    [House Hearing, 119 Congress]
    [From the U.S. Government Publishing Office]

        DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
                    RELATED AGENCIES APPROPRIATIONS FOR 2026
    _______________________________________________________________________

                                     HEARINGS

                                     BEFORE A

                               SUBCOMMITTEE OF THE

                           COMMITTEE ON APPROPRIATIONS

                             HOUSE OF REPRESENTATIVES

                         ONE HUNDRED NINETEENTH CONGRESS

                                  FIRST SESSION
                                   ___________

                 SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES,
                         EDUCATION, AND RELATED AGENCIES

                      ROBERT B. ADERHOLT, Alabama, Chairman

      JULIA LETLOW, Louisiana,              ROSA L. DeLAURO, Connecticut,
        Vice Chair                            Ranking Member
      MICHAEL K. SIMPSON, Idaho             STENY H. HOYER, Maryland
      ANDY HARRIS, Maryland                 MARK POCAN, Wisconsin
      CHARLES J. ``CHUCK'' FLEISCHMANN,     LOIS FRANKEL, Florida
        Tennessee                           BONNIE WATSON COLEMAN, New Jersey
      JOHN R. MOOLENAAR, Michigan           JOSH HARDER, California
      ANDREW S. CLYDE, Georgia              MADELEINE DEAN, Pennsylvania
      JAKE ELLZEY, Texas
      STEPHANIE I. BICE, Oklahoma
      RILEY M. MOORE, West Virginia

      NOTE: Under committee rules, Mr. Cole, as chairman of the full
    committee, and Ms. DeLauro, as ranking minority member of the full
    committee, are authorized to sit as members of all subcommittees.

                   Kathryn Salmon, Emily Goff, James Redstone,
                   Kirk Boyle, Jaime Varela, and Emma Lou Ford
                                Subcommittee Staff
                                   ___________

                                      PART 2

                                                                       Page
      Public Witness Day...........................................       1

                     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                      ------

              Printed for the use of the Committee on Appropriations

    PART 2--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
                    RELATED AGENCIES APPROPRIATIONS FOR 2026

        DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
                    RELATED AGENCIES APPROPRIATIONS FOR 2026
    _______________________________________________________________________

                                     HEARINGS

                                     BEFORE A

                               SUBCOMMITTEE OF THE

                           COMMITTEE ON APPROPRIATIONS

                             HOUSE OF REPRESENTATIVES

                         ONE HUNDRED NINETEENTH CONGRESS

                                  FIRST SESSION
                                   ___________

                 SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES,
                         EDUCATION, AND RELATED AGENCIES

                      ROBERT B. ADERHOLT, Alabama, Chairman

      JULIA LETLOW, Louisiana,              ROSA L. DeLAURO, Connecticut,
        Vice Chair                            Ranking Member
      MICHAEL K. SIMPSON, Idaho             STENY H. HOYER, Maryland
      ANDY HARRIS, Maryland                 MARK POCAN, Wisconsin
      CHARLES J. ``CHUCK'' FLEISCHMANN,     LOIS FRANKEL, Florida
        Tennessee                           BONNIE WATSON COLEMAN, New Jersey
      JOHN R. MOOLENAAR, Michigan           JOSH HARDER, California
      ANDREW S. CLYDE, Georgia              MADELEINE DEAN, Pennsylvania
      JAKE ELLZEY, Texas
      STEPHANIE I. BICE, Oklahoma
      RILEY M. MOORE, West Virginia

      NOTE: Under committee rules, Mr. Cole, as chairman of the full
    committee, and Ms. DeLauro, as ranking minority member of the full
    committee, are authorized to sit as members of all subcommittees.

                   Kathryn Salmon, Emily Goff, James Redstone,
                   Kirk Boyle, Jaime Varela, and Emma Lou Ford
                                Subcommittee Staff
                                   ___________

                                      PART 2

                                                                       Page
      Public Witness Day...........................................       1

                    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                      ------

              Printed for the use of the Committee on Appropriations

                       U.S. GOVERNMENT PUBLISHING OFFICE

    62-326                     WASHINGTON : 2026

                       HOUSE COMMITTEE ON APPROPRIATIONS

                          TOM COLE, Oklahoma, Chairman

      HAROLD ROGERS, Kentucky,                ROSA L. DeLAURO, Connecticut,
        Chairman Emeritus                       Ranking Member
      ROBERT B. ADERHOLT, Alabama             STENY H. HOYER, Maryland
      MICHAEL K. SIMPSON, Idaho               MARCY KAPTUR, Ohio
      JOHN R. CARTER, Texas                   JAMES E. CLYBURN, South Carolina
      KEN CALVERT, California                 SANFORD D. BISHOP, Jr., Georgia
      MARIO DIAZ-BALART, Florida              BETTY McCOLLUM, Minnesota
      STEVE WOMACK, Arkansas                  DEBBIE WASSERMAN SCHULTZ, Florida
      CHARLES J. ``CHUCK'' FLEISCHMANN,       HENRY CUELLAR, Texas
        Tennessee                             CHELLIE PINGREE, Maine
      DAVID P. JOYCE, Ohio                    MIKE QUIGLEY, Illinois
      ANDY HARRIS, Maryland                   GRACE MENG, New York
      MARK E. AMODEI, Nevada                  MARK POCAN, Wisconsin
      DAVID G. VALADAO, California            PETE AGUILAR, California
      DAN NEWHOUSE, Washington                LOIS FRANKEL, Florida
      JOHN R. MOOLENAAR, Michigan             BONNIE WATSON COLEMAN, New Jersey
      JOHN H. RUTHERFORD, Florida             NORMA J. TORRES, California
      BEN CLINE, Virginia                     ED CASE, Hawaii
      GUY RESCHENTHALER, Pennsylvania         ADRIANO ESPAILLAT, New York
      ASHLEY HINSON, Iowa                     JOSH HARDER, California
      TONY GONZALES, Texas                    LAUREN UNDERWOOD, Illinois
      JULIA LETLOW, Louisiana                 SUSIE LEE, Nevada
      MICHAEL CLOUD, Texas                    JOSEPH D. MORELLE, New York
      MICHAEL GUEST, Mississippi              MIKE LEVIN, California
      RYAN K. ZINKE, Montana                  MADELEINE DEAN, Pennsylvania
      ANDREW S. CLYDE, Georgia                VERONICA ESCOBAR, Texas
      STEPHANIE I. BICE, Oklahoma             FRANK J. MRVAN, Indiana
      SCOTT FRANKLIN, Florida                 MARIE GLUESENKAMP PEREZ,
      JAKE ELLZEY, Texas                        Washington
      JUAN CISCOMANI, Arizona                 GLENN IVEY, Maryland
      CHUCK EDWARDS, North Carolina
      MARK ALFORD, Missouri
      NICK LaLOTA, New York
      DALE W. STRONG, Alabama
      CELESTE MALOY, Utah
      RILEY M. MOORE, West Virginia

                   Susan Ross, Chief Clerk and Staff Director

                                       (II)

                       DEPARTMENTS OF LABOR, HEALTH, AND
                           HUMAN SERVICES, EDUCATION
                            APPROPRIATIONS FOR 2026

                                  ----------

                                              Wednesday, April 9, 2025.

             TESTIMONY OF INTERESTED INDIVIDUALS AND ORGANIZATIONS

                                    WITNESS

    JESSICA PESCATORE, CLINICAL DIRECTOR, ALABAMA POISON INFORMATION
        CENTER, AMERICA'S POISON CENTERS

        Mr. Aderholt. Okay. The committee will come to order, and I
    wanted to say good morning to everyone. It is my pleasure to
    welcome everyone to the Subcommittee on Labor, Health and Human
    Services, and Education, and for what is our hearing to hear
    from outside experts and the public.
        This is our Public Witness Day. It is an opportunity for
    members of the public to come before this panel and to draw our
    attention to issues of importance to them. I look forward to
    hearing from our witnesses this morning as we learn more
    regarding the challenges facing our constituents and also
    communities across the country and, at the end of the day, what
    this subcommittee can do to try to be of help.
        For our witnesses, a 5-minute clock will be the countdown
    on the microphone box that will be in front of you as you take
    the chair, and you will have 1 minute remaining when the light
    turns yellow. That, of course, will just be an indication, a
    signal for you to begin to wrap up your testimony. Remember, of
    course, all of your testimony, your written statement will be
    submitted to the committee and will appear in the hearing
    record. So if you don't get to all of your comments, they will
    be submitted for the record.
        But before we begin, I would like to turn to the ranking
    member of the full committee and the subcommittee here, Rosa
    DeLauro, for any remarks that she would like to make.
        Ms. DeLauro. Thank you very much, Mr. Chairman. It is a
    pleasure to join with you this morning, and thank you for
    holding this hearing with our wonderful public witnesses to
    discuss the 2026 budget.
        To our witnesses, we just offer a welcome to you to the
    Labor, Health, Human Services, and Education Subcommittee of
    Appropriations. I want to express my sincere gratitude to all
    of you and appreciation for the work that you do and on whose
    behalf you do it. You are such wonderful, wonderful advocates,
    and we thank you for the written testimonies for the record.
    Your advocacy and your testimony is invaluable to us and to the
    subcommittee's bill. I have said so many times in the past,
    today's hearing is really one of the most important parts of
    this subcommittee's process.
        The programs in Labor, HHS in this bill, they level the
    playing field for low-income children looking to get a good
    education. They equip our Nation to deal with public health
    emergencies, they fund lifesaving biomedical research, and they
    help Americans get the skills that they need to be able to find
    a job. And the list goes on and on and on because the programs
    directly impact the lives of every American across our country,
    especially children, workers, middle-class, families, and
    seniors.
        We are challenged these days with the future of some of
    these programs as there have been, as you know, illegal freeze
    payments, which take funds from programs that I believe
    American families and businesses rely on, and especially in the
    area that we are looking at that are under the jurisdiction of
    this subcommittee in both education, which we know there is a
    move to eliminate the Department of Education, and really, for
    me, that is about eliminating public education, which is so
    critical to our children. And the Department of Health and
    Human Services is undergoing this rapid transformation with the
    loss of potentially up to 20,000 people. So we know that
    thousands of Federal workers have been fired, billions of
    dollars canceled in funding for education. With regard to
    education, if you eliminate Title I of Education, we would lose
    72,000 teachers across the country, and then there will be more
    to come.
        I am very troubled by what is happening at HHS because of
    what is the threat to destroy the agencies that protect
    America's health. That includes the Center for Disease Control
    and Prevention, the National Institutes of Health, the Food and
    Drug Administration. Twenty thousand workers, as I have said,
    have been fired at HHS. That is one-fourth of their workforce,
    $12 billion in funds provided by the Congress for public health
    and substance abuse treatment. I believe what we will see next
    is the Department of Labor and already terminated funding for
    the Bureau of International Labor Affairs, or ILAB, an Agency
    whose mission is to ensure American workers are not put at a
    disadvantage by countries who violate their labor commitments
    under our trade agreements. We expect the axe to fall on the
    Department of Labor's worker protection agencies, the Wage and
    Hour Division and OSHA, that are responsible for protecting
    worker safety and hard-earned wages.
        The American people are calling our offices every day
    asking about this spending freeze and what has happened to
    already-appropriated funding. American people are concerned,
    and there is a lot of fear out there and we have to address
    that. I say these things to let you know, but I also say with
    great optimism that you have such a profound role to play, and
    your voices need to be heard very strongly and powerfully about
    the resources that this subcommittee provides for you to carry
    out your missions, to be able to address the health needs of
    our families or education needs of our families, or the ability
    for people to be gainfully employed and what their futures are
    going to be. That is what our job is in this subcommittee.
        So we welcome you because more than ever now, your voices
    need to be heard. Thank you for being here, and we look forward
    to your testimony. So thank you, Mr. Chairman, and I yield
    back.
        Mr. Aderholt. Thank you, Ranking Member DeLauro, and I
    would like to recognize our first witness. Our first witness
    will be Jessica Pescatore, and I may have butchered that a
    little bit, but Pescatore? Good. All right. We got it. All
    right. Well, welcome to the subcommittee, and we look forward
    to hearing your testimony.
        Ms. Pescatore. Thank you. Good morning, Chairman Aderholt,
    Ranking Member DeLauro, and distinguished members of the
    subcommittee. My name is Dr. Jessica Pescatore, and I am an
    emergency medicine pharmacist, clinical toxicologist, and the
    clinical director of the Alabama Poison Information Center.
    Thank you for the opportunity to share the critical work of our
    Nation's 53 poison centers, and thank you for your
    longstanding, bipartisan support of the Poison Control Center's
    program. We are especially grateful to have been reauthorized,
    and I am here today to respectfully request a $2 million
    increase over current funding levels for the program in fiscal
    year 2026. This morning I would like to highlight the value of
    a poison center, share my center's efforts in addressing public
    health risks, such as unregulated and illicitly manufactured
    substances, and discuss some nationwide challenges.
        Poison centers provide 24/7 lifesaving expertise to all
    Americans, from concerned parents to first responders and
    clinicians, to public health agencies. Our teams of expert
    nurse, pharmacist, and physician, poison specialists, and
    toxicologists deliver accurate real time guidance on poisoning
    emergencies. On average, poison centers receive a call every 15
    seconds. That means in our brief time together, 20 calls will
    have been managed by a poison center. In this last month alone,
    over 201,000 poisoning cases were handled by poison centers
    across the country, with cases ranging from a grandparent
    accidentally doubling their blood pressure medication dose, to
    a child ingesting a household cleaner, to a gardener bitten by
    a snake, to a teenager overdosing in a self-harm attempt. But
    beyond our day-to-day management of these poisoning
    emergencies, we also function as an all-hazards response
    program in the regions we serve.
        At the national level, we work together as a network to
    support our Nation's broader public health system, including
    through America's poison centers. Whether a foodborne illness
    outbreak, natural disaster, chemical attack, or emerging public
    health threat, you can count on a poison center being a part of
    the public health response. We also play a crucial role in
    lowering healthcare costs, in large part through our efficient
    triage methods, which prevent unnecessary and costly emergency
    department visits, enabling safe home monitoring with close
    follow-up and further preserving vital hospital resources.
    According to a Lewin Group report, for every dollar the Federal
    Government invests in poison centers, there is a saving of over
    $38. That equates to over $662 million saved per year.
        In Alabama, our Center has collaborated with key partners,
    including the Alabama Department of Public Health, to safeguard
    our constituents from unregulated agents, like tianeptine, a
    supplement with potent opioid-like effects that that was being
    sold at our local gas stations. Leveraging our Center's
    expertise and data, we informed and enabled statewide efforts
    to restrict access and reduce exposures by 75 percent. We are
    also committed to combating illicitly-manufactured substances
    of abuse, like fentanyl. Engaging in data-driven decision-
    making as well as community outreach across all levels, poison
    centers help to stake steer resource allocation and target
    messaging.
        Our centers face challenges that threaten our ability to
    continue this vital work, however. Like many organizations, we
    face a growing challenge to attract and retain qualified staff.
    The critical work of poison centers highly relies on highly-
    trained and credentialed professionals, such as toxicologists
    and poison specialists, and while our calls remain steady, our
    cases continue to grow in complexity and nuance. Additionally,
    public risks and, by extension, our mission are ever evolving.
    Thus, our professionals must commit to lifelong learning and be
    supported by advancing systems in order to do so.
        Finally, we are facing a critical risk to the National
    Poison Data System, or NPDS, an essential tool that provides
    real-time, integrated poison center data which aids in
    prevention and surveillance at every level. With regional data
    uploaded every 5 minutes, NPDS rapidly detects case clusters,
    anomalies, and enables swift, coordinated responses to crises
    of any form, driving a unified escalation of efforts across the
    Nation. Federal agencies, including the CDC, have long
    leveraged NPDS to provide them with real-time data and exposure
    monitoring. Recent Federal reorganization efforts could
    inadvertently jeopardize this vital partnership, and without
    continued Federal support, this essential data source could
    lapse, risking significant disruptions in our Nation's
    healthcare network. We request the subcommittee's continued
    support of our program and aid in preventing unintended
    consequences to NPDs, ensuring your constituents and healthcare
    professionals, as well as local, State, and Federal entities
    have access to critical, real-time data.
        On behalf of the Alabama Poison Information Center, our
    host institution, Children's of Alabama, and each of our
    Nation's 53 poison centers, I thank you all for the opportunity
    to testify before you today. Thank you.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Aderholt. Thanks so much. I appreciate your testimony,
    and, again, all of it will be included in the record. And we
    appreciate you giving that information to us, and we look
    forward to working with you. Ranking Member DeLauro, you are
    next.
        Ms. DeLauro. Thank you. I want to thank you for the great
    work and applaud the work in Alabama, and you talked about
    regulating tianeptine, which is a controlled substance. What
    you are doing is a good example of an unsafe food additive that
    is being marketed to the public deceptively, and it is being
    marketed as a dietary supplement, but it has real consequences,
    so I thank you for doing that. And I would just say that we
    want to preserve the programs that HRSA covers, as you do, in
    making sure that that efforts like yours don't fall by the
    wayside. Thank you.
        Mr. Aderholt. Thank you. Okay. Next, we will hear from
    Jennifer Carroll. Jennifer is the assistant director for
    children's services at the Community Action Partnership of
    North Alabama. So welcome, glad to have you here, and look
    forward to your testimony.

                                  ----------

                                              Wednesday, April 9, 2025.

                 COMMUNITY ACTION PARTNERSHIP OF NORTH ALABAMA

                                    WITNESS

    JENNIFER CARROLL, ASSISTANT DIRECTOR, COMMUNITY ACTION PARTNERSHIP OF
        NORTH ALABAMA

        Ms. Carroll. Thank you for having me. Good morning,
    Chairman Aderholt, Ranking Member DeLauro, and members of the
    subcommittee. I am Jennifer Carroll, the assistant director of
    Community Action Partnership of North Alabama, located in
    Decatur, Alabama. As you know, Head Start provides children
    from disadvantaged backgrounds the opportunity to enter school
    ready to learn, while also setting their families on a path to
    achieving economic stability and self-sufficiency. Thank you
    for the opportunity to share my perspective on the critical
    value of Head Start and the need for investment in Head Start
    of $14.9 billion in fiscal year 2026 to support the country's
    most vulnerable children, their families, and the communities
    they live in.
        Head Start has effectively implemented a multigeneration,
    whole-child, whole-family model. The children attending Head
    Start, those in poverty, in foster care, or experiencing
    homelessness, the children of seasonal farm workers, American
    Indian and Alaska Native children, and others known to be at
    risk due to life circumstances benefit from comprehensive
    education, health, and nutrition services in a safe and
    nurturing environment, and it is not just the children. Parents
    and caregivers also benefit significantly from Head Start
    services, including employment, housing, and educational
    support. In other words, Head Start is a lifeline for families
    seeking to achieve the American Dream.
        The Head Start model has proved to be extremely successful.
    Research shows that Head Start alumni are more likely to
    graduate from high school, enroll in and graduate school from
    college, and are less likely to experience poor health, live in
    poverty, or need public assistance as adults. Additionally,
    parents and caregivers, having benefited from goal setting,
    parent training, and experiencing real engagement, are more
    likely to join the workforce or stay employed, setting them and
    their families on a path of economic self-reliance. CAPNA'S
    Head Start program is a fiscally responsible, pro-family, pro-
    workforce solution that improves child and family outcomes,
    supports work, reduces dependency, and stimulates the local
    economy. It is funded through a smart, bipartisan investment
    that promotes work, strengthens families, and prepares for
    lifelong success.
        With your continued support, we can ensure every child--
    every child--has a strong head start and every parent has a
    positive pathway forward. CAPNA has 426 Head Start employees
    and invested over $32 million in North Alabama last year, and
    our procurement activity directly supported over 130 local
    businesses. Unlike some Federal Government contracts, the
    grants awarded to CAPNA for our 39 Head Start centers are all
    spent in the communities where we operate. Imagine this
    economic impact replicated across the 17,672 Head Start centers
    located across this country.
        While Head Start grant recipients are deeply appreciative
    of the funds Congress has previously appropriated, I am here to
    discuss our request for funding in fiscal year 2026. Head Start
    workforce situation has improved, but early childhood education
    ranks in the bottom 10 percent of all professions for
    compensation, making it difficult to recruit and retain staff.
    Those staff are necessary to work with not only the more than
    750,000 children currently enrolled, but those eligible
    children not being served yet. Head Start preschool reaches
    only 20 percent of eligible children and Early Head Start only
    13 percent, and the nationwide wait list is estimated to exceed
    170,000. At CAPNA alone, the waitlist exceeds 1,300 children.
    With that in mind, we are recommending a cost-of-living
    adjustment of 3.2 percent for Head Start in fiscal year 2026.
    This would equal $390 million, and it is critical to our
    programs and to the children, families, and communities where
    Head Start operates.
        As I noted earlier and as detailed in my written remarks,
    in addition to this, COLA fiscal year 2026 funding of $14.9
    billion for Head Start would allow programs to address critical
    local needs and expand recruitment and development of staff for
    AI/AN programs. It would also fund the demonstrated need for
    expansion of Head Start and facility improvements through
    separate competitive grants, but again, a 3.2 percent COLA is
    the most critical need for Head Start in fiscal year 2026.
        Let me end with a story that a mother whose child attends
    our program recently shared. ``My child has been in head start
    since 2023, and the program has exceeded my expectations. The
    staff genuinely care about the children and families. My son's
    language and social skills have grown more than I could
    imagine. As a single parent and substitute, I have gained
    skills that help in both my career and parenting. I am so
    thankful for this exceptional team.'' This is just one family.
    This is just one child whose life has been transformed because
    Congress has chosen every year to invest in Head Start. I urge
    you to continue that investment in fiscal year 2026. Thank you
    sincerely for your consideration of this critical request.
    Thank you so much for your time.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Aderholt. Yes, thank you so much for you testimony. I
    know you are very passionate about this----
        Ms. Carroll. I am.
        Mr. Aderholt [continuing]. And that comes through, and we
    appreciate you sharing that with us. Sure, yeah.
        Ms. DeLauro. I just want to just say thank you. I noticed
    Community Action Partnership of North Alabama.
        Ms. Carroll. Yes, ma'am.
        Ms. DeLauro. I started my career with the community action
    agency in the City of New Haven, one of the first in the
    Nation, and the work that gets done through community action
    programs is stellar. This is going way back, a long time ago,
    and the way that you have continued to play a role in the lives
    of people, and particularly Head Start.
        Ms. Carroll. Yes, ma'am.
        Ms. DeLauro. Head Start works. It is an unbelievable
    program that we need to maintain.
        Ms. Carroll. Yes, ma'am.
        Ms. DeLauro. There is a document that would call for the
    elimination of Head Start. I just say to you, we don't make
    promises in our business, but over my dead body----
        Ms. Carroll. Thank you, ma'am.
        Ms. DeLauro [continuing]. Will they do anything to
    eliminate the Head Start program. It is so valuable, and that
    includes Early Head Start as well. Thank you for what you do,
    and thank you for what you have done for that one child.
        Ms. Carroll. Yes, ma'am. Thank you so much.
        Ms. DeLauro. Thank you. Let's multiply that across this
    Nation.
        Ms. Carroll. Yes, ma'am.
        Ms. DeLauro. God bless you. Thank you.
        Ms. Carroll. Thank you.
        Mr. Aderholt. Lois, please.
        Ms. Frankel. Thank you, and thank you, everybody, for being
    here today. You know, I think it was our first hearing of this
    committee where we had a panel talking about ``the failures of
    public school.'' I mean, trying to make a case that test scores
    had gone down. And I think what was missing from that hearing
    was a discussion of what it takes for a child to be ready for
    school and to be a successful student. This is one example, and
    we will probably hear about lots of other programs, too,
    especially safety net programs, that get children ready, and
    thank you very much for what you do. I think there is no
    question if you have the proper head start----
        Ms. Carroll. Yes, ma'am.
        Ms. Frankel [continuing]. It boosts them towards success.
        Ms. Carroll. Thank you so much.
        Ms. Frankel. I yield back.
        Mr. Aderholt. Thank you.
        Ms. Carroll. Thank you.
        Mr. Aderholt. Thanks again. All right. Next, we will hear
    from Michelle Whitten. Michelle Whitten is the president and
    CEO and co-founder of the Global Down Syndrome Foundation.
    Welcome to the subcommittee, and we look forward to your
    testimony.
                                              Wednesday, April 9, 2025.

                      THE GLOBAL DOWN SYNDROME FOUNDATION

                                    WITNESS

    MICHELLE SIE WHITTEN, EXECUTIVE DIRECTOR, THE GLOBAL DOWN SYNDROME
        FOUNDATION

        Ms. Whitten. Thank you so much. Chairman Aderholt, Ranking
    Member DeLauro, thank you for the opportunity to testify today.
    My name is Michelle Sie Whitten, and I am the co-founder,
    president, and CEO of the Global Down Syndrome Foundation and
    the mother of two, including a 21-year-old who happens to have
    Down syndrome. Like other parents of children with Down
    syndrome, our family considers Sophia a gift who has
    transformed our lives and the lives of those around her for the
    better.
        The genesis of Global is the result of NIH leadership,
    acknowledging that its medical research priorities do not
    necessarily align with medical research needs. People with Down
    syndrome have a radically different disease spectrum whereby
    they are highly predisposed to certain diseases, such as
    Alzheimer's, autoimmune disorders, and leukemias, and highly
    protected from others, such as solid tumor cancers and certain
    types of heart attack and stroke. People with Down syndrome
    have complex yet treatable health needs that involve almost
    each of NIH's 27 institutes and centers.
        Global's goal is to elongate life and improve health
    outcomes for children and adults with Down syndrome by
    overhauling NIH's approach to funding Down syndrome research.
    When Global was established in 2009, Down syndrome was the
    least funded genetic condition by the NIH, receiving only $22
    million out of a $31 billion budget, despite Down syndrome
    being the leading cause of developmental delay in the U.S. and
    the world. This important goal has been supported by the
    brilliant Frank Stephens, David Egan, Damani Tichuana, Diandra
    Dixon, who sadly passed away in 2020, and by thousands of other
    self-advocates, families, researchers, and local Down syndrome
    organizations.
        We were fortunate that Chairman Cole and Ranking Member
    DeLauro, who led the House Labor, HHS Subcommittee in 2017,
    recognized the immense potential of Down syndrome research.
    After testifying before this subcommittee, there was bipartisan
    consensus that NIH was significantly underinvesting in Down
    syndrome research and that this research would also benefit
    millions of people without Down syndrome. This led to the
    creation of a transformative NIH Down syndrome funding program
    called the INCLUDE Project. The INCLUDE Project is a real-time
    example of how effective and efficient NIH can be when research
    priorities and plans are developed in collaborative, multi-
    institute, centralized approaches.
        Before INCLUDE, NIH's approach to Down syndrome was
    actually better, faster detection, and you saw that bias in the
    way that research dollars were funded and spent. Down syndrome
    research occurred almost exclusively at the NICHD. Today,
    because of INCLUDE, 18 of NIH's 27 institutes are investing in
    Down syndrome research, including 11 institutes for the very
    first time. Some examples of INCLUDE research, researchers at
    the University of Alabama, Birmingham are studying optic nerve
    disorders in people with Down syndrome who have a higher
    prevalence. Researchers at the University of Michigan are
    identifying molecular regulators of comorbidities in Down
    syndrome towards treatment for many neurological disorders.
    Scientists at Vanderbilt are researching the increased risk of
    leukemia in children with and without Down syndrome. Texas A&M
    researchers are using INCLUDE funding to understand bone
    regeneration and treatment for people with Down syndrome and
    those with limb loss. University of Florida researchers are
    examining significant genomic variants underlying congenital
    heart disease in patients with and without Down syndrome.
        We can already point to advances in research and concrete
    outcomes resulting from INCLUDE. Prior to INCLUDE, people with
    Down syndrome were essentially excluded from clinical trials.
    Today, there are 13 clinical trials for people with Down
    syndrome related to autoimmune disease, Alzheimer's, cognition
    deficit, regression disorder and more. INCLUDE established the
    Data Coordinating Center under the leadership of Dr. Joaquina
    Espinosa that now has more than 9,000 participants, 4,000 whole
    genome sequences, and hundreds of datasets that attracts new
    investigators. INCLUDE has funded the Alzheimer's Trial Ready
    Cohort Down Syndrome under the leadership of Dr. Mike Rafii,
    who runs the Alzheimer's Therapeutic Research Institute at the
    Keck School of Medicine. There is also significant INCLUDE
    investment in the Down Syndrome Registry and the Down Syndrome
    Clinical Cohort Coordinating Center. All of these were new and
    really contribute to the goal of increasing lifespan, improving
    health outcomes.
        People with Down syndrome clearly benefit from INCLUDE's
    goals to structurally streamline NIH research to support a
    holistic life-stage approach rather than by specific diseases,
    conditions, or organs, and the restructuring reflects what
    science has learned about the interconnectedness of health. We
    are entering a new era when it comes to valuing people with
    Down syndrome, we are seeing a renaissance for Down syndrome
    research, and witnessing the great promise and tangible results
    from this program.
        GLOBAL is closely following reports of changes in
    organization and reductions in workforce at NIH. We look
    forward to understanding how the administration will move
    forward with continuing the important research being done at
    NIH, including Down syndrome research. We also look forward to
    working with the new NIH director, Dr. Bhattacharya, and our
    champions in Congress to ensure U.S. leadership in the life
    sciences. We hope that Global can continue to be a resource for
    this committee and the NIH in terms of supporting impactful
    translational science and the dedicated researchers making a
    difference for the awesome people with Down syndrome we serve.
    Thank you very much.
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        Mr. Aderholt. Thank you.
        Ms. Whitten. Thank you.
        Ms. DeLauro. Mr. Chairman.
        Mr. Aderholt. Yes?
        Ms. DeLauro. I just want to just give you a shout-out and
    such a warm welcome, Michelle, the work that you are doing and
    your tenacity and commitment to this effort. You have been
    responsible for Congressman Cole and I coming together and
    saying that we need to focus time and effort on research on
    Down syndrome, that it is our real responsibility to do that. I
    won't forget in 2017, and I see Frank Wright here, who has one
    of the most powerful personal testimonies that this
    subcommittee has ever heard. And we are clearly concerned
    because it was wonderful to listen to the number of
    universities that are really engaged in this now. You know, you
    made it happen. This is what I am saying, you know, without
    your steadfastness on it.
        But there is, as we know, the proposed attempt to cut $5
    billion from universities, to cap the indirect costs at 15
    percent. Now, there is a temporary injunction to block that
    policy, but we cannot allow that to happen because of the vital
    research that you speak about, which, again, changes people's
    lives. In this subcommittee, we are not talking about tanks and
    helicopters and bridges and roads. We are talking about
    people's lives, and so all that you do and all that we must do
    to allow you to continue with that research is imperative.
        And I will just say, and I want to shout out again to my
    colleague, Congressman Cole, and, again, between the two of us,
    it is somewhat self-serving, but overall NIH research funding
    related to Down syndrome in fiscal year 2024 was $133 million.
    We need to only go up from there. Thank you very, very much for
    your testimony. Great to have you with us here, Frank, this
    morning.
        Ms. Whitten. Thank you so much. Thank you.
        Mr. Aderholt. Thank you again. Next we are going to be
    hearing from Christopher Frech. Yes, welcome. Good to have you
    here today, and he serves with Alliance for Biosecurity, and we
    look forward to hearing your testimony.

                                  ----------

                                              Wednesday, April 9, 2025.

                            ALLIANCE FOR BIOSECURITY

                                    WITNESS

    CHRISTOPHER FRECH, CO-CHAIR AND SENIOR VICE PRESIDENT, ALLIANCE FOR
        BIOSECURITY

        Mr. Frech. Good morning, Chairman Aderholt, Ranking Member
    DeLauro, members of the subcommittee. I am Chris Frech. I am
    the SVP at Emergent and the co-chair of the Alliance for
    Biosecurity. As a former House staffer of 11 years, it is good
    to be back here in my roots, and I appreciate the opportunity.
        The Alliance for Biosecurity represents members that
    develop and manufacture vaccines, therapeutics, devices, and
    diagnostics in response to CBRN threats, threats such as
    anthrax, smallpox, mpox, botulism, chemical threats, and
    fentanyl poisoning, to name a few. Because of this, I may be
    the only one testifying today that truly hopes that you never
    have to use our products, but we know that we need them. Our
    members aren't simply vendors selling to the government. We are
    partners responding to the needs and requirements of the
    government to better protect the public and/or the war fighter.
        It is important for me to just take a moment and say thank
    you to this committee for a history of bipartisan support. For
    example, Chairman Cole recently penned an op-ed on the
    importance of BARDA. Congressman Harris and Ranking Member
    DeLauro have in the past supported amendments for increases and
    have each supported the other's amendments. And importantly,
    under the leadership of you, Chairman Aderholt, the last number
    of marks have included increases within austere budget
    conditions as we went forward. The Alliance for Biosecurity has
    submitted written testimony that recommends specific increases
    in funding across medical countermeasure enterprise, including
    BARDA, the Special Reserve Fund, Pan Flu, the Strategic
    National Stockpile, and the Office of Preparedness. This all
    represents the what, but in the remaining time, I would like to
    focus on the why and simply make three points.
        First, the importance of the public private partnership.
    Governments can't do this on their own. Industry needs a level
    of clarity and certainty to be able to better respond to meet
    the needs of the government to better protect the public. They
    need to have a seat at the table early on so that we can align
    aspirational goals with the realities of the time and leverage
    industry expertise and innovation.
        Second, need for sustainable funding. Over the years, for
    those of us that have been in this space for a long time, we
    have moved from crisis to complacency. Many of these products
    lack a commercial market, and it was BioShield that first
    envisioned the need to have a process in place so that the
    government could actually have medical countermeasures that it
    needs to protect the public should the unthinkable happen.
    Funding needs to be maintained to allow for not just the
    procurement of products, but to maintain the capability, the
    capacity, and the industrial base to manufacture these products
    in the future. Like DOD, this is fundamentally a Federal
    responsibility, and we need to think about it in the same lines
    as we think about our national security issues. DOD procures
    guns, weapons, tanks, and ships before they declare war, and we
    have to have that same mindset when it comes to
    countermeasures, knowing that we need to have these measures
    stockpiled safely and approved, before something happens so
    that we are ready to respond should it happen.
        Third, we need alignment and harmonization across the MCM
    enterprise. Regardless of where people sit in the org chart,
    coordination is required from requirements, development,
    procurement, stockpiling, and response, in order to actually be
    prepared for that next event. A former member of this committee
    once told me that I needed to explain this so that he could
    explain it to the average voter in his district, maybe
    Savannah, Georgia. Just saying. At the end of the day, the U.S.
    Government identifies threats through the material threat list
    through DHS. The MCM enterprise is then tasked with each either
    developing or procuring medical countermeasures, vaccines,
    therapeutics, devices, and stockpiling those against
    requirements that the government has set based on different
    scenarios. If we don't have funding, it simply means that we
    don't have the medical countermeasures and, in fact, we are not
    prepared for that threat, but it doesn't make the threat go
    away. By funding essential programs, maintaining a strong
    public-private partnership, and treating biodefense as a
    national security priority, we can protect the American lives
    and ensure long-term resilience against biological threats for
    the future.
        Thank you again for the opportunity. The Alliance for
    Biosecurity and our members continue to stand ready to be a
    partner both to this committee as well as to the U.S.
    Government. Thank you.
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        Mr. Aderholt. Thanks so much for testimony and thank you.
    Ms. DeLauro, do you have any comments?
        Ms. DeLauro. Yes. I want to just say thank you because I
    think that you talked about sustainable funding. You talked
    about, you know, a comparable infrastructure to deal with
    countermeasures, which I think is critical. But HHS has
    announced it is eliminating the Administration for Strategic
    Preparedness and Response. That is ASPR. They are going to
    discontinue it as an independent agency. They will transfer
    some of its functions and a thousand employees to what, in
    fact, would be a severely-diminished CDC. I say that. BARDA is
    going to be combined with the Advanced Research Projects Agency
    for Health, ARPA-H.
        At the moment, there are no details with regard to what,
    you know, what will happen here, and I am going to ask you. I
    think we need to have answers to the questions in order to
    safeguard the BARDA project--BioShield, Strategic National
    Stockpile, pandemic flu preparedness--all of what ASPR has done
    in the past to make sure that it has the resources it needs
    because pandemics will visit us again, and we need to be
    prepared and other disasters. And so we need the competence,
    and we need the research and the technology that you oversee.
    Thank you.
        Mr. Aderholt. Thank you, and good to have you back on the
    House side.
        Mr. Frech. Thank you.
        Mr. Aderholt. All right. Next, we will hear from
    Christopher Kramer, who is the current president of the
    American College of Cardiology, and, Dr. Kramer, good to have
    you here today and look forward to your testimony.

                                  ----------

                                              Wednesday, April 9, 2025.

                         AMERICAN COLLEGE OF CARDIOLOGY

                                    WITNESS

    CHRISTOPHER M. KRAMER, PRESIDENT, AMERICAN COLLEGE OF CARDIOLOGY

        Dr. Kramer. My name is Dr. Christopher Kramer, and I am the
    president of the American College of Cardiology, or ACC. I am a
    practicing cardiologist and serve as chief of Cardiovascular
    Medicine at the University of Virginia. I am honored to speak
    on behalf of the ACC's more than 60,000 cardiovascular
    clinicians, including cardiologists, nurses, advanced practice
    providers, and researchers, who work every day to prevent and
    treat heart disease, improve patient outcomes, and transform
    cardiovascular care nationwide.
        The ACC has long been committed to advancing policies that
    support evidence-based care and promote public health, in
    addition to working alongside lawmakers to ensure the latest
    science is translated into lifesaving practice. Today, I am
    here to discuss one of the most promising and urgent
    opportunities to save young lives: fully funding the HEARTS
    Act. The Cardiomyopathy, Health, Education, Awareness,
    Research, and Training in Schools, or HEARTS Act for short, was
    passed by Congress last year with near unanimous bipartisan
    support in both chambers. Such consensus is rare, and it sends
    a powerful message. Cardiac arrest is not a partisan or
    regional issue. It is a public health concern, and we have the
    tools to make a difference.
        The HEARTS Act ensures that public, primary, and secondary
    schools across the country can develop cardiac emergency
    response plans, provide training for CPR and automated external
    defibrillators, better known as AEDs, and through a voluntary
    grant program, have AEDs available on site ready for use when
    they are needed most. While student athletes were the original
    focus of this bill, its benefits extend into the communities
    around them. Schools are a gathering point, a cornerstone in
    American public life. Having an AED nearby helps protect every
    person passing through a school setting, whether they be
    students, parents, educators, or seniors. The new law is so
    important because it builds upon the foundation of sustained
    investment in the NIH, the CDC, and HHS. The HEARTS Act is not
    solely about providing AEDs in schools. It is about leveraging
    the power of NIH-funded research to understand and prevent
    heart disease and utilizing valuable public health programs at
    the CDC and HHS to educate and protect our patients.
        Every year in this country, more than 2,000 young people
    under the age of 25 die from sudden cardiac arrest. Individuals
    experiencing an out-of-hospital sudden cardiac arrest event
    face a mortality rate between 70 and 90 percent. Many of these
    deaths can be prevented if the appropriate knowledge and
    systems are in place. Every second counts, and having access to
    training and easily-used technology, such as AEDs, can mean the
    difference between life and death. We are proud and grateful to
    our friends in Congress for this law designed to prevent tragic
    cardiac events, but passing the law was just the first step.
    Now we must fund it so that its promise becomes reality.
        The American College of Cardiology respectfully urges the
    subcommittee to provide full funding for the HEARTS Act in
    fiscal year 2026, including $25 million for grants to help
    schools purchase AEDs and develop cardiac emergency response
    plans; $5 million for the CDC to develop risk assessments and
    distribute educational materials to schools and families about
    conditions that lead to cardiac arrest in youth; and $20
    million for the NIH to conduct research into cardiomyopathy,
    the most prevalent cause of sudden cardiac death in young
    people.
        We cannot overstate the value of continued investment in
    the NIH. It is through NIH-funded research that we have learned
    how to prevent, treat, and manage heart conditions that once
    seemed untouchable. Since 1950, death rates from cardiovascular
    disease have declined 60 percent, and the number of people in
    the United States dying of a heart attack each year has dropped
    from 1 in 2 in the 1950s to now 1 in 8.5. America's leadership
    in medical science depends on strong investments in our
    Nation's research infrastructure, and the HEARTS Act is a
    worthy and impactful addition to that legacy.
        Distinguished members of the subcommittee, the HEARTS Act
    was passed by Congress with the unity and urgency this issue
    deserves. Now, with your support, we can ensure effective
    nationwide implementation, protecting and investing in the
    health and safety of our communities. On behalf of the American
    College of Cardiology and the thousands of patients, families,
    and clinicians we represent, thank you for your time, your
    leadership, and your commitment to building a heart healthy
    future for all Americans.
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        Mr. Aderholt. Thank you, Dr. Kramer. Thanks for your
    testimony this morning and appreciate you being here and
    sharing that with us.
        Dr. Kramer. Thanks so much, Mr. Chairman.
        Mr. Aderholt. Ranking Member DeLauro, would you like to
    make a comment?
        Ms. DeLauro. Yes. Thank you. Thank you very, very much for
    the testimony and the work of, you know, AEDs. I just want to
    reference our colleague, Representative Sheila Cherfilus-
    McCormick, who is from Florida, is the lead sponsor of a bill.
    It is H.R. 2370, and it is Expand Access to Defibrillators in
    Elementary Schools and Secondary Schools, and it would
    authorize up to $25 million annually for HHS to award grants to
    local education agencies to purchase FDA-approved
    defibrillators for schools. And the Heart Association, just so
    that you know, estimates that 50 percent of sudden cardiac
    arrest victims could survive if bystanders gave CPR and used a
    defibrillator immediately. So this is again saving lives. I am
    sure you know about the piece of legislation, but we have to
    work, it seems, about getting $25 million doing that.
        So keep up the testimony and the and the fight and the
    advocacy. Thanks so much.
        Dr. Kramer. Thank you.
        Mr. Aderholt. Thank you, Dr. Kramer. Next, we will hear
    from Rey Saldana, and he is the president and CEO of
    Communities in Schools. Welcome to the subcommittee this
    morning. We look forward to your testimony, and you have the
    floor.

                                  ----------

                                              Wednesday, April 9, 2025.

                             COMMUNITIES IN SCHOOLS

                                    WITNESS

    REY SALDANA, PRESIDENT AND CEO, COMMUNITIES IN SCHOOLS

        Mr. Saldana. Thank you. Chair Aderholt, Ranking Member
    DeLauro, and members of the subcommittee, thank you for the
    opportunity to provide testimony regarding the fiscal year 2026
    Labor, HHS, Education appropriations bill. I am Rey Saldana. I
    am president and CEO of Communities in Schools.
        Growing up in San Antonio, Texas, Communities in Schools
    coordinators helped me overcome barriers to become the first in
    my family to attend college, and today, I lead the organization
    that opened the doors of opportunity and access to the American
    Dream. That journey shapes my conviction in this work every
    day, and today, Communities in Schools works in 3,571 schools
    in 29 States. We connect 2 million students annually to
    resources that help them overcome barriers to success. Our
    evidence-based model of integrated student supports places a
    dedicated site coordinator inside each school to serve as the
    vital link between students and the resources that they need.
        Integrated Student Supports isn't another program. It is
    the operating system that makes all other programs and funding
    streams work efficiently. Think of integrated Student Supports
    as air traffic control for student success, coordinating
    Federal, State and local resources. While teachers focus on
    classroom instruction, our coordinators tackle chronic
    absenteeism, mental health concerns, and basic needs like
    transportation and nutrition. As our founder, Bill Milliken,
    described, students cannot be turned onto learning until they
    are turned on to living, and living can be sometimes the
    hardest part.
        At Communities in Schools, we have proven that being
    present matters. Ninety-nine percent of the case managed
    students we work with show up and make academic and behavioral
    strides year after year. Our seniors graduate 96 percent rate,
    representing significant lifetime tax contributions and cost
    savings. Federal dollars are crucial in our integrated student
    supports ecosystem. Core ESEA investments, like Title I and
    Title IV, not only underwrite direct services, but also unlock
    additional investment. For every Federal dollar that supports
    Integrated Student Supports, we leverage an additional $4 from
    State, local, and private resources.
        The strategic architecture of Federal education funding
    matters. When Title I schools implement Integrated Student
    Supports, they optimize their per-pupil allocation by
    addressing non-academic barriers. Title IV-A grants become more
    effective when delivered through an integrated supports
    framework, and Integrated Student Supports enables AmeriCorps
    and WIOA dollars to achieve cross-sector outcomes, advancing
    education, workforce development, and economic mobility gains.
    Parents remain central in our work. Our site coordinators work
    directly with 360,000 families annually, ensuring their voice
    drives the support that their children receive.
        Integrated Student Supports honors local control by
    strengthening what communities are already doing. We see
    success in communities across the country. In rural Jackson
    County, North Carolina, Community in Schools student support
    specialist, David Cawley, implemented the Tar Heel Charm
    Challenge to improve attendance and drive academic progress. In
    Montgomery, Alabama, Communities in Schools site coordinator,
    Kimberly Byrd, reduced absenteeism among 74 percent of her
    students through personalized plans and schoolwide initiatives,
    like attendance dance competitions. Our success builds on
    bipartisan cooperation.
        Congress recognized Integrated Student Supports in the
    bipartisan Every Student Succeeds Act of 2015. Schools
    implementing evidence-based integrated student supports are
    seeing dramatic improvements in attendance, behavior,
    coursework, and graduation rates. Integrated Student Support
    serves as both a standalone approach, but is also a
    foundational pillar of a comprehensive model of including
    community schools. Its flexibility allows rural, suburban, and
    urban communities to tailor implementation to fit their
    specific needs while maintaining the evidence-based core that
    drives results. The urgency of this work cannot be overstated.
    Today, as 15 million classroom seats sit empty across America,
    these strategic appropriations represent smart fiscal
    stewardship that taxpayers deserve and our children need.
        I urge Congress to protect and strengthen core Federal
    investments that support Integrated Student Supports and
    community schools, specifically Title I funding, Title IV-A
    student supports and academic enrichment grants, full-service
    community schools, 21st Century Learning center allocations,
    Project AWARE grants, AmeriCorps funding, and WIOA investments.
    Our children deserve nothing less than the fiscally-responsible
    approach to education. When we give the students the support
    they need, they show up for school today, and ultimately, they
    show up for America tomorrow. Thank you.
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        Mr. Aderholt. Thank you so much for your testimony, again,
    and for being here today. Ranking Member DeLauro.
        Ms. DeLauro. Thank you. Thank you very much, Mr. Chairman.
    Thank you so much for your testimony. I grew up in New Haven,
    Connecticut, and the Conte Community School was just almost
    across the street from our house. And I finished my graduate
    degree and I didn't have a job yet, so what I did was I went to
    volunteer at the community school, you know, every day, and
    what an eye-opener that was. That is what propelled me to
    introduce funding for community schools in the Labor, HHS
    funding bill. This was a facility that was open from 6:00 in
    the morning until 9:00 at night. There was an academic program,
    sports program, mothers, fathers, grandmothers, and so forth,
    where they are interacting with kids and so forth. It was just
    a beautiful overall educational experience and, I believe,
    helped to strengthen the lives of our kids.
        But you must know, and I am not going to pull punches here,
    the community schools funding for 2025, I believe, has been
    almost cut in half. It is $150 million now. The attempt is to
    cut it in half, and in the 2025 bill, my colleagues on the
    other side of the aisle have proposed, it eliminates--
    eliminates--WIOA for youth and cuts WIOA of funding for adults.
    I am asking you and your colleagues around the country, who
    support community schools, who understand their value,
    understand the value of these programs, that your voices need
    to be heard loud and clear that we can't roll back the
    resources that provide these new opportunities for children and
    to help to transform their lives.
        So I am pleading with you to please organize and let people
    know how you value community schools, Title I, as I said
    earlier. There are cases being made to eliminate Title I. I am
    not making it up. You can go and look. It is right there in
    black and white to eliminate Title I, 300,000 teachers across
    the country. We need your help. Thank you for your testimony,
    thank you for the work that you are doing, and thank you for
    making a difference in the lives of our kids.
        Mr. Aderholt. All right. Next, we will hear from Theresa
    Sokol, who is a State epidemiologist, program director
    infectious Disease in epidemiology section of Louisiana
    Department of Health. Welcome to the subcommittee. Glad to have
    you here and look forward to your testimony.

                                  ----------

                                              Wednesday, April 9, 2025.

                COUNCIL OF STATE AND TERRITORIAL EPIDEMIOLOGISTS

                                    WITNESS

    THERESA SOKOL, LA STATE EPIDEMIOLOGIST AND BOARD MEMBER, COUNCIL OF
        STATE AND TERRITORIAL EPIDEMIOLOGISTS

        Ms. Sokol. Chair Aderholt, Ranking Member DeLauro, and
    Representative Letlow, thank you for the opportunity to allow
    me to testify before you here today. I am Theresa Sokol, a
    member of the executive board of the Council of State and
    Territorial Epidemiologists, and I am the Louisiana State
    epidemiologist. I am here today representing CSTE and its 3,600
    members nationwide to talk about the important work
    epidemiologists do to save lives every day. I want to talk
    about the collaboration and support we get from the CDC and,
    specifically, two essential CDC programs: the Epidemiology and
    Laboratory Capacity program and Public Health Data
    Modernization.
        Epidemiologists are disease detectives. We work around the
    country to keep our communities safe, stopping outbreaks, and
    preventing every type of disease threat. Nationally, Federal
    dollars make up more than 80 percent of State epidemiology
    budgets. In some States, like Louisiana, it is even more.
    Ninety percent of my team's budget comes from CDC. Without CDC
    funding, we could not do our jobs. Key to this is CDC's
    Epidemiology and Laboratory Capacity Program, or ELC. ELC is
    the only source of core infectious disease funding for
    epidemiologists in State and local health departments. It is
    what allows us to respond to new outbreaks and threats.
        In January, you may remember, Louisiana reported the first
    human death related to H5N1, or bird flu. This patient became
    sick after exposure to a backyard bird flock. Our team of ELC-
    funded epidemiologists carried out an extensive investigation,
    including identifying and monitoring nearly 30 individuals who
    had been exposed to bird flu, and coordinating with the
    hospital to prevent transmission to healthcare workers and
    other hospital patients. Unfortunately, last month, pandemic-
    era resources that were allocated to States from CDC and were
    still being used to support our epidemiology and data
    modernization work efforts were canceled unexpectedly, putting
    our work in danger. This immediate loss of existing funding and
    the fact that the ELC funding line has not grown since 2011
    means State and local epidemiology efforts across the country
    are tremendously underfunded.
        CSTE estimates that an additional 2,537 epidemiologists are
    needed in State health departments to meet basic public health
    needs. We also need to modernize our public health data
    systems. Epidemiologists depend on data. In Louisiana and
    public health departments across the country, we are working to
    get better, faster, actionable data that can help us make
    decisions that will keep our communities safe. I am so proud to
    be joined here in D.C. today by my 16-year-old daughter, Elise.
    She and her 14-year-old brother, Gabriel, remind me why I do
    this: to make a difference for our kids across this country.
    Data modernization will help me protect their future.
        In 2021, Hurricane Ida knocked out the power in the New
    Orleans area. Our entire infectious disease data system was out
    of commission for about a week. We received no electronic
    notifications of diseases from healthcare providers, severely
    hobbling our public health response. Thanks to Federal
    investments, we have started the process of moving our public
    health data to a modern cloud-based system that will be safe
    during a natural disaster. Unfortunately, these upgrades are
    now at risk. Many health departments have had to lay off staff
    or discontinue system maintenance contracts. If we stop
    investing now or pull back existing resources, we will be
    forced to move backwards. Systems have only been partially
    upgraded, they remain in dire need of security enhancements,
    and they lack sustained trained personnel to keep them
    operational. Cuts will leave us behind industry standards and,
    yes, going back to the fax machine.
        I am here before you today to plead for sustained resources
    for both ELC and data modernization. Specifically, CSTE
    requests that you fully fund the CDC and appropriate $340
    million for data modernization and $120 million for the ELC
    base funding. These dollars make our public health system more
    efficient, not less. They are essential to our ability to
    detect and respond to public health threats of all kinds:
    foodborne illnesses, respiratory viruses, measles, lead
    poisoning, opioid overdoses, occupational diseases, and more.
    We cannot keep Americans safe without your support for our
    work. Thank you.
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        Ms. Letlow [presiding]. Thank you, Ms. Sokol, and I would
    like to recognize our vice chair, Ms. DeLauro.
        Ms. DeLauro. Thank you. Thank you very, very much. 2019,
    Janet Hamilton, Council of State and Territorial
    Epidemiologist, CSTE, testified at Public Witness Day to
    request funding to establish a new effort, public health data
    modernization. Compelling. I said earlier on in my opening
    remarks, what people say here and the pleas that you make on
    your behalf often get translated into resources in order to
    carry out the functions that you care so deeply about. Well,
    that was the case. I introduced the data modernization program,
    and I created that, and I am happy to say in that year's bill,
    2020, the Labor, HHS, Education appropriations bill, we
    included $50 million for this effort. Over the next 4 years, we
    increased annual funding for public health data modernization
    to $175 million. Significant progress. Significant progress.
        But you said it very eloquently. We cannot go back to fax
    machines. It is the lifeblood, data and understanding it, so
    that we can fight disease illness in this Nation, and there has
    to be a comprehensive approach, but I am going to be frank with
    you. Elon Musk and President Trump have fired 2,400 CDC
    employees, 20 percent of the CDC workforce of 13,000 people.
    HHS is terminating $11 billion in supplemental funding provided
    to State and local health departments for public health
    activities, including infectious disease surveillance and
    laboratory testing. And understand, for everybody here, it is
    the State laboratories, that is the infrastructure that allows
    CDC to do what it does. And if there is no ability to be able
    to collect and analyze data at the local level so that you can
    it is preventative as well as being responsive. That is what we
    are here dealing with today.
        Grant funding, additional $2.9 billion, as DOGE is
    reportedly demanding that CDC slash that funding, it would
    illegally cut CDC's annual discretionary budget of $9.2 billion
    by more than 30 percent. We can't undo years of improvements.
    We cannot return our public health system to a time when the
    sharing was so slow, it was burdensome, and we could not react,
    the benefit of saving lives, saving the lives of the people in
    this country. So again, your advocacy is so welcomed and needed
    at this time. I thank you very, very much for being there and
    helping to build that infrastructure that is so critically
    necessary. Thanks so much.
        Ms. Sokol. Thank you, Representative DeLauro.
        Ms. Letlow. Thank you, Ranking Member, and thank you so
    much, Mrs. Sokol, for your time and for all you do for
    Louisianans. I appreciate you. Thank you.
        Ms. Sokol. Thank you very much.
        Ms. Letlow. All right. We would now like to invite Ms.
    Sarah Schapiro--she is the executive director for the Alliance
    of Learning Innovation--to give her testimony. Ms. Schapiro,
    you have 5 minutes.
                                              Wednesday, April 9, 2025.

                        ALLIANCE FOR LEARNING INNOVATION

                                    WITNESS

    SARA SCHAPIRO, EXECUTIVE DIRECTOR, ALLIANCE FOR LEARNING INNOVATION

        Ms. Schapiro. Thank you, Chairman Aderholt, Ranking Member
    DeLauro, Vice Chair Letlow, and members of the subcommittee for
    having me today. I am Sarah Schapiro, executive director of the
    Alliance for Learning Innovation, or ALI. We are a bipartisan
    coalition that brings together 90-plus education nonprofits and
    industry leaders to advocate for building a better research and
    development infrastructure in education. I am grateful for the
    opportunity to speak about how in fiscal year 2026, a $900
    million investment in the Institute of Education Sciences, or
    IES, and $284 million for the Education Innovation and Research
    Program can continue education R&D's outsized impact on
    improving student learning.
        America is in the middle of a critical education crisis.
    The Nation's Report Card, or NAEP, reveals that one-third of
    8th graders score below basic in reading; one-quarter of 4th
    graders score below basic in math. These alarming data points
    collected by IES reflect a significant decline in student
    achievement from 2019. This directly threatens our national
    security and economic competitiveness. At the same time,
    Federal investments in education R&D have produced significant
    results over the last 20 years. For example, in 2024, Alabama
    adopted a literacy curriculum based on the science of reading,
    which is a body of evidence developed through Federal
    investment. This investment in research helps States craft
    literacy initiatives with hugely impressive outcomes.
    Mississippi's ranking in 4th grade reading improved from 49th
    to 21st between 2013 and 2022, Louisiana's from 50th to 16th--
    it is amazing--between 2019 and 2024. State Superintendent
    Kerry Wright, who led Mississippi's impressive literacy gains,
    is now implementing similar efforts based on the science of
    reading in Maryland.
        Examples like these make clear that Federal support for
    education R&D can provide the data States need to make
    decisions about which programs are best for their students.
    This approach respects local autonomy and ensures evidence-
    based practices are what drive policy. Moreover, Federal R&D
    investments help our Nation seize opportunities, like
    incorporating AI in the classroom and strengthening career
    pathways. As the executive director of ALI, I see an
    opportunity to work with both sides of the aisle to update our
    Federal investments in education R&D. I am working with
    partners to draft a blueprint envisioning a revitalized and
    rebuilt Federal education R&D system, and we are thinking about
    it with three pillars.
        The first is that the Federal Government should invest in
    world-class data systems to promote transparency and evidence-
    based decision-making in schools. This means leveraging the
    valuable work of the National Center for Education Statistics
    to improve transparency about K-12 education. This includes
    bipartisan efforts, like the NAEP test. The Federal Government
    can also incentivize State data systems to link information
    across agencies revealing how interventions impact students
    from birth through career. Second, the Federal Government
    should support State and local education leaders to know it
    works and do what works. We must leverage decades of best
    practices identified through Federal investments, make this
    information broadly available, and help scale these practices
    into classrooms. And third, the Federal Government should
    facilitate breakthroughs in education innovation to help the
    U.S. retain its competitive edge. Drawing inspiration from
    advanced research project agencies like the Defense's DARPA,
    the Federal Government should fund cutting-edge R&D to solve
    education's biggest challenges.
        To realize this blueprint, in fiscal year 2026, the
    Alliance for Learning Innovation respectfully requests at least
    900 million for the Institute of Education Sciences, supporting
    critical initiatives like NAEP, Accelerate, Transform and
    Scale, and Statewide Longitudinal Data Systems grant program,
    and $284 million for the Education, Innovation, and Research
    program to advance career-connected learning and emerging
    technologies. Lastly, we encourage Congress to ensure Federal
    agencies, like IES, have the appropriate staffing levels to
    ensure that congressionally-mandated programs reach kids.
        Thank you for this opportunity to present this testimony on
    behalf of the Alliance for Learning Innovation Coalition.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Ms. Letlow. Thank you, Ms. Schapiro. Ranking Member
    DeLauro.
        Ms. DeLauro. Thank you so much, and thank you for, you
    know, really laying out, you know, the work that you do. You
    know that there is an executive order to eliminate the
    Department of Education, and you know that Elon Musk has fired
    thousands of staff from the Department of Education, as much as
    one-half of the Department's workforce. Musk has canceled $881
    million in multiyear research contracts awarded under the
    Institute of Education Sciences--IES--of which you are speaking
    so eloquently, that has halted and has terminated all the
    scientific research that was ongoing, and it impacts various
    education methods on student learning and how kids learn. I
    think it is probably the one area that has been the most
    severely cut, and so every single contract in this Agency,
    which I find troubling in this regard.
        It is that this is such a bipartisan effort, it really is,
    and so many of the programs that we talk about, they wouldn't
    have been wound up in the bill or signed into law if we didn't
    have bipartisan support for this because in Appropriations,
    unless you have bipartisan and bicameral, House and Senate,
    Democrats and Republicans have to agree before a bill goes to
    the President for signature. And so I am trying to grapple with
    why we would take this valuable effort, which we all support in
    some way, which does the scientific research that looks at how
    our kids are learning, what are the best methods, what are the
    innovations, and push it aside. What that means to me is that
    we have to fight to get it back and to keep it because it is
    such a powerful tool that you have in the education profession.
        So I look to you again as I have looked to others. Your
    voices really need to be heard. Your testimony is powerful.
    Testimony needs to get to everyone so that people can
    understand what you do, how you do it, and what resources you
    need to accomplish your goals. Thank you.
        Ms. Schapiro. Thank you.
        Ms. DeLauro. Thank you very, very much for your work.
    Appreciate you.
        Ms. Letlow. Thank you, Ranking Member, and thank you, Ms.
    Schapiro, for coming out today and for your testimony.
        Ms. Schapiro. Thank you for having me.
        Ms. Letlow. I would now like to call on Dr. Scott Harris.
        [Pause.]
        Ms. Letlow. Thank you, Dr. Harris.
        Dr. Harris. Good morning.
        Ms. Letlow. The floor is yours.
        Dr. Harris. Thank you very much.
                                              Wednesday, April 9, 2025.

       ALABAMA DEPARTMENT OF PUBLIC HEALTH AND ASSOCIATION OF STATE AND
                          TERRITORIAL HEALTH OFFICIALS

                                    WITNESS

    DR. SCOTT HARRIS, STATE HEALTH OFFICER OF THE ALABAMA DEPARTMENT OF
        PUBLIC HEALTH, AND PRESIDENT, ASSOCIATION OF STATE AND TERRITORIAL
        HEALTH OFFICIALS

        Dr. Harris. Good morning, Ranking Member DeLauro,
    Congresswoman Letlow. Thank you so much for having me. I am
    Scott Harris. I serve as Alabama State health officer and also
    currently as president of ASTHO, which is the association of
    State and Territorial Health Officials. We represent the public
    health agencies of the states, of D.C., and U.S. territories.
    We are a nonpartisan organization. Although we have members
    representing red and blue and purple jurisdictions, we are
    actually all united in believing that we need sustained and
    flexible public health funding in order to keep our country
    safe and healthy. I have practiced medicine in Alabama for
    almost 35 years. I have seen firsthand how important public
    health is to Alabamians, to America. We don't just treat
    illness after people become ill, but actually work to prevent
    it.
        Our country, the United States, doesn't have a national
    system of public health. We only have a nationwide system of
    public health. We are a patchwork quilt of Federal agencies,
    and State health departments, and local and territorial and
    tribal public health authorities. But public health problems
    don't just stop at the State border, and so our Nation can only
    be as safe and healthy as the weakest link of that patchwork
    quilt.
        Most State health departments rely very heavily on Federal
    dollars. In some States, up to 80 percent of funding for health
    departments comes from Federal sources, mostly from CDC. In my
    State, that number is about 70 percent, so in my State, without
    these Federal dollars, over half a million children would not
    have access to routine vaccinations, and this is at a time when
    we are seeing outbreaks and deaths from diseases, like measles
    and whooping cough. Thousands of women in Alabama would not
    have the ability to have pap smears or mammograms without the
    Federal income that we have. There are over 4,000 Alabamians
    living with HIV who would not be able to afford their
    medications. And these are just a few, among literally
    hundreds, of public health programs nationwide that exist only
    because of congressional support.
        Health departments tend to work behind the scenes until
    there is a crisis. For example, recently in North Carolina,
    officials learned that children were being poisoned by
    applesauce products contaminated with lead. Once that became
    known, public health sprang into action around the country. Our
    environmentalists in Alabama found many locations that were
    continuing to sell these products. They were still on the
    shelves in spite of an FDA recall, and they were able to
    prevent them from being sold. They prevented children in our
    State from potentially permanent neurologic damage. If that is
    a story you didn't know already, it is because public health is
    just out there doing its job. We often say to people, public
    health may well have saved your life today, but you probably
    just didn't know it.
        The public health officials in each one of your States are
    working every day on many important things, like measles, rural
    hospital closures, opioids, mental health crises, but amid this
    work, we were all very shocked recently to learn overnight, we
    had lost $11 billion in Federal funding without any warning at
    all. These are funds that had already been appropriated by
    Congress. They had been approved by Federal agencies for us to
    spend. They weren't just COVID dollars. They were approved to
    be used for many other things, such as measles testing,
    bioterrorism, threat preparedness, protecting communities,
    supporting our local hospitals. The abrupt loss of those funds
    will stop essential work. It will lead to thousands of layoffs
    of State public health employees around the country. We are
    also deeply concerned about the lack of transparency with the
    recent restructuring at HHS. We all share the common goal of
    increasing government efficiency and using our resources
    responsibly, but eliminating large numbers of public health
    professionals overnight with no advance notice or even an
    explanation as to why risks the health and safety of our
    country.
        So we respectfully ask Congress for three things. First, we
    ask you to help sustain investments to State and territorial
    health departments. The return on investment generated by
    public health spending is clear. Preventing disease saves
    lives, but also saves dollars. Secondly, we just ask you to
    please support us in our wish to be included in the decisions
    that affect us in our work. We are on the front lines
    implementing Federal policy. We are the boots on the ground
    that do that work, and it is really vital that we be consulted
    on the impact of funding cuts or administrative changes.
    Finally, we ask you for flexibility in how Federal funds are
    felt. We are so grateful to this subcommittee, we are so
    grateful to Congress for the support of public health
    infrastructure and capacity at $350 million for fiscal year
    2025. We respectfully request $1 billion to CDC in fiscal year
    2026. We understand the budget challenges this year, but this
    allows your own State health officials to make the most
    efficient use of Federal dollars to address the public health
    needs in your own states.
        So, I sincerely appreciate the opportunity to be here
    today. Please know that ASTHO and its individual members stand
    ready to partner with Congress, to partner with the
    administration to keep this country safe and healthy. Thank you
    for your service to this country, and thank you for having me
    today.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Ms. Letlow. Thank you, Dr. Harris. Ranking Member DeLauro.
        Ms. DeLauro. Thank you. Thank you so much, Dr. Harris. You
    have just laid it out when you talk about $11 billion in
    supplemented funding to State and local health departments,
    including infectious disease surveillance, laboratory testing,
    but no warning. No warning. If you watched the TV last week,
    you saw a lineup before the Department of Health and Human
    Services where people were going to work, and when they got
    there, their ID was checked, and some of them were said, you
    are no longer here. You are gone. You are gone. But it is the
    individual, yes, but the work that the individual does, the
    repercussions, what you are talking about in terms of health of
    this Nation and the people of this Nation.
        I have a hard time understanding it, I have to imagine you
    have a hard time understanding it, watching the fruits of your
    labor and of what you are doing and how much progress that you
    have made, but they are going further. They are going to look
    at a 30-percent cut at the CDC. As I said earlier, State and
    local public health departments, they are the lifeblood. You
    know, I hear day in and day out around here, let's give the
    money to the States. Well, hell, we are giving the money to the
    States. You just cut it off and said no. Once again, what this
    subcommittee does in so many respects is the work that you do
    and all of the people here to save lives. We don't have and
    shouldn't have a higher priority. So I ask you and all of the
    ASTHO officials, you have to stand up, be counted, and don't
    take no for an answer. Thank you.
        Ms. Letlow. Thank you, Ranking Member, and thank you so
    much, Dr. Harris, for giving your testimony today.
        I would like to call up Dr. Colleen Kelley, faculty member
    in the Division of Infectious Diseases at Emory University
    School of Medicine, with a secondary appointment in the
    Department of Epidemiology at Rollins School of Public Health.
    Thank you for being here today.

                                  ----------

                                              Wednesday, April 9, 2025.

                            HIV MEDICINE ASSOCIATION

                                    WITNESS

    DR. COLLEEN KELLEY, CHAIR, HIV MEDICINE ASSOCIATION

        Dr. Kelley. Good morning. Thank you, Vice Chair Letlow and
    Ranking Member DeLauro. Thank you for this invitation to
    testify. My name is Dr. Colleen Kelley. I am a physician in
    research in the Division of Infectious Diseases at Emory
    University School of Medicine as well as the Grady Health
    System Ponce de Leon Center. I am here today to testify on
    behalf of the HIV Medicine Association, which I serve as chair.
    HIVMA represents nearly 6,000 HIV clinicians and researchers
    working in communities across the country and as part of the
    Infectious Disease Society of America. This opportunity is
    important to me because we stand at a crossroads that will
    determine the fate of millions and drive up healthcare costs.
        Decades of groundbreaking advancements in HIV treatment and
    prevention have saved lives, yet the programs and research that
    have propelled these advances are now in peril. To prevent what
    we fear could be a looming HIV public health crisis in our
    country, please consider the request I submitted in my written
    statement as you make important funding decisions for fiscal
    year 2026. These requests are for sustained funding for the
    Ending the HIV Epidemic Initiative, the Center for Disease
    Control and Prevention, the Ryan White HIV/AIDS Program, and
    research at the National Institutes of Health.
        As a college student in 1996, I volunteered at Connors
    Nursery, which was a home for children with HIV/AIDS in West
    Palm Beach, Florida. Many of the children were orphans due to
    the disease and were facing serious medical illnesses and
    limited life expectancies themselves. I played with the
    seriously ill children while nurses fed some through feeding
    tubes and coaxed others to take medications that tasted
    horribly. I don't know what happened to them, and I am saddened
    to think that many succumbed to HIV/AIDS before effective
    treatment was available to them. Now, almost 30 years later, I
    am here before you as an HIV physician and researcher who
    witnesses in my Atlanta clinic daily the profound impact of our
    country's investment in HIV research, care, and prevention on
    people with HIV who are thriving, as well as those who are
    benefiting from availability of preexposure prophylaxis, or
    PrEP, an HIV prevention drug.
        Our clinic serves over 6,000 people with HIV, thanks to the
    support of the Ryan White Program, and more than 40 other
    clinics and community programs in Georgia alone also count on
    the Ryan White program to offer HIV services. Since my time
    volunteering at Connors Nursery, medical research has given us
    the tools to end the HIV epidemic, a successful initiative
    started by President Trump in 2019. We have medications that
    are highly effective at suppressing virus to undetectable
    levels and ensuring that people, including newborns who may be
    exposed to HIV, do not acquire it. Due to these advances,
    Connors Nursery closed in 2005 because their services were no
    longer needed.
        Today, new HIV infections in the U.S. are at the lowest
    levels in history. The rate of perinatal transmission during
    birth is now less than 1 percent in the U.S., down from 30
    percent in the absence of HIV testing and treatment. Thanks to
    decades of bipartisan support, Federal programs have fueled the
    remarkable transformation of HIV from a certain fatal disease
    to a chronic, easily-managed condition for those with access to
    treatment. HIV can also be prevented with a daily pill for less
    than a dollar a day, which is important since averting one case
    of HIV saves an average half-a-million-dollar of lifetime
    treatment costs.
        However, we are not done yet, and we are now confronted
    with an alarming reality that decades of progress in the fight
    against HIV/AIDS are being reversed. In recent weeks, we have
    witnessed the terminations of hundreds of HIV/AIDS research
    grants and the abrupt dismantling of critical public health
    infrastructure and programs, such as the Office of Infectious
    Diseases and HIV Policy, CDC's Division of HIV Prevention, and
    the Sexually Transmitted Infection Lab Branch at CDC, which is
    the only lab in the country that monitors for the very real
    threat of drug-resistant gonorrhea. While we acknowledge there
    are opportunities to make programs more efficient, decisions on
    how to reduce costs without causing harm should be led by
    programmatic leaders, informed by the constituents, providers,
    and communities they serve.
        Without widespread access to treatment, deaths from HIV/
    AIDS will increase. Without HIV testing and prevention
    services, including PrEP, new HIV infections will surge.
    Without HIV research, treatment and prevention will not reach
    the people who need them, and we will not find a cure for HIV.
    We are now facing the very real possibility that places like
    Connor's Nursery will be needed once again to care for orphans
    with HIV/AIDS in the United States of America.
        Thank you for your time and for considering HIVMA's funding
    requests that are critical to sustaining progress in ending the
    HIV epidemic.
        [The information follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Ms. Letlow. Thank you, Dr. Kelley. Ranking Member DeLauro.
        Ms. DeLauro. Thanks so much. Dr. Kelley, thank you for your
    poignant remarks. I am reminded that I was at a hearing earlier
    this week with the State, Foreign Operations where there was a
    discussion of the PEPFAR program, which, as you know, was a
    George Bush, really, miracle and 23 million lives saved, and we
    are looking at potentially another, you know, 20 million people
    that we need to be able to assist. But PEPFAR is also under the
    gun, and so that the threat of HIV, with all of the progress
    that has been made, is really pretty staggering. I even asked
    the question then, if we are going to end this, what are we?
    Have we squandered all of that money that we spent saving lives
    in Africa and overseas, because somehow we are not going to
    continue to do what we are doing?
        But as I see it, the parallel is also on the domestic side.
    This is not just a one-off with regard to PEPFAR where they had
    a problem, but they corrected it, but this is, writ large, with
    regard to HIV. According to reports, Elon Musk fired about one-
    fourth of CDC staff at the National Center for HIV, Viral
    Hepatitis, STD, and Tuberculosis Prevention. The biggest cuts
    came from the Division of HIV Prevention. The Global Health
    Center Division of Global HIV and TB was also reduced by
    roughly a fourth. I don't know how many people have been fired
    from the Division of HIV Prevention or any other division of
    CDC. We can't get the information. We cannot get the
    information. We write letters. It is like a tree falling in the
    forest. You just don't have any response back. NIH has been
    canceling research grants that support HIV/AIDS research. Dr.
    Jean Marrazzo, director of the National Institute of Allergy
    and Infectious Diseases--NIAID--was fired last week. So I am
    deeply concerned about the cuts to HIV programs across multiple
    agencies, and I think what we will see in that case is a deadly
    reversal of the progress that we made in recent decades.
        Just one other example. The HIV Epidemic Initiative, that
    was first proposed by the first Trump administration, and we
    have been funding that effort because the research has been so
    powerful and the results so powerful that we could move in
    using that word, ``ending the HIV epidemic,'' and that has been
    a bipartisan effort. It included HIV prevention at CDC, HIV
    treatment at HRSA, HIV research at the NIH, but now the Trump
    administration is canceling all of these funds. These are
    lifesaving activities. As I said, this is not a road, a bridge,
    a playground. This is lifesaving.
        So I think we have to understand the scope of what is
    happening here domestically and internationally, and we have to
    gather the forces that will fight back on this because God help
    us if we go backward. And on our watch, many more people,
    millions of people, will die in the United States and all over
    this globe. God help us. Thank you for being here today. Thank
    you for your testimony. Thank you for your lifesaving work.
        Dr. Kelley. Thank you.
        Ms. Letlow. Thank you, Ranking Member, and thank you so
    much, Dr. Kelley, for being with us today. I would now like to
    recognize Ranking Member DeLauro for closing remarks.
        Ms. DeLauro. I want to thank the chair, and I thank her for
    her good work, and I know that she has interests in research
    and what we do in terms of life saving for children, for
    adults, wherever it is. I can only go back to I think this is
    such an important day for all of us in this committee. I said
    that at the outset. It is one of the most important parts of
    the subcommittee's process because so much of what you say here
    can get translated into action and resources. It has been done
    in the past. We all struggle with budgets and trying to address
    the issues to the best that we can. But we are not in the
    business of wholesale firing and dismantling the very
    foundations of our public health system, of our education
    system, of our ability to provide people with the training and
    the education that they need and ought to be gainfully
    employed.
        That is the scope of this committee--Labor, Health/Human
    Services, and Education--and I think at the moment, that the
    agencies that are included in this portfolio are the agencies
    that have been the most severely impacted with whatever is
    going on. And the loss of 20,000 people, we lose the expertise,
    the commitment and dedication. We lose the science and the
    breakthroughs because researchers, if they can't carry out that
    research, are already looking to go to Canada, to go to Europe,
    to go to China. They have been three crown jewels, I believe,
    of our public health system. The NIH, the CDC and the FDA have
    given us, has given to the world the best, the finest research
    and innovation and ability to conquer illness and disease. When
    we mindlessly and flagrantly and unlawfully strip those
    agencies of their ability to do their job, we are not living up
    to a moral responsibility that we have. That is not a
    responsibility, it is a moral responsibility, and as I said to
    a prior witness, God help us if we allow this to happen on our
    watch.
        And I ask you to fight alongside of us because it is your
    work, your drive, your commitment, your expertise that is being
    challenged. Thank you all for being here today. Thank you for
    what you do, and thank you for not being afraid to speak up on
    behalf of the work that you do. Really, I say this very
    sincerely, God bless you because you do save lives. Thank you.
        Ms. Letlow. Thank you, Ranking Member DeLauro, and a
    special thank you to all of our witnesses. Thank you so much
    for your time and all of the hard work that you do. We truly
    appreciate you.
        And with that, this hearing is adjourned.
        [Whereupon, at 12:06 p.m., the subcommittee was adjourned.]
        [Statements submitted for the record follow:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                               W I T N E S S E S

                                  ----------
                                                                       Page

    Pescatore, Jessica...............................................     1
    Carroll, Jennifer................................................    10
    Whitten, Michelle Sie............................................    18
    Frech, Christopher...............................................    24
    Kramer, Christopher M............................................    31
    Saldana, Rey.....................................................    36
    Sokol, Theresa...................................................    42
    Schapiro, Sara...................................................    50
    Harris, Scott, M.D...............................................    56
    Kelley, Colleen, M.D.............................................    62

                                      [all]

                                      (i)