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


                                                        S. Hrg. 117-17

                 VACCINATIONS AND THE ECONOMIC RECOVERY

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                            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
          

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        Available via the World Wide Web: http://www.govinfo.gov
        
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                    U.S. GOVERNMENT PUBLISHING OFFICE                    
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                        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

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                     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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