was adjourned.]

                           SUBMISSIONS FOR THE RECORD

     Prepared statement of Hon. Donald Beyer Jr., Chairman, Joint Economic
                                   Committee
                                  recognitions
        This hearing will come to order. I would like to welcome everyone
    to the first Joint Economic Committee hearing of the 117th Congress.
        I look forward to working with Vice Chairman Heinrich, Ranking
    Member Lee, Senior House Republican Schweikert, and all of our
    Committee members as we examine the many economic challenges and
    opportunities facing the country.
        I want to thank each of our distinguished witnesses for sharing
    their expertise today. Now, I would like to turn to my opening
    statement.
                              the end is in sight
        The pandemic and its tragic health and economic consequences have
    dominated our lives for the past year.
        After more than a year of physical distancing and mask wearing, of
    fearing for our health and the health of our loved ones, of widespread
    and deeply unequal economic hardship, the potential for returning to a
    sense of normalcy is finally within sight.
        The pandemic will leave no shortage of tragedy in its wake.
        More than 560,000 people have died in the United States, many
    isolated in hospitals rooms and without their family's last comfort.
        Thirty-one million have been infected with the coronavirus, and
    many of them continue to live with the disease's debilitating symptoms.
        Communities of color--particularly our Black, Latino, and American
    Indian communities--have been hit especially hard, experiencing the
    highest rates of COVID-19 infection, hospitalization and death.
        The economic damage persists as well.
        After job gains of more than 900,000 last month, close to 10
    million workers remained unemployed--one quarter have been jobless for
    a year or longer.
        Another 4 million people have left the labor force since the
    pandemic began.
        Thankfully, the economy is beginning to recover.
                          vaccination progress to date
        Much of that emerging recovery is due to the remarkable vaccination
    effort unfolding in our country and throughout the world right now,
    where millions of shots are going into arms every single day.
        It's an unprecedented undertaking.
        More than 190 million doses have been administered in the United
    States. More than one in three people in the U.S. has received at least
    one shot, and one in five Americans has been fully vaccinated.
        At the current rate, we could vaccinate all adults in the United
    States by the end of the summer.
        By then, perhaps our lives can begin to approach a new normal where
    we can see loved ones, where we no longer have to choose between going
    to work and keeping family safe, and where we can enjoy a meal inside
    at a restaurant or a trip to the movies.
                      economists project a strong recovery
        There is a consensus among economists that vaccinations will
    profoundly shape the course of the economic recovery.
        Forecasts call for accelerating growth, with Goldman Sachs
    projecting annual GDP growth in 2021 will reach 8 percent.
        In an interview that aired this past weekend, Federal Reserve Chair
    Jerome Powell said the economy and job creation are poised for faster
    growth, and the principal risk is that ``we will reopen too quickly,
    people will too quickly return to their old practices, and we'll see
    another spike in cases.''
                      the pandemic recovery is precarious
        Although the trajectory of the pandemic recovery is headed in the
    right direction, it remains precarious and can be derailed by hasty
    reopenings, new variants, anti-vaccine sentiment, or lack of access to
    vaccines.
        This means that our economic recovery is precarious as well.
        Public health experts warn that state efforts to roll back mask
    mandates and physical distancing requirements can backfire, especially
    in light of highly transmissible and deadlier variants.
        Michigan's recent experience makes clear that we cannot rely on
    vaccines alone as our only way out of the pandemic.
        We've seen recent spikes in cases as the more contagious B.1.1.7
    variant has now become the most common strain of the virus in the
    United States.
        Younger adults and children are comprising a larger share of new
    infections.
        If we cannot bring the pandemic under control, both domestically
    and globally, new variants might become resistant to our current
    treatments and vaccines, creating a need for adjusted vaccine products,
    further delaying recovery efforts.
        CDC Director Dr. Rochelle Walensky has said repeatedly that,
    because of these concerns, we cannot let our guard down and must
    continue to practice mask wearing and physical distancing until we
    reach herd immunity.
                   deep inequities at home and abroad remain
        There is also profound inequity in access to vaccines. Vaccination
    rates for people of color--especially Blacks and Latinos--lag far
    behind the rates for Whites.
        As a result, pandemic and economic recovery efforts in communities
    of color may fall behind recovery in White communities.
        The reality is even worse abroad.
        While wealthy countries have purchased enough vaccine to cover two,
    and sometimes even three times their populations, low- and middle-
    income countries--which account for 81 percent of the world's adult
    population--have collectively purchased only 33 percent of vaccines.
        As Treasury Secretary Yellen laid out last week, some low-income
    countries don't expect to be able to fully vaccinate their populations
    until 2023 or 2024, which should be unacceptable to all of us.
        To end this pandemic for good, the battle against the coronavirus
    must be won globally.
        So, while we have made extraordinary progress in the past few
    months, we are not out of the woods yet.
        I look forward to hearing from our witnesses about the state of our
    recovery, where it's going, and what we can do to ensure things stay on
    track. And now, I turn it over to Senator Lee for his opening
    statement.
                                   __________
      Prepared statement of Hon. Mike Lee, Ranking Member, Joint Economic
                                   Committee
        Good afternoon, and thank you to Chairman Beyer for convening
    today's hearing.
        After a long COVID winter that included unprecedented strains on
    our economy and public health, the spring has brought welcome signs of
    life and hope. Businesses are beginning to reopen, schools are
    reconvening in person, and friends and family members are finally
    reuniting. Perhaps what is most encouraging--and what has helped
    support the beginning of our ``return to normal''--is the development
    and distribution of vaccines.
        But there is still a long way to go. Many Americans have not
    returned to in-person experiences in the entertainment and travel
    industries, for instance; and our economy is still suffering. In order
    for people to feel safe returning to in-person interactions that
    support economic activity, we must continue to improve vaccine
    distribution.
        As we consider how to move forward, it is worth reflecting on our
    trajectory so far--both the strategies that have helped and those that
    have hindered our progress.
        Though vaccine production has had some supply chain setbacks--such
    as difficulty finding vaccine components like reagents and other
    chemicals that have led to manufacturing bottlenecks--it has overall
    exceeded expectations.
        Operation Warp Speed, an initiative begun by the Trump
    administration, sped the development and production of several
    vaccines--including Moderna, Pfizer, and Johnson & Johnson--by
    purchasing vaccines in development and directing resources toward
    vaccine manufacturing capacity. In total, through advance purchase
    agreements and grants, the Trump administration purchased more than 800
    million doses through the end of July 2022.
        The Council of Economic Advisers previously estimated that
    accelerated vaccine development and distribution by OWS could result in
    as much as $2.4 trillion in economic benefit if there was a viable
    vaccine by January 1, 2021. The effort actually outpaced that timeline,
    with first doses of the Pfizer vaccine available on December 14, 2020;
    and the CEA noted that their estimate might even underestimate the full
    economic benefit of accelerated vaccine development.
        In terms of vaccine distribution, there are worthwhile policy
    proposals to increase the number of people with some protection while
    vaccines are scarce. We should be open to creative solutions that can
    get people protected more quickly by stretching the limited supply as
    far as we can, and moving the doses we have as quickly as possible. Our
    main priority should be to extend at least some protection to as many
    people as possible.
        States also have an important role to play in distribution. In some
    cases, we've seen that restrictive Federal guidelines and rigid,
    complex eligibility requirements have impeded states' progress, leading
    to many vaccine doses being wasted or administered to unintended
    populations. Lack of health resources at the final stage of local
    distribution have also presented problems for many areas.
        On the other hand, successful states have implemented simple
    eligibility criteria and used technology to accelerate distribution.
    Some have built systems where patients can register online; others have
    used online event hosting software to schedule appointments. They have
    also partnered with local businesses and pharmacies.
        Despite our challenges, the U.S. has vaccinated more people per
    capita than most other countries in the world. Nearly 190 million doses
    have been administered as of April 13th; more American citizens have
    received a COVID-19 vaccine than tested positive for the virus since
    the beginning of the pandemic; and nearly a third of the adult U.S.
    population is fully vaccinated.
        There is reason for hope in our economic outlook, as well.
    Expectations are set for a stronger economic response in the second
    half of the year--the CBO expects real GDP to return to its pre-
    pandemic level by 2021, and the labor force is expected to return to
    its pre-pandemic size by 2022.
        But in order to accelerate our economic recovery, we should look
    for opportunities to improve vaccine distribution policy. The sooner
    the U.S. reaches herd immunity through vaccination, the sooner
    businesses can reopen to full capacity, students can fully return to
    schools, industries can come back to life, and Americans can return to
    work and social life without fear. I look forward to hearing our
    panelists' contributions today and their insights into how we can do
    just that.
        Before we do, I would like to ask Chairman Beyer for permission to
    submit five articles or studies from our witness Dr. Tabarrok for the
    record.
        Thank you, Chairman Beyer.
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

      Response from Dr. Gounder to Questions for the Record Submitted by
                         Representative Herrera Beutler
        1. A report in September showed that close to 100,000 businesses
    have permanently shut down during the pandemic.\1\ In Washington state,
    27% of businesses have closed their doors temporarily due to a
    government-mandated closure.\2\ Congress has worked to keep small
    businesses afloat throughout the pandemic with the Paycheck Protection
    Program, which saved 90,000 jobs in my district. Despite this, 6 out of
    10 small businesses are still struggling with overhead costs.\3\ We
    know that small businesses have a substantial footprint in the U.S.
    economy.
    ---------------------------------------------------------------------------
        \1\ Fortune, Nearly 100,000 establishments that temporarily shut
    down due to the pandemic are now out of business
        \2\ The Centers Square, Shutdowns closed 27% of Washington
    businesses--and more could close for good
        \3\ Business Wire US. Jobs Recovery Depends on Small Business,
    Which Remains Under Great Threat, According to IHS Markit
    ---------------------------------------------------------------------------
            a. What role will small businesses play in our nations'
            economic recovery? How can Congress continue to support small
            businesses in conjunction with the roll out of the vaccine?
        As a former Washingtonian and a graduate of the University of
    Washington School of Medicine, it is an honor to receive this question
    from Rep. Jaime Herrera.
        I strongly believe that small businesses will play a crucial and
    central role in our nations' economic recovery. Restaurants, bars, and
    gyms have been hit especially hard by public health restrictions. These
    establishments are the cultural hubs and economic drivers for many
    communities, including my own. However, I will defer to Drs. Paul
    Romer, Alexander Tabarrok, and Belinda Archibong to address how
    Congress can best support small businesses through pandemic recovery.
        2. Dr. Gounder, you have spoken about how vaccines are only one
    part of the equation to recovery from the economic harm the pandemic
    has caused. One of the counties I represent, Cowlitz County, was
    recently reverted from Phase 3 to Phase 2 due to failing metrics for
    case counts and hospitalizations. In this situation, it seems that
    increasing vaccination rates would help reduce the threat of regressing
    to a more restrictive phase, which hurt businesses and employees that
    must lower capacity and economic activity.
            a. Could you speak more to this point and what you view as
            other essential policy areas we must focus on in conjunction
            with vaccines?
        Vaccinations work best at a population level rather than an
    individual level. As more people are vaccinated, you get a
    multiplicative, synergistic reduction rather than simply additive
    reduction in risk. It's also important to remember that, when we're
    talking about vaccine effectiveness, that's a percentage or
    proportionate reduction in risk. A 95% vaccine effectiveness is
    excellent, but when there's still a lot of viral transmission in a
    community 95% reducing from very high risk may still be a significant
    risk. Finally, vaccines don't take effect the second a needle hits your
    arm. It takes two weeks after two doses of the Pfizer and Moderna
    vaccines and 4 weeks after a dose of the Johnson and Johnson vaccine
    before someone reaches full immunity.
        Until we have attained high enough vaccination coverage, we will
    need to continue employing public health mitigation measures like
    masking, social distancing, ventilation, and testing to suppress
    transmission of the virus. COVID credentials will be an important tool
    that must be regulated to ensure privacy and equity. We must develop
    better COVID therapeutics and plan for the long-term needs for COVID
    survivors. And we must strengthen our public health infrastructure: our
    public laboratories, including genomic surveillance capacity, our
    public health bioinformatics, and our public health workforce.
        Please see Section II of my written testimony (pages 27-37) for
    more details on what a comprehensive public health response would look
    like.
                                   __________
      Response from Dr. Gounder to Questions for the Record Submitted by
                                  Senator Cruz
        Question 1:
        During the hearing you stated, ``We have also seen that women can
    be safely vaccinated during pregnancy or when they are trying to get
    pregnant and when they are breastfeeding.''
        CDC's COVID-19 vaccine guidance for pregnant women states, ``Based
    on how these vaccines work in the body, experts believe they are
    unlikely to pose a specific risk for people who are pregnant. However,
    there are currently limited data on the safety of COVID-19 vaccines in
    pregnant people . . . . If you are pregnant, you may choose to receive
    a COVID-19 vaccine. You may want to have a conversation with your
    healthcare provider to help you decide whether to get vaccinated with a
    vaccine that has been authorized for use under Emergency Use
    Authorization. While a conversation with your healthcare provider may
    be helpful, it is not required prior to vaccination.''
            (a) Do you disagree with these statements from CDC?
            (b) Do you disagree with CDC's statement that ``there are
            currently limited data on the safety of COVID-19 vaccines in
            pregnant people''? If so, please explain why you disagree and
            provide data and scientific studies to support your position.
        I agree with the CDC and CDC Director Dr. Rochelle Walensky that
    there are ``no safety concerns'' for pregnant women to receive COVID
    vaccination.
        Earlier this month, researchers published data from several
    national surveillance systems in the New England Journal of Medicine
    showing that pregnant women have no higher rate of side-effects from
    vaccination than the rest of the population. This is just the latest
    report on COVID vaccine safety in pregnant and breastfeeding women.
    Others include:

          Gray KJ, et al. COVID-19 vaccine response in pregnant and
    lactating women: a cohort study. AJOG. March 25, 2021
          Mithal LB, et al. Cord Blood Antibodies following
    Maternal COVID-19 Vaccination During Pregnancy. AJOG. March 31, 2021
          Perl SH, et al. SARS-CoV-2-Specific Antibodies in breast
    milk after COVID-19 vaccination of breastfeeding women. JAMA. April 12,
    2021
          Prabhu M, et al. Antibody response to SARS-CoV-2 mRNA
    vaccines in pregnant women and their neonates. Pre-print not yet
    certified by peer review. April 6, 2021
          Rottenstreich R, et al. Efficient maternofetal
    transplacental transfer of anti- SARS-CoV-2 spike antibodies after
    antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Pre-print not yet
    certified by peer review. March 12, 2021
        We also know that pregnant women are far more likely to experience
    severe disease from SARS-CoV-2 (as they do from influenza). Pregnant
    women experiencing COVID in pregnancy are more likely to suffer from
    complications like severe COVID, need for intensive care unit care,
    preeclampsia, eclampsia, and death. They are also more likely to have
    preterm births. COVID in pregnancy is dangerous for the life of the
    mother and the unborn child.
          Villar J, et al. Maternal and neonatal morbidity and
    mortality among pregnant women with and without COVID-19 infection: The
    INTERCOVID multinational cohort study. JAMA Pediatrics. April 22, 2021
          Healy CM. COVID-19 in pregnant women and their newborn
    infants. JAMA Pediatrics. April 22, 2021

            (c) Do you disagree with CDC's statement that pregnant women
            ``may want to have a conversation with your healthcare provider
            to help you decide whether to get vaccinated with a vaccine
            that has been authorized for use under Emergency Use
            Authorization''? If so, please explain why you disagree and
            provide data and scientific studies to support your position.
        I agree with this statement and not only with reference to pregnant
    women, but also with respect to anyone who has questions about COVID,
    the COVID vaccines, and their personal health and healthcare in
    general. An important but unfortunately undervalued and
    undercompensated role of primary care providers is to educate and
    counsel their patients about their personal health decisions.
        To all witnesses:
        Question 1: If a vaccine passport or any other type of vaccine
    credential is required by individual private companies, do you have any
    concerns with an airline refusing service or otherwise discriminating
    against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 2:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a restaurant refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 3:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a hotel refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 4:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a movie theater or any type of live entertainment venue refusing
    service or otherwise discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 5:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a grocery store refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 6:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    any other type of retail establishment refusing service or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 7:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a private school or educational institution refusing service or
    otherwise discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 8:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a children's day care facility refusing service or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 9:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a doctor's office refusing service or otherwise discriminating against
    an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 10:
        In terms of a vaccine passport or any other type of vaccine
    credential, do you have any concerns with a local, state, or Federal
    Government entity refusing services or otherwise discriminating against
    an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Question 11:
        In terms of a vaccine passport or any other type of vaccine
    credential, do you have any concerns with a local, state, or Federal
    Government entity refusing to allow an individual to vote or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        With respect to questions 1-11 for all witnesses above, I would
    refer Senator Cruz and his staff to Section II-D of my written
    testimony (pages 31-33) and to the 1905 Supreme Court decision in
    Jacobson v. Massachusetts. Please note that the term ``vaccine
    passport'' is inappropriate because that implies COVID credentials are
    a form of identification. No such identification is being proposed.
                                   __________
       Response from Dr. Gounder to Question for the Record Submitted by
                                 Senator Kelly
        At this point, Arizonans can get a vaccine at a mass vaccine site,
    a retail pharmacy, a federally qualified health center, a health clinic
    or hospital, or a pop-up distribution site. But there are still
    barriers to accessing the vaccine. In communities that have been hit
    hard but still have low vaccination rates, folks say that one of the
    best ways to convince them to get the vaccine is to have their own
    doctor recommend it. Involving primary care providers strikes me as
    another potential piece of the puzzle to get everyone vaccinated--
    especially those who are hesitant about the vaccine. Even better if the
    primary care doctor can not only recommend the vaccine, but actually
    give it to you after they suggest it. In your opinion, what is the role
    of primary care providers in vaccination efforts? What should their
    role be?
        In survey after survey, Americans say that they trust their primary
    care provider above any other messenger to provide information about
    COVID and COVID vaccines. Not every primary care provider will have the
    staffing, space, and equipment necessary to administer vaccines in
    their office. However, they can still play an important role in
    counseling patients about COVID and COVID vaccination and help patients
    access vaccination. Counseling and health system navigation are
    impactful but time-consuming, and these services must be compensated
    appropriately, whether a patient is covered by private insurance,
    Medicare, Medicaid, or has no insurance.
        Please also see Section I-G-1 of my written testimony (page 25).
                                   __________
    Response of Dr. Romer to questions submitted by Representative Herrera
                                    Beutler
        1. A report in September showed that close to 100,000 businesses
    have permanently shut down during the pandemic. \1\ In Washington
    State, 27 percent of businesses have closed their doors temporarily due
    a government mandated closure. \2\ Congress has worked to keep small
    businesses afloat throughout the pandemic with the Paycheck Protection
    Program, which saved 90,000 jobs in my district. Despite this, 6 out of
    10 small businesses are still struggling with overhead costs. \3\ We
    know that small businesses have a substantial footprint in the US
    economy.
    ---------------------------------------------------------------------------
        \1\ Fortune, Nearly 100,000 establishments that temporarily shut
    down due to the pandemic are now out of business
        \2\ The Centers Square, Shutdowns closed 27 percent of Washington
    businesses--and more could close for good
        \3\ Business Wire US. Jobs Recovery Depends on Small Business,
    Which Remains Under Great Threat, According to IHS Markit
    ---------------------------------------------------------------------------
        a. What role will small businesses play in our nations' economic
    recovery? How can Congress continue to support small businesses in
    conjunction with the roll out of the vaccine?
        We know that compared to previous recessions, the pandemic has
    forced many more closures of small businesses, especially in the
    restaurant and hospitality sectors. We see it in the data. We see it
    when we walk down the street. The path I recommend is first to use the
    right measure--the employment to population ratio for prime age
    adults--to see if we have succeeded in getting employment back to the
    level we should aspire to, the level that prevailed in the late 1990's.
    Then we should be creative and doggedly persistent, trying a variety of
    interventions that create opportunities for work and not giving up
    until we truly recover.
        2. As of January 2021, women's labor force participation has hit a
    33-year low. 2.3 million women have left the labor force since February
    2020. \4\ Data has shown that the U.S. could add $1.6 trillion to the
    GDP if women entered and stayed in the workforce. \5\
    ---------------------------------------------------------------------------
        \4\ CBS News, Nearly 3 million U.S. women have dropped out of the
    labor force in the past year (Here)
        \5\ S & P Global, Women at Work: The Key to Global Growth
    ---------------------------------------------------------------------------
        a. Dr. Romer, could you speak more to the exodus of women from the
    labor force due to the pandemic and how this will impact on the U.S.
    economic recovery?
        In the wake of the recession in 2001 and the financial crisis, we
    know that many of the potential workers who gave up on the possibility
    of finding work were young men. In the wake of the pandemic, we are
    seeing signs that this time the discouraged workers are more likely to
    be women. One advantage of the strategy that I have outlined is that it
    works in either case: do whatever it takes to get the discouraged
    workers back into jobs because this is the only way to bring the
    employment rate back to where it could and should be.
                                   __________
    Response from Dr. Romer to Question for the Record Submitted by Senator
                                      Cruz
        Question 1: If a vaccine passport or any other type of vaccine
    credential is required by individual private companies, do you have any
    concerns with an airline refusing service or otherwise discriminating
    against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 2:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a restaurant refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 3:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a hotel refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 4:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a movie theater or any type of live entertainment venue refusing
    service or otherwise discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.

        Question 5:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a grocery store refusing service or otherwise discriminating against an
    individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.

        Question 6:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    any other type of retail establishment refusing service or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 7:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a private school or educational institution refusing service or
    otherwise discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 8:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a children's day care facility refusing service or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 9:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a doctor's office refusing service or otherwise discriminating against
    an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 10:
        In terms of a vaccine passport or any other type of vaccine
    credential, do you have any concerns with a local, state, or Federal
    Government entity refusing services or otherwise discriminating against
    an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
        Question 11:
        In terms of a vaccine passport or any other type of vaccine
    credential, do you have any concerns with a local, state, or Federal
    Government entity refusing to allow an individual to vote or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Because you are asking me to entertain hypotheticals, what I can
    say definitively is that I would have concerns if a member of Congress
    tried to use hypothetical questions to enlist me in an attempt at
    spreading misunderstandings and disinformation.
                                   __________
    Response from Dr. Romer to Question for the Record Submitted by Senator
                                     Kelly
        1. About a month ago we passed the American Rescue Plan. The bill
    included nearly $93 billion for COVID-related public health work,
    including for vaccine distribution and to improve vaccine confidence.
    We have already seen at least $135 million of those resources come to
    Arizona to help get vaccines into arms. Do you believe our investment
    in speeding up vaccine distribution and increasing testing is adequate
    to set us up for a strong economic recovery?
        No, stopping the pandemic is a necessary condition for full
    recovery, but it alone will not be sufficient. We faced no pandemic
    during the recovery from the recession of 2001. Nor did we face a
    pandemic in the recovery from the financial crisis of 2007-9. But after
    both of these recessions, we failed to fully recover according to the
    measure that I believe we should be using--the employment rate for
    prime-aged adults. To escape from our recent pattern of recoveries that
    fail to get us back to where we were before the recession hit, we need
    to implement aggressive recovery policies and we need to stick with
    them until we truly recover.
        2. I'd like to ask you about the impact of virus variants.
    Researchers at Arizona State University have discovered a variant in
    the past couple of weeks. The UK variant has become the most common
    strain throughout the US, and we know already that it's more contagious
    and more deadly. The California variant is also becoming a threat. The
    Pfizer and Moderna vaccines appear to be effective in protecting
    against the UK variant, but other variants are or might become a
    greater problem. How do we pivot to ensure vaccinated Americans remain
    protected from all variants? What do we need from the manufacturers,
    and what do we need from Congress?
        As I indicated in my testimony, the biggest threat posed by the UK
    variant that is taking over arises because it spreads so much faster
    than the variants that we were fighting during 2020. Experts are not
    certain about whether this new variant is more deadly for those who
    catch it. The balance of the evidence seems to suggest that it is
    somewhat more deadly, but the experts have not yet reached a consensus
    on this. So far, there is no reason to think that our vaccines are less
    effective in protecting us from this variant. But the evidence is very
    clear that this variant spreads much faster. This is why it is taking
    over. Faster spread puts us at risk. We need to make sure that our
    measures that limit the spread are getting more effective quickly
    enough to stay ahead in this race with this variant
                                   __________
      Response from Dr. Archibong to Question for the Record Submitted by
                         Representative Herrera Beutler
        Question 1. A report in September showed that close to 100,000
    businesses have permanently shut down during the pandemic.\1\ In
    Washington state, 27% of businesses have closed their doors temporarily
    due a government-mandated closure.\2\ Congress has worked to keep small
    businesses afloat throughout the pandemic with the Paycheck Protection
    Program, which saved 90,000 jobs in my district. Despite this, 6 out of
    10 small businesses are still struggling with overhead costs.\3\ We
    know that small businesses have a substantial footprint in the U.S.
    economy.
    ---------------------------------------------------------------------------
        \1\ Fortune. Nearly 100,000 establishments that temporarily shut
    down due to the pandemic are now out of business
        \2\ The Centers Square. Shutdowns closed 27% of Washington
    businesses--and more could close for good
        \3\ Business Wire. U.S. Jobs Recovery Depends on Small Business,
    Which Remains Under Great Threat, According to IHS Markit
    ---------------------------------------------------------------------------
            a. What role will small businesses play in our Nations'
            economic recovery? How can Congress continue to support small
            businesses in conjunction with the roll out of the vaccine?
        Thank you very much for the question Congresswoman Beutler. It is
    extremely important that we focus resources on small businesses that
    have struggled with recovery during the pandemic. As I outlined in my
    written testimony, a major share of losses to small business owners has
    been to Black and Hispanic business owners. The number of Black
    business owners actively working fell 41% between February and April
    2020, with over 400,000 Black business owners losing employment, and
    bringing the numbers of Black business owners down to 640,000 in April
    from 1.1 million (Fairlie, 2020). The comparable loss in business owner
    employment was 17% for White business owners, 32% for Hispanic business
    owners, and 26% for Asian business owners over the same time period
    (Fairlie, 2020). Despite these racial gaps in losses to business
    employment, banking and lending policies intended to provide relief to
    business owners have not targeted Black and Hispanic businesses. Any
    economic relief program aimed at improving the welfare of small
    businesses must target Black and Hispanic businesses with grants and
    loans, as they have been the hardest hit and serve some of the most
    vulnerable communities during the pandemic. Just as with vaccination
    efforts, there needs to be a concerted effort at the Federal, state,
    and local levels to provide more financial access, including
    information and access to credit to Black and Hispanic small business
    owners who have been worst off and have received relatively little of
    the PPP/CARES Act funding over the pandemic.
                                   __________
      Response from Dr. Archibong to Question for the Record Submitted by
                                  Senator Cruz
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    an airline (and other establishments) refusing service or otherwise
    discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        Thank you for the questions Senator Cruz. Based on my research into
    the issue of vaccine passports, I can say that, for years, people
    traveling to particular countries around the world have had to provide
    proof of vaccination against diseases like yellow fever and rubella
    with yellow cards showing proof of vaccination, so the idea of a
    ``vaccine passport'' is not a new one. The particular details of how
    these policies should be implemented, if they are implemented, in the
    case of the COVID-19 pandemic is something that governments will need
    to consult with health and medical professionals at the CDC to flesh
    out.
                                   __________
      Response from Dr. Archibong to Question for the Record Submitted by
                                 Senator Kelly
        Two point one million women left the labor force between February
    and December 2020. Just like the health impacts of the pandemic,
    unemployment has disproportionately impacted women of color. I've heard
    this in Arizona. Last summer I spoke to a woman named Sandy who was
    furloughed from her job as a housekeeper at a Phoenix hotel on March
    28th, 2020. She spent months hoping to go back to work. She and her
    husband struggled to pay their bills for themselves and their two
    children. She skipped meals, and was helped by increased unemployment
    benefits. Sandy has fortunately found a new job, but there are many
    women and women of color who are still looking for jobs or waiting to
    return to work in Arizona. As vaccinations increase and the country
    returns to work, how do we ensure women who have left the labor force
    and want to return are able to do so?
        Thank you very much for the question Senator Kelly. Women were
    particularly hard hit by the pandemic, with a net 2.4 million women
    leaving the work force between February 2020 and February 2021,
    according to Pew Research Center statistics. The figure was much higher
    than for male counterparts (1.8 million men), and there is a concern
    that, without concerted policy efforts aimed at lowering the costs of
    women's reentry into the labor market, the gender gap in employment may
    remain persistent over time. Within this loss, Black and Hispanic women
    have been worst hit, with these populations accounting for a major
    share of service sector jobs that saw significant losses during the
    pandemic. Bringing these women back into the work force is an essential
    part of the economic recovery post pandemic, and will require investing
    in policies like free or low-cost work retraining programs, cash grants
    targeted to female-headed households and policies like more job
    flexibility, more paid sick and parental leave and universal child
    care, especially in industries where women and Black and Hispanic women
    are concentrated--service/health sectors like home health aides that
    currently lack benefits, paid sick leave and are among lowest paid in
    US. These policies will lower the costs and increase the benefits of
    reentry into the labor market for women, and especially Black and
    Hispanic women, that have been disproportionately harmed by the
    pandemic.
                                   __________
      Response from Dr. Tabarrok to Questions for the Record Submitted by
                         Representative Herrera Beutler
        1. What role will small businesses play in our Nations' economic
    recovery? How can Congress continue to support small businesses in
    conjunction with the roll out of the vaccine?
        The American economy has been surprisingly robust to the pandemic.
    Business exits in some sectors are higher than normal, but recent work
    from the Federal Reserve suggests that overall business exits are not
    unusually high.

            ``Actual exit is likely to have been lower than widespread
            expectations from early in the pandemic. Moreover, businesses
            have recently exhibited notable optimism about their survival
            prospects.''

        Thus, I think that the best policy for business is to support an
    overall strong business climate and economy especially continuing a
    strong rollout of vaccines. Targeted programs are not needed.
        https://www.federalreserve.gov/econres/feds/business-exit-during-
    the-covid-19-pandemic.htm
        2. Dr. Tabarrok, could you speak to this argument and if we need to
    be considering underemployment, as the economy recovers with the
    vaccine rollout?
        There are a variety of ways of measuring unemployment but almost
    all of them move together over time and so provide similar signals as
    to the state of the economy. Underemployment, particular of young men,
    is a challenging issue for the United States but it's a perennial issue
    that must be addressed by education policy and work programs such as
    apprenticeship programs that appeal to a wider variety of people than
    traditional education.
                                   __________
      Response from Dr. Tabarrok to Question for the Record Submitted by
                                  Senator Cruz
        The questions are all of the form:
        If a vaccine passport or any other type of vaccine credential is
    required by individual private companies, do you have any concerns with
    a [educational institution/airline/grocery store . . . ] refusing
    service or otherwise discriminating against an individual that:
            (a) chooses not to receive the vaccine?
            (b) is not a suitable candidate to receive the vaccine for
            medical reasons?
        I answer as follows:
        During the pandemic it was common for bars and restaurants,
    churches, gyms, shopping malls, entertainment venues, schools and
    universities, and even parks and beaches in the United States to be
    closed for everyone. Similarly, international travel has been severely
    restricted for everyone. I think it an improvement to move from closed-
    for-all to open-for-some. Thus vaccine passports represent a lifting of
    restrictions and an increase in freedom on the path back to normality.
    Greece, for example, is scheduled to open to anyone with a record of
    vaccination, negative COVID test, or previous infection. This is good
    for Greece, which relies on tourist revenues for a significant share of
    its economy and good for the world who want to visit sunny beaches and
    ancient ruins.
        Moving in stages, from closed-for-all to open-for-some to fully-
    open, is reasonable. The aim, of course, is to be open-for-all, an
    achievable aim if a large enough proportion of the population is
    vaccinated. As we move to normality we should also make it possible for
    the non-vaccinated to access as many services as possible on reasonable
    grounds, for example, through the use of testing and masks.
        It bears repeating that the best way to avoid these difficult
    decisions is for as many people as possible to be vaccinated, thus
    making social life safe for the unvaccinated as well as the vaccinated.
    For these reasons I have supported free vaccinations, stretching doses
    to vaccinate more people quickly through policies such as delaying the
    second dose and testing fractional doses, using single-shot vaccines,
    and developing nasal and oral vaccines.
                                   __________
              Articles submitted to Senator Cruz from Dr. Gounder
        1. Efficient maternofetal transplacental transfer of anti-SARS-CoV-
    2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination
        https://www.medrxiv.org/content/10.1101/
    2021.03.11.21253352v1.full.pdf
        2. SARS-CoV-2-specific antibodies in breast milk after COVID-19
    vaccination of breastfeeding women
        https://www.medrxiv.org/content/10.1101/
    2021.03.11.21253352v1.full.pdf
        3. Antibody response to SARS-CoV-2 mRNA vaccines in pregnant women
    and their neonates
        https://www.biorxiv.org/content/10.1101/2021.04.05.438524v1
        4. Cord blood antibodies following maternal COVID-19 vaccination
    during pregnancy
        https://www.ajog.org/article/S0002-9378(21)00215-5/fulltext
        5. COVID-19 vaccine response in pregnant and lactating women: a
    cohort study
        https://www.ajog.org/article/S0002-9378(21)00187-3/fulltext
                                   __________
           Dr. Tabarrok--Submissions for the Record from Senator Lee
        1. What are we waiting for?
        https://www.washingtonpost.com/outlook/2021/02/12/first-doses-
    vaccine-rules-fda/
        2. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine
        https://www.nejm.org/doi/full/10.1056/nejmoa2034577
        3. Market design to accelerate COVID-19 vaccine supply
        https://science.sciencemag.org/content/371/6534/1107
        4. NACI rapid response: Extended dose intervals for COVID-19
    vaccines to optimize early vaccine rollout and population protection in
    Canada
        https://www.canada.ca/en/public-health/services/immunization/
    national-advisory-committee-on-immunization-naci/extended-dose-
    intervals-covid-19-vaccines-early-rollout-population-protection.html
        5. How to end the COVID-19 pandemic by March 2022
        https://openknowledge.worldbank.org/bitstream/handle/10986/35454/
    How-to-End-the-COVID-19-Pandemic-by-March-
    2022.pdf?sequence=1&isAllowed=y
                                   __________
         Article for the Record Submitted by Representative Schweikert
        https://www.theatlantic.com/ideas/archive/2021/03/how-mrna-
    technology-could-change-world/618431/

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