[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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