[Senate Hearing 117-68]
[From the U.S. Government Publishing Office]





                                                         S. Hrg. 117-68
 
                       COVID-19 PANDEMIC AND THE 
                      U.S. INTERNATIONAL RESPONSE

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

                                HEARING



                               BEFORE THE



                     COMMITTEE ON FOREIGN RELATIONS
                          UNITED STATES SENATE



                    ONE HUNDRED SEVENTEENTH CONGRESS



                             FIRST SESSION



                               __________

                              MAY 12, 2021

                               __________



       Printed for the use of the Committee on Foreign Relations
       
       
       
       
       
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             U.S. GOVERNMENT PUBLISHING OFFICE 
45-535 PDF           WASHINGTON : 2021                   
                  
                  
                  


                 COMMITTEE ON FOREIGN RELATIONS        

             ROBERT MENENDEZ, New Jersey, Chairman        
BENJAMIN L. CARDIN, Maryland         JAMES E. RISCH, Idaho
JEANNE SHAHEEN, New Hampshire        MARCO RUBIO, Florida
CHRISTOPHER A. COONS, Delaware       RON JOHNSON, Wisconsin
CHRISTOPHER MURPHY, Connecticut      MITT ROMNEY, Utah
TIM KAINE, Virginia                  ROB PORTMAN, Ohio
EDWARD J. MARKEY, Massachusetts      RAND PAUL, Kentucky
JEFF MERKLEY, Oregon                 TODD YOUNG, Indiana
CORY A. BOOKER, New Jersey           JOHN BARRASSO, Wyoming
BRIAN SCHATZ, Hawaii                 TED CRUZ, Texas
CHRIS VAN HOLLEN, Maryland           MIKE ROUNDS, South Dakota
                                     BILL HAGERTY, Tennessee
                 Jessica Lewis, Staff Director        
        Christopher M. Socha, Republican Staff Director        
                    John Dutton, Chief Clerk        



                              (ii)        

  


                         C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page

Menendez, Hon. Robert, U.S. Senator From New Jersey..............     1

Risch, Hon. James E., U.S. Senator From Idaho....................     3

    Prepared Statement...........................................     5

Smith, Hon. Gayle E., Coordinator for Global COVID-19 Response 
  and Health Security, U.S. Department of State, Washington, DC..     6
    Prepared Statement...........................................     8

Konyndyk, Jeremy, Executive Director of the COVID-19 Task Force, 
  United States Agency for International Development, Washington, 
  DC.............................................................     9
    Prepared Statement...........................................    11

              Additional Material Submitted for the Record

Responses of Ms. Gayle E. Smith to Questions Submitted by Senator 
  Robert Menendez................................................    47

Responses of Mr. Jeremy Konyndyk to Questions Submitted by 
  Senator 
  Robert Menendez................................................    49

Responses of Ms. Gayle E. Smith to Questions Submitted by Senator 
  James E. Risch.................................................    50

Responses of Ms. Gayle E. Smith to Questions Submitted by Senator 
  Jeanne Shaheen.................................................    52

Responses of Mr. Jeremy Konyndyk to Questions Submitted by 
  Senator Jeanne Shaheen.........................................    53

Responses of Ms. Gayle E. Smith to Questions Submitted by Senator 
  Edward J. Markey...............................................    54

Responses of Mr. Jeremy Konyndyk to Questions Submitted by 
  Senator 
  Edward J. Markey...............................................    56

Responses of Ms. Gayle E. Smith to Questions Submitted by Senator 
  Todd Young.....................................................    59

Article From Miami Herald Dated April 27, 2021, ``As Biden Rolls 
  out U.S. Vaccine Diplomacy He Needs to Start in Our Own 
  Hemisphere''...................................................    60

                                 (iii)

  


                      COVID-19 PANDEMIC AND THE 
                      U.S. INTERNATIONAL RESPONSE

                              ----------                              


                  WEDNESDAY, MAY 12, 2021

                                       U.S. Senate,
                            Committee on Foreign Relations,
                                                    Washington, DC.
    The committee met, pursuant to notice, at 10:02 a.m. in 
room SD-419, Dirksen Senate Office Building, Hon. Robert 
Menendez, chairman of the committee, presiding.
    Present: Senators Menendez [presiding], Cardin, Shaheen, 
Coons, Murphy, Kaine, Markey, Merkley, Van Hollen, Risch, 
Romney, Barrasso, Rounds, and Hagerty.

          OPENING STATEMENT OF HON. ROBERT MENENDEZ, 
                  U.S. SENATOR FROM NEW JERSEY

    The Chairman. This hearing of the Senate Foreign Relations 
Committee will come to order.
    Ms. Smith, Mr. Konyndyk, thank you for joining us today to 
discuss the Biden administration's efforts to address the 
international spread of COVID-19.
    Gayle Smith is the coordinator for Global COVID Response 
and Health Security at the U.S. Department of State. She is 
currently on leave from the One Campaign where she has served 
as the President and CEO since March of 2017.
    Prior to the One Campaign, she served in the Obama 
administration as Special Assistant to the President and Senior 
Director for Development and Democracy at the National Security 
Council, and as Administrator of the U.S. Agency for 
International Development.
    Jeremy Konyndyk is the Executive Director of the USAID 
COVID-19 Task Force. He served 4 years in the Obama 
administration as the Director of USAID's Office of U.S. 
Foreign Disaster Assistance where he led the U.S. Government's 
response to international disasters, including the Ebola 
outbreak in West Africa.
    Before rejoining the Federal Government, Mr. Konyndyk was a 
senior policy fellow at the Center for Global Development.
    So thank you both for your willingness to serve, once 
again, our nation. We appreciate it very much.
    The last time this committee held a COVID hearing, June of 
2020, there were nearly 8 million cases of COVID-19 around the 
globe. More than 2 million of those cases were in the United 
States, and at that time, the disease had claimed more than 
115,000 lives in this country alone.
    Nearly a year later, this deadly disease has killed more 
than 3 million people. Nearly 600,000 of them are fellow 
Americans. In addition to the devastating personal toll, the 
pandemic has had a catastrophic economic impact.
    According to the International Monetary Fund, the global 
economy contracted by negative 3.5 percent in 2020 alone, a 
severe shock acutely and adversely affecting youth, the poor, 
and those working in the informal economy.
    The U.S. economy shrank an almost equal amount, negative 
3.4 percent, in 2020. I am pleased that the Biden 
administration has plans that are working. As vaccinations roll 
out here in the United States, cities and schools are 
reopening.
    The American Rescue Plan, which we passed in March, put 
another $1,400 in the pockets of working people, keeps the 
unemployed afloat, and helps millions of Americans avoid 
eviction and foreclosure.
    It invests billions to help schools reopen safely and 
provide direct aid to state and local governments across 
America reeling from the enormous costs of responding to this 
public health crisis.
    However, as this pandemic has put into stark reality for 
every American, what happens in the rest of the world directly 
impacts us here at home, and in parts of the rest of the world 
the pandemic continues to rage.
    In India, Brazil, and other countries, COVID-19 cases are 
surging, taking hundreds of thousands of lives in the past few 
weeks and months alone.
    Less than 10 percent of the population in India has 
received one vaccine dose, and the regional implications of 
India's outbreak for Nepal, Bangladesh, and Pakistan are 
alarming. The entire continent of Africa has only administered 
2 percent of all the vaccine doses administered globally so 
far.
    COVAX, the organization created to provide equal access to 
COVID-19 vaccinations worldwide, has shipped over 53 million 
vaccines to 121 participant nations.
    This is a drop in the ocean compared to the approximately 
1.2 billion administered around the world and a far cry from 
the amount needed to provide herd immunity in those countries.
    In short, the global fight against the virus is far from 
over. We must rise to the challenge because the longer the 
virus circulates, the greater the chance that more virulent and 
vaccine-resistant variants will develop, continuing to place 
American lives at risk.
    I believe that fight involves looking forward as well as 
understanding how we got here. The American people and the 
world deserve answers about the origins of the pandemic.
    The Strategic Competition Act of 2021, which this committee 
passed by a vote of 21 to 1, directs the Director of National 
Intelligence to provide a report with those answers, not to 
engage in a blame game, but because we must understand the true 
origins of COVID-19 to ensure that we are taking appropriate 
steps to avoid future pandemics.
    Additionally, Senator Collins and I introduced the 
bipartisan National Coronavirus Commission Act with a companion 
bill in the House. Our bill would create a nonpartisan 
commission modeled on the 9/11 Commission to examine the 
emergence and spread of COVID-19 in the United States and 
abroad.
    The commission would examine the United States domestic and 
international response to COVID-19 from all angles, including 
international public health surveillance, early warning 
systems, intergovernmental coordination, foreign aid, and 
global supply chains.
    The commission would provide recommendations to Congress to 
prevent future pandemics, protect the health and economic 
security of the United States, and ultimately reestablish the 
United States as the global leader in public health.
    Let us be clear, we will need resources to do all of this. 
Those of us who supported the international spending included 
in the American Rescue Plan and beyond that understand the 
importance of it.
    Ranking Member Risch and I have begun the process of 
developing bipartisan legislation aimed at strengthening 
efforts to end the COVID-19 pandemic, ensuring we are better 
prepared to face future pandemic threats, and helping countries 
around the world recover from this one.
    In light of all of that, I convened today's hearing to 
address three critical questions.
    How can we meaningfully slow and ultimately stop the spread 
of this pandemic once and for all and what resources are needed 
to do so?
    Two, what steps do we need to take to support and enhance 
recovery around the world?
    Three, what must we do to ensure that the United States and 
our partners and allies are best prepared to prevent, detect, 
and respond to future pandemics?
    So once again, let me welcome our witnesses. We look 
forward to hearing from each of them about the Biden 
administration's strategy to lead international efforts on an 
improved pandemic response.
    With that, let me recognize the ranking member, Senator 
Risch.

               STATEMENT OF HON. JAMES E. RISCH, 
                    U.S. SENATOR FROM IDAHO

    Senator Risch. Thank you, Mr. Chairman.
    I recently looked back at my notes from the two hearings we 
held last June on the U.S. international response to COVID-19.
    Though a lot has changed, the United States finally appears 
to be turning a corner. Too much remains the same. Americans 
have grown weary and are anxious to get back to life as normal.
    We have to get ahead of variants that may be even more 
dangerous than the original strain that shuttered schools and 
businesses, isolated families, and up ended the global economy.
    Science tells us the best way to do that is to tackle 
vaccine hesitancy here at home while accelerating efforts to 
expand access to vaccines overseas. One need look no further 
than India to see why it is so important to tackle both of 
these imperatives at the same time and now.
    Congress has provided more than $16 billion in aid to try 
to contain this pandemic overseas, $4 billion of which is 
slated to go for the COVAX Partnership for Vaccines. I am eager 
to hear how these resources are being prioritized, coordinated, 
implemented, and, importantly, overseen.
    The Administration also recently announced that 60 million 
doses of surplus U.S. vaccines will be donated overseas.
    I am hoping to hear from Ms. Smith today, the coordinator 
for Global COVID Response and Health Security and the lead on 
U.S. vaccine diplomacy, how these resources will be 
prioritized.
    Who will get what, when, and how, and how will all of this 
U.S. assistance be effectively branded?
    I also hope to hear about the anticipated outcomes of the 
upcoming G-20 Summit on Global Health on May 21 and the World 
Health Organization Assembly on May 24th.
    Finally, I hope we all learn more about how the 
Administration is incorporating pandemic preparedness into its 
current response. I have consistently argued that the COVID-19 
pandemic is not the first and it, certainly, will not be the 
last pandemic to threaten the American people and, indeed, the 
world.
    We have to get serious about preparedness and prevention so 
we can get ahead of the next outbreak before it becomes a 
global pandemic. We need a reformed World Health Organization 
that is fit for the purpose.
    We need to figure out how to hold countries accountable for 
failing to uphold commitments to international health 
regulations, including by actively suppressing global health 
data.
    We need better early warning systems so we can identify 
threats in real time as they emerge, and we need a fire 
department capable of responding to those warnings so they can 
put out the flames before they spin out of control.
    The very recently released study that WHO commissioned 
really underscores how important that fire department is to 
getting on top of this quickly.
    I was pleased to see the President's first national 
security memorandum included a commitment to better coordinated 
U.S. global health security and diplomacy overseas, a prominent 
leadership role to be played by the Department of State and an 
interest in establishing a financing mechanism to help 
committed partners close the gaps in health security that 
threaten us all.
    These are concrete ideas, grounded in nearly two decades of 
experience in combating another global health threat, the HIV/
AIDS pandemic. Those of us who proposed and included these same 
propositions in legislation that has been offered are pleased 
that the President has embraced and followed suit on those 
proposals.
    As noted just now by the chairman, he and I are working on 
further legislation to move the ball forward. With the 
Administration having embraced the proposals that all of us 
seem to be on board with, this should be a constructive, 
positive, and successful enterprise.
    At the same time, I am disappointed to hear that the 
Administration is advocating to unilaterally surrender U.S. 
intellectual property to China. The American free enterprise 
system created the vaccines that are saving lives and restoring 
freedom around the world.
    All the U.S. Government had to do was ease regulation and 
get out of the way. The challenges now relate to logistics, not 
innovation.
    I understand this is a work in progress. I am going to 
watch it carefully. I believe that going overboard on this will 
undermine the U.S. companies, and that is deeply unfortunate.
    I look forward to a robust discussion today about these 
issues, and yield the rest of my time.
    Thank you, Mr. Chairman.
    [The prepared statement of Senator James E. Risch follows:]

              Prepared Statement of Senator James E. Risch

    Thank you, Mr. Chairman. I recently looked back at my notes from 
the two hearings we held last June on the U.S. international response 
to COVID-19. Though a lot has changed and the United States finally 
appears to be turning a corner, too much remains the same.
    Americans have grown weary and are anxious to get back to life as 
normal. I feel similarly, but we must remain vigilant.
    We have to get ahead of variants that may be even more dangerous 
than the original strain that shuttered schools and businesses, 
isolated families, and upended the global economy last year.
    Science tells us the best way to do that is to tackle vaccine 
hesitancy here at home, while accelerating efforts to expand access to 
vaccines overseas. One need look no further than India to see why it's 
so important to tackle both of these imperatives at once.
    Congress has provided more than $16 billion in aid to try to 
contain this pandemic overseas, $4 billion of which is slated for the 
COVAX partnership for vaccines. I am eager to hear how these resources 
are being prioritized, coordinated, implemented, and overseen.
    The Administration also recently announced that 60 million doses of 
surplus U.S. vaccines will be donated overseas.
    I would like to hear from Ms. Smith, the coordinator for global 
COVID response and health security and the lead on U.S. ``vaccine 
diplomacy'', how those resources will be prioritized. Who will get 
what, when, and how? And how will all of this U.S. assistance be 
effectively branded?
    I also expect to hear about the anticipated outcomes of the 
upcoming G20 Summit on Global Health on May 21, and the World Health 
Assembly on May 24.
    Finally, I expect to learn more about how the Administration is 
incorporating pandemic preparedness into its current response. I've 
consistently argued that the COVID-19 pandemic is not the first, and it 
certainly won't be the last pandemic to threaten the American people.
    We have to get serious about preparedness and prevention, so we can 
get ahead of the next outbreak before it becomes a global pandemic.
    We need a reformed World Health Organization that is fit for 
purpose.
    We need to figure out a way to hold countries accountable for 
failing to uphold commitments to the International Health Regulations, 
including by actively suppressing global health data.
    We need better early warning systems so we can identify threats in 
real time, as they emerge.
    And we need a ``fire department'' capable of responding to those 
warnings, so they can put out the flames before they spin out of 
control.
    I was pleased to see the President's first National Security 
Memorandum included:

   a commitment to better coordinate U.S. global health 
        security and diplomacy overseas;

   a prominent leadership role to be played by the Department 
        of State; and

   an interest in establishing a financing mechanism to help 
        committed partners close the gaps in health security that 
        threaten us all.

    These are concrete ideas grounded in nearly two decades of 
experience in combatting another global health threat: the HIV/AIDS 
pandemic. I'm pleased to see the President intends to build upon that 
experience.
    At the same time, I am disappointed to hear the Biden 
administration advocating to unilaterally surrender U.S. intellectual 
property to China. The American free enterprise system created the 
vaccines that are saving lives and restoring freedom around the world. 
All the U.S. Government had to do was ease regulation and get out of 
the way. The challenges now relate to logistics--not innovation. This 
wholesale undermining of U.S. companies is deeply unfortunate.
    I look forward to a robust discussion about these issues, and yield 
the balance of my time.

    The Chairman. Thank you, Senator Risch.
    We will start with the testimony of our witnesses. Your 
full statements will be included in the record, and I ask you 
to summarize in around 5 minutes or so that we can have a 
conversation.
    We will start with Ms. Smith.

  STATEMENT OF THE HONORABLE GAYLE E. SMITH, COORDINATOR FOR 
 GLOBAL COVID-19 RESPONSE AND HEALTH SECURITY, U.S. DEPARTMENT 
                    OF STATE, WASHINGTON, DC

    Ms. Smith. Thank you, Mr. Chair and Senator Risch, and the 
honorable members of the committee.
    Let me----
    The Chairman. Could you put your microphone on?
    Ms. Smith. Hello?
    The Chairman. Okay. Maybe you can bring it a little closer 
to you. That might be helpful.
    Ms. Smith. Yes.
    The Chairman. Thank you.
    Ms. Smith. Let me start with a round of thanks. We are 
enormously grateful for your support and interest in a robust 
international response led by the United States, and we are 
extremely grateful for the resources that have been provided 
through the American Rescue Plan.
    Those resources have enabled a number of things already, 
and if I may, just anecdotally mention one of them. We now 
have, through that previous funding, sufficient contributions 
to COVAX, and the international mechanism to provide vaccines 
around the world.
    In its first year, COVAX suffered a lot of difficulties 
including that it had donor pledges but did not necessarily 
have cash on hand. We all know you cannot conclude a deal with 
a pledge.
    It also suffered from the fact that, currently, vaccines 
are not being exported from India, for reasons we can 
understand. The U.S. contribution has enabled COVAX to get back 
on the market.
    So I am happy to start out by reporting that they have 
recently concluded deals with Moderna and Novavax, and so there 
are more vaccines moving into the system.
    They are not enough, as you have rightly pointed out, and 
if I may briefly just explain the framework which we are using 
for the foundation of our global response.
    The first plank is, obviously, on vaccines, increasing 
supply and access globally, because, as we all know, the safety 
of the American people and, indeed, people everywhere depends 
on our ability to defeat a virus that knows no borders.
    The second is to reduce mortality but also transmission. We 
know from our own experience in this country, even before we 
were able to avail ourselves of a vaccine that preventing 
transmission is key, as is strengthening the underlying health 
systems upon which we and all countries depend.
    The third is to deal with the acute shocks, economic and 
otherwise, that are the result of this pandemic.
    Fourth, bolstering the economic and other systematic 
impacts. We have seen entire sectors collapse in many countries 
around the world.
    Finally, to work on building the international architecture 
for global health security that we know that we need for the 
future, because we know we will see more threats like this, and 
let me briefly just point to the four elements of that.
    The first is strengthening and modernizing existing 
institutions.
    [Technical issue.]
    Ms. Smith. Is that aimed at me?
    The Chairman. No.
    Ms. Smith. That is just background.
    [Laughter.]
    Ms. Smith. Got it.
    Strengthening and modernizing----
    Senator Risch. I never did understand it.
    Ms. Smith. It is just testing me to see how I do at this--
--
    The Chairman. It is aimed at us, not at you.
    [Laughter.]
    Senator Risch. Yes.
    Ms. Smith. Oh, sorry.
    Senator Risch. We do ignore it.
    Ms. Smith. Strengthening and modernizing existing 
institutions, and I use that term modernizing deliberately 
because I think we have got to make sure they are fit for 
purpose for the future.
    The second is strengthening existing norms, also looking at 
what new norms may be needed for the world to handle these 
kinds of global health threats, and ensuring compliance with 
those existing norms.
    The third is to ensure adequate and sustainable financing, 
and I am encouraged by your references to your look at what is 
going to be needed for global health security.
    It is going to be critical that that funding be predictable 
and sustainable because we cannot afford false starts where 
countries get part of the way to having the capacity to 
prevent, detect, and respond, but not all the way there.
    The fourth pillar on global health security is 
transparency, accountability, and oversight. One of the things 
about a virus is that we are able, through science, to track 
it, to monitor it, to watch it, to measure it.
    We can only do that if we have got the transparency that 
affords us that insight. We need the accountability and 
oversight because only when and if all countries comport to the 
sets of regulations, norms, and standards that we have and that 
we need to build upon can we deny the virus the quarter it so 
commonly exploits in order to replicate, mutate, and then 
reinfect.
    So that is the broad brush on our strategy. We would be 
happy to take more questions on all of the things we are doing. 
India has, obviously, been added to this, given the surge 
there. My colleague can speak more to that.
    We thank you again for your attention and your interest.
    [The prepared statement of Ms. Smith follows:]

                Prepared Statement of Ms. Gayle E. Smith

    Thank you, Chairman Menendez, Ranking Member Risch, and 
distinguished Members of the Committee. It is my pleasure to appear 
before the committee today to discuss the Biden-Harris administration's 
progress towards ending and building back from the COVID-19 pandemic.
    As we know all too well, more than 576,000 of our fellow Americans 
have died due to COVID-19, and many without their families having had 
the chance to say goodbye. We've seen communities devastated, economic 
and racial divides exacerbated. And we know that this virus doesn't 
play fair. Communities of color have borne a heavier burden of the 
pandemic's impact, and women's employment gains have fallen.
    The devastating impact of the pandemic has been felt at home and 
all over the world, where the pandemic has triggered both a health 
crisis and an economic crisis. Globally, we are witnessing the first 
increase in extreme poverty in 20 years, the loss of decades of 
development progress, rising food insecurity, and increased 
unemployment, particularly among young people. Some countries face the 
collapse of entire sectors, such as tourism; supply chains and markets 
have been disrupted; and revenues are down. For a significant number of 
low-income countries, the risk of debt distress, a liquidity crisis, 
and even insolvency is real.
    Globally, cases are still increasing, as is the incidence of new 
and more transmissible variants. There have been over 3.3 million 
deaths worldwide. We are seeing both a dramatic surge in cases in India 
and other countries and the evidence of what happens when health 
systems are stretched beyond capacity. The surge in India is not the 
only one, and will not be the last that we see outside our borders.
    As the Secretary has said, this pandemic won't end at home until it 
ends worldwide. The United States must lead in this time of global 
peril to end the lifespan of the pandemic.
    And America is leading.
    Thanks to generous and bipartisan support in Congress, we are 
moving quickly to address the humanitarian and public health impacts of 
the pandemic, including through USAID, the agency I once had the honor 
to lead.
    We have dramatically increased U.S. financial support for COVAX and 
the Global Fund, which will expand the reach of vaccines, therapeutics 
and diagnostics. We have rejoined the WHO and joined the ACT-
Accelerator, a coalition of agencies that was built last year to 
respond to this crisis.
    At the same time, we are responding to the crisis in India with the 
recent delivery of approximately USD $100 million in emergency 
assistance and by facilitating a powerful and impactful response from 
the American private sector and diaspora.
    As you know, the demand from governments all over the world for 
vaccines is high, and urgent. We're moving on multiple fronts to 
respond. First, and thanks again to bipartisan support of Congress, the 
United States is now, with our recent USD $2 billion contribution 
through USAID, the single largest donor to COVAX, the global vaccine 
platform built on the foundation of Gavi, an organization this body has 
strongly supported since its creation. We will contribute an additional 
USD $2 billion through 2022 for a total of USD $4 billion. Last month, 
the Secretary of State co-launched the One World Protected campaign to 
mobilize partners to join us in helping COVAX reach its sprint goal of 
an additional USD $2 billion.
    Second, President Biden has announced that we expect to have up to 
60 million AstraZeneca doses to share globally in the coming months, 
contingent upon FDA review.
    Third, our U.S. International Development Finance Corporation (DFC) 
is pursuing investments designed to expand vaccine production in 
critical markets, including through the Quad--the United States, Japan, 
Australia and India.
    Fourth, and most recently, Ambassador Tai has announced that the 
United States supports a waiver of intellectual property protections 
for COVID-19 vaccines under the World Trade Organization Agreement on 
Trade-Related Aspects of Intellectual Property. While the 
Administration strongly believes in intellectual property protections, 
we are facing extraordinary times that demand extraordinary measures to 
end this pandemic.
    We will do more. All countries and all people need access to safe 
and effective vaccines, and we're not there yet. We are committed to 
working with global partners to increase global production and 
manufacturing to expand access.
    But this is only part of the story.
    This pandemic has driven home the urgency of achieving global 
health security--the capacity of all countries to prepare for, prevent, 
detect, and respond to infectious disease outbreaks. Since 2015, the 
United States has provided more than $1 billion in technical assistance 
to Global Health Security Agenda (GHSA) partner countries to strengthen 
country-level capacity. We are now focused on what must be done to 
further strengthen key capabilities, establish new norms and practices, 
reform and modernize existing institutions, expand actionable 
multilateral cooperation, and secure means of sustainably financing 
what we all need--a world that is safe from the global health threats 
we know are coming.
    We are also working closely with partners to strengthen and 
modernize the World Health Organization, including by improving its 
surveillance and alert systems. Ultimately, the WHO is only as strong 
as its members, so we are also engaged with WHO member states to 
increase their ability and commitment to quickly and effectively 
prevent, detect, transparently report, and respond to potential 
contagion outbreaks, particularly through greater adherence to the 
implementation of the International Health Regulations (IHRs).
    And this Administration will act on these fronts from a strong 
foundation. For almost two decades, and with consistent bipartisan 
support from Congress, the United States has led the world in 
supporting global health. The extraordinary work of the President's 
Emergency Program on AIDS Relief, the Department of State, USAID, 
Department of Health and Human Services, the Centers for Disease 
Control, National Institutes of Health and others have saved lives, 
dramatically improved health outcomes, and strengthened the health 
systems we must build upon now.
    I am honored that Secretary Blinken asked me to take on the 
position of Coordinator for Global COVID-19 Response and Health 
Security. In this capacity, I report directly to him and work closely 
with colleagues across the Department and U.S. Government, and with 
global partners. My mandate in this role is to build out our global 
COVID-19 response, to coordinate our work on global health security, 
and to advise the Secretary on how we can maximize the impact of the 
Department in the global health security area over time.
    My experience prepares me for the task today, including my previous 
roles as Administrator of USAID for President Obama, and my position on 
the National Security Council staff during the U.S. response to the 
Ebola crisis in 2014. I have worked throughout my career on the fight 
for global public health, development, equity and dignity.
    In closing, let me say thank you. For decades, Congress has enabled 
an enduring U.S. leadership role on global health, and has demonstrated 
this commitment once again with the funding provided in the ARPA. I 
look forward to your questions, and to working with you in the days 
ahead.

    The Chairman. Thank you.
    Mr. Konyndyk.

 STATEMENT OF JEREMY KONYNDYK, EXECUTIVE DIRECTOR OF THE COVID-
     19 TASK FORCE, UNITED STATES AGENCY FOR INTERNATIONAL 
                  DEVELOPMENT, WASHINGTON, DC

    Mr. Konyndyk. Thank you, Chairman Menendez. Thank you, 
Ranking Member Risch. It is a privilege to appear before the 
committee again to testify on coronavirus.
    I am here today as the executive director of USAID's COVID-
19 work, and I want to begin, as my colleague Gayle did, by 
just thanking Congress for the generosity shown through the 
American Rescue Plan in affording resources to battle this 
pandemic globally.
    I have led numerous disaster and crisis responses for the 
U.S. Government in my career. I lead USAID's work on Ebola in 
West Africa in 2014, which to that point was the most complex 
thing I had ever dealt with in my career.
    I think this goes well beyond it. This is really like 
nothing, I think, we have ever seen. It is an overlapping 
humanitarian crisis, health crisis, and development crisis.
    Any one of those on its own would be a historic crisis. The 
three of them overlapping together are truly beyond anything, 
that any of us in our careers have seen a precedent for.
    So fighting that is going to take every resource and every 
capability that the U.S. Government can muster. President Biden 
is committed to the goal of ending this pandemic globally, just 
as he is working to end it at home, and I am grateful to the 
committee for continuing to focus attention and effort and 
support as we take that fight forward.
    The pandemic has shown it can overwhelm even the most 
developed health systems as we have seen in parts of our own 
country at times, as we have seen in other countries, and so 
the devastation can be even more severe when it affects 
countries that do not have the sort of health capabilities that 
we do.
    We are seeing that right now with the rise in cases in 
India and growing across South Asia and we are very, very 
seized with that at the moment.
    Meeting this unprecedented challenge is going to take a 
great deal of American leadership. Fortunately, we have a good 
track record on that. The U.S. has a history of fighting 
pandemics and outbreaks, whether that is Ebola, malaria, 
tuberculosis, Zika, or, of course, the decades-long fight 
against HIV.
    Since the outbreak began, USAID has provided more than $3 
billion, thanks to the generosity of Congress and the American 
people, and we are continuing to program more funding every 
week to fight this pandemic around the world.
    As Gayle has mentioned, through USAID the U.S. has provided 
an initial contribution of $2 billion to GAVI for the COVAX 
equitable vaccine initiative. We will be providing another $2 
billion over the coming year as GAVI has more contracts that 
they need to lock down for providing more vaccines.
    We are also recognizing this is not just about vaccines. 
There is a colleague of mine from Resolve to Save Lives, an NGO 
partner that we engage with, who has said we need to make sure 
we are not being blinded by the light at the end of the tunnel. 
So vaccines are the light at the end of the tunnel. There is a 
long dark tunnel we need to get through until then.
    So as Gayle has laid out in our strategy, vaccines are the 
long-term play or the medium-term play. This virus can do a lot 
of damage in the near term while those vaccines come online at 
scale.
    So we also need to push hard on promoting and supporting 
good country policies, risk awareness, supporting health 
systems to reduce mortality in the immediate term while we work 
as hard as we can to scale up vaccine access.
    We are making significant headway on that within the U.S. 
Government through the work at AID and State but also with 
partners at DoD and the Department of Health and Human Services 
and the CDC.
    We are mounting a whole-of-government effort to defeat this 
pandemic globally, and I think you saw a picture of that and 
what we have done in India over the past couple of weeks, USAID 
assistance flying on DoD airplanes, coordinated with the HHS 
health attache and the USAID mission in Delhi, supported and 
backstopped by CDC technical assistance both in Atlanta and in 
Delhi.
    So it truly is a whole team effort that we are mounting 
here and we are continuing to expand that in the months ahead.
    We look forward to working closely with the committee and 
with the Congress as we take this initiative forward. We know 
it is going to take every part of what America can do to bring 
this pandemic to a close.
    The President is committed to that. We are committed to 
that. We will do what we can on the assistance front and on the 
policy front, and I think the diplomatic front, which Gayle is 
leading, and other forms of engagement, technical support with 
countries, are going to be very important in that, too.
    We can do this. It is going to be a big lift. We are ready, 
and we appreciate the strong support from Congress and I look 
forward to discussing with you further.
    Thank you.
    [The prepared statement of Mr. Konyndyk follows:]

               Prepared Statement of Mr. Jeremy Konyndyk

                              introduction
    Chairman Menendez, Ranking Member Risch, and Members of the 
Committee, thank you for the invitation to speak with you today about 
the U.S. Agency for International Development's (USAID) international 
COVID-19 response.
    My name is Jeremy Konyndyk, and I serve as the Executive Director 
of USAID's COVID-19 Task Force.
    Let me begin by first thanking you for Congress' generosity, which 
has allowed USAID to mount a strong response to the COVID-19 pandemic. 
During my career, I have led the U.S. Government's response to numerous 
international disasters, including the Ebola outbreak in West Africa in 
2014. However, nothing I have witnessed is quite like the overlapping 
global health, humanitarian and economic crises we are currently facing 
in scope and complexity. Fighting this global pandemic will take every 
resource we have at our disposal. I am grateful that the Committee 
continues to recognize the gravity of this challenge and convened us 
here today.
    This hearing comes as the COVID-19 pandemic strains some of the 
world's best equipped public health systems, including our own. As I 
have said to you all before, no country in the world was adequately 
prepared for this lethal pandemic. More than half a million Americans 
have tragically lost their lives to COVID-19, and more than 3 million 
people globally have died. The pandemic has had devastating economic 
and social impacts here in America and around the globe, and threatened 
decades of progress in poverty reduction and development. In some parts 
of the world, it is creating new or exacerbating current humanitarian 
crises. It has had disproportionate impacts on vulnerable populations, 
including women and girls. For these reasons, it is the 
Administration's top priority to end the COVID-19 pandemic.
    Our domestic vaccination campaign is successfully advancing, with 
over half of Americans having received their first dose. But Americans 
will not be fully safe if the wider world is not. Uncontrolled global 
transmission risks the emergence of dangerous, new variants around the 
world. It poses risks to under-vaccinated populations in our country. 
And as we are seeing vividly now in India, it poses enormous dangers to 
countries with large unvaccinated populations. This is precisely why 
the U.S. must be at the forefront of the global response to COVID-19. 
Stopping the virus worldwide, protecting lives, and stemming the spread 
of new variants is fundamental to protecting all Americans and ensuring 
our economic recovery. The COVID-19 crisis is not over; it is rapidly 
evolving, as we can see from the emergence of new hot spots around the 
world.
    It is important to recognize that the COVID-19 pandemic is not only 
a global health crisis; it is also a complex, multifaceted 
humanitarian, development, and economic crisis. The facts on the ground 
are stark: nearly half of the world's 3.3 billion person workforce are 
at risk of losing their livelihoods. The ongoing economic and social 
disruption could drive 90 to 132 million people back into extreme 
poverty, particularly affecting women and girls. The number of people 
in acute food insecurity increased by at least 20 million last year, to 
155 million people across 55 countries, increasing the risk of famine 
in a number of countries. This pandemic and its effects will likely 
result in 9.3 million more children suffering from wasting, a severe 
form of malnutrition caused by hunger and illness. A projected 2.6 
million more children who received poor nutrition due to COVID-19 will 
face stunted growth that limits their lifelong potential. COVID-19 has 
also reduced access to essential water, sanitation, and hygiene 
services for hundreds of millions of people and strained the solvency 
of water and sanitation providers. The staggering health and economic 
effects of COVID-19 exacerbate other humanitarian needs, rendering 
communities affected by conflict or disasters even more susceptible to 
the spread of COVID-19 and its impacts.
    Health providers are being asked to make impossible decisions, 
often re-directing services to cope with COVID-19. The number of 
children worldwide receiving routine vaccinations has decreased 
substantially as families observe lockdown procedures and refrain from 
proactive and routine healthcare practices. An estimated 1.6 billion 
learners across 144 countries--representing more than two-thirds of 
enrolled students worldwide--have been affected by pandemic-related 
school closures. More than 70 countries and territories have postponed 
elections. COVID-19 has exacerbated the global trend toward 
authoritarianism as leaders leverage ``emergency actions'' to 
consolidate power over democratic institutions. The number of protests 
and riots has increased, and around two-thirds of the countries where 
USAID works are affected by or at risk of violent conflict. Dozens of 
these countries have curtailed the right to peaceful assembly and to 
freedom of expression, with disinformation spreading rampantly. COVID-
19 has also disproportionately impacted women and girls, as public 
health lockdowns have increased the risk of gender-based violence, 
particularly intimate partner violence, and exacerbated the burdens of 
unpaid work, even as women are disproportionately represented on the 
frontlines as health care providers.
    Looking at both the health and second-order effects of the pandemic 
around the world, it is clear that a robust global response is 
essential to an effective domestic response. This global challenge, if 
unremedied, threatens not only the security and safety of communities 
around the world, but also jeopardizes the United States' own recovery.
                        usaid covid-19 response
    American leadership is rising to meet this unprecedented challenge. 
To guide the international response to COVID-19, USAID is finalizing 
work with the U.S. Centers for Disease Control and Prevention, the 
Department of State, and other interagency partners on the development 
of an interagency COVID-19 Global Response and Recovery Plan, as called 
for in National Security Memorandum One (NSM-1).
    Within this whole-of-government plan, USAID is uniquely positioned 
to provide assistance and technical support to help end the on-going 
pandemic, mitigate its wider impacts, and realize a sustained recovery. 
With decades of experience and investments in global health and global 
health security, USAID has been at the forefront of the international 
response to health threats like Ebola, HIV/AIDS, malaria, Tuberculosis 
(TB), and Zika.
    Since the outbreak first began, USAID has provided more than $3 
billion dollars, thanks to the generosity of Congress and the American 
people, to fight COVID-19 in more than 120 countries. Working with our 
partners around the world, USAID is addressing COVID-19's health, 
social, and economic effects by supporting vaccine access and 
distribution, strengthening strained health systems, protecting and 
training health workers, disseminating critical public health 
information, delivering emergency food assistance, sustaining education 
for millions of students, and protecting democracies and civic 
engagement.
                           arp implementation
    A key piece of the Administration's plan to end the global pandemic 
and tackle emerging hot spots is the American Rescue Plan (ARP). USAID 
is thankful to Congress for your support of the ARP, which provides 
nearly $11 billion to USAID and the Department of State to support the 
international health and humanitarian COVID-19 response. Our efforts 
will fight COVID-19, its variants, and its devastating impacts on 
vulnerable communities, economies, and health systems. With this 
funding, we will advance the five objectives of the aforementioned 
COVID-19 Global Response and Recovery Plan:

   Accelerate widespread and equitable access to and delivery 
        of safe and effective COVID-19 vaccinations;

   Reduce morbidity and mortality from COVID-19, mitigate 
        transmission, and strengthen health systems, including to 
        prevent, detect, and respond to pandemic threats;

   Address acute needs driven by COVID-19, mitigate household 
        shocks, and build resilience;

   Bolster economies and other critical systems under stress 
        due to COVID-19 to prevent backsliding and enable recovery; and

   Strengthen the international health security architecture to 
        prevent, detect, and respond to pandemic threats.
               supporting global equitable vaccine access
    Vaccines are the most effective tool we have to stop COVID-19 and 
get the global economy on track. In order to end the pandemic, save 
lives around the world, and stop the threat of new variants, we must 
vaccinate as many people as possible, as quickly as possible. Through 
the support of Congress and the American people, the United States is 
the world's largest single donor to the Gavi COVAX Advance Market 
Commitment (AMC), which pools global demand and funding to help 92 low- 
and middle-income economies access COVID-19 vaccines.
    Through USAID, the U.S. has contributed an initial $2 billion to 
Gavi, in support of COVAX, in March, and plans to contribute an 
additional $2 billion to Gavi through 2022. This historic commitment 
has already helped enable the deployment of safe and effective vaccines 
for the world's most vulnerable people, including frontline workers and 
displaced persons. We are also committed to leveraging U.S. 
contributions to galvanize global leaders from the public and private 
sectors to increase their contributions to COVAX. As of May 2021, COVAX 
has provided 40 million COVID-19 vaccines to 77 low- and middle-income 
countries.
    Additionally, USAID is providing more than $75 million to date to 
support partner countries in preparing for COVID-19 vaccine deployment. 
This funding supports activities to build confidence and trust in 
vaccines, address vaccine hesitancy and misinformation, and support 
logistics and administration of vaccines. With additional funding 
appropriated under the ARP, and building on decades of U.S. leadership 
and expertise supporting global health programs around the world, USAID 
and the U.S. Centers for Disease Control and Prevention will expand 
this support, ensuring that vaccines reach the most vulnerable 
populations and those at highest risk, including health care workers.
    As confidence in the U.S. supply of vaccines for domestic use 
increases, the U.S. Government is also exploring options for vaccine 
sharing. On April 26, 2021, the United States announced its intention 
to share up to 60 million doses of the AstraZeneca vaccine, pending a 
product quality review by the U.S. Food and Drug Administration (FDA). 
The U.S. Government is currently developing a plan for where these 
vaccines will be donated as they become available.
                  supporting frontline health response
    In addition to providing safe and effective vaccines worldwide, 
USAID is focused on supporting frontline health workers and health 
systems to save lives and stop the spread of COVID-19. For decades, 
USAID has been an unparalleled leader in global health. Through U.S. 
Government programs like the President's Emergency Plan for AIDS Relief 
(PEPFAR) and the President's Malaria Initiative, we have saved millions 
of lives, and our COVID-19 response efforts can build on the successes 
of those and other programs. However, COVID-19 is an unprecedented 
challenge. As we have seen in India and other countries, health systems 
where we supported countries to make strides have now been severely 
strained by the pandemic. USAID is fighting to protect countries' gains 
in global health while also supporting countries in their immediate 
fight against COVID-19.
    To support the community-level and frontline health response, USAID 
is working to slow and mitigate transmission by protecting healthcare 
workers, spreading critical health information, and ensuring our 
partner countries have the tools, supplies and capacity to save lives 
and avoid high death tolls during the acute phases of the pandemic. For 
example, we have provided millions of units of personal protective 
equipment, as well as training on infection prevention and control, to 
frontline healthcare workers around the world. As the evidence around 
treating COVID-19 evolves we are also working to ensure access to 
state-of-the-art case management protocols, including the critical use 
of oxygen therapy, by virtually connecting country teams with U.S. and 
international expertise.
    We also partnered with the U.S. International Development Finance 
Corporation to expand loan guarantees for private frontline healthcare 
providers recognizing that the private sector is well placed to provide 
surge support to the public sector both to help ensure the continuity 
of ongoing services and to help triage COVID-19 cases to the 
appropriate facilities. USAID assistance has strengthened laboratory 
testing capacity in more than 55 countries for large-scale COVID-19 
testing and specimen transport. Additionally, USAID has supported 
infection prevention and control (IPC) across more than 40 countries, 
including improvements in triage and isolation, hand hygiene, waste 
management, and emergency supply chains. IPC is critical to prevent the 
transmission of COVID-19 within health facilities, including among 
other patients and health care workers.
    To further strengthen health systems, USAID is supporting country 
efforts to prevent, detect and respond to health threats. In 
particular, USAID supports coordination across the health sector as 
well as with other sectors such as education and water, sanitation, and 
hygiene (WASH). We mobilize whole-of-society efforts that include both 
the public and private sectors. USAID is also focused on ensuring 
communities receive quick, accurate information about COVID-19 and how 
it spreads, while combating misinformation about the virus. So far, we 
have reached more than 200 million people with critical public health 
information through mass media in more than 85 countries. USAID is also 
facilitating public forums about the risks of COVID-19. These 
communications efforts help save lives.
                    responding to secondary impacts
    Beyond the direct impacts of COVID-19, the pandemic threatens 
decades of progress across USAID's investments in economic growth, food 
security, education, democracy, gender equality and women and girls' 
empowerment, and global health. In response, USAID is taking proactive 
steps to address these secondary effects and sustain our investments to 
help protect U.S. national security. Vice President Harris's recent 
announcement of $310 million in assistance to the Northern Triangle, 
including $125 million in USAID funding, is one of the most recent 
examples of how we are mobilizing our resources to provide emergency 
food assistance, economic recovery programs, and health support to 
communities in need.
    A sharp rise in poverty has created cascading effects across all 
sectors of USAID's work. The pandemic marked the first global rise in 
extreme poverty since the 1990s; COVID-19 eliminated jobs, shut down 
entire sectors of the economy, and disrupted food supply. In response, 
USAID is providing life-saving assistance to those who are most 
vulnerable to the pandemic's urgent consequences. Our immediate support 
includes life-saving assistance in 48 priority countries and supporting 
communities, helping them adopt strategies to reduce the spread of 
COVID-19. USAID is also delivering emergency food assistance to more 
than 4.7 million people affected by lockdowns and stressors from COVID-
19. In addition, through Feed the Future, USAID's food security and 
resilience programming is helping farmers and small businesses stay 
afloat, markets safely open, and local food prices and supplies 
stabilize. We are fighting pandemic induced spikes in hunger while 
simultaneously strengthening resilience to future shocks.
    Due to COVID-19 lockdowns, an estimated 1.6 billion students are 
out of school, including an estimated 11 million girls who may never 
return without targeted intervention, putting them at risk for early 
pregnancy, abuse, and gender-based violence, including child, early, 
and forced marriage. To combat these disruptions, USAID leveraged its 
partnerships, on-the-ground presence, and expertise to rapidly pivot 
programs by mobilizing more than $900 million for education across more 
than 50 countries to reach more than 24 million learners in 2020. We 
are supporting continued education through online, television, and 
radio school lessons, allowing millions of students to continue their 
studies outside of the classroom. We are also ensuring safe return to 
learning, especially for the most marginalized, including through 
distance learning, catch-up programs, and school safety protocols.
    In the face of COVID-19, investing in women's economic empowerment 
is more important now than ever, as women are disproportionately 
affected by the immediate and longer-term impacts of the pandemic. We 
are especially cognizant of the crucial role that women play in the 
informal and formal health sectors, and the increased workloads on 
women in all sectors due to caregiving at home under pandemic 
restrictions. Women are also more likely to have informal jobs or 
precarious employment compared to men, resulting in a greater 
likelihood that their earnings and health and other benefits will be 
interrupted and/or impaired due to the pandemic. Increasingly, USAID's 
women's economic empowerment programs have incorporated COVID-19 
responses, for instance, several programs have helped women-owned 
businesses in the garment industry to pivot production for personal 
protective equipment to meet growing global demand.
    COVID-19 continues to disrupt democracies by providing an 
opportunity for authoritarian regimes to tighten their grip, often 
through the use of ``emergency powers.'' To promote and protect 
democratic governance, USAID is supporting efforts to counter 
disinformation and defend human rights, the rule of law, and democratic 
safeguards. We have helped provide virtual platforms in some countries 
to ensure citizens can continue to monitor decision-making processes 
and hold their governments accountable.
    COVID-19 threatens to erase years of progress across our global 
health programs, particularly in our fight to end diseases like HIV/
AIDS, TB, and malaria. Ongoing stress on health systems weakens the 
ability of countries to respond to and adequately control the spread of 
other diseases. For example, TB case finding and treatment has 
decreased by as much as 25 percent, including in the highest burden 
countries, eliminating a decade of progress to reach every person with 
TB, cure those in need of treatment, and prevent the spread of disease 
and new infections. In 2020, one million fewer people were able to 
access reliable TB diagnosis, and thereby treatment, than in the 
previous year. To counter these effects, USAID has pivoted programs to 
provide remote diagnostic testing support and virtual health 
consultations.
    Despite these critical concerns, there is also a real opportunity 
to use the worldwide roll-out of COVID-19 vaccines to expand USAID's 
health system strengthening efforts. COVID-19 vaccination campaigns 
will involve an approach capable of reaching the entire population and 
require a substantial increase in the number of trained vaccinators and 
supervisory staff. The likely need for ongoing vaccination efforts will 
necessitate incorporating the supply chain, human resources, 
information, and financing arrangements into the core primary health 
care system for ongoing services. Failing to coordinate and integrate 
these efforts would represent a real missed opportunity to strengthen 
health systems and ensure we are better prepared for the next pandemic. 
USAID will similarly build on other COVID-19 response efforts to align 
primary health care, public health capacity, and health system 
resilience to enable a better response to future public health threats.
               responding to india and emerging hot spots
    While we have made significant steps towards tackling the pandemic 
and its second-order effects, we need not look any further than the 
current crisis in India to see the devastating impact of this disease 
and why we must show strong U.S. leadership in the international 
response to end the COVID-19 pandemic once and for all.
    Just as India sent assistance to the United States when our 
hospitals were strained early in the pandemic, the United States is 
determined to help India in its time of need. With this support, USAID 
is airlifting critical medical supplies and improving India's capacity 
to provide life-saving oxygen to COVID-19 patients. We are consulting 
constantly with the Government of India, non-governmental stakeholders, 
and our interagency partners to ensure that USAID's response is 
targeted to where it is most needed and will be most effective.
    This surge of immediate assistance builds on USAID's ongoing 
efforts to mitigate the pandemic in India. As this crisis unfolds, 
USAID stands with our staff in India, some of whom have lost family 
members to the virus or are themselves gravely ill. We are inspired by 
the strength and resilience of our colleagues who are leading this 
immense response while being deeply impacted themselves.
    Important to note, India's COVID-19 crisis is impacting its 
immediate neighbors, and beyond. The International Federation of Red 
Cross and Red Crescent Societies reports that in Nepal, towns near the 
Indian border are unable to cope with the growing number of people 
needing medical treatment. Nepal is recording more than 50 times more 
cases than this time last month. USAID is responding swiftly to improve 
Nepal's ability to respond to this crisis, including improving 
laboratory and hospital testing capacity, helping both federal and 
local governments facilitate infection prevention and control, 
supporting remote services for those seeking access to care, and 
addressing the secondary effects of the pandemic. It is also expected 
that we will see other hot spots emerge in the region, as well as 
around the globe. For example, we are closely tracking the situation in 
Brazil and working across the interagency to respond there and 
anticipate other hot spots.
    These emerging hot spots are a critical reminder that it will only 
be possible to keep Americans safe for the long term by stopping the 
global pandemic now. Our work is not done. To end the pandemic together 
as a global community, we must win the race between vaccinating all of 
humanity and the emergence of new and even more dangerous variants, 
which could threaten us all.
                               conclusion
    U.S. leadership will help to overcome this pandemic, but we cannot 
do it alone. Our partners are essential to our success. USAID is 
working closely with the global community, including the World Health 
Organization, our partner countries, non-governmental organizations, 
other donors, and the private sector. We are urging other countries to 
provide more funding for global COVID-19 response efforts and to 
advance information sharing, transparency, and accountability across 
these efforts.
    It is not enough to only end the COVID-19 pandemic. USAID is 
committed to building back a better world, one that is better prepared 
to prevent, detect, and respond to future biological threats, and where 
all people can live safe, prosperous, and healthy lives.
    Thank you for the opportunity to represent USAID. I welcome your 
questions.

    The Chairman. Well, thank you both. We will start a series 
of 5-minute rounds.
    Let me start by saying for our fellow citizens across the 
country who may be wondering why we are so focused on this 
internationally, as long as there is COVID anywhere, there can 
be COVID everywhere.
    We cannot hermetically seal off the United States of 
America. There are--viruses understand no borders, no oceans, 
no walls, nothing, and so it is in our own national interest 
and security as well as being a global citizen to meet this 
challenge.
    When we look at the numbers, 3 million confirmed deaths 
around the world but researchers and some reports--recently 
published study claims that the number of deaths are over--
closer to 7 million, which 900,000 alone would be here in the 
United States.
    So what I would like, and I listened to your testimony, but 
work with me to get a better understanding. Give me a clear 
articulation of what is needed, what major obstacles are there, 
and how the Administration is planning to lead efforts to get 
the job done to move towards an ultimate end of the pandemic, 
but in the interim dramatically changing the course of events.
    Ms. Smith. Let me point to three aspects of that. The first 
and most important thing we need is international coordination 
and leadership, and I believe the United States is able and 
willing to provide that.
    If you look at the fragmentation that characterized the 
first year of this pandemic, it, quite frankly, gave advantage 
to the virus.
    So we are reaching out to countries all over the world, to 
our key allies and partners, to make sure that what we do is we 
move out more robustly is a coordinated response that, 
therefore, can get to some scale.
    I think that the second is, as Jeremy rightly pointed out, 
vaccines are absolutely critical. We are going to have to work 
on that throughout this response. We are also going to have to 
respond in those areas where we can actually prevent and 
prepare.
    Let me say a couple of things on vaccines and what we are 
doing on that front.
    Number one, we are now the largest donor to COVAX. Again, 
thanks to the generosity of Congress, we are using our 
contribution to leverage and encourage other countries to 
increase their own contributions so that we have got adequate 
burden sharing but also we get to the scale we need.
    We are also looking at issues of supply and manufacture. We 
need more vaccines. That is why the United States, our 
Development Finance Corporation, under the rubric of the Quad 
countries that we work with, has embarked on a deal for an 
additional company in India to increase production of vaccines 
and is looking at other places around the world where the 
injection of DFC capital can result in fairly prompt increases 
in production.
    There is also sharing. It was rightly referenced to the 
President's decision to share AstraZeneca doses, and over the 
coming days you will hear more about that in our efforts to 
look at how to share more doses. That is going to be critical 
to the solution as well.
    So we have got a multi-pronged effort on vaccines.
    The second is that second part of our strategy on reducing 
transmission, strengthening the health systems that are going 
to be needed, and reducing mortality.
    There is a lot can be done, and I will turn to my colleague 
to say more about that, but, quite frankly, to prepare for what 
we know is coming as we try to ramp up the supply of vaccines.
    If you think about India and the sub region, there are 
other parts of the world that we are monitoring where we could 
likely see surges. So how do we deliver the assistance that we 
now have on hand to strengthen those health systems and 
position for them?
    So those are the three key areas I would point to. Let me--
do you want to add anything, or is that all right with you, 
sir?
    The Chairman. If you have something to add, yes. Then I 
have another question.
    Ms. Smith. Sure.
    Mr. Konyndyk. Yes, I think Gayle has covered sort of the 
broad strokes. In the near term, it really is imperative that 
countries not take their foot off the gas in terms of the 
distancing and masking and all the other behavioral measures 
that are needed to slow transmission.
    I think one of the factors in India seems to have been that 
some of those measures were somewhat relaxed and that in large, 
large gatherings, particularly some larger religious festivals, 
were allowed to continue in that provided opportunities for the 
virus to spread at large scale.
    Clearly, the variants are part of that as well. The 
multiple variants are now proving to be more transmissible and 
I think that just underscores the risk and the danger we face 
in the year ahead.
    So part of this is what we can do with our assistance and 
we are going to provide testing support. We are going to 
support contact tracing and other public health measures in 
countries.
    Part of this, too, is countries need to really maintain the 
rigor of their--the stringency of their policies to slow and 
prevent transmission until they have sufficient cover, 
vaccination coverage, and that is in much of the developing 
world not likely to happen for another year to a year and a 
half, even under a best case scenario.
    The Chairman. Let me turn to another question. I heard you 
say, Ms. Smith, that the U.S. is able and willing to help lead 
this international response, and my question is who is 
coordinating the Administration's international response?
    Sunday's Washington Post--you may have read it--has 
suggested that the Administration's international response is 
uncoordinated and it lacks a strategy. So I would like you to 
speak to that.
    Lastly, what steps is the Administration planning to take 
to lead collective efforts to end the pandemic? For example, 
should we expect announcements coming out of the G-7 and G-20 
with specific targets and goals related to health 
interventions?
    Ms. Smith. Thank you for those questions. I would not say 
that the response is uncoordinated. I certainly have not found 
that since I took on this position just a few weeks ago.
    Both the National Security Council and the domestic COVID 
team led by Jeff Zeints lead the across the board interagency 
effort in the big picture. That, as my colleague has said, has 
been exactly what we need, which is a whole-of-government 
response.
    So there is coordination at that level, particularly on the 
policy side. In my position, there is a coordination role with 
respect to colleagues at USAID and HHS. How we can pull those 
pieces together, I think that coordination is increasing. I 
have found it to be quite smooth.
    As is always the case in the executive branch, as we make 
decisions and look at doing additional things that moves up 
through a decision making process, the standard operating 
procedure, and I think that is working quite well. So I think 
there is coordination.
    I think that on the G-7 and the G-20 side, these are 
vitally important forums for galvanizing the kind of 
international response we want. The G-7 is very focused on it 
and I think we can anticipate that out of the summit coming up, 
we will see concrete action and decisions from the G-7.
    The G-20, as well, is very focused on the economic 
dimensions of the pandemic, whether it is with regard to the 
debt service initiative that they launched earlier that will 
likely be continued or now their examination of the special 
issuance of special drawing rights from the IMF.
    Because the economic shock of this has been felt all over 
the world at the macro level down to the household level. So I 
think you will see robust responses from both and you will see 
the United States leading in both cases to make sure that 
happens.
    The Chairman. I look forward to that.
    Senator Risch.
    Senator Risch. Well, thank you. I am going to pick up where 
the chairman left off, Ms. Smith.
    The National Security Memorandum Number One, which I 
referenced earlier talked about the State Department leading on 
developing a Government wide plan to combat COVID-19, reviewing 
and adjusting deployments of health and diplomatic personnel 
overseas and developing a diplomatic outreach plan to engage 
donors, strengthen partner capacity, mitigate the secondary 
impacts.
    Ms. Smith. Right.
    Senator Risch. So your position, as I read your job 
description, is exactly what was intended in the bill that we 
introduced in the last session. Senator Murphy and myself were 
the main sponsors.
    Senator Portman and Senator Cardin were also sponsors of 
that legislation, and the new one coming up, hopefully, with 
the chairman will probably also have a position in it with that 
job description just as you are.
    So that is a really good thing because when you have that 
amount of money that you are throwing against the wall and you 
have got such a complex and overlapping set of agencies, 
somebody has got to lead the charge.
    Now, I heard you respond to the chairman's question, saying 
that it was the National Security Council people that were 
leading.
    As I read the National Security Memorandum One and what we 
thought would be the appropriate way to do it was the 
department was supposed to lead and, specifically, the chair 
you are sitting in.
    So how do we reconcile those two?
    Ms. Smith. Sure.
    Senator Risch. Please do not take this as derogatory. I 
just--we need----
    Ms. Smith. No. No.
    Senator Risch. Under these circumstances, we need 
organization and coordination, as the chairman has pointed out.
    Ms. Smith. No, I could not----
    The Chairman. Excuse me one moment, if I may intercede. I 
have to go to a Finance Committee meeting. I have asked Senator 
Kaine to preside until I come back. So it is not that I did not 
like what you had to say so----
    Ms. Smith. Thank you.
    No, Senator, that is a fair question. Let me--let me 
elaborate. I think I would think of it as the National Security 
Council and the COVID team that the President established have 
the ability to set the framework, and the reason that I say 
that is important is, for example, much of what we do 
internationally derives from how well we are doing on the 
domestic front.
    In terms of coordinating the actual response, you are 
absolutely right. That would appear to be me, and I think that 
is an appropriate role. I think it is an important role. I 
think it is working very well.
    We have the ability not only as the State Department to 
marshal the kinds of coalitions that we need to galvanize that 
international support that is so necessary, but also to work 
with key agencies, including USAID, and the Department of 
Health and Human Services to make sure that we are marshaling a 
comprehensive strategic response.
    So, for example, with respect to the allocation of funding 
or the framework I described at the beginning, part of my task 
is, again, working with other agencies but to look across that 
and make sure that we do not have gaps or duplications, that we 
are moving out as robustly as we can, and that we are providing 
the resources, both personnel and financial, that we have in 
the budget, and again, thanks to Congress, behind those 
objectives.
    So I do not think there is disconnect. I think the 
reference to the domestic COVID team and the NSC derives from 
the fact that, again, as the President has made clear, his 
first responsibility is making sure the American people are 
safe. He is equally and strongly committed to an international 
response. It is important we have got that connectivity.
    Senator Risch. I appreciate that. I come back, again, to 
the point about there is so much money----
    Ms. Smith. Yes.
    Senator Risch. --and so many different agencies. We hear 
from time to time, and it does not get--fortunately, it does 
not get much publicity--about our own agencies butting heads 
overseas, and I am sure both of you, having worked in this 
area, have heard these stories before where when we were doing 
PEPFAR, which worked incredibly well, had difficulties with 
agencies going head to head.
    So it really needs somebody with the authority to get their 
arms around this and I am glad to see you are in that position, 
and I hope you will take back the message that we believe that 
that is appropriately where it should be and that the person in 
your position should have the authority to step in where 
agencies are having difficulty getting along.
    Thank you, sir.
    Ms. Smith. Thank you.
    Senator Kaine. [Presiding.] Thank you, Senator Risch.
    Via Webex, Senator Cardin is next up.
    [Pause.]
    Senator Kaine. Unmute, Senator Cardin.
    Senator Cardin. Hello?
    Senator Kaine. Now we can hear you.
    Senator Cardin. Okay, sorry about that.
    Again, let me thank both of our witnesses for their public 
service. These are, certainly, very challenging times.
    It has been noted in this hearing that this pandemic has 
been challenging to the health systems of developed countries, 
let alone those that are more challenged, and I just really 
want to deal with how we can prepare for the next pandemic, 
recognizing the lessons learned from PEPFAR. I appreciate 
Senator Risch mentioning that.
    We found that when we attacked the AIDS epidemic by helping 
countries that were extremely vulnerable, we helped build up 
their healthcare capacity and infrastructure, that when the 
next pandemic came, Ebola, they were much better prepared than 
those countries that were not PEPFAR countries.
    So my question to you is what lessons have been learned in 
what--how we have to assist in developing healthcare 
infrastructures in countries in order that they can deal with 
pandemics rather than just dealing one by one on a specific 
virus? Would not we be better off building up the 
infrastructures of countries to deal with what is likely to 
come?
    Ms. Smith. Senator, that is an excellent question, and I 
think there is an extraordinary foundation that the United 
States has helped to build in a number of countries through 
PEPFAR, through the President's malaria initiative, through 
maternal/child health and other programs at USAID, through the 
work of CDC, and, indeed, the work of NIH and other parts of 
the Government.
    It is absolutely critical that we build on those. The 
challenges are two. One is consistency. Preventing this kind of 
crisis from happening again means that we have got to close all 
the holes in the net.
    So that means that we and our partners need to look at all 
countries in the world to see how we raise that level of 
capacity building.
    Second, we need to make sure that we have got sustainable 
financing. Now, let me be very, very clear. The generosity of 
this Congress over almost 20 years to put the United States in 
the position to be the world's largest donor by far to global 
health is absolutely welcome.
    In order to get to where we need to go, if you think about, 
for example, the Global Health Security agenda that was 
launched some years ago, it made significant progress in 
building the capacity of countries to prevent, detect, and 
respond to health threats.
    It does not, today, have sustainable financing. It is an 
international effort, but it does not have sustainable 
financing. So we are looking at not only options that can be 
fulfilled through the provision of foreign assistance, but are 
there other mechanisms for financing this kind of capacity 
building over time.
    I would absolutely agree with you, Senator, it is 
overwhelmingly in our interest and, indeed, the world's 
interest to take a systematic approach building on the 
foundations we have been able with partners to set, and invest 
our health assistance in continuing to strengthen those health 
systems and build the capacity for all countries to prevent, 
detect, and respond.
    Senator Cardin. I would just respond by saying under PEPFAR 
we did provide substantial resources in order to be able to 
complete a task of health infrastructure in the country.
    Ms. Smith. Yes.
    Senator Cardin. Some of us have visited the countries that 
have been PEPFAR countries and we see a tremendous difference 
from those that were not PEPFAR countries.
    The second point I would just want to raise is that we do 
not yet know the secondary impact of COVID-19, and that could 
very well present challenges to us, as we look at our 
international assistance, as to how do we deal with the 
secondary impacts that have occurred as a result of COVID-19, 
in, particularly, the developing world.
    So these challenges are going to be continuing. I agree 
with you on the funding flow. We have to provide the funding. 
We also have to energize our partners in coordination. We did 
that with PEPFAR.
    We also did it with the sustainable development goals under 
the United Nations, which I think is another model that we can 
use in order to make consequential differences in countries and 
have them prepared to deal with the uncertainty of the future.
    Mr. Konyndyk. Senator, thank you for highlighting the 
secondary impacts. I think what we are seeing in USAID is that 
this pandemic is touching every part of everything that we do 
regardless of whether or not that is health related.
    So one example that has been--that I have seen is the way 
that the health crisis translates into an education crisis 
because of a financial crisis.
    So the health crisis hurts economies in the developing 
world. That puts financial pressure on household livelihoods. 
That means they cannot afford school fees and they need to put 
children to work. So the children are pulled out of school.
    So these crises cascade and link to each other. It starts 
with the virus, but it manifests in multiple other ways, and we 
are trying to tackle that through our programming as well.
    Senator Cardin. Let me, again, thank the witnesses.
    And thank you, Mr. Chairman.
    Senator Kaine. Thank you, Senator Cardin.
    Next, and we are moving in order of appearance and 
seniority, Senator Barrasso.
    Senator Barrasso. Thanks very much, Mr. Chairman.
    The World Health Organization, in my opinion, needs to be 
reformed. The coronavirus pandemic brought to light serious 
questions about the World Health Organization's transparency, 
independence, and ability to address the global pandemic.
    The United States, I believe, has to be much more clear-
eyed about the World Health Organization's leadership failures 
and mistakes if we are ever going to ensure that it will never 
happen again.
    So May 24 the World Health Assembly is meeting. It is an 
opportunity for us to raise concerns and demand reforms. Of 
course, the World Health Assembly is the decision-making body 
of the World Health Organization.
    So I believe reforms are needed to ensure the accurate and 
transparent information sharing to members. Changes need to be 
made in order to address the vulnerabilities of misinformation 
and political influence.
    For the WHO to be successful in the future, it must earn 
back the trust of the international community and perform much 
better than it did during this crisis.
    So could someone please outline for me the specific reforms 
this Administration is demanding from the World Health 
Organization?
    Ms. Smith. Yes, I will take a stab at that. Thank you, 
Senator, for the question.
    I think we are in strong agreement that for the present and 
for the future we need a very strong, very effective, very 
capable World Health Organization.
    We are engaged on three areas of reform, and as I said 
earlier, I think this is also about modernization to make sure, 
again, that the WHO is fit for purpose in the future.
    The first is on surveillance and alert. Those systems need 
improvement if we are to be able to move as quickly as we need 
to move.
    The second is in the area of transparency, which you 
mentioned, which is absolutely vital. Again, when we can see 
what is happening with a virus, we are much better positioned 
to track it, but also the capacity of WHO and its members to 
quickly respond and this includes strengthening the 
international health regulations and compliance with them.
    Because while we need to strengthen the institution, the 
WHO is also as strong as its members. So we feel very, very 
strongly and we are urging members across the board that they 
need to not only comply with but strengthen the IHRs, support 
the kind of transparency to which you reference, and so on.
    The third area is cost effectiveness and sustainability. 
This is a very expensive pandemic. We need to be well prepared 
for those things that may happen in the future. We have got to 
make sure that money is spent wisely and effectively and 
achieves results so that we can sustain those capabilities over 
time.
    Senator Barrasso. Along those lines, you had earlier in 
your testimony----
    Ms. Smith. Yes.
    Senator Barrasso. --used the word leverage.
    Ms. Smith. Yes.
    Senator Barrasso. I am wondering what leverage we now have 
to make the kind of changes that you have just outlined.
    Ms. Smith. I think that we have got significant leverage 
and significant influence. The United States is an absolutely 
critical partner to WHO. I think that the WHO itself would say 
there are reforms that are in need of making.
    I think the institution itself has spoken to those, and I 
think we are finding with countries around the world that there 
are some things in WHO that have worked well and there are some 
that have worked less well. We have had the most dramatic 
global scare you could imagine with this pandemic, and I think 
it has taught us all a lot.
    So, yes, I think we are in a very good position to 
influence WHO but also influence other members, including on 
their behavior but also on their role vis-a-vis supporting the 
institution.
    Senator Barrasso. Yes. I was one that felt by withholding 
money from the World Health Organization we would have more 
leverage, that they would then want the money. So that is where 
I have been coming from.
    Ms. Smith. Yes.
    Senator Barrasso. The American Rescue Plan provided a total 
of $3.5 billion in emergency funding for the Global Fund to 
fight AIDS, tuberculosis, malaria. To me, that is a dramatic 
commitment by U.S. taxpayers and our resources.
    As the largest contributor to the Global Fund, the U.S. 
provided over a billion and a half dollars fiscal year 2020. 
What specific steps has the Administration taken to leverage 
these funds in order to raise contributions from other donors 
you had said we have--we are using our leverage? What are we 
doing specifically?
    Ms. Smith. Thanks for asking this, and the Global Fund has 
been absolutely key on another key element. Vaccines are 
important, but we also need the diagnostics and the 
therapeutics to make all of this work.
    You may be aware, sir, that one of the things that we did 
years ago was establish, basically, a match where we had agreed 
that the United States--this was in--before the pandemic, so I 
want to be clear this has not pertained to this funding, but 
that the U.S. would cover a substantial portion of the Global 
Fund financing and we would, essentially, use that to match and 
leverage contributions from other countries.
    I think we are still in a position to do that. We are 
actively, on funding for the Global Fund, reaching out to other 
donors constantly to make sure that it is capitalized in the 
way it needs to be.
    I will tell you, quite honestly, that for those of us who 
are doing this work it is very effective when we can say our 
Congress just put billions of dollars on the table and that 
we----
    Senator Barrasso. I am running out of time. I do--I am 
looking across at Senator Kaine and Senator Coons is here----
    Ms. Smith. Yes.
    Senator Barrasso. --people that I have traveled to Africa 
with, our concerns with HIV, tuberculosis, malaria. There have 
been articles written that the pandemic itself, coronavirus, is 
going to push back opportunities to make the kind of progress 
we had been making----
    Ms. Smith. Absolutely.
    Senator Barrasso. --in those other areas. Could you just 
address that, briefly?
    Ms. Smith. Yes. I think, as Jeremy has said, this pandemic 
has got knock-on effects on every single thing we do, and what 
we have seen on the HIV/AIDS side, we have seen a decrease in 
testing. It is harder for people to get their medicines. We 
have seen reductions in voluntary male circumcision, which is 
key for prevention.
    PEPFAR and, indeed, the Global Fund have tried to pivot to 
compensate for some of those potential losses. How do we make 
it easier for people to access ARVs? How do we do the extra 
work to make sure that people can safely travel to undertake 
prevention and other measures?
    So there is a real focus on it. You are absolutely right, 
sir, that this pandemic is potent enough that not only are we 
seeing the first increase in extreme poverty worldwide in 20 
years, we are also likely to see some setbacks on the HIV and 
AIDS front.
    Senator Barrasso. Thank you, Mr. Chairman.
    Ms. Smith. Thank you, sir.
    The Chairman [presiding]. Thank you, with thanks to the 
chair.
    Senator Kaine is recognized.
    Senator Kaine. Thank you, Mr. Chair, and what an important 
hearing, and I am glad to have these witnesses before us. I 
think one of the challenges that we often deal with across 
Government is the U.S. wants to do everything but we do not 
want to fund everything. So we fund part of everything and then 
we spread it so thin that we cannot make the kind of impact 
that we want.
    I think when it comes to vaccine diplomacy, we have some 
significant and hard decisions to make about prioritization.
    I would like to enter into the record an article from the 
Miami Herald dated April 27, 2021. The title of it is ``As 
Biden Rolls out U.S. Vaccine Diplomacy He Needs to Start in Our 
Own Hemisphere.'' I would like to enter that into the record.
    The Chairman. Without objection.
    [The information referred to above can be found at the end 
of this Hearing.]
    Senator Kaine. Let me just read a paragraph from this that 
is--two paragraphs that are troubling.

        ``Since the COVID-19 outbreak, the presence of China 
        and Russia in Latin America and the Caribbean has 
        expanded significantly. A few months into the pandemic, 
        China capitalized on the moment to announce a $1 
        billion loan to the region to facilitate vaccine 
        access. Today, through three of its domestically 
        developed vaccines--Sinovac, Sinopharm, and CanSino--
        China's vaccine diplomacy extends to a dozen countries 
        in the region. Argentina, Bolivia, Brazil, Honduras, 
        Mexico, Panama, and Venezuela are using Russia's 
        Sputnik V vaccine. In a regional first, Argentina is on 
        the cusp of beginning its own mass production of the 
        Russian-made vaccine.

        ``And their diplomatic gestures do not go unnoticed. 
        Mexican President Andres Manuel Lopez Obrador and 
        Argentina's Alberto Fernandez are just two of the 
        region's leaders who have publicly thanked China and 
        Russia for their help.''

    The U.S. has made a commitment with about 60 million 
vaccines to focus on other countries and I think it has 
committed 4 million of those vaccines to Mexico--I think 2.7 
million to Mexico and 1.3 million to Canada.
    My worry is with China and Russia investing so heavily in 
vaccine diplomacy in the U.S., if we are not going into the 
Bolivias and Argentinas and Hondurases and other nations, this 
is going to be a very, very serious challenge for us.
    So I guess I would like to ask you, in particular, what 
will the Administration do or what might you recommend they do 
to prioritize vaccinations in the Americas.
    Some of the likely travel patterns back and forth are more 
likely to be intense from the Americas to the United States 
because so many folks in the region have family members living 
here.
    I think there would be a lot of kind of objective data that 
would suggest a prioritization of this hemisphere. Two of our 
top three trade partners in the world are in the region. Talk 
to me about how we should prioritize the Americas as we look at 
our vaccine diplomacy efforts.
    Ms. Smith. Is my microphone on?
    Senator Kaine. Yes, you are on.
    Ms. Smith. Okay. Senator, I think we need to do three 
things.
    I am sorry, it is not on. Actually, this microphone needs a 
new button. Is that on? Yes? Okay.
    Senator, I think we need to do three things at the same 
time. I think there is absolute merit in making the case about 
our own hemisphere that affects the United States directly, and 
the activities of Russia and China I would have to describe as 
robust but very cynical.
    So I think we need to take a look at that and figure out 
how to respond. One thing I would say is that one of the ways 
to respond is to make clear that the United States sees 
vaccines as tools for ending a pandemic and not as tools to 
twist people's arms or try to secure political influence.
    I think the second thing we have got to do, though, is also 
at the same time look globally, because as we have seen in 
India, as we look at surges in other areas, and given mobility 
today, I mean, the Indian variant is in multiple countries 
already and we are going to face that constant cycle of surges 
in the transmissibility of new variants.
    We have got to be focused on particular areas. We have also 
got to be focused on how we lead the effort to start to get the 
global coverage we need.
    The third thing is on supply, which is why we have got such 
a focus on how can we increase supply. As we are considering 
the allocation of the AZ doses and other things we may do on 
that front, we are taking a look at geography, absolutely, 
while we also try to keep an eye on how do we make sure we are 
starting to get that global coverage that is needed to seal it 
up.
    Senator Kaine. Let me just say this in my last 20 seconds. 
There is just this danger if everybody is somebody that nobody 
is anybody. I mean, if we are going to prioritize the entire 
globe, we may not make the kind of impact we want.
    Ranking Member, in your opening comments, you talked about 
how we might brand what we are doing. I think we might 
contemplate a little bit of a hybrid model where the U.S. is a 
significant investor in organizations like COVAX that are doing 
vaccinations globally, but that we might choose more of a 
unilateral effort to go big in a part of the world that is most 
likely to impact the U.S. population because of migration and 
trade.
    Ms. Smith. Okay. Could we add two quick things?
    Senator Kaine. I will leave it to the chairman because I am 
over my time.
    Ms. Smith. Mr. Chair?
    The Chairman. Go right ahead.
    Ms. Smith. I think one thing, and maybe you can take the 
issue on the branding, I think part, Senator, of the mission of 
getting the global coverage is using our leadership to also 
leverage other countries, right, because other countries around 
the world are looking in their own regions and may be focused 
on other areas.
    We have got to make sure that together we start to lay that 
global foundation. I can assure you there is a lot of attention 
to our own hemisphere. So that is very much on people's minds 
and----
    The Chairman. Let me just echo Senator Kaine's remarks. Of 
course, we want to be helpful everywhere in the world as much 
as we can. Here in our own hemisphere, it is in our own most 
direct national interest.
    I just left the Finance Committee on trade-related issues 
with Central America, DR-CAFTA, with those seeking refuge from 
their countries. I could just go on and on.
    Ms. Smith. Yes.
    The Chairman. So there is a lot to be said as we are 
prioritizing where we can make a big difference, both in a 
health context and also in terms of diplomatic advancements on 
critical issues that we need.
    So I appreciate the senator raising that.
    Senator Rounds is, I understand, on Webex.
    Senator Rounds. Thank you, Mr. Chairman. I presume I am up 
and operational now.
    Let me begin by thanking both of our witnesses here today. 
I think this has been a very interesting discussion so far. I 
would like to continue it along the lines of what Senator Kaine 
had indicated as to how we focus long term or, at least, with 
regard to the worldwide response.
    It is not the first time that our country has been expected 
to respond in times of an emergency or serious economic crisis 
throughout the rest of the world.
    We think back even to World War II and the aftermath of 
World War II where we created a Marshall Plan. We planned it 
out, we laid it out, and then in conjunction with other allies 
we were able to coordinate our efforts.
    Is it time for a Marshall Plan when it comes to our 
response, or our allies, and those in need across the entire 
globe? Is it time to take a look at that type of a 
comprehensive plan?
    I just ask both of you in terms of your thoughts about the 
focus now on whether or not we find ourselves in a position of 
leading a global effort that not only would take care of a lot 
of human suffering, but--and limit human suffering but would 
also bring us into that leadership position with regards to our 
allies who need that type of long-term leadership focus, going 
forward.
    Ms. Smith. I will start but I am sure my colleague, Jeremy, 
will have something to add to that. There is no question that 
we need a grand plan and that the United States needs to be at 
the forefront of that.
    Frankly, I think that is the difference between bringing 
this pandemic to an end in 3 or 4 years and bringing it to an 
end in a year, 18 months, or 2 years.
    That is a big difference. We know what that means for 
economic stability, for political stability, and for the lives 
and livelihoods of millions and, indeed, the security of the 
United States and our own citizens.
    So yes, we do need that kind of grand plan. I think that in 
our discussions with allies we were asked about the G-7 and the 
G-20. I think that kind of unity and coalition is forging. I 
think to do that we are going to have to, as the Marshall Plan 
did, focus on multiple fronts.
    The Marshall Plan was, indeed, about resources. It was also 
about policies. It was also about markets and dealing with the 
economic impacts of World War II and, similarly, we have got 
the same kinds of impacts in this pandemic.
    I think it is worth thinking that boldly. I think this is a 
different time. I am also confident that unless we all come 
together with a bold financed vision, prepared to take some 
risks and do some new things, we are going to suffer two 
consequences. This will last longer than need be and we will be 
less prepared for what we face in the future.
    Mr. Konyndyk. If I could just build on that. I think that 
that is also a key difference, and picking up on Senator 
Kaine's earlier point, that is a key difference between what we 
are trying to do and what we see China and Russia trying to do.
    What we see China and Russia trying to do is, in effect, 
use small amounts of vaccine sales to extract political 
concessions and gain political influence.
    What we want to do is use a mass response to end the 
pandemic and let that be the legacy of what America is trying 
to do here, not extracting small-scale political concessions 
with arm twisting for vaccine sales that they then, frankly, 
are often failing to deliver on.
    So we want to deliver--we will deliver on what we promise 
and what the President aspires to do and what the President is 
committed to leading is of the ambition of ending the global 
pandemic.
    That is the--whether that is the Marshall Plan or whatever 
we call that, that is the legacy that we want for this 
Administration and for American leadership in this crisis.
    Senator Rounds. Thank you very much for your responses. 
Look, I guess the way I look at it is if we do what is right in 
this particular case and if we lead from the moral high ground, 
which is not only good business, in this case, economically, it 
means that we respond quicker, our trade patterns return.
    We find, perhaps, more interest in our--in our allies 
responding and recognizing that there is a benefit in working 
with people that have the same common belief systems as we do, 
and that is what we are looking for around the world.
    It puts us in a better position long term, and at the same 
time back here at home we do not suffer the mutations and 
changes that are going to come back to haunt us if we do not 
get this pandemic under control in other areas of the world. So 
I think it is a win-win all the way around.
    Mr. Chairman, I am not sure but I suspect my time is real 
close to being expired. I thank you and I thank our two 
witnesses for participating today.
    The Chairman. Thank you, Senator Rounds.
    Senator Coons.
    Senator Coons. Thank you, Mr. Chairman, Ranking Member 
Risch. Thank you for holding this hearing and for the 
encouraging effort you are making together to develop a bill 
that will guarantee we learn from this pandemic and strengthen 
global public health systems.
    Thank you to Ms. Smith, Mr. Konyndyk. Great to be with you 
both again.
    Gayle and Jeremy, your previous experiences in very 
challenging moments, such as the Ebola outbreak in West Africa, 
give me confidence that you are just the right people to be 
leading these critical response efforts.
    To just follow up on what Senator Rounds was saying, this 
is a critical moment for us to seize this opening, to reengage 
with the world. We have got the experience.
    We have got the deserved reputation as a global public 
health leader. We invested in, innovated, and developed the 
most effective vaccines in the world, and our global 
competitor, China, is busy sending out a vaccine that has been 
demonstrated to have a significantly lower efficacy.
    Our global competitor, Russia, is engaging in a 
disinformation campaign to dissuade folks in Central America, 
South America, and elsewhere from using U.S.-delivered and 
developed vaccines.
    I am interested in talking with you about how we ramp up 
vaccine manufacturing both here in the United States and 
throughout the world, how we ensure it is delivered in as 
timely and equitable way as possible, and then how we push back 
on the disinformation campaigns.
    We really can only talk about the possibility of the 
pandemic ever ending if we get to a point where it is not 
mutating and we do not have new variants developing, as this 
disturbing new variant in India has, that are more transmissive 
and more lethal.
    So let me start with--you mentioned, Gayle, plans that DFC 
has announced for expanding manufacturing capacity. Rather than 
getting into IP issues, I think the priority issue for us ought 
to be dealing with manufacturing and distribution around the 
world.
    I am encouraged that South Africa's Aspen Pharmacare 
manufacturing plant is getting up and running, that the DFC is 
working with South Korea on a new manufacturing line.
    Just tell me about our plans to work with critical allies 
like the Quad, our four key partners in the Indo-Pacific, to 
tackle research and production hubs and to rapidly grow the 
capacity of the Global South to manufacture and distribute.
    Ms. Smith. That is an excellent question, and a vital step 
not just for now but also in the future----
    Senator Coons. Right.
    Ms. Smith. --because, clearly, I think one of the things we 
were seeing in this pandemic is that there is not enough 
decentralized vaccines manufactured around the world to lend 
itself to manage----
    Senator Romney. Your microphone is off.
    Ms. Smith. Is it on now?
    Senator Coons. Yes.
    Ms. Smith. All right. What I was just saying is that I 
think that is important for the present and for the future 
because we need to have more decentralized vaccine manufactured 
around the world to deal with global outbreaks, epidemics, or 
pandemics.
    There are a couple things we are exploring. One, as you 
rightly referred to, DFC reaching out to those places where an 
injection of capital would yield significant increases, 
actually, in the near to medium term.
    Now, one of the ways we can do that with allies is that all 
of our G-7 partners, for example, have the equivalent of a 
development finance institution. In the aggregate, that is a 
great deal of capital.
    Also, working with the IFC, with whom we are engaged, we 
can marshal a lot of capital to get those ramp-ups fairly 
quickly. So that is number one.
    I think number two, it is also making sure that even the 
domestic market and other markets are getting the signal that 
they need to receive that there is capital out there to 
actually buy vaccines.
    COVAX is looking to buy vaccines. The African Union, as you 
may know, is working with a $2 billion line of credit. The 
Asian Development Bank has capital available for its members to 
buy vaccines, as does the World Bank. Those are disaggregated 
signals to the market at this point.
    One of things we are trying to do is make sure that that is 
a very clear and loud signal that it is not simply dose sharing 
or just COVAX. There is money out there to procure and how do 
we make sure that we are increasing supply to meet that demand.
    So that is a second piece of it.
    Senator Coons. I would be interested in hearing from both 
of you how can we most effectively counter disinformation 
campaigns.
    Ms. Smith. Yes.
    Senator Coons. I have been really troubled to hear that 
Russia is actively engaging in a disinformation campaign to 
suggest that somehow American-sourced vaccines are less 
effective than Sputnik.
    Ms. Smith. Do you want to start?
    Mr. Konyndyk. Yes, I will start that.
    I would not oversell the effectiveness of those campaigns, 
to be honest. I think everything that we are hearing from every 
country where USAID works and, frankly, every country where the 
U.S. has a presence is that they prefer and want to obtain 
U.S.-produced and Western-produced vaccines because they 
recognize the higher quality.
    The Russian vaccines have not gone through any sort of 
approval process or authorization process at WHO or from any 
stringent regulatory authority. Countries know that. They know 
that ours have.
    I think, by sticking to that science that will be 
recognized, that puts them out front. Countries recognize that 
they want those vaccines. I do not think they are fighting a 
winning battle when they cannot put their own vaccine through 
authorization and have it come out the other end.
    Senator Coons. Let me just commend the Administration. We 
are at a point of having 110 million or more Americans 
vaccinated. We are going to continue vaccinating Americans at 
the rate of 2 million a day or so and keep pushing on equity 
and access here.
    We have to also now dramatically ramp up the availability 
of vaccines around the world. I am excited to keep working with 
you on this challenge.
    Thank you, Mr. Chairman.
    The Chairman. Thank you.
    Senator Romney.
    Senator Romney. Thank you, Mr. Chairman.
    Let me ask, is there a written plan at this stage saying 
what our priorities are country by country? Who is getting what 
PPE, who is getting what vaccine, what additional funding might 
be necessary to meet our objectives? Has that been written and 
established at this stage?
    Ms. Smith. Senator, there is a written and established 
framework that we are in the process of finalizing, which goes 
into great detail. We have the documentation. I will let USAID 
speak for this, given the new allocations of funding as that is 
allocated around the world.
    On your other piece in terms of where the vaccines are 
going, we are working closely with COVAX on the allocations of 
vaccines, which our funding has provided, and, obviously, on 
the AZ and any other doses we might share we will be able to 
take this----
    Senator Romney. So the decision that Senator Kaine raised 
about we need to provide additional support for Latin America, 
is that part of a document where we have laid out this is how 
much we are going to send to Latin America, this is how much is 
going to be going to India? Do we--have we--describe----
    Ms. Smith. Yes. It is--in terms of how we allocate the 
AstraZeneca doses, for example, there are deliberations----
    Senator Romney. I am talking about all of them--the PPE, 
each vaccine. I mean, have we--I mean, because it is apparent 
that China and Russia have a game plan. They have decided where 
they are going to send it. I mean, they have moved, they have 
acted.
    Ms. Smith. Right.
    Senator Romney. They are getting various approvals that 
they want to receive. Do we have the same thing in place or are 
we still on the process of deciding what we are going to do?
    Ms. Smith. Well, let me try and answer that two ways.
    One way is we have got a great deal of that. We are still 
making decisions. We will finalize a decision on the AZ doses 
soon, and those will be prioritized and you will be able to see 
where those are going.
    We have got a similar discussion ongoing with COVAX so that 
we do have some influence on where those doses go. Similarly, 
again, on things like PPE and other assistance, I think the 
distinction I would make between the United States and Russia 
and China on this is that, again, while we do prioritize and 
will prioritize, and I think your comments were well received 
on this, we are also sending a signal that we are not 
allocating PPE as a tool for trying to gain influence. We are 
allocating PPE so that we can help countries prepare, for 
example, for the kind of surge we have seen in India.
    Senator Romney. I just--I guess I am a little concerned, as 
I have been listening to these discussions so far, that we are 
discussing, we are planning, we are prioritizing. We are 
interacting with others.
    I mean, the President has put forward over $6 trillion 
dollars of legislation bills in his first 100 days. Yet, with 
regards to this global crisis, we are still planning and trying 
to prioritize.
    Ms. Smith. No. Yes.
    Senator Romney. I--it would strike me that that the 
Administration and other people have put forward a very clear 
plan as here is what we are doing. Here is what our objectives 
are. Here is phase one. Here is phase two. Here is phase three. 
Here are the countries we are going to first and the world 
would know what those things are.
    Ms. Smith. Sure.
    Senator Romney. At this stage, we are all here listening 
and, frankly, wondering why cannot we move as quickly as Russia 
and China to decide precisely what we want to do or where we 
want to do it and communicate that to the world.
    Ms. Smith. Senator, we have got that framework and, 
respectfully, we have not been asked----
    Senator Romney. Where is it? Because Senator Kaine just 
asked what is happening in Latin America. Could we not know--I 
mean, do the people in Latin America, country by country, know 
what is coming to them, when it is coming, what our priorities 
are?
    Ms. Smith. In some cases, yes. In other cases, we are in 
the process of allocating the funding that was provided by 
Congress. Yes, we can walk through the details of where that is 
going and how much----
    Senator Romney. I think it would be helpful to have that--
--
    Ms. Smith. Sure.
    Senator Romney. --have that available to the--not only 
Congress but to the American people and the people of the world 
as to what our priorities are and for us to have certain 
objectives that we may not communicate but to have that 
understood in this body.
    Let me turn to a different topic and that is with regards 
to the President's decision or tentative approval to waive 
patents with regards to vaccines. I do not know that that has 
happened in the past.
    It does strike me that the pharmaceutical companies have in 
the past tailored the prices of their products to the ability 
of a market to pay, if you will. So they do not charge the same 
price for statin drugs in Africa than they do in France that 
they do in the United States.
    We sometimes complain about that, but the reality is they 
have adjusted that way. Is there some reason to believe that 
they would not be willing to do that with regards to the sale 
of their vaccines and that we would not have to blow through 
patents and set a precedent that could affect their willingness 
to make investments in the future?
    Ms. Smith. We would, certainly, hope that they would do 
that. The negotiations of various countries have been based on 
variable prices is what we know to date. So that has been a bit 
of a challenge.
    I think just to be very clear on the position on the TRIPS 
waiver, the intention there is not to abandon the commitment to 
IP. The commitment to IP is very, very strong. This is a once 
in a century crisis.
    One of the things we know, for example, that on average it 
takes 7 years for drugs that are available in this country to 
make it to the world's poorest countries. So often they end up 
at prices that are affordable, but it takes a great deal of 
time.
    What will happen now, given the position on the TRIPS 
waiver, is that our U.S. Trade Representative and her team will 
enter into text negotiations, which will take some time. I 
think it was our view that extraordinary times require 
extraordinary measures and we need to look at that.
    Our hope would, certainly, be that companies would make 
vaccines available at the lowest possible price so that we can 
do everything we can to shorten the lifespan of the pandemic.
    Senator Romney. Thank you, Mr. Chairman.
    The Chairman. Thank you.
    Senator Murphy.
    Senator Murphy. Thank you very much, Mr. Chairman. Thank 
you both for your willingness to speak with us today and for 
your work on behalf of the country and the world.
    Let me just, first, associate myself with remarks made by 
Senator Risch earlier in the hearing regarding, I think, an 
effort that we need to undertake to clarify lines of authority 
with respect to our work around pandemic prevention and 
preparedness.
    I have spoken to Director Walensky about this, and the good 
news is that CDC is trusted all around the world. They have 
great relationships on the ground with public health 
practitioners, especially in developing nations.
    The bad news is that I think sometimes they do not always 
make the connections that they could into the kind of 
partnership programs that we can do through USAID and State, 
and now that we will, hopefully, have more resources to do that 
with, it is more important than ever that as quickly as 
possible we are entering into these conversations with 
countries about how to help build up their public health and 
pandemic prevention systems.
    So that clarifying line of authority for countries and for 
countries' public health professionals, I think, would be 
incredibly important.
    Two questions. One, a general one and one a country-
specific one. The general one is on a reference that President 
Biden made in his National Security Referendum to a new health 
security financing mechanism, and I think you have talked both 
a little bit about this already.
    I am a believer, and I have put forward legislation to do 
this, that the MCC model, while imperfect, is an important one 
and there is a way in which you can essentially enter into 
agreements with countries, whereby we will be a significant 
partner with them on helping to rebuild their public health 
systems in exchange for commitments on reform.
    That, to me, is a model that could work here and could, 
frankly, sell to the American taxpayers. Any more color on sort 
of what you are considering with respect to this new health 
security financing mechanism and is some of the dollars in the 
relief bill going to be used to seed fund that?
    Ms. Smith. Yes, and I think the way we are trying to look 
at that is, in part, what has worked and how do we come up with 
a financing mechanism that, frankly, is not fully reliant on 
foreign assistance.
    I would love a world where we could sort of guarantee that 
there was the capital, going forward, in a budget on the 
foreign assistance side to fund this kind of work years into 
the future.
    Now, we have seen that with things like PEPFAR. There has 
been sustained funding over the years. I think we need that 
kind of sustained funding on the foreign assistance side, but 
to also look at other models.
    We are looking at what may be possible on the multilateral 
development bank side, what may be possible with respect to 
other revenue streams, are there ways that we can get financing 
beyond just foreign assistance to sustain this because, 
unfortunately, the experience of the last several years, much 
to our collective regret--and this is not just the United 
States, this is all over the world--is that that kind of 
funding has generally fallen by the wayside.
    I take your point on MCC and I think one of the great 
advantages that we have is that we have got an awful lot of 
examples in our own Government. We are looking at all of those. 
We would also welcome any additional recommendations you all 
have on this.
    Senator Murphy. Let me ask a country-specific question. In 
my state, I have got a big Nepalese-American population.
    This is a country that, obviously, is already significantly 
impacted by an upsurge in COVID-19 cases but, particularly, 
because of the export ban in India and their inability to get 
medical supplies like ICU beds and oxygen and ventilators in 
from Indian suppliers.
    That country is in dire straits. I know that USAID has 
already allocated about $10 million. That is, obviously, a 
relative drop in the bucket.
    What else can we be doing to make sure that Nepal is not 
overwhelmed in the way that India is today--they are close, but 
they are not there yet--and some steps that we can take, too, 
for a country 30 million people strong today would be a 
seemingly wise investment.
    Mr. Konyndyk. Thank you, Senator. Yes, you are absolutely 
right. We are very focused on Nepal right now. In fact, 
directly prior to coming to this meeting, I was on a call with 
our team in Nepal and some of our other teams in the South Asia 
region planning exactly what--the sort of assistance that you 
are referencing.
    So far into the pandemic, USAID has provided about $23.7 
million of COVID-19-related support to Nepal, including a 
recent new allocation of $10 million to help them address the 
current surge.
    We are in the process of planning additional funding as 
well as planning material supply deliveries. One of the 
challenges that Nepal has is under-testing, so their test 
positivity rates are extraordinarily high. I think the average 
in the country is about 42 percent. There are parts of the 
country that are 70 to 90 percent. That is a sign they are not 
testing enough.
    So we are going to surge in testing support as well as 
other forms of support and continue to pay close attention to 
it.
    Senator Murphy. Well, thank you for your focus on that 
endeavor. Thank you, Mr. Chairman.
    The Chairman. Thank you.
    Senator Hagerty.
    Senator Hagerty. Thank you, Mr. Chairman, and thank you to 
both of our witnesses today for being here and for your 
service.
    Senator Romney inquired a few minutes ago about our 
strategic planning for allocating PPE, vaccines, and other 
resources. I would just like to make the comment that I hope 
that our allocation of these resources will be based on 
America's strategic interests.
    In that regard, I was in Guatemala, Mexico, last week. We 
have a surge of people coming across our border right now. In 
fact, 570,000 people have been encountered just this fiscal 
year.
    That surge is bringing in people that we do not know have 
been vaccine--whether they have COVID or not. I can tell you 
from meeting with the leadership in Guatemala and in Mexico 
there is a dearth of vaccine. Huge problems. You know the 
Sputnik problem down there.
    Ms. Smith. Yes.
    Senator Hagerty. If we are prioritizing these assets, I 
would like to know--or vaccines, what the plan is, again, for 
Mexico, for Central America, Latin America, and South America. 
How are we prioritizing the allocation of vaccines to those 
countries, given our strategic interest and the fact that in my 
home state of Tennessee, we have people being shipped in from 
across that border right now.
    Unaccompanied minors are being housed in my state. 
Hospitals do not know what to expect. The school system does 
not know what to expect. How do we address this?
    Ms. Smith. Thank you for the question, Senator.
    As I alluded to a few moments ago, we are in the process of 
finalizing the decisions on the allocation of the AstraZeneca 
vaccines, and I think you will see a reflection in those of the 
kind of interests and concerns that you point to.
    I do not want to get ahead of the process or ourselves. In 
the coming days, we will be able to walk through that in some 
detail with you.
    Senator Hagerty. Well, I would encourage speed in every 
respect here because we have a crisis at the border right now 
and we have partners south of the border that want to work with 
us and are desperate to work with us.
    Ms. Smith. Yes.
    Senator Hagerty. What I do not want to see happen is 
creating yet another magnet for illegal immigration because 
they cannot get the vaccines down there. This is just another 
reason why people are flooding across our border right now.
    So I would very much appreciate your attention to that in 
your planning.
    Ms. Smith. Sure.
    Senator Hagerty. Again, as soon as we have a plan, I would 
also concur with Senator Romney that plan needs to be made 
public, not only to the Congress but to the American people and 
to our allies around the world.
    Ms. Smith. We will be doing that. Thank you. Thank you very 
much.
    Senator Hagerty. Thank you very much. Thank you.
    I have got another question that I would like to turn to 
here. This has to do with the Quad framework. In my previous 
position, I spent a lot of time in that region as U.S. 
Ambassador to Japan, and I applaud the Biden administration for 
continuing to emphasize the importance of our cooperation with 
the Quad.
    The Quad partnership has come together around the COVID-19 
situation and have made significant pledges with respect to 
providing vaccines, over a billion doses, in fact, being 
pledged to that--to that region, and I want to come back to the 
conversation about what is happening in India that Senator 
Murphy brought up.
    What is the plan now that India is not able--not in the 
position to produce and deliver vaccines beyond its own border? 
How are we going to backfill that commitment? How are we going 
to address that commitment, now given what has happened in 
India?
    Ms. Smith. Yes. Do you want to start and I will follow?
    Mr. Konyndyk. Yes, I am happy to--thank you--and, Senator, 
that is the key question right now for global vaccination.
    A lot of the initial--because of India's role in supplying 
most of the vaccines that are produced globally and their 
ability to do so at low cost, much of the global vaccination 
effort initially was to hinge on that. That has changed now, 
given the situation in India.
    COVAX is working with U.S. support to diversify their 
portfolio. So they recently signed deals with Novavax and with 
Moderna for their vaccines. Moderna, of course, is the one that 
we have access to here.
    Novavax is one that is forthcoming and they are placing a 
bit of a bet but I think a safe bet that that will come through 
authorization and be usable.
    That helps to diversify so that their portfolio is less 
reliant on India. We are also working to enhance manufacturing 
and enhance the supply chain that feeds into manufacturing.
    One of the challenges that India has, and we are seeing it 
in other places like Brazil and in some of the European 
producers, they cannot--they just cannot access sufficient 
supply to produce the vaccine. So their production ceilings 
they are falling short of.
    So we are working with colleagues at the White House and at 
HHS who track those global supply availabilities to figure out 
how we can better optimize which vaccines are being produced 
where and the allocation of some of those supplies so that we 
can make sure that the greatest volumes of appropriate vaccines 
are being produced.
    That, I think, is the long-term play. We have got to get 
that supply chain piece right so that global production can 
rise to the level we are going to need.
    Senator Hagerty. I appreciate that, and I want to bring us 
back to my opening comment. We need to take into account 
America's strategic interest as we do this. We have a massive 
strategic interest in that region.
    So I appreciate your attention and focus on that. I am 
running out of time, but I would like to also ask, if I could, 
about COVAX. You mentioned COVAX. I would like to get an update 
at a separate time about how that program is functioning.
    When I met with leadership, both in Guatemala and Mexico, 
there is a very deep shortfall in terms of what expectations 
are versus what is being delivered, and if we could make 
arrangements to get an update on that I would appreciate that.
    Mr. Konyndyk. I would be very happy to do that. Thank you.
    Senator Hagerty. Thank you. Thank you, Mr. Chairman.
    The Chairman. Thank you.
    Senator Merkley.
    Senator Merkley. Thank you, Mr. Chairman.
    I wanted to get a--kind of a better roadmap of where we get 
to internationally in the sense that a group of public health 
advocates have said we should have a goal of producing 8 
billion doses of mRNA within a year to inoculate, essentially, 
half the world and cut 2 years off the pandemic's projected 
duration.
    Is that a goal that you have--Director, you have embraced 
in terms of creating an arc for American leadership and do you 
feel like we have sufficient resources and leadership 
connections to drive success in that vision?
    Mr. Konyndyk. So I would put it this way. We need enough 
supply of enough vaccines in the right combinations to get to 
the target levels.
    I am a little less concerned with whether they are 
specifically an mRNA vaccine or other vaccine technologies as 
long as they are effective and can be delivered safely and 
effectively, and I think there are merits to both.
    So mRNA has a really important role to play in that. mRNA 
is also a new technology. It is harder to take to scale than 
some of the others--some of the other more traditional 
vaccines, and at least in the case of the Pfizer mRNA vaccine 
has more difficult handling requirements.
    So I think we need to use all of the candidates that we 
have in appropriate combination to cover as much of the world, 
depending on what, you know, different countries are set up to 
handle.
    Senator Merkley. So you--but you embrace--you embrace the 
vision of that 8 billion dose goal?
    Mr. Konyndyk. I would say mRNA vaccines are, you know----
    Senator Merkley. I am not----
    Mr. Konyndyk. Yes.
    Senator Merkley. I will accept----
    Mr. Konyndyk. Yes. Yes.
    Senator Merkley. --that other vaccines may well fill in. 
That goal of the number of doses to try to speed up global 
resistance.
    Mr. Konyndyk. I think it is a matter of--without putting an 
8 billion figure on it, we need as many mRNA vaccines as we can 
get and----
    Senator Merkley. Okay. I will just--I will cut you off 
there.
    Mr. Konyndyk. Yes, sir.
    Senator Merkley. What I would like you to explore----
    Mr. Konyndyk. Yes.
    Senator Merkley. --is whether having our President, in 
partnership with other leaders, embrace some number because a 
number puts a flag in the ground. It says this will now--now 
how do we get there.
    Mr. Konyndyk. Yes.
    Senator Merkley. How do we put all the pieces together to 
get from this day and 365 days from now we are going to have 
this level.
    Mr. Konyndyk. Right.
    Senator Merkley. If you get to 7 billion, you get to 9 
billion, but it drives--but when it is just, like, we need as 
much as we can get, it does not drive a plan.
    Mr. Konyndyk. I agree.
    Senator Merkley. We have to have a plan.
    Mr. Konyndyk. Yes.
    Senator Merkley. We have so much at stake in this. I guess 
I will just put this as a question. I look at this as, one, the 
world needs to come together in this from a humanitarian, from 
a moral perspective.
    Second, we need to come together because as long as there 
is a reservoir of disease out there, that disease is going to 
be reimported to the U.S. It means more Americans getting sick. 
It means more Americans dying.
    It means more opportunity for this pandemic virus to mutate 
and cause new problems and have to drive, essentially, a lot 
more costs in the future. Do you share--am I describing a world 
that you agree with?
    Mr. Konyndyk. Absolutely. What we need--I think the target 
figure we need to start with is how much of the world do we 
need to cover and that is, President Biden has said for the 
U.S. he wants to target 70 percent. The African Union is trying 
to target 60 percent.
    I think something in that range, and then it is a question 
of which vaccines will come online in which volumes to enable 
us to get to that between the mRNA and any others. Absolutely, 
that is the----
    Senator Merkley. Well, I look forward to announcements from 
the Administration that--and I think it also puts the U.S. in a 
leadership role to say, this is our partnership with the world 
to make this happen. We are going to do everything we can.
    Mr. Konyndyk. Could not agree more.
    Senator Merkley. Then it drives resources that Congress can 
consider appropriating. When it is vague, like, well, let us 
get as much as we can, that does not drive action in the same 
way.
    Mr. Konyndyk. Completely agree.
    Senator Merkley. I would like to turn to you, Gayle, in 
terms of another piece of this, which is the sharing of 
technology, and I think the discussion has reverberated in two 
different ways: one, having companies share their recipe, if 
you will, because of the urgency, and it is tied into the first 
question I am asking about.
    How we get from here to there a year from now and reduce 
the risks to America and do the right thing globally? Also, the 
action in terms of changing the patent restrictions that needs 
to go through the World Trade Organization and are we 
aggressively pursuing both of those approaches. Do you support 
those approaches?
    Ms. Smith. Yes. I think, given the urgency of the 
situation, we do have to do both things, which is what led to 
the position on the TRIPS waiver. Technology transfer is 
another key variable, as you rightly point out. So that is 
going to be key, I think, for now and for into the future.
    I would add, though, it does not solve the whole problem, 
as Jeremy suggested. I would not minimize, though, given the 
technology requirements for mRNA vaccines and I would not 
minimize the importance of, say, some of the other vaccines and 
the scaling up on those to be able to meet the need.
    Yes, I think we absolutely have to look at a better 
solution than what we have now to making vaccines available 
sufficiently that we do not see another global pandemic and we 
bring this one to an end. Absolutely.
    Senator Merkley. I know I am out of time. Do I have time 
for a specific follow-up, Mr. Chair? Do you have others 
waiting?
    The Chairman. I know Senator Shaheen has come back. If you 
want to wait----
    Senator Merkley. I will follow-up. Thank you.
    The Chairman. If you are still here, Senator Merkley, we 
could consider going a second round.
    Senator Shaheen.
    Senator Shaheen. Thank you very much, Mr. Chairman, and 
thank you both for being here and for your testimony. I am 
sorry I had to miss so much of it because we had another 
hearing in Appropriations going on.
    I wanted to ask you about some of the ancillary impacts of 
the COVID pandemic, which, as you pointed out, has tragically 
taken more than 3 million lives over the last year.
    It has also created a global food security and malnutrition 
crisis, which you know very well. As of April 2021, the World 
Food Programme estimates that 296 million people in 35 
countries where it works are without sufficient food. That is 
111 million more than in April of 2020.
    So and prior to the COVID outbreak, we were losing about 3 
million children each year dying as the result of malnutrition. 
Obviously, that number is increasing.
    So can you talk about how USAID and the State Department is 
prioritizing assistance to address malnutrition as part of our 
effort to combat the COVID-19 pandemic?
    Mr. Konyndyk. Yes, absolutely. Thank you for that question, 
Senator.
    The humanitarian and development and, particularly, as you 
are noting, the food security and nutrition impacts of this 
pandemic have been one of the most severe manifestations we 
have seen beyond, of course, the deaths from the virus itself.
    The number of people in humanitarian need has risen by 
about 40 percent since pre-pandemic and much of that is 
manifesting in the food security space.
    So one of the first things that we did with ARP funding was 
expedite both some of the cash funding through the ESF and some 
of the Title 2 in kind food aid to patch gaps in the food 
pipeline--the World Food Programme global food pipelines that 
go to humanitarian settings--for exactly that reason, that we 
are very, very concerned about the potential for famine in 
multiple countries.
    So that that has been an urgent priority. That money has 
been flowing already. It was the first thing--it was the first 
money that we got moving from the ARP after the Congress passed 
the bill.
    We are not limiting our focus there to humanitarian 
settings, of course, because we know that the food security and 
malnutrition impacts are also showing outside of traditional 
crisis settings and in a situation like this, those kind of 
traditional definitions of what is and is not a crisis begin to 
blur as well.
    So through our Bureau for Resilience and Food Security, we 
are also providing additional support in more sort of 
traditional development settings to food security needs and to 
childhood nutrition needs as well, and the resources that we 
have received from Congress will be very important in that.
    I think the last thing I would say is we will do this 
through the ARP funding, but this is also going to be a long-
term priority because we are going to be paying for or kind of 
feeling the development impacts of this well beyond the point 
at which we end the virus.
    Senator Shaheen. So do we need more assistance--funding 
assistance?
    Mr. Konyndyk. We will--I am not going to get ahead of the 
White House on the funding request, as you can understand.
    I think, certainly, in the out years of the budget we are 
going to continue to feel the development impacts of this and 
we are going to need to reflect that if we are going to fully 
combat this.
    Senator Shaheen. I missed--I am sure you addressed what is 
happening in India in some of the questions, which is just 
horrific.
    I have heard from some of the members of the Nepalese 
community in New Hampshire that we are also seeing even faster 
rates of spread of the virus in Nepal.
    How are we prioritizing small countries that may not be on 
the front lines of the news these days but we know are having 
the same sort of critical challenges?
    Mr. Konyndyk. I would say that for USAID, Nepal is 
alongside India. It is our highest priority right now and, 
actually, just prior to the hearing, Senator Murphy asked about 
this as well while you were out.
    I came from a meeting directly on how we are expediting 
into Nepal. We have been sending aid there. We recently put 
another $10 million in just in the past few weeks and we are 
currently planning additional aid deliveries of in kind 
assistance that will be transported in, particularly on 
diagnostics and testing, which is a major weakness there.
    Senator Shaheen. That is great. Thank you.
    One of the--we know that this pandemic has affected women, 
certainly, in the United States and around the world probably 
more dramatically than men because women tend to be the 
caregivers in all of our societies.
    Can you--and one of--it is having an impact, as you pointed 
out, in other aspects of healthcare systems throughout the 
world. One of those areas has been family planning, which has 
been affected because of the focus on the coronavirus. We have 
seen family planning facilities shuttered around the world.
    So how can we support integrated health systems that ensure 
that family planning services are considered an essential 
service within the public health?
    Mr. Konyndyk. It is an extraordinarily important question, 
and as you say, the burden and the damages from this pandemic 
have fallen disproportionately on women and girls.
    We have seen that in the form of family planning. We have 
seen that in the form of disproportionate care giving 
obligations. More women have been pushed out of the workplace 
than men have.
    We have seen that in terms of girls falling out of 
educational opportunities. We are with the resources that 
Congress has provided us, we are working to do what we can to 
prioritize each of those, both with some of the ARP funding but 
also with our normal year development budgets, and we have 
pivoted a lot of our development programs to take account of 
the impacts of the pandemic, including some of our family 
planning work, and we look forward to continuing to collaborate 
with you, Senator, and with Congress on that.
    Senator Shaheen. Well, thank you very much for all of your 
efforts. I know they will continue, and anything that I or my 
office, and I am sure this is true of the full committee, can 
do to be helpful, please let us know.
    Mr. Konyndyk. Thank you.
    Senator Shaheen. We look forward to working with you.
    The Chairman. Thank you.
    I understand Senator Van Hollen is with us virtually.
    Senator Van Hollen.
    Senator Van Hollen. Yes, Mr. Chairman and Ranking Member, 
thank you for bringing us together on this important topic. To 
both our witnesses, thank you for your service and all your 
efforts to defeat this global pandemic.
    President Biden said that the United States will be the, 
``arsenal of vaccination,'' once we have sufficient guaranteed 
supply for every American, and my sense is, based on our 
ability now to take the AstraZeneca doses, the 60 million, that 
we have now secured enough for the U.S. population that we can 
begin to provide excess supply to other needy places around the 
world, both to do the right thing and for our own health 
interests. Is that right?
    Ms. Smith. I think we are nearing that time, yes. 
Absolutely, sir.
    Senator Van Hollen. Well, so there are different pieces to 
this challenge, right. There is the money piece and Congress, 
as you know, provided $4 billion for COVAX, and as you 
indicated, having that money available is a good incentive to 
increase supply.
    As of today, as I understand it, there is not $4 billion of 
vaccine to purchase and make available right away. Is not that 
the case?
    Ms. Smith. That is the case. So I think that you are 
absolutely right, that dose sharing needs to be a fundamental 
part of the equation so that we have got enough of a volume to 
get to the levels we need, if that is--if that is the point of 
your question.
    Senator Van Hollen. Yes. So here is what I am trying to do, 
and I know you are working on a plan. Everyone is trying to get 
their arms around the question Senator Merkley really posed, 
which is how much and how much can we provide in the form of 
actual vaccines.
    I am pleased that we loaned the vaccine--I think it was 4 
million doses--to our neighbors, Canada and Mexico. I am 
pleased we have identified India, because of their urgent need, 
as a recipient of some of those doses, going forward.
    Others have mentioned Nepal. I would say Bangladesh, 
Pakistan, all those countries that border on India, are at real 
risk of the rapid acceleration of the vaccine. So the faster we 
can get the vaccine to India and some of those other countries 
the better.
    What do you expect the timeline to be here? That is 
question number one. Second, beyond the 60 million AstraZeneca 
doses, what other U.S. sort of produced doses or purchased 
doses do you see coming online and being made available to 
support others around the world in the coming weeks?
    Ms. Smith. Senator, I am not trying to be too clever by 
half. The timing of this hearing is such that what I need to 
say is that in the coming days we want those answers for you.
    We are in the process of discussing all of that, looking at 
the options, and finalizing some things. So our timeline is 
very short, and we will be able to come back to you very soon.
    I think we agree with you, absolutely, that we need to move 
and move quickly and we are doing so. I just do not want to get 
ahead of things.
    Senator Van Hollen. Right. That is on the AstraZeneca 
vaccine distribution, right?
    Ms. Smith. That is on the AstraZeneca and, as you know, the 
President has said that when the situation in the United 
States, when he feels the level of confidence about where we 
are, then we will begin looking at other doses.
    I think, as you and others have rightly pointed out, we are 
getting to a level in the United States where confidence is 
much greater. It has been a very successful rollout. So we are 
also looking at those options.
    Senator Van Hollen. Got it. So when you say in the next--in 
the coming days you should have an announcement or decisions, 
can we also expect that you will tell us how much beyond the 60 
million in AstraZeneca vaccine may be available, whether it is 
Novavax or some of these others that the United States will be 
able to make available? Is that something that you are going to 
be able to tell us in the next couple days?
    Ms. Smith. Senator, what I can tell you is I can contact 
you and tell you what I will be able to tell you. I am not 
trying to be clever. I am trying to honor a system of 
deliberation, and so we are moving very quickly and we will 
have more to share with you very soon. I am uncomfortable going 
beyond that.
    Senator Van Hollen. I get it. I get it. I am not trying 
to--I just--again, we have the 60 million and we----
    Ms. Smith. Yes.
    Senator Van Hollen. --and we talked a lot about--I have not 
heard a lot of conversation about what other vaccines supply 
may be made available.
    Let me ask you quickly about the ingredients. Because we 
have the money channel. We have the direct distribution of 
vaccines. We have purchased excess vaccines.
    Then there is the issue of providing essential ingredients 
to other countries that have the capability of doing their own 
manufacturing.
    Ms. Smith. Right.
    Senator Van Hollen. I understand there are some bottlenecks 
in that process. I know India, for example, has asked for 
ingredients. How can we eliminate the bottlenecks and is the 
Defense Production Act a tool that we should be using more of?
    Ms. Smith. Do you want to start on that?
    Mr. Konyndyk. Yes, I will. Thank you, Senator.
    It is a key issue. It is probably the key issue right now 
for a global vaccine scale. We are trying as a world to produce 
14 billion extra doses of vaccine a year on a system built to 
produce four, and so there are these constraints in the 
upstream supplies and consumables.
    We are working closely with counterparts at HHS who have 
been supporting some of that analysis on the Operation Warp 
Speed, now the Countermeasures Acceleration Group Initiative, 
to take some of that expertise, feed that into what we need to 
do at the global level.
    We are coordinating closely with groups like CEPI and GAVI 
to feed that into some of their portfolio planning and their 
investments.
    That is the key issue is expanding that upstream supply but 
also, frankly, optimizing because I think we are going to have 
to make some hard choices and tradeoffs about which vaccines, 
ultimately, get selected for investment and purchase based on 
who can produce the most yield.
    Senator Van Hollen. Do you think we will require the--more 
use of the Defense Production Act, which is something I was 
pleased to see the Administration, the Biden administration, 
do----
    Mr. Konyndyk. Yes.
    Senator Van Hollen. --early on with respect to domestic 
supply?
    Mr. Konyndyk. I think we are exploring how that might work 
on the international level. Yes.
    Senator Van Hollen. Got it. Okay. Thank you. Thank you, Mr. 
Chairman. Thank you both.
    The Chairman. Thank you.
    Ms. Smith. Thank you.
    The Chairman. Now, I understand there are no members on 
either side of the aisle that are presently waiting, and if I 
am wrong, please, if you are, particularly, virtually, let me 
know. In the absence of that, I just have one or two questions 
to finalize.
    Let me ask you, on January 21, the Administration issued 
National Security Memorandum One and the National Strategy for 
COVID-19 Response and Pandemic Preparedness, which articulated 
a number of important actions it would take, including promptly 
providing to the President, ``recommendations for creating an 
enduring international catalytic financing mechanism for 
advancing and improving existing bilateral and multilateral 
approaches to global health security.''
    As you are aware, lack of funding has been a significant 
constraint for lower income countries in terms of addressing 
weaknesses in their ability to better prepare, to prevent, 
respond, and detect emerging infections with pandemic 
potential.
    As some have suggested, a mechanism at the World Bank; 
others have proposed a new multilateral fund similar to the 
Global Fund to fight AIDS, tuberculosis, and malaria.
    Can you share with us what options are currently under 
consideration by the Administration for such a mechanism?
    Ms. Smith. I am happy to take that, Senator, and thanks for 
flagging it. Upon coming into this position and addressing, 
obviously, India was just breaking it that time. This has also 
been a priority. Those options are on the table.
    We are, again, exploring with the Treasury Department and 
other agencies whether there are additional options that have 
not been explored yet, because, again, if we--if we create the 
kind of fund that has been mentioned, whether it is like the 
Global Fund or GAVI, whether it is a bank--a window at the 
World Bank or another MDB, one of the things we have got to 
have confidence in is that there will be long-term financing 
and that is dependent on the budgets of member states.
    Now, we have been able to do that, in some cases, in the 
past. If you look at the Global Fund, if you look at GAVI, over 
the years that funding has been pretty consistently--excuse 
me--maintained.
    So what we would need to do in that case is make sure that 
we have got an absolute commitment not just from our own 
Government but from other governments to maintain that funding 
over time.
    So all those models are on the table. What I am really 
focused on and we are really focused on is how do we ensure the 
sustainability of funding. We have had mechanisms in the past 
and funding was not sustained.
    The Chairman. Well, I would assume that as we go to the G-7 
and G-20, such a discussion would be very timely because it is 
not only in the United States national interests to help stem 
the tide of the pandemic, it is every country in the world, 
especially the more advanced economies it certainly is in their 
interest.
    So I hope we will, regardless of the mechanism----
    Ms. Smith. Yes.
    The Chairman. --we will look to engage in that.
    Let me ask you, how do we plan to ensure that our bilateral 
aid programs are contributing to health systems strengthening 
while at the same time achieving outcomes in areas those 
programs are meant to address?
    I mean, one of our--we are looking at the immediacy, and 
certainly we should, but it seems to me we should be thinking 
whether it is USAID or any of our other various programs, how 
do we strengthen as part of our effort these health systems so 
that they can meet this and other challenges?
    Ms. Smith. Do you want to comment on that?
    Mr. Konyndyk. I would----
    Ms. Smith. Then I would like to add one thing when you----
    Mr. Konyndyk. It is an extraordinarily important point, 
Senator. We have seen in this pandemic, as we saw with the 
Ebola outbreak, that work that we had done to invest in health 
systems, whether that was intentionally health system 
strengthening work or were more kind of disease targeted work, 
can be pivoted to other uses.
    So as we saw with some of the polio work that was done in 
Nigeria it was then pivoted to support the Ebola response 
there. We have seen, likewise, in southern Africa a lot of the 
work that has been done on things like lab strengthening 
through PEPFAR, which has been a major focus of PEPFAR, the 
kind of mass PCR testing that can be done now because of the 
HIV investments is also very useful for this.
    So I think there are ways that we can be more intentional 
about that, going forward, both through our own bilateral work 
and through some of the--for example, the support to the Global 
Fund so that we are building some of that work in a way that 
also serves other purposes more intentionally at the same time.
    The Chairman. Well, I look forward to seeing that and I 
will talk to the administrator when I speak to her this week.
    Lastly, many of us have raised the question of India. Of 
course, their massive COVID surge is an enormous challenge.
    I think the Administration made the right decision to 
expeditiously send raw vaccine materials, oxygen supplies, test 
kits, and other necessary resources to fund the expansion of 
India's vaccine manufacturing capacity.
    Mr. Konyndyk, what additional resources is the U.S. 
planning on providing to India in the coming days and weeks as 
India's central Government or any of its state governments 
requested manufactured vaccines from the United States, and if 
they have, what is our ability to fulfill that request?
    Mr. Konyndyk. So we are prioritizing further investments to 
support the oxygen supply chain in India. A lot of what we have 
done on oxygen so far has been in a stopgap to meet immediate 
clinical needs in overstretched health facilities.
    The long term, or not even the long term--the kind of the 
near and medium term play here is to help them expand their 
ability to produce and move medical grade oxygen throughout the 
country.
    So we are providing support to that, also to the Indian Red 
Cross, which has been the distribution agent for a lot of the 
aid that is coming in, and as needs to expand their capacity to 
handle that flood of incoming aid.
    On the vaccines front, as Gayle has already said, we are in 
the process of determining as the Administration how that 
initial 60 million of manufactured AstraZeneca doses will be 
allocated, and there will be more to say about that.
    Ms. Smith. I would just add one thing, Senator, that--and 
this will be a continued response, as Jeremy has indicated. 
This is not a short-term crisis.
    One of the things we have also been doing together as the 
State Department and USAID is working with an extraordinarily 
generous response from American citizens but also companies in 
the private sector.
    Together, we have probably worked 45, 50 crises in our 
lifetimes. I have never seen this kind of response from the 
private sector.
    So it is a significant amount of capital. It is a 
significant amount of support, logistical, and otherwise, and 
in-kind assistance. So that is--we are working with them to 
make sure that those contributions flow in to the system in a 
way that can be most effective.
    The Chairman. I hope that you will come back to us after 
you are ready to make your announcements so that we can get a 
full understanding of what we are doing on vaccine 
distribution.
    Ms. Smith. Absolutely. Happy to.
    The Chairman. Thank you.
    Senator Risch.
    Senator Risch. I am assuming both of you have, at least in 
a cursory fashion, looked at the Independent Panel for Pandemic 
Preparedness and Response that was just released, what, 
yesterday was it that it was released? It was----
    Ms. Smith. Actually, I think, 6 o'clock this morning.
    Mr. Konyndyk. Yes.
    Senator Risch. This morning.
    [Laughter.]
    Senator Risch. In any event, they--that was the study 
commissioned by the WHO and it was not just another study. I 
mean, it seems to me they dug in pretty good. They ignored a 
discussion of where this started and how it started, which I 
think is good. That takes some of the issues off the table and 
everybody knows what the answer to those questions are.
    Most importantly, I think, first of all, it was led by a 
former head of state of New Zealand and of Liberia, certainly 
not people that you could claim were involved in the global 
politics of the day, if you would.
    So I think this has got some real credibility, and they 
have some suggestions in here that I think are new, and we have 
all been talking about WHO reform. This study has very 
specifics in it for creation of a fund, an international 
pandemic financing facility.
    Most importantly, that the heads--they suggest that the 
heads of the governments of the world set up a global health 
threats council----
    Ms. Smith. Yes.
    Senator Risch. --and a pandemic framework convention, I 
guess what we would call a treaty. To me, these things are 
critical and I hope this gains some legs and gets some 
traction.
    I would assume this would be on the agenda later this month 
when this meeting takes place.
    Go ahead.
    Ms. Smith. This is a vital report, Senator, and----
    Senator Risch. I am sorry. I did not catch that. It is 
what?
    Ms. Smith. I said this is an absolutely vital report that 
we have been looking forward to reviewing the recommendations 
now. In fact, I am co-hosting a meeting with several other 
countries on financing for global health security and part of 
that meeting will be reviewing the IPPR recommendations on 
that.
    So we think it is critical. Their proposal for a global 
health security forum is a very intriguing one. I think one of 
the things we found is that we have got health ministers. You 
also need officials that deal with security issues because this 
is a global health and a security crisis.
    So we would agree with you. It is a really, really 
important report by some very smart people, and we are going to 
go through all their recommendations.
    Senator Risch. No, that is good. I think these are the 
kinds of things we were looking for and, actually, I guess, 
groping forward to try to come up with specific solutions when 
all of us--the chairman, myself, Senator Murphy, and the others 
on the committee--were--have been attempting to create this 
legislation to move forward.
    So I am glad that this happened now, before we got too far 
down the road with ours because it seems to me that if people 
can come together on this--and it is, certainly, not political 
by any stretch of the imagination.
    So I think this is a--something that will be very 
beneficial to us as we move forward with our legislation.
    Mr. Konyndyk. Senator Risch, if I may----
    Senator Risch. Yes, please.
    Mr. Konyndyk. --one thing I would foot-stomp from their 
report, and it is something that you mentioned in your opening 
remarks, is the need for enhanced early warning.
    So that is something that is cited in the IPPPR report. It 
is something that we are working on within the USG, envisioning 
how that might look.
    It is striking that for famines, for hurricanes, or things 
like this, we have very robust, very sophisticated, 
scientifically grounded early warning systems, and then when it 
comes time to predict a pandemic, you have a sort of binary on/
off of the public health emergency of international concern 
mechanisms.
    So that is an area that a lot of consensus needs to be 
strengthened.
    Senator Risch. Yes, I agree with that and, of course, that 
is one thing that we have all been focused on, and one of the 
difficulties is when you have something like a weather event 
you cannot really argue with it.
    When you get into something like where did this start, 
there is a natural reluctance for a Government or a country to 
drag its feet and try to find--hopefully, find another answer.
    We do not wind up with that problem in the U.S. as much as 
other countries because we have a robust and open media here 
and a population that is not afraid to criticize or point the 
finger or raise the alarm, sometimes overly much so.
    In any event, this is something that is really desperately 
needed so that we do have that early warning, that fire alarm. 
When the fire alarm goes off, there needs to be a fire 
department to respond.
    Mr. Konyndyk. Absolutely.
    Senator Risch. Thank you.
    The Chairman. Thank you.
    Well, we appreciate your testimony and your insights. You 
have probably one of the most important missions of our time, 
so we appreciate your work.
    The record of this hearing will remain open until the close 
of business tomorrow, and with the thanks of the committee this 
hearing is adjourned.
    [Whereupon, at 11:54 a.m., the committee was adjourned.]
                              ----------                              


              Additional Material Submitted for the Record


             Responses of Ms. Gayle E. Smith to Questions 
                  Submitted by Senator Robert Menendez

                            india h1-b visas
    Question. My office has heard from constituents with H1-B visas who 
are in India and are eligible to return even with the travel ban, for 
instance because they have young children who are U.S. citizens. 
However, they have been unable to get necessary appointments at the 
embassies and consulates.
    What steps is the State Department taking to ensure that people in 
India who are eligible to return to the U.S. can safely obtain the 
documents and appointments they need to do so?

    Answer. In April 2021, U.S. Embassy New Delhi and the consulates in 
Chennai, Hyderabad, and Kolkata cancelled all routine nonimmigrant visa 
(NIV) services, and the consulate in Mumbai cancelled all routine NIV 
and immigrant visa (IV) services in response to the surge of COVID-19 
in India. Individuals with urgent travel needs may request emergency 
appointments by following the instructions at https://in.usembassy.gov/
visas/. The Department is closely monitoring local conditions and will 
resume routine IV and NIV services when adequate resources are 
available and Post's Emergency Action Committee determines that the 
COVID-19 situation in country has improved sufficiently to allow 
consular employees to safely resume non-emergency services, assuming 
local government restrictions allow.
                      sdr allocation and recovery
    Question. COVID-19 has spurred devastating health, social and 
economic crises that have had serious impacts everywhere, but 
especially in developing countries where the pandemic has deepened 
development and inequality challenges and erased years of progress on 
poverty reduction. The Biden administration's notification last month 
of authorizing a Special Drawing Rights (SDR) allocation at the IMF is 
welcome news.
    How does the Administration envision leveraging the SDR allocation 
to help developing countries get the virus under control and get back 
on track? Do you believe that this $650 billion SDR allocation will be 
sufficient to meet the current global demand? Or do you expect that you 
will need more resources?

    Answer. Treasury has noted that a $650 billion SDR allocation will 
provide approximately $21 billion worth of SDRs in liquidity support to 
low-income countries and approximately $212 billion to other emerging 
markets and developing countries (excluding China). SDRs are an 
important tool for countries whose economies have been devastated by 
the pandemic. SDR will help boost recipient countries' global reserves, 
and also be used to respond to the pandemic and support recovery 
efforts.
    Any new SDR allocation would complement several existing 
multilateral efforts to assist countries in need. These efforts include 
emergency financing extended by the IMF, World Bank and other 
international institutions; financial support to the COVID-19 Vaccines 
Global Access (COVAX) Facility; and the G20/Paris Club Debt Service 
Suspension Initiative, which has delivered approximately $5 billion in 
liquidity relief to more than 40 eligible countries. A combination of 
all these efforts would assist the global recovery effort.
    Treasury is working with our international partners, including G7 
and G20 finance ministries and the IMF, to develop a menu of options 
for major economies to voluntarily channel (or lend) as much as $100 
billion worth of their SDRs to support low-income countries and 
vulnerable middle-income countries. The first most straightforward 
option would be for major economies to channel SDRs to scale up the 
IMF's concessional lending to the world's poorest countries through the 
Poverty Reduction and Growth Trust (PRGT). Beyond the PRGT, the IMF has 
proposed developing a new trust fund to co-finance eligible IMF 
programs in support of countries' pandemic recoveries and economic 
transformations, including green transitions.
    Treasury is seeking congressional authorization and appropriation 
to lend the United States' SDRs to these IMF trust funds. Treasury's 
ability to participate in the SDR channeling initiative would send a 
powerful signal of U.S. support for poor countries and significantly 
boost our credibility in leading the design of the IMF's support to 
these countries. U.S. participation would also likely have a catalytic 
effect on contributions from other IMF member governments.
    The direct allocation of new SDRs does not add to a country's debt 
burden. Only the portion of SDR holdings ``used''--i.e., exchanged for 
hard currency or used to settle obligations to the IMF and other 
multilateral institutions--carries an interest cost. However, the SDR 
interest rate is currently relatively low, at about 0.05 percent, 
compared to the far higher rates on debt instruments available to 
recipient country governments. Regarding channeling, borrowing 
additional SDRs from the PGRT or a new trust fund would result in new 
debt for borrowing countries, though again on relatively favorable 
terms and in the context of a macroeconomic adjustment and review 
agenda supported by an IMF program.

    Question. The COVID-19 pandemic has proven that authoritarians will 
not hesitate to use it as a pretext to engage in repression. This 
includes through measures that undermine democratic institutions, 
weaken transparency and public integrity norms, and attack journalists, 
activists, trade union leaders, independent business voices, and 
marginalized social groups, like refugees and migrants, with far-
reaching consequences that outlive the current crisis. It has had a 
particularly devastating impact on women and girls, rolling back 
generations of progress. What's more, the development of life-saving 
vaccines has opened a new avenue for corrupt and authoritarian 
governments to worsen inequality. At the same time, WHO and COVAX have 
few tools to prevent such governments from favoring preferred 
constituencies and further disenfranchising disfavored groups. My 
question is for either witness:
    How can the United States work with the WHO and COVAX to facilitate 
fair and equitable distribution of COVID-19 vaccines in countries with 
corrupt or authoritarian leadership? What can the United States do to 
help ensure that public health recommendations related to controlling 
the pandemic are not used to unnecessarily restrict fundamental human 
rights in countries around the world?

    Answer. The Biden-Harris administration is playing a leading role 
in ending the global COVID-19 pandemic and is committed to facilitating 
equitable and rapid global access to safe and effective vaccines. 
Thanks to the generosity of Congress and the American people, the 
United States, through USAID, is now the leading contributor supporting 
COVAX. The U.S. contributed an initial $2 billion to Gavi, in support 
of COVAX, in March, and plans to contribute an additional $2 billion to 
Gavi through 2022.
    Through COVAX's Advance Market Commitment (AMC), the U.S. 
Government is supporting access to safe and effective vaccines to 92 
low and middle-income countries, including for high-risk and vulnerable 
populations. Further, 5 percent of all COVAX doses are reserved for a 
Humanitarian Buffer, to provide access to COVID-19 vaccines as a last 
resort for some high-risk populations who cannot be reached through 
national vaccination efforts. The very limited Humanitarian Buffer can 
be used in instances of state failure, conflict, or for those living in 
areas outside Government control.
    In addition to support through COVAX, USAID is providing more than 
$75 million in bilateral support to vaccination efforts at the country 
level. This support builds on decades of experience and lessons learned 
from implementing vaccine programs around the world, including in 
countries with corrupt or authoritarian leadership. In these settings, 
USAID often works directly with local and international non-
governmental organizations who have greater access and trust in 
communities and are able to provide oversight and accountability for 
U.S. taxpayer resources.
    While public health responses to COVID-19 are critical, they have 
also been exploited by authoritarian governments to violate and abuse 
human rights, engage in inappropriate or excessive monitoring of 
citizens, and to enable disinformation and hate speech. In particular, 
these responses have negatively affected freedom of peaceful assembly 
and freedom of expression. Governments have also used COVID-19 as the 
justification for arbitrary arrests, restrictions on access to justice, 
heavy-handed security responses, reinforcement of social divisions and 
discrimination, and more.
    USAID has responded to these challenges with a number of new short-
term programs as well as adaptations to medium- and long-term programs. 
Rapid response programs have included human rights funding to 
specifically respond to COVID-19 risks and repression in areas 
including: freedom of expression and protections for journalists; 
gender-based violence and the increased risks faced by women and girls 
during lockdowns; protecting the rights of persons with disabilities, 
indigenous peoples, LGBTQI+ persons, and other marginalized populations 
under threat during the pandemic; and preventing and documenting 
security sector abuses in enforcing COVID-19 regulations.
                                 ______
                                 

             Responses of Mr. Jeremy Konyndyk to Questions 
                  Submitted by Senator Robert Menendez

    Question. The COVID-19 pandemic has proven that authoritarians will 
not hesitate to use it as a pretext to engage in repression. This 
includes through measures that undermine democratic institutions, 
weaken transparency and public integrity norms, and attack journalists, 
activists, trade union leaders, independent business voices, and 
marginalized social groups, like refugees and migrants, with far-
reaching consequences that outlive the current crisis. It has had a 
particularly devastating impact on women and girls, rolling back 
generations of progress. What's more, the development of life-saving 
vaccines has opened a new avenue for corrupt and authoritarian 
governments to worsen inequality. At the same time, WHO and COVAX have 
few tools to prevent such governments from favoring preferred 
constituencies and further disenfranchising disfavored groups. My 
question is for either witness: How can the United States work with the 
WHO and COVAX to facilitate fair and equitable distribution of COVID-19 
vaccines in countries with corrupt or authoritarian leadership? What 
can the United States do to help ensure that public health 
recommendations related to controlling the pandemic are not used to 
unnecessarily restrict fundamental human rights in countries around the 
world?

    Answer. The Biden-Harris administration is playing a leading role 
in ending the global COVID-19 pandemic and is committed to facilitating 
equitable and rapid global access to safe and effective vaccines. 
Thanks to the generosity of Congress and the American people, the 
United States, through USAID, is now the leading contributor to COVAX. 
The U.S. contributed an initial $2 billion to Gavi, in support of 
COVAX, in March, and plans to contribute an additional $2 billion to 
Gavi through 2022.
    Through COVAX's Advance Market Commitment (AMC), the U.S. 
Government is supporting access to safe and effective vaccines for 
high-risk and vulnerable populations in 92 low and middle-income 
countries. Further, 5 percent of all COVAX doses are reserved for a 
Humanitarian Buffer, to provide access to COVID-19 vaccines as a last 
resort for some high-risk populations who are not reached through 
national vaccination efforts. The very limited Humanitarian Buffer 
might be used in instances of state failure, conflict, or for those 
living in areas outside Government control.
    In addition to support through COVAX, USAID has provided an initial 
$75 million in bilateral support to vaccination efforts at the country 
level, and will expand this significantly with additional support under 
the American Rescue Plan. This support builds on decades of experience 
and lessons learned from implementing vaccine programs around the 
world, including in countries with corrupt or authoritarian leadership. 
In these settings, USAID often works directly with local and 
international non-governmental organizations who have greater access 
and trust in communities, and are able to provide oversight and 
accountability for U.S. taxpayer resources.
    Public health responses to COVID-19 are critical, but have 
sometimes been abused by authoritarian leaders and governments around 
the world to excuse democratic backsliding, including by suppressing 
political activity, violating and abusing human rights, inappropriate 
or excessive monitoring of citizens, and enabling disinformation and 
hate speech. In particular, these responses by some regimes have 
negatively affected freedom of peaceful assembly and freedom of 
expression, but governments have also used COVID-19 as justification 
for arbitrary arrests, restrictions on access to justice, heavy-handed 
security responses, reinforcement of social divisions and 
discrimination, and more. USAID has responded to these challenges with 
a number of new short-term programs as well as adaptations to medium- 
and long-term governance, rights, and conflict programs. Rapid response 
programs provided human rights funding to specifically respond to 
COVID-19 risks and repression in areas including: freedom of expression 
and protections for journalists; gender-based violence, and the 
increased risks faced by women and girls during lockdowns; protecting 
the rights of persons with disabilities, indigenous peoples, LGBTQI+ 
persons, and other marginalized populations under threat during the 
pandemic; and preventing and documenting security sector abuses in 
enforcing COVID-19 regulations.
                                 ______
                                 

             Responses of Ms. Gayle E. Smith to Questions 
                  Submitted by Senator James E. Risch

                           vaccine diplomacy
    The Administration has started taking fire for its piecemeal 
approach toward combatting COVID-19 overseas, including with regard to 
sharing vaccines. We've heard about vaccines being donated to Mexico 
and Canada, and understand that an additional 60 million doses of 
AstraZeneca will be shared at some point--but there doesn't seem to be 
an overarching strategy guiding these announcements.
    Question. What is the strategy for sharing vaccines overseas, once 
domestic demand has been met? What criteria will you be using to 
determine where and when we share vaccines?

    Answer. As President Biden has announced, America will help lead 
the world's global vaccination effort against COVID-19 by providing 
excess doses overseas. While the allocation of this initial allotment 
of U.S. Government-owned doses has not yet been finalized, the U.S. 
Government has affirmed a commitment to work with COVAX and other 
partners to ensure these vaccines are delivered in a way that is 
equitable and follows the science and public health data.
    For your awareness, we are now assessing requirements in all 
regions, with a particular focus on our own hemisphere. Our strategy, 
however, assumes that an initial allotment represents only the first 
phase of addressing the vaccine gap, and aims to steadily increase that 
supply over time by working with producers to increase manufacture, 
investing in manufacturing capacity in partner countries, and 
leveraging our own commitment to dose sharing to secure increased 
commitments from other donors. I am pleased to inform you that both 
Germany and France have announced dose-sharing commitments since the 
President's recent announcement, and that we are actively engaging G7 
member countries to expand vaccine volume further.

    Question. Will they be shared through COVAX or bilaterally? Will 
they be branded?

    Answer. Yes, we are working closely with COVAX on delivery 
modalities. These vaccines will be branded, so that upon delivery 
countries will be aware that these donations have been made possible by 
the generosity of the American people. We have engaged Gavi leadership 
on branding matters and have coordinated with them to ensure that 
branding reflects U.S. support on both U.S. dose-sharing shipments and 
Gavi-purchased shipments supported by U.S. funding.

    Question. How is the Administration approaching countries who have 
purchased supplies directly from vaccine manufacturers?

    Answer. Our overarching aim is to get as many safe and effective 
vaccines to as many people as fast as possible. We are sharing vaccines 
and leading the world in global vaccination efforts that follow sound 
science and public health data. We will work with and coordinate 
closely with COVAX and partner countries around the world to ensure 
equitable vaccine distribution.

    Question. What is your strategy for combatting Chinese and Russian 
vaccine diplomacy and COVID-19 disinformation?

    Answer. Since the early days of this pandemic, Russia and the 
People's Republic of China have spread disinformation, including about 
Western vaccines' safety and efficacy. We analyze these narratives and 
share findings with international partners to drive coordinated 
responses to foreign disinformation and propaganda. Despite efforts to 
undermine confidence in proven vaccines, there is clear, consistent 
demand for them worldwide. The United States will not share vaccines 
with strings attached. Vaccines are a key tool in ending the pandemic 
faster, and we are leading with COVAX and other partners to get as many 
doses to as many people as possible. We will work with partners to 
ensure equitable vaccine distribution based on public health data.
                      american vaccine innovation
    The World Health Organization (WHO) listed the Sinopharm COVID-19 
vaccine for emergency use (https://www.who.int/news/item/07-05-2021-
who-lists-additional-covid-19-vaccine-for-emergency-use-and-issues-
interim-policy-recommendations), giving the green light for a Chinese 
vaccine to be rolled out globally. It is also the first COVID vaccine 
that will carry a vaccine vial monitor (VVM) (https://www.path.org/
articles/vaccine-vial-monitor-worlds-smartest-sticker/).
    The VVM technology was seed-funded by the U.S. Agency for 
International Development (USAID) in the mid-1980's to overcome 
challenges relating to the distribution of temperature sensitive oral 
polio vaccine (OPV) to low- and middle-income countries (LMICs). This 
American innovation has since been used over 9 billion times on OPV and 
other vaccines to prevent wastage due to excess temperature, and is 
currently mandated by WHO and UNICEF on all non-COVID vaccines to 
LMICs. Remarkably, the USG has not committed to using our own 
innovation on highly temperature sensitive COVID vaccines that will be 
donated overseas, whether bilaterally or through COVAX.
    The failure of the U.S. to use its own technology to protect 
against waste and build public confidence in vaccine integrity--and the 
announcement by the Chinese that they will--only serves to amplify the 
PRC's aggressive vaccine diplomacy.

    Question. As we think about our own role in vaccine diplomacy and 
the use of U.S. innovations by competitors, what is the State 
Department and USAID doing to ensure use of the VVM to protect against 
waste, build public confidence, and enable the United States to 
maintain its long-standing reputation as the undisputed leader in 
global health?

    Answer. USAID recognizes the important role we played in the 
development of the Vaccine Vial Monitor (VVM) technology. This 
innovation has been critical to preventing millions of life-saving 
vaccines from going to waste. For each new vaccine that is developed, a 
new VVM needs to be developed and tested. The Pfizer and Moderna 
vaccines are required to be stored at extremely cold temperatures, 
between ^80 and ^60 degrees Celsius for the Pfizer vaccine, and between 
^15 and ^50 degrees Celsius for Moderna. Additionally, both vaccines 
are more sensitive to heat exposure. Due to the heat-sensitive nature 
of these vaccines, and the high risk for temperature fluctuations at 
country level, the VVM manufacturer, TempTime, has developed a VVM for 
both Pfizer and Moderna vaccines, both of which are currently under 
review by WHO for approval. USAID recently met with TempTime, the sole 
producer of VVM, to discuss how this technology could be used for 
COVID-19 vaccines.
                              trips waiver

    Question. Do you believe IP really is the binding constraint to 
vaccine supply and distribution? Would a TRIPS waiver resolve urgent 
supply and distribution challenges in places like India (which already 
has licenses to produce at least four vaccines) or should we instead be 
working with partners to facilitate trade in vaccine components?

    Answer. This Administration believes strongly in intellectual 
property (IP) protections. In service of ending this pandemic, the 
United States is supporting a waiver of IP protections for COVID-19 
vaccines under the WTO TRIPS Agreement. We will actively participate in 
text-based negotiations at the WTO, which will take time given the 
consensus-based nature of the institution and complexity of the issues 
involved. We aim to deliver as many safe and effective vaccines to as 
many people as quickly as possible. We will continue to ramp up our 
efforts--working with the private sector and all possible partners--to 
expand vaccine manufacturing and distribution around the world and 
increase supply of raw materials needed to produce vaccines.

    Question. Are you concerned about the unintended consequences of 
handing over U.S. innovation and mRNA technologies to the Chinese, who 
already have gone to great lengths to steal it?

    Answer. The Administration is mindful of potential risks from a WTO 
TRIPS waiver and will be focused on them in the negotiations at the 
World Trade Organization. The United States will work to ensure that a 
WTO TRIPS waiver is fit for its intended purpose.
    A majority of countries face constraints borne of limited global 
vaccine supply, which is why our most urgent work is focused on working 
with producers to increase volume and investing in vaccine 
manufacturing in several countries.
    Countries that have purchased vaccines fall into several 
categories: some have the financial capacity to procure their own 
vaccines; some have procured some but insufficient vaccine, and of 
these, many are challenged by having given the first of a two-shot 
series but lacking sufficient vaccine to provide the second shot; some 
countries purchased vaccines from the Serum Institute, which has ceased 
delivery of vaccines to other countries; and some, and indeed many 
countries cannot afford to procure vaccines from manufacturers.
    In light of these conditions, we are focused on increasing supply 
and are, among other conditions, considering the ability of individual 
countries to procure vaccines. Our contribution to COVAX is critical in 
this regard, as its AMC countries are, in the main, countries that have 
the least capacity to procure vaccines directly from manufacturers.
                         ipppr recommendations
    The final report of the Independent Panel for Pandemic Preparedness 
and Response, released on May 12, 2021, included a number of 
recommendations to enhance global pandemic preparedness and response, 
including recommendations to:

   Limit the term of the WHO Executive Director to a single 7-
        year term, rather than renewable 5-year terms;

   Enable the WHO to focus on its core competencies as a 
        normative and coordinating body rather than as an implementing 
        entity in emergencies;

   Negotiate a Pandemic Treaty; and

   Establish a senior Global Health Threats Council, comprised 
        by heads of state, to maintain political commitments to global 
        health security, promote collective action, monitor progress 
        toward goals and commitments, guide resources, and hold actors 
        accountable.

    Question. What is the Administration's view of these 
recommendations? What can we expect in terms of commitments to these 
and other recommendations of the IPPPR at upcoming meetings of the G7, 
G20, and the World Health Assembly?

    Answer. We are reviewing the IPPPR recommendations alongside those 
of other assessments. After so many lives lost, the global community 
and individual countries must take immediate, tangible actions to end 
this pandemic and to prepare for the next by taking steps to improve 
preparedness and response capabilities, including by increasing 
sustainable financing, enhancing bio-surveillance with clear 
``triggers'' for action, and expanding pandemic-related manufacturing 
with rapid surge capacity. Steps must be taken to strengthen the global 
health architecture to promote preparedness, transparency, 
accountability, and innovation to prevent the next outbreak from 
becoming a pandemic.
                                 ______
                                 

             Responses of Ms. Gayle E. Smith to Questions 
                  Submitted by Senator Jeanne Shaheen

    Question. As a result of the dramatic impacts of COVID19, the 
financing needs for developing countries have grown exponentially. 
Domestic revenues have fallen between 20 and 40 percent, while debt 
levels continue to rise significantly. Despite historic stimulus and 
recovery efforts in the U.S. and elsewhere, many developing countries 
do not have the fiscal space to respond to the pandemic. The U.N. has 
also found that a decade of development progress could be lost if the 
international community does not take immediate action.
    What options is the U.S. Government considering at this time for 
reallocating its excess Special Drawing Rights in order to support the 
global COVID response and recovery effort? How do we make sure that any 
SDRs do not add debt to the recipient countries?

    Answer. Treasury has noted that a $650 billion SDR allocation will 
provide approximately $21 billion worth of SDRs in liquidity support to 
low-income countries and approximately $212 billion to other emerging 
markets and developing countries (excluding China). SDRs are an 
important tool for countries whose economies have been devastated by 
the pandemic. SDR will help boost recipient countries' global reserves, 
and also be used to respond to the pandemic and support recovery 
efforts.
    Any new SDR allocation would complement several existing 
multilateral efforts to assist countries in need. These efforts include 
emergency financing extended by the IMF, World Bank and other 
international institutions; financial support to the COVID-19 Vaccines 
Global Access (COVAX) Facility; and the G20/Paris Club Debt Service 
Suspension Initiative, which has delivered approximately $5 billion in 
liquidity relief to more than 40 eligible countries. A combination of 
all these efforts would assist the global recovery effort.
    Treasury is working with our international partners, including G7 
and G20 finance ministries and the IMF, to develop a menu of options 
for major economies to voluntarily channel (or lend) as much as $100 
billion worth of their SDRs to support low-income countries and 
vulnerable middle-income countries. The first most straightforward 
option would be for major economies to channel SDRs to scale up the 
IMF's concessional lending to the world's poorest countries through the 
Poverty Reduction and Growth Trust (PRGT). Beyond the PRGT, the IMF has 
proposed developing a new trust fund to co-finance eligible IMF 
programs in support of countries' pandemic recoveries and economic 
transformations, including green transitions.
    Treasury is seeking congressional authorization and appropriation 
to lend the United States' SDRs to these IMF trust funds. Treasury's 
ability to participate in the SDR channeling initiative would send a 
powerful signal of U.S. support for poor countries and significantly 
boost our credibility in leading the design of the IMF's support to 
these countries. U.S. participation would also likely have a catalytic 
effect on contributions from other IMF member governments.
    Regarding the risk of adding to recipient countries' debt burdens, 
the direct allocation of new SDRs does not add to a country's debt 
burden. Only the portion of SDR holdings ``used''--i.e., exchanged for 
hard currency or used to settle obligations to the IMF and other 
multilateral institutions--carries an interest cost. However, the SDR 
interest rate is currently relatively low, at about 0.05 percent, 
compared to the far higher rates on debt instruments available to 
recipient country governments. Regarding channeling, borrowing 
additional SDRs from the PGRT or a new trust fund would result in new 
debt for borrowing countries, though again on relatively favorable 
terms and in the context of a macroeconomic adjustment and review 
agenda supported by an IMF program.
                                 ______
                                 

             Responses of Mr. Jeremy Konyndyk to Questions 
                  Submitted by Senator Jeanne Shaheen

    Question. As a result of the dramatic impacts of COVID-19, the 
financing needs for developing countries have grown exponentially. 
Domestic revenues have fallen between 20 percent and 40 percent, while 
debt levels continue to rise significantly. Despite historic stimulus 
and recovery efforts in the U.S. and elsewhere, many developing 
countries do not have the fiscal space to respond to the pandemic. The 
U.N. has also found that a decade of development progress could be lost 
if the international community does not take immediate action.
    What options is the U.S. government considering at this time for 
reallocating its excess Special Drawing Rights in order to support the 
global COVID response and recovery effort? How do we make sure that any 
SDRs do not add debt to the recipient countries?

    Answer. Treasury has noted that a $650 billion SDR allocation will 
provide approximately $21 billion worth of SDRs in liquidity support to 
low-income countries and approximately $212 billion to other emerging 
markets and developing countries (excluding China). SDRs are an 
important tool for countries whose economies have been devastated by 
the pandemic. The countries receiving these allocations may also use 
them to respond to the pandemic and support recovery efforts.
    Any new SDR allocation would complement several existing 
multilateral efforts to assist countries in need. These efforts include 
emergency financing extended by the IMF, World Bank and other 
international institutions; financial support to the COVID-19 Vaccines 
Global Access (COVAX) Facility; and the G20/Paris Club Debt Service 
Suspension Initiative, which has delivered approximately $5 billion in 
liquidity relief to more than 40 eligible countries. A combination of 
all of these efforts would assist the global recovery effort.
    Treasury is working with G7 finance ministries and the IMF to 
develop a menu of options for major economies to channel as much as 
$100 billion worth of their SDRs (ambition set by G7 Leaders) to 
support low-income countries and some vulnerable middle-income 
countries. The first and easiest option is scaling up the IMF's 
concessional lending to low-income countries through the Poverty 
Reduction and Growth Trust (PRGT). Beyond the PRGT, we are aiming to 
develop a Resilience and Sustainability Trust fund at the IMF to co-
finance eligible IMF programs in support of countries' pandemic 
recoveries and economic transformations, including green transitions.
    On SDR channeling, Treasury will likely require congressional 
authorization and the authority to use appropriated funds to lend SDRs 
of the United States to IMF trust funds. If granted, this support would 
send a powerful signal of U.S. support for SDR channeling and 
significantly boost our credibility in leading the design and 
development of new IMF trust funds. It would also likely have a 
catalytic effect on contributions from other IMF member governments.
    Regarding the risk of adding to recipient countries' debt burdens, 
it is important to recognize that the allocation or reallocation of 
SDRs does not entail any new debt. The use of SDR allocations carries a 
cost, but only on the portion actually used, and currently has a low 
interest rate of 0.05 percent compared to far higher rates of interest 
on other debt instruments available to recipient country governments. 
In this respect, SDR reallocation would likely add marginally to the 
debt of recipient countries that use it, but carry much greater 
potential benefit for meeting countries' emergency needs. Additional 
grants, debt restructuring, or other measures could then be used to 
offset the impacts of SDR use.
                                 ______
                                 

             Responses of Ms. Gayle E. Smith to Questions 
                 Submitted by Senator Edward J. Markey

    Question. Time is of the essence in the fight against the pandemic. 
Distributing 60 million doses of the AstraZeneca vaccines before the 
end of June is a good start. But distributing our domestic surplus must 
also be paired with a global manufacturing plan that maps capacity, 
goals, and timelines. Most experts note that we need roughly 8 billion 
vaccines to reach 60-70 percent inoculation rates to defeat this 
pandemic. Limiting intellectual property barriers must also be combined 
with technology transfer, technical assistance, and increasing 
manufacturing production lines to drastically speed up vaccinations.
    When will the Administration have a clear plan to present to the 
Congress for disturbing surplus vaccines and increasing global 
production of vaccines?

    Answer. Our strategy on global vaccine access includes several 
lines of effort, three of which involve manufacturing. As we share 
surplus doses and as the largest donor to COVAX, the Administration is 
also engaging producers to increase production for delivery this year 
and into 2022 and, through our Development Finance Corporation, 
actively pursuing investments in local manufacture. Two deals are on 
track to be finalized shortly, one in India and one in Africa, with 
increased production anticipated this year.

    Question. While we've rightfully focused the early fight against 
the pandemic on PPE and humanitarian assistance to combat the secondary 
impacts of the pandemic, China and Russia have strategically been 
providing vaccines globally for months. China alone has exported more 
than 200 million doses as of April 25. Both China and Russia have also 
aggressively secured manufacturing facilities around the globe to 
produce their vaccines. It is critical the United States does not pass 
up the opportunity to show global leadership during this once-in-a-
lifetime pandemic.
    Have we also secured key industry manufacturing partnerships, and 
what constraints still exist to scaling global production?

    Answer. We will continue to ramp up our efforts--working with the 
private sector and all possible partners--to expand vaccine 
manufacturing around the world and increase supplies of raw materials 
needed to produce vaccines. Already, through the Quad Vaccine 
Partnership, the United States has committed to support expanded 
manufacturing capacity in India to produce at least one billion doses 
of safe and effective COVID-19 vaccines through 2022. The U.S. 
Development Finance Corporation recently announced an investment in 
partnership with the IFC, Germany and France, to increase production in 
Africa, and is actively pursuing additional investment opportunities. 
We believe that these investments can serve the needs borne of this 
pandemic but also serve to decentralize global vaccine production for 
the future, which is critical to our global health security.

    Question. This virus has laid bare the inequities of our global 
society. Low-income countries are underserved, most vulnerable, and in-
need of our help. Only 0.3 percent of global vaccine resources have 
been provided to low-income countries. Will USAID remain steadfast in 
providing assistance, including vaccines, impartially and according to 
highest needs?

    Answer. The Biden-Harris administration will play a steadfast and 
leading role in ending the global COVID-19 pandemic, and is committed 
to ensuring equitable, needs-based, and rapid global access to safe and 
effective vaccines. Thanks to the generosity of Congress and the 
American people, the United States, through USAID, is now the leading 
contributor to the Gavi COVAX Advance Market Commitment (AMC). USAID 
has obligated $2 billion of the intended $4 billion contribution to 
Gavi. Through the Gavi COVAX AMC, USAID is supporting access to safe 
and effective vaccines for high-risk and vulnerable populations in 92 
low and middle-income countries.
    USAID has provided more than $75 million to date to support partner 
countries in preparing for COVID-19 vaccine deployment. This funding 
supports activities to build confidence and trust in vaccines, address 
vaccine hesitancy and misinformation, and support logistics and 
administration of vaccines. We will expand this support with additional 
funding appropriated under the American Rescue Plan Act, building on 
decades of U.S. leadership and expertise supporting global health 
programs around the world. USAID and the U.S. Centers for Disease 
Control and Prevention are working to ensure that vaccines reach the 
most vulnerable populations and those at highest risk, including health 
care workers.
    As President Biden announced, the U.S. will donate excess doses of 
U.S. vaccines overseas. While recipients of U.S.-owned doses have not 
yet been finalized, the U.S. Government has affirmed a commitment to 
work with COVAX and other partners to ensure these vaccines are 
delivered in a way that is equitable and follows the science and public 
health data.

    Question. Over the course of the COVID-19 pandemic, governments 
around the world have misused public health emergency measures as a way 
to crack down on human rights. We have seen attempts to curtail the 
freedom of movement, expression, speech, and the right to peaceful 
assembly. Authoritarians have moved to limit the spread of information 
about the pandemic, and any criticism of the Government's response for 
their own political gain.
    How is the United States taking steps to ensure that as the world 
is rightly focused on combatting the COVID pandemic while pushing back 
against authoritarian gains and supporting human rights?

    Answer. The evidence that the pandemic has been exploited to 
profoundly and negatively impact democracy and violate human rights is 
compelling. Reversing this trend is a priority, and the State 
Department and USAID are at the forefront of the U.S. Government's 
response. This response includes bilateral and multilateral 
engagements, as well as USAID programs designed to empower local civil 
society partners to advocate for transparent and accountable crisis 
responses that are consistent with democratic principles, address the 
alarming increase in gender-based violence, and enable local media to 
provide objective information to the public. The U.S. Government will 
continue to consider tools, such as visa restrictions and trade 
incentives, to counter democratic backsliding and promote 
accountability for human rights abuses.

    Question. There have been incidents throughout the pandemic in 
which the LGBTQI community has been blamed for the spread of the 
disease, increasing stigma and discrimination. Some governments even 
enacted measures that target LGBTQI people under the guise of public 
health precautions. As a result, LGBTQI people are often unable to 
access relief efforts. Has USAID committed any current COVID funding 
towards responding to the needs of LGBTQI people? What is being done to 
ensure that the LGBTQI and other vulnerable communities have access to 
health care, social services, employment assistance, and other vital 
lifelines during this difficult time?

    Answer. USAID has partnered with the Governments of Canada and 
Sweden to support the Multi-Donor LGBTI Global Human Rights Initiative 
(GHRI) (https://www.usaid.gov/documents/multi-donor-lgbti-global-human-
rights-initiative), a public-private partnership that has increased 
emergency response funds available to LGBTQI+ people and organizations 
that are impacted by the pandemic. In addition, through the Human 
Rights Grants Program, USAID plans to disburse $2,400,000 to a small 
number of Missions to address human rights challenges and disruptions 
to livelihoods facing LGBTQI+ people. These programs take into 
consideration the devastating impact of the COVID-19 pandemic on 
LGBTQI+ people in the informal sector, as well as survivors of violence 
and homelessness due to the pandemic.
    USAID shares your concern that COVID-19 and its follow-on impacts 
are having devastating effects on LGBTQI+ people, households, and 
communities--deepening existing vulnerabilities and inequalities. USAID 
has made multiple efforts to: 1) support programs that include 
marginalized groups; and 2) enhance its approach to addressing the 
needs of LGBTQI+ people. In addition to supporting programs that 
advance the human rights of LGBTQI+ people, USAID commits to 
meaningfully integrating considerations of sexual orientation, gender 
identity and expression, and sex characteristics in broader development 
programming, including the COVID-19 response.
    USAID welcomes Agency responsibility under President Biden's 
Memorandum on Advancing the Human Rights of Lesbian, Gay, Bisexual, 
Transgender, Queer, and Intersex (LGBTQI+) Persons Around the World, 
which makes clear that the United States, through its diplomatic and 
foreign-assistance efforts, will pursue an end to violence, 
discrimination, stigma, and criminalization on the basis of sexual 
orientation, gender identity or expression, or sex characteristics.
    Diversity, equity, and inclusion are guiding principles of the U.S. 
Government's COVID-19 Recovery and Response Plan. USAID will ensure 
these values are central to and integrated throughout all of its 
efforts, starting by prioritizing the voices of women and girls, youth, 
older persons, persons with disabilities, LGBTQI+ people, indigenous 
peoples, displaced people, and other marginalized populations, 
especially those who have been disproportionately affected by COVID-19 
and are now facing amplified discrimination, stigma, and violence. In 
implementing the USG Response Plan, USAID will also seek to expand 
multilateral and local partnerships, including with LGBTQI-led or -
focused organizations that are working to respond to COVID-19 and lead 
recovery efforts in their communities.

    Question. What proactive steps is the U.S. Government taking, both 
unilaterally and in coordination with other countries and international 
institutions, to prevent the next pandemic or future variant mutations?

    Answer. We are leveraging the political momentum of the COVID-19 
response to prioritize health security investments necessary to better 
prevent, detect, rapidly respond to, and contain future outbreaks 
before they can become pandemics. U.S. Government investments in the 
Global Health Security Agenda continue to support the COVID-19 response 
and the implementation of National Action Plans for Health Security. 
These plans are designed to increase the capacity of countries to 
prevent, detect and respond to viral or other health crises. We are 
also actively pursuing a four-pronged strategy to achieve global health 
security, with emphasis on: reforming and modernizing international 
institutions, including the WHO; securing greater adherence to existing 
norms, including the International Health Regulations; identifying and 
securing international support for sustained global health security 
financing; and establishing the mechanisms and agreements needed to 
ensure oversight, transparency and accountability.
    The State Department coordinates with U.S. implementing agencies to 
provide targeted programming in priority countries to make global 
health security improvements along specific metrics. We are also 
working closely with partners, including through the G7 and G20, to 
identify and develop new capabilities for health security. This work is 
being pursued through the World Health Assembly, the G7, the G20, in 
the lead up to the U.N. General Assembly in September, and through 
bilateral initiatives.
                                 ______
                                 

             Responses of Mr. Jeremy Konyndyk to Questions 
                 Submitted by Senator Edward J. Markey

    Question. Time is of the essence in the fight against the pandemic. 
Distributing 60 million doses of the AstraZeneca vaccines before the 
end of June is a good start. But distributing our domestic surplus must 
also be paired with a global manufacturing plan that maps capacity, 
goals, and timelines. Most experts note that we need roughly 8 billion 
vaccines to reach 60-70 percent inoculation rates to defeat this 
pandemic. Limiting intellectual property barriers must also be combined 
with technology transfer, technical assistance, and increasing 
manufacturing production lines to drastically speed up vaccinations. 
When will the Administration have a clear plan to present to the 
Congress for distributing surplus vaccines and increasing global 
production of vaccines?

    Answer. The USG is drawing on the skills and expertise of 
Departments and Agencies across the U.S. Government. Experts from the 
Department of Health and Human Services (HHS), Department of the 
Treasury, the U.S. Development Finance Corporation (DFC), the 
Department of State, and USAID are currently determining how best to 
expand and optimize production and identify potential bottlenecks in 
manufacturing including supply of raw materials and other key inputs. 
As part of this analysis, technical and financial resource needs will 
be identified and quantified.
    As President Biden has stated, our distribution of surplus vaccines 
will take place in cooperation with COVAX and other partners to ensure 
an approach that is equitable and follows the science and public health 
data. And to increase the global production of vaccines, the United 
States will work with the private sector and all possible partners to 
expand global vaccine manufacturing and distribution, as well as 
production of vital raw materials. We also want to see more innovation 
that can lead to the production of quality raw materials. We are 
calling on countries around the world to join us in applying their best 
and brightest to help ensure that no manufacturing capacity goes unused 
for want of raw materials.

    Question. While we've rightfully focused the early fight against 
the pandemic on PPE and humanitarian assistance to combat the secondary 
impacts of the pandemic, China and Russia have strategically been 
providing vaccines globally for months. China alone has exported more 
than 200 million doses as of April 25th. Both China and Russia have 
also aggressively secured manufacturing facilities around the globe to 
produce their vaccines. It is critical the United States does not pass 
up the opportunity to show global leadership during this once-in-a-
lifetime pandemic. Have we also secured key industry manufacturing 
partnerships, and what constraints still exist to scaling global 
production?

    Answer. Typically, global pharmaceutical companies produce 
approximately four billion vaccines annually, primarily for childhood 
immunization programs. This year, companies are seeking to produce 
nearly 14 billion vaccines. The scale of this unprecedented vaccine 
production effort is significantly straining existing supply chains and 
requires the establishment of new partnerships and coordination 
efforts. The United States, including USAID, is working with the 
private sector and all possible partners to expand global vaccine 
manufacturing, distribution, and the production of vital raw materials. 
For example, the U.S. International Development Finance Corporation 
(DFC) has launched a global vaccine initiative targeting investments in 
multiple regions of the world to scale production of COVID-19 vaccines 
and related delivery commodities. This new DFC effort includes the Quad 
Vaccine partnership to supply at least one billion doses of COVID-19 
vaccines by the end of 2022 and will be expanding to include additional 
investments in the coming months.

    Question. This virus has laid bare the inequities of our global 
society. Low-income countries are underserved, most vulnerable, and in-
need of our help. Only 0.3 percent of global vaccine resources have 
been provided to low-income countries. Will USAID remain steadfast in 
providing assistance, including vaccines, impartially and according to 
highest needs?

    Answer. The Biden-Harris administration will play a steadfast and 
leading role in ending the global COVID-19 pandemic, and is committed 
to ensuring equitable, needs-based, and rapid global access to safe and 
effective vaccines. Thanks to the generosity of Congress and the 
American people, the United States, through USAID, is now the leading 
contributor to the Gavi COVAX Advance Market Commitment (AMC). USAID 
has obligated $2 billion of the intended $4 billion contribution to 
Gavi. Through the Gavi COVAX AMC, USAID is supporting access to safe 
and effective vaccines for high-risk and vulnerable populations in 92 
low and middle-income countries.
    USAID has provided more than $75 million to date to support partner 
countries in preparing for COVID-19 vaccine deployment. This funding 
supports activities to build confidence and trust in vaccines, address 
vaccine hesitancy and misinformation, and support logistics and 
administration of vaccines. We will expand this support with additional 
funding appropriated under the American Rescue Plan Act, building on 
decades of U.S. leadership and expertise supporting global health 
programs around the world. USAID and the U.S. Centers for Disease 
Control and Prevention are working to ensure that vaccines reach the 
most vulnerable populations and those at highest risk, including health 
care workers.
    As President Biden announced, the U.S. will donate excess doses of 
U.S. vaccines overseas. While recipients of U.S.-owned doses have not 
yet been finalized, USG has affirmed a commitment to work with COVAX 
and other partners to ensure these vaccines are delivered in a way that 
is equitable and follows the science and public health data.

    Question. Over the course of the COVID-19 pandemic, governments 
around the world have misused public health emergency measures as a way 
to crack down on human rights. We have seen attempts to curtail the 
freedom of movement, expression, speech, and the right to peaceful 
assembly. Authoritarians have moved to limit the spread of information 
about the pandemic, and any criticism of the Government's response for 
their own political gain. How is the United States taking steps to 
ensure that as the world is rightly focused on combating the COVID 
pandemic while pushing back against authoritarian gains and supporting 
human rights?

    Answer. At a time when democracy was already under threat, the 
COVID-19 pandemic has, in some countries, accelerated democratic 
backsliding and allowed autocrats to further consolidate power. 
Repressive governments are using emergency powers to excessively 
restrict freedoms of expression, assembly, association and movement; 
limit digital rights; and reduce transparency. According to the 
International Center for Not-for-Profit Law (ICNL), during COVID-19, 56 
countries have increased restrictions on expression and 141 on freedom 
of assembly. In addition, the spread of mis- and disinformation can 
erode trust in institutions and contribute to vaccine hesitancy. In 
fragile democracies, the response to COVID-19 is straining weak 
institutions and democratic norms and practices and impeding political 
competition. This can result in ineffective pandemic responses, less 
equitable distribution of resources, weakening of human and labor 
rights, diminished rule of law, and increased corruption. These 
deficiencies could undermine public trust in the Government and foment 
conflict.
    Fortunately, the resilience of democratic governments, robust and 
innovative responses by civil society, and reinvigorated protest 
activity provide fertile ground for democracy assistance. Since last 
year, we have made rapid adaptations and started new programs across 
USAID to directly respond to backsliding in the context of COVID. More 
generally, USAID programs are supporting civil society around the world 
to monitor and expose encroachment on rights and advocate for 
democratic reforms; supporting independent media by expanding skills 
and legal protections for investigative journalists; and promoting 
efforts to combat disinformation and hate speech by government regimes, 
malign actors, and non-state actors and to disseminate accurate public 
health information.

    Question. There have been incidents throughout the pandemic in 
which the LGBTQI community has been blamed for the spread of the 
disease, increasing stigma and discrimination. Some governments even 
enacted measures that target LGBTQI people under the guise of public 
health precautions. As a result, LGBTQI people are often unable to 
access relief efforts. Has USAID committed any current COVID funding 
towards responding to the needs of LGBTQI people? What is being done to 
ensure that the LGBTQI and other vulnerable communities have access to 
health care, social services, employment assistance, and other vital 
lifelines during this difficult time?

    Answer. USAID has partnered with the governments of Canada and 
Sweden to support the Multi-Donor LGBTI Global Human Rights Initiative 
(GHRI), a public-private partnership that has increased emergency 
response funds available to LGBTQI+ people and organizations that are 
impacted by the pandemic. In addition, through the Human Rights Grants 
Program, USAID plans to disburse $2,400,000 to a small number of 
Missions to address human rights challenges and disruptions to 
livelihoods facing LGBTQI+ people. These programs take into 
consideration the devastating impact of the COVID-19 pandemic on 
LGBTQI+ people in the informal sector, as well as survivors of violence 
and homelessness due to the pandemic.
    USAID shares your concern that COVID-19 and its follow-on impacts 
are having devastating effects on LGBTQI+ people, households, and 
communities--deepening existing vulnerabilities and inequalities. USAID 
has made multiple efforts to: 1) support programs that include 
marginalized groups; and 2) enhance its approach to addressing the 
needs of LGBTQI+ people. In addition to supporting programs that 
advance the human rights of LGBTQI+ people, USAID commits to 
meaningfully integrating considerations of sexual orientation, gender 
identity and expression, and sex characteristics in broader development 
programming, including the COVID-19 response.
    USAID welcomes Agency responsibility under President Biden's 
Memorandum on Advancing the Human Rights of Lesbian, Gay, Bisexual, 
Transgender, Queer, and Intersex (LGBTQI+) Persons Around the World, 
which makes clear that the United States, through its diplomatic and 
foreign-assistance efforts, will pursue an end to violence, 
discrimination, stigma, and criminalization on the basis of sexual 
orientation, gender identity or expression, or sex characteristics.
    Diversity, equity, and inclusion are guiding principles of the U.S. 
Government's COVID-19 Recovery and Response Plan. USAID will ensure 
these values are central to and integrated throughout all of its 
efforts, starting by prioritizing the voices of women and girls, youth, 
older persons, persons with disabilities, LGBTQI+ people, indigenous 
peoples, displaced people, and other marginalized populations, 
especially those who have been disproportionately affected by COVID-19 
and are now facing amplified discrimination, stigma, and violence. In 
implementing the USG Response Plan, USAID will also seek to expand 
multilateral and local partnerships, including with LGBTQI-led or -
focused organizations that are working to respond to COVID-19 and lead 
recovery efforts in their communities.

    Question. What proactive steps is the U.S. Government taking, both 
unilaterally and in coordination with other countries and international 
institutions, to prevent the next pandemic or future variant mutations?

    Answer. USAID has been addressing global health security threats 
for more than 15 years and is a leader with a long history of 
innovation, unique comparative advantages, and a strategic vision for 
preventing or reducing the impact of outbreaks. USAID plays a leading 
role in U.S. Government (USG) and global efforts to ensure countries 
are better prepared to protect lives and economies from future 
infectious disease threats. Since 2009, USAID has invested over $1.1 
billion to ensure the necessary systems are in place to prevent, 
detect, and respond to epidemic-prone emerging and endemic disease 
threats wherever they exist.
    As part of its Global Health Security (GHS) program, USAID partners 
with other USG Departments and Agencies to implement a portfolio of 
projects, as well as the Global Health Security Agenda (GHSA)--an 
international, multilateral initiative launched in 2014 to advance 
epidemic preparedness and raise political salience, marshal resources, 
and coordinate measured action to prevent, detect, and respond to 
biological threats. As part of its implementation of the GHSA, USAID 
builds country capacities to prevent, detect, and respond to infectious 
disease threats in 19 intensive focus countries and other high-risk 
countries.
    USAID's GHS program works with other countries and the global 
community to build better preparedness for future health threats, 
including working to prevent potential epidemics or pandemics. To 
achieve this goal, USAID applies a comprehensive approach to GHS 
through a portfolio of projects that includes:

   strengthening partner country capacities to prevent, detect 
        and respond to health threats;

   training the next generation of health workers;

   carrying out viral surveillance and characterization to find 
        new viruses with pandemic potential;

   identifying and reducing risks associated with viruses 
        ``spilling over'' from animals to humans;

   responding to outbreaks quickly and effectively before they 
        spread; and

   conducting research and development to identify new and 
        innovative approaches to pandemic preparedness and response.

                                 ______
                                 

             Responses of Ms. Gayle E. Smith to Questions 
                    Submitted by Senator Todd Young

    Question. Can you please tell me why, in your most recent visa 
prioritization announcement as of April 30th, employment-based visas 
were given the lowest priority, as nurses utilize employment-based 
visas to enter the country and when the need for healthcare workers is 
so great?

    Answer. The Department had to make difficult decisions regarding 
how our consular sections should begin to reduce the backlog of 
immigrant visa (IV) applications we were prohibited from processing for 
10 months due to Presidential Proclamation 10014. Due to local 
restrictions and prudent pandemic social distancing, all consular 
sections operate at limited capacity. The Department bases its IV 
prioritization on the guiding principle of family reunification, which 
is a clear priority of the U.S. Government's immigration policy and is 
expressed in the Immigration and Nationality Act (INA). Specifically, 
this prioritization relies on direction from Congress in P.L. 107-228 
to adopt a policy prioritizing immediate relative and K-1 fiance(e) 
visas, followed by family preference IVs. The Department has, 
therefore, prioritized family-based visas over employment-based IVs.

    Question. Will you commit to working with me to ensure that nurses 
are given the highest priority so we can better assist hospitals and 
communities that continue to experience a shortage of frontline 
workers?

    Answer. We have based our immigrant visa (IV) prioritization on the 
guiding principle of family reunification, which is a clear priority of 
the U.S. Government's immigration policy expressed in the Immigration 
and Nationality Act (INA) and in legislation. Specifically, the 
Department's prioritization relies on direction from Congress in P.L. 
107-228 to adopt a policy of prioritizing immediate relative and K-1 
fiance(e) visas, followed by family preference IVs. Consistent with the 
law, the Department will continue to prioritize family-based visas over 
employment-based IVs. Despite the operational constraints and backlog 
resulting from the pandemic, we will aim to process as many employment-
based IV cases as possible, consistent with other priorities.

    Question. Will you work with the Department of State to provide the 
Committee a detailed plan for bringing these nurses into the United 
States over the next 90 days?

    Answer. The health and safety of the Department of State's 
personnel and U.S. citizens and foreign nationals seeking consular 
services is paramount. The volume and type of visa cases our U.S. 
embassies and consulates can process continues to depend on local 
conditions and restrictions. In addition, consistent with U.S. 
Government guidance on safety in the federal workplace, U.S. embassies 
and consulates have implemented social distancing and other safety 
measures, which have reduced the number of applicants consular sections 
are able to process in a single day. Consular sections will resume 
providing all routine visa services when it is safe to do so in each 
location.
                                 ______
                                 

 Article From Miami Herald Dated April 27, 2021, ``As Biden Rolls out 
   U.S. Vaccine Diplomacy He Needs to Start in Our Own Hemisphere'' 
   
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