[Joint House and Senate Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
S. Hrg. 117-17
VACCINATIONS AND THE ECONOMIC RECOVERY
=======================================================================
VIRTUAL HEARING
BEFORE THE
JOINT ECONOMIC COMMITTEE
OF THE
CONGRESS OF THE UNITED STATES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
APRIL 14, 2021
__________
Printed for the use of the Joint Economic Committee
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-730 WASHINGTON : 2021
-----------------------------------------------------------------------------------
JOINT ECONOMIC COMMITTEE
[Created pursuant to Sec. 5(a) of Public Law 304, 79th Congress]
HOUSE OF REPRESENTATIVES SENATE
Donald S. Beyer Jr., Virginia, Martin Heinrich, New Mexico, Vice
Chairman Chairman
David Trone, Maryland Amy Klobuchar, Minnesota
Joyce Beatty, Ohio Margaret Wood Hassan, New
Mark Pocan, Wisconsin Hampshire
Scott Peters, California Mark Kelly, Arizona
Sharice L. Davids, Kansas Raphael G. Warnock, Georgia
David Schweikert, Arizona Mike Lee, Utah, Ranking Member
Jaime Herrera Beutler, Washington Tom Cotton, Arkansas
Jodey C. Arrington, Texas Rob Portman, Ohio
Ron Estes, Kansas Bill Cassidy, M.D., Louisiana
Ted Cruz, Texas
James Whitney, Democratic Senior Advisor
Vanessa Brown Calder, Republican Staff Director
Colleen J. Healy, Financial Director
C O N T E N T S
----------
Opening Statements of Members
Hon. Donald S. Beyer Jr., Chairman, a U.S. Representative from
the Commonwealth of Virginia................................... 1
Hon. Mike Lee, Ranking Member, a U.S. Senator from Utah.......... 3
Witnesses
Dr. Celine Gounder, M.D., ScM, FIDSA Clinical Assistant,
Professor of Medicine & Infectious Diseases, NYU School of
Medicine & Bellevue Hospital CEO of Just Human Productions New
York, NY....................................................... 6
Dr. Paul Romer, Nobel Prize Winning Economist and NYU Professor,
New York, NY................................................... 7
Dr. Belinda Archibong, Assistant Professor, Economics, Barnard
College, Columbia University, New York, NY..................... 9
Dr. Alexander Tabarrok, Bartley J. Madden Chair in Economics at
the Mercatus Center and Professor of Economics, George Mason
University Fairfax, VA......................................... 11
Submissions for the Record
Prepared statement of Hon. Donald S. Beyer Jr., Chairman, a U.S.
Representative from the Commonwealth of Virginia............... 40
Prepared statement of Hon. Mike Lee, Ranking Member, a U.S.
Senator from Utah.............................................. 41
Prepared statement of Dr. Celine Gounder, M.D., ScM, FIDSA
Clinical Assistant, Professor of Medicine & Infectious
Diseases, NYU School of Medicine & Bellevue Hospital CEO of
Just Human Productions New York, NY............................ 43
Prepared statement of Dr. Paul Romer, Nobel Prize Winning
Economist and NYU Professor, New York, NY...................... 80
Prepared statement of Dr. Belinda Archibong, Assistant Professor,
Economics, Barnard College, Columbia University, New York, NY.. 82
Prepared statement of Dr. Alexander Tabarrok, Bartley J. Madden
Chair in Economics at the Mercatus Center and Professor of
Economics, George Mason University Fairfax, VA................. 97
Response from Dr. Gounder to Questions for the Record Submitted
by Representative Herrera Beutler.............................. 101
Response from Dr. Gounder to Questions for the Record Submitted
by Senator Cruz................................................ 101
Response from Dr. Gounder to Question for the Record Submitted by
Senator Kelly.................................................. 104
Response from Dr. Romer to Questions for the Record Submitted by
Representative Herrera Beutler................................. 104
Response from Dr. Romer to Questions for the Record Submitted by
Senator Cruz................................................... 105
Response from Dr. Romer to Questions for the Record Submitted by
Senator Kelly.................................................. 107
Response from Dr. Archibong to Question for the Record Submitted
by Representative Herrera Beutler.............................. 108
Response from Dr. Archibong to Question for the Record Submitted
by Senator Cruz................................................ 108
Response from Dr. Archibong to Question for the Record Submitted
by Senator Kelly............................................... 108
Response from Dr. Tabarrok to Questions for the Record Submitted
by Representative Herrera Beutler.............................. 109
Response from Dr. Tabarrok to Question for the Record Submitted
by Senator Cruz................................................ 109
Articles submitted to Senator Cruz from Dr. Gounder.............. 110
Dr. Tabarrok--Submissions for the Record from Senator Lee........ 110
Article for the Record Submitted by Representative Schweikert.... 110
VACCINATIONS AND THE ECONOMIC RECOVERY
----------
WEDNESDAY, APRIL 14, 2021
United States Congress,
Joint Economic Committee,
Washington, DC.
The WebEx virtual hearing was convened, pursuant to notice,
at 2:30 p.m., before the Joint Economic Committee, Hon. Donald
S. Beyer Jr., Chairman, presiding.
Representatives present: Beyer, Estes, Schweikert, Pocan,
Arrington, Beatty, Peters, and Trone.
Senators present: Lee, Heinrich, Warnock, Cruz, and
Klobuchar.
Staff present: Vanessa Brown Calder, Barry Dexter, Colleen
J. Healy, Jeremy Johnson, Christina King, Nita Somasundaram,
Kyle Treasure, Jackie Varas, Emily Volk, Jim Whitney, and
Ismael Cid-Martinez.
OPENING STATEMENT OF HON. DONALD BEYER JR., CHAIRMAN, A U.S.
REPRESENTATIVE FROM THE COMMONWEALTH OF VIRGINIA
Chairman Beyer. So this hearing will come to order. I would
like to welcome everyone to the first Joint Economic Hearing of
the 117th Congress. So welcome back, and welcome to all the new
members.
I really look forward to working with Vice Chairman
Heinrich, Senate and Ranking Member Mike Lee, who chaired this
in the last Congress, House senior Republican David Schweikert,
and all of our committee members, as we examine the many
economic challenges and opportunities in our country.
I want to thank each of our distinguished witnesses for
sharing their expertise today. Now, my brief opening statement.
The end is in sight. The pandemic and its tragic health and
economic consequences have dominated our lives for the last
year. After more than a year of physical distancing and mask
wearing, of fearing for our health and the health of our loved
ones, of widespread unequal economic hardship, the potential
returning to a sense of normalcy is finally within sight. The
pandemic will leave no shortage of tragedy in its wake. More
than 560,000 people have died in the United States, many
isolated in hospital rooms without their family's last comfort.
Thirty-one million, that we know of, have been infected
with the coronavirus, and many of them continue to live with
the disease's debilitating symptoms. Communities of color,
particularly Black, Latino, and American Indian communities,
have been hit especially hard, experiencing the highest rates
of COVID-19 infections, hospitalizations, and deaths.
Economic damage persists, as well. After job gains of more
than 900,000 last month, still close to 10 million workers
remain unemployed. One-quarter have been jobless for a year or
longer. Another four million people have simply left the labor
force since the pandemic began.
Thankfully, the economy is beginning to recover. Much of
that recovery is due to the remarkable vaccination efforts
unfolding in our country and throughout the world right now.
Millions of shots are going into arms every single day.
More than 190 million doses have been administered in the
United States. More than one in three people in the U.S. have
received at least one shot. One in five Americans has been
fully vaccinated. At the current rate, we can vaccinate all
adults in the United States by the end of the summer.
And then, perhaps our lives will begin to approach a new
normal where we can see loved ones, we no longer have to choose
between going to work and keeping the family safe, where we can
enjoy a meal inside the restaurant, or a trip to the movies.
There is a profound consensus among economists that
vaccinations will shape the course of the economic recovery.
Forecasts call for economic growth. Goldman Sachs may be the
most optimistic, suggesting 8 percent in 2021. In an interview
this past weekend, Fed Chair Jay Powell said the economy and
job creation are poised for faster growth, and the principal
risk is that, quote, ``We will reopen too quickly. People will
too quickly return to their old practices, and we will see
another spike.''
Although the trajectory of the pandemic recovery is headed
in the right direction, it remains precarious and can be
derailed by hasty reopenings, new variants, anti-vaccine
sentiment, and world access to vaccines. This means that our
economic recovery is precarious, as well.
Public health experts warn that state efforts to roll back
mask mandates and physical distancing requirements can
backfire, especially in light of highly transmissible and
deadlier variants.
Michigan's recent experience makes clear that we cannot
rely on vaccines alone as our only way out of the pandemic. We
have seen recent spikes in cases as the more contagious V117
variant has now become the most common strain of the virus in
the United States.
Young adults and children are comprising an ever-larger
share of the new infectants, and if we cannot bring the
pandemic under control globally, new variants might become
resistant to our current treatments of vaccines, creating a
need for adjusted vaccine products, further delaying the
recovery efforts.
CDC Director Rochelle Walensky has said repeatedly that
because of these concerns we cannot let our guard down and must
continue to practice mask wearing and physical distancing until
we reach herd immunity.
There is also profound inequity in access to vaccines.
Vaccination rates for people of color, especially Blacks and
Latinos, lag far behind the rates for Whites. As a result,
pandemic recovery efforts in communities of color may fall
behind recovery to White communities. The reality is even worse
abroad.
While wealthy countries have purchased enough vaccine to
cover two and sometimes even three times their populations,
low- and middle-income countries, which account for 81 percent
of the world's adult population, have collectively purchased
only 33 percent of vaccines.
As Treasury Secretary Yellen laid out last week, some low-
income countries do not expect to be able to fully vaccinate
the population until 2023 or 2024, which should be unacceptable
and dangerous to all of us.
To end this pandemic for good, the battle against the
coronavirus must be won globally. So while we have made
progress in the last few months, we are not out of the woods
yet. And I really look forward to hearing from our witnesses
about the state of our recovery, where it is going, and what we
are going to do to ensure things stay on track.
So let me turn this over to Senator Lee for his opening
statement. Senator Lee is with us? Mike?
[The prepared statement of Chairman Beyer appears in the
Submissions for the Record on page 40.]
OPENING STATEMENT OF HON. MIKE LEE, RANKING MEMBER, A U.S.
SENATOR FROM UTAH
Senator Lee. Yes. Thanks so much, Mr. Chairman. Thanks for
convening today's hearing.
After a long COVID winter, one that included some
unprecedented strains on our economy and on public health, the
Spring has brought some welcome signs of life and of hope.
Businesses are beginning to reopen. Schools are starting to
reconvene in person, and friends and family members are finally
starting to reunite.
Perhaps what is most encouraging, and what has helped
support the beginning of our return to normal, has been the
development and distribution of vaccines. But there is still a
long way to go. Many Americans still have not returned to the
in-person experiences of the entertainment and travel
industries, for example, and our economy has suffered in order
for people to feel safe, to return to in-person interactions
that support economic activity.
We must continue to improve vaccine distribution. As we
consider how best to move forward, it is worth reflecting on
our trajectory so far, both the strategies that have helped,
and those that have hindered our progress.
Though vaccine production has had some supply chain
setbacks, such as the difficulty in finding vaccine components
like reagents and other chemicals that have led to
manufacturing bottlenecks, it has overall exceeded
expectations.
Operation Warp Speed, an initiative begun by the Trump
Administration, sped the development and the production of
several vaccines, including Moderna, Pfizer, and Johnson &
Johnson, by purchasing vaccines in development and directing
resources toward vaccine manufacturing capacity.
In total, through advance purchase agreements and grants,
the Trump Administration purchased more than 800 million doses
through the end of July 2022. The Council of Economic Advisers
previously estimated that accelerated vaccine development and
distribution by OWS could result in as much as $2.4 trillion in
economic benefit, if there was a viable vaccine by January 1st,
2021.
The effort actually outpaced that timeline with first doses
of the Pfizer vaccine being made available on December 14th,
2020. And the CEA noted that its own estimate might even
underestimate the full economic benefit of accelerated vaccine
development.
In terms of vaccine distribution, there are worthwhile
policy proposals to increase the number of people with some
protection during that time period in which vaccine supplies
are still somewhat scarce. We should be open to creative
solutions that can help get people protected more quickly by
strengthening the limited supply as far as we possibly can, and
moving the doses that we have as quickly as possible to as many
people as possible.
Our main priority should be to extend at least some
protection to as many people as we possibly can. States also
have an important role to play in distribution. In some cases,
we have seen that restrictive Federal guidelines and rigid,
complex eligibility requirements have impeded states' progress,
leaving many vaccine doses to being wasted or administered to
unintended populations.
Lack of health resources at the final stage of local
distribution have also presented some problems for many areas.
On the other hand, successful states have implemented simple
eligibility criteria, and used technology to accelerate the
distribution. Some have developed systems where patients can
register online. Others have used online event hosting software
to schedule appointments. And they have also partnered with
local businesses and pharmacies.
Despite all of the challenges that we have faced, the U.S.
has vaccinated more people per capita than most other countries
in the world--nearly 190 million doses have been administered
as of April 13th. More American citizens have received a COVID-
19 vaccine than tested positive for the virus since the
beginning of the pandemic. And nearly a third of the adult U.S.
population is now fully vaccinated.
There is reason for hope in our economic outlook, as well.
Expectations are set for a stronger economic response in the
second half of the year. The CBO expects real GDP to return to
its pre-pandemic level by 2021, and the labor force is expected
to return to its pre-pandemic size by 2022.
But in order to accelerate our economic recovery, we should
look for opportunities to improve vaccine distribution policy.
The sooner the U.S. reaches herd immunity through vaccinations,
the sooner businesses can reopen to full capacity, and students
can return fully to schools, and industries can come back to
life, and Americans can return to work and social life without
fear.
So I look forward to hearing our panelists' contributions
today, and their insights into how we can do just that. But
before I do, I would like to ask Chairman Beyer for permission
to submit five articles, or studies from our witness, Dr.
Tabarrok, for the record.
Chairman Beyer. Without objection, they are admitted.
[The five articles referred to by Senator Lee appear in the
Submissions for the Record on page 111.]
Senator Lee. Thank you.
[The prepared statement of Senator Lee appears in the
Submissions for the Record on page 41.]
Chairman Beyer. Senator Lee, thank you very much for your
statement.
I would now like to introduce our four distinguished
witnesses.
Dr. Celine Gounder is Clinical Assistant Professor of
Medicine and Infectious Diseases at the NYU School of Medicine
& Bellevue Hospital. An infectious disease specialist and
epidemiologist, Dr. Gounder served on the Biden-Harris COVID-19
Advisory Board. She is also the CEO of Just Human Productions,
which works to build awareness around issues of health
disparity. Dr. Gounder is a CNN Medical Analyst, and has
written several publications.
She holds a B.A. in Molecular Biology from Princeton
University, a Master of Science in Epidemiology from Johns
Hopkins University of Public Health, and her M.D. from the
University of Washington.
Dr. Paul Romer is the University Professor of Economics at
NYU. In 2018, he received the Nobel Prize in Economic Sciences
for his work integrating technological innovations--for
economic analysis.
Dr. Romer is a frequent commentator on the COVID-19
pandemic, and has been a strong proponent of large-scale COVID-
19 testing as a means of restarting the economy. In fact, about
a year ago, Dr. Romer spent an hour with the Joint Economic
Committee team talking about how we can use testing to protect
the United States.
In his career at the intersects of economics and invasive
technology and urbanization, working to speed up human
progress.
Dr. Romer previously served as the Chief Economist for the
World Bank, and he earned his B.S. in Mathematics with the
University of Chicago, and a Ph.D. also in Economics from the
University of Chicago.
Dr. Belinda Archibong is an Assistant Professor of
Economics at Barnard College, Columbia University. She has done
research on the economics of epidemics and vaccinations, and
her broader research areas include developing economics,
political economy, economic history, and environmental
economics with an African regional focus.
Some of Dr. Archibong's research investigated historical
institutions such as environment and unequal access to public
services in the development of human capital. This research
includes the effects of epidemics on gender gaps in human
capital investment. She received her B.A. in Economics,
Philosophy, and a Ph.D. in Sustainable Development both from
Columbia University. And my mom was a 1948 Barnard graduate.
Then finally, Dr. Alexander Tabarrok, who is the Bartley J.
Madden Chair in Economics at the Mercatus Center, and is
Professor of Economics at our own George Mason University.
Dr. Tabarrok has advocated for policies to speed up the
rate of vaccinations, including delaying second doses and
fractional doses. Dr. Tabarrok is the co-author of
FDAReview.Org, which is the website that scrutinizes the FDA's
regulatory and authority and performance.
Dr. Tabarrok is a Senior Fellow and former Research
Director of the Independent Institute. He was a co-founder of
the online educational platform ``Marginal Revolution
University,'' and co-author of the textbook Modern Principles
of Economics.
Dr. Tabarrok has a Ph.D. in Economics from George Mason
University.
So, Dr. Gounder, I will offer you the floor for your
testimony, and then we will continue in the order each of you
was introduced. Dr. Gounder, the floor is yours.
STATEMENT OF DR. CELINE GOUNDER, M.D., ScM, FIDSA, CLINICAL
ASSISTANT PROFESSOR OF MEDICINE & INFECTIOUS DISEASES, NYU
SCHOOL OF MEDICINE & BELLEVUE HOSPITAL, CEO OF JUST HUMAN
PRODUCTIONS, NEW YORK, NY
Dr. Gounder. Thank you.
Chairman Beyer, Vice Chair Heinrich, Ranking Member Lee,
and Members of the Committee, thank you for the opportunity to
discuss with you today the role of vaccination in our pandemic
and economic recovery.
It is important to give credit where credit is due. The
prior administration helped accelerate vaccine development
safely, scientifically, and in record time. The current
Administration is helping to scale up manufacturing and speed
up distribution of vaccines.
We are currently vaccinating an average of 3 million people
per day. And according to the CDC's latest data, 37 percent of
the total population has received at least one dose of vaccine,
and 23 percent of the total population has been fully
vaccinated.
Despite recent setbacks involving production and safety
concerns with the Johnson & Johnson vaccine, we remain on track
to have enough vaccine supply for every adult in the United
States by the end of May.
Assuming we can continue vaccinating at the same pace of 3
to 3.5 million vaccine doses per day, we could vaccinate all
adults well before the end of August. Vaccination rates reflect
vaccine supply, access to vaccines, and demand for vaccines.
Our supply is solid. We have done a lot of work to improve
distribution and access, and yet we still have room to do
better. But, importantly, we are about to see a big drop in
demand. And this is going to have a big impact on our daily
rate of vaccination.
Supply is already outstripping demand in several states.
There is a spectrum of vaccine hesitancy, vaccine confidence,
and vaccine seeking. The good news is that the share of
Americans who want to, quote, ``wait and see,'' what we call
the moveable middle, shrank from 39 percent in December to 17
percent in March. So we made a lot of progress among
communities of color, and persons for whom issues of access are
the greatest barriers to vaccinations.
The bad news is that 20 percent of Americans say they will
only get vaccinated if required or will definitely not get
vaccinated. Our daily COVID vaccination rates could drop
significantly within the coming months as a result of dropping
demand.
With 20 percent of Americans currently unlikely to get
vaccinated, and another 25 percent of the population who are
children, we will not be reaching herd immunity for quite
sometime yet.
It is also important to understand that vaccine rollout is
necessary but not sufficient for pandemic recovery. And I think
of pandemic recovery in four phases: ending the emergency,
relaxing mitigation measures, getting to herd immunity, and
long-term control.
To end the emergency, we have to vaccinate the highest risk
persons who are most likely to develop severe COVID, most
likely to be hospitalized, and most likely to die. That means
vaccinating older adults and people with chronic medical
conditions, and we must also pay special attention to the
hardest hit, most vulnerable communities, including communities
of color and front-line essential workers. We cannot end the
emergency phase of the pandemic by relying only on vaccination,
without risking another surge in cases, hospitalizations, and
death.
I think of the pandemic a bit like a speeding car. Lifting
mitigation measures too soon is like taking your foot off the
brake before putting the car into park. With the emergence of
more infectious variants, the virus is hitting the gas at the
same time. Vaccination is like a parking brake. It works well
once the car is in park, but not nearly as well when you're
racing down a highway.
We are likely facing a prolonged interim period when we can
safely lift mitigation measures, because the most at-risk have
been shielded by vaccinations, but before we have reached herd
immunity. And this means that, even once restrictions are
lifted, we are unlikely to get back to business as usual right
away.
While COVID credentials may not be mandated by the
government, the private sector is forging ahead. The purpose of
COVID credentials, what some mislabel ``COVID passports,'' is
to demonstrate that when individuals engage in certain
activities, they pose minimal infectious risk to others. COVID
credentials may take the form of COVID test results, as well as
COVID vaccination status. COVID credentials are not COVID
vaccination mandates.
Finally, our pandemic recovery plans must address chronic
underfunding of the CDC and state and local health departments,
for building a strong modern public health infrastructure. We
need a professional public health corps and 21st Century
bioinformatics and laboratory systems. Our financial and
political investment in preparedness for epidemics and
pandemics should reflect the serious health, economic, and
national security triple threat they pose.
We must re-engage on the global health stage, as this
pandemic has shown us the emergence of a new virus halfway
around the world poses a very real and present danger to us
all.
[The prepared statement of Dr. Gounder appears in the
Submissions for the Record on page 43.]
Chairman Beyer. Dr. Gounder, thank you very much.
I now recognize Dr. Romer for his testimony.
STATEMENT OF DR. PAUL ROMER, NOBEL PRIZE WINNING ECONOMIST AND
NYU PROFESSOR, NEW YORK, NY
Dr. Romer. Yes, Chairman, Vice Chairman, Ranking Member,
other Members, thank you for the chance to speak with you
today.
As all of the speakers have emphasized so far, we are
benefiting from some dramatic successes right now--the success
in developing the vaccines, and then the very difficult
logistical challenge but one we have successfully met, of
getting these vaccines into the arms of the American people.
Now in the context of these two dramatic successes, I want to
offer two notes of caution.
The first is to remind everyone that the damage to the
economy and to livelihoods has been very significant, and we
need to have an economic recovery that gets everyone who was
working before in 2019 back into some kind of employment
opportunity--and, only decide that we have recovered when we
reach that point.
But yet we should go even farther. We should not just get
back to the employment-to-population ratio we had in 2019. We
should aim for the employment-to-population ratio that we had
in 1999, 20 years ago, which was one percentage point higher.
We have tolerated over the last 20 years a steady reduction
in the employment-to-population ratio, which has not been
visible in our unemployment rate because the employment-to-
population ratio falls when people become so discouraged they
stop even trying to find a job.
So we need a goal for recovery that is not just to get back
to the kind of low unemployment rates we saw in 2019, we want
to get back to the very hot labor market conditions of 1999
where more people could work, and where wages for the lowest
skilled members of the workforce were rising because of the
demand for these workers. So we cannot lose track of the right
measure of recovery, and we cannot give up on recovery until we
get back to full recovery.
The second cautionary note is that we run--even though the
vaccines can with certainty end this pandemic by the fall, we
run a non-trivial risk of--we face a non-trivial risk of a
third wave of infections and deaths in the spring and the
spring and summer. This is because we have got a race right now
between a new variant, which is spreading rapidly, which is
more aggressive. So control measures that worked for the old
variant will not work for the new variant. So we have got a new
variant, which is spreading rapidly, and then the opposing
advantage we are getting is we are vaccinating more and more
people.
There is a race between those two effects, and it is
complicated because there is also a tendency for people to see
deaths are going down, at least for now, vaccinations are going
forward, so social distance measures are being withdrawn. And
this means that, at least temporarily during the spring and
summer, the relaxed social distancing measures and the more
aggressive variant could lead to one more wave of infections
and deaths.
What we are seeing in Michigan is a kind of an early
warning signal of what we could see throughout the economy. If
this happens, we need to not panic. We need to understand we
will get to the end of this by the fall. We need to not be too
obsessed about who to blame, who is at fault. We do need to
think about what we can do.
And Dr. Gounder, if you read her recent op ed, makes this
very important point, that accelerating vaccinations, which
would be good across the country, is not the right spot
treatment effect when we do see this new wave emerge.
We need things that act more quickly. And the kind of thing
that could act quickly is to get tests into the hands of people
who might be infected. And if they can test and find out
quickly that they are infected, they will tend to isolate
themselves. They will try to protect the people around them.
So my advice on Michigan is the kind of advice I gave a
year ago for the country, which is to make these tests
available. I would be carpet-bombing Michigan right now with
these at-home tests that people could take. Do not worry about
whether they get recorded in the data. Do not worry about
anything but let people take these tests, find out if they are
infected, and isolate themselves right away. And they can go
get a confirming test from some official source, but this is
the kind of measure that could help us during the spring and
summer. And of course social distance will save lives during
this period, but we have got to be realistic that it is going
to be hard to keep people sticking to these social distance
measures when they are seeing, at least for a time, so many
signals that look optimistic.
So to conclude, if we work hard enough, we can recover not
just to where we were in 2019, or 2009, but--2007, but all the
way back to 1999. That is the kind of recovery we should aim
for, and we will get through what could be a little bit of a
troubling period in the next few months.
Thank you.
[The prepared statement of Dr. Romer appears in the
Submissions for the Record on page 80.]
Chairman Beyer. Great. Thank you, Dr. Romer, very much.
Dr. Archibong, the floor is yours.
STATEMENT OF DR. BELINDA ARCHIBONG, ASSISTANT PROFESSOR OF
ECONOMICS AT BERNARD COLLEGE, COLUMBIA UNIVERSITY, NEW YORK, NY
Dr. Archibong. Great. Thank you very much, Chairman Beyer,
Vice Chairman Heinrich, and Ranking Member Lee, and committee
members for the opportunity to testify today.
So I just wanted to highlight three key points around this,
being that any effect of economic policy needs to focus on
equitable recovery. So as far as highlighting the differential
risks and disparities of economic recovery that have been faced
by Black communities during the pandemic.
Second, assessing the role of vaccination in economic
recovery, especially addressing the disparities that my
colleagues have mentioned in access and also in vaccine
compliance.
And third, highlighting four main policies for more
equitable post-pandemic recovery.
So on this first point, so we knew early on that Black
communities, and Black populations were disproportionately
being infected, and also the case mortality rates were higher
among Black communities, at the start of the pandemic. Part of
the reason for this was that Black workers were more highly
represented related to their population shares in the kind of
essential service sector. And why is this? This has been due to
the history of racial discrimination in labor markets in the
United States.
So that said, despite the fact that Black communities have
been disproportionately negatively affected during the
pandemic, we have seen that the kind of pandemic response in
the economic recovery has been unequal and uneven.
So we have all seen the unemployment statistics that came
out last month, so 6 percent unemployment rates were kind of
improved from last year. But if you look at the unemployment
rates by race, you will notice that the Black unemployment rate
is still twice the rate of White workers. It is still around
9.6 percent compared to 5.4 percent for White workers.
We also know that Black business owners faced much higher
employment losses at the start of the pandemic. They lost about
41 percent of employment between February and April of last
year, compared to 17 percent loss in employment for White
business owners.
Now despite these losses, Black business owners, especially
Black women business owners, were less likely to receive loans
from the Paycheck Protection Program due to poor targeting and
also partly due to discrimination.
Second, on vaccination, we know that vaccination is a key
part of the economic recovery, but as has been mentioned
earlier, there are disparities in access to vaccines. We need
to target the 85 percent vaccination rate to public health
experts to get the positive benefits of reduced diseases from
the pandemic. We are currently at 22 percent fully vaccinated,
but if you look at it again, the kind of Black/White difference
in vaccination rates, the vaccination rates among the White
population are around 28 percent--so it is about two times
higher than vaccination rates for Black and Hispanic
populations, which are about 17 and 16 percent currently.
So we definitely need more equitable distribution that
focuses on improving access in Black and Hispanic
neighborhoods, especially different--and again, these
populations are relatively over-represented in these essential
service workers, and we know the key sector, the necessary
sector, for the economic recovery.
So lastly, just on these four policies for a more equitable
post-pandemic recovery, so one definitely we need much better
targeting of grants of credit to Black neighborhoods, to
industries where you have higher concentrations of Black
business owners. More regulation and monitoring is also needed
to reduce discrimination.
Second, we need to address the disparities in vaccine
access. We all know that people who study the history of
vaccine compliance, we know that there is a history of racism
in medicine in the United States that has led to the mistrust
we have seen among the Black population today when it comes to
the vaccine issue. So really working with trusted community
partners in Black neighborhoods to disseminate information
about vaccines, and improve access through local communities in
Black neighborhoods is essential, again, to get--close the
disparity in vaccination and get us to this 85 percent
coverage.
Thirdly, we know that the pandemic has widened racial and
gender disparities in employment, in health and wealth. These
effects will last for a long time, except we have real
concerted policies, everything around universal health care,
and thinking about government-funded savings accounts for low-
income families, thinking about, you know, support for and
protection for labor in these essential service sectors, as
well.
And then lastly, you know, thinking forward. Right? We
expect that we might see more of these pandemics in the future.
This is what our environmental health policies are predicting.
So we need to strengthen environmental regulation around, for
example, clean air quality, to reduce the health and
environmental vulnerability faced by the Black populations from
these pandemics.
So to conclude, any aspect of pandemic economic recovery
needs to focus on an equitable recovery. It needs to be aimed
especially at improving the lives of Black communities, or
communities of color, and women within these communities that
have been disproportionately harmed by the pandemic.
Thank you.
[The prepared statement of Dr. Archibong appears in the
Submissions for the Record on page 82.]
Chairman Beyer. Thank you, Dr. Archibong. Thank you, very
much.
Finally, we will hear from Dr. Tabarrok. Dr. Tabarrok, the
floor is yours.
STATEMENT OF DR. ALEXANDER TABARROK, BARTLEY J. MADDEN CHAIR IN
ECONOMICS AT THE MERCATUS CENTER AND PROFESSOR OF ECONOMICS,
GEORGE MASON UNIVERSITY, FAIRFAX, VA
Dr. Tabarrok. Thank you, Chairman, Vice Chairman. It is an
honor to be here.
About a year ago, a Nobel Prize winner, Michael Kramer, and
I were asked by the Domestic Policy Council of the White House
to write a report on using incentives to accelerate vaccines.
Joined by a number of other top economists, we wrote a report
advocating spending on the world scale of approximately $150
billion to invest in 18 vaccine candidates.
We wrote similar reports for the British Government, and
also came to later advise the World Bank and other
organizations around the world.
The world did not go as big as we wanted. Operation Warp
Speed, however, was by far the best. These fed about $15
billion and were tremendously successful. In a recent paper in
Science, we calculate that if we get 3 billion courses of
vaccine this year, which is a conservative estimate, that will
be worth $17.4 trillion--Trillion--to the world economy. And
Operation Warp Speed should be credited with the significant
fraction--certainly not all--but with a significant fraction of
that success.
Moreover, it is not too late to do more. We calculate that
if we could get an additional one billion courses of capacity
online this year, that will be worth 500 billion to one
trillion for the world economy, depending upon how quickly it
can be brought online.
Now is it possible to get more doses this year? Yes, it is.
The Biden Administration spent $269 million, giving that to
Merck, to increase the capacity to produce the Johnson &
Johnson vaccine. That was a smart investment, and continues to
be a smart investment.
Another smart investment which we could make is to invest
in nasal vaccines. The next big hurdle is going to be vaccine
hesitancy. And a significant fraction of vaccine hesitancy is
fear of needles. Adults do not like to say that they are afraid
of needles, or that they do not want to get a shot because of
needle fear, but that is in fact the case.
A needle--excuse me, a nasal vaccine would have advantages,
not only in reducing vaccine hesitancy but a nasal vaccine
stimulates the mucosal immune system, which is where the virus
attacks. So they also have medical benefits, as well.
Moreover, a nasal vaccine or an oral vaccine is going to be
important to vaccinate children. And that also is going to help
us to get to herd immunity. After we vaccinate the next--after
we vaccinate the United States--our next big job is to
vaccinate the world. And there are health, economic, and
political reasons to do so.
The unvaccinated are the biggest risks that we face for
generating new variants and mutations. You have heard, no
doubt, about the South African and Brazilian variants. Well,
the best way to protect your constituents from South African
and Brazilian variants, and others, is to vaccinate South
Africans and Brazilians.
Moreover, economics. Even after the United States and other
high-income countries are vaccinated, the United States is
still going to face economic costs from reduced exports,
reduced imports, and supply chain disruptions due to COVID
elsewhere in the world. So there are sound economic reasons for
vaccinating the world. And an additional $4 billion donation to
COVAX would go a very long way to getting that last mile,
getting those last people vaccinated.
Finally, political reasons. We can have an American plan to
vaccinate the world, or a Chinese plan. I would prefer that we
have an American plan. Next, as we vaccinate the world, we need
to think about dose stretching. We know from the clinical
trials that both the Moderna and Pfizer vaccines, the first
dose is about 80 percent effective. And in my view, it is
better to bring more people from zero percent to 80 percent
protected, than to bring one person from zero percent to 80
percent and then boost them to 95 percent.
Speaking loosely, the first dose protects you from being
killed, from dying. The second dose protects you from getting
the sniffles. Related to this, we should investigate fractional
dosing. The phase one and phase two clinical trials indicate
that half-dosing would be also potentially very, very
effective. And if one thinks about this half-dosing, that would
be equivalent to doubling the number of Pfizer and Moderna
factories. So that would be extremely valuable if we could do
that. Great Britain and Canada have moved to delaying the
second dose, and other countries will soon follow suit.
So summing up, it is not too late to do more. We should
invest in nasal vaccines. We should vaccinate the world. We
should stretch doses through fractional dosing and delaying the
second dose. And this is going to be important to vaccinate the
world quickly.
Thank you, very much.
[The prepared statement of Dr. Tabarrok appears in the
Submissions for the Record on page 97.]
Chairman Beyer. Thank you, Dr. Tabarrok. Thank you, very
much.
We will now begin the first round of questions. I will
lead. So, Dr. Gounder, let me start with you. In your
testimony, you wrote that most scientists believe that SARS-
CoV-2 is here to stay; that this virus will become endemic and
will be around with us for years and years to come.
What are the implications of that understanding?
Dr. Gounder. So first of all, the reason that this is not a
virus that we can eradicate is because it does infect other
species. There are very few viruses that can be eradicated.
Smallpox is one of the few that which we have successfully
eradicated, and we are hopefully going to be eradicating polio
in the coming years. But I think the fact that we have been
working so long at this with polio speaks to the fact that this
is a very difficult thing to do, even when it is not a virus
that infects other species.
So we do realize that there are going to be pockets of
people, whether it is in the United States or overseas, who
will choose not to be vaccinated, who cannot be vaccinated, who
do not have access, and then others who may be vaccinated but
who have for whatever reason either waning immunity or just do
not mount an immune response.
And so we are going to see ongoing transmission, and that
means we cannot only rely on vaccination. We need to anticipate
the needs for testing to make sure that we can assess if
somebody is infected so we can triage and isolate as
appropriate. We also need much better therapeutics for COVID.
Right now, really the best therapeutic we have is
dexamethasone, which is an old steroid. We have monoclonal
antibodies, which have a lot of tradeoff in terms of risk,
especially as we see the rise of these new mutant variants. And
then we have a number of old drugs that we are trying to
repurpose and study for their use in COVID. But we really do
not have a slam-dunk here. And so that is one area we really do
need to be looking at.
I think you are also looking at a lot of people who will be
COVID survivors. And how do you even accurately assess who was
a COVID survivor, and then be prepared to manage all of the
health and disability rehabilitation needs that those people
are going to have? So I think we need to be anticipating and
preparing on all those fronts, as well.
Chairman Beyer. Thank you very much.
Dr. Romer, when we spoke a year ago you were thinking then
about testing the entire population every two weeks. I would
love to know why the past tests have not hit the way we had
hoped. And also, the one percent higher employment-to-
population ratio of 22 years ago. What should we be doing right
now, from an economic policy standpoint, to move it back? What
are the hurdles like child care affordability?
Dr. Romer. So I think it is an interesting question, why we
did not make the same kind of push on testing as we made on
vaccines. And I think there are at least two possible
contributing factors.
I think one is that, you know, the health care community
has been hesitant about testing when there is low prevalence of
a condition. And in clinical care, it does not make sense to
just test people with no other indication that they are stick.
But screening is a very different use of testing. And I
think people have been a little bit slow to appreciate the
potential power of screening.
The other factor I think, which you cannot deny, is that we
had an administration that had a very explicit policy of trying
to reduce the number of tests, because it did not want more
tested confirmed cases as a sign of the seriousness of the
pandemic.
So I think both bad administration policy and hesitancy
contributed to the failure to use the tests. But just as Dr.
Tabarrok said, it is not too late here. We have a really
serious question to address about how do we help places like
Michigan that are getting hit so hard?
And I think these new at-home tests that are like little
cards, we should be giving those out to everybody in Michigan,
everybody who is willing to do one of these tests, and just
assume and understand that they will isolate themselves if they
get a test that the test results signal that they are positive.
Now on how we get back to the kind of labor market
conditions of the 1990s, I think the most important thing is we
agree on that is the goal, and we agree on this metric of the
fraction of adults who are employed.
Once we agree on that, then we can take the stance of
trying many different things. Stimulus like we are doing right
now, aggressive stimulus, will be part of this. And
infrastructure build could be part of this. But there could be
other things we could do. We could look at things like targeted
subsidies for employment, or for new jobs, or for hiring. You
know, there are many things that we could do.
But we have got to get away from unemployment rates as our
metric of success, and get to the more important measure of
employment rates. And we should remember that by that measure,
the employment rate, the United States now lags far behind
other nations that it used to do better than--Canada, Great
Britain, Germany, Sweden, Australia.
So we really have kind of failed repeatedly to recover and
achieve the kind of employment, and the widespread benefits
from work, and we really need as a Nation to commit to doing
whatever it takes to get back to that point.
Chairman Beyer. Thank you, Doctor, very much.
I recognize Senator Lee for his questions.
Senator Lee. Thanks so much, Mr. Chairman.
Dr. Tabarrok, let's talk about the $1.9 trillion American
rescue plan for a moment. This $1.9 trillion bill was a massive
economic stimulus. And it was sold as a COVID Relief Package,
even though less than 7 percent of it was actually allocated to
COVID testing and vaccines.
So, Dr. Tabarrok, given that massive economic spending
today imposes consequences on future generations, does it make
sense to focus spending on activities necessary for recovery?
Specifically, those that help us reduce the incidence of COVID?
Dr. Tabarrok. So I think there is no recovery until COVID
is defeated. We are close to that. We should have spent more on
vaccines. I think that is clearer today. We should still be
spending, as I suggested, on nasal vaccines and oral vaccines.
I agree entirely with Dr. Romer that testing was
underdeveloped and could still be used today. Denmark is
testing 8 percent of their population every single day, about
50 percent a week. So Denmark is getting close to what Paul
Romer originally argued for a year ago. And rapid tests I think
would be very useful in Michigan, as Dr. Romer said.
The rest of the stimulus budget I think just has to be
evaluated on its own ground, not as a stimulus, not as COVID
fighting; you just simply have to ask do we want this
particular investment? Does it face a cost/benefit test?
Some of what we spend on vaccines and testing has a
tremendous multiplier effect. Everything else is much, much
smaller. Much, much smaller. So I think those other investments
need to be evaluated on their own grounds.
Senator Lee. You know, that makes sense. And I tend to
agree. In looking at that, we have got to remember that one of
the strengths of our system of government, which is rooted in
federalism, is a system in which sovereignty and decision-
making authority are shared. They are divided between Federal
and state governments.
But during the COVID-19 pandemic, states were often
dependent on the Federal Government for both financial
assistance and guidance. So I have a couple of questions
related to that.
In what ways do you think states' reliance on Federal
support might have inhibited an effective innovative pandemic
response?
And what lessons can we learn from state-level
experimentation where it did occur? And just show us how we can
support a decentralized type of innovation for future crises.
Dr. Tabarrok. I was disappointed by the reactions of many
states and local governments. Let me give you a few examples.
The states and local governments were told months and
months in advance, the vaccines are coming. The vaccines are
coming. The vaccines are coming. And yet when the vaccines
arrived on their doorstep, they said, ``We do not have enough
money. We do not have enough money to set up clinics,'' which
was total nonsense.
The states and the local governments have spent trillions
of dollars. You are telling me they could not find a way of
reducing their budgets, with this huge, incredible benefit of
getting the vaccination clinics available? No.
So that was a very poor response, and it slowed us down in
the early weeks.
I do think that a lot of energy has been drained through
the Presidential system to the Executive. I would have liked
for there to be more experimentation at the state level. As far
as I know, for example, a state could have introduced, could
have required going with first doses first, delaying the second
dose. No state did that.
So I would have liked to have seen more experimentation and
a more federalist system. It is one of the United States' great
strengths, and I think we are losing it by focusing too much on
what is going on with the Federal Government.
Senator Lee. Yeah. You know, and I very much agree. I am
also concerned about the fact that with the recent virus
mutations that we have seen arising in Spain, the UK, South
Africa, and Brazil, we have got mutations that could threaten
the efficacy of our domestic vaccination process as these new
strains appear in the United States.
Can you talk to us a little bit about the importance of
administering more first doses, especially in light of this?
And would you describe some of the economic and societal
tradeoffs of not pursuing the first doses first policy.
Dr. Tabarrok. Right. So the first dose appears to have
protected about 80 percent. That is very good for the
individual. But in addition, when you protect two people at 80
percent, rather than one person at 95 percent, you reduce the
transmission rate of the virus. To reduce the transmission, it
is much better to protect more people.
It also looks like protecting more people, vaccinating more
people, which you can do by delaying the second dose, it looks
like that will also reduce mutations. We do not know that for
sure, but that is what the epidemiologists are now thinking.
So by protecting more people, we reduce transmission, we
reduce mutations, we get more people vaccinated sooner. And
then finally, I would just like to reiterate that another way,
in addition to this, we need to do this for the entire world.
Because the best way to protect against South African,
Brazilian variants is to protect South Africans and Brazilians.
And so we have an economic, medical, as well as a political and
ethical responsibility to vaccinate the entire world. And the
United States is only one of the very few countries that can
credibly do this. And this is a good opportunity to show our
entrepreneurship and our power in the world, and our benefit to
the world.
Dr. Romer. Senator Lee, if I could, I would like to
reinforce the point that you were pointing to. It is a
discussion we need to have.
If you think back to the 19th Century, the way the United
States built the best university system in the world was not by
saying we are going to have this national university, which is
this shining light for the world. We said we are going to have
universities in every one of the 50 states. And so the Morrill
Act, which created the Land Grant Universities, built this very
robust system.
Now fast-forward to the most recent period. When we think
about the capacity of the CDC, or the FDA, we have done the
opposite. We have said let's build this enormous capacity that
is centralized under the control of the Federal Government, and
make all of the states dependent on those organizations. And
they have sometimes erred and they have left us with what the
engineers call a single point of failure.
I think we need to think hard about investing more in
public health and regulation, but perhaps going back to the
methods of the Land Grant approach and invest in that capacity
in the states rather than creating these Federal single points
of failure.
Senator Lee. That is fantastic. I am pleased to hear about
your enthusiasm for federalism, and let's bring back the
Morrill Act.
Chairman Beyer. Thank all of you very much. Let me now
recognize the senior Senator from New Mexico, Senator Heinrich.
Senator Heinrich. I thank you, Chairman. And I want to
start with Dr. Gounder on an issue that has been very much in
the news in just the last couple of days.
Yesterday alone COVID claimed 987 lives in the United
States, 9 of those in my home State of New Mexico, that I am
proud to say is at the forefront of trying to develop herd
immunity.
Meanwhile, out of over 6.8 million doses received of the
Johnson & Johnson vaccine nationwide, 6 people have developed a
rare and serious form of blood clots.
So from what the CDC and the FDA and Johnson & Johnson have
stated publicly, those six individuals also had a very--had a
known and defined risk profile with respect to blood clots.
So how can we properly weigh the relative risk of COVID
versus the Johnson & Johnson COVID vaccine to ensure that we
are saving as many lives as possible?
Dr. Gounder. Thank you for that question. I think it is
really important to understand that the FDA has not pulled the
Johnson & Johnson vaccine from the market; that the Emergency
Use Authorization still stands. This is just a pause, a time-
out for the scientists to step back and review the data.
And I think that is really important. Because when you look
at what our biggest obstacles are in the coming months, it is
really around vaccine demand, or hesitancy, or confidence,
whichever word you want to use. And one of the biggest drivers,
especially in those who are most recalcitrant, most resistant
to getting vaccinated, it really comes down to either a lack of
trust in health systems, or a lack of trust in the government.
And so it is absolutely essential that the CDC and the FDA
behave in a way that is transparent, honest, above-board, and
that they show they are doing their due diligence, because that
is really what is going to predict in the longer term whether
people feel comfortable getting vaccinated. They need to trust
in the government, in the CDC, in the FDA. And by doing this
review that is going on--actually, I think as we speak today--I
think that is what is going to get us there.
We have seen, as you mentioned, six of these severe side
effects. They are all in women who are between the ages of 18
and 48, and they have had other predisposing conditions. And I
think there is quite a good possibility that what you will see
happen, and we have seen something similar happen with the
AstraZenica vaccine in Europe, is that the CDC and FDA will
recommend potentially restricting access, or restricting use of
this vaccine for certain populations.
We have not seen any of these severe side effects here with
J&J among men, for example. We have not seen that side effect
with older people. And so it may just be that they step back
and say maybe this is not the best option for younger women of
reproductive age, but for the rest of the population this
continues to be a great option.
You know, I think as physicians we err on the side of doing
no harm, and so I think it is really important that we abide by
that. And I think it is really important that this message got
out there as soon as possible so that doctors and patients know
what to look for.
The most common treatment we use for blood clots, heparin,
is actually dangerous for this particular kind of blood clot
and can be deadly. So it was really essential to get the
message out there as soon as possible, so that if me, for
example, as a provider, I have had patients who got the J&J
vaccine. If I see one of those patients back, I know what to be
looking for and what to do.
Senator Heinrich. Thank you, Dr. Gounder. What you outlined
there in terms of changing the target population is exactly
what I was discussing with the White House just minutes ago.
And so I am hopeful that we can be absolutely transparent in
this process, look at the data, and then hopefully get this
very efficacious vaccine back into the places where it is
appropriate. Because it is our best tool in some of the hardest
to reach communities.
Fractional dosing, is that something, Dr. Gounder, that you
would agree with Dr. Tabarrok on? And should we view looking at
vaccinating the entire country with the first dose, for
example, and then coming back and prioritizing second doses for
the most immune-compromised and having that same sort of phased
approach that we have used in New Mexico to really get ahead of
most of the rest of the country in terms of developing herd
immunity?
Dr. Gounder. I think you need to be very careful in how you
interpret the data about 80 percent effectiveness after a first
dose, and over 90 percent after a second dose. I think the
problem is that immunity is not ``on or off.'' It is a range or
a spectrum.
And so you may be immune after one dose to the most
prevalent original strains, but now we have also seen the rise
of the B.1.1.7 variant, and also, as you mentioned earlier, as
we have mentioned earlier, the variants out of South Africa and
Brazil. And we have several studies now that indicate that
after one dose you still have break-through infections with
both the B.1.351 from South Africa, and the B.1.1.7 from the
UK.
So there is a very real risk that you would be creating
this prolonged window where you would be selecting for, putting
immune pressure for more of these variants to emerge. That
said, I think the fractional dosing strategy is something that
should be studied. It can be done pretty quickly, and it is
something that we should go ahead and evaluate. And if that
proves to be as effective in terms of the immune response
solicited as the current full dose, that is something we should
absolutely be doing.
Senator Heinrich. Thank you very much. Thank you, Chairman.
Chairman Beyer. Thank you, Senator, very much. And I
recognize my fellow Ways and Means classmate, the gentleman
from Wichita, Mr. Estes.
Representative Estes. Well thank you, Chairman Beyer.
From the beginning of the health crisis, we were told that
vaccines and herd immunity were the keys to reopening the
economy. Now we have multiple vaccines, and two more in Phase
III trials. We are moving forward with that. And having 180
million people, Americans that have already received at least
one dose of the vaccine, and a vaccination rate of 78 percent
of those over 65.
What I hear in my District in Kansas is, you know, when we
get back to life? A lot of businesses have suffered. Children
are falling behind in school. And a lot of people have lost
their jobs.
We have done a mixed review, or mixed results maybe in
terms of vaccinations within the state. Specifically, we have
done a good job of vaccinating seniors, and now of
vaccinating--reaching out to all adults. But we rate 35 in the
country of swiftly administering the vaccinations that have
been given to us.
The operational speed, as mentioned earlier, and some smart
investments, the United States were able to develop this
vaccine in record time. And your Trump Administration purchased
over 800 million doses, which just set things up now, at the
end of the Trump Administration and with the current
Administration, for success.
Although experts repeatedly said we would not have the
vaccine by the end of 2020, they were wrong. Tomorrow, 26
states will expand vaccine eligibility to all adults, and by
May 1st all states will have open eligibility.
But instead of focusing on COVID relief to help get the
economy going, some of the discussions in some of the bills
like the Rescue Plan have very little funding for vaccine
distribution efforts, and, instead, spend a lot of money
bailing out states, again taking away the federalism mindset.
Even Politifact, which is not known for a conservative point of
view, has admitted that the COVID-19, the American Rescue Plan,
is not a COVID-19 package. And I quote that at the end, direct
COVID-19 spending is about 8\1/2\ percent of the bill's $1.9
trillion cost.
Instead of backing big government spending initiatives, we
should focus on crushing the virus, kick starting the economy,
and getting Americans back to work by implementing pro-growth
policies to help American businesses such as R&D expensing,
which is going to be expiring this year. We need to make it
permanent in order to make some of the jobs back in America.
I do want to ask a couple of questions of Dr. Tabarrok.
Through Operation Warp Speed, the vaccine testing and
production was able to be conducted in tandem and in a more
streamlined manner. How can we formalize or codify this process
to help make sure that we minimize such severe economic impacts
in the future?
Dr. Tabarrok. So I think one of the silver linings to the
crisis is that it has shown that FDA delay can also be very,
very costly. So people are seeing for the first time that the
longer the FDA takes to approve, whether it is a vaccine or a
drug or something like that, can have a real consequence in
terms of people dying of COVID or some other disease.
This is also true for cancer. This is also true for heart
disease. This is true for all of the products that go through
the FDA. And it now costs over a billion dollars to get the
typical new drug approved.
We need to find some way of reducing that to have more
experimentation and more new drugs. Because new drugs
absolutely do save lives. So if we can find a way of using our
experience from COVID to accelerate FDA approvals across the
range, I think that would be tremendously beneficial to
American patients.
Representative Estes. Great. That kind of leads into
another thought I had around the breakthrough that we and with
mRNA technology that really did allow us to develop the vaccine
very quickly.
Are there things that we can do, incentives such as
improving R&D expensing, or genius prizes, some of those so-
called genius prizes that would help us make breakthroughs in
the future?
Dr. Tabarrok. Yeah, so two points. Going back to one of the
earlier questions which was asked--what about if COVID becomes
endemic--well, one consequence of that is that every investment
we make now is going to have a very long payoff. So that is
great. So this increases our incentive to invest in mRNA
technology, which is capable of not just producing a vaccine,
but is also capable of producing drugs to treat cancer and
heart disease, and so forth.
So I think all of these things are a great way to invest.
R&D expensing may be certainly a part of that. And, prizes,
yeah, I do think that prizes should be looked at more. The pre-
market purchases, the advance-market commitments which we made
for Pfizer, saying we are going to buy hundreds of millions of
these doses, that is very similar to a prize. And that worked
very well in incentivizing Pfizer to invest billions of dollars
in factories, which is now paying off now.
Representative Estes. Thank you very much. And, Mr.
Chairman, I yield back.
Chairman Beyer. Thank you. Thank you, Mr. Estes. I now
recognize who I believe is the senior Senator from Georgia,
Senator Warnock.
Senator Warnock. Well thank you so very much, Chairman
Beyer, for that promotion. Senator Ossoff, who is my colleague
and friend, will be glad to know that I am now the senior
Senator. He is actually the senior Senator. Let me note this
only because ``O'' comes before ``W.'' I have been suffering my
whole life having my last name Warnock. It is the only reason
he is the senior Senator, because he is Ossoff and I am
Warnock.
[Laughter.]
Chairman Beyer. There is no fairness. You got more votes
than he did.
Senator Warnock. Go figure. Well, I did not say all of
that. You said those things. But we both won.
Listen, thank you so much. It is an honor to be here at my
first Joint Economic Committee hearing, and I look forward to
working under your leadership, and working with all of my
colleagues to discuss issues and propose solutions that will
allow for a robust economic recovery.
As has already been discussed in this committee hearing,
the COVID-19 pandemic, while it has impacted all of us, some
communities have experienced a profound disproportionate
impact. And I am speaking in this instance about women in
general, particularly low-income women, and women of color who
are not only experiencing the steepest job declines, but also
severely lagging in the overall jobs recovery.
It took until 2018 for the rate of employment among Black
women to recover from the last financial crisis, almost a full
decade later. And now, almost all of those hard-won gains have
been erased due to this economic downturn created by a once-in-
a-century pandemic. And so I would like to ask Dr. Archibong,
based on your experience studying how pandemics affect
economies, what should we expect about our own economic
recovery, if past is prologue? Should we expect that economic
prospects for women, especially women of color, to continue to
lag behind? And what can we do to avoid that from happening?
Dr. Archibong. Thank you very much, Senator Warnock, Rev.
Warnock. I do not know if you remember that we met sometime
ago, but it is nice to see you again. And it is nice to see you
again.
It is a very, very important question. It is something that
I have been studying, the effects of the pandemics on gender
inequality. We are seeing that women generally,
disproportionately are involved in home production. So a lot of
women dropped out of the labor force to take care of families,
to take care of children. And one of the things that the
official statistics might decide on kind of the workforce
statistics, the unemployment statistics, by gender, is that we
might be missing a lot of women who have just dropped out of
the workforce altogether, that are no longer looking for jobs,
which would not be reflected in the unemployment statistics.
So that is incredibly worrying. This is something that in
other contexts that I have looked at we see that these widening
gender gaps are in human capital investment, in the labor
market, in educational attainment, and these have existed for a
number of years, except we have, again, a policy that is not
just a blanket policy about pandemics, but a policy that says
we are going to take very seriously the fact that certain
populations, as you said, are disproportionately being harmed.
Women are disproportionately being harmed by the pandemic. They
are dropping out of the labor market almost entirely.
How do we get them back to pre-pandemic levels? And even, I
would say, better than pre-pandemic levels especially if we are
looking at women of color, Black women who in pre-pandemic
times were much, much strained when it comes to unemployment
rates.
So what does this mean? This means like thinking about--
when we think about stimulus and cash grants, thinking about
incentives that are targeted by gender, thinking about
incentives that are targeted toward households where women are
living and doing a lot of unpaid care work, and really being
very deliberate about the kind of policy, and thinking about
gender and racial implications of the policies that we are
passing.
So I think that is important. And I just wanted to add,
just to respond, I have been listening to the very interesting
conversations and responding to Dr. Romer's point earlier, I
think actually where you really need centralized authority. So
the CDC is important. The WHO in my experience is very
important in terms of coordinating these efforts. And also
coordinating efforts that again to think very carefully about
the gender and racial disparities that come about from the
effects of these. So thank you very much for the question.
Senator Warnock. Thank you so much. And I have got a few
seconds. So we passed the American Rescue Plan, which is, you
know, a step in addressing some of the disparities that you
talked about exacerbated by the pandemic. We are now focused on
infrastructure, the American Jobs Plan. And we think about
women, and child care, and a whole range of issues.
What kinds of things should we be thinking about as we put
together an infrastructure program to take seriously the need
to address these disparities as we think about jobs and the
economy?
Dr. Archibong. Right. So one thing that my colleagues have
studied and mentioned and thinking about are subsidies for
child care. So that is something that, again, women are
disproportionately dropping out of the labor market to take
care of children, a lot of women, to take care of household
members that were sick. And so thinking about the necessity for
child care, and thinking about, you know, whether it is kind of
easily accessible work retraining programs to get women back
into the workforce, these are the types of policies that I
think would be very effective and have worked in other contexts
in closing these gender gaps as a result of pandemics.
Senator Warnock. Thank you so very much.
Chairman Beyer. Thank you, Senator, very much. I now
recognize the Senator from Texas, Senator Cruz.
Senator Cruz. Well thank you very much, Mr. Chairman, and
welcome to each of the witnesses. Thank you for your testimony.
Dr. Tabarrok, I want to start with you and address a topic
that is of significant concern to me. And that is the topic of
vaccine passports, where there has been a lot of discussion
about requiring vaccine passports, either the Federal
Government requiring vaccine passports, or individual private
companies requiring vaccine passports to be able to utilize
transportation, to be able to utilize essential infrastructure.
I have deep concerns about any mandated vaccine passports.
My concerns include concerns about protecting patient privacy
rights. What personally identifiable information would be
shared? Who maintains the information? Whether patients that
have provided informed consent on the use of this information,
can the information be shared or exploited by governments or
businesses? What are the risks of hacking this information by
foreign nations and criminals? And also the significant
potential for discrimination against individuals who either
make the choice not to get the vaccine, or for various medical
reasons are not suitable candidates to receive the vaccine,
whether they will face discrimination in terms of public
carriers, discrimination in terms of being able to stay in a
hotel, discrimination in terms of being able to eat at a
restaurant. And in my experience, I think a lot of Americans,
certainly a lot of Texans, are very concerned about this.
Recently, White House Press Secretary Jen Psaki said,
``There will be no Federal vaccinations database and no Federal
mandate requiring everyone to obtain a single vaccination
credential. America's privacy and rights should be protected so
that these systems are not used against people unfairly.''
I was encouraged by those comments. I am not sure I believe
that is where the administration will end up, but I liked at
least that they were saying that. I think that was a step in
the right direction.
Dr. Tabarrok, do you agree that the Federal Government
should not establish a Federal vaccine mandate?
Dr. Tabarrok. Yes, I agree with that. I do have mixed
feelings on so-called vaccine passports. I am not particularly
against universities, for example, requiring their students to
be vaccinated, as a number of universities already have
suggested they will.
So I think private employers should be allowed to say that
we want our employees to be vaccinated. I do think the
following is maybe some way of finding some compromise, and
that is: Look, this is going to be a very temporary problem. I
believe that we will quickly, with more vaccinations we will
quickly get back to normality, even as early as the summer, the
late summer. I think these issues will begin to fade away at
that time, particularly as most people will be vaccinated just
because it is the smart thing to do, it is the rational thing
to do. And as death rates fall, as the infections fall, I think
some of these calls will go away.
Many countries, however, will require a vaccination to get
into their country. So literally you will require to be
vaccinated if you want to visit a lot of foreign countries. I,
myself, am eager to travel again, and many countries already
require a yellow fever vaccination. And so I think that is
going to become fairly common, whether one wants it or not.
I am against the Federal mandate but, as I said, I think if
we can make vaccines easier to get, at low cost, then people
are going to be vaccinated, and this problem will fade away
very quickly.
Senator Cruz. Well, look, I agree that vaccines should be
widely available. I have been vaccinated. My wife has been
vaccinated. Both my parents have been vaccinated. That being
said, our children, who are 10 and 13, have not been
vaccinated. And in terms of the cost/benefit analysis, I think
it is quite different for an adult, or for a senior, than it is
for the young child.
Are you concerned about the civil rights implications of a
vaccine passport? You suggested universities requiring students
to be, or faculty members to be vaccinated. Right now, women
who are pregnant or trying to get pregnant are not recommended
to take the vaccine. Would you be troubled by the
discrimination effects of a university that in effect excluded
women who were pregnant or trying to get pregnant from
attending university? Are you troubled by airlines saying
children who have not been vaccinated are not allowed on the
plane and cannot travel anywhere? Does that raise concerns that
should give us pause?
Dr. Tabarrok. So first of all, I think the recommendation
actually is that pregnant women are--should be vaccinated.
Second, yes, of course I would be concerned if that were to
happen.
However, I think this is a case where there is going to be
loss of opt-outs. It is going to be possible to say, you know,
children are excluded. You know, if you have a good reason, you
do not need the vaccine.
Basically, once we get to herd immunity, these problems are
going to fade away. So I do not think--although I would
certainly be worried if the things which you describe were to
happen, I do not think they are going to happen. And the way to
prevent them from happening, ironically enough, is through,
look, everyone get vaccinated. Make it cheap, make it easily
available. It needs to be rolled out in all kinds of
communities.
One of the reasons--one of the good things we have been
doing lately is getting the vaccines into the pharmacies. The
pharmacies have much greater ability to reach low-income
minority communities. They are trusted. And so we need to use
the pharmacies even more than we have been. And if we get it
out widely so that you can just walk into a pharmacy, which is
going to be happening--Texas, by the way, has led the way. So
Texas should be applauded for leading the way on making it easy
for anybody to get a vaccine. Texas has done great in that way.
We should all be following the Texas model for the entire
country.
Senator Cruz. Dr. Gounder, I saw you shaking your head when
I was asking the question, and I would welcome your views. You
seemed to be disagreeing with the proposition that women who
were pregnant or trying to get pregnant should not take the
vaccine. So I guess I would ask, what are your views on that?
And what are the scientific data that back up those views?
Dr. Gounder. Sure. It is always that great----
Senator Cruz. Dr. Gounder, if you could do that quickly so
we can move on?
Dr. Gounder. Sure. Sure. It is always great to speak to
another Princetonian alum, Senator. There is data that
demonstrates that, one, if a woman gets COVID during pregnancy,
similar to what we see with the flu, she can have a much more
severe case. It is deadly for the mother. It is deadly for the
child. She is much more likely to have a pre-term delivery. And
we have also seen that women can be safely vaccinated during
pregnancy, when they are trying to get pregnant, and when they
are breast feeding. And it is the best way to protect her
pregnancy and the unborn child.
Senator Cruz. Are there any data or empirical studies you
can point to on that, that it is safe for pregnant women? I
know there are a lot of women who are concerned about that.
Dr. Gounder. Yes. And I am happy to share some of those
after the hearing.
Senator Cruz. I would ask you to share that with the
committee members. I think there would be widespread interest.
Thank you, very much.
Chairman Beyer. Thank you very much. I now recognize the
Senator from Minnesota, Senator Klobuchar.
Senator Klobuchar. Thank you very much, Chair Beyer, and
congratulations to Senator Lee on his work as well on the
committee in his new position. And thank you for taking on this
really important topic.
I look at this in terms of the vaccine in a few ways. The
first is, I have to start at home. I did a number of events on
misinformation, starting with at the Mayo Clinic. I made the
point that 95 percent of their doctors got the vaccine. And we
still are having issues. I was in a campaign in my
neighborhood, and one of the workers there told me that his
mother-in-law would not get it because she read on the internet
that a microchip would be planted in her if she took the
vaccine.
So I wondered if, Dr. Gounder, you could talk about what is
going on, and speak to how the misinformation can undermine our
efforts, and what we should do about it. I have some strong
views about the tech companies, but I am not going to go there
today or I will use up all my time. Okay, thank you.
Dr. Gounder. I think it is a really important question.
There are really two main groups of people who have hesitancy
about getting vaccinated. You have people who we would call
them ``movable middle'' who are just straight-up concerned
about safety and effectiveness. And there has certainly been
misinformation whether the vaccines are safe and effective--and
to be clear, they are.
And then you have people who just do not trust government,
do not trust public health officials, do not trust the health
system, and that is a much more difficult one to overcome.
What we have seen with respect to disinformation is that
there is a lot of incorrect information that is circulating
online. This has been looked at and studied, and there are
actually--and I have this in the written testimony--some 12
people who are responsible for the vast majority of that. And
they have remained on the social media platforms. They have not
been deplatformed, and that would be a highly effective way of
dramatically reducing the amount of disinformation.
Because essentially what is happening is those are the
sources that then get amplified.
Senator Klobuchar. Oh, I know. Well it's rare that someone
is so practical in their answer--no, I do not mean that to the
other witnesses, but so thank you. Maybe we can try to do
something about these 12 people.
Dr. Gounder. Yeah, and it is interesting, having spoken to
a number of the social media companies, very often you get this
answer: Well, it is a really hard problem. We are trying--but
there are some very practical, easy things they could do here.
But I think that is one.
Senator Klobuchar. Yes.
Dr. Gounder. I think it is not just social media. It is
also the mainstream media, television, other outlets that are
responsible for this. For example, any time there has been
supposedly a side effect related to vaccination, you will get
all of the headlines initially reporting that. And then when
you have the follow-up data as to what really happened, that
does not get covered. That is not the catchy story, right?
And then finally, the other thing that we are seeing in
this relates to what Dr. Tabarrok was saying earlier about, you
know, he would rather see this global vaccination effort be led
by the Americans, not the Chinese. I think you are also seeing
very intentional efforts by the Russians to smear Western
vaccines to make their vaccine look better. And, unfortunately,
that is permeating what is online, and some of what the
mainstream media is even picking up now.
Senator Klobuchar. Exactly. Okay. Well, thank you. That was
a very thorough answer.
Dr. Archibong, throughout the pandemic women, especially
moms, have been disproportionately affected by job losses. And
I came up with this Marshall Plan for Moms to combine a lot of
the things that we have learned during the pandemic about child
care, and schools, and the help that they need.
It is interesting, because the last downturn
disproportionately affected men, and construction jobs, and the
like. And this has sent tons of women out of the job market
because of the kind of jobs that they lost, but also because
they were home with their kids. And now a number of them are
starting to come back, but there is not child care.
Your research has shown that epidemics can contribute
significantly to worsening gender inequality. Can you talk
about the policies that would work to address it?
Dr. Archibong. Thank you, Senator Klobuchar. And just as I
mentioned to Senator Warnock, this is something where you need
any policy--be it cash grants, stimulus, subsidies to
households--to think about the composition of households to
say, look, if there are more in the households, maybe you want
to direct more of these subsidies for child care toward those
households.
So having policies that are very gender conscious in how
they are implemented is something that has worked in other
contexts to try and include these gender gaps that happen after
these pandemics.
So I mentioned, again, households, thinking about how do
you get women back into the labor market, right? So in the
post-pandemic economy. So this might involve like work
retraining programs, investing in outreach and work retraining
that is focused on women. And so that is something that, you
know, again has worked in other countries and I think it will
be very important to do here.
Senator Klobuchar. Alright, thank you. Thank you to all of
you.
Chairman Beyer. Thank you, Senator, very much. I now
recognize the senior House Republican on the Joint Economic
Committee, Congressman Schweikert.
Representative Schweikert. Thank you, Chairman Beyer. And
actually a couple of things.
One--and this is more for you--and I would like to submit
this one for the record, it is an Atlantic article in regards
to mRNA Technology and the fact that we have just leaped almost
a decade in our technology for almost the biofoundry that we--
actually, you and I talked about a couple of years ago, as
being a health care cost disrupter. So I would like to submit
that for the record. I think you have to say ``yes.''
Chairman Beyer. Without objection, it is accepted.
[The URL for the article referred to appears in the
Submissions for the Record on page 110.]
Representative Schweikert. And to Dr. Romer, I would love
to try to work with you to encourage Chairman Beyer to do a
discussion in regards to labor force participation, where we
are in the demographic curve. We actually had a conversation in
Joint Economic a couple of years ago in regards to everything
from barriers to what was happening out there, to--and it was
surprising what we learned from some of the testimony of things
we thought were barriers were not, and things we would have
never thought of as encouragements to come back into the labor
force to get back up to that type of participation.
Mr. Chairman, and this is sort of--I am going to take
advantage of having a freaky smart group of witnesses here. We
have been looking in our office at some of the health care
outcomes, some of the populations that had very uncomfortable
mortality statistics, who got sickest, who--these sorts of
things. In my part of the country, being from the Phoenix,
Scottsdale area, it is Native Americans.
I represent a couple of Tribal communities. One of those
Tribal communities may have the second highest diabetes, type 2
diabetes, population in the country. And they had some pretty
rough numbers in regards to COVID.
So as we have this discussion of getting a vaccine rolled
out, and efficacies in different parts of the country, and
different populations, I am wondering if we should actually
have a somewhat different conversation as the Joint Economic
Committee. Are we ready to maybe discuss a real disruption?
And, look, Chairman Beyer knows this, a number of my charts
show I have a fixation on charts, and I am not going to show
all of them--but health care turns out to be the primary driver
of U.S. sovereign debt over the next three decades.
I have a factoid over here that for Medicare--Medicare is
the primary driver of U.S. sovereign debt over the next three
decades--Medicate beneficiaries with diabetes account for about
30 percent of medicare spending. Would it be one of the most
elementary and very difficult things we could promote as a
committee to help minority communities, my Native American
communities, that suffer from diabetes, at the same time being
able to make an argument that this is one of the most powerful
things we could do for future debt and spending, but also
differential health care outcomes?
Maybe it is time for an Operation Warp Speed/Diabetes. And
could technology such as the mRNA, or other things--and, look,
it is tough. Because on one side we have an autoimmune; the
other side we have some lifestyle issues. I would love some
input from the panel, with what we have experienced this last
year on concentrating resources, moving technology, could we
now take on one of the most expensive diseases in our society?
And I would love to start with Professor Romer. Give me
your thoughts. Am I being a big Utopian?
Dr. Romer. Well, thank you. I think, no, you are not being
Utopian at all. I think our consistent failure is that we lack
imagination and ambition. Because when we try and do something
audacious--let's go to the moon! Let's build an interstate
highway system that links the whole country. When we set a big
ambition and then go for it, this Nation can do it.
So I think, no, we should be setting that kind of a target.
And in terms of how we get there, I understand Professor
Archibong's hesitancy about my suggestion about just kind of
involving the states. I think this is the conversation that we
should have, though, when thinking about a mixed system.
If you think about, for example, like Professor Tabarrok's
point that we are not running tests to see if lower doses could
actually work with the current vaccine, if we had a system
where we really relied on the states as the laboratories of
democracy, we could have some states that take the lead in
trying to say through the fractionated doses, or a state that
could be particularly interested in diabetes and say we are
going to make an aggressive push in trying to treat this.
I think what we need is something which is kind of parallel
to the universities. We have a wonder system of universities
across the United States. But you need these organizations that
really focus on the transition from the academic research into
the public policy goals. And, you know, the mechanisms that can
do like what we did with, you know, the BRDA commitments on
mRNA vaccines. I think more competition, more ambition would be
great.
Representative Schweikert. I am up against the tyranny of
the clock, but it is actually something I would be elated to
have input from the panel, but even from my fellow members.
Maybe it is time we come together, because this one could be
bipartisan, and do an Operation Warp Speed Diabetes, and bring
those goods to all of society.
So thank you, and thank you, Don, for your patience.
Chairman Beyer. You gave us the lead. Twenty-five percent
of Medicare is just end-stage renal disease right now. So let
me recognize my dear friend, the dear Congressman from Madison
Wisconsin, Mr. Pocan.
Representative Pocan. Thank you very much, Mr. Chairman,
and thank you to the witnesses. I am one of the new Dems on the
committee, so very glad to be with everyone today. Also, a 33-
year owner of a very small business, under 20 employees. I
guess these days people call them micro businesses. I
personally hate that term. But, you know, a very small
business.
And it seems like, you know, when we had the 2008 economic
crisis, there was a little more, from memory, general malaise.
This time there are real almost winners and losers, right.
There are some deep industry hits--you know, restaurants and
bars, travel industry, meeting industry. And I have a few
questions related to that.
I would like to get to a few subjects, so I will try to be
quick for answers. Dr. Romer, you talked about getting more
testing out there. That is one of the solutions.
Let me ask this, because I have had a lot of talks with my
state about this. Should we also keep up, or intensify contact
tracing as part of that answer, as well?
I think you are on mute.
Dr. Romer. This is a very good question. And I should say
that reasonable people will disagree on this one. I think in
general people think that when you have got a low level of
prevalence, then contact tracing is a very good way to try and
respond and keep it low.
The problem is that, once the prevalence gets too high, the
tracing system is just overwhelmed. So we need to have a system
that works like the kind of screening testing when you get to
high prevalence, but also emphasize contact tracing at low
levels.
The other thing, just to be completely honest here, public
attitudes are changing. And I wish they were not changing, but
they are. People are a lot less willing to answer the phone. If
they answer the phone, a lot less willing to answer a specific
question. Like the yield rate, where you have got somebody who
is a known positive, and then you try and trace back and find
contacts. The yield rates are very low right now.
So I wish it were not so, but it may be that we have to
accept that this is the new world we are dealing with, and then
try and find some other mechanisms where we can try and address
this. And if I can make like a tip of the hat to Senator
Klobuchar, I think part of why people are so suspicious and so
mistrusting is they have had their trust abused repeatedly by
these big tech firms.
And so, unfortunately, it is the government which is now
being distrusted because of repeated abuses of trust in the
private sector. So I wish we could do something about that.
Representative Pocan. Thank you. Just to make sure I get my
two more questions, I am going to throw them both out there,
and whoever wants to take them, because you specifically
mentioned testing and I wanted to follow up on contact tracing.
The second one is, it was mentioned that, you know, if you
get one shot you might just get the sniffles, with two shots--
or, yeah, you will not die with one shot, but you might get the
sniffles.
The question of long haulers are now what you call post-
acute, whatever the new term we are using. Do we know anything
about people, if you still get it now after you have been
vaccinated, does it still have the same potential effect around
long-haulers? That is the first question.
And then the second question is, what is the realistic
expectations around summer? I happen to, in my small business
we work very closely with the meeting industry, and it has been
devastated. People are completely out of work, because you
cannot have the virtual meeting in the normal way, and with the
jobs that are there.
Someone is looking at a convention of 1,500 people in late
August. Is that realistic? Or is any number like that
realistic? What are we honestly looking at, assuming that
people keep getting vaccinated and we are keeping the rates
down. So sniffles, long-term--long-hauler issues, realistic
expectations around things like meetings and conventions.
Dr. Gounder. Yeah, I can comment on some of that. So with
respect to sniffles versus severe disease, what you see is you
have higher neutralizing antibody levels after a second dose of
vaccine versus just a dose of vaccine. So that is going to
correlate to some degree with disease severity.
But it also--again, it is important to understand that you
may have breakthrough infections, especially with the variants,
after just one dose.
With respect to long-haulers, the COVID vaccines may
actually function as therapeutic for those groups. There are a
couple of different hypotheses as to why long-haulers have the
symptoms they do. But by giving them a dose of vaccine, you are
priming their immune system to respond to perhaps what may be a
latent, ongoing low-level virus infection. Maybe you have
remnants of the virus. But it is causing your immune system to
respond to that. And a lot of people are reporting improvement
in symptoms.
So this is something that is being actively studied right
now. If we are able to maintain the same pace of vaccinations,
we will be in a much better place by the end of the summer. We
could be reaching, at least among the adults, you know, the 80
percent plus range. Of course, you still do not have kids
vaccinated. But it really will depend on what happens, whether
we can keep up that same pace.
Dr. Romer. Yeah, if I can just weigh in. I think we have
got to admit that there is some real uncertainty about what
happens this summer. If I were responsible for organizing a
meeting, I would set it for September or October.
If it were July, I would cancel it. August, you are just a
little bit on the edge. And it could be that things turn out
fine, but there is just a lot of uncertainty about how this
will play out.
And as I said about Dr. Gounder's point before, it takes
about a month after somebody gets their vaccinations to be
fully immune. So it is wonderful that we are going to have
everybody--essentially everybody vaccinated by August, but, you
know, we are still going to be in this kind of vulnerable
period until we really get into the fall.
Representative Pocan. Thank you, Mr. Chairman.
Chairman Beyer. Thank you, Mr. Pocan, very much. Now I
would like to welcome another of my Ways and Means members to
the Joint Economic Committee, the gentleman from Texas, Mr.
Arrington, the floor is yours.
Representative Arrington. Chairman Beyer, good to be with
you, and great to join the Joint Economic Committee, and this
great group of thinkers, and patriots. And as we formulate
together advice and counsel economic policies to get our
country back to the pre-COVID prosperity. I am looking forward
to working with you, sir, and my other colleagues in both
chambers, also recognizing Ranking Member Lee for his
leadership.
I represent rural--a big swath of rural America in West
Texas. We have our unique challenges, and we have some unique
benefits to being rural. But I am very proud of what our State
has done, Texas, to balance the various factors that are
important, like the spread of COVID, obviously, but also the
long-term effects of being isolated, and kids being not in
school in that very important support system. And whether
substance abuse, or deferred screenings and treatments, there
are some major consequences to not getting back and reopening
our country, going to work and obviously having children in
school.
So no doubt having vaccines widely distributed, and the
effectiveness and the development of new therapeutics are
absolutely key to that. But I have got a question first for Dr.
Gounder about the big drop, you said, in demand in terms of
taking the vaccines.
Explain to me the reasons for the drop with respect to the
hesitancy factor. What are some of the reasons within the
different demographics--women, men, rural, urban, older,
younger. I would like to understand that whole dynamic of
hesitancy as it cuts across the different demographics.
Dr. Gounder. So if you look at the demographics and how
that correlates with the type of vaccine hesitancy, what we see
among communities of color, and among younger Americans, it is
much more questions of access, of not being able to navigate
the system, of getting to a vaccination site. Maybe they are
not able to take time off work because they are an hourly wage
worker.
There are some historic reasons for lack of trust. Everyone
always points to that Tuskegee study, but that is actually a
drop in the bucket. There is a whole history of this, even
ongoing up to the present day.
And I think this is where colleagues of mine, like Rhea
Boyd, Uche Blackstock, a lot of Black doctors have really done
a tremendous job of reaching out, and we have seen the impacts
already in terms of increased trust, increased confidence in
the vaccines that has not been done with younger people yet.
But I think those two groups are a bit easier to get to because
in general their concerns tend to be pretty practical in terms
of access, the costs, and so on.
Then you also have other groups, which include more rural
Americans, more conservative Americans, who just do not like to
be told by the government what to do. They do not trust the
health system, or public health officials, or the government.
And so----
Representative Arrington. Some of my constituents?
Dr. Gounder. Excuse me?
Representative Arrington. You must have been talking to my
constituents.
[Laughter.]
Dr. Gounder. That is funny. I actually spoke to somebody
from Bedias, Texas, which is between College Station and
Houston, a different rural area, but also rural in Texas and,
sometimes this is also cultural. People want the freedom to do
what everybody else like them is doing.
And so if it is not what people in their community are
doing, they are just going to be resistant. They are not always
going to be able to explain exactly why, but we really need to
be reaching out through the people who are credible in those
communities, who they trust. And very often that is local
health care providers, their primary care provider, who can
really get through here.
Representative Arrington. Thank you very much. In my
remaining seconds here, Dr. Tabarrok, I know a lot of employers
that want to respect the personal freedom to choose whether to
take the vaccine or not, notwithstanding the fact that we need
to be better communicating the benefits of that to that person
and their family in the community. But I think there would be
some legal liability issues and concerns if employers mandate
that with their employees. There may be major lawsuits to bear.
Talk about legal liability protections as an important
factor in all this. And I yield back.
Dr. Tabarrok. I think that is an interesting question. I
prefer to leave that to a lawyer to answer the details of that.
If I could, I just want to say one thing about if vaccine has
not been see. Some of it actually is people who have already
had COVID. And that is less of a concern.
Some people, they do not want to be the first person to get
it, but they are okay being the second person to get it. So I
think some of it is going away over time.
And let me just say one thing about vaccines. I do not like
to be told what to do by the government, either, but I love
vaccines. I love vaccines. To me, it is like a super power,
right, because a vaccine gives you the super power of immunity.
And if we could get the super power of being immune to bullets,
who would not want to be immune to bullets? Well viruses have
killed a lot more people this year than have bullets.
So I am very, very happy to have the immunity to viruses.
It is a great super power to have. Everybody should have it.
Representative Arrington. Thank you very much. Thank you,
Chairman.
Chairman Beyer. Thank you very much, Mr. Arrington. I now
recognize the chairman of the Congressional Black Caucus, my
dear friend from Ohio, Congresswoman Beatty.
Representative Beatty. Thank you so much to Chairman Beyer
for this very academic, educational, and healthy dialogue. Let
me say to all of our panelists, thank you for your remarks. I
have had time to go through your presentations, and I want to
thank you for that.
Let me just say to you, Dr. Gounder, being the physician. I
have been telling people, you listen to the medical profession,
and you listen to our scientists. A lot of good information
here. Thank you for telling us to meet people where they are.
To Dr. Archibong, let me just say thank you for looking at
the total picture. Now obviously, as the Chairman said, I am
the Chair of the Congressional Black Caucus. I represent the
largest number of people in Congress in a caucus. It is our
50th anniversary.
And when we look at the disparities which you outlined so
eloquently, and I would suggest that everybody on this panel
read her presentation, because it is real. It talks about the
real issues that many times we skate around in hearings like
this.
Black people are dying disproportionately. There is
systemic racism in this country that we have underinsured, or
not insured. I am so glad that diabetes came up. My colleague
is so right. Again, Black Americans have the highest mortality
rate in dying from diabetes.
So with that, there are so many disparities, but when I
look at--the question is to anyone on the panel who can jump in
with this. Do you believe that our economy can get back to
normal, or at least to pre-pandemic levels, without getting to
herd immunity?
And the second part, if we cannot get to herd immunity
because of vaccine--and I am going to add some stuff--not only
hesitancy, but the unequal distribution of it, the lack of the
vaccine in communities. What kind of effect will that have on
our economy?
And to be fair, I asked the same question to the Federal
Reserve Chair. Anyone? Do you want me to call you by name?
Dr. Romer. Let me respond. I think we absolutely have to
get to the point where this pandemic is not a cloud that is
hanging over the economy, if we want the economy to recover.
I think we should remember that incentives matter. Costs
matter. A lot of the costs for getting vaccinated is the time
to go find a place, and to get there, and to get vaccinated. So
I think we should be investing aggressively in things like the
suggestion to use the Dollar Stores as an outlet, in parallel
with the pharmacies, where it is easier for people to get to
one and get vaccinated.
I think accessibility should be a huge focus. We should
make it as easy as possible for everybody to get vaccinated.
And even if people are a little bit hesitant, if you make it a
little bit easier you may be able to get them to go along. So
we just need to push as hard as we can on that.
Representative Beatty. Thank you. And I like the analogy of
putting it, I am going to say, in community centers. The Dollar
Store may work, but in health centers, churches, schools, post
offices, et cetera.
To the issue about state government, if we had, somebody
used the word ``democracy,'' well if we had fairness in our
democracy at the state level, you know, maybe I would support
that fully. But right now, when we look at many of the states
across this United States, there was a lot of unfairness with
what some of our governors said about things that we know were
fair, whether it was the election, whether it was Medicaid
expansion. Until we do more work there, I think that is very
dangerous, or could be dangerous.
The last question in my time I have, and maybe Dr.
Archibong or Dr. Gounder you can answer this. There have
already been reports that some states around the country are
not able to fill the appointment of Blacks for the vaccine.
Some reports are projecting that the supply will outstrip the
demand nationwide as early as the end of the month.
What steps should we be taking in the Federal Government,
or even in the states, to target populations with lower vaccine
rates?
Dr. Archibong. I will just say, very briefly, thank you
very much Congresswoman Beatty. One of the things that we
mentioned before was saying that, given the disparities by race
in vaccination rates, it was very, very important to direct
vaccines toward--within Black communities, within Hispanic
communities, communities of color. This where I know--let me
talk about the federalism--this is where I think a coordinated
effort from the Federal Government with the states would be
very, very efficient. But I am going to stop there.
Dr. Gounder. Yeah, I think we are out of time but, I think
this is what the retail pharmacies, the FEMA vaccination sites,
the community health center strategy is really all about,
trying to focus the vaccination resources access in communities
of color, in the CDC highest social vulnerability index zip
code to try to really bring vaccines to where people are.
Representative Beatty. Thank you. And, Mr. Chairman, if I
could have ten seconds to say the Congressional Black Caucus--
may I have 10 seconds, please, I'm sorry.
Chairman Beyer. Yes. Please proceed.
Representative Beatty. The Congressional Black Caucus
announced yesterday at the White House, with the President of
the United States, that we are going to have Congressional
Black Caucus Vaccination Week, just like in parallel--and Day,
like Voting Day, Early Vote, because we are indoctrinated, but
that is something our leaders tell us to do, and that we do.
And the last thing is--you do not have to answer, but could
someone send me more on this oral vaccination that I hear you
talking about at the beginning, if that is an option? Nobody is
talking about that in the Congress, or in our communities, that
there is an option--all we are hearing is that either Pfizer or
Moderna, and that is by injection. So that would be very
helpful if that is real and out there.
Thank you, Mr. Chairman, so much for an incredible hearing.
Chairman Beyer. And, Ms. Beatty, we will ask the Joint
Economic Committee staff to run down the research on both oral
and nasal vaccine.
Representative Beatty. Thank you.
Chairman Beyer. Thank you. I now recognize the policy
leader--and much else.
Representative Peters. Thank you, Mr. Chairman.
Dr. Romer, your past statements, I remember you talking
about the need for widespread testing--so that people can stay
at home and isolate if they test positive.
I even remember what your academic research says. I just
know that you are the rapid testing guy. You have been known
for that. And I think that in the context of a lack of trust,
that empowering people to be their own actors, and their own
diagnosers, and their own treaters, if you will, makes a lot of
sense. It could be a game changer.
But what about the capabilities? I think only two home
tests have been approved by the FDA. You described some of the
benefit of this, but does the FDA have the testing capabilities
in the pipeline for approval to do the carpet bombing that you
described?
Dr. Romer. This is an area where I think one has to take a
nuanced approach. I think, for example, it is important for the
FDA to be extremely rigorous, and demanding, and cautious about
vaccine safety.
So I think jumping in actively when the first signs of the
J&J problems emerged was the right thing to do. This is very
important for kind of sustaining this broad social consensus
that vaccines are something that we should all take.
But on the other extreme, on the process for approving
tests, I think the FDA has been a huge bottleneck. And really
just a tragic bottleneck, very concerned about small issues,
and not attentive to the huge benefits that could come from
just trusting people at home with a little bit more information
about their own health conditions.
Now there are reasons why the FDA kind of historically came
to the position here it is, but they need to be quicker to
update and say things have changed and we have got to be able
to respond more quickly.
So to be honest, I think, no, the FDA is still going to get
in the way if we try to carpet bomb Michigan with these kind of
home rapid tests. I think the Governor of Michigan ought to
just say, I do not care what the FDA says you can do with these
tests. I am going to say we are going to send it to peoples'
homes and they can use them, and then the FDA can come after me
if they do not like it.
Dr. Gounder. One thing I would add Dr. Romer's comment on
the mass testing, I think that works if people are able to stay
home. This is something I see all the time, as someone who
discharges patients from the hospital who had COVID, and we ask
them to isolate afterwards until they are fully out of the
infectious window, and they are not able to because they have
to get back to work.
And so for this to work, you need to allow--you need to
make it so that people can stay home.
Representative Peters. That is two problems, though, is it
not? I mean the first problem is still empowering patients to
know what they are up to. And then giving them the autonomy to
act based on that information.
And I think, you know, the notion that we should be in the
way of this really flies in the face of the trend toward
patient empowerment and responsibility for your own health,
which I think is inevitable and it is coming----
Dr. Romer. If I could just say, if you want to think about
how this system could work, you could have people doing these
at-home tests. If they test positive, they might then have the
option to go and get an official MPCR confirmation. Then, if
they get a confirmation, the government could pay them their
lost wages to stay home.
Not that many people are positive. It would not be that
expensive. We could do this.
Representative Peters. It could be tailored. Let me ask a
question about something else, about confidence in the vaccine.
There has been a decision made to shelve the J&J vaccine
because of very, very few, but admittedly serious consequences.
I was in local government. I know people do not analyze
risks the way that you do. I think that is the end of the J&J
vaccine in terms of acceptance. I am interested in hearing Dr.
Gounder and maybe Dr. Romer, what is your reaction to that? And
how do we inspire confidence in the face of what I think may be
an over-reaction?
Dr. Gounder. Well, you know, I think it is important that
we maintain confidence in our vaccines more generally. The
Pfizer and Moderna vaccines are highly effective, highly safe.
The fact is----
Representative Peters. Well that is just J&J, right? I
mean, J&J is also highly effective.
Dr. Gounder. Well, it is highly effective, but we are still
evaluating as you said, very rare but serious complications.
The fact is, our vaccination supply, we have enough vaccine to
vaccinate our American adults even without the J&J, number one.
Number two, there have been manufacturing issues, as you
are probably aware, at the Emergent BioSolution Manufacturing
Plant in Baltimore. And so we were anticipating already that
supply of the Johnson & Johnson vaccine would really slow down
over the next couple of months.
So I do not think this is going to have a huge impact,
frankly, for most of our vaccination efforts. It is really
going to have the greatest impact on certain hard-to-reach
communities in this country, and on the global vaccine supply.
Representative Peters. Alright. Well thank you, Mr.
Chairman, my time has expired. I yield back.
Chairman Beyer. Thank you. Thank you, Mr. Peters, for
making the interesting psychological argument about what
happens when you challenge the efficacy rebuilding of that
trust.
And we wrap up with Congressman David Trone from Maryland,
who is one of the most successful business people I have ever
known.
David.
Representative Trone. Very generous. Thank you, Mr.
Chairman.
Dr. Gounder, as we continue to recover from COVID, one
issue on many, many families' minds is their kids returning to
school. Having all adults eligible by April 19th is a great
first step, but the reality is many children will not receive a
vaccine. Recently I hosted a Q&A live with Dr. Fauci, and my
chat box was blown out by constituents asking when will a
vaccine be safe for my kids? And when will it be safe for my
kids to return to school?
So how difficult is it going to be to reach herd immunity
until we get the vaccine approved for children of all ages?
Dr. Gounder. Pfizer has submitted their vaccines to the FDA
for Emergency Use Authorization for kids 12 and up. And I
anticipate that that will come through pretty quickly here. And
so that actually will help us, especially if we start to see
the demand for vaccines among adults slow down. Then you might
actually see adolescents picking up and taking some of those
empty vaccination slots in the coming months. And I do not
think that would be a bad thing, if we can expand vaccine
coverage that way.
With respect to schools, I think that we have learned a lot
in the past year. It has really been a crash course in this
virus. And in the beginning we thought this virus was largely
transmitted through droplets and through contact--skin-to-skin
contact, or contact with contaminated surfaces--and what we
have learned over the past year is that aerosol, airborne
spread is probably the more significant driver.
And so what that means is that your mitigation measures,
your infection control measures in the school may be different.
If you are talking about surface contact, you are cleaning
surfaces and hand washing. If you are talking about droplets,
it is a combination of wearing masks and being six feet apart.
But if it is aerosol, airborne, then it is masks and
ventilation that become the most critical thing here. And you
do not want to have a high density of people in that room, but
they can be at closer distances together as long as you do not
have high density.
So what we have learned is, you can reopen schools safely
as long as you have the masking, the ventilation, reasonable
classroom density, testing, as Dr. Romer would advocate for.
And the other thing we have learned is, when you see a
transmission in schools, it is largely adult to adult. It is
not children to adults. And when children transmit, it is
usually in the setting of play dates, or sports team activities
outside of the classroom, not in the classroom.
So based on what we have learned, we really can reopen
schools safely as long as you can continue with those
mitigation measures--the masks, ventilation, ideally testing,
even if you do not have mass vaccination of the students yet.
Dr. Romer. If I could just weigh in on this, too. Of course
I approve testing. But one of the things I wish we had
committed to in this new infrastructure bill was a massive
upgrade in the quality of the ventilation and the air quality
in schools. This could help with the current COVID pandemic,
but with future viruses. And even other health issues related
to particulates.
So if we made the right investments, we could have much
cleaner air and a lot of good would come of that, of much
cleaner air in schools.
Representative Trone. I completely agree with you on that
100 percent. I sit on a bunch of school boards and could not
agree more.
Dr. Gounder, again quickly, with the J&J problem coming up,
the AstraZenica challenges on their vaccine also, I mean we
have got to figure how to get the COVID vaccine out to the
entire globe. And, you know, with the poorest 19 countries
getting unequal access to a safe and effective vaccine. Could
you speak a little bit about what efforts we are trying to help
these other countries on the poor side acquire a vaccine, and
they take issues now with AZ and J&J that this is complicating
it.
Dr. Gounder. What is great about both of those vaccines is
they are cheap. They do not have the same strict cold-storage
requirements that you have with Pfizer and Moderna. And so we
were really counting on AstraZenica and Johnson & Johnson for
our global vaccine supply. And the Merck-Johnson & Johnson
collaboration, Merck assisting Johnson & Johnson, which is
really an astounding feat that is happening, but the idea that
they would help scale up supply was really intended for the
world.
And the other vaccines that are being used, say the Sputnik
Vaccine, the CanSino vaccine out of China, these are also
adenovirus vector vaccines that may have some of the same
complications. We do not yet know. But I think what I am most
concerned about with respect to, you know, how this all pans
out is what will this mean for vaccinating the world?
Dr. Romer. If I could just weigh in as the former World
Bank Chief Economist, the World Bank is saying somebody else
needs to go donate a bunch of money to help vaccinate the
world.
We have got to remember that that was the job of the World
Bank, is to help poor countries. They are spending a lot of
money, including their concessionary aid, on things with a very
low bang per buck. And as Dr. Tabarrok has shown, the bank per
buck on these vaccines is extraordinarily high.
So we should be putting a lot more pressure on the Bank to
not just engage in business as usual, but go out and pay for
the vaccinations that people need in the developing world.
Dr. Archibong. Can I just add something? I have expertise
in African countries. I would highly encourage investment in
GAVI, the vaccine alliance. There definitely need to be more
funds accorded to them because they are doing really, really
good work in African countries, just to highlight that there.
Dr. Tabarrok. And with that, for the rest of the world I
think it is important to underline: It is more important to get
vaccinated now. Use the AstraZenica, use the Johnson & Johnson
when the pause is over. It is much, much more important to get
an early vaccination. Do not wait for Moderna and Pfizer. It is
going to take too long.
Take the vaccine, whatever you can get now. The Russian
vaccine is actually pretty good. Use the vaccines that you can
get access to, and start your vaccination early. That is the
message to take to the rest of the world.
The U.S. is very fortunate. We have Moderna and Pfizer. The
rest of the world: vaccine early and vaccinate often. That is
the route to health and to wealth.
Chairman Beyer. And the message I have to give to you guys
is that the vote is going to close in three minutes. And since
I am carrying proxies for a number of other people, I have to
go. But I want to thank you very, very much. This was a
fascinating hearing. You managed to keep Senators and
Congressmen here for two-and-a-half hours, which is a wonderful
thing. I am very grateful.
This record will be open for three days. This is recorded.
I am sure tens of thousands of people across the country will
watch what you offer. So thank you very much. We hope to work
with you again in the years to come.
And with that, the hearing is concluded. Thank you.
[Whereupon, at 4:32 p.m., Wednesday, April 14, 2021, the
hearing was adjourned.]
SUBMISSIONS FOR THE RECORD
Prepared statement of Hon. Donald Beyer Jr., Chairman, Joint Economic
Committee
recognitions
This hearing will come to order. I would like to welcome everyone
to the first Joint Economic Committee hearing of the 117th Congress.
I look forward to working with Vice Chairman Heinrich, Ranking
Member Lee, Senior House Republican Schweikert, and all of our
Committee members as we examine the many economic challenges and
opportunities facing the country.
I want to thank each of our distinguished witnesses for sharing
their expertise today. Now, I would like to turn to my opening
statement.
the end is in sight
The pandemic and its tragic health and economic consequences have
dominated our lives for the past year.
After more than a year of physical distancing and mask wearing, of
fearing for our health and the health of our loved ones, of widespread
and deeply unequal economic hardship, the potential for returning to a
sense of normalcy is finally within sight.
The pandemic will leave no shortage of tragedy in its wake.
More than 560,000 people have died in the United States, many
isolated in hospitals rooms and without their family's last comfort.
Thirty-one million have been infected with the coronavirus, and
many of them continue to live with the disease's debilitating symptoms.
Communities of color--particularly our Black, Latino, and American
Indian communities--have been hit especially hard, experiencing the
highest rates of COVID-19 infection, hospitalization and death.
The economic damage persists as well.
After job gains of more than 900,000 last month, close to 10
million workers remained unemployed--one quarter have been jobless for
a year or longer.
Another 4 million people have left the labor force since the
pandemic began.
Thankfully, the economy is beginning to recover.
vaccination progress to date
Much of that emerging recovery is due to the remarkable vaccination
effort unfolding in our country and throughout the world right now,
where millions of shots are going into arms every single day.
It's an unprecedented undertaking.
More than 190 million doses have been administered in the United
States. More than one in three people in the U.S. has received at least
one shot, and one in five Americans has been fully vaccinated.
At the current rate, we could vaccinate all adults in the United
States by the end of the summer.
By then, perhaps our lives can begin to approach a new normal where
we can see loved ones, where we no longer have to choose between going
to work and keeping family safe, and where we can enjoy a meal inside
at a restaurant or a trip to the movies.
economists project a strong recovery
There is a consensus among economists that vaccinations will
profoundly shape the course of the economic recovery.
Forecasts call for accelerating growth, with Goldman Sachs
projecting annual GDP growth in 2021 will reach 8 percent.
In an interview that aired this past weekend, Federal Reserve Chair
Jerome Powell said the economy and job creation are poised for faster
growth, and the principal risk is that ``we will reopen too quickly,
people will too quickly return to their old practices, and we'll see
another spike in cases.''
the pandemic recovery is precarious
Although the trajectory of the pandemic recovery is headed in the
right direction, it remains precarious and can be derailed by hasty
reopenings, new variants, anti-vaccine sentiment, or lack of access to
vaccines.
This means that our economic recovery is precarious as well.
Public health experts warn that state efforts to roll back mask
mandates and physical distancing requirements can backfire, especially
in light of highly transmissible and deadlier variants.
Michigan's recent experience makes clear that we cannot rely on
vaccines alone as our only way out of the pandemic.
We've seen recent spikes in cases as the more contagious B.1.1.7
variant has now become the most common strain of the virus in the
United States.
Younger adults and children are comprising a larger share of new
infections.
If we cannot bring the pandemic under control, both domestically
and globally, new variants might become resistant to our current
treatments and vaccines, creating a need for adjusted vaccine products,
further delaying recovery efforts.
CDC Director Dr. Rochelle Walensky has said repeatedly that,
because of these concerns, we cannot let our guard down and must
continue to practice mask wearing and physical distancing until we
reach herd immunity.
deep inequities at home and abroad remain
There is also profound inequity in access to vaccines. Vaccination
rates for people of color--especially Blacks and Latinos--lag far
behind the rates for Whites.
As a result, pandemic and economic recovery efforts in communities
of color may fall behind recovery in White communities.
The reality is even worse abroad.
While wealthy countries have purchased enough vaccine to cover two,
and sometimes even three times their populations, low- and middle-
income countries--which account for 81 percent of the world's adult
population--have collectively purchased only 33 percent of vaccines.
As Treasury Secretary Yellen laid out last week, some low-income
countries don't expect to be able to fully vaccinate their populations
until 2023 or 2024, which should be unacceptable to all of us.
To end this pandemic for good, the battle against the coronavirus
must be won globally.
So, while we have made extraordinary progress in the past few
months, we are not out of the woods yet.
I look forward to hearing from our witnesses about the state of our
recovery, where it's going, and what we can do to ensure things stay on
track. And now, I turn it over to Senator Lee for his opening
statement.
__________
Prepared statement of Hon. Mike Lee, Ranking Member, Joint Economic
Committee
Good afternoon, and thank you to Chairman Beyer for convening
today's hearing.
After a long COVID winter that included unprecedented strains on
our economy and public health, the spring has brought welcome signs of
life and hope. Businesses are beginning to reopen, schools are
reconvening in person, and friends and family members are finally
reuniting. Perhaps what is most encouraging--and what has helped
support the beginning of our ``return to normal''--is the development
and distribution of vaccines.
But there is still a long way to go. Many Americans have not
returned to in-person experiences in the entertainment and travel
industries, for instance; and our economy is still suffering. In order
for people to feel safe returning to in-person interactions that
support economic activity, we must continue to improve vaccine
distribution.
As we consider how to move forward, it is worth reflecting on our
trajectory so far--both the strategies that have helped and those that
have hindered our progress.
Though vaccine production has had some supply chain setbacks--such
as difficulty finding vaccine components like reagents and other
chemicals that have led to manufacturing bottlenecks--it has overall
exceeded expectations.
Operation Warp Speed, an initiative begun by the Trump
administration, sped the development and production of several
vaccines--including Moderna, Pfizer, and Johnson & Johnson--by
purchasing vaccines in development and directing resources toward
vaccine manufacturing capacity. In total, through advance purchase
agreements and grants, the Trump administration purchased more than 800
million doses through the end of July 2022.
The Council of Economic Advisers previously estimated that
accelerated vaccine development and distribution by OWS could result in
as much as $2.4 trillion in economic benefit if there was a viable
vaccine by January 1, 2021. The effort actually outpaced that timeline,
with first doses of the Pfizer vaccine available on December 14, 2020;
and the CEA noted that their estimate might even underestimate the full
economic benefit of accelerated vaccine development.
In terms of vaccine distribution, there are worthwhile policy
proposals to increase the number of people with some protection while
vaccines are scarce. We should be open to creative solutions that can
get people protected more quickly by stretching the limited supply as
far as we can, and moving the doses we have as quickly as possible. Our
main priority should be to extend at least some protection to as many
people as possible.
States also have an important role to play in distribution. In some
cases, we've seen that restrictive Federal guidelines and rigid,
complex eligibility requirements have impeded states' progress, leading
to many vaccine doses being wasted or administered to unintended
populations. Lack of health resources at the final stage of local
distribution have also presented problems for many areas.
On the other hand, successful states have implemented simple
eligibility criteria and used technology to accelerate distribution.
Some have built systems where patients can register online; others have
used online event hosting software to schedule appointments. They have
also partnered with local businesses and pharmacies.
Despite our challenges, the U.S. has vaccinated more people per
capita than most other countries in the world. Nearly 190 million doses
have been administered as of April 13th; more American citizens have
received a COVID-19 vaccine than tested positive for the virus since
the beginning of the pandemic; and nearly a third of the adult U.S.
population is fully vaccinated.
There is reason for hope in our economic outlook, as well.
Expectations are set for a stronger economic response in the second
half of the year--the CBO expects real GDP to return to its pre-
pandemic level by 2021, and the labor force is expected to return to
its pre-pandemic size by 2022.
But in order to accelerate our economic recovery, we should look
for opportunities to improve vaccine distribution policy. The sooner
the U.S. reaches herd immunity through vaccination, the sooner
businesses can reopen to full capacity, students can fully return to
schools, industries can come back to life, and Americans can return to
work and social life without fear. I look forward to hearing our
panelists' contributions today and their insights into how we can do
just that.
Before we do, I would like to ask Chairman Beyer for permission to
submit five articles or studies from our witness Dr. Tabarrok for the
record.
Thank you, Chairman Beyer.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Response from Dr. Gounder to Questions for the Record Submitted by
Representative Herrera Beutler
1. A report in September showed that close to 100,000 businesses
have permanently shut down during the pandemic.\1\ In Washington state,
27% of businesses have closed their doors temporarily due to a
government-mandated closure.\2\ Congress has worked to keep small
businesses afloat throughout the pandemic with the Paycheck Protection
Program, which saved 90,000 jobs in my district. Despite this, 6 out of
10 small businesses are still struggling with overhead costs.\3\ We
know that small businesses have a substantial footprint in the U.S.
economy.
---------------------------------------------------------------------------
\1\ Fortune, Nearly 100,000 establishments that temporarily shut
down due to the pandemic are now out of business
\2\ The Centers Square, Shutdowns closed 27% of Washington
businesses--and more could close for good
\3\ Business Wire US. Jobs Recovery Depends on Small Business,
Which Remains Under Great Threat, According to IHS Markit
---------------------------------------------------------------------------
a. What role will small businesses play in our nations'
economic recovery? How can Congress continue to support small
businesses in conjunction with the roll out of the vaccine?
As a former Washingtonian and a graduate of the University of
Washington School of Medicine, it is an honor to receive this question
from Rep. Jaime Herrera.
I strongly believe that small businesses will play a crucial and
central role in our nations' economic recovery. Restaurants, bars, and
gyms have been hit especially hard by public health restrictions. These
establishments are the cultural hubs and economic drivers for many
communities, including my own. However, I will defer to Drs. Paul
Romer, Alexander Tabarrok, and Belinda Archibong to address how
Congress can best support small businesses through pandemic recovery.
2. Dr. Gounder, you have spoken about how vaccines are only one
part of the equation to recovery from the economic harm the pandemic
has caused. One of the counties I represent, Cowlitz County, was
recently reverted from Phase 3 to Phase 2 due to failing metrics for
case counts and hospitalizations. In this situation, it seems that
increasing vaccination rates would help reduce the threat of regressing
to a more restrictive phase, which hurt businesses and employees that
must lower capacity and economic activity.
a. Could you speak more to this point and what you view as
other essential policy areas we must focus on in conjunction
with vaccines?
Vaccinations work best at a population level rather than an
individual level. As more people are vaccinated, you get a
multiplicative, synergistic reduction rather than simply additive
reduction in risk. It's also important to remember that, when we're
talking about vaccine effectiveness, that's a percentage or
proportionate reduction in risk. A 95% vaccine effectiveness is
excellent, but when there's still a lot of viral transmission in a
community 95% reducing from very high risk may still be a significant
risk. Finally, vaccines don't take effect the second a needle hits your
arm. It takes two weeks after two doses of the Pfizer and Moderna
vaccines and 4 weeks after a dose of the Johnson and Johnson vaccine
before someone reaches full immunity.
Until we have attained high enough vaccination coverage, we will
need to continue employing public health mitigation measures like
masking, social distancing, ventilation, and testing to suppress
transmission of the virus. COVID credentials will be an important tool
that must be regulated to ensure privacy and equity. We must develop
better COVID therapeutics and plan for the long-term needs for COVID
survivors. And we must strengthen our public health infrastructure: our
public laboratories, including genomic surveillance capacity, our
public health bioinformatics, and our public health workforce.
Please see Section II of my written testimony (pages 27-37) for
more details on what a comprehensive public health response would look
like.
__________
Response from Dr. Gounder to Questions for the Record Submitted by
Senator Cruz
Question 1:
During the hearing you stated, ``We have also seen that women can
be safely vaccinated during pregnancy or when they are trying to get
pregnant and when they are breastfeeding.''
CDC's COVID-19 vaccine guidance for pregnant women states, ``Based
on how these vaccines work in the body, experts believe they are
unlikely to pose a specific risk for people who are pregnant. However,
there are currently limited data on the safety of COVID-19 vaccines in
pregnant people . . . . If you are pregnant, you may choose to receive
a COVID-19 vaccine. You may want to have a conversation with your
healthcare provider to help you decide whether to get vaccinated with a
vaccine that has been authorized for use under Emergency Use
Authorization. While a conversation with your healthcare provider may
be helpful, it is not required prior to vaccination.''
(a) Do you disagree with these statements from CDC?
(b) Do you disagree with CDC's statement that ``there are
currently limited data on the safety of COVID-19 vaccines in
pregnant people''? If so, please explain why you disagree and
provide data and scientific studies to support your position.
I agree with the CDC and CDC Director Dr. Rochelle Walensky that
there are ``no safety concerns'' for pregnant women to receive COVID
vaccination.
Earlier this month, researchers published data from several
national surveillance systems in the New England Journal of Medicine
showing that pregnant women have no higher rate of side-effects from
vaccination than the rest of the population. This is just the latest
report on COVID vaccine safety in pregnant and breastfeeding women.
Others include:
Gray KJ, et al. COVID-19 vaccine response in pregnant and
lactating women: a cohort study. AJOG. March 25, 2021
Mithal LB, et al. Cord Blood Antibodies following
Maternal COVID-19 Vaccination During Pregnancy. AJOG. March 31, 2021
Perl SH, et al. SARS-CoV-2-Specific Antibodies in breast
milk after COVID-19 vaccination of breastfeeding women. JAMA. April 12,
2021
Prabhu M, et al. Antibody response to SARS-CoV-2 mRNA
vaccines in pregnant women and their neonates. Pre-print not yet
certified by peer review. April 6, 2021
Rottenstreich R, et al. Efficient maternofetal
transplacental transfer of anti- SARS-CoV-2 spike antibodies after
antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Pre-print not yet
certified by peer review. March 12, 2021
We also know that pregnant women are far more likely to experience
severe disease from SARS-CoV-2 (as they do from influenza). Pregnant
women experiencing COVID in pregnancy are more likely to suffer from
complications like severe COVID, need for intensive care unit care,
preeclampsia, eclampsia, and death. They are also more likely to have
preterm births. COVID in pregnancy is dangerous for the life of the
mother and the unborn child.
Villar J, et al. Maternal and neonatal morbidity and
mortality among pregnant women with and without COVID-19 infection: The
INTERCOVID multinational cohort study. JAMA Pediatrics. April 22, 2021
Healy CM. COVID-19 in pregnant women and their newborn
infants. JAMA Pediatrics. April 22, 2021
(c) Do you disagree with CDC's statement that pregnant women
``may want to have a conversation with your healthcare provider
to help you decide whether to get vaccinated with a vaccine
that has been authorized for use under Emergency Use
Authorization''? If so, please explain why you disagree and
provide data and scientific studies to support your position.
I agree with this statement and not only with reference to pregnant
women, but also with respect to anyone who has questions about COVID,
the COVID vaccines, and their personal health and healthcare in
general. An important but unfortunately undervalued and
undercompensated role of primary care providers is to educate and
counsel their patients about their personal health decisions.
To all witnesses:
Question 1: If a vaccine passport or any other type of vaccine
credential is required by individual private companies, do you have any
concerns with an airline refusing service or otherwise discriminating
against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 2:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a restaurant refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 3:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a hotel refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 4:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a movie theater or any type of live entertainment venue refusing
service or otherwise discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 5:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a grocery store refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 6:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
any other type of retail establishment refusing service or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 7:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a private school or educational institution refusing service or
otherwise discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 8:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a children's day care facility refusing service or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 9:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a doctor's office refusing service or otherwise discriminating against
an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 10:
In terms of a vaccine passport or any other type of vaccine
credential, do you have any concerns with a local, state, or Federal
Government entity refusing services or otherwise discriminating against
an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Question 11:
In terms of a vaccine passport or any other type of vaccine
credential, do you have any concerns with a local, state, or Federal
Government entity refusing to allow an individual to vote or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
With respect to questions 1-11 for all witnesses above, I would
refer Senator Cruz and his staff to Section II-D of my written
testimony (pages 31-33) and to the 1905 Supreme Court decision in
Jacobson v. Massachusetts. Please note that the term ``vaccine
passport'' is inappropriate because that implies COVID credentials are
a form of identification. No such identification is being proposed.
__________
Response from Dr. Gounder to Question for the Record Submitted by
Senator Kelly
At this point, Arizonans can get a vaccine at a mass vaccine site,
a retail pharmacy, a federally qualified health center, a health clinic
or hospital, or a pop-up distribution site. But there are still
barriers to accessing the vaccine. In communities that have been hit
hard but still have low vaccination rates, folks say that one of the
best ways to convince them to get the vaccine is to have their own
doctor recommend it. Involving primary care providers strikes me as
another potential piece of the puzzle to get everyone vaccinated--
especially those who are hesitant about the vaccine. Even better if the
primary care doctor can not only recommend the vaccine, but actually
give it to you after they suggest it. In your opinion, what is the role
of primary care providers in vaccination efforts? What should their
role be?
In survey after survey, Americans say that they trust their primary
care provider above any other messenger to provide information about
COVID and COVID vaccines. Not every primary care provider will have the
staffing, space, and equipment necessary to administer vaccines in
their office. However, they can still play an important role in
counseling patients about COVID and COVID vaccination and help patients
access vaccination. Counseling and health system navigation are
impactful but time-consuming, and these services must be compensated
appropriately, whether a patient is covered by private insurance,
Medicare, Medicaid, or has no insurance.
Please also see Section I-G-1 of my written testimony (page 25).
__________
Response of Dr. Romer to questions submitted by Representative Herrera
Beutler
1. A report in September showed that close to 100,000 businesses
have permanently shut down during the pandemic. \1\ In Washington
State, 27 percent of businesses have closed their doors temporarily due
a government mandated closure. \2\ Congress has worked to keep small
businesses afloat throughout the pandemic with the Paycheck Protection
Program, which saved 90,000 jobs in my district. Despite this, 6 out of
10 small businesses are still struggling with overhead costs. \3\ We
know that small businesses have a substantial footprint in the US
economy.
---------------------------------------------------------------------------
\1\ Fortune, Nearly 100,000 establishments that temporarily shut
down due to the pandemic are now out of business
\2\ The Centers Square, Shutdowns closed 27 percent of Washington
businesses--and more could close for good
\3\ Business Wire US. Jobs Recovery Depends on Small Business,
Which Remains Under Great Threat, According to IHS Markit
---------------------------------------------------------------------------
a. What role will small businesses play in our nations' economic
recovery? How can Congress continue to support small businesses in
conjunction with the roll out of the vaccine?
We know that compared to previous recessions, the pandemic has
forced many more closures of small businesses, especially in the
restaurant and hospitality sectors. We see it in the data. We see it
when we walk down the street. The path I recommend is first to use the
right measure--the employment to population ratio for prime age
adults--to see if we have succeeded in getting employment back to the
level we should aspire to, the level that prevailed in the late 1990's.
Then we should be creative and doggedly persistent, trying a variety of
interventions that create opportunities for work and not giving up
until we truly recover.
2. As of January 2021, women's labor force participation has hit a
33-year low. 2.3 million women have left the labor force since February
2020. \4\ Data has shown that the U.S. could add $1.6 trillion to the
GDP if women entered and stayed in the workforce. \5\
---------------------------------------------------------------------------
\4\ CBS News, Nearly 3 million U.S. women have dropped out of the
labor force in the past year (Here)
\5\ S & P Global, Women at Work: The Key to Global Growth
---------------------------------------------------------------------------
a. Dr. Romer, could you speak more to the exodus of women from the
labor force due to the pandemic and how this will impact on the U.S.
economic recovery?
In the wake of the recession in 2001 and the financial crisis, we
know that many of the potential workers who gave up on the possibility
of finding work were young men. In the wake of the pandemic, we are
seeing signs that this time the discouraged workers are more likely to
be women. One advantage of the strategy that I have outlined is that it
works in either case: do whatever it takes to get the discouraged
workers back into jobs because this is the only way to bring the
employment rate back to where it could and should be.
__________
Response from Dr. Romer to Question for the Record Submitted by Senator
Cruz
Question 1: If a vaccine passport or any other type of vaccine
credential is required by individual private companies, do you have any
concerns with an airline refusing service or otherwise discriminating
against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 2:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a restaurant refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 3:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a hotel refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 4:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a movie theater or any type of live entertainment venue refusing
service or otherwise discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 5:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a grocery store refusing service or otherwise discriminating against an
individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 6:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
any other type of retail establishment refusing service or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 7:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a private school or educational institution refusing service or
otherwise discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 8:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a children's day care facility refusing service or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 9:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a doctor's office refusing service or otherwise discriminating against
an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 10:
In terms of a vaccine passport or any other type of vaccine
credential, do you have any concerns with a local, state, or Federal
Government entity refusing services or otherwise discriminating against
an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
Question 11:
In terms of a vaccine passport or any other type of vaccine
credential, do you have any concerns with a local, state, or Federal
Government entity refusing to allow an individual to vote or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Because you are asking me to entertain hypotheticals, what I can
say definitively is that I would have concerns if a member of Congress
tried to use hypothetical questions to enlist me in an attempt at
spreading misunderstandings and disinformation.
__________
Response from Dr. Romer to Question for the Record Submitted by Senator
Kelly
1. About a month ago we passed the American Rescue Plan. The bill
included nearly $93 billion for COVID-related public health work,
including for vaccine distribution and to improve vaccine confidence.
We have already seen at least $135 million of those resources come to
Arizona to help get vaccines into arms. Do you believe our investment
in speeding up vaccine distribution and increasing testing is adequate
to set us up for a strong economic recovery?
No, stopping the pandemic is a necessary condition for full
recovery, but it alone will not be sufficient. We faced no pandemic
during the recovery from the recession of 2001. Nor did we face a
pandemic in the recovery from the financial crisis of 2007-9. But after
both of these recessions, we failed to fully recover according to the
measure that I believe we should be using--the employment rate for
prime-aged adults. To escape from our recent pattern of recoveries that
fail to get us back to where we were before the recession hit, we need
to implement aggressive recovery policies and we need to stick with
them until we truly recover.
2. I'd like to ask you about the impact of virus variants.
Researchers at Arizona State University have discovered a variant in
the past couple of weeks. The UK variant has become the most common
strain throughout the US, and we know already that it's more contagious
and more deadly. The California variant is also becoming a threat. The
Pfizer and Moderna vaccines appear to be effective in protecting
against the UK variant, but other variants are or might become a
greater problem. How do we pivot to ensure vaccinated Americans remain
protected from all variants? What do we need from the manufacturers,
and what do we need from Congress?
As I indicated in my testimony, the biggest threat posed by the UK
variant that is taking over arises because it spreads so much faster
than the variants that we were fighting during 2020. Experts are not
certain about whether this new variant is more deadly for those who
catch it. The balance of the evidence seems to suggest that it is
somewhat more deadly, but the experts have not yet reached a consensus
on this. So far, there is no reason to think that our vaccines are less
effective in protecting us from this variant. But the evidence is very
clear that this variant spreads much faster. This is why it is taking
over. Faster spread puts us at risk. We need to make sure that our
measures that limit the spread are getting more effective quickly
enough to stay ahead in this race with this variant
__________
Response from Dr. Archibong to Question for the Record Submitted by
Representative Herrera Beutler
Question 1. A report in September showed that close to 100,000
businesses have permanently shut down during the pandemic.\1\ In
Washington state, 27% of businesses have closed their doors temporarily
due a government-mandated closure.\2\ Congress has worked to keep small
businesses afloat throughout the pandemic with the Paycheck Protection
Program, which saved 90,000 jobs in my district. Despite this, 6 out of
10 small businesses are still struggling with overhead costs.\3\ We
know that small businesses have a substantial footprint in the U.S.
economy.
---------------------------------------------------------------------------
\1\ Fortune. Nearly 100,000 establishments that temporarily shut
down due to the pandemic are now out of business
\2\ The Centers Square. Shutdowns closed 27% of Washington
businesses--and more could close for good
\3\ Business Wire. U.S. Jobs Recovery Depends on Small Business,
Which Remains Under Great Threat, According to IHS Markit
---------------------------------------------------------------------------
a. What role will small businesses play in our Nations'
economic recovery? How can Congress continue to support small
businesses in conjunction with the roll out of the vaccine?
Thank you very much for the question Congresswoman Beutler. It is
extremely important that we focus resources on small businesses that
have struggled with recovery during the pandemic. As I outlined in my
written testimony, a major share of losses to small business owners has
been to Black and Hispanic business owners. The number of Black
business owners actively working fell 41% between February and April
2020, with over 400,000 Black business owners losing employment, and
bringing the numbers of Black business owners down to 640,000 in April
from 1.1 million (Fairlie, 2020). The comparable loss in business owner
employment was 17% for White business owners, 32% for Hispanic business
owners, and 26% for Asian business owners over the same time period
(Fairlie, 2020). Despite these racial gaps in losses to business
employment, banking and lending policies intended to provide relief to
business owners have not targeted Black and Hispanic businesses. Any
economic relief program aimed at improving the welfare of small
businesses must target Black and Hispanic businesses with grants and
loans, as they have been the hardest hit and serve some of the most
vulnerable communities during the pandemic. Just as with vaccination
efforts, there needs to be a concerted effort at the Federal, state,
and local levels to provide more financial access, including
information and access to credit to Black and Hispanic small business
owners who have been worst off and have received relatively little of
the PPP/CARES Act funding over the pandemic.
__________
Response from Dr. Archibong to Question for the Record Submitted by
Senator Cruz
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
an airline (and other establishments) refusing service or otherwise
discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
Thank you for the questions Senator Cruz. Based on my research into
the issue of vaccine passports, I can say that, for years, people
traveling to particular countries around the world have had to provide
proof of vaccination against diseases like yellow fever and rubella
with yellow cards showing proof of vaccination, so the idea of a
``vaccine passport'' is not a new one. The particular details of how
these policies should be implemented, if they are implemented, in the
case of the COVID-19 pandemic is something that governments will need
to consult with health and medical professionals at the CDC to flesh
out.
__________
Response from Dr. Archibong to Question for the Record Submitted by
Senator Kelly
Two point one million women left the labor force between February
and December 2020. Just like the health impacts of the pandemic,
unemployment has disproportionately impacted women of color. I've heard
this in Arizona. Last summer I spoke to a woman named Sandy who was
furloughed from her job as a housekeeper at a Phoenix hotel on March
28th, 2020. She spent months hoping to go back to work. She and her
husband struggled to pay their bills for themselves and their two
children. She skipped meals, and was helped by increased unemployment
benefits. Sandy has fortunately found a new job, but there are many
women and women of color who are still looking for jobs or waiting to
return to work in Arizona. As vaccinations increase and the country
returns to work, how do we ensure women who have left the labor force
and want to return are able to do so?
Thank you very much for the question Senator Kelly. Women were
particularly hard hit by the pandemic, with a net 2.4 million women
leaving the work force between February 2020 and February 2021,
according to Pew Research Center statistics. The figure was much higher
than for male counterparts (1.8 million men), and there is a concern
that, without concerted policy efforts aimed at lowering the costs of
women's reentry into the labor market, the gender gap in employment may
remain persistent over time. Within this loss, Black and Hispanic women
have been worst hit, with these populations accounting for a major
share of service sector jobs that saw significant losses during the
pandemic. Bringing these women back into the work force is an essential
part of the economic recovery post pandemic, and will require investing
in policies like free or low-cost work retraining programs, cash grants
targeted to female-headed households and policies like more job
flexibility, more paid sick and parental leave and universal child
care, especially in industries where women and Black and Hispanic women
are concentrated--service/health sectors like home health aides that
currently lack benefits, paid sick leave and are among lowest paid in
US. These policies will lower the costs and increase the benefits of
reentry into the labor market for women, and especially Black and
Hispanic women, that have been disproportionately harmed by the
pandemic.
__________
Response from Dr. Tabarrok to Questions for the Record Submitted by
Representative Herrera Beutler
1. What role will small businesses play in our Nations' economic
recovery? How can Congress continue to support small businesses in
conjunction with the roll out of the vaccine?
The American economy has been surprisingly robust to the pandemic.
Business exits in some sectors are higher than normal, but recent work
from the Federal Reserve suggests that overall business exits are not
unusually high.
``Actual exit is likely to have been lower than widespread
expectations from early in the pandemic. Moreover, businesses
have recently exhibited notable optimism about their survival
prospects.''
Thus, I think that the best policy for business is to support an
overall strong business climate and economy especially continuing a
strong rollout of vaccines. Targeted programs are not needed.
https://www.federalreserve.gov/econres/feds/business-exit-during-
the-covid-19-pandemic.htm
2. Dr. Tabarrok, could you speak to this argument and if we need to
be considering underemployment, as the economy recovers with the
vaccine rollout?
There are a variety of ways of measuring unemployment but almost
all of them move together over time and so provide similar signals as
to the state of the economy. Underemployment, particular of young men,
is a challenging issue for the United States but it's a perennial issue
that must be addressed by education policy and work programs such as
apprenticeship programs that appeal to a wider variety of people than
traditional education.
__________
Response from Dr. Tabarrok to Question for the Record Submitted by
Senator Cruz
The questions are all of the form:
If a vaccine passport or any other type of vaccine credential is
required by individual private companies, do you have any concerns with
a [educational institution/airline/grocery store . . . ] refusing
service or otherwise discriminating against an individual that:
(a) chooses not to receive the vaccine?
(b) is not a suitable candidate to receive the vaccine for
medical reasons?
I answer as follows:
During the pandemic it was common for bars and restaurants,
churches, gyms, shopping malls, entertainment venues, schools and
universities, and even parks and beaches in the United States to be
closed for everyone. Similarly, international travel has been severely
restricted for everyone. I think it an improvement to move from closed-
for-all to open-for-some. Thus vaccine passports represent a lifting of
restrictions and an increase in freedom on the path back to normality.
Greece, for example, is scheduled to open to anyone with a record of
vaccination, negative COVID test, or previous infection. This is good
for Greece, which relies on tourist revenues for a significant share of
its economy and good for the world who want to visit sunny beaches and
ancient ruins.
Moving in stages, from closed-for-all to open-for-some to fully-
open, is reasonable. The aim, of course, is to be open-for-all, an
achievable aim if a large enough proportion of the population is
vaccinated. As we move to normality we should also make it possible for
the non-vaccinated to access as many services as possible on reasonable
grounds, for example, through the use of testing and masks.
It bears repeating that the best way to avoid these difficult
decisions is for as many people as possible to be vaccinated, thus
making social life safe for the unvaccinated as well as the vaccinated.
For these reasons I have supported free vaccinations, stretching doses
to vaccinate more people quickly through policies such as delaying the
second dose and testing fractional doses, using single-shot vaccines,
and developing nasal and oral vaccines.
__________
Articles submitted to Senator Cruz from Dr. Gounder
1. Efficient maternofetal transplacental transfer of anti-SARS-CoV-
2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination
https://www.medrxiv.org/content/10.1101/
2021.03.11.21253352v1.full.pdf
2. SARS-CoV-2-specific antibodies in breast milk after COVID-19
vaccination of breastfeeding women
https://www.medrxiv.org/content/10.1101/
2021.03.11.21253352v1.full.pdf
3. Antibody response to SARS-CoV-2 mRNA vaccines in pregnant women
and their neonates
https://www.biorxiv.org/content/10.1101/2021.04.05.438524v1
4. Cord blood antibodies following maternal COVID-19 vaccination
during pregnancy
https://www.ajog.org/article/S0002-9378(21)00215-5/fulltext
5. COVID-19 vaccine response in pregnant and lactating women: a
cohort study
https://www.ajog.org/article/S0002-9378(21)00187-3/fulltext
__________
Dr. Tabarrok--Submissions for the Record from Senator Lee
1. What are we waiting for?
https://www.washingtonpost.com/outlook/2021/02/12/first-doses-
vaccine-rules-fda/
2. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine
https://www.nejm.org/doi/full/10.1056/nejmoa2034577
3. Market design to accelerate COVID-19 vaccine supply
https://science.sciencemag.org/content/371/6534/1107
4. NACI rapid response: Extended dose intervals for COVID-19
vaccines to optimize early vaccine rollout and population protection in
Canada
https://www.canada.ca/en/public-health/services/immunization/
national-advisory-committee-on-immunization-naci/extended-dose-
intervals-covid-19-vaccines-early-rollout-population-protection.html
5. How to end the COVID-19 pandemic by March 2022
https://openknowledge.worldbank.org/bitstream/handle/10986/35454/
How-to-End-the-COVID-19-Pandemic-by-March-
2022.pdf?sequence=1&isAllowed=y
__________
Article for the Record Submitted by Representative Schweikert
https://www.theatlantic.com/ideas/archive/2021/03/how-mrna-
technology-could-change-world/618431/
[all]