    [House Hearing, 118 Congress]
    [From the U.S. Government Publishing Office]

                   LOOKING BACK BEFORE MOVING FORWARD: AS-
                    SESSING CDC'S FAILURES IN FULFILLING ITS
                    MISSION

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

                                    HEARING

                                   BEFORE THE

                  SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                                     OF THE

                        COMMITTEE ON ENERGY AND COMMERCE
                            HOUSE OF REPRESENTATIVES

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  JUNE 7, 2023

                                   __________

                               Serial No. 118-43

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

         Published for the use of the Committee on Energy and Commerce

                       govinfo.gov/committee/house-energy
                            energycommerce.house.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    56-528 PDF                  WASHINGTON : 2025

    -----------------------------------------------------------------------------------

                        COMMITTEE ON ENERGY AND COMMERCE

                       CATHY McMORRIS RODGERS, Washington
                                      Chair
    MICHAEL C. BURGESS, Texas            FRANK PALLONE, Jr., New Jersey
    ROBERT E. LATTA, Ohio                  Ranking Member
    BRETT GUTHRIE, Kentucky              ANNA G. ESHOO, California
    H. MORGAN GRIFFITH, Virginia         DIANA DeGETTE, Colorado
    GUS M. BILIRAKIS, Florida            JAN SCHAKOWSKY, Illinois
    BILL JOHNSON, Ohio                   DORIS O. MATSUI, California
    LARRY BUCSHON, Indiana               KATHY CASTOR, Florida
    RICHARD HUDSON, North Carolina       JOHN P. SARBANES, Maryland
    TIM WALBERG, Michigan                PAUL TONKO, New York
    EARL L. ``BUDDY'' CARTER, Georgia    YVETTE D. CLARKE, New York
    JEFF DUNCAN, South Carolina          TONY CARDENAS, California
    GARY J. PALMER, Alabama              RAUL RUIZ, California
    NEAL P. DUNN, Florida                SCOTT H. PETERS, California
    JOHN R. CURTIS, Utah                 DEBBIE DINGELL, Michigan
    DEBBBIE LESKO, Arizona               MARC A. VEASEY, Texas
    GREG PENCE, Indiana                  ANN M. KUSTER, New Hampshire
    DAN CRENSHAW, Texas                  ROBIN L. KELLY, Illinois
    JOHN JOYCE, Pennsylvania             NANETTE DIAZ BARRAGAN, California
    KELLY ARMSTRONG, North Dakota, Vice  LISA BLUNT ROCHESTER, Delaware
        Chair                            DARREN SOTO, Florida
    RANDY K. WEBER, Sr., Texas           ANGIE CRAIG, Minnesota
    RICK W. ALLEN, Georgia               KIM SCHRIER, Washington
    TROY BALDERSON, Ohio                 LORI TRAHAN, Massachusetts
    RUSS FULCHER, Idaho                  LIZZIE FLETCHER, Texas
    AUGUST PFLUGER, Texas
    DIANA HARSHBARGER, Tennessee
    MARIANNETTE MILLER-MEEKS, Iowa
    KAT CAMMACK, Florida
    JAY OBERNOLTE, California
                                     ------

                               Professional Staff

                          NATE HODSON, Staff Director
                       SARAH BURKE, Deputy Staff Director
                   TIFFANY GUARASCIO, Minority Staff Director
                  Subcommittee on Oversight and Investigations

                          H. MORGAN GRIFFITH, Virginia
                                     Chairman
    MICHAEL C. BURGESS, Texas            KATHY CASTOR, Florida
    BRETT GUTHRIE, Kentucky                Ranking Member
    JEFF DUNCAN, South Carolina          DIANA DeGETTE, Colorado
    GARY J. PALMER, Alabama              JAN SCHAKOWSKY, Illinois
    DEBBIE LESKO, Arizona, Vice Chair    PAUL TONKO, New York
    DAN CRENSHAW, Texas                  RAUL RUIZ, California
    KELLY ARMSTRONG, North Dakota        SCOTT H. PETERS, California
    KAT CAMMACK, Florida                 FRANK PALLONE, Jr., New Jersey (ex
    CATHY McMORRIS RODGERS, Washington       officio)
        (ex officio)

                                 C O N T E N T S

                                  ----------
                                                                       Page
    Hon. H. Morgan Griffith, a Representative in Congress from the
      Commonwealth of Virginia, opening statement....................     1
        Prepared statement...........................................     4
    Hon. Kathy Castor, a Representative in Congress from the State of
      Florida, opening statement.....................................    17
        Prepared statement...........................................    19
    Hon. Cathy McMorris Rodgers, a Representative in Congress from
      the State of Washington, opening statement \1\.................    22
        Prepared statement...........................................    24
    Hon. Frank Pallone, Jr., a Representative in Congress from the
      State of New Jersey, opening statement.........................    28
        Prepared statement...........................................    30

                                   Witnesses

    Mary Denigan-Macauley, Ph.D., Director, Health Care, Government
      Accountability Office..........................................    33
        Prepared statement...........................................    35
        Answers to submitted questions...............................   112
    Charity Dean, M.D., Chief Executive Officer and Board Chair, The
      Public Health Company Group, Inc...............................    44
        Prepared statement...........................................    46
        Answers to submitted questions...............................   117
    Tracy Beth Høeg, M.D., Ph.D., Epidemiologist, Department
      of Epidemiology and Biostatistics, University of California-San
      Francisco......................................................    49
        Prepared statement...........................................    51
        Answers to submitted questions...............................   122
    Georges C. Benjamin, M.D., Executive Director, American Public
      Health Association.............................................    57
        Prepared statement...........................................    59
        Answers to submitted questions...............................   127

                               Submitted Material

    Inclusion of the following was approved by unanimous consent.
    List of documents submitted for the record.......................    92
    Letter of June 6, 2023, from Melanie Anne Egorin, Assistant
      Secretary for Legislation, Department of Health and Human
      Services, to Mrs. Rodgers......................................    93
    Article of July 4, 2020, ``Lessons unlearned: Four years before
      the CDC fumbled coronavirus testing, the agency made some of
      the same mistakes with Zika,'' by David Willman, Washington
      Post...........................................................    97
    Report, ``Potential CDC Use Cases for Data''.....................   106
    Letter of April 5, 2023, from Ms. Miller-Meeks...................   107
    Article of June 3, 2021, ``Fact check: Missing context in claim
      about emails, Fauci's position on masks,'' by Rick Rouan, USA
      Today..........................................................   108

    ----------

    \1\ Mr. Guthrie presented Mrs. Rodgers' statement orally.

        LOOKING BACK BEFORE MOVING FORWARD: ASSESSING CDC'S FAILURES IN
                             FULFILLING ITS MISSION

                                  ----------

                            WEDNESDAY, JUNE 7, 2023

                      House of Representatives,
          Subcommittee on Oversight and Investigations,
                              Committee on Energy and Commerce,
                                                        Washington, DC.
        The subcommittee met, pursuant to call, at 10:31 a.m. in
    room 2322, Rayburn House Office Building, Hon. H. Morgan
    Griffith (chairman of the subcommittee) presiding.
        Members present: Representatives Griffith, Burgess,
    Guthrie, Duncan, Palmer, Lesko, Armstrong, Cammack, Rodgers (ex
    officio), Castor (subcommittee ranking member), DeGette, Tonko,
    Ruiz, Peters, and Pallone (ex officio).
        Also present: Representative Miller-Meeks
        Staff present: Sean Brebbia, Chief Counsel; Lauren Eriksen,
    Clerk; Tara Hupman, Chief Counsel; Peter Kielty, General
    Counsel; Emily King, Member Services Director; Chris Krepich,
    Press Secretary; Molly Lolli, Counsel; Gavin Proffitt,
    Professional Staff Member; John Strom, Counsel; Joanne Thomas,
    Counsel; Austin Flack, Minority Junior Professional Staff
    Member; Waverly Gordon, Minority Deputy Staff Director and
    General Counsel; Liz Johns, Minority GAO Detailee; Will
    McAuliffe, Minority Chief Counsel, Oversight and
    Investigations; Constance O'Connor, Minority Senior Counsel;
    Christina Parisi, Minority Professional Staff Member; Harry
    Samuels, Minority Oversight Counsel; Andrew Souvall, Minority
    Director of Communications, Outreach, and Member Services; and
    Caroline Wood, Minority Research Analyst.
        Mr. Griffith. The Subcommittee on Oversight and
    Investigations will now come to order.
        The Chair now recognizes himself for a 5-minute opening
    statement.

    OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE
             IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA

        Welcome to today's hearing to look back and to take stock
    of the recent performance of the Centers for Disease Control
    and Prevention, or the CDC. I speak for many of my colleagues
    when I say that the COVID-19 pandemic revealed that we did not
    have the CDC that we thought we had.
        Before I continue my remarks, I want to be clear: The
    COVID-19 pandemic was an immense challenge for public health
    agencies, healthcare providers, every level of government, and
    the American people. There were always going to be mistakes
    made, and we need to avoid the distortions of hindsight.
        I also believe there are many hard-working, talented
    doctors and public health experts working at CDC who want to do
    their part to keep Americans safe. One of my biggest
    frustrations, however, with the CDC is that, when you look at
    all of the talent, all of the scientific knowledge, technical
    resources, and immense funding that we have put into the
    agency, the end product is somehow less than the sum of its
    parts.
        It is reasonable for the American people to expect CDC to
    use the best available science when preparing guidance and
    recommendations. All too often during the pandemic, the CDC
    appeared to work backwards. The agency seemed to first decide
    its preferred policy outcome, whether that was universal
    masking, vaccine mandates, shutting down businesses, or school
    closures. Once the policy was decided, then the agency sought
    out data supporting that policy decision. Data that could
    undermine CDC's preferred outcome was either ignored or
    discounted in many cases, particularly if the data came from
    outside of the CDC itself.
        As we saw during the COVID-19 pandemic, the CDC's
    recommendations carry great weight. There is perhaps no better
    example of this than the process creating CDC's school
    reopening guidance. The damage wrought by school closures has
    been enormous and well-documented, and, fairly, I do not
    believe that my kids' education has recovered yet from these
    closures, even as we speak.
        The single biggest factor determining whether schools were
    in-person or remote was the political power of public school
    teacher unions. At a time when parents and school systems were
    desperate for accurate public health guidance, the CDC allowed
    the group most opposed to reopening to directly edit its
    finalized guidance. CDC Director Dr. Walensky was even forced
    to state on national television that her school reopening
    statements many took as a CDC position--that she made them and
    they were given in a personal capacity, not as the CDC
    Director. As best I can tell, this was the only time that she
    spoke in a personal capacity on an issue related to CDC
    guidance while she was agency Director.
        In addition, when the Department of Labor issued its
    nationwide vaccine mandate for companies with 100 or more
    employees in November of 2021, it cited CDC science and
    guidance more than 80 times to justify the mandate. At the time
    the mandate was issued, there was a growing body of evidence,
    largely ignored by the CDC, indicating that vaccines did not
    stop the transmission of the disease. Thankfully, the Supreme
    Court struck down this mandate after only 2 months, ruling that
    it was unconstitutional.
        The CMS vaccine mandate for healthcare providers, which
    only ended on May 1st of this year, also relied heavily on the
    CDC, citing the agency over 50 times. Thousands of healthcare
    workers who were heralded as heroes during the early months of
    the pandemic lost their jobs, in part because of CDC's
    reluctance to admit the limitations of the COVID-19 vaccines
    and failure to acknowledge that natural immunity can provide
    protection.
        The problems at CDC that led to the failures we saw during
    the COVID-19 pandemic are not new. The CDC made mistakes during
    its response to Ebola and Zika and other smaller, localized
    events. What differentiates the mistakes made during COVID-19
    was the scale of the emergency and the impact of those failures
    on the American people.
        It is appropriate that CDC's failures during COVID-19
    prompted the agency to conduct an internal review: the first
    step is admitting you have a problem. This review has now led
    to a reorganization that appears on its face to be extensive,
    but there is no way for us to tell without more information
    from the CDC.
        As a part of the reorganization, CDC has asked Congress for
    extensive legal authorities that would require State and local
    governments, pharmacies, hospitals, and other healthcare
    providers to report to the CDC health-related information. This
    has huge implications for privacy and for data security.
        In May, this committee wrote to Director Walensky
    requesting information and documents related to the review and
    the reorganization. Congress needs this information to
    understand and independently assess the CDC's reorganization.
    Congress is constitutionally entitled to this information.
        We did, however, receive--we did receive a four-page letter
    last night that mostly reflects what is already posted on the
    CDC website. It was not sufficient, however, and I hope the CDC
    will provide the complete documentation that we have requested
    in our letter, and that they will get that to us in short
    order.
        In closing, until we get full cooperation, the CDC's
    request for new legal authorities cannot and will not move
    forward.
        In today's hearing, we will hear from witnesses who will
    help us explore what reforms are appropriate and necessary at
    the CDC.
        [The prepared statement of Mr. Griffith follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Griffith. And with that, I yield back and now recognize
    the gentlelady from Florida, the ranking member, Ms. Castor,
    for her 5-minute opening statement.

      OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN
                   CONGRESS FROM THE STATE OF FLORIDA

        Ms. Castor. Well, thank you, Mr. Chairman. Good morning.
    Thank you to the witnesses for being here.
        In the 5 months since the start of the Republican majority
    here in the House, this subcommittee has held several hearings
    that seem geared more toward undermining public health and the
    professionals working to protect our neighbors than
    constructive oversight and improvements to public health
    partnerships. This is concerning for many reasons. It
    irresponsibly ignores the lessons from the COVID-19 pandemic,
    which took the lives of over 1 million Americans, and
    diminishes the importance of a strong public health network
    across America.
        The pandemic exposed weaknesses and inefficiencies in our
    existing infrastructure that put us at a disadvantage to
    adequately respond from the start.
        We also saw firsthand how the COVID-19 crisis was further
    fueled by then-President Trump's early insistence that the
    virus was not serious, a message that contradicted what health
    officials were seeing on the ground. During a critical period,
    we lost time that we couldn't afford in getting a handle on the
    size and the scope of the deadly pandemic.
        Disinformation also ran rampant. In my home State of
    Florida, Governor DeSantis and his administration spread
    disinformation often, and vilified scientists who were
    recommending ways to protect everyone from the deadly virus.
    The State withheld and censored data on nursing home infections
    and deaths, overall mortality data, and other valuable
    information. This caused confusion at the local, State, and
    Federal level. And unlike many other States, many more
    Floridians died after the vaccine was widely available, due to
    misinformation.
        So how can public health officials combat a pandemic if
    political leaders are actively undermining their efforts to
    protect and inform the public? These are the sort of historical
    facts that cannot be ignored when we assess the government
    response to COVID-19 and set priorities moving forward.
        Federal health agencies are our first line of defense
    against the next threat, and we need to take an honest,
    holistic look at their responses to public health challenges.
    For example, in recent hearings with leaders of the Federal
    health agencies, they have told us that preparedness needs to
    be a centerpiece of future plans. Even today, we are using our
    knowledge from COVID-19 to monitor and respond to impacts as
    cases tick back up.
        Everyone acknowledges that improvements are needed. The CDC
    took initiative to conduct an internal review and is pursuing a
    Moving Forward plan aimed at making the agency more resilient
    and accountable to the American people. If you are a critic of
    the CDC for its response to COVID-19, this should be a welcome
    development. I certainly look forward to hearing more as this
    reorganization continues, and I appreciated the bipartisan
    visit to CDC headquarters in Atlanta last year, where we
    discussed needed improvements.
        In addition to the descriptions of the improvement process
    on CDC's website, CDC has also provided a letter that I would
    like to include in the record describing in more detail just
    how thoughtful and extensive their efforts have been.
        Hundreds of employees have participated, and they have
    provided feedback, they have been briefed. In short, CDC
    continues to apply the hard lessons learned, and we must
    support that effort.
        I also want to take this opportunity to thank outgoing CDC
    Director Dr. Walensky for her tireless work under incredibly
    challenging conditions. She inherited a terrible situation.
    When she took office, there were nearly 100,000 COVID-19
    hospitalizations per week and 25,000 deaths per week. We are
    now under 10,000 new hospitalizations per week and 500 deaths
    per week. Schools reopened safely under her watch. Despite
    politicization and misinformation, Americans got vaccinated. I
    thank her and the dedicated public servants at CDC who work
    hard every day to keep us healthy.
        Last month, CDC Director Walensky testified before the
    Health Subcommittee and further detailed the reorganization
    initiative, saying it aims to eliminate bureaucratic reporting
    layers, break down silos in the agency, promote foundational
    public health capabilities, and improve accountability at CDC.
        But the CDC cannot do it alone. The Congress must step into
    its role to improve the Nation's public health. That includes
    investing in data modernization we need at the local level,
    improving CDC's ability to collect and act upon timely and
    complete health data.
        We will not be successful if Republicans in Congress
    continue to target public health for large budget cuts. I am
    deeply disappointed that House Republicans insisted upon
    rescinding funds for public health efforts in exchange for not
    destroying the U.S. economy last week. This rescission of funds
    only worsens the challenges we face in protecting the health
    and safety of our neighbors. These are not the challenges my
    colleagues claim they want to solve. They cannot have it both
    ways.
        The Biden administration and Democrats in Congress,
    however, will remain focused on providing public health
    institutions the necessary support and resources they need to
    be more prepared and responsive to public health challenges.
        [The prepared statement of Ms. Castor follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Ms. Castor. Thank you, and I yield back my time.
        Mr. Griffith. The gentlelady yields back. I now recognize
    Mr. Guthrie for a 5-minute opening statement. He is Chair
    Rodgers' designee this morning.

          OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
        REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

        Mr. Guthrie. Thank you, Chair, for yielding. I appreciate
    everyone for being here today.
        In today's hearing we will focus on understanding the scope
    of what is wrong at the CDC so that we can begin to fix it.
    This is not about villainizing the CDC; it is about
    accountability--accountability for children kept out of school
    who are dealing with mental, social, and emotional health
    issues; small business owners who watch their life's work dry
    up; for people who lost their jobs because of vaccine mandates.
        The CDC's response to the COVID-19 pandemic created a
    crisis in confidence in the agency. The pandemic made it
    overwhelmingly clear that the CDC has serious foundational
    problems in the roots, in many cases spanning multiple
    administrations.
        From the start of the pandemic, it was clear how
    challenging the novel coronavirus would be to contain, which
    was made even more difficult because of how unprepared CDC was
    to respond to the emerging threat. No doubt that a virus as
    transmissible as SARS-CoV-2 was always going to be difficult.
    But in the earliest days of the pandemic the CDC's faulty test
    kits set us back. Without testing, we cannot effectively slow
    the spread of the virus when cases amounted to just a few
    numbers.
        People also counted on the CDC to provide timely and clear
    guidance based on the best available science to keep themselves
    and their loved ones safe. Yet, time and again, CDC's guidance
    failed to meet this expectation and instead consistently issued
    guidance that lacked clarity and the best available science.
        More consequentially, CDC's guidance reflected the agency's
    preferred policy outcomes or political considerations. At its
    worst, CDC released guidance that was influenced by teachers'
    unions and was a significant signal to States that they weren't
    fully confident in the schools' ability to return to school
    safely, despite earlier versions of the guidance suggesting
    otherwise. Our children are paying a terrible price
    academically, physically, and emotionally for the CDC's
    shortcomings.
        Bad science and CDC guidance, when used to justify
    mandates, destroyed lives.
        CDC public communications on COVID-19 vaccines were just as
    bad. Simply put, CDC overpromised when it should have known
    better. CDC's leadership told the public that vaccines
    prevented transmission, while the agency was streaming reports
    of breakthrough infections among the vaccinated. CDC downplayed
    the existence of adverse events while it was receiving reports
    of postvaccination myocarditis in young men.
        The CDC's decades of experience running mass vaccination
    programs should have prepared it to manage the administration
    of COVID-19 vaccines. The CDC knows only 30 to 40 percent of
    people get an annual flu shot. That vaccine hesitancy did not
    just begin with the COVID-19 vaccine.
        It is going to be a long road to rebuild the trust, and the
    agency cannot go it alone. Many of CDC's COVID-19 failures have
    their roots in longstanding problems at the agency. The CDC
    needs to address its failures with openness and, frankly,
    humility. I am deeply worried that CDC's insular, academic
    culture will prevent it from learning the right lessons.
        Outgoing Director Walensky launched a reorganization at
    CDC. Whether it survives her departure is unclear. Whether the
    reorganization would address CDC's foundational problems is
    also unclear.
        This committee intends on conducting oversight to ensure
    the agency gets back on track. The CDC still hasn't provided
    this committee with the information needed to independently
    assess the reorganization. As Chairman Griffith noted, in a
    conclusory letter sent to us the night before, a hearing isn't
    sufficient. But I do look forward to obtaining more details
    from the agency about this restructuring plan in the coming
    weeks.
        I will close by noting that Congress is not without blame
    for the current state of CDC. CDC has never been authorized.
    Congress has never, in a single voice, told the CDC what its
    mission is and is not. This must be fixed. This committee's
    majority is committed to working on CDC reform.
        Today's hearing, Dr. Miller-Meeks, and our ongoing
    oversight of CDC's--Dr. Miller-Meeks' request for information,
    and our ongoing oversight of CDC's reorganization are the first
    steps towards getting the agency back on track. In addition to
    this work, I look forward to our Health legislative hearing
    next week to reauthorize immediate preparedness and response
    programs.
        It is critical we come together to assure the American
    people the Federal Government is equipped for the immediate
    response for all types of public health hazards, such as a
    pandemic or a chemical, nuclear, radiological, biological, or
    cyber attack.
        [The prepared statement of Mrs. Rodgers follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Guthrie. Thank you to our witnesses. I look forward to
    your testimony, and I yield back.
        Mr. Griffith. The gentleman yields back. I now recognize
    the ranking member of the full committee, Mr. Pallone, for his
    5-minute opening statement.

    OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
                IN CONGRESS FROM THE STATE OF NEW JERSEY

        Mr. Pallone. Thank you, Mr. Chairman. Let's call this
    hearing what it is, an opportunity for committee Republicans to
    criticize the work of the Centers for Disease Control and
    Prevention during the COVID-19 pandemic without them being
    here.
        CDC Director Walensky testified before this subcommittee in
    February, along with leaders of the other key public health
    agencies. She then testified before the Health Subcommittee
    last month. And while I appreciate the witnesses for being here
    and look forward to their testimony, if Republicans were really
    interested in conducting oversight of the CDC, they would have
    invited the CDC to be here today.
        Now, the COVID-19 pandemic was an unprecedented challenge
    for the Nation. From the outset, there was uncertainty and
    confusion and a total lack of leadership.
        If we are going to take a look back, let's start by going
    back to the beginning of the pandemic and looking right at the
    top: then-President Donald Trump. We all remember him
    repeatedly casting doubt about the dangers of COVID-19 right
    from the start. In January of 2020, Trump said that it was
    ``one person coming in from China, and we have it under
    control, it is going to be just fine.'' He praised the efforts
    of the Chinese Government, saying, ``It will all work out well.
    In particular on behalf of the American people, I want to thank
    President Xi.'' At the end of February 2020, he said that cases
    would ``be down to close to zero,'' and that ``one day it is
    like a miracle, it will all disappear like magic.''
        He publicly promoted hydro--what is it--hydroxychloroquine
    as a treatment. I remember that. Maybe the Republicans have
    forgotten that one. He asked whether disinfectant could be
    injected. He pondered whether UV light inside the body would
    cure people. Then, in June, when the virus was killing hundreds
    of people every day, he said, and I quote, ``It is fading away,
    and the numbers are starting to get very good.'' He admitted
    that--he quoted again, ``said to my people, 'slow the testing
    down, please, slow the testing down.'''
        Now, that is just a small sample of the antiscience
    misinformation that President Trump spread during the first
    years of the pandemic. This misinformation seriously undercut
    our public health institutions, including the CDC, who were
    doing difficult work under impossible circumstances with
    President Trump.
        And certainly, there are lessons to be learned, and CDC has
    acknowledged the need for reforms. It is implementing over 100
    recommendations that were developed based on the feedback of
    hundreds of CDC staffers and is also recognizing to be more
    efficient and responsive when facing future threats.
        Last month, the--Director Walensky further detailed the
    CDC's plans during her appearance before the Health
    Subcommittee. She said the agency's Moving Forward initiative
    aims to ``eliminate bureaucratic reporting layers, break down
    silos in the agency, promote foundational public health
    capabilities, and improve accountability at CDC.'' And we
    certainly look forward to hearing more from CDC as it continues
    that process.
        Now, the committee, I have to say, is also in the process
    of reauthorizing the Pandemic and All-Hazards Preparedness Act,
    the first opportunity to review PAHPA since COVID-19. It is
    clear that CDC needs additional authorities, including public
    health data authority, to be better prepared for the future.
        We also need to strengthen our drug and medical device
    supply chains, which have known vulnerabilities that would be
    exacerbated by another pandemic.
        But unfortunately, it seems the Republican majority is not
    interested in these approaches to better prepare for the next
    pandemic but instead is focused on tearing down public health
    institutions, and that is extremely disappointing. We should be
    working together to strengthen our Nation's health agencies for
    the future and enable them to institute reforms that will
    improve future pandemic response. So I am hoping we will be
    able to do that in the future.
        But it is clear that that is not the Republicans' goal
    right now. So I don't know what else to say. I mean, I
    certainly don't--I certainly want to hear from this panel, but
    the CDC should be here, and the idea that there were problems
    with the CDC, you know, just go back and look at what your
    President was doing that first year. I mean, I was listening to
    all this nonsense while he was President and supposedly dealing
    with this crisis, and all he did was make things worse. And I
    think a lot of people died and--because of the fact that he
    misinformed everybody about what was going on.
        [The prepared statement of Mr. Pallone follows:]
       [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Pallone. So with that----
        Ms. DeGette. Will the gentleman yield?
        Mr. Pallone. Yes, sure.
        Ms. DeGette. Thank you for yielding. I just want to also
    add the lack of cohesive leadership from the top, from the
    White House, added to preexisting issues at the CDC that were
    longstanding. And this committee, in a bipartisan way, has
    explored those for many years, and that led to the chaos.
        So we do need to move forward, but blaming it on the
    current CDC is just wrong.
        Thank you, Mr. Ranking Member, and I yield back.
        Mr. Pallone. Thank you, and I yield back, Mr. Chairman.
        Mr. Griffith. I thank the gentleman for yielding back, and
    in response to his question about the CDC being here, we will
    get to the CDC in due time. But they need to answer our written
    requests for documents and information in something other than
    just a thin, cursory statement and response, a superficial
    response, before we bring them in there--in here for a detailed
    oversight hearing.
        Today we are going to gather information. We are going to
    go forward and get the information that we can today and then,
    when we bring in the CDC, they will have the stage all to
    themselves to explain it to us. But first they have got to
    cooperate with this subcommittee and its jurisdiction.
        That being said----
        Ms. Castor. Mr. Chairman, I did have a unanimous consent
    request for----
        Mr. Griffith. You did, and we will get to that at the end
    of the hearing.
        Ms. Castor. OK, thank you.
        Mr. Griffith. Yes. Not ignoring you, just putting it to the
    end, where we do that.
        All right, I want to thank our witnesses for being here
    today and taking time to testify before the subcommittee.
        You all will have an opportunity to give an opening
    statement, followed by a round of questions from our Members.
        Our witnesses today are Mary Denigan-Macauley, director of
    public health, U.S. Government Accountability Office. We are
    going to have to get you a permanent seat here. You give great
    testimony, and we appreciate you coming in today to talk yet
    again about issues, but today's issues focused on the CDC.
        We also have Charity Dean, CEO and founder of the Public
    Health Company; Tracy Beth Høeg, epidemiologist,
    Department of Epidemiology and Biostatistics, University of
    California, San Francisco; and Georges C. Benjamin, executive
    director of American Public Health Association.
        We appreciate you all being here today, and I look forward
    to hearing from you all.
        As you are aware, this subcommittee is holding a oversight
    hearing and when doing so has the practice of taking our
    testimony under oath. Does anyone have an objection to--any of
    our witnesses have an objection to taking the testimony under
    oath?
        Seeing no objections, we will proceed.
        The Chair would also advise you that you are entitled to be
    advised by counsel, pursuant to House rules. Do you have a
    desire to be advised by counsel during your testimony today?
        Seeing that no one has requested that, if you all would,
    please rise and raise your right hand.
        [Witnesses sworn.]
        Mr. Griffith. Seeing the witnesses all answered in the
    affirmative, you are now sworn in and under oath and subject to
    the penalties set forth in title 18, section 1001 of the United
    States Code.
        With that, we will now recognize Mary Denigan-Macauley for
    her 5-minute opening statement.

     STATEMENTS OF MARY DENIGAN-MACAULEY, Ph.D., DIRECTOR, HEALTH
      CARE, GOVERNMENT ACCOUNTABILITY OFFICE; CHARITY DEAN, M.D.,
      CHIEF EXECUTIVE OFFICER AND BOARD CHAIR, THE PUBLIC HEALTH
       COMPANY GROUP, INC.; TRACY BETH HØEG, M.D., Ph.D.,
     EPIDEMIOLOGIST, DEPARTMENT OF EPIDEMIOLOGY AND BIOSTATISTICS,
        UNIVERSITY OF CALIFORNIA-SAN FRANCISCO; AND GEORGES C.
      BENJAMIN, M.D., EXECUTIVE DIRECTOR, AMERICAN PUBLIC HEALTH
                              ASSOCIATION

               STATEMENT OF MARY DENIGAN-MACAULEY, Ph.D.

        Dr. Denigan-Macauley. Thank you.
        Chairs Griffith, Guthrie, Ranking Members Castor and
    Pallone, and members of the subcommittee, thank you for the
    opportunity to discuss the Centers for Disease Control and
    Prevention reform efforts.
        In January 2022, we determined that HHS's leadership and
    coordination of our Nation's preparedness for and response to
    public health emergencies is in need of transformation, placing
    it on GAO's high-risk list. We made this determination based on
    a body of work that found persistent deficiencies for more than
    a decade in HHS's ability to perform its leadership role. These
    deficiencies, including those at the CDC, hindered the Nation's
    response to the COVID-19 pandemic and to a variety of past
    emergencies.
        In April we reported that CDC intends to undergo
    programmatic, scientific, and operational improvements to
    better support the agency's public health response during
    emergencies and in peacetime. We met with CDC to get more
    information about the reform efforts and to share GAO's leading
    practices for successful agency reform.
        These leading practices state that, while transformation to
    improve performance is no easy task and that it can take time
    to fully implement, agencies can successfully change when
    careful consideration is given to capacity, capabilities and
    essential change management practices such as the involvement
    of key stakeholders. We developed questions that Congress, CDC,
    and others can use to assess agencies' proposals for and
    implementation of reform efforts.
        For example, what is CDC trying to achieve with its
    proposed reforms, and who or which agencies should achieve
    them? Public health preparedness, as we all have seen, is not a
    capability held just at the CDC. It takes a whole-of-nation
    approach.
        To that end, how did CDC develop the proposed reforms, and
    what factors were considered? For example, to what extent did
    the agency consult with Congress; State, local, Tribal, and
    territorial jurisdictions; public health and private
    laboratories?
        How will the reforms address identified concerns, including
    GAO's concerns about clearly identifying roles and
    responsibilities; improving the completeness and consistency of
    data; ensuring clear and consistent communication; enhancing
    transparency and accountability; and understanding key
    partners' capabilities and their limitations?
        Further, what practices did CDC put in place to ensure the
    proposed reforms will succeed? For example, is there a
    dedicated implementation team that has the capacity?
        Do they have the staffing, the resources, and the
    authorities needed to manage the reform process?
        Has CDC developed a plan with key milestones and
    deliverables to track their progress?
        What considerations are given to the workforce? For
    example, to what extent has CDC conducted strategic workforce
    planning to determine whether it will have the needed resources
    and capacity, including the right people with the right skills
    to carry out the reforms now and in the future?
        CDC has acknowledged failures and launched a review to help
    the agency know what it needs to change. For example, CDC says
    that it needs to share science and data faster, it needs to
    translate science into practical policy, it needs to prioritize
    communications for the American public, it needs to develop a
    workforce ready to respond to future threats, and it needs to
    promote partnerships. But CDC has not detailed answers to the
    questions I posed for how it will carry out these reforms.
        These leading practices, importantly, along with sustained
    leadership commitment, are essential to helping ensure the
    country is better prepared for future public health
    emergencies. Leadership commitment is critical for initiating
    and sustaining progress and making the types of management and
    operational improvements required to narrow or remove it from a
    high-risk area.
        With Dr. Walensky leaving her post at the end of this
    month, it raises additional questions about leadership
    commitment for these reforms going forward. We encourage the
    next Director to engage with stakeholders to develop detailed,
    transparent, and accountable reform plans that close identified
    gaps and to work with Congress doing so, for is not a question
    of if but when the next public health emergency will occur. CDC
    has an opportunity now to learn from past mistakes so that it
    is better prepared for the future.
        Mr. Chairman, and Ranking Member, and distinguished members
    of the subcommittee, this concludes my prepared statement. I
    look forward to any questions you may have.
        [The prepared statement of Dr. Denigan-Macauley follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Griffith. I thank the lady for yielding back and now
    recognize Dr. Charity Dean for her 5-minute opening statement.

                    STATEMENT OF CHARITY DEAN, M.D.

        Dr. Dean. Thank you. Is my microphone on?
        Chairs McMorris Rodgers and Griffith, Ranking Members
    Pallone and Castor, and distinguished members of this
    committee, thank you for the invitation to be here today.
        I believe that, in order to prepare for future disease
    threats, we have a duty to conduct a rigorous assessment of our
    COVID-19 response. Even if it is painful, this thorough
    inventory then becomes a gift, a clear roadmap of what we must
    do now to meet future threats with strength, and that is
    something I have dedicated my life to: building system
    solutions to protect all Americans from public health threats.
        My experience as a local and State public health official
    has given me a unique vantage point which I have shared in
    other forums, including in Michael Lewis' ``The Premonition''
    as well as in ``Lessons From the COVID War,'' an investigative
    report of which I am a coauthor.
        The COVID-19 response was a massive systems failure across
    the whole of the U.S. public health system, including the CDC.
    I want to be clear: Our humans didn't fail, our systems failed.
    Our humans and our public servants gave it their all. This core
    failure was due to a lack of an intelligence and operational
    infrastructure capable of meeting the moment. Containment of
    biological threats, which must always be the first objective,
    is not possible without these twin capabilities. They would
    have enabled the United States to convert disparate, scattered
    data into reliable intelligence across both public and private
    sectors, enabling fast, unified, front-line decisions.
    Intelligence makes the invisible visible.
        I served as the local health officer for Santa Barbara
    County when the Disneyland measles outbreak struck in 2014. I
    received a panicked phone call that a toddler in a busy daycare
    center had a rash spreading down from their forehead. Their
    cousin had visited Disneyland just a few weeks before. Soon
    there were two cases in young children and exposures across
    three adjoining counties and a suspicious cluster in two other
    States. With measles, every hour matters. When a kiddo first
    develops the classic rash, they have already been contagious
    for 4 days, so we are 4 days behind. It is a race against time.
        Around-the-clock flurry of phone calls, emails, fax
    machines ensued with my tribe of local health officers, which
    now included more than five other States. My wall was covered
    in sticky notes with connecting locations and suspects and
    large exposure venues. We formed an ad hoc intelligence
    infrastructure, using tools essentially from the 1970s. The
    outbreak ultimately spread to seven States, Mexico, and Canada
    before we contained it.
        A college meningococcal outbreak had similar lessons. On a
    Saturday afternoon in 2013, I received a phone call alerting me
    to a college kid with what appeared to be meningococcal
    disease, a bacterial blood infection that goes to the brain and
    spreads fast among students. I immediately attempted to form an
    intelligence picture: How many kids were infected? Which dorm
    rooms? Which sports teams?
        Operating without much of a playbook of intelligence, I
    implemented a range of broad temporary measures all at once:
    canceled parties, sports, gave antibiotics. I enlisted the
    university, ERs, local businesses to find cases. We found more.
    By contrast, the CDC wanted to implement one mitigation measure
    at a time, like a controlled academic study. At the end of one
    long conference call with them, I was told I was alone in my
    decisions and response.
        The truth is, trust is the currency of public health. It is
    earned with honesty and transparency. It has little to do with
    government titles. To quote ``Braveheart,'' ``Men don't follow
    titles, they follow courage.'' Together with the university and
    community, we contained that outbreak. A few years later, CDC
    guidance was published with our approach as a model.
        I am not going to dwell on the COVID-19 story, as much ink
    has been spilled on that. Suffice it to say, I was the number-
    two doctor for the State of California. I experienced the same
    phenomenon yet again. We were all flying blind, relying on an
    antiquated public health system built on disconnected local
    nodes that are siloed from each other to meet a fast-moving
    21st century biological threat. To quote Edwards Deming, ``A
    bad system beats a good person every time.''
        In September 2020, I founded the Public Health Company out
    of a deep conviction that a new intelligence capability must
    exist, built on transparency and accountability. I believe that
    the core technology for this capability had to come not from
    government but from the innovation made possible by the private
    sector, with its advances in artificial intelligence and data
    streaming. Nearly 3 years later, we have now built from scratch
    commercial-grade software. Our company is venture capital
    backed, and we are honored to be supported by BARDA Ventures
    within ASPR.
        In closing, I want to emphasize my belief that the United
    States is still capable of solving hard problems. Solutions
    will require innovation, courage, and bold leadership. I am
    deeply grateful to every committee member here for your
    tireless efforts to that end. Thank you.
        [The prepared statement of Dr. Dean follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Griffith. Thank you. I now recognize Dr. Høeg
    for her 5 minutes.

            STATEMENT OF TRACY BETH HØEG, M.D., Ph.D.

        Dr. Høeg. All right, good morning. Thank you for the
    invitation to be here. My name is Tracy Beth Høeg. I am
    a practicing M.D. and Ph.D. epidemiologist currently in the
    Department of Epidemiology and Biostatistics at the University
    of California, San Francisco. And I am also affiliated with the
    University of Southern Denmark.
        I am a Danish-American dual citizen, and moved back to the
    U.S. from Denmark in 2015. I have coauthored 14 scientific
    publications related to the epidemiology and medical evidence
    during the COVID-19 pandemic, 13 where I was first or senior
    author. My own research and publication experiences during the
    pandemic led me to numerous eye-opening and disappointing
    revelations about the CDC.
        One of the most important questions--if not the most
    important question--as we look back on the pandemic is why,
    under the CDC's guidance, K-through-12 schools in the United
    States remained closed to in-person learning longer than any
    other high-income nations, with around a fifth of U.S. students
    out of in-person learning for an entire year.
        In the fall of 2020 I was the senior author of a landmark
    study published in the CDC's journal, MMWR, on COVID-19
    transmission in schools. My coauthors and I expected the
    findings of our study would be used to swiftly reopen the
    schools in early 2021, as our peer nations had done many months
    earlier. In line with research from Europe and our own country,
    we found remarkably limited transmission between students and
    none to teachers and staff during a time of high community
    disease prevalence among greater than 5,000 students and staff
    over a 14-week period.
        However, shortly after our study's publication, the CDC,
    under Rochelle Walensky, in spite of the scientific data,
    doubled down on the need for closures at high community
    transmission levels and the unproven need for 6 feet of
    distance in screening testing. When the school reopening
    guidelines were released, over 90 percent of the country was in
    the high transmission level, meaning the CDC recommended
    virtual learning for secondary schools that did not have access
    to screening testing programs and hybrid learning, with 6 feet
    of distancing for elementary students. This would keep as many
    as 90 percent of students in the U.S. out of either full-time
    school or any in-person learning.
        I thought the current administration, like Europe, believed
    in a progressive ideology which valued the education of the
    most vulnerable and disadvantaged in our society. So why were
    they putting up so many unproven barriers in their guidelines
    when it came to getting children back in the classrooms?
        And why did they not consult us, the authors of the study
    published on this very topic in their own journal? We could
    have told them we did not have a screening testing program, and
    greater than 90 percent of elementary students in our study
    were less than 6 feet apart, and children ate lunch without
    masks indoors.
        In fact, out of desperation to communicate with the CDC, we
    rapidly released a preprint outlining the simple circumstances
    under which the schools in our study stayed open. I eventually
    learned what was happening, that the CDC was consulting with
    the leaders of the U.S.'s two largest teachers unions over text
    messages up to the day before about exactly how the school
    reopening guidelines should be worded. It was not that I felt
    teachers should not be consulted, but that the science and
    anticipated harms of continued school closures were being
    ignored when they should have been the utmost priority.
        My second experience involved the downplaying and lack of
    sense of urgency about postvaccination myocarditis in young
    people, especially males, which I have published two harm-
    benefit analyses on and one additional publication. Briefly,
    the CDC's unwillingness to properly communicate and address
    this adverse effect among young, healthy people, especially
    those who had already been infected with COVID-19 for whom the
    benefit of vaccination was entirely unclear, demonstrated a
    greater commitment to partisanship than the health of our
    Nation's youth.
        My third example has to do with concerning publication bias
    within the CDC's journal, MMWR, when they refused in 2021 to
    publish a followup study that I and my coauthor did, looking at
    a study that was published in fall of 2021, which was a brief,
    2-week study which found a barely significant association
    between school mask mandates and a lower rise in pediatric
    cases in counties. When we expanded the study out to 6 weeks
    and included the remaining counties that had reopened the
    schools, we failed to find any significant association between
    the pediatric--between the school mask mandates and pediatric
    cases, and MMWR refused to publish the followup publication,
    which any journal should have readily published, considering
    that we found a reversal of the original findings.
        We did go on to get this published in the highly respected
    Journal of Infection, and one should bear in mind that what we
    found, the lack of correlation, was consistent with the highest
    evidence at the time, from randomized studies, that wearing
    masks in the community probably makes little to no difference
    in the outcome of laboratory-confirmed influenza or SARS-CoV-2.
        There is a desperate need for more scientific rigor within
    the CDC and MMWR and a transparent review process, including
    external peer review, to restore integrity of the journal.
    Whatever our political beliefs, we should all be deeply
    concerned about a national public health agency that chooses to
    publish, promote, and develop guidelines around politically
    favorable policies instead of the highest quality evidence.
    Thank you.
        [The prepared statement of Dr. Høeg follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Griffith. I appreciate it, thank you. Now I recognize
    Dr. Georges Benjamin for his 5 minutes of opening statement.

                 STATEMENT OF GEORGES C. BENJAMIN, M.D.

        Dr. Benjamin. Thank you, Mr. Chairman and Ranking Member
    Castor and members of the subcommittee. Thank you very much for
    allowing me to spend some time with you today. I am Georges
    Benjamin. I am the executive director at the American Public
    Health Association. I am in my 21st year. What that means is I
    am old, and it also means that I have had a chance, over not
    only the 20 years of being at APHA but also the many years of
    practicing public health in this community, both in D.C. and
    Maryland, in interacting with the CDC in a variety of roles.
        I have had the opportunity to advise both the agency and
    the Department of Health and Human Services, both in
    administrations--both the Republican and Democratic
    administrations. I have had a chance to support their efforts,
    and I have a chance--have had an opportunity to yell at them
    when I think they are not on track.
        I think that one of the things we have to be very careful
    about is the retrospective scope, which I think is a very, very
    powerful tool. It is a powerful tool because it allows you to
    go back and look at what happened in the past, and you want to
    be careful that you don't--you remember what decisions you made
    and what you knew when you made those decisions going forward.
    And I know we all know that, and I just wanted to say that.
        I also think that it is important that we understand that
    the politicization that has happened for public health is very
    destructive, and people die because of that destructive nature.
    The misinformation and disinformation that has occurred at a
    variety of levels has resulted in people, I believe, dying
    prematurely. And so we, as a collective--those of us doing
    policy, those of us on the advocacy world, those of us doing
    science--need to do a better job to bring that to an end as
    quickly as we possibly can.
        We live in a very, very rapidly changing health
    environment. COVID is transitioning to something else. We will
    figure out what that is when it tells us what it is about to
    do. We have been wrong on almost every single assumption that
    we have made with COVID, and I suspect we are still going to
    learn some things.
        But just to remind you that we still have an obesity
    epidemic, we still have an opioid epidemic, we still have an
    epidemic of firearms and premature death from injury from
    firearms, we have the opportunity to finally get our hands
    around HIV AIDS, to finally get the opportunity to stamp out
    hepatitis C. We have a growing STD epidemic, and I remind you
    we now have the return of babies with syphilis, which we used
    to think was very, very uncommon. And we have the return of
    vaccine-preventable diseases.
        Dr. Dean's experience in southern California is just the
    tip of the iceberg of what we should expect as we look at what
    is going forward with vaccines and vaccine hesitancy in our
    country.
        My point is that we need a very, very strong CDC if we are
    serious about that. It is the only agency within the Department
    of Health and Human Services that does what it does. It has
    historically done it very, very well. That does not mean that
    they are perfect. It does not mean that they are not perfect--
    or that they are perfect. They are not.
        So going forward, let's talk about what they need. They
    need data. Public health is fundamentally a data-driven
    science. Without data, we can't make data-driven decisions. And
    we need to end the practice of being data archaeologists.
        We need a health information technology system. The fact is
    that I can get food right now on my phone in DoorDash in this
    room, but I can't get my EKG. We need to fix that.
        We need to strengthen the public health workforce. We have
    a huge vacancy level in public health, even though--thank you
    very much--the funding that you have given under the Recovery
    Act certainly has gone to help public health, but we still have
    lots of vacancies, and we need to fix those.
        We need--CDC needs budget flexibility. Their budget is
    extremely rigid, and they are unable to do a lot of the things
    that I was able to do as a State and local health officer.
        Clearly, public health needs adequate and sustainable
    funding. This yo-yo funding has to end, where we put in a lot
    of money in when something bad happens--often it comes a little
    late, not quite enough--and then we take it away too quickly.
    And you can't build a system like that. In fact, none of you
    would tolerate that for the Department of Defense.
        And CDC needs external supports. You have heard from, I
    think, every one of these witnesses how important it is to have
    this as part of a system.
        And we need to finally, once and for all, build a sound
    public health system in our country.
        With that, I will stop and thank you very much, Mr.
    Chairman and Ranking Member.
        [The prepared statement of Dr. Benjamin follows:]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Griffith. Thank you very much. I appreciate your
    testimony. I appreciate all the witnesses' testimony. I will
    now begin the question-and-answer portion of our hearing, and I
    will recognize myself for 5 minutes.
        Dr. Benjamin, I would agree that making this issue into
    the--into a political football will not help us. It will
    distract us from our job. It is true early on President Trump
    made statements that turned out to be in error. It is also true
    that then-candidate Biden made statements that turned out to be
    in error. What we need to do is to get answers from the CDC, so
    we can figure out what went wrong, what went right, and what we
    can do to move forward appropriately.
        Dr. Denigan-Macauley, I heard in your opening statement
    that, just like this committee, you are having a hard time
    getting answers out of the CDC. Is that correct, yes or no?
        Dr. Denigan-Macauley. Yes.
        Mr. Griffith. And do you feel that the lack of being able
    to get these answers has impaired your ability to give us an
    assessment of whether or not this reorganization is going to
    help solve problems or not?
        Dr. Denigan-Macauley. We do need more information.
        Mr. Griffith. All right, and I appreciate that, and I agree
    with you. All of us need more information if we are going to
    try to make this not a political football but something where
    we are just trying to get to the facts, as Jack Webb would have
    said many years ago. ``Just the facts.''
        All right, Dr. Høeg, I got to tell you, I appreciate
    your testimony, very concerned. And as I said in my opening
    statement, I don't think my kids have yet recovered. The
    schools in my district were scared that if they didn't follow
    the CDC guidelines they would be sued. I talked to a number of
    them, and that is what I was told behind the scenes: ``Well, we
    don't know that--we think we can do it, but if we do it our
    lawyers tell us we are in jeopardy.'' And so they kept them--
    they closed them, and then they kept them closed for longer out
    of fear of reopening because the CDC guidelines about reopening
    came out, and they did not reflect, as you said, science.
        Did they--I mean, they clearly ignored your studies. They
    clearly wouldn't publish your peer-reviewed paper in their
    flagship journal, The Morbidity and Mortality Weekly Report. To
    your knowledge, did they--to any extent did they consider the
    science, the studies, the reports that were out there showing
    that, among school-aged children, social distancing and
    transmission rates were fairly low, if existing at all?
        Dr. Høeg. So we had data very early on from Europe
    from already June of 2020 that--comparing Finland to Sweden--
    that reopening or having schools closed did not have any impact
    on community transmission of the disease. And we had similar
    investigation from the Centers of Global Education and
    Development that they found, similarly, with all of the
    countries that reopened their schools, which was most of Europe
    in the spring of 2020, that there was no correlation between
    opening and increase in community disease spread.
        And so I think that we really--you know, the CDC really
    failed for quite a long time to look at the data coming out of
    Europe, which, you know, not only considered the very low
    transmission that we were seeing in schools but also considered
    the effects, the long-term effects and the collateral damage,
    of keeping the schools closed.
        And many private schools were open. I was the advisor for a
    large diocese in Sacramento, where we reopened the schools
    actually based on the data out of Europe in the fall of 2020.
    And we were able to keep them open the entire year and had a
    very successful year. And it is very sad that schools,
    especially public schools, especially inner-city schools,
    defaulted to the CDC for their guidance, when the CDC was
    really--you know, they were--well, we know that they--now--that
    they were basing, at least in February of 2021, their
    guidelines on the teachers unions, what the teachers unions
    wanted, rather than the science that had been accumulating for
    months out of Europe and our own country, also from our own
    daycares.
        And so it is really tragic, what happened to American
    children. And I do view it as a result of politicization and
    schools relying on the CDC and defaulting to them, and it hurt
    our Nation's children.
        Mr. Griffith. And it wasn't just the inner cities. It was
    also the rural schools and everywhere that you have any
    disadvantaged children, because what I have done for my kids is
    we have brought in tutors, and they are catching up. I don't
    think they will ever get fully recovered for that lost year,
    but they are catching up. But most families can't afford to
    bring in tutors one or two times a week to try to get that--
    particularly in our family, math--to get that math skill back
    to where it ought to be if they had been in the classroom.
    Would you agree with that? Yes or no, because I am running out
    of time.
        Dr. Høeg. Yes, I agree with that, yes.
        Mr. Griffith. All right. And because I am running out of
    time, I am just going to make this next one simple. It is not
    just the learning. It is also the mental health, is it not?
        Dr. Høeg. Absolutely.
        Mr. Griffith. The socialization, the lack of socialization.
    And for kids that are already in trauma, not having that
    security of going to see their friends at school, not being
    able to have interaction with their teachers who love them--
    teachers are great--is a mental health crisis in and of itself,
    is it not, yes or no?
        Dr. Høeg. Absolutely.
        Mr. Griffith. I have to yield back. I yield back and now
    recognize Ms. Castor, the ranking member, for 5 minutes of
    questions.
        Ms. Castor. Well, thank you, Mr. Chairman. I think everyone
    agrees with Dr. Benjamin. We need a strong CDC. And as we
    transition out of the public health emergency, we have just got
    to make sure that our public health partnerships across the
    country have the tools necessary to protect our neighbors and
    ensure they are healthy and well.
        And I think I see a common thread in what a lot of you are
    saying: We need to have the most accurate, thorough, and timely
    data to inform the guidance. We need to be able to detect
    disease in real time, stamping out problems before they grow.
        I know the GAO, one of your top recommendations, data are
    critical to inform the response to a public health emergency.
    However, the data HHS relied on during COVID-19 were incomplete
    and inconsistent, highlighting longstanding concerns there.
    Public health data are collected by thousands of disparate
    health departments, healthcare providers, and laboratories, as
    well as multiple agencies.
        But Dr. Benjamin, as you state in your testimony, you
    watched in horror as rural communities, hospitals, skilled
    nursing centers tried to send data via fax machine. It is
    completely outdated. So the Congress responded, and we provided
    some emergency authorities to CDC and some funds to modernize.
        But now, as the public health emergency expires, those
    emergency authorities expire. That is why I have reintroduced
    the Improving Data and Public Health Act with Congresswoman
    Lauren Underwood to promote data sharing and modernization, to
    better identify, monitor, and respond to public health
    emergencies.
        So how would--Dr. Benjamin, talk to us about the outdated
    nature of data gathering across the country and how a more
    modern system would improve the result.
        Dr. Benjamin. You know, the--thank you very much. The truth
    of the matter is that, when I was the deputy health officer in
    Maryland in the mid-1990s, we were sending information by fax
    machine, and we are still doing it. And the problem with that
    is that the person that fills it out fills it out by pen and
    ink, they put it in the machine, it goes off to another place,
    and then you suddenly realize the data set is incomplete. Now
    you have got to go back and track and find the person who
    filled out the data. And we have just far too much of that.
        And, you know, look, Congress did invest after 9/11 and the
    anthrax letters funding for public health. The problem was
    obsolescence kicked in. We didn't keep the funding up.
        We were just talking a little earlier that, you know,
    college today is a--used to be a one-computer experience. Now
    it is a two- or three-computer experience for your kids, just
    because the technology changes so quickly. And we have not done
    that, we have not built a data information technology highway.
    We don't have a single patient identifier. We don't know that
    Dr. George Benjamin in one system is the same George Benjamin
    in another data system.
        I know there are concerns about patient privacy and the
    data being misused, but the bank gets your data, other systems
    get your data. The proof of concept we had during COVID was
    that it worked. And I think you have heard from all of us that
    the importance of--how important that data is.
        Ms. Castor. So you can deidentify personal identification
    of people, but it is important to collect all sorts of
    information on age and health disparities. Isn't that right?
        Dr. Benjamin. Yes, most of the time--and we can divide it
    up in many ways, but most of the time what CDC needs is to know
    whether it is going up, down, and whether or not the numbers
    are not duplicative. And so there are systems that can do that.
    And you can--the box can make that happen for you. We have--the
    data systems are ready to do it. This is not new technology.
        Ms. Castor. But it is not standardized. So----
        Dr. Benjamin. It is not even standardized.
        Ms. Castor. So that is a very significant problem. Talk
    about that a little bit.
        Dr. Benjamin. Yes, the fact that just the data that comes
    from one hospital to another hospital from a health department,
    you may not be all sitting in the same data set. Those of you
    who have looked at your lab tests when you have gone to the
    doctor, you will know that sometimes they are not the same.
    They don't get reported in the same way. And that is a problem,
    particularly when you are using electronic systems which use,
    you know, zeros and ones, the system will misinterpret what it
    is getting.
        Ms. Castor. So where would you rank improving data
    reporting and giving CDC the authority to standardize things
    across the country in our toolbox as we move to improve the
    CDC?
        Dr. Benjamin. I think it is a tool that is number one. I
    think, from a functional perspective, I have another issue. But
    for--in terms of data, data is at the top of my list.
        Ms. Castor. Thank you very much. I yield back.
        Mr. Griffith. The gentlelady yields back. The Chair now
    recognizes the chairwoman of the full committee, Mrs. McMorris
    Rodgers.
        You are now recognized.
        Mrs. Rodgers. Thank you. Thank you, Mr. Chairman. Before I
    begin, I need to respond to what the ranking member said in his
    opening statement.
        I am extremely disappointed that he and others on this
    committee have decided to make this hearing political about the
    former President, about scoring political points, not about
    serious reforms.
        If you want to look at bad decisions, the number-one
    mistake was blindly following Dr. Fauci, who was so focused on
    COVID-19 that he refused to think about every other aspect of
    public health to the detriment of our children, our economy,
    our country.
        We have already had CDC Director Walensky in front of this
    committee, even in the last 5 months. And then Ranking Member
    Pallone did not--did in the last--we have had her more in front
    of the committee this Congress than in the last Congress, when
    the Democrats were setting the agenda and refusing to have her
    come up here and talk about monkeypox or COVID.
        We on this--we celebrate this committee. This is a serious
    committee that does the hard work necessary to legislate. And
    we have shown that by moving complicated legislation on privacy
    and reducing healthcare costs, when we come together, we can do
    the hard work necessary to legislate.
        Why should examining existing agencies be any different?
    CDC has never been authorized, never. And now CDC has broken
    the trust of the American people.
        To be an effective public health agency, the American
    people must be able to trust and understand what is coming out
    of CDC, and why.
        Like the chairman said, I had numerous conversations with
    Dr. Walensky during COVID, and I was impressing upon her that,
    at the local level, the school districts, my communities
    believe there should be a different approach to COVID, to the
    mask, to lockdowns of our schools, our kids being locked down
    in schools. And yet--and she said, ``Oh, Cathy, these are
    guidelines. These are not mandates. These are guidelines.''
    Well, at the local level, they were mandates. And she said they
    shouldn't even be at the State level. Washington State was
    locked down until the spring of 2021.
        Unlike CDC's closed-door Moving Forward initiative, this
    hearing is the start of our effort to focus on public and a
    transparent process to understand what Congress should be doing
    to make needed reforms, because that is our role as the elected
    representatives of the people. That is our constitutional
    responsibility. And it includes authorizing the committee--or,
    the agency giving direction and guardrails.
        I am not interested in blindly following CDC and saying
    that, yes, they need more money, they need more authority, and
    we are just going to say yes to that. The American people rely
    on us to know how to make decisions or to know how decisions
    are made. They are relying on us to know how decisions are
    made--how decisions are made at the CDC, how the priorities are
    set. The American people are relying on us to ensure that it is
    a transparent process. And certainly, before we give them more
    authority and money we, as the elected representatives of the
    people, need to ensure that we are fulfilling that
    responsibility.
        So I hope that this committee and all the members of this
    committee that I greatly respect and admire will come together.
    Let's do our job. Let's improve CDC, and let's make sure that
    the tone is not one that is about scoring political points, OK?
        Yes, and we do have a disagreement over the data, and the
    amount of data that we should just be handing over to CDC. So
    under CDC they are requesting right now sweeping legal
    authority to require State and local governments, as well as
    hospitals, pharmacies, doctor's offices to report health
    information to them if requested. In my opinion, this is
    dramatically changing the current Federal-State public health
    relationship, and I am deeply troubled by CDC's inability to
    articulate any limitations on how they would or would not use
    this authority.
        We know that people were being tracked during COVID-19. We
    know that. And we are working on a privacy legislation right
    now because we believe that individuals--I think that there is
    a shared belief among Republicans and Democrats that
    individuals need to own their personal data, and we need to
    have privacy protections in place.
        There is a lot more to do on this issue. There's a lot more
    questions to ask of CDC. My plea to my colleagues on the other
    side of the aisle is let's do this together. We are the elected
    representatives of the people.
        I yield back.
        Mr. Griffith. The gentlelady yields back. The Chair now
    recognizes Representative Pallone, the ranking member of the
    full committee, for 5 minutes for questions.
        Mr. Pallone. Thank you, Chairman. You know, I respect all
    of you on the other side of the aisle, but I am so frustrated
    because I really don't know how we proceed here anymore.
        The ranking member criticized Dr. Fauci, who I greatly
    respect and think was one of the best things we had during the
    COVID crisis, OK?
        Chairman Griffith said that President Trump's statements
    were in error, but the President doesn't admit his errors. Many
    of his supporters continue to insist that COVID was a
    conspiracy, vaccines shouldn't be taken, masks shouldn't be
    worn, schools shouldn't have been closed in certain
    circumstances. I don't know how we can make improvements at the
    CDC when we fundamentally disagree on almost everything that
    happened during the COVID crisis.
        We--you know, we talk about data--and I am going to ask you
    questions, Dr. Benjamin, about the data--but the bottom line is
    that we look at the same data and come to totally different
    conclusions about what to do. So I don't know where we are
    going here. I mean, I love you on the other side of the aisle,
    but I really don't know how we proceed when we have such
    disagreements over fundamentally what happened during the COVID
    crisisS and how to deal with it in a new way. I just don't see
    it.
        I--you know, I am an advocate for vaccines. I think
    everyone should take the vaccines. I think that COVID was real.
    I think masks should have been worn in many circumstances. I
    think some schools should have been closed. I don't--I just
    don't know.
        And I, you know, the--Chairwoman Rodgers, it is just so
    frustrating because I don't know how we can proceed with such a
    disagreement on everything even though we look at the same
    facts.
        But in any case, let me ask a question. Everything that the
    CDC does depends on good data. It needs to have accurate,
    timely health data from State and local partners to determine
    an appropriate response to health crisis. It informs the
    guidance that CDC will put out to support State and local
    healthcare institutions, so the data has great value for the
    CDC and health officials across the Nation.
        But at the same time, through reauthorization of the
    Pandemic and All-Hazards Preparedness Act, Congress has the
    opportunity to support sensible reforms and further ensure that
    our Nation's public health agencies, including CDC, have the
    necessary authority and resources to respond to future threats.
        So let me start out with Dr. Benjamin. I have two
    questions, if you can do them both in this--whatever time is
    remaining here. How would better data enable CDC to keep up
    with persistent health threats the Nation faces?
        And secondly, would giving our health institutions like CDC
    and FDA broader authority to address issues like drug shortages
    and data transparency help our pandemic response abilities?
        Those are separate questions, but you have got 2 minutes.
        Dr. Benjamin. Yes, speed and efficiency. We missed opioids
    when we had, you know, thousands and thousands of doses of
    opioids going into communities and nobody paying attention
    because the data wasn't timely. You heard the measles story.
        I am sitting at home during COVID, head of the Public
    Health Association. My phone rings, and the health officer in
    Milwaukee, Wisconsin, calls me to tell me that she has seen a
    disproportionate number of African-American men dying of COVID.
    That is how I found out there was a disparity occurring. I
    assumed it was occurring, but it was the first evidence that I
    had was a phone call to my home from a member of the American
    Public Health Association who wanted me to fix it at, you know,
    9:00 at night. And that should not happen. And CDC was
    struggling to get that kind of disparity data. So time and
    efficiency--speed and efficiency are the two things you get.
        Mr. Pallone. And what about the authorities? I mentioned
    about the--giving CDC and FDA broad authority to address drug
    shortages and data transparency.
        Dr. Benjamin. No, I think it is essential, and I understand
    there is a difference of opinion there, but I think we can do
    it. I think we can sit in the room, we can figure out how to do
    that in a way that protects patient confidentiality, increases
    speed.
        Look, we give the banks a whole lot of latitude, and they
    have a lot of information on us. Google has a lot of
    information on us. You know, the social media companies have a
    lot of information on us. And I know you are struggling with
    that, as well, but I don't see why you can't come up with a way
    to do this. Maybe ask for a study. You know, put the, you know,
    the authority in the law when you reauthorize the law but
    require some kind of study in order to understand how best to
    implement that before it gets implemented. I don't know, but
    I----
        Mr. Pallone. Well, you are a lot more optimistic than I am
    at this point--I got to be honest with you--about our ability
    to come together and address some of these concerns. But hope
    springs eternal.
        Dr. Benjamin. We don't have a choice. And I am just going
    to, you know, to argue here today we have to solve this. We
    cannot wait. People are dying, literally, while this is
    happening because we don't have the numbers, we don't have the
    data.
        And I think we--I can see a solution here. And I can tell
    you that there are many of us who will be eager to sit down
    with you to try to figure that one out.
        Mr. Pallone. Thank you. Thank you so much. I yield back.
        Mr. Griffith. The gentleman yields back. I now recognize
    Dr. Burgess of Texas for his 5 minutes of questioning.
        Mr. Burgess. Thank you, Mr. Chairman. Boy, I wish we had
    had Dr. Dean and Dr. Høeg at the Office of Attending
    Physician a few years ago.
        We had a microcosm here, if you will, in the United States
    Capitol. The House of Representatives was required to mask
    before we could go into the Capitol and sit on the floor
    masked, and the United States Senate was not. Well, wait a
    minute, COVID--what is the population that is more likely to be
    stricken by COVID? It is the older individuals, which--and I
    don't want to cast aspersions on the United States Senate, but
    they are generally older than your average House person. So
    what was magical about the Rotunda that made the virus--took
    away all its potency by going from the House to the Senate? It
    made no sense, and the population--people saw this. And that is
    what was so frustrating over and over again.
        Look, I want to share with you. In 2005, during the first
    bird flu, my first term on this committee, I was asked to go to
    Geneva and visit the World Health Organization, which I did.
    And my takeaway from that visit at the World Health
    Organization is that, if it was not for the CDC, the World
    Health Organization would not be worth anything. It was the
    embedded people from the CDC at the World Health Organization
    that gave it its value. That is why it is particularly painful
    to be here today, recognizing the CDC has lost all kinds of
    credibility.
        It is not--Mr. Pallone, it is not us fighting that caused
    them to lose their credibility. It was them not having the
    simple humility to come before the American people and say,
    ``We have never seen this before. This is what we think today.
    And you know, what we told you last week, something that was a
    little different, we have learned something along the way.''
    They would not do that. And that was just--it just decimated
    any credibility that people had--that the CDC might have had
    with the American people.
        Now, look. In 2016 there was Zika crisis, and the Zika
    crisis was going to affect the Olympics, and the CDC badly
    mishandled the testing then. I have got an article, Mr.
    Chairman, from The Washington Post. I am going to ask unanimous
    consent to put it into the record after I finish. But this
    article talks about how the CDC sidelined an effective
    laboratory test, and the test that the CDC recommended be used
    failed about a third of the time, and there was a more reliable
    test.
        Look, we had all kinds of young people, athletes going down
    to Brazil during the height of Zika. These are the people who
    would be at risk for the sequelae of a Zika infection. And
    unfortunately, the CDC was way behind on this on the testing.
    Why is that important? Because in February of 2020 the CDC
    badly mishandled the test for the coronavirus, for COVID-19.
    And we were a month behind. The United States was a month
    behind countries like South Korea and Japan that had the
    laboratory-developed test that was necessary to detect.
        I mean, measles is a problem, I agree with you, and I am so
    grateful you brought that to the committee's attention. You got
    4 days of infectivity that is in the community before you
    realized it was there. COVID-19, it was 2 weeks, we think. We
    don't really even know. But that period of infectivity after
    exposure, 2 weeks, and we were a month behind in getting a
    reliable test.
        I spoke to Dr. Burke several times during the COVID
    problem, and I got to tell you one of my great frustrations --
    we knew we had a problem with testing after we finally got the
    testing up and running a month late. Then we just didn't have
    enough. And the President would go on television and--or the
    Vice President would say, ``Everyone who wants a test is going
    to get a test,'' and LabCorp would say, ``How?'' But we all
    knew that people wanted testing. We actually had a lot of
    testing capacity, capacity that was probably paid for by NIH
    grants that sat in hospitals and research labs across the
    country, and it was on the sidelines and wasn't used.
        So Ms. Dean, let me ask you. Does the CDC currently have
    the authority to tap into that network of hospital and research
    lab equipment to use it at a time of a national crisis?
        [No response.]
        Mr. Burgess. Dr. Dean, yes, you are the one who has
    probably had the most experience with this.
        Dr. Dean. I am not able to comment on the current
    authorities the CDC has, what they can or can't do regarding
    laboratory testing. But I will share that in California I was a
    cochair of the testing task force in March, and we had to stand
    it up fast to solve that problem. And it was remarkable to see
    the private sector voluntarily participate.
        Mr. Burgess. Yes.
        Dr. Dean. Machines, humans, everyone was in it together,
    public, private. And that is what I saw work.
        Mr. Burgess. Well, Mr. Chairman, I see my time has expired.
    I have got a number of other questions I will submit for the
    record. And I look forward to your written responses. Thank
    you.
        Mr. Griffith. I thank the gentleman for yielding back. I
    now recognize Ms. DeGette of Colorado for her 5 minutes of
    questions.
        Ms. DeGette. Thank you so much, Mr. Chairman.
        You know, I have to associate myself with Dr. Burgess'
    timeline here, because he is absolutely right. In the late
    aughts--I have been on this subcommittee for 27 years, and I
    have either been the Chair or the ranking member a number of
    years. And the CDC has been an agency that, for all those 27
    years, we have been wringing our hands about how we can improve
    and bring into the 21st century.
        And Dr. Burgess is right. When we had the avian flu
    hearings, we thought that we had solved some of these
    fundamental systemic problems at the agency. We were pretty
    smug.
        But then, as he said, we had Zika in 2016, and then in
    2020--well, first of all, let me say December 4th, 2019, this
    subcommittee had a hearing. And in that hearing we asked--we
    were doing a hearing about CDC and about pandemic preparedness.
    And we asked the experts, including Dr. Fauci, ``What is your
    worst nightmare?'' This was December 2019. And Dr. Fauci said
    his worst nightmare would have been an international pandemic.
    And lo, it came to be only a few months later.
        And the problem was the CDC, as an agency, still had not
    updated its data collection, its communications with the
    States, its organization to the point where it could deal with
    an international pandemic. Dr. Redfield was the head of the CDC
    at that time, and Dr. Burgess is absolutely right, the CDC
    could not even complete the fundamental efforts of developing a
    COVID test because the test samples at what is supposed to be
    the preeminent agency in the world were contaminated.
        So I think we can sit here and emote all we want and finger
    point about the schools and everything else, and much of that I
    agree with. But I think that the usefulness of this committee,
    Madam Chair and Mr. Chair, is if we start to think about what
    kinds of reforms we can really make, and how we can be partners
    in that.
        So Dr. Walensky, before she--and she saw this, too--this
    subcommittee had a trip down to Atlanta to look at the CDC, and
    we met with Dr. Walensky, and she was brought in, and she saw
    these issues too. So before she announced her departure she had
    a number of changes that she suggested in the Moving Forward
    initiative. And I am just going to state what some of those
    initiatives are, because I think they are worth us and the CDC
    exploring them: standing up new internal systems, processes,
    and policies to enhance bidirectional communication and
    accountability; establishing clear outcomes and timeframes for
    deliverables and bidirectional engagement for core capabilities
    and agencywide initiatives; implement new government
    structure--governance structures to ensure accountability
    closely tied to funding decisions; share scientific findings
    and data faster, and better translate; share scientific
    findings and data better--or no, promote results-based
    partnerships; develop a workforce prepared for future
    emergencies.
        These are broad goals, but I would like to ask the panel:
    Do any of you disagree with these as broad goals? First I will
    ask you, Dr. Denigan-Macauley. Yes or no, do you disagree with
    these as broad goals?
        Dr. Denigan-Macauley. We do not disagree.
        Ms. DeGette. And what about you, Dr. Dean?
        Dr. Dean. I do not disagree.
        Ms. DeGette. And what about you, Dr. Høeg?
        Dr. Høeg. I don't disagree.
        Ms. DeGette. And what about you, Dr. Benjamin?
        Dr. Benjamin. I agree with those goals.
        Ms. DeGette. Thank you. I think so too.
        They also--she also talks about a list of new authorities
    that Congress should provide: public health and regulatory
    authorities, e.g., mandatory data reporting, paperwork
    reduction, action exemptions, et cetera--I know we all love fax
    machines, but maybe we should look at paperwork reduction;
    human resources authorities, e.g., hazard pay, overtime pay,
    direct hire authority, hiring authority exemption, et cetera;
    and other operational authorities.
        And then she suggests a bunch of other next steps:
    appointing a seasoned executive to implement the vision--and we
    are really hoping that President Biden's new nominee will do
    exactly that--and then some other things I don't have time to
    mention.
        Look, we need to fix this agency, and so let's just do it
    because the next pandemic is right around the corner. And if we
    don't have our public health ducks in order, if we are still
    sitting around bickering about should the schools have been
    closed or should there have been mask mandates, then we are
    going to really lose in the next round.
        And I yield back.
        Mr. Griffith. I thank the gentlelady. I now recognize Mr.
    Palmer of Alabama for his 5 minutes of questioning.
        Mr. Palmer. Thank you, Mr. Chairman, and I agree with my
    distinguished colleague from Colorado that we do need to follow
    the evidence.
        I speak to a lot of young people, and I tell them smart
    people learn from their mistakes but brilliant people learn
    from other people's mistakes. This is one of those learning
    opportunities. And I think mistakes were made, and I think
    trying to somehow convince us that mistakes were not made is
    not helpful.
        I think if you look at the evidence--say for instance from
    Sweden, and how they went about things--it clearly indicates
    that we did enormous harm with the policies that we enacted
    with school-aged children. And it makes me wonder how much
    interaction was taking place, how much discussion was taking
    place. It reminds me of politics a lot. You know, you make up
    your mind what you believe is right, and you dig in, and it
    doesn't matter what the evidence shows, you just stick with it,
    and that kind of makes me sick to even think about it on the
    political side about where we are today.
        But the thing that I want to get into is how we went about
    this decision-making on the mask. And I talk to a lot of people
    in medicine, and it was pretty evident to me that a lot of
    people realized the masks were marginally effective, yet we
    were--we had situations where we weren't--we were forcing kids,
    toddlers to wear a mask. We saw things where parents were
    removed from airline flights because they couldn't get their
    toddler to keep the mask on. I mean, this was unbelievably
    disruptive.
        So that said, it is a learning experience. It is a learning
    opportunity. And what has happened is we have talked a little
    bit about how much the CDC's reputation has been damaged, how
    much other institutions, government institutions' reputations
    have been damaged. And I think the way you overcome that is you
    get back to real science, you get back to real medicine, you
    get back to respecting people's personal rights, which I think
    this was--the heavyhandedness of government came to bear on
    people. And like I say, we are still suffering the consequences
    of it, not the least of which is the enormous amount of debt we
    have inflicted on coming generations of this country.
        Dr. Høeg, in your testimony you outlined your
    concerns with the CDC making the decision to keep schools
    closed based on the whims of teachers' union leaders,
    particularly Randi Weingarten. This is part of what I am
    talking about. This wasn't science, was it?
        Dr. Høeg. I mean, it didn't feel like--I mean--and I
    can see looking back that the CDC was not looking at the
    science. I mean, they were not looking at the data that was
    coming out of Europe. They were not looking at the data from
    our study. They were not consulting us. I--they were not
    consulting similar, you know, experts in this subject in the
    United States who had published a study with similar findings
    from North Carolina.
        And so, to us it felt like politics. It felt like a
    tragedy. It felt like, you know, why are decisions being made
    based on, you know, just asking one group of people rather than
    also consulting the scientists and, you know, the relevant
    science around this topic? So I----
        Mr. Palmer. Well, what you are saying is you can't cherry
    pick the data. And it is not just on the COVID virus and other
    biological issues like that, it is across the board in science
    right now. It has become so politicized, and both sides are
    guilty. I will admit that, to a certain extent, both sides are
    guilty of cherry picking the data. And at the end of the day,
    who suffers?
        Dr. Høeg. We all do. I mean, we all suffer if they
    cherry pick the data.
        And the masking is another perfect example of that, because
    the data that was published in their journal, you know, was
    clearly not in line with the randomized, higher-quality data
    that we had. And the fact that they would not publish a study
    that was a more robust data set followup to their initial study
    that didn't find a significant association between masking and
    reduced cases just speaks very strongly to the political bias
    and the cherry picking of data within the CDC's flagship
    journal, MMWR. It is a huge problem.
        Mr. Palmer. Well, this is--gets into the issue then of
    transparency and accountability, and it is something, again,
    that I try to confront on a number of issues related to
    science.
        And Dr. Denigan-Macauley, your written testimony--you said
    when agencies need to quickly disseminate funding and
    information during a public health emergency, transparency and
    accountability are especially critical to help ensure that
    these programs have integrity, that they build public trust.
    But we found deficiencies in this area prior to and during the
    COVID pandemic. Just what--how do you--what do you say about
    that? How do you address this issue of these deficiencies?
        Dr. Denigan-Macauley. Yes, absolutely, and I actually think
    it is a way forward for the committee, as well, is go on the
    data, go on the science, and be very transparent and
    accountable about how decisions are made. We said that with
    therapeutics. Hydroxychloroquine was mentioned. You know, if
    you are transparent on how the decisions were made, it will be
    much easier for everyone going forward. And it is guidance, and
    that way everyone can make their decisions to the best of their
    knowledge, based on the information.
        Mr. Palmer. Well, I appreciate all the witnesses being
    here--Mr. Chairman, for you holding this hearing. I just hope
    this is a learning opportunity for us, and I yield back.
        Mr. Griffith. The gentleman yields back, and I now
    recognize Mr. Armstrong for his 5 minutes of questions.
        Mr. Armstrong. I am going to talk a little bit about data,
    but I am going to do it in a little different way.
        Sunday morning, April 18th, 2021, was the first time I knew
    we had a problem, and we had a real problem. And I did--there
    was a hearing, and people got in an interesting conversation.
    But the head of the CDC was on a Sunday morning show on CNN and
    said, ``This is a public health issue. It has nothing--it is
    not a civil liberties issue. This has nothing to do with civil
    liberties.''
        This committee has been working on comprehensive privacy
    legislation, and the focus on the extent to which Americans'
    sensitive information is in the hands of third parties,
    particularly data brokers and purchasers of that data. In a
    recent subcommittee hearing we learned how seemingly
    deidentified data can easily reidentify individuals. While our
    focus has largely been on private actors' use of this data, I
    have been equally concerned about the Government's purchase and
    use of this data.
        In March, FTC Chair Kahn testified before the IDC
    Subcommittee that ``a lot of people have concerns about data
    collection by the Government. I would argue that we should be
    more concerned about government's collection and use of this
    data compared to private actors.'' Republican members of this
    committee sent a letter to CDC Director Walensky in May of 2022
    inquiring about the CDC's $420,000 purchase of Americans'
    location data to monitor COVID lockdown compliance.
        Mr. Chair, I will seek unanimous consent to enter that into
    the record.
        The company the CDC bought this data from has a checkered
    history, if I am being polite, of misusing location data. They
    have sold 2 years of deaggregated data, device-specific
    location data, to the Illinois State Government which, guess
    what, turns out wasn't deidentified. And they were selling ads
    in real time to women who were sitting in an abortion clinic.
    That is who the CDC contracted with.
        This CDC data request details a list of 21 different
    potential uses for cases for that data, covering location
    information, points of interest. The CDC request specifically
    sought data to track people who were attending places of
    worship during quarantine.
        CDC's response to the committee was that this--that it has
    the authority under 42 USC 241, which is a vague authorization
    to research diseases. And I want to repeat that: the CDC cited
    general research statute as justifying purchasing location data
    about Americans exercising their First Amendment right.
        The CDC's response to the committee's letter also dedicated
    an entire paragraph describing how this aggregated an anonymous
    data population. Again, we had hearings in this subcommittee
    last month describing that is a fallacy, and multiple studies
    since 2013 showed that less than 5 points of data are enough to
    reidentify 90 percent of individuals. And individuals can
    really be identified particularly when they are going to Mass
    in a place like Beulah, North Dakota, that has under 4,000
    citizens.
        If we are going to legislate on data privacy and we are
    going to continue to get asked to provide more and more data, I
    think it is our duty to address government access to what the
    Supreme Court has referred to as the time-stamped data that
    provides an intimate window into a person's life, revealing
    familial, political, professional, religious, and sexual
    associations.
        I don't know--there is a lot of debate about Dr. Fauci. I
    am not a doctor. I never went to medical school. I have no
    idea. But you know what I know he is not an expert on? Civil
    liberties. And when people continue to ask us for this stuff,
    and they say that this is--that civil liberties have no place
    in an emergency, my response to them would be that is when they
    matter the most. Every single--I don't care if it is a 15-day
    emergency order, I don't care if it is a 2-year emergency
    order.
        Civil liberties matter the most when the government is
    trying to clamp down on them. And when we have the head of the
    CDC on a Sunday morning show acknowledging that he didn't care
    about civil liberties while he was pontificating out to be the
    expert on this--because I have a lot of constituents that cared
    about their civil liberties. I have people who couldn't send
    their kids to school. Whether that decision was right or not,
    that is an infringement on their civil liberties. I have people
    that were worried about whether they were getting tracked to
    church during quarantine.
        And so if we want to have--if we want to fix this data
    conversation, and we want to be able to track whatever the new
    disease is and how we do this, the first thing we have to do is
    figure out how we protect this and keep people from having
    their--identified by a government that really, really is trying
    to help, but people don't trust them. And it doesn't help when
    the head of the CDC, who knows nothing about civil liberties,
    is opining on them on Sunday morning, April 18th, 2021.
        And with that, I yield back.
        Mr. Griffith. Will the gentleman yield for a question?
        I would assume you are not a--as you told us, you are not a
    doctor, but I would let the committee know that you are trained
    as an attorney who did some work in civil liberties. Is that
    not correct?
        Mr. Armstrong. I have written quite a few briefs on the
    Fourth Amendment, yes.
        Mr. Griffith. There you go. All right. I yield now to--for
    5 minutes to Mr.--Dr. Ruiz from California for his 5 minutes of
    questioning.
        Mr. Ruiz. Thank you. So the esteemed Chair had lots to say
    about making this partisan, but one of the Republican Members
    sent a letter to CDC in a purely partisan fashion. Those
    responses have not been shared with the minority, and we
    specifically asked committee staff that responses be shared,
    and we were told that the letter was the act of an individual
    Member, not the committee. However, today you present a desire
    to work together and infer that somehow Democrats are making
    this political. So----
        Mr. Griffith. Will the gentleman yield?
        Mr. Ruiz. Yes.
        Mr. Griffith. Are you referring to the response we got last
    night?
        Mr. Ruiz. I am referring to this letter dated April 5th,
    2023.
        Mr. Griffith. And the response we received last night? I am
    happy to share with you I was unaware you had not been shared
    with. We will make sure you get that response.
        Mr. Ruiz. We will work with staff to make sure the staff--
    it is a different letter?
        Mr. Griffith. It is a different letter, all right.
        Mr. Ruiz. So do you want to mention which letter it was?
        Voice. [Inaudible.]
        Mr. Griffith. Oh, OK. I don't know anything about that, so
    I apologize.
        Mr. Ruiz. Well, we will----
        Mr. Griffith. But anything that I have, you are more than
    welcome to have.
        Mr. Ruiz. OK.
        Mr. Griffith. All right.
        Mr. Ruiz. Thank you.
        Mr. Griffith. And I will--we will give you some extra time.
    Oh, you stopped the clock. OK, good. I didn't want to eat up
    your time with that.
        Mr. Ruiz. All right, thank you.
        Mr. Griffith. Thank you, Dr. Ruiz. I yield back, thank you.
        Mr. Ruiz. So the suggestion here is that the letter should
    have been--well, we should have started with sending an
    oversight letter from the committee that both Republicans and
    Democratic committee staff would have access to the responses.
    And so, if you want to do the good oversight together, we are
    absolutely willing to do that. That is not the approach that
    the committee and the staff have said that has been taken.
        So I ask unanimous consent to add the letter dated April
    5th, 2023, into the record. I appreciate it.
        So now, CDC. CDC cannot fulfill its mission to equitably
    protect Americans from disease and death without a foundation
    of trust between the agency, healthcare providers, and the
    public. And during the pandemic we saw the confusion and damage
    caused by policymakers promoting fake treatments or undermining
    scientific evidence like the importance of masking.
        There was a lot of conspiratorial accusations that were not
    founded with any conclusive evidence. This type of
    misinformation and disinformation and partisan weighing in on,
    you know, masks and social distancing and whether the virus was
    a hoax or not is the misinformation and--sometimes
    intentionally--disinformation, which I cannot emphasize enough
    is not the same as a difference in opinion.
        This type undermines the efforts of healthcare providers,
    CDC, and other public health institution. It manufactures
    distrust, in fact. The public hears conflicting advice and can
    become unsure of who to listen to for reliable information.
    This is a manufactured distrust that harms CDC and other public
    health entities' ability to be trusted and effective messengers
    both for physicians, who look to them for guidance, as well as
    the general public, who now isn't sure who to listen to.
        Dr. Benjamin, how did we get here? How did early attacks on
    the integrity of our public health agencies degrade Americans'
    long-term trust in our institutions?
        Dr. Benjamin. You know, we had a failure of leadership
    during the COVID pandemic. We didn't function as a collective
    at a national level to respond to that emergency.
        By the way, we still don't do that real well.
        And I think that we undercommunicated to the American
    people. We didn't respond quickly to the amount of
    misinformation and disinformation that was out there. We, you
    know, as you know, both of us are emergency docs, so we know
    how things happen in an emergency. And it is always difficult
    to address some of these things in an emergency condition. But
    we have got to do a much better job of partnerships, engagement
    of people, and addressing the false things that are out there.
        And I have got to tell you, there is a leadership vacuum
    here that has to be filled. And I am very concerned that I
    still see it coming.
        Mr. Ruiz. You know, I think that there is a misguided
    prioritization of how to deal with lessons learned in this
    pandemic. There seems to be a lot of--and I say this
    wholeheartedly in the concern for our country moving forward--
    there is a lot of emphasis in trying to prove some intentional,
    nefarious scheme from Dr. Fauci and Dr. Collins that somehow
    suppressed information that the virus was created in a lab and
    leaked from a lab, and now there is some kind of web of
    coverups, and without any conclusive evidence, with multiple
    statements from our public health leaders, that is not true.
        And we are missing the opportunity to focus on things that
    will actually prevent a pandemic and help us prepare for a
    pandemic. Nobody in the next pandemic is going to be
    remembering whether or not this alleged accusation is true or
    not. They are going to want to stay safe, and they are going to
    want to make sure that we have learned so that we can go
    through a pandemic resilient and not have to close schools or
    not have to undergo some of the more extreme measures we had to
    take because we weren't prepared.
        And so that is my warning in general, and that is--I am
    hoping that we can move from this partisan narrative to more
    concrete solutions. And with that I yield back.
        Mr. Griffith. I thank the gentleman for yielding back. And
    clearing up the question, it appears that the letter was from
    Dr. Mariannette Miller-Meeks. I was not privy to it until you
    gave it to me, either. And we will move forward with that, and
    it certainly is already public, so we can deal with that at the
    appropriate time.
        I now recognize Mrs. Lesko, vice chair of this
    subcommittee, for her 5 minutes of questioning.
        Mrs. Lesko. Well, thank you, Mr. Chairman, and thank you
    for all of you being here today.
        I--you know, I don't know if you have ever read the
    riveting deposition by Dr. Fauci in a lawsuit, but this is
    where this question is coming from. In a deposition in November
    2022, Dr. Anthony Fauci was questioned about an email exchange
    he shared with former HHS Secretary Sylvia Burwell in February
    of 2020. She asked him in the email, ``I am traveling to''--it
    is a redacted location. ``Folks are suggesting I take a mask
    through the airport. Is that something I should do?'' And Dr.
    Fauci responded to Ms. Burwell saying that masks don't
    protect--don't protect--uninfected people from acquiring
    infection. He recommended not wearing a mask.
        And I remember being in the Homeland Security Committee at
    the beginning of this whole thing, and they--you know, the
    healthcare workers were wearing masks, and then the Government
    officials said, ``No, you shouldn't wear masks.'' Like, the
    standard people shouldn't wear masks. And it went back--it
    seemed like it went back and forth, and it was very confusing
    to the American public.
        So my question is, why do you think--I guess this is to Ms.
    Dean and--or Ms. Høeg. Why do you think Dr. Fauci would
    tell a personal friend not to wear a mask, and then later--I
    mean, it was shortly later after that he said, ``Everybody,
    everybody should be mandated to wear a mask''?
        Dr. Dean. I can't speak to what Dr. Fauci was thinking, or
    really comment on his statement.
        I will say that in the U.S., because there are about 3,000
    local nodes of local health officers who have the authority to
    give recommendations, issue mandates, and then 50 State health
    officers, that what we really have is a patchwork quilt. So it
    is never a surprise in the United States when different places
    are giving different recommendations.
        That is part of the problem that I think we need to fix
    with a coordinated intelligence capability, operational
    capability. It led to a lot of confusion during COVID,
    including different and conflicting mask mandates in different
    parts of the U.S. with different officials speaking to them.
        Dr. Høeg. And I guess I would add to that that the
    evidence that we had going into the COVID-19 pandemic for
    influenzalike illness had failed to find in randomized studies
    that masks prevented transmission in the community setting or
    the hospital setting. And so in the summer of 2020--and I think
    you said 2022, but I think you meant 2020----
        Mrs. Lesko. Oh, OK, sorry.
        Dr. Høeg. That was when Dr. Fauci----
        Mrs. Lesko. Thanks for correcting.
        Dr. Høeg. We didn't have good evidence showing that
    masks worked. And so, you know, it was really up to us to
    generate good data to find out was it going to--were masks
    going to be effective against COVID-19, surgical and N-95
    masks. The United States did not run randomized studies in our
    country to get the answer to that.
        And so really, we then had a Cochrane review that reviewed
    the data of the randomized studies that had been done during
    the COVID-19 pandemic. They didn't find that masks were
    effective at preventing COVID-19 transmission. They failed to
    find that in the randomized studies. However, the United States
    continued to recommend masking of children down to age 2, which
    they actually still do today under certain circumstances. So we
    act like we are talking about things in the past. CDC is still
    recommending children down to the ages of 2 mask under certain
    circumstances of high disease burden.
        And so I think that he said that because that is what he
    felt the data showed at the time, and that--in my understanding
    of the data, would--is--was an accurate representation of what
    we knew, that masks were not effective, from the data that we
    had.
        Mrs. Lesko. Yes. I think, you know, part of the reason that
    we are asking about this is--in fact, most of the reason--is we
    don't want to repeat the problems that we had before.
        And, you know, I am also on the select subcommittee
    investigating COVID and its effects. And one of the things I
    think we talked about there was the closing of schools for our
    children, and how far behind they are. And Ms. Høeg, I
    don't know if I had a chance to ask you questions last time,
    but in Sweden, if I remember right, they didn't close the
    schools at all. They didn't close the schools at all.
        Dr. Høeg. They didn't close the public----
        Mrs. Lesko. And none of the kids died, right? None of the
    kids died. Is that accurate? From COVID.
        Dr. Høeg. So from their----
        Mrs. Lesko. Yes.
        Dr. Høeg [continuing]. Initial report, there were no
    children that died.
        Mrs. Lesko. Yes.
        Dr. Høeg. I actually don't have the latest data----
        Mrs. Lesko. Yes, right.
        Dr. Høeg. I apologize, but--yes. And--but they did
    not close the primary schools, and then they have had very
    brief closures of the secondary schools. And their excess
    mortality--I mean, they--their excess mortality has been none
    to, you know, negative.
        Mrs. Lesko. Yes.
        Dr. Høeg. I mean, they have done--probably one of
    the best countries in the world during the pandemic, if not the
    best.
        Mrs. Lesko. So, Ms. Macauley, do you think that the CDC in
    the future could look to what other countries did? If this
    happens again--which, eventually, it will happen again--do you
    think that they should look to what other countries did?
    Because some other countries didn't do all these mandates and
    closing schools and things like that, and they didn't seem to
    have a problem. Do you think that is a good thing for the CDC
    to do?
        Dr. Denigan-Macauley. Yes.
        Mrs. Lesko. Sorry, I ran out of time.
        Dr. Denigan-Macauley. We have always encouraged to look at
    all lessons learned, and to revise plans as needed.
        Mrs. Lesko. Thank you.
        Dr. Denigan-Macauley. Domestic or international.
        Mrs. Lesko. Thank you. Thank you, Mr.----
        Mr. Griffith. The gentlelady yields back. I now recognize
    Mr. Tonko of New York for his 5 minutes of questioning.
        Mr. Tonko. Thank you Mr. Chair, and I would think that
    deaths is one--happens to be one measurement, but permanent
    damage or damage of any kind to the respiratory system and
    cardio systems might also be another calculation that we should
    pay attention to.
        Public trust in our health agencies can be quickly eroded
    by political interference in public health decisions. We saw
    this during the pandemic: politically motivated efforts to
    downplay the dangers of COVID-19 by then-President Donald Trump
    are well documented. Reports showed that during the early
    stages of the pandemic the Trump White House interfered with
    CDC efforts to carry out media briefings that would have
    provided science-based information to the public. I am a big
    believer in relying on science, and I think we have rejected it
    in many, many occasions on the Hill. And rampant misinformation
    also impeded public health officials' efforts to get critical
    information out to the public.
        So, Dr. Benjamin, how does low public trust in healthcare
    institutions impede our ability to effectively respond to what
    was a public health emergency, if not continues to be?
        Dr. Benjamin. Yes, it creates an environment when you have
    low public trust that people won't do what generally is
    recognized by experts. And we saw that in, you know, vaccine
    uptake, we saw that in people taking medications that have been
    clearly proven not to be effective, like hydroxychloroquine. We
    saw that in people using all kinds of things that they would go
    to the internet and find and use.
        So it is a real problem, and it is persistent. And we are
    now seeing it bleed into routine childhood vaccinations, uptake
    in other adult vaccinations. So it is a big problem.
        Mr. Tonko. So the damage can spread. I don't ever remember
    in my many years a public health crisis becoming so politically
    charged, and I think that is a difficult dynamic to introduce.
        How does the spread of misinformation about, for instance,
    the safety of vaccines worsen the risk posed by an infectious
    disease like COVID-19?
        Dr. Benjamin. Well, it means that people won't get
    vaccinated or do other protective things, and then they get
    infected and they infect other people.
        You know, in the spring of 2020, early part of the
    pandemic, we already had antivaccine groups handing out fliers,
    going into communities and telling those communities don't get
    tested when the vaccine is available. We didn't have a vaccine
    yet, but before we even had a vaccine----
        Mr. Tonko. Right.
        Dr. Benjamin [continuing]. Don't get the vaccine, and all
    the bad things that they hypothesized would happen if you got
    it. So they were already working against good public health.
        Mr. Tonko. Yes, and that just creates a weak environment
    and especially as it relates to our children, because they are
    not many times making those decisions.
        GAO has issued several recommendations to immunize HHS's
    operating divisions from political influence, including by
    developing policies and training staff in reporting bias. HHS
    has agreed with these recommendations and is in the process of
    implementing them.
        So, Dr. Benjamin, how do efforts to reduce political
    interference or--excuse me--yes, how do efforts to reduce
    political interference strengthen CDC and improve public
    confidence in health institutions?
        Dr. Benjamin. Well, quite frankly, the current
    administration stopped screwing around with your website,
    telling them what to say, interfering with their public
    presentations, and, all in all, followed the science. And that
    has dramatically changed the way the agency has been able to
    function and engage with the public and engage with other
    partners. That was a terrible mistake that was previously done.
    And that will help CDC recover the trust of the American
    people.
        Mr. Tonko. Right. Well, science-based and evidence-based
    data and anecdotes should be what guide us.
        Dr. Denigan-Macauley, GAO's latest high-risk report
    mentions the importance of HHS building a skilled health
    workforce. I would argue that persistent political interference
    with the work of healthcare professionals would be
    counterproductive to achieving that goal. Why is strengthening
    the healthcare workforce a key component to public health
    emergency preparedness?
        Dr. Denigan-Macauley. It is absolutely essential. No matter
    how many systems you build, or--you have to have the people to
    be able to run it. I mean, obviously, we are getting artificial
    intelligence, and we are getting smarter and being able to do
    things without staff. But that is not where we are. And as we
    have said on this committee--or on this board right here today,
    on your panel--it takes the whole of nation. It is patchwork.
    And the--it is from--at the local level, Tribal, territorial.
    It is everyone.
        Mr. Tonko. OK. Well, my time has now been exhausted. But I
    would say it is important for us to pay attention to and listen
    to science so that we can do the appropriate policy.
        Mr. Griffith. I thank the gentleman for yielding back and
    now recognize Mrs. Cammack of Florida for her 5 minutes of
    questioning.
        Mrs. Cammack. I have a microphone that won't cooperate with
    me, so I will adjust. I will start with you, Dr. Dean.
        I am going through your testimony for a second time, and
    there's a couple of things that have just stuck out to me,
    talking about the failures of the CDC to listen to those on the
    front lines. This is something that seems to happen, whether it
    is COVID, whether it is Ebola. It doesn't seem to matter what
    crisis we are facing down, it seems that the bureaucrats in
    Washington are greatly removed from those on the front lines,
    be it EMS, our public health safety officials. Can you
    elaborate on what you have seen?
        And if you had to give me in three bullet points what CDC
    needs to do to turn this around, to be more forward facing and
    actually start listening to people on the ground who are
    dealing with it rather than operating from computer screens up
    here in Washington, DC, that would be much appreciated.
        Dr. Dean. Thank you for the question. I would highlight
    this is a systems problem. I never blame the humans. The public
    servants are my heroes, but we are all operating in a broken
    system. On the front lines you have to make decisions in the
    fog of war, oftentimes without the data that you want.
        If I were to bullet point the three things, it would be,
    number one, the CDC reform that they are attempting to do that
    is deeply discussed by this committee. As part of that, looking
    at not just the infrastructure but the culture. In academic
    research, institute culture is very much needed. We rely on
    that for the kind of information retrospective that we use on
    the front lines, but it is different than front-lines response.
        So I would say bullet two would be an intelligence
    infrastructure, real-time data shared with all the nodes on the
    front lines so we can make decisions.
        And number three, an operational infrastructure. We already
    do this. We call each other and ask for help. We back each
    other up. Let's formalize that into a structure, where someone
    really is coming to save us when we need it.
        Those would be my three.
        Mrs. Cammack. And as a followup to that, we are concerned
    about Federal authority that undermines the mayors, the
    Governors, and other local elected officials that are on the
    front lines. If the Federal Government can demand data and
    there is no need to work cooperatively with the States and
    local governments, what kind of data, then, do we need to be
    pinpointing that is going to be beneficial for the State and
    local responders?
        Dr. Dean. On the front lines, as a local health officer, we
    already call each other. We share information. We are calling
    firefighters and EMS. I am calling my colleagues in other
    States. So that kind of intelligence sharing is happening right
    now.
        Mrs. Cammack. Is it everything, though, from predictive
    data, or is it more of, ``Hey, this is the PPE that we have in
    stock, and we are moving things around''? What----
        Dr. Dean. It is all of it. It is all of it. Because what we
    are trying to do is gain situational awareness.
        So when talking about data sharing, the point I would make
    is it is really important that it doesn't just go to one place
    where it is held, that it is immediately shared out to everyone
    on the front lines. And this is far beyond public health. My
    colleagues in EMS, those that run supply chain, we all need
    that real-time, situational awareness. We live in a data-rich
    but intelligence-poor system in the U.S. And let's fix that.
        Mrs. Cammack. I like the way you phrased that, thank you.
        OK, Dr.--I am going to mess this up.
        Dr. Høeg. Høeg.
        Mrs. Cammack. Høeg, got it, OK.
        Many of the COVID-19 mandates, particularly the national
    mandates, have done tremendous harm to our country: people who
    have lost their jobs, communities'--children's development was
    impaired. There is truly an extensive list of the harms that
    have been created, many of which were not science-based.
    National mandates undermine the public's trust in public health
    because it is not something that the Federal Government has
    done or done well. It is inconsistent, quite frankly, with our
    constitutional system.
        The national COVID-19 mandates were made worse by the fact
    that they were put in place despite conflicting scientific
    evidence. Now, in your testimony you noted that the CDC often
    cherry picks what scientific data they find relevant. For
    example, the mask mandate that was implemented here on the--on
    Capitol Hill for Members and staff was based on a peer-reviewed
    study that had failed peer review and had been tested on a
    sample size that was not an American population. So if that is
    happening here on Capitol Hill, how can we be sure that the
    decisions at the highest level of government are not based on
    incomplete, conflicting science like what we saw during the
    pandemic?
        Dr. Høeg. Yes, thanks for that question. So I guess
    I would say, you know, we--just to get to the vaccine issue
    first, I mean, we have talked about this distrust in public
    health and vaccine hesitancy. And I am actually concerned that
    a lot of that came from making extrapolations from the initial
    data, and sort of telling the American people that these
    vaccines were going to be stopping infection, all infection. We
    really only knew about the 94 to 95 percent efficacy against
    symptomatic infection from the initial trials. We didn't know
    how long it would last. We didn't know if it was going to
    prevent transmission.
        And so--and then, you know, the mandates were sort of
    instituted--based on, like, incomplete data. And then people
    ended up losing their jobs because they felt uncomfortable
    taking the vaccine. They didn't feel like they had enough
    information. And that has been devastating.
        And then we find out, you know, as we gather more data, the
    vaccines were not effective at preventing transmission,
    especially not long term, maybe a few-month period that they
    can decrease infection risk, but they don't decrease
    transmission risk. And so I feel like people lost trust because
    they were told that, for sure, that the vaccines did something,
    and then we found out that that wasn't true, and they were
    coerced to get a vaccine. And so that has fueled some distrust.
        And I know I am, like, running out of time here, but I
    wanted to get to that point. I am sorry I didn't answer----
        Mrs. Cammack. No, I appreciate that. And thank you for the
    chairman's grace, and----
        Mr. Griffith. Yes, the gentlelady yields back time.
        Mrs. Cammack [continuing]. Time, thank you.
        Mr. Griffith. I now recognize Mr. Peters for his 6 minutes
    or so.
        [Laughter.]
        Mr. Griffith. For his 5 minutes of questioning.
        Mr. Peters. All right, thank you very much, Mr. Chairman. I
    do appreciate you having this hearing. I think anything like
    this deserves an after-action report. And we ought to be
    looking, honestly, at what we got right and what we got wrong,
    and we should not expect that we would have gotten everything
    right.
        I would just say, on behalf of President Trump, Project
    Warp Speed was great. I think getting a vaccine in a year is
    something that is--deserves a lot of credit and is something we
    can replicate for other things here too. On the other hand, you
    know, suggesting on TV that you inject bleach, that probably
    wasn't a good idea.
        And there was--now there is politics around vaccines that
    the very people who did all the work to do vaccines don't even
    want to admit that they took the vaccine, because that has
    become politicized. So we could use some help across the board
    of getting really honest after action on vaccines.
        And I would say about Dr. Høeg, yes, it didn't
    transmit--it didn't prevent transmission, but we prevented
    people from dying, in general, which was really the objective,
    I think, as we started. And I think that is good.
        I do agree with you that schools--school closures was
    wrong. It was a--it was--kind of ended up being a disaster, I
    think. Going into it, we didn't know that, but once we had
    vaccines that would keep teachers alive, we should have gotten
    those schools back open again. You have made a very serious
    charge that I am not going to adjudicate here that it was the
    teachers unions that drove that decision, but I think that CDC
    should answer for that. How did that factor in? I think we
    should understand that, because we don't want it to be
    politicized. We want it to be factual going forward.
        On that topic, though, something that I have been trying to
    talk about forever since the beginning of this is the terrible
    data system that we have here. On--you know, I am not an
    advocate of having a national health system like England, but
    they have the same data on every patient. And we don't. We have
    different hospitals in different States collecting and
    reporting different data. And we are asked, as policymakers, to
    make policy judgments based on, basically, a lot of guesswork.
    There is a lot of holes in that data. And I am going to ask the
    epidemiologist something about that in a second.
        But if--you know, we heard rumors that it was type O blood
    that had an effect, or vitamin D. I mean, great, that might be
    true, we had no way to really figure that out without data.
        And then looking backwards, you know, learning loss, mask
    efficacy, community spread around schools. I don't know that we
    have the data that we need for that, even, tragically, now that
    this is--at least this phase of it has passed us by.
        So, Dr. Høeg, what would you advise us, as Members
    of Congress, to ask for from the CDC or DHS or the Department
    of Health in terms of data? What do we need to concentrate on,
    and what do we need to have before us, what do we need to be
    collecting that we are not doing now?
        Dr. Høeg. Yes. I mean, in terms of looking back, I
    mean, we should--you know, I want to say that I am concerned
    about the role that the teachers unions played, just so--I
    think we do need more----
        Mr. Peters. Like----
        Dr. Høeg [continuing]. On that.
        Mr. Peters. So, well, let's take that up.
        Dr. Høeg. In terms of the data, I think that we have
    a problem that we have not--we don't have a culture here of
    running high-quality randomized trials of the efficacy of
    different interventions, like, promptly, so that we can get
    real answers about how well things work, like masks, like
    school closures.
        Even for--currently, the bivalent booster--and the
    boosters, we didn't have large-enough randomized trials in
    young people. So I think that we need to have a culture where
    we quickly are able to run randomized studies to get real
    answers, because right now with the MMWR, as we saw over and
    over again, they are publishing observational studies which
    have very low-quality data. I mean, they are publishing, you
    know, studies about----
        Mr. Peters. Let us take a step back from that, though,
    because I am going to run out of time. What is it we should be
    collecting? What should we be getting from patients that we
    need to make judgments about?
        Dr. Høeg. So, I mean, I think that I would bring up
    just one of my studies in terms of, you know, what data we
    should be collecting, is we do need accurate death rates,
    actually, from--is one of the studies that we did showing that,
    you know, the CDC was repeatedly reporting inaccurate data
    based on the COVID-19 tracker, which doesn't use death
    certificates, overestimating the death rates, the true death
    rates in children. And so I think that that is one of the
    things, is we need to have a better data system that is
    reliable, so that we know that the data that we are getting is
    accurately representing----
        Mr. Peters. I am going to run out of time, and I ask--
    invite any of you, if you have thoughts about that, to let us
    know in writing how you would improve Federal data.
        I would just say this, though, on--you know, look, I feel a
    little bit like I am getting two sides of a message. One is
    that we should have really good information, but the other is
    we have to act based on the information we had. And at the time
    I think we had these vaccines, I think it was very prudent to
    require the military to get them, people over 18, and to ask
    teachers to do that too. And so I am not going to fault anyone
    for that.
        I hope we learn from this experience so that we do it
    better when we face it again. But I really do appreciate your
    thoughts, and I yield back.
        Mr. Griffith. I thank the gentleman for yielding back, and
    now recognize Mrs. Miller-Meeks for her 5 minutes of
    questioning as a waive-on.
        Mrs. Miller-Meeks. Thank you very much, Mr. Chair, and I
    want to thank all of our witnesses who are here today.
        As many of you know, I am a physician and a former director
    of the Department of Public Health. And so I take public health
    very seriously, and I recognize the important role. And for me,
    the CDC, prior to the pandemic, was the premier institution.
    But I also recognize the important role of State health
    departments and local public health agencies in keeping
    Americans safe.
        In April of this year, I released a CDC RFI, request for
    information, to hundreds of stakeholders requesting feedback on
    how to sensibly and effectively reform America's top
    communicable diseases agency. And I want to address and clarify
    some comments made by Representative Dr. Ruiz.
        First, this was an RFI that my office sent publicly to
    stakeholders and constituents to seek feedback and input on CDC
    reform as a result of the CDC's many failures. This was not a
    letter sent to the CDC, though I would also welcome their
    feedback and input. And in fact, to this end, I met privately
    with Dr. Walensky and a staff member.
        It sounds like there are many opportunities for improvement
    based upon the discussion today, and I thank you for that. And
    I welcome additional conversations with Dr. Ruiz and his staff
    as to constructive and thoughtful ways to reform the CDC.
        Not surprisingly, public trust in the CDC is at an all-time
    low, and health experts across the Nation have presented many
    suggestions on how to rebuild that trust.
        During the pandemic, much of the CDC's guidance did not
    appear to emanate from data and scientific evidence, and they
    certainly weren't able to incorporate real-world evidence that
    was occurring, and data and research occurring in other
    countries. Rather, the data seemed to come from political
    interests, such as the clear coordination between the CDC and
    the American Federation of Teachers Unions on school closures,
    despite clear evidence that children did not transmit the virus
    and they were not super spreader organizations. And we, in
    fact, opened our schools in Iowa in April of 2020.
        To the CDC's credit, however, they recognized the declining
    public trust, which led Dr. Walensky to launching the Moving
    Forward initiative. This effort included reorganization and
    potential requests for new authorities from Congress. As part
    of the initiative, CDC acknowledges that the agency faces
    significant structural and systematic operational challenges.
    One of those was just discussed, and that is data. And it
    indicates a central goal to create new internal processes,
    systems, and governance to empower leaders, align incentives,
    and hold CDC accountable.
        Dr. Høeg, in your written testimony you highlight
    the confusing and backward school closure guidance, stating
    that the recommendation to keep schools shut down was
    unthinkable. And I asked Dr. Walensky in testimony if she had
    contacted the State of Iowa or the State of Iowa's Department
    of Education for their experiences with opening schools. Can
    you detail what you believe the science behind Dr. Walensky's
    school closure recommendations--why it was so flawed, and what
    guidance reforms the Moving Forward initiative should include?
        Dr. Høeg. Yes. So we had data at the time of the--
    that--the winter of 2021, the February of 2021 guidance from,
    essentially, all over the world of schools reopening safely,
    successfully. And I think most of the world recognized that
    schools should be open by default, and that closing schools is
    an emergency measure.
        And so also in our own country we had private schools,
    public schools in many States, often depending on political
    affiliation, that were already open, had data. It wasn't just
    my Wisconsin study, it was the diocese, very diverse diocese
    that I am medical advisor for, that we had successfully
    reopened with very simple, straightforward mitigation
    strategies, that--there was a total lack of sort of commitment
    and creativity and willingness to get these kids back into
    school and then, you know, figure out, you know, how to make it
    as safe as possible.
        And so I do think it is unthinkable what happened, the way
    the data were ignored from, really, all over the world and our
    own country about how schools could be reopened safely,
    considering the enormous damage from prolonged school closures
    that we all knew was coming and we see the effects of now.
        Mrs. Miller-Meeks. Thank you. As a first-term
    congresswoman, my first markup hearing on Education and Labor
    Committee brought up school closures, the rate of youth
    suicide, the rate of mental health and depression and anxiety,
    and what that has done. So not only the learning loss, but the
    obesity, the physical effects, and also the tremendous mental
    effects that closing schools had on our children and a
    generation that may be lost and difficult to recover. So thank
    you so much for your testimony.
        Thank you for, despite all of the pushback--I have been
    part of that--that you were willing to continue to publish and
    to make known your findings. Thank you.
        I yield back, Mr. Chair.
        Mr. Griffith. The gentlelady yields back. I now recognize
    Ms. Castor for a unanimous consent request.
        Ms. Castor. Thank you, Mr. Chairman.
        I would like to ask unanimous consent to submit for the
    record just some context regarding the Dr. Fauci February 2020
    email in the early days of the pandemic response regarding his
    mask suggestions.
        As we all know, the understanding about the effectiveness
    of masks and guidance about wearing them evolved during the
    pandemic, as did Dr. Fauci's position on their use.
        So I will ask a UC.
        Mr. Griffith. The gentlelady has requested unanimous
    consent. We would also--during this hearing we have had
    unanimous consent requests both from Ms. Castor, but also Dr.
    Burgess, Mr. Armstrong, and Mr. Ruiz--Dr. Ruiz, excuse me. And
    have I missed any? I think that has got all of them, but--and
    also any documents that have been included in the staff hearing
    documents list.
        Any objection to any of those documents being submitted to
    the record?
        Hearing none, the documents are----
        Ms. Castor. Thank you.
        Mr. Griffith [continuing]. Agreed to be put in as a part of
    the record.
        [The information appears at the conclusion of the hearing.]
        Mr. Griffith. Seeing that there are no further Members
    wishing to ask questions, I would like to thank our witnesses
    again for being here today. Thank you. This has been very
    informative.
        In pursuance of the committee rules, I remind Members they
    have 10 business days to submit additional questions for the
    record, and I have already got a few, so I will be sending
    those along. And I ask that witnesses submit their response
    within 10 business days upon receipt of those questions.
        Without objection, the subcommittee is adjourned.
        [Whereupon, at 12:37 p.m., the subcommittee was adjourned.]
        [Material submitted for inclusion in the record follows:]
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