[Senate Hearing 117-192]
[From the U.S. Government Publishing Office]


                                                       S. Hrg. 117-192

                       VACCINES: AMERICA'S SHOT 
                        AT ENDING THE COVID-19 
                                PANDEMIC

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

                                HEARING

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                                   ON

        EXAMINING VACCINES, FOCUSING ON AMERICA'S SHOT AT ENDING 
                        THE COVID-19 PANDEMIC

                               __________

                             JUNE 22, 2021

                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions
                                
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                               __________

                                
                    U.S. GOVERNMENT PUBLISHING OFFICE                    
46-772 PDF                  WASHINGTON : 2023                    
          
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          COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                    PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont          RICHARD BURR, North Carolina, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota                MIKE BRAUN, Indiana
JACKY ROSEN, Nevada                  ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado          MITT ROMNEY, Utah
                                     TOMMY TUBERVILLE, Alabama
                                     JERRY MORAN, Kansas

                     Evan T. Schatz, Staff Director
               David P. Cleary, Republican Staff Director
                  John Righter, Deputy Staff Director
                            
                            
                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                         TUESDAY, JUNE 22, 2021

                                                                   Page

                           Committee Members

Murray, Hon. Patty, Chair, Committee on Health, Education, Labor, 
  and Pensions, Opening statement................................     1
Burr, Hon. Richard, Ranking Member, a U.S. Senator from the State 
  of North Carolina, Opening statement...........................     3

                               Witnesses

Bailey, Susan, M.D., Immediate Past President, American Medical 
  Association, Fort Worth, TX....................................     6
    Prepared statement...........................................     7
    Summary statement............................................    12
Nichols, Michelle, M.D., M.S., Associate Dean of Clinical 
  Affairs, Morehouse School of Medicine, Atlanta, GA.............    13
    Prepared statement...........................................    14
    Summary statement............................................    16
Chang, Curtis, Consulting Professor, Duke Divinity School, San 
  Jose, CA.......................................................    17
    Prepared statement...........................................    18
    Summary statement............................................    20
Betancourt, Jeanette, Ed.D, Senior Vice President for U.S. Social 
  Impact, Sesame Workshop, New York, NY..........................    21
    Prepared statement...........................................    22
    Summary statement............................................    25

 
                        VACCINES: AMERICA'S SHOT
                       AT ENDING THE COVID-19 PANDEMIC

                              ----------                              


                         Tuesday, June 22, 2021

                                       U.S. Senate,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:58 a.m., in 
room 430, Dirksen Senate Office Building, Hon. Patty Murray, 
Chair of the Committee, presiding.
    Present: Senators Murray [presiding], Casey, Baldwin, 
Murphy, Kaine, Hassan, Smith, Rosen, Hickenlooper, Burr, Paul, 
Cassidy, Braun, Marshall, and Tuberville.

                  OPENING STATEMENT OF SENATOR MURRAY

    The Chair. Good morning. Senate Health, Education, Labor, 
and Pensions Committee will please come to order.
    Today, we are holding a hearing on how to get people the 
information and encouragement they need to get vaccinated so we 
can end the COVID-19 pandemic.
    Ranking Member Burr and I will each have an opening 
statement, and then we will introduce today's witnesses. After 
the witnesses give their testimony, Senators will each have 5 
minutes for a round of questions.
    While we remain unable to have this hearing fully open to 
the public or media for in-person attendance, live video is 
available on our Committee website at help.senate.gov. And, if 
you are in need of accommodations, including closed captioning, 
you can reach out to the Committee or the Office of 
Congressional Accessibility Services.
    President Biden has declared June a month of action as we 
near his goal of having 70 percent of adults vaccinated with 
their first dose by the 4th of July. We have made incredible 
progress toward that goal. In fact, several states, including 
my home State of Washington, have already reached it. But, 
nationally, we are still short. Only 65 percent of adults have 
received their first dose.
    While the progress we have made so far is promising, it has 
not been consistent. Some states may have vaccinated over 70 
percent of adults with one dose, but some have not even reached 
50. And even in states like mine, there are areas, especially 
in rural communities, that are falling behind. In some rural 
counties in our state, the rate of adults who are partially 
vaccinated is below 40 percent. We are also continuing to see 
huge inequities when it comes to the rate of vaccination, 
including in Black and Latino communities.
    It is so important that we keep pushing because, as the 
rapid spread of the Delta variant in India is showing, this 
pandemic is not over, and the threat it poses is still very 
real. The new Delta variant of COVID-19 is more contagious, 
more likely to send people to the hospital, and it is already 
here. Researchers in Washington State have identified 170 cases 
in my state, and the Centers for Disease Control and Prevention 
says it now accounts for 10 percent of COVID cases across the 
Country.
    In the United Kingdom, the Delta variant has already 
delayed efforts to reopen and surged among youth aged 12 to 20. 
That should be a red flag, especially as CDC recently found, 
even as cases across the Country have been trending down, 
hospitalizations for adolescents due to COVID increased in 
April.
    We have to stop this pandemic. We need to do it soon. And, 
we know vaccines are the best shot we have, which is why, 
starting in January and February 2020, I worked with then-
Chairman Alexander and other Members of this Committee to fund 
and scale up COVID-19 vaccination efforts throughout our 
response bills.
    Working together, we made historic investments that allowed 
experts to create a remarkable system to speed up the 
manufacturing and development of COVID-19 vaccines and that I 
believe will be seen as the cornerstone of our efforts to beat 
COVID-19 here in the United States and around the world.
    Throughout our work, I also pushed to make sure we focused 
on how we distribute and administer vaccines quickly and 
equitably, and how we promote confidence and fight 
misinformation. And, I'm pleased the Biden administration is 
prioritizing vaccination both domestically and internationally 
by providing millions of excess doses to fight this pandemic 
globally.
    We managed to administer over 200 million vaccines in the 
U.S. during President Biden's first 100 days in office. But, in 
the past few weeks, our vaccination rate has dropped down to 
where it was in January, less than a million vaccinations a 
day.
    As remarkable as the last few months have been, everyone in 
this room knows, even with our system to develop, distribute, 
and deploy COVID-19 vaccines, we will not reach the goals in 
many states and communities if we do not continue to address 
the hesitancy, misinformation, and other issues holding back 
Americans from getting vaccinated.
    We have to continue increasing access and addressing 
barriers, which make it hard for people to get vaccines, 
especially for people of color, people with disabilities, and 
people who live in rural areas. As we tear down those barriers, 
we also have to tell people they can get vaccinated quickly, 
close to home, and at absolutely no cost.
    We are also still seeing an alarming number of people say 
they do not trust vaccines and do not intend to get vaccinated. 
People want to make the right decisions for their family's 
health, but too many people with genuine concerns are being 
misled by false information. We need to address the 
misinformation and make sure people with questions are getting 
reliable answers. Facts, science, and experts are a central 
part of that work. But, encouraging people to get vaccinated is 
not just about getting the facts right; it is about trust. That 
is why we need to make sure we have messages that resonate with 
people and address their unique concerns, delivered by 
messengers they know and trust.
    We need to work with healthcare providers, as well as 
advocates and leaders from every background, people of 
different races and religions, different geographies and 
generations, and yes, even different political parties.
    I am glad we are having this bipartisan hearing today to 
talk with experts from different backgrounds about how we meet 
people where they are when it comes to trust in vaccines, what 
messages are most effective in reaching people, where people 
are getting their information, and who are the voices they 
trust the most.
    I hope our discussion will provide helpful answers to 
anyone listening who might have concerns about getting 
vaccinated themselves. People are not sure how to productively 
discuss those issues with others in their life, and leaders and 
communities across the Country.
    At the end of the day, we need people to understand 
choosing not to get vaccinated does not just put themselves at 
risk. It puts at risk the people around them, including people 
who are fighting cancer and are immunocompromised, and kids who 
are not yet eligible for vaccines.
    Getting vaccinated also does not just help you stay safe; 
it helps us get back to school and work and concerts and sport 
games and family gatherings without people having to fear 
getting sick with this virus, which has now killed over 600,000 
people in this Country.
    I look forward to hearing from our witnesses today. Thank 
you all for being with us. We want to hear from you about how 
we get these messages out, how we get vaccines in arms, and 
finally get through this pandemic.
    With that, I will turn it over to Ranking Member Burr for 
his opening remarks.

                   OPENING STATEMENT OF SENATOR BURR

    Senator Burr. Thank you, Madam Chair. I am glad we are able 
to hold this important hearing together today.
    The COVID-19 vaccine is the fastest way for our Country to 
recover from this pandemic. We all have to do our part in 
encouraging Americans to take this safe and effective vaccine. 
I have experienced the hesitancy of some Americans to take the 
first shot firsthand with friends, family members wondering 
whether the vaccine is safe enough for their families. The 
answer is absolutely yes.
    I got the vaccine. So did my wife. So did my children. When 
the FDA authorizes the vaccine for children under 12, I will 
encourage my children to vaccinate my grandchildren. The staff 
in this hearing room have gotten vaccinated. My Senate 
colleagues have either gotten vaccinated or had COVID 
themselves, which provides a natural immunity.
    Clinical trial data shows that Moderna and Pfizer vaccines 
are 100 percent effective in preventing hospitalization and 
death, and the Johnson & Johnson vaccine is 85 percent 
effective for preventing hospitalization and death from the 
virus.
    A year ago, when we were in the darkest days of the 
pandemic, I thought people would line up for miles to get a 
vaccine that kept you out of the hospital and prevented you 
from dying from COVID-19. I still believe that, which is why 
this hearing, I believe, is so important. We have experienced 
much loss in this Country over the last year, and now we have a 
tool--the vaccine--to end this and to return to normal. Let's 
use it.
    The efforts of Operation Warp Speed brought our Country and 
the world three vaccines to protect against COVID. They are 
safe, and they are effective. Operation Warp Speed is a 
testament to American innovation and ingenuity, and shows that 
the framework we designed and the statute actually worked.
    The vaccines we have for COVID are safe, and they do work. 
Pfizer is 95 percent effective, Moderna is 94 percent 
effective, Johnson & Johnson, 67 percent effective in 
preventing COVID-19.
    Today, over 177 million people have received at least one 
dose.
    Fifty-five percent of adults in America are fully 
vaccinated.
    Over 87 percent of seniors, those most vulnerable to the 
effects of the virus, have received at least one dose of the 
shot.
    At least 10 percent of the Americans have had COVID-19, so 
there is also a number of people who have some natural immunity 
to the virus.
    Even with all this progress, there is so much more work to 
be done. I said during our last COVID-19 Task Force hearing 
with the Administration that we would reach a point where we 
have more shots than we do arms. This moment has arrived in the 
United States, and we cannot be complacent.
    Israel showed us the roadmap for what to expect where 
vaccination rates began to level off as roughly 60 percent of 
the population became vaccinated.
    Reports out of India and the U.K. of the Delta variant are 
evidence of the importance of protecting Americans now and 
encouraging everyone who still needs to get vaccinated to get 
it.
    The number of doses administered in the United States per 
day is falling. Earlier this month, the rate dropped below one 
million doses per day for the first time since January. That is 
compared to a peak of 3.3 million doses per day in April.
    Of the 328 million Americans, almost 284 are 12 or older, 
making them eligible today for vaccine. Nearly 177 million 
people so far have received at least one dose, which means 
about 106 million are still eligible. Clearly, we still have a 
lot of ways to go to get all eligible people vaccinated and put 
this pandemic firmly behind us.
    We also cannot forget about the importance of global health 
security. If we do not help other countries access the vaccine, 
we will not see the end of the pandemic. The way to help other 
countries access vaccines to protect against COVID-19 is 
through the extremely successful public/private partnerships 
that have developed and manufactured the vaccines we have 
today. As I have said before, removing the intellectual 
property protection only ensures that we do not have the 
vaccines we need when the next pandemic occurs.
    Americans that have not yet gotten the COVID-19 vaccine 
need to know the benefits that come along with it. The most 
compelling case to me is that the shot keeps you out of the 
hospital. It also gets you back to work and helps keep people 
who you work with safe.
    Senator Kaine--he is not here this morning--said at the 
last hearing earlier this year that he wore a mask so the 
grocery clerks felt safe. Getting a vaccination helps keep you 
safe, it helps keep your family safe, and it keeps those around 
you safe. It also helps Americans return to the things they 
enjoy, like concerts, movies, baseball games, or watching the 
Panthers in Charlotte play.
    Over the next few months, important outreach efforts will 
continue to focus on younger people. Schools are reopening in 
the fall, and one of the vaccines is already available for 
children 12 and up. In-person learning is critical, and our 
efforts over the summer should be to focus on getting kids the 
shot, protecting them from the virus. As a grandparent, I look 
forward to the day when the vaccine is available to young 
children, as well.
    I am pleased to have representatives from Sesame Street 
here today to talk about the information families need as we 
prepare for that round of vaccinations. Our efforts should be 
focused on reaching communities that have questions.
    I look forward to hearing from each of our witnesses today 
about the partnerships and programs that you have underway to 
meet America where they are, answer questions, dispel myths 
about safe and effective vaccines, and get more shots in arms.
    Before I yield back, Madam Chair, let me just say, it is 
hard for me to believe that the best example of innovation in 
this Country seems to be the thing that makes individuals 
hesitant about being vaccinated. It happened too quickly. Well, 
let me assure my colleagues, let me assure the American people 
what I think the witnesses know. These vaccines went through 
the most exhaustive clinical trials of any medication that we 
have ever approved for this market. We have not shortcut 
anything in any area of Government. But, we did set up a 
pathway for accelerated consideration that was taken advantage 
of.
    As I think Dr. Cassidy would agree, it is the science that 
you follow. And when the clinical trials come back and prove 
safe and effective, then you should feel comfortable taking 
this vaccine.
    I thank the Chair.
    The Chair. Thank you so much, Senator Burr.
    With that, we will now introduce today's witnesses. I will 
start with Dr. Susan Bailey. She is a pediatric allergist and 
immunologist from Fort Worth, Texas; a distinguished fellow of 
the American College of Allergy, Asthma and Immunology; and, 
she recently finished her tenure as President of the American 
Medical Association.
    Dr. Bailey, thank you for joining us today.
    Our next witness is Dr. Michelle Nichols. Dr. Nichols is an 
Associate Professor of Family Medicine and Associate Dean of 
Clinical Affairs at Morehouse School of Medicine. She has led 
the historically Black university's community vaccination 
efforts and research focused on community engagement, health 
disparities, preventive health, and COVID-19.
    Thank you for joining us today, Dr. Nichols.
    With that, I am going to turn it over to Senator Burr to 
introduce our next witness, Curtis Chang.
    Senator Burr. Thank you, Madam Chair. As the son of a 
minister, I am privileged to be able to do this.
    Mr. Chang is the cofounder of Christians and the Vaccine, a 
group that aims to promote vaccine confidence among evangelical 
Christians. To conduct this outreach, Christians and the 
Vaccine has partnered with the Ad Council, National Association 
of Evangelicals, COVID Collaborative, and The Values 
Partnership.
    In addition to his faculty appointment at Duke Divinity 
School, Mr. Chang is a senior fellow at the Fuller Theological 
Seminary. His ministry experience includes serving as Senior 
Pastor of an Evangelical Covenant Church in California, and as 
a campus minister with the Intervarsity Christian Fellowship. 
He has also done mission work in South Africa and is the 
founder of an award-winning, non-profit consulting firm.
    Mr. Chang earned his Bachelor's degree at Harvard 
University and is a former Rockefeller Fellow.
    Mr. Chang, thank you for being here with us today.
    The Chair. Thank you. And finally, our last witness is 
brought to us by the Letter S for Sesame Street. (Laughter.)
    Dr. Jeanette Betancourt is the Senior Vice President for 
U.S. Social Impact at Sesame Workshop. She is a licensed, 
bilingual education therapist and leads Sesame Street's 
community initiatives to improve the health and well-being of 
children and families.
    Dr. Betancourt, thank you for joining us today.
    With that, we will begin our testimony with Dr. Bailey.


  STATEMENT OF SUSAN BAILEY, M.D., IMMEDIATE PAST PRESIDENT, 
          AMERICAN MEDICAL ASSOCIATION, FORT WORTH, TX

    Dr. Bailey. Good morning, Chair Murray, Ranking Member 
Burr, and Members of the Committee. The American Medical 
Association commends you for holding this hearing today, and I 
thank you for the opportunity to testify.
    I am Dr. Susan Bailey, and I am the Immediate Past 
President of the American Medical Association. I am also a 
practicing allergist/immunologist in Fort Worth, Texas. And 
those two roles have given me a unique perspective on the 
COVID-19 pandemic and its impact on our patients, on our 
physician community, and on our Nation's health.
    COVID-19 is a watershed moment in our Nation's history. It 
is both an epic tragedy and one of the greatest scientific 
achievements in our lifetimes, thanks to the courageous efforts 
of physicians, nurses, scientists, researchers, and the 
tireless efforts of so many working in government.
    The AMA has been committed from the beginning of the 
pandemic to making sure that physicians have the information 
and the resources they need to take care of COVID patients, to 
keep their offices safe, and to answer all of the questions 
that patients and physicians have about COVID-19 vaccine 
development.
    COVID-19 remains a very serious threat for certain high-
risk groups and for those that have not been vaccinated. But, 
much has changed in the last few months to give us hope that 
the worst of the pandemic may be behind us. The good news--and 
I think it is good news--that more than 55 percent of adults 
are fully vaccinated, and 65 percent have received at least one 
vaccine shot. And, while there are racial and ethnic 
differences in vaccination, as well as regional differences, 
attitudes are shifting in most groups. To maintain this 
momentum, however, and finally bring an end to this pandemic, 
we need to work to get as many people as possible vaccinated 
against this virus.
    Many individuals are hesitant to receive the shot for 
personal, religious, or political reasons. The speed with which 
the vaccines have been developed and the politicization of the 
pandemic has naturally led to concern among the public about 
safety and efficacy.
    Physicians play a critical role as vaccine Ambassadors for 
our patients. Experience has shown us that our patients place 
great faith in a strong, positive recommendation from their 
physicians; and that the information and education provided by 
physicians and other healthcare professionals results in higher 
vaccine acceptance rates. So, the responsibility falls to us to 
answer their questions honestly, to address their concerns, and 
to be firm and encouraging them to receive the vaccine. This is 
our surest way through the pandemic.
    Regardless of the reason, though, we need to engage these 
vaccine-hesitant individuals and find ways to reach a common 
understanding of why these vaccines are important and safe, not 
only for the health of individuals and their families, but for 
the health of our Country.
    We have to lead with the science. To do this well, 
physicians need to be part empathetic counselors, part research 
scientists, and part myth busters. Obviously, our messages may 
differ depending on the reason for our patients' hesitancy or 
refusal, but that personal relationship and trust, built in 
many cases over years, can make all the difference.
    That is why we have advocated for distributing the vaccines 
to physicians' offices. It is a lot easier to get shots in arms 
when your patients are actually in your office and the vaccines 
are in your office.
    We are also working with partners, including the Ad Council 
and the COVID Collaborative, which are leading a massive 
communications effort to educate the American public and build 
confidence around COVID-19 vaccines.
    We have a lot more work to do to convince as many people as 
possible to get vaccinated. It will take all of us working 
together.
    Thank you, and I look forward to answering your questions.

    [The prepared statement of Dr. Bailey follows:]
                   prepared statement of susan bailey
    The American Medical Association (AMA) appreciates the opportunity 
to provide testimony to the U.S. Senate Committee on Health, Education, 
Labor, and Pensions as part of its June 22, 2021 hearing entitled, 
``Vaccines: America's Shot at Ending the COVID-19 Pandemic.'' As the 
largest professional association for physicians and medical students, 
and the umbrella organization for state and national specialty medical 
societies, the AMA and our members have been, and continue to be, 
strongly engaged and committed to confronting and ending the 
unprecedented COVID-19 pandemic and ensuring that as many people as 
possible are vaccinated against COVID-19 (SARS-CoV-2). We commend the 
Committee for holding this important hearing to examine barriers to a 
successful vaccination campaign and how to overcome them, as well as 
lessons learned from this pandemic that will better prepare us for 
future vaccination activities related to COVID-19 and other public 
health threats.
                              Introduction
    The United States is at a critical juncture in its battle against 
the COVID-19 pandemic. While there has been a sharp decline in new 
infections and deaths, over 600,000 Americans are known to have died 
from COVID-19, and people are still dying from the virus and related 
complications, particularly in certain parts of the country and among 
certain population groups. COVID-19 remains a very serious threat, yet 
much has changed in the last few months to give us hope that the worst 
of the pandemic may be behind us. According to the most recent data 
from the Centers for Disease Control and Prevention (CDC), more than 55 
percent of the adult (age 18 or over) population is fully vaccinated 
and 65 percent have received at least one vaccine shot, although there 
are stark racial and ethnic inequities in rates of vaccination as well 
as regional differences. But, in order to maintain this momentum and 
finally bring an end to this pandemic, we need to work to get as many 
people as possible vaccinated against the virus. Physicians play a 
critical role as vaccine ambassadors for their patients, and surveys 
show that even when people have a general distrust of medicine at-
large, they tend to trust their personal physicians.

    Large numbers of the population remain unvaccinated and are 
hesitant to receive the shot for personal, religious, or political 
reasons or due to vaccine access issues. The supply of vaccine is now 
outpacing demand in many areas of the U.S., particularly in the South 
and Midwest, even with the Administration's push to vaccinate at least 
70 percent of adults by July 4. While at one point in mid-April more 
than three million people received a vaccine every day, vaccinations 
had decreased to only about 1.2 million daily as of early June. Enough 
Americans are reluctant to get the vaccine that it may be difficult to 
reach a level of immunity in certain communities, which would prevent 
illness and death from being limited and from such communities being 
able to fully move on from COVID-era restrictions. This is especially 
the concerning given the continued spread of variants, such as the 
highly transmissible ``Delta'' variant first identified in India. The 
Delta variant is quickly becoming the predominant variant in many 
countries and now makes up at least 19 percent of all cases in the 
U.S.; as an illustration of how quickly it is spreading, on May 22, the 
variant made up only 2.7 percent of cases. The CDC also now designated 
Delta as a variant of concern, which means the agency officially 
recognizes that the variant may carry a risk of more severe illness and 
transmissibility. In addition to Delta, the CDC has noted five other 
variants of concern.

    The rapid rise of the Delta variant in the United Kingdom--where it 
now accounts for 90 percent of cases--has slowed that nation's 
reopening efforts by four or five weeks and should serve as a warning 
to other countries. At the same time, other parts of the world are 
experiencing their worst COVID-19 surges yet, and in addition to issues 
accessing COVID-19 vaccines in many countries, a recent Gallup poll 
showed that 1.3 billion people or 32 percent of adults worldwide are 
unwilling to get vaccinated. Until more people in the U.S. and around 
the world are fully vaccinated, especially as international travel 
increases this summer, the global pandemic will be far from over.
                     Vaccine Hesitancy and Refusal
    Unfortunately, there has been increasing vaccine refusal and 
hesitancy over the past several years in the U.S. In many cases, this 
lack of confidence has surrounded established vaccines despite long 
track records of safe and effective use in the population. With vaccine 
hesitancy on the rise, as well as the ongoing spread of medical 
misinformation and disinformation related to COVID-19, it should not be 
surprising that there has been, and continues to be, even greater 
concern regarding the safety and efficacy of a vaccine developed 
through ``Operation Warp Speed'' in a much shorter timeframe than has 
usually been the case for past vaccines.

    Moreover, trust in scientific institutions, public health, and 
health professionals has been seriously eroded, especially throughout 
the course of the pandemic, and this has spilled over to fear of the 
vaccines and potential side effects. There are a several reasons for 
this, including the spread of misinformation and disinformation and 
conspiracy theories, particularly by social media, and the 
politicization of COVID-19 and COVID-19 vaccines. Black Americans, for 
example, report lower levels of trust in the health care system, a 
result of historical abuses such as the Tuskegee study (in which Black 
people were experimented on without their consent), but also day-to-day 
discrimination they often experience during health care encounters. 
However, vaccine confidence has grown since February among Black 
adults, with about 14 percent more saying in May that they already had 
been vaccinated or planned on being vaccinated.

    Among the most challenging issues to address is that the highly 
partisan nature of the Nation's politics has spread to many aspects of 
interpersonal discourse, including the highly politicized debate over 
COVID-19 vaccines. According to the Kaiser Family Foundation, hesitancy 
is the highest among some Republicans, specifically men, who have 
questioned the severity of the COVID-19 pandemic and have significant 
doubts and concerns about vaccination, and who have expressed unease 
about government mandates of vaccines and personal liberties/freedoms. 
In addition, White evangelicals, who have similar concerns and doubts 
but also are concerned about regarding rumors of the use of fetal 
tissue in vaccines, are among the most reluctant; a March poll by the 
nonprofit Public Religion Research Institute found that White 
evangelicals ranked highest among those who are religious and refusing 
to get vaccinated. Only 45 percent of White evangelicals said they 
would get the vaccine, the second-lowest acceptance of any religious 
affiliation behind Latino Protestant groups. Another reluctant group is 
young adults, who do not believe they are susceptible to COVID-19 or 
that it poses a risk to them and are the most likely group to engage in 
behaviors that result in high rates of transmission. With the rise in 
the Delta variant, it is critical that this group is vaccinated. Women 
in this group are also more susceptible to false information regarding 
vaccine impact on menstruation and fertility, as well as concerns 
regarding pediatric vaccinations.

    While it is beyond the scope of this hearing and not the intent of 
the AMA to engage in a First Amendment debate, the role of social media 
in allowing misinformation/disinformation to spread rapidly and 
unchecked must be acknowledged. This allows medical misinformation to 
be conveyed as real news. While social media has the potential to help 
provide accurate, evidence-informed health information, during the 
pandemic it has contributed significantly to vaccine hesitancy with 
very little being done, until recently, to combat the spread of 
blatantly false information. This has done tremendous damage to vaccine 
confidence in certain groups, such as women of child-bearing years--for 
example, rumors about vaccines impacting fertility have been rampant 
and difficult to overcome. In December 2020, the AMA wrote to the chief 
executive officers of leading technology companies, urging them to 
guard against disinformation that could derail the vaccination campaign 
and to remain vigilant against the proliferation of unintentional 
misinformation and purposeful disinformation on their platforms. The 
AMA further stressed how important it is for social media platforms to 
share timely, transparent, and accurate information about COVID-19 
vaccines from public health institutions like the U.S. Food and Drug 
Administration (FDA) and the CDC that are rooted in science and 
evidence.

    At the AMA's policy meeting last week, the AMA adopted new policy 
to address misinformation on social media. The House of Delegates 
directed the AMA to:

          Encourage social media companies and organizations to 
        further strengthen their content-moderation policies related to 
        medical and public health misinformation, including enhanced 
        content monitoring, augmentation of recommendation engines 
        focused on false information, and stronger integration of 
        verified health information.

          Encourage social media companies and organizations to 
        recognize the spread of medical and public health 
        misinformation over dissemination networks and collaborate with 
        relevant stakeholders to address this problem as appropriate, 
        including but not limited to altering underlying network 
        dynamics or redesigning platform algorithms.

          Support the dissemination of accurate medical and 
        public health information by public health organizations and 
        health-policy experts.

          Work with public health agencies in an effort to 
        establish relationships with journalists and news agencies to 
        enhance the public reach in disseminating accurate medical and 
        public health information.

    Delegates also modified existing policy that calls on the AMA to 
support COVID-19 vaccination and information programs. According to the 
amended policy, the AMA will educate the public about up-to-date, 
evidence-based information regarding COVID-19 and associated 
infections, as well as the safety and efficacy of COVID-19 vaccines, by 
countering misinformation and building public confidence. Moreover, the 
AMA will educate physicians and other health care professionals on ways 
to disseminate accurate information and methods to combat medical 
misinformation online.
                         Vaccine Access Issues
    Concern over access, especially equitable distribution and 
availability, to the COVID-19 vaccines has been a top AMA concern since 
the vaccines received FDA emergency use approvals. Preventing racial 
disparities in the uptake of COVID-19 vaccines has been, and continues 
to be, critical to mitigate the disproportionate impacts of the virus 
for people of color and prevent widening racial health disparities 
going forward. According to Thomas R. Frieden, MD, MPH, former director 
of the CDC during the Obama administration, the biggest impediment to 
getting more people fully vaccinated for COVID-19 is access, not 
vaccine hesitancy. During an episode of the ``AMA COVID-19 Update'' 
examining vaccine hesitancy and the role of politics at the end of May, 
Dr. Frieden stated, ``Most of the people who are not yet vaccinated 
aren't strongly opposed to being vaccinated. They just haven't had the 
vaccine be as convenient as it should be.'' He stressed that providing 
easier access to vaccines ``means walk-in hours. That means easy 
locations, easy hours, supporting transportation and setting up pop-up 
sites outside of everywhere, from ball games to bars to bowling alleys 
to shopping centers. We need to make it the default choice, basically, 
to get a vaccine.'' The AMA strongly agrees. We must ensure that 
communities struggling with access are met where they are. These 
communities need local solutions and partnerships with local leaders to 
find the best possible strategies to bringing vaccinations to 
communities struggling with access.

    Some communities have been falsely accused of driving vaccine 
hesitancy, when easy access to vaccines, lack of transportation to 
vaccine sites, and concerns about issues such as unpaid time off for 
vaccination are driving lower rates of vaccination. Health care 
services are not as easily accessible in many communities of color. 
These communities also struggle with being able to find time to both 
get vaccinated and recover from any potential side-effects of the 
vaccine. Taking time off work to get vaccinated can result in lost jobs 
or pay for many, which makes getting vaccinated difficult and has led 
to many individuals deciding not to get vaccinated. According to a 
recent issue brief, ``Latest Data on COVID-19 Vaccinations by Race/
Ethnicity,'' by the Kaiser Family Foundation, Black and Hispanic people 
have received smaller shares of vaccinations compared to their shares 
of cases and compared to their shares of the total population in most 
states. The share of vaccinations received by Black people also 
continues to be smaller than their share of deaths in most states and 
the share of vaccinations received by Hispanic people is similar to or 
higher than their share of deaths in most reporting states, although in 
some states it continues to be lower. For example, in California, only 
29 percent of vaccinations have gone to Hispanic people, while they 
account for 63 percent of cases, 48 percent of deaths, and 40 percent 
of the total population in the state. Similarly, in the District of 
Columbia, Black people have received 41percent of vaccinations, while 
they make up 56 percent of cases, 71 percent of deaths, and 46 percent 
of the total population.

    Rural communities also lag behind urban areas in vaccination rates. 
These communities frequently lack easy access to health care. Since 
they have higher proportions of uninsured and those with comorbidities, 
leading to higher risks of morbidity and mortality from COVID-19, it is 
essential to ensure they are vaccinated. Rural areas in the Southern 
U.S. are particularly at risk, especially since the Delta variant is 
about 12 to 14 percent of cases in the South, higher than the national 
average.
                AMA Activities to Encourage Vaccination
    The AMA and its physician and medical student members, as well as 
its partners in medical specialty and state societies, have worked 
tirelessly during the pandemic to educate physicians, their patients, 
and the public about the safety of the COVID-19 vaccines, dispelling 
myths and misinformation about the vaccines, and building confidence in 
patients' willingness to get a vaccination. Physicians remain one of 
the most trusted sources of information for patients on COVID-19 
vaccines and it is critical to continue to involve physicians in this 
work and ensure physicians are able to vaccinate potentially hesitant 
patients. It makes a big difference to be able to talk to patients 
face-to-face about their vaccine concerns and answer questions and be 
able to vaccinate them while they are onsite in the office for an 
appointment. That is why we have urged, and continue to urge, that 
vaccines be distributed to physician offices. Physicians are leading by 
example, with a recent survey among practicing physicians conducted by 
the AMA showing that more than 96 percent of surveyed U.S. physicians 
have been fully vaccinated for COVID-19, with no significant difference 
in vaccination rates across regions. Of the physicians who are not yet 
vaccinated, an additional 45 percent do plan to get vaccinated.

    More specifically, the AMA has developed dozens of resources free 
on our website, including the flagship Journal of the American Medical 
Association (JAMA) website to ensure physicians have a clear 
understanding of the COVID-19 vaccines, including the development 
process and the safety and efficacy data underlying them so they are 
prepared to discuss this with their patients. The AMA also strongly 
encouraged Federal officials to be as transparent as possible 
throughout the vaccine development process, to explain the key steps, 
and to share the vaccine trial data, and we continue to provide updates 
on a regular basis, including through the COVID-19 (2019 novel 
coronavirus) Resource Center for Physicians on the AMA website. We also 
developed extensive frequently-asked-questions documents on COVID-19 
vaccination covering safety, allocation and distribution, 
administration and more. There are three FAQs documents, one designed 
to answer patients' questions, another to address physicians' COVID-19 
vaccine questions and a third to address physicians' clinical concerns. 
The AMA also launched a free AMA webinar series specifically for 
physicians called What Physicians Need to Know that aims to gain fact-
based insights from the Nation's highest-ranking subject matter 
experts, including from the FDA and CDC. The most recent episode 
focused on vaccine misinformation. The AMA recently joined other 
leading organizations and corporations in a national campaign with the 
Ad Council and the COVID Collaborative, which are leading a massive 
communications effort to educate the American public and build 
confidence around the COVID-19 vaccines. The COVID-19 Vaccine Education 
Initiative is designed to reach different audiences, including 
communities of color who have been disproportionately affected by 
COVID-19.

    The AMA is also encouraging all state and medical specialty members 
to help involve their members in efforts to increase COVID-19 
vaccination rates and ensure COVID-19 vaccination is equitable. The AMA 
has partnered with Made to Save, a national organizing campaign working 
closely with the Biden administration to help increase vaccine equity 
and access in communities of color. Made to Save has identified 
individuals most likely not to be vaccinated and is asking for 
assistance in reaching those people through a number of events for 
health care providers. These upcoming events include ``Housecalls,'' a 
phone banking opportunity where physicians and other health care 
providers are invited to call people in key communities to listen to 
their concerns, answer any questions, and help them get their shots. 
Made to Save is also sponsoring ``Ask Me Anything about COVID-19,'' 
where physicians and health care providers participate in one-on-one 
conversations in their community about vaccination.
                            Lessons Learned
    There have been many lessons learned throughout the pandemic, 
especially about the importance of open communication, information 
sharing, and targeted messaging, particularly focused on specific 
populations and communities. Whether for medical, political, religious, 
or other personal reasons, all vaccine-hesitant groups need to be 
engaged to reach a common understanding of why these vaccines are 
important--not only for the health of individuals and their families, 
but for the health of the country. Physicians have more work to do to 
reach all communities with a clear and consistent message: that the 
vaccines for COVID-19 are safe, they are effective, and that they have 
followed the same rigorous scientific process that every vaccine does 
before it reaches the public. In addition, specific messages and 
initiatives need to be geared to different populations and communities: 
what works for one individual or in one community may not work for a 
different individual or in another community. Physicians have played a 
critical role throughout the COVID-19 vaccination campaign and will 
continue to have a leading role as vaccine ambassadors in educating and 
their patients and communities about why they should get vaccinated.

    The AMA believes the following lessons learned are critical to move 
beyond this pandemic and be able to address the next one:

          Transparency and early information sharing from 
        government officials is critical, based upon evidence and 
        science rather than politics.

          Trust must be restored in science, scientists, and 
        public health professionals--public health officials need to be 
        empowered to communicate clear, consistent, and credible 
        evidence-based public health information to the public.

          The spread of misinformation and disinformation, 
        especially from online sources, must be addressed.

          Private physicians need to be involved as partners 
        early in all phases of a vaccination campaign, including 
        planning and implementation.

          Increased Federal, state, and local funding is needed 
        to modernize the Nation's public health data systems to improve 
        the quality and timeliness of data and support electronic case 
        reporting, which alleviates the burden of case reporting on 
        physicians through the automatic generation and transmission of 
        case reports from electronic health records to public health 
        agencies for review and action in accordance with applicable 
        health care privacy and public health reporting laws.

          Public health preparedness and response must be 
        bolstered, including surveillance systems, preparedness and 
        response efforts, and leadership capabilities of public health 
        agencies. Public health agencies will need considerable support 
        to maintain core public health activities: detecting and 
        investigating cases, identifying underlying causes and 
        etiologies, assessing the needs of vulnerable communities, 
        communicating with the public, collecting data and developing 
        comprehensive plans with stakeholders to enact actions for 
        mitigation, preparedness, response, and recovery.

          Communities of color and underserved communities 
        should receive early intervention in any future pandemic and 
        vaccination campaign, given their disproportionate lack of 
        access to health care.
                               Conclusion
    The United States is emerging from the most serious public health 
crisis we have faced in a century, but much work remains to be done 
before the pandemic can be declared over or no longer a threat. It will 
take all of us--government, physicians and other health care 
professionals, communities, individuals--working together to get as 
many people vaccinated as soon as possible. Widespread access to 
accurate, evidence-based information that is grounded in science is key 
to our success. The AMA and our members are strongly committed to 
ending this global pandemic and to fighting medical misinformation. The 
AMA looks forward to working with Members of this Committee and your 
colleagues to advance these critical goals.
                                 ______
                                 
                  [summary statement of susan bailey]
    The American Medical Association (AMA) appreciates the opportunity 
to provide testimony to the HELP Committee as part of its June 22, 2021 
hearing entitled ``Vaccines: America's Shot at Ending the COVID-19 
Pandemic.'' the AMA and our members have been, and continue to be, 
strongly engaged and committed to confronting and ending the 
unprecedented COVID-19 pandemic and ensuring that as many people as 
possible are vaccinated against COVID-19 (SARS-CoV-2). Physicians have 
a critical role as trusted Ambassadors in the current vaccination 
campaign, and the AMA has helped prepare our members to be ready and 
able to educate their patients and the public to reduce vaccine 
hesitancy and refusal.

    The United States is at a critical juncture in its battle against 
the COVID-19 pandemic. While there has been a sharp decline in new 
infections and deaths, over 600,000 Americans are known to have died 
from COVID-19, and people are still dying from the virus and related 
complications, particularly in certain parts of the country and among 
certain population groups. COVID-19 remains a very serious threat, yet 
much has changed in the last few months to give us hope that the worst 
of the pandemic may be behind us. Large numbers of the population 
remain unvaccinated and are hesitant to receive the shot for personal, 
religious, or political reasons or due to vaccine access issues.

    Unfortunately, there has been increasing vaccine refusal and 
hesitancy over the past several years in the U.S.. With vaccine 
hesitancy on the rise, as well as the ongoing spread of medical 
misinformation and disinformation related to COVID-19, it should not be 
surprising that there has been, and continues to be, even greater 
concern regarding the safety and efficacy of a vaccine. Moreover, trust 
in scientific institutions, public health, and health professionals has 
been seriously eroded, especially throughout the course of the 
pandemic, and this has spilled over to fear of the vaccines and 
potential side effects. While it is beyond the scope of this hearing 
and not the intent of the AMA to engage in a First Amendment debate, 
the role of social media in allowing misinformation/disinformation to 
spread rapidly and unchecked must be acknowledged. This allows medical 
misinformation to be conveyed as real news. While social media has the 
potential to help provide accurate, evidence-informed health 
information, during the pandemic it has contributed significantly to 
vaccine hesitancy with very little being done, until recently, to 
combat the spread of blatantly false information.

    Concern over access, especially equitable distribution and 
availability, to the COVID-19 vaccines has been a top AMA concern since 
the vaccines received FDA emergency use approvals. Preventing racial 
disparities in the uptake of COVID-19 vaccines has been, and continues 
to be, critical to mitigate the disproportionate impacts of the virus 
for people of color and prevent widening racial health disparities 
going forward. There have been many lessons learned throughout the 
pandemic, especially about the importance of open communication, 
information sharing, and targeted messaging, particularly focused on 
specific populations and communities. Whether for medical, political, 
religious, or other personal reasons, all vaccine-hesitant groups need 
to be engaged to reach a common understanding of why these vaccines are 
important--not only for the health of individuals and their families, 
but for the health of the country. It will take all of us--government, 
physicians and other health care professionals, communities, 
individuals--working together to get as many people vaccinated as soon 
as possible. Widespread access to accurate, evidence-based information 
that is grounded in science is key to our success. The AMA and our 
members are strongly committed to ending this global pandemic and to 
fighting medical misinformation. The AMA looks forward to working with 
Members of this Committee and your colleagues to advance these critical 
goals.
                                 ______
                                 
    The Chair. Thank you very much.
    Dr. Nichols.

 STATEMENT OF MICHELLE NICHOLS, M.D., M.S., ASSOCIATE DEAN OF 
  CLINICAL AFFAIRS, MOREHOUSE SCHOOL OF MEDICINE, ATLANTA, GA

    Dr. Nichols. Good morning, Chair Murray, Ranking Member 
Burr, and Members of the Committee on Health, Education, Labor, 
and Pensions. Thank you very much for convening this important 
hearing on Vaccines: America's Shot at Ending COVID-19 
Pandemic.
    I am Dr. Michelle Nichols, and I am presenting testimony on 
behalf of Morehouse School of Medicine, and I bring you 
greetings from President and Dean, Dr. Valerie Montgomery Rice. 
I am a family physician, and I am the Medical Director of our 
COVID-19 Community Vaccination program, as well as the 
Associate Dean for Clinical Affairs.
    According to the CDC, the COVID-19 pandemic has brought 
social and racial injustice and inequity to the forefront of 
public health, and that has applied to vaccines, as well. We 
were an early adopter in becoming a COVID-19 community 
vaccinator, vaccine provider. Based on our commitment to health 
equity and being a trusted entity within the African-American 
community in both healthcare and research, we knew that we must 
tackle the hesitancy, mistrust, misinformation, and myths. We 
knew what we had to do to tackle this virus.
    When vaccinations were first offered to the 75 years and 
older population in early January, we did a kickoff event and 
invited legendary civil rights leaders to become vaccinated 
because we wanted to build confidence and trust in the 
community. As we were vaccinating, we were concurrently doing 
educational programs, doing weekly town halls, panel 
discussions, and community outreach programs.
    Lessons learned from our first couple of months of the 
vaccinations led us to applying for and receiving grant funding 
to reach beyond Atlanta, Georgia via our traveling vaccination 
mobile program. Since we are a trusted entity within the 
communities of color, over 75 percent of our vaccine recipients 
have been African-American, compared to only approximately 9.9 
percent nationally, based on yesterday's CDC data.
    To help expand vaccinations in our Hispanic community, we 
started engaging and partnering with Latino organizations and 
the consulate, and particularly the Mexican Consulate, because 
patients tend to trust people who look like them, talk like 
them, and have similar backgrounds in education and 
experiences, which resulted in our current Latino vaccination 
rate being 13 percent, which has positively impacted the 
Hispanic population rate, vaccination rate, in Georgia.
    At Morehouse School of Medicine, with our community 
outreach and focus on decreasing health disparities, 
vaccinations for Black and Brown people and communities of 
color represent approximately 88 percent of our vaccinations.
    Lessons learned over the last 6 months are to impact trust 
by engaging the community and being part of the community, as 
well as having vaccinators who look like, sound like, and have 
similar experiences. Also, providing information and education 
to dispel myths and misinformation and to educate and make sure 
that material is multilingual, also multimedia, and also with 
the appropriate educational level, and to meet people where 
they are in their vaccine journey, and to know that we are 
ready to vaccinate whenever they are.
    As far as our adolescents, we want to engage and educate 
both the parents and the children and plan back-to-school 
vaccine events with incentives, such as book bags and supplies. 
And, at the same time, doing school physicals, preventive 
health reviews, and health checks. And when people come to get 
tested for COVID-19, we need to vaccinate them at the same 
time. We need to travel where the vaccine recipients are and 
make it as convenient as possible. And finally, we do not want 
to politicize this. We need to stay focused on the goal and 
educate and meet people where they are in their vaccine 
journey.
    Thank you for the opportunity to share our views with you. 
I am pleased to respond to any questions. Thank you.

    [The prepared statement of Dr. Nichols follows:]
                 prepared statement of michelle nichols
    Chair Murray, Ranking Member Burr, and Members of the Committee on 
Health, Education, Labor, and Pensions, thank you very much for 
convening this important hearing on ``Vaccines: America's Shot at 
Ending the COVID-19 Pandemic.''

    I am Michelle Nichols, MD, MS and am presenting testimony on behalf 
of Morehouse School of Medicine (MSM). I bring greetings to you from 
our President and Dean, Dr. Valerie Montgomery Rice. At Morehouse 
School of Medicine, I serve as associate professor of family medicine, 
medical director of Morehouse Healthcare (MHC) which is our faculty 
practice plan, medical director of MSM/MHC Community COVID-19 
Vaccination Program, and Associate Dean for Clinical Affairs.

    According to the CDC, the COVID-19 pandemic has brought social and 
racial injustice and inequity to the forefront of public health. 
Unfortunately, it has highlighted that health equity is far from being 
a reality since COVID-19 has unequally impacted many racial and ethnic 
minority groups, putting them at greater risk for infections, 
hospitalizations, death, and access to vaccinations. These findings 
were not a surprise to us at Morehouse School of Medicine since we are 
on the front lines in leading the creation and advancement of health 
equity by engaging, educating, serving, and providing healthcare and 
research in communities of color.

    When the opportunity presented itself in December to become a 
community vaccine provider, Morehouse School of Medicine became an 
early adopter. Based on our commitment to health equity and being a 
trusted entity within the African American community in both healthcare 
and research, we knew that we must tackle the hesitancy, mistrust, 
misinformation, and myths associated with not only the vaccine but also 
the novel coronavirus in general. When vaccinations were first offered 
to those 75 years and older in early January, we did a kick-off vaccine 
event and invited and vaccinated Atlanta's prominent civil rights, 
church, and community leaders, legendary icons and role models, all 
whom were >75 years old such as former Ambassador and civil rights 
leader Reverend Andrew Young, former HHS secretary Dr. Louis Sullivan 
and other prominent >75 year old Atlanta legends, whom all consented to 
publicly be vaccinated so they can impact trust and to serve as role 
models (like they had done earlier as trail blazers in the civil rights 
movement and their careers) as we rolled out vaccinations for the 
seniors. Within days after that event, we set up a drive through 
vaccine event on our campus doing the first week in January and 
continued these events for 2 months. Since we are an academic health 
center, we engaged our students to not only vaccinate (vaccinators for 
medical students and PA students) but also to provide preventive health 
information (navigators for MPH and graduate students) during the 
observation period. This was very important because the pandemic 
resulted in many people missing on several preventive health services 
such as mammograms and colonoscopies and we wanted to encourage people 
to resume their in-person healthcare and procedures. We also helped 
vaccine recipients complete paperwork and register for CDC V-safe while 
waiting. As we were vaccinating, we were concurrently doing educational 
programs through weekly town halls, panel discussions, community 
outreach programs, Public Service Announcements, and social media.

    Lessons learned from the first 2 months of vaccinations were that 
the keys to success were community engagement, education, 
accessibility, and outreach. This led to us applying for and receiving 
grants to expand our reach beyond Atlanta, through our mobile unit for 
the traveling vaccination program that started in April.

    Since Morehouse School of Medicine is one of the four HBCU medical 
schools, we are a trusted entity in the community. This has resulted in 
over 75 percent of our vaccine recipients being African American 
compared to only approximately 9 percent nationally based on recent CDC 
data tracker from June 18, 2021. Additionally, starting in March as the 
vaccine supplies increased, we expanded our vaccination outreach and 
review of other vulnerable populations, and the DPH data on vaccination 
rate within the Hispanic community stood out as being low in Georgia. 
To help expand vaccination in the Hispanic community, we started 
engaging and forming partnership with Latino organizations and the 
Mexican consulate. Additional keys to success in impacting trust in the 
Latino community were through the consulates and traveling to the 
consulate facilities to vaccinate. Patients tend to trust people who 
look like them and have similar backgrounds and experiences. For these 
events, we also added and engaged our bilingual Spanish speaking 
students, nurses, and providers to vaccinate and educate. Currently, as 
we expand on our traveling vaccination program, we have started to 
engage with other Latino consulates as we go into rural migrant 
agricultural areas. From this we have learned that other languages and 
educational materials must be done besides English and Spanish. For 
example, as a result of engaging the other consulates-consents, videos, 
and educational materials were developed using the Mayan language. 
Because of these efforts, we are reaching more communities of color. At 
MSM, our current Latino vaccination rate is 13 percent which has 
positively impacted the Hispanic vaccination rate in Georgia. At MSM, 
with our community outreach and focus on decreasing health disparities, 
vaccinations for communities of color represent approximately 88 
percent of our vaccinations.

    Lessons learned over the last 6 months are:

        (1). Impact trust by engaging the community and being a part of 
        the community as well as having vaccine providers who look 
        like, sound like, or have similar experiences and backgrounds 
        to the vaccine recipients. Define the community (church, civic 
        organization, consulates, ethnic organizations, HBCUs, schools, 
        sports, etc.) and determine who are the best spokespersons 
        (civic rights or community leaders, athletes, people that look 
        like them and speaks their language, etc).

        (2). Provide information and education to dispel myths and 
        misinformation and to educate on vaccines through panel 
        discussion, town halls, media, PSAs, social media, Q&As, 
        pamphlets. Ensure material is multi-lingual, multi-media, and 
        at appropriate educational levels. Do not make assumptions. Do 
        not stereotype.

        (3). Meet people where they are in their vaccine journey. 
        Realize that not everyone is ready to be vaccinated. Do not 
        judge. Let potential vaccine recipients know that we are ready 
        to vaccinate them whenever they are ready.

        (4). As for adolescents, engage and educate both the parents 
        and children (12-17 year olds) so that our schools can resume a 
        sense of normalcy again, plan back-to-school vaccine events 
        with incentives (book bags, school supplies, etc.) while at the 
        same time doing sports physicals, preventive health reviews, 
        and health checks.

        (5). When people come for testing because of potential fear of 
        exposure, offer vaccinations at the same time. Never waste an 
        opportunity to educate and vaccinate.

        (6). Travel to where the vaccine recipient is and make it 
        convenient (go to school/college, work, home for the homebound 
        and senior communities, sporting events, fitness centers, rural 
        areas, etc.)

        (7). Do not politicize. Stay focused on the goal, educate, and 
        meet people where they are and vaccinate.

    Morehouse School of Medicine because of its mission is uniquely 
positioned to help boost vaccination rates because we are viewed as a 
trusted source of COVID-19 help, health, and vaccine information within 
communities of color.

    Thank you for the opportunity to share our views with you. I am 
pleased to respond to any questions.
                                 ______
                                 
                [summary statement of michelle nichols]
    I am Michelle Nichols, MD, MS and am presenting testimony on behalf 
of Morehouse School of Medicine (MSM). At MSM, I serve as associate 
professor of family medicine, Medical Director of Morehouse Healthcare 
(MHC) which is our faculty practice plan, Medical Director of MSM/MHC 
Community COVID-19 Vaccination Program, and Associate Dean for Clinical 
Affairs.

    Beginning in December 2020, based on our commitment to health 
equity and being a trusted entity within the community in both 
healthcare and research, Morehouse School of Medicine endeavored to 
serve as a community vaccine provider and to tackle the hesitancy, 
mistrust, misinformation, and myths associated with not only the 
vaccine but also the novel coronavirus in general.

    To date, over 75 percent of our vaccine recipients have been 
African American, compared to only approximately 9 percent nationally, 
based on recent CDC data tracker from June 18, 2021. Given our 
intentional efforts to reach more communities of color, our current 
Latino vaccination rate is 13 percent which has positively impacted the 
Hispanic vaccination rate in Georgia.

    In our efforts to continue to advance health equity by providing 
vaccinations to our community, we have learned several critical 
lessons. These lessons learned will be expanded upon in my testimony, 
but can be best summarized as:

        (1). The keys to success are in community engagement, 
        education, accessibility, and outreach.

        (2). Impact trust by engaging the community and being a part of 
        the community as well as having vaccine providers who look 
        like, sound like, or have similar experiences and backgrounds 
        to the vaccine recipients. Define the community (church, civic 
        organization, consulates, ethnic organizations, HBCUs, schools, 
        sports, etc) and determine who are the best spokespersons 
        (civic rights or community leaders, athletes, people that look 
        like them and speak their language, etc).

        (3). Provide information and education to dispel myths and 
        misinformation and to educate on vaccines through panel 
        discussion, townhalls, media, PSAs, social media, Q&A's, 
        pamphlets. Ensure material is multi-lingual, multi-media, and 
        at appropriate educational levels. Do not make assumptions. Do 
        not stereotype.

        (4). Meet people where they are in their vaccine journey. 
        Realize that not everyone is ready to be vaccinated. Do not 
        judge. Let potential vaccine recipients know that we are ready 
        to vaccinate them whenever they are ready.

        (5). As for adolescents, engage and educate both the parents 
        and children (12-17 yo) so that our schools can resume a sense 
        of normalcy again, plan back-to-school vaccine events with 
        incentives (bookbags, school supplies, etc) while at the same 
        time doing sports physicals, preventive health reviews, and 
        health checks.

        (6). When people come for testing because of potential fear of 
        exposure, offer vaccinations at the same time. Never waste an 
        opportunity to educate and vaccinate.

        (7). Travel to where the vaccine recipient is and make it 
        convenient (go to school/college, work, home for the homebound 
        and senior communities, sporting events, fitness centers, rural 
        areas, etc.).

        (8). Do not politicize. Stay focused on the goal, educate, and 
        meet people where they are and vaccinate.
                                 ______
                                 
    The Chair. Thank you.
    Mr. Chang.

STATEMENT OF CURTIS CHANG, CONSULTING PROFESSOR, DUKE DIVINITY 
                      SCHOOL, SAN JOSE, CA

    Mr. Chang. Senators, the road to ending the pandemic runs 
through the evangelical church, especially the White 
evangelical church. At the national level, White evangelicals 
comprise the single largest vaccine-hesitant demographic in the 
Country, with almost half signaling that they will not get 
vaccinated.
    At the state level, if you took a map of the least-
vaccinated states, it corresponds very tightly to a map of the 
Bible Belt, with some states not reaching even one-third 
vaccination rates.
    At the global level, American evangelical culture is highly 
influential in parts of Asia and Africa. We are already 
exporting our misinformation and fears to the rest of the 
world, especially via social media.
    Reaching every demographic in our Country matters, but we 
are not ending the pandemic unless we convince more White 
evangelicals to get vaccinated. And this is why I, along with 
Chris Carter, who is here today, founded Christians and the 
Vaccine. It is a partnership with the Ad Council, COVID 
Collaborative, the National Association of Evangelicals, and 
Values Partnerships. We have produced and distributed a range 
of online video content to equip the evangelical community to 
address vaccine hesitancy in our own community.
    Why are White evangelicals so hesitant? Well, vaccine trust 
is essentially a proxy for institutional trust. Every one of us 
only takes the vaccine to the extent we trust the FDA, the CDC, 
pharmaceutical companies, and public health. Unfortunately, the 
level of distrust among White evangelicals with large 
institutions is at an all-time high.
    Now, there's complex and longstanding reasons for this 
growing distrust. Our own communities' vulnerability to 
misinformation is certainly a big factor. But, in the context 
of the vaccine, this tendency toward distrust has been 
exacerbated by public health's inattention and overlooking this 
particular community. While there has been hammering about 
evangelical attitudes in the mainline media, there has been 
little targeted outreach from public health. As one state 
health official admitted to us, she said, we have spent maybe 2 
minutes thinking about White evangelicals.
    To the extent that the public health has engaged with faith 
communities, it has overwhelmingly been with minority faith 
communities, where it has succeeded with remarkable effect, 
driving a 10-point jump in vaccine acceptance among Black 
Protestants in just a few months of outreach.
    Now, this racial equity emphasis has been absolutely 
necessary, given historical inequities and current barriers of 
access. However, this focus has not been matched by attention 
to the largest and most vaccine-hesitant community. And this 
inattention is simply counterproductive in a national pandemic 
where we are all connected. As a person of color, I need public 
health to focus on White evangelicals because what they decide 
affects my community.
    As our work has gained prominence, we did have the 
opportunity to speak with several key national public health 
institutions, all of whom showed great interest. However, they 
had no available pathway to partner with us to expand our 
efforts. Again, a key reason given was the fact that our focus 
did not fit the minority-focused communities.
    Another issue was that the vast majority of Federal funding 
on vaccine outreach simply gets distributed to state public 
health agencies, meaning there is no efficient pathway for the 
Federal Government to partner with us on a coordinated national 
outreach.
    But, it is not too late. It is not too late to persuade the 
White evangelical community. Faith-based efforts do work as 
demonstrated by the success reaching Black Christians. And one 
very recent study by PRRI showed that 44 percent of vaccine-
hesitant evangelicals say that they would still be influenced 
by faith-based efforts.
    The key recipe is a partnership between public health and 
faith leaders in the evangelical community. The message and the 
voice have to come from the faith leaders themselves because 
they are the trusted voices. But, public health can make a big 
difference by convening the faith leaders, by providing 
resources to amplify their voices, and then especially by 
taking cues from those faith leaders on which public health 
efforts will work in their communities.
    The last point about taking cues from faith leaders is 
critical because there is no one-size-fits-all approach. For 
instance, what works in the Black church, such as having 
churches host vaccination sites, often does not work in the 
White evangelical church context.
    I respectfully submit the following two requests to this 
Committee for consideration. First, please consider 
supplementing the current state-focused approach with 
additional resources and national coordinated outreach. A 
state-by-state approach may be effective in some health issues, 
but in pandemic, we need coordination.
    Then, finally, please direct Federal outreach to pay 
attention to White evangelicals. This community requires a 
specific type of outreach, and failure to do so puts all 
communities at risk.

    [The prepared statement of Mr. Chang follows:]
                   prepared statement of curtis chang
    The pathway to ending the pandemic runs through the evangelical 
church. Almost half of all white evangelicals are resistant to getting 
vaccinated. The sheer size of this population nationally and within 
concentrated regions mean evangelicals could make or break the 
vaccine's potential to restore life to normal in communities across the 
country. Yet for many outside the evangelical world, this resistance 
seems incomprehensible.

    As life-long evangelicals, we worry about how our people could 
become a barrier for recovery from the pandemic. But as insiders, we 
also have an understanding of how we got here. Evangelical resistance 
to the vaccine is driven by larger forces that have reshaped our 
tribe's relationship with the broader secular world. Vaccine outreach 
efforts to our community must account for these deeper dynamics, and 
should partner with evangelical leaders who know best how to navigate 
this altered landscape.

    For everyone--evangelical or not--the decision to take the vaccine 
is essentially a decision to trust institutions. Few of us are equipped 
to understand the vaccines' scientific complexities. We only take the 
vaccine when we decide to trust ``Them:'' the constellation of 
scientific, government, and media institutions assuring everyone that 
the vaccine is truly safe, effective, and necessary.

    But what happens when this trust in ``Them'' is thoroughly 
undermined within a particular community?

    American evangelicals are historically prone to ambivalence toward 
the dominant secular institutions of the day. In fact, a posture of 
critical evaluation is built into the fabric of our faith. Evangelicals 
interpret Jesus' teaching that his followers are in the world but not 
``of the world'' (John 17:16) to mean we should engage with the world's 
secular institutions with a certain measure of caution. In proper 
doses, a certain amount of caution is healthy for all communities--not 
just evangelicals. No institution is infallible, and critical thinking 
can be a civic virtue.

    Unfortunately, in recent years, the evangelical posture of critical 
engagement with secular institutions has mutated from caution into 
outright fear and hostility. Reminders to be on guard while engaging 
``Them'' have turned into a belief that ``They are out to get us!'' 
Many social forces--both internal and external to our community--caused 
this, but three current forces have especially exploited our built-in 
ambivalence toward secular institutions.

    First, conservative media have mastered the art of sowing 
evangelical suspicion of ``the Establishment'' to attract our eyeballs 
and grow their ratings. Second, politicians--some Christian and some 
not--have mastered the art of leveraging fear of elite institutions to 
gain our votes. Third, online conspiracy movements such as QAnon and 
the anti-vaxxers--which are thoroughly secular in their origins--have 
mastered the art of creating fictional enemies that are out to destroy 
our values, and in the case of the vaccine, our actual bodies. All of 
these forces now actively shape how large segments of our community 
perceive the vaccine.

    In our vaccine outreach with evangelicals, we hear a variety of 
reasons for suspicion, ranging from common fears that the vaccine was 
rushed to conspiracy theories that the vaccine contains tracking chips 
or is the ``the mark of the beast''. But underneath all of those 
diverse reasons is the sharply intensified reflex of institutional 
distrust.

    This reflex has taken root so rapidly that an alarming gap has 
opened up between evangelical pastors and the people in their pews. One 
survey from the National Association of Evangelicals conducted in 
January showed that 95 percent of leaders were planning to take the 
vaccine themselves, a marked contrast to other surveys that show 45 
percent to 55 percent of evangelicals continuing to be reluctant on the 
vaccine. This gap follows a well-researched trend of pastors feeling 
afraid to speak on public issues for fear of alienating some portion of 
their members.

    Even so, there is a path forward. A just-released study from Public 
Religion Research Institute and Interfaith Youth Core (PRRI/IFYC) 
reveals two key encouraging truths. First, there still exists a large 
``moveable middle'' even among vaccine-hesitant evangelicals. Second, 
faith-based appeals--distinguished from secular public health appeals--
are an effective strategy. Among vaccine-hesitant white evangelicals, 
47 percent said that more faith-based outreach would encourage them to 
get the shot.

    Several high-profile evangelical leaders have already begun faith-
based outreach. NIH Director Francis Collins, a well-known evangelical, 
has worked tirelessly to promote the vaccine. BioLogos, a Christian 
nonprofit that promotes the integration of faith and science, has 
rallied other evangelical scientists for the cause. Russell Moore, head 
of the Southern Baptist Convention's Ethics & Religious Liberty 
Commission, has provided important guidance to the country's largest 
Protestant denomination. Even Donald Trump-supporting conservatives 
like Franklin Graham and Dr. Robert Jeffress have come out strongly in 
favor of the vaccines, willingly enduring hostile reactions from their 
base.

    These national voices are important, but we are now at a pivotal 
moment: the ground game phase of vaccination outreach. The PRRI/IFYC 
study spotlighted that the remaining vaccine-hesitant evangelicals will 
be most persuaded by a mixture of subtle, local and highly relational 
efforts: e.g. people learning that their pastor or fellow church member 
got vaccinated, or getting help from their church in scheduling a 
vaccination appointment.

    Evangelicals on the ground must take the lead in implementing these 
efforts because the underlying problem is our community's distrust of 
secular institutions. Resistance won't be overcome by more well-
intended PSAs from the Biden administration; it can only happen via 
millions of granular exchanges like that between a pro-vaccine 
evangelical and a vaccine-hesitant friend who attends the same church.

    While evangelicals are best-equipped to reach evangelicals, secular 
institutions still have a critical role to play, particularly to 
achieve the scale of outreach necessary in this crucial moment. 
Philanthropy, social media platforms, public health all can 
meaningfully accelerate this ground game phase--if those institutions 
are willing to partner with evangelicals.

    American evangelicals must help our own community find their way 
out of the thicket of vaccine confusion and distrust. But we still need 
the partnership of secular institutions. The pandemic has provided this 
Nation many lessons in humility, perhaps none greater than the 
realization that none of us--and no sub-community--ever stands fully 
alone.
                                 ______
                                 
                  [summary statement of curtis chang]
    The road to ending the pandemic runs through the evangelical 
church. At the national level, white evangelicals comprise the single 
largest vaccine hesitant demographic. At the state level, a map of the 
states with the lowest vaccination rates corresponds tightly with a map 
of the Bible Belt. And at the global level, US evangelical culture is 
already exporting our misinformation and fears to the rest of the 
world, especially via social media.

    Evangelicals are prone to vaccine distrust because vaccine trust is 
essentially a proxy for institutional trust. Every one of us will take 
the vaccine only to the extent that we trust the FDA, the CDC, public 
health, pharmaceutical companies, and others. Unfortunately, white 
evangelical distrust of institutions is at an all time high.

    There are complex and longstanding reasons for this distrust. But 
in the context of the vaccine, this distrust has been exacerbated by 
public health overlooking the need to reach out to white evangelicals. 
There has simply been little targeted outreach efforts from public 
health.

    To the extent that public health has engaged faith communities, it 
has overwhelmingly been with minority faith communities, where it has 
succeeded with remarkable effect, driving a 10 point jump in vaccine 
acceptance among Black Protestants in just a few months of outreach. 
The racial equity emphasis has been necessary, but it unfortunately has 
excluded attention to the largest and most hesitant population, which 
is counter-productive in a nationwide pandemic. Because of this 
exclusive focus on minority communities, there has been no available 
pathway to partner with the government to expand our efforts. Moreover, 
the vast majority of Federal funding on vaccine outreach was simply 
distributed to the state level, meaning there was no efficient pathway 
for the Federal Government to partner with us on national outreach.

    It is critical that faith based outreach increases for white 
evangelicals with the COVID vaccine, and for future public health 
crises. This is because studies show that faith based public health 
outreach works. One study by PRRI showed that 44 percent of vaccine 
hesitant evangelicals say that they would be influenced by faith based 
efforts.

    The key recipe is a partnership between faith leaders and public 
health. The message and voice has to come most directly from trusted 
voices within the faith community, but public health can make a big 
difference in convening faith leaders, providing resources to amplify 
those faith voices, and taking cues from those leaders on what public 
health efforts work best in their particular communities. This last 
point about taking cues from faith leaders is critical, because there 
is no one-size-fits all approach.

    We respectfully submit the following two requests to this Committee 
for consideration: (1) Please direct Federal outreach efforts on the 
vaccine and future public health crises to pay attention to white 
evangelicals, in addition to minority faith communities; and (2) Please 
direct public health funds on the vaccine to include coordinated 
national outreach efforts.
                                 ______
                                 
    The Chair. Thank you very much.
    Dr. Betancourt.

STATEMENT OF JEANETTE BETANCOURT, Ed.D., SENIOR VICE PRESIDENT 
     FOR U.S. SOCIAL IMPACT, SESAME WORKSHOP, NEW YORK, NY

    Dr. Betancourt. Thank you very much. Thank you, Senator 
Murray, Senator Burr, and all of the Committee in terms of 
HELP.
    First of all, what I would love to do is introduce our 
process that we have engaged in throughout the pandemic because 
one of the things I am hoping to leave you with is the idea of 
looking at young children's perspective, along with parenting.
    At Sesame Workshop, which is the non-profit, global 
organization whose mission is to help all children grow 
smarter, stronger, and kinder, we continually, not only through 
our programming, but through our social impact work, tackle the 
toughest topics. We have dealt with parental addiction, foster 
care, family homelessness. And throughout the process of the 
pandemic, we have actually structured this to meet the stages 
that families and children are engaged in throughout the 
pandemic.
    When the pandemic first hit, we called that stage the ``For 
Now Normal.'' Suddenly, young children and their families were 
in shelter-in-place. All the safety routines that are so 
typical for young children were lost. They no longer had the 
physical contact and routines that they generally have.
    The next stage, that we are in now, is the ``Different But 
Before Normal.'' In other words, we are transitioning back, but 
it is in steps. And additionally, we are preparing children to 
adjust, along with their families, to those steps.
    However, they have had quite a bit of crisis. It is the 
focus on our young children's and their families' mental health 
that we need to look at as we are making decisions around 
vaccination, as well.
    We also look at our third stage as ``Long-Term 
Consequences,'' what is the mental health of now this young 
COVID generation.
    Tying all those pieces together now, we have also 
partnered, like many of the colleagues here, with the Ad 
Council and the COVID Collaborative around messaging on 
improving and informing parents with young children that they 
should be vaccinated. There, the approach that we took is, how 
do you return to those safety moments, those things that you 
have missed before, that relevance to family life, and, also, 
the relevance to young children's well-being in their safety 
routines.
    In addition to that, we created all of these resources 
bilingually, in English and Spanish, in different formats. Not 
only in terms of video, audio, and also digital resources that 
can be posted, whether it is posters specific for the Latino 
community, or the African-American Black community, or the 
immigrant community. Again, using the trusted power of our 
Muppets as a trusted source for parents and caregivers and 
children.
    Now, as we are reaching this next vital stage, we believe 
very strongly of the idea of creating a circle of care, a 
circle of safety, when we get to the stage of now encouraging 
parents to vaccinate their young children.
    But, I also ask you to look at the way we have messaged 
thus far. Our role, many times, is, how do we message in a 
friendly way for children and families and the adults who 
influence them so that they are making the decisions for the 
well-being of their children.
    However, throughout the pandemic, and rightly so, we have 
mentioned the young children are the least influenced or 
impacted by the pandemic. Again, it is not adverse; it is true. 
They are also very much likely the first to have returned to, 
quote, school, early childhood programs, whether it is through 
family, friend, and neighbor care, through center-based 
programs, or family childcare.
    From a parent's point of view, children, young children 
especially below five, are Okay. The decision on vaccination 
will be a little harder because, along the way, they have been 
sort of told they are doing Okay. It is the priority on 
children, on youth, and adults.
    We are here to work with all of you, to partner, to also 
continue our messaging. And we believe that the next stage of 
convincing young parents in terms of vaccinating their young 
children is the idea of forming a circle of safety. I do it. My 
family does it. I include my children. But, also, the idea of 
bringing back those valuable routines to young children's well-
being in which all of us, as a Nation, should be invested in.
    Thank you very much for this opportunity, and I look 
forward to your questions.

    [The prepared statement of Dr. Betancourt follows:]
               prepared statement of jeanette betancourt
                              Introduction
    Good morning Chair Murray, Ranking Member Burr, and other 
distinguished Members of the Committee on Health, Education, Labor, and 
Pensions.

    I am Jeanette Betancourt, Ed. D., Senior Vice President of U.S. 
Social Impact at Sesame Workshop. I wish to thank all of you for the 
opportunity to share Sesame Workshop's response to the COVID-19 
pandemic, especially in meeting the sudden and evolving needs of young 
children and, most recently, our focus on encouraging parents and 
caregivers to get vaccinated as an important part of the whole family's 
well-being. If I can leave you with only one major takeaway, apart from 
the joy of sharing a few special moments with our Sesame Street 
Muppets, it is the importance of considering the child's perspective 
and of recognizing what children and families have experienced over the 
past 18 months and how that has informed their decision-making process 
regarding vaccination.
                               Who We Are
    Sesame Workshop is the nonprofit global organization with a mission 
to help children around the world grow smarter, stronger, and kinder. 
We do so through a wide range of media, formal education, and 
philanthropically funded social impact programs. Our iconic and beloved 
Sesame Street premiered at the height of the Civil Rights movement with 
the first racially integrated cast on children's television, and it has 
remained a place where humans and Muppets of all shapes, sizes, and 
skin (or fur!) colors model diversity, equity, inclusion, and mutual 
respect and understanding. While our efforts are made on behalf of all 
children--and all children stand to benefit from them--our primary aim 
from the outset has been to improve outcomes and well-being among the 
most marginalized children and their families, who are so often 
impacted by the effects of poverty, trauma, and racial injustice.

    Sesame Workshop's U.S. Social Impact team develops 
philanthropically supported initiatives that address critical 
challenges impacting children, parents, and caregivers as well as the 
community providers who support them. Our initiatives are research-
driven, proven, and innovative, especially the wide-ranging and ever-
growing Sesame Street in Communities (SSIC), which creates and delivers 
free bilingual resources in response to widespread issues such as: 
trauma, food insecurity, a parent's incarceration, family homelessness, 
divorce, school readiness, health and well-being, and other important 
early childhood topics. These initiatives model parent and caregiver 
strategies that are vital to ensuring that every child--especially 
those most at risk--can succeed in school and in life. The success of 
our initiatives is rooted in our approach, which ties together 
curriculum, research, and accountability for achieving results. We are 
also extremely nimble, with the ability to respond immediately to 
crises or plan out for the longer term.
              Our COVID-19 Response: Caring for Each Other
    The COVID-19 pandemic prompted unprecedented disruption and 
uncertainty in the lives of young children and their families. We knew 
immediately that we had a responsibility to respond and that, having 
built a half-century's worth of trust and dependability among parents, 
we were uniquely positioned to explain for children the many changes 
that were so dramatically altering family life, while offering 
responses to their questions and concerns. Sesame Workshop acted 
quickly. To help young children feel a sense of comfort, engage in 
playful learning away from school, and maintain a more hopeful outlook, 
we created our Caring for Each Other (CFEO) initiative and the SSIC 
Health Emergencies topic page and brought families clarity, comfort, 
and moments of joy through televised specials such as Sesame Street: 
Elmo's Playdate and a series of CNN Town Halls.

    Foreseeing the ongoing impact of constant change in children's 
lives, we developed a phased approach to meeting the needs of 
families--as always, from the child's perspective. We grouped our 
efforts into three stages, creating bilingual CFEO resources for each, 
aligned with the progression of change as the COVID-19 pandemic 
evolved.

          For Now Normal: Initially, families and their young 
        children found themselves dealing with a complete halt to their 
        everyday routines, the need to shelter-in-place, and facing 
        questions about a deadly virus that did not have a child-
        friendly explanation. As families settled into a ``for now 
        normal,'' CFEO offered ways to support children's emotional ups 
        and downs, including challenges such as missing friends, coping 
        with sickness, and grieving the death of a loved one. As the 
        urgent reliance upon essential workers became more prevalent, 
        we offered special support, encouragement, and gratitude to 
        frontline workers and their families while helping them explain 
        to children why sometimes-lengthy separations were unavoidable.

          Before But Different Normal: This is our current 
        stage. As children and families transition back to pre-pandemic 
        routines, CFEO continues to provide resources across a broad 
        variety of experiences, from understanding mask wearing 
        (including resources for autistic children) and other safety 
        precautions, to managing separation anxiety, building 
        mindfulness and fortitude, and, for many, returning to school. 
        As guidelines and mandates for in-school learning have shifted, 
        parents and caregivers have had to prepare children for changes 
        to school as they had known it, while staying flexible to 
        handle fluctuations between in-school and at-home learning. 
        Community providers, especially early childhood educators, have 
        had to learn to connect with children while wearing PPE and 
        staying physically distant. They must also understand 
        children's emotions during these constant changes, find new 
        ways to nurture them, and maintain open lines of communication 
        with parents/caregivers.

          Longer-Term Consequences: Often there is a tendency 
        to assume young children are resilient and that they can easily 
        and/or quickly recover from (and even forget) challenging 
        situations. Although children do possess a certain resiliency, 
        recovery from the longer-term consequences of the pandemic will 
        likely take time and consideration, due to the traumatic 
        disruption of their established routines and sense of safety. 
        In many marginalized communities, which have been the hardest 
        hit, children are expressing stress, anxiety, and major effects 
        on their mental health and well-being. Furthermore, we must 
        acknowledge that parents, caregivers, and community providers 
        have been deeply affected as well, and what they model will 
        ultimately reflect upon young children.

    Our approach has proven effective. During the first phase of our 
work, we executed a pre-and post-survey \1\ with parents of young 
children after they used the CFEO Health Emergencies resources. Results 
indicated that parents who used the strategies (e.g., belly breathing) 
helped their child cope with the challenges and stress of COVID-19 more 
successfully than before exposure to the resources. Parents also rated 
themselves as significantly more confident in helping their children 
manage difficult emotions, feel physically safe, and have a greater 
sense of hope during sheltering-in-place, especially due to their 
children's connection to Sesame Street characters as they modeled 
behaviors. ``My son was so interested in the video and activities, and 
would be talking to the characters. I saw relief on his face as he saw 
his character friends discuss things I didn't realize he was worried 
about.''
    --Parent of 4-year-old boy responding to the survey.
---------------------------------------------------------------------------
    \1\  Sesame Street Health Emergencies: COVID-19 Parent Survey. 
MediaKidz Research & Consulting. July 2020.
---------------------------------------------------------------------------
                          COVID-19 Vaccination
    Continuing CFEO's nimble response, we partnered with the Ad 
Council, COVID Collaborative, and CDC, and launched a series of public 
service announcements and resources in English and Spanish to guide 
parents and caregivers about the importance of COVID-19 vaccines. 
Featuring Elmo, Elmo's dad Louie, and the Sesame Street Muppets, the 
PSAs highlight that COVID-19 vaccines for adults are here and that 
getting vaccinated can help lead to sunnier days ahead.

          I'll Be Seeing U: I'll Be Seeing You Song (60'sec). 
        This take on Billie Holiday's ``I'll Be Seeing You'' is sung by 
        the Letter U and shows what families miss and want to return 
        to.

          Healthy Family with Elmo and Louie: Elmo's Daddy Gets 
        Vaccinated (60'sec). Here, Elmo's dad, Louie, responds to 
        Elmo's curiosity and explains why he got vaccinated--so he can 
        stay healthy and keep everyone safe.

    An additional bilingual digital toolkit includes printable 
activities, posters, and FAQ that take children's perspectives and 
build on their curiosity, explaining why grownups are getting 
vaccinated, answering common questions in age-appropriate ways, and 
reminding children to practice other healthy behaviors like 
handwashing. It also customizes messaging to different communities, 
i.e., Black/African American, Latino, and Immigrant.
                    Our Learning and Recommendations
    We continue to observe that young children are curious about the 
ongoing transition to recovery, however many are experiencing 
challenging feelings and/or are unsure how to express their concerns. 
Parents and caregivers are also struggling. Many are still managing 
their children's hybrid learning or transitioning back to school; 
coping with possible ongoing economic hardships; and/or are not 
considering self-care as a priority. Vaccination and other transitional 
practices are allowing our collective return to the ``before but 
different normal,'' bringing greater hope for the future. Yet vaccine 
hesitancy remains pervasive and, as we approach the phase when young 
children will be afforded vaccination access, we recommend the 
following considerations:

          Acknowledge that, for the youngest children and their 
        parents and caregivers, there will be confusion in messaging. 
        Throughout the pandemic, the overall messaging was that young 
        children were less vulnerable to contracting COVID-19 or 
        experiencing ill effects.

          Vaccine hesitancy might be prompted by the fact that 
        young children returned to in-person childcare settings 
        (family, friend, and neighbor care; family childcare, or 
        center-based) much earlier than other ``students,'' and most 
        are doing ``fine'' as perceived by parents or caregivers.

          Parents and caregivers are likely to be more hesitant 
        of the longer-term effects of a new vaccine the younger their 
        child is.

          There is a critical relationship between the mental 
        health and overall well-being of parents and caregivers and 
        their openness to considering what may seem to be challenging 
        decisions. Many parents and caregivers are still experiencing 
        high levels of stress, anxiety, coping with loss, economic 
        hardships, and/or feelings of isolation.

      Although young children, parents, and caregivers do rely 
on the health care community as a trusted source, many may have lost 
their connection to a consistent medical provider.
                               Next Steps
    Sesame Workshop's CFEO will partner with the Ad Council, the COVID 
Collaborative, and the CDC (and possibly other partners) to create 
specific resources to encourage vaccination for our youngest citizens. 
We are in the process of determining the most effective messaging, but 
we know we will once again rely upon the power of our beloved Sesame 
Street Muppets and our long held trust with parents, caregivers, and 
providers to continue to make a difference in the well-being of our 
youngest citizens.
                                 ______
                                 
               [summary statement of jeanette betancourt]
          Sesame Workshop's response to the COVID-19 pandemic 
        has focused on meeting the evolving needs of young children as 
        well as encouraging parents and caregivers to get vaccinated as 
        an important part of the whole family's well-being.

          We must consider the child's perspective and 
        recognize that what children and families have experienced over 
        the past 18 months impacts their decisions regarding 
        vaccination.

          The COVID-19 pandemic has prompted unprecedented 
        disruption and uncertainty in the lives of young children and 
        their families. In response, Sesame Workshop has developed a 
        three-phased approach--For Now Normal; Before, But Different 
        Normal; and Longer-Term Consequences--to provide resources that 
        bring families clarity, comfort, and moments of joy aligned 
        with the progression of change as the COVID-19 pandemic 
        evolved.

          For COVID-19 vaccinations, Sesame Workshop partnered 
        with the Ad Council, COVID Collaborative, and CDC to launch a 
        series of public service announcements and resources in English 
        and Spanish to guide parents and caregivers about the 
        importance of COVID-19 vaccines.

          The PSAs feature Elmo, Elmo's dad Louie, and the 
        Sesame Street Muppets and highlight that getting vaccinated can 
        help lead to sunnier days ahead. An additional bilingual 
        digital toolkit is customized for different communities to help 
        explain why grownups are getting vaccinated, and answers common 
        questions in age-appropriate ways.
                    Our Learning and Recommendations
          Young children are curious about the ongoing 
        transition to recovery, however many are unsure how to express 
        their concerns. Parents and caregivers are also struggling.

          Vaccination and other transitional practices are 
        bringing greater hope for the future. Yet vaccine hesitancy 
        remains pervasive and, as we approach the phase when young 
        children will be afforded vaccination access, we recommend the 
        following considerations:

                Y  Acknowledge that, for the youngest children and 
                their parents and caregivers, there will be confusion 
                in messaging. The overall messaging has been that young 
                children were less vulnerable to contracting COVID-19.

                Y  Vaccine hesitancy might be prompted by young 
                children returning to in-person childcare settings much 
                earlier than other ``students,'' and most are doing 
                ``fine.''

                Y  Parents and caregivers are likely to be more 
                hesitant of the longer-term effects of a new vaccine 
                the younger their child is.

                Y  There is a critical relationship between the overall 
                well-being of parents and caregivers and their openness 
                to consider challenging decisions.

                Y  Although families do rely on the health care 
                community as a trusted source, many may have lost their 
                connection to a consistent medical provider.

          Looking ahead, Sesame Workshop will collaborate with 
        the Ad Council, the COVID Collaborative, and the CDC to create 
        specific resources to encourage vaccination for our youngest 
        citizens. We are in the process of determining the most 
        effective messaging.
                                 ______
                                 
    The Chair. Thank you very much to all of our witnesses. We 
really appreciate your testimony this morning and find it 
invaluable. So, thank you.
    Dr. Betancourt. Sorry.
    The Chair. Yes.
    Dr. Betancourt. I forgot to mention that we have actually a 
PSA. I could not forget that.
    The Chair. Okay.
    Dr. Betancourt. We have--sorry. I bring my Elmo friend and 
also a PSA that we wanted to demonstrate. So sorry.
    The Chair. Okay.
    Dr. Betancourt. Demonstrate how we have messaged. And this 
is Elmo and his daddy, looking ahead.
    Oh, we do not have volume.
    What we can do is actually send this to you. All Elmo and 
Daddy are exploring is really why he got vaccinated, and it is 
that hope for the future and return to routines. So, thank you.
    The Chair. Okay. Thank you very much.
    Dr. Betancourt. Sorry.
    The Chair. I think all of us probably know what they are 
saying just by having the question----
    Dr. Betancourt. Yes. And you can imagine. Yes. Children's 
curiosity.
    [Laughter.]
    [Video presentation.]
    The Chair. Can we start it over at the beginning?
    [Video presentation.]
    Dr. Betancourt. Thank you.
    The Chair. Thank you so much. As a former preschool 
teacher, I now feel I can start my day.
    [Laughter.]
    The Chair. Thank you.
    We will now begin a round of 5-minute questions of our 
witnesses, and I ask all of our colleagues to please keep track 
of your clocks, stay within those 5 minutes.
    Let me start. We know that the best way to reach people and 
address their concerns about vaccines is to actually tailor the 
message to their specific background and concerns. We also know 
the same kind of outreach will not work for everyone. Different 
communities may prefer to receive information in different 
settings, different messengers.
    Let me start with Dr. Nichols and Mr. Chang. You frequently 
talk to people who have not received COVID-19 vaccines. What 
are effective ways to customize outreach on vaccines to the 
person or community at hand?
    Dr. Nichols, let me start with you.
    Dr. Nichols. Thank you for the question. So, I am a family 
physician, so one of the things that I do is, I started back in 
January a modeling, telling people that I had completed my 
vaccine series, and I told them what the effects were.
    The other thing is, I always say go where--reach people 
where they are in their journey. So, if people are hesitant, I 
give them the information, I give them the data, I give them 
the science, to say that these vaccines are safe.
    Also, it is important to go where they are, so I go to 
their locations. I have actually gone to the various 
communities and had conversations with them. Preplan--pre now 
opening up to a sense of normalcy, I also went to--I did Zoom 
presentations.
    Also, when I go toward my adolescents and my younger 
people, I talk to them about the importance of getting back to 
normalcy, of going back to playing their sports events, not 
worrying if they are going to be quarantined because some 
member of their team is--now has COVID-19. So, I talk about 
that.
    I talk to parents about the opportunities so that their 
kids can get back to school and learn because we all know that 
what happened was that we often saw there are--kids were far 
behind. They were getting behind. And, so, I said, let's do 
what we can to get it back to normalcy.
    When I talk to my patients, I say, let's try--don't you 
look for the opportunity that you could now hug your grandkids? 
I have a lot of older patients. So, I said, don't you wish that 
you had the opportunity to hug your grandkids? I say the same 
thing to my patients about seeing their parents. I was able to 
see my parents for the first time in February, and I was very 
thrilled to have the opportunity of seeing them in over a year, 
and they are in their 80's.
    I talk to people about those things and those family 
gatherings. So, I talk to people about what is important to 
them.
    Finally, one of the things that I did that was very 
important is that we engaged people who look like and talk like 
them. Because I found that in our other communities, that if 
you had someone who was similar to you, this helped. When we 
looked at some of our other immigrants, such as those that were 
from Ecuador and different people, we found out that the--that 
Spanish nor English were the right language for them. And, so, 
we did videos that were in the Mayan language so that you can 
reach and help people to understand.
    That is the important thing. Just meet people where they 
are. And if they are not ready, I say, that is Okay, because I 
am here and we are here to vaccinate you whenever you are 
ready.
    Thank you for your question.
    The Chair. Mr. Chang.
    Mr. Chang. I think, given that there is institutional 
mistrust, the key is providing information and content to 
friends and family who vaccine-hesitant folks will trust, 
people in their own social networks. This is why we created 
short, sharable videos to put in the hands of evangelicals to 
share with their neighbors, fellow church members, friends and 
family, and so forth.
    The key here, I think, is actually social media. Because, 
in the pandemic, how we are sharing and influencing each other 
is significantly mediated through social media. And this is 
where I would encourage efforts by the government to fund more 
outreach through social media, through generating content, 
through targeted advertising, because that is the battlefield 
right now for the vaccine trust efforts.
    The Chair. Thank you very much.
    Many of you mentioned misinformation in your testimony and 
the concern about that. These efforts seem to be growing and 
undermining all of your work and our work. We hear about 
constituents who are getting misinformation or spreading false 
information via Facebook, Twitter, other platforms.
    Let me just quickly ask Dr. Bailey and Dr. Betancourt. What 
would you tell all of us that we should be doing to stop the 
spread of false and misleading information on these platforms?
    Dr. Bailey.
    Dr. Bailey. Social media is certainly a double-edged sword. 
It can be a great venue for spreading good information, but 
also spreading misinformation. We--the AMA believes that social 
media networks need to have some responsibility for spreading 
false information that they know not to be true. And, we need 
to be able to counter that with factual information from 
trusted sources, as my colleagues have said.
    If we completely bow out of social media and do not 
participate, then we are ceding that territory to those who are 
willing to spread misinformation. And, I think it is important 
to understand that folks that are spreading misinformation are 
often doing so because they may have a book to sell. They may 
have a site they want you to go see. They may have something 
that they are trying to buildup, and, so, it might not 
necessarily be in your best interest that this misinformation 
is being spread. I think it is important to know the source and 
to go to trusted sources.
    The Chair. Thank you.
    Dr. Betancourt.
    Dr. Betancourt. Thank you for the opportunity. I would say 
that for our role, it is not directly dealing with 
misinformation, but how do we provide information that is 
relevant, valued, research-based for parents, caregivers, and 
we do so because we do an incredible amount of research in the 
way we are messaging. Our hope is that we are counteracting 
that misinformation.
    But, the other factor is, how do we deliver this 
information so that it is relevant to the everyday moments of 
families and children; that it is also relevant to the key 
influencers in their lives, whether it is the healthcare 
community, the social work community, any--the early childhood 
community.
    The other way that we address, as a trusted source now over 
50 years, is how do we use--and the reaction that you had--our 
trusted Muppets and, again, presenting from the child's 
perspective. Often, because this is viewed as such a grownup 
issue, we lose the fact of how our young children can be 
advocates, as well. And that means looking at young children, 
having information on what helps them keep safe, on what helps 
their parents keep safe, and how we can do that collectively. 
Thank you.
    The Chair. Thank you very much. I am well over my time. I 
will turn it over to Senator Burr.
    Senator Burr. Thank you, Madam Chair.
    It is remarkable to me that our whole national campaign 
from the start, and continues today, is all about TV. The only 
thing consistent with 30 years ago is Sesame Street, so it is a 
tremendous avenue for a particular population. The rest of 
America tunes out ads. I do not care if they are on COVID or 
something else. And it is remarkable how much money we have 
injected into this.
    But, where we have seen success, Dr. Nichols, is when you 
have gone into those African-American churches; Mr. Chang, when 
you have focused on White evangelicals; Dr. Bailey, when you 
have said the family doctor, the physician, we totally took out 
of the loop. Some of the reasons were the unique requirements 
for vaccines, and we really did not have an explosion in 
vaccinations until we actually penetrated the retail 
pharmacies.
    Here is my question, Dr. Bailey, just real quick. How much 
of the challenges behind vaccination is transportation?
    Dr. Bailey. Transportation of the vaccine is a challenge. 
Transportation of patients----
    Senator Burr. Transportation of somebody getting there.
    Dr. Bailey [continuing]. Is a challenge. There--the initial 
phase of our mass vaccination efforts were to bring patients to 
the vaccines. That phase is over, and we knew that it would not 
last forever. We knew that there was a lot of pent-up demand. 
But, now that patients that have been wanting to be vaccinated 
are vaccinated, now we are reaching individuals that are more 
hesitant. Many do not have transportation. Many may have 
transportation but it is limited. It has been said that over 90 
percent of Americans have vaccines available within 5 miles of 
their home, but that leaves 10 percent out. And 5 miles can be 
a long way if you do not have a vehicle and if----
    Senator Burr. It is a long walk.
    Dr. Bailey [continuing]. You have to walk.
    Senator Burr. It is a long walk.
    Mr. Chang, should we have anticipated the White evangelical 
resistance?
    Mr. Chang. Absolutely. The reason we started this campaign 
as early as end of December, even before vaccines were 
released, was because I think the masking controversy told us 
where this was headed; that the commonsense public health 
effort got politicized, got polarized, got used by folks trying 
to gain attention and trying to divide our Country and our 
evangelical community. And we saw that same thing was likely 
going to happen with the vaccine.
    I would say that overall, from where I sit, the public 
health efforts have been amazing in terms of the logistics and 
the development of the vaccine. It has been slow and a little 
bit late in messaging. That is where I would encourage, for the 
rest of this campaign and for future public health efforts, to 
prioritize messaging as important of an investment to make as 
you do in the research and development of the actual vaccine 
itself, because a vaccine sitting on a shelf is not doing any 
good to anyone.
    Senator Burr. Dr. Betancourt, I commend what you guys have 
done and, more importantly, the fact that you are thinking in 
the future because we will be in a situation where we vaccinate 
one- to 12-year olds. I am convinced of it. We have got to.
    Dr. Betancourt. Yes.
    Senator Burr. I am more curious about how in your 
organization, in the Workshop, you addressed this change in the 
life of young people in the Country.
    Dr. Betancourt. Yes.
    Senator Burr. They no longer saw their grandparents.
    Dr. Betancourt. Yes.
    Senator Burr. They no longer went to school. They no longer 
could go play with a friend. How did the Workshop try to 
present that to this population?
    Dr. Betancourt. It was really a--we are very nimble, and we 
took advantage of taking the perspective of our child 
development and also parenting information.
    We actually addressed it in phases. The first phase that we 
called was the ``For Now Normal.'' And bringing two factors--
how do you normalize something that is now totally changed? 
And, so, we helped parents establish routines while still 
working and learning from home.
    We also started to bring the factor of joy and hopefulness, 
because suddenly, everything was shut down. And from a parent, 
and especially a child's point of view, I no longer get to see 
my grandparents, my friends, and suddenly, all of those 
connections are lost.
    We used the power of our trusted Muppets in different ways, 
not only through our programming, but what we also do, like my 
colleagues here, is work with national and local partnerships 
to integrate these resources, so as they are connecting in the 
community, we are so doing, as well.
    Last one is really the second phase that we are in now. It 
is the ``Different But Before Normal.'' And we love these terms 
because they are very practical. They sort of reflect the stage 
that we are in. How do you adjust to what were before routines 
but are now very different in certain circumstances? We use 
animation. We use interactives. We use what we call printables, 
posters, to deliver consistent messages that fit into everyday 
moments.
    Senator Burr. What I have learned is that kids are quite 
resilient, and adults very----
    The Chair. Not.
    [Laughter.]
    Senator Burr. Very counter-resilient. But, let me just say, 
everything that you guys have shared with us is important, and 
the challenge is, for me, why are we not doing it all? Why are 
we not in every Black church that we can find on Sunday with 
somebody with vaccines and needles? Why are we not in White 
evangelical churches? Why are we not promoting as much to the 
generational mix out there? Why have we not got the full 
complement of doctors with vaccines in their office ready to 
inoculate folks?
    I might add, why are we not pushing the envelope and trying 
to figure out how to do microneedle patches where we are not 
relying on a nurse that comes in and draws a vaccine, sticks 
you in the arm; where you could sit at church and pop these on 
people's arms and, for 72 hours, they get their first dose and 
then they come back and get a second dose?
    From a technology standpoint, that is available to us, but 
the bandwidth of how much can you do at the same time as you 
are innovating? We have also got to look at the communications 
and the parallel delivery systems if we want to capture as much 
as we can.
    Thank you, Madam Chair.
    The Chair. Thank you.
    Senator Hassan.
    Senator Hassan. Well, thank you, Madam Chair and Ranking 
Member Burr, and to all of our witnesses. Thank you so much not 
only for being here today, but for what you do every day.
    Dr. Nichols, I want to start with a question for you. As 
you know, Congress has provided funding to ensure that COVID-19 
vaccines are available to all individuals at no cost. However, 
there remains a perception among some that they will be 
required to pay a copay or they are going to receive a bill if 
they go get the vaccine. What can we be doing at the Federal 
level to ensure that people know that the COVID-19 vaccine is 
available at no cost?
    Dr. Nichols. One--thank you for your question. So, one of 
the things is--I think that message is starting to get out--is 
to do ads that say, Go for your free COVID-19----
    Senator Hassan. Right.
    Dr. Nichols [continuing]. Vaccine. And, so, another thing, 
that is the important thing, is just keep emphasizing the word 
that this is free.
    Senator Hassan. Yes.
    Dr. Nichols. The other things besides, social media is just 
overwhelming.
    Senator Hassan. Yes.
    Dr. Nichols. That is again where you have to go, is go into 
social media and keep emphasizing those words, that this--there 
is no cost to this; that this is our gift to you. Because so 
many people have lost loved ones, and, so, let people know that 
our gift, we are giving you a free vaccine. Thank you.
    Senator Hassan. Well, thank you. I want to follow-up, too, 
on a point that Senator Burr began to make because for many, 
there are related financial barriers associated with taking the 
vaccine. We talked about transportation a couple of minutes 
ago. There is childcare expenses, and some people are concerned 
if they have a reaction to the vaccine, there might be lost 
wages involved.
    How do we most effectively acknowledge and work to address 
these barriers so that they do not limit the ability of 
individuals and families to access COVID-19 vaccines?
    Dr. Nichols. One of the things that is important is for 
employers to give people the opportunity; to stress the 
importance that you get--if you have side effects, we give you, 
well, both. One, the time to go and get your vaccine.
    Senator Hassan. Right.
    Dr. Nichols. No. 2, that we give you the opportunity that 
if you are having side effects, that is a paid leave; that you 
have the opportunity to be paid. So, that is important.
    If we are going toward mandatory requirements, which many 
employers are doing, that those are things that you must do. 
So, I think, again, it is just getting the word out through 
whatever means necessary to let us know that we are going to 
support you and also your childcare issues and your child--and 
your transportation.
    Senator Hassan. Anecdotally, I am hearing, for instance, 
from some workers in long-term care facilities that they do not 
want to risk losing wages. When you are living paycheck to 
paycheck, this is a real issue. So, thank you for that answer.
    I want to follow-up to both Professor Chang and Dr. 
Nichols. We have talked a little bit about this. You both have 
learned from your work and the work of countless individuals 
across the Country that the most effective way to improve trust 
in the vaccines is to meet people where they are--you have used 
that term several times--and engage respectfully about the 
safety and effectiveness of these vaccines.
    The American Rescue Plan included funding to expand access 
to COVID-19 vaccines. So, is there anything that you have not 
said about how you believe we can effectively use these 
resources to continue and expand on your work? Just talk a 
little bit about what specifically you think we could use--the 
Federal Government could be using these dollars to do?
    Mr. Chang. Yes. I will repeat again that I think the fact 
that much of these faith-based outreach has been directed to 
minority communities, which again----
    Senator Hassan. Yes.
    Mr. Chang [continuing]. Is critical.
    Senator Hassan. Right.
    Mr. Chang. But, to--I would encourage you to redirect some 
of that attention and resources to the White evangelical 
community.
    Then, second, I do think the fact that the general 
channeling of these resources to the state level is proving to 
be ineffective to reaching this particular community. I think a 
national outreach coordinated at a national level will be your 
most effective bang for their buck here.
    Senator Hassan. Okay. Dr. Nichols, anything to add to that?
    Dr. Nichols. I echo what Dr. Chang said, that what you 
really want to do is a national outreach to make sure that--and 
like I said, do not politicize this.
    Senator Hassan. Yes.
    Dr. Nichols. That is an important key, is that we are all 
working toward the same goal of decreasing deaths, decreasing 
hospitalization, and getting our world back to normalcy again.
    Senator Hassan. Thank you. Dr. Bailey, I want to turn to 
kind of a related topic. But, as you know, we have seen a 
concerning drop in routine pediatric vaccinations during the 
COVID-19 pandemic. A year ago, I sent a letter to the CDC 
requesting that they provide additional support to states and 
healthcare workers in order to reverse this trend. And, while 
progress is being made, many children remain behind on their 
routine vaccination schedule.
    How do we work to catch children up on routine 
vaccinations?
    Dr. Bailey. I agree, it is incredibly important that we get 
our children up to speed on vaccinations. And there have now 
been advisories issued that COVID vaccines can be given at the 
same time as routine childhood vaccines, and, so, I think that 
will be very helpful in trying to get as much done in as short 
a period of time as possible.
    Senator Hassan. Okay. Thank you.
    Thank you, Madam Chair.
    The Chair. Thank you.
    Senator Marshall.
    Senator Marshall. Thank you, Madam Chair and Ranking 
Member. My first question would be for Dr. Nichols.
    Dr. Nichols, one of my biggest frustrations was that we had 
a system in place where we would give three million flu 
vaccinations a day across this Country, and that system 
consisted of community pharmacies, health departments, and 
doctors' offices. And, all long, we knew we would hit this 
wall, that if those people were not involved with this process, 
we would have not good compliance with getting the vaccine. 
And, so, we were the last ones to get the vaccine, 
unfortunately.
    Has that been your experience, as well, that doctors were 
the last ones to get the vaccine? And now, do the doctors have 
access to it?
    Dr. Nichols. That is true. So, one of the things is that 
before, we were really--it was very important that we get the 
vaccines into the doctors' offices. Majority of the physicians 
are vaccinated. About 96 percent or so say that they are 
vaccinated. But, it is important to get it into the offices.
    Because I was fortunate. I was one of the people who was an 
early adopter. And, so, we go into our clinic, and that is part 
of the routine questions. I ask everyone, Have you been 
vaccinated? So, we give vaccines while people are in the 
office, as well, besides going out.
    It is important that you give the access to the doctors and 
get it into their offices so that they can vaccinate during 
those routine visits. For the pediatricians, during those 
routine health checks, that you give them their vaccines, when 
you go to just any other facility. So, that is key getting it 
into the doctors' offices because often your physician is your 
most trusted person that people have.
    Senator Marshall. You bet. Thank you.
    Dr. Bailey, I will go to you. Your life and my life has 
been centered around giving advice to patients, and we 
typically talk about the benefits and the risk of what we are 
prescribing. And for me, it was, should you have a surgery? 
Should you have a C-section? You prescribe treatments that can 
cause anaphylaxis and you have to weigh that risk-benefit with 
everybody.
    When we started out with this process, no one worked harder 
than we did to make sure every American adult had the 
opportunity to get the vaccine. And when we sat down with 
people over the age of 60, it was a slam dunk, that the 
benefits outweighed the risk.
    Now we are talking about people under the age of 21 and the 
benefits and the risk of the vaccine. The risk of the virus to 
a person less than 21, pretty small. More and more, we are 
seeing some concern about complications and risk to the 
vaccine, as well.
    As you advise parents or young adults, do you feel like you 
have the data, the science, that you can actually have a great 
conversation discussing the benefits and the risk of the 
vaccine to give them advice?
    Dr. Bailey. Yes, I do. These vaccines have been thoroughly 
studied in adolescents, and we are now studying them in 
children. And, yes, the benefits and the risks discussion is 
something that definitely needs to be had. But, I think there 
is a general misconception among the population that children 
are at no risk or that the risk is so small that it is less 
than the risk of getting the vaccine, and that is simply not 
true. Children do get COVID. Children get long COVID after 
having----
    Senator Marshall. You see the science side by side that 
would say here is the risk of a serious complication to a 
person under the age of 21 versus the risk associated with this 
vaccine? You have seen that side by side? Because I have not 
seen it.
    Dr. Bailey. Well, we will be happy to share the data that 
we do have. But, the risks of side effects in adolescents 
appears to be very, very small, but we know that the risks of 
long COVID in children can be quite significant.
    Senator Marshall. Okay. Dr. Bailey, would a T cell test be 
a benefit to you as you are sitting there considering a person, 
a young adult especially, that has already had the virus? Would 
that be a benefit to you in making--in that decision making 
process?
    Dr. Bailey. I think it would be helpful, but we still do 
not have the perfect package of laboratory tests that we can 
run on someone to say, You are immune, you are not immune.
    Senator Marshall. Right, but if we had a T cell test, it 
would be very helpful, I think, for most doctors in giving 
advice.
    Dr. Bailey. It would add to our armamentarium.
    Senator Marshall. Right.
    Dr. Betancourt, as we watched, I assume--was that Elmo?
    Dr. Betancourt. That was Elmo and Elmo's daddy.
    Senator Marshall. Elmo's dad. One of the things I noticed 
is that neither one of them had a mask on, and I assume there 
is a reason for that because----
    Dr. Betancourt. There was.
    Senator Marshall [continuing]. Kids do not trust adults 
with--or trust people with masks on. Have you all looked into 
the mental impact on children by making them wear masks and 
adults around them wearing masks?
    Dr. Betancourt. Yes. Actually--well, we had also PSAs on 
mask wearing, and particularly for children, to ease that 
process. And, also, we used our other character, Julia, who is 
an autistic Muppet who is 4 years old, and also guided mask 
wearing at that time.
    What we do is, in this case, with the PSA, it was focused 
on vaccine. It was indoors, and it was, again, parent, child, 
so the use of--mask wearing in that context would not be the 
modeling that we would use. The focus was on the vaccination.
    Then last, also in that case with the PSAs and 
transparency, with any Muppet speaking and with the mask over 
it, it is going to be a little harder in voicing. But, 
regardless, in that situation, mask wearing was not necessary.
    But, we have advocated for, again, the process of easing 
mask wearing when it was necessary, and how to take that 
child's perspective to do so. But, also, now what we are 
dealing with is also how do you transition into the stages 
where you are not having to do mask wearing. So, we are 
tackling both. Our focus is how do we ease transitions in a 
child-appropriate way.
    Senator Marshall. Okay. Thank you. I yield back.
    The Chair. Thank you.
    Senator Casey.
    Senator Casey. Thank you, Chair Murray. I want to thank the 
panel for their presence here today and the message you are 
delivering. Just your presence and your testimony today and the 
answers to your question is helping to get the word out.
    I will start with Dr. Nichols and, of course, would open 
this up to others, as well. But, I want to talk to you about 
people with disabilities as a particular community.
    You have great personal experience with family medicine and 
providing healthcare access across a number of communities. One 
of them--one of the communities that is often neglected during 
not only this public health crisis, but others, is people with 
disabilities as a community. Because of their primary 
disability or secondary health conditions, they are often at 
greater risks than others. In fact, during the height of the 
pandemic, people with developmental disabilities, such as 
Down's Syndrome, had the highest mortality rate, other than 
those 75 and older.
    Communicating the importance of becoming vaccinated in 
people with disabilities is, of course, complex. Communication 
methods needed to take into account including accessible video 
with sign language interpretation and plain language documents 
so that someone needing kind of jargon-free descriptions can 
understand information. You mentioned, and others have, as 
well, and we cannot say it enough, meeting people where they 
are, as you have said, on their vaccine journey.
    The question I have is, how should we be communicating with 
this particular community, which is diverse, the disability 
community, and ensure they receive the information that is 
necessary about vaccinations?
    Dr. Nichols. Again, thank you for the question. You hit on 
a great topic as far as getting to people with disabilities. 
One of the things is, again, through the physician's office is 
to ensure that the vaccines are available in the physician's 
office so you can reach the disabilities. Also, going in, too, 
if there are places--like we go into our senior homes. So, I am 
going Wednesday to go and vaccinate within the senior 
community. So, also going.
    We have also--I believe in making it easy as possible. Not 
everyone can get in a car. And, so, that is something that you 
have to do as far as going to them. That is what our mobile 
program is about.
    Also, you touched on a great area. Make sure you have the 
information in multiple languages. Multiple languages, also 
sign languages, to make sure that people understand. And that 
is why with the face masks--so, that is a good thing because 
people who are deaf, they cannot--they do not know what you are 
saying. So, before, it was important to use the clear masks, 
but now, since most people are vaccinated that are providing 
the vaccines, is to make sure that you make it easy for them to 
read your lips, and also to have the ability to have the sign 
language available, as well.
    But, I think the key is going into the physicians' offices 
so that they--because they are the ones with the direct 
interaction with the patients.
    Senator Casey. Anybody else on this question from the 
panel?
    I was going to move to Dr. Betancourt on children--of 
course, that is your area of expertise--and hesitancy. We have 
also seen major disparities in the vaccination rollout to date, 
and particularly when it comes to vulnerable children getting 
left behind as more children become eligible for the vaccine.
    We have to address, of course, the concerns of parents who 
are hesitant to get their children vaccinated, and we have to 
do that, as you and others have talked about, through 
thoughtful and culturally appropriate community engagement.
    What are your thoughts on how we can best engage families, 
particularly families that have lots of challenges, to help 
parents make informed decisions?
    Dr. Betancourt. Yes, it is a couple of things in terms of 
more marginalized communities, and we always address that as we 
are developing any of the content that we have discussed.
    It is two ways. One, it is looking at the other trusted 
sources. We have discussed a lot in terms of the medical or 
healthcare community and its diversity, whether it is the 
pediatric community, whether it is public health clinics, and 
making those connections. But, it is also the messaging.
    As we have said, for younger children, it is going to be a 
little bit of a challenge. As we discussed, many times that 
perception is that they are fine. And, again, it is twisting 
the messaging a little bit.
    How do you, again, try to leverage what we are calling a 
circle of care, a circle of safety in that care? How do we 
encourage not only the vaccination, but I think returning to a 
medical home? Most marginalized families, and many families, 
have been separated from their medical home.
    How do we unite what we call the key influencers in young 
children's lives? So, it is the healthcare community. It is 
also the early childhood community. It is the faith-based 
community.
    Our belief is, to make a difference, you need to message 
with similar messaging across all those groups where they are, 
but with similar approaches. Use social media or use posters. 
Use a variety of elements. Use audio, as well. Radio. We have 
created our PSAs so that they are available also in audio 
formats. We also close caption, both in terms of visual and 
auditory, to make sure that everything is also accessible as 
much as possible.
    Last, version it as much as we can into a variety of 
languages that are culturally relevant.
    Senator Casey. Thank you.
    The Chair. Thank you.
    Senator Paul.
    Senator Paul. Dr. Bailey, I agree with you that 
misinformation is leading to vaccine hesitancy, and I think 
probably the largest area of misinformation is actually coming 
from the government regarding natural immunity. There is 
actually dozens and dozens of peer-reviewed articles on natural 
immunity. The natural immunity is robust.
    A study from Washington University School of Medicine just 
recently says, Mild infection with SARS-CoV-2 induces a robust 
antigen-specific, long-lived humoral immune memory in humans.
    Cleveland Clinic study, 50,000 employees showed that those 
who had the disease previously had the same, if not better 
immunity than those who have been vaccinated.
    If we deny this and we say, stick your head in the sand, 
everybody be vaccinated, do not worry your pretty little head 
about whether you have had it or not. We do not do any testing. 
We have lots of ways of testing for immunity. Guess what? The 
government--the people are going to have hesitancy because they 
think you are not telling them the truth, which is true. That 
is not the truth. We do know that you get robust immunity from 
this.
    We also know that, even taking conservative estimates from 
the CDC, that about 100 million people have had this. How do we 
know that? Thirty-four million people have tested positive. 
But, even the most conservative antibody surveys show that at 
least two people for every one that got it, also had it. That 
is 100 million people.
    If we discount that, we say, oh, we are never getting to 
herd immunity. You have all these articles saying we will never 
make it, we will never make it, we do not have enough people 
vaccinated. But, then we say, oh, we have to go harder. Now we 
are going to have to go for the 10-year old, then the 5-year 
old. Then we are going to go for the 2-year old. Then we are 
going to say, oh, you cannot leave the hospital until you are 
vaccinated.
    People are going to be hesitant because they do not believe 
you and they do not believe that the risk of the disease in 
children anywhere equates to adults. Over 65, it is at least a 
thousand times more dangerous. The death rate under 25? About 
one in a million.
    If you combine natural immunity with vaccine immunity, Dr. 
Makary of Johns Hopkins estimates that 80 to 85 percent of 
adults have immunity and that we have reached herd immunity. 
Yet, the government insists on discounting or really not 
counting at all the millions of individuals who have acquired 
natural immunity. This scientific error causes the government 
to believe that we have not gotten there, that we have to go 
harder and harder and harder.
    There are reports of myocarditis. It is not decided yet. We 
are in the means of talking about this. And, if we just say 
blithely, go take your vaccine, do not think about this, that 
is not good medicine. We should think about it.
    I do not know what the risk is. It may turn out that it is 
one in 10 million, and then, by all means, I would say go. If 
you are over 65, I would say without question, the vaccine is 
way safer than the disease. But, I cannot say that with 
assurety for a 10-year old. I really cannot say that.
    I also cannot say that we have not reached herd immunity, 
and that we are pushing so hard on the kids that we might do 
damage to children with this. It is an unknown question. The 
science is not completely done on children. They are discussing 
it this week.
    How frequent is myocarditis? We do not know that. If it is 
one in 100,000 and the chance of myocarditis in the normal 
population is one in a million, I would probably say you ought 
to think twice about it.
    But, another way to do it is, we could test the children. 
We could test the adults. If they have antibodies let them make 
a choice. Let them make an intelligent choice. Some people will 
still choose to be vaccinated. But, we are so adamant, get the 
vaccine, do not think about it, that leads to hesitancy because 
people do not think we are following the science or that people 
who give that advice are following the science.
    My question is, should previous infection not be considered 
in the effort to push vaccination on our children?
    Dr. Bailey. Yes, I think previous infection should be 
considered. I also think that we need to understand that a 
previous infection is not as robust in protecting against new 
variants as----
    Senator Paul. We actually do not know that.
    Dr. Bailey [continuing]. The vaccines seem to be.
    Senator Paul. We actually do not know that. All of the 
testing on natural immunity and the vaccinated has shown that 
we have great immunity both with the vaccine and with natural 
immunity.
    The Delta variant that everybody is talking about, the 
vaccine is very good for it. So, you see hysteria on TV. We are 
driving--we are still driving this debate by the hysteria of 
the Delta variant.
    If you get vaccinated, there is a 96 percent chance you 
will not be hospitalized. The numbers are very similar for 
natural immunity, too. This what if, what if, what if has been 
played, but it is just not true and we are scaring people 
needlessly. We should study it honestly in a rational fashion 
and give people advice, but we should not be pushing people, do 
not think about it, just take a vaccine.
    Dr. Bailey, failure to acknowledge natural immunity has led 
to the policy of indiscriminate vaccination. So, when we do 
this, we divert the vaccine from those who truly need it.
    In India, getting to herd immunity may take a couple of 
years. Six thousand people are dying a day recently, and they 
are taking the advice of the government experts in our Country 
that they should vaccinate everybody indiscriminately. In doing 
so, tens of thousands, if not millions of Indians will die 
because you are going to have millions of people who have 
already had it. If you could get the vaccine to those who need 
it more, you will save lives. It is the same way with diverting 
it to those over 65. In my community, in this Country, we are 
giving it to young, healthy 28-year old volunteer firemen. That 
makes no sense at all.
    Do you think in countries like India we should take into 
account whether you have had it to try to make the vaccine go 
farther so we could save lives?
    Dr. Bailey. I cannot comment on vaccine administration 
strategies in other countries. I do know that----
    Senator Paul. It is the same as ours.
    Dr. Bailey [continuing]. We need to be a good part of the 
global community and provide as many vaccines as we are able to 
make--after we have taken care of our own population, which we 
have plenty of vaccine for.
    The Chair. Thank you.
    Senator Baldwin.
    Senator Baldwin. Thank you, Madam Chair.
    Last fall, a green bean canning plant in Wisconsin 
experienced a COVID-19 outbreak that killed at least 11 migrant 
workers. COVID outbreaks hit food-processing facilities in my 
home state especially hard. And I am increasingly concerned 
that many workers, who often live and work in crowded settings, 
have not been vaccinated.
    Dr. Nichols, can you describe the specific barriers that 
wage workers, particularly workers of color, face when it comes 
to getting vaccinated? And what should employers do to make it 
easier for workers, including seasonal or temporary workers, to 
get vaccinated?
    Dr. Nichols. Senator Baldwin, thank you for your question. 
You bring up a great point. One of the things that we are doing 
is going out to the agricultural migrant, agricultural workers 
to get vaccinated, and we are taking our mobile unit out to 
them so that they can get vaccinated. So, I think that is one 
of the important things that partnership. So, you can partner 
with the various companies to vaccinate their workers.
    We have also talked to other companies and vaccinating like 
the grocery store workers, the people that work at the 
different organizations, such as the food services, and said 
that we are here, and if you want a partnership, we will be 
willing. So, that is one of the things that the employers need 
to partner with those who have the vaccine.
    We have an abundance of vaccines now. We are looking to put 
shots in people's arms. So, I think that is something that we 
need to do, is go out to the different organizations, the 
different companies, so that you can get those essential 
workers vaccinated, and make it convenient. Because you have to 
go to them. They cannot necessarily get off to come to us, so 
you have to go to them. And, so, I think that has been the key. 
Thank you.
    Senator Baldwin. Thank you. I appreciate that response.
    As my colleagues on this Committee know, throughout the 
pandemic, I have called for the Occupational Safety and Health 
Administration to issue an emergency temporary standard to 
protect our Nation's workers. The Trump administration failed, 
did not work on this at all. And while the Biden administration 
has finally issued a standard, it really does not protect all 
workers, including those in food processing. The lack of a 
comprehensive workplace safety standard for all of our Nation's 
workers and lagging vaccination rates should concern us, and we 
really must do more.
    I am now going to turn to a pervasive problem of 
misinformation in Wisconsin. While 45 percent of Wisconsinites 
are now fully vaccinated, this figure is only 29 percent for 
Hispanic individuals in my state. One of the factors that has 
been cited by the Wisconsin-based group, Forward Latino, is--as 
contributing to this hesitancy is a widespread concern that a 
state-issued ID is a requirement to receive the vaccine, which 
it is not.
    Dr. Nichols, how can we combat vaccine hesitancy in 
underserved communities, particularly when that is based on 
misinformation and fear, widespread rumors like this one that I 
describe? And further, how can the Federal Government best 
support communities in addressing the vaccination disparities 
and other public health challenges?
    Dr. Nichols. Thank you for the question. I think that is a 
really good point. We engage the consulates because one of the 
things that we found, that they are--people are most trusting 
of going into the place, and we actually went to the locations. 
So, we have been going weekly to the Mexican consulate, and now 
we are going to others. So, it is important that you go to the 
location. We partner with them and you go out so that people go 
to a trusted entity.
    That is the key, because unless they trust you, they will 
not come, and they will think that it is a conspiracy or that 
there are other things that are waiting there. So, you cannot 
just say come to this vaccination site.
    We also tell people we do not require your ID. We just--if 
you are going to do the two-shot vaccine, we are just saying 
that whatever name you give right now, make sure it is the same 
one so we can document it. But, we do not require that they 
give ID because that will--that is a limiting factor for a lot 
of people. So, we rest assure and we make sure there are 
translators that are available so that they can speak the 
language and tell them that this is free, that this is safe, 
and that no one will come after you because of your status. 
Thank you.
    Senator Baldwin. Thank you.
    The Chair. Senator Tuberville.
    Senator Tuberville. Thank you. Thank you all for being here 
today, and I would like to say thank you for your commonsense 
approach. We have not had a lot of that up here since this 
pandemic. And I will say this, too, that when we put politics 
into this, which we have--it has been heated up with politics, 
this whole pandemic. People back in Alabama, where I come from, 
do not trust a lot of things that are going on because they do 
not understand because they have been told so many different 
things from CDC and everybody that works for the CDC, and it 
just has not been a commonsense approach. But, thank you all 
for being here today and doing this.
    We are trying to get everybody to take the vaccine, and 
everybody in here over 50 should have taken the shingles 
vaccine. Everybody in here. I have not taken it. I am much over 
50, and I have seen people with shingles and, my God, we just 
keep putting it off, and that is something Americans do. They 
think that they are not vulnerable to something like this, but 
they are.
    Ms. Bailey, let me ask you this. Back in April, we--J & J, 
they had a 10-day pause. Now people back in Alabama ask me, 
Coach, why should I take this vaccine, this J & J? They stopped 
it. They are scared to death of it. I do not know why we--did 
you agree with them making the pause to that?
    Dr. Bailey. I believe that the pause that was taken with 
the J & J vaccine was a sign that our system of detecting what 
we call safety signals or adverse effects is working. And, I 
think it was a serious enough issue of having blood clots in 
the brain that we really needed to look very carefully at what 
was going on before we decided to go forward out of an 
abundance of caution. I think it was a reasonable thing to do, 
but I agree that it planted some seeds of hesitancy in some 
folks.
    But, the fact of the matter is, is that all vaccines have 
had some reported side effects, but we have always felt that 
the benefits of the vaccine outweighed the risks. And the 
beauty is that if someone is of this certain age group that is 
affected by the J & J vaccine issue with blood clots, 
especially women of a certain age group, they have choices. The 
mRNA vaccines are not associated with those types of blood 
clots and, so, if someone is concerned about that particular 
vaccine, they have a couple of great choices.
    Senator Tuberville. In Alabama, we have only had 30 percent 
of the people that are fully vaccinated, and one reason why we 
got hammered early with the COVID. A lot of people had it. 
And--but, they see all this information on television. If you 
have had it you really do not need the vaccine. What would you 
tell these people?
    Dr. Bailey. Well, I would tell them that they do need the 
vaccine because I am a belt and suspenders kind of person. I 
believe that COVID is a bad enough disease that it is worth 
doing everything you possibly can to keep from getting it and 
to keep from spreading it to someone else that you love, which 
you can do with an inapparent infection. And, so, I believe 
people--and I agree with the authorities, that people that have 
been diagnosed with COVID should be vaccinated. They should get 
the second shot if appropriate, and should do everything 
humanly possible to stop this pandemic in its tracks.
    Senator Tuberville. We hear of a booster getting ready to 
come out for the fall. How are we going to sell that?
    Dr. Bailey. Well, we will have to kind of wait and see what 
happens. I think we need to have the data to show folks that it 
really does make enough of a difference to justify getting all 
these folks in to give it to them. But, I certainly would not 
do, personally, a big booster campaign until we had gotten the 
first batch of folks vaccinated in the first place. I think our 
emphasis should be on complete vaccination for the first time 
around of the general population before we start worrying too 
much about boosters.
    Senator Tuberville. Thank you.
    Thank you, Madam Chair.
    The Chair. Senator Hickenlooper.
    Senator Hickenlooper. First, I want to thank all of you for 
your--not just for your time here today, but for your efforts 
and your public service. And this has got to be one of the 
hardest things that we, as a Country, have gone through going 
back all the way probably to the Second World War.
    I was in Aurora, Colorado last week with Secretary Becerra, 
Senator Bennet, Governor Polis, members of the entire 
congressional delegation, and looking at these same issues that 
you are getting questions on and asking. We were touring--
looking at a--getting a tour of a bus, as you guys have 
described, but a bus that goes to those communities that we are 
having the most trouble getting people vaccinated.
    I think maybe I will start with Dr. Nichols, if that is all 
right. I think it is critical that what we have learned about 
the health disparities from this pandemic that we use that to 
better inform our healthcare efforts to communities of color 
and any community where we see these inequities. You talked a 
little bit about robust public education as being part of the 
major lesson learned.
    How can we, at the Federal level, boost public health 
education efforts starting now so that we can--what 
specifically should you be telling us to make sure we are ready 
for the next pandemic, which, whether we like it or not, we 
know is going to come?
    Dr. Nichols. Thank you for the question. So, one of the 
things that we really can do to boost this through public 
education is to do targeted campaigns. There are a lot of 
lessons learned, and we need to let people know that these are 
the lessons learned from this pandemic because there might be 
another one. There most likely will be.
    With that in place, then what we need to do is say lessons 
learned is, one, is that as soon as you--this, any type of 
virus or infection hits us that you hit it hard and you hit it 
fast and you hit it as soon as it occurs.
    No. 2, that one of the things that you need to do is that--
meet people where they are.
    I keep saying you cannot politicize this. This is an effort 
that is affecting all of us. It does not matter if you are 
Republican, Democrat, or Independent. This is going to--or 
Black or Brown or whatever. This is something that has affected 
all of us.
    What we want to do is to say our goal, as a Nation, is to 
protect our citizens. And, so, that is what I think we need to 
get out there, is the importance of protecting our citizens and 
getting people, meeting them where they are, and educating them 
through every avenue possible, and in every language. Thank 
you.
    Senator Hickenlooper. Great. And Mr. Chang, I will ask you 
just to comment on that, as well, just from the outside of 
government. Obviously, the--and there is, I think, a 
significant amount of evidence that it is not politics that 
are--as a major reason why many people are choosing not to be 
vaccinated. It is more in that framework of their own autonomy 
and who they do trust. Do you want to maybe address that in 
terms of preparing for the next pandemic?
    Mr. Chang. I think one of the things that the Federal 
Government should think about and putting in its toolkit to 
prepare for the next pandemic is to develop a roster of trusted 
faith leaders they can convene very quickly and early on to 
bring them together to have a unified message.
    If you look at what happened with White evangelicals, what 
happened was individual leaders had to take the position at 
different times to speak out on this, and then it got slammed 
by the opposition. So, Franklin Graham did that, got killed on 
social media. He withdrew and went quiet for a while. J.D. 
Greear, the former president of the Southern Baptist 
Convention, then stepped up. He got slammed on social media.
    This was one by one, they were coming forward, and all of 
you, know what that is like, to be the lone target out there. 
And, so, if the Federal Government had enough foresight to 
actually do the convening work of bringing leaders together, 
because unfortunately, the evangelical church does not convene 
itself very easily. It is a very, by design, a sort of 
decentralized movement, so it requires an outside body, like 
the Federal Government, to convene these folks together, let 
them present a united front. They were there. They just could 
not bring themselves together to form a united voice. They 
needed the government to help them.
    Senator Hickenlooper. Absolutely. I think that is a good 
point.
    Dr. Bailey, the numbers from the United Kingdom on the 
Delta variant are obviously very concerning to all of us. It 
now accounts for 90 percent of new infections there, and 
obviously, whether it is 10 percent or 15 percent now in the 
United States, who knows how rapidly that is going to grow. 
Clearly, it is going to spread rapidly.
    Given our current rate of vaccination, do you think that we 
will get to a similar impact from the Delta variation, similar 
to what we are seeing in Great Britain?
    Dr. Bailey. I certainly hope not. We have been in a 
footrace with variants from the very beginning, and right now I 
think we are outpacing them because we have had good vaccine 
uptake.
    But, I think it is important to understand that the vaccine 
strategy in the U.K. was very different, in the vaccine 
strategy there. And the U.K. decided to delay the second 
vaccine in patients in order to get the first vaccine in as 
many people as possible. And we realize now that is not the 
best way to fight variants, that you need to get as many people 
vaccinated on time, with both doses, if you are--if that is the 
vaccine that you are dealing with, which is the best way to 
fight the variants.
    I think we are better prepared to fight the variants.
    Senator Hickenlooper. Great. Well, I appreciate that. I 
hope you are right.
    I yield back. Thank you all.
    The Chair. Thank you. Senator Smith.
    Senator Smith. Thank you so much, Chair Murray and Ranking 
Member Burr. I really appreciate this hearing. It gives us all 
an opportunity to kind of dive into where people are on the 
spectrum of acceptance versus I am not really sure to sort of a 
hell-no mentality.
    As of yesterday, 54 percent of Minnesotans have received at 
least one dose of COVID-19; 51 percent have been fully 
vaccinated. And we are making good progress in Minnesota, but 
we have a ways to go to get to where the Governor has said is 
our goal in the state of 70 percent.
    I have a few questions that I hope can kind of clarify some 
of the misinformation that is out there, and also help us 
understand what more we need to do.
    Let me just start, if you do not mind, Dr. Bailey. I just 
want to start with you because Senator Paul interrupted your 
comments regarding the efficacy of the vaccines compared to 
immunity when people are exposed to a new variant, like the 
Delta variant. I just wanted to give you an opportunity to 
finish your thought.
    Dr. Bailey. Oh, well, thank you, Senator. I appreciate 
that. And my interpretation of the literature--and it is vast, 
and there are so many thousands of studies that are available 
now for review. We have to be able to put them together. But my 
understanding is that adequate vaccination with both mRNA 
vaccines or the Johnson & Johnson vaccine gives you better 
protection against variants than natural immunity does.
    Senator Smith. Okay. All right. Thank you. And, so, the 
COVID-19 vaccines do protect against the Delta variant is what 
the science tells us right now?
    Dr. Bailey. Yes.
    Senator Smith. Okay. Thank you. That is very helpful.
    Dr. Nichols, can you just quickly sort of say, what do you 
think are the biggest structural barriers? Meaning there are 
reasons that people do not get the vaccine not because they do 
not want to, but just because they cannot--they cannot make 
their lives work to get the vaccine. What are the biggest 
structural barriers?
    Dr. Nichols. Transportation is one, so that is why I say it 
is important to go where people are.
    Senator Smith. Right.
    Dr. Nichols. The other one is hours. Some people work two, 
three jobs.
    Senator Smith. Right.
    Dr. Nichols. You have to make sure that the availability is 
there at all hours. And I really appreciate now the pharmacies 
and some of the grocery stores are extending those hours for up 
to 24 hours.
    Senator Smith. Yes.
    Dr. Nichols. You have to make sure that--those are the main 
ones.
    Also, before structural barriers happened to be internet 
and computers, so that is why it is important to make sure that 
when people were making appointments that you made it easy. So, 
now people do not have to make an appointment. You can just 
walk up.
    I think that those are things that we are seeing are true 
that were barriers before that we are helping to overcome. But, 
the main thing is making sure that you are there and make it 
very convenient for everyone.
    Senator Smith. You are going where people are. You are 
help--you are just--you are not assuming that everybody has 
the, has the wherewithal if they are working three jobs to get 
someplace.
    What do you hear are the kind of the most common myths, 
just the flat out, not true but get repeated, that you hear 
about why people are thinking the--why not? Why not get the 
vaccine, the most----
    Dr. Nichols. My young people, my early 20-something people, 
a lot of them are talking about infertility.
    Senator Smith. Yes.
    Dr. Nichols. I told them that is absolute--that does not go 
with the science. That is a very common one that--that is 
probably the most common.
    Another one is the myth that people say, oh, I already had 
COVID-19, so therefore, I do not need to be vaccinated. But, 
there are people getting the--getting COVID for the second time 
around, and there are variants out there.
    Those are the really big two myths. And then the whole 
thing with Johnson & Johnson. People say, Remember talc powder, 
so I have to then remind them that this is a very safe vaccine; 
that this is a vaccine that has gone through all the rigors and 
the science and everywhere else. So, those are--I just hit them 
with the facts and the data and the science.
    Senator Smith. Very helpful. Dr. Bailey, are there other 
myths that you have heard repeated frequently that are 
different from what Dr. Nichols just laid out?
    Dr. Bailey. There is a common, almost an existential, 
concern that something that we do not know about is going to 
happen down the road; that, well, how do I know that if I get 
this vaccine today that I am--something is not going to happen 
to me in 5 or 10 years.
    We have decades of experience with dozens of different 
types of vaccines, and we have never seen a vaccine cause a 
distant side effect past about 6 weeks of administration. So, 
we feel very comfortable about that. There is no reason why 
COVID vaccines should be any different. But granted, the 
farther you are from getting the vaccine, it is going to be to 
correlate an event to that vaccine. But, so many events that 
have been reported are coincidences and not causal, and it is 
hard to explain to folks that just because something happened 
near the time of the event does not mean the vaccine made it 
happen.
    Senator Smith. I know I am out of time, but that--is that 
data essentially also true when you are talking about vaccines 
for young people as well as older people? So, it is not like 
there is some sort of a different set of data for a young 
person?
    Dr. Bailey. That is true, Senator.
    Senator Smith. I think that is very helpful, just to remind 
people that we do have science and facts and data that back up 
what we are doing. And it is good to help to speak out against 
these myths that get repeated over and over again.
    Thank you. Thank you, Senator.
    The Chair. Thank you.
    Senator Murphy.
    Senator Murphy. Thank you very much, Madam Chair. Thank you 
all for your testimony. I have been listening to a lot of it 
from my office.
    Dr. Nichols, I had a really interesting conversation 
yesterday--I put it up on my social media channels--with the 
Student Body President at the University of Connecticut, 
talking about the specific challenges around vaccinating 
students. And I wanted to sort of ask for your opinion about 
how we build out best practices to make sure that college 
students are ready to get back to school in the fall.
    Data suggests that less than 40 percent of 18 to 29 year 
olds have received one or more doses, and there seems to be 
some differences with respect to how colleges are treating this 
issue. In Connecticut, for instance, our flagship university 
says everybody has to be vaccinated and have proof of 
vaccination in by the end of July, but our state university 
systems have not made a decision yet. And, so, it is confusing 
to students because some may have a requirement to get a 
vaccine, but other students may not. In addition, the 
requirement seems to be that a lot of the proof come in during 
the summer, which means students may not get to do this while 
they are on campus.
    I know you have been leading a lot of Morehouse's efforts 
in this regard. What do we know about the specific challenges 
related to getting students vaccinated, and what can we 
recommend as a Committee to schools and to school associations 
to make sure that there is some degree of uniformity in terms 
of what we expect of kids to get back onto campus?
    Dr. Nichols. Thank you for the question. So, it is very 
important that we, again, provide the data and the information 
to the students and to the administrators on vaccines.
    Also, doing town halls and panels--I have one coming up on 
Thursday--where you talk to them, to the parents of the 
students about vaccine safety.
    Right now, over 500 colleges and universities have made it 
mandatory. I think that--I personally think that is the right 
thing, but not everyone is ready to get vaccinated. And there 
are ways--some people have religious reasons that they feel 
that they cannot be vaccinated. Other people are medical 
reasons. So, you do give that option.
    But, I think the important thing is to talk about so you 
can get back to normalcy. Many of the people that are now 
college-age kids, they did not have a normal experience. They 
were not able to have proms when they--if they were in high 
school, or even to have normal graduations. So, I think that 
one of the things that you have to explain to that age group, 
which is a very difficult group to talk to, is--because they 
are young, and they think they are invincible. So, it is to say 
that this is your opportunity to get back to normalcy, not to 
wear a face mask, to be able to get out toward your friends. 
But, also, to give them the data, because these are college 
kids. So, to make sure that they have the data and the science 
to show the safety and the rigors that were involved with this 
vaccination process.
    I think that we are on the right path, but I think that we, 
as an institution, must talk to all the colleges at the 
administrative level, to the parents of those students, and to 
the students themselves. Thank you.
    Senator Murphy. Just food for thought. One of the things 
that the student body president wanted to make clear is that 
there needs to be safe space for questions to get answered, and 
sometimes there is a feeling that students are maybe going to 
be looked down upon when they sort of ask some basic questions 
about the vaccine. They are always a little careful, right, in 
not wanting to sort of look foolish or look like they do not--
are not as plugged in. We need to make sure that nobody feels 
bad about asking questions because we have answers. That is the 
good news.
    Dr. Nichols. I tell everyone there is never a stupid 
question. So, I always tell the students, I really want you to 
ask those questions, and we need to answer it in ways that can 
relate to them. And social media is very important in that age 
range, as well.
    Senator Murphy. I know we have a bunch of people that want 
to ask questions and we are going to have votes, so I am just 
going to submit a question for the record to you, Dr. Bailey.
    I am really interested in some of the comments you made in 
your opening statement about the dangers of misinformation. And 
I am working on legislation right now with the American Medical 
Association that would set up an interagency effort housed 
within the U.S. Department of Health and Human Services to try 
to bring together both government agencies, think tanks, 
academic institutions to both track and evaluate 
misinformation. Sometimes it is difficult to sort of know what 
to label as misinformation. And I look forward to working with 
you and others as we try to work through that legislation.
    Dr. Bailey. Thank you.
    Senator Murphy. Great. Thank you, Madam Chair.
    The Chair. Thank you.
    Senator Kaine.
    Senator Kaine. Thank you, Chair Murray, and thanks to the 
witnesses. This is fascinating.
    A couple of quick research questions. So, as I am trying to 
make the case to my constituents to get vaccinated--and 
yesterday, our Governor announced that Virginia has just 
crossed the 70 percent mark on at least one vaccination, which 
is great--I point out it is effective in stopping COVID if you 
have not had it. But, there is also two other benefits that I 
cite based on some initial studies, but I wonder if I am on 
solid ground in talking about this.
    The vaccine is not 100 percent effective, so someone can 
get the vaccine and still get COVID. But, it does seem like 
that there is some evidence that if you have been vaccinated 
and you get COVID, your symptoms might be lesser. Is that a 
fair statement of the kind of early evidence that is emerging, 
when people get vaccinated and then get COVID, it tends to be 
less serious cases?
    Dr. Bailey. That is true, and people who are vaccinated are 
very unlikely to be hospitalized, and in some situations, it 
prevents death entirely.
    Senator Kaine. That is very, very powerful because 
obviously, some--I had COVID. I was not hospitalized. The 
difference between not being hospitalized and being 
hospitalized, and being hospitalized on a ventilator, serious 
issues, is very stark, so that is a good piece of evidence for 
being vaccinated.
    Second, there is also some suggestion that people who have 
had COVID and are suffering long COVID symptoms, which might be 
15 to 20 percent of people who get COVID, there is some, again, 
articles suggesting that some of the long COVID symptoms 
disappear upon vaccination. And, again, I have seen that 
reported in media. I do not know if there has been enough 
research on it to kind of validate it. But, what is the current 
state of play on that?
    Dr. Bailey. Senator, I have heard the same things that you 
have, and there have been some case reports of patients with 
long COVID whose symptoms have improved after vaccination. That 
is still under study. We do not really know enough about long 
COVID itself to understand what makes it better or what makes 
it worse. But, the few case reports are encouraging.
    Senator Kaine. That is also positive. So, I think there is 
multiple reasons to get it.
    Dr. Bailey, I have focused some significant attention upon 
vaccination of pregnant women and wanted to make sure, A, that 
it is safe; B, that they have access and that there is an 
effective take-up rate among vaccines. So, what are you able to 
tell us, again, based upon kind of the initial experience--and 
I will open this up to anyone--about the safety of receiving 
COVID-19 vaccinations during pregnancy?
    Dr. Bailey. There were a number of women in the clinical 
trials, who became pregnant after they had received the COVID 
vaccine, and did well. There was one pregnancy loss, but that 
turned out to be in the placebo group, not among the group that 
received vaccines. There are--the American College of 
Obstetricians and Gynecologists now recommends that pregnant 
women get the vaccine. We know that pregnancy is a somewhat 
immunocompromised state in and of itself, and pregnant women 
are susceptible to more severe disease if they contract COVID-
19, so we believe it is important to immunize pregnant women. 
And, those antibodies will transfer to the baby, and, so, the 
baby will have some degree of protection, as well.
    Senator Kaine. Excellent. Thank you.
    Mr. Chang, I found your testimony fascinating. I read the 
written version of it because I was not here during your 
opening. I was at an Armed Services Committee hearing. You 
point out that a path to greater vaccination is through the 
White evangelical church. You have two kind of recommendations, 
one of which just seems unassailable--find trusted leaders, 
evangelical leaders, and gather them together so that when 
there are messages about vaccination, people are hearing them 
from the folks that they most trust. And I think you have all 
sort of testified to this--you have to meet people where they 
are rather than expect people to come to where you are. So, 
whether that is outreach in minority communities, evangelical 
communities, that sounds like a really good strategy.
    But, the other sort of half of what you said is that sort 
of a mistrust among evangelicals for sort of governmental 
authority. And over the course of my public life, that has 
puzzled me. I had a pivotal experience of living in a military 
dictatorship in Honduras when I was young, 1983, 1984. So, I 
guess I saw what a really bad government can do, and it gave me 
a perspective that our government here, our small-d democracy, 
certainly is not perfect, but I can--I see how it is elsewhere. 
So, while I never hesitated to criticize authority, I have a 
sort of deep appreciation for how lucky we have it compared to 
elsewhere.
    What are strategies that we ought to be embracing to try to 
bring down that mistrust? In addition to using trusted 
messengers, what are things that we, as officials, could do to 
start to tear down slowly that mistrust?
    Mr. Chang. That is a great question. And I think one of the 
things that I have been trying to do is to actually teach my 
fellow Christians that institutions are people, too. 
Institutions are comprised of people, that they are human. 
These are human institutions, and therefore, they are going to 
be flawed. And I think part of the problem is--for evangelical 
Christians is we are in some ways hyper-individualistic. It is 
probably built into our faith. It is sort of me and God.
    Senator Kaine. Personal relationship.
    Mr. Chang. Personal relationship. And the idea that 
actually, also, human beings also comprise institutions is 
something that is not very strongly taught in the evangelical 
community. But, it is critical because if we do not think of 
institutions as human, then when they do change their mind, we 
think those institutions are just--cannot be trusted, whereas 
we are Okay with individuals changing their mind. We somehow 
are not Okay with institutions changing their mind.
    A lot of when we say, well I am hearing so many different 
things from the CDC, it is because the CDC is made up of 
scientists, who are human beings, who are responding to new 
information and new data and are changing their mind and may 
not get it right from the first time.
    I think certainly within the evangelical community to 
humanize institutions is critical. And, then, from the vantage 
point of public institutions, the more you can present a human 
face behind the institutions, the more that I think that sense 
of humanity can come through.
    Senator Kaine. Thank you very much.
    Thanks, Chair Murray.
    The Chair. Thank you.
    Senator Braun.
    Senator Braun. Thank you, Madam Chair.
    My first question will be for Dr. Betancourt. Back in 
Indiana recently, Indiana University, flagship institution, 
required students and faculty to be vaccinated before they 
could return. I have a simple question. Do you believe that 
American citizens have a right to privacy about their own 
healthcare?
    Dr. Betancourt. In--I would think so, absolutely. And from 
a Sesame Workshop point of view, we do focus on our youngest 
children and the grownups who make decisions for them, and we 
know that in terms of privacy or any--that is extremely 
relevant to their questions and also their information 
gathering.
    Senator Braun. Do you think that would also apply to adult 
college students and faculty, as well?
    Dr. Betancourt. From a Sesame Workshop point of view, I 
would say that is a little higher, but I would say that our 
experiences many times on what applies to young parents making 
decisions about their children also applies to, again, older 
college--college-age students or youth.
    Senator Braun. To zero in on, then, do you think that you 
need to have a proof of vaccination as a condition for 
enrollment?
    Dr. Betancourt. That is beyond--I am going to be honest. 
That is going to be beyond our Sesame Workshop decision-making. 
Our focus is basically how do we promote the awareness of 
vaccination as being something for not only in the moment, but 
also for your future. So, what I would take into context is 
that college students come from families, and our message is 
that, as a family, you are making a decision for safety, for 
also hopefulness for the future, and that there is advantages 
if you do that holistically. Regardless of whether you are a 
college student or you are an essential worker or anything like 
that. So, our messaging is more in that context, and hopefully 
it is creating what we have often called that circle of care.
    Senator Braun. Thank you. Next question is for Dr. Bailey.
    Clearly, I think the biggest variable that has gotten this 
in the rearview mirror was the speed at which the vaccine was 
developed. I remember interviewing Dr. Fauci and Dr. Collins 
and Redfield back then, and there was kind of a wrestling match 
in terms of which bureaucracy was going to lead the dynamic. I 
think had that gone according to normal procedure, we could 
still be wrestling with having that vaccination being done. And 
it was a tribute to the entrepreneurialism in the industry and 
the agility, I think, of the Administration at the time.
    Do you think that, when it comes to something as simple as 
trying to get people comfortable with vaccinations, that maybe 
time spent better by the Biden administration to where it would 
have educated folks on the vaccine instead of still weighing in 
on mandates and shutdowns and things maybe not directly related 
to what was going to probably be the only thing close to a 
silver bullet of getting this in the rearview mirror? Did we 
waste time?
    Dr. Bailey. That is a difficult question to answer. And I 
do believe that one of the issues that my patients have concern 
with is that they feel that the vaccine was rushed, that it was 
made too quickly. They need more information about that. And I 
always take great pains to explain to them that the beauty of 
Operation Warp Speed was that no corners were cut. No 
scientific rigor was left on the table; that the companies were 
given the financial security to be able to do this very quickly 
because there were a whole lot of real smart people and a lot 
of money involved, and they were able to get it done in an 
amazingly short period of time.
    We can never stop talking about the importance of reviewing 
vaccine safety and efficacy and how these vaccines have gone 
through incredible clinical testing and is, I think, one of the 
greatest scientific achievements in our lifetime.
    Senator Braun. Well, very good. I think that is well said. 
How about going forward? We are seeing now variants. I watched 
something over the weekend where they were talking about using 
mRNA technology to maybe apply it toward fighting cancer in a 
particular way. And, also, to where it might end up playing 
into going about contriving, creating therapeutics versus just 
vaccinations because it looks like this could be repeating 
itself through variants, maybe get to where it is in a rhythm 
similar to how we wrestle with the common flu. Where does 
emphasis on therapeutics fit in to the long-term journey of how 
we deal with and live with the coronavirus?
    Dr. Bailey. I believe that is an incredibly important area 
to pursue because I think all of us acknowledge that, although 
we want to get as many people vaccinated as possible to get 
past the pandemic, that COVID is probably always going to be 
with us in some way, shape, or form. And we need to learn 
better how to treat COVID at early stages, to keep it from 
progressing to hospitalization and death in someone that hasn't 
been immunized, or in a new variant that may be resistant to 
vaccination. And mRNA technology in and of itself is absolutely 
mind boggling in its potential across all specialties of 
medicine. And, so, I think that it is important for us to make 
sure that we continue to focus on research for therapeutics, 
research for diagnosis, research for care, for vaccination, and 
for long-term complications.
    Senator Braun. That is good to hear that you think that 
might make sense because it seems like that is going to have to 
play into the formula in the long run. Thank you.
    The Chair. Thank you.
    Senator Burr, do you have any additional comments?
    Senator Burr. Just two quick ones, Madam Chair.
    Dr. Bailey, if a patient diagnosed with pancreatic cancer 
was provided a cure delivered on a mRNA platform today, do you 
think they would be as reluctant to take it as they are a 
vaccine on an mRNA platform?
    Dr. Bailey. I am not a cancer specialist, but my experience 
is that when patients are really desperate for help, they will 
take risks that they might not take otherwise.
    Senator Burr. Isn't part of the problem that we have is 
that some people believe that this is not as bad as what we 
have suggested?
    Dr. Bailey. The disease of COVID is not as bad----
    Senator Burr. Right.
    Dr. Bailey [continuing]. As we have suggested? I believe--I 
worry about that going forward as the huge numbers of 
hospitalizations and deaths seem to fade into the rearview 
mirror that we will have some collective amnesia about how bad 
it really was.
    COVID-19 infection is a devastating disease. It is a tricky 
virus unlike anything we have ever seen before, and we must 
never underestimate its potential to wreak havoc and cause 
death. And, I think that someone who still doubts the existence 
of COVID, gosh, we need to put them in--hopefully--I wish we 
had time travel so they could back and safely walk through a 
hospital ward where every patient was on a ventilator. They 
were unable to speak to their loved ones and had to say their 
goodbyes over an iPad, surrounded by people that they could not 
see because they had so much PPE on. I hope we never have 
anything like this again, and we must always remain vigilant to 
make it so.
    Senator Burr. We would agree with you. And I think if you 
could take everything that this Committee, the Committee 
Members have said throughout this process, and sort of add them 
together, it would have addressed the mental health for 
children. It would address the physical challenges that are 
presented, the employment challenges, the society challenges. 
Hopefully, our memories will not be as short as we have proven 
in the past.
    Last thing. I have said to the Administration, because I 
think we are destined for a booster, based upon the science. 
When, nobody knows. But, I have made it perfectly clear that we 
better have a strategy when we get ready for the booster 
period, meaning that we are out selling it long before we start 
it.
    I agree with you. We ought to inoculate as many folks as we 
possibly can in the first round, but you cannot start too early 
at educating what that booster can mean based upon what we do 
not know, not necessarily based upon what we do know.
    It may be that all three vaccines that are currently 
approved are sufficient for Delta. Does it mean it is 
sufficient for what we are seeing in South America today? And I 
cannot remember what the name that we are calling it, but it is 
devastating South America. So, the one thing we know about 
viruses, they continue to mutate as long as they exist. This 
one will continue to do it. And if the booster provides us a 
better defense, then I hope we will sell it so that the 
American people will aggressively take it.
    Thank you, Madam Chair.
    The Chair. Thank you very much. Thank you, Senator Burr. 
Well stated.
    That will end our hearing today. And I do want to thank all 
of my colleagues for such a thoughtful discussion, and I want 
to really thank all of our witnesses today--Dr. Bailey, Dr. 
Nichols, Dr. Chang, and Dr. Betancourt. Thank you. Mr. Chang, 
Dr. Betancourt. Thank you so much for sharing your experience 
and expertise. It was very, very helpful.
    For any Senators who wish to ask additional questions, 
questions for the record will be due in 10 business days, July 
7th, 5 p.m. The hearing record will remain open until then for 
Members who wish to submit additional materials for the record.
    With that, the Committee stands adjourned.
    [Whereupon, the hearing was adjourned at 11:56 a.m.]

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