[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
REFORMING THE WHO: ENSURING GLOBAL
HEALTH SECURITY AND ACCOUNTABILITY
=======================================================================
HEARING
before the
SELECT SUBCOMMITTEE ON THE CORONAVIRUS PANDEMIC
of the
COMMITTEE ON OVERSIGHT AND ACCOUNTABILITY
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 13, 2023
__________
Serial No. 118-82
__________
Printed for the use of the Committee on Oversight and Accountability
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov, oversight.house.gov or docs.house.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
54-398 PDF WASHINGTON : 2026
COMMITTEE ON OVERSIGHT AND ACCOUNTABILITY
JAMES COMER, Kentucky, Chairman
Jim Jordan, Ohio Jamie Raskin, Maryland, Ranking
Mike Turner, Ohio Minority Member
Paul Gosar, Arizona Eleanor Holmes Norton, District of
Virginia Foxx, North Carolina Columbia
Glenn Grothman, Wisconsin Stephen F. Lynch, Massachusetts
Gary Palmer, Alabama Gerald E. Connolly, Virginia
Clay Higgins, Louisiana Raja Krishnamoorthi, Illinois
Pete Sessions, Texas Ro Khanna, California
Andy Biggs, Arizona Kweisi Mfume, Maryland
Nancy Mace, South Carolina Alexandria Ocasio-Cortez, New York
Jake LaTurner, Kansas Katie Porter, California
Pat Fallon, Texas Cori Bush, Missouri
Byron Donalds, Florida Jimmy Gomez, California
Kelly Armstrong, North Dakota Shontel Brown, Ohio
Scott Perry, Pennsylvania Melanie Stansbury, New Mexico
William Timmons, South Carolina Robert Garcia, California
Tim Burchett, Tennessee Maxwell Frost, Florida
Marjorie Taylor Greene, Georgia Summer Lee, Pennsylvania
Lisa McClain, Michigan Greg Casar, Texas
Lauren Boebert, Colorado Jasmine Crockett, Texas
Russell Fry, South Carolina Dan Goldman, New York
Anna Paulina Luna, Florida Jared Moskowitz, Florida
Chuck Edwards, North Carolina Rashida Tlaib, Michigan
Nick Langworthy, New York
Eric Burlison, Missouri
------
Mark Marin, Staff Director
Mitchell Benzine, Subcommittee Staff Director
Marie Policastro, Clerk
Contact Number: 202-225-5074
Miles Lichtman, Minority Staff Director
------
Select Subcommittee on the Coronavirus Pandemic
Brad Wenstrup, Ohio, Chairman
Nicole Malliotakis, New York Raul Ruiz, California, Ranking
Mariannette Miller-Meeks, Iowa Minority Member
Debbie Lesko, Arizona Debbie Dingell, Michigan
Michael Cloud, Texas Kweisi Mfume, Maryland
John Joyce, Pennsylvania Deborah Ross, North Carolina
Marjorie Taylor Greene, Georgia Robert Garcia, California
Ronny Jackson, Texas Ami Bera, California
Rich Mccormick, Georgia Jill Tokuda, Hawaii
C O N T E N T S
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OPENING STATEMENTS
Page
Hon. Brad Wenstrup, U.S. Representative, Chairman................ 1
Hon. Raul Ruiz, U.S. Representative, Ranking Member.............. 3
WITNESSES
Ms. Loyce Pace, M.P.H., Assistant Secretary for Global Affairs,
Department of Health and Human Services
Oral Statement................................................... 6
Dr. John Nkengasong, M. Sc., Ph.D., Ambassador-at-Large, U.S.
Global AIDS Coordinator, Senior Bureau Official for Global
Health Security and Diplomacy, U.S. Department of State
Oral Statement................................................... 7
Dr. Atul Gawande, M.D., M.P.H., Assistant Administrator for
Global Health, United States Agency for International
Development
Oral Statement................................................... 8
Written opening statements and the written statements of the
witnesses are available on the U.S. House of Representatives
Document Repository at: docs.house.gov.
INDEX OF DOCUMENTS
Documents entered into the record during this hearing are listed
below.
* Email from Chinese Embassy; submitted by Rep. Wenstrup.
* H.R. 79; submitted by Rep. Mfume.
* H.R. 1546; submitted by Rep. Mfume.
* Amendment to Rules Committee Print 118-13; submitted by Rep.
Mfume.
Documents are available at: docs.house.gov.
ADDITIONAL DOCUMENTS
* Questions for the Record: Dr. Gawande; submitted by Rep.
Miller-Meeks.
* Questions for the Record: Dr. Gawande; submitted by Rep.
Cloud.
* Questions for the Record: Dr. Pace; submitted by Rep. Cloud.
These documents were submitted after the hearing, and may be
available upon request.
REFORMING THE WHO: ENSURING GLOBAL
HEALTH SECURITY AND ACCOUNTABILITY
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WEDNESDAY, DECEMBER 13, 2023
House of Representatives
Committee on Oversight and Accountability
Select Subcommittee on the Coronavirus Pandemic
Washington, D.C.
The Subcommittee met, pursuant to notice, at 2:03 p.m., in
room 2154, Rayburn House Office Building, Hon. Brad Wenstrup
[Chairman of the Subcommittee] presiding.
Present: Representatives Wenstrup, Comer, Malliotakis,
Miller-Meeks, Lesko, Cloud, Joyce, Greene, McCormick, Ruiz,
Dingell, Mfume, Ross, Garcia, and Tokuda.
Dr. Wenstrup. The Select Subcommittee on the Coronavirus
Pandemic will come to order. I want to welcome everyone here
today.
Without objection, the Chair may declare a recess at any
time.
I now recognize myself for the purpose of making an opening
statement.
OPENING STATEMENT OF CHAIRMAN BRAD WENSTRUP
REPRESENTATIVE FROM OHIO
Today, the Select Subcommittee is holding a hearing to
examine the future of the World Health Organization and our
relationship as the United States with the WHO. The World
Health Organization is supposed to be the preeminent
organization that governs just that, the world's health. It
played a key role in eradicating smallpox and significantly
reducing the cases of polio around the globe. And yet, when the
world was faced with the outbreak of COVID-19, the pandemic, we
saw that the WHO does not always serve all of its members
equally. We saw it is not an organization that serves all of
humankind but instead perhaps an organization that became
beholden to or entrapped in politics. When it was most
essential that the WHO be able to step up and help everyone, it
seems to have bowed to political affiliations over global
public health. When the WHO should have been conducting
independent investigations into the origins of COVID-19 and
presenting the global community with verified information to
help keep them safe, we instead saw that they ignored some
facts and parroted back statements that came from the Chinese
Communist Party.
We saw the WHO deny that COVID-19 was spread via human-to-
human transmission, based entirely on the word of the Chinese
Government. The WHO delayed naming COVID-19 a public health
emergency of international concern, a World Health Organization
procedure that, amongst other things, would have allowed for
the procurement and distribution of scarce supplies, all
because the Chinese Communist Party told them the spread was
under control. The WHO delayed serious measures to counter the
global spread of COVID-19 because the CCP was only worried
about their own bottom line.
When the WHO produced a report evaluating the possible
origins of COVID-19, it became unquestionably evident that the
entire report was nothing or but Chinese propaganda. Even Dr.
Fauci was worried about the report, stating, ``There was a lot
of restrictions on the ability of the people who went there to
really take a look. I have some considerable concerns about
that.'' The CCP was so entrenched in influencing the WHO's
investigation into the origins of COVID that they even
contacted me.
With unanimous consent, I wish to submit for the record an
email sent to me by the Chinese Embassy. So ordered.
This email from the Chinese Embassy is another attempt to
interfere with the investigations of COVID. The letter stated,
``We express our grave concern regarding the COVID-19 origins
hearing. We firmly oppose it.'' This kind of communication and
action hardly expresses a clear conscience. The WHO's lack of
independent investigation potentially allowed the beginning of
the pandemic to be worse and spread further than it could have
been. All in all, we saw the WHO more influenced by politics
than public health, not necessarily their fault. There is no
denying it, the WHO stumbled out the gate.
This Subcommittee is as much about looking back as it is
looking forward and preparing for the future. We must be better
prepared when the next pandemic surfaces, and a scientifically
focused WHO is paramount to that. It is evident the WHO is in
need of some reform. So why not take an opportunity to ask the
very people who are in the trenches how we can help them? Why
not ask direct sources what we can do right now to equip future
generations? Should there be an independent body that is able
to conduct oversight? How can the ideal methods of data sharing
and development be implemented across the world?
What we do know is that the WHO needs to be reestablished
with raised expectations of transparency, verifiability, and
accountability amongst its members as well. Running any public
health organization in a political manner destroys the
organization's credibility. The WHO needs to police its
members, and not cower behind bullies. The WHO should have been
in a position to tell the world that China was lying, if they
were lying. The fact that it did not do so until later is very
telling. Honesty is always non-negotiable, especially during a
once-in-a-generation public health emergency.
The WHO is currently drafting a new pandemic accord and new
International Health Regulations that will apply to all its
members. These changes must ensure American interests are
protected. They must not violate international sovereignty, and
they must hold China and others accountable. Further, any
accord or treaty must be presented to Congress for approval.
Anything else is wholly insufficient, especially in the minds
of the American people. Let us use this opportunity to ensure
that the WHO can actually protect the world's global health and
not just the political interest of a few of its members.
The United States should be setting the gold standard in
incentivizing best practices, and we should be doing everything
we can to force the WHO to listen to American interests.
Nothing is more important than global public health, and
properly reforming the WHO is the first step to that protection
so that our officials and our providers can better care for our
citizens and establish best practices, not only for here but
perhaps around the world.
We are holding this hearing to look at the current
circumstances surrounding the WHO and see how we can make it
better and stronger for the future. I look forward to a strong
on-topic discussion today. And I would now like to recognize
Ranking Member Dr. Ruiz for the purpose of making an opening
statement.
OPENING STATEMENT OF RANKING MEMBER RAUL RUIZ
REPRESENTATIVE FROM CALIFORNIA
Dr. Ruiz. Thank you, and I believe, Mr. Chairman, that this
is the first time we gather after you made your announcement.
So I think it is absolutely appropriate to congratulate you on
your decision regarding your retirement and to show you our
full respect and full appreciation for the amount of service
you have given to our Nation, not just as a policymaker here in
Congress, but also in your service in our military and as a
physician. And so as a fellow physician, it is going to be sad
to see you leave but know you are loved and know that you are
very well respected, and our Nation appreciates you 100
percent.
Dr. Wenstrup. And I will miss working with you, and I think
we got a few bills we can get passed this year.
Dr. Ruiz. We must. We must. It has been a while, my friend,
you know, and thank you to Ambassador Nkengasong, Assistant
Secretary Pace, and Assistant Administrator Gawande for your
participation today. I must say, Mr. Chairman, right now you
probably cannot see or really feel, but inside I am like a kid
at a candy store. I am really excited to have all three of you
here. All three of you have done remarkable work, have led your
profession, and have been thought leaders for our Nation and
many countries around the globe, so I want to thank you
personally.
And I also want to give a special thank you to Dr. Atul
Gawande, you see, because when I was a third-year medical
school during my general surgery rotation at the Brigham and
Women's Hospital, I actually scrubbed in with Dr. Gawande when
he was a fellow there. And I really need to thank you for your
kindness because despite you looking like you had not slept in
seven days, you were still kind and patient in helping me
maneuver around the operating room, so thank you so much.
In the last three years, the world has persevered through a
deadly pandemic that has claimed nearly seven million lives
across the globe. Now as we reflect on the international
response to this public health crisis and look to the future,
we must do so with a commitment to advancing global health
security. There is no international organization as central to
this work as the World Health Organization, which has
contributed to monumental advancements in healthcare access,
improvements in population health outcomes, and the defeat of
deadly diseases even in the farthest corners of the world. The
WHO's continued surveillance of global health threats has
helped prevent outbreaks of deadly diseases, such as measles,
from arriving on our shores. And the WHO's global vaccination
programs have helped contribute to an overall 54 percent
increase in global life expectancy in the last 70 years and put
us on track to prevent 51 million deaths from measles and
hepatitis B around the world.
So I want to take the time to emphasize now that our work
to prevent and prepare for future pandemics is not in conflict
with enhancing international cooperation, instead, our efforts
are strengthened and fortified by it. In our last hearing on
biosafety and biosecurity, we all agreed that threats to the
American people's health do not end at our borders. So in order
for us to ensure our Nation is truly prepared for the next
pandemic, we must continue to engage with the international
community on work that prevents future threats from reaching
our Nation. The United States has served as the preeminent
leader in global health for decades, and now is not the time to
cede that role to another country angling for global influence.
No. Now is the time to reinforce the United States' global
health leadership with meaningful reforms to the WHO that
promote transparency and strengthen international cooperation
in the event of future pandemics.
Thankfully, after years of volatile leadership under the
previous Trump Administration, the Biden Administration has
sought to correct course by re-engaging not only with the World
Health Organization but our partners around the world to
advance global health and our interest abroad. You see, when we
become an isolationist Nation, we leave a void that other
countries can come in and easily fill to use public health
diplomacy as a way of geopolitical dominance.
Taking a lessons-learned approach from the early days of
the pandemic, the Biden Administration has pursued reforms to
the WHO that I think we can all get behind, reforms that, one,
enhance oversight of member states, compliance with
international health regulations; two, develop an early warning
system for public health threats; and three, strengthen
investigative capabilities for public health emergencies of
international concern, exactly what we are working on to
strengthen. So these reforms would not only institute positive
change at the World Health Organization, but they would also
enhance pandemic preparedness on a global scale and, therefore,
reinforce U.S. influence in international institutions and
norms.
You see, in many ways, global health is the cornerstone of
our diplomatic efforts, and we must continue to find ways that
enhance our role in this space on the international stage. The
fact of the matter is when we leave gaps, our adversaries will
fill them. So now, more than ever, we should work to deepen
cooperation with our allies and commit to a collaborative
approach to global health security that will ultimately counter
the Chinese Communist Party and deter their influence. Bold
investments in global health and pandemic prevention made
through the Consolidated Appropriations Act and the American
Rescue Plan have set the stage for this work. For example, the
American Rescue Plan funds bolstering the WHO's COVID-19
vaccination administration efforts helped vaccinate
approximately half the world's population for COVID-19 within a
one year period, with the United States vaccines making their
way to key regions of the world where we compete with the
People's Republic of China (PRC) for influence. Additionally,
the Biden Administration has complemented these investments
with forward-looking policies that advance U.S. interests
abroad. Notably, under President Biden's leadership, the State
Department established its Bureau of Global Health Security and
Diplomacy with Ambassador-at-Large Nkengasong at the helm.
Ambassador Nkengasong, I look forward to hearing from you today
about how the Bureau has integrated global health security in
our national security and foreign policy priorities and how the
United States is engaging with WHO to advance that effort.
So there is certainly a great deal of ground to cover in
today's discussion, and it is my hope that today we can
identify constructive reforms to the WHO that build on the
Administration's effort to enhance global pandemic preparedness
as well as forward-looking policies that further cement
America's leadership in global health security. So with that,
thank you, Mr. Chairman, and I yield back.
Dr. Wenstrup. Well, thank you. Our witnesses today are Ms.
Loyce Pace. Ms. Pace is the Assistant Secretary of Health and
Human Services for Global Affairs. Ambassador John Nkengasong.
Ambassador Nkengasong is the U.S. Global AIDS Coordinator and
Senior Bureau Official for Global Health Security and Diplomacy
for the Department of State. He worked as the WHO's special
envoy for Africa during the COVID-19 pandemic. And Dr. Atul
Gawande. Dr. Gawande is a surgeon, writer, and public health
researcher. He is the current Assistant Administrator of the
U.S. Agency for International Development for Global Health, as
well as board certified in general and endocrine surgery.
Pursuant to the Committee on Oversight and Accountability
Rule 9(g), the witnesses will please stand and raise their
right hands.
Do you solemnly swear or affirm that the testimony that you
are about to give is the truth, the whole truth, and nothing
but the truth, so help you God?
[A chorus of ayes.]
Dr. Wenstrup. Thank you. Let the record show that the
witnesses all answered in the affirmative.
The Select Subcommittee certainly appreciates you all being
here today, and I am sorry we had a delay in this meeting, but
we are grateful that you are here today and look forward to
your testimony.
Let me remind the witnesses we have read your written
statements, and they will appear in full in the hearing record,
but please limit your oral statements to 5 minutes. As a
reminder, please press the button on the microphone in front of
you so that it is on when you speak and so that the Members can
hear you. When you begin to speak, the light in front of you
will turn green. After 4 minutes, the light will turn yellow.
When the red light comes on, your 5 minutes has expired, and we
would ask that you please wrap up opening statement.
I now recognize Ms. Pace to give an opening statement.
STATEMENT OF LOYCE PACE, M.P.H.
ASSISTANT SECRETARY FOR GLOBAL AFFAIRS
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Ms. Pace. Good afternoon, Chairman Wenstrup, Ranking Member
Ruiz, and Members of the Subcommittee. Thank you for ensuring
that we identify and implement lessons from the COVID-19
pandemic to enhance our public health preparedness and our
national security.
My office leads U.S. engagement with WHO and has been
working since the start of the pandemic on institutional
reforms that improve transparency and accountability both
within the organization and, as you said, sir, across its 194
member states. We work closely with our colleagues at the
Department of State, and U.S. Agency for International
Development (USAID), as well as other Federal agencies to build
pandemic prevention, preparedness, and response capacities
worldwide.
Of course, the world has been profoundly impacted by the
COVID-19 pandemic. In the United States, unfortunately, we
tragically lost more than a million lives, and nearly seven
million have died globally. We know there is no ocean large
enough to protect Americans from a virus that can spread
rapidly across the globe, so we also know that it is only a
matter of time before the world faces another serious public
health threat.
As it turns out, WHO has been on the front lines of nearly
every global health challenge over the past 75 years,
combating, containing, and curing some of the planet's most
deadly diseases. Currently, WHO is responding to dozens of
serious health emergencies, including in Gaza and in Ukraine,
but it takes an effective WHO to adequately guard global health
and well-being, supporting the safety and sovereignty of
America. Frankly, if WHO did not exist, we would have to create
it.
That said, the COVID-19 pandemic also revealed major gaps
in our global health security architecture, including and
importantly at WHO. Working with like-minded member states, the
United States is leveraging our seat at the table to drive
dialogs and solutions required today because, unfortunately, we
have learned the hard way that this is in our national
interest. So at that table, the Department of Health and Human
Services (HHS) is leading efforts to update the International
Health Regulations to make them clearer, more precise, and
better fit for purpose. Among other important reforms, we are
advocating for amendments that would ensure rapid and
transparent information sharing, enhance WHO's ability to
assess health threats, and improve global implementation and
compliance. Additionally, we are actively working alongside
State Department colleagues to negotiate a global agreement
that seeks to improve international accountability and
collaboration on pandemic preparedness and response. Through
both of these negotiations, we are advancing longstanding U.S.
priorities to reinforce regional capacity and reduce risks
posed by emerging infections. Ultimately, we are focused on
finding sustainable solutions that break the cycle of pandemic
crisis and complacency.
The United States is also pushing for reforms within WHO
itself. With vocal U.S. leadership, the 2023 executive board
meeting at the World Health Assembly approved a set of
recommendations and plans for more stringent oversight of WHO's
budget and business functions. We are closely monitoring
progress with WHO leadership and ensuring principles of good
governance at all levels of the organization.
In closing, I would like to highlight two of the greatest
health achievements of the 20th and 21st centuries: the
elimination of smallpox and significant progress in eradicating
polio. Both are the direct result of a partnership between the
United States, non-governmental organizations, countries around
the world, and WHO. In fact, the United States was one of 59
countries that first signed the treaty establishing a World
Health Organization. Since then, we have been party to many of
its successes and, at the same time, have pushed the
organization to be better over these last 75 years. You can be
assured that the Biden-Harris Administration is committed to
building on this legacy through our ongoing work in service to
the American people, which is our North Star.
Thank you again for the opportunity to testify on these
important issues.
Dr. Wenstrup. Thank you. I now recognize Ambassador
Nkengasong to give an opening statement.
STATEMENT OF JOHN NKENGASONG, M. SC., PH.D.
AMBASSADOR-AT-LARGE, U.S. GLOBAL AIDS COORDINATOR
SENIOR BUREAU OFFICIAL FOR GLOBAL HEALTH
SECURITY AND DIPLOMACY, U.S. DEPARTMENT OF STATE
Ambassador Nkengasong. Good afternoon, Chairman Wenstrup,
Ranking Member Ruiz, and Members of the Subcommittee. It is an
honor to be with you today on behalf of the Department of State
to discuss the U.S. Government's commitment to strengthen
global health security to protect the American people. We
engage internationally at all levels: bilaterally, regionally,
and multilaterally with international organizations like the
World Health Organization, WHO. I come before you today
representing the State Department's newest bureau, the Bureau
of Global Health Security and Diplomacy, which was launched on
August 1 of this year by Secretary Blinken. I would like to
thank Members of Congress for their support to establishing
this Bureau.
The COVID-19 pandemic left a deep, lasting impact on all of
us, with over one million American lives lost and at least
seven million globally. One estimate found that the American
economy lost more than $14 trillion due to the pandemic, and
economists estimate global GDP contracted by three percentage
point in 2020. The last few years have reinforced that a
pandemic is not only a health crisis, it is an economic crisis,
and it is a national security crisis. Without the combined
leadership of the U.S. multilateral partners, including the WHO
and others, the world may not yet have successfully made it out
of the acute phase of the COVID-19 pandemic. The coordinated
global effort required to deploy COVID-19 vaccines around the
world was a major demonstration of this lesson.
A coalition of countries, including the United States, came
together with the WHO to support the COVID-19 Vaccines Global
Access initiative, commonly called COVAX. The United States, in
partnership with COVAX and bilaterally, has donated close to
seven million safe and effective vaccines to over 117 countries
and economies around the world, while simultaneously investing
in regional vaccine manufacturing, supporting health workers
and strengthening our capacity to prevent, detect, and respond
to COVID-19 and future global health threats.
Under Secretary Blinken's leadership, the State Department
continues to play a critical role in elevating global health
security as a major priority in high-level global and regional
dialogs. Our team at the Bureau of Global Health Security and
Diplomacy is focused on collaborating across the U.S.
interagency community and with Congress to do all that we can
to mitigate future threats. Unfortunately, it is not a question
of if a new health threat will emerge, it is a matter of when.
The world needs greater cooperation, coordination,
collaboration, and communication. A major priority continues to
be ending HIV/AIDS as a public health threat by 2030. And in
that spirit, I look forward to working with you in continued
strong bipartisan fashion to pass a clean five year's U.S.
President's Emergency Plan for AIDS Relief (PEPFAR)
reauthorization.
Despite the challenges WHO has faced, it continues to play
a critical role in advancing global health security priorities
by its coordinating roles and responding to emergencies and in
promoting healthy lives worldwide. The WHO's leadership in
developing evidence-based guidelines and policies for
combatting HIV/AIDS have been critical for enhancing our own
diplomatic efforts when working with partner countries to
advance their respective HIV/AIDS responses. The United States
must continue to play a critical leadership role to ensure the
WHO is reformed to effectively address current and future
global health challenges. We have engaged with the task force
involved in these efforts and we continue to exercise our
leadership in this space.
Thank you, Chairman Wenstrup and Ranking Member Ruiz, for
the opportunity to testify on this important topic, and I look
forward to your questions.
Dr. Wenstrup. Thank you, Ambassador. I now recognize Dr.
Gawande to give an opening statement.
STATEMENT OF ATUL GAWANDE, M.D., M.P.H.
ASSISTANT ADMINISTRATOR FOR GLOBAL HEALTH
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT
Dr. Gawande. Chairman Wenstrup, Ranking Member Ruiz, Dr.
Ruiz, we are across a different table today, and who knew we
would be here from where we were a few years ago. Also, Members
of the Select Subcommittee, thank you all for the chance to
speak about USAID's commitment to global health security, to
our partnership with the World Health Organization, and the
importance of continuing reform to the systems required to
secure our collective protection from international health
threats.
USAID's health investments focus on reducing the global
burden of mortality and disease and on protecting Americans
from health threats from abroad. We work daily to prevent and
respond to emerging threats, while also pursuing long-term
goals, such as eradicating polio and ending the public health
threats of HIV, malaria, and tuberculosis by 2030.
Success requires global collaboration. Collaboration for
impact on health is what WHO has done for 75 years, and that is
why WHO has been an essential partner and recipient of USAID
funding. WHO's leadership of the Global Polio Eradication
Initiative is one excellent example. The WHO demonstrates its
unique convening power and technical capacity in leading polio
activities worldwide. USAID has supported WHO's polio
eradication efforts for 35 years, and now we have only 12 wild-
type cases documented worldwide in the last year in a small
region along the Afghanistan-Pakistan border. And last week,
WHO's quiet but persistent diplomacy persuaded the Taliban to
finally allow house-to-house vaccination, reversing its long
opposition.
Among USAID's top priorities is strengthening global health
security: the capacity to prevent, detect, and respond to
infectious threats that can spread worldwide. And our
partnership with WHO is critical in this work, allowing us to
leverage its global network and technical expertise to help
countries everywhere prepare for and manage dangerous
outbreaks.
For example, in February, an outbreak of Marburg virus, a
deadly cousin of Ebola, occurred in Central Africa in
Equatorial Guinea. USAID and Centers for Disease Control and
Prevention (CDC) supported and worked closely with WHO to
respond because of their particular relationships and technical
capacity there. Equatorial Guinea had resisted, as often
happens with countries, resisted sharing information or
permitting foreign involvement in what was happening, but WHO
persuaded the government to accept United States support that
ended up delivering diagnostic capacity, proper screening,
isolation, and emergency treatment procedures, and Personal
Protective Equipment (PPE) from the joint USAID-WHO emergency
stockpile for frontline workers, and that produce the
turnaround that ended the outbreak before it spread anywhere
else.
There is simply no entity in global health other than WHO
that has an equivalent mandate, reach, or capacity to influence
the countries where USAID works and where we do not, and that
influence is not, however, foolproof. It is up to countries
whether they adhere to WHO recommendations, but as we saw
during the COVID-19 pandemic, WHO's role is vital. Their
systems for safety review, for sharing technical information
for emergency response made vaccines, tests, and treatments
available globally, saving millions of lives.
The pandemic exposed some fractures in our global health
security systems, including at WHO. With our interagency
partners, USAID has pushed for the critical reforms that WHO
needed to increase effectiveness, transparency, and
accountability in future emergencies and in tackling other
health goals, and we see progress in what matters, which is
lives saved. For example, historically, Ebola outbreaks have
killed thousands, but in the six outbreaks of Ebola and Marburg
virus that have occurred since I have started, I have seen the
response get faster and better.
I was especially concerned about an April 2022 Ebola
outbreak in a city of a million people in the Democratic
Republic of Congo. In 2018, a similar outbreak in that region
killed more than 2,000 people and required a two year billion-
dollar global effort to stop it from getting across the world.
Since then, USAID, CDC, and WHO came together with others to
help the country improve its response capacity. So in 2022,
when a man with a high fever arrived in a clinic in Equatorial
province and died that day, the health worker had the training
to recognize this could be Ebola. He had the protective gear he
needed. He had the test equipment to make the diagnosis. He
alerted contacts and the national health authorities who got a
team onsite within 48 hours. They identified the contacts and
brought newly approved vaccines, and as a result, Ebola claimed
just five lives compared to the 2,000 lost in 2018. WHO and
U.S. investment meant that the outbreak required no emergency
foreign assistance at all.
I thank the Subcommittee, and I look forward to your
questions.
Dr. Wenstrup. Well, thank you. That is excellent testimony
from all of you. It is greatly appreciated. I now recognize
myself for questions.
You have really touched on some things that I appreciate
greatly. I have been in Vietnam twice in the last year, and I
do not know that WHO was involved, but more our own CDC. And I
think that the work that we did with our CDC and the Vietnamese
Government during COVID was a tremendous plus, not only for the
lives of the Vietnamese people but for our diplomacy, and so
there is great opportunity. So like I said, I do not know if
WHO was involved with that, but the importance of the WHO being
trusted comes into play with the example you just gave, Doctor,
where they came in and said trust the Americans on this, let
them work with you.
And if that what is needed for that conduit, then they
certainly need to be the trusted institution that we want them
to be and that they have been and make sure that everyone
agrees with that. And I suspect everyone here would agree that
politics getting involved with science can create a distrust
among the public at large just as politics always does. But I
guess with your knowledge of what we have now in looking at
COVID-19, I ask, was, in your opinion, China forthcoming and
transparent regarding COVID-19 because, you know, the WHO put
together a group to study this and go to China. The only
American in the group was Dr. Peter Daszak of EcoHealth
Alliance, and he maybe should have been somebody that even
recused himself because he was a collaborator with Wuhan
Institute of Virology. And China was deciding who got to go,
and so these are things that raise people's concerns.
And Secretary Blinken said we have got real concerns about
the methodology and the process that went into their report,
including the fact that the government in Beijing apparently
helped to write it. That is not an independent organization.
And so do you agree with the Secretary's assessment, and what
are your thoughts during that time and moving forward? And we
can go down the line.
Ms. Pace. Thank you, Mr. Chairman, and thank you for your
reflections on your travel to Vietnam. I, too, have been able
to visit the work of CDC and our partnership with WHO there.
With regards to your question, it is an important one,
especially because we have a lot of lessons to learn regarding
COVID-19, and, unfortunately, one of those lessons is the
importance of transparency. We are quite disappointed and share
your frustration with the Government of China not being as
forthcoming as they should have been with WHO at the time,
especially because getting to the bottom of this crisis is
critically important, as you said, not only for COVID but for
any outbreaks moving forward.
Ambassador Nkengasong. Thank you, Chairman. We fully agree
with your opening remarks about the trust capital that is
required to dealing with global disease threats, and that comes
with the ability to be fully transparent, to be accountable, to
report in a timely fashion, and also to cooperate, and all of
these elements were lacking in China's ability to cooperate
with WHO and the world. And when you have a fast-moving
respiratory disease like COVID, all of these elements are very
important for the global health security.
I think the burden is still on China, that for the past
three years China has not been forthcoming the way it should be
in working with WHO, working with us directly so that we just
understand what the origin is of the virus is so that it can
better prepare us for the future. As we have all said, it is a
matter of time before we are faced with another threat, yes, so
I think I fully agree with you that we need to build a trusting
relationship that will enable us to be able to respond in a
very timely fashion.
Dr. Gawande. I will add only that I am in complete
agreement with my colleagues. China was not forthcoming early
on about human-to-human transmission. As we noted, it has
common reluctance under Severe Acute Respiratory Syndrome
(SARS), which happened years before. WHO pushed hard and was
public about that lack of forthcoming behavior in a way that
did not occur in this particular instance. However, WHO got a
lot right that were critical to getting vaccines out to the
world, getting treatments out to the world.
We will say that we have also seen that history has shown
that they are capable of improvement. After Ebola where
response to emergencies were very slow, United States pressure
ended up driving the creation of a Global Health Emergencies
Program that massively improved response on the ground in many
subsequent outbreaks. And similarly, after COVID, the United
States pushed successfully for the creation of a Standing
Committee on Health Emergencies Prevention, Preparedness, and
Response, and that is already giving the United States and
others more real-time oversight of handling in the case of
potential PHEIC, the Public Health Emergencies of International
Concern.
Dr. Wenstrup. I think, you know, new methodologies coming
forward are going to benefit us all in the future. I guess my
real concern is if a member is not participating in the way
that should be expected, not only how do we call them out in a
way that might get them to behave as they should, you know. So
my question would be, do we say, well, you cannot be part of
the WHO if you are not going to adhere to the rules or is there
some enforcement mechanism? I do not know where to turn on
that, if that were to happen again in the same way, so I would
love to hear your ideas as you deal with the WHO and the
frustration that everyone had.
Ms. Pace. So I will try and respond to this question, Mr.
Chair. Again, it is a good one, especially because we need
everyone to be good actors around the table. One of the things
that we are able to do as board members of WHO is at least
track that very level of accountability and really understand
how we all come together to support the work of the
organization. As it turns out, we are board members alongside
the Chinese Government as well as other actors, like Syria. And
so it is one of the reasons why we want to remain at the table,
if nothing else, to be a voice in that room and ensure that
that voice is rooted in science and in the important work of
WHO really serving not only America but the world in ways that
we want to see.
Ambassador Nkengasong. Chairman, I agree with my colleague
that we have to be at the table all the time and exercise our
leadership because it is by being at the table that we will
rally our friends and allies to put pressure across the board
on countries that may not want to cooperate fully. We know that
when we are not at the table, others will take our seat at the
table. I think we have to always be at the table and continue
to put pressure on to them. The Administration has been very
clear on this, that we have to work in the area of global
health security. We must work with people that we agree with
and with people that we do not agree with because we just do
not know where the next threat will come from. The platform for
that is WHO. I cannot think of any other platform that could
serve that role.
Now, the burden is on all of us, the burden of leadership
to continue to put pressure on WHO to reform so that it can be
more agile, it can be more forceful, and it can be more
accountable in responding to or putting pressure where it is
needed so that countries can be more transparent in their
reporting.
Dr. Gawande. I will only add a couple of points to my
colleagues. One is that we want respect for our sovereignty and
so we also limit how much WHO can control or demand things of
us. And that is one of the challenges here that we are
protective of our own sovereignty and, therefore, do not want
to have those tools potentially challenge us or other member
states.
The second point about possibly, well, then could we force
out a China that does not adhere, and we want China under the
tent. Once a country pulls out, they become a blind spot in our
national security. Currently, China does participate as a
network of 129 countries that submit flu and other illness
data. It is the reason we have an effective annual flu vaccine
because we have access to information being supplied through
those means. And so we want to have China continue to be a
joint actor in this work, and so that leaves us in a space
where it is diplomacy.
Now, the additional reforms that the United States is
advocating for under reforming the International Health
Regulations are to make a clear, tiered response. Right now we
just have a Public Health Emergency of International Concern,
and that is the declared level, and we are looking for a three
level set of tiers so that there is an earlier indication that
countries have a health issue developing of concern. There are
clear standards about what transparency requires and then clear
requirements that WHO has to live up to for reporting, making
public, and indicating when countries are not adhering to
those. So that set of commitments are a part of what we are
aiming to negotiate and produce in strengthening international
health regulations and pandemic accord.
Dr. Wenstrup. Well, I would also like to see something
where the host nation, in this case China, does not get to
decide who the United States sends and does not restrict who we
send because, frankly, I would have been very pleased if any of
the three of you were there when that occurred. With that I
yield back, and I now recognize the Ranking Member for
questions.
Dr. Ruiz. Thank you. As Ranking Member of the Select
Subcommittee, I have long called for a forward-looking approach
to preventing and preparing for future public health threats
that applies the lessons that we have learned from the COVID-19
pandemic. Emerging public health threats are not bound by our
borders, meaning that this objective is as important for our
engagement with the international community as it is for our
domestic efforts. Reforming the World Health Organization to
insulate it from political pressure and strengthen the
international community's response to emerging public health
threats is central to this mission.
So I would like to begin by asking each of our witnesses,
with respect to the United States' global health engagement in
reforming the WHO, what is the single most important lesson
that we should take away from the COVID-19 pandemic? Let us
start with you, Assistant Administrator Gawande, and then we
will move to the left.
Dr. Gawande. Thank you. Number one lesson from COVID, I
think, is that in crisis, U.S. leadership is indispensable.
First, we are often the first in, and then we bring others
along. A case in point is the United States providing more
COVID vaccines without charge than any country in the world
with 700 million vaccines, but then we also supported COVAX as
a mechanism that then got other countries to do their share. We
came in early with funding first, but the net contribution of
COVAX was even larger in the end. There are multiple other
examples in the ways we lead on oxygen capacity and building
that out in places that did not have capacity for oxygen in the
face of a respiratory virus around antivirals being
distributed.
American leadership works because when we lead, we pull in
partners and allies with us. We demonstrate the values of
global collaboration and harnessing collective national
security, and American engagement with the WHO has been
essential to our effective global response as a result.
Dr. Ruiz. Thank you. Ambassador Nkengasong?
Ambassador Nkengasong. Thank you, Congressman. I think
then, but one lesson from, I believe, or one of the lessons
from the COVID-19 pandemic is that a disease threat anywhere in
the world is immediately a threat in the United States. It took
only two months for COVID to spread: 165 days, two months. On
January the 4th, there were just about four countries in the
world that had reported COVID but by March 20, about 165
countries that reported COVID. So it tells us a story of a
common connectivity, common vulnerability, and the inequalities
or inequities that we have to address. In all of this, I think
the lesson that follows from there is our leadership is
important, a leadership in making sure that we are engaged,
proactively engaged, such that such a threat when it occurs and
anywhere that it occurs, we squash it before it becomes a
threat in the United States.
Dr. Ruiz. Thank you. Assistant Secretary Pace?
Ms. Pace. Thank you, Ranking Member Ruiz, for this
question. My colleague, Assistant Administrator Gawande,
touched on the importance of the International Health
Regulations, and when it comes to lessons, I think we can think
of it in a couple of different ways. First, as he mentioned,
there are ways that we as HHS are working to amend those
International Health Regulations, not only through the alert
system or improvement of that system that he described, but
also thinking of ways to give WHO flexibility to share the
information that they see or receive by other means. So I
believe the Chair as well spoke to the limitations with regards
to countries if and when they choose to be transparent with us.
In the event they are less than transparent with WHO, WHO
actually has other means to understand the situation, perhaps
by other sources or other publicly available information, but
they might hesitate for fear of backlash from that country if
they get ahead of them. And then that country essentially
retracts and is not a partner in the response or otherwise
continues to be more opaque in what they share or less than
forthcoming. And so what we are hoping to do also through these
amendments is make it so that WHO has permission, so to speak,
to notify other countries around the world if and when they
give certain actors a chance to provide what they know and
those actors just do not respond. We just, essentially, do not
want to be in the dark, and that is why it is so important to
work in this way on these International Health Regulations
(IHR).
Dr. Ruiz. Thank you. The State Department and Department of
Health and Human Services have also been representing the
United States in the ongoing pandemic agreement negotiations,
which are generating recommendations for member states to
promote cooperation on preventing, preparing, and responding to
future pandemics. Ambassador Nkengasong, what steps is the
State Department taking to advance the United States' interest
in global health leadership in the ongoing pandemic agreement
negotiations?
Ambassador Nkengasong. Thank you. The State Department is
working very closely with colleagues from the Department of
Health and Human Services to support our negotiating team in
Geneva. And it is very clear, as you earlier said, that we need
this instrument, pandemic accord or pandemic agreement, that
would protect us. I mean, if you ask me to summarize that in
one line, I would say it is an accord that will do the things
that we have been discussing here, which is allow us to dictate
early, respond early to threats that will emerge and invariably
would emerge because we all know that we live in an era of
pandemics.
So we are actually looking at ways we could continue to
work with several countries, more than 190 countries around the
table negotiating this. This is not a fast process, but it is a
necessary process. We have to be at the table and continue to
show leadership in the way we work with countries to share
sequences, share viruses when a threat arises, and share of
course the medical countermeasures. Yes, I think that is
central to our ability to protect ourselves. Imagine if a virus
or an unknown virus emerge in anywhere in the world where we do
not have access to. I mean, we rely on this kind of an accord
or agreement to have access to those specimens, sequences, so
that we can develop a diagnostic test, vaccines, or
therapeutics.
Dr. Ruiz. Assistant Secretary Pace, how would the framework
of the recommendations in the pandemic agreement apply lessons
we learned from the COVID-19 pandemic to advance international
pandemic prevention and preparedness?
Ms. Pace. Well, certainly this potential agreement would do
quite a bit to complement what is already in place, such as the
International Health Regulations. One of the shortcomings,
unfortunately, of the COVID-19 pandemic is it did not allow for
a high degree of accountability when it came to accessing
innovations in particular, and one of the things we are trying
to negotiate as part of this agreement is to ensure that those
innovations reach everyone, including Americans, on time.
As the Ambassador mentioned, that involves sharing samples
and data so that we can actually produce or manufacture these
innovations, in other words, spur R&D, essential R&D, but then
there is a question of how these innovations reach people
around the world. That is not just a moral question, but it is
a strategic one, frankly, because in the absence of
vaccinations, for example, we had the opportunity for variants
to emerge, and thus kept us in this ongoing fight against
COVID. So it is our hope that this potential agreement helps
to, again, sort of buttress what we are able to do at a more
technical level with regards to pandemic preparedness and
response.
Dr. Ruiz. Thank you. And as negotiation for the pandemic
agreement have been underway, there have been some
misrepresentations of how this treaty would square with the
U.S. sovereignty. Ambassador Nkengasong, could you please help
us understand, correct the record regarding these
misinterpretations?
Ambassador Nkengasong. Thank you, Congressman. Let me say
upfront that that has not at all been a subject of discussion
during the pandemic accord or agreement. We will not allow
such. If ever such a discussion was to occur during the
negotiation, I can assure you that we will not allow it to
happen. As a matter of fact, when you look at the draft that is
circulating, the draft pandemic accord agreement or instrument,
on Article 3, Section 2 clearly on the principles stipulates
and affirm the importance of the sovereignty of the countries.
That is, the countries themselves that have the right over
their people. I think that is very clear, Article 3, Section 2
of that, so I think that misinformation or disinformation is
unfortunate. The accord has absolutely nothing to do with the
sovereignty of our country.
Dr. Ruiz. Thank you. And now that we have closed the
chapter on the darkest days of the COVID-19 pandemic, we must
dedicate our efforts to ensuring that the United States is
leading the way, as you have identified, as one of the biggest
lessons learned in preventing and preparing for the future
public health threats, which requires an international response
that will allow access, transparency, and data to contain an
emergency virus in the host country with full cooperation of
the host country in order to prevent it from spreading
elsewhere. I think that should be our singular focus as a
global community wherever this virus may arise, even if it
arises in the United States, to really have international
cooperation to prevent because that is how you are going to
prevent the next pandemic. Thank you, and with that, I yield
back.
Dr. Wenstrup. Now I recognize Ms. Malliotakis from New
York.
Ms. Malliotakis. Thank you. I am sure you all know that the
United States stands as one of the World Health Organization's
top donors, contributing roughly $700 million in 2020 and 2021,
with over 65 percent being voluntary above our membership dues.
And in December 2021, the Biden Administration announced
another $280 million contribution aimed at ending COVID-19,
bolstering health systems, and providing urgent relief, and as
taxpayers, we want to make sure that our money is being used
properly, that there are metrics in place, and that, as you
say, we have a seat at the table.
However, I am really concerned about what we have seen from
the WHO throughout the COVID-19 pandemic. I mean, they denied
human-to-human spread of COVID-19 based solely on CCP
propaganda. It was not until January 23 of 2020 the WHO finally
recognized that human-to-human spread was occurring. It was a
month after the first warnings. The WHO delayed naming COVID-19
a public health emergency. It delayed serious measures like
travel restrictions because the CCP told them the spread was
under control. The WHO continued to praise the Communist
Chinese Party's failed efforts to combat the pandemic despite a
globally recognized cover-up. And then when we pushed for an
investigation into the origins, the CCP was given full veto
power over inclusion of American scientists, right? The
communist Chinese vetoed the three Americans put forward by our
government to be in that investigative body, and the CCP was
given full power to edit and alter the final reports.
And so I am compelled to ask the question, I mean, how do
you justify continuing U.S. support for the WHO given their
debatable handling of COVID-19 investigations and apparent
compliance with misleading communist Chinese narratives? And I
agree, the World Health Organization has played a tremendous
role in history. United States was one of the founders, and
when it came to the AIDS epidemic, in particular, and others,
they have been, but it seems to me that they are now corrupted
by the communist Chinese. So what do we do, and why should we
continue to fund them if they continue to do what the Chinese
tell them to do?
Ms. Pace. Well, thank you, Madam Congresswoman, for that
question. Again, we really do appreciate being able to reflect
on some of these very important lessons learned. With regards
to our support of WHO, the leadership is very clear that we
expect reforms with regards to the way they do business, and
the United States has worked with WHO over time, particularly
in the past several years, toward those types of reforms.
You had Assistant Administrator Gawande mention the
Standing Committee on Health Emergency Preparedness and
Response. That Committee was established by the executive board
in which we hold a seat, and the United States was supportive
for the reasons that you described, particularly because we
felt the board needed to have better oversight over WHO's
response in emergencies and direct them accordingly.
Ms. Malliotakis. Yes. The issue is that even when we have a
seat at the table, it does not mean that we are seeing actual
reforms, and we have this problem with other international
organizations as well. It is not just the World Health
Organization. The fact that we have so much of those egregious
violators of human rights sitting on the U.N. Human Rights
Council and that they are allowed to get away with it, I mean,
it is a much larger issue of these global international
organizations that have been infiltrated by these nefarious bad
actors. You know, Iran chairing the U.N. Human Rights Council,
I mean, that is disgraceful, okay? So this is just another
example, I mean, the way that here we are seeing Communist
China having this much influence in the World Health
Organization, so it is a much larger question.
I guess my question to all of you is, what can we do as
United States, other than send more American tax dollars to
these organizations, what else can we do to truly reform them
because what I hear from the Administration is, oh, we have got
to elect better actors to the Committee. That is why we went
back to the U.N. Human Rights Council after President Trump
removed us was because this Administration felt, well, if we
were at a seat at the table, we can get better nations,
democracies, freedom-loving people to be represented on those
councils, but it has not happened. So what really can we do to
change it?
Ambassador Nkengasong. Thank you. Let me provide additional
information on what we are practically doing. We, the United
States, are part of the Member States Task Force on
Strengthening WHO's Budget, Programmatic, and Financial
Governance, and as you have heard from us, I mean, there were
about 96 actions that were required. And thanks to our
leadership, our presence at the table, about 67 of those have
been implemented, and we have about 25 or more that by the end
of 2025 must be implemented. We are actively putting pressure
where we believe it is producing the return on investment in
terms of the actions that were required of WHO and what they
are actually implementing.
Ms. Malliotakis. Well, I appreciate that. It is yet to be
seen whether any of this will really amount to anything other
than nice words, but, again, I have run out of time, so I will
yield back. But I think we just got to stop throwing good money
after bad until we see some changes at these international
institutions.
Dr. Wenstrup. I now recognize Mrs. Dingell from Michigan.
Mrs. Dingell. Thank you, Madam Chair. I want to build
actually on what you were talking about because we are all
worried about what did happen, et cetera, during COVID how we
do not repeat it and how we make WHO stronger. When it comes to
preventing and preparing for future pandemics, whether we like
it or not, safeguarding global health and our own national
security interests are inextricably linked with other countries
around the world. That is when we live in this modern world.
That is a reality. So under President Biden, the United States
has reasserted its global health leadership by reengaging with
the WHO and proposing substantive reforms to promote
transparency and strengthen the international community's
position against countries that obfuscate and evade
accountability.
So let me start with you, Assistant Secretary Pace, and
have you elaborate a little more. How has the Biden
Administration's reengagement with the WHO helped to solidify
America's global health leadership in the wake of COVID-19
pandemic, and what are you doing? You are not just talking, you
are acting?
Ms. Pace. Absolutely, Madam Congresswoman. Thank you for
that question. Yes, we want to reassure you that our role as
leaders at this table is directly connected to what we view as
our national security and those interests. I talked about the
executive board and I will continue to talk about the executive
board because that governing body really does serve an
important purpose in steering and guiding the work of WHO.
There are 34 members. The United States is one. As I mentioned,
China, Syria, Belarus are also members of that body.
So what we do is we really take advantage of our seat at
the table to ensure that our interests, whether they be in
global health security, specifically in biosafety and
biosecurity, or in other areas of public health, are well-
represented. We have had other members cycle on and off of the
board as well, even in my time as alternate board member,
including Russia. And you can imagine during that time as we
were deliberating as a board around how we respond in Ukraine,
for example, and WHO's work in that space, how important U.S.
leadership was, again, at that table.
Finally, when it comes to the reforms that Ambassador
Nkengasong mentioned, we have been very specific and deliberate
with WHO about what we would like to see. We really need to
understand, for example, how they are allocating their funding
and ensuring that funding is going toward programs that have a
real impact. This might seem basic to us, but we have to
remember WHO was a technical institution in its origination, in
its origins, and over time it has had to become more management
savvy. And so we as a U.S. Government are helping steer the
organization in that direction and again having it operate at
its highest and best use.
Mrs. Dingell. So thank you for that. Mr. Ambassador, I am
going to go to you, and I am going to ask you to build on that
and ask you another question. The Biden Administration has
established the Bureau of Global Health Security and Diplomacy
to lead the State Department's work on preventing, detecting,
and responding to infectious disease. How has the Biden
Administration's efforts to integrate global health security
across foreign policy through your bureau advanced our national
security interests? And knowing that you all work together, how
do we make sure China does not lie to us the next time, which
is what my colleagues on the other side and we are worried
about? How do we not undermine people's confidence in WHO but
assure them that we are working and holding those countries
accountable for telling us what is going on?
Ambassador Nkengasong. Thank you, Congresswoman, for that.
There are three goals that are driving the new bill that
Secretary Blinken launched on August the 1st. One is to
leverage all the assets that we have domestically and globally
so that we can address the challenges of global health security
as a whole.
As you know, Congresswoman, through the program, the
PEPFAR, the President's Emergency Plan for AIDS Relief, we have
footprints in about 55 countries in the world, and we have
built capacity in those countries. Those assets and public
health systems are being used in responding to other disease
threats like COVID. It was very instrumental, especially in
Africa, when COVID emerged, and we used that for rolling out
testing, vaccinations, and other PPEs there. So by having such
a footprint, we have diplomatic leverage in countries that we
are operating in, and we have access to the leadership of those
countries. We have professional allies and we have control over
what is going on in terms of having the right information
through such a platform there.
Second is really to coordinate, I mean coordinating. We
have said severally during this hearing that and highlighted
the importance of coordination. I think one of the things that
the Bureau is doing, will do, to advance our foreign policy
through the lens of global health security is to coordinate
everything, assets that we have both internally and externally.
Last is to elevate the global health security as part of our
foreign policy. During the COVID-19 pandemic, our Secretary of
State, Secretary Blinken, established a platform called the
Foreign Ministers' Platform, which was very instrumental in
reaching out other sectors of the society, other than the
ministries of health in our partner countries. And that
platform was very useful in the way we discussed how vaccines
would be distributed and the way PPE were made available. So we
want to build on that, those existing platforms, and expand on
it so that we have regular contacts with foreign ministries
across the world to continue to promote global health security
as a foreign policy.
Mrs. Dingell. Thank you, Mr. Ambassador. I yield back.
Dr. Wenstrup. Now I will now recognize Dr. Miller-Meeks
from Iowa.
Dr. Miller-Meeks. Thank you, Mr. Chairman, and I thank the
witnesses for testifying before the Select Subcommittee today.
It is no secret that the World Health Organization failed
during the early phases of the COVID-19 pandemic. Our leading
world health agency ended up being manipulated by the Chinese
Communist Party and used to dilute transparency and
accountability, especially when it came to investigating the
origins of the coronavirus. And since the beginning of 2021, I
have stated the origins were necessary to understand because of
immediate disclosure of potential pathogens because of
biosafety lab work being done in the appropriate laboratory
setting and the ethics of certain types of research, such as
gain-of-function research.
As a physician and a former state public health director, I
value public health and both the mission of the World Health
Organization, and it has done good since its creation in 1948,
since eradicating polio or smallpox in 1980, and working to
reduce polio cases worldwide. However, previous achievements
cannot be used as a cover for undeniable and costly failures
during the COVID-19 pandemic, especially when the United States
has historically been the WHO's largest contributor.
During the pandemic, the WHO constantly and adamantly
praised China's leadership, delayed calling it a pandemic and
acknowledging human-to-human transmission, while many of us in
the public health community were saying exactly those things.
And it is clear evidence that the Chinese Communist Party was
lying to world leaders and restricting international access to
its labs and information. The CCP was given full access to the
WHO's COVID-19 origins report before it was published. The Wall
Street Journal reported that the WHO-led team sent to
investigate COVID-19 origins had little power to conduct a
thorough, independent investigation during that trip. And China
initially resisted international pressure for an inquiry and
later imposed strict limitations, secured China veto rights
over participants, and expanded its scope to encompass other
countries.
As the WHO seeks to alter international health regulations,
it is vital that the United States and other member countries
not let bad actors hijack the review process. Similar to how
the CDC lost public trust during its actions during the
pandemic, the WHO has accomplished the same, but now has the
chance to rebuild its reputation. And let me just comment on
several of the things you said. Dr. Gawande, we do not want
respect for our sovereignty. We demand to be respected. We
demand it, especially from members who are not acting in good
faith. And if we cannot be assured of our sovereignty, it is up
to Members of Congress to have an accord or a treaty, have
congressional approval so that our sovereignty is respected.
And, Ms. Pace, we do not choose to be transparent. The 24-
hour disclosure of potential pandemic pathogens is not a
choice, it is a violation, and that is where accountability
comes into play. So oversight of the global bureaucracy is
vital, as is reviewing investments the United States is making
in global health landscape through its agencies like the U.S.
Agency for International Development. Ms. Pace, in your written
testimony, you state that the Biden-Harris Administration is
working tirelessly to ensure that WHO is effectively delivering
on its mission. Do you believe that limiting the influence of
the Chinese Communist Party on IHR revision process is
important to ensure that the WHO is effectively delivering on
its mission?
Ms. Pace. Thank you for that question, Madam Congresswoman.
And yes, it is quite important for us to ensure that in these
deliberations around improving the International Health
Regulations, that they evolve in a way that serves all
countries, and, importantly, to your point, ensures our highest
and best level of prevention, preparedness, and response. It is
one of the reasons that the United States actually took a
leadership role in calling for the revisions of the
International Health Regulations and introduced the original 13
or handful of amendments that now other countries have also
come in to say we think this is also a good idea and we are
also willing to come to the table and have a constructive
conversation about how this can be improved.
Dr. Miller-Meeks. While I do not support withdrawing from
the WHO or necessarily not funding the WHO, I do believe there
are other ways to hold the Chinese Communist Party accountable,
and one of those is whether or not they have a seat at the
negotiating table for the pandemic accords and IHR revisions.
Dr. Nkengasong, or, excuse me, Mr. Nkengasong, Ambassador, do
you believe that China was transparent during and after the
pandemic, and do you think they should have a seat at the
negotiating table?
Ambassador Nkengasong. Thank you, Congresswoman. As I said
earlier, China was not transparent in its ability to report and
be accountable to a serious threat that ended up costing the
lives of one million people here in the United States and seven
million in the world. This is the worst crisis that we have
faced in the last 100 years in terms of a pandemic, a
respiratory disease that emerged, and it actually required more
transparency, full transparency of what happened at that time.
And I do not think for the past three years we can say that
China has been fully cooperative and accountable, both to the
WHO and to the rest of the world.
Dr. Miller-Meeks. Thank you, Ambassador. I have one last
question for Dr. Gawande in relationship to fraud within USAID
and then the request for additional funding. However, due to my
time being expired, I am going to submit the question and ask
for it to be responded to in writing.
Thank you, Mr. Chair. I yield back.
Dr. Wenstrup. Mr. Mfume from Maryland is now recognized.
Mr. Mfume. Thank you, Mr. Chairman. By the way, I did not
know that you were leaving us, so I will associate my remarks
with the Ranking Member and say to you that it is indeed a loss
for the Congress and for the sense of bipartisanship, quite
frankly, that has really been demonstrated over and over again
by this Committee. I want you to know that your decision to
voluntarily leave is not new. I did the same thing 27 years
ago, and look where it got me, so.
Dr. Wenstrup. That crossed my mind.
Mr. Mfume. Yes, you may be back. And by the way, I want to
also agree that this is a great panel of witnesses. And I
appreciate all the work that you have done, all that you are
doing, and the many things that we do not know about because we
get an hour here with you or two hours there, but your
reputations precede all of you, and I am glad that you are here
today.
Mr. Chairman, the World Health Organization has helped, as
we all know, to build an effective health system and has
overseen for many, many years the expansion of healthcare
access across the globe, in fact, 75 years. And through this
work, the World Health Organization has markedly increased a
number of things, not the least of which is the average life
expectancy globally from 47 years to 72 years. It is, of
course, important for countries that are part of the WHO, such
as the United States, to give critical feedback to the WHO on
reforms to help strengthen its mission. I mean, we all have
some ideas, I think, of what we would like to see.
And that is why I was actually shocked when I learned that
the Committee was not going to center this hearing around
bringing witnesses from the World Health Organization to
testify before us, particularly since the title of the hearing
is reforming the WHO. It just seems like we have lost a great
opportunity here. And some of the things that have been raised,
such as finding a way to reduce, if not eliminate, China's
influence, finding ways to have greater accountability and
finding ways to make sure that oversight is fixed and set,
seems to have eluded us as a result of this. I strongly hope
that the Committee will at some point in the future consider
bringing in representatives from the WHO so that we might, in
fact, be able to get to the heart of some of the things that
keep us up at night and trouble us when we think about what we
would like to see from this particular organization.
Again, I appreciate the witnesses who are here today. There
are a couple of things that strike me as kind of ironic. And I
believe, Mr. Chairman, that the horse just got out of the barn,
that some of this stuff that we are reacting to, it was really
the role of this Congress and the previous Congress to get in
front of, and that did not happen. So we are playing catch-up.
We are mopping up the floor. In some instances we are assigning
blame. But the real blame, I think, here is in the Congress for
not providing the proper oversight from the time that the
pandemic hit. And I agree it was a difficult time for all of us
then, but we ought to be a little careful about warning reform
without being able to identify the reform that we warn.
This year, several members of the other side of the aisle
are offering amendments that would eviscerate, gut, and do away
with, quite frankly, the World Health Organization. I have
before me H.R. 1546 to prohibit the use of any and all funds to
implement any obligations of the United States under the World
Health Organization pandemic treaty; H.R. 79, a bill directing
the President to withdraw the United States from the
constitution of the World Health Organization; and an amendment
to the Labor HHS appropriation that says none of the funds made
available by this appropriation shall be made available to the
World Health Organization.
I would ask unanimous consent that they be entered into the
record.
Dr. Wenstrup. Without objection.
Mr. Mfume. So this is a very serious situation. I am going
to come to the Assistant Secretary, Ms. Pace, in just a moment
because she said something that struck me, and that is that if
there was no World Health Organization, we would have to invent
one. And I agree with that totally, much as was the case in
1948 when countries around the world really understood the need
to find a way to collaborate together.
And I would ask Ms. Pace, as Assistant Secretary, if you
had your way and a magic wand, since we do not have the WHO
here to talk about reforms that we think and they think might
be needed, what would be one or two of the things that you
would suggest for the consideration of this Committee?
Ms. Pace. Well, thank you for that question, Mr.
Congressman. I appreciate it because we do want a WHO that is
effective and truly in service to the world. I also want to
reflect on what we have offered as highlights on what the WHO
has done right or well. It is not just smallpox or polio that
are its success stories. In fact, many of its success stories
in global health security, as we call it, are even seen and
heard today, only they do not make headlines because of that
very success.
So whether it is with regards to Ebola or Marburg
outbreaks, which we have all experienced and worked with WHO to
address in the past couple of years, or even in longstanding
programs, such as childhood immunizations or maternal care
around the world, addressing maternal mortality, and other
really important issues such as AIDS, TB, and malaria, this is
the work of WHO that even helps to complement longstanding U.S.
programs. The fact is we cannot be everywhere as a country, nor
should we be. We cannot be the World Health Organization
ourselves, and so we rely on this multilateral institution to
work or partner with us and leverage our resources so that they
and we collectively can have that much greater impact.
Mr. Mfume. Thank you very much. My time has expired. Thank
you, Mr. Chairman.
Dr. Wenstrup. I just want to point out that the WHO and
other international organizations are immune from congressional
testimony. That does not mean we cannot reach out to them
directly in a less official way.
Mr. Mfume. Yes, because I would like to know what they
think their reform should be.
Dr. Wenstrup. We are planning that, and we are planning
that.
Mr. Mfume. Okay. Thank you.
Dr. Wenstrup. Yes. Thank you. I now recognize Mrs. Lesko
from Arizona.
Mrs. Lesko. Thank you, Mr. Chairman, and thank you all for
being here today. My questions are going to be to the
Ambassador. Ambassador, on January 14, 2020, the WHO tweeted
that, ``Preliminary investigations conducted by Chinese
authorities have found no clear evidence of human-to-human
transmission of the novel coronavirus.'' A National Review
article states that the Chinese Communist Party jailed any
doctor that disseminated any information about COVID-19 that
was not first cleared through their state-run media. A Wall
Street Journal article states that the U.S. intelligence
sources since discovered that the CCP covered up and lied about
the extent of the outbreak.
According to the CIA, on January 21, 2020, China threatened
to cease participation in all international COVID-19 efforts if
the WHO declared a Public Health Emergency of International
Concern. Well, guess what? WHO delayed declaring COVID-19 a
Public Health Emergency of International Concern. By the time
the WHO declared COVID-19 a Public Health Emergency of
International Concern on January 30 of 2020, the disease
infected almost 10,000 and killed 1,000 in 19 different
countries.
Despite declaring COVID-19 a Public Health Emergency of
International Concern and extensive evidence of transmission
through travel, the WHO insisted other countries not restrict
travel or trade to China. In fact, the WHO never recommended
restricting travel. The WHO routinely praised the Chinese
Communist Party's efforts to combat the spread of COVID-19
despite multiple reports that the CCP engaged in a massive
disinformation campaign. According to the U.S. intelligence
community report, the CCP severely under reported both its
total number of cases and deaths caused by COVID-19.
My question, Ambassador, do you believe the WHO relied too
much on false information from the Chinese Communist Party?
Ambassador Nkengasong. Thank you, Congresswoman, for that
very important question. And it is very clear that, and I agree
with you entirely, that the CCP did not act in this crisis in a
way that was responsible in terms of fighting a threat that had
emerged. It was not accountable, it was not transparent, and it
did not act in a timely fashion. That is very, very clear. I
think WHO has since become more forceful. There are several
pronouncements that WHO's leadership had made over the course
as the pandemic evolved and they have become more critical, but
has that enabled and provided the right access to information?
I do not think so. We need to continue to press hard on CCP to
have the right information. I think the reforms that are on the
way going on at WHO and the pandemic accord and the revisions
of the IHR are all instruments that I believe strongly, so that
working with others is the best way for us to be at the table,
build a coalition of people that are like minded so that they
can put the right pressure on any country that behaves in that
fashion, including the PRC.
Mrs. Lesko. Well, and so I think you said something about
it, but what other reforms are needed before the United States
invests more money in the WHO, because, ultimately, is not that
the United States' leverage is not to invest money until they
do the reforms?
Ambassador Nkengasong. The reforms that WHO is currently
leading, and we are at the table pushing that, is in the areas
of accountability, country-level impact. That is what happens
in country because we know that a threat anywhere in the world
is immediately a threat here in the United States, governance
of WHO, the human resources, financial resources. So there is a
whole set of categories of reforms that we have put on the
table for WHO, and we are pressing WHO to carry that on, and as
I said earlier, of the 96 action items, about 67 have been
acted on. About 29 of them will be acted on by end of 2025, and
we will keep an eye on that and continue to press them to
change and reform.
Mrs. Lesko. Well, thank you, and please continue to press
them to reform because it is a lot of money that we are
investing, and I do not want them controlled by the Chinese
Communist Party. And so with that, I yield back.
Dr. Wenstrup. I now recognize Ms. Ross from North Carolina.
Ms. Ross. Thank you, Mr. Chairman, and I, too, want to
thank you for your leadership, and you will be sorely missed in
Congress.
So I want to appreciate, first, all of the witnesses
acknowledging the problems with the WHO and the Chinese
Communist Party during the coronavirus pandemic. Mr. Raskin is
not with us today, so I also want to remind the Committee that
the Trump Administration was praising the Chinese Communist
Party at the beginning of the coronavirus pandemic and was not
stepping up to the plate to work with our international
partners. The Biden Administration came in, recognized many of
these problems, and thanks to the good work of many of you, we
have become a better global partner. It does not mean that the
WHO should be exonerated for not cracking down on the Chinese
Communist Party, but the WHO was not alone in believing the
Chinese Communist Party at the beginning of the pandemic, to
the detriment of the entire world and to this country.
I do want to talk about how we should work with the WHO
going forward and the value of all of your leadership and any
contributions that we make going forward. So with our guidance
and our leadership, the WHO has worked to improve health
outcomes around the world, standing up localized responses to
public health emergencies, and bolstering defenses against
deadly diseases. And we will talk about some of the ones that
Ms. Pace has raised, but, in fact, for every dollar we invest
in the WHO, the WHO generates a minimum return of $35 in public
health benefits.
Assistant Administrator Gawande, how has U.S. participation
in the WHO not just benefited the world, but benefited public
health here at home?
Dr. Gawande. This is such an important question. There are
multiple roles that WHO plays that leads to them improving
health and lifespan of billions of people around the world,
including Americans, and there are three central roles. One is
that they lead collective action to reduce common killers, and
we talked about eradication of smallpox, we talked about polio,
but there are many other examples, and one that we rely on here
at home is WHO is essential for our annual flu shot. The global
tracking system has a network of 129 countries, including
China, that report on flu upticks, share specimens and data,
and that is the way we ended up with a annual effective flu
shot here, and it is important that we participate in WHO to
maintain that effectiveness.
A second example is WHO coordinates action on health
threats in countries where USAID and our other agencies are in
and in places that are not, and they do that through something
called the Global Outbreak Alert and Response Network. And I
can attest to, from experience on a weekly basis responding to
news of potential outbreaks across the world, whether it is
Ebola, Marburg, potentially unknown causes, that this
information is vital for our early action, triangulating to
other sources when you do not necessarily trust the country
source, and making sure that we understand what is happening so
we can move quickly to stop spread and address issues that
protect the lives and economic security of all Americans.
And third, the WHO brings together global experts for
agreed-upon norms and standards for treatments and preventions
of virtually every medical condition that human beings can
face, and the results of that benefit us in a variety of
different ways. One example is that they create the
International Classification of Diseases. And that system where
we all call diseases the same thing means that our electronic
medical record companies have a global market for their medical
record systems, and we are the biggest supplier and seller of
those record systems because of that common framework that is
negotiated. And there are many examples of these in addition to
that.
Ms. Ross. I see my time is about to expire. I am going to
submit a couple more questions for the record, but a couple of
you have mentioned PEPFAR. Could somebody--you choose who--
briefly talk about how important it is that Congress continue
to fund PEPFAR?
Ambassador Nkengasong. PEPFAR, Congresswoman, is, in a
collective view, the greatest act of humanity in terms of our
solidarity to the world. I mean, imagine what PEPFAR has done
over 20 years: save 25 million lives, prevented HIV infection
from occurring in about 5.5 million children in the world.
Before PEPFAR, the face of the devastation that the disease had
caused in the world was just frightening.
In the recent commentary, the former President of Botswana
stated that in a headline that without PEPFAR, the country
would have been extinct by now. We should be very proud of what
we have done, the values that we have shown, which is the
values of our solidarity with the rest of the world, that we
care for the rest of the world, and we are leaders in the
discussion we are having today, which is leaders in global
health and global health security.
It has also provided a huge platform for the ability for
countries to detect and respond to other diseases. I mean, as I
mentioned earlier, PEPFAR platforms were instrumental in being
leveraged to roll out testing for COVID and for vaccination.
And in other countries where Ebola and cholera outbreaks have
occurred, they have been used, and by doing that, they enable
these infections to be detected early before they become a
threat in our own country. So we are not just helping countries
in Africa and the rest of the world, but we are also protecting
ourselves by making sure that PEPFAR continues to be
reauthorized.
So I am really counting on working with you in a bipartisan
way to get PEPFAR reauthorized for the next five years so that
we get the job done. I think our goal is to bring HIV-AIDS to
an end as a public health threat in six short years, 2030.
Ms. Ross. Thank you for your indulgence. Mr. Chairman, I
yield back.
Dr. Wenstrup. I now recognize Mr. Cloud from Texas for 5
minutes of questions.
Mr. Cloud. Thank you, Mr. Chairman, Ranking Member, and
thank you all for being here today. Very important topic of
conversation.
I wanted to start with kind of the leadup to COVID and what
was happening before then. In 2018-2019, I believe the United
States contributed about $839 million, China about $80 million.
The Rotary Club actually had more investment in the WHO than
China. Does the Rotary Club have a seat on the board? No. Okay.
China does? Still? Okay. And then some of the items that the
resources were being used for: in September 2019, the WHO
published a paper on addressing the harmful masculinities to
improve sexual and reproductive health rights. February 2020,
this is right after saying that there is not human-to-human
transmission and then working to correct that, the WHO was busy
addressing the important health issues by holding a conference
on road safety. Right now they are still working on
groundbreaking research series on health benefits of the arts.
Other, there are resources being spent to shift negative
attitudes toward abortion and prevent conscientious objection.
Regardless of what you think on abortion, even if you think it
is right, if you are working to change people's minds on it,
that is not providing you scientific medical service, which I
would--you know, I am pro-life, I disagree with abortion--but
this is political action, not medical action.
Legal recognition of self-determined gender identity in the
provision of gender-affirming care, things that the WHO is
invested in. Now, this is not protecting countries against the
pandemic. And so we continue to be by far the largest
contributor to the WHO, ten times the amount of China leading
into the pandemic, but it would have seemed that China had
about ten times the influence during the pandemic in having
their issues protected and addressed. And I appreciate the
Ambassador acknowledging the list that Mrs. Lesko so capably
presented of the missteps and misinformation that came from
China and the WHO, but you kind of shifted the finger to China,
which is appropriate, but her point was in getting back to the
missteps the WHO had in protecting it.
And so what I wonder at this point is why we are not seeing
full-throated response to bring China to account. Why is China
still on the board? Why did they get a vote? Will the Biden
Administration stand up to China and have them removed from the
board? Why do they get a vote going forward on any of this?
Could you speak to that, please?
Ms. Pace. Certainly. Mr. Congressman, thank you for this
question because it is important to understand sort of the
inner workings of WHO and how it is directed or working in
service to its member states.
So the way that board elections work or selections work is
each region actually puts forth someone from amongst their
member countries to serve on the board. Now, there have been
times when the United States has objected to those nominations.
However, not being a member of certain regions, we do not have
the say in terms of who they put forward and ultimately
nominate to the board, just as they do not have a say in what
the Americas region does to put the United States on the board
as many times as we have. And so we do, in the World Health
Assembly object, as we did when Belarus was nominated, when
Democratic People's Republic of Korea (DPRK) was nominated for
the reasons that I am sure you and your colleagues agree, there
are issues with their engagement. However, what we do with
their space----
Mr. Cloud. Well, we are not seeing those bold full-throated
acknowledgment that we need to. You know, there could be a vote
held in the board meeting to discipline China, to remove them
from it, to counteract their influence in what is going on. I
think after you have killed a couple million people, you should
not be able to get a vote on the board, and from our
perspective, we are continuing to fund this. And so I will go
back to my initial list, which we could add a number of other
items, to encouraging taxing on sugar and climate change and
all these different things.
If you are involved in any issue that remotely affects the
health of an individual, that seems like a whole lot of mission
creep and a whole lot of power that the WHO was asking for,
that you are asking us to be the primary funder with only one-
thirty-fourth influence on the board. And so how do we, as the
people funding this on the backs of the American people,
address those concerns when there seems to be a whole lot of
mission creep that goes beyond protecting against pandemics?
Ms. Pace. Well, if I may try to respond again, Mr.
Congressman. Thank you again for that question. With regards to
WHO's program of work, they do work across the spectrum of
public health, not only in pandemics or outbreaks. Importantly,
when it comes back to the benefit of WHO for Americans, their
work in non-communicable diseases is applicable to us and even
justifies our engagement with them. Whether it is on diabetes
or cancer or other issues that we face here in our country, it
is an important partnership that we maintain.
Mr. Cloud. The vast majority of our input is voluntary, and
my understanding is that comes with our ability to earmark what
that is for, and we have great concerns. There is a lot of
opacity in us getting to what we are earmarking and what it is
actually being spent on, so we can talk about transparency, the
need for transparency of what we are earmarking for it. We
cannot find the information on that, so it would be great if
you could help us with that. But then it gets earmarked to
these very vague categories. Many of the items I read are under
these vague broad categories on the WHO website. And there are
things I do not think the American people feel like they should
be funding when it comes to, yes, happy to work with polio and
those kinds of things, a number of these other things should
not be on the backs of American people. Thank you. I yield
back. Thank you, Chairman.
Dr. Wenstrup. I now recognize Ms. Tokuda from Hawaii for 5
minutes of questions.
Ms. Tokuda. Thank you, Mr. Chair, and mahalo for your
leadership, and I echo the comments of our colleagues today in
thanking you for your service.
Sadly, we have heard too often dangerous claims that
withdrawing from the World Health Organization would somehow
make the world safer for Americans and hold the PRC
accountable. Make no mistake, a return to the Trump
Administration's isolationist approach to global health will
undoubtably put American lives at risk. Calls for
accountability and cutting funding or withdrawing from the WHO
are not part of any legitimate effort for reform, and they are
not part of any thoughtful strategy about how to make us safer
and healthier.
As our witnesses have shared today, if we are not at the
table, someone else will take our place, and if it is
accountability we want, we need China under the tent versus
operating in a blind spot. Republicans' repeated attempts to
gut global health programs, including domestic programs at the
CDC that track the outbreaks of emerging diseases and fight
bioterrorism, will not keep Americans safe. In fact, just the
opposite.
Donald Trump's dissolution of the National Security
Council's Global Health Unit, which is monitoring cases of a
deadly flu strain in China and an outbreak of yellow fever in
Angola just prior to the pandemic, did not keep Americans safe.
And in one of the most egregious global health decisions of
all, Donald Trump's attempts to halt U.S. funding and withdraw
from the World Health Organization are not only a national
embarrassment but also sent a signal to our competitors that
the United States was willing to abdicate our global
leadership.
Ambassador Nkengasong, you previously served at the World
Health Organization, including during the pandemic. How did
Donald Trump's decision to cut U.S. funding for the WHO and
pull us out of the organization shape perceptions of the United
States, and in what ways might this have actually elevated the
PRC's influence on interest within the organization?
Ambassador Nkengasong. Thank you, Congresswoman, for that
statement and the question. I must state very clearly that we
always have to have a seat at the table, is the only way that
we can influence the issues and protect our interests, is the
only way we can influence the issues and protect our interests.
We are not at the table because we want to just be generous but
because we are truly wanting to protect our interests. When we,
the United States, is not at the table, others will take our
place. Our competitors are waiting for such an opportunity to
influence the discussion, the dialog, and tilt it even in their
favor. I think we should never accept that to happen.
And just for the record, Congresswoman, I have never worked
at WHO, so my comments are totally transparent. I was a special
envoy for COVID for Africa during very early days of COVID
until I was nominated for this position, so I have been an
envoy but not worked at WHO. But you are absolutely right, we
should always have a seat at the table and use that seat to
protect our interests and to advance our interest in global
health security.
Ms. Tokuda. Thank you for that clarification there,
Ambassador. And I would also argue that we have heard a lot
today on this dais about the PRC's elevated influence within
the WHO, and I would argue that that probably happened as a
result of the United States vacating its position upon the WHO.
So again, we should always have that seat at the table, lest
someone else take it from us. We are thankful that President
Biden has moved quickly to reverse the Trump Administration's
harmful decision even if the damage has already been done.
Assistant Secretary Pace, as a senior official regularly
engaged with the WHO, what is your assessment of how our
country is still recovering on the international stage from the
harmful decision to cut U.S. funding and withdraw from the WHO?
Ms. Pace. Well, thank you, Madam Congresswoman, for this
very important question because U.S. leadership is quite
essential in this space. And just turning back to the
negotiations, for example, it took quite a bit for us to bring
countries along with our proposal to amend the International
Health Regulations. I think to this day, we feel there is quite
a bit of skepticism with regards to whether or not the United
States is entering those conversations in good faith. Honestly,
I think we know here our intentions and the importance of
improving those existing regulations, but there are still
questions about our intentions and our staying power, if you
will. An important aspect of those regulations as well includes
helping build or rebuild the capacity of countries around the
world to actually implement them and adhere to them.
And so one important question that countries have or
continue to have of us is whether the United States will
continue to be a part of that technical assistance even beyond
funding. The enduring relationships that we have had, that my
colleagues have described are essential, and so we have tried
to ensure those member states that we are here again in service
to Americans but also in ways that hopefully will benefit the
world.
Ms. Tokuda. Thank you very much. And no doubt we have a lot
of work to do to, again, rebuild that trust and that presence
on the global stage. And no doubt, attempted cuts to funding is
not helping in assuring those other member countries that we
have the staying power that we should have to ensure safety and
security of the health and accountability overall for Americans
and others across the globe. So thank you very much, Mr. Chair,
and I yield back my time.
Dr. Wenstrup. I now recognize the Chairman of the full
Committee, Mr. Comer.
Chairman Comer. Thank you, Mr. Chairman. During the COVID-
19 pandemic, the WHO did not step up to the plate. Instead, it
aligned itself with the Chinese Communist Party. On December
31, 2019, Taiwan sent an email to the WHO that warned about a
potential outbreak, particularly human-to-human transmission.
On January 14, 2020, ignoring this warning, the WHO, based on
information from China, claimed there was no evidence of human-
to-human transmission. This tweet contradicted even the WHO's
own expert. Then, in June 2020, the WHO was still claiming
there was no transmission of COVID-19, so this was also false.
Starting with Ms. Pace and going down the line, do you
agree that these statements were not accurate?
Ms. Pace. Thank you for the question, Mr. Chair. We of
course are here to really learn the lessons of COVID-19, and
one of the things that we have talked about with WHO is the
importance of ensuring that we get to the bottom of its
origins.
Chairman Comer. Ambassador?
Ambassador Nkengasong. I fully agree with my colleague. WHO
should continue to be reformed, strengthen its reform so that
in future, they can actually play the role that they have
played in the past in protecting us.
Chairman Comer. Doctor?
Dr. Gawande. And I would agree with your calling out that
the Chinese Government was intransigent, was not transparent,
and was behaving irresponsibly. This is the situation where the
WHO was too credulous. They called out Chinese behavior in SARS
and were willing to call out publicly that China was not being
forthcoming, and in this particular case, they did not until
too late.
Chairman Comer. So----
Dr. Gawande. Now, there was more they did better, but this
was important.
Chairman Comer. Well, the WHO also praised China's
transparency during the outbreak, even while China was
silencing journalists and whistleblowers were going missing.
Again, down the line, do you think China was forthcoming in
sharing data about the pandemic, Ms. Pace?
Ms. Pace. No, sir, absolutely not.
Chairman Comer. Ambassador?
Ambassador Nkengasong. No.
Chairman Comer. Doctor?
Dr. Gawande. No.
Chairman Comer. So the flaws of the WHO all culminated in
its origins report in 2021, a report based off an investigation
that only had one American, Peter Daszak, who was funding the
lab being investigated. He was the only American on that, had
its access to labs restricted by the Chinese Communist Party.
And the Chinese Communist Party had final editing privileges of
the report, so it is no wonder the report was bogus. Dr. Fauci
said he had considerable concerns about the report, and
Secretary Blinken said we have got real concerns about the
methodology and the process that went into that report,
including the fact that the Government in Beijing helped write
the report. Ambassador, do you believe the Chinese Government
improperly influenced the outcome of the report?
Ambassador Nkengasong. They did.
Chairman Comer. Ms. Pace, it is our understanding that the
United States put forward some names to be part of that
investigation, and China rejected them. Is that your
understanding as well?
Ms. Pace. Thank you for the question, Mr. Chair. I do know
that the United States has worked to not just put forward names
for that particular investigation but for the multiple visits
or investigations and missions that the WHO was seeking to
have.
Chairman Comer. So did China reject those names?
Ms. Pace. I am not aware of why those recommendations were
not accepted, unfortunately, but we----
Chairman Comer. But it is our understanding that China
rejected those. Like, China was calling the shots, so the WHO
took China's word time and time again. Ms. Pace, how can we
better ensure that the WHO reports facts, not just what the
Chinese Communist Party is telling them?
Ms. Pace. Thank you for the question, Mr. Chair. It is
important for us to get to the bottom of this. I just want to
take a step back and also note the multiple missions,
international missions that WHO----
Chairman Comer. We know about the missions.
Ms. Pace. Okay.
Chairman Comer. We just have a problem with China, or I
have a problem, with China calling the shots on it. I do not
think that turned out very well during COVID-19. My last
question for each of you, and you can just answer ``yes'' or
``no'' for the sake of time. Do you believe that the Chinese
Government ought to be held accountable for the lack of
cooperation in the early days of the pandemic? Ms. Pace?
Ms. Pace. Thank you, sir. We do think that the
International Health Regulations and improving those will make
all countries be held accountable.
Chairman Comer. Should China be held accountable?
Ms. Pace. We believe all countries should be held
accountable for any violation.
Chairman Comer. Well, I mean, do you not think China is a
little special in this situation since it, by all accounts,
came from China and they completely lied and were not truthful
with the world population about the outbreak of COVID-19, that
they, you know, had veto power over who America put on boards,
and rejected reports that we now know could have been helpful?
Mr. Pace. I share your frustration with China's lack of
cooperation.
Chairman Comer. But should we hold China accountable?
Mr. Pace. Well, that is something that we are trying to do
by amending these International Health Regulations and ensuring
that violations cannot happen in the way that they did
previously.
Chairman Comer. Ambassador, should we hold China
accountable?
Ambassador Nkengasong. I think we have said, Congressman,
that transparency and accountability were totally lacking, and
we hope that it is the purpose and intent of the IHR reforms
and the pandemic agreement accord, that will improve
accountability to any country, and not just PRC, but any
country in future when they default.
Chairman Comer. Doctor?
Dr. Gawande. Yes, China should be called to account, and
the Office of the Director of National Intelligence has
indicated that we are still in a world where there is no
definitive answer to two viable theories about the origins of
COVID, and that in order to resolve this issue, the People's
Republic of China would need to be forthcoming about data that
can resolve these issues, which they have not been.
Chairman Comer. Mr. Chairman, my time has expired. I yield
back.
Dr. Wenstrup. I now recognize Mr. Garcia from California.
Mr. Garcia. Thank you, and thank you, Mr. Chairman. I want
to thank our witnesses for making the time to be here today as
well and for your service to health not just here at home, but
across the world.
We know that the World Health Organization plays a critical
role in global response, which impacts, of course, everything
that happens here in the United States. During the pandemic
especially, we know that the World Health Organization was a
critical partner to everything going on globally across the
world. And just as our own country's response to the pandemic
was imperfect and we learned as we went along, we also know
that that also was the case for the WHO. Everyone across the
globe struggled to address this crisis as it happened, and we
lost millions and millions of lives, not just here at home but
across the world.
I am grateful for each of you to speak candidly about ways
we can improve in ways we can, not just strengthen our
partnerships but also look at lessons learned. I am also
grateful to my colleagues here today for the chance to have a
serious discussion of how to prevent and respond to future
emergencies, that we should be also very clear there is a
difference between a good faith conversation about ways to
improve the World Health Organization and proposals to slash
the World Health Organization, including critical funding or
even withdraw from the World Health Organization completely.
Now, at the last hearing in the Subcommittee, we heard
about the importance of international biosafety standards--we
had a great discussion--and everyone agreed that we needed both
additional funding and oversight for global biosafety and
biosecurity. There was wide agreement on this. Assistant
Secretary Pace, if I am not mistaken, the WHO plays a huge role
in safeguarding biosafety and biosecurity in our laboratories.
Isn't that correct?
Ms. Pace. Yes, Mr. Congressman, that is correct. It is
important.
Mr. Garcia. Thank you. That is what I understand as well.
So if my colleagues are serious about international biosafety
standards, it sure seems that co-sponsoring bills that are
titled, ``Withdraw the United States From the Constitution of
the World Health Organization,'' or another bill that is
titled, ``The No Taxpayer Funding for the World Health
Organization Act,'' it would appear to me that bills like this
would actually hurt global health and hurt our health programs
here in the United States. Would you agree that that would be
the case, Assistant Secretary?
Ms. Pace. Thank you, Mr. Congressman. We would certainly
not want anything to hinder WHO's ability to protect Americans
and the world.
Mr. Garcia. And, Assistant Secretary Pace, and it is not
just Members of this Committee because numerous Members of this
Committee actually co-sponsored these bills that are on this
Subcommittee. The former President now, of course, trying to be
President again, Donald Trump, tried to destroy the World
Health Organization and separate the United States from any of
its health responsibilities. He quoted it as ``extraordinarily
bad,'' ``a threat to all Americans,'' ``the U.S. role will be
diminished,'' ``it is short-sighted, unnecessary, and
unequivocally dangerous.'' He is talking about the world's
leading health collaborative that brings countries together to
take on pandemics. And we know, and at least I believe, that he
is also responsible, in large part, for the failures of the
last pandemic that led to the death, as we know, of over a
million Americans. And so would you also agree that supporting
the World Health Organization is critical to the success of
American health, Assistant Secretary Pace?
Ms. Pace. Yes, Mr. Congressman, I would agree that it is
critical. Of course, we need an effective WHO to do so, but
they have done much over the past 75 years to demonstrate their
value to Americans and the world.
Mr. Garcia. Thank you. And finally, I just want to also add
that it is also unfortunate that there is so much vaccine
misinformation happening just right now and across this country
and across the world, and it is happening here in the
Subcommittee. I mean, just last week, we had a colleague that
published a post openly encouraging parents to defy
pediatricians and refuse childhood vaccinations, which we know
is not advised by the medical science here today, and anti-
vaccine misinformation is dangerous and is costing American
lives. Childhood vaccine rates against preventable diseases,
like measles, polio, and hepatitis, are declining to
dangerously low levels, and we are seeing a resurgence of some
of these same diseases in our communities because of declining
vaccination rates.
And so while we are having these hearings on the broader
pandemic, we must also remember to be honest, focus on the
truth, and support organizations that are battling pandemics
and trying to keep people safe. And so with that, I yield back.
Dr. Wenstrup. I now recognize Dr. Joyce from Pennsylvania.
Dr. Joyce. Thank you, Chairman Wenstrup, for holding
today's hearing, and thank you for our witnesses for your time
and for your testimony.
COVID-19 was the most devastating global public health
emergency since the inception of the World Health Organization.
Their flagrant lack of action from the beginning was a primary
concern, but their blatant dereliction of responsibility is why
there must be reform, why we are holding this hearing.
This Subcommittee was established in response to the
misguided policies, mishandling, and inconsistent guidance that
arose amid the pandemic. In the beginning, the COVID narrative
was controlled by the WHO, who are corrupted by the CCP, and
they ultimately placed CCP political interests ahead of their
international duties. The CCP steered clear, steered the
dialog. The CCP skewed the statistics, and they fed the WHO
information that would ultimately effectively shield the
Chinese Government from blame.
Now, it is almost four years later, and the same
organization is calling on member nations to enter a pandemic
treaty. Entering a treaty with an organization that refuses to
hold bad actors accountable is the antithesis of what WHO's
mission, and it is the antithesis of the principles of all
Americans. The American people want and American people deserve
answers from this Committee. They deserve to know that we
intend to safeguard our Nation and protect our citizens from
the next global public health emergency.
Ambassador Nkengasong, Article II, Section 2, Clause 2 of
the United States Constitution clearly states the powers of the
executive office as it pertains to the making or entering of
treaties. Nowhere does it grant the World Health Assembly that
authority. Do you believe that the World Health Assembly will
attempt to act unilaterally and circumvent congressional
approval and enter the United States into an agreement like the
Pandemic Prevention, Preparedness, Response Treaty?
Ambassador Nkengasong. Thank you, Congressman, for the
statement, and let me just repeat what I stated earlier before.
You are right that the pandemic accord, which is still being
drafted, if we look at Article 3, Section 2, it talks about
sovereignty, which is that the countries and only the countries
have the right over the people and themselves to make a
determination as to how to manage health issues in their
country. So absolutely, as a principal of that pandemic accord
treaty--we still do not know how we will call it in the end,
but the ``accord'' is a word that has been used now, not
necessarily a treaty because we are still early on in the
process of negotiation with more than 194 countries or so--so
that absolutely we are at the table. We will never allow any
language in the accord or treaty that will remotely suggest
that our sovereignty will be taken over by WHO.
Dr. Joyce. And it would never occur, from your
understanding, whether you call it a treaty or an accord, it
would not occur without congressional approval. Is that what
you just stated, sir?
Ambassador Nkengasong. I am stating that we are still early
in the negotiation, and we do not know how the final outcome
will look and----
Dr. Joyce. The citizens of the United States expect that
any treaty would only occur by the Senate with congressional
approval.
Ms. Pace, the WHO acted as a bulwarking apologist for the
CCP, and a few examples include they praised the CCP's failed
efforts to combat the pandemic despite a globally recognized
cover-up. The WHO denied human-to-human spread of COVID-19
based solely on CCP propaganda. The WHO delayed naming COVID-19
as a public health emergency because China claimed that the
spread was under control. The WHO delayed implementing
pandemic-stalling measures to protect trade with and travel to
China. With that in mind, how can we ever restore public trust
in the WHO? All three of you just stated, you acknowledged when
Chairman Comer asked if China was forthcoming with COVID-19,
you all said no. When Chairman Comer continued, and all three
of you stated that the People's Republic of China should be
held accountable, isn't that trust permanently fractured with
the WHO's firm alliance with the Chinese Communist Party?
Ms. Pace. Thank you for this question, sir--Mr.
Congressman--excuse me. You know, it is, as I mentioned
earlier, very frustrating and unfortunate that China in
particular did not cooperate at such a critical time. It is one
of the reasons why we are working through these International
Health Regulations to rebalance things, to make it so that we
are not all beholden to the failure of a single actor.
Dr. Joyce. Didn't that fracture your ability to come forth
as what you should be doing by your mission statement? Isn't
that culpability because of the Chinese Communist Party's undue
and over-influence on the WHO?
Ms. Pace. It is one of the reasons we are frustrated. Our
hands were tied because we did not receive the information that
we needed from them. And so what we are trying to do through
these amendments is unlock that information by other means in
the event something like that ever happens again.
Dr. Joyce. So my final question is how would you prepare
your organizations for the next pandemic, both in-house and in
conjunction with the WHO, knowing what you just stated, that
that makes it an incredibly difficult situation and a
relationship that does not have trust in it?
Ms. Pace. Thank you again for this question because it is
so important that we do rebuild that very trust and so that we
can be most effective in preventing or mitigating a future
pandemic. One of the things that we are doing as a lesson
learned is strengthening not only our multilateral partnerships
but our regional partnerships. And so ensuring that we are
working with networks, particularly in Asia but in other
regions of the world, to understand disease trends, this is
building on, obviously, decades of relationships and
partnerships that HHS has had globally over time. But really
looking to not rely, again, on a single actor to save us is
something that we have taken away from COVID-19----
Dr. Joyce. And my time is closing, and I think you really
drive home that the single actor did not save us. That single
actor, the Chinese Communist Party, destroyed so many human
lives, and the culpability and the ability to respond is what
we have taken on as a charge for this Committee. Mr. Chairman,
thank you. I thank the witnesses for being present here today,
and I yield the remainder of my time.
Dr. Wenstrup. I now recognize Ms. Greene from Georgia.
Ms. Greene. Thank you, Mr. Chairman, and thank you to the
witnesses that are here today. This is an important
conversation due to the COVID-19 pandemic response, government
lockdowns, forced vaccinations, school closures. Many Americans
have lost faith and trust not only in our government, but also
in the WHO, and it is extremely serious.
The WHO colluded with the Chinese Communist Party. In
January 2020, the WHO repeated Chinese communist propaganda by
saying that there was no human-to-human transmission with
COVID. The WHO waited several weeks to declare COVID-19 a
public health emergency because China insisted they had the
situation under control, which was a lie. The WHO did not
impose any travel restrictions, unlike President Trump, to help
slow the spread of COVID-19 because China did not want their
economy to slow down. The WHO continued to praise China's
handling of the pandemic despite a globally recognized cover
up. The WHO went along with the CCP's fake claims about the
origins of the virus not being from a lab, and our
investigations and our own intelligence agencies have told us
otherwise.
The International Health Regulations, the IHR, is a treaty
of the WHO meant to usher in a new era of global public health
that requires all member states to cooperate to make the world
more secure. The IHR requires only a simple majority to amend
it. There have been over 300 amendments proposed, and member
states will not be able to see these amendments before they are
scheduled to vote. At an October 2023 meeting, the working
group compiling the amendments for the 77th World Health
Assembly in May 2024 was told that they do not have to produce
their document before the meeting. Some of the amendments
include expanding the ability of the WHO Director-General to
declare public health emergencies, to include regional
declarations as well as intermediate threats, allowing
Director-General to act on information in the public domain
without verification from member states and creation of a
compliance committee to enforce their rules. I can assure you
the American people do not want the WHO enforcing any rules on
their own personal decisions regarding their health.
If certain IHR amendments are adopted next year, sovereign
countries, including the United States, would be obligated to
adhere to the treaty. The Biden Administration led the charge
for amendments to the IHR, including a new compliance
committee. The treaty would create a conference of the parties
which could call on the United Nations for help in implementing
the treaty. There is already talk of that conference of the
parties being merged together with the IHR. While the Biden
Administration wants to entangle the United States in more
globalist organizations and imperil the health and safety of
American citizens, President Trump withdrew the United States
from the WHO completely, wisely anticipating such precarious
mandates as the ones being proposed.
The move toward a global health security state is reliant
upon surveillance, which relies on data. Remember China, that
is what they did to their citizens and still do. The treaty and
the IHR call for more sharing of personal health data in the
name of safety and outbreak prevention. That is an invasion of
privacy for the American people.
The next step is to create a digital profile of everyone in
the world, and if the WHO is given binding power, the U.N. will
essentially have the power to restrict any American's movement,
access to healthcare, medicine, et cetera. I can assure you
right now the American people will never comply with anything
like this from a globalist organization regarding their
personal health decisions and, as a matter of fact, any way
they decide to conduct their lives. I think this is extremely
dangerous.
I have a question, Ms. Pace. The working group for the IHR
were told recently they did not have to produce their final
draft of proposed amendments to the IHR for the 77th World
Health Assembly until the event in May 2024. How can the United
States or any member state have any meaningful way to evaluate
and consider the proposed amendments before they are put to a
vote?
Ms. Pace. Thank you very much for the question, Madam
Congresswoman. This is a really important issue for us,
especially considering our leadership on the International
Health Regulations, not only in this Administration but also
going back to the previous Administration.
And so a couple of things in response. One, I want to be
certain and assure everyone here that we echo what the
Ambassador said earlier about the pandemic agreement. That also
applies to the International Health Regulations and any
negotiations or amendments there. We are not going to accept
anything that would undermine our national sovereignty and, in
fact, the WHO does not have that authority over our U.S. health
policies. And so I wanted to be sure and reiterate that. I
think that, in addition, one of the things that we are hoping,
I also wanted to assure you--excuse me--that the United States
is very much at the table for these negotiations. And so we do
have visibility into the various amendments being proposed and
the opportunity or ability to push back, again, as we need to
out of respect for our own sovereignty or other national laws
and policy. And that is something we are absolutely doing if
and when necessary.
Finally, with regards to our own amendments, we did feel it
was important to revisit the tiered alert system, as we
described earlier, so that we are not in a position of
scrambling in an outbreak but rather have some intermediate
alert whereby we can mobilize resources before we are all in a
panic. Also, one of the reasons why we touched on verification
of public information is because you had actors like the CCP or
a PRC not providing that. And so we wanted to provide a sort of
alternate pathway, again, to protect America and the world in
the event countries were not being forthcoming.
Ms. Greene. Thank you, Ms. Pace. I can also assure you in a
future Trump Administration, given the way the WHO conducted
itself, it could be very likely that we withdraw again from the
WHO. Thank you, Mr. Chairman, I yield back.
Dr. Wenstrup. I now recognize Dr. McCormick from Georgia.
Dr. McCormick. Thank you, Mr. Chair. Much like other
international organizations, such as the World Trade
Organization, the United Nations, the World Health Organization
is vying to gain more authority through Pandemic Prevention,
Preparedness, and Response Accord, in my opinion. This worries
me greatly. Let me be clear: the United States should never
ever allow international organizations, specifically the World
Health Organization, to impede our sovereignty, which I know
you just reaffirmed.
With that said, I think that when you designed the World
Health Organization, it was intended to be a data gathering, an
observer, an informant to nations around the world with a goal
of providing interchange of information from different
healthcare organizations for emergencies. However, the Biden
Administration must ensure the WHO authority is limited to
setting public health standards and providing a forum for
countries to exchange information but not to be given greater
authority to infringe on our Nation's sovereignty.
Now, I know we had this debate, world tribunals and other
areas where we have world organizations that want to overreach.
I think it is really important when we talk about U.S. national
interests advanced to these upcoming negotiations of the
Pandemic Prevention, Preparedness and Response accord, which I
believe both of you are involved in, correct? Ambassador? Okay.
So you are both involved. Can you both commit to complete
transparency during these processes?
Ms. Pace. Yes, sir. Thank you for the question. We have
been----
Dr. McCormick. Just ``yes'' is fine.
Ms. Pace. Yes, sir. Thank you.
Dr. McCormick. Mr. Ambassador?
Ambassador Nkengasong. Yes.
Dr. McCormick. Thank you. Can you both commit to making the
proposed treaty and amendments public to any proposal public to
allow for commentary and opinion?
Ms. Pace. We have done so. Thank you, sir.
Dr. McCormick. Right, and we will continue to do so----
Ms. Pace. Yes, we absolutely will continue to do so.
Dr. McCormick. Okay. Great. With that said, one of the
things I am worried about is we obviously have been compromised
in the past where we have been given misinformation and then
propagated that information, which you fully admitted and which
we pointed out probably ten times just today, where we
propagated Chinese misinformation, if you will, whether it be
just through not vetting the process or not thinking it
through. We did not really take the world's opinion. We just
took one country's and kind of propagated that. That worries me
in the future. My question is how do we get the trust back,
and, even more importantly, I think, what have we done to hold
China accountable, or is there a way because I am telling you,
if you look at the World Trade Organization, for example, China
has been taken to Court 27 times and defeated in court. We
still do not have any teeth actually to hold them accountable.
How do we keep countries like China and other bad actors from
abusing the system from giving us the inappropriate
information, and how do we hold them accountable because I do
not feel like they have been held accountable at all.
Ms. Pace. Well, I will try to respond to this question, Mr.
Congressman. It is an important one. As the Ambassador said
earlier, we are quite clear, particularly in multilateral
settings, what we expect of all member states, including China,
and even in our bilateral engagements, we also have been able
to reiterate our expectation----
Dr. McCormick. With all due respect, Ms. Pace.
Ms. Pace. Yes.
Dr. McCormick. Saying I expect you to do something and
holding somebody accountable is like saying I expect my kid not
to take cookies and then doing nothing when they steal them.
What have we done to keep them accountable? Mr. Ambassador? I
will give you a shot.
Ambassador Nkengasong. Thank you, Congressman, for that
question. I share your concerns with how China conducted itself
during this pandemic and continue to do so, and there are two
instruments that we are working on, and I see those as
instruments for accountability, the IHR and the pandemic
accord. And let me be very clear, there is absolutely no room
in the pandemic accord that will allow WHO to have influence or
to make any determination over our sovereignty. Absolutely not.
As principle, Article Number 3, as I have stated repeatedly
during this hearing, clearly defines what countries have versus
what WHO would have. I mean, that really affirm the leading
role of each country over his sovereignty.
Dr. McCormick. So I appreciate you answering the question
you already previously answered, which we are not going to lose
our sovereignty. That is great, but the question that was never
answered and the reason we are here is to hold you accountable.
The question is, what are we doing to hold them accountable,
which was not answered.
Ambassador Nkengasong. No, I think we answered that. Very
quickly, there are two instruments we are working on, the IHR
and the pandemic accord, which are instruments that will be
used for ensuring accountability.
Dr. McCormick. Accountability for sovereignty, yes, but I
guess my question is the bad actions. But I am out of time, so
I yield back. Thank you.
Dr. Wenstrup. I would like to yield to the Ranking Member,
Dr. Ruiz for a closing statement, if you would like to make
one.
Dr. Ruiz. I would. Thank you, Mr. Chairman, and excuse my
absence. I was opening a national roundtable on healthcare with
the congressional Hispanic Caucus and came back as soon as I
could, right in the nick of time. So thank you again to the
witnesses for your testimonies.
The WHO plays a critical role in advancing global health
security. Throughout today's hearing, we have discussed much of
this vital work: improving access to care, surveilling for
deadly diseases, administering lifesaving vaccines, and more.
And so before we conclude today I want to emphasize, again, for
the record, that our work to prevent and prepare for future
pandemics is not in conflict with enhancing international
cooperation, but rather our efforts are strengthened and
fortified by it. In all of our conversations, both today and
going forward, I hope we continue to recognize the value our
participation in the WHO brings to our Nation's diplomatic
foreign policy and national security interest. In fact, almost
everyone in the panel today said that one of the biggest
lessons learned is that we need to lead in this effort.
And so right now we have the opportunity to not only
enhance global pandemic prevention and preparedness but also
cement our Nation's leadership in global health. And we can do
so by continuing to foster international collaboration and
advance reforms to the WHO, in the International Health
Regulations. The pandemic accords are very vital, real-time
priority instruments and tools to have the influence that we
need in this space and that promote transparency, improve
surveillance, and strengthen cooperation with standards and
norms. So these matters are of critical importance to global
health security and hope that we can find ways to work together
here in Congress and with our Administration partners to pursue
constructive reforms that will save lives and reduce harm in
the event of a future pandemic.
Again, I want to thank all of our witnesses. You are in the
frontlines, much respect. Thank you for your hard work. Thank
you for your service to our Nation, and I want to thank the
Chairman and yield back.
Dr. Wenstrup. Thank you, Dr. Ruiz. And again, thank all of
you for your time today. I think this has been extremely
valuable. You know, the whole situation obviously is
frustrating, but this Committee remains committed to a shared
goal of preparing for the next pandemic, lessons learned, so
that the issues that the WHO had, Chinese transparency, all of
these, they are highly relevant to our preparedness here in the
United States.
My feeling is the more we can set the tone for what it
takes to be prepared, others can as well and could make an
organization like the WHO much stronger if there is
cooperation. Like every witness today said, China was not
transparent, they were not forthcoming, all of those things. I
cannot help but think of Ronald Reagan's line: we need to trust
but verify. That is what was missing is the verification, and
so, why not trust? You assume people are going to be honest
brokers, you would hope, and when they are not and you cannot
check that, I think that lesson learned is international
organizations, or at least ourselves, need to be there on the
ground to see what the actual truth is. So I think that is one
of the lessons learned.
And I would say here, too, early on in the pandemic, I said
to the Administration, America needs to be hearing from the
doctors treating COVID patients. That is who they trust. That
is what every patient in America, person in America can relate
to, is the one wearing the white coat that is there to say I am
going to try and take care of you as best I can. Doctor, you
know that feeling, and it makes a big difference.
You know, we heard some comments today, again, trusting
without verification is a problem. If the president of one
country is telling the president of another country
everything's under control, we got this, well, we see what that
leads to, when you are lied to and do not know you are being
lied to, then you do not get the guidance and leadership that
you should. Honesty is the lesson learned. To me, the WHO needs
full access and the WHO representing all of its partners need
full access to be able to do things correctly.
We talked about revisions to IHR. We need that to be
without political influence. You all have testified to that
today, and I thank you for your work. I heard things today that
I think are really good for us to hear, and we agree: U.S.
leadership is indispensable in this process. And I was pleased
to hear all of you talking about an agreement that protects the
United States is your priority, and that is what we need to
have. But I also agree that if we are going to protect the
United States, we have to do everything we can around the globe
when we are talking about a pandemic. It cannot just be the
United States. You know, without accurate data, without truth,
without honesty, we cannot help fully or quickly, which is key
to a pandemic response.
So it became clear to me that the WHO's success depends on
the United States and that the United States is going to have
to depend on honest data access and everything else through the
WHO. So we cannot have a situation where one can country gets
to deny us from being part of the team and controlling the
situation on the ground, but I see a lot of opportunity here. I
do have in front of me the draft and appreciate that this is
public, and we need to go through it.
We are here to represent the American people and the
taxpayer dollars, so we want to know what the investment is and
what it looks like, and so I appreciate the openness. There is
a difference between an accord and a treaty, and that concerns
Members of Congress, as you can imagine. And I will say, so in
Congress, when Congress is frustrated, what is the power they
have? The power of the purse. So we do want to be involved. We
want to be involved with this so we can honestly report what
the intent is, where the money is going, and how we are trying
to make the world a better place and the health of America, in
particular. And with that, I yield back, and I want to again
thank you all.
With that and without objection, all Members will have five
legislative days within which to submit materials and to submit
additional written requests for the witnesses, which will be
forwarded to the witnesses for their response.
Dr. Wenstrup. And if there is no further business, without
objection, the Select Subcommittee stands adjourned. Thank you
all.
[Whereupon, at 4:29 p.m., the Subcommittee was adjourned.]
[all]