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


                 HOW TO SAVE A LIFE: SUCCESSFUL MODELS
                    FOR PROTECTING COMMUNITIES FROM
                                COVID-19

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

                             JOINT HEARING

                               BEFORE THE

                            SUBCOMMITTEE ON
                            CIVIL RIGHTS AND
                             HUMAN SERVICES

                                AND THE

                            SUBCOMMITTEE ON
                          HEALTH, EMPLOYMENT,
                          LABOR, AND PENSIONS

                                 OF THE

                    COMMITTEE ON EDUCATION AND LABOR
                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

           HEARING HELD IN WASHINGTON, DC, SEPTEMBER 28, 2021

                               __________

                           Serial No. 117-27

                               __________

      Printed for the use of the Committee on Education and Labor

[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                                    
                                    

          Available via: edlabor.house.gov or www.govinfo.gov
                               __________
                               

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
45-795 PDF                     WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------                                  
                               

                    COMMITTEE ON EDUCATION AND LABOR

             ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman

RAUL M. GRIJALVA, Arizona            VIRGINIA FOXX, North Carolina,
JOE COURTNEY, Connecticut              Ranking Member
GREGORIO KILILI CAMACHO SABLAN,      JOE WILSON, South Carolina
  Northern Mariana Islands           GLENN THOMPSON, Pennsylvania
FREDERICA S. WILSON, Florida         TIM WALBERG, Michigan
SUZANNE BONAMICI, Oregon             GLENN GROTHMAN, Wisconsin
MARK TAKANO, California              ELISE M. STEFANIK, New York
ALMA S. ADAMS, North Carolina        RICK W. ALLEN, Georgia
MARK DeSAULNIER, California          JIM BANKS, Indiana
DONALD NORCROSS, New Jersey          JAMES COMER, Kentucky
PRAMILA JAYAPAL, Washington          RUSS FULCHER, Idaho
JOSEPH D. MORELLE, New York          FRED KELLER, Pennsylvania
SUSAN WILD, Pennsylvania             GREGORY F. MURPHY, North Carolina
LUCY McBATH, Georgia                 MARIANNETTE MILLER-MEEKS, Iowa
JAHANA HAYES, Connecticut            BURGESS OWENS, Utah
ANDY LEVIN, Michigan                 BOB GOOD, Virginia
ILHAN OMAR, Minnesota                LISA C. McCLAIN, Michigan
HALEY M. STEVENS, Michigan           DIANA HARSHBARGER, Tennessee
TERESA LEGER FERNANDEZ, New Mexico   MARY E. MILLER, Illinois
MONDAIRE JONES, New York             VICTORIA SPARTZ, Indiana
KATHY E. MANNING, North Carolina     SCOTT FITZGERALD, Wisconsin
FRANK J. MRVAN, Indiana              MADISON CAWTHORN, North Carolina
JAMAAL BOWMAN, New York, Vice-Chair  MICHELLE STEEL, California
MARK POCAN, Wisconsin                JULIA LETLOW, Louisiana
JOAQUIN CASTRO, Texas                Vacancy
MIKIE SHERRILL, New Jersey
JOHN A. YARMUTH, Kentucky
ADRIANO ESPAILLAT, New York
KWEISI MFUME, Maryland

                   Veronique Pluviose, Staff Director
                  Cyrus Artz, Minority Staff Director
                                 ------                                

            SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES

                  SUZANNE BONAMICI, Oregon, Chairwoman

ALMA S. ADAMS, North Carolina        RUSS FULCHER, Idaho, Ranking 
JAHANA HAYES, Connecticut                Member
TERESA LEGER FERNANDEZ, New Mexico   GLENN THOMPSON, Pennsylvania
FRANK J. MRVAN, Indiana              LISA C. McCLAIN, Michigan
JAMAAL BOWMAN, New York              VICTORIA SPARTZ, Indiana
KWEISI MFUME, Maryland               SCOTT FITZGERALD, Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia  VIRGINIA FOXX, North Carolina (ex 
  (ex officio)                           officio)
        
        
        SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS

                 MARK DeSAULNIER, California, Chairman

JOE COURTNEY, Connecticut            RICK W. ALLEN, Georgia
DONALD NORCROSS, New Jersey            Ranking Member
JOSEPH D. MORELLE, New York          JOE WILSON, South Carolina
SUSAN WILD, Pennsylvania             TIM WALBERG, Michigan
LUCY McBATH, Georgia                 JIM BANKS, Indiana
ANDY LEVIN, Michigan                 DIANA HARSHBARGER, Tennessee
HALEY M. STEVENS, Michigan           MARY E. MILLER, Illinois
FRANK J. MRVAN, Indiana              SCOTT FITZGERALD, Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia  VIRGINIA FOXX, North Carolina
  (ex officio)                         (ex officio)
                            
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page

Hearing held on September 28, 2021...............................     1

Statement of Members:
    Bonamici, Hon. Suzanne, Chairwoman, Subcommittee on Civil 
      Rights 
      and Human Services.........................................     1
        Prepared statement of....................................     3
    Spartz, Hon. Victoria, Member, Subcommittee on Civil Rights 
      and Human Services.........................................     4
        Prepared statement of....................................     5
    DeSaulnier, Hon. Mark, Chairman, Subcommittee on Health, 
      Employment, Labor, and Pensions............................     5
        Prepared statement of....................................     6
    Allen, Hon. Rick, Ranking Member, Subcommittee on Health, 
      Employment, Labor, and Pensions............................     7
        Prepared statement of....................................     8

Statement of Witnesses:
    Martinez-Bianchi, Viviana, Director of Health Equity and 
      Associate 
      Professor, Department of Family Medicine and Community 
      Health, 
      Duke University School of Medicine.........................    16
        Prepared statement of....................................    19
    Pernell, Chris T., Chief Strategic Integration and Health 
      Equity Officer, University Hospital, Newark NJ.............    47
        Prepared statement of....................................    49
    Roy, Avik, President, The Foundation for Research on Equal 
      Opportunity................................................    36
        Prepared statement of....................................    39
    Wen, Leana, Professor and Distinguished Fellow, Fitzhugh 
      Mullan 
      Institute of Health Workforce Equity, The George Washington 

      University Milken Institute School of Public Health........     9
        Prepared statement of....................................    11

Additional Submissions:
    Chairwoman Bonamici:
        ``Community Action and Health Equity in the Response to 
          COVID-19,'' National Community Action Foundation.......   105
    Chairman Scott:
        ``Carrying Equity in COVID-19 Vaccination Forward: 
          Guidance 
          Informed by Communities of Color,'' CommuniVax 
          Coalition, July 2021...................................   113
    Harshbarger, Hon. Diana, a Representative in Congress from 
      the State of Tennesee:
        ``Opinion: In my community, Biden's vaccine mandates 
          could put more lives at risk,'' David Yamamoto, 
          September 13, 2021, The Washington Post................   184
    Questions submitted for the record by:
        Chairman Scott 
        Morelle, Hon. Joseph D., a Representative in Congress 
          from the State of New York 
    Response to question submitted for the record by:
        Dr. Wen..................................................   187
        Dr. Martinez-Bianchi.....................................   192
        Dr. Pernell..............................................   198

 
                 HOW TO SAVE A LIFE: SUCCESSFUL MODELS
                    FOR PROTECTING COMMUNITIES FROM
                                COVID-19

                              ----------                              


                      Tuesday, September 28, 2021

                  House of Representatives,
   Subcommittee on Civil Rights and Human Services,
                Subcommittee on Health, Employment,
                               Labor, and Pensions,
                          Committee on Education and Labor,
                                                    Washington, DC.
    The Subcommittees met, pursuant to notice, at 10:17 a.m., 
via Zoom, Hon. Suzanne Bonamici (Chairwoman of the Subcommittee 
on Civil Rights and Human Services) presiding.
    Present: Representatives Bonamici, DeSaulnier, Courtney, 
Adams, Morelle, Wild, McBath, Hayes, Levin, Stevens, Leger 
Fernandez, Mrvan, Bowman, Scott (ex officio), Allen, Thompson, 
Walberg, Banks, McClain, Harshbarger, Miller, Spartz, 
Fitzgerald, and Foxx (ex officio).
    Staff present: Ilana Brunner, General Counsel; Ijeoma 
Egekeze, Professional Staff; Rashage Green, Director of 
Education Policy; Rasheedah Hasan, Chief Clerk; Sheila 
Havenner, Director of Information Technology; Carrie Hughes, 
Director of Health and Human Services; Ariel Jona, Policy 
Associate; Andre Lindsay, Policy Associate; Richard Miller, 
Director of Labor Policy; Max Moore, Staff Assistant; Mariah 
Mowbray, Clerk/Special Assistant to the Staff Director; Kayla 
Pennebecker, Staff Assistant; Veronique Pluviose, Staff 
Director; Banyon Vassar, Deputy Director of Information 
Technology; Cyrus Artz, Minority Staff Director; Michael Davis, 
Minority Operations Assistant; Rob Green, Minority Director of 
Workforce Policy; Taylor Hittle, Minority Professional Staff 
Member; Georgie Littlefair, Minority Staff Assistant; John 
Martin, Minority Deputy Director of Workforce Policy/Counsel; 
Hannah Matesic, Minority Director of Member Services and 
Coalitions; Audra McGeorge, Minority Communications Director; 
and Ben Ridder, Minority Professional Staff Member.
    Chairwoman Bonamici. The Subcommittee on Civil Rights and 
Human Services, and Subcommittee on Health, Employment, Labor, 
and Pensions will come to order.
    Welcome, everyone. I note that a quorum is present.
    The subcommittees are meeting today for a joint hearing to 
hear testimony on ``How to Save a Life: Successful Models for 
Protecting Communities from COVID-19.''
    This is an entirely remote hearing, and, as such, the 
Committee's hearing room is officially closed. All microphones 
will be kept muted as a general rule to avoid unnecessary 
background noise. Members and witnesses will be responsible for 
unmuting themselves when they are recognized to speak or when 
they wish to seek recognition.
    If a Member or witness experiences technical difficulties 
during the hearing, please stay connected on the platform, make 
sure you are muted, and use your phone to immediately call the 
Committee's IT director. His number was provided in advance. 
Should the Chair experience technical difficulty or need to 
step away, Chairman DeSaulnier or another majority Member is 
hereby authorized to assume the gavel in the Chair's absence.
    To adhere to the Committee's five-minute rule, staff will 
be keeping track of time using the Committee's digital timer, 
which appears in its own thumbnail picture. Members and 
witnesses are asked to wrap up promptly when their time is 
expired.
    Pursuant to Committee Rule 8(c), opening statements are 
limited to the Chairs and Ranking Members. This allows us to 
hear from our witnesses sooner and provides all Members with 
adequate time to ask questions.
    I now recognize myself for the purpose of making an opening 
statement.
    Good morning, everyone. Today, we are examining best 
practices for increasing COVID-19 vaccinations through the lens 
of health equity. To date, the CDC reports that 686,639 
people--I am going to say that again--686,639 people in the 
United States have tragically died from COVID-19.
    We are now experiencing a resurgence of the virus as the 
Delta variant continues to spread across the country. Every 
day, we continue to lose an average of more than 2,000 of our 
loved ones, friends, and neighbors. Unfortunately, millions of 
unvaccinated Americans are still at risk of succumbing to this 
deadly virus.
    Vaccination rates have been lowest in the most underserved 
areas, particularly rural and BIPOC--Black, indigenous, and 
people of color--communities. And, for a multitude of reasons 
that our expert witnesses will discuss, many unprotected 
Americans are simply not getting the vaccinations they need to 
stay safe and healthy. These individuals are not concentrated 
in any single region of the country or on any one end of the 
political spectrum. So, we, as policymakers, should be working 
together to better support our public health professionals in 
reaching those populations.
    To address obstacles to vaccination, the American Rescue 
Plan Act has invested more than $240 million in community-led 
efforts and provided significant funding to increase 
vaccination rates in rural areas. These investments helped 
bolster the efforts of a wide range of community-based 
organizations and federally funded partners, such as the Aging 
Network supported by the Older Americans Act and the Community 
Action Network authorized by the Community Services Block 
Grant.
    These efforts have been essential to saving lives of those 
who have long been medically underserved. For example, many 
community action agencies across the country have supported 
vaccinations by engaging in outreach and education, providing 
vaccine registration, scheduling assistance and transportation, 
and hosting vaccination clinics or supporting, importantly, 
mobile units.
    To highlight the successful approaches of these entities, I 
ask unanimous consent to enter into the record a report from 
the National Community Action Foundation entitled ``Community 
Action and Health Equity in response to COVID-19.''
    Without objection, so ordered in the record.
    Chairwoman Bonamici. Today's hearing is an opportunity to 
learn from successful initiatives so we can provide every 
community with the tools they need to finally defeat this 
virus. If we listen to the advice of our medical experts and 
work together, we can keep our communities healthier and save 
lives.
    So, thank you again for your witnesses for being here 
today.
    I now yield to the distinguished Ranking Member, Mrs. 
Spartz, for her opening statement. She will be serving as 
Ranking Member of the Subcommittee on Civil Rights and Human 
Services for this hearing.
    I turn it over to you, Mrs. Spartz.
    [The prepared statement of Chairwoman Bonamici follows:]

 Statement of Hon. Suzanne Bonamici, Chairwoman, Subcommittee on Civil 
                       Rights and Human Services

    Today, we are examining best practices for increasing COVID-19 
vaccinations through the lens of health equity.
    To date, the CDC reports that 686,639 people in the United States 
have tragically died from COVID-19.
    We are now experiencing a resurgence of the virus as the Delta 
variant continues spreads across the country. Every day, we continue to 
lose an average of more than 2,000 of our loved ones, friends and 
neighbors.
    Unfortunately, millions of unvaccinated Americans are still at risk 
of succumbing to this deadly virus. Vaccination rates have been the 
lowest in our most underserved areas, particularly rural and BIPOC--
Black, indigenous and people of color--communities.
    And for a multitude of reasons that our expert witnesses will 
discuss, many unprotected Americans are simply not getting the 
vaccinations they need to stay safe and healthy. These individuals are 
not concentrated in any single region of the country or on any one end 
of the political spectrum, so we, as policymakers, should be working 
together to better support our public health officials in reaching 
those populations.
    To address obstacles to vaccination, the American Rescue Plan Act 
invested more than $240 million in community-led efforts and provided 
significant funding to increase vaccination rates in rural areas.
    These investments helped bolster the efforts of a wide range of 
community-based organizations and federally funded partners, such as 
the Aging Network supported by the Older Americans Act, and the 
Community Action Network authorized by the Community Services Block 
Grant.
    These efforts have been essential to saving the lives of those who 
have long been medically underserved.
    For example, many community action agencies across the country have 
supported vaccinations by engaging in outreach and education, providing 
vaccine registration, scheduling assistance and transportation, and 
hosting vaccination clinics or supporting, importantly, mobile units.
    To highlight the successful approaches of these entities, I ask 
unanimous consent to enter into the record a report from the National 
Community Action Foundation entitled, ``Community Action and Healthy 
Equity in Response to COVID-19.'' Without objection, so ordered.
    Today's hearing is an opportunity to learn from successful 
vaccination initiatives like these so that we can provide every 
individual with the tools to finally defeat this virus.
    If we listen to the advice of our medical experts and work 
together, we can keep our communities healthier and save lives.
    So thank you, again, to our witnesses for being here today. I now 
yield to the distinguished Ranking Member, Ms. Spartz, for her opening 
statement. She will be serving as the Ranking Member for the 
Subcommittee on Civil Rights and Human Services for this hearing. I 
turn it over to you, Ms. Spartz.
                                 ______
                                 
    Mrs. Spartz. Thank you, Madam Chairman.
    I believe it is an important discussion to have, how do we 
manage and mitigate pandemic risks, look at them 
comprehensively, and stop politicizing serious government 
decisions to play politics with people's lives or advance a 
party agenda.
    Let's look at the prior year's successes: Operation Warp 
Speed was the gold standard of vaccine development and 
distribution. Under President Trump, who promptly cut red tape 
and regulations, our private healthcare sector was able to 
produce a lifesaving vaccine in record time. This proved yet 
again that America's healthcare system thrives when government 
gets out of the way and supports private innovation.
    As we continue discussing successful models for protecting 
communities from COVID-19, we must acknowledge that the most 
effective mitigation and prevention strategy, vaccination, is 
both free and widely available for every American over age 12. 
Our free enterprise system and the private healthcare industry 
made this miraculous feat possible.
    The timing of the pandemic to happen during an intense 
election year caused it to be politicized even further. And 
despite claiming to be the party of science, Democrats fueled 
the public's vaccine hesitancy by spawning doubt over whether a 
Republican President could be trusted to deliver a safe and 
effective COVID-19 vaccination. This politically motivated 
disinformation was cowardly, cost people their lives, and 
exacerbated health disparities.
    Unfortunately, the Biden administration continues to sow 
fear, doubt, and confusion. Through ever-changing guidance and 
policies drafted along ideological lines, President Biden has 
created another pandemic: misinformation. We need our 
Commander-in-Chief to put facts before factions and to clearly 
communicate with the public about the State of COVID-19, the 
vaccine's effectiveness, and the path forward to a pre-pandemic 
level.
    From the latest vaccine mandates, which are not based on 
risk or science, to precluding our children from in-person 
learning, which is not based on risk or science, this President 
has traded our country's long-term viability for short-term 
political wins for the Democrat Party.
    To capitalize on early successes, we experienced responding 
to COVID-19, it is imperative that we establish local and State 
control, working together with those leaders to execute policy 
that encourages vaccination and government transparency, not 
government force and fear. It backfires and only belongs to 
totalitarian regimes, not a constitutional republic of free 
people. Only then can we begin to regain our pre-pandemic 
prosperity.
    Thank you to our witnesses for joining us in what I hope, 
for a change, will be a fact-based, productive, and meaningful 
discussion.
    And I yield back.
    [The prepared statement of Mrs. Spartz follows:]

Statement of Hon. Victoria Spartz, Member, Subcommittee on Civil Rights 
                           and Human Services

    It's an important discussion to have: how do we manage and mitigate 
pandemic risks, look at them comprehensively, and stop politicizing 
serious government decisions to play politics with people's lives and 
advance a party agenda.
    Let's look at the prior year's successes: Operation Warp Speed was 
the gold standard of vaccine development and distribution. Under 
President Trump, who promptly cut red tape and regulations, our private 
health care sector was able to produce several lifesaving vaccines in 
record time.
    This proved, yet again, that America's health care system thrives 
when government gets out of the way and supports private innovation. As 
we continue discussing successful models for protecting communities 
from COVID-19, we must acknowledge that the most effective mitigation 
and prevention strategy-vaccination-is both free and widely available 
for every American over age 12. Our free-enterprise system and the 
private health care industry made this miraculous feat possible.
    The timing of the pandemic, happening during an intense reelection 
year, caused it to be politicized even further; and despite claiming to 
be the `party of science,' Democrats fueled the public's vaccine 
hesitancy by spawning doubt over whether a Republican president could 
be trusted to deliver a safe and effective COVID-19 vaccination. This 
politically motivated disinformation was cowardly, cost people their 
lives, and exacerbated health disparities. Unfortunately, the Biden 
administration continues to sow fear, doubt, and confusion.
    Through ever-changing guidance and policies crafted along 
ideological lines, President Biden is creating another pandemic: 
misinformation. We need our Commander-in-Chief to put facts before 
factions and to clearly communicate with the public about the State of 
COVID-19, the vaccines' effectiveness, and the path forward to a pre-
pandemic life.
    From the latest vaccine mandates-which are not based on risk or 
science-to precluding our children from in-person learning-which is not 
based on risk or science-this President has traded our country's long-
term viability for short-term political wins for the Democrat Party.
    To capitalize on early successes we experienced responding to 
COVID-19, it is imperative that we reestablish local and State control, 
working together with those leaders to execute policies that encourage 
vaccination and government transparency. Not government force and 
fear--it backfires and only belongs to totalitarian regimes, not a 
constitutional republic of free people. Only then can we begin to 
regain our pre-pandemic prosperity.
    Thank you to all our witnesses for joining us in what, I hope for a 
change, will be a fact-based, productive, and meaningful discussion.
                                 ______
                                 
    Chairwoman Bonamici. Thank you, Ranking Member Spartz.
    And now I recognize the distinguished Chair of the 
Subcommittee on Health, Employment, Labor, and Pensions, 
Chairman DeSaulnier, for the purpose of making an opening 
statement.
    Chairman DeSaulnier. Thank you, Chair Bonamici. Thank you 
so much for this hearing.
    And thank you to all of our witnesses, really terrific, for 
your words here and for your work.
    The Delta variant is continuing to pose a serious threat to 
our public health as we mourn the loss of more than 680,000 
family Members, friends, neighbors and fellow countrymen so 
far. This is particularly true for communities that have 
historically been left behind by our healthcare system and 
suffered the greatest losses during this pandemic.
    Despite these significant challenges, hope is far from 
lost. COVID-19 vaccinations continue to be our most effective 
strategy to prevent people from succumbing to this virus. And 
the critical investments we provided in the American Rescue 
Plan are helping to expand vaccinations in the areas that need 
them most.
    Yet, even as we fight against the Delta variant, we are 
still seeing lawmakers and leaders politicize vaccinations 
instead of following the science and putting the health of our 
communities first. This is a disservice to the American people 
that we all represent. We have a responsibility to unite behind 
this scientifically proven vaccine and public health guidance 
that are saving lives as we speak.
    In the area I am very privileged to represent, San 
Francisco Bay area, Contra Costa County, we have been working 
to make significant investments in vaccine equity. In May, the 
equity gap between White residents in my county and African 
American residents was 22 percent. By August, thanks to the 
hard work of people in our public health system, by August, 
however, that equity gap had decreased from 22 percent to 6 
percent: 22 percent to 6 percent.
    To achieve these significant improvements, the Contra Costa 
Regional Medical Center recognized, the public hospital, that 
they had to do more than just set up vaccine sites in 
neighborhoods with low vaccination rates. They created a 
system, preferential, with preferential scheduling in those 
neighborhoods where residents in ZIP Codes with the worst 
health outcomes were given the first appointments. They also 
created a multilingual call center to schedule appointments for 
residents that conducted outreach through text campaigns and 
direct phone calls to residents in those communities.
    By coupling or equity lens with data and technology 
systems, Contra Costa County was able to prioritize residents 
and address the equity gap in a significant way in a short 
period of time.
    Today, I look forward to hearing from our witnesses about 
what we should do in best practices, what we should do from 
lessons they have learned in their critical efforts to help 
underserved communities recover from this historic pandemic and 
then make sure that all Americans benefit.
    I am now happy to recognize my friend, the Ranking Member, 
Mr. Allen.
    [The prepared statement of Chairman DeSaulnier follows:]

             Statement of Hon. Mark DeSaulnier, Chairman, 
        Subcommittee on Health, Employment, Labor, and Pensions

    Thank you, Chair Bonamici, thank you so much for this hearing. And 
thank you to all of our witnesses, really terrific for your words here 
and your work.
    The Delta variant is continuing to pose a serious threat to our 
public health as we mourn the loss of more than 680,000 family members, 
friends, neighbors and fellow countrymen so far.
    This is particularly true for communities that have historically 
been left behind by our health care system and suffered the greatest 
losses during this pandemic.
    Despite these significant challenges, hope is far from lost. COVID-
19 vaccinations continue to be our most effective strategy to prevent 
people from succumbing to this virus. And the critical investments we 
provided in the American Rescue Plan are helping to expand vaccinations 
in the areas that need them most.
    Yet, even as we fight against the Delta variant, we are still 
seeing lawmakers and leaders politicize vaccinations instead of 
following the science and putting the health of their communities 
first.
    This is a disservice to the American people that we all represent. 
We have a responsibility to unite behind this scientifically proven 
vaccine and public health guidance that are saving lives as we speak.
    In the area I am very privileged to represent, the San Francisco 
Bay area, Contra Costa County, we have been working to make significant 
investments in vaccine equity.
    In May, the equity gap between white residents in my county and 
African American residents, was 22 percent. By August, thanks to the 
hard work of the people in our public health system, by August, 
however, that equity gap had decreased from 22 percent to 6 percent--22 
percent to 6 percent.
    To achieve these significant improvements, the Contra Costa 
Regional Medical Center, the public hospital, recognized that they had 
to do more than just setup vaccine sites in neighborhoods with low 
vaccination rates.
    They created a system with preferential scheduling in those 
neighborhoods for residents in zip-codes with the worst health outcomes 
were given the first appointments. They also created a multilingual 
call center to schedule appointments for residents and conducted 
outreach through text campaigns and direct phone calls to residents in 
those communities.
    By coupling our equity lens with data and technology systems, 
Contra Costa County was able to prioritize residents and address the 
equity gap in a significant way in a short period of time.
    Today, I look forward to hearing from our witnesses about what we 
should do and best practices from lessons they have learned in their 
critical efforts to help underserved communities recover from this 
historic pandemic and then make sure all Americans benefit.
    I am now happy to recognize my friend, Ranking Member, Mr. Allen.
                                 ______
                                 
    Chairwoman Bonamici. Mr. Allen, you are recognized for five 
minutes for your opening statement.
    Mr. Allen. Can you hear me OK?
    Chairwoman Bonamici. We can hear you.
    Mr. Allen. OK. Thank you, Mr. Chairman and Madam Chairman.
    You know, as I look back, our Nation's pre-pandemic economy 
was the best in the world. Unemployment, particularly for 
minority groups, was an all-time low. Wages increased for more 
than 19 straight months and grew faster for the bottom 10 
percent of income earners than it did for the top 10 percent of 
income earners.
    Business owners and workers are eager to get back to this 
unprecedented period of economic growth and prosperity, but 
President Biden is either incapable of or unwilling to lead our 
economy and our Nation forward. There are currently over 8.4 
million unemployed Americans and 10.9 million job openings, a 
gap that is due, in part, to the Biden administration's absurd 
policies that are keeping would-be workers out of the 
workforce. For minority groups, the unemployment rate is as 
high as 8.8 percent.
    At gas pumps and grocery stores, workers are spending more 
due to President Biden's inflation crisis. To put it simply, 
inflation is a tax on the middle class and the Biden 
administration is forcing already cash-strapped families to 
tighten their belts to pay for Democrats' outlandish taxpayer-
funded spending sprees.
    It is truly astonishing to watch an administration trade 
long-term economic prosperity for short-term liberal special 
interests. The worst part is that there is little evidence that 
government-mandated lockdowns did much to reduce COVID-19 
transmissions. As we successfully demonstrated in my home State 
of Georgia, our economy can and should safely reopen.
    Effective lifesaving vaccines are readily available to 
those who make an informed decision, based on their physician's 
advice. Schools and employers have received far more government 
funding than necessary to weather the pandemic-induced economic 
disruption. More top-down mandates from Washington will not 
alleviate the financial suffering this President's policies 
have inflicted on this Nation.
    As Members of Congress, we must lead by example. It is 
imperative that this Committee meet in person as a signal to 
job creators that it is safe for them to do so as well. Without 
strong leadership from our President, it is equally as 
important that we continue to bolster State and local efforts 
to balance public health with economic prosperity and uphold 
individual freedoms. The Federal Government does not have all 
the answers, which is why I look forward to a discussion with 
our witnesses about how our economy can regain its footing 
without burdening business owners and restricting individual 
freedoms.
    And, with that, I yield back.
    [The prepared statement of Mr. Allen follows:]

             Statement of Hon. Rick Allen, Ranking Member, 
        Subcommittee on Health, Employment, Labor, and Pensions

    Our nation's pre-pandemic economy was the best in the world.
    Unemployment, particularly for minority groups, was at an all-time 
low. Wages increased for more than 19 straight months and grew faster 
for the bottom 10 percent of income earners than for the top 10 percent 
of income earners.
    Business owners and workers are eager to get back to this 
unprecedented period of economic growth and prosperity. But President 
Biden is either incapable of or unwilling to lead our economy and our 
Nation forward.
    There are currently over 8.4 million unemployed Americans and 10.9 
million job openings, a gap that is due in part to the Biden 
administration's absurd policies that are keeping would-be workers out 
of the workforce. For minority groups, the unemployment rate is as high 
as 8.8 percent.
    At gas pumps and grocery stores, workers are spending more due to 
President Biden's inflation crisis. To put it simply, inflation is a 
tax on the middle class, and the Biden administration is forcing 
already cash-strapped families to tighten their belts to pay for 
Democrats' outlandish taxpayer-funded spending sprees. It is truly 
astonishing to watch an administration trade long-term economic 
prosperity for short-term liberal special interests. The worst part is 
that there is little evidence that government-mandated lockdowns did 
much to reduce COVID-19 transmission.
    As we've successfully demonstrated in my home State of Georgia, our 
economy can and should safely reopen. Effective, life-saving vaccines 
are readily available to those who make an informed decision based on 
their physicians' advice. Schools and employers have received far more 
government funding than necessary to weather the pandemic-induced 
economic disruption.
    More top-down mandates from Washington will not alleviate the 
financial
    suffering this President's policies have inflicted.
    As Members of Congress, we must lead by example. It is imperative 
that this Committee meet in person as a signal to job creators that it 
is safe for them to
    do so as well. Without strong leadership from our President, it is 
equally as important that we continue to bolster State and local 
efforts to balance public health with economic prosperity and uphold 
individual freedoms.
    The Federal Government does not have all the answers, which is why 
I look forward to a discussion with our witnesses about how our economy 
can regain its footing without burdening business owners and 
restricting individual freedoms.
                                 ______
                                 
    Chairwoman Bonamici. Thank you very much, Ranking Member 
Allen.
    And now I will introduce our witnesses. Dr. Leana Wen is a 
Professor and Distinguished Fellow at the Fitzhugh Mullan 
Institute for Health Workforce Equity at The George Washington 
University Milken Institute School of Public Health in 
Washington, DC.
    Welcome, Dr. Wen.
    Dr. Viviana Martinez-Bianchi is the Director of Health 
Equity and is an Associate Professor for the Department of 
Family Medicine and Community Health at Duke University School 
of Medicine in Durham, North Carolina.
    Welcome, Dr. Martinez-Bianchi.
    Mr. Avik Roy is the President of the Foundation for 
Research on Equal Opportunity in Washington, DC.
    Welcome, Mr. Roy.
    And Dr. Chris Pernell is the Chief Strategic Integration 
and Health Equity Officer at University Hospital in Newark, New 
Jersey.
    Welcome, Dr. Pernell.
    We appreciate the witnesses for participating today and we 
look forward to your testimony. Please note that your written 
statements will appear in full in the hearing record; and you 
are asked to limit your oral presentation to a five-minute 
summary; and, after your presentations, we will move to Member 
questions.
    I know the witnesses are aware of their responsibility to 
provide accurate information to this joint Subcommittee, and, 
therefore, we will proceed with their testimony.
    I will first recognize Dr. Wen for five minutes for your 
testimony.

   STATEMENT OF LEANA WEN, PROFESSOR & DISTINGUISHED FELLOW, 
              FITZHUGH MULLAN INSTITUTE OF HEALTH 
            WORKFORCE EQUITY, THE GEORGE WASHINGTON 
      UNIVERSITY MILKEN INSTITUTE SCHOOL OF PUBLIC HEALTH

    Dr. Wen. Thank you very much, Chairwoman Bonamici, Chairman 
DeSaulnier, Ranking Member Spartz and Allen and Chairman Scott, 
Ranking Member Foxx, and the distinguished Members of the 
Subcommittees on Civil Rights and Human Services and Health, 
Education, Labor, and Pensions. Thank you for convening this 
important conversation to address the urgent actions that must 
be taken to protect our communities.
    There is no question that COVID-19 has unveiled rampant 
health disparities and that people of color, families with low 
income, who already bear the brunt of disparities, have 
suffered the most. We must go beyond admiring the problem, and, 
in my testimony I want to emphasize six actions that Congress 
must take to reduce the disproportionate impact of the pandemic 
on vulnerable communities:
    No. 1, take every available measure to protect our 
children. Now is the most dangerous time in the pandemic when 
it comes to kids too young to be vaccinated. The CDC has 
provided extensive evidence-based guidance for what should be 
done in schools. Congress should stand behind the CDC's 
recommendations to keep schools open safely.
    No. 2, increase availability of rapid testing. Testing is a 
crucial layer of protection that the U.S. has not utilized to 
its full potential. Imagine if every student can take a rapid 
test before going to school and every worker can test before 
going to work, and if extended families can all take tests 
before seeing one another.
    A rapid antigen test is not 100 percent effective, but even 
if it is 80 percent effective it will identify 80 percent of 
those who otherwise could have infected others. The U.K. has 
made free tests available to everyone so that all residents can 
be tested twice a week. Canada is providing free rapid tests to 
businesses.
    The Biden administration has said that they will purchase 
280 million tests for around $7 each, but this is far too 
little for far too much. Congress should urge the 
administration to make free tests available for everyone so 
that all Americans can be tested at least twice a week.
    No. 3, improve vaccination rates. Only about 55 percent of 
Americans are fully vaccinated, which is far too low to stem 
the surge of coronavirus. It is unacceptable that about 2,000 
Americans are still dying every day. Members of Congress should 
use your extensive platforms to support all efforts to increase 
vaccine uptake, including scaling up education and outreach, 
combating misinformation and disinformation, and increasing 
accessibility of vaccines.
    Baltimore is among the cities that utilized mobile vaccine 
vans that travel to people's homes. This was particularly 
necessary for older residents, homebound individuals, people 
with disabilities and others whose barrier to vaccination is 
mainly about access.
    New York City is also a standout in making vaccines 
available in transportation hubs and in schools. These efforts 
to reach people where they are continues to be so important 
because nearly half of the unvaccinated are in the 
unvaccinated-but-willing category. They can be reached through 
ongoing outreach, and vaccine requirements will help as well.
    No. 4, ensure workplace protections. Congress should urge 
the administration to make high-quality N95 and KN9five masks 
available to every worker free of charge. While COVID-19 cases 
are surging, indoor masking should be required at workplaces 
unless there is universal vaccination and a robust testing 
regimen.
    No. 5, increase data collection and improve oversight. 
There should be a real-time dashboard coordinated by the 
Federal Government with data uploaded by State and local health 
departments that provide on-the-ground information about 
primary vaccinations, booster uptake, breakthrough infections, 
testing rates, among other metrics. This provides transparency 
and accountability and allows for targeted interventions. 
Federal funding can be tied to the availability of this data, 
adding a strong incentive for compliance.
    And, No. 6, support safety net public health systems. It is 
excellent that there is new funding to address COVID-19, but we 
must not forget that public health is not only about infection 
control. There were other issues that were crises prior to 
COVID and have gotten worse, like the opioid epidemic, the 
crisis of maternal health, and the lack of food and housing 
access. Congress should allocate resources to address these 
other public health issues too, and Congress should also allow 
maximal flexibility for local jurisdictions that are closest to 
the ground and that can best serve their communities.
    Thank you for considering these six specific steps to 
combat COVID-19, reduce disparities, and in so doing improve 
health for all and strengthen our communities.
    [The prepared statement of Dr. Wen follows:]

                  Prepared Statement of Dr. Leanna Wen
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

    Chairwoman Bonamici. Thank you very much for your 
testimony, Dr. Wen.
    Next we are going to hear from Dr. Martinez-Bianchi.
    You are recognized for five minutes for your testimony.

   STATEMENT OF VIVIANA MARTINEZ-BIANCHI, DIRECTOR OF HEALTH 
                EQUITY AND ASSOCIATE PROFESSOR, 
          DEPARTMENT OF FAMILY MEDICINE AND COMMUNITY
           HEALTH, DUKE UNIVERSITY SCHOOL OF MEDICINE


    Dr. Martinez-Bianchi. Thanks, Chairwoman Bonamici and 
Chairman DeSaulnier, Ranking Members and Members of the 
subcommittees, for inviting my testimony. I offer this 
testimony in my personal capacity and as a representative of 
LATIN-19. My views do not necessarily represent the views of my 
employer, Duke University.
    I am pleased to be here today not only as someone who has 
been on the front lines of the COVID-19 pandemic as a family 
doctor but also on the front lines in our LatinX community, as 
cofounder of LATIN-19, the LatinX Advocacy Team and 
Interdisciplinary Network for COVID-19. LATIN-19 is a 
multisector coalition including over 700 people, representing a 
broad range of organizations and the Hispanic community across 
Durham and in North Carolina.
    LATIN-19 was launched in March 2020 in anticipation of the 
expected impact of COVID-19, and it has been meeting every 
Wednesday at noon via Zoom with simultaneous interpretation. We 
provide a critical shared space for Members of the community--
Latina, multisector leaders, and allies--to create 
collaborative and interdisciplinary solutions in a trusting and 
committed environment.
    At our weekly meetings, entities discuss challenges, needs, 
and opportunities facing the Latina community and propose 
changes in programs, systems, and policies for improvement of 
health and the promotion of health equity. LATIN-19 meetings 
consider the myriad of social and health conditions that are 
driving the increased risk and disproportionate burden of 
COVID-19 among the LatinX community. For example, LatinX 
employees are overrepresented in frontline essential jobs. They 
are more likely to live in densely populated areas and in 
multigenerational, multifamily households.
    Another key reason has been the systematic exclusion from 
access to health services, health information networks, and 
health insurance, even when eligible. It is ironic, 
disappointing, and unacceptable that the Hispanic community 
lacks access to healthcare, given their significant 
contribution to the labor force and to the economy of the 
country.
    Throughout 2020 and 2021, LATIN-19 has engaged in broad 
dissemination of information on COVID-19 prevention and 
services by developing and sharing culturally appropriate 
essential information in Spanish and English to multiple 
networks, including local and national news outlets. In 
addition, the electronic patient portal of Duke Medical Center 
is being made available in Spanish to facilitate connection 
with the health system.
    In July 2020, Hispanics comprised almost half of the COVID-
19 cases in the entire State of North Carolina, where they were 
only 10 percent of the State's population. Since July 2020, 
LATIN-19 has been at the forefront of COVID-19 testing, and 
since January we have been involved in vaccination efforts to 
reach the LatinX communities. These efforts have contributed to 
lowering COVID-19 case rates and in increasing COVID-19 
vaccination.
    Currently, the proportion of Hispanic residents vaccinated 
in Durham County is the same as non-Hispanic residents, and we 
have reached another important milestone. At 59 percent, the 
proportion of vaccinated Hispanic residents in Durham County is 
now higher than the proportion of all people vaccinated for the 
whole State.
    As other entities might be considering a LATIN-19 type 
model, I recommend these best practices: No. 1, building trust 
is vital, but it can take time, and it takes being a presence, 
being a Member of the community, being curious, listening to 
the questions and the diversity of voices, exhibiting our own 
humility and vulnerability when we are trying to come to 
solutions together with community Members.
    No. 2, build and maintain strong channels of communication 
with leaders in government, public and private health systems, 
and the business sector to translate current needs, missed 
opportunities, and successes for the LatinX community.
    No. 3, connect, communicate, and empower. As part of LATIN-
19, we have learned that how and from whom people get their 
information is key.
    No. 4, direct community care, including mobile primary 
healthcare to address community needs and diminish barriers to 
access. Community health workers, or promotoras, are integral 
to the successful deployment of healthcare in the community.
    No. 5, engage the LatinX community to participate and have 
a voice in clinical and community-based research.
    And, No. 6, education. By providing learners the 
opportunity to engage in community-based experiences and work 
closely with educators and leaders in advocacy healthcare 
disparities and in the intersection between primary care and 
public health, LATIN-19 impacts the training of the next 
generation of healthcare professionals and the recruitment of a 
diverse workforce representative of the communities we serve. 
Si se puede, if we can, if we engage our community.
    I want to thank you for this opportunity to offer testimony 
on this critical issue. The LATIN-19 Network and I stand ready 
to be a resource for the Subcommittee's efforts, and we will be 
glad to provide any additional detail, data, and 
recommendations at your request.
    [The prepared statement of Dr. Martinez-Bianchi follows:]

           Prepared statement of Viviana Martinez-Bianchi, MD
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

    Chairwoman Bonamici. Thank you for your testimony, Dr. 
Martinez-Bianchi.
    Next, we are going to recognize Mr. Roy for five minutes 
for your testimony.

 STATEMENT OF AVIK ROY, PRESIDENT, THE FOUNDATION FOR RESEARCH 
                      ON EQUAL OPPORTUNITY

    Mr. Roy. Chairs Bonamici and DeSaulnier, Mrs. Spartz, Mr. 
Allen, Members of the subcommittees, it is good to see many of 
you again. Thanks for inviting me hero today.
    The Foundation for Research on Equal Opportunity, or FREOPP 
for short, is a nonpartisan think tank that focuses exclusively 
on ideas that can help improve the lives of Americans on the 
bottom half of the economic ladder. I welcome the opportunity 
to discuss how we can do better to protect communities from 
COVID-19.
    A year ago in The New Yorker, Alec MacGillis wrote about a 
12-year-old from east Baltimore named Shemar. Despite a 
difficult home life with a mother who suffered from drug 
addiction, Shemar had a special talent for math and loved 
school. But Shemar's school didn't love him back. Contrary to 
all evidence regarding low transmission and risk of the 
coronavirus in young children, Maryland kept its schools 
closed. MacGillis saw the enthusiasm for education evaporate 
from Shemar as his education was replaced by Zoom links that 
didn't work for classes taught by teachers who didn't show up.
    Those who endorsed the closure of schools have argued that 
it was worth it in order to save lives from COVID-19, but we 
didn't save lives by shutting down schools, we diminished them. 
How many permanent dropouts have we created with COVID-related 
school closures? On average, Americans without a high school 
diploma live 10 to 13 years shorter than those with a college 
degree.
    COVID-related school closures have disproportionately 
affected lower income and minority students. By last summer, 
two-thirds of White fourth-graders were enjoying fully in-
person schools, compared to only 45 percent of Hispanic, 41 
percent of Black, and 27 percent of Asians.
    As we at FREOPP detailed last summer, nearly all European 
countries kept their schools open in 2020 and suffered no 
greater risk of COVID transmission or illness as a result. Here 
in America, those places that have reopened schools have seen 
similar outcomes.
    Too often, the Federal and State governments have acted as 
if all Americans are at equal risk of illness and death from 
COVID-19 when from the very beginning it was clear that the 
elderly were far more at risk than young children. On April 17, 
2020, 78 percent of U.S. COVID deaths were in individuals older 
than 65. Today, it is 77 percent. By contrast, only 389 
Americans under the age of 15 have died of COVID, fewer than 
the number of deaths from influenza in an average year.
    We were not nearly aggressive enough last year in 
protecting elderly Americans from COVID, especially those who 
live in nursing homes and assisted living facilities. In 2020, 
nearly 40 percent of all U.S. deaths from COVID took place in 
long-term care facilities housing 0.6 percent of the U.S. 
population. And yet, as late as last June, 11 States weren't 
bothering to track how many of their deaths were taking place 
in nursing homes. Infamously, New York, New Jersey, Michigan, 
and other states forced nursing homes to accept elderly 
individuals being discharged from hospitals with active SARS-
CoV-2 infections, contributing to the spread and lethality of 
the virus. Notably, nursing home residents are 
disproportionately low-income recipients of Medicaid.
    Now that we know mRNA vaccines work, it is important to 
approve their use in children aged 5 to 12 and accelerate 
development and authorization of new vaccines that can further 
protect against variants of concern. The FDA needs to get out 
of the mentality of treating COVID vaccines like cholesterol 
drugs.
    We are in a public health emergency and authorization of 
new vaccines should take that into account, especially for mRNA 
vaccines, which can be rapidly adapted to novel variants. 
Moderna's first vaccine was designed in January 2020, 2 days 
after the SARS-Cov-2 sequence had been published by a Chinese 
scientist. Now that we know that these vaccines work, we 
shouldn't have to wait 11 months for the next generation.
    As I discuss in my written testimony, I have concerns about 
OSHA's employer vaccine mandate, but the Biden administration 
is right to require that nursing home staffers receive the 
vaccine unless they have a medical reason not to. Infected 
staffers played a significant role in spreading the virus among 
nursing homes in 2020, and we must avoid a repeat of this 
problem in 2021.
    The problem is Federal agencies and many local governments 
continue to act as if everyone is at the same risk of dying of 
COVID-19; for example, by recommending or requiring that young 
schoolchildren wear masks despite their limited benefit in that 
setting, since children are at very low risk and teachers can 
receive the vaccine.
    Of the 180 million Americans fully vaccinated, only 19,136 
have been hospitalized, a rate of 0.01 percent. Of those, 86 
percent of deaths and 69 percent of nonfatal hospitalizations 
have occurred in people over the age of 65. When governments 
act as if everyone is at equal risk of illness or death from 
COVID, irrespective of vaccination status, previous infection 
or age, it can be no wonder that hesitant Americans see little 
benefit in receiving the vaccine. If we want to overcome that 
hesitation, we have to act like vaccines save lives, which they 
absolutely do. Thank you.
    [The prepared statement of Mr. Roy follows:]

                     Prepared Statement of Avik Roy
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

    Chairwoman Bonamici. Thank you for your testimony.
    And, finally, we are going to hear from Dr. Pernell.
    Dr. Pernell, you are recognized for five minutes for your 
testimony.

        STATEMENT OF CHRIS T. PERNELL, CHIEF STRATEGIC 
            INTEGRATION AND HEALTH EQUITY OFFICER, 
                      UNIVERSITY HOSPITAL

    Dr. Pernell. Thank you, Chairwoman Bonamici, Chairman 
DeSaulnier, Ranking Members Spartz and Allen and Members of the 
Subcommittee, for the opportunity to share my institution's 
approach to health equity and our experiences during the COVID-
19 crisis.
    My name is Dr. Chris T. Pernell, Chief Strategic 
Integration and Health Equity Officer at University Hospital in 
Newark, New Jersey. I am the daughter of Timothy L. Pernell, 
Sr., who lost his life to COVID on April 13, 2020. On the day 
U.S. Army reservists arrived to help us save lives, my father 
died in another hospital 4 miles away, a brave man who overcame 
the Jim Crow South and worked at the famous Bell Labs, he 
couldn't survive this pandemic. I am the sister of Kim Maria, a 
breast cancer survivor and now a long COVID survivor too. I 
also invoke the lives of two cousins and 13 university hospital 
heroes who passed from this virus.
    While COVID's toll on all Americans is seismic, the 
collision of systemic racism and COVID-19 has led to 
earthquakes of devastation in Black and Brown communities like 
ours, where my hospital provides critical care as the state's 
public hospital, a level one trauma center, and a principal 
teaching hospital for the Rutgers Biomedical and Health 
Sciences.
    In New Jersey, there have been nearly 1 million confirmed 
cases, leading to more than 27,000 deaths. Newark, the most 
populous city, has felt COVID's brutal grip, with over 40,000 
cases and 1,052 deaths.
    It is known that racism unfairly disadvantages some 
individuals and groups, unfairly advantages other individuals 
and groups, and saps the strength of the whole society. Albeit 
racism operates as a preexisting American condition.
    Drivers of COVID mortality in Black and Brown populations 
likely include increased COVID exposure due to poverty, 
residential crowding, frontline occupation and public 
transportation, higher rates of known comorbidity not 
effectively treated, and a higher burden of unrecognized 
disease from the lack of access to or trust in care.
    To solve disparities, we must enact an antiracism agenda in 
healthcare and society more broadly. Health equity must be 
central to care, and the integration of clinical medicine, and 
public health must be seen as key to preparedness.
    The first priority: Strengthen primary care through 
community health centers, community health workers, and fully 
funded safety net institutions, and expand insurance coverage 
in order to provide robust access to care for all.
    As a safety net, University Hospital reengaged persons lost 
to care during the pandemic and connected them to primary care 
and prevention, administered more than 47,000 vaccine doses, 
coordinated the State's vaccination vans, providing 2,840 shots 
to 10 low-income and low-vaccinated communities across 76 days 
and is building a Prevention Army.
    The second priority: Healthcare must deliver high-quality 
care and practice accountability from a historical, authentic, 
and transparent place to build trust. It matters who the 
providers are, which trusted messengers are amplified, and how 
we share power to ensure socially and culturally fluent and 
competent care systems.
    University Hospital developed a multiformat, multilingual 
engagement strategy, completed its first 360 Cultural 
Competency Assessment, mobilized a Community Advisory Council, 
and collaborated with city stakeholders to perform the most 
robust community health needs assessment in our history.
    Third priority: Deploy a social determinant of health 
strategy to tackle differences in exposures and life 
opportunities. For instance, UH is incentivizing our suppliers 
to drive economic empowerment among local and regional and 
minority-and women-owned businesses.
    Our partners at the State have made policy decisions 
through a health equity lens. Beyond their 1,500 vaccination 
sites, the State has mandated reporting of race and ethnicity 
data, activated a COVID Community Corps, and created a 
Vulnerable Populations Plan.
    Finding ourselves in the eye of the storm, no one in our 
community has been spared. Yet, with programs designed to share 
and process our collective grief and trauma, we battle both 
pandemics alongside all those impacted in the human circle and 
vow to save lives by all means necessary.
    I thank you for this opportunity to share.
    [The prepared statement of Dr. Pernell follows:]

         Prepared Statement of Chris T. Pernell, MD, MPH, FACPM
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

    Chairwoman Bonamici. Dr. Pernell, thank you for sharing 
your expertise, but also for sharing your personal story, and I 
know everyone here shares condolences on your personal loss of 
your father and family Members.
    Now, we are going to move on to questions but before we do 
that I wanted to add on the written statements, without 
objection, all Members who wish to insert written statements 
into the record may do so by submitting them to the Committee 
electronically in Microsoft Word format by 5 p.m. on October 
11, 2021.
    So now, under Committee Rule 9(a), we will question the 
witnesses under the five-minute rule. As this is a joint 
Subcommittee hearing, after the Chairs and Ranking Members, I 
will be recognizing Subcommittee Members based on seniority 
order on the full Committee.
    I will wait for the bells to stop here for just a minute.
    As Chair, I now recognize myself for five minutes.
    So, thank you again to the witnesses for your testimony. 
You have highlighted some good examples of where you had 
success in overcoming the many obstacles that health 
professionals and community groups face in their efforts to 
help people get vaccinated and win the fight against COVID-19.
    So, in the district I am proud to represent in northwest 
Oregon, Washington County, Oregon, recently became the first 
county in the State to cross the threshold of vaccinating 80 
percent of adults. And, also in Oregon, the Oregon Pacific 
Islander Coalition has been working successfully, with State 
and local partners, to vaccinate more than 90 percent of 
Oregonians who identify as Native Hawaiian or Pacific Islander.
    They are meeting people where they are, such as a local 
food market or favorite neighborhood restaurant. They often 
pair this outreach with additional support, maybe a meal or 
fresh produce or groceries that can be used to make culturally 
traditional recipes. And these sites, importantly, are run by 
trusted community groups, staffed by people who speak the same 
language as community Members, and held in familiar locations 
where people feel comfortable and safe. And it has made a 
difference.
    So, I am going to start with Dr. Martinez-Bianchi. As we 
approach the end of the second year of the pandemic, what are 
the most effective ways to build community trust, and how can 
local providers continue strengthening their engagement with 
underserved communities to address language barriers and 
provide culturally appropriate healthcare and services?
    Dr. Martinez-Bianchi. In our experience, the most important 
way of building that trust is being a presence, listening, like 
I said before, being humble in our approach.
    When we work together, when we are listening to our 
community, what we saw at the very beginning of the pandemic, 
it was that because there were no health networks, there was 
not enough information, the community had started doing it 
themselves. They were addressing food insecurity. They were 
canvassing their own neighborhoods, trying to understand how 
much of an impact COVID-19 was having in the community.
    So, we got together with the community to understand the 
impact of what was happening. We started seeing the numbers 
before there were numbers from the CDC or in the State 
tracking, right?
    Connecting, being there, and also making sure, that we are, 
as health professionals in academic institutions, that we 
understand that the community knows where the problems are 
occurring, the community knows where there are barriers, and 
they actually have wonderful ideas on how to diminish and 
improve access. So----
    Chairwoman Bonamici. I don't mean to cut you off, but I 
just want to get another question in before my time runs out. 
Thank you.
    Dr. Wen, you mentioned this in your testimony. According to 
recent data from Kaiser Family Foundation, about 25 percent of 
unvaccinated adults do plan to get a vaccine by the end of the 
year, but conflicting medical opinions, inaccurate information, 
especially on the internet, related to COVID-19 have created 
some serious challenges to reaching population immunity through 
vaccination.
    So, when communicating with people who are ambivalent or 
skeptical, what effective strategies have healthcare providers 
and public health educators used to increase uptake, address 
concerns, and also debunk misinformation?
    Dr. Wen. I really appreciate the question because I do 
think we need to recognize that there are a lot of people who 
actually are in that middle ground. There are definitely some 
people who are really dug in and will not get the vaccine. 
There are other people who are strong proponents of the 
vaccine, but there are a lot of people who need a little bit 
more of a push.
    And so, everything that was said earlier about the trusted 
messenger, reaching people where they are, all those are very 
important. But to your question, I think it is really important 
to approach people individually with compassion, not with 
judgment, to understand why it is that they have not yet gotten 
vaccinated. Many people are not trying to be purveyors of 
misinformation or disinformation, but they may have heard 
something, and, actually that disinformation is harming their 
health. It is preventing them from protecting their families in 
the way that they should.
    I also do think that vaccine requirements, including in the 
workplace, can also push people to get vaccinated. United 
Airlines, for example, after instituting their vaccine 
requirements already is at 97 percent compliance. And I think 
that, in combination with a robust education campaign, is 
essential.
    Chairwoman Bonamici. Thank you. That is important.
    In my final time, Dr. Wen, again, I am really concerned 
about seniors over the age of 65 who may be eligible for a 
booster or are eligible for a booster if they had Pfizer.
    So, what systems need to be in place to effectively deliver 
those booster shots to seniors who are outside of a long-term 
care setting where they may have somebody come in to provide 
them, but seniors outside of the long-term care system? In the 
3 seconds I have left.
    Dr. Wen. Things are a lot better now than they were at the 
very beginning of the vaccination campaign. Seniors should be 
able to get vaccines in their pharmacies, in their grocery 
stores, in their doctors' offices. Those community vaccination 
sites are absolutely essential. And I think we also need to do 
even more outreach to bring vaccines to where people are, 
including in churches and schools.
    Chairwoman Bonamici. Absolutely. And I don't want to run 
over. I want to set a good example for the rest of the 
Committee.
    So, I am going to yield back and recognize Ranking Member 
Spartz for five minutes for your questions.
    Mrs. Spartz. Thank you, Madam Chair.
    Mr. Roy, in your testimony, you said that the most 
significant mistake that the government has made is its 
inability to properly assess risk. As you know very well, 
government has never been known for its extraordinary ability 
to assess risk or strategically plan or be efficient or 
effective or even its extraordinary ability of common sense 
too. It is inherently political.
    So, if you look at this, what do you believe we could do to 
have a better mechanism to deal with the pandemic, engage 
better with private enterprise, and have a more effective way 
to do it and have more risk-based, not politics-based, approach 
to deal with the pandemic? Do you have any suggestions?
    Mr. Roy. Well, it is a great question, Mrs. Spartz, 
because, as you say, this is a very challenging problem. And 
public health is one of those roles or functions that 
government needs to be involved in. So, it is not something you 
can just say, well, the private sector should just handle it. 
Right? There needs to be a better approach to risk management 
from the government.
    I would say two things: One, we need a much better CDC. The 
CDC from beginning to end has had a lot of problems, both in 
terms of suppressing private sector efforts to test, develop 
tests for COVID, to their ability to collect timely data, that 
basically the Trump administration had to create a completely 
different data architecture using private sector companies to 
help in order to compensate for the problems that the CDC had 
in terms of providing real-time data to the government and to 
providers.
    And I would say the last thing is it is incredibly 
important that we have an open debate about the risks and 
benefits of various interventions when it comes to public 
health. We did a lot in the last 12 to 18 months to suppress 
honest scientific debate about how best to approach this 
problem, and that created more skepticism, that created more 
mistrust, and actually also prevented us from identifying the 
best solutions where they were appropriate.
    Mrs. Spartz. Thank you. If you look at that, I mean, we do 
have a challenge with open debate. This should be, you know, a 
democracy where debate is encouraged, but we don't have that. 
You know, we have a very politicized problem right now.
    So, what are the things you would think could help us to 
have that debate, how we can build the transparency, have 
better data for people and, actually, you know, have people 
trust in us a little bit more, because, to tell you the truth, 
the level of trust on the ground from both sides is very low to 
our government? Any particular tools you can suggest?
    You know, I read through your testimony. You bring a lot of 
very comprehensive risk assessment, looks at what are societal 
risks, what are long-term risks, what are short-term risks. 
What are the other things maybe you can mention additionally to 
have an open debate and have reform of CDC and better maybe 
oversight of CDC by Congress?
    Mr. Roy. Right. Well, absolutely, look, I mean, risk 
assessment is a challenge for human beings in general. So, we 
can't overestimate our ability to solve this problem through 
public policy. Having said that, I think the tech platforms in 
particular have a lot of responsibility for suppressing--they 
have egged on and encouraged by important government officials 
and policymakers. That is a serious problem we need to revisit.
    I testified last year in a hearing about this problem of 
the CDC and information gathering--I am happy to share that 
testimony with the committee--where, again, the CDC, and the 
HHS tried to solve this problem, and they were accused of being 
political. They were accused because they were trying to solve 
a problem the CDC failed to solve. It was the people who were 
trying to fix the problem that were accused of being political, 
and it was the other way around. The CDC was the problem, and 
the administration was trying to be responsible in fixing it.
    So, I think we just need to tone down the partisanship on 
some level and just say, you know what, there are a lot of 
people who are trying in very challenging circumstances to 
solve these problems. And the temptation is always to be 
partisan in Washington, I know, but lowering the temperature 
and trying to find opportunities for good faith engagement with 
the other side, that probably would make a big difference.
    Mrs. Spartz. I appreciate it. I appreciate it. Hopefully, 
we can have this deliberation and debate because, you know, in 
the recent polls, it shows that public trust in Joe Biden's 
administration is significantly going lower and lower, and we 
have less and less trust. And it is very unhealthy for people 
to have such a low trust for our government. So, we will be 
happy to work with you if you can share some information and 
provide it to this administration, to CDC, to have it better 
because we have to combat and deal with it better. So, thank 
you very much.
    And I yield back.
    Chairwoman Bonamici. Thank you, Ranking Member Spartz.
    I now recognize the Chair of the Subcommittee, Mr. 
DeSaulnier, for five minutes for your questions.
    Chairman DeSaulnier. Thank you, Madam Chair.
    And I would love to have that kind of conversation. I think 
we all would. A civil lively conversation and evidence-based.
    So, Mr. Roy, I am going to reach out to you.
    And, Congresswoman Spartz, I would love to have not so much 
a debate but a conversation.
    I believe in evidence-based research. We have shown that in 
judicial reform, criminal justice reform. It would be good if 
we could do it for public health. I am a person who believes 
that there is a lot in human institutions--as you said, Mr. 
Roy, there are some struggles as we as humans.
    And I don't think the private sector has a monopoly on 
transparency, honesty, or integrity either. And I don't need to 
go through a list of the corporations that have let us down. 
And I think there are a lot of good, amazing public employees 
and institutions.
    And, in my district, the district I am so proud to 
represent, having come from local government, I am particularly 
proud of our public health department and the partnership it 
has with other providers. Kaiser was started in the East Bay in 
San Francisco, where they have a very strong partnership with 
them and other private health providers.
    So, Dr. Pernell, one example we had was--and this is a long 
history we have in the East Bay in the Bay area. Richmond, 
California, is one of the poorest communities in a very wealthy 
area. And our public health department decided, based on a long 
history not with pandemics but with public health, to do mobile 
drive-through clinics. We know that people in poverty, people 
of color, whether they are trying to get to work, get a job, 
get their kids to school, they have more obstacles than other 
people. And doing things like this is obvious to me.
    So, Dr. Pernell, to reach communities with limited access 
to reliable transportation, limited access to technologies, 
what strategies do you think can be used--and point to specific 
cases if you can--to increase COVID-19 vaccinations and booster 
shots and trust in the public health system?
    Dr. Pernell. Thank you. Very, very good question. I am 
going to start with, again, we cannot afford to practice 
healthcare or public health from an ahistorical or an 
inauthentic perspective. And it becomes inauthentic when we 
don't recognize the truth, the lived experiences, and the 
narratives of those lives in the public.
    If you just look at our community here in Newark, a social, 
cultural gem, a very diverse community, what has led to 
increased vaccination rates is taking the vaccines to the 
people, whether that is partnerships with churches, 
partnerships with local government, partnership with 
institutions like my own, partnership with community-based 
organizations, leading in an asset-informed approach.
    Too much of healthcare is from a deficit approach. And what 
the deficit approach is what a person or community lacks and a 
provider coming in to plug that gap. When there are assets and 
resources in communities, there are trusted messengers in 
communities. So, we have to find those trusted messengers. We 
have to partner with them and amplify their voices and share 
power with them.
    So, for instance, we use a Prevention Army or a popup 
model. In our popup model, we are partnering with a CBO or we 
are partnering with a church that can bring people to the table 
who need particular services, and oftentimes that is vaccines 
in this climate.
    So, whether it is through our partnership with the State, 
where we have Ambassadors that go out into communities to meet 
people where they are, knocking on doors, to provide vaccines 
through a mobile vaccine unit, or whether it is opening up a 
vaccination clinic in our own parking lot, or the State has 
done that in Trenton. Where communities can see institutions 
share power, communities are able to trust and to say: This 
care interaction will be meaningful, and this care interaction 
is done with me in mind.
    Chairman DeSaulnier. Doctor, can we talk a little bit 
about, just to followup, community action agencies and 
nongovernmental agencies, this partnership. Many years ago, I 
remember doing outreach, again, in the Bay Area to low-income 
communities of color on air quality. And it was striking to me 
that our public agencies sent public information officers into 
those communities who look like me, and they were shocked that 
the community didn't embrace them.
    So, we talked about cultural competency, but more than 
that, going to these nonprofits that are not just culturally 
competent but are from the community to engage.
    Dr. Pernell. Definitely. That is sharing power. That is 
what you are describing, Chairman. And we need to do more of 
that, especially with historically excluded and stigmatized 
groups. Share power by identifying assets or resources already 
in the community, already with a track record, already equipped 
with some currency or value or power that we can then marry our 
power with as an organization or institution, and that is how 
we begin to demonstrate accountability.
    Chairman DeSaulnier. That is wonderful. As a White male, it 
is sort of funny in a way for me personally to go to those 
meetings and subsequent more and see how defensive the 
institutions were and people who weren't from that community 
that didn't have that life experience.
    And then, however you are able to break through that, the 
power when everyone respects one another and understands they 
are coming from a distinctly different place. Thank you so 
much.
    Thank you, Madam Chair, and I yield back.
    Chairwoman Bonamici. Thank you, Mr. Ranking Member.
    And I am going to turn it over to Ranking Member Allen for 
five minutes for your questions.
    I do want to note we have the Chairman of the full 
Committee, Congressman Bobby Scott, with us, as well as the 
Ranking Member, Representative Virginia Foxx. It is my 
understanding that the full Committee Chairman and Ranking 
Member would like to ask questions later. If that is not 
correct, wave or send me a note, and we will get you in sooner.
    I will turn it over to Ranking Member Allen.
    Mr. Allen. Thank you, Chairwoman.
    And, Mr. Roy, you know, I always learn a lot from these 
hearings. And as I reflect back on the confusion through this 
whole process, I remember doing a press conference in February 
in my district with our public health officials. And, 
basically, the risk assessment then was that we probably would 
not be severely affected by this virus; we know it exists, but 
it is really not anything we should be concerned about. And 
then, all of a sudden in March, I go to a briefing and the 
experts say that we could lose as many as 3 million people; it 
would collapse our healthcare system and our economy.
    You know, typically in a crisis, this Nation comes 
together. I have never seen us so divided in this process. And, 
again, I lay most of that right here at the feet of Congress 
and the White House and the Senate, because it is up to us to 
try to bring this Nation together.
    But a lot of it is perception and also the fact that we 
have this disagreement between private medicine and public 
medicine. I mean, when the Trump administration said they were 
going to produce these vaccines, the public medicine people and 
many folks on the other side of the aisle said: That is 
ridiculous; you can't do that.
    So, the Trump administration had to go to the private 
sector to get this done. And everyone says what a miracle it 
was. But then, all of a sudden, there was this confusion about, 
well, you know, if the Trump administration produces a vaccine, 
we are not going to take that vaccine. And these are leaders of 
our country. So, some have embraced the COVID-19 precautions, 
and they have made it a part of their identity. They are now 
reluctant to return to normal life.
    How do we, as a Nation, break through this new culture of 
fear-mongering regarding COVID-19 and return to, you know, the 
greatest economy in the history of the world that we had? And 
we had, you know, the greatest income growth among low-income 
people in the world. How do we get over this?
    Mr. Roy. Well, you know, in my last set of questions with 
Mrs. Spartz, we were talking about the issue of risk, right? 
And look, Americans are going to have different approaches in 
terms of their risk, their fear. We are not going to have a 
homogeneous reaction that way.
    But I think where public health and policymaking leadership 
failed last year is in not making those distinctions between 
the risk of, say, children and the risks of people living in 
long-term care facilities.
    As I detail in my written testimony, there was a huge gap 
between the actual evidence in that regard and Americans' 
perception of their risk. That was driven by a lot of factors. 
Journalism played a role in that as well. But, I mean, I think 
all we can do is just try to be more evidence-based, right? I 
mean, really just try to emphasize to everyone who has an 
ability to influence Americans' attitudes, let's be evidence-
based. Let's make sure that--for example, when we closed 
everything but, quote/unquote, essential businesses. Well, 
there were lots of so-called nonessential businesses that were 
capable of operating safely, as we detailed in a very long 
report we published in April of last year. So, that was an 
example of where we were just not taking the risk into account 
and the evidence into account.
    So, look, people--Americans are going to have a broad range 
of attitudes, but policymakers have a special responsibility to 
be evidence-based, and we didn't pass that test last year.
    Mr. Allen. Well, you obviously were involved in, you know, 
the pre-pandemic levels of economic growth. I mean, we had 
record-low unemployment across the board, including Black, 
Hispanic, and Asian workers.
    What significant policies and economic conditions resulted 
in the historically low rates that existed before the pandemic? 
I mean, what drove that?
    Because there is a lot of discussion about, OK, where do we 
go from here? I like history. I like what works. Tell us what 
your experience was with that.
    Mr. Roy. It is a great question, Mr. Allen, and to bring it 
back up--bring it again to previous testimony I have given to 
this Committee and to Congress, the record unemployment rates 
were amazing in terms of the relative unemployment rates, not 
just low unemployment rates in general, but the disparity 
between White unemployment rates and non-White unemployment 
rates had reached record lows right before the pandemic, and 
then, of course, spiked up.
    And so, the lockdowns were particularly tragic for lower 
and middle-income Americans because if you are a white-collar 
American who can work from your laptop, good for you. But for 
people who have jobs that require them to actually be in that 
physical workplace, that is a different matter.
    Now, look, again, there was a public health role in you 
know, we have to be careful about sporting events, say, or bars 
maybe, but there were plenty of things that we could have done 
safely, and we needed to work harder to try to find those areas 
to reopen the economy.
    Why is that important? Because of what we have talked about 
already--the issue of trust. Right? When you do things to lock 
down businesses and close schools that clearly have no 
relationship to the science, you can't then demand that people 
trust you about vaccines. Right? They are not going to.
    Mr. Allen. Exactly.
    Mr. Roy. And that is why there is so much mistrust right 
now, and that is tragic.
    Mr. Allen. Yes. Thank you, and I yield back.
    Chairwoman Bonamici. Thank you, Ranking Member Allen.
    Next we are going to Representative Courtney. 
Representative Courtney, you are recognized for five minutes 
for your questions.
    Mr. Courtney. Thank you, Madam Chair.
    Thank you to all the witnesses for being here today.
    You know, I come from the State of Connecticut, which this 
morning, in terms of the latest data, we are at 80 percent 
vaccination as a State for population 18 and up. We have the 
lowest infection rate of any State in the country, 14 per 
100,000.
    So, you know, when I listen to some of the witnesses talk 
about how, you know, there was some, you know, structural sort 
of divide that was taking place, I come from a State where the 
Governor, public health experts at Yale, the State public 
health department, and our friends at Pfizer, who were very 
involved in terms of developing the vaccination--we have about 
4,000 employees there that were part of this amazing effort 
that was there. In fact, the public-private collaboration is 
fantastic, and the results speak for themselves--this morning, 
the superintendent of the Coast Guard Academy in New London, 
Connecticut, met with a bunch of us: 99 percent vaccination 
rate on the campus.
    The submarine base in Groton with 10,000 sailors, that is 
there is over 90 percent vaccination. That is why they haven't 
missed one submarine deployment throughout the entire pandemic. 
They followed strict rules, which were difficult, particularly 
in submarines, which you can't--social distancing is 
impossible.
    But the fact of the matter is, is that for some of the 
testimony we are hearing today about how there was, you know, 
this confusion that was inherently driving suspicion and 
hesitancy, I would just say, coming from a State that has the 
lowest infection rate, lowest hospitalization rate in the 
country, in fact, people working together in the private and 
public sector, in fact, succeeded.
    And I would just note for some of the comments that were 
made that, you know, the vaccine was the result of private 
sector investment, I mean, you know, I kind of pinch myself. 
Back in March 2020 when we passed the CARES Act, there was a 
huge allocation in there to develop the vaccine through the 
NIH.
    Moderna, in particular, you know, took advantage of those 
funds and was critical in terms of getting that drug approved 
by FDA and deployed out in the population.
    So, the notion that this was, you know, one way or the 
other, is just, you know, it is just, if you look at the 
chronology, you look at the forensics of how we got to this 
place, in terms of a highly effective vaccine and that by just 
basically shedding all of the noise about, you know, 
disinformation about the vaccine, you can actually succeed.
    And I am very proud of my State in terms of the fact that 
we have brought those infections down, we have brought those 
hospitalizations down.
    However, last week, we did actually have, in the name of 
debate, a hearing at Hartford where some State legislators 
brought in various witnesses.
    And, Dr. Wen, you talked about how it is really important 
for public officials to combat disinformation. One frequent 
talking point that took place in Hartford last week was when 
the conversation came up about full authorization by the FDA 
for the Pfizer vaccine, there were a number of legislators who 
actually made the point that there was, in fact, only 
authorization for the, quote/unquote, German vaccine, which 
presumably was BioNTech, which is where the research that was 
done that developed the vaccine, but not the American Pfizer 
vaccine.
    And, you know, I see some smiles on people's faces, but 
that was repeated at a public event at the State capital a 
number of times. So, Dr. Wen, just for the record, can you 
clarify, is there any difference or any such thing as a German 
Pfizer vaccine versus an American Pfizer vaccine?
    Dr. Wen. No, Congressman, there is not. So, there is a 
Pfizer BioNTech vaccine that is now given full approval by the 
Food and Drug Administration.
    The Moderna vaccine and the Johnson & Johnson vaccine both 
have emergency use authorization. It is expected that they will 
also receive full approval as well.
    And I think it is time for us to speak about the COVID 
vaccines as being no different than any of the other vaccines 
that our children, that we routinely receive, there really is 
not a difference, and we need to talk about COVID-19 as a 
disease like all other vaccine-preventable diseases.
    And I think the statistics that you cite are so compelling 
that it is areas that have high vaccination rates that we are 
also seeing lower rates of infection, hospitalization, and 
death.
    Mr. Courtney. Thank you. I yield back.
    Chairwoman Bonamici. Thank you, Representative Courtney.
    And next I am going to recognize Representative Thompson. 
Representative Thompson, you are recognized for five minutes 
for your questions.
    Mr. Thompson. Madam Chair, thank you so much.
    I really appreciate this hearing. Thank you for all the 
witnesses. Specifically, Mr. Roy, thank you for being here 
today.
    You know, before 2020, the U.S. economy and labor markets 
were strong. Real GDP increased 2.3 percent in 2019 and 2.9 
percent in 2018.
    The 3.5-percent unemployment rate in September 2019 was the 
lowest since 1969. However, due to COVID-19 and resulting 
State-mandated shutdowns, there has been a dramatic, negative 
impact on the economy, workers, and families.
    Now, as we began to believe that this pandemic was in our 
rearview mirror and vaccines began to be developed and 
distributed through Operation Warp Speed, we faced continued 
obstacles in getting our economy back on track.
    Additional mask mandates and lockdowns, as well as 
increased scrutiny on vaccination efficacy, are keeping us from 
returning to the pre-pandemic output and ultimately will create 
lasting impacts on our country.
    To make things worse, the even more--to make things even 
more complicated, on September 9, 2021, President Biden 
released a COVID-19 plan entitled, quote, ``Path Out of the 
Pandemic,'' end quote, which includes the Director for the 
Occupational Safety and Health Administration to issue an 
emergency temporary standard on workplace COVID-19 vaccination.
    This ETS will require all employers with 100 or more 
employees to ensure the workforce is fully vaccinated or 
require any workers who remain unvaccinated to produce a 
negative COVID-19 test result on at least a weekly basis before 
coming to work.
    And the administration estimates that the mandate will 
impact more than 80 million workers in the private sector. I 
don't think they know that private sector very well, and I will 
get back to that.
    Having spent nearly three decades in the healthcare 
industry, I encourage everyone to weigh the benefits to 
receiving a vaccination and consult with their healthcare 
professionals.
    In fact, more than 445,000 people are fully vaccinated in 
the 14 counties that are all or partially in my congressional 
district.
    Now, the universe is not probably 680,000. It is less than 
that when you figure individuals that are children, who are not 
eligible for vaccination.
    So that is a significant number that I am very proud of, 
actually, and every week, every day, we see more and more 
people becoming vaccinated.
    With that said, the pending ETS will likely cause many 
individuals to leave their jobs and create massive uncertainty, 
costs, and liabilities for many employers, particularly small 
businesses.
    I had a conversation yesterday with Secretary Tom Vilsack, 
Secretary of Agriculture. I serve as the Ranking Member on 
Agriculture. And it was interesting. We talked about five 
different issues that were going on. I agreed with all five 
with the Secretary. We are trying to figure out what we can do 
about those issues, and one of them is the disruption of the 
food supply chain to our schools. And that there are many 
schools, starting in large urban centers, that are starting to 
report difficulty getting reliable food in order to prepare the 
school meals, whether it is breakfast, lunch, or, in some 
districts, actually dinner as well.
    And so, as I dug deeper into that and reached out to my 
school districts, I found that even small rural school 
districts are having challenges with certain commodities. And I 
dug deeper and reached out to the industry, the food 
distribution industry, that one of the prevailing issues I am 
hearing is workforce and the fact that these large companies 
with over a hundred employees are losing workforce, 
specifically CDL drivers to be able to transport those food 
products and people working in warehouses.
    So, the President Biden vaccine mandate for large companies 
is causing, it looks like, a significant--I hope it will not be 
a significant impact, but somewhat of an impact on access to 
nutrition for our children in schools and certainly on our 
workforce, as people that are working for large companies, a 
hundred or more, are making a transition to smaller companies.
    So, I apologize I went so long, Mr. Roy. Can you talk, with 
the time we have, about the impacts of COVID-19-related 
restrictions on the American workforce that you see and comment 
on the effects of those restrictions on small businesses versus 
large.
    Mr. Roy. Well, I will be very--try to be brief. So, two 
things that I would highlight from your comments. The first is, 
you all know this, but the public may not appreciate how much 
nutrition flows through the school lunch program. So, when low-
income students don't have in-person schooling, that is a big 
problem from a nutritional standpoint and a healthcare 
standpoint for a lot of those kids.
    On the workforce piece, there is a lot of problems 
logistically and legally with the Federal Government dragooning 
private companies to enforce a vaccine mandate. If the Federal 
Government wants to try to have a vaccine mandate, that is one 
thing, but companies should do it on their own.
    And I think there is a lot of problems with how those 
employers are going to be expected to enforce a mandate. What 
are they going to do, are they supposed to fire people or get 
fined $700,000 per violation? I mean, this is a real problem, 
and there needs to be a proper comment period for that ETS.
    Mr. Thompson. Thank you, and I yield back.
    Chairwoman Bonamici. Thank you, Representative Thompson, 
and thank you, Mr. Roy, for acknowledging the importance of 
those healthy school meals. We talk about that a lot on this 
Committee.
    Next I am going to recognize Representative Adams. You are 
recognized for five minutes for your questions.
    Ms. Adams. Thank you, Madam Chair.
    To also the Ranking Member, thank you as well.
    And I want to, first of all, thank all the witnesses. You 
were all really great in your testimony. Your work in public 
health and in studying our communities as they continue to 
grapple with the pandemic is crucial to pursuing both public 
health-based and community-based solutions. So, thank you for 
what you do.
    This hearing is a much needed one, particularly as we look 
ahead and continue to work on protecting our loved ones.
    Dr. Martinez-Bianchi, I represent North Carolina's 12th 
District, which is in the Charlotte-Mecklenburg area. I 
appreciate the details that you offered today in your testimony 
underscoring the importance of cultural competency in the 
context of vaccines for North Carolina.
    So, in your research and from your observations, have you 
noticed discrepancies between access to information about 
vaccines between men and women, and as a followup, could you 
please speak to potential solutions to more effectively 
disseminate information about vaccines?
    Dr. Martinez-Bianchi. So, we are doing--yes, I have seen 
differences, and I have seen the importance of that aspect of 
community engagement, to listen to the community, to know what 
are their concerns. We have done a lot of work for many 
different groups in my--I am testifying more about the Latino 
health, but for every group, the idea of sitting together and 
listening and understanding what are the questions.
    Initially, women had a lot of questions regarding the 
potential of vaccines affecting fertility. They had questions 
in regards to the potential of vaccines being problematic for a 
pregnancy, for example.
    But we have good data--good data--to support that actually 
vaccinating is healthier on the long term for women who may 
become pregnant because pregnancy becomes a higher risk of a 
poor outcome.
    So, yes, it is important to listen, to go on airwaves but 
also to go directly to speak to people.
    Ms. Adams. Right.
    Dr. Martinez-Bianchi. One of the approaches that we are 
doing is, you know, if we are doing a vaccination event, do it 
together with the school district, with the public school, and 
together with a job fair. You get a job. We are doing this 
together.
    Ms. Adams. OK, OK, thank you very much. Let me move on, 
please. Thank you so much.
    Dr. Wen, you talked about various recommendations related 
to vaccines. Could you explain the steps that employers can 
take to protect vulnerable employees at the workplace and also 
how employees can protect themselves at the workplace?
    Dr. Wen. Thank you very much, Congressman Adams.
    One, so, I think it is important for us to talk about this 
as layers of protection. In the same way that we talk about 
layers of protection in the school room, we also think about 
layers in the workplace.
    So indoor masking, for example, is an important layer of 
protection. Improving ventilation is another layer of 
protection. Very importantly, vaccination is a layer of 
protection as well.
    We note that vaccinated people are five times less likely 
to get infected with COVID compared to somebody who is 
unvaccinated. And so, I would much, if I had to be in a 
conference room with a whole bunch of people, I would feel a 
lot better being in a conference room with people who are all 
vaccinated than compared to if they are unvaccinated.
    Also, at least weekly testing but ideally twice weekly 
testing would also help to filter out those who end up testing 
positive and could be infecting others as well. And so, I think 
it is the combination of these approaches.
    Right now, we are hearing from a lot of people who are from 
a vocal minority, if you will, who really oppose these types of 
measures. Maybe they oppose vaccine requirements or masking or 
something else.
    But I think we also have to remember that there is a much 
larger majority of individuals who really support these 
measures, and I think it is the duty of the Federal Government, 
of Congress, to ensure that workers are being kept safe.
    Ms. Adams. Thank you very much.
    Dr. Pernell, how would equitable access to COVID-19 
boosters protect the hard-fought gains in the COVID-19 
increased vaccine rates that we have seen in communities of 
color? I have about 30 seconds.
    Dr. Pernell. Thank you, Congresswoman. I think I will point 
to specifically, we can't only focus on age, but we must look 
at the intersectionality of age and race. Right? So, we should 
be thinking about how historically excluded groups like Black 
elders and Latino elders, how they have access to care and 
specifically access to boosters. Do they understand that they 
are now eligible for boosters?
    Are we partnering with churches, are we partnering with 
CBOs, are we partnering with civic organizations to make sure 
that information is culturally and socially fluent and that it 
is plain-spoken and they understand the importance of a 
booster, in particular, in that age group.
    Ms. Adams. Great. Thank you very much.
    And, Madam Chair, I am out of time. I am going to yield 
back.
    Chairwoman Bonamici. Thank you, Representative Adams.
    And next I no longer see Mr. Walberg.
    Mr. Banks, you are recognized for five minutes for your 
questions.
    Mr. Banks. Thank you, Madam Chair.
    In their testimonies, both Dr. Martinez-Bianchi and Dr. Wen 
have advocated strongly for equity in vaccination rates among 
Hispanic and African American communities.
    However, State governments have already attempted to 
address disparities in infection and vaccination rates among 
minority communities.
    California has reserved 40 percent of its vaccines for its, 
quote, disadvantaged residents. Both Massachusetts and 
Connecticut have respectively reserved 20 percent and 10 
percent of their vaccine supply for communities that rank high 
on the CDC's social vulnerability index.
    Despite these outreach efforts, minority and disadvantaged 
populations still see lower vaccination rates than other 
communities.
    Mr. Roy, can you explain why government-led, top-down 
approaches are ineffective in reaching these communities?
    Mr. Roy. Well, first of all, I want to say that I think it 
is immoral for the government, on a racial basis, to say 
certain people are going to be eligible for the vaccines and 
others are not. It is arguably a violation of the Civil Rights 
Act of 1964.
    And, when vaccines were scarce, that was a serious problem, 
and I hope there is litigation that comes out of that to 
address that principle.
    Having said that, today vaccines fortunately are not 
scarce, and everybody who wants to get vaccinated can. And we 
have already heard some of the stories, success stories, of 
places where broad-based vaccination is happening.
    As, you know, Mr. Banks, and as I think everyone on this 
Committee knows, there is a lot of mistrust in particular 
minority communities, particularly African Americans, because 
of a lot of checkered history that we have when it comes to 
public health and race.
    And so, there is understandable hesitancy that, you know, 
that all we can do, as I think Dr. Martinez mentioned, is try 
to do more to reach out, meet people where they are, have 
people--trusted figures in the community address things that 
are not--that is not something, you know, the government can do 
as a mandate where that is something--you can't force people to 
overcome their trust. They have to do it on their own.
    So, I think these are hard problems to solve. We can only 
overcome it one step at a time, but I think we got to start by 
just making sure that the vaccine is accessible and affordable 
to everyone.
    Mr. Banks. Thank you for that.
    I know that Representative Allen touched on this a little 
bit already, but I want to dive a little bit deeper on this 
next subject. President Trump's Operation Warp Speed produced 
the COVID-19 vaccine in record time, delivering the first 
vaccines within 8 months of beginning the operation.
    Despite his success, Democrats sowed doubt and confusion 
over its effectiveness. For example, Representative Ilhan Omar, 
who sits on this Committee, said, quote: We can't trust the 
President and take his word and take a vaccine that might cause 
harm to us, end quote.
    Vice President Kamala Harris said during a televised 
debate, quote: If Trump tells us to take a vaccine, I won't 
take it, end quote.
    President Joe Biden was also opposed to this vaccine prior 
to the election, stating, quote: If and when a vaccine comes, 
it is not likely to go through all the tests and the trials 
that are needed to be done. Who is going to be the first one to 
get in line and take it, he asked, end quote.
    Mr. Roy, what effect did these statements have on minority 
communities who overwhelmingly look to Democrat politicians for 
guidance?
    Mr. Roy. This was a tragic series of events, Mr. Banks, and 
the reason why it was tragic is that we could have gotten FDA 
authorization of the vaccine sooner had there not been this 
cloud of, well, if the FDA approves the vaccine sooner, that 
must be because Trump made the FDA do it, not because it was 
scientifically warranted.
    And there are probably tens of thousands of Americans who 
would still be alive today if we had gotten that vaccine 
several weeks earlier than we actually did, for those 
particularly at-risk communities, the nursing home residents 
that we have talked about. So, that was super damaging.
    How it affects vaccine hesitancy today, who knows, but 
clearly there must be some effect.
    Mr. Banks. That is a powerful answer. I appreciate those 
answers.
    And, with that, Madam Chair, I will yield back.
    Chairwoman Bonamici. Next, I am going to recognize the 
Chairman of the full Committee.
    Chairman Scott, you are recognized for five minutes for 
your questions.
    Chairman Scott. Thank you. Thank you, Madam Chair.
    First of all, I also serve on the Budget Committee and 
would like to get one thing on the record. The great economy 
that was in the first 3 years of the Trump administration, I 
think we need to put on the record the fact that not any of 
those 3 years produced as many jobs as any of the last 3 years 
of the Obama administration.
    All of the last 3 years of the administration of Barack 
Obama produced more jobs than all of the jobs created in any of 
the first 3 years of President Trump.
    They talk about a raging economy. I mean, that is just not 
the facts.
    Dr. Pernell, what barriers exist, in the minority 
communities, to people deciding to accept the vaccine?
    Dr. Pernell. Thank you, sir, and I just want to say, first 
and foremost, thank you for representing the area where my 
beloved father was born. My father was born in Newport News. 
So, I wanted to say that and acknowledge him.
    I got to say this and I got to make this clear: Race 
matters because racism exists. We have Black women dying 
disproportionately in maternal mortality. We have Black people 
who die prematurely on average of 200 a day.
    We saw disparities in this pandemic that caused earthquakes 
of devastation in Black and Brown communities.
    That history, that truth, we must start there. This is a 
conversation about equity. We must start there in order to 
build trust.
    When you have conversations with communities and you 
minimize their experiences or you minimize their histories or 
you minimize their truths, they can't trust you.
    Institutions, systems, hospitals, government, we must 
practice accountability and with that accountability must be 
authenticity. So, those barriers are historical. Those barriers 
are contemporary. Those barriers are rooted in access issues 
whether those are informational issues around access, whether 
those are convenience and time-based issues around access.
    We have to show people that we are not ignorant of the 
truth of what they lived through and then design solutions. 
That is what you saw happening in Newark. Now, in Newark, 
currently there are 72 percent of Newark residents age 12 and 
older that have had at least one vaccine dose. There are 60 
percent that are fully vaccinated.
    That didn't happen by magic. That happened because of 
equity-based solutions to get to people who have been 
historically stigmatized and disadvantaged.
    Chairman Scott. Well, thank you. I think Hampton University 
and Norfolk State and Eastern Virginia Medical School are doing 
some of the same things.
    Dr. Wen, what is wrong with local control and personal 
choice on vaccinations, especially in the healthcare area?
    Dr. Wen. I thank you for that question, Chairman Scott. I 
think that there has been this unfortunate narrative that 
vaccines are only a personal choice, just as choosing to eat 
unhealthy foods or smoking may be seen as a personal choice.
    Here is the thing. You can choose to remain unvaccinated. 
The problem though is if you then choose to go out in public, 
you are potentially infecting others with a deadly disease that 
has already caused more than 675,000 lives here in America.
    I have actually equated with my colleague, Sam Wang, a 
neuroscientist at Princeton, with the following analogy, that 
the choice to remain unvaccinated should be seen as being 
equivalent to drunk driving because you have a choice to be 
intoxicated, but once you get behind the wheel of that car and 
have the potential to impact other people, that no longer is 
seen as a personal choice.
    And I think when you consider about the individuals who are 
going into work and are now going into conference rooms or 
other settings with unvaccinated, unmasked individuals, and 
then potentially bring that home to their family to elderly 
relatives, to young children who are too young to be 
vaccinated, that is a serious concern.
    So, I want to say we really need to consider the health of 
our unvaccinated children as well. I very much disagree with 
Mr. Roy in this respect. As the mom of two very young kids, I 
am very concerned that 27 percent of new cases are in children.
    The increase in the number of COVID cases in children is 26 
percent now compared to earlier in June, and we have to do 
everything we can to protect our most vulnerable, including our 
children.
    Chairman Scott. And can you say a word about the 
vaccinations in the healthcare industry?
    Dr. Wen. We require vaccines for healthcare workers.
    Chairman Scott. Madam Chair----
    Dr. Wen. We have to take a flu vaccine every year. We have 
to take hepatitis, measles, mumps, rubella vaccines. The COVID 
vaccine should be required as all others are.
    Chairman Scott. Thank you. Thank you, Madam Chair.
    Chairwoman Bonamici. Thank you, Chairman Scott.
    I now recognize Mr. Walberg for five minutes for your 
questions.
    Mr. Walberg. I thank the Chairman.
    And thanks to the panel for being here. Though I must admit 
I am just absolutely astounded by the unwillingness to deal 
with science and accept science and not make up statistics and 
disregard other statistics. It is just unbelievable.
    And I have been vaccinated, and I have had COVID, so, I am 
not undermining the issue of believing in reality, but my 
gracious. Let me ask the questions. Thank you.
    Mr. Roy, the Biden administration has decided the best way 
to get more people vaccinated is to impose a private sector 
vaccine mandate, enforced through an emergency temporary 
standard issued by Occupational Safety and Health 
Administration.
    However, you note in your testimony that the Biden 
administration should reexamine its efforts to impose a Federal 
vaccine mandate on private businesses. Would you please 
elaborate further on that recommendation?
    What challenges will such an order place on businesses both 
large and small, and what would you say is a better way to 
reach vaccine-hesitant communities rather than through a 
Federal mandate?
    Mr. Roy. Well, we have talked a lot about how to reach 
vaccine-hesitant communities today. You know, in terms of the 
OSHA mandate specifically, there is a lot of problems with it.
    Leaving aside the legal problems, which we addressed 
earlier, let me talk about just the practical and logistical 
and economic problems.
    So, again, if you are an employer and you are now being 
told, ``Well, you must vaccinate everyone or there will be a 
violation,'' exactly how does that work?
    If somebody refused to get vaccinated, it is your fault as 
an employer for not forcing them to? How is that your role as 
an employer? That is a violation of all sorts of other laws.
    What about previously infected people who have recovered 
from COVID? There is a lot of evidence--the Israeli study found 
that, after 6 months, people who have previously been infected 
and recovered from COVID have 13 times less likelihood of 
reinfection or breakthrough infection than people who are 
vaccinated who were never infected previously. So, why don't we 
take that into account, both in our official vaccination 
statistics and in the performance of employers?
    Then there is the cost to these businesses. Right? What if 
you were in a business where labor shortage is a real problem? 
Now you are exacerbating those labor shortages by basically 
driving people out of the workforce. That is a big problem too.
    So, you know, it would be one thing if we were talking 
about the nursing home facilities where they are funded by 
Medicare if we are talking about Federal workers. There, there 
is a clear legal authority for the government. Right?
    When you talk about private employers, it is much dicier, 
and there I think focusing on high-risk occupations for COVID 
and working with those employers to help them vaccinate their 
workers would be a much better approach.
    Mr. Walberg. And believing the statistics.
    Mr. Roy, the media often portray public health as being 
intentioned with reopenings and a return to normal activities 
as we deal with COVID-19. Do you see it that way, and how can 
public health policies and a recovering economy work together 
to improve the lives of all Americans?
    Mr. Roy. Absolutely is the answer. And we wrote a lot about 
this at my think tank, FREOPP, last year. I testified, I think, 
eight times on this topic. You know, we spent a lot of time 
walking people through exactly, from an evidence-based 
standpoint, how you could reopen the economy safely while also 
making sure high-risk activities we were being more cautious, 
more prudent, more evidence-based.
    So that absolutely was possible then. It is certainly 
possible now. States that have reopened have, broadly speaking, 
had a good experience with that. I talk about it in my written 
testimony, how California, which was excessively restricted, 
had basically the same rates of cases and deaths as Texas and 
Florida did.
    It is a little different now because vaccination rates are 
playing a role in all these stats, but, last year, when we 
didn't have a vaccine, restrictions were not correlated at all 
to performance in terms of deaths and cases from COVID.
    And so, we need to--first we need to have some humility. I 
think when policymakers say, ``We are going to do X, we must do 
X, and if you disagree we are going to censor you,'' that is a 
real problem.
    We have to have the humility where we say: You know what? 
We are going to look at evidence. We are going to revise our 
opinions based on the facts, and we are going to tolerate 
different approaches. It is good that we had 50 States trying 
different things so that we could optimize for reopening 
schools and reopening workplaces, and those who did so in a 
data-driven way have been very successful with it.
    Mr. Walberg. And, in schools, what an important area that 
is. And don't have much time to touch on it, but how can we 
relate that risk versus reward having kids in the classroom, 
having parents back to work, and still dealing with this 
pandemic?
    Mr. Roy. Listen, I am a father of young children too, and 
my two children are in school, and I am so glad that they are 
because I can't imagine what the loss of the last 18 months 
would have been had they not had the opportunity to get 
educated at that tender age.
    It is so important to their brain development, to their 
emotional health, to their social development, to their long-
term economic and health outcomes. The evidence is overwhelming 
and not just in the United States but around the world.
    We did a study last year. We looked at every major 
industrialized country and showed that there were no risks of 
additional outbreaks from COVID based on school reopenings or 
school closures. And that still holds true today.
    Mr. Walberg. Thanks. My time expired. I yield back.
    Chairwoman Bonamici. Thank you.
    I now recognize Representative Wild. Representative Wild, 
you are recognized for five minutes for your questions.
    Ms. Wild. Thank you so, so much, and this is directed to 
all of the witnesses. I want to talk about two of our most at-
risk populations: the homeless and people with disabilities.
    In many places, there was unequal access to vaccines, and 
vaccines for individuals in the disability community and our 
homeless population. The focus on center-based distribution has 
made it difficult for folks, at least in my district, who are 
home-bound or homeless to get testing or vaccines.
    We have helped, my office, a number of individuals who 
wanted a vaccine but could not get an appointment. And I know 
that sounds almost incredulous given the widespread 
availability of vaccines, but again, at this point, it is a 
matter of getting them to the people who have trouble getting 
to these centers and that kind of thing.
    So, I am just wondering what lessons have been learned that 
you have seen that we can apply to continue to fight the 
pandemic for our homeless and people with disabilities. And 
anybody that wants to take that.
    Dr. Pernell. Sure. So, if I may----
    Dr. Martinez-Bianchi. Go ahead, Dr. Pernell.
    Dr. Pernell. Thank you. I will start with some of the 
things that we have been doing here at University Hospital even 
pre-pandemic. What we know is important is having those 
navigators in care who are socially and culturally fluent and 
aware of the different disparities that many groups face. And, 
on both experiencing homelessness, we have a program called 
Familiar Faces in our population health where we pair a 
community healthcare chaplain that checks in with persons, 
either going physically, pre-pandemic, to where they are, 
whether they are housed or unhoused, or a person who can walk 
you through the care process.
    And I can't stress this enough: The prevention model is 
that you must bring care out of brick-and-mortar institutions 
and bring care to where people are, on the front lines of their 
lives, whether that life is underneath a bridge or that life is 
in a housing scenario that is more standard.
    And if we have learned anything from this pandemic is that 
we cannot afford to practice care from this oblivious place 
that says that everybody needs care or should receive care in 
the same way.
    The more we can specialize and customize, that is when we 
begin to have equitable approaches, and we will continue to do 
that. If we don't, we will continue to lose lives disparately.
    Ms. Wild. I have been very impressed by communities that 
are doing essentially door-to-door vaccinations and that kind 
of thing.
    And I will let anybody else who wants to respond to that 
previous question do so, but I also wanted to add to my 
question whether that is potentially a way of getting past what 
we are still calling vaccine hesitancy?
    I don't know if that is the right term anymore, but if 
people are directly approached, are they any more likely to be 
willing to get the vaccination? And, again, I will open that up 
to anybody here who wants to answer.
    Dr. Martinez-Bianchi. Well, what we are seeing both in our 
family healthcare offices and going door to door, when our 
community has workers that are going door-to-door canvassing, 
they are always asking, when you have somebody who is convinced 
and ready, this is the moment to get that vaccine.
    And bringing the vaccine to the home of those who are home-
bound or to camp sites if there are homeless communities is key 
to be able to reach those communities.
    And then the other issue is making sure that, as we are 
deploying, that we are planning and looking, where is it, who 
hasn't been involved, who hasn't been vaccinated, where are the 
groups, and having Members of the community, representative of 
those communities, being part of the teams that are doing that 
mobile healthcare type of access. It is key if we have 
representatives of the community guiding the effort.
    Ms. Wild. Thank you.
    Dr. Wen. May I add one more thing? Actually, two more 
things. One is that we have actually seen incredible stories 
from contact tracers, contact tracers who are talking to people 
about quarantining and isolation.
    And they are also finding out about individuals' needs when 
it comes to food and housing, and even people who have concerns 
about domestic violence.
    And I think that just really underscores the importance of 
care navigators more broadly in assisting with public health 
needs.
    The other issue, though, to your direct question, 
Congresswoman Wild, I do think that it is really important to 
reach people where they are in their homes.
    But, in many communities around the country, public health 
officials and public health workers on the ground have actually 
been assaulted or harassed or turned away because of the 
rampant misinformation and disinformation.
    So, I hope that more will be done to protect those 
individuals who are just really trying to do their job and 
deliver care to the most vulnerable.
    Ms. Wild. Thank you. And I think you are absolutely right 
about that.
    And, Dr. Pernell, your comments about making sure that we 
are accompanying it with culturally competent individuals to 
deliver this care I think is really, really important.
    With that, Madam Chair, I yield back. Thank you so much.
    Chairwoman Bonamici. Thank you.
    I now recognize Representative McClain for five minutes for 
your questions.
    Mrs. McClain. Thank you, Madam Chair. You know, as I sit 
here and I listen to everybody today, I think we all--or at 
least I think we all--are on the same page, that we want to do 
what is right for our children and the Americans, and we all 
want to work together.
    We respect COVID, but I think at times we need to fear it a 
little less and have a little bit more faith in the American 
people and the doctors.
    And I believe most people are good and not perfect, but I 
believe we have made tremendous strides and tremendous 
progress.
    And I will lead with this, is one of the lessons my mom 
told me growing up, you catch a lot more bees with honey than 
you do vinegar. So, I mean, I think one of the biggest issues 
that I have seen in government is the American people want some 
truth, some transparency, and a heck of a lot more consistency.
    And, if we can all come together on truth, transparency, 
and consistency, and truly follow the science, I think the 
American people would be a heck of a lot more apt to jump on 
board.
    You know, I look at this, as during the campaign, Vice 
President Harris said over and over again that, you know, don't 
trust the vaccine developed under President Trump.
    And now we have three vaccines under Trump's Operation Warp 
Speed, and the Biden administration has been begging people, 
now forcing people, to get vaccinated, with these very vaccines 
that he railed against for months.
    So, you know, have a little empathy for the Americans who 
you can't say, ``Oh my God, I would never get the vaccine,'' 
and then turn around and mandate it. A little consistency would 
go a long way.
    And, Mr. Roy, I am asking you, how can the American people 
trust the administration's message on vaccines if we continue 
to talk out of both sides of our mouth?
    Mr. Roy. You know what? In my written testimony, Mrs. 
McClain, I brought up the point about, you know, the CDC had 
this panic after the Provincetown outbreak and vaccinated--some 
of whom were vaccinated individuals, and all of a sudden it was 
like vaccines don't work anymore. Right? Oh, gosh, we have got 
to go back to locking down and hiding in your basement and 
wearing a mask outdoors because if you don't wear a mask 
outdoors and you are vaccinated, God forbid you might get 
COVID.
    I mean, it was just insane. Right? And so how could you 
not--how could you be surprised that there is vaccine 
skepticism when you have the CDC saying wear a mask outdoors 
even if you are vaccinated? Right? So, that is a big problem.
    And, you know, it goes back to things that happened last 
year. Dr. Fauci said: Don't wear a mask.
    Then he said: Wear a mask.
    And mandate it, right? The World Health Organization said 
the same.
    And again, look, I can understand the evidence changes; you 
are going to revise your opinion. That is fine, but then have 
some humility as we go through the process, instead of saying, 
``Do what I am saying now, or you are this ignoramus,'' instead 
say: The evidence suggests we should do this. The evidence may 
change over time, but this is our best assessment of the 
evidence today. And our best assessment of the evidence today 
is that, if you are vaccinated and you are outdoors, you are 
almost certainly safe.
    Mrs. McClain. Well, thank you. I do believe in the American 
parent as well. So, I believe actually the parents are probably 
most qualified to parent their children. And this is where I 
think we need to bring them inclusive into these conversations 
because I don't believe any parent would intentionally want to 
do harm to their child. And we need to begin to treat them that 
way.
    But, Dr. Wen, this is for you. I am trying to get our 
Federal Government to finally provide some consistency and 
transparency with information regarding COVID. The 
administration says: Get vaccinated and wear a mask.
    My constituents are receiving mixed messages because they 
interpret the message from the President, with that being the 
vaccines don't work, which I think we can show that the 
vaccines do work. Then why the mixed message on the masks?
    Now, some school districts are mandating vaccines for 
students before they even return to the class.
    My question is this. Who is better suited to make the calls 
for the health of their child--a school superintendent or the 
parent? See, I think we are missing this parents. We need to 
bring the parents closer.
    Dr. Wen. Was that for me, Congresswoman?
    Ms. Wild. Yes.
    Dr. Wen. Apologize. Thank you. I am a parent also. I have 
two little kids, ages 1 and 4. My 4-year-old just started back 
in preschool in person. I am very thankful that my preschool 
requires many layers of mitigation. It requires indoor masking, 
and so I think it is a combination. I think that----
    Mrs. McClain [continuing]. school superintendent to make 
the decision as opposed to you?
    Dr. Wen. I think that we need to recognize what impacts my 
child is not just my decision. It is also the decisions of 
other parents----
    Mrs. McClain [continuing]. if you prefer to defer that and 
make a community decision on what is best for your children, as 
opposed to the parent? I am OK with the answer. I am just 
trying to understand. Because the parents in my district 
believe that they are the best people to make the 
recommendations for their--parents. So, I appreciate that.
    Would a child's doctor know what is best for their child, 
or would the school superintendent know what is better?
    Chairwoman Bonamici. Representative McClain, your time is 
expired. We have let you go over a bit, but I am going to----
    Mrs. McClain. Thank you very much.
    Chairwoman Bonamici [continuing]. move on to--yes, of 
course--move on to Representative Hayes. You are recognized for 
five minutes for your questions.
    Mrs. Hayes. Actually, I think Representative McBath is 
next.
    Chairwoman Bonamici. Oh. I apologize. You are absolutely 
right.
    I recognize Representative McBath for five minutes for your 
questions.
    Mrs. McBath. Thank you so much, Madam Chair.
    And thank you to our guests who have joined us to talk 
about this really very pressing matter.
    And, for the last year and a half now, this pandemic has 
just caused grief for many and financial difficulty for 
millions and, of course, drastic changes to the lives of every 
single American family.
    Even recently hospitals in my home State of Georgia are so 
full of sick COVID patients that they have had to postpone 
elective surgeries, and I think we have seen that around the 
country.
    And, you know, there is still so much work that remains to 
be done, and so, I thank you for taking the time to come to 
Congress and to share your expertise with us this morning.
    I remain convinced that increasing the number of vaccinated 
individuals is absolutely the key to our recovery, both for our 
economy and for our health.
    And, according to the recent data from Kaiser Family 
Foundation, only about 25 percent of unvaccinated adults plan 
to get a COVID-19 vaccine by the end of the year.
    And we have also seen a growing increase in partisan 
polarization around the vaccine and negative feedback loops 
from different information ecosystems.
    Dr. Wen, my question is for you. Emergency physicians, 
nurses, and other healthcare workers have persevered for nearly 
2 years now on the front lines, and, with each departure, our 
Nation's healthcare workforce loses an invaluable resource.
    And I believe that healthcare workers can also be a 
resource in improving our vaccination rate. How can we include 
more emergency physicians and first responders in community 
engagement efforts to share their experiences and to encourage 
COVID-19 vaccinations?
    Dr. Wen. Thank you for that question, Congressman McBath. I 
very much agree with you, that there are so many frontline 
healthcare workers who are burnt out, who have been going 
through this and really see no end in sight.
    And there are so many healthcare systems that continue to 
be overwhelmed, and so, I think there is a level of compassion 
fatigue that also exists.
    However, of course, it is our duty to always take care of 
our patients no matter what choices they may or may not have 
made. I know that all my colleagues are united in continuing 
our education and outreach efforts because that is not a choice 
for us. When we see patients coming in, it is our choice--or it 
is our job, our responsibility, to assist them in every way.
    I think that part of it is also all of us embracing our 
responsibility too because we are the most trusted messenger to 
someone. Doctors, nurses, pharmacists certainly are trusted 
messengers to their patients and to others. But we are also 
trusted messengers to somebody in our lives as well.
    And there are individuals, many of whom may have changed 
their minds on the vaccines who I think we need to uplift their 
voices more. So many patients anecdotally that I have spoken to 
who said they changed their minds, it is because of an illness 
in a relative, or it is somebody that they knew who initially 
were not going to get vaccinated but now got vaccinated. 
Telling those stories of change also helps a lot too.
    Mrs. McBath. Thank you. And also, too as policymakers, is 
there anything that you believe that we need to be doing more 
of to help create that kind of climate and environment across 
the Nation? Because, you know, we are doing as much as we 
possibly can to create the funding and the policy and put forth 
that effort, but is there anything that you believe that we 
have left out that we need to continue to do to make sure that 
everyone is cared for and everyone is healthy?
    Dr. Wen. Well, I do think that we need to continue talking 
about the layers of mitigation. There was brought up earlier 
about, well, why is it that vaccinated people might still be 
wearing masks in some circumstances?
    Well, it is because when we have this high level of 
transmission, we need multiple layers. And so, understanding 
that vaccines are a layer, testing is a layer, masking may be a 
layer. When the rate of transmission goes down, we can remove 
some of these layers. I think having that holistic approach is 
really important.
    Mrs. McBath. Thank you. And one more question I will ask. 
If we are not to overcome being able to get that message 
through to individuals across the country, for whatever their 
reasons are, are not wanting to get vaccinated, what do you 
foresee for this Nation going forward from a healthcare 
perspective with COVID-19?
    Dr. Wen. We have already seen it. I mean, 1 in 500 
Americans have already died from COVID. Right now, we have 
2,000 Americans dying every day. That means that within a year, 
if we sustain this pace, which I don't think we will, but if we 
sustain this pace, that is 700,000 Americans dying.
    I mean, I don't think any of us should find these numbers 
to be acceptable. We are seeing the Delta surge that was 
actually preventable because we didn't have high levels of 
vaccinations.
    If you asked me last year, if you gave these numbers last 
year to me and said, ``Well, what do you think about this,'' I 
would have said: Oh, that means that we never got a vaccine. 
But we have a safe and effective vaccine. This is really tragic 
that we still are seeing this level of preventable suffering.
    Mrs. McBath. Well, thank you so much, and I am out of time.
    Chairwoman Bonamici. Thank you, Representative. I now 
recognize the Ranking Member of the full Committee. Ranking 
Member Foxx, you are recognized for five minutes.
    Ms. Foxx. Thank you, Madam Chair. I appreciate that. I want 
to thank all of our witnesses for being here today, especially 
Mr. Roy.
    Mr. Roy, you are, of course, asking for a lot when you ask 
for humility from elected officials. Most of the time you get 
hubris, which is what we are getting in terms of the mandates 
on so many things that are occurring in our culture these days.
    Mr. Roy, I am concerned that our colleagues who claim to be 
advocates for vulnerable communities, have fought Republicans? 
efforts to ensure that all students have access to in-person 
learning, even though school closures have had a 
disproportionate impact on lower income communities and 
communities of color, the very people they pretend to care 
about. Can you speak to the effects of school closures on 
vulnerable communities?
    Mr. Roy. Well, I discussed this a lot in my written 
testimony and I think in my oral testimony as well. 
Disproportionately, it is minority parents, minority children, 
who have been affected by school closures. A lot of that is 
geographic, but it has been a huge problem.
    And that disparity, you know, it is interesting. Asian 
Americans are actually the group that has had the most 
disproportionately impacted by school closures. Next highest is 
African Americans, then Hispanics. Whites, two-thirds of White 
children are able to have in-person learning.
    So there has been a massive racial disparity in the 
ability--the opportunity the children have had to have in-
person learning.
    And we all know that the virtual model at the elementary 
level, at the preschool level, the middle school level, is just 
not working, right, that hasn't worked. And so, you know, you 
have kids who are being promoted to the next grade having never 
actually attended school in the prior grade. How do you think 
they are going to do in the new grade having not learned what 
happened in the last grade?
    These are kids we have effectively abandoned through the 
educational system. It is an incredible tragedy, and the untold 
losses, economically and on a human level, for those kids, I 
shudder to contemplate what the total damage is going to be. I 
am just grateful that more and more schools are opening now.
    Ms. Foxx. Thank you. I was going to ask you a question 
about the mandates on employers, but you have done a very, very 
good job of acknowledging OSHA mandates and the challenge 
employers will face, and I don't think we can understate that.
    Mr. Roy, there is currently also an enormous shortage of 
COVID-19 rapid tests in the U.S. What will be the impact of 
this shortage on the business owners and workers when the OSHA 
vaccine and testing national mandate is implemented in the 
coming weeks?
    Mr. Roy. That is an important question, Ms. Foxx. I 
appreciate you raising it, because we have heard a lot today, 
and elsewhere, about, well, everyone should just have rapid 
tests all the time and then everything would be fine.
    Well, we can't just snap our fingers and get the supply 
chain to expand by the multiples it would need to expand to 
deliver that quantity of tests, let alone for the OSHA mandates 
that are forthcoming.
    So that is a real problem, and we are already seeing it. We 
are already seeing it. It used to be, just a couple of weeks 
ago, prior to the Biden executive order, if you wanted to order 
a Binax test (BinaxNOW COVID-19 test) on Amazon.com, you could 
do it. I have done it. I have a stack of them at home so for--
when I need them and when our family needs them.
    But you can't do that anymore. They are out because of the 
fact that this OSHA mandate has now led to the complete 
elimination of that extra supply. So, if you are going to 
mandate that everyone get tested when we don't have the supply 
of tests to address that mandate, that is just asking for a 
catastrophe.
    Ms. Foxx. That is just one more irresponsible decision and 
mandate that this administration has made in a long line of 
irresponsible decisions.
    We can remember, I think, Mr. Roy, the slogan ``2 weeks to 
slow the spread'' in a rather ironic sense given the prevalence 
of mask mandates and restrictions that continue in the U.S.
    In the early days of the pandemic, the goal was to keep 
hospitals from being overwhelmed. Today community life 
continues to be impacted, if even one case is discovered.
    At the start of the pandemic, Dr. Fauci said Americans 
needed 60 to 70 percent vaccination rate to reach herd immunity 
and return to normal. Yesterday, President Biden said our 
country needs to reach a 97 to 98 vaccination rate to return to 
normal. What do you think--why do you think the goalposts keep 
changing?
    Mr. Roy. Well, we don't know what level of immunity, what 
percentage of immunity is required to achieve herd immunity 
with COVID. I think a lot of theories have proven to be 
inaccurate over time.
    Having said that, it is extremely important that we not 
just look at vaccinated individuals but, as I have alluded to 
earlier, individuals who have successfully recovered from a 
prior COVID infection. That turns out to be significantly more 
protective than the vaccines. And that is not to encourage 
people to go out and get COVID, of course, but it does mean 
that people who have previous episodes of COVID infection, the 
SARS-CoV-2 infection, should be counted toward that immunity 
status. So, let's say we have 70 percent who have been fully 
vaccinated, another 27 percent who have been previously 
infected, that would be 97 percent, right? So, include the 
previously infected in your totals, and then we can assess the 
situation.
    Ms. Foxx. A little more--it is more hubris and less 
humility. Thank you.
    I yield back, Madam Chair.
    Chairwoman Bonamici. Thank you, Dr. Foxx.
    Now I recognize Representative Hayes for five minutes for 
your questions.
    Mrs. Hayes. Thank you, Madam Chair.
    And thank you to our witnesses for being here today.
    A couple points I want to make before I begin my 
questioning is, first of all, I don't think that the CDC has 
been disingenuous or dishonest as the information has changed 
throughout this pandemic. I don't think that the goalpost is 
moving.
    No one can endure this pandemic for 18 months and your 
position today be the same as it was a year and a half ago. As 
we learn new information, we evolve and we adapt and we respond 
to the information that we have right in front of us.
    I have heard several Members quote President Biden or Dr. 
Fauci at different points, but let us not forget that the 
leader on vaccine skepticism was President Trump who, himself, 
said just a month ago: I encourage everyone to get vaccinated.
    So, as people are learning new information, they are 
evolving with the information that they have in front of them. 
So, I just want to make that point. No one is attempting to 
mislead the American people or be dishonest. As we get new 
information, we are adjusting to the situation that we are in.
    The second point I want to bring up is that, as a parent of 
a public school student and having been a teacher for 15 years, 
parents make the decision for their individual child. 
Superintendents have to make a decision for an entire school 
district.
    My superintendent had to make a decision for 19,000 
children. She did that in conjunction with public health 
officials, with local officials, with our local hospitals, and 
did what she needed to do and continues to do what she needs to 
do for all of those children.
    Individual parents, their responsibility begins and ends at 
their child. When you are a school superintendent, you have a 
different level of responsibility, so that is why some of those 
decisions are being made.
    And I heard Mr. Roy talk about the disparities in different 
communities. You are absolutely right; my district has some of 
the largest equity gaps, and some of our schools were equipped 
to be up and running, open full scale. They had the spacing. 
They had the HVAC systems. They had modern facilities.
    Those are things that we have tried to address and that we 
need to address. So, all communities are not created equally. 
So, that leads me to my questions today.
    In Connecticut, there are about 390,000 cases of COVID-19. 
8,400 Connecticut residents have been lost to this virus, and 
to date, we had about 22,000 people in ICU hospital beds.
    And my State is doing well. We have 75 percent of people 
vaccinated and a Governor who is incredibly proactive and 
always looking for solutions.
    But there are several socioeconomic and geographic factors 
that limit people's ability to be vaccinated. We have tried to 
include transportation, some of those other things, tried to 
mitigate some of the problems.
    Dr. Wen, can you explain how community engagement and 
wraparound supports creates barriers and affects people's 
access to the vaccine, what that looks like, and how we, as 
Federal legislators, can facilitate greater community 
involvement so that more people can get vaccinated?
    Dr. Wen. Representative Hayes, thank you for your work and 
for pointing out also that a strong public health response 
means that you are evolving to change your policies, based on 
new data. That is not flip-flopping if you have new data; that 
is actually responding to the moment.
    I do think that having Congress help to combat 
misinformation is very important. Also, supporting local 
efforts that Dr. Martinez-Bianchi, that Dr. Pernell and others 
have mentioned, there are so many examples of local 
partnerships. We need to trust the communities. I think that is 
something we should all be able to agree on, that people on the 
front lines, people in the communities that they are serving 
know best about what works there.
    And, when we see efforts that are successful in bringing 
vaccines to individuals experiencing homelessness or helping 
low-income families, we should be scaling up those efforts. And 
allowing maximal flexibility and funding for local communities 
is really essential.
    Mrs. Hayes. Thank you. And, really quickly, Dr. Pernell, in 
high-risk priority groups, we just saw that President Biden had 
guidance on booster shots. Can you tell us how those vulnerable 
populations will be impacted and how this booster shot guidance 
will affect them?
    Dr. Pernell. Great question, Congresswoman. I don't think 
we can emphasize enough that the disproportionate burdens that 
Black and Brown groups bear deserves, in particular, attention. 
And what I mean, I think we focus a lot on age, and we need to 
focus more on race.
    We need to stratify data by race because what we see in 
Black and Brown communities is, actually, they are impacted at 
younger ages and younger rates. So, I would be very interested 
to see how boosters are distributed among those populations 
that have been disproportionately burdened by disease, 
disproportionately burdened by disability due to this 
infection.
    I think it is going to be very, very important that we 
continue to do the things that we know work. What works? What 
works is partnering and sharing power with community, 
explaining and making sure community understands the utility of 
boosters in those high-risk groups, those who have 
comorbidities, comorbid diseases, same communities, saddled 
with the diabetes, saddled with the high blood pressure.
    Mrs. Hayes. Dr. Pernell, I am really sorry. My time has 
expired, and I don't want the Chair to be mad at me.
    Chairwoman Bonamici. Not a chance, Representative Hayes.
    Mrs. Hayes. You can submit the rest of that answer. I am 
very interested in it. Thank you so much.
    Chairwoman Bonamici. I now recognize Representative 
Harshbarger for five minutes for your questions.
    Mrs. Harshbarger. Thank you, Chairwoman and Ranking Member.
    And thank you to the witnesses here today. You know, I 
think I understand a lot of the confusion.
    And, Mr. Roy, you tell me if I am wrong in anything I say, 
because, you know, it is really regrettable, but you correctly 
stated in your testimony that all this started back in the 2020 
election when you had then-President-elect Biden and Vice 
President Harris talking about how they didn't trust how the 
vaccines were developed. That is the first step; you don't 
trust in how these are developed through Operation Warp Speed.
    And then you have the COVID guidance flip-flops on do you 
wear a mask, do you not; do you wear two masks, do you not. You 
have how did the CDC set policies with-- what the studies said. 
If you want to follow the science, let's look at those studies. 
You have got the reported influence of the teachers unions on 
the CDC guidances. And that just happened when they said you 
don't have to have a mask mandate in schools, and now you do.
    We still don't know the origins of COVID, do we? As Members 
of Congress, we don't have the hearings to hear that. And then 
you have the latest with the flip-flop from the FDA and the CDC 
on the boosters. And they say do it, and now there is different 
guidance.
    But, you know, what tops it all off is the vaccine mandate. 
And you are telling private employers that if you have a 
hundred employees or more, you have to have them vaccinated or 
they don't have a job. And then you have your healthcare 
workers in your hospital systems. Your healthcare workers have 
to be vaccinated.
    I understand it. I am a pharmacist, for God's sake. I took 
the vaccine. I tell people we didn't cut corners; we cut red 
tape. Do the vaccine. But, when you force them to do that, but 
you have over 200,000 people coming across the southern border 
illegally every month, and they are not--and I am on Homeland 
too so I know this is fact. They are not COVID tested, and they 
are not mandated to have that vaccine. And you wonder why 
Americans are hesitant? Well, I will tell you, there is your 
sign.
    Does this sound like a mitigation strategy to you that is 
based on science? And, also, there is being monoclonal 
antibodies that are going to be withheld from certain states, 
and we don't know why. There is no shortage in the supply from 
the manufacturers, but they negated not to ask that question to 
the manufacturers, and now there are several states that we 
don't have the supply that we need. And you tell me that is not 
political? There is a problem there. So, if you would expound 
on that. And I am in a rural district, and you don't think this 
is going to influence the healthcare workers and the employees 
that were already in short supply? Our patients are not going 
to be taken care of.
    And I would like to ask unanimous consent to place into the 
hearing record a September 13, 2021, Washington Post op-ed 
entitled ``In my community, Biden's vaccine mandates could put 
more lives at risk.''
    But, if you could answer that, sir, about mitigation 
strategy and things like that. I could go into a whole lot more 
as far as natural immunity and things that they should be 
doing, but you tell me what is wrong with anything I just said 
or what we need to correct.
    Mr. Roy. Well, Mrs. Harshbarger, you raise a lot of points. 
Let me try in the time we have to focus on one or two. I think 
that, you know, many of you in Congress are former or current 
business owners. And what business owner, what employer wants 
their workers to die of COVID or to become seriously ill of 
COVID? Zero, zero.
    So, this idea that somehow employers are the obstacle in 
getting their workers vaccinated is absolutely not the case. 
Every employer wants their workers to show up to work healthy 
and happy. That is in the absolute economic and human interests 
of every employer. So, why don't we actually engage employers 
and learn from employers about the strategies they have 
succeeded with or failed with at getting their workers 
vaccinated. That seems to me a much better approach than what 
we are describing here for all the reasons that we described. I 
think that is such an important--we all want everyone to be 
protected from COVID-19.
    And the other piece I would bring up is something I alluded 
to in my last remarks, which is people who have recovered from 
COVID, right? This is an important thing to track and to 
monitor. People who have recovered from COVID have a very 
compelling form of immunity, generally speaking. Obviously, 
people who are immunocompromised or people who are elderly 
whose immune systems may not be as robust, there are always 
asterisks and things to take into account. But, broadly 
speaking, recovering from COVID is a form of immunity, more 
powerful in many cases than mRNA or other vaccines. So, we 
should be taking that into account in our strategy and in our 
policies.
    Mrs. Harshbarger. Absolutely. Antibody testing should be 
one of the things available to the American public, and natural 
immunity, but we are not discussing that.
    So, I know I am out of time, and I yield back.
    Chairwoman Bonamici. Thank you, Representative.
    I now recognize Representative Levin for five minutes for 
your questions.
    Mr. Levin. Thanks so much, Madam Chairwoman.
    I will jump right in with first a few questions for Dr. 
Martinez-Bianchi.
    You know, for many vulnerable communities, language 
barriers have kept COVID-19 testing and vaccination services 
out of reach. Without access to translators, what challenges 
have first responders and contact tracers faced while working 
to prevent COVID-19 outbreaks in communities with limited 
English proficiency?
    Dr. Martinez-Bianchi. So, COVID definitely highlighted the 
language barriers. And some of the challenges have been that, 
during the COVID pandemic, you are not able to really have your 
interpreter on the site at the same time.
    So often what first responders and physicians have done has 
to be using tablets or other ways of translation. This has 
really impacted the community, the Latino community, the trust, 
not having somebody--one of the deficits we have in the country 
is that how many children that are Brown and Black have been 
historically excluded from health professionals as well.
    So, we need to continue to work on getting more kids, more 
adults who are Members of these minoritized communities to be 
able to be part of the health workforce, but the challenges are 
there.
    Mr. Levin. Yes, it has really exposed problems that were 
already there, hasn't it, in terms of access to healthcare? But 
what can States do? How can they improve access to dialect-
specific language translation services and prevent disruptions, 
particularly to make sure people get their two-dose vaccination 
series and other things?
    Dr. Martinez-Bianchi. One of the most brilliant things I 
have seen has been the contract and use of community health 
workers, contracted from the community, representatives of the 
community, often even
    [inaudible] language speakers of the language spoken in the 
community.
    Mr. Levin. Yes.
    Dr. Martinez-Bianchi. And their representation of the 
community has earned a tremendous amount of trust. When we do a 
vaccination event and our community health workers 
representative of those communities are part of the canvassing 
and the encouragement and recruitment, we have much more 
success with vaccination, with access to care, and access to 
testing and the use of monoclonal antibodies as well.
    Mr. Levin. Wow. I have to say that was part of the proposal 
in Senator Warren's and my Coronavirus Containment Corps Act at 
the beginning of the pandemic, so I wish we had gotten that 
through.
    Let me ask Dr. Pernell questions about this, the thing we 
have been talking about to some extent, vaccine hesitancy.
    How have broad generalizations about vaccine hesitancy 
prompted widespread disengagement, really, from certain 
communities, and how can stakeholders involved in COVID-19 
response efforts overcome communication hurdles and address 
vaccine-related concerns directly, to ensure people receive 
COVID-19 vaccines?
    And as you get ready to respond, let me just say to my 
colleagues, I would say some of the most meaningful moments in 
my life in the last months has been when I talk to someone who 
really believes in me or I have a real relationship with and 
get them to get vaccinated, often right where we are, you know, 
because there is a clinic related to an event.
    So, Dr. Pernell, help us out here.
    Dr. Pernell. Definitely. I have had this conversation, as 
you can imagine, so frequently. And I can tell you most people, 
Black people, Brown people are no different. Most people want 
to be seen, heard, and validated, and we want to be understood 
for the fullness of our stories.
    And, with that being said, there actually has been movement 
in Black and Brown communities around vaccination, whether we 
are talking about the mobile vaccination units that we have 
used here in the State, across 76 days, almost 3,000 shots. 
Fifty percent of those shots have gone to Latinos or Hispanic 
persons. Another 30-plus percent have gone to Black or African 
Americans. And that is because we have helped them along their 
decision journey. Black people, Brown people at baseline were 
not just hesitant. At baseline, we have history. At baseline, 
we have questions. At baseline, we want to feel heard.
    And so, when we can navigate those conversations with that 
level of authenticity, with that level of transparency, we see 
movement. We see groups move. If you look at the Kaiser Family 
Foundation and you look at the groups who were originally in 
that wait-and-see category, a lot of Black and Brown persons 
were in that wait-and-see category, and we have seen 
conversion. We have seen conversion of that wait and see to 
already having been vaccinated.
    And the last thing that I would say, there is data that is 
becoming available that there has been significant improvement 
in the African American community, and perhaps as high as 70 
percent of those in the African American community being 
vaccinated. And we are not telling that story enough. And the 
more we tell that story, it gives a sense of permission for 
others to say: Hey, I have fears and concerns, but I got them 
addressed, and I went ahead and I got vaccinated.
    Mr. Levin. Thank you. Outstanding.
    Thanks, Madam Chairwoman. My time has expired. I yield 
back.
    Chairwoman Bonamici. Thank you.
    And next I want to recognize Representative Fitzgerald. You 
are recognized for five minutes for your questions.
    Mr. Fitzgerald. Thank you very much. Thank you very much.
    Mr. Roy, in your testimony, you stated nearly 40 percent of 
the deaths from COVID-19 that occurred in 2020 were in long-
term care facilities. I was in Wisconsin State Legislature for 
the first part of the pandemic, and later on, between our 
Secretary of Health, Andrea Palm, who is now in D.C., 
obviously, and also with Governor Evers, they reclassified a 
lot of those deaths kind of in one large change that was made 
kind of across the board. And, you know, I have heard of 
similar types of adjustments being made.
    So, my question to you is, you know, the misclassifying 
long-term care facilities, what they experienced, is this 
something that, you know, should continue to be investigated? 
And I don't even mean like in a legal way. I mean investigated 
so, in the future, any of these types of major health crises in 
which, you know, any governmental entity is suddenly required 
to record this data does a much better job.
    Mr. Roy. Both excellent questions, Mr. Fitzgerald.
    So, on the first point, yes, there absolutely has been 
problems with misclassification. New York is one of the 
infamous examples where they basically said: If you got COVID 
in a nursing home but you died in a hospital, we are going to 
count you as a hospital death, not a nursing home death. That 
was one of the ways in which New York engineered and 
undercounted its nursing home deaths, which was done apparently 
because the Governor had mandated that people discharged from 
hospitals with active COVID infections must be put into nursing 
homes. Nursing homes were required to accept those individuals, 
which they objected to strenuously at the time.
    This was something we tracked at my think tank, at The 
Foundation for Research on Equal Opportunity, because no one 
else was measuring this in the spring of 2020. So, we actually 
scraped the data from every State to develop maps of, OK, where 
were these deaths happening? How, what share of the COVID 
deaths in each State were happening in nursing homes? And what 
was amazing is 11 States weren't even collecting the data, even 
though 40 percent, in some cases a majority of the deaths, were 
happening in long-term care facilities.
    So, absolutely, we should look back. But, in terms of 
looking forward, I think it is really important that we examine 
thoroughly how nursing homes protect their residents against 
infectious disease. This was a problem before COVID. COVID 
certainly brought to the surface, brought to the fore how bad 
this problem is, but this problem will continue in the future 
with other infectious diseases if we don't make some lemonade 
out of a lemon, so to speak, and just try to learn from what 
has happened here and try to improve the protocols that are in 
place in nursing homes and other long-term care facilities.
    Again, it can't be emphasized enough. Forty percent of the 
deaths in facilities that house 0.6 percent of Americans.
    Mr. Fitzgerald. Yes. Just in a quick followup to that too, 
I mean, one of the other things we experienced in Wisconsin was 
that, because there are many different levels of long-term 
care, obviously, all the way from a nursing home, a full-blown 
nursing home to some type of assisted living, the populations 
that kind of come and go in that environment, they vary.
    You know, you could have much younger individuals who could 
be carrying in one environment, and there is really no cross-
check there. And I don't know if that is something else you 
saw, based on the type of environment and what their 
experiences were.
    Mr. Roy. Yes, absolutely. You know, more of the deaths 
proportionally occurred among more medically vulnerable and 
disabled elderly population, so nursing homes. Most seriously 
assisted living facilities would be next and so on.
    So, you know, you have to look at it that way and tier 
accordingly. But, again, medically vulnerable populations, 
medically vulnerable elderly populations was where there was 
enormous risk. And, if we had spent all this energy locking 
down the economy and closing schools on protecting medically 
vulnerable seniors, we could have done a lot better.
    Mr. Fitzgerald. Thank you very much.
    And I yield back. Thank you.
    Chairwoman Bonamici. Thank you, Representative.
    I now recognize Representative Stevens for five minutes for 
your questions.
    Ms. Stevens. Great. Thank you.
    Madam Chair, can you hear me OK? Excellent. Thank you.
    Chairwoman Bonamici. We can hear you.
    Ms. Stevens. Phenomenal. It is great to be with you, and 
thank you for Chairing this just very important and timely 
hearing.
    And thank you to our witnesses as well, not only for your 
testimony but for your answers today to the questions.
    Specifically, as we are talking about how to build for safe 
communities and how to target populations who remain 
unvaccinated, I am really focused on females and, in 
particular, pregnant women who continue to have just some of 
the lowest vaccination rates in the country, most recently 
reported somewhere between 25 percent to 30 percent being fully 
vaccinated.
    And a CDC analysis of data from the V-SAFE Pregnancy 
Registry assessed vaccination early in pregnancy and did not 
find an increased risk of miscarriage among nearly 2,500 
pregnant women who received an mRNA COVID-19 vaccine before 20 
weeks of pregnancy. The CDC announced this in August. And we 
continue I know in Michigan to try and communicate and reach 
out to young women and, most importantly, to save lives.
    And, Dr. Wen, I know that you have been so very much on the 
front line of communication, particularly around combating 
vaccine misinformation and also reaching out to populations who 
we want to encourage them to get the vaccine.
    And I was wondering if you could shed some light around 
some of the effective strategies that public health educators 
have used or could use to debunk COVID-19 misinformation or 
even hesitancy, which is something that we have seen so 
pervasive among young women, unfortunately.
    Dr. Wen. Representative Stevens, thank you for that 
excellent question. You are absolutely right. The rates of 
vaccination among pregnant women is extremely low, which is 
very concerning, considering that pregnancy increases the 
vulnerability to severe outcomes from COVID-19.
    I think it does help to say that the American College of 
Obstetricians and Gynecologists, the Society for Maternal and 
Fetal Medicine, basically all these OB/GYNs across the country 
have said that these vaccines are safe and effective in 
pregnancy.
    Another strategy is to emphasize too that the protection 
also conveys to the baby, that there are antibodies that are 
present that are then transferred through the placenta that 
then also are transferred through breast milk. Then we don't 
know how long that protection lasts, but that also is something 
that for new moms that may increase their likelihood of getting 
the vaccine as well.
    Ultimately, this is meeting people where they are, 
understanding what their specific concerns are about the 
vaccine, and also addressing the issue not only for expectant 
moms but women who are looking to become pregnant.
    One thing that I have also seen to be effective as a 
strategy is to say, look, we want you to be as healthy as 
possible in every way. We want to optimize--if you have blood 
pressure issues or diabetes, we want you to be healthy in that 
way. And one thing that we can do that will help to protect you 
now as you are looking to start a family is to also get the 
COVID-19 vaccine. Debunking any of these misinformation of 
infertility are important too.
    Ms. Stevens. Dr. Pernell, I know that your work is probably 
intersected with this as well, particularly as we have, you 
know, another challenge, which is maternal mortality challenges 
in this country, and, particularly, as Congresswoman Lauren 
Underwood, who used to be with us on Education and Labor, is 
now on Appropriations, has formed the Black Maternal Mortality 
Caucus that many of us on this Committee are a part of.
    And I am just wondering if you have seen any research that 
shows how some of these challenges intersect with one another 
and how we can try and tackle both together.
    Dr. Pernell. Right. I would say that we have to tackle both 
together because what we should have learned through the 
experience of this pandemic is that equity always has to be a 
comprehensive approach.
    Black mothers are dying. Black persons who are pregnant are 
dying at disproportionate rates. Maternal mortality in this 
country as a whole is abysmal when you compare it to other 
developed nations. If we look at these in silos, we do a 
disservice to actually achieving health and well-being.
    The best thing we can do is to communicate to people in 
socially and culturally fluent terms. I do this day in and I do 
this day out, whether it is a phone, it is a text, partnering 
with another group on a virtual. We have to have conversations 
where people are and then help navigate them along that 
journey.
    People want to hear from people who look like them. People 
want to hear from people who understand their stories. We know 
that is true. We can see with Black babies who fared better 
when cared for by Black physicians. So, people want to know 
that their lives count and that their lives matter, and this 
pandemic is an opportunity for us in healthcare to perfect that 
because we have been failing at that miserably. That is why we 
got in the situation of mistrust, because of abuses and because 
of lack of meaningful engagement.
    So, the more we can amplify the stories of those who have 
been vaccinated and who are pregnant, the more we can amplify 
the stories of those who have, unfortunately, had devastating 
outcomes because of COVID during pregnancy, the more I think we 
can help communities navigate these difficult challenges.
    Ms. Stevens. Phenomenal. We are so glad we captured that 
for the record.
    Thank you, Madam Chair, and I will yield back.
    Chairwoman Bonamici. Thank you so much.
    I now recognize Representative Leger Fernandez for five 
minutes for your questions.
    Ms. Leger Fernandez. Thank you so much, Chair Bonamici and 
Chair DeSaulnier.
    Thank you to our witnesses for your work protecting and 
advocating for the communities, exactly what we heard Dr. 
Pernell talk about in terms of they need to understand that we 
care about them and that we will work for them.
    You know, I have heard today talk about the politicization 
of vaccinations and partisanship. I want to be really honest 
about where that politicization is coming from. Vaccines work 
across the country where they are being promoted. Where they 
are not working is where politicians, including my colleagues 
on the other side of the aisle, are arguing against the 
vaccine.
    In New Mexico, we lost two individuals who, taking their 
cue, sadly, from several of my Republican colleagues, took 
ivermectin, a horse dewormer. They took a horse dewormer, which 
certain of our Republican colleagues described as effective, 
instead of the vaccine.
    This misinformation is killing Americans. I want every 
Member of my community to live, whether they are in a red 
county or a blue city, you know, in our villages. I want them 
to live and be healthy. I ask my colleagues on the other side 
of the aisle to stop sacrificing people's health and lives for 
political points. Our duty has to be about protection and care.
    OK. So, pushing against disinformation, I am proud that New 
Mexico has been a leader in vaccinations. More than 70 percent 
of New Mexicans age 18 and older.
    You know, our Native communities in New Mexico and across 
the country were devastated because, as we just heard, there 
were issues that were underlying before COVID hit. I am really 
pleased that, in our Native, Latino, and rural communities, we 
are seeing an uptick to 70 percent, 73 percent we heard today, 
73 percent responders have now received the vaccine. It surged.
    Dr. Martinez-Bianchi, could you give us a description about 
what makes a program to vaccinate a Latino or other underserved 
community successful?
    Dr. Martinez-Bianchi. Thank you, Congresswoman, for your--I 
think I need you to repeat the actual question.
    Ms. Leger Fernandez. So, you know, we have seen this 
uptick, this surge with vaccinating Latinos. There was a recent 
study released that said we now have 73 percent.
    So, I want to hear a bit more about--and you wrote about 
those issues in your testimony. Tell us about how we were able 
to achieve that and how we can use that as a model to continue 
and to serve these communities, such as Latinos and other 
underserved communities.
    Dr. Martinez-Bianchi. So, creating a multi-stakeholder 
conversation. The media, Spanish Latino media has been one of 
our best allies in information, in accurate information of
    [inaudible] the vaccines work, how to protect themselves, 
how to mask, why the masks work. They have been some of our 
best allies.
    Community health workers representative of the Latino 
community have been key at participating as promotoras, 
bringing the community forward and going into the community. 
And then us, Members of the Latino community as health 
professionals, engaging with both government, private, and 
other businesses. One great example, vaccination of the Latino 
Community Credit Union. Often we don't talk about how much the 
private sector, that where people already are or at comprar 
foods or restaurants. We have done vaccinations in taquerias. 
We have done them in supermercados and we have done them at the 
Latino Credit Union.
    Going to the places that people already consider 
trustworthy and becoming, as a health system, a trusted Member 
of that community that welcomes Latinos into our fold is----
    Ms. Leger Fernandez. Thank you. I wanted to go quickly to 
another point is, we have had in my district--and I know this 
occurs all the time--where immigrant workers, healthcare 
workers sometimes cannot get their U.S. Customs and Immigration 
permits renewed.
    And we know that immigrants play a big role in serving in 
our healthcare system. Could you talk about that impact that 
immigrants working in healthcare have with regards to serving 
not just immigrant communities, but our entire country, the 
role that--and that we need to sort of honor the role that 
immigrant healthcare workers play in our communities.
    Dr. Martinez-Bianchi. Well, I think it is important to 
note, as I mentioned before, the significant contributions of 
all immigrant communities to the economy and the country. The 
tremendous amount of support through taxes, both to State and 
Federal Government, which are written in my report.
    Wherever I am, wherever I have been as a Spanish-speaking 
rural doctor, city doctor, leader in academia, et cetera, I 
have found immigrants really doing a lot of work for their 
community, bringing the community together. And this is very, 
very visible right now in this COVID pandemic response.
    It is immigrants taking care of each other and also lifting 
the community up to be able to actually not just say we are 
here because we need, but we are here to support the rest of 
our community, including the U.S.
    Ms. Leger Fernandez. Thank you so much. I think we have to 
really remember that we cannot leave our immigrant communities 
behind today as we are looking at this, our larger legislation.
    Madam Chair, I yield back.
    Chairwoman Bonamici. Thank you.
    And I now recognize Representative Mrvan for five minutes 
for your questions.
    Mr. Mrvan. Thank you, Chairwoman.
    Dr. Pernell, what constraints or challenges affected COVID-
19 inequity in greater Newark area earlier this year, and how 
can other cities leverage the best practices you have shared to 
drive down COVID-19 transmission rates for extended periods of 
time?
    Dr. Pernell. Definitely. I would say that the Newark story 
has not been different from many stories across America and, in 
particular, in Black and Brown majority cities in urban 
America.
    The challenges that we initially faced were challenges 
rooted in access, meaning access was too often tied to a 
healthcare setting or institution initially. As the vaccine was 
made more available through federally Qualified Health Centers, 
as the vaccine became mobile and on the move, meaning that 
there were community health workers in community with the 
State's mobile vaccination unit that was in Newark, East 
Orange, Irvington, Camden, Trenton, Bridgeton, you name it, 
people were able to get their vaccine as close as possible to 
where they live, and people were able to get the vaccine from 
trustworthy community assets.
    I want to emphasize that word ``asset.'' Too much of 
healthcare in public health is from a deficit approach. When 
there are barriers or gaps and inequities, we must find assets 
in community and then partner and share power with those 
assets.
    So, in addition to assets that could help convey value and 
trust around language or literacy, there were assets that could 
make the vaccine more accessible by convenience or time. So, we 
are really employing this nature--I mean, this idea of a 
Prevention Army. And we are looking not just to bring vaccines 
to the front lines of where people are, but care to the front 
lines of where people are. Getting community health nurses, 
public health nurses, getting community health workers, getting 
those folks as close to where people are.
    That is the Newark story, and that is why Newark has gotten 
to where it is currently. Is there more work to be done? You 
better believe it. But the Newark story is one I want to say of 
success and one of overcoming. And the more that we can help 
empower communities to decide, the more that we can help 
empower communities to say this is the way that the approach is 
going to be most effective here, the better.
    And the last thing I would say is our hospital was an 
example of an institution sharing power, whether it was the 
city, the city health department directly supplying vaccines or 
whether it was FEMA. We had our EMS staffing over 500 events 
and sites to be as a support. That is how you achieve an 
equitable response.
    Mr. Mrvan. I thank you very much, Dr. Pernell. I am from 
northwest Indiana, and I represent Gary, Indiana, Hammond, 
Indiana, East Chicago, Indiana. And all of those federally 
Qualified Health Centers were boots on the ground. And you are 
exactly right, they are assets that were meeting people where 
they are. And our share of success had a lot to do with not 
only the combination of the health departments along with the 
federally Qualified Health Centers and the faith-based 
community to push and to have those initiatives and assurances 
to the constituencies that there is value in it. So, I thank 
you very much.
    My next question is for Dr. Wen. Direct care workers and 
agencies receiving Medicaid funding are among the 17 million 
healthcare workers who must now be vaccinated, according to the 
new Federal mandate.
    How could vaccine hesitancy among this critical workforce 
impact the people that rely on them for home-and community-
based services, which are largely funded by Medicaid?
    Dr. Wen. Thank you for that question. You know, I have 
stated earlier that I am a big proponent of vaccine 
requirements. It is something that we know dramatically 
increases vaccination numbers. We have already seen this 
happen. Houston Methodist, for example, one of the first 
hospitals, out of 25,000 workers, only about 150 did not comply 
with this mandate.
    We also know that, when people are unvaccinated, of course, 
they are exposing their vulnerable patients and nursing home 
residents and individuals that they are caring for in the home-
care setting. Also, it increases their likelihood of being out 
of work if they are quarantined, if they are exposed to 
somebody who is positive for COVID-19.
    And so, I recognize the challenges that may be faced by 
organizations that may have staffing shortage issues, but we 
also have to recognize that there is another side of this, that 
it also increases the protection, including for some of our 
most vulnerable individuals.
    Finally, a lot of employers have actually been looking for 
cover. And the Federal Government saying that there is a 
vaccine mandate provides them with the cover that they need in 
order to implement vaccine mandates that many of their 
employers and certainly the people that they serve have wanted.
    Mr. Mrvan. I thank you, Dr. Wen.
    I want to thank all the participants who have testified 
today with your passionate views, and may we always keep 
advocating for the health of our Nation.
    Chairwoman Bonamici. Thank you, Representative.
    I now recognize Representative Bowman for five minutes for 
your questions.
    Mr. Bowman. Thank you very much, Madam Chair.
    This question is for Dr. Martinez-Bianchi. I want to thank 
you so much for joining us today and for providing us with such 
important information on the disparate impacts of COVID-19 on 
LatinX communities.
    It is clear from your testimony that uplifting the voices, 
experiences, and needs of the communities most impacted by 
health inequity is the first step to pursuing justice. This is 
something that my office and organizations in my district have 
been working to do as well since the onset of the pandemic.
    In the 16th District of New York, nearly two-thirds of 
constituents are Black or Latino. White households in my 
district make double what Black and LatinX households make, and 
these income disparities are inextricably linked to disparities 
in health outcomes, as we all know.
    Earlier this year, my office helped advocate for vaccine 
sites to be located in Yonkers and Co-Op City, two areas with 
high concentrations of LatinX and Black residents. Before these 
sites opened closer to home, residents would often have to 
spend 2 hours on multiple trains and a bus to reach the nearest 
vaccinationsite. Continuing to address these barriers to 
equitable health access is vitally important for my 
constituents.
    Reflecting on the stories that you have heard thus far in 
your community, what do you think are the biggest barriers to 
vaccine access that are faced by LatinX communities who still 
have not gotten their vaccine or are now eligible for a 
booster, and what do you think are the most important 
strategies that organizations and community Members can employ 
to combat those barriers?
    Dr. Martinez-Bianchi. So, thank you, Representative Bowman, 
for such a great question. And the story that you are talking 
about in New York is very similar to what we have seen 
initially also, that a lot of the vaccination, a lot of the 
testing initially was set alongside normal places where 
healthcare is delivered. And what we know is that we are not 
delivering where the people are.
    So, the best approach is going into where the people are, 
listening to the community, understanding their fears, their 
concerns, and explaining that--one of the things that I heard a 
lot from both African American and Latino communities was, why 
now? Why are you now talking to us, telling us we need to get 
vaccinated when we were completely forgotten before?
    And what I said was, now because the majority of White 
people have gotten vaccinated, because the people who had the 
access and had the privilege and wanted a vaccine already got 
it, so now we are coming to talk to you because maybe there is 
an important part of this information that you are not aware 
of.
    And I have been in many places. I have sat at lunchtimes. 
We have done vaccination events in so many different settings. 
And it was sitting down with people at their table and saying, 
hey, who is vaccinated here, asking one-on-one, what is it, 
what are their concerns? And then suddenly realizing that a 
group of seven people would get off of their table and go get a 
vaccine.
    It is going one-to-one. It is having people that speak the 
language, that look like you, that look like me, that are going 
in and answering the questions, being about the humility that 
we are talking about but being about that engagement.
    And then studying the settings where people are, getting 
those vaccines where people are, provided by people, again, 
that look like you, that look like me, who are speaking the 
languages of everyone that we are trying to reach out and to 
get vaccinated. Working with schools.
    Mr. Bowman. No, absolutely. And you are referring to the 
lack of trust that has been in place in Black and Latino 
communities for several decades, throughout American history. 
And that trust needs to be rebuilt with intimate engagement and 
building relationships. Thank you so much.
    Dr. Wen, I have a question for you. First of all, thank you 
again for taking the time to be here and providing your 
expertise.
    Listening to your testimony, you mentioned recent data that 
nearly half of the unvaccinated are not opposed to getting the 
vaccine. The key, as you say, is community outreach, as we just 
heard. As a former teacher and principal, I also know that 
schools can play a vital role in this type of community 
outreach by helping to identify community needs, provide 
services directly to students and families, and connect 
community Members to external resources when unable to directly 
provide them.
    You mentioned briefly that schools and transportation hubs 
could be additional access points of vaccines. Can you talk a 
bit more about how schools can play a role in helping to test 
and vaccinate key populations, such as the unvaccinated but 
willing, those who are now eligible for boosters, and young 
students who are or may soon be eligible for vaccines, and how 
can we coordinate across agencies and levels of government to 
support schools in playing this role?
    Dr. Wen. Thank you, Representative Bowman. I completely 
agree with you. I used to oversee school health for the city of 
Baltimore, and I definitely believe that schools are a hub. 
Ideally, they are not just a hub of healthcare for the student 
but also for the entire family.
    And so, when we get vaccines approved for younger children 
but also now vaccines approved for 12 and older, we should be 
able to offer the vaccines in schools, but also offer parents 
and the extended family the opportunity to get vaccinated there 
as well.
    And I certainly think we should do a lot more to expand 
testing in our schools. Ideally, there is rapid testing 
available to every student every week, the way that L.A. 
Unified, for example, has done, some others have done. And 
perhaps those tests could be made available to the entire 
family too.
    Mr. Bowman. Thank you so much.
    Madam Chair, I yield back, and sorry for going over my 
time.
    Chairwoman Bonamici. No worries. Thank you, Representative.
    I see no further Members to ask questions, so I want to 
remind my colleagues that, pursuant to Committee practice, 
materials for submission to the hearing record must be 
submitted to the Committee Clerk within 14 days following the 
last day of the hearing, so by close of business on October 11, 
preferably in Microsoft Word format.
    The material submitted must address the subject matter of 
the hearing. Only a Member of the joint Subcommittee or an 
invited witness may submit materials for inclusion in the 
hearing record.
    Documents are limited to 50 pages each. Documents longer 
than 50 pages will be incorporated into the record via an 
internet link that you must provide to the Committee Clerk 
within the required timeframe, but please recognize that, in 
the future, the link may no longer work.
    Pursuant to House rules and regulations, items for the 
record should be submitted to the clerk electronically by 
emailing submissions to [email protected].
    Again, I want to thank the witnesses for their 
participation today. Members of the joint Subcommittee may have 
some additional questions for you, and we ask the witnesses to 
please respond to those questions in writing.
    The hearing record will be held open for 14 days to receive 
those responses. And I remind my colleagues that, pursuant to 
Committee practice, witness questions for the hearing record 
must be submitted to the Majority Committee Staff or Committee 
Clerk within 7 days, and the questions submitted must address 
the subject matter of the hearing.
    So, I now want to recognize the distinguished Ranking 
Member of the HELP Subcommittee, Ranking Member Allen, for a 
closing statement.
    Mr. Allen. Thank you, Madam Chairwoman.
    And I want to thank the witnesses. This has been a very 
informative hearing. I think we have learned a great deal about 
where we are and maybe where we need to go.
    As we discussed today, Operation Warp Speed was the gold 
standard of vaccine development and distribution. I don't think 
there is any argument about that. Under the Trump 
administration, our private healthcare sector was able to 
produce several lifesaving vaccines in record time.
    This proved yet again that America's healthcare system 
thrives when government gets out of the way and supports 
private innovation. As we continue discussing successful models 
for protecting communities from COVID-19, we must acknowledge 
that the most effective mitigation and prevention strategy, 
vaccination, is both free and widely available for every 
American over the age of 12. Our free enterprise system and the 
private healthcare industry made this miraculous feat possible.
    Additionally, our Nation's pre-pandemic economy was 
booming. And I want to give a shout-out to all of our medical 
personnel for their great work during this very difficult time 
in our economy. Again, I said the pre-pandemic economy was 
booming. Contrary to a claim made earlier in this hearing, 
economic growth during the Obama economy suffered greatly 
because of top-down government regulations and hostility toward 
job creators.
    Under President Trump, unemployment, particularly for 
minority groups, was at an all-time low, worker wages 
skyrocketed, and job creation boomed, because of the Trump 
administration deregulatory policies.
    Business owners and workers are eager to get back to this 
unprecedented period of economic growth and prosperity, but it 
seems that President Biden appears to know little about 
creating a booming economy. With three COVID-19 vaccines 
approved by the FDA, our economy should be back to normal. 
There are currently over 8.4 million unemployed Americans and 
10.9 million job openings, a gap that is due, in part, to the 
Biden administration's absurd policies that are keeping would-
be workers out of the workforce. For minority groups, the 
unemployment rate is a staggering high 8.8 percent.
    It is truly astounding to watch an administration trade 
long-term economic prosperity for short-term liberal special 
interests. The worst part is there is little evidence that the 
government mandated lockdowns did much to reduce COVID-19 
transmission.
    To build on these early successes, it is imperative that we 
reestablish local and State control, working together with 
those leaders to execute policies that encourage vaccination. 
More top-down mandates from Washington will not alleviate the 
financial suffering this President's policies have inflicted.
    Again, I thank the witnesses for participating today.
    And, with that, I yield back.
    Chairwoman Bonamici. Thank you, Ranking Member Allen.
    And I now recognize the distinguished Chair of the HELP 
Subcommittee, Chairman DeSaulnier, for a closing statement.
    Chairman DeSaulnier. Thank you so much, Chair Bonamici. I 
really appreciate it.
    Ranking Member Spartz and Ranking Member Allen, thank you.
    And I want to especially thank all of our witnesses. Your 
testimony was terrific.
    As I shared at the beginning of the hearing, those who have 
been historically and now continue to be left behind by our 
healthcare system have suffered the greatest losses during this 
pandemic. The Delta variant is only deepening those 
inequalities.
    Today, we heard how communities across the country are 
leading effective vaccination initiatives to fight back and 
protect our loved ones from COVID-19. We still have a long way 
to go, and, unfortunately, the most vulnerable Americans are 
some of the last to get vaccinated. To that end, we must rally 
behind compassionate community-based initiatives that are 
reaching every corner of America and are doing something very 
important for everyone during this historic pandemic.
    Thank you again to our witnesses. I now want to recognize 
the distinguished--I already did. I want to turn it back to 
you, Madam Chair. Thank you so much.
    Chairwoman Bonamici. Thank you, Chair DeSaulnier.
    And it is my understanding Ranking Member Spartz is no 
longer on the platform, so I will recognize myself for purposes 
of making a closing statement.
    Thank you so much to the witnesses for sharing your 
expertise and your experience. And today we reflected on the 
importance of equitable access to the COVID-19 vaccine in our 
efforts to defeat dangerous variants and protect our loved 
ones.
    As of this morning, 56 percent of Americans are fully 
vaccinated. This is a testament to the successful vaccine 
initiatives made possible by community leaders and the historic 
funding provided through the American Rescue Plan, but, 
unfortunately, as our witnesses made clear, there are still 
many Americans not getting the vaccinations they need to stay 
safe and healthy, and, as a result, we are experiencing a 
resurgence of COVID-19 and too many Americans, primarily those 
who are unvaccinated, are losing their lives.
    And, throughout this hearing today, I have been thinking 
about the challenges and the opportunities, both of which we 
have discussed today. And I am following up on Representative 
Leger Fernandez. I had a conversation with a school 
superintendent in the district I am honored to represent in a 
rural area where, even though there is a vaccine mandate, many 
of the teachers are not getting vaccinated.
    And she said to me: My parents are calling and saying, I 
don't want my child, who is too young to be vaccinated, in a 
classroom with a teacher who is not vaccinated. What am I 
supposed to do?
    And today's hearing will help us answer that question.
    Then she added: And by the way, I can't get deworming 
medicine for my horse because it is all sold out.
    So, challenges, yes, we have, but we also have the 
opportunities. And, following up on Mr. Mrvan's comment about 
the importance of our FQHCs, our federally Qualified Health 
Centers, in the district I represent, we have a wonderful 
Virginia Garcia Memorial Health Center. And they have done a 
remarkable job with their mobile health clinic, going out to 
the farms and fields and making sure that the people who are 
working there harvesting our crops and getting food to market 
are vaccinated.
    So, lots of opportunities. And, just over the weekend, 
about 400,000 Americans got booster shots at their local 
pharmacy. So, we are making progress, but we know that 
communities must continue to invest in these vaccination 
initiatives and make sure that every American has equitable 
access to the vaccination.
    And, if you haven't received yours yet, go to vaccines.gov 
to learn more and find a provider near you. It is the best 
thing you can do to protect yourself and your loved ones. So, 
thank you again to the expert witnesses for your testimony and, 
importantly, for your work on the ground helping our community.
    If there is no further business, without objection, the 
joint Subcommittee stands adjourned. Thank you again.
    [Additional submission by Chairwoman Bonamici follows:]
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    [Additional submission by Chairman Scott follows:]
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    [Additional submission by Hon. Diana Harshbarger, a 
Representative in Congress from the State of Tennessee 
follows:]
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    [Questions submitted for the record and the response by Dr. 
Wen follow:]
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    [Questions submitted for the record and the response by Dr. 
Martinez-Bianchi follow:]
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    [Questions submitted for the record and the response by Dr. 
Pernell follow:]
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    [Whereupon, at 1:05 p.m., the subcommittees were 
adjourned.]

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