[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
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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:]
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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:]
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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:]
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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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