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



 
  STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS APPROPRIATIONS FOR 
                            FISCAL YEAR2023

                              ----------                              


                        WEDNESDAY, MAY 11, 2022

                                       U.S. Senate,
           Subcommittee of the Committee on Appropriations,
                                                    Washington, DC.

    The subcommittee met at 2:02 p.m., in room SD-124, Dirksen 
Senate Office Building, Hon. Christopher Coons, (Chairman), 
presiding.
    Present: Senators Coons, Durbin, Murphy, Van Hollen, 
Graham, Blunt, Boozman, and Moran.

                          WORLD FOOD PROGRAMME


             opening statement of senator christopher coons


    Senator Coons. Good afternoon. I would like to call this 
hearing of the subcommittee on State and Foreign Operations of 
the Senate Appropriations Committee to order. The purpose of 
today's hearing is to hear testimony from six exceptionally 
experienced witnesses concerning two of the most urgent crises 
confronting our world today.
    The ongoing destruction of cities and the daily atrocities 
committed by Russian forces against defenseless Ukrainian 
civilians outrages and offends the sensibilities of all of us, 
but we should also be concerned, even alarmed, about the 
widening food security crisis that this needless and brutal war 
by Russia is causing for hundreds of millions far beyond 
Eastern Europe.
    Before the war began in Ukraine, more than 50 countries, 
including nations like Ethiopia, Sudan, Syria, Yemen, and 
Afghanistan were facing acute food shortages due to prolonged 
drought and conflict. And today, their circumstances are 
markedly worse. As we will hear from our first panel of three 
witnesses, the collapse of exports of grain and vegetable oil 
from Ukraine, combined with inflation and higher costs for 
fertilizer, fuel, and transportation, have caused commodity 
prices to skyrocket.
    Latest UN information says the total number of people 
hungry has increased to 273 million, more than doubling the 
number living in hunger in 2019. Millions are at risk of 
starvation.
    Some estimates are even higher. This food security crisis 
is compounded by a second ongoing global crisis, the COVID-19 
pandemic, triggering complex humanitarian emergencies on 
several continents that threaten economic, social, and 
political stability.
    Now, while the number of Americans hospitalized and dying 
from COVID has declined significantly after Omicron peaked in 
January, it is again rising sharply in a number of our States, 
and this pandemic is far from over with us.
    COVID-19, I will remind you, originated halfway around the 
world, and we are no less vulnerable to this pandemic today 
from a global perspective than we were a year ago. Roughly two-
thirds of Americans are fully vaccinated, but worldwide 
billions are not, and they are concentrated mostly in countries 
where the virus continues to spread and in countries with weak 
or fragile public health systems that struggle to respond to 
this ongoing challenge.
    Global campaigns against HIV, AIDS, Malaria, TB, Polio, and 
other infectious diseases long led by American funds or 
initiatives have stalled or lost ground. And there is a very 
real risk to our nation and the world that new COVID variants 
will emerge overseas, causing a sudden resurgence of 
potentially deadly infections.
    That might force another lockdown that would threaten to 
once again shutter businesses, schools, public transportation, 
and government offices. If we can increase global vaccine 
coverage, we can dramatically reduce the spread of the virus 
and the incidence of new variants protecting everyone, 
including Americans.
    As we consider our President's request for emergency 
supplemental military and humanitarian assistance for Ukraine 
and other countries impacted by the food crisis in Ukraine, our 
challenge is determining how the United States can best respond 
to these interrelated global challenges.
    The President's request initially included about $1.8 
billion for food aid, which in my view, fell far short of what 
is urgently needed. Senator Graham and I have both called for 
at least $5 billion, and I am optimistic, given the action in 
the House last night, that that amount will be in the final 
supplemental. The President's request for $5 billion in 
emergency funding for global COVID response was submitted in 
March and has not yet been acted on by this Congress.
    Now, as the Appropriations subcommittee responsible for 
providing the relevant funding, we are looking to our six 
witnesses this afternoon to help us understand what the COVID 
virus is doing, what we should most be concerned about, how 
other organizations and other donors are responding, and the 
recommendations we can make the strongest case to our 
colleagues in the Senate.
    Any successful global response against the COVID pandemic 
requires United States leadership and resources. I also want to 
emphasize in closing that we are in a critical global, 
strategic situation as well, because dozens of countries and 
millions of people were forced to rely on Chinese and Russian 
vaccines, which have ultimately proven ineffective against the 
Omicron variant.
    We have an opportunity, 20 years after the PEPFAR program 
was launched, to once again demonstrate that the United States 
is a reliable global public health partner, and we should take 
that chance.
    Before introducing the first panel, I will turn to my 
Ranking Member, and wanted to express my gratitude to my 
colleague, Senator Graham, who has been a strong partner and 
advocate for additional funding to address both these crises, 
for any opening remarks he care to make.


              opening statement of senator lindsey graham


    Senator Graham. Well, thank you, Mr. Chairman. I appreciate 
it very much. I think the Committee has done a good job working 
together, and one of our witnesses is a South Carolinian, David 
Beasley. We are very proud of you at home, former Governor of 
South Carolina and the leader of the World Food Program.
    Thank you, Ms. McKenna, for coming, our second witness 
here. The bottom line is, if you believe in a strong national 
security to keep America safe, then you have to be involved in 
addressing world hunger.
    As you will hear from David here pretty soon, the number of 
people that are in desperate straits will lead to mass 
migration, will start the cycle all over again--there are so 
many conflicts on the globe, it is hard to keep up with them, 
then you have got COVID on top of that.
    The amount of money that will be in this supplemental for 
food and humanitarian assistance is about $5 billion. That is a 
lot more than requested, but still not enough. And to the 
American people, what does it matter? Well, if somebody is 
starving over there, they are not going to just sit around and 
starve. They are very vulnerable to terrorist recruitment. I 
spent a lot of time in Afghanistan doing reserve duty. There 
are a lot of ideologically driven terrorists, but a lot of 
people wound up in Afghan prisons because they couldn't feed 
their family and $500 bucks sounded pretty good. That is why 
they plant the IED. The ability of terrorists to recruit and 
sell their cause goes up exponentially as people are looking 
for a way to feed their families.
    The downside to famine and hunger is so enormous that the 
amount of money we are spending, I think, is inadequate to the 
task, but we shouldn't be the only country spending the money. 
The Gulf Cooperation Council (GCC) nations need to do more, the 
European Union needs to do more. But to the American taxpayer, 
it is in your interests and our interest that we deal with this 
hunger problem not only just from a moral point of view, but 
from a national security perspective. One last thought and we 
will get to witnesses.
    We have a Global Fund to Fight AIDS, Tuberculosis and 
Malaria that did a terrific job dealing with AIDS and malaria. 
I would like the Committee to think about creating a global 
fund for food security to get a new line of revenue from the 
private sector. We will put money in, but other countries have 
to match, have a multi-national approach to food security and 
get more involvement with the private sector.
    Elon Musk, who has gotten a lot of attention lately, is one 
of the world's richest people. He said, he was asked to give $1 
billion, I think, to the World Food Program or some cause, and 
he asked, well, tell me how $1 billion will solve world hunger? 
It won't. But $1 billion that can be leveraged to get more 
money from other people goes a long way to providing the gap in 
funding that exists today.
    Ambassador Cindy McCain, who works with David Beasley on 
the same line of effort at the United Nations, has lots of 
plans to teach people to farm and to bring new farming 
practices to bear so people can feed themselves. The World Food 
Program is a result of people not having food available in 
their own backyard.
    The goal is to get those people through the crisis and 
create a backyard that has food. If you don't understand, after 
9/11, how important dealing with hunger and poverty and the 
abuse of women is in this war against terrorism and extremism, 
you have missed a lot. Thank you.
    Senator Coons. Thank you, Senator Graham. Our first panel 
of three witnesses will focus on food security. We are very 
fortunate to have three witnesses whose combined experience in 
this field is unmatched.
    First will be the Honorable David Beasley, Executive 
Director of the World Food Program, an organization that won 
the Nobel Prize in 2020. Ms. Tjada D'Oyen McKenna is Chief 
Executive Officer of Mercy Corps, a well-regarded global 
humanitarian relief organization. And Dr. Akinwumi Adesina is 
President of the African Development Bank.
    President Adesina is in Accra, Ghana and will be testifying 
remotely. I had the honor of visiting with Dr. Adesina in Accra 
a number of years ago, and his leadership of the African 
Development Bank is very widely regarded. We welcome each of 
you.
    I would ask you make opening remarks of up to 6 minutes and 
your full written testimony will be included in the hearing 
record. Members will then have 6 minute rounds for questioning. 
Dr. Beasley--excuse me, Director Beasley, if you would please 
lead off, followed by Ms. McKenna and Dr. Adesina. Thank you.
STATEMENT OF HON. DAVID BEASLEY, EXECUTIVE DIRECTOR, 
            UNITED NATIONS WORLD FOOD PROGRAMME
    Mr. Beasley. Senator, thank you very much, and it is an 
absolute honor to be here. And I know Democrats and Republicans 
fight on a lot of things, but when it comes to strategic 
international aid and food security, it is quite a remarkable 
thing to see everyone come together recognizing the catastrophe 
that we are facing.
    Because, as you said, and Senator Graham, as you said, if 
you don't have food security, you are not going to have any 
other security. And we have seen that firsthand. And I have 
been out in the field, and I have heard this many times over, 
particularly where ISIS and Al Qaida and extremist groups are, 
where women will say, Mr. Beasley, my son, my husband did not 
want to join ISIS or Al Qaida or this extremist group, but we 
hadn't fed our little girl in two weeks, what were we supposed 
to do?
    And so if you are not going to--if you are not going to 
respond out of the goodness of your heart, because I tell 
friends around the world said, so why should I send money down 
to Chad or Niger or Nicaragua when we got issues at home? I 
say, well, it is going to cost you a thousand times more if you 
don't address the root cause and get ahead of it quickly.
    And I can give the mathematics expert experientially what 
we are talking about, because when we are not there--and if you 
are not going to do it out of the goodness of your heart, you 
better do it out of your National Security interest. What we 
are already seeing, for example, in Central America from just 1 
year ago, when you feed 125 million people like we do on any 
given day, week, or month, we survey a lot of people. We know 
what they are thinking.
    We watch their patterns. Five times the number of people 
are already talking about migrating from Central America to the 
United States. And The Washington Post did an article that 
said, on the children that end up at the border in the 
shelters, it was something like $3,750 per child per week. For 
$1 to $2 per week, we can stabilize the environment in 
Guatemala, Honduras, or Nicaragua, or El Salvador. The math is 
simple.
    Germany just did a study from the Syrian crisis, which is 
ongoing. They had a million refugees. We can feed a Syrian in 
Syria for $0.50. That same Syrian is up in Berlin, $70 per day. 
$125 billion, divide that by 140 and you will get the cost of 
what we could have done inside Syria. And we surveyed Syrians 
left and right. And what was the response? They did not want to 
leave home.
    But when they didn't have food security, they would 
actually move on average 3 to 4 times inside their country 
before they had no other alternative when they couldn't feed 
their family and no degree of security, they did what any 
mother, any father would do in any country around the planet.
    When I arrived at this job 5 years ago, there were 80 
million people marching towards starvation. There were 650 
million that were chronically hunger. That number is now up to 
810 and it will go be going higher now. But that 80 million, 
those 80 million that are acutely food insecure, I thought we 
could eliminate that.
    I was hoping to put the World Food Program out of business, 
that we would no longer be needed. We have ended hunger and 
created sustainability and resilience, but we had manmade 
conflict one after the other, and climate shocks, and that 
number went from 80 million to 135 million right before COVID.
    COVID comes along, that number went from 135 to 276 million 
people marching towards starvation. This is pre-Ukraine now. 
And out of that 276 million, you have 48 million of them that 
are knocking on famine's door in 43 countries. So I can tell 
you which 43 countries are vulnerable to famine, 
destabilization, and mass migration by necessity. And we have 
an answer to that, and that is food.
    If we get the resources we need, just like we did over the 
last 2 years, even with COVID economic crippling effect, we 
were able to avert famine and destabilization and mass 
migration because the United States Government responded along 
with countries like Germany that stepped up and others. But we 
have many other countries now that need to step up.
    And especially with oil prices, the Gulf States need to 
step up in a way they have never done before. At least, if they 
would pick up the price tag for humanitarian funds of need in 
their own neighborhood. So just when you think it can't get any 
worse, Ethiopia, then Afghanistan, and then of course, Ukraine.
    Why is Ukraine troubling? Because it is the breadbasket of 
the world. They grow enough food to feed 400 million people. 
That is gone. The ripple effect of that around the world, 26 
nations alone depend on 50 percent or more of their grain from 
that region. The silos are full. Why are the silos full? 
Because the ports are blocked. Why are the ports blocked? 
Because Russian forces.
    The farmers need to harvest again in July and August, where 
are they? They are on the front lines. They need to be putting 
out pesticides and fertilizers. Even if they do get a harvest, 
of which we expect maybe half the yield, where is it going to 
go? If the ports aren't opened, the global ripple effect will 
be famines around the world.
    And this is why it is critical, and so much appreciated, 
that the United States, the Senate and the House is responding 
in such a time as this. But we have got to get those ports 
open. We have got to get the resources we are talking about out 
into the field quickly into the countries that are going to be 
very vulnerable in the Sahel and Eastern Africa, in the Middle 
East and Central America, and I can go on and on.
    But if we get the resources that you are now talking about 
appropriated, it will go a long way in stabilizing nations 
around the world, which the American taxpayer will save money 
because you won't have famine and destabilization and mass 
migration. Thank you, Mr. Chairman.
    [The statement follows:]
Prepared Statement of David Beasley, Executive Director, United Nations 
                          World Food Programme
    This brief is being provided on a voluntary basis and should not be 
understood to be a waiver, express or implied, of the privileges and 
immunities of the United Nations and its officials under the 1946 
Convention on the Privileges and Immunities of the United Nations.
                            i. introduction
    Chairman Coons, Ranking Member Graham, members of the Senate State, 
Foreign Operations, and Related Programs Appropriations Subcommittee, 
thank you for convening this hearing on the dramatic need for resources 
to address the growing threat of starvation around the world.
    I want to thank this Subcommittee for your support of the United 
Nations World Food Programme (WFP). The United States is WFP's most 
generous and longstanding partner. Last year, the United States 
provided $3.86 billion in support to WFP, and a considerable amount was 
provided through programs under this committee's jurisdiction.
    And many thanks are in order in this moment. I commend the Biden 
Administration for the recent release of the Bill Emerson Humanitarian 
Trust and the chorus of support from lawmakers on Capitol Hill that 
made that possible. I also thank Congress for including emergency 
humanitarian assistance for the Ukraine crisis in the fiscal year 2022 
omnibus spending package signed into law on March 16. We are hopeful 
that a considerable portion of those resources can be directed to the 
worsening hunger emergency occurring within and beyond Ukraine.
    I would also like to thank the United States Agency for 
International Development for its excellent cooperation and 
longstanding partnership. Despite this generous support, needs are 
still outpacing resources. Today, I will outline the state of global 
hunger in the context of the Ukraine crisis, provide you with an update 
on WFP global needs and resourcing, and a picture of what might 
transpire should humanitarian responders like WFP not receive the 
resources required.
                       ii. state of global hunger
    It is no secret that the world is not on track to achieve Zero 
Hunger. Progress toward this global goal was waning even before the 
COVID-19 pandemic produced economic turmoil and eroded food security. 
Currently, in the 81 countries where WFP operates, up to 276 million 
people are acutely food insecure and in need of urgent food, nutrition, 
and livelihoods assistance--in other words, marching towards 
starvation. This is a record high, and more than double the 135 million 
people living with acute hunger before the pandemic. Refugees, 
returnees, asylum-seekers, and internally displaced persons are 
particularly vulnerable.
    Among the 276 million, there are 48.9 million people living across 
43 countries in even graver danger. They presently face severe hunger 
emergencies (IPC/CH Phase 4)--just one step from famine. To put the 
severity of these numbers into context, people in IPC 4 are in a state 
of ``emergency conditions'' where they are acutely hungry and are 
liquidating their final assets to do whatever they can to get food. 
They are exceptionally fragile, and many die from the impact of their 
hunger. Thirty percent of their children are wasting and many are now 
permanently stunted, undermining their ability to ever achieve their 
potential. This is not just a critical moment of hunger; it is a 
generational impact that will have consequences for decades to come.
    And finally, there are 730,000 people languishing in IPC 5, a 
catastrophic condition of hunger which is the highest number on record 
since the 2011 famine in Somalia. About 400,000 of these souls are in 
Tigray in Ethiopia, and the others in parts of Yemen, Somalia and South 
Sudan. While famine has not officially been declared in these places 
because the technical thresholds have not yet been verified, the people 
living in them are experiencing the same horrific conditions. The very 
real risk that famines will be declared in 2022 is an admission of 
failure at a time when the world has enough resources, food and money 
to reach them.
    While all of this is very bad news, it is about to get much worse.
                        iii. the ukraine crisis
    We cannot adequately speak to the current global hunger crisis 
without addressing the conflict in Ukraine and the ripple effects it 
has produced across the globe.
    I have just returned from Odesa, my fifth trip to the region since 
Russia's invasion on February 24. In Ukraine, Poland and Moldova, I 
witnessed the same heart-breaking scenes again and again: women and 
children who weeks ago led safe, comfortable self-sufficient lives now 
suddenly struggling to survive in a world of the unknown--and lack of 
food is one of their major concerns. These are families who have never 
had to worry about food and did not need the world's help to feed their 
families.
    That has all changed. Last year, Ukraine grew enough food to feed 
400 million people, but now the food they grew is unable to reach its 
own population because of this war. Ukraine has gone from being a 
global breadbasket to being on the breadlines. About 35 percent of the 
remaining population inside Ukraine have resorted to missing meals, 
reducing portion sizes, restricting adult consumption to feed children 
or borrowing food. To date, 3.6 million people have received help from 
WFP and we are preparing to serve 6 million by June, if needed. These 
people have every right to expect the global community to respond in 
their time of need.
    But even greater concerns lie beyond Ukraine's borders. The war is 
already causing ``collateral hunger'' all over the world. The tens of 
millions of tons of wheat, barley, maize and vegetable oil produced by 
Ukrainian farmers, are trapped in ports, silos and warehouses--
threatened by the destruction of the infrastructure to get them to 
market and the blockade of ports in the Odesa area of southern Ukraine.
    We urgently need these ports to reopen so that food being produced 
in the war-torn country can flow freely to the rest of the world before 
the current global hunger crisis spins out of control. Unless they are 
reopened, Ukrainian farmers will have nowhere to store the next harvest 
in July and August. The result will be mountains of grain going to 
waste while WFP and the world struggle to deal with an already 
catastrophic global hunger crisis. WFP urges all parties involved to 
allow this food to get out of Ukraine to where it is desperately needed 
so we can avert the looming threat of famine.
    In recent years Ukraine and Russia became major engines for feeding 
the world, serving as critical suppliers to global markets for wheat, 
maize and other food commodities, as well as energy and fertilizer. 
This conflict has rocked global food and energy markets as exports from 
Ukraine have been halted by this war. Steep rises are occurring in 
international prices for basic staples--notably wheat, maize and 
vegetable oil--creating a food price environment that resembles the 
2008 and 2011 crises. Given heavy reliance on world commodity markets 
by numerous countries, prices are rising even in places that do not 
source their wheat or maize directly from Ukraine or Russia. So in 
truth, instead of exporting food to help feed entire countries, the 
conflict means that Ukraine is now being forced to export hunger.
    In the case of a prolonged conflict, we should expect the 
destruction of the commodities currently trapped in storage, worsening 
declines in Ukraine's upcoming grain harvests and severe limits on its 
capacity to supply global markets. Countries that rely heavily on grain 
imports from the Black Sea, like Egypt, Lebanon and Yemen, will be 
greatly affected. To make matters worse, a lack of fertilizer supplies 
from Russia and continuously high energy costs will further constrain 
yields in many countries far from Ukraine, especially across Africa. 
Some 25 countries depend on Russia for 30 percent or more of their 
fertilizers.
    WFP now anticipates that in the countries where we operate, acute 
hunger could rise by 47 million people, from a pre-war baseline of 276 
million people who were already in the grip of acute hunger. This means 
that up to 323 million people could be facing crisis levels of acute 
food insecurity in the coming months.
    Let me be crystal clear: Conflict in Ukraine is quickly 
transforming a series of already terrible hunger crises into a global 
food crisis that the world cannot afford. A crisis of this scale will 
destabilize many parts of Africa, the Middle East, Central and South 
America and Central Asia.
                        iv. needs and resourcing
    This dramatic turn of events leaves WFP in the position of serving 
the greatest number of people in its 60+ year history. In the face of 
COVID-19, multiple conflicts and climate-related crises, we aim this 
year to assist 147 million people. This is after reaching a record-
breaking 128 million beneficiaries in 2021.
    Unfortunately, we are doing this in a time of dramatically 
insufficient resources. WFP's assistance this year will cost 
approximately US$21.5 billion. To say that our needs outstrip our funds 
would be a significant understatement--today WFP faces a funding gap of 
over 50 percent. While WFP has historically faced funding shortfalls, 
they have not been as great as this in the past or surfaced in such a 
complicated environment. As other UN agency and government budgets are 
similarly under strain, many responders are forced to cut assistance at 
the same time. This makes cuts in WFP's assistance much more painful 
for recipients than in prior years.
    The Ukraine conflict has further added to the funding gap by 
increasing WFP's operational costs and constraining its response at a 
time when it is needed the most. While other exporters of staple food 
commodities should--at least partially--be able to make up for the 
shortfall in supplies from the Black Sea region, these commodities are 
higher priced and moving them comes with significantly greater 
operational costs; shipping costs are now 4 times what they were in 
2019. Buying from farther away means higher transport costs and longer 
delivery times--for WFP and everyone else dependent on purchases in 
international markets. WFP's operational costs are now $71 million more 
per month than they were just 2 years ago, an increase of 44 percent. 
This is enough to feed 3.8 million people for 1 month.
    Because of these increased costs, we have had to cut rations to our 
beneficiaries. In the past month in Yemen we have had to reduce rations 
to 8 million individuals who are already in IPC 3 and 4. We are being 
forced to make the terrible decision to literally take food from hungry 
children to give it to starving children. Those hungry children are now 
getting hungrier. This is also true for many of our beneficiaries in 
Niger, Chad, Burkina Faso, Central African Republic, Mali, Nigeria, the 
Democratic Republic of the Congo, and sadly the list goes on.
                  v. implications for global stability
    We have long known that war produces hunger; that has been true of 
every major conflict in human history and the world is seeing this 
dynamic unfold in real time in Ukraine today. But we have also observed 
that hunger itself can produce conflict and instability, creating a 
vicious cycle of deepening hunger fueling increasing conflict. This is 
what we should be afraid of today--the further weaponization of food.
    In localized cases, we see how food insecurity produces conflict in 
a community because of competition over agricultural inputs like land 
and water. In other cases, a party will deliberately manipulate food 
supplies as a weapon of war. However, one of the most predictable ways 
that food insecurity can produce instability is through unexpected, 
rapid spikes in food prices or a lack of access to food. As prices of 
grains, oils and other basic commodities suddenly spike in countries 
around the world it is important that we realize the risks this 
portends. Recent history serves to warn us.
    In 2007-08, a rapid increase in prices for major food staples 
produced social unrest in at least 40 developing and middle-income 
countries, and regime change in at least one. A former WFP Executive 
Director, Josette Sheeran. referred to this period as the ``Silent 
Tsunami.''
    We saw food-related instability strike again in 2011 with a second 
wave of price spikes linked to the Arab Spring in the Middle East, 
which created social upheaval in Tunisia, Egypt, Libya, and especially 
Syria. It is not well known that the conflict in Syria was predated by 
what some experts have referred to as ``the worst long-term drought and 
most severe set of crop failures since agricultural civilizations began 
in the Fertile Crescent many millennia ago.'' As a result of that 
drought, the southwestern city of Dara'a, situated in one of the 
traditionally fertile areas of Syria, saw a large influx of 
agricultural migrants and was one of the first sites of social unrest 
in the country. From there, the dominoes continued to fall, and Syria 
remains in the grip of a crisis that has overflowed its borders. WFP 
currently serves over 2 million Syrian refugees in Lebanon, Jordan and 
Turkey, along with another 5.8 million beneficiaries inside Syria.
    The links between food insecurity and instability often produce 
spikes in migration. Food insecurity in Middle Eastern countries during 
the Arab Spring led to an increase in refugee flows and asylum seeking 
in Europe. WFP's own research into the causes of migration, based on 
data from 88 countries, found that a 1 percent increase in food 
insecurity fueled a 2 percent increase in migration. More recent 
surveys across Central America have produced similar results--a 1 
percent increase in hunger leads to a 2 percent increase in migration.
    The bottom line is that people do not stand idly by when they 
cannot feed themselves or their families. Already in the past month, we 
have seen social unrest triggered by food price spikes in Peru, 
Pakistan, Indonesia, and Sri Lanka. This is likely just the beginning: 
the conditions for food-related instability today are far greater and 
the risks of social upheaval are much higher than they were a decade 
ago.
    First, in 2008, the world was more stable than it is today. Several 
major conflicts have erupted since that time. The civil war in Ethiopia 
began in 2020, the Yemeni civil war in 2014, the Syrian civil war in 
2011; while the conflict in Northeast Nigeria began in 2009 and in 
Central Sahel in 2017. Furthermore, we are experiencing exceptional, 
persistent droughts across the Horn of Africa, central Asia and the Dry 
Corridor, which have already created millions of additional migrants. 
The combination of conflict and drought has created fragility in 
multiple regions impacting hundreds of millions of people.
    Second, the world has still not fully recovered from the ripple-
effects of the COVID-19 pandemic, leaving it ill-equipped to cope with 
yet another crisis. In low- and middle-income countries especially, 
incomes are still depressed from COVID-19, labor markets are struggling 
to recover, and debt is at record levels. Governments around the world 
are less economically resilient and unable to respond with fiscal and 
monetary measures to help reduce the impacts of increasing food prices 
on their populations. With rising interest rates, the costs of credit 
further limit the options for governments to respond to these 
difficulties.
    Third, city dwellers are facing increasing obstacles to accessing 
affordable food due to reductions in incomes and closures of informal 
markets, combined with price surges due to COVID-19 containment 
measures. While hunger has long been associated with rural areas, 
COVID-19 has created a growing class of hungry people: city dwellers in 
low- and middle-income countries. This matters as food price riots 
occur overwhelmingly amongst urban populations, particularly in 
relation to food products of cultural significance, and among countries 
with a strong reliance on agricultural imports. For example, Egypt, the 
most populous country in the Middle East and Ukraine's top wheat 
customer, will struggle to maintain existing subsidies on bread--a 
staple of the Egyptian diet--in the face of rising global wheat prices.
    The combined effects of these factors, exacerbated by the war in 
Ukraine, have created a perfect storm that threatens to unleash an 
unprecedented global wave of food insecurity and instability.
                             vi. conclusion
    A swift resolution to the crisis in Ukraine appears unlikely. 
Therefore, its global repercussions for food security and stability 
will become progressively more dangerous in the coming weeks and 
months. As humanitarian needs soar our ability to respond is 
diminishing due to the lack of funds. While global food supply chains 
are stressed, there are enough resources available in the world to feed 
everyone; the issue is one of cost and allocation. Because needs have 
outpaced funding, WFP is increasingly being confronted with the 
impossible decision of who to support--and who not to support. We are 
being forced to decide who will live and who will die because we do not 
have the resources available to feed them.
    Today you have the opportunity to decide whether or not to provide 
funds to help save the hungry. The costs of humanitarian inaction are 
tremendous, especially for people in need, who in the worst cases pay 
with their lives. Failing to mobilize sufficient, strategic, and timely 
funds for humanitarian assistance will not spare national budgets. Let 
me warn you clearly: if you do not respond now, we will see 
destabilization, mass starvation, and migration on an unprecedented 
scale, and at a far greater cost. A massive influx of refugees to 
Western countries could soon become a reality. As soon as they arrive, 
the host governments will start paying the price--literally --for not 
having acted earlier. Germany's recent experience of absorbing Syrian 
refugees in the aftermath of the civil war is a case in point. It costs 
less than 50 cents to feed someone for a day in Syria versus almost $70 
a day in Germany to provide a refugee with the humanitarian support 
they require.
    I therefore urge the members of this body to take decisive action 
to prevent a rapidly worsening global food crisis and help WFP and our 
partners stabilize the food security of the most fragile countries at 
this time of unprecedented need.
    At a minimum, an additional $5 billion dollars for food assistance 
from the United States will provide WFP and other aid agencies with the 
support we need to stem the rising tide of famine. It will also send a 
very clear message to other donor nations that they must step up to do 
their part.
    I do not look to the United States to solve these problems alone, 
but I do ask that you show the humanitarian leadership the U.S. is 
renowned for and which the world urgently needs right now. We are 
counting on you to lead with your actions as much as your words. As the 
Washington Post said in an editorial just 10 days ago, ``Whether this 
precarious situation turns into a true global famine depends largely on 
what the United States, European Union, China and other large and 
wealthy nations do now [ . . . ] The United States and other major 
world powers have the ability to prevent a global famine. This is as 
urgent and morally necessary as sending tanks to Ukraine.''

    Senator Coons. Thank you, Mr. Beasley. Ms. McKenna.
STATEMENT OF TJADA D'OYEN MCKENNA, CHIEF EXECUTIVE 
            OFFICER, MERCY CORPS
    Ms. McKenna: Thank you. Good afternoon, and thank you 
Subcommittee Chair Coons, Ranking Member Graham, and Members of 
this Committee. I want to express my gratitude for convening 
this hearing on rising global food insecurity, a problem that 
was already acute, but that has already deepened dramatically 
in recent months.
    My name is Tjada D'Oyen McKenna. I am the CEO of Mercy 
Corps. We are an international humanitarian and development and 
peacebuilding organization. We operate in 40 fragile countries 
facing conflict and hunger, supporting more than 37 million 
people. I previously stood up and ran the U.S. Government's 
Feed the Future Initiative at USAID in response to the last 
global food crisis, and I know how critical it is to respond to 
immediate hunger crises while strengthening food systems and 
building long term resilience.
    A perfect storm is leading to heightened global food 
insecurity, worse, much worse than the previous food crises 
over the past decade. Food and fuel price hikes resulting from 
the war in the Ukraine are the latest shock, undercutting the 
ability of the poorest and most vulnerable to feed themselves.
    The deepening effects of climate change, conflict in other 
parts of the world, and the economic pummeling of the COVID-19 
pandemic combined to push those least able to cope towards the 
abyss of hunger before the shockwaves caused by Ukraine. I 
testified last year in front of the House Foreign Affairs 
Committee that COVID-19 was burdening people's ability to feed 
themselves through the loss of income and global supply chain 
disruptions, and those words continue to ring true.
    COVID-19 was not only a health crisis, it is a food and 
socioeconomic crisis as well, one which rolled back decades of 
hard won poverty reduction and food security gains and 
continues to do so today. The drought unfolding in the Horn of 
Africa is a prime example of the devastation wrought by a 
second hunger driver, climate change. The region is 
experiencing its third drought in just a decade.
    The current one is the most devastating in a generation, 
with over 15 million people experiencing extreme hunger, a 70 
percent increase in comparison to past severe droughts. In 
Somalia, a recent famine risk assessment clearly signals the 
potential for widespread malnutrition and starvation, with 
81,000 people already in famine like conditions and over 1.7 
million on the brink.
    Additional projections indicate the lives of 350,000 
children are at risk. The dual challenges of COVID-19 and 
climate shocks are now being compounded by conflict. While the 
war in Ukraine is responsible for food, fuel, and fertilizer 
price hikes, it is not the only conflict undercutting people's 
ability to feed themselves.
    Conflicts in the Sahel, Somalia, Syria, and Yemen have 
decimated food systems, destroyed livelihoods, and led to 
widespread hunger. As my colleague, Mr. Beasley said, several 
of the most fragile countries reliant on Ukrainian imports find 
themselves in serious trouble. The prices of wheat, corn, and 
oil--and cooking oil across Africa and the Middle East are 
rising sharply. I recently traveled to Lebanon just after 
visiting Poland to visit the Ukrainian border.
    I saw that the price of some basic food items were 
increased already within three weeks of the conflict starting. 
In Somalia, basic food items have increased by over 100 
percent. Lebanon, which--where I was, which imported 81 percent 
of its wheat from Ukraine, faces the fallout from the grain 
shortages and higher commodities, it continues to host a very 
large Syrian refugee population, and is still reeling from the 
Beirut port blast, with a growing proportion of the population 
already relying on subsidized wheat.
    There is increasing risk that higher fuel and food prices 
could drive social tensions, instability, and protest. The 
global price of wheat has never been higher, eclipsing the last 
highest price, which was just prior to the Arab Spring, which 
threatened regional stability in the Middle East. While this 
perfect storm may appear unique, it is a window into the types 
of multifactor challenges we face if conflict goes unchecked, 
climate impacts increase, and new health security challenges 
unfold.
    In order to tackle this current crisis, Mercy Corps urges 
Congress to specifically increase humanitarian and food 
security funding this year. Organizations on the front lines 
estimate that an additional $5 billion will be needed for the 
U.S. to tackle. I know that you all agree, so I will leave 
that.
    Mercy Corps also recommends that the U.S. Government double 
down on efforts to mitigate future food insecurity through a 
series of critical actions. First, we recommend that the U.S. 
Government urgently make humanitarian aid smarter by 
prioritizing the use of flexible cash and voucher programs 
complemented by actions to sustain local markets.
    Second, we recommend scaling resilient food systems by 
doubling investments in Feed the Future countries to shockproof 
those communities. And lastly, we recommend tackling the root 
causes of hunger by significantly increasing investments in 
peacebuilding and conflict prevention in fragile contexts, 
reinvigorating the coordination of the R3 bureaus at USAID.
    And finally, appropriately layering and sequencing both 
humanitarian and development interventions for better outcomes. 
We must not only act to address immediate food security 
situations, but also to insulate communities to help withstand 
future shocks that will be costly in both human resources and 
human lives lost unnecessarily.
    The U.S. Government exercised leadership in the wake of the 
last crisis in standing up Feed the Future. We encourage an 
equally bold, and even bolder because the situation is so much 
worse than the last one, to address the drivers of the current 
crisis and build resilience. Otherwise, I fear food aid needs 
will continue to grow and we will continue to have to hold 
hearings like this every 10--5, 10, 15 years if we don't act 
now. Thank you.
    [The statement follows:]
 Prepared Statement of Tjada D'Oyen McKenna, Chief Executive Officer, 
                              Mercy Corps
                              introduction
    Good morning, and thank you Subcommittee Chair Coons, Ranking 
Member Graham, and members of the Senate Appropriations Subcommittee on 
State and Foreign Operations. I first and foremost want to express my 
gratitude for convening this hearing on the pressing topic of rising 
global food insecurity--a problem that has deepened dramatically in 
recent months.
    My name is Tjada D'Oyen McKenna, and I am the Chief Executive 
Officer of Mercy Corps, an international humanitarian, development, and 
peacebuilding organization. Our global team of 5,600 humanitarians 
operates in 40 fragile countries facing conflict and hunger, where our 
work supports more than 37 million people to improve their lives in the 
face of adversity and crisis. In my previous work standing up the 
United States government's Feed the Future initiative at USAID in 
response to the last global food crisis, I focused intensively on 
strengthening global food security and know first-hand how critical it 
is to simultaneously invest in smart responses to immediate hunger 
crises while strengthening food systems and building long-term 
resilience.
    Food systems in many of the countries in which we work are on the 
verge of collapse. In places like Ethiopia, Kenya, Lebanon, Nigeria, 
Somalia, South Sudan, and Yemen, communities are being battered by a 
perfect storm of conditions: ongoing economic setbacks from COVID-19, 
climate stresses, conflict and skyrocketing food, fuel, and fertilizer 
prices resulting from the war in Ukraine. This potent combination of 
challenges imperils lives around the world and threatens to fuel 
instability and civil strife. While the conflict in Ukraine is 
responsible for the recent price hikes, they are only the most recent 
factors contributing to global food insecurity. Given this combination 
of threats, solutions must, by definition, include bold short-term 
relief and medium, and long-term interventions that fortify communities 
to cope with and withstand future shocks.
                 covid economic shocks to food security
    I testified in front of the House Foreign Affairs Committee a 
little over a year ago and stated, ``Due to COVID-19, global food 
insecurity and hunger are on the rise. In part, this is because [at the 
time] 114 million people have lost their jobs due to market disruptions 
and movement restrictions. Another 141 million people have reduced 
their hours, which has led to an income loss of over $3.7 trillion. The 
price of basic staples, such as grains and dairy, has inflated 
tremendously, triggered by COVID-19's disruption of supply chains.'' 
That statement is as relevant today as when I first testified and, 
unfortunately, the statistics are worse now than then. These impacts 
will persist for years to come, pushing those who were already 
vulnerable closer to the edge of acute food insecurity.
    From the start of the pandemic to today, COVID-19 continues to 
drive hunger and poverty and now a global food security crisis is 
staring us in the face. The World Bank and the International Food 
Policy Research Institute, with analysis from the Pardee Center, 
estimates that COVID-19 may cause a persistent increase in extreme 
poverty, leading to a six to thirteen-year setback relative to a No-
COVID scenario. Furthermore, at least two-thirds of households with 
children have lost income since the start of the COVID-19 pandemic, and 
income losses have left 1 in 4 adults in households with children going 
without food for a day or more.
    In this sense, COVID-19 has not been just a health crisis, but a 
food, and socio-economic crisis, one which has rolled back decades of 
hard-won poverty reduction and food security gains. This impact means 
vulnerable populations such as women, children, and marginalized 
groups' ability to respond to shocks and stresses is impaired as we 
have witnessed first-hand in many places, particularly the Horn of 
Africa.
                      climate shocks and stresses
    The effects of climate change are a primary driving force in the 
current global food crisis. Increasing weather risks and the associated 
impacts of a dramatically changing climate continue to unfold around 
the world, disrupting agriculture and pastoral activity, decimating 
livelihoods, and increasing conflict within and between communities 
suffering from a diminishing ability to provide for themselves. This is 
particularly true in the most fragile places in the world, where 
smallholder farmers are reliant on rainfed agriculture for subsistence 
farming. Continued crop loss both limits household earnings from 
agriculture and causes an increase in food prices.
    The drought unfolding in the Horn of Africa is a primary example of 
the devastation wrought by climate change. The region is experiencing 
its third drought--an event that is supposed to take place every twenty 
years--in just a decade. The current one is the most devastating in a 
generation with over 15 million people in Ethiopia, Somalia and Kenya 
currently experiencing extreme hunger--a 70 percent increase in 
comparison to the population in need during past severe droughts.
    After three consecutive seasons of failed rains, parts of the 
region are facing their driest conditions and hottest temperatures 
since satellite record-keeping began 40 years ago. Forecasts suggest 
that the situation is likely to escalate further, as a fourth 
consecutive season of below-average rains (March-May 2022) is now 
widely acknowledged to be occurring. This would be the first occurrence 
of four consecutive below-average rains in the region since at least 
1981, resulting in one of the worst climate-related emergencies on 
record. A fourth season of failed rains could leave a staggering 45-55 
million people facing acute food insecurity by mid-2022.
    In Somalia, a recent Famine Risk Assessment Report clearly signals 
the potential for the drought to lead to widespread malnutrition and 
starvation, and indicates food security and malnutrition will 
deteriorate ``further and faster'' through June. Based on past drought 
responses in 2011 and 2017, we know that the worst is yet to come and 
that we should expect heightened humanitarian needs through at least 
September. The assessment concluded that as of right now 81,000 people 
are already in famine-like conditions, while over 1.7 million are on 
the brink. Additional United Nations projections indicate the lives of 
350,000 children are at risk of death in coming months.
    On top of the urgent threat to human lives, the protracted drought 
crisis also threatens livelihoods for millions. Severe water shortages 
are leading to crop failures. Over three million livestock have already 
died across the region; without access to enough pasture, water, and 
fodder, the health of remaining livestock is rapidly deteriorating. 
This is greatly reducing people's ability to sell off animals--a key 
coping strategy for agro-pastoralists. Mercy Corps is responding to the 
drought by protecting lives, assets, and livelihoods in the immediate 
term while laying the groundwork for long-term resilience by working 
with communities, governments, and the private sector to improve local 
capacities and systems.
    Prices of wheat, corn, cooking oil, and other staples across Africa 
and the Middle East are on the rise due to the conflict in Ukraine. For 
example, the price of some basic food items in Somalia has gone up over 
100 percent, with three liters of cooking oil going from $3 USD to as 
high as $12 USD. A 50-kilogram bag of flour increased by 34 percent. 
The impact will contribute to the cycle of compounding and recurring 
crises that has eroded communities' coping strategies. While regional 
governments and development actors' investments in local systems and 
capacities have been crucial in helping lessen these impacts, the scale 
of the current drought occurrence, in combination with the array of 
other shocks, is overwhelming communities. Women and girls will bear 
the heavier brunt of the impacts of the drought, due to prevailing 
gender inequality. For instance, in times of crises, affected 
households adopt negative coping strategies such as skipping meals or 
removing children from school. Cultural norms dictate that women and 
girls will be the last to eat or not eat at all, and girls will be the 
first to miss out on their education. The displacement that results 
from drought can also lead to greater gender-based violence.
    The countries in the Horn are far from the only ones experiencing 
climate-related shocks. South Sudan, a country known more for its past 
as a conflict hotspot and political turmoil, has struggled through 
multiple heavy cycles of rains in the previous 3 years. Last year was 
the wettest on record, flooding 33 out of the 79 counties across the 
country and causing the displacement of 835,000 people. An estimated 
800,000 livestock without the ability to graze due to the flooding have 
died and the ability of smallholder farmers to support themselves and 
their communities has been devastated. Very little water has receded, 
leaving these communities at risk of complete inundation in the next 
round of rains traditionally starting this month. Beyond lives lost to 
the flooding and flood-related hunger, the desperate situation has 
fueled increased conflict across the country, continuing the cycle of 
violence and misery borne by the people of South Sudan.
                           the ukraine effect
    The dual challenges of COVID-19 and climate shocks are now being 
compounded by the conflict in Ukraine and elsewhere. In this globalized 
economy, those living far beyond Ukraine's borders are feeling ripple 
effects in their daily lives through inflation and increased food and 
fuel prices.
    The Ukrainian and Russian agricultural sector accounts for roughly 
29 percent of the global wheat supply and due to the conflict in 
Ukraine the price of wheat is at an all-time high. Disruptions caused 
by the conflict, particularly in Ukraine's agricultural heartlands, are 
already having a disastrous effect on food prices and availability in 
the Middle East and the Horn of Africa. If fields continue to lay 
fallow, crops are not planted or harvested, and it remains near 
impossible or cost prohibitive to transport critical commodities out of 
the country, there will be less food on the global market, driving up 
scarcity and prices.
    This is compounded by skyrocketing fuel costs, which have added 
cost to every link of the supply chain. These challenges will likely 
remain far beyond this planting and harvesting season--meaning scarcity 
and increased prices will be a feature of global food commodity markets 
well into the future. Additionally, fertilizer use will also be heavily 
impacted as Russia and Ukraine are both top exporters of three key 
fertilizers and crucial suppliers to many countries whose agricultural 
sectors are highly dependent on fertilizer imports. Globally, 
fertilizer supply continues to drop, and prices have increased fourfold 
since early 2020, driving up the cost of agricultural goods and 
affecting long-term yields.
    Several of the most fragile countries in the world reliant on 
Ukrainian wheat and other staple crop imports, or dependent on food 
security assistance provided by the World Food Programme and other 
actors, find themselves in serious trouble, unable to feed their 
populations. A prime example is Lebanon, which imported 81.2 percent of 
its wheat from Ukraine in 2020, and as a result faces significant 
fallout from grain shortages and the economic impact of higher 
commodity prices. The country continues to host a large Syrian refugee 
population and is still reeling from the Beirut Port blast in August 
2020, with a growing proportion of the population relying on subsidized 
wheat as a primary source of sustenance.
    I recently traveled to Lebanon and saw firsthand how dramatic the 
impact global food and fuel price increases are having on Lebanese 
households. The Ukraine-related shortages and price hikes are 
increasing pressure on the national government to respond quickly and 
forcing families to commit dwindling economic resources to skyrocketing 
food prices. There is increasing risk that higher fuel and food prices 
could drive social tensions, instability, and protests. Historically, 
there is a strong correlation between political instability and rising 
international food prices.
    Lebanon is not the only country in the Middle East, contending with 
this potent mix of conflict and Ukraine-induced food insecurity. Food 
prices in northwest Syria--an area wracked by nearly a decade of 
conflict--were already up 86 percent, before the conflict in Ukraine 
had even started. The Turkish-supported Syrian Interim Government in 
northwest Syria and the opposition's Syrian Salvation Government have 
both implemented policies to combat the high level of food insecurity 
in the region given Turkey imported 69.7 percent of its sunflower oil 
and 78 percent of its wheat from Ukraine and Russia. In Yemen, which 
imports more than 90 percent of its wheat from Ukraine and Russia, 16 
million people do not know where their next meal will come from.
                            recommendations
    While the perfect storm of climate change, conflict, and COVID-19 I 
just outlined may appear to have emerged from a unique confluence of 
circumstances, we are likely to witness similar combinations of shocks 
manifest in the future. The global food security crisis is a window 
into the types of multi-factor global challenges we will likely face 
repeatedly if conflict goes unchecked, climate impacts increase in 
severity, and new global health security issues unfold. The 
international community and U.S. government must not only meet this 
moment by providing adequate humanitarian assistance to address acute 
food insecurity today, but by investing in and reorienting our 
assistance modalities to prepare vulnerable communities to weather 
these future shocks. As this committee and the broader U.S. government 
considers how to respond, Mercy Corps urges the following:
Rise to the Challenge through Adequate fiscal year 22 Funding
    Based on new and worsening humanitarian emergencies and increased 
food, fuel, and shipping costs, the global humanitarian and food 
security assistance funding shortfall in 2022 has increased by 50 
percent. We welcome the Administration's recent release of the Bill 
Emerson Humanitarian Trust to the Horn of Africa and Yemen, but these 
food commodities will take months to arrive, let alone get to people's 
plates. The Administration's recent second Ukraine supplemental request 
included some international food security assistance, but from our 
estimation there is only $1.85 billion dedicated to addressing the 
urgent humanitarian needs. Put simply, this is entirely insufficient to 
meet the current challenges.
    Consequently, we are asking Congress to provide $5 billion in 
supplemental funding for international food security programs. The now 
323 million people likely facing crisis levels of hunger around the 
world cannot afford further delay, nor can U.S. partner humanitarian 
organizations continue making impossible choices everyday as to who 
lives and who dies because of a lack of funding.
Make Humanitarian Response ``Smarter''
    Humanitarian and food security assistance are vitally important 
tools in mitigating the impacts of crises and saving lives. First and 
foremost, it must be immediately available and provided in sufficient 
quantity to actually meet needs around the world. It must also be 
provided in ways that promote maximum speed and effectiveness. 
Finally--and of critical importance--it must promote readiness for 
future shocks and strengthen local systems that people rely on to meet 
during emergencies and times of acute stress.
    We encourage the U.S. government to:

  1. Ensure robust base funding for humanitarian accounts.--While 
        supplemental funding for unexpected emergencies may be 
        required, nothing will ever replace the adequate baseline 
        budget necessary to respond to needs that are clear at the 
        outset of a fiscal year. We know enough about current needs and 
        historical spending patterns to set an adequate spending level 
        for the humanitarian accounts and to provide a State and 
        Foreign Operations topline number that will accommodate them. 
        This is essential to make sure U.S. humanitarian offices can 
        plan and make better choices throughout the fiscal year.
  2. Prioritize cash and voucher interventions.--Cash and voucher 
        interventions support household's ability to purchase food and 
        farmers' ability to access seeds and fertilizer. These 
        interventions directly support local market interventions as 
        part of emergency response and recovery. Evidence suggests that 
        in most cases, cash is a more efficient and effective mechanism 
        to reach needy people. It has the added benefit of sustaining 
        markets and offering people dignity of choice. Where markets 
        are thin, it should be complemented by direct support for local 
        businesses and other actors to sustain the marketplace.
  3. Universally integrate the use of flexible financing mechanisms 
        into all existing and new procurement mechanisms across 
        USAID.--Streamlining the activation of crisis modifiers will 
        enable bureaus to better pivot quickly to emergency response 
        while protecting development gains. This flexible funding 
        mechanism allows USAID to rapidly pass-through new rounds of 
        funding to current, existing partners whenever a crisis hits, 
        without the need to go through time intensive new rounds of 
        requests for applications. This allows crisis response to 
        leverage existing partnerships and interventions to ensure 
        response is faster and more effective. Additional flexibility 
        through procurement reform will also be required to fully 
        implement smarter humanitarian assistance.
  4. Implement peacebuilding and good governance alongside emergency 
        response.--While emergency assistance is focused on saving 
        lives, there are ways that it can be provided to promote peace, 
        improve good governance, and strengthen systems that help 
        vulnerable people cope. Mercy Corps' Advancing Peace in Complex 
        Crisis framework provides guidance on how this can be achieved 
        across a range of conflict types and security conditions.
Invest in Resilient Food Systems
    The U.S. recognized the need to strengthen food systems when it 
stood up the Feed the Future Initiative after the 2007/2008 food price 
crisis. Feed the Future is a ``whole of government'' initiative with 
proven results in reducing poverty, preventing hunger, and reducing 
stunting. Congressional investments in food systems were successful in 
increasing the resilience of households vulnerable to the impacts of 
COVID-19 and food systems proved more resilient during the pandemic 
than originally expected. Feed the Future has also proven that 
investments in fragile areas can increase household resilience to food 
security and reduce the need for humanitarian assistance. For example, 
in Northeastern Nigeria Mercy Corps is strengthening local market 
systems, partnering with input suppliers, buyers, and other local 
actors to improve the resilience of food systems and strengthen 
livelihoods of households. 80 percent of participants in Mercy Corps' 
poultry market interventions have reported improved ability to address 
conflict related shocks, while agriculture businesses and farmers 
supported with financial assistance in Northeastern Nigeria were able 
to generate revenues up to four times larger than the program budget 
that supported them. Given these proven results, we would recommend the 
following:

  1. Invest in Feed the Future Countries.--Despite the increase in 
        frequency of disruptions, food systems investments at the 
        country level have remained the same for more than a decade. 
        The U.S. government must commit adequate resourcing to this 
        global anti-hunger agenda to ensure it is truly able to ``shock 
        proof'' global food systems as we head into a future that will 
        inevitably include more events like those we are currently 
        experiencing. These must focus on building the resilience of 
        global and local food systems to more frequent climate and 
        conflict disruptions. Feed the Future can help mitigate 
        additional needs by expanding the program into fragile areas to 
        strengthen food systems for the future.
  2. Reauthorize the Global Food Security Act (GFSA).--The GFSA 
        authorized Feed the Future and sets forth Congressional 
        expectations on a bold global food security agenda. It must be 
        reauthorized this year and this process should be used as an 
        opportunity to incorporate lessons learned and reinvigorate 
        Congressional support for global food security in light of the 
        crisis we are currently witnessing. We would encourage Congress 
        to double the authorized amount for Feed the Future through the 
        GFSA.
Commit to Proactively Addressing Conflict and Climate Change in a 
        Strengthened Resilience Agenda
    The U.S. and other bilateral and multilateral donors continue to be 
stuck in a paradigm of foreign assistance that is reactive. In recent 
years, with the passage of the Global Food Security Act, the Global 
Fragility Act, and other important pieces of legislation, the U.S. has 
begun to pivot toward a more forward leaning and proactive agenda to 
head off crises. We must strengthen this posture by squarely focusing 
foreign assistance investments on tackling the root causes of conflict, 
violence, and fragility, prevent the escalation of crises where we can, 
and mitigate the impacts of inevitable shocks. In short, we must 
redouble our efforts on building resilience to help communities prevent 
or reduce effects of crises.
    Conflict, climate change, and COVID-19 are major, intertwined 
challenges across the globe. There is increasing evidence that climate 
change compounds existing sources of economic, political, and social 
risks that drive violence. Climatic shocks like drought are already 
increasing the risk of intercommunal conflict in the Horn. Ongoing 
conflicts in Ethiopia, Northern Kenya, the Sahel, South Sudan, Somalia, 
Syria, Ukraine, and Yemen are exacerbating disparities among vulnerable 
communities, destroying livelihoods, and limiting humanitarian access. 
Of the more than 161 million people around the world that live in 
countries with crisis levels of food insecurity, more than 100 million 
live in places where conflict is the main driver of that food 
insecurity.
    A strengthened resilience agenda should prioritize development 
investments and peacebuilding initiatives alongside humanitarian 
assistance, which we know all too well cannot solve the underlying 
causes of these crises. These different types of interventions should 
be thoughtfully integrated and connected for impact. The three USAID 
bureaus--for Resilience and Food Security, Humanitarian Assistance, and 
Conflict Prevention and Stabilization--were brought together expressly 
to ensure a better response to these mutually reinforcing challenges. 
We must do more to layer and sequence humanitarian and development 
investments in fragile contexts and be more intentional, and bolder in 
our efforts to do so.
    Our research on this topic in the Horn of Africa demonstrates 
resilience programming that better integrates early warning systems, 
more shock-responsive social protection programs, and stronger market 
systems are arguably mitigating some of the worst effects of the 
current shocks--at a fraction of the cost of emergency assistance. 
Recent analysis drawn from drought data in the Horn between 2000 and 
2015 indicates that investments in resilience and safety nets ``reduces 
the net cost of humanitarian response by an estimated $1.6 billion 
[USD] over a 15-year period over the cost of a late response.'' When 
considering the costs of meeting immediate needs and the benefits to 
incomes and livestock, investments in resilience building are estimated 
to save $4.3 billion over a 15-year period, which averages to $287 
million USD per year.
    Put simply, we cannot afford to take any other approach. The 
intricate connectivity between climate change, conflict, economic 
shocks, and food insecurity demands a more integrated, better 
coordinated, and sequenced approach to our foreign assistance 
investments. No amount of humanitarian assistance will suffice if this 
gordian knot is not untangled.
Mercy Corps recommends that efforts be made to:

  1. Increase investments in development and peacebuilding 
        interventions in contexts affected by recurrent or protracted 
        humanitarian crises.--Investments in addressing root causes of 
        these challenges is insufficient. Furthermore, we believe 
        embedding a conflict-sensitive approach throughout all food 
        security programming, supporting peaceful migration and 
        resource sharing makes our humanitarian assistance smarter.
  2.  Ensure USAID works collaboratively across bureaus.--The 
        Administration must expand and enhance its focus on working 
        collaboratively across all relevant parts of our foreign 
        assistance apparatus with relevant mandates to create an 
        integrated package of assistance that is mutually reinforcing. 
        It is particularly important that USAID's efforts break silos 
        and add up to a greater sum than their individual parts. This 
        includes ensuring all humanitarian action is conflict 
        sensitive, and that social and market systems are reinforced 
        rather than undermined in areas where humanitarian aid is 
        prolonged. We recommend reinvigorating the ``R3'' concept with 
        a fully empowered Deputy Administrator role to oversee USAID's 
        Bureaus for Humanitarian Assistance, Resilience and Food 
        Security, and Conflict Prevention and Stabilization.
  3.  Build Resilient Food Systems in Fragile Areas.--The evidence is 
        clear that resilience investments can mitigate humanitarian 
        needs in fragile contexts. Through the reauthorization of the 
        GFSA and the elevation of the USAID Resilience Leadership 
        Council, we can ensure resources are being targeted in areas of 
        greatest need and opportunity. Ultimately, food system 
        resilience must include efforts to prevent and reduce the 
        impacts of future health, climate, and conflict shocks, among 
        others, that can impact functioning food systems. Resilience 
        requires the ability to adapt to the rapidly changing contexts 
        within which food systems operate, including increasing 
        urbanization, income changes, complex supply chains, and 
        natural resource and equity constraints. Adaptive food system 
        monitoring systems are also needed as part of the resilience-
        building pathway.
  4.  Layer and Sequence Humanitarian, Development, and Peacebuilding 
        Approaches from the start.--In every context, program 
        interventions must be layered and sequenced with the full range 
        of foreign assistance resources, tailored to individual 
        contexts, communities, and countries. This means that when 
        responding to a weather emergency or a new conflict that 
        humanitarian and development funding tools are aligned, 
        mutually reinforcing and appropriately timed, and sequenced to 
        give individuals and communities the best opportunity to 
        survive, cope and thrive.
                         closing call to action
    Taken together, the impact of COVID-19, enduring and escalating 
climate shocks, unchecked conflict and now the war in Ukraine are the 
perfect storm impacting vulnerable communities' ability to feed and 
support themselves. The consequences could be catastrophic--in terms of 
lives lost and further global instability--if adequate efforts are not 
made to provide immediate assistance at the scale required.
    We must also recognize that these interconnected challenges are not 
in fact anomalous, but a glimpse into a future where multi-factor 
shocks will combine to create significant threats to lives around the 
world. Knowing this means we must proceed boldly and strategically, 
making dedicated efforts to ensure our humanitarian assistance not only 
prevents lives from being lost, but fortifies communities and food 
systems to withstand inevitable shocks. It also means better combining 
our foreign assistance tools and approaches to promote resilience by 
planning and executing assistance that layers and sequences different 
interventions. We have a critical window of opportunity to better 
prepare for a complex and potentially dangerous future in which global 
food security will be imperiled by an array of interrelated shocks, 
let's seize it.
    Thank you.

    Senator Coons. Thank you. Dr. Adesina.
STATEMENT OF AKINWUMI ADESINA, PRESIDENT, AFRICAN 
            DEVELOPMENT BANK
    Mr. Adesina. Thank you very much, Chairman, Senator Chris 
Coons. It was great to have you visit us in Abidjan. It is nice 
to see you again. Ranking Member, Senator Lindsey Graham, it 
was also great to see you in Abidjan when you visited.
    Distinguished Members of the U.S. Senate Appropriations 
subcommittee office on State and Foreign Operations, and I hope 
I will have the opportunity to welcome several of you also to 
the headquarters of the African Development Bank that is based 
in Abidjan. I very much appreciate the opportunity to testify 
about the U.S. response and policy options for a global food 
security crisis.
    I have dedicated my professional life to realizing Africa's 
potential through development. I have served Africa's most 
populous nation as Nigeria's agriculture minister, and I am 
President of the African Development Bank Group, Africa's 
premier and most trusted development finance institution.
    And I am also the 2017 World Food Prize winner. So I like 
things about food. With an active portfolio of $60.35 billion 
in more than 140,000 locations, the African Development Bank is 
Africa's only triple A rated financial institution. Our 
strategic high five priorities are to light up and power 
Africa, feed Africa, industrialize Africa, integrate Africa, as 
well as improve the quality of life of the people of Africa.
    Today, I would like to focus on feeding Africa and what the 
African Development Bank is doing to address the global food 
crisis. Africa has an estimated 33 million smallholder farmers. 
They are key to food production and the livelihoods of millions 
of more Africans whose walk and lives are linked to the 
agriculture sector.
    The truth is, with America's financing and those of other 
80 shareholder members of the bank, the African Development 
Banks group actions to boost harvests from Africa's farms are 
achieving impressive results.
    For example, through our technologies for African 
agricultural transformation, which are called T-A-A-T or TAAT, 
our support reached 11 million farmers in 28 countries in a 
little over 2 years. The program is delivering climate smart 
seeds, fertilizers, and technical support, allowing farmers to 
harvest high yields of wheat, corn, rice, and other staples.
    African food production, as a result of those efforts, has 
increased by more than 12 million metric tons. The economic 
shocks from the Russian war in Ukraine are causing all of us to 
pay more to put food on the table.
    The magnitude of food price interests and trade disruptions 
caused by the Russia and Ukraine conflict have hit Africa 
harder than other developing regions of the world, threatening 
to topple the continent's food systems already stressed by the 
COVID-19 pandemic. Africa must prepare for the inevitable 
global food crisis. Ukraine exports 40 percent of its wheat and 
corn to Africa.
    According to the United Nations, 15 African countries 
import more than half of their wheat and as much of their 
fertilizers and oil from Ukraine and Russia. As the Russian, 
Ukraine conflict rages, Africa is also dealing with a 30 
million metric ton loss of wheat and corn that won't be coming 
from Russia nor from Ukraine. The cost of bread is now beyond 
the reach of many Africans.
    The Russian, Ukraine conflict is a huge factor in 
fertilizer prices, hiking upwards of 300 percent. Our analysis 
is that America faces a fertilizer shortage of 2 million metric 
tons this year. We estimate it will cost about $2 billion at 
current market prices to source new fertilizer to cover the 
gap. If we don't mitigate this shortage rapidly, food 
production will decline by at least 20 percent, and we estimate 
in many places by more than 50 percent as well.
    This horrific perfect storm will see Africa lose more than 
$11 billion in the value of food production according to our 
analysis. Without urgent and immediate global action, we may 
witness social and political unrest, as we have seen only too 
often in the past, as we heard from Senator Graham and also 
Senator Coons.
    The truth is that the African Development Bank, with your 
support, is prepared to meet this challenge and others head on. 
Let me share what we are doing to help avert a looming food 
crisis. We have developed an Africa emergency food production 
plan. A $1.5 billion plan will be used to support African 
countries to produce food rapidly. Produce 38 million metric 
tons of food, in fact.
    The total value of the additional food production is $12 
billion U.S. dollars. The Africa Emergency Food Production Plan 
will deliver climate resilient agricultural technologies to 20 
million farmers, a majority of those will be women farmers. The 
$1.5 billion plan intends to source $1.3 billion of own 
resources.
    With U.S. Government support to reduce the $200 million 
financing gap, we can ensure the Africa Emergency Food 
Production Plan's success. Distinguished members of the 
subcommittee, we are spearheading efforts for African solutions 
to Africa's immediate, medium, and long term challenges.
    The strong support of the U.S. for the Africa Emergency 
Food production Plan will allow Africa to avert the looming 
food crisis and use the opportunity to drive structural changes 
in agriculture to unleash the full potential of Africa to 
become a breadbasket to the world. Thank you very much for the 
invitation.
    [The statement follows:]

   Prepared Statement of Dr. Akinwumi A. Adesina, President, African 
                            Development Bank

    Chairman Senator Chris Coons, Ranking Member, Senator 
Lindsey Graham, and distinguished Members of the U.S Senate 
Appropriations Subcommittee on State and Foreign Operations, I 
appreciate the opportunity to testify about the U.S. response 
and policy options for global food security crises.
    I have dedicated my professional life to realizing Africa's 
potential through development. I have served Africa's most 
populous nation as Nigeria's Agriculture Minister, and I am the 
President of the African Development Bank Group--Africa's 
premier and most trusted development finance institution.
    With an active portfolio of $60.35 billion in more than 
140,000 locations, the African Development Bank is Africa's 
only AAA-rated financial institution.
    Our strategic High 5 priorities are to light up and power 
Africa, feed Africa, industrialize Africa, integrate Africa, as 
well as improve the quality of life for the people of Africa.
    Today, I would like to focus on feeding Africa and what the 
African Development Bank is doing to address the global food 
crisis.
    Africa has an estimated 33 million smallholder farms. They 
are key to food production and the livelihoods of millions of 
more Africans whose work and lives are linked to the 
agricultural sector.
    Truth is, with America's financing, the African Development 
Bank Group's actions to boost harvests from Africa's farms are 
achieving impressive results. For example, through our 
Technologies for African Agricultural Transformation (TAAT) 
program, our support reached 11 million farmers in 28 countries 
in little over 2 years. The program is delivering climate-smart 
seeds, fertilizers and technical support allowing farmers to 
harvest higher yields of wheat, corn, rice and other staples. 
African food production has increased by more than 12 million 
metric tons.
    The economic shocks from the Russian war in Ukraine are 
causing all of us to pay more to put food on the table.
    The magnitude of food price increases and trade disruptions 
caused by the Russian-Ukraine conflict have hit Africa harder 
than other developing regions of the world, threatening to 
topple the continent's food systems already stressed by the 
COVID-19 pandemic.
    Africa must prepare for the inevitable global food crisis.
    Ukraine exports 40 percent of its wheat and corn to Africa. 
According to the United Nations, 15 African counties import 
more than half of their wheat, and much of their fertilizers 
and oil from Ukraine and Russia. As the Russia-Ukraine conflict 
rages, Africa is also dealing with a 30-million metric ton loss 
of wheat and corn that won't be coming from Russia.
    The cost of bread is now beyond the reach of many Africans.
    The Russia-Ukraine conflict is a huge factor in fertilizer 
prices hiking upwards of 300 percent. Our analysis is that 
Africa faces a fertilizer shortage of 2 million metric tons 
this year. We estimate it will cost about $2 billion dollars--
at current market prices--to source new fertilizer to cover the 
gap.
    If we don't mitigate this shortage rapidly, food production 
will decline by at least 20 percent. This horrific `perfect 
storm' will see Africa lose more than $11 billion in the value 
of food production, according to our analysis.
    Without urgent and immediate global action, we may witness 
social and political unrest, as we have seen only too often in 
the past.
    The truth is, that the African Development Bank, with your 
support, is prepared to meet this new challenge and others head 
on. Let me share what we are doing to help avert a looming food 
crisis.
    We have developed an Africa Emergency Food Production Plan. 
Our $1.5 billion plan will be used to support African countries 
to produce food rapidly--produce 38 million metric tons of food 
in fact.
    The total value of the additional food production is $12 
billion. The Africa Emergency Food Production Plan will deliver 
climate-resilient agricultural technologies to 20 million 
farmers.
    The $1.5 billion plan intends to source $1.3 billion of our 
own resources. With U.S. support to reduce the $200 million 
financing gap--we can ensure the Africa Emergency Food 
Production Plan's success.
    Distinguished members of the Subcommittee, we are 
spearheading efforts for African solutions to Africa's 
immediate, medium, and long-term challenges.
    The strong support of the U.S. for our Africa Emergency 
Food Production Plan will allow Africa to avert a looming food 
crisis and use the opportunity to drive structural changes in 
agriculture, to unleash the full potential of Africa to become 
a breadbasket to the world.
    Thank you very much.

    Senator Coons. Thank you, Dr. Adesina. Thank you, Ms. 
McKenna and Mr. Beasley. My colleague had a quick comment he 
wanted to make before.
    Senator Graham. Yes, Mr. Chairman, we had a huge bipartisan 
vote last night in the House. I am hoping we can pass the 
supplemental appropriations bill this week and that there will 
be $5 billion in the package to help the problems identified by 
our witnesses. Governor Beasley's advocacy has been huge.
    But I want to also recognize Senator Blunt. He is the 
conference Chairman on the Republican side. He has made this a 
top issue for the conference for the last three or four weeks. 
He laid the groundwork better than anyone, quite frankly, about 
why we need to think about paying now or paying later. Governor 
Beasley was at the conference yesterday. So Roy, I just want to 
let people know that we would not be here on our side without 
you, and I appreciate your leadership.
    Senator Blunt. Thank you, Senator.
    Senator Coons. As a seasoned senior appropriator and a 
widely respected colleague, I look forward to your engagement 
both on this Ukraine supplemental and on figuring out a path 
forward on COVID internationally, domestically. And I also want 
to thank you for your friendship and leadership, Senator Blunt. 
We have only got 6 minutes, so I will try and touch on a few 
main issues.
    Across all three of your testimony, it seems clear this is 
one of the worst food crises in the world in decades, certainly 
in the lifetime of any of us. I would be interested in how you 
think we can best maximize the effectiveness of our response. 
You have made references to resiliency, to investing in 
smallholder farmers, to bringing to market climate resilient 
seeds, to unblocking access to the capabilities of Ukraine.
    I would be interested in each of the three of you would 
simply talk to, given that we may well have a $5 billion 
additional contribution from the United States, if and when we 
pass this Ukraine supplemental, how do we make it as flexible, 
responsive, and effective as possible? Please. First, Mr. 
Beasley.
    Mr. Beasley. Senator, thank you. And a limited time. But 
first thing is get the money out the door as fast as we can 
because we do have a crisis. We are already cutting millions 
upon millions of beneficiaries down to 50 percent. Like in 
Yemen, 8 million have been cut down to 50 percent. In the Sahel 
region, Mali, Burkina Faso, Chad. And those are areas that you 
will have destabilization and mass migration. It will be 
absolute catastrophic consequences. And so we need to move 
fast.
    We need to make certain that USAID is encouraged to move 
the resources out as quickly as possible, and we have got means 
and mechanisms to do that. I think what we are facing right now 
is a short term crisis and phenomenon that we do need to talk 
about the long term of resilience and sustainability because we 
have solutions on that too. But right now the house is burning 
down, we have got to make certain that we put the fire out 
before the entire world is on fire, and that is where we are.
    So, and just by the way, just our operational cost increase 
of $71 million more per month because of food price increases, 
fuel price increases, as well as shipping costs. And what we 
are facing right now in the next 8 to 12 months is a food 
pricing problem, which creates access issues for those who 
can't afford it, which is critical.
    But next year, because of the fertilizer and the droughts, 
we could have a food availability problem next year. And so we 
have got a lot of work to do, and we have got to move fast. And 
I think that is critical to stabilize the countries that we are 
concerned are at risk.
    Senator Coons. Thank you. Ms. McKenna, resiliency. Future, 
long term, what should we be doing? We have to address a 
crisis, but what else should we----
    Ms. McKenna: Yes. Exactly. It would be a grave mistake if 
USAID were to err and put, you know, 95 or most of the money in 
the current food--although obviously we need the current 
commodities. Based on research that we have done in the Horn of 
Africa, we have seen that investments in resilience building 
are estimated to save $4.3 billion over a 15 year period. So 
that averages to about $287 million per year. And what does 
that look like?
    That looks like the real long term layering of longer term 
assistance and mechanisms while doing the humanitarian 
assistance. So humanitarian assistance that helps to build and 
support local markets like cash and flexible vouchers, support 
to entrepreneurs to do import substitution or other things 
needed to kind of keep people in place.
    Programs that support youth to help prevent them from being 
recruited into conflict. Things that promote governments and 
their own fiscal stability to provide safety nets so that 
doesn't further impair social cohesion. So we would love to see 
more of this long term, comprehensive focus on building 
systems, more coordination between those three bureaus around 
conflict, more support to conflict prevention actors and social 
cohesion, and the fighting of misinformation.
    We have got to--food, climate, conflict, they all go 
together. It is a circle. So we are really making sure that 
USAID is thinking about this comprehensively is critical, and 
with a lens particularly on conflict affected countries, is 
critical.
    Senator Coons. Thank you, Ms. McKenna. Dr. Adesina.
    Mr. Adesina. Thank you very much, Senator. Firstly I think, 
as Senator Graham was saying in his introductory remarks, if 
people can produce food in their backyard, they really have 
absolutely no resilience at all. So the first thing to do is to 
make sure that people can actually produce the food that they 
are actually going to grow for their families without having to 
check out a boat and beg for food.
    So I think the first thing for building resilience is 
support people, smallholder farmers to produce the food, and 
decouple from such effects that happen so often. The second is 
you have got to also focus a lot on making sure that we can 
leverage resources. Fantastic to really hear what the Ranking 
Member has said about $5 billion, but that can be leveraged a 
lot and I think international multilateral financial 
institutions like ourselves can use some of those monies and 
actually leverage them significantly.
    So leveraging matters, as you actually said, Senator Coons, 
in your introductory remarks. I think that whatever we do to 
ensure effectiveness and efficiencies, the private sector is 
critical. Governments are going to have to play a role, yes, in 
terms of support. But we have got to make sure that whatever 
support is provided does not undermine the private sector, but 
rather promotes and enhances and facilitates the private sector 
in input markets, in financial markets, and in logistics and 
getting food out to markets.
    I think we also have to make sure that targeting is done in 
such a way that those who actually need based support for seeds 
and fertilizers get it. Most of those are actually women 
smallholder farmers. And so targeting that, I would say is very 
important, and digital technologies can play a role in that. 
And finally, at the end of the day, as you all said in the 
beginning, both the Ranking Members, the issue of fragility is 
important.
    Many of these countries, and my other colleagues have 
already said it, in the Sahel, in the Horn of Africa, where we 
are having what I call a disaster triangle, that has to do with 
very high structural poverty, high levels of unemployment, and 
environmental degradation makes these areas so highly 
vulnerable. So I think that we should target quite a lot of 
support to make sure we can stabilize these particular areas.
    Senator Coons. Thank you to all three of you. I agree that 
we need to move swiftly. We need to be flexible in how we 
deliver this aid, how it partners between the private sector, 
multilateral development banks, nonprofit partners, and the 
largest agencies and entities like the World Food Program and 
USAID. I look forward to hearing more of your testimony. 
Senator Graham.
    Senator Graham. Thank you. Governor Beasley, the demand for 
your product is going through the roof, is that correct?
    Mr. Beasley. Yes, sir. In fact, we are 50 percent of the 
resources we need. We now, because of all the crises that we 
are talking about, from conflict, to climate, to COVID, and now 
Ukraine, we are about $10 billion short of what we need.
    Senator Graham. Okay, so the $5 billion--we are 
appropriators so, you know, I am not much of a farmer, but I 
want to help people help themselves. That is the whole point of 
this hearing. The $5 billion helps, but it is not enough by 
itself.
    Mr. Beasley. That is correct.
    Senator Graham. Okay. What I want to know is what did the 
GCC nations give to causes like this?
    Mr. Beasley. This year has not been much compared to what 
the United States----
    Senator Graham. So every time you go to the gas pump--these 
folks are getting rich, they are allies in problem areas, too. 
I want the subcommittee not only to fill in the gap that 
Governor Beasley has with American taxpayer dollars but I want 
us as a group, Mr. Chairman, to call our allies and say you 
need to help too. In terms of Europe, how do they do?
    Mr. Beasley. Germany has really stepped up compared to 
where they were about 7 or 8 years ago. They were $300, $350 
million. Now they are at $1.4 billion. I have spoken to the 
Bundestag on a number of occasions.
    Senator Graham. What about the European Union? It 
represents all of Europe.
    Mr. Beasley. The European Union, in my opinion, has stepped 
up, but it can do more.
    Senator Graham. Do you know what they give to us?
    Mr. Beasley. To us about $500 or $600 million.
    Senator Graham. Now they are the same amount of people as 
United States, so we are going to visit these other groups and 
we will make an argument to the American taxpayer, we need to 
spend this money and spend it now for the reasons you said, but 
I promise the American taxpayer, we are going to rattle some 
cages.
    So to the President of the African Development Bank Group, 
you have been very impressive in your presentation. How has 
COVID hurt the economy in Africa?
    Mr. Adesina. Well, thank you very much, distinguished 
Senator. COVID situation has really hurt Africa quite a lot, of 
course. Economic growth rates actually declined by roughly 1.5 
percent as a result of that, the lockdowns, and you couldn't 
get trade going, and all of that. And we had roughly about 26 
million people that fell further--into poverty as a result of 
the COVID-19 pandemic.
    And roughly 30 million people actually lost their jobs. So 
the impact is beyond just the amount of disease, of people that 
actually died from it. Roughly--so that's the impact. But in 
the recovery of Africa from that, it has been rather muted 
compared to other parts of the world, we project that our 
economies will probably go back about 5.1 percent. But the real 
issue is how do we ensure that we don't have a divergence in 
the growth rates of the developed countries and the developing 
countries such as Africa?
    The big issue there is access to vaccines. And as you know, 
right now we have only 16 percent of Africa's population is 
actually vaccinated, I mean fully vaccinated. And if you look 
compared to developed economies, countries in the world, 
Australia, it is about 83 percent. If you look at the United 
States, well--I mean, you have so high here. If you look at 
Europe, well over almost 70 percent.
    So the issue is--access to vaccine. A lot of work is being 
done, distinguished Senator, in terms of local manufacturing of 
vaccines in Africa. That ought to be promoted. But I do think 
that we have got to make sure that we prepare not only for this 
particular COVID situation, but we build what I call Africa 
health care defense system, which will have to be predicated in 
three factors, three areas.
    One is build Africa's pharmaceutical industry, which is 
very critical. We import over 80, 90 percent of pharmaceutical 
products in Africa, which is not acceptable. The second thing 
is to make sure we build local vaccine manufacturing capacity. 
And third one, the most critical, is the issue of health 
infrastructure, primary healthcare, secondary healthcare, and 
tertiary healthcare, especially also diagnostic infrastructure.
    I know that when you came, Senator Graham, to Abidjan and 
we had a conversation over dinner, the whole issue was around 
infrastructure. And this is one area of infrastructure that we 
think is critical, infrastructure for life.
    Senator Graham. One of the things I learned on the trip 
from the Gates Foundation, there was a single mother, I think, 
with four daughters, and where the power lines go, everything 
changes. As you build the road and build the power system, you 
can get products to market better.
    Drought resistant seeds were used by this young woman and 
her yields were ten times what they were before because she was 
using technology. They moved the cow out of the house into its 
own place and it improve the health care environment. They were 
able to get some disposable income and didn't have to walk five 
or six miles a day to get water.
    So, infrastructure really is important to economic 
development, particularly on the food side. Ms. McKenna, the 
Global Fund has been, I think, a good success of where money 
has been matched. Do you see a need for something like that in 
the food security space?
    Ms. McKenna. Absolutely. Absolutely. Multilateral action is 
key. And what is concerning is that we have seen some countries 
kind of take away aid from places like--from places like Yemen 
or Syria in order to support responses in the Ukraine. And the 
answer is more, including private sector and other motivations. 
It is not less or moving it around.
    Mr. Beasley. Senator, can I add real quick? I pulled out 
the 2 numbers on like Saudi Arabia and UAE. Three years ago, we 
received from both those countries $658 million, primarily in 
Yemen. This year we received $6 million from Saudi Arabia and 
$0 from UAE.
    Senator Graham. Wow. Thank you. That may change next week.
    Mr. Beasley. Thank you, sir.
    Senator Coons. Look forward to the persuasive effort. 
Senator Durbin.
    Senator Durbin. Thanks, Mr. Chairman. And thank you to the 
witnesses and all of you here today for this critically 
important hearing. I am going to ask you some questions that 
may be a little bit different. When we talk about food and 
feeding people, most of us think in terms of raw foods, 
foodstuffs, and I would like to be more specific. In areas of 
famine, I have seen, and this goes back a few years, I don't 
know if this is still the case, the use of food supplements 
like Plumpy Nut, is that still out there?
    Ms. McKenna: Therapeutic.
    Senator Durbin. It's a winner, isn't it?
    Mr. Beasley. Super coffee nut----
    [Technical problems.]
    Senator Durbin. And also rehydration therapies. When we 
talk about food aid through your agencies and such, does it 
include these things?
    Mr. Beasley. Yes, sir. In fact, there has been a deliberate 
effort and a substantial improvement in not just calories, but 
the right calories and nutritional added value products. And 
that is one of the things that we are really working together 
more strategically than we were years ago.
    Senator Durbin. When we hear about the increasing cost of 
local food producers, I think of how we might help them 
directly, but I also think indirectly. Are there microcredit 
programs that are part of your effort so that local farmers can 
borrow some money to get through the tough times?
    Mr. Beasley. We think this is a very critical part of the 
success going forward. Not nearly, nearly enough. One of the 
things that Congress has done in the last few years is given us 
more flexibility with funding. So we now do $2 billion in cash 
based transfers, which puts liquidity into the local economies, 
which stimulates the local smallholder farmers.
    And we are also now buying internally like for Africa to 
stimulate farming operations in that regard as well, as well as 
we are bringing obviously tremendous amount of quantity of 
commodities from the United States into the countries that are 
in great need. But these resilience programs are the long term 
success.
    The charity is never going to be the final solution, as you 
well know. It has got to be--we have got to create an incentive 
such as you have water harvesting and all the things that you 
create the resilience. Because in many of these countries we 
are struggling with right now because of this shock from 
Ukraine, if we could go in with the right programs to scale 
them up, then they won't have these shocks like we are 
experiencing.
    And that would be--that will save a lot of money, Senator.
    Ms. McKenna: May I add, Senator. In addition to 
microcredit, which can be difficult sometimes for agricultural 
producers to make the frequent payments it requires, we are 
also have looked at things like microinsurance to kind of help 
protect against crop failures, the things like risk--different 
micro savings products to help them plan better. So 
comprehensive financial tools are part of the services that we 
offer.
    Senator Durbin. We know that COVID----
    Mr. Adesina. Sorry. Distinguished Senator, may I come in?
    Senator Durbin. Sure. Go ahead.
    Mr. Adesina. Thank you. I just wanted to make two quick 
points about what you said about the importance of 
malnutrition. We should make sure that in the interventions 
that we do, it is not just calories that matter, it is actually 
nutritious food that is also very important.
    So, because at the end of the day, if you have children 
that are stunted and they are not getting the right kind of 
nutrients, it affects actually the capacity of the brain to 
function well. So, you know what I call gray matter 
infrastructure, we have got to really build that into this. And 
one of the things that we will be supporting through this 
emergency food production plan is the whole area of bio 
fortified foods.
    So what I highlighted, maize, sorghum that is actually 
fortified with iron, or beans and things like that that are 
also fortified, is very important. Nutrition and 
supplementation is important. Now, one thing I just wanted to 
say is how important these interventions are. We have a program 
that we are doing in the Soqota area, which is in Ethiopia, 
which is in the Tigray area.
    In fact, as part of war in that area, the number of 
percentage of kids that were actually stunted was as high as 
50, 60 percent. We brought it down to about 38 percent in a 
very short period of time. So these focused production things 
that are targeted with high nutrient foods does make a 
difference very quickly. And on the point of the microcredit 
that you said, I think at the end of the day it comes back to 
what Senator Coons was saying.
    We have got to make sure that $5 billion that we are 
talking about here is used to also leverage financial 
institutions. Banks don't lend to agriculture in most cases 
because of high perceived risk, but when I was Minister of 
Agriculture, I got the banks in Nigeria to actually lend to 
agriculture, put together a $350 million risk guarantee 
facility for them if they lost their money.
    And we ran it. We leveraged over $3.5 billion from the 
banks into agriculture. And non-performing loans, less than 1 
percent. So which means that the passive risk is excessively 
high. And so we at the bank, as part of our intervention, are 
looking into how we are going to use risk mitigating factors 
and risk guarantees to leverage the capital of the balance 
sheet of those banks, going to seek companies, fertilizer 
companies, logistics, and all of those factors in the 
agricultural value chain. This is very, very important.
    Senator Durbin. Thank you, sir. I want to ask one last 
question, if I can, and it relates to COVID-19. We all know the 
death toll in the United States has reached a million, maybe 6 
million worldwide. The U.S. has developed very effective 
vaccines, but we have struggled to supply them to the rest of 
the world.
    Now we have a greater challenge in poor countries than just 
providing vaccine. We have weak health infrastructures in those 
countries, vaccine hesitancy, and other competing basic health 
demands. A member of my staff went to West Africa, and I asked 
he specifically to look at COVID-19 vaccine supplies. He 
reported a surplus of vaccines, but not enough demand. There is 
a hesitancy involved in it.
    There is a lack of infrastructure to deliver it, and that 
has to be part of our conversation. So it isn't just the value 
of the vaccine, its taking with it the means of delivery. Can 
anyone on the panel comment on that aspect?
    Mr. Beasley. Senator, when most of the airline industry 
shut down during the height of COVID, the World Food Program 
stepped up and began delivering COVID supplies, from PPE, 
testing equipment, ventilators, the whole nine yards in 183 
countries. So someone said that we were actually the world's 
largest operating airline at one time.
    That is something that you aren't really proud of, but when 
the airline industry shut down, we had to do what we needed to 
do. When it came to vaccines, we were and are prepared to step 
up and deliver and take advantage of our logistics supply 
chain, because we were really very good at it.
    But we have really not been asked to do that much in the 
supply chain of vaccines. We have been--we have had a very 
little role in that.
    Ms. McKenna: I would like to echo that. NGO partners like 
Mercy Corps and our peers, we are your last mile partners. We 
are in these deep communities that are difficult to reach with 
deep, long standing relationships. And we reached out several 
times kind of trying to get people to work with us to support 
that last mile delivery and it just was not something that was 
taken up in a huge way.
    Mr. Adesina. For Africa, from a--distinguished Senator, the 
issue with the vaccine hesitancy that you mentioned, yes, there 
is some truth to that, but I will not say that there are 
surplus of vaccines in Africa. In fact, what happens is that 
there is not enough supply. We have--even well what was 
supposed to be delivered to Africa wasn't really delivered. It 
came late. Some of them were actually expired vaccines, so they 
couldn't really be--doses couldn't be applied.
    You have a situation in which as developed countries 
actually have, double doses, triple doses or booster shots, 
Africa was just basically still struggling to have basic shots. 
So I do think that it is not necessarily correct to think that 
there is a surplus of vaccines in Africa. There is not a 
surplus of vaccines in Africa.
    There are structural issues that we must deal with in terms 
of making sure that we have the capacity to produce those 
vaccines in Africa, and also issues that have to do with 
intellectual property rights that can make sure those vaccines 
and antigens and things like that, that are needed are actually 
available through R&D systems in local pharmaceutical and 
vaccine manufacturing industry.
    So in Africa right now, a lot has been done in terms of 
Johnson & Johnson in South Africa and many other places to set 
up vaccines manufacturing. And when they are setting up those 
vaccine manufacturing is because there is demand, but they are 
trying to deal with the problem of structural bottlenecks that 
have made it difficult for Africa to actually access the 
vaccines in the quantity, at the cost, and at the timing that 
is needed.
    Senator Graham. Thank you. We have votes, and I am going to 
go vote and we will do the best we can.
    Senator Blunt. All right. That means I am in charge until 
you get back?
    Senator Graham. Means you are in charge--maybe----
    [Laughter.]
    Senator Blunt. I have got lots of time then. Well, thanks 
to all three of you for being here. Ten years or so ago, when I 
started talking about the demographic impact on food, which is 
highly predictable, and the double in the world food need in a 
relatively short period of time--and I was talking to somebody 
who runs one of our big agricultural companies, and I said, how 
do we--can we do this?
    And his answer is, yes, we can do it, but we can't do it 
without science, and we can't do it without Africa. That that 
incredible population growth in Africa, that what all three of 
you are saying, the importance of Africa producing more of its 
own food and us helping figure out how to do that is critical. 
I do think at this moment, this immediate $5 billion, frankly, 
is going to go pretty fast, and go fast to meet the crisis 
need.
    I as--Governor, you said you bought a lot of--Governor 
Beasley you buy a lot of food from Ukraine. What happens as the 
Russians move across Southern Ukraine, they have almost 
destroyed Mariupol, if not--and probably the port at Mariupol, 
I don't know. But they are now focusing on Odessa.
    What happens, one, to the rest of the world if those ports 
are not operational for some period of time? And then two, what 
do you think happens to Ukraine and the food they maybe would 
be able to still continue to grow if those ports aren't 
available to them or to anybody else, perhaps?
    Mr. Beasley. I guess you could actually say goodbye to 
Ukraine if you don't get those ports open because the economy 
collapses. 40 more percent of their GDP is based upon 
agricultural products that are exported through those ports, so 
it is critical. And then you talk about the impact that it will 
have on global food security, famines around the world, the 
pricing that we already see is spiking.
    And so over the next 8 to 12 months, you will be--you will 
see continued pricing spikes. And here is what is very 
frightening. When you look at the Arab Spring in 2011, 2012, 
the economic indicators is now are worse than they were in Arab 
Spring, because we see food pricing and what it leads to, from 
migration to riots to protests to destabilization. Just in the 
past few weeks, you have seen Sri Lanka, Indonesia, Pakistan, 
Peru.
    In the last few months you saw Chad, of course, and Burkina 
Faso, and Mali. And so it will only get worse in these places 
if food prices continue to spike, and they will, because you 
don't have the availability of $400 million--400 million--
Ukraine feeds 400 million people with the food. So if that is 
out of the equation, where is that going to come from? You 
can't make that up that fast.
    So it creates tremendous market volatility, and then you 
compound that with the fertilizer problem, and like Ethiopia 
and Sudan, 85 percent of their fertilizer comes from Russia and 
Belarus. And they are already in very, very fragile state. That 
is just two, and I can go from country----
    Senator Blunt. But without those ports, could Ukraine even 
if it could grow the food, how would the--how would they get 
the food--how would you get the food out of Ukraine?
    Mr. Beasley. You can't. You can't get enough food out. To 
try to truck it out--for example, when an average day at the 
ports is 3,000, give or take, train carloads per day, and the 
average train carload is 3 to 4 trucks. So do the math.
    That would be at least 10,000 trucks per day. And it is not 
a one day trip. It is several days. So you could talk about 4 
to 5 days' worth of trucking operations, 50,000 trucks. What we 
have, and sitting down with the Ukrainian government, a best 
case scenario is you could truck and train out about 1 million 
metric tons a month.
    Now, the problem with that, and that is not much compared 
to how much they produce, it is a drop in the bucket. But the 
problem with that is pricing spikes with that, because the cost 
of transportation will move it up to $120 more per ton, which 
prices it out of the market.
    Senator Blunt. Right, right. Let me ask one more question 
here. You said, and I think Ms. McKenna has also said, we need 
to move fast. What can we do to speed up our efforts through 
you, through USAID? Are there elements--are there tools we can 
better use to get this done quicker? And I want to go next to 
Ms. McKenna and ask her if the NGOs have the capacity to do 
more, if we will work in a better way. But, David, you want to 
answer that?
    Senator Blunt. Yes, I do. I think there are several things. 
I think first and foremost, I think encouragement to USAID from 
the Senate in the House to move these funds quickly. I think 
they are in a lot of pressure.
    You have got lawyers and all the bureaucracy, and I think 
as much encouragement as we can do down to USAID, that would be 
very important. Number two, in the past, we have mechanisms 
that we can put in place--that we have in place ready to move 
quickly. Funds, I mean, cash based transfers, we can move just 
like that.
    IRA accounts and major tranches for regional areas of the 
world. We can move these funds very quickly, so we have the 
capacity to handle such. And then we can move funds with our 
partners as quickly as possible. But I think it is going to 
take a lot of encouragement down the street.
    Senator Blunt. Ms. McKenna.
    Ms. McKenna: Yes. Thank you for that question. We would 
encourage USAID to really work with NGOs to move that quickly, 
obviously, but also really leveraging NGOs and leveraging 
existing relationships they have to do things like creating 
cash consortiums that can be used in multiple markets around 
the world like Yemen or Syria to kind of support local markets 
while also supporting food production and other things. So we 
saw them able to do that a bit with COVID, being able to top up 
existing awards to support that, and we would encourage them to 
look at that again.
    Senator Blunt. Well, thank you. And I have a whole lot of 
other questions if the Chairman hadn't returned, but he is back 
and----
    Senator Coons. Please feel free to ask----
    Senator Blunt. No, go right ahead, Chairman.
    Senator Coons. We have no other members currently. And I 
know two are on their way back.
    Senator Blunt. Well, from the African Bank point of view, 
what are we--again, the key points to, one, get food out 
quickly, and two, to encourage more production.
    Mr. Adesina. Thank you very much, Senator. And so back to 
your point, you were saying earlier on, it was an excellent 
point, on the importance of R&D science models. And I just want 
to make two examples of that.
    One is, in Africa today, we have actually supported what is 
called the water efficient maize for Africa, which is a very, 
very drought tolerant maize variety. Interestingly, I was at 
that time an associate director of the Rockefeller Foundation, 
and I was based in Zimbabwe, where we actually supported the 
global setup for wheat and maize cement based in Mexico to 
develop those varieties.
    And those varieties worked. When we had drought in East and 
Southern Africa in 2018, 2019, the African Development Bank, 
through this program that I mentioned to you, called 
Technologies for African Agricultural Transformation, we 
actually got those water efficient maize varieties out to 5.2 
million households, and that is why we were able to avoid a 
food crisis that there.
    The second one is about wheat. As we all know, wheat is a 
temperate crop, but with technology right now, we actually have 
heat tolerant wheat varieties. And the African Development Bank 
was able to provide, and Beasley was talking about the case of 
Sudan and also Ethiopia. We provided for Ethiopia--I mean 
Sudan, 65,000 metric tons of certified seed of these heat 
tolerant varieties and that is about the equivalent of if one 
takes an Airbus A380 in terms of passenger cargo and we have a 
90 metric tons or 98.2 or so metric tons.
    So you are talking about almost 665 A380 Airbus of seed 
provided for them. And that allowed them to reduce that import 
of wheat, most of you, of course, you know, coming from Russia 
and all of those places, by 50 percent.
    We did the same also in Ethiopia, where today they were 
closing in 2018 to 5,000 hectares of heat tolerant varieties. 
They have gone to 400,000 hectares of that today. So technology 
actually does matter. And in terms of, you know, the issue of 
getting things out, I think just to add to what Tjada was 
saying and also to David, is I think that we should get into 
what is working on the ground.
    To come back to what Senator Graham was saying, produce 
food in your backyard. You know, and we have part which 
actually brings together the global R&D centers, the national 
centers, the regional centers, the private R&D centers, to 
actually get technologies to move agricultural value chains all 
across Africa.
    So put the money where it is working on the ground. The 
plan that we have put forward here, distinguished Senators, is 
not one we developed in our offices. It is one that is actually 
developed from the countries, over 44 countries where we have 
been impacting them in terms of access to climate resilient 
technologies.
    So one of the things we can do with this money, given also 
that the Administration, U.S. Administration is big on climate, 
as much as we are big on climate, is to make sure that the 
money is used for food, but also wins on climate. So we can win 
on food, but we also have to win on climate, and R&D is the 
best way. And we have--the best way of getting these 
technologies out, I would say, is the mobile phones.
    We can register, we have to register farmers biometrically, 
give them access to technologies, and give them via their 
mobile phones, and send them money by mobile phones, that way 
we make sure there is inclusiveness, in particular that women 
have to be carried along.
    I continue to say that because you have to make sure that 
women participate and benefit from this because they are the 
majority. I have done this when I was Minister of Agriculture 
in Nigeria. We got all the farmers registered on mobile phones. 
We put them on a digital databases.
    I was sending money by vouchers on their on their on their 
mobile phones. And I remember walking into one perimeter one 
day. The farmer told me, the woman from out there said, well, 
thank you, Minister. Now we get seeds and fertilizers in our 
villages, and the men cannot cheat us anymore. We have got to 
bring transparency and accountability and inclusiveness to the 
way in which these phones are deployed for impact.
    Senator Blunt. Thank you. Thank you, Chairman.
    Senator Coons. Thank you, Senator Blunt. And thank you to 
my colleagues who have come to join this compelling hearing. I 
believe we will move next to Senator Murphy, then to Senator 
Moran, then to Senator Van Hollen, then to Senator Boozman. I 
am basing that on the order of when they were here before. We 
have another panel following this on COVID, which will be 
equally compelling. Senator Murphy.
    Senator Murphy. Thank you very much, Mr. Chairman. Thank 
you all for being here and for your fantastic work. I just 
wanted to have you all take a few minutes to delve a little bit 
deeper into the crisis in Afghanistan. This started as one of 
the world's poorest countries, and it has descended into what 
is really now the world's worst humanitarian crisis.
    And I would like you all to give us a little bit of advice 
as to how we best unlock the significant amount of money that 
the United States currently has in its possession and at its 
disposal to try to address this crisis. In February, President 
Biden authorized $3.5 billion, that is about half of 
Afghanistan's frozen assets to be used, ``for the benefit of 
the Afghan people.''
    But 3 months later, we have not yet figured out what that 
international financing mechanism is. It still hasn't been set 
up. And so what advice would you give the Administration? What 
advice would you suggest we give the Administration as to how 
to push that $3.5 billion? Because it cannot be that we can't 
both save lives while also not unjustly enrich the Taliban.
    There is a mechanism by which to get this money as directly 
connected to the Afghan people as possible. So, I am 
certainly--I will start with you, Mr. Beasley, but I would love 
comments from all three of our panelists.
    Mr. Beasley. Yes, Senator Murphy. I mean, this is one of 
the things we have been talking about from the beginning, 
because of the lack of funds that we have globally and then in 
Afghanistan hit. We were already--right before Afghanistan, we 
were talking about the crises that we are facing around the 
world. And Afghanistan hit, a nation of over 40 million people, 
23 million people are in IPC 3, 4, 5.
    I mean, that is just unheard of 8, give or take, 7 million 
are knocking on famine's door. So we were like, look, we don't 
have enough money. So what we did with the World Bank because 
the World Bank couldn't give it to the Taliban, and so we 
actually sat down with the Taliban, said, look, no one is going 
to give you money. Let it go directly to us without your 
fingerprints being on it.
    And they, I would say, consented, but didn't matter. But it 
worked out with--money came directly to us. Same thing on these 
frozen assets. I don't think there is any question whether it 
is us or UNICEF and others, that we can work with teachers, 
health care providers, and of course, is working with 
beneficiaries throughout the country is not difficult to do. We 
are reaching about 40 million people right now.
    But because of the lack of funding, we are having to cut 
back, cut back, cut back and at least try to reach those 
knocking on famine's door. But we have got to unleash those 
funds, whatever it takes, because otherwise you either got 
appropriated more dollars, and if you don't, you will have 
famine, you will have destabilization, which means you have 
more migration coming out of Afghanistan and you are going to 
have an extraordinary amount of recruitment by extremist groups 
for terrorist training activities.
    Senator Murphy. Ms. McKenna.
    Ms. McKenna: Afghanistan is actually our largest--our 
longest continuous country presence. We have been operating in 
Afghanistan since the 1980s through multiple Administrations. 
The Government needs to figure out a mechanism to program that 
money to partners like us who are in those communities.
    That economy has collapsed. We have seen news accounts of 
families selling off young children, young girls for dowry 
money because there is just no money coming in. Opium 
production is through the roof. We need to be able to start--we 
need to that to help starved--save people from starvation.
    Senator Murphy. But money coming directly to your 
programmings does not enrich the Taliban, in any way, shape or 
form?
    Ms. McKenna: No, and we have been working with Treasury to 
create different rules and such that we can program those 
funds.
    Senator Murphy. Dr. Adesina.
    Mr. Adesina. I will have to take a pass because my mandate 
doesn't cover Afghanistan.
    [Laughter.]
    Senator Murphy. All right. Thank you all. This is long 
overdue. In a world in which we are starved for resources, here 
lies for the time being, $3.5 billion that is ready to go. And 
you have pointed out that the programmings you are running on 
the ground right now directly benefits the Afghan people 
without unjustly profiting the Taliban.
    You are not alone in that club. There are plenty of 
mechanisms that will allow us to do both, save lives and make 
sure that this money doesn't end up in the hands of the wrong 
people. And so my hope is that this Committee can work with the 
Administration to expedite a mechanism to get that money 
released. Thank you, Mr. Chairman.
    Senator Coons. Thank you, Senator Murphy. Senator Moran.
    Senator Moran. Chairman Coons, thank you. Thank you to our 
witnesses who care so much about this topic. I guess Ambassador 
Beasley, Secretary--or Governor Beasley, Yemen. You talked 
about Afghanistan. A lot of unsavory individuals who control 
most of the populous parts of Yemen. How has the cooperation 
been with the Houthis, and what worries you with those 
countries going forward?
    Mr. Beasley. Senator, I have had some very frank 
conversations with the Houthis. I was just there a month and a 
half ago meeting with the Houthi leadership. And I know you 
probably recall back when I was pretty tough on the coalition 
about the blockade in Hudaydah and really was--in fact, 60 
Minutes did a story then that helped break up the issue of the 
blockade in Hudaydah because we couldn't get food supplies in.
    And that is a country that relies on 90 percent--85, 90 
percent of all its food comes from the outside. And so when I 
was pretty hard on the coalition and that broke apart in terms 
of allowing the blockade to be set aside and food came in. The 
Houthis were just so excited and patted me on the back, thank 
you, thank you, you are our friend.
    And I said, look, I am not doing this because I am on your 
side. I am doing this because it is the right thing to do. And 
I said, and if you cross that line, too--I probably should say 
what I said to them here. But anyway, the bottom line, I said, 
I am going to kick your rear end. You know that kind of thing. 
And they kind of laughed about it.
    Well, a couple of years later, we had some serious issues 
with regards to many of our provisions in place to move food 
out there and neutral impartiality to reach the beneficiaries 
with independence. We had significant issues. So I went and sat 
down with them and said, let me be very clear.
    We don't have enough money right now to feed everybody in 
the world. And our donors want to make sure that every dollar 
go--is maximized to reach the most people possible. And so when 
what you are doing in diverting our aid and creating all these 
unnecessary obstacles, there is no way that we can get the 
funding we need to help the people in Yemen. And we want to be 
able to do it in a neutral, impartial, independent way.
    I actually made the decision to cut off all food supplies 
for about a million people for about a month. It was a hard 
decision, but with diversion taking place--otherwise I would be 
participating in diverting food from innocent children over 
here to help--you know, and this is what we are facing today.
    We are having to take the lack of money, food from hungry 
children to give to starving children. That is horrible. So it 
was quite remarkable. Houthis didn't think there was anyone in 
the United Nations, I think, that would actually do that. We 
made that hard decision, and they were at the table within a 
few weeks, and we resolved it.
    And things have moved incredibly better since then. That 
doesn't mean it is all perfect. Anytime you are dealing these 
types of places is tough. But the cooperation has been--has 
remarkably improved inside Yemen. But there is still a lot of 
issues there.
    Senator Moran. Is there attention being paid to this, and 
this is--perhaps it is to you again, Governor, the attention 
being paid to the countries that are enacting protectionist 
policies to keep the food they grow within their country? And 
is there something that you, the United States of America, the 
United Nations, needs to be doing to encourage--it drives up 
the cost and makes it more difficult for us to meet the needs 
of hungry people elsewhere.
    Mr. Beasley. We faced this in COVID in a remarkable way. A 
lot of ministers of different governments of economies and 
trade were doing lockdown, shutdowns, border controls, 
limitations on imports, exports, and it was creating havoc.
    So I was on the phone, particularly those first 6 months, 
and my teams were on the phone saying, let me explain to you 
what is going to happen, you shut down this port right now or 
you put this limitation at this stage, and here is what is 
going to happen in the next three, 6 months. And so we were 
able to really avert a lot of the complications from those 
types of restrictions.
    Now we are seeing that bubbling again. And I think not just 
us, but everywhere we see it, we try to make a phone call. 
Explain, please don't do this, here is what is going to happen. 
Talking to the secretary general and others in the United 
Nations, as well as talking to our friends like in the United 
States to say, please call this particular government leader to 
minimize these types of issues. And so that is one of the----
    Senator Moran. Actions are being taken.
    Mr. Beasley. Actions are being taken. But you have got to 
be on top of it literally every day.
    Senator Moran. Let me quickly, in the last minute or so, 
raise the topic of ready to use therapeutic food, RUTF. Two 
countries, I think South Sudan and Ethiopia, have already 
requested RUTF through the Bill Emerson Humanitarian Trust. Do 
you support including funding for RUTF via the Bill Emerson 
Trust, the emergency supplemental package, or annual 
appropriations to ensure that this lifesaving product gets into 
the hands of those who need it most?
    Mr. Beasley. Yes, sir. The Emerson Trust is a godsend right 
now with the crises that we are facing. If you don't use it 
now, I don't know when you would use it. And so we are 100 
percent supportive.
    Senator Moran. Thank you. Mrs. McKenna, anything to add 
or----?
    Ms. McKenna: No, nothing to add.
    Senator Moran. Thank you, Chairman.
    Senator Coons. Thank you, Senator Moran. Senator Van 
Hollen.
    Senator Van Hollen. Thank you, Mr. Chairman. Thank you to 
all of our witnesses. Mr. Beasley, it is good to see you today. 
We were together yesterday morning talking about some of these 
issues. And thank you for all your passion and the experience 
you bring to these critical matters. Yesterday, I was able to 
bring you the preliminary good news that we were on the verge 
of passing the $40 billion assistance package, including $5 
billion for food security assistance.
    And I do want to thank the Chairman of our subcommittee for 
all his work on making that happen. I am confident that--I am 
increasingly confident we will have bipartisan support here. I 
want to get to how the $5 billion will help the emergency food 
situation around the world. But before that, I have a question 
about Odessa and the Russian ports.
    And I know it was covered a little bit already, but if you 
could dig down more deeply on what will happen to food 
insecurity around the world if we don't unblock those ports--
there is some people saying, well, we can use the land routes 
and obviously we want to do our best.
    But Mr. Beasley, tell us what will happen if that? I think 
it is over 30 million tons of wheat is stuck in those Ukrainian 
ports. What does that mean for world hunger?
    Mr. Beasley. Ukraine normally ships about 60 million metric 
tons through those ports on an annualized basis. That is about 
3,000 train carloads per day. You can't truck enough out. You 
can't do it. You might can truck out about a million metric 
tons a month on a good day at best. And even then, you are 
talking about $120 more per metric ton. So it puts it out of 
the market in terms of pricing.
    And so the ports have got to open. Ukraine grows enough 
food to feed 400 million people. It is not just availability of 
food price--food, it is also food pricing. That is going to do 
more harm to the poorest of the poor around the world who 
barely can afford it now. As I was saying earlier, we have gone 
from 80 million people marching to starvation to 276 right 
before Ukraine.
    And now that number is going to go up an additional 50 
million. So, number one, the Ukraine economy, 40--over 40 
percent is export, over 40 percent is agricultural exports. So 
it will have catastrophic consequences if another shot is not 
fired in the war and the ports are just blocked. I don't know 
how--I mean, I am not the economist here. I am just a 
humanitarian. But I don't know how you don't have economic 
collapse.
    Then you have the impact--inside Ukraine--then you have the 
agricultural impact on food supplies, particularly in Eastern 
Africa, Western Africa, the Sahel, countries that depend on 
this grain from this region. For example, Egypt, 80, 85 percent 
dependency, Lebanon 80 percent.
    Twenty-six countries depend upon Ukraine, over 50--Ukraine, 
Russia over 50 percent. And we buy over 50 percent from Ukraine 
itself. We assist about 125 million people on any given day, 
week, or month. So it is already having a $71 million increase 
of operational cost per month on our operations, which means we 
will feed 4 million people less as we--right now----
    Senator Van Hollen. Yes. No, I appreciate you going into 
that. So what I wanted to paint a clear picture of what the 
consequences here. I think the world, at least outside of 
Russia, knows that Putin is killing people indiscriminately in 
Ukraine. But countries around the world need to recognize that 
what he is doing in Ukraine and the blocking the ports are 
going to result in starvation and food insecurity for tens of 
millions of people around the world. Do you know of any ongoing 
efforts to address this issue? And I don't mean those of us who 
are calling for something to happen. I mean any material 
progress in this.
    Mr. Beasley. Senator. I know, as you know, I have made 
requests straight to President Putin that the world's famines 
are in your hands right now and you need to open up these 
ports. I do believe there are efforts being made as we sit to 
try to create an opportunity to open up the ports.
    And it cannot--it can't just be an open of the ports for 
humanitarian purposes, because the commercial side is just as 
equally on a humanitarian basis. And we cannot use--food can't 
be weaponized. It just cannot. And right now, if those ports 
stay closed, food would be weaponized.
    Senator Van Hollen. Let me in my remaining time here, first 
associate myself with the comments of Senator Murphy with 
respect to Afghanistan and the situation there. I think, as he 
indicated, we can find a way to help people without in any way 
strengthening or reinforcing the Taliban government. Thank you 
for the efforts you made in Yemen. That remains a really 
terrible situation, but your efforts improved it.
    And in my final seconds here, maybe if I could just get a 
sense of the $5 billion. Maybe, Ms. McKenna, you could tell me, 
what will that mean for your efforts around the world, if we 
are able to get the $5 billion for food assistance?
    Mr. Beasley. The $5 billion, a chunk of it obviously will 
go to emergency food relief, and we expect that through our 
colleagues at the World Food Program. But what is really 
important is that we have a chunk of it that really goes 
towards long term resilience and building long term systems so 
that these economies can support themselves and that they can 
further withstand the shocks that are to come with climate 
change, drought, and conflicts.
    That is things like supporting farmers long term, like 
using cash and vouchers and things to support local markets, 
incorporating youth into activities, and really working with 
conflict actors. May I add one other point kind of based on 
your prior question? Russia is using hunger as a weapon of war, 
and Congress is on record kind of condemning the use of hunger 
as a weapon of war through the recently introduced House 
Resolution 922. And we hope that the Senate will take up a 
companion version of that as well.
    Senator Van Hollen. Thank you. We will look into that.
    Mr. Adesina. Can I comment--Senator Hollen?
    Senator Van Hollen. Oh, yes, I was going to ahead, but let 
me----
    Ms. McKenna: Yes, Akin--
    Mr. Adesina. Yes. Right here. On the video, yes. Well, just 
on that point, distinguished Senator, on the, what will this 
mean? In the case of Africa, I think we need to refocus on what 
the problems are. You know, for Africa right now, it is not 
just giving food away, it is actually producing food because we 
are dealing with a very massive food price inflation at the 
market level to bring that down. It has to be something that is 
structural, that is scalable, and that is sustainable.
    And that is why we have the African Emergency Food 
Production plan to actually produce that food. And that is 
going to, with the $5 billion, you know, we have put in $1.3 
billion of our own money on the line. We have put in our money 
where our mouths are, you know, and we need $200 million to be 
able to come up to $1.5 billion that we want to be able to help 
Africa to avoid a looming food crisis.
    What this will do, the $1.5 billion, if we are able to get 
$200 million from the U.S. Government to complement $1.3 
billion that we are putting down ourselves, it will allow us to 
get climate resilient agriculture technologies to 20 million 
farmers in Africa. It will allow them to produce 38 million 
metric tons of food. And a big part of that will be 11 million 
metric tons of that will be wheat. I just mentioned my 
experience in Sudan and also in Ethiopia.
    We will have 18 million metric tons of corn and we are 
looking at 6 million metric tons of soybean--rice and 2.5 
million metric tons of soybeans. So it will make a lot of 
impact, but we need to also use this crisis to deal with the 
structural issues to unlock agriculture potentially in Africa.
    And from the African Development Bank, we have a program 
that we are also going to see as a relay basically from this 
emergency production program, that we are calling 1 for 200 
mission, 1 for 200, which is to allow support of African 
countries to produce an additional 100 million metric tons of 
food that will feed 200 million people.
    If we are able to feed 200 million people, that means that 
we can actually cut hunger in Africa by 80 percent. I have been 
in agriculture all my life. I have never been this confident 
that we can actually reach zero hunger, but it will have to be 
done via a structural approach, not just only giving food away.
    Senator Van Hollen. Thank you. Thank you for emphasizing 
that. Thank you, Mr. Chairman.
    Senator Coons. And thank you, Senator Van Hollen. Senator 
Boozman, for the last questioner of this round. We do still 
have three great witnesses for a second panel and about half an 
hour left.
    Senator Boozman. Thank you. And I will be brief, because I 
know we need to move on. We appreciate all of you being here 
and we appreciate the great work that you do. Governor Beasley, 
congratulations on your Nobel Prize, you and your agency.
    That is remarkable. And we are very, very proud of you. 
U.S. is a very generous country, and it has really stepped up 
in the past. It is stepping up now. Tell us about that. Tell us 
about what that means. And then also, how does that help you 
when you are dealing with other countries to pony up the way 
that they should?
    Mr. Beasley. When I arrived, the United States was 
appropriating about $1.8 to $1.9 billion. And if you--we had 
many of us in this room had a conversation out of concern that 
this new Republican Administration would, Trump would zero out 
the budget and we would have significant funding problems. And 
all of us came together.
    It was quite remarkable to see everybody come together--and 
actually on both ends of Pennsylvania Avenue on this particular 
issue. And so our funding went from $1.8 billion to $3.84 
billion. And like I was saying earlier, my goal was put the 
World Food Program out of business and funding would go down, 
but because of crisis after crisis, war after war, climate 
shock, and now Ukraine, Afghanistan, Ethiopia, the needs are 
going up substantially. So the United States has led the way 
and I have been able to use that.
    When I go to Germany, the colleagues in the Bundestag or in 
the UK Parliament or the Nordic countries, the EU, and say, 
look, the United States is stepping up because usually the 
first line of impact is in Europe. And now, Central America's 
first line of impact is the United States.
    But because of what the United States has done and Germany 
and a few other major donors, we, particularly during COVID, 
because not many people realize the economic ripple effect that 
COVID had on the poorest--on the poor countries around the 
world. Had it not been for the United States, the taxpayers of 
this country, we would have had mass famine, we would have had 
destabilization of many nations, and we would have had mass 
migration.
    We were able to avert that in the last couple of years 
because of the generosity of the American taxpayer, along with 
Germany and other donors. So here we are again, unfortunately, 
because of COVID recycled--and now in Ukraine, we have got a 
crisis within a crisis, that perfect storm.
    And so this appropriation right now, as I am sure--I get 
some of my friends of South Carolina, why should I send money 
down there, you know, and I am like, well, if you don't it is 
going to cost you a thousand times more.
    I don't say that hypothetically, theoretically. I have 
experiential data that proves very clearly when we have 
strategic international aid and food security, it saves 
taxpayers anywhere from $100 to $1,000 more, a thousand times 
more. So thank you, sir.
    Senator Boozman. So, no, and again, we have got all of this 
going on the--I am very active in agriculture right now. The 
increase in fertilizer costs, the input costs are just through 
the roof. Part of that being, you know, fertilizer from Belarus 
and Russia and, you know, areas. And other countries seeing 
this are actually holding their fertilizer. So you have got the 
input cost problem.
    You have got the high cost of diesel. So as you mentioned 
earlier, we are going to have, you know, tremendous commodity 
increases, so these countries aren't going to be able to buy as 
much. And then the other problem is, you know, Senator Van 
Hollen mentioned the importance of opening the ports and all 
that.
    You know, even if that is done, high commodity prices, 
high--because of the high inputs. And then--what I would like 
for you to talk about is the potential. Even if we do, ports, 
do all we can, are we looking at shortages? How do we plan--
what do you need for us to do? And it is not--you know, with 
shortages it is not money.
    You know, what do we do to coordinate, to make it such that 
we are proactive and see this coming and people like you help 
us plan as we go into the future?
    Mr. Beasley. Senator, before Ukraine, I was already 
declaring to the world we were facing the worst humanitarian 
crisis for the year 2022 that we have ever seen since World War 
II. And just when you think it couldn't get any worse, then 
Ukraine, the breadbasket of the world, a nation that feeds 400 
million people.
    And so you are seeing fuel costs, shipping costs just 
escalate beyond the roof. Food price, you know, commodity was 
already doubling and tripling in many, many of the poorest of 
the poor countries. And so it was already a problem. Then 
Ukraine comes into the scene. So what is critical is to get 
those ports operational for a variety of reasons. It will not 
eliminate the problems.
    It will at least diminish some of the excesses of the 
problems we are going to face, because right now, when you look 
at the droughts taking place around the world, even in the 
United States, and then you get the Horn of Africa and other 
places in Central Asia, for example, you are talking about a 
dynamic impact on food production. Compound that with the 
fertilizer problem.
    Countries are not able to get the fertilizers, or the cost 
is so high they can't afford it, so smallholder farmers can't 
afford it. Now, we are already hearing farmers say they can't 
afford the fertilizers. They will be cutting back on 
production. And this is not the time we need that. So when--I 
have talked with the, about four weeks ago, the minister--
foreign affairs minister for France who called me and when I 
went through this scenario, what we were looking at, he 
literally was just shocked.
    And we brought, got together the G-7 agriculture ministers, 
Tom Vilsack and all of us had a very practical conversation. 
And I said, let me tell you what we are facing. The question to 
me, to you is how quickly can you react in the major producing 
countries to offset not just Ukraine, but the crises that we 
are facing around the world, from the lands that have been set 
aside to fertilizers.
    And which has been interesting because like the Green Party 
in Europe and in Germany have been very open and pragmatic at 
this stage, which is, it is good to see everybody coming 
together to understand that we truly have a global crisis 
coming before us.
    And so the next 8 to 12 months, we will have a food pricing 
problem. And I think in the spring--well, I will say the spring 
and the fall of next year, we could have a food availability 
problem.
    Senator Boozman. Very good. Thank you. Thank you, to all of 
the witness. Appreciate it.
    Mr. Adesina. Senator Boozman, can I make a point on the 
fertilizer question?
    Senator Boozman. Yes.
    Mr. Adesina. Thank you. Just on that fertilizer question, 
as I said in my remarks at the start that Africa faces 2 
million metric tons of shortage. And if we don't actually very 
quickly to close that, it means that even productivity on 
existing arable land will decline by anything between 20 
percent to 50 percent. Just to let you know, concrete actions 
are actually being taken on that.
    I called for a meeting of all the global CEOs of fertilizer 
companies that meeting is actually tomorrow, you know, to 
really look into how is it that we make sure that Africa is not 
shortchanged this time around, and we know what happened with 
regard to the COVID-19 issue with vaccines. We want to make 
sure that Africa's priorities are not at the end, that all the 
rich countries of the world take all the fertilizer, and then, 
of course, then we have a problem.
    So ammonia phosphate are the main issues so we are trying 
to see how we can actually deal with some of this issue. Now, 
the point on the price, I think of fertilizer. I am right here 
in Ghana. I am not based in Ghana, but just came here to see 
the President as we are preparing for the annual meetings of 
the African Development Bank that is holding here in Accra. But 
I was surprised at the price of fertilizers here, you know.
    You know the price of fertilizer has gone up about GH cents 
65 Ghanian cedis of about 25 Kg bag, you know, to roughly on 
the open market, part of the market almost GH cents 220. You 
can imagine what this will do. So it is a big issue. If we 
don't solve the fertilizer problem, we cannot solve the food 
problem. And one of the things I want to suggest to the 
distinguished Members of the Senate Committee is that the issue 
of trade finance is going to play a very, very important role.
    And secondly, guaranteed facilities are going to be very 
important to make sure that financial institutions can actually 
lend to the fertilizer importers and wholesalers and the 
retailers to actually get it out to the end. And in particular 
also, maybe I will link it back to the original point, at least 
by one of the Senators on efficiency of the use of the $5 
billion, you have got to make sure also that we deal with 
delivery risks, because if we look at the price of fertilizers 
as high as it is, that is not that we are going to have to 
subsidize.
    But if we have to subsidize, we have to then make sure that 
the subsidies are done in a way that are market friendly, in a 
way that is well-targeted, in a way that actually uses digital 
technologies to redefine the standard. And in fact, I actually 
don't so much even like the word subsidy. I like to call it the 
growth enhancement support.
    Which is we give people what they need to boost their 
production and very quickly transition that to a more market 
based system. So these, I think, are very important if we are 
going to actually have to deal with this. But this fertilizer 
question is very important, and we actually have a global 
meeting on that tomorrow.
    Senator Boozman. Right. Thank you very much. Thank you, Mr. 
Chairman.
    Senator Coons. Thank you, Senator Boozman. Thank you, Dr. 
Adesina. I remember well our visit in Abidjan, and I appreciate 
your insightful testimony today. Ms. McKenna, thank you, and 
thank you for everything Mercy Corps does around the world. And 
I thank David Beasley in the World Food Program. We are now 
going to quickly transition to the second panel. We are 
awaiting notification of when the next vote will be. A number 
of the Members of the Committee are holding, waiting for that 
next vote, but I think we should proceed with this second 
panel.
    I want to thank the witnesses for a second panel today that 
will focus on the COVID-19 pandemic, and in particular, its 
global impacts and what investments the United States should be 
making to address the current status and future risks 
associated with this and other potential pandemics.
    We have three of remarkable witnesses, physicians with 
extensive experience in responding to infectious disease 
outbreaks, Dr. Tom Frieden, former Director of the U.S. Centers 
for Disease Control and Prevention, and currently serves as 
President of Resolve to Save Lives. Dr. Atul Gawande is the 
Assistant Administrator for Global Health at the U.S. Agency 
for International Development and testifying or speaking with 
us remotely today is Dr. Michael Ryan, Executive Director of 
the World Health Organization's Health Emergencies Program, who 
will be joining us remotely from Geneva.
    This second panel is a briefing of the subcommittee for 
some technical reasons relating to the World Health 
Organization, but it is important that I recognize that. Dr. 
Frieden, if you would please start us off, and if there is a 
vote that interrupts us, I will inform you. But thank you for 
your testimony.
    If you can keep it concise, that will allow us to have more 
of a discussion. But I appreciate your testimony and your 
patience with the first panel and the enthusiasm of our 
members.
STATEMENT OF TOM FRIEDEN, PRESIDENT AND CEO, RESOLVE TO 
            SAVE LIVES
    Dr. Frieden. Thank you very much, Chairman Coons, and 
Ranking Member, and distinguished Members of the Committee for 
the opportunity to testify today. Here is the bottom line. The 
U.S. and the world were underprepared for COVID, haven't 
responded well, and we are well on our way to making the deadly 
mistake of repeating the cycle of panic and neglect. This would 
leave us avoidably vulnerable not only to future COVID 
variants, but also to future health threats.
    I urge Congress to approve the proposed COVID supplemental 
request at least the $5 billion for global COVID control, with 
funding to both USAID and CDC. Most of the one million deaths 
that the U.S. has suffered and most of the nearly 20 million 
deaths that the world have suffered did not have to happen. 
Pandemics do not stop because of wars. In fact, wars tend to 
accelerate pandemics.
    That is certainly what happened 100 years ago. With safe 
and effective vaccines, as well as stunningly effective 
treatment, we can have the upper hand on COVID in this country. 
However, this is only true as long as a worse variant doesn't 
emerge. We have to face three dichotomies, and in each of these 
there is a pull toward one side that would imbalance our 
response.
    The first dichotomy is the temptation to spend money on 
stuff, vaccines, equipment, medications, while neglecting the 
need for staff. To increase vaccination uptake, you need health 
care workers, you need to focus on vaccinating health care 
workers, as well as the elderly and immunosuppressed people who 
are not only most likely to die, but perhaps most likely to 
have the emergence of variants if they are infected. We have to 
support staff on the ground who can do this.
    And I will say that in Sierra Leone, my organization, 
Resolved to Save Lives, worked with one of the organizations 
implementing the tremendous success story of PEPFAR, a 
bipartisan program. We approached more than 7,000 health care 
workers because health care workers getting vaccinated is a 
critical first step to change the narrative on vaccinations in 
many countries. 2 percent, 2 percent declined vaccination. 90 
percent were double vaccinated. 8 percent got a single dose.
    The second dichotomy is the need to focus on both response 
and prevention. It is tempting to focus on putting the fire 
out, but we have to make our world more resistant to future 
outbreaks. This is why it is essential to have at least the $5 
billion previously requested for the global health 
appropriations supplemental.
    I also strongly support the fiscal year 2023 budget 
proposal of $88.2 billion over 5 years to allow sustained, 
targeted interventions, and investments in public health and 
preparedness domestically and around the world, including to 
support both CDC and USAID for global protection.
    The third dichotomy is protecting the U.S. versus 
recognizing that it is in our self-interest to support programs 
to fight COVID and other threats around the world. The plain 
truth is that it saves more lives and costs less money to fight 
outbreaks at their source than fighting them on our shores. 
When it comes to access to vaccines and treatment, the right 
thing to do ethically is also the right thing to do 
epidemiologically.
    But that is going to require more money from the U.S. and 
from other countries. The CDC plays a critical role around the 
world in vaccine planning and implementation, vaccine safety 
monitoring, supporting ministries of health. CDC has over 1,000 
doctors and other public health specialists who know how to 
plan vaccine campaigns, support countries, assess and improve 
vaccine administration.
    Both USAID and CDC have indicated that they will no longer 
be able to continue this work unless Congress approves 
additional funding. This funding was cut, unfortunately, from 
the recent bipartisan supplemental deal framework. I urge you 
to find a way through to provide support for global COVID 
control.
    Representative Tom Cole of Oklahoma said at the start of 
this epidemic, it is just a no brainer to spend millions--to 
spend billions on preparedness to save trillions of dollars in 
costs. He also predicted years before COVID hit that Americans 
are much more likely to be killed by a pandemic than by a 
terrorist. He was right then, and he is right today. COVID has 
claimed more than a million American lives.
    That is more than any in all wars over the past 150 years. 
And yet we spend only about 300 times to 500 times less on our 
health defense than we do on our military defense. We have to 
address COVID now, be ready for the next variant, and protect 
against future threats. Fiscal responsibility certainly 
includes cutting direct costs when appropriate, but fiscal 
responsibility also requires making sound investments to save 
money and save lives.
    We can't afford not to spend the $5 billion and ideally 
more to protect the world and protect ourselves through 
increasing global vaccination. We have to be better prepared 
for the next threat, and that is why the fiscal year 2023 
proposal is so very important. This really is the make or break 
year.
    This is the world's teachable moment to prevent the next 
pandemic. You and Congress have the power to provide the 
essential investments to make this possible. Thank you.
    [The statement follows:]
 Prepared Statement of Dr. Tom Frieden, President and Chief Executive 
                     Officer, Resolve to Save Lives
    Good morning. I thank Chairman Coons, Ranking Member Graham, and 
distinguished members of the Committee for the opportunity to testify 
today. I'm Dr. Tom Frieden. I was CDC Director from 2009 to 2017 and 
New York City Health Commissioner from 2002 until my appointment to 
lead the CDC. I received my MD and MPH degrees from Columbia 
University, with advanced training in internal medicine, infectious 
disease, public health, and epidemiology. I am currently President and 
CEO of Resolve to Save Lives, a global public health organization that 
partners with countries to prevent 100 million deaths from heart 
disease and stroke and to make the world safer from epidemics, and am 
Senior Fellow for Global Health at the Council on Foreign Relations.
    I will give you the bottom-line up front: The U.S. and the world 
were underprepared for COVID, haven't responded well, and we are well 
on our way to the deadly mistake of repeating the cycle of panic and 
neglect, leaving us unnecessarily vulnerable to future COVID variants 
and to future health threats. The result: Most of the 1 million U.S. 
deaths and most of the approximately 20 million global deaths from 
COVID could have been avoided. No war in American history has cost the 
lives of one million of our people, as COVID has, and yet we spend more 
than 300 times as much on our military defense as we do on our health 
defense. Unless we spend more now, COVID and future health threats will 
cost us more later--in both lives and money.
    With very safe and highly effective vaccines developed in large 
part through the efforts of the prior administration and provided in 
large part through the vaccination campaigns of this administration, as 
well as stunningly effective treatments such as Paxlovid, we can have 
the upper hand over COVID in this country--as long as a worse variant 
doesn't emerge. COVID isn't over--it will almost certainly be with us, 
with ongoing spread and flare-ups in different times and places, for 
years. In much of the world, lacking widespread vaccination coverage 
and access to effective treatment, COVID continues to be a deadly 
threat. And COVID will not be the last health threat our world will 
face. Because a pathogen can travel from one part of the globe to 
anywhere else within 24 to 36 hours, uncontrolled disease spread 
anywhere is a threat to people everywhere.
    More than half of deaths in the U.S. and globally were 
preventable--first by better and faster public health action, then by 
immunization. But even though we've begun to strengthen the global 
capacity to find, stop, and prevent disease outbreaks, the world 
remains unprepared for and unprotected from epidemics. The United 
States must continue to address COVID now, be ready for new variants, 
and prepare for future health treats. To do this requires addressing 
three dichotomies and avoiding a gravitational pull that risks having 
an unhealthy balance in how we address each of the three.
    First, the temptation to spend money on stuff while neglecting the 
need for staff. This is crucial to help vaccinate the world, which we 
must do to reduce the risk of emergence of more dangerous variants. 
Today 2.7 billion people have yet to receive their first shot of COVID 
vaccine,\1\ with 91 percent of the unvaccinated living in low- and 
middle-income countries.
    Donating vaccines is essential but insufficient. It's not enough to 
airdrop vials of vaccine into countries without supporting the overall 
vaccination programs needed to get vaccines into arms. Many vaccines 
were delivered too close to their expiration date and some countries 
received large shipments of vaccines only to discover that they lacked 
the appropriate syringes to administer them.
    It will be particularly important to increase vaccination uptake 
among healthcare workers in order to maintain essential health 
services, as among the elderly and those who are immunocompromised, who 
are not only at the highest risk of hospitalization and death from 
COVID but are also the most likely to be incubate new variants. To do 
this, we must support national staff on the ground who manage supply 
chains, organize vaccinations, and get shots in arms.
    Early international cooperation can contain a disease outbreak 
before it becomes widespread, as happened with SARS back in 2003. 
Ongoing cooperation can reduce illness and death worldwide, as 
countries around the world are doing, with crucial support from the 
United States, in the continuing fight against AIDS, TB, and malaria. 
PEPFAR, a bipartisan success story that has saved millions of lives, 
has strengthened health systems in more than 50 countries. In Sierra 
Leone, my organization, Resolve to Save Lives, worked with a PEPFAR 
implementer to reach more than 7,000 healthcare workers and offer 
vaccination. Only 2%--2%!--declined vaccination, with 90 percent 
getting both doses and 8 percent a single dose. The U.S. has strong 
programs to build the capacity of staff in countries around the world, 
and doing so is crucial for our collective health protection.
    The second dichotomy: The need to focus on both response and 
preparedness. Our impulse to fund immediate COVID response risks 
overlooking our need to also invest in protection from future 
pandemics. Responding to the blaze is not enough; we need to make our 
world more resistant to future pandemics. This will not be our last 
pandemic threat.
    We must prepare for the next health threat while we provide the 
resources to fight this one. We need at LEAST the $5 billion previously 
requested for global health appropriation supplemental. Protecting the 
U.S. against pandemics here without finding and fighting them abroad is 
like having a military that only works in the US. That is why I also 
strongly support the expanded proposal for $88.2 billion over 5 years 
that will enable sustained, targeted investments in public health and 
pandemic preparedness both domestically and around the globe, including 
the support for CDC and the $6.5 billion which would address the need 
for better global protection.
    Although the price tag sounds high, the annualized cost for the 
Administration's preparedness plan is $18 billion--less than one 
fortieth the U.S military budget.
    We need transformative investments to protect our health security 
as well as our economy. If major pandemics similar to COVID, which has 
cost more than $15 trillion, occur every 30 years, the annualized 
economic impact on the U.S. would be more than $500 billion per year. 
In this estimation, the proposed $88.2 billion over 5 years would 
generate a return on investment of approximately 30-to-1.
    These investments also need to address equitable access to vaccines 
and other products to confront outbreaks at they emerge. Vaccine 
nationalism is both ethically unjustifiable and, unfortunately, 
politically inevitable. Solutions need to address ensuring quality, 
quantity, timeliness, sustainability, and equity of distribution of 
vaccines, medications, diagnostics, protective equipment, and other 
essential supplies around the world.
    The third dichotomy: Focusing on the United States vs. recognizing 
that it is in our self-interest to support programs to fight COVID and 
other epidemics around the world. The plain truth is that we live in an 
interconnected world. A disease outbreak anywhere is a threat 
everywhere. It saves more lives--and costs less money--to fight 
outbreaks at their source than on our shores. Improving detection and 
protection in low- and middle-income countries could save millions of 
lives and trillions of dollars. We can't protect Americans effectively 
without supporting global progress.
    Neglecting preparedness is tantamount to playing with matches and 
gasoline. Letting COVID burn unchecked through other countries makes 
Americans less safe, similar to a fire burning in building in which 
only some rooms have sprinkler systems. We can either fund global 
vaccination and control efforts now, or increase the risk of paying far 
more later when new, more dangerous variants reach our shores. Failing 
to make vaccination programs, testing, and life-saving treatments 
available wherever people are at risk of dying is not just a moral 
failing, it is epidemiologically dangerous, and will worsen the impact 
of the pandemic. When it comes to access to vaccines and treatment, the 
right thing to do ethically is also the right thing to do 
epidemiologically--but it will require more funds from the U.S. and 
other countries.
    I'm especially pleased that the Administration's initiative for 
Global Vaccine Access (the Global VAX initiative) has worked to build 
on the successes and lessons learned from the President's Emergency 
Plan for AIDS Relief, better known as PEPFAR, rather than duplicate 
them. As you know, this is an all-of-government effort led by both 
USAID and CDC. I'll let my friend and colleague Dr. Gawande tell you 
more about USAID's activities in this area.
    CDC plays a critical role not only in this effort to help vaccinate 
the world but also in strengthening health system readiness, vaccine 
planning and implementation, vaccine safety monitoring, implementing 
evidence-based interventions to reduce vaccine hesitancy, and 
supporting ministries of health with which CDC has many close 
relationships. CDC must maintain and expand CDC country offices around 
the world to strengthen the capacity of those countries to detect novel 
diseases and outbreaks, as well as ensure strong ties with 
international organizations so they can get the financial, technical, 
and logistical support they need. CDC has more than 1,000 doctors and 
other health professionals who are experts in planning, implementing, 
assessing, and improving vaccination programs, including hundreds who 
work in CDC's Global Immunization Division. Both USAID and CDC have 
indicated that they will no longer be able to continue this work unless 
Congress approves additional funding--at a bare minimum the $5 billion 
in the Administration's original request to Congress for global 
vaccination. This funding was cut from the recent bipartisan COVID 
supplemental deal framework; I urge you in the strongest possible terms 
to ensure that the full $5 billion is restored to any future 
supplemental appropriations bill.
    Someone I consider a friend, Representative Tom Cole of Oklahoma, 
the Vice Ranking Republican of the House Appropriations Committee, said 
at the start of this pandemic: ``I think it's just a no-brainer to 
spend billions [on preparedness] to save trillions.'' He also 
predicted--years before the COVID pandemic hit--that Americans are much 
more likely to be killed by a pandemic than by a terrorist. He was 
right then and he is right today. COVID has claimed more than a million 
American lives, more than all deaths in war over the past 150 years in 
this country.
    We need to address COVID now, be ready for next variant, and 
protect against future threats. Fighting the fire of COVID today 
requires that we that we help vaccinate the world and invest in global 
health security--because you can be certain that there will be more 
fires. Funding for pandemic preparedness to ensure our nation's health 
defense is just as critical as the 300 to 500 times more that we spend 
on our military defense.
    Fiscal responsibility certainly includes cutting direct costs where 
appropriate. But fiscal responsibility also requires making sound 
investments to save money and lives. We can't afford NOT to spend at 
least $5 billion--and ideally more--to help facilitate global 
vaccination. We must be better prepared for the next pandemic by 
passing the proposed pandemic preparedness plan into law. This is THE 
make-or-break year to prevent the next pandemic. You in Congress have 
the power to make the essential investments to make this possible.
    Thank you.

    Senator Coons. Thank you, Dr. Frieden. Dr. Gawande.
STATEMENT OF ATUL GAWANDE, ASSISTANT ADMINISTRATOR FOR 
            GLOBAL HEALTH, USAID
    Dr. Gawande. Thank you, Chairman Coons. Here we go. 
Chairman Coons, Ranking Member Graham, and Members of the 
Subcommittee, thank you for the invitation to speak today. I 
lead Global Health at USAID and I get to co-chair our COVID-19 
task force. My written testimony I put into the record, so I am 
just going to try to hit a few of the high points for you. The 
direct and indirect impacts of this pandemic have been 
horrendous.
    The result is the first reduction in global life expectancy 
in a century. It is development in reverse. If it weren't for 
the bipartisan support that you and Congress and American 
taxpayers have provided, these numbers would be far worse. The 
Government, the U.S. Government is providing more than $19 
billion in assistance towards the fight against COVID-19. Of 
this, USAID has deployed almost $10 billion.
    And through the President's global COVID-19 summit last 
year and the second one, which will take place tomorrow, we 
have also rallied the world to join this fight. And in the 
course of this, we have accomplished a lot. We have donated 
more than half a billion COVID-19 doses to 115 countries in 
just 9 months.
    That is a historic accomplishment. We launched the Global 
Vax effort to ensure that we are able to get shots into arms 
with $1.7 billion in committed funding. And USAID is also 
leading the non-vaccine work where we become the global leader 
in providing oxygen systems as well as testing and treatment 
supplies. But here we are. We are now at a precipice.
    As of the first of May, we have approved and, or notified 
99.9 percent of the total COVID-19 supplemental funds that we 
have received. And we have obligated 95 percent of those funds. 
When it comes to the American Rescue Plan Act funds, we have 
obligated 90 percent of that. We expect to obligate virtually 
all remaining supplemental funds by July. Our work at that 
point will begin grinding to a halt. And it is clear that the 
fight against COVID is not done. I just want to say, the worst 
may not be behind us. I want us to understand that.
    The potential outcome scenarios that we face are extremely 
wide. I am a cancer surgeon, and I tell my patients that we 
will hope for the best, but hope is not a plan. Of more than 10 
million vaccine doses administered worldwide, only 1 percent 
has been administered in low income countries. We have barely 
more than 16 percent of people across Africa fully vaccinated.
    Lower income countries face even bigger gaps in access to 
the arsenal that we now have been able to count on, that is 
they barely have access to rapid diagnostic tests, to oxygen 
capacity, and now the new generation of oral antiviral pills 
that have proven to be so effective. And that is why the 
Administration requested $5 billion to support the immediate 
needs of the global COVID-19 response.
    That includes $2.55 billion to enable an expansion of 
Global Vax to get more shots into arms in under-vaccinated 
countries. I pointed out--I will point out, it requested no 
money, not a dime for new vaccines, because we are in a 
situation of vaccine abundance. We had $1.7 billion in request, 
however, to enable us to shrink the gaps in global access to 
testing, oxygen capacity, and antiviral treatments.
    And then finally, we have requested $750 million to enable 
humanitarian assistance. As you heard from the prior panel, 
COVID-19 has complicated humanitarian assistance in a number of 
domains, made disasters worse, in particular, increasing food 
insecurity. We are now facing the cost, potentially, of 
inaction.
    If the--if no further funds are appropriated, we will have 
to end our leadership in increasing vaccinations. We will have 
to give up on fighting dangerous variants, even though each 
surge of variants has disrupted our supply chains, disrupted 
the trade we rely on, and driven inflationary pressures that 
are hurting every American.
    These recurrent cycles of damage. Have endangered and 
continue to endanger the health and lives of all Americans, as 
well as people around the world. So I want to emphasize here, 
stopping global COVID-19 funding would be a geopolitical 
mistake. It would be an ethical mistake. It would be a health 
security mistake, and it would be an economic mistake of 
historic proportions.
    Throughout the pandemic, you in Congress have done what has 
had to be done in passed supplemental funding that has saved 
the lives of millions abroad and protected hundreds of millions 
here at home. And once again, we are asking you to please come 
together to continue America's leadership to end the acute 
phase of this pandemic.
    I am grateful for this opportunity to be here today. I 
welcome many questions.
    [The statement follows:]
  Prepared Statement of Dr. Atul Gawande, Assistant Administrator for 
        Global Health, U.S. Agency for International Development
    Chairman Coons, Ranking Member Graham, and Members of the 
Subcommittee, thank you for the invitation to speak with you today 
about United States leadership in controlling the COVID-19 pandemic, 
the key role played by the U.S. Agency for International Development 
(USAID), and the funding necessary to continue this fight to control 
the pandemic.
    My name is Atul Gawande, and I serve as the Assistant Administrator 
for USAID's Bureau for Global Health and as Co-Chair of the USAID 
COVID-19 Task Force.
    I am grateful to the Subcommittee for calling today's hearing and 
for continuing to prioritize the global response to COVID-19. Since the 
start of this pandemic, we have lost almost one million American lives, 
with the death toll globally now exceeding six million. The effects on 
worldwide health, development, and the global economy are like nothing 
we have seen in our lifetimes.
    Data recently published in The Lancet estimates that total deaths 
during this pandemic increased by approximately 18 million 
worldwide\1\--most not directly from COVID-19 but from the indirect 
effects of its disruptions of healthcare and economies. The result is 
the first reduction in global life expectancy in more than a century. 
It is development in reverse. It has pushed back the impact of our 
decades of bipartisan U.S. global health investments.
    Thanks to bipartisan support from Congress and American taxpayers, 
the U.S. government has mounted a historic response to this global 
crisis. Since the beginning of this pandemic, the U.S. Government is 
providing more than $19 billion, of which USAID has provided $9.9 
billion in supplemental funding towards the fight against COVID-19. The 
U.S. government led the world by donating, in partnership with COVAX 
and bilaterally, more than half a billion COVID-19 doses to 115 
countries in just 9 months, as part of President Biden's commitment to 
donate and deliver more than a billion COVID-19 vaccines.
    In December, the U.S. government announced the Initiative for 
Global Vaccine Access--or Global VAX--a whole-of-government effort, led 
by USAID in partnership with the CDC and other interagency partners, to 
turn vaccines in vials into vaccinations in arms around the world 
through more than $1.7 billion in funding committed to date. Global VAX 
encompasses all of the U.S. government's work with more than 100 
countries to accelerate COVID-19 vaccine uptake, and involves a surge 
of technical and financial resources to 11 countries in sub-Saharan 
Africa where we see the greatest opportunity to increase coverage 
rapidly. USAID is also making progress to save lives now through 
programs that provide oxygen, testing, and treatments in order to slow 
transmission and decrease COVID-19 morbidity and mortality.
    But we are now at a precipice. As of May 1, USAID has approved, and 
when required notified Congress, of 99.9 percent of the total COVID-19 
supplemental funds received since the beginning of the pandemic, and we 
have obligated 95 percent of these funds. We expect to obligate 
virtually all remaining supplemental funds by July of this year. Under 
the American Rescue Plan Act--or ARPA--we have so far obligated 90 
percent of the funds.
    As much as it may feel like we are returning to normal in the 
United States, the fight against COVID-19 is not over. This is 
especially acute for those in low and lower-middle income countries 
(LIC/LMICs), but as long as COVID-19 continues to persist anywhere, 
inevitably more variants of concern will emerge, putting us all at risk 
everywhere. Of the more than 10 billion vaccine doses administered 
worldwide, only 1 percent has been administered in low income 
countries. The result is that although almost 60 percent of the world 
is fully vaccinated--including 50 percent of people in low-middle 
income countries--barely more than 16 percent of people across Africa 
are. At the same time, low income countries have begun to delay vaccine 
deliveries, not because they are not desperately needed, but because 
the flow of supply is now outstripping their capacity to get shots in 
arms fast enough. This is why Global VAX's efforts are so vitally 
important, and broader U.S. efforts such as the Global Action Plan and 
the COVID-19 Summit to lead efforts to galvanize commitments and 
coordinate these efforts, alongside our partners in governments, 
international and multilateral organizations, and beyond. Lower income 
countries simultaneously face even bigger gaps in access to rapid 
diagnostic tests, oxygen, and the new generation of oral antiviral 
pills that we in the United States have been able to count on to help 
us so markedly reduce the morbidity and mortality of COVID-19. These 
gaps create a situation poised to produce further COVID-19 variants 
that pose risks to not only to other countries, but also to U.S. lives, 
our economy, and our national security.
    In March, the Administration requested $22.5 billion in additional 
COVID-19 response funding, including $5 billion to support the 
immediate needs of the global COVID-19 response. This global funding 
would enable a significant expansion of our Global VAX surge efforts to 
another 20 to 25 countries and other global COVID-19 vaccination 
priorities, including the rollout of boosters and pediatric doses. With 
more than 30 countries qualifying as severely undervaccinated, it 
remains critical to expand the initiative beyond the 11 surge countries 
we currently support. This request will also enable us to shrink the 
severe gaps in global access to testing, oxygen capacity, and antiviral 
treatments--enabling lifesaving services for more than 100 million 
people--as well as enhanced monitoring of potential or emerging 
variants.
    Failure to continue our supplemental global funding would abdicate 
U.S. leadership even as the People's Republic of China continues its 
transactional approach to pandemic response and global health; it would 
weaken health systems that are crucial to fighting this and future 
pandemics; and it would amount to a surrender to the inevitability of 
dangerous new variants. Failing to provide supplemental global funding 
would also jeopardize our long-term baseline pandemic preparedness, 
global health, and health security investments. In sum: it would be a 
geopolitical, ethical, health security, and economic mistake of 
historic proportions.
    The President has repeatedly outlined the stark realities of not 
passing a COVID-19 supplemental. Variants of concern continue to 
emerge. Each surge has disrupted the supply chains and the trade we 
rely on and driven inflationary pressures. U.S. leadership is critical 
to keeping political momentum and commitment to clear action. Barring 
additional funding, however, essential work cannot launch and many of 
our existing programs will begin to grind to a halt in the coming 
months.
    By not helping lower income countries get shots into arms, and not 
fostering adequate testing, treatment and oxygen delivery capabilities, 
their populations will be left unprotected and we'll continue to see 
more preventable deaths and societal disruptions. New, potentially more 
dangerous variants may also be more likely to emerge from a long-term 
infection in immuno-compromised individuals who lack access to 
vaccination or treatment. That outcome would be disastrous both 
globally and here at home, with the potential to claim more lives and 
deliver a serious blow to the economic recovery that all countries and 
economies seek. We will need additional resources in order to improve 
our ability to track variants. We were lucky that Omicron was not more 
lethal. The next time, the variant, or the new pathogen, may be more 
lethal and may spread even faster; we need to be able to identify the 
new organism rapidly and respond quickly.
    U.S. leadership has led to significant achievements since the 
beginning of this pandemic. But now is not the time to be complacent or 
we risk the normalcy and security we are just beginning to experience.
         details on usaid's global health response to covid-19
    USAID is supporting more than 120 countries to contain, combat, and 
recover from this pandemic with more than $9.9 billion in funding. Our 
activities align with the goals outlined during President Biden's 
Global COVID-19 Summit last year and those that will be discussed at 
the Second Global COVID-19 Summit tomorrow--vaccinating the world, 
saving lives now, and building back better to prevent future 
pandemics--and are driven by USAID's COVID-19 Implementation Plan which 
outlines USAID's role in the whole-of-government U.S. COVID-19 Global 
Response and Recovery Framework (``Framework''). The global community 
came together around last year's Summit, making new commitments 
centered around these global response goals. We continue our work to 
rally the world to deliver on these goals during the second Global 
COVID-19 Summit, taking place tomorrow.
Vaccinating The World
    Safe and effective vaccines are one of our best tools to end this 
acute phase of the pandemic. President Biden committed to donating 1.2 
billion COVID-19 vaccines--more vaccines donated than by all other 
countries combined--to the world for free and with no political strings 
attached. Completing the job collectively with other nations and donors 
is the Administration's and USAID's top COVID-19 priority. As of May 
10, the United States, in partnership with COVAX and bilaterally, has 
donated close to 540 million vaccines, the result of highly successful 
coordination with our interagency partners, and the White House.
    But vaccines on tarmacs are not vaccines in arms, which is why the 
U.S. government launched Global VAX. This initiative supports countries 
to scale up their vaccination campaigns and help with last mile 
efforts, including vaccinating the highest risk populations; planning 
and logistics; the purchase of ancillary supplies; cold chain 
infrastructure; and community engagement and public outreach, 
especially to strengthen vaccine confidence and counter mis/
disinformation about vaccines. In the 11 Global VAX surge countries--
Angola, Cote d'Ivoire, Eswatini, Ghana, Lesotho, Nigeria, Senegal, 
South Africa, Tanzania, Uganda, and Zambia--the U.S. Government is 
surging technical, financial, and diplomatic support in close 
partnership with the interagency. And we are seeing results:

  1. In Angola, the U.S. government supported vaccination efforts 
        through ultra cold chain strengthening, logistics support to 
        vaccination sites, social media campaigns, and vaccination 
        donations, which contributed to 18.5 million doses administered 
        as of May 2, 2022. To date, around 11.7 million people received 
        their first dose, 5.9 million people received their second 
        dose, and another 440,185 received a booster dose. The U.S. 
        Government is the largest donor of COVID-19 vaccines in Angola, 
        providing more than 8.6 million doses of Pfizer and Johnson & 
        Johnson vaccines, in partnership with COVAX. Of the eligible 
        population, 64 percent have received at least one dose.
  2. In Nigeria, U.S. Government vaccine donations and logistics 
        support, in addition to other implementation support, improved 
        the availability of vaccines at the state level and helped 
        sustain vaccination rates of around 200,000--250,000 doses 
        administered per day by April--up from 30,000 to 55,000 doses 
        daily prior to acceleration.
  3. In South Africa, Global VAX acceleration plans have built on 
        existing health platforms to deliver integrated services. 
        USAID's partner BroadReach integrated HIV testing services via 
        PEPFAR into a vaccination campaign in February to April 2022 in 
        the coastal region of KwaZulu-Natal. During this campaign, 57 
        percent of individuals reached were first-time COVID-19 vaccine 
        recipients, and 69 percent of individuals were high-priority 
        populations. BroadReach also conducted 3,000 HIV screenings, 
        identifying nearly three times more positive cases than usual 
        community testing programs.

Saving Lives Now by Strengthening Health Systems And Countering 
        Emergency Impacts
    Success in stopping the catastrophic damage of COVID-19, however, 
has required more than a vaccination strategy. Omicron makes clear that 
we must sustain and expand support for activities that minimize spread 
and prevent the emergence of new viral strains, decrease severe illness 
and death, and limit the burden on health systems, including health 
workers who are on the frontline of this battle. We must save lives now 
while we continue our efforts to vaccinate the world.
    At the first Global COVID-19 Summit in September 2021, President 
Biden emphasized the importance of reducing morbidity, mortality, and 
disease transmission. With the constant threat of emerging variants and 
many lower income countries still facing low vaccine coverage rates, 
increasing global access to COVID-19 testing, therapeutics, and 
countermeasures is critical to saving lives among those who experience 
a breakthrough infection or who are yet to be vaccinated. Two of our 
efforts with greatest impact have been increasing oxygen capacity and 
providing resources for emergency response.
    Oxygen.--USAID has become a world leader in supporting increased 
access to lifesaving oxygen in health facilities that lack it. An 
estimated 50 percent of facilities with inpatient services in LMICs 
lack reliable access to oxygen--even before COVID-19.\2\ Thanks to more 
than $100 million in COVID-19 assistance funding, USAID has built 
systems to provide oxygen to facilities in more than 50 countries--
including India, Haiti, and Ghana, to name just a few--and is in the 
process of building oxygen systems for facilities in 13 countries 
across Africa, Asia, and Latin America and the Caribbean.
    When expanding access to oxygen, USAID acted quickly to strengthen 
oxygen ecosystems and is currently a leader in bulk liquid oxygen 
investments for LMICs, the standard for oxygen delivery in high-income 
countries. To promote sustainability, we are exploring market-shaping 
opportunities so that oxygen markets can work more efficiently in 
LMICs, and lower prices and increase distribution. Our leadership is 
also informing other partners' investments, including those of The 
Global Fund to Fight AIDS, Tuberculosis and Malaria. All of these 
investments have the potential for long-term impact on countries' 
health systems--strengthening their capacity to respond to not only 
this pandemic, but also other critical health needs, such as child and 
adult pneumonia, safe birth, safe surgery, and new infectious disease 
outbreaks.
    Emergency response.--Since the beginning of 2021, USAID has 
supported rapid responses across the world as COVID-19 hotspots 
developed. To date, we have provided $429 million to support urgent 
healthcare needs and critical commodities (including PPE, diagnostic 
tests and treatments) in South Asia, Latin America and the Caribbean, 
and sub-Saharan Africa.
    COVID-19 has also continued to exacerbate humanitarian crises 
around the world by increasing food insecurity, reducing access to 
lifesaving services, and fueling a shadow pandemic of gender-based 
violence against women and girls. In response, USAID has provided more 
than $2.658 billion in COVID-19 supplemental funding focused on 
preventing famine and mitigating food insecurity, supporting protection 
and gender-based violence programs, and strengthening critical public 
health initiatives to reduce transmission of COVID-19 in humanitarian 
settings. For instance, in Ukraine, we are supporting the World Health 
Organization (WHO) to expand delivery of COVID-19 vaccines to 
internally displaced people, and to expand hospital oxygen supply to 
improve health system readiness to manage COVID-19 cases.
    USAID has also been investing in the capacity of the humanitarian 
assistance community to respond to outbreaks. The READY initiative 
(currently in its fourth year) has been focused on building and 
retaining capacity among non-governmental organizations (NGOs) and 
other stakeholders in priority regions and countries to more quickly 
and effectively respond to major outbreaks. Risk Communication and 
Community Engagement continues to be a priority as well, with USAID 
partnering with the International Federation of Red Cross and Red 
Crescent Societies (IFRC) in building community trust, social cohesion, 
and public solidarity to pave the way for uptake of emerging lifesaving 
COVID-19 biomedical measures.
         a new area of focus to save lives now: test-and-treat
    Recently authorized oral antivirals have been shown to 
significantly reduce the risk of hospitalization or death by almost 90 
percent among people who are at high-risk for severe disease. These 
treatments are becoming a mainstay of treatment in the United States 
and limiting the COVID-19 hospitalization rates and risk of death, 
especially among the unvaccinated and the medically vulnerable. But 
lower income countries have little to no access to the new therapies 
and have limited access to rapid diagnostic tests. In collaboration 
with other agencies and global stakeholders, USAID is working to 
increase the supply, availability, and use of low-cost, generic 
versions of these oral COVID-19 antiviral drugs for lower income 
countries.
    With additional resources, USAID can work to build a ``test-and-
treat'' approach and the capacity to deliver it to those who need it 
the most. This work would build on successful test-and-treat approaches 
for HIV and malaria and will require educating communities about the 
importance of prompt testing (including use of self-testing) and 
availability of treatment. It will also require the expansion of health 
systems' capacity to quickly identify new infections and initiate 
appropriate treatment in high-risk patients. USAID can support these 
strategies to ensure that test-and-treat programs are integrated into 
existing health infrastructure and community systems. In addition to 
reducing morbidity and mortality, these activities would also help stem 
transmission and reduce the likelihood of health systems being 
overwhelmed by patients suffering from severe disease by promoting 
early diagnosis and intervention.
    Diagnostic testing remains a critical part of the public health 
response, not just for diagnosis of new infections and linkage to care, 
but also to help identify emerging variants. The President's Global 
COVID-19 Summit laid out ambitious goals of reducing the cost of 
diagnostic test kits to $1 per test and achieving global equity for 
testing. But rapid diagnostic tests are largely not accessible in many 
LMICs. Only five rapid diagnostic test kits have WHO Emergency Use 
Listing. When Omicron spread more rapidly than had been anticipated 
during the Omicron surge, manufacturers could not keep up with surging 
demand, and many countries did not receive the testing supplies they 
ordered until after the Omicron wave had passed. Available laboratory 
testing can be slow, and extremely costly, with a diagnostic test 
costing as much as $99 in some countries. As a result, testing rates in 
lower-middle income countries remain low, and low income countries 
account for less than 0.5 percent of the tests performed, despite 
having almost 8 percent of the world's population.\3\ The WHO has now 
committed to accelerating test approvals, but low income countries have 
limited capacity to drive demand. For them to effectively roll out new 
test and treat strategies, investment in purchases of low-cost, rapid 
diagnostic testing is essential.
    Much of the world also lacks excess laboratory capacity and is 
unable to respond to a dramatic rise in testing need; therefore, we 
have invested in laboratory strengthening activities that will pay 
benefits beyond the current COVID-19 crisis. To support national 
laboratory networks, we have funded sample transport networks to ensure 
timely and safe delivery of samples within 24 hours so results can 
quickly be returned to individuals. Future surges are likely to 
encounter the same challenges without additional financial support.
      the cost of inaction: an urgent need for covid-19 resources
    We have made huge strides since this pandemic first began, and we 
are witnessing the end of the acute stage of this pandemic here in the 
United States. But we simply cannot ignore that in many parts of the 
world--where countries face low vaccination rates and lack of access to 
tests and treatments--this pandemic is far from over. And as long as 
that is the reality, we face a world in which new and more dangerous 
COVID-19 variants will be able to continue developing and endanger the 
recovery we have made so far.
    Without additional COVID-19 resources, we will be unable to mount 
the response needed to end this acute stage of the global pandemic. 
That is why the White House has requested $5 billion to support the 
global COVID-19 response, which includes:

  --$2.55 billion to resource our efforts to vaccinate the world 
        through Global VAX programs that are strengthening countries' 
        vaccine deployment and readiness capacities, including $1.8 
        billion for USAID and the State Department and $750 million for 
        CDC. These additional resources would enable us to support an 
        additional 20-25 countries to get shots into arms; support 
        multilateral partners providing critical assistance; and 
        prepare for pediatric doses;
  --$1.7 billion to finance our efforts to save lives now, covering 
        activities that are critical to ensuring adequate global supply 
        and technical assistance to support COVID-19 testing, 
        treatments, access to oxygen, personal protective equipment 
        (PPE), and support for health workers to reduce morbidity and 
        mortality and mitigate transmission. This would provide 
        lifesaving testing, treatment, and care for more than 100 
        million people; and
  --$750 million for lifesaving humanitarian assistance as global 
        humanitarian needs have skyrocketed, with COVID-19 adding an 
        additional layer of suffering upon the world's most vulnerable. 
        This humanitarian funding will help us to continue to scale up 
        to meet new and growing needs, while sustaining our ongoing 
        complex emergency responses in places such as Ethiopia and 
        Afghanistan.

    Without additional funding, we will be forced to scale back the 
expansion of Global VAX into 20-25 countries and our existing programs 
will begin grinding to a halt this fall. Many countries that finally 
have received the vaccines needed to protect their populations will 
risk seeing them spoil on the tarmac because they can't be distributed 
in country and/or administered to the population. And at the same time, 
we will not be able to expand the critically needed testing and 
treatment programs that we would have otherwise been able to support 
and continue our leadership in expanding access to oxygen. All the 
while, COVID-19 will continue mutating and growing, endangering 
populations abroad and the health and prosperity of all Americans.
    Throughout this pandemic, Congress has come together to pass 
supplemental funding that has saved the lives of millions abroad and 
protected millions more here at home. Once again, we are urging you to 
come together in support of continued U.S. leadership to control and 
end the acute phase of this pandemic.
    Thank you for the opportunity to represent USAID. I welcome your 
questions.
---------------------------------------------------------------------------
    \1\ Wang, et al. Estimating excess mortality due to the COVID-19 
pandemic: a systematic analysis of COVID-19-related mortality, 2020--
21, The Lancet 399, no. 10334 p. 1513-36 (2022).
    \2\ PATH, Oxygen Is Essential: A Policy and Advocacy Primer, PDF p. 
7 (2017).
    \3\ FIND, SARS-COV-2 TEST TRACKER (2022).

    Senator Coons. Thank you. Dr. Gawande. Dr. Ryan.
STATEMENT OF MICHAEL RYAN, EXECUTIVE DIRECTOR, WHO 
            HEALTH EMERGENCIES PROGRAMME
    Dr. Ryan. Good afternoon, Chairman Coons, Ranking Member 
Graham, distinguished Members of the Subcommittee. Thank you so 
much for the opportunity to speak with you today, as we--this 
will be an informal technical briefing.
    I am the Executive Director of the Health Emergencies 
Program here at WHO, and for over 25 years, I have worked on 
the front line in epidemics, conflicts, and natural disasters 
all over the world.
    I have just returned from Ukraine--I have just returned 
from Ukraine, where I saw firsthand the work of frontline 
health workers and witnessed the power of resilience in the 
face of horror.
    This is the same resilience, compassion and dedication that 
we have and continue to witness in our frontline workers around 
the world against COVID-19, in their determination to protect 
communities, save lives, and deliver to the last mile.
    COVID-19 has infected billions and killed millions. 
However, every single person on the planet has been impacted by 
this virus, with health weakened, loved ones lost, future 
stolen, and livelihoods destroyed. This virus has ripped 
through our communities like a tornado.
    And like that tornado remains highly unpredictable in its 
course and its intensity. While global reported cases are 
declining, the virus continues to evolve and evade, leaving our 
inter-linked communities highly vulnerable everywhere, 
especially in areas with low vaccination, high rates of people 
with underlying conditions, and limited access to health 
systems.
    Continued major disruptions of vital programs for HIV, 
AIDS, malaria, tuberculosis, maternal health and immunization, 
and others threaten decades of progress. Intense circulation of 
this virus has resulted in many variants of concern, each more 
transmissible than the last. All these variants have emerged 
outside the United States, and all have reached the United 
States.
    Yes, testing, sequencing, and surveillance activities in 
many countries are falling, blinding us to the potential--to 
potentially dangerous new variants. However, in a world of 
intractable problems, COVID-19 has solutions. This is thanks to 
the scientists who developed lifesaving interventions and the 
public health of frontline workers who have delivered them. 
This is in great part due to the leadership of the United 
States and other countries supporting a global effort led by 
WHO and its partners.
    But massive disparities in access to vaccines, antivirals, 
oxygen and other lifesaving tools and interventions threatens 
to undermine all we have achieved in the fight against COVID. 
While almost 12 billion doses of COVID vaccines were 
administered around the world, nearly 1 billion people in lower 
income countries have not received a single dose of vaccine 
against COVID. That number includes more than two-thirds of 
health care workers and older persons in those countries.
    We can end this emergency phase of the pandemic, but we 
will not do so unless we deliver these lifesaving interventions 
to everyone, everywhere. This will not happen with vaccines 
alone. It also requires surveillance, testing and sequencing, 
protective gear and therapeutics, and most of all, effective 
community engagement and empowerment. It requires that all of 
these are delivered to the last mile and administered by well 
trained and equipped workers.
    The funding you are considering today is critical to help 
us to get these lifesaving tools to the people that need them 
most everywhere. WHO's strategic preparedness readiness and 
response plan details how to achieve this, but it remains 
underfunded by $1 billion.
    WHO also coordinates the access to COVID tools, our ACT-
accelerator, and is shipping millions of vaccines, test kits, 
and therapeutics to lower income countries? The ACT's COVAX 
pillar has delivered 1.42 billion vaccine doses so far, 80 
percent of the supply for low income countries so far.
    However, the ACT is facing a nearly $15 billion funding 
gap. This includes--this money is needed to purchase over 700 
million tests, treatments for 120 million patients, protective 
equipment for 1.7 million health workers, and 600 million doses 
of vaccine.
    In summary, Senators, as long as this virus is circulating 
widely anywhere in the world, we are all at risk. We have to 
act now to save lives and enable the global economy to get back 
on track. We need to track this virus. We need to vaccinate the 
world. We need to diagnose and treat patients quickly and 
early, and we need to communicate with and engage our 
communities deeply.
    We need scale up investments in the solutions that are so 
badly needed to end this pandemic. The world has long looked to 
the U.S. for global health leadership. It was nearly 20 years 
ago that you introduced the PEPFAR Program, a bipartisan effort 
which saved the lives of 20 million people from AIDS.
    Today, the leadership of the United States is more vital 
than ever. The funding you are considering today will be a 
major contribution towards ending the acute phase of this 
pandemic and making the world prepared for the next global 
threat. Thank you, sirs.
    [The statement follows:]
Prepared Statement of Dr. Michael Ryan, Excutive Directory, WHO Health 
                         Emergencies Programme
    Good afternoon, Chairman Coons, Ranking Member Graham, 
Distinguished Members of the Subcommittee.
    Thank you for the opportunity to speak with you today. As agreed, 
this will be an informal briefing.\1\
    I am the Executive Director of the Health Emergencies Programme of 
the World Health Organization. Over 25 years, I have worked on the 
frontline in epidemics, conflicts and natural disasters all over the 
world.
    I have just returned from Ukraine, where I saw first-hand the work 
of frontline health workers and witnessed the power of resilience in 
the face of horror.
    This is the same resilience, compassion and dedication that we have 
and continue to witness in our frontline workers around the world 
against COVID-19 in their determination to protect communities, save 
lives and deliver to the last mile.
    COVID-19 has infected billions and killed millions. However, every 
single person on the planet has been impacted by this virus . . . with 
health weakened, loved ones lost, futures stolen and livelihoods 
destroyed.
    This virus has ripped through our communities like a tornado and 
like that tornado remains highly unpredictable in it course and 
intensity.
    While global reported cases are declining, the virus continues to 
evolve and evade leaving our interlinked communities highly vulnerable 
everywhere especially in areas with low vaccination, high rates of 
people with underlying conditions and limited access to health systems.
    Continued major disruptions in vital programmes for HIV/AIDS, 
malaria, Tuberculosis, maternal health and immunization and others 
threaten decades of progress.
    Intense circulation of this virus has resulted in many variants of 
concern each more transmissible than the last. All these variants have 
emerged outside the United States and all have reached the United 
States.
    Yet, testing, sequencing, and surveillance activities in many 
countries are falling, blinding us to potentially dangerous new 
variants.
    However, in a world of intractable problems, COVID has solutions.
    This is thanks to the scientists who have developed the life-saving 
interventions and the public health and frontline workers who deliver 
them. This is in great part due to the leadership of the United States 
and other countries supporting a global effort led by WHO and its 
partners.
    But massive disparities in access to vaccines, antivirals, oxygen 
and other lifesaving tools and interventions threatens to undermine all 
we have achieved in the fight against COVID.
    While almost 12 billion doses of COVID vaccines have been 
administered around the world, nearly one billion people in lower 
income countries have not been vaccinated against COVID. That number 
includes more than two-thirds of healthcare workers and older people in 
those countries.
    We can end the emergency phase of this pandemic but will not do so 
unless we deliver these lifesaving interventions to everyone 
everywhere.
    This will not happen with vaccines alone. It also requires 
surveillance, testing and sequencing, protective gear, and 
therapeutics, and most of all effective community engagement and 
empowerment. It requires that these are delivered to the last mile and 
administered by well trained and equipped workers.
    The funding you are considering today is critical to help us to 
getting these lifesaving tools to the people that need them the most 
everywhere.
    WHO's Strategic Preparedness, Readiness and Response Plan details 
how to achieve this but remains underfunded by over $1 billion.
    WHO also coordinates the Access to COVID Tools (or ACT) Accelerator 
and is shipping millions of vaccines, test kits, and therapeutics, to 
lower income countries. The ACT 's COVAX pillar has delivered 1.42 
billion vaccine doses so far. However, the ACT A is facing a nearly US$ 
15 billion funding gap. This money is needed to purchase nearly 700 
million tests, treatment for 120 million patients, protective equipment 
for 1.7 million health workers, and 600 million doses of vaccine.
    In summary:

    As long as the virus is circulating widely anywhere in the world, 
we are all at risk. We have to act now, to save lives and enable the 
global economy to get back on track.
    We need to track this virus, we need to vaccinate the world, we 
need to diagnose and treat patients quickly and we need to communicate 
with and engage our communities deeply.
    We need scaled up investment in the solutions that are so badly 
needed to end this pandemic.
    The world has long looked to the United States for global health 
leadership. It was nearly 20 years ago that the U.S. introduced the 
PEPFAR program, a bipartisan effort, which saved the lives of 20 
million people from AIDS.
    Today the leadership of the United States is more vital than ever. 
The funding you are considering today will be a major contribution 
towards ending the acute phase of the pandemic and making the world 
better prepared for the next global threat.
    Thank you.
---------------------------------------------------------------------------
    \1\ WHO's attendance before the Subcommittee is on a purely 
informal and voluntary basis, and nothing in the briefing should be 
understood to be a waiver, express or implied, of the privileges and 
immunities of the World Health Organization and its officials. This 
briefing is being provided on a voluntary basis as a technical 
contribution, and based on available scientific evidence.
     In principle, WHO would have no objection to the information being 
published provided that it will not be presented as ``evidence'' given 
by witnesses, but as technical information given by WHO. In the 
interests of transparency and access by its Member States to the same 
information, please note that WHO reserves the possibility to publish 
any information exchanged within this framework.

    Senator Coons. Thank you, doctor. Thank you, all three of 
you, for your testimony. If you might, you used particularly 
pointed, unsettling, difficult, and memorable phrases about our 
being avoidably vulnerable, about the balance between stuff and 
staff, about this being a tornado whose course and intensity we 
cannot predict.
    Let me just first ask of all three of you, if I might, it 
is a compound question, but what is the risk of the development 
of a variant that is more deadly as well as more transmissive 
than what we have seen so far? I am struggling with my 
colleagues. One of them said to me memorably, my colleague--my 
constituents are done with this pandemic. And I said, sir, with 
all due respect, this pandemic is not done with your 
constituents. One of our real challenges is one of imagination.
    Most Americans and many Senators don't appreciate that as 
long as there are billions who are unvaccinated and whose 
public health systems in the countries they inhabit are 
fragile, and where testing and monitoring is dropping rapidly, 
the risk of a new variant emerging that is more deadly and that 
can get around the vaccine protection we have already deployed, 
I think is significant. But I would be interested in hearing 
from all three of you whether there is any real risk of this, 
first.
    Second, the timing of money matters. We failed to deliver 
$5 billion when requested months ago. We failed to get it on to 
the Ukraine supplemental likely to pass tomorrow. I don't see 
what the timing is or the path forward on getting the 
international COVID relief funded through this Committee and 
through this Congress. I will try. I raise it every day. I 
press it with leadership, with my caucus and the other caucus. 
What difference does it make if we deliver this $5 billion this 
month, next month, or not until the fall? What would the 
consequences be domestically and globally?
    And last, what do you think is the right balance between 
staff and stuff, between making sure that we are investing in 
public health system personnel and resources, as opposed to 
delivering more therapeutics, delivering more testing, 
delivering more vaccines? What is the right balance? If each of 
the three of you in turn would answer those questions, I would 
really appreciate it. Dr. Frieden.
    Dr. Frieden. Thank you very much. The Nobel laureate, 
Joshua Lederberg, used to say that microbes outnumber us 
millions, billions, or trillions to one. Our only hope is to 
outsmart them. The risk of a variant that is deadlier than the 
Delta variant and just as or more infectious than Omicron is 
absolutely present, but it is not inevitable, and it is not 
something that we can't do something about.
    Unlike perhaps a tornado, we are able to reduce the risk by 
tamping down spread, particularly in areas of vulnerability and 
where there are people with immunosuppression, which is one 
theory of how some of the more dangerous variants have emerged. 
No one can tell you with certainty that it may or may not occur 
or when it may occur. It could have already occurred. It might 
not happen for a month, a year, or 5 years.
    There is no inevitability about various variants becoming 
less vicious. There is an inevitability that variants that are 
able to spread better do spread more. And those that have begun 
spreading in one area may spread more in that area. But the 
virus is only rewarded, if you will, if it spreads faster, 
whether that is a devastating variant that causes a high 
fatality rate or as Omicron, may be somewhat less deadly, 
particularly for people with immunity from either prior 
vaccination or prior infection.
    What we are seeing with the new Omicron variants is 
increasingly the virus is learning about our immune systems and 
learning to get around our immunity, either from prior 
infection or from vaccination.
    And that is why it is so important that we get these first 
generation vaccines out as quickly as possible and continue to 
develop second generation vaccines, and make sure that if and 
when we do have better, broader, longer lasting vaccines that 
may be able to address vaccine escape variants, they are 
available to the world promptly after they become available, so 
we don't have a repeat of what happened this time around. In 
terms of the timing, better late than never.
    The sooner, the better. But every month that goes by, we 
have a greater chance of unchecked spread, leading to a more 
dangerous variant. And in terms of the balance of stuff versus 
staff, I think that may maybe one way to think about that is to 
think about the minimum necessary for staff and to protect or 
ringfence those fundamental systems. You need systems to detect 
problems when they first occur.
    So you need a laboratory network, you need a surveillance 
and monitoring system. You also need rapid response capacity so 
that the public health staff can go out and investigate 
outbreaks when they occur.
    There are great new tools, I really am very excited about 
them, genomics, artificial intelligence, machine learning, but 
none of them are shortcuts to building a system where someone 
who feel sick goes to their local health provider, the local 
health provider contacts the public health department, there is 
a prompt and effective investigation, and a prompt and 
effective response.
    In fact, that is what we have promoted with our approach 
for rapid diagnosis and rapid response.
    Senator Coons. I apologize. My staff is telling me that we 
are down to very few Senators who have not voted, and the floor 
is waiting for me. If I could ask each of the two remaining 
witnesses about 3 minutes in answering my question.
    Are there any staff or are we aware of any Senator who is 
seeking to come back? In the absence of that, I am going to ask 
for the two remaining witnesses to speak, and then I am going 
to close the hearing and return to cast my vote on this. If you 
would, please, doctor, go on. And thank you to all three of you 
for really compelling written testimony and in-person 
testimony.
    I will berate my colleagues for their attendance on the 
floor rather than here.
    Dr. Gawande. I will say quickly. The risk of development of 
a more deadly disease--WHO laid out the best case scenario. The 
best case scenario and the worst case scenario. The best case 
scenario is that we continue to have what we have had thus far, 
which is a contagious, relatively milder form of the variant, 
variants that remain amenable to vaccine effectiveness.
    However, evasion of vaccine effectiveness or being more 
deadly is absolutely a potential outcome. And so we have to be 
prepared for the worst case scenario, much as we don't want to 
think about it. It is just the reality of what we should be 
preparing to do. Time really matters. We already see now, the 
production lines for testing is not unlike before Delta last 
time. That basically we are at some of the lowest levels of 
rapid test production that we have seen.
    We have low levels of production on PPE and masks because 
the demand for these things have disappeared, and that is going 
to cost us. So if we wait, we are not seeding those supply 
lines, we are not keeping them, we are not keeping the workers 
in place, and so it will be weeks to months to get them back 
online.
    Then add in the antivirals. If we don't have advanced 
market commitments to get production of the new oral antivirals 
that so protect us--that is our safeguard so that if a virus 
develops, a variant develops that evades the vaccines, then we 
have the oral antivirals to work with.
    But if production is not happening for the world, we will 
find our own countries behind. Finally on staff and stuff, what 
I would say is that we have been very good about buying stuff. 
It is easier to move out quickly, it is easier to buy.
    But when it comes to making these services happen, whether 
it is oxygen, whether it is antivirals or vaccines, making it 
possible for in the United States and abroad, having more 
commitment to the staff so that we are getting the mobile units 
out to do the vaccinations or do the treatment or enable the 
systems to get into place.
    That is what makes these lasting systems. And those systems 
are helping us not only for the next variant, it is for the 
next possible outbreak, it is for addressing childhood 
pneumonia, making safer births. It makes for a better system of 
care.
    Senator Coons. Thank you, Dr. Gawande, Dr. Ryan and Dr. 
Frieden. I am going to want to follow up with you about the 
therapeutic procurement in particular, something Senator Murray 
has been relentlessly pressing our caucus about. Dr. Ryan, you 
are going to get the last word today.
    Dr. Ryan. Well, thank you, Senator. In terms of will more 
transmissible variants emerge. They are emerging as we speak. 
They are emerging on almost a monthly basis. This is a 
nonrandom effect. This is pressure on the virus through 
transmission and survival. Whether more virulent or more 
dangerous, more lethal variants emerge is very much--it is a 
random effect.
    It can happen instantly, or it may never happen. It is very 
hard to quantify that risk. But if we leave millions of people 
getting infected who are not getting well quickly, people with 
immunosuppression, underlying conditions, with longstanding 
infections that we don't either prevent or treat early, those 
people produce quantum more virus because the virus stays in 
the individual human body for longer and can produce more and 
more variants, and those variants become much, much more 
dangerous.
    In terms of timing, I have said it before, perfection is 
the enemy of the good when you are dealing with epidemics. 
Speed beats perfection. Speed is what we need. We need to act 
now. We need to reduce the number of people on this planet who 
are being infected. We need to reduce the number of people who 
have longstanding severe clinical infections, who can produce 
variants that can go on to infect others and potentially evade 
our vaccines.
    And in terms of staff versus stuff, we have a big focus on 
commodities but to protect communities and to save lives, it is 
as it has always been, we need frontline health workers, 
frontline community workers, frontline NGOs, frontline people 
in the system who can deliver the solutions that we develop 
upstream. Just having stuff without the staff makes no 
difference in the world, Senator. Thank you.
    Senator Coons. Thank you, Dr. Ryan. Thank you, Dr. Gawande. 
Thank you, Dr. Frieden. I am grateful for your testimony today, 
for your long service to protecting the world and the American 
people and advancing public health.

                     ADDITIONAL COMMITTEE QUESTIONS

    We will keep this record open for a week until 5:00 p.m. on 
Wednesday, May 18.
    [The following questions were not asked at the hearing, but 
were submitted to the Agency for response subsequent to the 
hearing:]
    No questions were submitted for the hearing.

                          SUBCOMMITTEE RECESS

    Senator Coons. And I look forward to working tirelessly 
with each of you and with my colleagues to ensure that we do in 
fact advance this desperately needed appropriation to ensure 
that the world is safer from this pandemic, and I look forward 
to working with you on preparations for the next. Thank you, 
and with that, this hearing is concluded.
    [Whereupon, at 4:06 p.m., Wednesday, May 11, the 
subcommittee was recessed, to reconvene subject to the call of 
the Chair.]