CDC Director Robert Redfield Coronavirus Response Senate Hearing Transcript September 16

Chairman Blunt: (00:17) Health and Human Services, Education and related agencies will come to order. Want to thank our witnesses for appearing before the subcommittee today to provide an update on where we are on the areas that they are so involved in on COVID-19. As we continue to be challenged by this pandemic in the country, we know that 195,961 Americans have died as part of the pandemic and 6.6 million have tested positive during the process of testing in the pandemic. This has rapidly swept across the globe and even countries who thought their cases were contained are facing new outbreaks and dealing with those new and unanticipated outbreaks. This is a new disease and many ways and even after nine months, we still know relatively little about this disease or coronavirus generally. This has hindered our public health response. In many ways, this has been like trying to build the plane while we were flying the plane. And that is a challenging, challenging thing to deal with. Chairman Blunt: (01:42) That's not to fully exonerated, certainly, the way the administration has dealt with it or the way it's been funded. And I'm sure that justified criticisms can and will be leveled. But history allows us to look back over past events and to put current ones into perspective. If we wanted to look back just six years to 2014, for instance, when West Africa faced the largest Ebola outbreak the world had ever seen. And unlike COVID-19, we knew a lot about Ebola at the time, the disease had been around since the mid-seventies, it was disease that scientifically, we knew a lot more about in 2014 than we do about COVID-19 even today. And frankly, we just didn't handle it very well. We made significant mistakes and we've seen those mistakes occur in other disease areas. Members of Congress use words when they talked about the CDC response like cryptic and misleading and thought that the information provided wasn't enough. Chairman Blunt: (02:55) We even had a case that was found in a Dallas hospital and the CDC director blamed the hospital. At the same time, one of the nurses in the hospital was allowed to board a commercial flight with CDC's consent. So we seem to keep having to learn these lessons over and over again, that we have to be a better prepared. Public health is hard, and it seems to be hard for us to keep our eye on what might happen in the future once we get beyond that moment. We should learned, and more importantly, implemented more than we did from Ebola or from H1N1, both of which created real response problems, but real lessons, if we'd have tried to learn them. Hopefully we'll do a better job learning the lessons we need to learn right now. Neither this administration or the last one, frankly, prioritized research like this committee has. Chairman Blunt: (03:55) And we know that in our committee, we've worked hard in the last six years and in the last five budgets in a bipartisan manner to increase the funding in the annual appropriations bills for the NIH by nearly 40%, for CDC by 21%, and for preparedness by 44%. But those numbers all have to be coming together before we begin to use them the way that our witnesses today or this committee would like to see them used. We've proven in our committee that medical research, public health preparedness are all priorities and because we've done so, we're more ready than we were at the last time, or hopefully more ready in the future for them next pandemic. Right now 238 FDA emergency use authorizations for diagnostic tests and antigen tests are on the market and every day we get closer to an affordable, reliable, rapid test where you can get an answer in a way that allows us to really fight the pandemic rather than have another data point. Chairman Blunt: (05:17) In a few years, when someone gives a history lesson about COVID-19 response, there will be criticism. It'll go back about 20 years and it will be significant, but I know there are things we all agree on. We need to have more investment in testing, more resources for our vaccine candidates to finish their trials, manufacture the vaccine and for CDC to distribute through a vetted well thought out plan. I hope we learn more about, and I'm going to insist that we learn more about all of those things today. I'd hope we might be able to include childcare in our hearing today. We weren't able to do that because of time, but clearly if you're going to get back to school, back to work and back to better health, childcare has to be part of that and something this committee has to stay focused on. Chairman Blunt: (06:09) So again, welcome our witnesses and Senator Murray is joining us from her office, I believe. And Senator Murray, we're ready for your opening comments. Senator Murray: (06:22) Well, thank you very much, Mr. Chairman, and thank you to all of our witnesses who are joining us today. You know, as our country approaches a tragic milestone in this pandemic, 200,000 dead, I want to recognize that our rising national death count represents countless personal losses. Families have lost parents and grandparents and children. Communities have lost educators and healthcare providers and other frontline workers. And people have not only lost loved ones, but many have lost the small solace of being able to visit and comfort those they care about in their final moments. My heart goes out to everyone who's struggling with the hardship caused by this virus, whether they are suffering with the loss of life or livelihood. You all deserve leaders who take this crisis seriously, who take action to support and protect you, your family and your community, who arm you with the facts you need to stay safe. Senator Murray: (07:25) Unfortunately, we have yet to see that leadership from the President. Like many Americans, I was deeply angered last week to hear President Trump admitting that even though he understood COVID-19 was more deadly than even your strenuous flu, that's a quote, he was intentionally playing down this crisis, but I was not surprised. These recordings were not a revelation. The reality has been painfully obvious for months. Early on, President Trump not only claimed this virus was contained, controlled, going away. He claimed it was a democratic hoax. His vice president wrote on an op-ed arguing that there would be no second wave just before we saw a heartbreaking and record-breaking increase in new cases and deaths across our country. When it came to testing, President Trump, didn't just say he took no responsibility at all. He said, he liked the numbers where they were. He said he wanted to slow down testing and he blamed testing for the rising case numbers. Senator Murray: (08:37) When it came to wearing masks, he not only said that masks caused problems too. He also shared a tweet saying masks represent a culture of silence, slavery and social death, and a video falsely claiming people don't need to wear masks, and there is no cure. He made false claims on treatments as well, continuing to promote hydroxychloroquine and suggested we look at bleach as an option. And he is still, still downplaying this virus. He is still saying it will just go away. He is saying, we are "rounding the final turn." Dr. Fauci has made it clear that's not true and pointed out that we have plateaued at around 40,000 cases a day. The daily deaths are still regularly around a thousand and experts have warned that we still need to prepare for a fall wave that will coincide with the flu season. But President Trump has not been listening to the public health experts. Senator Murray: (09:41) He has been fighting them and suggesting FDA is part of a deep state conspiracy and CDC is overstating the death counts. But not only is he spreading inaccuracies and outright lies, at a time when truth is a matter of life and death and trust, trust in our public health agencies is paramount, his administration has been recklessly interfering with the work of these agencies for political benefit, to promote unproven treatments, alter CDC guidance on reopening and testing and more. Just over the last week, we have learned that president Trump put pressure on NIH and FDA to authorize convalescent plasma as a treatment and that political appointees at HHS have worked unsuccessfully to dictate talking points for Dr. Fauci and have succeeded in demanding oversight of and changes to CDC's flagship scientific publication, The Morbidity and Mortality Weekly Report. That publication is a cornerstone of public health work across the world. Senator Murray: (11:01) It is dangerous and unprecedented that political appointees are editing, censoring, and ultimately undermining a report that is intended to give families, public health professionals, researchers, and healthcare providers, what they need, the truth. The Trump's administration's political meddling shows a dangerous disregard for truth, facts, science, and most importantly people's lives. Data and science are key tools in our fight against any health crisis and the damage being done to public trust in those tools by this administration threatens to undermine our ability to respond to this pandemic, public trust in an eventual vaccine and public health for years to come. The Trump administration needs to leave the science to the scientists immediately. Full stop. The leaders of our public health agencies need to provide full account of what political pressure has been applied and what steps they are taking to make sure it does not influence their work or the work of the agencies they lead. Senator Murray: (12:19) Congress needs to act now to demand the transparency we need to hold this administration accountable. Democrats will be laying out steps soon for how we can do that. And I hope every Republican who has said they believe we need to follow the science will prove it by working with us on this, because you cannot be for science if you aren't against political interference. I also hope Republicans will come to the table to work with us in earnest on a larger COVID-19 package that our communities so desperately need. Unfortunately, they've not taken this seriously so far. And when Democrats put forward the HEROES Act back in May, Republicans said there was no rush. They would wait to see if more was needed. When Republicans finally did put forward a proposal months later, it was woefully inadequate to address the crisis at hand. And while Democrats have moved to find common ground and even offered to negotiate towards a lower top line number, Republicans refused that offer and instead put forward a bill last week that moved us even further away from common ground. Senator Murray: (13:31) This isn't serious negotiating. And the ideas that have been put forward are not serious solutions, but the crisis we be face remains deadly serious. We can't afford to waste any more time. We need to stabilize the childcare sector and make sure schools can educate students safely, whether they're remotely or in-person. we need to make significant investments in public health, particularly regarding testing and contact tracing and distributing and administering a safe, effective and trusted vaccine. And we need to demand the type of comprehensive national plan for those efforts that has been long overdue. The distribution plan that CDC finally put out just today is a long overdue step forward, but there is still more to do. I'm still reviewing this and I'll have more to say, but it's clear this is still not the kind of comprehensive end to end national plan I've called for, and that we desperately need. Senator Murray: (14:38) We are still missing important details on research and review, like what standards FDA would use to authorize a vaccine for emergency use development. Like how we make sure disparities are addressed in clinical trials, and manufacturing, like how we address supply chain issues and avoid bottlenecks. And we still need more details on addressing disparities. We also need to protect the safety and civil rights of those going to work and provide relief to those who have lost their jobs. We need to support families who are struggling to make rent and afford healthcare and get nutritional meals. And we need to address the severe disparities we're seeing and how much harder this crisis is hitting black and Latino and tribal communities. Senator Murray: (15:26) We need to provide relief for our state local and tribal governments and last, but as we have seen recently, certainly not least, we need to make sure once and for all that political interference from President Trump does not further undermine our response to this crisis. Now I'm going to have several questions for our witnesses, but I hope we are all able to get more than just answers in the days ahead. I hope we're all able to finally come together and take action before we lose any more time to save lives and prevent costly mistakes. Thank you, Mr. Chairman. Chairman Blunt: (16:09) Thank you, Senator Murray. Again, let me welcome our guests today. Our witnesses today. Admiral Brett Giroir is the Assistant Secretary for Health. Dr. Robert Kadlec is the Assistant Secretary for Preparedness and Response. And Dr. Robert Redfield is the Director of the Center for Disease Control and Prevention. We're pleased you're here, like to give you time to make an opening statement. We have the statements you've presented. You can summarize those if you want, but we are eager to get to questions, but we're also eager to hear from you. So Admiral Giroir, why don't you go ahead and start with your opening statement. Admiral Giroir: (16:49) Chairman Blunt, Ranking Member Murray and distinguished members of the subcommittee, I am honored to update you on our nation's effort to combat COVID-19 with a specific focus on testing. Testing is an essential component of America's public health response to the pandemic. Recommended practices like wearing a mask, avoiding crowds, especially indoors and washing your hands combined with smart testing is the formula to effectively slow the spread, flatten the curve and save lives. By being evidence-based, providing county specific weekly guidance to governors, expanding supplies and managing their distribution, providing the right test to the right person at the right time and developing and allocating safe and a fair therapeutics, we are seeing promising results. Specifically since the post Memorial day peaks in community spread, the number of new COVID-19 cases is down 48%. The number people hospitalized with COVID-19 is down 49%. The number of people in an intensive care unit due to COVID is down 62%, and deaths associated with COVID are down 33%. But let me say emphatically that these gains could be fleeting or even reversed if we do not continue to follow the national plan and exercise personal responsibility, especially wearing masks and avoiding crowds. Admiral Giroir: (18:19) Now specifically regarding testing, the nation will surpass 100 million viral tests completed this week. We have purchased and shipped over 95 million swabs and 81 million tubes of media to states, tribes, and federal partners. Starting April 7th, we have purchased and delivered to public health laboratories and the Indian health service, 2.3 million Abbott ID NOW point of care molecular test to support outbreak control and rural testing. We have established federal surge testing in 19 different sites, helping to squelch emerging outbreaks typically among asymptomatic young adults. These sites are in addition to the over 2,700 federally supported or federally enabled community-based testing sites at trusted retailers focused in areas of moderate to high social vulnerability and the literally thousands of HERSA, federally qualified health centers, that offer testing to predominantly racial or ethnic minority patients. Admiral Giroir: (19:24) We are now at an inflection point in testing. This month, we anticipate the availability of approximately three million tests per day, and at least half of these will be rapid point of care. We will have available more point of care tests in September than the total number of tests performed in August. We have been building towards this inflection point and I've previously testified to it's coming several times over the past months. As a result of regulatory flexibility, investments and coordination of the public and private sectors, we have implemented comprehensive, cutting edge testing initiatives to flatten the curve and save lives while supporting reopening of America. Let me discuss just two of these. Admiral Giroir: (20:08) Protecting the elderly has been, is, and will continue to be a foremost priority for this administration. So on July 14th, we announced that every single eligible nursing home in America would receive a point of care instrument and point of care testing supplies. We have delivered on this promise. All 13,850 eligible nursing homes have now received a total of 13,985 instruments and over 4.9 million rapid point of care tests ahead of schedule. On August 27th, after months of planning and only one day after it's FDA authorization, the administration announced a $760 million contract with Abbott for the delivery of 150 million Rapid By Next NOW point of care test. This test is easy to perform, does not require an instrument, delivers test results in 15 minutes or less and costs five bucks. Admiral Giroir: (21:07) It can easily be deployed to many settings across the country, and it comes with a companion app that enables instantaneous reporting. We have already deployed 50,000 of these tests in support of disaster operations in California, Texas, and Louisiana, and now another 15,000 to support wildfire operations in Oregon. This week, we will ship our first 2 million tests to further prevent spread of COVID in nursing homes, assisted living and in tribes. In the coming weeks, we will begin shipping millions of tests per week in support of our teachers and students to open and keep open K through 12 schools and to support vulnerable populations at HBCUs. Thank you for the opportunity to provide these remarks and I look forward to your question. Chairman Blunt: (21:54) Thank you, Admiral. Dr. Kadlec. Dr. Kadlec: (22:01) Thank you. Chairman Blunt, Ranking Member Murray and distinguished members of the committee. I'm Dr. Bob Kadlec, the Assistant Secretary for Preparedness and Response. As a medical doctor and former Senate staffer, retired military officer and having served in the White House, I've spent my adulthood career working to serve and protect the American people. I appreciate the opportunity to testify before you to highlight ASPR's response to the COVID-19 pandemic, our progress in vaccine development and our efforts to confront and mitigate this pandemic. I want to thank this committee for providing both supplemental resources for COVID response, as well as supporting and sustaining the ASPR organization in the past. Your investments have been critical to support our operations and ensure we have tools available to respond to the COVID-19 pandemic. Throughout 2020, ASPR has used these resources to protect American lives. Dr. Kadlec: (22:52) We've assisted in the repatriation of Americans from China and Japan at the start of the pandemic. ASPR provided medical surge support in Louisiana, Texas, and Mississippi after Hurricane Laura and today we have teams deployed to Louisiana and Mississippi prepared to assist in response and recovery operations following Hurricane Sally. We have deployed personnel and teams to California and Oregon to support wildfire response. And the Secretary has just signed the public health emergency for Oregon to assist in the search and rescue of individuals who've been affected there. We've deployed personnel to Beirut to assist the government in Lebanon with hospital recovery, following the catastrophic explosion. With that, we've supported these calls to action while simultaneously responding to state, local, territorial and tribal requests for assistance in the COVID response. It is an honor to lead this organization. I'm truly humbled by the selflessness and dedication of the men and women of ASPR. Dr. Kadlec: (23:53) While we have seen a decline in new cases and deaths and hospitalizations, we know it takes constant vigilance and personal responsibility by every American to wear masks, wash hands and keep our social distance. But as everyone does their part, ASPR continues to work hard to enhance our country's preparedness and response capabilities. I'm proud that ASPR has been part of a driving force in this whole American effort. Since early 2020 ASPR BARTA began working to accelerate vaccine development. This work was foundational to the development of operation, Warp Speed, a whole of government approach working with our private sector partners to produce and deliver a safe and effective vaccine as fast as possible. The supplemental appropriations provided by this committee have been essential in permitting significant advancements under Warp Speed. As a result, America's far better positioned than before to keep Americans safe, protect vulnerable communities and individuals, and defeat the COVID-19 virus. Dr. Kadlec: (24:52) To date we have awarded $13.6 billion to support over 50 medical countermeasure projects, some of these awards are vaccine contracts. We're making significant progress in advancing these vaccines through clinical trial process. In fact, three candidates are in phase three clinical trials, meaning that we're closer than ever to a safe and effective vaccine available to the public. Three others are in phase one and two. Safety is our top priority in the development of vaccines and therapeutics, which is why science is driving the development of all COVID-19 countermeasures to ensure they meet FDA's gold standard of approval. In the meantime, we've implemented an intensive efficient process to promote vaccine development and in parallel manufacturing. Supporting these efforts simultaneously ensures we're positioned to distribute and administer the vaccine quickly once approved. ASPR also continues to support advancements in lifesaving therapeutics. For example, ASPR has taken data driven approach to oversee the fair and equitable distribution of remdesivir. Dr. Kadlec: (25:57) To date, we have a distributed to states enough remdesivir to treat almost 650,000 patients. ASPR also supported the mitigation efforts to slow virus transmission. Since March, ASPR has produced and distributed more than 500 million cloth facial coverings across the country to protect vulnerable populations and essential workers. This month, we're supporting the administration's school facial coverings initiative by sending an additional 125 million cloth facial masks to states and territories for distribution to low income students in order to support the safe reopening of America schools. As the federal agency leading emergency support function eight, ASPR is capitalizing on existing relationships with DOD, VA, and DHS to coordinate a more comprehensive medical nationwide response. Dr. Kadlec: (26:49) We've responded to requests from 32 states, three territories, five tribes with nearly a hundred medical support missions with over 5,700 staff from ASPR's national disaster medical teams, the public health service, the VA and DOD. We've provided personal protective equipment that I know will be subject to quite a few questions under this SNS 2.0 initiative to expand the depth and breadth of our stockpile, grow the US industrial base and reduce our vulnerabilities to foreign suppliers. We have used the Defense Production Act as well. Dr. Kadlec: (27:23) I thank you again for your support and the opportunity to testify before you an ASPR's efforts during this pandemic and I'm happy to answer any questions you may have at this time. Chairman Blunt: (27:33) Thank you, Dr. Kadlec. Dr. Redfield. Dr. Redfield: (27:36) Good morning, Chairman Blunt and Ranking Member Murray and members of the committee. Thank you for the opportunity to be here today. On behalf of CDC, thank you also for your continued support of our public health professionals and the lifesaving work they're committed to do 24/7. Over 6,700 CDC staff have been engaged in the agency's COVID-19 response, 1200 of whom have been deployed to more than 200 locations in the United States and abroad. And I know you share with me the gratitude for their resilience, dedication, and service to our nation. Throughout this global pandemic, CDC has brought its scientific expertise to the front lines, conducting rapid investigation of disease outbreaks that identified the highest risk populations and settings. Understanding which populations are at risk and how the virus has spread in various settings is critical to developing the guidance and protecting the health of Americans. Dr. Redfield: (28:33) Today and even after we have a vaccine, CDC encourages all Americans to embrace the powerful tools that we have right now, to wear a mask, particularly when they're in public, maintain social distancing, routine, vigilant hand-washing. Be smart about crowds and stay home when you're sick. And as we move into the fall, we're adding one of the most significant scientific contributions to medicine through our evidence-based mitigation strategies, flu vaccination. flu vaccine is safe and CDC encourages Americans to embrace flu vaccine with confidence for themselves, their families and their communities. These simple actions combined could help this nation avert a very difficult fall, lessening the burden on our healthcare system and saving lives. Dr. Redfield: (29:28) CDC has awarded $ 140 million to 64 jurisdictions through our existing immunization cooperative agreements to scale up flu vaccination this season. This funding, supporting staff, and preparedness with the focus of ensuring that flu vaccine coverages can reach the populations at most risk. This year, CDC purchased an additional 9.3 million doses of adult influenza vaccine up from the usual annual 500,000 dose purchase in prior years, as well as 18.5 million doses for children and CDC has developed a new multiplex laboratory test that can check for three viruses at the same time, influenza A and B plus SARS COVID-2 in a single test from a single sample. Dr. Redfield: (30:17) This test was granted an EUA by the FDA and will save public health laboratories time and resources and help better understand and identify co-infections with influenza one and SARS- COV2. To date, CDC has distributed over 135 multiplex kits to more than 100 laboratories across the country with each kit having enough reagents to do approximately 500 tests. CDC is also working with 64, and immunization grant recipients to build readiness for timely and most importantly, equitable administration when a COVID-19 vaccine becomes available. CDC is leveraging its expertise and immunization infrastructure to support Operation Warp Speed in vaccine promotion, distribution, administration, and monitoring. In coordination with Operation Warp Speed, CDC is working closely with state and local, territorial, tribal health departments and community organizations to prepare a detailed yet flexible plan for vaccine distribution to critical infrastructure workers and people at increased risk for serious outcomes. Dr. Redfield: (31:29) At this time, CDC continues to support partners with its ongoing community mitigation efforts, including case identification, contact tracing, surveillance, and reporting, as well as testing capacity. To support these activities on behalf of HHS, CDC is awarded $12 billion to these jurisdictions in 2020 thanks to the support of Congress. Included in that amount was more than $200 million to support the American Indian, Alaska native communities, which have had some of the most significant effects from COVID-19. Timely, accurate, and most importantly, actionable data are essential if we're going to learn to impact COVID-19 on all Americans, particularly the populations at greater risk, such as older Americans, those with chronic medical conditions, racial and ethnic minority populations. CDC reports monthly to the Congress the most recent data analysis on the impact in racial and ethnic groups. Dr. Redfield: (32:31) As I've emphasized in my prior hearings, now is the time to commit to prioritize a sustained in the core capabilities of public health. That is data and data analytics, laboratory resilience, workforce expansion, and rapid response capabilities. Years of underinvestment in public health have led to a system that has been sorely tested by the current pandemic. COVID-19 is the most significant public health challenge to face our nation in more than a century. Now is the time to build not only the public health core capability that our nation needs, but that the people of our nation deserve. As we work together collectively to fight COVID-19 to end the pandemic, CDC has committed to the mission to protect all Americans from the disease threats, to save lives now and in the future. Thank you for the opportunity and I look forward to your questions. Chairman Blunt: (33:23) Thank you, Dr. Redfield. So we're going to have a series of five minute round of questions. There are a dozen members either here or virtually here, ready to ask questions. There'll be an 11:30 vote that we will just kind of work around those votes that come at 11:30. And certainly we'd hope to have an opportunity for a second round of questions, if people have them after their first round is gone. Let me start, Admiral Giroir, with you on tests. I think tests are essential to get back to school, back to work and for tests to really work, they have to be- Chairman Blunt: (34:02) And for tests to really work, they have to be easily taken, there needs to be a quick response and they need to be affordable. It seems to me that with the Shark Tank effort, that members of this committee, particularly Senator Alexander and I were involved in trying to encourage looking at ideas that are out there. I think the Shark Tank has approved at least 16 different tests now. In your testimony, you mentioned that a significant number of these tasks were point of care response test. What should we expect in October, or this month? But let's talk about, I've been told in October we could reach a hundred million tests between the Shark Tank and Abbott alone. Is that a number that you think is close to right? Admiral Brett Giroir M.D.: (34:56) Yes, sir. And thank you for the question and thank you for the support of the Shark Tank and all of the NIH efforts. We've seen just a tremendous blending of programs at DARPA at NIH, at CDC, at BARDA, in my office, with the Defense Production Act, all coming together. And we do meet every week to put these together in a very cogent, synergistic way. Admiral Brett Giroir M.D.: (35:19) Yes, in October, and again, these are conservative estimates based on what we know has EUAs and what we know that manufacturing will be. In October, we're looking at somewhere in the neighborhood of 125 to 135 million tests available. That does not mean that 125 to 135 million tests will be done, but these will be easily and readily available. And the majority of them, we really hit that inflection point, will be point of care. Chairman Blunt: (35:47) Good. Admiral Brett Giroir M.D.: (35:48) Many of them will be the Binax that we talked about that will be made at approximately 48 to 50 million per month. Again, $5 test, 15 minute result, no instrument. Very, very important, but we're starting to see the point of cost coming from the RADx program, the Shark Tank, really hitting the streets. So the next generation sequencing the microfluidics platforms like Fluidigm and some advanced point of care are all starting to hit from Shark Tank. Chairman Blunt: (36:17) And I think you said in your testimony that sometime this month we will have passed the first hundred million test that people have taken. Is that right? Admiral Brett Giroir M.D.: (36:26) Yes, sir. Today's total, as of about five o'clock this morning was 99.3 million test having been performed in the US. Those are viral tests, not serological tests. Chairman Blunt: (36:38) And starting the first of the year. This is from the outbreak of the COVID-19, right? Admiral Brett Giroir M.D.: (36:45) Right. When I took over in March 12th, I think there were 15, or 20,000 tests done. It was a very small number. So, this is ramped in a historic way, not just a number. Numbers are important, but it's the ecosystem, the point of care- Chairman Blunt: (37:00) Absolutely. Admiral Brett Giroir M.D.: (37:00) ... laboratory, these all have to fit together in a [crosstalk 00:03:04]. Chairman Blunt: (37:04) I think I'm right in assuming, but the three of you would know this better than anybody. If you take a test and you don't get a result for three days, or five day, or seven days, you find out a data point and you find out for that individual, the problem they have. But you've generally done nothing to tell them that they could be spreading this disease. Is that correct? Admiral Brett Giroir M.D.: (37:29) Clearly we want tests to be turned around as rapidly as possible. And that's why point of care is so important. The issue with most point of care tasks is they're not as "good, sensitive, and specific", as the very important laboratory tests. Now everybody's making progress, but you are right. We want rapid turnarounds. And because we have more point of care tasks, and because we're doing more in the nursing homes that way, for the major referral labs that had such an issue with turnaround times, our average turnaround time for Quest, LabCorp, et cetera, this month is 1.49 days. Admiral Brett Giroir M.D.: (38:05) So that has been improved dramatically because of the expansion of their capability, but also the insertion of point of care tests. Chairman Blunt: (38:11) But again, that's the average. That averages out the point of care, plus the tests that averages all this down to one point? Admiral Brett Giroir M.D.: (38:17) No, sir that's just the referral laboratory [crosstalk 00:04:21]. Chairman Blunt: (38:20) Got it. [crosstalk 00:38:23]. Admiral Brett Giroir M.D.: (38:22) But the other half of testing is either point of care or at your local hospital, which is generally either 15 minutes, or within 24 hours. So the turnaround time, at least right now with all the investments coming together is under control. Chairman Blunt: (38:36) I think our sense, many of the members on this committee, certainly my sense of testing has been, we want to test that millions of people can take maybe dozens of times and get the information at the time they take the test. And it sounds like to me, that we're finally getting to where that's a real realistic likelihood. All right, Senator Murray. Senator Murray: (39:04) Thank you very much, Mr. Chairman. And let me just say again, I am deeply troubled by reports of rampant political interference in scientific decision making at the CDC. It is unprecedented and it is unacceptable. We learned last week that despite knowing in January how serious COVID-19 was, President Trump has been working to downplay this crisis. And on Friday night we learned that Trump political operatives in HHS communications office have been manipulating CDCs flagship publication for months to align with that messaging. Dr. Redfield, did anyone at CDC advise the president to downplay this crisis? Dr. Redfield: (39:48) No. Senator Murray: (39:50) Did you agree with the president's decision to downplay it? Dr. Redfield: (39:55) I'm not going to comment on that. But no one advised the president to downplay this crisis. Senator Murray: (40:02) Well, understanding the dangers. Why have you not done more to push back on President Trump's political interference and its efforts to downplay this? Dr. Redfield: (40:13) I want to make it really clear, Senator, and I appreciate your question and the opportunity that about the respect for the science at CDC and the independent integrity of the MMWR. At no time has the scientific integrity of the MMWR been compromised. And I can say that under my watch, it will not be compromised. Senator Murray: (40:39) Well, I understand the efforts to edit the CDC publications started in response to a May report that reviewed the spread of COVID-19 in the U.S. that was authored by CDC, highly respected Career Deputy, Dr. Schuchat. HHS political officials perceived this report is reflecting negatively on the president. Well, Dr. Redfield, yes or no, did that May report, as drafted by Dr. Schuchat, adhere to the agency strict code of scientific integrity? Dr. Redfield: (41:13) Yes. Senator Murray: (41:15) Well, the spokesperson for HHS claimed that there is a resistance unit at CDC and voiced concerns about ulterior deep state motives and President Trump has bolstered skepticism in the agency's death toll. Do you agree with me that there is no truth to all those claims? Dr. Redfield: (41:35) Absolutely, Senator, and I want to make a comment that not only is it not true, it deeply saddened me when I read those comments. And because, as I said in my statement, CDC is made up of thousands of dedicated men and women, highly competent. It is the premier public health agency in the world, dedicated 24/7, to use their skills, to protect the American public and the world from the health issues. And it deeply saddened me that those false accusations were made by a group of really unbelievably professional people that serve this nation. Senator Murray: (42:19) Well, I agree. Let me ask you then, what can Congress do to make sure we are hearing directly from public health officials without political interference? Dr. Redfield: (42:31) Well, again, I'm willing to commit that we're going to continue to give Congress and the nation the best public health advice. We're not going to let political influence try to modulate that. As I mentioned the MMWR, and it's another thing that has saddened me to hear on our watch, the concern that some have that the integrity of this really important publication and was somehow compromised. Dr. Redfield: (43:05) And I just want to assure you and the other senators and the American public, that the scientific integrity of the MMWR has not been compromised. It will not be compromised on my watch. And I will stand by the men and women that are the scientific experts that are there to do their job, to express what they know, in a way that can be interpreted to the American public. Senator Murray: (43:28) Well, I hear you, but I do think Congress needs to make clear that there's no political interference there. I will be pursuing that. Admiral Giroir, on the same issue, you are among HSS's top health officials. What are you doing to protect scientific integrity of the work done by the scientists and public health experts at CDC, HRSA and NIH from political interference? Admiral Brett Giroir M.D.: (43:55) Part of my job as the Senior Scientific Advisor to the Secretary, is to make sure that he gets the best science and the best evidence-based that's unfiltered. I do that every single day. I work with Bob Redfield. I work with Bob Kadlec, Francis Collins, and I are on speed dials, Tom Engels, very, very important with HRSA. So you have my commitment as you always have, Senator, that I will provide the best advice to the decision makers, that will be based on science and evidence. And that's the way we're going to operate going through. Senator Murray: (44:31) Can you, right now, reject the unfounded, harmful conspiracy theory that career professional leadership of CDC or any of our public health agencies have "deep state ulterior motives that compromise their ability to act in the best interest of public health", as other Trump political appointees have planned. Can you reject that? Yes or no? Admiral Brett Giroir M.D.: (44:54) I have not seen anything out of CDC, HRSA, any of the agencies I work with that is anything but people acting in the best interest to the American people. I've certainly not seen anything that you described. Chairman Blunt: (45:09) Thank you, Senator Murray, Senator Alexander? Senator Lamar Alexander: (45:12) Thank you, Mr. Chairman, and thanks to the witnesses for coming. This committee has shown on many occasions, a good capacity to work in a bipartisan way. So, I would like to say something to my Democratic friends, as well as my Republican colleagues on a subject that I think we agree on, but the Congress has had a hard time doing over the last 20 years, and that is preparing for the next pandemic. I've been rereading, Jared Diamond's book, Guns, Germs, and Steel. And he wrote an article in the Wall Street Journal a few months ago about the current infectious disease. Senator Lamar Alexander: (45:53) He said, "The most different thing about COVID-19 is not that it's more infectious, but the jet plane is what is different about this disease." That it can spread instantly from Wuhan to San Francisco, to Nashville, to Boston. And that the next pandemic could be next year. So we had a hearing about preparing for the next pandemic and people like Bill Frist, who was majority leader 20 years ago said, "We keep trying to do things to prepare for the next pandemic." But we go, in Dr. Tom Frieden's words, "From panic to neglect to panic." Senator Lamar Alexander: (46:34) In other words, while we're in the middle of a pandemic, it's got our attention. But as soon as it's over, we don't do all the things that we should do. So my hope is that with any action that we take this year, we would include the three or four things that we should take, to make sure that we sustain funding, which is the hardest thing to do. How do you fund for more than one year? For onshore manufacturing of vaccines, for example. For stockpiles that were depleted between vaccines, for making sure that FEMA and Dr. Kadlec's organization are aligned properly and operating together. Senator Lamar Alexander: (47:20) Dr. Redfield's talk about, and Dr. Mike Leavitt did, to our committee, the Former Governor of Utah, that we've been underfunding public health for 30, or 40 years. I think it's important we do it this year. And so in the Republican bill that we offered last week, we did have in there some authorization from our committee to fund onshore manufacturing and continuous funding of stockpiles, so they would be full. And I would just like for our committee to give that the same kind of attention, the subcommittee, that we gave, for example, to funding for NIH, because it will take some sort of mandatory funding, or advanced appropriation as this sub committee did under Senator Gregg a few years ago for Bioshield. Senator Lamar Alexander: (48:12) It's not a lot of money. I think what we suggested was a half billion dollars a year for 10 years, for onshore manufacturing. Why is that important? In 2012, we created three manufacturing plants just for this purpose, but two of them as Governor Leavitt's words, "Went cold", and they weren't available instantly to do what we needed done. And the third one had a hard time finding anything to do between pandemics. So, we need some funding for it. And then for in stockpile, stockpiles got depleted at the federal level in hospitals and states, because of budget cuts. And so we weren't ready for what we needed to be ready for. Senator Lamar Alexander: (49:00) And then public health funding is a separate one, Bioshield is another one. So I think we're not talking about lots of money. What talking about is different, is sustained funding for a period of years. Now, Dr. Kadlec, I've taken most of my time, but would you comment on that. And precisely, in the ideal world, what should we do now to prepare for the next pandemic, which Jared Diamond says might be next year? Dr. Kadlec: (49:29) Well, thank you very much, Senator Alexander. And I agree entirely with your proposition that we do need to make investments over the long term. That we need to look at this problem as a national security problem, as it is a public health problem. We lose on a day, a given day [crosstalk 00:49:47]. Senator Lamar Alexander: (49:47) Yeah, but what are the specific things, we've got about 30 seconds. Dr. Kadlec: (49:50) Sir, manufacturing, domestic manufacturing for biologics and vaccines. We also basically need to have a capacity to basically manage those stockpiles effectively, through both commercial and state level processes. And we need to probably require hospitals and other healthcare institutions to have some baseline level of preparedness and stockpiling. Senator Lamar Alexander: (50:12) So we need to keep the stockpiles full. Are we talking about a lot of money? Dr. Kadlec: (50:16) No, sir. I think in your bill, you've identified about $2 billion. I think that's where you start. And then again, most of these items are common use used anyway, daily in hospital use and healthcare use and just maintaining that stockpile over time. But it does require a business model to support that. Senator Lamar Alexander: (50:32) Thank you, Mr. Chairman. Chairman Blunt: (50:33) Thank you, Senator Alexander. Senator Durbin. Senator Dick Durbin: (50:36) Thanks Mr. Chairman. Dr. Kadlec, last night, the President of the United States said, and I quote. "We are within weeks of getting a vaccine, could be three weeks, four weeks." True or false? Dr. Kadlec: (50:52) Sir, it's possible. And so with Operation Warp Speed, we have basically worked to basically do simultaneously the clinical trials, as well as doing the manufacturing of vaccines. So if, and when, whether that's two weeks, three weeks, two months, or four months, once a clinical trial is complete and that scientific data is reviewed by the FDA and approved, then we have vaccine potentially available immediately to use. And that's the strategy that has been adopted in operation warp Speed, sir. Senator Dick Durbin: (51:29) So, I want to make sure this is on the record. Dr. Kadlec: (51:31) Yes, sir. Senator Dick Durbin: (51:32) You're saying three weeks to four weeks for a vaccine? Dr. Kadlec: (51:35) Sir, that's manufactured. Yes, sir. Now, is it approved by the FDA? That is a decision that they will have to do based on the scientific data that they receive from the clinical trials. Senator Dick Durbin: (51:46) So, what you're saying to me is they could manufacture it before it's approved as being safe and effective for distribution in America, is going to be beyond three or four weeks? Dr. Kadlec: (51:56) Sir, it depends on the outcomes of those clinical trials. And so I can predict that. They're ongoing right now. Some of them complete in October and the FDA is the one who will make the decision to determine safety and efficacy, sir. Senator Dick Durbin: (52:10) The president predicted it last night. We have about four and a half percent of the world's population in the United States. We have more than 20% of the deaths from COVID-19. Last night, the president said, "We have 20% of the cases in the world because of the fact that we do much more testing. If we wouldn't do testing, you wouldn't have cases, you would have very few cases." So let me ask Admiral Giroir, would ending testing in the spread of the COVID-19 disease? Admiral Brett Giroir M.D.: (52:44) No, sir. Senator Dick Durbin: (52:46) Could you explain the president's explanation last night? Does it make any sense to you? Admiral Brett Giroir M.D.: (52:50) I didn't hear it. Senator Dick Durbin: (52:52) Oh, we've heard this over and over again. Come on. He's repeating what he said over and over again. Admiral Brett Giroir M.D.: (52:57) So, let me just clarify that the number of cases are going to be the number of cases. We do more testing so we can detect more and more cases. That's a good thing. We want to detect as many cases as we can so that they can be appropriately isolated, do contact tracing, et cetera. It is true that the more testing you do, the more cases you will discover, but the cases are there no matter what. Senator Dick Durbin: (53:23) Now, you talked in your testimony here about expanding testing and I couldn't endorse that more hardly. The president says just the opposite. If we wouldn't do testing, you wouldn't have cases. Don't we want to create the mindset of America that regular testing to make sure that we're not positive and not spreading this disease should be routine until we come to grips with a therapy, or a vaccine to deal with this? Admiral Brett Giroir M.D.: (53:49) So, I do want to state what I did state earlier in multiple testimonies. I've never been asked, told hinted, suggested, that we should decrease testing. In fact, basically every time at the task force, we work to expand testing to the degree possible, investing hundreds of billions of dollars in that. So, my job is to expand testing as much as feasibly, even infeasibly possible, and get the right test to the right people at the right time. And that's been my mission. No, one's told me to alter that. Senator Dick Durbin: (54:21) In July of 2017, the United States Senate considered the repealing of the Affordable Care Act on the floor of the Senate. I'll remember that morning, that night forever. A few feet away from me, the late Senator, John McCain cast a no vote, and the Affordable Care Act survived. The president has said repeatedly that he has a replacement plan for the Affordable Care Act. As head the agencies responsible for dealing with such a public health undertaking, I would like to ask you, does a replacement plan exist that you are aware of? Any of you? Yes or no? Admiral? Admiral Brett Giroir M.D.: (55:07) I'm not involved in the replacement plan. I don't know what that is. I supply public health advice as much as I can for whatever that plan would be? Senator Dick Durbin: (55:16) Dr. Kadlec, are you aware of such a replacement plan? Dr. Kadlec: (55:20) Sir, it's not in my portfolio and sir, honestly, I've been so busy with the other things, I have no awareness of that. Senator Dick Durbin: (55:26) Dr. Redfield, are you aware of a replacement plan? Dr. Redfield: (55:28) Again, it's really not in my main lane, but I'm not aware of one. Senator Dick Durbin: (55:36) Just a few weeks ago, the nine major pharmaceutical companies had full page ads saying they would not bow to political pressure to rush vaccine production. Were any of you consulted before they made the decision to buy that ad across the United States? Dr. Kadlec: (55:54) Sir, not consulted but aware of it. And it conforms with, I think the feelings and the commitments that the leadership in Warp Speed and in my organization are committed to as well. Senator Dick Durbin: (56:03) Do you know why they did it? Dr. Kadlec: (56:05) Sir, I think to the point of making that everyone is believing in the same way, which is a safe and efficacious vaccine has to be trusted. Senator Dick Durbin: (56:15) Thank you. Chairman Blunt: (56:16) Thank you, Senator Durbin, Senator Capito. While we're trying to figure out how we get Senator Capito for her question, Senator Kennedy, why don't you go ahead with yours and then we'll go to Senator Reed after Senator Kennedy and see if Senator Capito's ready. Senator Kennedy. Senator John Neely Kennedy: (56:42) Thank you, Mr. Chairman. Thank you gentlemen, for being here today. You are all MDs, medical doctors? Is that correct? Dr. Redfield: (56:56) Yes. Dr. Kadlec: (56:56) Yes, sir. Senator John Neely Kennedy: (56:58) Would any of you do anything to violate your Hippocratic Oath? Dr. Redfield: (57:07) Never. Dr. Kadlec: (57:08) No, sir. Dr. Redfield: (57:10) Have any of you, as Senator Murray, alleged, recklessly interfered with the treatment, or prevention of COVID-19? Admiral Brett Giroir M.D.: (57:29) No, sir. Dr. Redfield: (57:30) [crosstalk 00:57:30] No, sir. Senator John Neely Kennedy: (57:32) Do you know of anyone who has and the Trump Administration? Admiral Brett Giroir M.D.: (57:36) No, sir. Dr. Kadlec: (57:36) No, sir. Dr. Redfield: (57:37) No. Senator John Neely Kennedy: (57:38) Okay. Dr. Redfield, have you ever had polio? Dr. Redfield: (57:49) No, sir. Senator John Neely Kennedy: (57:50) Me neither. Thank you, science. When the coronavirus was first discovered, we didn't have much science about it, did we? Dr. Redfield: (58:02) No, sir. Senator John Neely Kennedy: (58:03) You couldn't go to WebMD and look it up, could you? Dr. Redfield: (58:07) No, sir. Senator John Neely Kennedy: (58:09) We've learned a lot about it, haven't we? Dr. Redfield: (58:11) Yes, sir. Senator John Neely Kennedy: (58:14) Would it be fair to say, and disagree with me, if you do, I know you will, that the coronavirus is a lot more contagious than we originally thought. Is that fair? Dr. Redfield: (58:28) Yes, sir. Senator John Neely Kennedy: (58:30) Now, I read on the CDC site, tell me if I misinterpret this, that out of every 1000 people who get coronavirus, not out of every 1000 people, but our of every 1000 people who get the virus, six are going to die. Is that accurate? Dr. Redfield: (58:55) It depends on age group and risk factors, sir. So if you were to look right now, individuals under the age of 18, it's about 0.01%, 18 to 19 to say 69, it's more like 0.3%. And if you're over the age of 70, it's about 5% now. Senator John Neely Kennedy: (59:20) Okay, but if you look at population as a whole, it's about six out of a thousand, is that correct? Dr. Redfield: (59:28) I'd have to get back to you. Overall, we're probably looking at an overall mortality in the range of somewhere between 0.4 and 0.6% of the population. Senator John Neely Kennedy: (59:40) Right. That would be six out of a thousand. Dr. Redfield: (59:43) Yep. Senator John Neely Kennedy: (59:45) That's on the high end. Dr. Redfield: (59:46) Yep. Senator John Neely Kennedy: (59:47) Obviously the older you get the more at risk you are. Tell me when you think we'll have a vaccine, as best you can, ready to administer to the public, Dr. Redfield? Dr. Redfield: (01:00:16) Well, I think Dr, Kadlec said, I think there will be a vaccine that initially be available sometime between November and December, but very limited supply and will have to be prioritized. If you're asking me, when is it going to be generally available to the American public, so we can begin to take advantage of vaccine to get back to our regular life? I think we're probably looking at late second quarter, third quarter 2021. Senator John Neely Kennedy: (01:00:49) And so, you think by the late second, or third quarter, we will have started to vaccinate people? Dr. Redfield: (01:00:57) I think that vaccination will begin in November, December, and then we'll pick up, and it'll be in a prioritized way. Those first responders and those at greatest risk for death. And then eventually that will expand. There's about, it's hard to believe, but there's about 80 million people in our country that have significant comorbidities that put themselves at risk. Senator John Neely Kennedy: (01:01:19) Right. Dr. Redfield: (01:01:19) They have to get vaccinated and then the general public. Senator John Neely Kennedy: (01:01:22) Excuse me, but I'm about to run out of time. And what do you call this effort? This worldwide effort led by the United States of America to develop a vaccine? What is the term for it? Dr. Redfield: (01:01:34) Operation Warp Speed, sir. Senator John Neely Kennedy: (01:01:36) Have you ever seen anything like Operation Warp Speed? Dr. Redfield: (01:01:39) It's unprecedented. Senator John Neely Kennedy: (01:01:41) How long does it usually take, this will be my last question, Mr. Chairman, to develop a vaccine? Dr. Redfield: (01:01:47) I think the fastest prior was two years and usually four to six years. Senator John Neely Kennedy: (01:01:52) Thank you, Mr. Chairman. Chairman Blunt: (01:01:53) Thank you, Senator Kennedy, Senator Reed. Senator Jack Reed: (01:01:55) Thank you very much, Mr. Chairman, and thank you gentlemen, for your testimony. I was particularly struck how emphatic you all were in insisting that the use of face masks is absolutely critical in a social setting. You're all wearing face masks. I have mine, I took off, so I could hear the question. And yet, last evening, the president, once again, disparaged the importance of wearing face masks. He does not wear one usually. He's conducted rallies in which many of the participants are with face masks and he doesn't have a face mask. So let me just ask all of you, Admiral you're a uniformed officer, is the president providing the appropriate leadership when it comes to this critical issue, one of the most direct and important things anyone can do to protect themselves and the community from this disease? Admiral Brett Giroir M.D.: (01:02:58) Well, as a uniformed officer, I'm not going to comment about the president, but I do want to emphasize that wearing a mask is one of the most important things that we can do to prevent spread. Particularly because people who are asymptomatic, you could feel totally fine, but still be spreading the virus, which is why wearing a mask when you can't physically distance is absolutely critical. Admiral Brett Giroir M.D.: (01:03:19) And I think I probably speak for my other two colleagues, but you'll want them... Senator Jack Reed: (01:03:23) I want them too, but I think you've just directly contradicted the president's behavior and the president's comments, even though you've done it, politely, doctor? Dr. Kadlec: (01:03:35) Sir, we're supportive of the masks, that's why we produced a half a billion of them and made them available to the American public at large. Senator Jack Reed: (01:03:42) The answer is... Dr. Kadlec: (01:03:43) Yes. Senator Jack Reed: (01:03:43) ... is the president undercutting what you've all said, and you repeated, One of the most important steps that Americans can take to defend themselves and the country against this disease? Dr. Kadlec: (01:03:58) Sir, my view is, is that he is an individual who can exercise his rights to do what he pleases as we see others, Americans doing that. And so he's... Senator Jack Reed: (01:04:10) But it's also the leader of the country trying to cope with a disease, a pandemic that's killed over a hundred thousand people, and he's rejecting this emphatic advice that you give repeatedly and you yourself demonstrate. Dr. Redfield, your comment? Dr. Redfield: (01:04:32) I'm not going to comment directly about the president, but I am going to comment as the CDC director, that face masks, these face masks are the most important, powerful public health tool we have. And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings. I've said it, if we did it for six, eight, 10, 12 weeks, we'd bring this pandemic under control. Dr. Redfield: (01:04:58) These actually, we have clear, scientific evidence they work, and they are our best defense. I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine, because the immunogenicity may be 70%. And if I don't get an immune response to vaccine, it's not going to protect me. This face mask will. So, I do want to keep asking the American public to take the responsibility, particularly the 18 to 25 year olds, where we're seeing the outbreak in America continue to go like this. Because we haven't got the acceptance to personal responsibility that we need for all Americans to embrace this face mask. Senator Jack Reed: (01:05:43) Once again, I think you've refuted at the president more eloquently than I've heard. You're the expert, leaders have to depend on expert advice. That's why they have people like you there. And when they don't take your advice, in fact, when they disregard it, and it's been said so emphatically here, it's not a question of any doubt at all in your views, all of you. Just a final, quick, quick question, and I only have a bit of time. And Dr. Redfield and Dr. Kadlec, quickly. Your vaccine plan has to involve the states. Can you just very, very briefly, Dr. Redfield, is there a conscious integration of the states in terms of their public health services? And is there resources available for the states in this plan? Because they'll need them. Dr. Redfield: (01:06:41) Yes, sir. It's critical. We've done micro planning, already with five jurisdictions, North Dakota, Minnesota, California, Florida, and Philadelphia. And this plan will be going out today to all of the states. I'll be talking to the state public health leaders this week. We'll be working with them so that they can integrate this plan in their own unique way for their own state. And there will be support to help them begin to resource this plan. Senator Jack Reed: (01:07:12) Thank you. Thank you, Mr. Chairman. Chairman Blunt: (01:07:13) Thank you, Senator Reed. Senator Capito. Senator Shelley Moore Capito: (01:07:15) Oh, thank you, Senator Blunt. And thank all of you. I'm pleased to be a part of this hearing today and I'll start off with Dr. Redfield. I'm not sure if you're aware of Dr. Redfield, but I'm abiding now by the CDC guidelines. I was made aware on Monday that I had been exposed to somebody who tested positive for COVID. According to what the physician told me, I had been in and around that individual for at least 15 minutes around within 48 to 72 hours of when he exhibited symptoms. And out of abundance of caution, and I think seeding to your guidelines, I went immediately to the position at the Capitol who advised me then that I must quarantine... Senator Shelley Moore Capito: (01:08:03) ... position at the Capitol who advised me then that I must quarantine for 14 days. I did subsequently take a test and tested negative, which I'm very obviously pleased about. But I want to ask you, are your guidelines on quarantine for those of us who are quarantining following the rules, what kind of success does that bring in terms of isolating and containing the spread? And do you further recommend further testing as people are coming out of their quarantine and at what points of the quarantine would they need to get retested if that's necessary? Dr. Redfield: (01:08:35) Well, first I want to thank you for setting the example and embracing these guidelines, although, misinterpreted some of the changes that we put in our guideline, the whole purpose of those guidelines was to engage the public health and medical community back into the decisions when people get tested. So as it was talked about earlier, there was the appropriate public health action. So the test led to an action. It wasn't just a test and so I want to thank you for setting that example. The reality is if you've had a close contact, it could take seven days, it could take 10 days, it could take 12 days before you turn virus positive. That's why we have our current recommendations based on the data we have for isolation for 14 days. As we get more data that may change, but the reality is the data that we have today, we still support the 14 days of isolation. Dr. Redfield: (01:09:44) We do have very good data in our household studies, where households that have introduced COVID, where individuals practice masks and hand washing and distancing. We've been able to show there's limited transmission in those households settings. And in households that didn't, we've seen attack rates of 20%, 30%, 40%, 50% within the household. So again, that's where the state of knowledge is right now. There may come a time when we have better data that can shorten it, but right now, even if we shortened it to 10 days and a number of people have asked to look at the data, we would still then send home probably 10 to 12% of people who'd later turn out virus positive. Senator Shelley Moore Capito: (01:10:33) Well, thank you for that. Admiral Giroir, I heard Dr. Redfield brought up an issue that I know is cascading across the country and that is as some of our colleges and universities are opening, the incidents in testing and the incidents of positives have gone way up because of some behavioral issues and just the whole atmosphere at times in a college and university setting. So there's a great interest on tests to get the rapid turnaround test, the Abbott test, I know is of interest to the universities. I know you're beginning to deploy these to nursing homes and highly challenged communities, which I applaud, but how do you deal with it in college and university setting in terms of testing and what do you recommend here? What do you see in the future? Admiral Brett Giroir M.D.: (01:11:27) Thank you for that question. Universities generally have a very substantial capability to do testing in their research laboratories, in their veterinary diagnostic laboratories. Senator Durbin, University of Illinois is one of the real leaders in being out front. So we have had multiple calls, seminars, technical webinars to allow the universities to turn on their research equipment. We've done the CLIA waivers, we've done all of that to really use that to support testing. Eventually, we want to get to a point that rapid point of care tests are available for everyone, but 50 million a month, doesn't go into 300 million people. Admiral Brett Giroir M.D.: (01:12:10) So what we're advising universities is to use those resourses that have been funded by the NIH that they have to use them. A nursing home can't do that. Many universities are using their veterinary laboratories, which are very successful and again, University of Illinois has done just really tremendous. We had them on one of our leadership calls as an example, telling the rest of the country. Senator Shelley Moore Capito: (01:12:34) Thank you very much and just in closing, I know my time is up. I am concerned, Dr. Redfield, as we talked about before the rise in overdose and overdose deaths during this pandemic is extremely alarming and I'm very concerned as we keep moving forward, what kind of impacts this is going to have on the addiction community. You and I have talked about it. We've got to keep our eye on it. Thank you so much. Speaker 1: (01:12:58) Dr. Redfield. Dr. Redfield: (01:13:00) Oh, yes. I couldn't agree with you more. I mean, we've seen an increase almost 18% now in our suspected overdose submissions into hospitals. Clearly the isolation that's been associated, also the ability to get access to the proper pain control and a lot of the medical services cut back and CDC recently did a survey and actually shocked me just the survey across our nation found that 31% of adults reported now significant anxiety and depressive disorders. So this is a significant co-morbidity that has been negatively influenced by the COVID response and it is something that we have to continue to double our efforts to try to prevent the death from overdose. Speaker 1: (01:13:52) Thank you, Dr. Redfield. Thank you, Senator Capito. Senator Shaheen. Senator Shaheen: (01:13:56) Thank you, Mr. Chairman, and thank you to each of you for being here. Admiral Giroir, in your opening statement you talked about the importance of protecting the elderly, which I think all of us would agree is critical. And yet the elderly have been impacted the most by this COVID-19. In New Hampshire, over 80% of our deaths from COVID-19 have been in longterm care facilities. That's why I am so concerned about the slow pace that HHS has provided and giving support for infection control in these facilities. The CARES Act provided up to $200 million for nursing home infection control efforts, and to date only 17 million of that has been spent. Senator Shaheen: (01:14:43) On top of that, HHS has only spent about half of the 16 billion that Congress has provided for the acquisition of personal protective equipment, which continues to be a need. Nursing facilities and providers across the care system in New Hampshire desperately need these supplies. So Admiral, the Infection Control Funds are vital to helping our nursing homes reduce the spread of diseases, you alluded to that. So when can we expect the remaining funds to be distributed? Admiral Brett Giroir M.D.: (01:15:14) I can't answer that on that specific. I don't know when they will be distributed. What I can say is that I know even in the last couple of months, there's been $5 billion of extra funding to nursing homes. 2.5 billion of that is to support testing, which is really in our regime. And we do get Admiral pull up check the other Admiral on the team with an unpronounceable name. Every day we get about 99% of nursing homes reporting. So we know exactly what their PPE situation is. So, but in terms of that specific fund, I'm going to have to have the team get back to you on that. Senator Shaheen: (01:15:55) I would appreciate that. One of the challenges with that 5 billion that was just distributed is that it can only be used for hiring only not retention. And the biggest challenge our nursing homes have in New Hampshire is retention of employees. So is there going to be any thought given to providing more flexibility for longterm care facilities and how those funds can be used? Admiral Brett Giroir M.D.: (01:16:19) I'm really sorry. I'm going to have to get Seema Verma and the secretary to respond to that. That's not within my realm of responsibilities. Senator Shaheen: (01:16:28) Well, I would urge you to do that because if we're providing funds to long-term care facilities that can't be used, then it's not accomplishing the concern that all of us share. I want to go on to another issue because there is a report that just came out about HHS seeking bids for a $250 million contract for public relations campaign to defeat fear and inspire hope regarding the pandemic. And while I think all of us want to make sure that Americans know that there is going to be a better time ahead for us, the timing of this contract raises real concerns about the potential intersection with the president's reelection campaign, and more importantly, Congress didn't direct HHS to conduct this campaign. Senator Shaheen: (01:17:19) So is the $250 million that's going to that coming from funding that should be going out to our long-term care facilities, to our hospitals, to our medical providers, to actually respond to the spread of COVID-19? And what is the purpose of this contract at this time to do a public relations campaign? Wouldn't it be better to give information to the American public about what all of you have said so eloquently this morning about what we need to do to respond to this virus and what we need to do to ensure that people have the healthcare they need, if they contract it. Admiral, can you answer that? Admiral Brett Giroir M.D.: (01:18:05) Ma'am, I really do apologize but I don't know anything about public affairs campaigns or where that money comes from or what it's going to do. That's just not something that I deal with. We all try to provide the best information we can through whatever vehicles we can, but I just don't know about public affairs contracts. Senator Shaheen: (01:18:24) So you are not aware that the department is going to be spending $250 billion on that advertising campaign? Admiral Brett Giroir M.D.: (01:18:31) I mean, I'm generally aware from what I read in the news, but I'm really not involved in that. All I know about public affairs is that we do want to get all of us in front of the public to make sure number one, they get their flu vaccines this year because that's really critically very important. Senator Shaheen: (01:18:49) Thank you. I think that's very helpful. Dr. Kadlec, were you aware of this expenditure? Dr. Kadlec: (01:18:55) No, ma'am. Senator Shaheen: (01:18:57) Mr. Chairman, I would hope that this committee would ask some very tough questions about what's going on here because that's a lot of money for a campaign that we ought to be spending to address this pandemic and Senator Alexander, I totally agree with you on doing some work now to respond to the next pandemic and I would suggest that we also ought to restore the Global Health Security and Biodefense unit either at the National Security Council or somewhere where it can provide an early warning for what's ahead. Thank you very much. Speaker 1: (01:19:28) Thank you, Senator Shaheen. Senator Hyde-Smith. Senator Hyde-Smith: (01:19:35) Thank you Mr. Chairman, and to the panel. I truly thank you for all you have done and your tremendous tireless efforts of guiding this country through COVID-19. You are to be commended applauded, and I'm certainly one that appreciate you being here today and answering the that we have and being willing to serve in the capacity that you serve in. I represent Mississippi. We're less than 3 million people, and one of our largest challenges is rural health care and getting these vaccines to rural areas such as those in Mississippi. Senator Hyde-Smith: (01:20:12) Of course, I'm very concerned about the universities and colleges and the protection that we need there through that age population. But I'm just going to ask you, what are your agencies working on to help address the challenges in unique rule America's response to COVID-19, but mainly how can this subcommittee support you in that? How can we help you address those issues there? And I'd like to hear from all three of you on that and getting the vaccines to rural America where it needs to be, where we have such a challenge. Dr. Redfield: (01:20:53) Thank you very much, Senator. Very, very important. We have continued to try to develop outreach and vaccine distribution particularly in the hard to reach rural areas. This is part of the efforts that we've accelerated with our flu program right now, with the idea of how to vaccinate with confidence, by trying to protect communities, empower families and stop myths. We've developed rural partnerships with the National Rural Health Association, the National Association of Rural Health Clinics and the National Organization of State Rural Health Offices with the goal to really work to improve the acceptance of vaccination in general, flu being the important one with confidence. Dr. Redfield: (01:21:43) I do think the recent decision that the secretary made in expanding the ability of pharmacies to vaccinate down to age three to age 18, is going to be an important expansion of being able to engage pharmacies throughout our nation as vaccine centers. But we're continuing to work with those rural organizations to see if there's other innovative solutions to try to expand vaccination. I am hopeful that the pharmacy expansion is going to have a significant impact. Senator Hyde-Smith: (01:22:22) Thank you very much. Dr. Kadlec: (01:22:23) Ma'am with regard to rural health care, what HRSA has been doing in the last years prior to the COVID event was trying to expand what would be the regionalization of disaster emergency care to really focus on areas where you have critical access hospitals or underserved populations. In the current COVID event, we've been working with the Department of Defense to employ a system that they originally started, which was called the National Emergency Telecritical Care Network or NETCCN which is a means by which to do telemedicine to again, rural and critical access hospitals, to make them available the best information, critical care specialty support, as well as arranging for transportation and referral of cases to a higher level of care. Dr. Kadlec: (01:23:12) So we're actively doing that right now. We've done it in many parts of the country as a result of our work and COVID response and we're also trying to do that for ambulatory care telemedicine as well. So by building out our regionalization approach our hope is not only create those establish referral patterns, but also establish telemedicine consulting support so that we can support the rural parts of this country over. Senator Hyde-Smith: (01:23:41) Thank you. Admiral Brett Giroir M.D.: (01:23:41) And I will add on again with the prep Act guidance that allowed pharmacists to do COVID vaccines. I issued that last week to get into the pharmacy communities. But I just want to be a little bit of a cheerleader for federally qualified health centers. We now have 221 federally qualified health center sites in Mississippi performing testing. I think FQHCs are a real gem. They take care of 30 million people and very much of the underserved migrant farm workers, homeless, and they do so at a savings. Better outcomes at less cost. So again, that's a major point for us in Mississippi, where we're reaching people both urban and rural and anything I could do something for HRSA and the health centers, that's going to be money well invested. Senator Hyde-Smith: (01:24:35) Thank you all for those answers and I appreciate that because it is one of my top priorities. I had a young lady not long ago that died of an asthma attack because the emergency room had been closed in her area. So I certainly appreciate your work there. Speaker 1: (01:24:53) Thank you, Senator Hyde-Smith. Senator Merkley. Senator Merkley: (01:24:58) Thank you very much. Dr. Redfield, I am concerned at the CDC has revised guidelines that no longer recommend testing for asymptomatic individuals who have been in close contact of a person with COVID-19 infection for at least 15 minutes. Just a few days ago, on a media interview on September 10th, Admiral Giroir stated that all of us in the room have been hearing from public health experts, we need to test asymptomatic individuals. So explain this to me, is the Admiral right or wrong? Dr. Redfield: (01:25:37) Thank you very much, Senator for the opportunity to address your question. I think first and foremost, I want to say the CDC guidance that came out was clearly and misinterpreted and within 24 hours, I published a statement to try to make it clear what CDC was recommending. We were never recommending not to test asymptomatics and we were never recommending, obviously not to do the public health contact tracing and trace them. What was attempted was to replace the emphasis of testing so that as we talked about earlier, a testing led to an action. It drove public health objectives. So we placed the emphasis on testing symptomatics, but then we placed the emphasis on individuals with significant exposure, they're asymptomatic or vulnerable populations, nursing homes, long-term care facilities, critical infrastructure workers, healthcare workers, first responders they're asymptomatic. Dr. Redfield: (01:26:37) And the last group that we talked about was individuals who may be asymptomatic and rather than just get tested, what we asked them to do was consult like we heard from the Senator of West Virginia, consult with your medical and public health officials and follow their direction because as you saw with the Senator, when she chose to get tested, even though the test was negative, there was a critical public health action that was for her to stay home for 14 days. So we're going to continue to try to make sure our guidance isn't interpreted incorrectly because as the Admiral said, and as I've said, asymptomatic infection and presymptomatic infection is a critical component of the transmission cycle of this virus. Senator Merkley: (01:27:26) [crosstalk 01:27:26] doctor because I've got other questions and I think you've answered it and even the example you've given shows the positive impact of testing asymptomatic individuals, because they can get appropriate guidance on how to behave thereafter. And we know that a tremendous amount of infections are happening from people who are asymptomatic. And so I think that's such an important point to keep driving home. I wanted to also ask you, you told governors to prepare for the distribution of COVID-19 vaccine on November 1st, it escapes no one's a perspective that you're deliberately laying it out two days before the election, who in the administration asked you to choose that particular date? Dr. Redfield: (01:28:14) No one, sir. Senator Merkley: (01:28:16) You just froze it on your own political motivation to try to influence the election in this manner and what happened to science driving decisions? Dr. Redfield: (01:28:26) There was no political interest in it whatsoever. It was actually prepared by our subject matter experts because we wanted to get to the point of realizing that vaccine may be available. We don't know when, and we wanted the governors to be able to not have red tape interfere with the distributor McKesson, from setting up their distribution sites. I will argue that the thing that I was most concerned of and my subject matter experts who actually generated the letter which I signed was that the worst thing that could happen is we had vaccine delivered and we're still not ready to distribute, but I can tell you there was absolutely no political thinking about it. You could say in retroactive somebody should've thought a little more political, but there was no political intention whatsoever. Senator Merkley: (01:29:20) Okay. Well, I must say that I don't find that persuasive. You're saying that there was not a single contact from the administration after the president said, I'd like to have a vaccine before November, before the election, no one from the administration contacted your team at any level to say, "Can you please emphasize that message?" There are no emails, no meetings, no phone calls, no backroom chats connected with your choosing that particular date? Dr. Redfield: (01:29:50) Absolutely not. It was independently developed by our subject matter experts that were laying out this document to start the plan for the jurisdictions that we needed to get that letter out so McKesson could get the licensing agreements that they needed to get their distribution sites up. And they drafted the letter of the subject matter experts that I signed. Senator Merkley: (01:30:11) Yeah. [crosstalk 01:30:12] so much misrepresentation by the administration. I think Americans would find it hard to believe that there were no conversations when administration is actively pushing every piece of the federal government to engage in actions to promote their elections. So it undermines your credibility, that you should have at least thought about how it undermined your credibility, because it's so important to have the CDC be above politics. Speaker 1: (01:30:42) Thank you, Senator Merkley. Senator Lankford. Senator Lankford: (01:30:45) Thank you. It has been interesting how much of the dialogue today has been about politics and about the election. I do appreciate the work that you're doing regardless of party. I don't find people getting COVID only if they're Republican, Democrat or independent voters and non-voters. So I appreciate the ongoing work that you have done for a very long time to be able to work us through this. Your days are very long and your work is very important and so we appreciate the work that you continue to be able to do. And this hearing shouldn't try to be some sort of political trap for the president it should be about the facts and details. So I appreciate that. Senator Lankford: (01:31:20) Let me ask you a couple of quick questions on this. I want to dig into more, the first one is there's been a lot of conversation about the amount of resources that is needed for the vaccines, especially, and for vaccine production and distribution. What do you still need for vaccine production and distribution as far as supplemental appropriations? Dr. Kadlec: (01:31:44) Senator, thanks for question. At this point, we have funded six vaccine candidates for both the advanced development and manufacture. I think at this stage, the $13.6 billion that have been appropriated or pardon me, committed for this purpose is adequate for the initial part of this. If you're talking about, at this point in time, when one vaccine candidate may fail and we may have to replace it with another candidate or expand production of another, that could basically change our accounting and our calculus for what we would need, but at this stage we have what we need and we're poised at least at this point by I think by the end of this month and into early October to at least have the funds that we need to basically provide for the first several candidates. Senator Lankford: (01:32:35) Okay. That's good to know. There's obviously six different candidates going through the vaccine process right now, because no one knows if any, one of them is going to be successful. So you've got basically six hooks in the water. At this point, I'm going to drill down a little bit on the vaccine candidates that are out there and also some of the treatments. Some of the pharmaceutical companies have chosen to do ethical production, that is they're not using tissue from aborted children for the production of the treatment or the vaccines. Some of them have chosen to use aborted fetal tissue in the production of the vaccines. How are you balancing out to be able to make sure that there will be an ethical alternative for individuals that don't want to take a vaccine that's also produced using the tissue of an aborted child? Dr. Kadlec: (01:33:21) Sir, thank you for that question. I'm going to have to take that for the record and bring you back an answer to get more details on those particular matters. I don't have those immediately available and I do not want to speak on this issue. Senator Lankford: (01:33:33) It's fair enough. Dr. Redfield, do you have any comments or thoughts on the production? Dr. Redfield: (01:33:38) Again, I would have to go back and see specifically. I think my recollection is we're going to have a number of candidates. It's not going to compromise one's ethics related to the use of human tissue, but I will have to get back to you too because I don't want to say something that's incorrect. Senator Lankford: (01:34:01) No, I get that. And it's not just human tissue in the production. I mean, there are some companies that are using adult stem cells, there are some that are using placentas from children after birth, those are not objectionable. I don't find anyone challenging that. So it's not just the use of human tissue and specifically the use of tissue that's from aborted children that becomes the challenge. And the Moderna is using embryonic kidney cells from aborted children, Johnson & Johnson is using a boarded children embryonic retinal tissue for its production of the vaccines. Senator Lankford: (01:34:37) There are others that are not choosing to use those tissues from children and so I think there just needs to be as many options out there as we can and again, I just wonder on the science side, if we don't have to use tissue from aborted children, why would we do that when there's others that are choosing to be able to develop vaccines that they're not being used that way. So I want to be able to follow up with you on that and just be able to see what options are out there and how we're handling the funding and what direction that we're going to go and long-term for vaccines, most of the vaccines that we have in America now don't use embryonic tissue in it. There are still some that still do that. That is the line that is still used. Senator Lankford: (01:35:21) And again, when we don't have to do that, why would we do that? And to have it as ethical as we possibly can. So again, I appreciate the work. We'll follow up in the days ahead on this particular topic because I think it's very important that as many people get vaccinated as possible and I don't want to have a reason for people to not go get a vaccine because they're concerned about the origin of the vaccine. I want as many people as possible to actually get a vaccine because I think it's important and it's been an odd conversation to hear so much of people saying, "Well, I'm challenging whether we're going to get a vaccine because the Trump administration may be rushing this and so I don't want to go get one." I think we need to have nothing that distracts from the science and the details of this as we walk through it as well. So appreciate your work. Speaker 1: (01:36:05) Thank you, Senator Lankford. Senator Schatz. Senator Schatz: (01:36:08) Thank you, Mr. Chairman. Thank you to the panelists for being here. I'll start with Admiral Giroir. You said in July that it was not a question that we would be soon running a million tests per day. We've gone from about 800,000 tests per day to 675,000 tests per day. What's happening? Admiral Brett Giroir M.D.: (01:36:34) I want to be clear that we're talking about capability to produce tests and I think we need to always draw the distinction between how many tests we have that can be deployed and what the states are doing. In August for example, the states combined goals were in the low 20 millions of tests which they exceeded to 25 million. But what we're seeing at some parts of the country is testing is going down. We're trying to change that. I know you're from Hawaii. We have a surge site in Honolulu right now we can test unto 5,000 per day and moving into [crosstalk 01:37:11]. Senator Schatz: (01:37:11) You're saying this is [inaudible 01:37:12]? I guess the question is, is this a supply chain problem or are you saying that states are individually deciding to do less testing? Admiral Brett Giroir M.D.: (01:37:21) This is not a supply chain problem. We had double the availability of tests that were done in August and we'll be over 90 million tests available in September. I would presume that a higher proportion will be done because they're going to be very easy to do. They're going to be point of care by annex testing and were surging in nursing homes, but this is not a supply chain problem of testing. Senator Schatz: (01:37:45) Can you just talk a little bit about the Binax testing because I guess where a lot of people are coming from is that we hope you're right, that this new test is a game changer and we are pleased, and I think it will be very helpful in the context of first responders and in nursing homes and perhaps educational context as well, but it's a card and as you know, you can't really process that many tests at once this way. And so, although it's really useful in certain contexts, it's not going to get you to your 90 million tests goal. I mean, in your testimony today, you say that we should have 90 million tests completed by the end of September. We're about halfway through September and we're at 10 million tests. Admiral Brett Giroir M.D.: (01:38:34) I did not say that. I said, we have... Senator Schatz: (01:38:36) In today's testimony. Admiral Brett Giroir M.D.: (01:38:37) You said we will have the availability of 90 million tests in September. I never stated that we would do 90 million tests in September. We're certainly hoping that the testing goes up. And let me just say about Binax, it only takes a swab and put it in and wait 15 minutes. I could probably go through this room and swab every one and do that within about five or 10 minutes. So it's a low throughput test, but you could do them very rapidly and quickly. So I would expect that as many of these that get put in the market, particularly used in nursing homes, assisted livings and to support K-12 that they would be used very, very rapidly. Senator Schatz: (01:39:17) Just because I have limited time, what is the difference between testing availability and tests being completed because that seems like a distinction that is lost on the ground? To know that there are 90 million tests theoretically available, but the nursing homes, the schools, the first responders, the firehouses, they don't have the tests available. So what does it mean that it is theoretically available to do 90 million tests and yet people can't get their hands on the test? Admiral Brett Giroir M.D.: (01:39:50) I don't think that's true. I think people can get their hands on the test. Even with federal sites, we have 2,700 and retailers, we have surge sites. There is enormous capability in the referral labs. So the testing is available even when we do search sites, unless there's there's not a public order that demands people to come in and get a swab up their nose. This is voluntary and sometimes the demand is not there. But let me just turn that around and say with the Binax, that's one reason why we purchase them all for the federal government, the first 150 million to make sure they got to sites that would use them and really could benefit them like nursing homes, assisted living, tribes, HBCUs, disaster situations and in just a couple of weeks to support K-12. So I do expect this will... Senator Schatz: (01:40:43) Admiral, I know you're working on this and I know you're trying to do this in good faith, but I just want to convey to you that when the surge testing happened in the state of Hawaii, on the Island of O‘ahu over the last two weeks, it was only then that we were able to test our firefighters. It was only then that we were able to test our first responders. It was only then that we were able to have the tests available to do what it is that is theoretically possible under other circumstances and it was only because we saw a precipitous spike in COVID cases. And so it is not true, it is not true that tests are available for first responders except in certain [crosstalk 01:41:25]. Admiral Brett Giroir M.D.: (01:41:25) I respectfully disagree with you that if the state of Hawaii, you have a turnaround time of under 24 hours with the ACLA labs, and I'm happy to work with your state, but there is no reason before the surge, you could have hired this company to come do the search for you. We did it, sent it down there and the demand was great. Hawaii has been unbelievable to work with. We've been doing fully subscribed 5,000 tests a day, but I'm very happy to work with Hawaii. The surgeon general just went down. We're expanding on the big Island but there is no reason that first responders could not have been tested before the surge. Senator Schatz: (01:42:01) Well, I'll just end it with this and I'm sure my time... Admiral Brett Giroir M.D.: (01:42:03) Been tested before the search. Senator Schatz: (01:42:03) Well, I'll just end with this, and I'm sure my time is almost up, there continues to be a disconnect with how things are represented in this committee, in the United States Congress, and how things are felt on the ground. This was evident in February when we met with HHS, and it continues to be the case here. We hear lots of triumphant statements with lots of data, but on the ground, people still lack resources. Thank you, Mr. Chairman. Chairman Blunt: (01:42:35) Senator Baldwin. Senator Baldwin: (01:42:37) Thank you, Mr. Chairman. So the administration's failure to confront this deadly pandemic has led to lost lives. There is still an urgent need to provide more support to our communities. And I'm increasingly concerned that the funds appropriated thus far have not been handled as well as they could, they've been misused and mishandled. Last month, I wrote to Vice President Pence about a health system in my State that temporarily suspended COVID testing for patients undergoing surgery because of supply shortages. I've heard from assisted living facilities that they can't get the tests they've ordered, and academic medical centers that aren't able to secure a reliable source of reagent. However, Wisconsin did receive unrequested hydroxychloroquine before it ever received a ventilator. Congress provided more than $16 billion for the strategic national stockpile for critical supplies of PPE, less than 9 billion of that has been obligated for the stockpile. Dr. Kadlec, what percentage of the funds appropriated for the stockpile this year have helped States get the PPE and testing supplies they need? As of this moment, what is that percentage? Dr. Kadlec: (01:44:19) Ma'am, I'm going to have to get back to you with a percentage, but what we have done in terms of our approach to basically managing the PPE part, and I'll defer to [inaudible 01:44:29] to talk about the testing piece, is that we've basically made available everything that we had in our stockpile by may, beginning in March with the monies that were available in the Cares Act, the subsequent Cares Act. We've been basically funding, if you will, the purchase of personal protective equipment to be distributed through commercial distributors directly to hospitals, and only beginning in June and July, have we been filling, if you will, replenishing our stockpile as part of a strategy to make available three months of supply for the fall and winter, should that be necessary. But we are, by the virtue of TeleTracking, now getting information from hospitals. Last week, about 95% hospitals have been reporting to us. And I'm just looking at your State, ma'am, we've identified that 16% of hospitals have one type of PPE that may be three days of supply or less. So [crosstalk 01:45:32]. Senator Baldwin: (01:45:32) I'm aware of the Wisconsin statistics, but I'm also aware of the 16 billion that we appropriated to address stockpile issues. So you may have chosen a different strategy, but I think when we're six months into this pandemic, and we still can't get the supplies we need, and you've identified the supplies that are in high demand, that you should use the money we appropriated to obtain those things. Congress also provided $1 billion for department of defense for similar purposes, and the president delegated authorities under the Defense Production Act to HHS to increase production of personal protective equipment. Department of Defense has only used $300 million for PPE, and said they'd use the rest to support the Defense Industrial Base. Dr. Kadlec, how much funding have you spent on increasing domestic manufacturing capacity using all of the DPA authorities available to use so that we can prepare for the remainder of this pandemic or future pandemics? Dr. Kadlec: (01:46:47) Yes, ma'am. So far we've awarded $638 million for that purpose, which runs the gamut from addressing shortages of diagnostics and ancillary supplies, N95 respirators, injection technology for the use for vaccine administration, filter media for masks, as well as ventilators, gloves, surgical masks, as well as the ventilator supply chain. There are other, other things that are being considered at this point in time to use the rest of those funds. But we're trying to be very [inaudible 01:47:23] strategic. Senator Baldwin: (01:47:23) Dr. Kadlec, what is melt-blown? Dr. Kadlec: (01:47:26) Ma'am, that's the material, the fiber material that's used in the disposable surgical mask, N95 respirators, as well as ventilators. Senator Baldwin: (01:47:34) Have you used the DPA to either increase production of melt-blown in the U.S.? I'm not talking about contracting, I'm talking about using the DPA authorities. Dr. Kadlec: (01:47:50) Yes ma'am, we have. Senator Baldwin: (01:47:51) And have you used DPA authorities to shut off the export of melt-blown when it's obviously so needed here? Dr. Kadlec: (01:48:01) Ma'am I'm going to have to get back to you in a firm answer on that, but my recollection is that we have, we did limit the export of that material, but I have to be just be sure and return your [crosstalk 01:48:12]. Senator Baldwin: (01:48:12) Please do. Thank you, Mr. Chairman. Chairman Blunt: (01:48:16) Thank you Senator Baldwin. Senator Graham. Senator Graham: (01:48:17) Thank you, Mr. Chairman. Dr. Redfield, have you been part of the task force since its beginning? Dr. Redfield: (01:48:24) Yes, sir. Senator Graham: (01:48:25) So see if haven't got the timeline right, I believe President Trump was briefed by Mr. O'Brien on January 28th. You had a major problem coming out of China when it comes to the Coronavirus. He sets up the task force on January 29th. Is that correct? Dr. Redfield: (01:48:43) That's my recollection, sir. Senator Graham: (01:48:45) On January the 31st, the President issues an orders called the China Travel Ban. Does that sound right? Dr. Redfield: (01:48:53) Yes, sir. 31st of January is when the request was to inhibit travelers to China. Senator Graham: (01:48:59) On February the 29th, Dr. Fauci was asked by host of the today show, "This is Saturday morning people waking up right now. We're real concerned about this. They want to go to malls and movies, maybe the gym as well. Should we be changing our habits? And if so, how?" Dr. Fauci says, February the 29th, "No, right now at this moment, there's no need to change anything that you're doing on a day by day basis. Right now the risk is still low, but this could change." Is that the general view back in February 29th? Did you agree with that assessment? Dr. Redfield: (01:49:37) At that time, there was limited evidence of community transmission in the United States. Senator Graham: (01:49:43) So in March there was an order basically issued, declaring this a national emergency. Do you recall that, March 11th? Dr. Redfield: (01:49:56) Yes, sir. I think Secretary Azar called it a public health emergency. I think it was January 27th, and then the President of a national emergency. Senator Graham: (01:50:05) On March the 13th. March 11th, we do a travel ban from Europe. Is that about right? Dr. Redfield: (01:50:10) Yes, sir. Senator Graham: (01:50:11) Between January the 29th and March 13th, did the taskforce ever recommend shutting the country down? Dr. Redfield: (01:50:22) No, sir. Senator Graham: (01:50:22) When the task force recommended to the President to declare this a national emergency, and to basically encourage shelter in place orders, did the President respond to the recommendation of the taskforce? Dr. Redfield: (01:50:35) Yes, sir. Senator Graham: (01:50:36) Was there any time when the President refused to do what the taskforce recommended about shutting the economy down before he made that decision? Dr. Redfield: (01:50:46) Not in the decisions that I was involved in. Senator Graham: (01:50:48) Thank you. So vaccines, if we found a vaccine, let's say, next month, at end of October, how long would it take for it to be distributed throughout the country and to become effective? Dr. Redfield: (01:51:03) Well, I think that's the critical question, because currently we've used the supplemental resources to get this distribution capacity up about $600 million. But the funds that we currently have aren't sufficient for us to get all 64 jurisdictions ready to be able to implement this plan that we issued today. Senator Graham: (01:51:21) And I'm sure you've made a request of the committee of additional money, and I'm sure will respond. But what I want the American people to know if a vaccine was developed tomorrow, that was considered to be safe and acceptable, how long would it be before it would have a real effect in terms of controlling the virus? Dr. Redfield: (01:51:39) I think we have to assume that if we had a vaccine, say, released today, that it's going to take us probably in the order of six to nine months to get the American public vaccinated. Senator Graham: (01:51:54) So I just want everybody to understand that we're working Operation Warp Speed. Do you feel like that is going well? Dr. Redfield: (01:52:00) Yes, sir. Senator Graham: (01:52:02) So if we got a vaccine in the near future, before it would really have a massive impact, it would take six to nine months to get it distributed. And for it to begin to take effect, for lack of a better word. Is that accurate? Dr. Redfield: (01:52:16) And in order to have enough of us immunized, so we have immunity, I think it's going to take us six to nine months. Senator Graham: (01:52:22) So during that six to nine month period, we'll continue to do basically what we're doing now, is that correct? Dr. Redfield: (01:52:29) Yeah, Senator. That's why it's so important to embrace these mitigation steps that we talked about. Senator Graham: (01:52:35) So is it fair to say that at no time did President Trump reject the recommendation by the task force when it came to slowing down the economy or putting shelter in place orders, that when it was recommended to him to take those actions he complied, is that correct? Dr. Redfield: (01:52:55) Yes, sir. Senator Graham: (01:52:56) Is it fair to say that as late as February, the 29th, Dr. Fauci, one of the experts of our time, was telling people it's okay to go to the gym, it's okay to go out and about, because at that time we thought the risk was relatively low? Dr. Redfield: (01:53:11) I have to defer that. I didn't follow Dr. Fauci's statements, but I would say in general, we all felt- Senator Graham: (01:53:18) That's what he said on national television. That's what he said that day on February the 29th. So this idea that President Trump didn't respond, I think it's ridiculous for the President to be shutting the whole economy down when his leading expert is telling people, "You can go to the gym, you can go to movies, you can go out and about." So let's not rewrite history here. Thank you, Mr. Chairman. Chairman Blunt: (01:53:39) Thank you, Senator Graham. Before we go to Senator Murphy, Dr. Redfield, let's be sure we're clear here on the vaccine. You're not saying that it would take six to nine months before the vaccine would do any good for anybody, and are trying to come up with a priority that the country and Governors should look at of who is the most at risk that would get that vaccine first. Is that right? Dr. Redfield: (01:54:09) Yes, sir. Chairman Blunt: (01:54:10) And if the vaccine works with the efficacy that we would hope for, most of the people that get the vaccine are then protected from the virus for at least the near term future, is that right? Dr. Redfield: (01:54:24) The FDA has set guidance that if it's 50% efficacious, which is similar to the flu vaccine, that that would meet their threshold for approval. And I do want to be clear that as soon as this vaccine gets approved by anyway or actually approved, we want to be in a position to distribute that within 24 hours, because you point out very clearly, this vaccine has the potential to save a lot of lives in November and December, but we need to be able to get that vaccine once it's ready to... Once it's approved, we need to get it distributed as rapidly as we can. Chairman Blunt: (01:55:05) And in July at the hearing we had in D.C... In July, I asked you specifically to focus on being able to report back on a plan that hopefully we'll get to later. I just don't want to leave this moment with any thought that just because everybody that wants to have the vaccine might not have it before Memorial Day, that doesn't mean that many people who do have it, and hopefully it would be the most in need, would be substantially better off than they are right now. Is that right? Dr. Redfield: (01:55:35) Yes. Mr. Chairman, you're going to have an enormous impact, we believe, on the mortality and the most vulnerable, and an enormous impact in protecting those at greater risk from infection. And we should see that impact relatively immediately. Chairman Blunt: (01:55:50) Thank you, sir. Senator Murphy. Senator Murphy: (01:55:52) Thank you very much, Mr. Chairman. Thank you for spending so much time with us today. Just first, a note on communication to and through Congress in this committee, Senator Jeanne earlier asked about a $250 million contract that is being awarded by HHS to defeat despair and promote hope, which sounds an awful lot like a political reelection year oriented message out of the administration. And we have two deputy secretaries of HHS before us today, and neither one of them can testify as to whether that contract is awarded, why it was awarded, what the reasons for it were. It's increasingly impossible for any of us to know who's in charge. Senator Murphy: (01:56:34) We've got two people who are at the highest echelon of HHS, and can't answer a question about a massive contract that has been awarded, and I think that's the same thing for the American public. Dr. Burks was in charge, then Vice President Pence was charge. It's really hard for there to be any accountability around decisions when we can't get these basic questions answered. I want to come back to Senator Merkley's question regarding the change guidance. Dr. Redfield, so the president says he wants less testing. He says that out loud, he's asked for clarification, he doubles down, says, "I want less testing." And then right around that time, you issue this guidance that dramatically scales back recommendations for who gets tested. Senator Murphy: (01:57:23) The New York times reports that that is because, in part, of instruction from the White House. You say today, that that report is in fact untrue. But to many of us, it just belies reason that we would be encouraging fewer people to get tested today, given the massive expansion of this virus on the day that we passed the cares act, there were 10,000 new cases reported in this country. On average, we are seeing 34,000 new cases all across this country today. Your testimony was that you weren't necessarily saying folks who are asymptomatic, shouldn't get tested, you're saying they should just see a doctor first. Is that correct? That was your clarification today. Dr. Redfield: (01:58:16) No. What I was saying that when you get a test, like any physician who does a test, it needs to be linked to an action. And what we were trying to do is reemphasize that testing is linked to an action, just like the Senator said. She got tested, she was in quarantine, she got tested, she was negative, but that still was linked to an action, to stay in quarantine for 14 days. What was happening was people were getting tested and there was no action. So we were trying to bring action back into testing. We were not trying to limit. And I'll be very clear [crosstalk 01:58:54]. Senator Murphy: (01:58:53) Before you do that let me just read you, this is from a medical journal. This is from the American Journal of Managed Care. "Earlier in this week, CDC changes guidance saying even if you want to come into contact with an infected individual, a test is not necessary if there are no symptoms. Dr. Redfield: (01:59:08) That's not true, what the guidance was attempting to say. It's true that some people interpreted that way. And that's why I issued a very clear statement in 24 hours afterwards to say, CDC is not trying to emphasize. I do believe that more test, as was said by Senator Durbin, more tests actually can lead to less cases if testing is leaked to public health action. Senator Murphy: (01:59:35) But you did recommend, you did say they don't need a test. Dr. Redfield: (01:59:39) We said they may not necessarily need a test. [crosstalk 01:59:44]. Senator Murphy: (01:59:42) What's that mean? Listen, you're speaking to the American public when you tell them that they don't necessarily need a test. Dr. Redfield: (01:59:48) Public health person to make that decision- Senator Murphy: (01:59:50) What's the difference? Dr. Redfield: (01:59:51) ... appropriate public health action can be taken into conjunction [crosstalk 00:01:59:53]. Senator Murphy: (01:59:54) When you tell them that it's not automatic that they need to test, that they should see a doctor first, it gets communicated to people that the urgency is much lower. Dr. Redfield: (02:00:05) For all contexts, sir, we're recommending all of them be tested. It was a misinterpretation by some. And again, we're going to continue to clarify because we are not recommending less tests. I do believe more tests ultimately is going to lead the less cases in this country, because it's going to allow public health action to happen just like it did for the Senator. And we can use those tools to stop this pandemic. Senator Murphy: (02:00:27) I will ask this question for the record, Mr. Chairman, to Admiral Giroir. There's a report earlier this month that the United States is going to scale down its engagement further with the WHO, including recalling detailees from WHO headquarters, regional offices and country offices, and then reassigning these experts. I acknowledge, I don't have time to get the answer today, but I think it's incredibly concerning that we might not have American personnel on the front lines to watch this virus and others through WHO field offices. And so I'd appreciate a answer, for the record, regarding who's going to replace those individuals inside countries of concern, and how we keep eyes on this virus and future viruses. Thank you, Mr. Chairman. Chairman Blunt: (02:01:21) Thank you, Senator Murphy. Senator Moran. Senator Moran: (02:01:23) Chairman, thank you. Dr. Kadlec, let me start with you. I want to talk a moment about ventilators. HHS has entered into a number of ventilator contracts, most of which were canceled a week or so ago, before they reached their intended, I guess, conclusion. And is there an accounting of how many ventilators, which is troublesome to me because the signals even a week before that was, "Fulfill your responsibilities first to USAID, and then come back and finish your contract to us at HHS." And then a week later the message is, "We don't want any more ventilators." And it's interesting to me that the contract requires HHS, the taxpayers to pay for the startup costs, the closing down costs and all the equipment and materials that had been purchased. So for a marginal amount of money, the contract could be fulfilled. Setting that aside, what's the accounting on how many ventilators that are high acuity ventilators in the strategic national stockpile. And is there a calculation by HHS as how many need to be this higher acuity as compared to a more standard ventilator with one dial that you adjust? Dr. Kadlec: (02:02:50) Well, thank you sir for the question, and yes sir, we have been looking at our ventilators supply. Just to put this in context, when the COVID 19 event occurred in January, we had 17,000 ventilators in our stockpile, with another 10,000 ordered. As a consequence of the modeling and the concern that we may need much more ventilators by pre-pandemic calculations, for pandemic influenza, it was a figured or calculated that you needed about 170,000 ventilators. As a course of this event, there was a concern that we may actually need more than that number, and that is when we went into agreements with seven companies across the country, and a few from outside the United States, to basically produce over 200,000 ventilators. Dr. Kadlec: (02:03:40) With that, as things progress, as we learn more about the disease, and more importantly, how to clinically manage this disease, both from a respiratory setting, as well as an intensive care setting, we identified we needed to change maybe our strategy with the ventilators. Maybe needing less, but also deep different kinds of machines. And so with your point, the higher acuity ventilators, which we have over a 120,000 of, at this point, was to basically diversify that so that we could use some that could be used for high flow nasal cannula, which seemed to have better clinical outcomes. Dr. Kadlec: (02:04:19) So adjusting that number with modifications to some of the orders that we made, we basically also identified that we could meet our pandemic requirements of 170,000, make available to other countries, additional 20,000 ventilators that we decided to then, if you will, cut back on the number of ventilators that we needed to order and to have shipped. Yes, there is a cost to that, but there is a significant cost on the backend of this, with the maintenance requirements that you need to maintain these ventilators. And so that's why we did, sir. I'm the responsible party. And sir, I'll be happy to get with you and your staff to provide you any other details you need. Senator Moran: (02:05:00) Doctor, thank you. Let me quickly turn in to Admiral Giroir. I think the stand that the witnesses, the position the witnesses have taken this morning is that you're incapable of telling us, but would take back these issues for the record, you're incapable of telling us about future spending from the Provider Relief Fund. Let me just suggest to you that please take back, for the record, that the ability to get information from HHS on any spending from the Provider Relief Fund has been minimal at best. As a United States, Senator who appropriates money, who supported the Cares Package, my ability to communicate with my constituents as to how you're going to spend the money, what the plan is, has been next to nil. Senator Moran: (02:05:47) I've not experienced that during Coronavirus with other departments, with other agencies, but HHS has failed, time and time again, to respond to congressional inquiry and to provide us with information about how money, taxpayer money is being spent, but how to help our constituents prepare for what you might be doing or what you're not going to do. Admiral, somewhat in that regard, that the increasing costs associated with complying with HHS rules and regulations by our nursing homes, our skilled nursing facilities, our senior living facilities is significant. And my question for HHS, because I would understand that you will defer to somebody else than who's here today to answer the question, is what can they expect to help them pay for the tremendous increase in costs, in compliance with COVID regulations in policies that they are attempting to comply with to protect the safety and wellbeing of their residents, but have little financial capability to actually pay for? Admiral Brett Giroir M.D.: (02:06:52) Thank you for that question. Independent of whatever regulations there are nursing homes have the responsibility and the ethical responsibility to do the types of testing that we recommended, it's the only way that you protect the elderly, full stop. Number two, the reason why we've distributed point of care tests to the nursing homes is because there are about 20% of the costs that they would incur as opposed to a laboratory test. The Binaca test that we're distributing to all those right now, 2 million this week, or at no cost to the nursing homes, and they come with automated reporting. And finally, again, I do defer to SEMA about sending money, but I know $5 billion was sent to nursing homes, of which 2.5 billion was to support testing. That's the level of detail I know, but I'm happy to bring anything back from her or from our assistant secretary for finances to you sir. Senator Moran: (02:07:48) Admiral, I'm using you as a conduit for purposes of expressing my concern and expressing my desire for a lot more information. I would point out that every time that I've raised this issue, these issues with HHS, I talk about senior living nursing home and skilled nursing facilities. And every response, just as, I think, yours was, comes back to what we're doing for nursing homes. And again, I can't determine if there's any plan to be helpful, which I think is necessary, for example, to senior living. Admiral Brett Giroir M.D.: (02:08:22) I will bring that back, and we'll take it for the record. I do want to let you know that the moment we had the Binaca test, we're sending to 5,000 assisted living centers this week to support testing in an assisted living environment, not a nursing home environment, there's still 6,000 of those, or even more that don't have a CLIA waiver that we need to work with, but we're going to work with them. As soon as we get the technology, it's out the door to support our seniors. Senator Moran: (02:08:50) Admiral you caused me just to change my commentary slightly. So every time I raised this topic, now you mentioned two of the three topics, and I still would raise for you and for HHS, senior living, which never seems to be a component of any conversation that I've had with, what few conversations I've been able to have with HHS. Admiral Brett Giroir M.D.: (02:09:09) Yes, sir. Senator Moran: (02:09:12) My time has expired. Chairman Blunt: (02:09:15) Thank you. I've got a couple of other questions, and Senator Murray has another question or two. On the point that Senator Moran raised, what's going to happen at the department is going to be an increasing reluctance by this committee to appropriate money and give the department flexibility. We appropriate money for the Provider Fund, we expect that money to go to the Provider Fund, not to go to whatever other fund the department thinks it's better spent. So in fact, when we appropriated the second 75 billion to the Provider Fund, we absolutely prohibited spending that money any other way or some language close to that. And that's all because of the department's actions. The appropriating committee appropriates based on your request, and responds to that request in ways we think it's appropriate. And you can't just decide to ignore that on the vaccine, Dr. Kadlec. Chairman Blunt: (02:10:25) And we specifically did not appropriate to Warp Speed, we appropriated money to the partners, NIH and Barta. My understanding is that at least $16 billion has come through those agencies for the vaccine up until now. HHS has told us that to have 300 million copies of vaccine available, they need another $20 billion that they don't have in any specifically appropriated line. Do you agree with that number? Dr. Kadlec: (02:11:08) Sir, based on the current situation, yes, sir. That seems to be the number. Chairman Blunt: (02:11:13) Dr. Redfield, the plans you expect to get back from the States by November one, on distribution of the vaccine, do you think you'll be ready shortly after that to announce your final distribution plan for vaccine? Dr. Redfield: (02:11:41) Senator, it's going to be dependent on the advisory committee of immunization practices, which will make the final recommendation for prioritization- Chairman Blunt: (02:11:53) I think I'm asking another question. Maybe I didn't as well. Prioritization, I want to talk about that too, but surely prioritization will not impact how you send this out to the States, might impact the number they get, but in terms of the protection of the vaccine, the way it's distributed, to be sure that you have a plan to get this in response to all these State plans as soon as possible. Is that your intention? Dr. Redfield: (02:12:25) Yes, sir. Obviously the issue that I tried to mention earlier is that, and I've said this in our earlier testimony, some people may be not... That it doesn't seem like they see this just as it was important. Chairman Blunt: (02:12:40) It is important. It's a second issue, but it's really important. And that was my next question. Where are we on the prioritization? And that will be recommended to the States, or will that be a prioritization we expect the States to comply with? Dr. Redfield: (02:12:57) Yeah, it will be in a recommendation of the advisory committee for how this vaccine, whichever ones are approved, are recommended to be used. Chairman Blunt: (02:13:06) And when will that be available? Dr. Redfield: (02:13:07) That will be available after the committee gets to see the data on the particular vaccine. But to answer your first question, because I think it was really important and I want to get to it. This plan for distribution is what we are now to get. And what I was going to try to say is, I said before this committee it's as important that we start that plan back in June- Chairman Blunt: (02:13:31) Totally agree. Dr. Redfield: (02:13:32) ... as manufacturing. And right now we've leveraged about $600 million, but we do not have the resources to support 64 jurisdictions to get this plan operational. So to me, it's an urgency that we get that, and we've done this in the past, we have experience in what it's going to take for us to do distribution, and monitoring safety, and get this vaccines. As I mentioned, we distributed 80 million doses of vaccine a year at CDC, we have an idea. But this is going to take substantial resources, and like I suggested in June, and the time is now for us to be able to get those resources out to the State. And we currently don't have those resources. Chairman Blunt: (02:14:11) The best I could tell, there were no resources provided in the Heroes Act in the house in both the bill we voted on in the Senate and the bigger bill we proposed in the Senate. We had roughly $6 billion for distribution. Is that the right number or is that close to the right number? Dr. Redfield: (02:14:33) Senator in my professional opinion, I think, you've got that really nails. That was somewhere between five and a half and $6 million is what I think it's going to take to distribute this vaccine. Chairman Blunt: (02:14:42) And you don't have that money right now? Dr. Redfield: (02:14:44) No sir. Chairman Blunt: (02:14:45) And you need it to distribute the vaccine? Dr. Redfield: (02:14:47) I think it's as urgent as getting these manufacturing facilities up. Chairman Blunt: (02:14:51) Yeah. I think I said in July, and you agreed, that if you have the vaccine and don't have either the plan or the resources to distribute it, that's a huge failure on the part of the Congress to provide the resources that we know are going to be necessary. I hope it's part of whatever package we put together this very month, to be sure you have the capacity to do that. Senator Murray. She may have gone to vote. Senator Murray: (02:15:29) Mr. Chairman, can you see me? Chairman Blunt: (02:15:31) There you are. I see you now. Senator Murray: (02:15:33) Well, thank you so much. I appreciate it, and I'm just getting back to my desk here. So hold on one second. Thank you. Thank you very much. I appreciate it. Listen, I wanted to follow up on Senator Shaheen's question regarding HHS is $250 million contractor public service advertisements to, "Defeat disparate and inspire hope amid the Coronavirus pandemic." Based on comments made by Michael Kaputo it looks. Senator Murray: (02:16:03) [inaudible 00:02:16:00]. Based on comments made by Michael Caputo, it looks like the administration intends to use a quarter of a billion dollars on a massive media campaign to mislead the public, to actually downplay the pandemic, and that's really unacceptable. Congress provided these files to fight COVID-19, not to support any kind of campaign or reelection campaign. Dr. Redfield, let me just ask you. Can you clarify if CDC was tapped to provide that funding? Dr. Redfield: (02:16:30) Thank you, Senator. CDC received the direction from HHS and OMB to transfer $300 million to HHS ASPA. Senator Murray: (02:16:41) What role has CDC played in the award process and developing that media campaign? Dr. Redfield: (02:16:47) We haven't played a role. We were just, as I've mentioned, instructed by HHS and OMB to transfer the funds to HHS ASPA. Senator Murray: (02:16:55) Well, then what role is CDC going to play in making sure the messages put out will include accurate public health information based on science? Dr. Redfield: (02:17:07) Again, Senator, at this moment, we haven't been involved other than be given the direct directive from HHS and OMB to transfer the funds. Senator Murray: (02:17:18) So funds only? You're not going to help to look information and make sure it's accurate? Dr. Redfield: (02:17:24) Well, again, I would assume that they would want our instruction to do all of that, but we haven't been involved in this other than the extent that the funds were transferred to HHS and ASPA. I assume that they're going to come back to the different subject matter experts, but again, we haven't been involved in that. Senator Murray: (02:17:42) Okay. Dr. Giroir, what role are you going to play in making sure the media campaign will only be used to disseminate public health information based on science? Admiral Brett Giroir M.D.: (02:17:53) Thank you, Senator. I have not been involved in any discussions. I've only been asked peripherally, which I think is the same campaign, to be subject to questions and to have a dialogue about public health issues. But I haven't been involved in the development of the content the same way as Dr. Redfield mentioned. Senator Murray: (02:18:12) Do you think it's your role, either of you, to weigh in to make sure this is accurate? Admiral Brett Giroir M.D.: (02:18:20) I certainly believe that the CDC director has an important role in messaging, and I'm the senior public health advisor to the secretary, so we certainly would welcome the opportunity to help support the correct messages to the American people. Don't mean to speak for Bob, but ... Dr. Redfield: (02:18:42) Again, I would echo that if given the opportunity, the CDC with would obviously want to put forth the accurate messaging for the American public. Senator Murray: (02:18:54) Well finally, Dr. Redfield, public health groups have really raised the alarm that billions of dollars are needed for vaccine distribution and administration. CDC should be leading that effort, and I'm wanting to know what activities should be included in a distribution campaign and how you plan to make sure you're involved. Dr. Redfield: (02:19:15) Thank you very much, Senator. I think it's critical CDC does have the lead within Operation Warp Speed. Again, the playbook that we put out is, again, it's version one. It's going to go through, I'm sure, iterations as the states get involved in and help improve the plan. And so CDC is in the lead of working with the state and territorials is to do this. As I mentioned, since the last time, I think it was June when you asked me and we really didn't have funds, and we've been able to leverage about $600 million to start some of the most critical activity, but as I mentioned to the chairman just a minute, now is the time. It is now. I mean, the rubber's hitting the road now to get these 64 jurisdictions up to speed. Dr. Redfield: (02:20:05) This is going to be a very resource intensive distribution. We've never tried to distribute a vaccine that has a cold chain requirement like this one does, minus 80 degrees potentially for one of the vaccines, so we're prepared. We did meet with five of the jurisdictions, North Dakota, California, Minnesota, Florida, and Philadelphia, to go down to microplanning, so we've got a pretty good idea, but now we're getting the plans for the rest of the 61 jurisdictions. It really is going to require resources. These jurisdictions are not going to be able to put these plans in place without resources. Senator Murray: (02:20:43) crosstalk 00:04:44]. Let me emphasize that response, because as we just heard, one of these vaccines is going to require a very cold storage. I think you said minus 60 or minus 80 degrees. Distribution across this country is going to be extremely challenging, and we need to make sure the resources are there that it has a national plan for distribution, and that communities that don't actually have often access to healthcare really get access to this. And the distribution and storage and all the things that go along with this is going to be very complex, will require resources, and it, again, requires a national plan. Chairman Blunt: (02:21:22) Thank you, Senator Murray. I couldn't agree more. It's all about priorities, and this should be one of our top priorities at this moment. Senator Moran for the last question. Senator Moran: (02:21:31) Mr. Chairman, thank you for that courtesy, and I know the second vote has been called. So this question is for the admiral, and I think it should be brief at least if I'd start asking it. Admiral, we were alerted just recently about an HHS request for information that was posted. I think it was posted last week. It was soliciting interest from laboratories. Admiral Brett Giroir M.D.: (02:21:54) Yes. Senator Moran: (02:21:54) That could scale up with additional from Thermo Fisher Scientific. Thermo Fisher is located in Kansas, and just recently they had an expansion to create more test tubes to do the test results. Could you tell me what the ultimate plans are, assuming that you receive interest from these laboratories, and more specifically, what's the budget for this strategy? How many labs do you intend to support and how much more testing will get accomplished? Admiral Brett Giroir M.D.: (02:22:24) So let me just say first, it was an NIH solicitation, and we received information from about 27 universities that had interest. Let me just say that a top line piece particularly now is that there are certain types of assays like Hologic, like Roche, like Cepheid that are relatively flat, but there's huge supply of other outstanding assays, of which Thermo Fisher has. They have a huge industrial capability. They have instruments, they have everything that goes with it. It's soup to nuts, full Happy Meal, however you want to say it. So we're trying to encourage laboratories around the country including universities to use these, because Thermo Fisher can make tens of millions of high quality laboratory based assays. Admiral Brett Giroir M.D.: (02:23:12) We've supplied some of these to private laboratories like Sonic and EGIS, and we're also trying to make sure that the universities use what they have, but also if they need help, we're happy to fund this. This is a relatively small amount of money to get them the capability to do assays, and Thermo Fisher has been really good to work with about really knocking down the prices, particularly for surveillance. So it's really another way to try to get the message out. We talk of thousands of universities, but Thermo is just one of those assets that we have a lot of. It's an excellent test. It's a great company. We want people to use it. Senator Moran: (02:23:48) And too early to tell whether there's a response, whether your outreach is having any effect? Admiral Brett Giroir M.D.: (02:23:54) Seriously probably three times a week, we match a major laboratory up with Thermo Fisher, getting their instruments together with their supplies, so it is absolutely having effect. Again, we have a lot of capability. We just want to make sure that people understand where the capabilities are, and Thermo's one of them Senator Moran: (02:24:14) Admiral, thank you for your work. Chairman Blunt: (02:24:16) Thank you, Senator Moran. I think I'm going to turn to Senator Alexander for a final question, but before I do that, we're going to go vote, and I want to thank all of you for being here. The country is depending on all three of you to lead in these critically important issues. As Dr. Redfield, and one way or another, all of you have said this, we are at a critical moment in testing, in vaccines, in therapeutics, in distribution, in prioritization. All these things need to come to as much of a conclusion as they can so we can move forward. Chairman Blunt: (02:24:53) I think you've all been great witnesses today. There were questions you were asked that were outside of your area of responsibility, and of course the proper answer to that is, "That's not what I'm doing every day," and that totally fine. We were grateful for your time. I know this is a critical time for all of you, and I'm grateful to you for having been here. Senator Alexander will mention that the record will stay open for a week for additional questions, but we hope you respond as quickly as possible to those questions. We are intensely involved in being your partner in this effort, but we need to know what we need to do so we can do it and do it in the right way. Senator Alexander. Senator Lamar Alexander: (02:25:35) Thank you, Mr. Chairman, and thanks to Senator Blunt for being aggressive on all these issues and leading, especially in the area of support for the maximum number of tests. I do have some wrap up questions. Dr. Redfield, I heard the questions that Senator Merkley asked you about, whether there was some invidious scheme in asking the states to get ready to receive the vaccine, and you said, no, that it had been recommended. Am I remembering right that when we had a problem with a virus called H1N1 that the administration and the companies had a virus to distribute, but the states weren't ready to receive it, and that was a big problem? Is that right? Dr. Redfield: (02:26:25) Yes, Senator. Senator Lamar Alexander: (02:26:26) When was that? Dr. Redfield: (02:26:27) 2009, 2010. Senator Lamar Alexander: (02:26:29) And what happened? Dr. Redfield: (02:26:30) Well, I wasn't there, but we're very fortunate to have the gentlemen that was part of that and had the opportunity to learn from all of the experiences now leading our distribution for this to ensure that we don't have the same hiccups. That's why I was stressing how important it is for us now to be able to operationalize this plan. Senator Lamar Alexander: (02:26:53) Yeah. More than a hiccup. I mean, it'd be a tragedy if we had vaccines ready and available and we couldn't distribute it because no one had asked the states to be ready. Now, I believe you said, Dr. Kadlec said. I believe you said that vaccines could be ready as early as November, December. Is that correct? Dr. Kadlec: (02:27:14) Yes, sir. Senator Lamar Alexander: (02:27:15) So, and they would be ready in much larger volume most likely after the first of the year and then on into the second and third quarter, correct? Dr. Kadlec: (02:27:26) Yes, sir. Senator Lamar Alexander: (02:27:27) And how long does it take a state to get ready to manage the distribution of these vaccines and make sure they go properly to the right people with the right equipment at the right time? Dr. Kadlec: (02:27:42) I'll defer to Dr. Redfield. Dr. Redfield: (02:27:44) Senator, I think this is why I said it's urgent. I mean, when we say that the vaccine can be ready in November, that's really six weeks away, so it is really urgent that we operationalize as rapidly as possible. Senator Lamar Alexander: (02:27:59) What do you suppose this committee and many others would say to you if you had a vaccine ready in November, in December and you had not asked the states to get ready to receive it? Dr. Redfield: (02:28:09) You'd probably be recommending that I get replaced. Senator Lamar Alexander: (02:28:11) I think so. I think so. So I think this criticism of you and the professionals at the CDC for asking states to get ready to receive the vaccine when we know full well that it's likely to begin to be available in November and December is very, very misplaced, and I appreciated your comments and the way you handled them. A dentist told me that there's no evidence, Dr. Redfield of transmissibility of COVID-19 in a dentist's office. Is that true? Dr. Redfield: (02:28:49) I wouldn't necessarily. Since you stated that, I think the dentist is probably going to say there's been no proven transmission in a dentist office. Senator Lamar Alexander: (02:28:58) Yeah. So I was a little surprised by that, that the dentist said that dentists have a history of handling infections all the time all the way back to HIV, and so they're trained to do that and they know how to wear protective equipment and they know how to adopt practices. Do any of you know whether it's true that in other parts of the world and in the United States, there has been problems with going to the dentist because of transmissibility of COVID? Dr. Redfield: (02:29:33) I would just come back to the statement I tried to make earlier. These masks work, and one thing you'll know about when you go to a dentist, everyone's masked up. So I can say that we haven't had evidence, outbreaks that we've linked back to dentists. I'm not going to say it will never happen, but just like we reported recently, two hair salon people that were highly infected. They went and did their work to I think over 150 people, but they wore a mask and there was no evidence of transmission. So I keep coming back to the importance of wearing masks. Senator Lamar Alexander: (02:30:09) And I have one last question, and I understand Senator Murray would like to make a closing statement or question, so I'll go to her when I finish. I want to go back to the CDC guidance on asymptomatic testing, which you acknowledged has created confusion, and I wonder what else you might be able to do to eliminate that confusion, and let me tell you why I think it's important. My feeling all along has been that it was a good idea to produce tens of millions of rapid tests so that anybody who wanted a test to get one basically. Now from a medical point of view, there's no reason to do that, but that's not the only concern we have in the United States right now. I mean, we'd like to go back to school. We'd like to go back to college. We'd like to go back to childcare. We'd like to go back to work. We'd like to go out to eat, and if by frequent testing or surveillance testing or any of a whole number of strategies that test a lot of people who don't have symptoms, we build confidence that your school is a safe place, your college campus is a safe place, that your childcare center is a safe place, that your workplace is safe, that your restaurant is safe. If we build confidence, we'll have better lives, and so it seems to me that there's particularly, since Admiral Giroir has said that we're now heading toward a situation where we may have 120, 150 million tests a month. We're going to have plenty of tests. We're going to have capacity for plenty of tests. Senator Lamar Alexander: (02:31:57) And by frequent tests, I mean what if a school wanted to test every student at the beginning of school, there at the beginning of a week for two or three weeks, just to make sure that there wasn't some spreading and wanted to create a regime where you do random testing. Surveillance testing is, I think, a word for it. Of the kind of testing when you go through the airport, for example. They pull you out of the line every now and then, check to see if you've got explosives on your hands. That makes us feel better when we get on an airplane that we're not going to blow up, and so people fly, two million a day without worrying too much about getting blown up by passengers with explosives on their hands. The University of Illinois, as one of you have mentioned, is I think testing twice a week. I think the University of Illinois must have 40,000-50,000 students and faculty members and staff on that campus. I know the president of Brown said she wanted to test everybody before they came back. Senator Lamar Alexander: (02:33:10) I can imagine in a workplace that somebody would worry about working next to somebody who's infected and worry that the might have ... Just be afraid that they might have COVID, and wouldn't it be a good idea for the managers to say, "Come in here and take a 15 minute test saying you don't have it today." It's all that means. Or you could say to all your employees, " We give you tests if you're symptomatic, but we also give random tests on a regular basis throughout the plant, so you can have more confidence when you come back to work." So it seems to me that that it's a good thing for our country to have more tests than we need, more rapid tests that we need so that anyone who wants to test can get one if they feel it's necessary. Now, I think once they know that they can, they won't want one, and I think that's one reason we're seeing a lower demand in other parts of the country, because people understand the limited value of a diagnostic test that just tells you on that one day whether you have it. Senator Lamar Alexander: (02:34:15) But this is a little bit of a long question, but what I'm trying to get around to, is there some way that the CDC could clear up whatever confusion has been caused and make it clear that since we now have such a large supply of tests, that different strategies for testing people without symptoms is a perfectly good idea and doesn't take tests away from healthcare professionals or people in nursing homes or assisted living or people like that. That clearly would help, I think, as we move into October, November, and December to encourage people to use this growing number, especially of rapid tests that we have to build confidence that the school, the college, the childcare center, the workplace, and the restaurant are safe places to go, regularly checked, and that would help us restore our economy. What could you do about clearing up the confusion? Dr. Redfield: (02:35:21) Yeah, I appreciate the comment, Senator. First, because there's three areas here, but I'll be very brief. First is we are working on clarification document related to the diagnostic and public health use of testing. And again, we've never recommended against asymptomatic testing. You'll see in the clarification, it's very clear that we make it very clear that asymptomatic and presymptomatic transmission's important. We make it very clear that if you've been exposed to somebody, you need to be tested and contact traced, so that's going to come out. I've done my clarification statement in 24 hours after, but it didn't solve the problem, so we are going to come out with that hopefully sometime in the next ... I hope before the end of the week. Dr. Redfield: (02:36:17) Secondly, and the admiral may want to comment. We're working on guidance because in addition to diagnosis public health, as you pointed out, there's screening, and screening can be very powerful for maybe nonpublic health reasons. Maybe getting us back to life and screening in schools, K through 12, screening in universities, screening in business. So you'll see that CDC will be coming out in conjunction with the admiral. We'll be coming out with some guidance around screening. Dr. Redfield: (02:36:47) And then, there's the other word that you use, which we also believe is really important, which is surveillance where you can actually systematically begin to look at random individuals to get an idea, is this outbreak starting to pop into a new community? So all three of those are important. All three of those you're going to see that we're developing follow up guidance for. It really wasn't possible to really have a lot of that guidance when there was no test, but as you point out, Admiral Giroir has really done a yeoman's job with the private sector and really has gotten to the point now that we have. We're going to try to clarify the clinical public health use. We're going to try to give guidance to screening, particularly in K through 12's and universities, but it's also going to have a role in businesses and also in entertainment activity like sports, and then there's the other side of how to set up systematic surveillance so we don't get blindsided by all of a sudden finding that there was a huge new cluster outbreak that we just didn't have eyes on until it got to great. But Admiral, do you want ... Senator Lamar Alexander: (02:38:04) Admiral, do you want to add to that? Admiral Brett Giroir M.D.: (02:38:06) I just agree. I just agree 100% with everything that has been said. We are going to continue to invest in a number of different types of platforms, but clearly low cost, ultra available, sensitive, and specific tests like the BinaxNOW. They are going to be more like that coming through, and again, we're going to increase that supply as much as possible. There are also going to be some new point of care tests that are actually very sophisticated and very sensitive and specific that could be layered on top of the Binax, and our goal is to provide as many tools as possible in the right domain so we could implement this type of guidance. Admiral Brett Giroir M.D.: (02:38:50) Again, in March, it doesn't make sense to talk about random screening of children going to school, because you didn't have that available. Now that we have a very robust ecosystem of testing, this is the exact right time, which is why we purchased a 150 million of those card-based tests while we have point of care and distributing them. First to protect the vulnerable, but then within a couple of weeks, they're going out to States to support school reopening and other infrastructure according to their priorities. We are at that point. We are at that inflection. Senator Lamar Alexander: (02:39:26) Now, how many will be going out to States that a couple of weeks, can you give me a rough idea? Admiral Brett Giroir M.D.: (02:39:30) So when Binax, when Abbott gets to their full production capability of about 12 million per week, which will be within a few weeks, we anticipate, depending on how things go with the nursing homes, et cetera, somewhere between five to eight million per week going to states that we can provide them for those needs. Again, if the cases continue to go down in nursing homes, we'll need less and less tests to protect the nursing homes, if it stays high, [crosstalk 00:02:40:06]. Senator Lamar Alexander: (02:40:06) So that's five to eight million a week? Admiral Brett Giroir M.D.: (02:40:07) Yes, sir. Senator Lamar Alexander: (02:40:08) Well, five to eight million a week, Tennessee's usually about 2% of everything, so that would mean a state like Tennessee would be getting a few hundred thousand tests a week, or several hundred thousand tests a month at least that the state could distribute according to its priorities. Is that the general idea after you've used ... with that five to eight minutes? Admiral Brett Giroir M.D.: (02:40:33) Yep. Yes, sir. There's some policy discussion, and we certainly want to support the states, but we think it's a priority, as I know you do, to open education, K through 12, even preschool and potentially universities. But I think universities are in a different class because they have resources, so we do want to emphasize very strongly the protection of teachers and the reopening of K through 12 as a significant priority for [crosstalk 02:41:02]. Senator Lamar Alexander: (02:41:01) Well, I certainly do too, but some states are doing some things, some states are doing others, so I think it's a good idea to reserve some of ... First, I congratulate the administration on buying the full three-month supply of that, which as I understand it, about 50 million tests a month starting in October with several million this month, and then assigning it to the priorities like nursing homes, et cetera, and then giving a lot to states, which would be ... I mean, if the state of Tennessee got 200,000 tests a week that it knew it could distribute during the rest of this school semester, my guess is many of them would go to schools because the ones who are most worried about that are not the kids, it's the teachers and the parents and the grandparents when the kids go home. So I think that's tremendously reassuring, the prospect that a state might receive that many rapid tests just from that source. Senator Lamar Alexander: (02:42:07) And Dr. Redfield, and we'll conclude with this, because I think Senator Murray does not want to say anything now, but one time you and I had a discussion about guidance that used examples. I think we talked about colleges, and I think you did that. Maybe one way to help clarify the use of tests for asymptomatic individuals would be to list five, six, eight, 10 examples of schools, colleges, workplaces, that are doing that now that make sense, and I'll let you decide what those might be. It wouldn't be only those things, but I think if you said, "These are all the kinds of ways that this large number of tests that we have may be used effectively and sensibly to build confidence in going back to school, work, childcare and out to eat," that might be easier for people to read and understand than the words in a guidance, so the use of examples is a suggestion I would make. Dr. Redfield: (02:43:16) I appreciate your advice, sir. Senator Lamar Alexander: (02:43:19) Thanks to the three of you. As Senator Blunt said, we're grateful to you for your long hours, for your effective work, for your planning, and if the money that this appropriation subcommittee has targeted for you isn't forthcoming and the way that Congress intended for it to be, we expect you to let Senator Blunt, Senator Murray and others of us on the subcommittee know that. The record will stay open for one week. The subcommittee stands adjourned. (silence). Speaker 2: (02:45:13) We're out of time. Only pay for what you need at libertymutual.com. Speaker 3: (02:45:16) Liberty, Liberty, Liberty, Liberty. Speaker 4: (02:45:20) Go Ask Ali is presented by Caress. Inspiration starts here. Ali Wentworth: (02:45:25) Hi, I'm Ali Wentworth, bestselling author, actor, host. In my new podcast, Go Ask Ali, I'm really taking a look at modern life since. This pandemic, there's a new normal ...