Fauci, health officials testify at Senate hearing on COVID variants — full video

[0:00] by this new variant including vaccines, boosters, and high-quality masks. But the sheer number of [0:07] infections is in putting an enormous strain on hospitals, healthcare workers, schools, families, [0:14] and communities across the country. We all need to do our part to address this new challenge by [0:20] getting vaccinated and boosted and wearing high-quality masks. That is why we are having [0:26] this hearing in a larger hearing room where we can be socially distanced, limiting the number of people [0:33] who are here in this hearing room, and taking additional measures such as wearing masks. [0:40] I will be wearing my mask during the entire hearing and would respectfully request others in the room [0:45] today do the same. As always, I appreciate the work from the staff of the Sergeant-at-Arms, [0:51] the architect of the Capitol, and our committee clerk and his staff to make this hearing as safe [0:57] as possible. Nearly two years into this pandemic, people are exhausted after all we have been [1:05] through. And even as the Delta strain is still circulating, we are all alarmed by how quickly [1:11] Omicron has spread and anxious about what is next. People back in my home state of Washington and across [1:18] the country are frustrated and worried about the course of this pandemic and its persistent challenges, [1:25] like how hard it still is to get a test. I've heard from so many people who are waiting in long lines [1:32] and going from pharmacy to pharmacy trying to find a test, or who are giving up on getting tested because [1:39] tests are unavailable or cost too much. I've also heard from people who have found the communication about [1:46] new isolation and quarantine guidance confusing and frustrating. They are trying to keep themselves and [1:53] their families safe as this pandemic evolves and we continue to learn more. But I'm hearing more and more [1:59] questions like, what kind of test should I get? When should I get tested? Why can't I find a test? Do I need to [2:05] isolate 10 days, five days, or even at all? Testing in particular is a huge concern for parents who are [2:12] starting 2022 exhausted from the last two years and worried about schools staying open safely this year. I know what a [2:20] struggle it is for parents scrambling to figure out child care when they've got to go to work or how tough [2:26] it is for kids to keep up with classwork while transitioning back and forth from in-person to [2:31] online learning. And while most schools are still safely open for in-person learning and we all want to [2:38] make sure they stay that way, we know schools are struggling with this especially as Omicron creates new challenges. [2:45] I'm hearing from schools in my states that they're worried they'll have to shut down again if they can't [2:51] get the support for testing they need or they have staff shortages because of staff who are ill. Nobody [2:58] wants that. And based on what we now know about this virus and the tools we have to fight it, schools should [3:03] be able to stay open safely if they have tests, masks, ventilation, and people are vaccinated. Hospital and [3:11] health care providers are worried too. They've been stretched thin after two exhausting years and [3:17] now Omicron is causing the worst surge in cases and hospitalizations yet because while it may be less [3:23] severe in most cases, especially for those who are vaccinated and boosted, it is so much more [3:29] contagious meaning we are still seeing high rates of hospitalization overall. And we also have to [3:35] protect children who are too young to get vaccinated and people with health conditions and disabilities that [3:41] put them at high risk. Back in my state, hospitals are asking our state leaders to declare a crisis for [3:49] our medical facilities. I've heard from health care providers in Washington who have been well over their [3:54] staffed bed capacity for several days and are pausing non-essential procedures. Families are wondering [4:01] whether they can get care for non-COVID-related conditions and alarmed by how long ER wait times are [4:08] getting. Health care providers are concerned about how we continue to keep health care workers [4:13] safe and also address the fatigue and burnout and mental health challenges that they face. These [4:19] are not new challenges. I've been raising many of these concerns since the earliest days of the pandemic. [4:25] So I'm frustrated we're still behind on issues as important to families as testing and supporting [4:30] schools. That's not to say we have not made progress. It's just clear we haven't made enough. [4:36] But even though we aren't where we need to be yet, we are not back at the starting line when it comes to [4:41] COVID-19 either. We have safe and effective vaccines for everyone ages 5 and up. We have booster shots [4:49] available for those 12 and up. More and more people are getting their shots each day. The administration [4:56] is also working to help get the world vaccinated to end this pandemic and has already pledged over a [5:02] billion vaccine doses to that effort. We have new life-saving therapeutics. We have additional resources [5:09] Congress passed in the American Rescue Plan, which can help increase our testing capacity, protect [5:15] workers, and give schools the support they need to stay safely open. And we have an administration [5:22] that is focused on following the science, facing this pandemic head-on, and addressing the frustration [5:28] people are feeling. That is crucial at this moment when the path forward requires steady leadership and [5:35] clear communication about the challenges we are still facing and the work ahead to tackle them. [5:41] President Biden has said plainly that he shares family's frustration around testing and he wants [5:47] to make sure schools stay safely open. And he has announced steps to address these challenges by [5:53] making 500 million tests available free of charge, ordering over 200 million courses of antivirals, [6:01] expanding manufacturing to be able to make hundreds of millions of tests a month, providing schools with [6:07] guidance on how to test to stay protocols, which can help keep students in the classroom, [6:12] standing up more testing and vaccination sites across the country, and providing medical personnel [6:19] to struggling areas. I expect to hear more detail on those efforts today, along with what other steps [6:25] the administration plans to take. And I will be watching closely as they are implemented. But I also want [6:32] to be clear, when we talk about these problems, we have to be focused on solutions. You can't just say [6:38] our schools must stay open. If you don't vote to provide additional resources, schools need to do [6:43] so. You can't just say the latest health guidance is confusing and not call out the blatant misinformation [6:50] that has come from so many members of the Republican Party. We are not going to get out of this crisis by [6:56] treating each challenge as a political opportunity. We are going to get through it by being honest about [7:02] what we are facing and clear about what we are going to do about it. And as we continue working to get through [7:08] this pandemic, it's important, we also look at what we can do to prevent future health crises. [7:14] That is exactly why Senator Burr and I have been working in a bipartisan way over the last several [7:19] months on legislation to learn from and improve on our pandemic response, like strengthening our supply [7:26] chain for medical products, updating old and incompatible public health data systems, modernizing the [7:33] process for developing tests, fighting misinformation, addressing root causes of health inequities and [7:40] more. We will be unveiling a discussion draft soon and I look forward to working with all of our [7:45] colleagues to finalize and pass this important package. In the meantime, we will continue working [7:51] to address the pandemic at hand. People across the country are worried this will be another year of [7:57] uncertainty. Uncertainty for their work, their schools and their everyday lives. But there's no reason it [8:03] should be. People should be able to make plans for the future without fearing that everything they are [8:08] looking forward to or even the everyday things they used to take for granted will be uphanded by this [8:13] virus. We all want that and we have the tools we need to get us there. We have the tools to get everyone [8:19] tested quickly, easily and for free. To keep schools safely open during the Omicron surge and beyond. [8:27] To keep workers, especially our health care workers, safe and healthy in the workplace. [8:31] We have the tools to mitigate this virus, to protect those at high risk like seniors or kids [8:37] who are too young to get vaccinated and people with other health conditions. To get people back to their [8:42] friends and their lives and to give families back some certainty and stability. We can do all this now [8:49] thanks to the incredibly hard work on the part of health care providers and scientists, parents and [8:54] teachers, workers and our witnesses who are here with us today. So what I hope to hear from this [9:00] administration at this hearing is what are you doing right now to make sure every American can [9:05] make use of that progress they've worked so hard for. What can my constituents expect to see improve [9:11] this week and the week after? We've come a long way since the start of this pandemic and I look forward [9:18] to hearing from each of you today about what you're going to do to build on what we know, bring this [9:23] virus under control and bring certainty and stability back to families who are burnt out after two [9:29] years of fighting this pandemic. Thank you. And with that I will turn it over to ranking member Burr for [9:34] his opening remarks. Madam Chairman, thank you. And before my opening statement I hope the chair will [9:39] indulge with me for just a second since this is a hearing on preparation. I want to help my good friend, [9:50] Senator Cain, as he gets ready for his weekly travels. I want to make sure that he's got an orange [9:56] for his car, that he's got a Dr. Pepper, and I've provided a Lumbee blanket to make sure that these [10:03] are three things you've got in your car regardless of what you run into on I-95, and I'll have my staff [10:09] bring them over to you. I hope you provide those for everyone. As we used to say to our kids in the [10:14] classroom, do you have a piece of gum for everyone? Well, in his particular case I think he's the only one [10:20] that makes that trip on a weekly basis. Tim, we're sorry you had to spend 27 hours, but you're now [10:26] qualified to be the Secretary of Transportation if you're looking for a second job. [10:29] Thank you. It's sad when a career in the Senate's most notable highlight is my long commute. [10:38] Madam Chairman, thank you for holding this hearing to our witnesses. Welcome back. Today's going to be a [10:44] tough hearing, but the American people deserve accountability and transparency. I appreciate that [10:50] all of you have cleared your schedules to allow multiple rounds of questions today. Next week [10:55] marks one year of this administration. It also marks two years since the first COVID case was confirmed. [11:02] President Biden said in his first, second, and third priorities would be bringing us out of COVID [11:08] pandemic and that his team would shut down the virus. This administration was lucky. It started off [11:14] on day one with the tools to change the trajectory of COVID response. Operation Warp Speed worked with the [11:21] private sector to bring us groundbreaking vaccines and treatments in record time. Although we had a [11:28] very bumpy start with testing early in the pandemic, we successfully built some strong partnerships with [11:33] the private sector to support the development and manufacturing of more tests. State and local [11:38] leaders were rising to the challenge of testing and vaccinating their citizens. There was reason for [11:44] hope. Instead, now a full year later, here's where we are. More than 830,000 deaths caused by COVID, [11:51] the majority of which occurred under this administration, despite having many tools and significant [11:56] resources from Congress, including $80 billion plus for testing. A variant is now spreading out of [12:03] control across the country, with places like Washington, D.C., seeing a staggering increase in [12:08] case counts over the holidays, and now my state of North Carolina is following suit with a 319 percent [12:14] increase as of yesterday. Over the holidays, when Americans were instructed to do the responsible thing [12:20] and get tests before they see loved ones, there were no tests on the shelves or online. And hours-long lines [12:27] were the norm at testing sites across the country. The testing situation was worse when many sought tests [12:34] to safely return to work or to school. And the most vulnerable Americans who contracted the virus [12:40] could not get the treatments designed to help because they were now in short supply. This administration has [12:46] time and again squandered its opportunities and made worse in the decisions you've made on testing and [12:53] treatment, and most crucially, in communications with the American people. The American people are right [12:59] to be confused. It seems like you all don't talk amongst yourself. Some examples. Last August, the [13:07] President announced that boosters would be available to all vaxxed by the week of September 20th. Three of you [13:14] here today signed that statement. But neither the FDA nor the CDC had yet approved boosters when the [13:19] President made the promise. And when you went to your advisory panels with a predetermined outcome [13:24] already made, those independent experts pushed back and ultimately had to be overridden to meet the [13:29] President's goal on boosters. I know the data shows that boosters are necessary. I'm boosted. I want [13:36] everybody to get vaccinated and boosted. The facts about the value of vaccines and booster are crystal clear. [13:42] But the way this administration rolled out boosters was a disaster. You created skepticism and mass [13:49] confusion. Example two, last summer the President dramatically announced that CDC recommendations [13:57] changed so that vaccinated Americans didn't need to wear masks indoors, implying that the worst of the [14:03] pandemic was behind us. Even as the Delta variant was exploding in India, only after Delta hit America [14:10] did CDC begin to take it seriously and the administration had to change course. Example three, [14:16] last week Dr. Fauci said that the CDC was going to update its guidance on quarantine. He left the [14:21] American people with the impression that CDC's guidance was going to include some testing component [14:26] to reduce the quarantine to five days. But when CDC did update its guidance, there wasn't a testing [14:32] requirement. Again, I'm not questioning the science. I'm glad you refrained from testing mandates. [14:38] But I'm questioning your communication strategies. It's no wonder the American – it's no wonder that [14:46] the American people are confused. When the President announced on December 21st that 500 million tests [14:51] were going to be purchased, he left out that the contract wasn't going to be signed for weeks, [14:57] and it would take even longer for those tests to be – to materialize. Immediately other experts and [15:05] medical professionals were asking what the value of just 1.5 tests per person was when CDC's own [15:11] guidance said that you need multiple at-home tests to be assured of the results. Yesterday, [15:18] the administration mandated that insurers now cover the 170 million Americans that are covered [15:24] by private insurance. They must cover up to 8 tests per person per month. That would be 16 billion tests, [15:33] and we have 500 million today that are aspirationally going to be contracted for. It's still unclear when [15:42] these tests will be available, how to get them, whether any more are on their way. But it's especially [15:47] frustrating that the White House press secretary had previously mocked the very idea of doing what the [15:52] President later announced. In a sarcastic and withering tone when this was first proposed, [15:58] she had four questions – whether we should just send one to every American, then what happens, [16:05] how much does it cost, what happens after that. Those are all good questions that remain unanswered [16:12] by the administration. My final example, though there are many to choose from, happened last week too. [16:19] The White House press secretary, a repeat offender in poor communications, was asked about boosters. [16:25] The press secretary said, and I quote, they can get boosted now regardless of what CDC guidance is, [16:31] whether you're just approved for booster or you've been approved for weeks, end quote. [16:36] Regardless of what CDC guidance is. From the White House podium. And then I was amazed when I got home [16:45] on Sunday and I had this letter from Centers for Medicare and Medicaid Services telling me as a Medicare [16:51] beneficiary that I'm eligible to get a free vaccine booster. Five months after the President announced [17:00] we're going to have boosters, this is the first communication from CMS that I've gotten as a [17:06] Medicare beneficiary in the two years of COVID. And all of a sudden I get a request to get boosted. [17:13] When a Republican governor or a senator, including some of this committee, suggests concerns about CDC [17:22] guidance. Twitter and MSNBC can't react fast enough with scorn and anger. So it can't come as a surprise [17:29] that there is confusion and anger when the White House says to ignore CDC guidance. I tell my staff, [17:37] as I've repeatedly said to you all in all previous hearings, to look 30, 60, 90 days ahead. Look six [17:44] months ahead. Look abroad. See what's happening in Asia, Europe, Israel, Africa, UK, and elsewhere around [17:50] the world. What do we need to anticipate? In our hearing on July 20th, I warned that Delta would be, [17:57] would not be our last variant. And I plead it with each of you to have a plan in place for the next [18:03] mutation of the virus. So why was the Vice President surprised that Omicron came to our shores? [18:10] Well, I'll say it's very clear, very clearly. So the administration does not yet again say they're [18:17] surprised. Viruses change, viruses mutate. There will be more variants. They will come to America, [18:23] period, end of sentence. I don't understand why after tens of billions of federal dollars [18:29] being appropriated, this administration has failed to ensure that the Americans have the tests they [18:33] need. I don't understand why suddenly it's okay to take into account the economic and job impact [18:40] of your guidance and recommendations. You shorten the quarantine guidance because too many people [18:45] would be out of work. Was that because of science or was it because you now know that lockdowns, [18:52] shutdowns, and school closures come with a significant downside impact? You ask the American [18:58] people to trust you. Quite frankly, you've lost their trust. Rather than attempting to gain their trust [19:06] back, the administration chooses to litigate mandate requirements for employers with over 100 employees. [19:14] I've asked before, what's the plan? Never gotten a response. Very seldom do I get a letter responded [19:21] to by this administration. The administration has not responded to my letters. Maybe folks at the [19:26] White House don't think they need to respond to Republican senators. I think my record shows I'm [19:31] approaching all of this as I have for the last 20 years. I'm trying to help. I love this country, [19:38] love its people, and I know we can do better than we've done. I know we have to do better. [19:44] Maybe I'm wrong about this. Maybe you'll tell me where I got it wrong. Instead, I'm hoping that you'll [19:50] understand that my criticism comes from a place of concern because the communication efforts are a [19:57] mess and have only made things worse. Now, I admit it. I'm at the end of my rope. I think you'll see [20:04] today that most of my colleagues are as well. I've tried to give my best advice and share what we [20:10] hear and what we see because no one's paying attention to the message from this administration [20:16] right now. Maybe today you respond to my request to learn what the plan is. Hopefully you'll take this [20:23] challenge to rebuild the trust, not just with me, not just with my colleagues, but with the American [20:29] people we all serve. What are you changing and fixing to restore the confidence with the American [20:36] people that there is a strategy for testing, for treatments, for fixing your communication strategy? [20:42] Because if you don't, things are going to get worse before they get better. Madam Chairman, I yield back. [20:50] Thank you, Senator Burr. We will now introduce today's witnesses. Dr. Rochelle Walensky is the [20:56] Director of the Centers for Disease Control and Prevention and the Administrator of the Agency [21:00] for Toxic Substances and Disease Registry. Dr. Anthony Fauci is the Director of the National [21:05] Institute of Allergy and Infectious Diseases and the Chief Medical Advisor on President Biden's [21:11] COVID-19 Response Team. Dr. Janet Woodcock is the Acting Commissioner of the Food and Drug Administration. [21:18] Don O'Connell is the Assistant Secretary for Preparedness and Response. And Director Walensky, [21:24] Director Fauci, Acting Commissioner Woodcock, and Assistant Secretary O'Connell, I want to thank [21:29] you all for joining us today. We all look forward to your testimony, and we will begin with Dr. [21:34] Walensky on your opening statement. Good morning. Chair Murray, Ranking Member Burr, [21:40] members of the Senate Health Committee, I appreciate the opportunity to join you to provide an update on [21:45] the COVID-19 pandemic and the impact of the Omicron variant. It has been just over two years since we were [21:52] first alerted to the emergence of SARS-CoV-2 in China. And since that time, CDC has worked with [21:57] our partner agencies and you in Congress to take remarkable action to protect the health and safety [22:04] of Americans. Omicron is now the dominant variant in the United States, driving case counts to [22:10] unprecedented heights here in the United States and around the world. Despite the increases in cases, [22:16] there are promising emerging data from South Africa and the United Kingdom that hospitalization rates [22:22] for people infected with Omicron are lower compared with prior variants. These data seem consistent with [22:28] what we're seeing so far in the United States. However, despite a potential decrease in severity, [22:34] the substantial number of absolute cases is resulting in hospitalization increases across all age groups, [22:41] including children age zero to four. The emergence of the Omicron variant again emphasizes the importance [22:48] of vaccinations and boosters, which decrease the risk of infection, severe disease, and death caused by [22:55] COVID-19. Just last week, we made important progress towards increasing booster coverage through [23:02] key, four key actions. First, we expanded eligibility of booster doses to those 12 to 15 years old. [23:10] Second, CDC strengthens its booster recommendation for adolescents, now recommending that adolescents age [23:17] 12 to 17 years old should receive a booster shot five months after their initial Pfizer-BioNTech vaccine [23:24] series. Third, we recommended that moderately or severely immunocompromised 5 to 11-year-olds receive [23:31] an additional primary dose of vaccine 28 days after their second shot. And fourth, we shortened the [23:38] recommended time between a primary mRNA series and a booster dose from six months to five months. Each [23:46] action increases access to vaccines and booster doses at a time when protection is critical. As we continue [23:55] to monitor monitor this rapidly evolving virus, we are working quickly to adapt with it. Over the holidays, [24:03] CDC updated our quarantine and isolation guidance, first for healthcare workers and then for the general [24:09] public. I know this update has resulted in numerous questions, so I would like to take a moment to walk [24:16] through it now. For people who tested positive for COVID-19, CDC recommends isolation for five days. If you are [24:25] asymptomatic or if your symptoms are resolving, for example, you're without a fever for 24 hours, you no longer [24:31] need to isolate. However, you should continue to wear a well-fitting mask at all times when around others, [24:40] including at home and in public for an additional five days. We recommend that you avoid activities [24:47] where you are unable to wear a mask and that you avoid travel for the full 10 days. In addition, [24:53] CDC changed the recommended duration of quarantine. Quarantine is what you do after you're exposed. [25:00] People who are not up to date on recommended COVID-19 vaccines should quarantine for five days if they [25:08] come in contact with someone with COVID-19. People who do not develop symptoms by day five should get [25:15] tested. If you test positive, you should begin isolation. People who test negative may end quarantine [25:21] and should continue to wear a well-fitting mask when around others for an additional five days. [25:27] These recommendations are consistent with over 100 studies collected over the past two years, [25:34] indicating that people are most infectious during their first few days of infection and significantly [25:39] less infectious six to 10 days after infection. A core part of CDC's mission is to translate science [25:48] into recommendations for best practices and real-world circumstances. Over the holidays, [25:54] we saw the growing surge of Omicron and took swift science-based action to address the very real [26:01] possibility of staffing shortages in hospitals and in other essential areas of the workforce, including [26:08] schools, pharmacies, public safety, public labs, grocery stores, and other sites, where shortages could have [26:17] and have proven to have dire public health consequences. This is the right guidance for what we currently know [26:24] about transmission and the real-world circumstances we currently face. As we will learn more, we will [26:31] continue to update accordingly. Omicron is likely not to be the last curveball this virus throws at us, [26:37] but we have the tools to prevent further spread of this virus. This means for everyone five and older, [26:44] please get vaccinated. For those 12 and older, get your booster shot. And please continue to adhere to [26:51] the multi-layer prevention measures, including masking and, yes, washing your hands. Thank you, [26:57] and I look forward to your questions. Thank you. Dr. Fauci. Madam Chair, Ranking Member Burr, [27:06] members of the committee, thank you for giving me the opportunity to discuss with you the role of the [27:11] National Institute of Allergy and Infectious Diseases in the conduct and support of research addressing our [27:18] nation's response to COVID-19. In our most recent hearing before this committee on November the 4th, [27:24] I discussed the importance of booster shots to enhance immunity against the Delta variant that [27:29] wanes over time. Indeed, booster shots have dramatically reconstituted the waning immunity [27:36] and has increased protection over and above the original level afforded by the primary vaccine [27:42] regimen. Today, we are faced with a different challenge, a new variant called Omicron that has [27:49] rapidly spread throughout the world, including a massive, unprecedented surge in the United States. [27:55] This variant possesses a large number of mutations that are associated with an increased efficiency [28:02] of transmission, immune evasion from certain monoclonal antibodies, convalescent plasma, [28:08] and antibodies induced by our current vaccines. Thus far, data from our own laboratories at NIAID, [28:16] as well as from laboratories throughout the world, have indicated that vaccine-induced antibodies lose [28:22] a considerable amount of potency in neutralizing the Omicron variant. Although this is of obvious [28:28] concern, the encouraging news is that a third shot boost of an mRNA vaccine significantly reconstitutes [28:35] and enhances the ability of antibodies from boosted individuals to neutralize the Omicron variant, [28:41] strongly suggesting that boosters will play a major role in protecting our population at least from severe [28:50] disease in the context of the ongoing massive surge of the Omicron variant that we are currently [28:57] experiencing, underscoring why it is so important for the unvaccinated to get vaccinated and for those [29:05] who are already vaccinated to obtain the booster shot. Therapies in general are an important part of our [29:12] armamentarium against COVID. In this regard, the NIH has been heavily involved in the development and [29:18] or clinical testing of several effective monoclonal antibodies against SARS-CoV-2. However, we have [29:26] ascertained that certain of the authorized monoclonal antibodies are negatively impacted by the Omicron [29:32] variant. Direct antiviral therapies also are an extremely important tool in the fight against COVID-19. [29:40] Importantly, it appears that the mutations expressed by the Omicron variant do not interfere with the [29:48] oral antiviral drugs Paxlovid and Molnupiravir that NIH-funded investigators played an early role in [29:56] developing and that have recently received emergency use authorization from the FDA. Nor do they appear to [30:04] interfere with the FDA fully approved drug remdesivir shown by NIH-sponsored studies to be highly effective [30:14] in preventing severe disease. Looking ahead in the context of the inevitable continual emergence of new [30:21] variants, the importance of developing a pan-coronavirus vaccine, namely one that would be effective [30:28] against all SARS-CoV-2 variants, and ultimately against all coronaviruses, becomes even more apparent. [30:37] My colleagues and I recently published a paper in the New England Journal of Medicine emphasizing the [30:43] urgent need for such an effort. In this regard, we have made significant progress in that direction. [30:51] We have identified antibodies that neutralize multiple different coronaviruses, and in addition, [30:58] NIAID has issued new awards to fund pan-coronavirus vaccines at four academic institutions. [31:06] These awards will fund multidisciplinary collaborative teams to conduct research focused on coronavirus [31:13] virology and immunology, immunogen design, and innovative vaccine and adjuvant platforms, [31:22] as well as technologies to discover, design, and develop pan-coronavirus vaccine candidates. [31:29] Finally, I would like to close by looking forward to how we might best enhance our preparedness [31:36] for what inevitably will be the emergence of future pandemics. The NIAID will play an important role in [31:42] the multi-billion dollar all-of-government plan for pandemic preparedness. Our mission is the rapid [31:50] development and implementation of successful countermeasures against several prototype pathogen [31:57] families of viruses that threaten the health and safety, not only of our nation, but of the entire [32:03] world. Thank you for your attention, and I would be happy to answer your questions following the [32:08] presentations. Thank you. Dr. Woodcock. Good morning, Chair Murray, Ranking Member Burr, and members of the [32:16] committee. Thank you for the opportunity to testify. FDA's thousands of employees remain steadfast in [32:24] fighting this pandemic. Our work continued during the holiday season and led to critical advancements in [32:31] combating the virus. The agency has been closely monitoring the potential impact of the Omicron variant [32:39] on the currently available vaccines, diagnostics, and therapeutics. I'll provide a brief update and [32:45] actions the agency has taken in these three areas since I last testified before this committee. First, [32:54] regarding vaccines, the currently authorized and approved vaccines remain highly effective at [33:00] preventing serious outcomes associated with COVID-19 infection, including hospitalization and death. [33:08] Additionally, data evaluated by the FDA suggests that an additional booster shot following the completion [33:14] of primary vaccination provides further protection against these outcomes. Following these data, [33:22] FDA updated the Pfizer-BioNTech and Moderna vaccine EUAs to shorten the time between completion of a primary [33:30] series and a booster dose to at least five months rather than six months. FDA also updated the Pfizer-BioNTech EUA, [33:39] so it's now available for a primary series in children five, ages five and older, and for the use of a booster dose in all individuals 12 through 15 years of age after completion of primary vaccination. As you've already heard from Dr. Olinsky, as the CDC followed up on this. The agency also authorized the Pfizer vaccine for a third primary series dose for certain immunocompromised children that are five through 11, and the agency also authorized the Pfizer vaccine for a third primary series dose for certain immunocompromised [34:09] review. And the first two of them is also approved for clinical screening of the Pfizer vaccine. [34:15] And the bottom line is getting vaccinated or receiving a booster with one of the [34:19] currently available vaccines is the best thing the public can do right now to [34:23] protect themselves and those they care about. [34:26] It is not too late to get vaccinated or get boosted. [34:30] Second, diagnostic tests, which are another key line of defense in this pandemic. [34:36] Increasing access to accurate, rapid at home tests continues to be a priority for [34:42] FDA. [34:43] Since I last testified, the agencies authorized four additional over-the-counter [34:48] at home tests, bringing the total number to 15. [34:52] And the agency continues to prioritize the review of these type of tests. [34:58] We also partnered with the NIH to establish ITAP, which streamlines validation and [35:04] authorization of antigen tests with potential for large scale manufacturing. [35:10] We expect shorter review times for such EUA requests due to our partnership with ITAP. [35:16] In fact, the first two tests that participated in this program were authorized in two days [35:22] or less from the time FDA received the final data. [35:25] So this is a very good model for government assistance of diagnostic manufacturers. [35:32] In this new program, ITAP will prioritize new over-the-counter test submissions that could [35:38] be manufactured at significant scale to accelerate the availability of high quality, accurate and [35:46] reliable tests for the public as quickly as possible. [35:49] Third, as new variants continue to emerge, it's crucial to expand the country's arsenals of COVID-19 [35:59] therapeutics, especially for those unable to get vaccinated or who can't respond to vaccination. [36:06] Since I last testified, three therapeutics have been authorized for use in the treatment of COVID-19 [36:12] COVID-19 for emergency use. [36:15] The first of these EUAs, EVU-SHIELD, was authorized for the prevention of COVID-19. [36:22] The other two therapies, Paxlovid and Molnupiravir, as you heard from Dr. Fauci, are the first authorized [36:29] treatments for COVID-19 in the form of a pill that can be taken orally, which is a major step in the fight [36:37] against this global pandemic. These authorizations provide new tools to combat COVID-19 at a crucial [36:44] time. And it should make antiviral therapy more accessible to people who are at high risk for [36:50] progression. Now, while these are important tools, they're not substitute for vaccination and people [36:58] for whom vaccination is recommended. And I continue to urge the public to get vaccinated if eligible. [37:05] And fourth, we continue our mission of protecting the public from fraudulent medical products. [37:10] Since March, we've refused admission of more than 23,000 lines of FDA regulated products that we're [37:17] trying to get into the country illegally. And finally, I want to assure the public that FDA is committed to [37:24] continue to use every tool in our toolbox to fight this pandemic with the best available diagnostics, [37:31] life-saving therapeutics, and vaccines. Thank you. And I look forward to your questions. [37:36] Thank you. Assistant Secretary O'Connell. [37:42] Chair Murray, Ranking Member Burr, and distinguished members of the committee, [37:47] it is an honor to testify before you today on efforts within ASPR to respond to the pandemic since [37:54] the emergence of the Omicron variant. When Omicron first emerged, as we have done with each new variant, [38:01] we immediately evaluated its impact on our current vaccines, therapeutics, and diagnostics, [38:07] and adjusted our response accordingly. Data suggests that our current vaccine doses with a boost [38:14] confer protection against Omicron. As a result, we have continued distributing the three authorized and [38:20] approved vaccines. Over 600 million doses of vaccine have been developed and delivered since the start of [38:28] the pandemic. We have ample supply of both primary and booster doses, contributing to more than 200 million [38:36] Americans now being fully vaccinated. However, we have had to make adjustments to our therapeutic supply [38:43] in light of Omicron. Two of our workhorse monoclonal therapies, one from Lilly, the other from Regeneron, [38:50] are not as effective against Omicron. As a result, we have increased our supply of GSKs monoclonal, [38:57] which is effective. We continue to purchase all that we can from GSK, though this supply is still limited. [39:04] We are on track to have 250,000 courses available this month. A fourth monoclonal by AstraZeneca is [39:12] targeted for immunocompromised individuals at high risk and is taken prior to exposure to prevent infection. [39:21] It has retained effectiveness against Omicron and we will have made nearly half a million courses [39:27] available through the end of this month. All four monoclonals are currently available for states and [39:33] jurisdictions to order free of charge on a weekly basis to treat either Omicron or Delta infections. [39:41] Also, we now have antivirals by Pfizer and Merck that are effective against Omicron and are being [39:47] delivered to states free of charge every other week. We have procured 3.1 million courses of Merck [39:54] that are now available. Last week, we doubled our commitment to order 20 million courses of Pfizer's [39:59] product. We have 265,000 courses available through this month and anticipate delivering the first 10 [40:07] million courses to states by mid-summer. We remain in frequent communication with states and territorial health [40:14] officials on the distribution of therapeutic products and continue to focus on ensuring these [40:21] life-saving therapies are available to Americans across the country. The dramatic rise in cases due to [40:27] Omicron has put a significant strain on our testing capacity. Despite significant effort and investment, [40:34] there is more work to do and we are working every day and night with manufacturers to increase the [40:40] availability of tests. As soon as we saw the dramatic increase in cases in South Africa and Europe, [40:46] we reached out to test manufacturers to understand their surge capacity and supply chain constraints. [40:53] We are engaging daily with the lab test providers to mitigate any supply chain constraints with their [40:58] sub-tier suppliers. We are also working with the commercial and public health labs to prioritize their [41:05] needs. We continue to use the Defense Production Act's authorities when needed. To further increase [41:12] test availability, we are procuring 500 million rapid tests to distribute to American households. As a [41:19] requirement in this procurement, none of these tests can interfere with what is available in the [41:24] current commercial market, so as not to diminish what consumers are able to access now. We are currently [41:31] shipping 2.8 million tests to long-term care facilities per week, as we have throughout the pandemic. We [41:38] continue to work to send 50 million rapid tests to federally qualified health centers and food banks, [41:43] with 7 million having shipped so far. And we will keep working around the clock with manufacturers and our [41:50] government partners to increase and sustain the number of tests available now and in the future. And [41:56] finally, in addition to vaccines, therapeutics and testing, ASPR continues to provide on-the-ground [42:02] support to states and communities in need. Since July, 40 National Disaster Medical System teams, [42:08] nearly 880 team members, have deployed to 19 separate states and the Commonwealth of the Northern [42:15] Mariana Islands to support a range of functions, including hospital augmentation and decompression, [42:21] setting up medical overflow centers for patients, and mortuary support. We continue to send supplies, [42:27] as requested, from the Strategic National Stockpile, including 300 ventilators to six jurisdictions [42:34] since the emergence of Omicron. We are grateful for the support from this committee in Congress, [42:40] and I look forward to answering your questions. Thank you to all of our witnesses. We will now begin a [42:46] round of five-minute questions of our witnesses, and I again ask my colleagues to keep track of your clock and [42:51] stay within those five minutes. As the Omicron variant of COVID-19 continues to spread at an alarming [42:59] rate, people are looking for clear, straightforward guidance on how to protect themselves and those [43:05] around them. It is really critical that we reduce the infection rates so we can relieve pressure on our [43:12] healthcare workers, protect people with disabilities and older Americans, young kids, and anyone else who's [43:17] been disproportionately impacted by COVID-19. However, I have heard from so many people who find the [43:25] latest CDC isolation and quarantine guidance confusing and hard to interpret. So, Dr. Walensky, [43:32] can you please clearly explain CDC's latest guidance on what people need to do to protect themselves and [43:40] others if they are exposed to or contract COVID-19? And let me start with vaccinated people. What is your guidance [43:47] to them? [43:47] Thank you, Chair Murray, for the opportunity to clarify. Maybe if I could just rewind the clock to [43:53] just before the holidays, where we were hearing from hospitals that they were, their staff were going out and [43:58] that they were in a real crunch in terms of beds. They had plenty of beds, but they didn't have staff to, to staff them. ICU beds were starting to close. So, [44:08] immediately we worked towards our updated healthcare worker guidance, but when we did so, we recognized [44:13] that we were going to have challenges and that this Omicron surge that we were about to face was [44:19] threatening many other places of our healthcare sector. Okay, I appreciate the background, but I just want to [44:24] know, straightforward, if someone is exposed to or has COVID-19 and they're vaccinated, what do they do? [44:30] If they are exposed to COVID-19 and they are completely boosted, they should, they do not need to stay home. [44:38] But they should get a test at day five. If they have COVID, our guidance is not, does not distinguish [44:45] between your vaccination status. And our science has demonstrated that you're maximally infectious two [44:50] days before and two to three days after. So by five days after your symptoms, if you're feeling better, [44:57] if your fever is better, if your cough and sore throat are better, then on day six, you can go out, [45:02] but you have to wear a mask. You have to wear a mask reliably and you should not go to places [45:07] you can't wear a mask. You probably shouldn't go and visit grandma. You shouldn't get on an airplane. [45:11] For vaccinated, what about unvaccinated? Same for unvaccinated for isolation. So isolation [45:16] being those who have had disease, who have disease. Okay. Well, let me just say nearly two years ago, [45:24] when this committee first started having congressional hearings on COVID-19, the very first thing I asked [45:30] was, where are the tests? And we've made progress since then. And we're now producing 300 million [45:36] rapid at-home tests each month, along with ramping up our lab-based testing. But I am disappointed, [45:42] as I said, by the testing challenges that we're facing. Tests are hard to find. They're costly. [45:48] People are unable to find the at-home tests in pharmacies, online. They're waiting in long lines, [45:55] and often after that, waiting days for results. So it's, you know, ineffective at the end of the day. [46:02] So, Ms. O'Connell, I want to ask you, what are you doing to address the frustrations and challenges [46:08] we are hearing about COVID testing? Chair Murray, thank you so much for this [46:13] very important question. Testing remains a critical priority for this administration. When we saw the [46:20] unprecedented cases of Omicron sweep into South Africa and Europe, we immediately reached out [46:27] to our manufacturers to understand any supply constraints they had and to evaluate their surge [46:33] capacity. We have also met daily with them to make sure that they have what they need from their [46:40] suppliers and have used the Defense Production Act authorities 12 times throughout this pandemic in [46:46] support of testing needs. Most recently, in the last few weeks, for two tests, we were able to [46:53] unlock supplies and manufacturing capacity. We continue to invest in rapid over-the-counter tests, [47:02] which are in high demand. And in the fall, we invested $3 billion to increase manufacturing line [47:08] staffing and to commit to those manufacturing lines for 13 months. As a result, we went from [47:15] 46 million tests, over-the-counter tests available in October to the 300 million, [47:21] Chair Murray, that you just mentioned that are available now. But that's not enough. We're continuing [47:29] to bring tests to the American people. As a result, the President has announced and we are in the process [47:35] of procuring the 500 million tests, which every American household will be able to order and have shipped [47:42] directly to their house. We have completed four contracts so far, have secured 50 million tests, [47:48] and are in the process of securing the additional tests over the next several days. The U.S. Postal [47:54] Service has agreed to do the distribution, and the U.S. Digital Services is going to help with the website. [48:01] We anticipate the first tests going out at the end of this month, with the remaining tests going out over [48:07] the next 60 days. Okay. And I'm out of time, but I do want to just say this. I am hearing from so many [48:13] schools that are having trouble staying open. They want to stay open. Part of it is they have staff [48:17] that are sick. That's understandable. But a big part of it is they don't have access to the safety measures [48:24] like masks and testing supplies. What do I tell them about where they go to get that? Chair Murray, [48:32] thank you. Schools having enough testing supplies to stay open is a critical priority for us. We've invested [48:39] 10 billion dollars of the American Rescue Plan given to states to support and stand up testing programs. [48:46] We've also invested 650 million dollars in a program called Operation Expanded Testing, which set up [48:54] regional hubs of labs that schools could contract with to run their testing programs. But that doesn't work if [49:01] there aren't tests available. So ASPR is working directly with states to match additional manufacturing [49:07] capacity with states that need it. Not only that, we are in the process within ASPR of looking at our [49:14] contracts to see if we have any additional capacity and will commit to sending that capacity to the school [49:20] programs. Senator Burr. Thank you, Madam Chairman. Let me just cut to the chase. Dr. Fauci, you said CDC was [49:31] going to update its guidance and include antigen testing or suggested that it would. Dr. Walensky [49:37] and CDC came out with the guidance that didn't include it. Was that part of the communications plan [49:44] to start with and they diverted or was that something you just chose to inject? Thank you for that question, [49:54] Senator Burr. In discussions about the real gray zone, which Dr. Walensky described about after the five [50:03] days where you have a considerable diminution in the likelihood of being transmitting, we had been [50:10] in discussions about what the role of antigen testing would be. And as a matter of fact, when Dr. [50:17] Walensky came out with the final guidelines, they include that if you have a test available, [50:24] you may take a test. So at the end of the day, we were quite in concordance with our views. [50:30] Well, I think the chair and I share this. We found it very confusing. And I think the American [50:39] people found it confusing. And I don't say it lightly when I say not too many people in America are [50:44] listening to what comes out of Washington, whether it's Congress or out of the administration as it [50:48] relates to COVID. So the president makes an announcement, Ms. McConnell, of 500 million at-home [50:53] tests. Is this the first time that you've thought about purchasing an at-home test or have you tried to [51:00] do before and it was rejected? Thank you, Ranking Member Burr. This is the first time [51:07] the administration has committed to purchasing tests to send to the American households. [51:13] So is that ASPR or is that DOD? Because of all the notifications of contracts signed, [51:24] I've seen them from DOD. I haven't seen them from HHS. Thank you for that question, [51:29] Ranking Member Burr. We have a relationship with DOD for assisted acquisitions. So ASPR will request [51:36] that DOD put out a solicitation or manage a contract on our behalf. They're able to do it extraordinarily [51:44] quickly. And we've had an MOU in place with DOD for this work that will run through June 2023. [51:52] We've used this relationship to purchase vaccines and therapeutics and we're now using it for testing. [51:59] So the best I can find, you mentioned 50 million doses having been contracted. [52:04] I can identify 27 million out of two companies, Media and Atlantic Trading. Neither one of them are [52:14] manufacturers of tests. And I believe the third one, Revival, is not a manufacturer of tests. [52:20] Media actually came to fame with importation of vodka and tying cell phones to vodka. And like a lot of [52:29] other companies, they got in the PPE business in 2020 with some nominal FEMA contracts. Why should we [52:38] have any confidence in these contracts if, in fact, we're dealing with companies that don't manufacture [52:45] anything? And can you assure me that the tests that are coming in are not coming from China? [52:51] Thank you, Ranking Member Burr. Absolutely. These tests, what we initially did to be able to [53:00] access tests for the initial shipments that will go towards the end of January, we worked with [53:06] warehouses to see where additional tests were stored and assessed that additional capacity and are bringing [53:13] that capacity to bear for these initial tests that are going out, which is why you're seeing contracts [53:18] with warehouses and not with test manufacturers. So is what you're telling me, they've got 50 million tests [53:25] in warehouses in the United States and all we did was access that inventory? That is my understanding. [53:33] Well, will you confirm your understanding? This is a very, very important piece when you've got companies that [53:40] don't manufacture tests, and all of a sudden we're giving them a $190 million contract for about 14 million [53:48] home tests, and their expertise is importation of vodka. I encourage you to look through the list of [53:57] people that we're signing up with. Are you aware that some of the larger test manufacturers in 2021 [54:04] shut down lines because of the lack of purchases for at-home tests? [54:09] One of the things we did in the fall with the $3 billion investment that we made was to turn lines [54:15] on and to commit to those lines for 13 months so they wouldn't be turned off again. [54:20] Dr. Woodcock, let me just, last question, Chair. Of the 15 tests that you've currently [54:29] approved for over-the-counter, how many detect Omicron? [54:33] We're still working on that, but we believe all of them detect Omicron. We simply feel they are somewhat less [54:42] sensitive than they were to some of the previous variants. [54:45] Of the 50 million tests that the ASPR has contracted for, how many of those tests detect Omicron? [54:53] I don't know which tests there are. We can get back to you on that. [54:58] So you haven't consulted with what we're purchasing on the $500 million. They haven't consulted with FDA [55:03] to figure out whether the tests they're buying actually detect Omicron. [55:07] I believe they have. I simply don't have that list. [55:09] Okay. I thank the Chair. [55:10] Senator Cain. [55:12] Thank you, Chair Murray, and to the witnesses. Dr. Fauci, can you provide us [55:19] a general breakdown of what percentage of hospitalized individuals are vaccinated versus unvaccinated [55:27] and what percentage of COVID deaths are among vaccinated or unvaccinated individuals? [55:35] Thank you for that question, Senator Cain. One of the ways to answer that question would be to look [55:40] at people who are in the hospital and take a look at if you are vaccinated versus unvaccinated. [55:47] And if you look at vaccinated versus unvaccinated, there's about a 10 times greater chance that you'd [55:53] be infected if you were unvaccinated, about a 17 times greater chance that you'd be hospitalized if [56:00] you were unvaccinated, and about a 20 times likelihood that you would be dead if you were unvaccinated. [56:09] So when you look at every parameter, 10 times, 17 times, 20 times, infection, hospitalization, death. [56:17] Thank you, Dr. Fauci. Ms. O'Connell, I want to ask you a question about additional vaccine development. [56:24] The current vaccines against COVID, as was indicated by Dr. Fauci's answer, have been very successful in [56:30] reducing deaths, severity of illnesses, and hospital admissions. However, they've had more limited success in [56:36] preventing forward transmission from vaccinated individuals after breakthrough cases, and the [56:42] existing vaccines are not as durable as vaccines in other areas, so we need booster shots to continue [56:49] to protect against the virus. Is the administration considering supporting the development of additional [56:56] vaccines that might be able to address the gaps in the current vaccines capabilities? [57:00] Senator Cain, thank you so much for that question. Yes, absolutely. I think we all see the need for next [57:06] generation vaccines. We are also looking for next generation antivirals and therapeutics as well. [57:12] We're in the process of working with Dr. Fauci's team to develop a unified NIH BARDA research agenda [57:20] and budget to address these issues, to identify candidates that might already be in the pipeline, [57:26] to help support the research into candidates that are just starting in the pipeline, so we can accelerate [57:32] the availability of next generation vaccines and therapeutics. Thank you for that answer. Dr. Walensky, [57:38] I'd like to ask you a question about access to testing, and in particular, what is the CDC doing to make sure that [57:48] testing capacity is robust in rural America and also among community health centers in disadvantaged parts of the country? [57:58] Dr. Walensky. Thank you, Senator Cain. So we have this program, Increased Community Access to Testing, [58:03] in collaboration with ASPR as well. This is a program that has collaborated with FEMA to increase surge testing [58:12] just over the holidays. We've increased testing, federal testing sites for PCRs, 12 federal testing sites, [58:18] doing thousands of tests over the holiday. We also work with pharmacies. This is a collaboration with pharmacies, [58:23] and in that stead, we are able to map where the pharmacies are and their social vulnerability index, [58:30] and we can actually put PCR tests in areas of high social vulnerability index through all of our pharmacy [58:36] partners, CVS, Walgreens, Rite Aid, and whatnot. And then we actually put tests in our community centers [58:41] as well. So really a broad stretch in order to be able to get access to testing, especially among those [58:48] most vulnerable. And then, of course, as Asper O'Connell mentioned, $10 billion for testing supplies [58:54] to our schools and working closely with our schools in peer-to-peer support and technical support to [59:01] allow those tests to be used well in those school settings. Thank you. Thank you for that answer. And [59:05] Dr. Fauci, one more question for you. I ask a version of this question every time we have this panel [59:11] before us, what is the NIH doing right now or what's the current status of NIH research to better [59:17] understand long COVID to look at symptoms and potential treatments? There are several levels of [59:26] activity going on. Some news since we spoke last, I had mentioned to you, Senator, that in fact there was [59:34] a $1.15 billion program for studying long COVID that is now developing cohorts to look at various [59:44] incidences, prevalences, pathogenesis, and potential interventions. There have been a number of awards [59:50] that have been given. Most recently, in September, there was an additional $470 million funding supported [59:57] through the American Rescue Plan, engaging about 100 researchers from 30 institutions to get [1:00:04] individuals together. One of the things that's really interesting that we're seeing right now is [1:00:10] that when you look at individuals who have these symptoms that go on, as you know, and have experienced [1:00:17] yourself for a considerable period of time, a recent study that is in the preprint stage, so it hasn't [1:00:26] been peer-reviewed, has some very interesting information that needs to be validated and verified. [1:00:32] It was an autopsy study in people who had varying levels of COVID from relatively mildly symptomatic [1:00:41] to moderately symptomatic to individuals who actually died. And when they looked at the spread [1:00:47] of what was not necessarily replication-competent virus, but was PCR-able virus, which means you could [1:00:54] have nucleotides that were there, there was, it seems to be, a persistence in multiple organ systems, [1:01:01] indicating that even if you clear the virus, one of the possibilities, and I have to emphasize [1:01:07] possibility because it needs to be validated, is that you don't completely clear the fragments of the [1:01:13] virus and you have continual stimulation, not that you're infectious or that you're going to infect anybody [1:01:19] else, but that it is still generating, perhaps, an aberrant response in your immune system. I underscore again, [1:01:25] it's preliminary, it's in the preprint stage, and it needs to be peer-reviewed. But that's some of the [1:01:31] information we're starting to gather. Thank you very much for that answer. Thank you, Chair Murray. [1:01:37] Senator Paul. [1:01:39] Dr. Fauci, the idea that a government official like yourself would claim unilaterally to [1:01:46] represent science, that any criticism of you would be considered a criticism of science itself, [1:01:52] is quite dangerous. Central planning, whether it be of the economy or of science, is risky because of [1:01:57] the fallibility of the planner. It would not be so catastrophic if the planner were simply one [1:02:03] physician in Peoria, then the mistakes would only affect that physician's patients, the people who [1:02:09] chose that physician. But when the planner is a government official, like yourself, who rules by [1:02:15] mandate, the errors are compounded and become much more harmful. A planner who believes he is the [1:02:21] data science leads to an arrogance that justifies, in his mind, using government resources to smear [1:02:28] and to destroy the reputations of other scientists who disagree with him. In an email exchange with Dr. [1:02:33] Collins, you conspire, and I quote here directly from the email, to create a quick and devastating [1:02:40] published takedown of three prominent epidemiologists from Harvard, Oxford, and Stanford. Apparently, [1:02:47] there's a lot of fringe epidemiologists at Harvard, Oxford, and Stanford. And you quote in the email [1:02:54] that they, or from Dr. Collins, and you agree that they are fringe. And immediately there's this [1:03:00] takedown effort. A published takedown, though, you know, doesn't exactly conjure up the image of a [1:03:05] dispassionate scientist. Instead of engaging them on the merits, you and Dr. Collins sought to smear them [1:03:11] as fringe and take them down. And not in journals, in lay press. This is not only antithetical to the [1:03:18] scientific method, it's the epitome of cheap politics, and it's reprehensible, Dr. Fauci. [1:03:24] Do you really think it's appropriate to use your $420,000 salary to attack scientists that disagree [1:03:30] with you? The email you're referring to was an email of Dr. Collins to me. If you look at the email, [1:03:41] that you responded to, and hurried up and said, I can do it, I can do it, we got something in [1:03:45] wired packaging. No, no, no, I think in usual fashion, Senator, you are distorting everything [1:03:52] about me. Did you ever object to Dr. Collins' characterization of them as fringe? Did you [1:03:56] write back to Dr. Collins and say, no, they're not fringe, they're esteemed scientists, and it would [1:04:00] be beneath me that you do that? I did not do that. You responded to him that you would do it. And you [1:04:04] immediately got an article in wired, and you sent it back to him and said, hey, look, I've got them, [1:04:08] I nailed them in wired of all scientific publications. That's not what went on. There you go again. [1:04:13] That was your response. You just do the same thing every hearing. That was your response. [1:04:16] And this wasn't the only time. So your desire to take down people- You're absolutely incorrect. [1:04:21] As usual, Senator, you are incorrect almost everything you've said. Well, no, you deny, [1:04:26] you deny, but the emails tell the truth of this. No. This wasn't the only time. Your desire to take [1:04:31] down those who disagree with you didn't stop with Harvard, Oxford, and Stanford. You conspired with Peter [1:04:37] DAZAC, who you communicated with privately, and other members of the scientific community that [1:04:42] wrote opinion pieces for nature. Five of them signed a paper for nature, an opinion piece. 17 signed a [1:04:48] paper that called it conspiracy theory, the idea that the virus could have originated in the lab. [1:04:54] Do you think words like conspiracy theory should be in a scientific paper? [1:04:59] Senator, I never used that word when I was referring to it. You're distorting virtually everything. [1:05:07] Did you communicate with the five scientists who wrote the opinion piece in Nature, [1:05:12] where they were describing, oh, there's no way this could have come from the lab? [1:05:16] That was not me. What I did- [1:05:17] Did you talk with any of those scientists privately? [1:05:19] See, but you keep the story and the truth. It is stunning how you do that. [1:05:23] Did you talk to any of the scientists privately- [1:05:25] Yes. [1:05:26] ...who wrote the opinion? You did. [1:05:27] Well- [1:05:28] What were they telling you privately? [1:05:29] Well, let me explain. You know you're going back to that original discussion when I brought together [1:05:34] a group of people to look at every possibility with an open mind. So not only are you distorting it, [1:05:42] you are completely turning it around, as you usually do. [1:05:44] Were most of the scientists that came to you privately, did they come to you privately and [1:05:48] say, no way this came from the lab? Or was their initial impression, Dr. Gary and others that were [1:05:54] involved, was their initial impression actually that it looked very suspicious for a virus that came from a lab? [1:05:59] Senator, we are here at a committee to look at a virus now that has killed almost 900,000 people. [1:06:09] And the purpose of the committee was to try and get things out how we can help to get the American [1:06:15] public. And you keep coming back to personal attacks on me that have absolutely no relevance to reality. [1:06:23] Do you think anybody has had more influence over our response to this than you have? [1:06:27] Do you think it's a great success? Do you think it's a great success what's happened so far? [1:06:31] Do you think lockdowns are good for our kids? Do you think we slowed down the death rate? [1:06:35] More people have died now under President Biden than did under President Trump. [1:06:39] You are the one responsible. You are the architect. You are the lead architect for the response from [1:06:43] the government. And now 800,000 people have died. Do you think it's a winning success what you've [1:06:49] advocated for government? Senator, first of all, if you look at everything that I said, [1:06:55] you accuse me of, in a monolithic way, telling people what they need to do. Everything that I've [1:07:02] said has been in support of the CDC guidelines. Wear a mask. Get boosted. And you've advocated to make [1:07:10] it coercive and done through force. And you've advocated that it be done by mandate. You've advocated that [1:07:16] your infallible opinion be dictated by law. Right. So again, Madam Chair, I would like just a couple of [1:07:23] minutes because this happens all the time. You personally attack me and with absolutely not a [1:07:30] shred of evidence of anything you say. So I would like to make something clear to the committee. [1:07:36] He's doing this for political reasons. What you need to do is he said in front of this committee. [1:07:42] You think your takedown of three prominent epidemiologists was not political? [1:07:46] You don't want me to finish because you know what I'm going to say. [1:07:48] Senator Paul, if you would please, I'm going to allow Dr. Fauci to respond. We have a number of [1:07:59] senators who would like to ask questions and I would like him to be able to respond. Please do. [1:08:03] So the last time we had a committee or the time before, he was accusing me of being [1:08:09] responsible for the death of four to five million people, which is really irresponsible. And I say, [1:08:16] why is he doing that? There are two reasons why that's really bad. The first is it distracts from [1:08:23] what we're all trying to do here today is get our arms around the epidemic and the pandemic that we're [1:08:30] dealing with, not something imaginary. Number two, what happens when he gets out and accuses me of things [1:08:38] that are completely untrue is that all of a sudden that kindles the crazies out there. And I have life, [1:08:46] the threats upon my life, harassment of my family and my children with obscene phone calls because [1:08:56] people are lying about me. Now, you know, I guess you could say, well, that's the way it goes. I can take [1:09:02] the hit. Well, it makes a difference because as some of you may know, just about three or four weeks ago, [1:09:10] on December 21st, a person was arrested who was on their way from Sacramento to Washington DC at a speed [1:09:19] stop in Iowa. And they asked, the police asked him where he was going and he was going to Washington DC to [1:09:27] kill Dr. Fauci. And they found in his car an AR-15 and multiple magazines of ammunition because he [1:09:37] thinks that maybe I'm killing people. So I asked myself, why would Senator want to do this? So go to [1:09:46] Rand Paul website and you see fire Dr. Fauci with a little box that says contribute here. You can do [1:09:54] five dollars, 10 dollars, 20 dollars, a hundred dollars. So you are making a catastrophic epidemic [1:10:02] for your political gain. So the only thing that I can... You have politically attacked your colleagues [1:10:07] and in a politically reprehensible way you attacked their reputations. You won't defend it. You won't [1:10:12] argue it. You'll just simply turn around the attack. We're going to continue this hearing. We have a [1:10:16] number of questions from other senators. Just one more minute, please. Dr. Fauci, I really appreciate [1:10:22] your response, but we do have a number of questions from senators and we do have a second round and I'm [1:10:27] being asked to make sure that everybody has their time. So thank you. Thank you very much for allowing [1:10:31] me, Madam Chair. We will move to Senator Murphy. Thank you, Madam Chair. Dr. Fauci, thank you. Thank you, [1:10:39] first of all, for what you do. You shouldn't have to put your life at risk. You shouldn't have to put your [1:10:45] family's life at risk to simply stand up and do your job to try to protect my constituents from a [1:10:51] pandemic disease. And thank you for calling out this agenda for what it is, an attempt to score [1:10:58] political points, to build a political power base around the denial of science and around personal [1:11:04] attacks on you and your family. On social media, I follow many of President Trump's advisors and family [1:11:11] members and they make a sport out of attacking you personally in some of the most vicious, hateful, [1:11:19] ugly ways that are possible. They do it because it gets clicks. They don't do it because they're [1:11:25] legitimately engaged in a honest debate about the science revolving surrounding COVID. Those people [1:11:34] attack you because it gains them political followers. And so I appreciate the fact that you're willing to [1:11:42] stand up for yourself and for your colleagues who have been dragged into the political muck, [1:11:49] not because those that follow President Trump are interested in an honest, science-based debate [1:11:57] about how to attack COVID, but because they see political opportunity. So thank you, Dr. Fauci, [1:12:06] for your work, for the panel's work, and for sticking up for yourself, which is not always easy. [1:12:12] Dr. Walensky, I want to take my time to just do a little bit of an update on best practices for [1:12:21] schools. I know we talk about this a lot here, but you know, part of what I think is frustrating for [1:12:29] a lot of parents is that the guidance they're getting from their schools changes. And I get it, [1:12:35] educators are sort of adjusting as the variant changes, as technology changes. But what has changed [1:12:44] since the last time? Has anything changed since the last time you were here about what you are [1:12:48] recommending for schools to stay open? I appreciate what you said in the last hearing is that schools [1:12:53] should be the first places to open and the last places to close. Man, as the parent of two public [1:12:59] school kids, I couldn't agree more. The trauma on these kids during this pandemic has been significant, [1:13:07] and the data tells us that especially for poorer kids and kids of color, distance learning just doesn't work. [1:13:12] So I'm grateful that I've got a governor who's gone to extraordinary lengths to make sure that the [1:13:18] federal dollars are used to keep schools open. But anything new that you can share with us about [1:13:23] what you're recommending for schools to stay open for the rest of the year? [1:13:25] Thank you, Senator Murphy. And in fact, you took the words right out of my mouth. Schools should be the [1:13:30] first places to open and the last places to close. We had a delta surge in the fall and 99 percent of our [1:13:36] schools were safely open. And one of the things that's majorly different between September of 2021 [1:13:42] and today is we have pediatric vaccinations. We have vaccines that are available for every child [1:13:48] over the age of five, and the children who are in the hospital now are largely those who are [1:13:53] unvaccinated. So first and foremost, one of the most important things that's changed is we should be [1:13:57] getting our children and our teenagers vaccinated. And if our teenagers are eligible, we have boosters [1:14:02] available for our teenagers as well. So we saw through the delta surge that we were able to keep [1:14:08] our children safely in school before we had vaccines. So now today, what do we have for our children? We have [1:14:13] vaccines, of course, that we can use. We have school testing programs. We have new science that demonstrates [1:14:19] tests to stay. This is where a child might be exposed in the classroom, but if they are exposed, they don't [1:14:24] have to stay home in quarantine. They can test every other day or twice a week and stay in the classroom [1:14:30] safely. And what that has demonstrated is hundreds of thousands of person days of children in school [1:14:36] rather than at home. We have new science that has demonstrated the value of masking, three and a half [1:14:41] times increased risk of school outbreaks if you're masking, if you're unmasked in schools versus if you're [1:14:47] masking in schools. And just this week, we updated our K-12 guidance so that it is consistent with our [1:14:52] isolation and quarantine guidance for the general public so that people can come back to school after [1:14:57] isolation after five days. Thank you, Dr. Walensky, for that and for your commitment to keeping our [1:15:04] schools open. Final quick question for you, Ms. O'Connell. Talking about in-home tests, obviously a [1:15:10] lot of focus on in-home tests today, but these are antigen tests. There's some, you know, interesting [1:15:15] research going on about the ability to make PCR tests available at home. And there's companies all over [1:15:21] the country, including one in Connecticut, that, you know, believe that with some additional investment [1:15:26] to bring those tests to scale, we could get PCR tests into families' hands at home for a cost [1:15:33] that is at or below what we're currently charging or companies are currently charging for antigen [1:15:39] tests. Is that a possibility? Senator Murphy, thank you. We share your interest, of course, [1:15:44] in seeing as many tests available for the American people as quickly as possible. And at BARDA have [1:15:49] worked very closely with several of the manufacturers that you mentioned for these at-home PCR tests. [1:15:54] We've contracted with one of them and have reached 5 million per month manufacturing capacity in [1:16:02] contract with them and continue to look at the others in ways that we can support them. I would [1:16:07] also like to say NIH colleagues in a program called RADx, the Rapid Acceleration of Diagnostics, are working [1:16:14] very closely with many of these companies as well as they go through the development stages. So we remain [1:16:19] very committed to the work that these companies are doing and look forward to partnering with them [1:16:24] as they begin to bring these products forward. Thank you. Senator Collins. Thank you. Ms. O'Connell, [1:16:34] over the past two years, Congress has appropriated $82.6 billion specifically for testing. In addition, [1:16:46] we've given the department flexibility to use other sources of funding. And yet, as you've heard repeatedly [1:16:55] today, our frustrated constituents cannot find rapid tests when they need them. This testing crisis appears to [1:17:06] have been entirely preventable, as is evidenced by the availability, the widespread availability, [1:17:14] of rapid tests in Europe, for example. The fact is that it appears the administration simply failed [1:17:23] to anticipate our testing needs. As the former Assistant Secretary of Health recently pointed out, [1:17:32] a lack of federal orders for tests between January and September of 2021 caused the manufacturers to reduce [1:17:43] their lines and lay workers off, including at Abbott facilities in the state of Maine where 400 workers [1:17:52] were laid off. As a member of the Appropriations Committee, I share the concerns that have been expressed [1:18:01] by Senators Burr and Blunt. I don't believe that we're in the position that we are in now due to a lack of funding, [1:18:10] but rather a lack of planning. My question to you is, has any of this funding, this close to $83 billion [1:18:24] that was supposed to be used for testing been diverted for other purposes? Senator Collins, thank you for this [1:18:34] question. Testing remains a priority for this administration. And all the work we've done on testing [1:18:39] has been to promote the priorities of expanding the number of testing sites available, expanding the type [1:18:49] of tests that are available for use in the United States, expanding the supply of tests in the United [1:18:54] States, and lowering the cost of tests. And we used the $47 billion that came in the American Rescue Plan. [1:19:01] Ten billion of that went to schools, you know, through the states to set up the school testing programs. [1:19:07] $8.3 billion has gone to community testing sites, including for the uninsured and at the community health centers, [1:19:15] the pharmacy program Dr. Walensky mentioned. $5 billion has gone to procure tests and supplies, [1:19:22] and an additional $4.5 billion will go towards this $500 million that we are in the process of procuring. [1:19:29] $29 billion has gone directly to states from previous supplementals for them to build and promote testing [1:19:37] programs within their jurisdictions. The testing money, as you recall, was for testing, contact tracing, [1:19:45] and mitigation efforts. And some of the funds have been used for mitigation efforts. For example, [1:19:54] when children are crossing the border, one of the responsibilities that we have within HHS is to [1:20:01] make sure that the children that are unaccompanied are cared for. And we used some of the funds to test [1:20:10] those children and then to separate them from COVID-negative children at the border. [1:20:15] Was, I'm going to repeat my question because you did not answer it. Has any of that money been used [1:20:24] for non-testing related purposes at the border? For the mitigation purposes as well, which the [1:20:34] legislation allowed the funding to be used for. I will follow up with you because I don't feel like [1:20:42] I'm getting an answer. Dr. Fauci, just last week, the president once again said that COVID-19 is a [1:20:54] pandemic of the unvaccinated. And let me make very clear that I've encouraged vaccinations. I believe [1:21:04] in them, but contracting, contradicting the president's statement, in Maine, our largest health system [1:21:13] reported that absences of vaccinated staff caused by COVID-19 last week was at the highest point since [1:21:25] vaccines became available. It's increased by fourfold. Does the message that COVID [1:21:34] vaccinated is a pandemic of the unvaccinated still hold true with the emergence of Omicron? [1:21:43] And do you agree with the New York Times, which has twice reported that while the COVID vaccine [1:21:52] is critical in preventing hospitalizations and death, it is less effective against the Omicron variant? [1:22:05] Thank you for that question, Senator. Yes, indeed. It is, there's no doubt that the Omicron variant, [1:22:13] when you look at the protection against symptomatic disease and asymptomatic infection, dramatically goes [1:22:20] down to about 30 percent. What maintains itself, it goes up to about 70, it's about 70 percent against [1:22:30] severe disease. When you boost, when you boost, when you boost, what happens is you get a rather significant [1:22:36] reconstitution of the protection, particularly against hospitalization. So if you were to say that Omicron, or even [1:22:47] COVID-19 as it is, is really a pandemic, when you're talking about pandemic that causes serious disease, there's no doubt that [1:22:57] there's an extraordinary divergence of risk between a vaccinated and an unvaccinated person. In response [1:23:07] to the question just a bit ago, when I said that, if you look at vaccinated versus unvaccinated, there's a 17 [1:23:15] times greater chance of being hospitalized and a 20 times greater chance of dying if you are unvaccinated [1:23:24] versus vaccinated. Thank you. Senator Hassan. Thank you, Madam Chair and Ranking Member Byrne. Thank you to [1:23:36] all of our witnesses for being here today and for your ongoing work. I deeply appreciate it. Dr. Fauci, I want [1:23:43] to start with a couple of questions for you. We need to make sure that individuals who become seriously [1:23:49] ill with COVID-19 can receive treatment and that doctors have clear guidelines on the effectiveness [1:23:55] of each treatment for the latest variant. And you touched on this in your opening statement, but I [1:24:01] would like you to just expand a little bit on this. In light of Omicron, how is the administration [1:24:07] evaluating new COVID-19 treatments and monitoring the effectiveness of existing treatments? [1:24:13] Thank you for that question, Senator. There are a number of studies that have been conducted [1:24:22] and that are being conducted right now, and they have to do with studies that are NIH-sponsored, [1:24:30] one of which is the adaptive COVID-19 treatment trials or ACT, ACT, which in fact have been from the [1:24:39] very beginning, as early as February of 2020, was the basis for the FDA approval of the antiviral remdesivir. [1:24:49] Other of those studies, particularly those on monoclonal antibodies, showed several of them [1:24:55] in the clinical trials to be effective at first against Delta. We know now that a couple of them, [1:25:02] except for one, has now lost some of its effectiveness. There's another group of studies [1:25:08] called ACTIV, and there are six of those, and that stands for Accelerating COVID-19 Therapeutic [1:25:15] Interventions and Vaccines, and the whole gamut of oral, IV, monoclonal antibodies, direct antivirals. [1:25:25] And as I mentioned in my opening statement, antivirals like Paxlovid and Molnupiravir, [1:25:33] the original research had been done in the early trials by the NIH. But importantly, in direct answer to [1:25:40] how we know what to use, the NIH has put together a guidelines panel made up of 48 highly qualified [1:25:50] clinicians and individuals with experience in COVID-19 to give a prioritization of what you do [1:25:59] if you're infected and with advanced disease in the hospital, as well as what you do as an outpatient. [1:26:06] And they're fairly clearly delineated in the guidelines, which is easily accessible by just [1:26:12] going to the NIH website and going to NIH.gov and then guidelines panel, and people can get a good [1:26:20] idea, clinicians throughout the country and the world, of how to use these antivirals. Thank you. [1:26:26] Thank you. I want to follow up. I am grateful that the administration heeded my call [1:26:32] to send FEMA teams to New Hampshire to help administer COVID-19 treatments. [1:26:36] However, the teams were delayed in arriving and are scheduled to stay only for a short period of [1:26:41] time. So Dr. Fauci, what additional personnel and support is the administration planning to [1:26:47] provide to New Hampshire and other states to help treat COVID-19 patients in the most effective way [1:26:52] possible? Well, there are several things perhaps Assistant Secretary O'Connell can answer, [1:27:00] but I can start off by saying that there are surge teams right now, at least 60 surge teams, [1:27:07] that have been deployed to help those areas that have difficulty because of the surge and the fewer [1:27:15] volume of cases to be able to handle them with regard to everything from hospitalizations to treatment [1:27:21] and other implementations. And I appreciate that Assistant Secretary O'Connell is in a good [1:27:28] position to follow up, and I would like to follow up after the hearing, but I did want to ask one other [1:27:32] question to Dr. Walensky. We've long had problems with accurate state vaccination data in New Hampshire. [1:27:40] It's come to light that the CDC's data on New Hampshire's vaccination rates is also inaccurate. [1:27:46] Apparently, the CDC can't consistently distinguish in its data between first doses of the vaccine [1:27:52] and boosters. And as a result, the agency incorrectly records boosters as first doses, [1:27:58] artificially raising the vaccination rate. The CDC's data is inaccurate for other states as well. We've [1:28:04] been looking at this for other states too. So what steps is the CDC taking to resolve these data [1:28:12] inaccuracies? And when will the CDC have accurate data for New Hampshire? [1:28:16] Thank you, Senator. This is a really important question. So CDC is the compiler of the data, [1:28:21] and we rely on the state immunization services to provide CDC the data at the state level. Now, [1:28:28] among the challenges with these accuracies is that if people don't bring in their card, [1:28:33] they are counted as a first dose when, in fact, their card would have been a third dose. And we rely on [1:28:38] the states to work to reconcile any differences if a person put in a minimal initial on one card [1:28:44] but not on another. And we're working closely with every single state to increase the accuracy. [1:28:49] We're encouraging people to bring their cards because that also increases the accuracy. We [1:28:54] recognize this challenge, and we are working state by state, including in New Hampshire, [1:28:59] to reconcile these inaccuracies to get them more accurate in our comprehensive reporting of every state. [1:29:04] Well, I appreciate that very much. Thank you, Madam Chair. I'll just say that [1:29:08] what I'm hearing you say to the general public is it's really important to help with the accuracy of [1:29:15] data by keeping your card, taking a photo of your card, making sure that you're sharing all your [1:29:19] information at the site where you're getting a vaccine or booster shot. Very helpful. Yes, [1:29:24] thank you very much. Thank you. Thank you. Senator Marshall. President Biden inherited a vaccine, [1:29:30] a distribution plan, trillions of dollars in funding, but unfortunately this administration has [1:29:36] chosen to put all its eggs in one basket, prioritized unconstitutional vaccine mandates and testing. [1:29:43] Yet comparing 2021 to 2022, COVID infections have increased 72% and deaths increased 27%. [1:29:54] This we know. If you look at this data, your current plan is not working. The current plan is not [1:30:01] working. We need therapeutics at warp speed. Ms. O'Connell, who is responsible for this failure? [1:30:08] Senator Marshall, thank you for that question. We are making six therapies available [1:30:16] to the American people free of charge. Who's responsible for the failure? [1:30:20] Senator Marshall, we continue to make therapies available [1:30:24] at warp speed to the American people. The Biden administration has allocated over 80 billion [1:30:29] dollars for testing and only 15 billion dollars on therapeutics. It's obvious that your plan has [1:30:35] failed. We can't keep throwing good money after bad money. This is insanity. We have to admit our [1:30:41] mistakes and go a different direction. Ms. McConnell, would you commit to an Operation Warp Speed for [1:30:49] therapeutics? Senator Marshall, thank you. Therapeutics are part of Operation Warp Speed, [1:30:55] and that's how we have the six therapies that we're currently making available to states free of [1:31:00] charge. They'll be available after Delta has already been come and gone, and also after, [1:31:07] of course, Omicron will be said and done as well. Dr. Fauci, 59% of Americans and 81% of Republicans [1:31:15] do not have a favorable opinion of you. Frankly, honestly, you've lost your reputation. The American [1:31:22] people don't trust the words coming out of your mouth. Every day you appear on TV, you do more [1:31:27] damage than good when it comes to educating the public on COVID. Suppose you were leading a team [1:31:33] in an effort to try to get people to stop smoking cigarettes, but every time your spokesperson goes [1:31:38] on television, over half the nation goes out and buys a pack of marbles. Wouldn't you stop that [1:31:44] person from appearing on national television? Once again, Senator Marshall, I believe that's a real [1:31:53] distortion of the reality. If you look at everything that I've said on TV, it is to validate, encourage, [1:32:04] and get people to abide by the recommendations of the Centers for Disease Control and Prevention. [1:32:10] Look at everything I've ever said. Dr. Fauci, I understand that, but perception is reality. [1:32:15] Yeah. And you're hurting the team right now. You are hurting the team right now. Dr. Fauci, [1:32:22] you previously told this committee under oath that NIH and NAIAD have never funded gain-of-function [1:32:27] research with the EcoHealth Alliance. However, a report from the Department of Defense Inspector [1:32:34] General released yesterday states that EcoHealth Alliance proposed DARPA in 2018 seeking funding to [1:32:41] conduct gain-of-function research on bat-borne coronaviruses. This proposal, named Project [1:32:47] Diffuse, D-E-F-U-S-E, was rejected by DARPA because the project didn't address the current [1:32:53] research's potential to violate the gain-of-function moratorium. The proposal does not mention or assess [1:33:01] potential risk of gain-of-function research. That's a direct quote from the DARPA rejection letter. [1:33:07] The same proposal rejected by DARPA for gain-of-function [1:33:10] potential was not rejected but by NIAID under your leadership. You funded Project Diffuse and [1:33:19] its research that took place at the Wuhan Institute of Virology. Why did you tell the committee that your [1:33:25] agency has never funded gain-of-function research? Why did your agency award this grant despite it being [1:33:31] rejected by DARPA due to its concerns about violating the moratorium that was in place? And finally, [1:33:37] will you commit today to release all records fully unredacted by the end of this week so Congress and [1:33:43] the American people can know the truth about NIH's role and the origins of COVID-19? [1:33:50] So again, Senator, it really pains me to have to just point out to the American public how absolutely [1:33:58] incorrect you are. What came out last night on Project Veritas was a grant that was submitted to [1:34:06] DARPA. Then it distorted and said, we funded the grant. We have never seen that grant and we have [1:34:15] never funded that grant. So once again, you are completely and unequivocally incorrect when you [1:34:23] joined the DARPA proposal was a grant that we never saw and we did not fund. So you are incorrect. [1:34:31] Our social media will have all the supporting documents and we'll be supporting these through [1:34:35] the record as well. Senator, you are backing down on this? Why don't we go and look at [1:34:41] the Veritas statement? They were talking about a grant that was submitted to DARPA. Are you saying this [1:34:47] is not, are you saying that this was viral gain-of-function research? I'm telling you that you're saying [1:34:52] that we funded the DARPA grant. Are you saying that this was not viral gain-of-function research? [1:34:55] By the definition that you are very well aware. Your P3CO definition is just a legal ease to get [1:35:02] away to allow you to do the viral gain-of-function studies. Senator Marshall, if you'll please allow [1:35:07] the witness to respond. Senator, we know and the misinformation that the guide rails for what can [1:35:15] be done or not were not established by me. They were established by a three-year process led by the [1:35:23] Office of Science and Technology Policy of the White House. And decided by you in a secret meeting at the [1:35:28] White House in December of 2019. Senator, that is incorrect and this refers exactly to what I was [1:35:37] talking about in response to Senator Rand Paul. You are incorrect completely and every time I try to [1:35:46] explain- You keep saying you're incorrect but the facts are on my side. So why would you not commit to [1:35:51] sharing everything open, unredacted with this Congress? So here's an example- Dr. Fauci, this [1:35:58] hearing is critically important to the American people. There are millions of people infected with [1:36:04] the COVID virus. It is impacting every part of our economy. Every family is asking for answers to [1:36:11] critical questions. Both sides of the aisle have asked tough questions, but we are not going to allow [1:36:17] this committee hearing to be another personal attack that undermines our ability to deal with this [1:36:25] terrible virus that is impacting so many people. I will then turn to Senator Smith. Thank you. [1:36:30] Thank you, Senator. Thank you. Thank you, Chair Murray. And I'll just let that go. [1:36:42] So as we move into the third year of the COVID-19 response, it seems to me that our strategy is [1:36:48] shifting. We are shifting from a goal of trying to get to zero COVID cases to eradicating the virus. [1:36:55] And our goal is really much more about minimizing the damage of this pandemic. You and I have talked [1:37:01] about this, Dr. Fauci, as well as with Dr. Walensky. So we need, of course, to minimize hospitalizations [1:37:07] and deaths caused by COVID. We do that through vaccines and through therapies. We also need to minimize the [1:37:13] COVID damage by understanding how to keep kids in school, how to keep businesses open and how to protect [1:37:21] against the damage that is caused by social isolation and burnout and other stresses that injures our [1:37:28] mental health. It seems to me that while this is happening, while COVID continues to seriously stress [1:37:35] our health care system, and while we still have people in this country, including, sadly, [1:37:40] some members of Congress who continue to spread misinformation and lies about the pandemic. [1:37:46] So it seems like we have to be realistic that these cycles of the pandemic until it becomes endemic [1:37:53] are going to continue. We're going to probably continue to see some unpredictable variants arise. [1:37:58] Madam Chair, I just want to say that I hope that this committee can find some time to discuss [1:38:03] these issues as they relate to global vaccine strategy, because this is going to be crucial to [1:38:11] our work to protect Americans' health as we go forward, since we are not an island. But let me ask, [1:38:18] I'm very interested in how we think about, like, the data that is important for Americans to keep in [1:38:24] their minds as they're trying to measure relative risk. Last week, public health experts published some [1:38:31] interesting articles that suggested that we should maybe think about incorporating COVID-19 data into [1:38:38] aggregate risk for all respiratory viruses that are circulating, including the flu and RSV. And, you [1:38:44] know, that maybe this data, if we could look at it in real time from medical facilities and ERs and so [1:38:49] forth, testing facilities, private homes even, would give us a better picture of what's happening. [1:38:56] So let me ask Dr. Wolenski and Dr. Fauci, if you could talk a little bit, I want to understand about this, I [1:39:02] want to understand how you think about this question of relative risk, how we should be transitioning and [1:39:07] what we consider from daily case counts, for example, to looking at other data, and particularly how you [1:39:16] evaluate this idea of looking at all respiratory illnesses in one basket. [1:39:21] Yeah, Senator Smith, this is such a critically important question. Thank you for raising this. So [1:39:27] we have to do two things simultaneously. Right now, we're dealing with an Omicron surge where we have [1:39:32] the most number of cases we've ever had in a day in this country. And so we have to get out of this [1:39:37] Omicron surge. But in the meantime, we have to look down the field and we have to understand what is this [1:39:42] going to look like when we're not in a surge? How do we deal with endemic disease? And what do we start [1:39:46] looking at with regard to endemic disease? And you're absolutely right. We need to think about the [1:39:51] severity of that disease because now with 62% of Americans vaccinated, some of that disease is not [1:39:57] as severe as it was. That's a success of our vaccines. We have to look critically at hospital [1:40:01] capacity. What can our hospitals handle? Because if people are coming in with COVID or if hospital [1:40:07] staff are out with COVID, that's a really important measure that we're going to look at. And one of the [1:40:12] things we probably still are going to examine, although perhaps with less import, is the actual number of [1:40:18] the cases. And why that's important in general is because it generally foreshadows what's coming [1:40:23] into the hospital. So knowing that and understanding what that might mean for the future of hospitalizations, [1:40:28] future severity, future capacity. And all of those are things that we're looking at right now. But one [1:40:33] of the things that you critically mentioned was our efforts in data monetization. How do we take the [1:40:38] efforts that we've had so far with COVID and increase them, continue to keep the pedal to the metal, [1:40:44] as it were? When we started here, we were not collecting racial and ethnicity data. We didn't [1:40:50] have a way to link in a personal, with personal identifiers removed, electronic health records with [1:40:59] our testing records. We had 187 hospital systems who could do that. Now we have 10,000. So what we [1:41:05] really need to do is scale up our data monetization efforts and do it, as you say, not just for COVID, [1:41:11] but and not just for other respiratory diseases like flu, RSV, as you note, but for all diseases. [1:41:17] So we're looking at doing this for maternal mortality, for sickle cell disease, for opioid [1:41:23] injury, for many, many diseases. And this is going to be the power of our data monetization efforts. And [1:41:29] I'm really grateful for resources from Congress to be able to leverage those. Thank you. [1:41:33] Thank you. Madam Chair, I believe I'm out of time, but I'll have other questions if we have a second round. [1:41:38] We will have a second round. Senator Tuberville. Thank you, Madam Chair. Thank you for being here [1:41:44] today. You know, this administration has been in charge of the federal COVID response for a year. [1:41:52] I have to say, I don't think it's been a job well done. Our federal government not only sets the tone [1:41:58] and the guidance for how millions of Americans should be handling COVID, we set the standard for [1:42:03] the world. Our information has to be correct. I continue to hear that we need to follow the science, [1:42:10] and I agree. But we have to yet hear the clarity from this administration. We hear conflicting [1:42:20] guidance across the board. In order to be effective, guidance has to be understood and implemented [1:42:26] by the average American. But most Americans can't make heads or tails of anything [1:42:32] coming out of this administration. So we are all, all of us are failing this test. One thing I do know [1:42:40] is that when we finally, toward the end of this thing, Congress is going to have an investigation. [1:42:46] We all know that. We've heard that the FDA and President Biden say 55 years will be needed [1:42:53] to share data related to a lot of those decisions. But we will have to investigate. [1:43:01] This group will have to investigate and have the information before 2076. Heck, most of us won't be here [1:43:07] in 2076. This investigation will look into who had authority to make decisions. I know there are more [1:43:15] people making decisions behind the scenes. So what I'd like to know is, I'm just concerned how badly [1:43:24] the response has been. It's handled, you know, President Biden's handled this in his first year. [1:43:28] We've heard all the pluses and minuses. This administration took office with three successful [1:43:34] vaccines and numerous effective therapeutics and basically drove the response into a ditch. [1:43:39] At times, it doesn't seem like anyone's in charge. You started the year by dismantling [1:43:44] Operation Warp Speed, canceling contracts for monoclonal antibodies, underinvesting and testing, [1:43:50] and we've spent billions in that. First with Delta, now Omicron. People can't find a test. I'm getting [1:43:56] texts as we speak, sitting here, where do I get a test? We spent billions on this. You know, [1:44:02] if we can't find a test and test positive, they can't get treatment. Monoclonal antibodies are [1:44:08] rationed. Antiviral pills are months away. So I just got a simple question. Of all of you up there, [1:44:15] and whoever wants to answer this, if you have a problem and you're coordinating, who do you go to? [1:44:20] Who is the head coach of this virus that you have to go to, whether it's an administration, [1:44:27] whether it's one of you? Dr. Fauci, who do we go to? [1:44:30] The person who's in charge of that is Jeff Zients, who is at the White House. And we meet [1:44:40] very, very regularly, the entire medical team, as well as others, going over all of the data, [1:44:45] going over what the strategies are, going over what the issues are, what the problems are, [1:44:50] what we've done right, what we've done wrong. We examine it literally continually, sir. [1:44:55] Has he done a good job? No, I think given the circumstances that we're in right now, [1:45:00] I believe he's done a very good job. I really do. This is an extraordinary virus, [1:45:06] the likes of which we have not seen even close to in well over 100 years. It is a very wily virus. [1:45:13] It has fooled everybody all the time, from the time it first came in to Delta to now Omicron. [1:45:20] Very unpredictable, and we're doing the best we possibly can. [1:45:23] Yeah. Dr. Walensky, it's been reported by some virologists and scientists that this year, [1:45:28] around 170 people have died from taking the regular flu vaccine. The Vaccine Advisory [1:45:36] Adverse Reporting System reported that the number of people dying after or following the COVID vaccine [1:45:42] is actually in the thousands. Now, this is what I'm hearing. I'll give you a chance to refute that [1:45:49] or confirm it here. You know, is this true? Are we having that many people die after taking one of [1:45:56] these vaccines? Senator Tuberville, thank you for that question. The Vaccine Adverse Event Reporting [1:46:01] System is a mandatory system of any adverse event that happens after being vaccinated. So if you get [1:46:07] hit by a car tragically after getting vaccinated, that gets reported in the Vaccine Adverse Reporting [1:46:12] System, their system. So the vaccines are incredibly safe. They protect us against Omicron, [1:46:19] they protect us against Delta, they protect us against COVID. They don't protect us against every [1:46:25] other form of mortality out there. Do we keep numbers of people that died following taking a COVID [1:46:30] test from taking this vaccine? Do we have any idea? I'm just asking. I'm sorry, those who have died [1:46:36] after taking a COVID test? Died following taking the vaccine. Is there any number count? Do we keep [1:46:41] records on that that died of just from? Absolutely, yes. I couldn't give you the absolute number off the top [1:46:47] of my head, but our staff could absolutely get back in touch with you. We collect this data. You know, [1:46:51] Dr. Fauci, do you have any clue on that? A hundred? I don't know the number, but I really, you can [1:47:00] turn on your microphone. Microphone. Sorry. I don't have a number, but I think part of the confusion is [1:47:06] that when you do a reporting, if you get vaccinated and you walk out and get hit by a car, that is [1:47:14] considered a debt. I mean, that's the thing that gets confusing, that everything that happens after the [1:47:20] vaccination. Even if you die of something completely obviously unrelated, it's considered a death. [1:47:27] So if I had metastatic cancer, got vaccinated and died two weeks later, that's a death that gets [1:47:33] counted. I understand that. And every one of those is adjudicated. Yeah. And one quick question before [1:47:37] we get through here. I'm in rural Alabama, but I get one of these home tests and I test positive. [1:47:42] I have asymptomatic. What do I do? People call up, what do I do? I don't have a doctor around. What do I do? [1:47:51] Thank you. So you're asymptomatic. You're asymptomatic. No symptoms feel well. [1:47:57] Yeah. You stay home for five days and the next five days, if you continue to be asymptomatic, [1:48:01] you can go out, wear a mask, don't go traveling, don't go to gyms, don't go restrooms. But I get [1:48:06] real sick, then what do I do? Then, well, first you go and call your physician. And in fact, [1:48:10] I'd say you call your physician regardless, but call your physician, call your provider. [1:48:14] If you're continuing to have symptoms, then you stay home until your symptoms resolve. No therapeutics. [1:48:20] Well, that's where I would say call your physician and see if you're eligible for therapeutics. [1:48:24] A lot of these people don't have physicians. They've got a drugstore. [1:48:26] Senator, we do need to move on. Thank you. Senator Rosen. [1:48:31] Thank you, Madam Chair. Thank you, Ranking Member Burr. This hearing is so very important. I really want [1:48:37] to thank all of the witnesses here for testifying today, your continued work. Thank you so much as we [1:48:44] combat this pandemic in real time, in real time. And so first, I just do want to echo the concerns. My [1:48:51] colleagues have raised about access to testing both in-person PCR tests and the at-home rapid tests. [1:48:58] We do know that home test kits are scarce. Americans are standing in extremely long lines [1:49:03] to get a COVID test. And hospital emergency departments in my home state of Nevada have [1:49:08] seen a significant increase in people coming solely for tests because there just aren't enough [1:49:14] alternatives. And so this is just really only adding to the stress as, again, I can say, speak to Nevada [1:49:21] on our health systems. Nevada's been expanding our testing options, but increased federal support on [1:49:26] the ground in addition to home testing we feel is absolutely critical. And in the future, the federal [1:49:33] response must be more proactive in this space. And so I'm a little bit concerned about the testing [1:49:40] keeping up with the variants because this is all happening in real time. COVID is evolving. You don't [1:49:45] know which strain may become the dominant strain. And so we want to ensure just in addition to the [1:49:52] effectiveness of the vaccines and therapeutics that the testing accuracy must also keep up. So Dr. Fauci, [1:50:00] with some recent reports about the current variant settling more in the throat than in the nose for [1:50:05] some patients, what are we doing with the development and deployment of rapid at-home tests based on [1:50:12] saliva versus a nasal swab? And then Dr. Woodcock, how rapidly do you think the over-the-counting testing [1:50:20] can be delivered, approved, you know, looked at, approved, delivered to the American public to make sure [1:50:26] that they're less anxious? Thank you for that question, Senator. Yes, there have been recent reports [1:50:32] reports that, in fact, the sensitivity and the ability to detect in a swab of the throat versus [1:50:41] the nasal pharynx, at least with Omicron, that's the preliminary report. I think it needs to be [1:50:47] validated and verified. If the data are strong enough, then the company, whatever who makes that, [1:50:54] will likely go to the FDA to ask to change the indication because the emergency use authorization [1:51:02] is for a nasal swab. If the data, the scientific data indicate that it is better to get an oral [1:51:08] or other swab, they would present that to the FDA. So I would leave that to Dr. Woodcock to answer the [1:51:14] rest of that question. Thank you. Certainly. Well, we can act very rapidly, but first I would like to say [1:51:21] people should not use swabs that are designed as nasal swabs and try to swab their throat. They may [1:51:27] stab themselves, okay? That would not be good, okay? What we need to do is have tests that, you know, [1:51:35] see whether the throat swab, as Dr. Fauci said, could provide more sensitivity. We do know the tests [1:51:44] are picking up Omicron, but right now with less sensitivity than they did some of the other variants. [1:51:51] As far as time, as I said, after the ITAP program does the testing at NIH, FDA has been able to [1:52:02] authorize within a day or two of getting those data. However, the companies would have to change [1:52:09] the test configuration to accommodate the swab, the larger swab that you'd use in the throat. [1:52:16] That's probably what would take the most time as well, seeing whether that was better. [1:52:20] And to continue with that point, as we've seen with some of the testing, the reagents or the [1:52:28] materials that it really takes to use the test, is there the ability for people to return a test [1:52:34] that might no longer work? Can those agents, any of that, be recycled or upcycled if they're returned to [1:52:40] the company on open? Like how can, how do we not dispose them and not get some recyclability out of [1:52:48] that? Is that possible in some way? We can get back to you on those parameters. We'd be happy to do that. [1:52:54] Thank you. I appreciate that. I'd like to talk a little bit again, people are talking about the public [1:53:00] health data. You know, we're noting about all the daily statistics. We're noting about some of the [1:53:07] statistics about possibly death. And so positive or negative, critical, this data is critical even [1:53:15] for us to make our decisions as far as what we fund. And sometimes there's notes to say that we [1:53:21] shouldn't include home testing in the daily statistics because they might not be reliable. [1:53:25] So Dr. Walensky, to build on some of that testing and the statistics that you need to do your job, [1:53:31] that all of us need to do our job, how is the CDC working with the state, local health, our hospitals, [1:53:37] to be sure that the voluntary self-reporting guidance is going to be accurate and give us the [1:53:44] kind of statistics we need going forward? Yeah, thank you for that question, Senator. So we are [1:53:50] routinely reporting PCR tests. That is what is routinely reported from the state and that is what our [1:53:55] updated statistics are. There are, there's passive reporting that occurs with rapid tests, but I also [1:54:00] want to understand the importance of rapid tests, at-home tests, for people to be empowered to use [1:54:07] these rapid tests to do the right thing. So regardless of whether we can count them, generally they tend to [1:54:12] be people who have milder symptoms. They might have been vaccinated, have a runny nose, and they decide to [1:54:17] go and get a rapid test and do the test at home. Less important is counting that case than it is that [1:54:24] that person stay home, isolate, do the right thing, and not before transmitting. So I think that many of these [1:54:29] tests have different purposes, but one of the really important purposes of these rapid tests, [1:54:34] even if we don't count them, is to empower the public to do the right thing through this pandemic. [1:54:39] Thank you. Thank you very much. Senator Romney. [1:54:41] Thank you, Madam Chairman. Just a couple of thoughts. One, it's been two hours since we've been [1:54:53] here. It's one of the people at the low level here out in the hinterlands. Just a couple of thoughts. [1:54:59] One, I think it would be helpful if the – please excuse me for this comment – if the chair and [1:55:04] ranking member limited their opening comments to the five minutes, just like you expect those folks [1:55:10] to limit their comments to five minutes. We didn't get started until 25 minutes after asking these [1:55:14] folks their questions. I do want to note also that in this process, as I'm sure you who are testifying [1:55:23] here today, recognize that some of what we do is performing, and some of what we do is to become [1:55:29] informed. And I do both from time to time, so I'm not just in one camp or the other in that regard. [1:55:36] But I do want to point out how much I personally, and I believe the great majority of the people in [1:55:42] our country, respect you individually and professionally for the work that you do. [1:55:47] You are scientists, not politicians. Nevertheless, you are being made subject to the political whims [1:55:56] of various political individuals, and that comes at a high cost, which unfortunately, I fear, [1:56:03] will lead some to not want to participate in helping our government make scientific choices. [1:56:11] But I very deeply appreciate your commitment to the American people and your desire to do things as [1:56:16] well as we possibly know how to do. That doesn't mean they'll be done perfectly. That doesn't mean [1:56:21] you won't make mistakes. It doesn't mean there won't be changes from time to time. Sometimes [1:56:25] this data comes in that's different than what you had anticipated. And sometimes just because you [1:56:30] are wrong. I mean, it's the nature of being a human being. That's where we are. I think, [1:56:35] unfortunately, the administration was wrong in not building testing capacity at a time when [1:56:43] when we all thought COVID was kind of going away. I remember the summer and the fall, [1:56:48] going into a grocery store, excuse me, into a drug store and seeing two rapid tests on the shelf. [1:56:53] And those things stayed there for days. No one was interested in buying a rapid test. And apparently, [1:56:59] the administration didn't think that it should be aggressively building rapid tests. Omicron came [1:57:05] along, caught people by surprise, and we were obviously badly mistaken. The administration was, [1:57:13] and we're suffering in part because of that. Let me ask with regards to Paxlovid. Ms. O'Connell, [1:57:22] is that being subject to warp speed? My understanding is that Paxlovid is far superior [1:57:29] to other oral antivirals. Should we not be much more aggressively producing that and getting that out [1:57:35] such that it can be prescribed? Thank you, Senator Romney. We're in active conversations with Pfizer [1:57:40] about how to increase their time limits. My understanding, and the scientists on the panel [1:57:47] can feel free to jump in, is that the process required in order to generate this particular [1:57:52] antiviral is months long. It's a chemical process. It's one that's very, very hard to accelerate. [1:57:57] What we have been able to do is to find additional doses to work with Pfizer to try to unlock additional [1:58:03] capacity where they can find it. And we're continuing to do that actively. [1:58:09] Thank you. Dr. Walensky, good to see you again, and appreciate the chance we had to speak earlier [1:58:15] this week, or last week, rather. As I've looked on the CDC's COVID tracker report, I know the data goes [1:58:22] through November 20th, and I remember my days in business. If we didn't have daily information, [1:58:28] we couldn't make good decisions. And I wonder, do we need to invest in either developing a new [1:58:35] sub-agency or a task force to get basically immediate data, daily data, so we know what's [1:58:44] going on? And that's not just for the public. That's for those of you who are making those decisions. [1:58:48] Do we need to do a much better job moving faster, getting data? [1:58:51] Senator, first of all, let me thank you for your earlier comments, but also to comment on our COVID data [1:58:56] tracker. I think you're speaking to the 27 jurisdictions that we now compile data that [1:59:02] allows those jurisdictions to report together their testing data, their cases data, their [1:59:08] immunizations data, their age data, as well as their death data. It's over two-thirds of the country [1:59:14] that we do, and we update that about once a month, and it's about three or four weeks in arrear. So [1:59:19] mid-January, we will be having data through the end of December, and it simply does take that long [1:59:24] for our jurisdictions to compile those data. And of course, our death data are generally lagging. [1:59:28] It takes a while for those to get reported and adjudicated. So we're now updating those. They're [1:59:33] about six weeks in arrear, and we're working hard to keep those in real time. [1:59:39] Yeah, I know retailers like Zara, for instance, they apparently get data and correlate it daily. [1:59:47] So I'd hope we could find a way to increase the speed with which we get that data. I know my time is up. [1:59:52] I'm just going to make a comment, and that is that I think it would be helpful if people knew [1:59:57] when they should get tested, when it's called for, because I think a lot of individuals, [2:00:03] myself included, get tested when there's no indication that I need to get tested, [2:00:08] other than just want to make sure I'm not sick. And there's huge demand for tests, [2:00:12] which are in short supply in part because of that. And number two, when you say when people have been [2:00:16] exposed, please let us know what it means to be exposed. We're in a room right now. I'm sure someone [2:00:21] here has Omicron. Are we all exposed and therefore need to get tested? What does it mean to be exposed, [2:00:29] and when do we need to get tested? I know that I wanted to ask that of Dr. Fauci. I can't do that [2:00:34] given my time. Those are topics I'd love to have elaborated on. Senator Romney, I think that is a [2:00:38] question we all want answered, and I will give Dr. Fauci the opportunity to respond to that. [2:00:44] Dr. Fauci? Well, the CDC guidelines make that very clear, and it is if you are exposed to an [2:00:52] individual with known, if you are in a period of 15 minutes at a time or a total of 15 minutes over a [2:00:59] 24-hour period in a situation where you come into close contact. Perhaps Dr. Walensky could expand on [2:01:05] that, but that's the fundamental core of the CDC guidelines. That's exactly right in terms of the [2:01:11] definition of exposure in terms of who should get tested. You should get tested if you have symptoms [2:01:15] of COVID-19. If you do a rapid at-home test and you continue to have symptoms and that test is [2:01:21] negative, you should do another test or get a PCR. You should get tested within five days of your [2:01:26] exposure or after five days of your exposure with the definition that Dr. Fauci mentioned. And, [2:01:33] you know, we're testing through test to stay and other mechanisms as well. So [2:01:37] many reasons to test. But really, most importantly, if you are exposed, if you have symptoms, and also [2:01:45] if you're going into a setting where you might be seeing an immunocompromised person, somebody who's [2:01:49] vulnerable, not able to be to take a vaccine. Thank you very much. Senator Casey. [2:01:56] Chair Murray, thank you very much for this hearing. And I want to start by commending the public service of [2:02:04] all of the members of the panel, Dr. Walensky, Dr. Fauci, Dr. Woodcock, and Assistant Secretary O'Connell. [2:02:11] This is difficult work, and we appreciate your public service. In particular, I want to reiterate [2:02:19] statements I think I've made, had to make before in light of Dr. Fauci's commendable public service, [2:02:27] not just in the middle of this pandemic, throughout the pandemic, but also for decades. I think I speak for [2:02:33] a lot of people back home and across the country that not only have confidence in your integrity, [2:02:41] but also your work in public health. And so we're grateful for that. Let me start with a question [2:02:50] for Dr. Walensky. Dr., I'm quoting from a statement you made on Friday on television in the context of a [2:03:00] question about COVID-19 deaths, and I'll quote two sentences. One is, quote, the overwhelming number [2:03:09] of deaths over 75 percent occurred in people who had at least four comorbidities. So really, [2:03:19] these are people who were unwell to begin with, and yes, really encouraging the news in the context of [2:03:27] Omicron, unquote. Now, this statement, and I know it was part of a broader interview, [2:03:33] caused great concern. I know from my work as a senator for years that you and your team at CDC, [2:03:45] whether it's the policy or the work that you do, that policy and that work are both focused on [2:03:52] ensuring that all Americans receive the best possible treatment and protection. This is [2:03:59] especially important for older adults and people with disabilities who may need additional supports [2:04:07] and protections. So context is important in an interview like this. So please explain what point [2:04:16] you were making. That's number one, the point you were making. And secondly, outline CDC's commitment [2:04:22] to protecting older adults and people with disabilities as we continue to address the pandemic. [2:04:28] Senator Casey, I'm really grateful for the opportunity [2:04:32] to explain this. And, you know, to step back that interview on Friday, I recently spoke to a study [2:04:39] on the high level of protection against vaccines. It was a pre-taped interview and much of it was cut, [2:04:44] and that phrase was taken out of context, as you note. The study was a cohort of 1.2 million people [2:04:51] who were vaccinated and 36 people passed, demonstrating the remarkable effectiveness of our vaccines. [2:04:59] But no less tragic is the 36 people who passed because of COVID-19, and that many of them had [2:05:07] comorbidities, comorbidities that I've spent my career taking care of, comorbidities that just prior [2:05:13] to coming to the CDC, we saw time and time again, disproportionately impacting people with COVID-19 and [2:05:19] the hospitals that I cared for patients. So what are we doing at CDC, given the critical importance? [2:05:25] Well, we have toolkits for COVID-19 for patients with disabilities. We have accessible materials [2:05:31] that are available in Braille, in American Sign Language, so that people with disabilities in easier [2:05:37] to read and understand language, so that people with disabilities can access our materials. We have [2:05:43] improved data collection systems on our COVID data tracker. You can track vaccination status by [2:05:48] disability. And we've worked with states to make sure that those are reporting. And then we're funding [2:05:52] partners and our public health partners to do more for patients with disability. And if anything, this [2:05:58] issue on Friday has redoubled our commitment to continuing to make sure that we have access for [2:06:03] people with disabilities. Thank you for allowing me to clarify. [2:06:06] Well, I appreciate that, and I appreciate the time it took to respond. I would also suggest and maybe even [2:06:14] ask you to spend some time meeting with leaders from both the disability and aging communities to walk [2:06:20] through what you just walked through and even expand beyond that. [2:06:24] We're already planning. Thank you. [2:06:25] Thanks very much. I want to turn now to vaccine development for children. The recent setbacks in [2:06:33] vaccine trials for children under five is of great concern. So many parents are exhausted from this [2:06:40] pandemic. So I know we can't change the outcome of the trials, but we can take steps to reassure parents [2:06:48] that their young children will still get vaccinated as soon as possible. Dr. Fauci, Dr. Woodcock, [2:06:55] if you could briefly talk about these trials and anything you can tell us about speeding up the [2:07:05] development of safe and effective vaccines for children under five. Thank you for that question, [2:07:12] Senator. I'll take a quick shot at it and then pass it over to Dr. Woodcock. The situation that I believe [2:07:19] the public needs to understand is that the trials from children from six months to four years was [2:07:24] broken up into two groups. It was six months to 24 months, 24 months to four years. And in the dosage [2:07:32] that was used, the individual, the children, the younger group, the trial met the endpoint of non-inferiority, [2:07:41] comparing it to what would be the standard of what would be success. However, for the middle group, [2:07:47] the 24 months to four year group, they did not meet that standard of non-inferiority. [2:07:54] So because of that, it was felt that this likely will be a three dose vaccination for children in [2:08:00] that group. So the trials are being done now as quickly as possible to see if they can get that data [2:08:07] to have a uniform dose and a uniform regimen. But I'll pass it over to Dr. Woodcock. [2:08:13] Yeah, well, of course, I can't say a lot. But we are working very closely with the manufacturers, [2:08:18] the vaccines on accelerating and making sure that vaccines are available for the youngest children. [2:08:26] Thank you very much. [2:08:27] Thank you. Senator Murkowski. [2:08:29] Thank you, Mr. Chairman. Madam Chairman. [2:08:32] It says a lot about 2021 when the most appreciated gift under the Christmas tree [2:08:40] in our family was COVID kits for everybody. I'm still getting thank yous for those. [2:08:47] Dr. Walensky, there has been a lot of discussion here today about some of the confusion with guidance [2:08:55] and just some very clear asks to tell us what that is. So a question that I'm going to forward [2:09:05] to you from a teacher is if the teacher is fully vaccinated, boosted, test positive for COVID, [2:09:16] but after they test positive, they feel pretty fine. There's no fever, there's no nothing. After five [2:09:23] days, can that teacher return to school without testing negative just so long as that individual [2:09:32] wears a mask? Yes. Thank you, Senator. [2:09:35] That's exactly what I needed to know. I'm going to be having a meeting, a Zoom meeting later this [2:09:41] afternoon with several different Alaska-based companies that have more than 100 employees. [2:09:50] They're quite concerned about the mandate that requires testing of unvaccinated employees. We all know [2:10:00] that this is under litigation now and things may change on that, but right now their real concern is [2:10:08] if this goes into place and we are required to ensure that these unvaccinated individuals receive [2:10:18] testing, right now testing all around the state is in limited supply. The front page of the Anchorage [2:10:25] Daily News shows the line of cars that are waiting to get their PCR tests. You can't find the at-home [2:10:35] tests available in the stores now. It is becoming harder and harder. And then again, if you really do [2:10:45] have a mandate in place, it's going to require this. So I know that the question has been asked about what [2:10:50] is being done. I know we've heard the extraordinary federal resources that have gone that way, but the [2:10:58] facts on the ground remain that we are in an extraordinarily short supply of testing, whether [2:11:06] it's the at-home kits or whether it's the ability to get the testing that you need. It's cold back home [2:11:15] right now and my hearts go out to those workers who are working in the outdoor drive-in where they have [2:11:23] to go out when it's 20 below as it is in Fairbanks. That's more of a statement rather than a question [2:11:34] there, but I think it is important for folks to realize that we are still in a very difficult place [2:11:40] when it comes to accessibility. Dr. Walensky, this is a question for you and you and I have had many [2:11:46] conversations last year about the specific impact of conditional sale orders as it relates to the [2:11:53] cruise industry. That industry was effectively shut down for all of 2020 and we were able to salvage a [2:12:04] bit of it as things relaxed last year. But in fairness, the industry itself has undertaken extraordinary [2:12:12] precautions as one industry to make sure that people are protected from from this virus. So the [2:12:19] question to me to you is I want to make sure that Alaskan communities and businesses can can have a season [2:12:28] this coming year. And right now people are making their decisions as to whether or not to book a trip [2:12:34] to Alaska for the summer or not. I understand the conditional sale order is is set to expire in a few days [2:12:42] in recognition that the companies have practices that adhere to or even exceed the guidance in the order. [2:12:50] So I I guess I'd like some assurance from you that that they can count on that that that this is clear [2:12:59] guidance and messaging to uh to those within the industries and and to those who are counting on [2:13:05] being able to to have a season this coming summer. Yeah thank you senator and I think the conditional sale [2:13:11] order and the fact that the industry has stepped up and is now interested in doing and exceeding as [2:13:17] you know to the the compliance with the sale order without the order even necessarily needing to be [2:13:22] in place is a is a real testimony to how well that has worked and how we've worked collaboratively with [2:13:26] the industry. What I can say is that you know just over the last two weeks with Omicron we've seen a 30-fold [2:13:33] increase in cases on ships um during this season because of Omicron so while I um anticipate that [2:13:41] with ships following conditional sale order we still will continue to follow do the oversight and watch [2:13:47] and do all the technical assistance and support in every single way. We anticipate that this order will [2:13:53] not be renewed and that the cruise ship industries will continue to understand that this is a really safe [2:13:59] practice for those industries. What I can't predict is what the summer will bring. I understand that but for [2:14:04] right now you expect this guidance to stay in place. That's my anticipation. Thank you. Thank you [2:14:09] madam chairman. Thank you. Senator Hickenlooper. Now it's on. Thank you madam chair and ranking member chair. [2:14:24] First I want to reiterate a little bit of what about what Senator Romney said um you know I was the odd [2:14:33] one out I was uh worked as a scientist for a number of years then I was a mayor of a big city and was [2:14:38] pretty much the only scientist among all the bears. I was a governor and pretty much the only scientist [2:14:43] around governors and now I'm one of the only scientists among uh senators and I recognize from that [2:14:53] long list of experience the frustration that you must feel having to put up with the attacks and assaults [2:15:02] when you're out there trying to do your job and something that each of you have committed to is [2:15:08] it the service of society uh anyway I just want you to know that I appreciate how difficult science is [2:15:19] it's not perfect and when you combine that with the complexity of dealing with any large bureaucracy [2:15:25] I'm not making apologies these are just like you know just like any well we're having a war against [2:15:33] this virus and just like in any wartime situation mistakes have have serious consequences but I [2:15:39] appreciate more than I can say how much work you all have done and and I don't think anyone here [2:15:47] thinks you're not trying your very best all the time uh really appreciate that uh Dr Fauci uh I think [2:15:54] one of the problems we haven't gotten far enough on is innovation and how do we stimulate innovation to go [2:16:00] faster and better how do we increase the not just the breadth of our vaccines but the durability so [2:16:06] that as we get the next wave I'm I'm not sure how many letters there are in the Greek alphabet but I [2:16:12] know there's going to be another one and in that process because I think we are this country is known [2:16:20] for innovation it is one of the tools that we have that we know will work I'm hoping that it will you [2:16:27] can take the opportunity to be a little bit optimistic and feel that you're not going to be judged and held a [2:16:32] accountable because I think people want to hear that we are going to come through and begin to look at [2:16:36] some of these things successfully yeah well well thank you very much senator for your original kind [2:16:41] comments and I'll answer your question now as you know as a scientist that there are fundamental basic [2:16:49] issues that are discovery that once you get the discovery then you could do the implementation of [2:16:55] that discovery we were very fortunate in that the basic research and clinical research investments [2:17:02] that had been made literally for decades prior to the new revelation that we had a very threatening [2:17:12] virus among us was the reason why we were able to use new platform technologies as well as immunogenes design [2:17:20] to get highly successful and safe vaccines that same thing is going on right now it isn't well known [2:17:28] because it isn't front page yet and you know as a scientist when you're doing your basic research [2:17:33] it's only until you get the result that people really understand what you've been doing there's [2:17:38] a lot of investment not only in improving the vaccines that we have for COVID for SARS-CoV-2 [2:17:46] but a lot of work as I mentioned in my opening statement about looking at using the tools of [2:17:52] fundamental basic and applied science to develop next generation of vaccines particularly universal [2:18:00] coronavirus vaccines or at least universal SARS-CoV-2 vaccines so we won't be chasing after the next [2:18:08] variant that we'll be able to have a vaccine that has the capability of responding to every iteration [2:18:15] of a variant and there's a lot of work going on with that right now but again when you're doing [2:18:20] basic research as you can appreciate as well or more than anyone that usually isn't very well recognized [2:18:26] by the public point made in terms of testing and a parallel thought dr woodcock maybe you can address [2:18:36] this the testing now is by the time it gets to the retail is somewhere in the 15 to 20 dollar range [2:18:43] maybe as high as 22 or 23 dollars in some places uh is there the prospect of because i keep reading [2:18:50] about different approaches to testing that we might find a way to do reduce the cost of testing down to [2:18:57] set of instead of 15 dollars could be 15 cents or at least for the chemical side of it i realize then [2:19:04] you've got to manufacture it and put it in cases and you know packaging maybe you can provide a little [2:19:09] optimism on that sure well i believe the rad x program which congress provided funding for quite [2:19:16] some time ago um is really uh cutting edge and they have a sort of a shark tank approach uh they're [2:19:24] really looking for innovation they are they provide assistance to developers and i really believe that's [2:19:31] promising that we will come up with uh additional technologies are easier to manufacture and actually [2:19:38] easier for people to use and cheaper great thank you and i i have obviously more questions but i'll [2:19:44] i'll yield the floor back thank you for now senator braun thank you madam chair reading the paper last [2:19:53] night a lead editorial in the washington post and i about dropped it when i read the first paragraph [2:20:03] in the title of the editorial is living with covid quite understandably the coronavirus pandemic at first [2:20:11] was a dire emergency but it can't be one forever the crisis will have to shift to a manageable health [2:20:22] threat without massive disruption and overwhelming anxiety president biden has been fighting the virus [2:20:34] as an emergency in his first year but a shift must come before too long never thought i'd read anything [2:20:44] like that in a place like washington post but i think it reflects where we're at in the journey and [2:20:53] generally when you wrestle with something of this magnitude where it's dominated the conversation for [2:20:58] now two years and you're still seeing results similar to if not worse from when we started it would beg the [2:21:10] question do we need to take a different approach it's been very top down um been put in place i think [2:21:21] understandably by the agencies that would be most pertinent but when you look at the results you look at the [2:21:28] fact that a third of the country for whatever reason is not going to get vaccinated you got a mandate [2:21:37] that now is going to force the hand and when you get someplace like the washington post saying that [2:21:44] we got to take a different approach i'm wondering do we have it within our constitution here when we've [2:21:51] been bought in for so long that this is the way it's got to be listen to senator casey earlier made a very [2:22:01] good point everybody talks about data paying attention to the data and when this is so ravaged [2:22:10] such a small percentage so significantly of our population with comorbidities that are elderly [2:22:21] it just keeps saying why don't we change the approach you don't want to have the legacy of being [2:22:29] a country in disruption and full of anxiety and kind of what i'm hearing here today i'm not sensing that [2:22:41] we're going to see a real change in approach and even more so doubling down on what now for two years [2:22:51] has arguably not gotten us in a place where we feel better about it where we're not drowning in anxiety [2:23:00] and i'm going to pose the question to dr woodcock you've been involved in federal health care in one way [2:23:08] or another for a long time acting commissioner at the fda normally a board of directors a ceo [2:23:20] would be fired as a ceo number one a board of directors would be questioned in terms of how [2:23:26] good they are meaning maybe us here in the senate to where you're not directing for something other [2:23:34] than what we've had which in my opinion would be decentralizing it providing the information to the [2:23:41] american public to make their own best decisions dr woodcock you think that is sensible do you think the [2:23:53] washington post makes sense and are you willing to change up there on this panel to reflect accordingly [2:24:02] well i think that we're talking about a natural disaster and you can fire your board of directors [2:24:09] because your factory was devastated by a hurricane a tornado or a wildfire but i don't know whether that [2:24:17] would improve the situation i think right now we need to focus on continuity of operations for hospitals [2:24:26] and other essential services as this variant sweeps through the population i don't think that will last [2:24:35] a really long time but that's what i where i think we are right now so i don't think prior [2:24:42] you know approaches reflect what's going on right now i think it's hard to process what's actually [2:24:51] happening right now which is most people are going to get covered all right and what we need to do is [2:24:58] make sure the hospitals can still function transportation you know other essential services are not [2:25:04] disrupted while this happens i think after that will be a good time to reassess how we're approaching this [2:25:13] pandemic i'm out of time but i think if you want to regain the trust of the american public you [2:25:20] probably need to look at a total revamp on what we do in terms of how we contend with it over the [2:25:27] next year or so or i think you're going to get more forceful editorials from places that you would [2:25:33] never imagine if you keep doing the same thing generating the same results that isn't the formula for [2:25:39] success in any endeavor thank you senator baldwin thank you uh madam chair and i want to thank all of [2:25:51] our uh witnesses today and i also want to just um underscore uh the preface that uh our colleague senator [2:26:01] romney gave to his um his questioning um i i i like the way he described it sometimes we come to perform [2:26:09] sometimes we come to be informed and um i i guess i would just uh speculate a little bit beyond that [2:26:17] if there were to be a true tit for tat on the performance angle um there's any number of areas we [2:26:26] could go i reflect on uh proposals for ultraviolet light and drinking bleach and drinking uh hydro hydroxychloroquine [2:26:37] um we could go there but it's not constructive and so i'm going to be constructive in my questions [2:26:45] and i just urge my colleagues to do that we're all in this together and we have a duty uh to act [2:26:54] responsibly in that fashion and again thank you to our uh our witnesses um dr walanski i'm going to start [2:27:02] with you on a topic that i bring up frequently when you're uh in our presence and that is um uh the tools we [2:27:09] we have now to sequence uh do genomic sequences um to uh better understand variants to better track [2:27:18] variants um i know that there's been much investment in that i'd like to hear um uh what tools that we [2:27:27] have in place now that we didn't before and what you see the future of um this genomic sequencing is [2:27:34] especially as this committee looks at um pandemic preparation for future uh potential uh pandemics [2:27:43] um thank you senator baldwin and for your championing our ability to um to ramp up our genomic sequencing [2:27:49] efforts and the resources from the american rescue plan once at 0.7 billion dollars really did allow us [2:27:54] to detect omicron swiftly so maybe i'll just give you tell you the story of what happened with omicron and [2:27:59] that is we heard about this variant that was coming from south africa and we didn't know if it was here [2:28:05] yet but we did know it had this unique footprint of the s gene target failure on pcr so what we did [2:28:11] immediately after hearing about this is to enhance surveillance for this footprint um and do enhance [2:28:18] sequencing so that any uh sequence that had this footprint i shouldn't say any many sequences that [2:28:24] have this footprint we were specifically looking for um for this omicron variant within days [2:28:29] we found it um so within three days i think um that we started doing this enhanced surveillance and [2:28:35] then within days we had you know tens forties um by about four days later by december 5th is [2:28:42] when we started detecting it in our background genomic sequencing so that background genomic [2:28:46] sequencing now does tens of thousands of sequences a week it's a collaboration with academic partners [2:28:52] industry commercial labs cdc labs public health partners to do tens of thousands of sequences a week [2:28:58] and what we do is we look at the number of cases that are out there and our goal is to detect a variant [2:29:05] that is present at 0.1 percent with 99 confidence so that we see the menu of variants that are out there [2:29:14] we are enthusiastic about this program we are intending to ramp up this program for potentially other viruses [2:29:20] but the potential to do so there for other um foodborne outbreaks as well as for um wastewater um investigation [2:29:28] we have the capacity to do that there as well so again thank you for championing this effort which truly did [2:29:34] allow us to detect omicron in in real um record speed thank you thank you um next um assistant secretary [2:29:43] o'connell uh when we last met i i at this committee um i asked you for a commitment that a significant [2:29:52] portion of the 10 billion dollars for the defense production act funding that i helped secure as part [2:29:57] of the american rescue plan be invested in the raw materials needed to make n95 masks here in america [2:30:06] um the alarming spread of omicron has made the need for n95s um even more clear um and yet uh asper has not [2:30:18] spent any of this american rescue plan funding on the raw material needed to make n95 uh in n95s in america [2:30:28] while it has invested 3.1 billion on other priorities um primarily using prior supplemental funding [2:30:36] the fda reports now that 60 of the kn95 masks that are being imported from china are fake and americans [2:30:48] still can't go to a local pharmacy and purchase an american-made n95 so president biden has now [2:30:55] personally urged americans to upgrade the quality of the masks they wear i want to know when the american [2:31:02] people will be able to buy an american-made n95 mask that they know will protect them and when we can [2:31:10] expect asper to invest the american rescue plan funding into the raw materials necessary senator [2:31:20] baldwin thank you for that question you can buy an n95 mask manufactured in america now we have 737 [2:31:27] million of those in the strategic national stockpile we are also in the process uh this month we hope to [2:31:35] award or next month you know as contracts go uh to award an agreement for warm-based manufacturing of n95 [2:31:44] masks what we're asking the vendors to return to us as part of the proposal is their ability to [2:31:50] manufacture 141 million masks a month at a surge capacity and to be able to maintain that manufacturing [2:31:59] at a 20 to 30 percent rate uh in times where demand is not as high so we are very invested in n95 masks [2:32:07] being made available and we'll continue to look and i appreciate your support uh in getting us the american [2:32:15] rescue plan dollars uh that we're currently investing and we'll continue to look at the right ways to [2:32:21] invest that and have really appreciated uh the conversations you and i have had around that thank [2:32:28] you very much um i appreciate the witnesses have been here well over two and a half hours we are going [2:32:33] to have a second round of questions um so i'm going to recess for 10 minutes uh to allow a break for [2:32:40] our witnesses we will reconvene at 12 45. are you aware of are you going to hide away maybe for yeah [2:34:01] so um um i'm just [2:34:06] i'm just [2:34:53] i'm just sitting here [2:35:07] first off car we got the tire patched and the back and the uh and the tire's still going to work [2:35:13] it's patched we'll see i'll go back and check i ran on for about quarter of a mile it was pretty [2:35:19] down uh but uh but yeah we got that and then but it appeared you couldn't hear it hissing no so [2:35:27] so the real question on when you do something like that [2:35:35] would you get the the uh triple a to come yeah so there wasn't a [2:35:40] there wasn't a tire um jack or tire wrench in the car oh you're kidding [2:35:44] uh [2:35:46] fuck me so called conrad he came to help and brought a wrench but then by the time he got there [2:35:52] some other guy that popped out of his car and was helping us and the triple a showed up once we [2:35:56] got the tire off and then he put air in it he saw the pop um hatched it for us and then [2:36:01] i'll just put it back on was it a nail or something what it looked like he said it looked like a nail [2:36:06] was in and popped out that he like popped it and he could see the air coming back up out of it [2:36:11] what happens when you go to downtown watch and you get nails um yeah thank you so much [2:36:17] okay [2:36:21] and then if you're going to stay through here i was going to pick up the sandwich do you want [2:36:24] any of the cups or anything or i can get you a salad from downstairs [2:36:55] where does this come from uh cups downstairs [2:37:02] they have salads down in a dining hall um but then i can make you one or they have um just kind of a [2:37:10] typical one that has i use half of the shade and crumb spouts and then they have kind of a [2:37:19] southwestern-esque but with a little bit of a not benedric sauce here in the south [2:37:28] you just got a message that says i'm definitely uber but thanks for offering [2:37:53] oh i see it doesn't have salad [2:37:59] all right how about a spinach [2:38:00] it doesn't have to be a little bit of a peach [2:38:04] yeah and um see if instead of doing that on the pizza they can do it on uh doing it on p to see [2:38:18] if they can do it on [2:38:33] oh it's okay yeah cool sounds good yeah thanks first [2:38:37] the committee will reconvene and [2:42:33] And before I start, I do wanna make clear that this committee [2:42:37] will conduct itself with the quorum and respect. [2:42:39] And if I do hear personal attacks, I will gavel. [2:42:42] And we'll move on to the next questions. [2:42:44] And I wanna thank the committee members and witnesses. [2:42:46] And I also am going to be very strict with the five-minute rule, [2:42:50] as we have moved way past our time here and we need to move on. [2:42:53] So with that, I look forward to the next round of questions so [2:42:56] we can get to the essential work of addressing this pandemic, [2:42:59] which has upended so many lives and that continues to threaten the public health. [2:43:04] And we will begin with Senator Baldwin. [2:43:14] Thank you, Madam Chair. [2:43:17] Dr. Walensky, during our last hearing, we discussed the critical need for [2:43:23] my Biopreparedness Workforce Act legislation that I introduced with Senators Collin, [2:43:29] Rose, and Murkowski to strengthen our outbreak response workforce so [2:43:34] that we can better prepare for the next pandemic. [2:43:37] This legislation would address the serious workforce shortages and recruitment challenges [2:43:42] that you mentioned by establishing a new loan repayment program, [2:43:47] focused on encouraging students to pursue careers as clinicians [2:43:52] and biopreparedness health professionals. [2:43:56] As this committee assembles a package of policies to respond to the next pandemic, [2:44:02] it's important to remember that without people, there is no preparedness. [2:44:07] In the midst of the Omicron surge, it has never been clearer that we need [2:44:12] a robust and capable workforce to fully respond to public health emergencies. [2:44:18] The Biopreparedness Workforce Act would go a long way towards that goal. [2:44:22] So Dr. Walensky, as an infectious disease physician and public health leader, [2:44:28] can you share more about how a strong clinical and public health workforce is key to responding to outbreaks, [2:44:35] and how legislation like the Biopreparedness Workforce Act is important to prepare for future public health emergencies? [2:44:44] Yes. Thank you, Senator. There's so much here. [2:44:47] So first, let me just say there's been a recent study that has demonstrated that our public health workforce is now down about 80,000 jobs. [2:44:56] So just to give you a sense, and that's public health workforce, that's not physicians who are actually doing the work on the ground, right, in the hospitals. [2:45:04] This is a public health workforce, down 80,000 jobs. [2:45:07] We saw through this pandemic the challenges in sort of the volume of people who were doing public health work, [2:45:14] but also where they were located and their experience. [2:45:17] We need an up-skilled public health workforce. [2:45:19] For example, we need people to do those genomic sequences. [2:45:23] We need genomic epidemiologists. [2:45:25] We need people who are diverse, as diverse as the communities they serve. [2:45:30] We also need to make sure that they are compensated, have the right salaries, [2:45:34] and as you say, have loan repayment for their work. [2:45:37] To give folks a sense, the infectious disease physicians are among the lowest paying physicians in hospitals. [2:45:43] They don't do procedures. [2:45:44] And by virtue of not doing procedures, there's not a large incentive from a financial standpoint to continue to go into infectious diseases, [2:45:51] which are the bread and butter of what outbreak investigation and clinical it does. [2:45:56] So there have been many resources that we're moving forward to expand our public health workforce. [2:46:03] Public Health AmeriCorps is a big piece of that, and that is something that we're working on, [2:46:07] and really grateful to resources from Congress to be able to do so. [2:46:11] But there's a vital need now to expand our public health workforce in laboratory capacity, [2:46:18] in genomic surveillance, in disease outbreak investigation, [2:46:22] in a workforce that is up-skilled and as diverse as the communities we serve. [2:46:27] Thank you. [2:46:29] Thank you. [2:46:30] We all know that vaccines remain the best way to protect yourself against existing variants of COVID-19, [2:46:37] and I've been encouraged by the FDA's work to authorize vaccines for the public, [2:46:42] but parents continue to be concerned that we don't have a vaccine for their kids as Omicron surges. [2:46:48] Dr. Woodcock, can you provide an update on where we are in examination of the authorization of COVID-19 vaccines for children under five? [2:46:57] Certainly. As Dr. Fauci said earlier, one of the companies, Pfizer, had done trials, there were other trials going on. [2:47:08] There were probably complications with the dose in the slightly older of the younger children, [2:47:18] perhaps indicating that a third dose, as Dr. Fauci said, might be needed to the primary regimen. [2:47:26] FDA is working with the company very closely. Trials are ongoing. [2:47:32] I, too, have heard from many, many parents of the youngest children. [2:47:37] They have other children in school. [2:47:38] They may have immunocompromised individuals in their household and there are people who really want to get this vaccine. [2:47:46] So, well, one of the vaccines and get the children vaccinated. [2:47:50] So, we are working very intensely on this right now and we're working, of course, with NIH and with the companies. [2:47:57] Thank you. [2:47:59] I yield back. [2:48:00] Thank you. [2:48:01] Senator Paul. [2:48:03] Dr. Fauci, it's disappointing for you to suggest that people who dare to question you are responsible somehow for violent threats. [2:48:10] Realize that by attacking me, you're attacking the one member who actually has suffered from violent attacks. [2:48:16] I was at the ball field today. [2:48:19] Steve Scalise almost died. [2:48:20] I was 10 feet away from a staffer who was shot in the leg. [2:48:24] We had over 160 rounds of semi-automatic weapons fired at us, ammunition. [2:48:29] So, for you to somehow suggest that somehow I or people who dare to oppose you are responsible for threats, that's insulting. [2:48:36] The person who shot at us and almost killed Steve Scalise was a rabid supporter of Bernie Sanders. [2:48:44] But the one thing you'll find if you look at the record is that not one of us accused Bernie Sanders of being responsible for that. [2:48:50] So, this is the kind of ignorant sort of personal attacks that you've engaged in. [2:48:56] You engaged in these attacks with fellow scientists. [2:48:59] Not only was it three scientists from Harvard, Oxford, and Stanford that you chose to malign, [2:49:05] 50,000 scientists and medical doctors signed this petition. [2:49:10] And what they wanted was something that most Americans think is pretty reasonable. [2:49:14] It's a different kind of approach. [2:49:16] Instead of saying that everyone is the same and everyone should get the same treatment [2:49:20] and everybody ought to just get vaccinated, what it did is it said that the death rate for this disease is extraordinary [2:49:27] and the risk being different according to ages. [2:49:30] So, if you look at an 80-year-old, it's at least 1,000 times greater death rate than it is for a 10-year-old. [2:49:36] So, wouldn't we want to say that, well, we're going to assess the risks of each individual and have the treatment according to that, [2:49:43] or would we just simply say everyone should be vaccinated? [2:49:47] The death rate for kids under 18 is about one in a million, a little bit less than the chance of being struck by lightning. [2:49:53] We don't yet know fully whether or not kids who have already had COVID might be at risk for some of the side effects of the vaccine. [2:50:01] It still needs to be explored. [2:50:03] But for a kid under 18 who has already had COVID, see, it's a death rate of about one in a million, [2:50:08] even if you haven't had a disease, even if you haven't had COVID, it's about one in a million. [2:50:12] It's extraordinarily uncommon for a child to die. [2:50:15] If you've already had the disease, it's probably a great deal less than that. [2:50:18] Many Americans wonder why you've steadfastly refused and worked with others to try to hide any kind of knowledge of natural immunity [2:50:28] and how it would affect our decision-making. [2:50:31] So, for example, you know, you have a 10-year-old kid and his mom comes up and all of a sudden he gets myocarditis from the vaccine and dies. [2:50:38] Admittedly, a rare complication. [2:50:40] But what are you going to tell her when she says, well, he had COVID three months ago. [2:50:44] I mean, why would you force me to vaccinate my kid? [2:50:47] Why would you force me to vaccinate my kid without even checking to see whether he's already immune? [2:50:52] Now, the idea of natural immunity is the idea upon which vaccines are based. [2:50:57] We've believed and all of medicine is based on the idea of acquiring natural immunity. [2:51:03] People often respond and say, but you don't know how long it'll last. [2:51:06] Well, we don't know how long vaccines will last, even. [2:51:09] That doesn't make us anti-vaccine. [2:51:11] We do know that the vaccines are waning very quickly in potency. [2:51:15] We do know that the vaccine against Omicron really isn't preventing transmission. [2:51:20] You've noticed that the debate has shifted, and the debate is now talking about trying to prevent hospitalizations and death. [2:51:25] And I agree with those statistics. [2:51:27] I think it's a good idea, if you're at risk, to be vaccinated. [2:51:30] I've always been pro-vaccine. [2:51:31] I'm just simply against authoritarianism and against mandates. [2:51:35] The anger that's developed with you, Dr. Fauci, is that you don't want to give us advice. [2:51:39] You want to tell us what to do. [2:51:41] You think you are the science, and that anybody responds to you, how dare you, how dare you [2:51:49] criticize science, as if you somehow are science. [2:51:53] That kind of arrogance, that hubris is really, that's where the anger is coming towards you. [2:51:58] If you were one doctor among hundreds of doctors in the government who gave advice, I don't think anybody, [2:52:04] people might object to your advice, but there wouldn't be such a degree of anger. [2:52:08] But you are so certain that you're right that you're not willing to hear anyone else. [2:52:12] Three epidemiologists, of which you are not even an epidemiologist, but three epidemiologists prominent in their field. [2:52:18] Oxford, Stanford, and Harvard. [2:52:20] You maligned them. [2:52:21] You spoke openly with Dr. Collins, and you did not disagree that let's paint them as fringe. [2:52:28] You went after them and said, we will do a public takedown, not in Science or Nature or Lancet, in Wired, in The Nation, a left-wing publication. [2:52:38] You've engaged in base politics. [2:52:40] You wonder why there's so much anger? [2:52:42] You're not an objective scientist. [2:52:44] You've lost that long ago. [2:52:46] And so many of the things that people want, they want to know why you're forcing their children to be vaccinated [2:52:51] when 95 percent of people at risk have been vaccinated. [2:52:54] Over 95 percent of people over 65. [2:52:56] It's a huge, voluntary success. [2:52:58] And yet you won't rest until you force every child to get this. [2:53:02] So yes, there's a great deal of dissatisfaction with you, and many people want you to go, but nobody wishes you violence. [2:53:08] Senator Paul, your time has expired. [2:53:10] I will use one time of my remaining five minutes to allow Senator Fauci to respond. [2:53:18] Thank you very much. [2:53:19] Dr. Fauci, sorry. [2:53:21] Thank you. [2:53:22] Thank you, Dr. Murray. [2:53:25] No, no. [2:53:27] So, first of all, Senator, again, at a hearing such as this, where there are almost 900,000 people in this country have died from this outbreak, [2:53:38] you have chosen to just personal attacks on me that go back to multiple hearings. [2:53:43] And again, just for the record, for people to check, I have never said take people down in that email. [2:53:52] It was an email that was sent to me. [2:53:54] See, and again, you agreed with Dr. Collins in the email. [2:53:57] Senator Paul, this is my time. [2:53:58] You know, you personally attacked me, and the things that you do are incorrect and proven incorrect. [2:54:06] You've publicly accused me at a hearing of being responsible for the death of 5 million people, when there is not a single, single shred of evidence that anything that was done with the NIH had anything to do with COVID-19. [2:54:23] You talk about things like gain of function. [2:54:26] Dr. Fauci, I'm going to let you respond continually, but I think you have responded, and I appreciate your response very much. [2:54:32] Okay, I appreciate the time. [2:54:33] Thank you very much, Madam Chair. [2:54:35] But I just want to say, I'm actually stunned by the amount of misinformation. [2:54:40] The only thing I have ever done, and this will take 20 seconds, if you look at the things I've said, they've been to support the recommendations of the CDC, of their advisory committees, and of the FDA. [2:54:55] I've told people that it's important to get vaccinated, to get boosted, to wear a mask, and to be prudent. [2:55:02] That's the only thing I've said. [2:55:04] I haven't dictated anything that's only a monolith with me. [2:55:08] It's always public health practices, and anybody goes back over any record of me, they know that. [2:55:15] Thank you, and I will retain the balance of my time. [2:55:18] Thank you very much. [2:55:19] Senator Casey. [2:55:20] Thank you, Chair Murray. [2:55:22] I want to start with Dr. Walensky. [2:55:24] Doctor, as you know, the CDC has been working with my staff on an outstanding nursing home vaccine data request. [2:55:34] I would appreciate it if you and your team would continue to work with me and with our team at the Aging Committee to resolve this matter. [2:55:42] Yes, thank you, Senator. [2:55:45] I'm aware of that matter, and we are committed to continuing to work with you. [2:55:48] Thank you. [2:55:49] Thank you. [2:55:50] Let me turn to a matter for Health and Human Services. [2:55:54] Assistant Secretary O'Connell, you know that our nation's long-term care facilities were ground zero during the first year of COVID-19. [2:56:03] 200,000 residents and workers, when you add up the number of residents plus the number of workers who died, it gets to 200,000 over these two years. [2:56:13] However, nursing home deaths have declined, declined dramatically, thanks to the safety and effectiveness of the vaccines. [2:56:22] It's a credit to the administration that 90 percent of nursing home residents and 80 percent of workers have been vaccinated. [2:56:30] We know that infections are on the rise right now, though, in nursing homes, raising safety concerns and putting additional pressures on workers who have been stretched thin. [2:56:40] For instance, we know the pandemic has worsened existing staffing shortages and turnover issues. [2:56:47] So we also know at the same time that the rescue plan that Democrats passed in March helps to fill the staffing gap with a $500 million initiative for strike teams based upon legislation that I was leading recently. [2:57:06] These strike teams provide medical personnel and other supports that help nursing homes get through the surges like the one that we're seeing right now. [2:57:15] On the 22nd of December of last year, I, along with three of my colleagues, sent a letter to Secretary Becerra asking how Health and Human Services was protecting nursing home residents and workers in the current COVID-19 surge, including the distribution of booster shots. [2:57:34] What is HHS? What is HHS doing to ensure nursing homes have the supports they need to protect residents and workers who care for those residents? [2:57:43] Senator Casey, thank you so much for your question. We share your concern for nursing home staff and long-term care facility residents and have continued to do all we can to make sure they have access to boosts. [2:58:00] We've worked with pharmacies to bring in vaccination clinics, bring those to the long-term care facilities and skilled nursing facilities. [2:58:09] So the vaccines are available on the ground and the residents don't have to travel or access the vaccines on their own. [2:58:19] In addition, ASPR has been sending since the beginning of the pandemic or since the beginning that these tests were available, 2.8 million tests per week to long-term care facilities across the country. [2:58:31] We know how important it is that they are able to surveil any disease in their facilities and having access to these tests is one of the ways they can stay on top of where they are. [2:58:42] So we share your concern and we will look forward to responding to your letter. [2:58:47] Thanks very much. [2:58:48] Senator Burr. [2:58:51] Thank you, Madam Chairman. [2:58:57] Ms. Woodcock, I know you said a while ago that you are excited about what RADx accomplished and I think we all are. [2:59:08] But FDA issued revised guidance stating that it would focus its review efforts on at-home tests and point-of-care COVID test applications from developers with the capacity to manufacture more than 500,000 tests per week within three months of being authorized. [2:59:26] Why did the FDA move the goalpost at this particular time and suggest to companies that can't ramp up to that manufacturing that they're not going to get an accelerated EUA pathway? [2:59:40] Well, because of what some of the members have been discussing over the last several hours that we have an urgent need for high-volume home-based tests. [2:59:53] And we have a queue, we have moved heaven and earth to get as many done as possible. [3:00:02] We've approved, authorized over 400 different kinds of tests or test collection devices during this pandemic. [3:00:12] But as far as what the queue is, the priority, we're prioritizing the highest volume and just putting them to the front so that we can get home test kits into the hands of people. [3:00:26] Dr. Woodcock, I get what you're doing. [3:00:28] Yes. [3:00:29] My question is this. [3:00:30] What does this say to the innovative company that's out there that doesn't have the manufacturing capacity? [3:00:35] And without us marrying them to a large manufacturing capacity, it's basically saying don't innovate because you're not going to get consideration under the EUA if you don't have a manufacturing capacity of 500,000 tests a week. [3:00:51] It says these are prioritized. [3:00:53] It doesn't say we won't get to the others. [3:00:55] Well, get to the others, I mean, there's all a sense of urgency here. [3:00:59] I just think that that might have been thought of before we did this. [3:01:04] Let me go to you, Ms. O'Connell. [3:01:06] I'm really challenged on this procurement of 500 million tests, as you can tell. [3:01:13] And one, I don't understand why there's not been a release that came out of ASPR or BARDA publicly announcing here's how many we've contracted, [3:01:25] that I've got to find it somewhere in a DOD contract that a very limited amount of people go to, certainly not one that I regularly looked at. [3:01:35] But based on one of your contracts, we've got 13.6 million tests costing $190 million. [3:01:42] I think that's from the vodka distributor. [3:01:45] When I break that down, that's about $14 a test. [3:01:49] Now, CMS just put out a new rule that mandated that insurers must cover up to eight tests per person per month for a family of four that's 32 tests and that they can reimburse it $12. [3:02:03] Now, if I'm a manufacturer and I'm under a $12 reimbursement or I can go over here and I can sell directly to the federal government and get $14, [3:02:14] I'm probably going to sell to the federal government and get $14. [3:02:17] Where am I wrong? [3:02:19] Thank you, Senator Burr. [3:02:22] We continue to work to access the tests that will be distributed as part of the $500 million and the tests that you're referring to. [3:02:31] So, first of all, DOD by tradition has put out whenever we've done an assisted acquisitions with them, [3:02:38] they put out within the first 24 hours of that contract going out an announcement that the contract has gone out. [3:02:44] So that's what you're seeing and that's been de rigueur. [3:02:47] It's been the way DOD has approached this through our entire relationship. [3:02:52] We're continuing to. [3:02:53] Why is Asper not putting out a similar public statement? [3:02:58] We'd be happy to. [3:03:00] And thank you, Senator. [3:03:01] I'll go back and talk to the communications team and see if there's a companion press release that makes sense for us to put out. [3:03:08] Well, I'm not sure you addressed my concern, which is it's more profitable to settle the federal government than it is to put it on retail based upon the reimbursements that this administration has now required of insurers. [3:03:21] I hope you'll think about that. [3:03:23] This is alarming to me. [3:03:24] And as we've all displayed, there are no tests out there. [3:03:28] There are no tests on the shelves at Walgreens, CVS, that people can go in, buy and take home and do it. [3:03:35] So it makes even more confusing CDC's policy that if you want to take a test, go ahead and take it. [3:03:40] It's not required, but you can take it. [3:03:42] You can't get it. [3:03:43] Dr. Fauci, just very quickly. [3:03:45] South African data suggests that Omicron may have an ability to build immunity to Delta. [3:03:56] Delta does not have an immunity to, does not build an immunity to Omicron. [3:04:01] Have you got any comments on that? [3:04:05] Cyprus announced a Delta Crom variant. [3:04:10] Are you worried about that? [3:04:12] And we've been about three weeks behind Israel throughout this whole thing. [3:04:17] And even though we've seen South African data go up and go back down very quickly, [3:04:22] Israel epidemiologists just this week said they expect that for the next two weeks they will see a doubling of the infections in Israel, [3:04:31] meaning they're not following the same timeline that we saw in South Africa. [3:04:35] How should we interpret that for the U.S.? [3:04:37] Okay, thank you very much for those questions, Senator. [3:04:40] With regard to the cross protection, I think it's too early to tell because you're dealing with multiple population demography of people who have been previously infected, vaccinated or what have you. [3:04:52] It seems pretty clear that if you get infected with Omicron, you're going to get good protection against Omicron, but also good protection against some of the other spillovers. [3:05:04] So we really yet to have seen, and I think the basis of your question is a reasonable one, if we wind up getting infected with Omicron at a very, very low level of pathogenicity, is that going to be sort of almost like a live attenuated vaccine? [3:05:19] I don't think we can say that right now. [3:05:21] We really have to see how things spread out when we see how that fares in the next variant. [3:05:28] So there will be invariably another variant. [3:05:31] We're going to have to take a look at whether or not there's going to be any protection there. [3:05:34] That's the first thing. [3:05:36] With regard to the Deltacron, this new variant, right now, even though it's got, you know, a bunch of mutations that people look at, it is not something that at least the WHO, who's looked at this carefully, feels that that has to be something that is of great concern. [3:05:52] But we always keep our eye on it to make sure. [3:05:55] So when you say it's not of a great concern now, the one encouraging thing about it is that it's been around for a while. [3:06:02] It isn't something that just propped up. [3:06:04] And yet Omicron completely outstripped it, as did Delta. [3:06:08] So it doesn't look like it has the capability of being transmissible enough to be a problem. [3:06:14] Nonetheless, we still keep an eye out on it. [3:06:17] With regard to Israel, I mean, I'm not sure, I'm sorry, I forgot your question about Israel. [3:06:22] Could you repeat it? [3:06:23] And we are way over time here. [3:06:25] They run about three weeks in front of us. [3:06:27] Yeah. [3:06:28] Yet their experience is not up and down drastically like South Africa data begins to show. [3:06:33] They went up and now it looks like over the next two weeks their epidemiologists say it's going to double and maybe double again before they hope it comes down. [3:06:41] What should we expect? [3:06:42] Yeah, I think that's a great question, Senator. [3:06:44] But what it really reflects is that when you have an outbreak of a particular variant, how high it goes up, when it peaks and comes down, is a reflection of what the status is in your country. [3:06:58] Because if you look at what you saw in South Africa, they were almost free of Delta when they got Omicron. [3:07:05] So Omicron sort of had the unfettered capability of going way up and way down. [3:07:10] When you talk about what happened in Israel, that's a different population. [3:07:14] It's a mostly vaccinated population. [3:07:16] So they're likely going to see breakthrough infections. [3:07:19] In the United States, we have such a large country with such differences in vaccinations versus infections, et cetera, that we believe we will see it peak and we will see it come down. [3:07:32] But it's very difficult to predict whether it's going to be a sharp decrease or whether it's going to do this. [3:07:38] Our own feeling, and I believe that Dr. Walensky feels the same way as I do, that it's going to vary depending upon where in the country you are, how much infection you had previously, what the level of vaccination is. [3:07:51] So we may see a peak up and down in some regions of the country and a peak up and doing this in other regions of the country. [3:07:59] Thank you. [3:08:00] Thank you very much, Senator Smith. [3:08:01] Thank you, Madam Chair. [3:08:07] I'd like to ask a question of Dr. Walensky, if I could. [3:08:11] I think we all know that Americans need better access to rapid testing, and this is a big deal for us in terms of trying to figure out what are our health risks, how do we protect ourselves, and how do we also go about our lives. [3:08:25] And I think that we are making headway here, that we have a long way to go. [3:08:28] Dr. Walensky, I'd like you to talk about this issue of how we should be, or not, collecting and analyzing the data from rapid home tests. [3:08:38] Should we be incorporating this data into, like, should we be trying to capture that data? [3:08:46] Is this important for local communities? [3:08:48] Is they're trying to make decisions about masking and other public health strategies that they want to deploy? [3:08:54] Should we be thinking of the data from rapid tests as a tool for individual risk assessment or as an important tool for population level understanding of what's happening? [3:09:02] How do you see that? [3:09:03] Dr. Yeah, thank you so much, Senator Smith. [3:09:05] So we have been using the PCR test, not the rapid test, the lab tests, the molecular tests, to really capture our case counts and really get a good view of where we are in terms of the epidemiology, anticipating what was going to be coming into the hospitals. [3:09:19] But the self-tests are a really important, valuable tool for people to empower themselves, their own health, to not expose themselves to other people, to get some information about their own health. [3:09:29] And so if an individual were to test positive, if they're feeling unwell, they should certainly consult with a healthcare provider, consult with a pharmacist and your health department. [3:09:39] But if you're feeling well, then use that rapid test to say, okay, my test was positive. [3:09:45] I need to stay home and isolate, protect myself from the community, protect myself or the community from me, and protect me, you know, my loved ones so that they don't get infected themselves. [3:09:55] And I think that it's less about the absolute case count of understanding whether you have asymptomatic infection or a runny nose and your rapid test is positive than it is really about empowering you to do the right thing and not be forward transmitting. [3:10:08] And could you talk a little bit about what other countries are doing? [3:10:12] Are other countries in trying to incorporate this rapid testing data into their population metrics, how is that working in other places around the world? [3:10:21] Some countries are and some countries aren't. London and UK have been doing more reporting of rapid testing, but they too are saying that they're missing, I think, somewhere around 40%. [3:10:32] I'd have to confirm that number. But they too, well, they capture more than we have tried to. They also agree that they're missing some as well. [3:10:40] Okay. Thank you very much. Madam Chair, I'm going to cede back the rest of my time. I just want to acknowledge something I think has been going on here today that I think just deserves being called out. [3:10:51] You know, Dr. Fauci has been the target of a concerted and coordinated campaign of disinformation and distortion and personal attacks. [3:11:01] And then he's being blamed for all of this hatred and anger that has been generated against him. [3:11:09] And I mean, I think we just need to be honest here that this is being done by some members of the Republican Party that are using it for fundraising. [3:11:17] I'm not saying that that's happening by members of this. I'm just saying that that's happening. [3:11:21] I was just pointed out to me that somebody sent out earlier this, you know, in 2021, a Fauci for prison email. [3:11:28] So I just think it's important that we, I have to call this out. And I think it's important that we see it and we have to try to rise above this kind of behavior. [3:11:45] Our committee here should be focusing on these kinds of kind of nitty gritty policy questions. And we're not always going to agree. [3:11:53] I've never heard Dr. Fauci or Dr. Walensky for that matter, declare themselves to be invincible. I certainly am not. [3:11:59] But that should not mean that individuals, career public servants are subjected to this kind of abuse. [3:12:07] Thank you, Madam Chair. [3:12:08] Thank you. Senator Collins. [3:12:09] Ms. O'Connell, I want to follow up on my previous questions to you because I don't feel, frankly, that I got answers. [3:12:21] I'm asking you specifically how much money was diverted from the testing budget to deal with the surge of people, including unaccompanied minors, illegally crossing the southern border? [3:12:44] And how much money was diverted out of the funds allocated for the strategic stockpile? [3:12:52] Thank you, Senator Collins. [3:12:56] Again, all of the funds as they were appropriated to the American Rescue Plan were for testing, contact tracing, and mitigation efforts. [3:13:08] Of those funds, funds were used to test unaccompanied children at the border and then to mitigate the COVID positive cases so they wouldn't enter the community and spread COVID, [3:13:21] which was a, you know, a use of the funds that was allowed under the testing, contact tracing, and mitigation requirements. [3:13:30] Well, you're still not answering my question on the amount of money that was used to deal with the crisis at the southern border. [3:13:42] So I will tell you that our staff's investigation found that $850 million out of the testing budget and another $850 million out of the allocation for the stockpile were instead used to deal with the crisis at the southern border. [3:14:08] Do you, do those numbers sound right to you? [3:14:11] Senator, I'll be happy to take that back and discuss that with our finance team to make sure that those numbers are the same numbers that they're tracking. [3:14:21] Well, I have to say that it's interesting to me that you knew all of the numbers, and I commend you for this, that we're going to community programs, to schools, et cetera. [3:14:34] But you can't tell me how much was reallocated to deal with the crisis at the southern border. [3:14:44] A crisis that were it brought under control, we would have these funds for the purposes that they were intended. [3:14:55] Let me ask you further, what do you mean when you say mitigation as applied to the southern border and the surge, the unprecedented surge of people crossing? [3:15:10] Thank you. [3:15:11] One of the important things that we needed to do when we identified a COVID positive unaccompanied child was to make sure, for example, they didn't ride on the same bus to a shelter with a COVID negative child. [3:15:23] So there were additional costs for transportation to keep the children separate to mitigate spread as the statute allowed us to spend those funds. [3:15:32] In addition, within the shelters, it was necessary to set up a separate room where COVID positive unaccompanied children would reside. [3:15:40] So they wouldn't interact with the COVID negative children and that required additional, you know, additional resources in those shelters in order to keep them separate. [3:15:50] So when the children entered the community with their sponsors, they were not bringing COVID into the communities. [3:15:57] Well, I will tell you, having visited the southern border in late March, testing was being done, but people had been there for weeks at a time with no testing. [3:16:14] And there were adults who were released into the community with no testing. [3:16:22] The fact remains that if we had the southern border under control, we would be using the $850 million designated for testing to buy more rapid tests. [3:16:40] We would be using the money out of the stockpile, the $850 million for the purposes for which it was intended. [3:16:50] So I think that this is a problem that has contributed to the shortage of testing, the uncontrolled crisis at the border. [3:17:04] And I also am perplexed by the lack of federal orders for tests between January and September of 2021, which I know from my experience in Maine caused a major manufacturer, Abbott, to lay off 400 workers that were producing those tests because it lacked the federal orders. [3:17:33] So that makes no sense to me and seems very short sight. [3:17:37] Thank you. [3:17:40] Thank you, Senator. [3:17:42] Senator Hickenlooper. [3:17:43] Great. [3:17:47] Thank you, Madam Chair. [3:17:48] And again, thank each of you for your public service. [3:17:51] Dr. Walensky, I wanted to talk to you just for a moment about genomic sequencing. [3:17:59] Even before COVID-19 appeared, Colorado made a genomic sequencing of diseases a high priority and we're now I think one of the leading states in detecting changes as they evolve in COVID-19. [3:18:15] We test about 15% of all positive COVID tests. [3:18:19] I think that's still one of the highest rates in the country. [3:18:22] And we also monitor wastewater for community detection. [3:18:27] So, Dr. Walensky, how would we or how can we expand genomic surveillance and expand those capabilities in order to try to stay ahead of existing but also future threats, COVID-19 or otherwise? [3:18:47] How do we close the gap between, you know, the states that are heavily sequencing and following this and those that aren't? [3:18:55] Yes, thank you for that and for your leadership in Colorado in genomic sequencing. [3:19:00] As I've mentioned, you know, we need to have both numbers and breadth and geographic distribution in order to get a real good view of what's happening in genomic sequencing. [3:19:11] So, we need to sample from state labs so we get samples from every single lab. [3:19:15] We also get samples from commercial labs which gives us a lot of volume. [3:19:19] We have partnerships now with 19, I believe, academic medical centers in order to do so. [3:19:25] And what we do and power our genomic sequencing is so that we are able to detect a sequence that's present at less than 0.1%. [3:19:33] So, we scale up and based on the number of cases that we have, we scale up or scale down our genomic sequencing so we can detect it. [3:19:40] And what we were able to do with Omicron is when we saw the footprint of the S gene target failure in PCRs, a similar footprint as alpha, [3:19:48] we were able to do targeted enhanced surveillance of sequences that actually had that initial footprint and able to identify sequences even before they reach that 0.1% threshold. [3:20:00] So, as you said, we can scale this up in wastewater. [3:20:03] We're able to potentially scale it up for purposes of antimicrobial resistance for foodborne outbreaks and many other things, [3:20:09] which we're really looking forward to doing now that we've established this incredible capacity. [3:20:14] Right. [3:20:15] Great. [3:20:16] Perfect. [3:20:17] Ms. O'Connell, I want to ask you a question in terms of the, we've talked a lot about the distribution of tests and whether it's schools or workplaces, hospitals. [3:20:28] And we've talked about how at this moment we don't have enough tests out there and we're not getting results quickly enough. [3:20:35] In terms of the distribution of tests on a national level, we're still obviously working on a system. [3:20:45] I know the administration is hard at work on this. [3:20:47] But some states like Colorado already have systems in place where tests are being mailed directly to people in their home. [3:20:54] And I guess I'm, I don't know, is the federal government working with states like Colorado and trying to look at those systems already in place and how do we integrate the federal system with those states? [3:21:09] Absolutely. [3:21:11] Thank you, Senator. [3:21:12] That's terrific what Colorado is doing. [3:21:14] We have invested $29 billion with the states so they could set up such testing programs however they saw fit. [3:21:22] And we are seeing states like Colorado use those funds to be able to do exactly what we're hoping to do on a national level. [3:21:31] We are in the process, as we've talked about today, setting this up, working with the U.S. Postal Service as the federal government. [3:21:38] We will allow American households to order and have them delivered to their house as well. [3:21:44] I imagine that we will, these will be in addition to what Colorado is able to provide. [3:21:50] And we want to have as many tests, of course, available to all Americans as possible. [3:21:55] So if Colorado is already doing it, that's terrific. [3:21:58] I'm sure we will learn some lessons from the experiences you've had in your state and apply those to this national initiative. [3:22:06] Great. [3:22:07] Thank you on that. [3:22:08] And then just real quickly, Dr. Fauci, we've heard from, Dr. Walensky was just talking about how we integrate the aggregation of large amounts of data. [3:22:19] And we've had a discussion about Israel versus South Africa. [3:22:28] It really is a question of how do we take, my question is how do we take information from global sources and, you know, learn from those countries who are ahead of us on the curve, make sure that we're learning from their experiences. [3:22:46] And I think how can we do a better job working with our international partners to make sure that we are prepared for the next Greek letter? [3:22:53] Yeah. [3:22:54] Well, thank you very much. [3:22:55] Excellent question. [3:22:56] And we are just actually doing that. [3:22:59] Every week to 10 days, I have a long phone call with Chris Witte and Patrick Valens, who are the two leading medical and scientific advisors to the Prime Minister of England, to get a feel of what's going on there. [3:23:13] We have regular phone calls with our Israeli colleagues. [3:23:16] And every Saturday or Sunday morning, depending upon what it is, Dr. Walensky and I and others are on the phone with our South African colleagues. [3:23:24] So we are in literally constant communication with them. [3:23:28] Thank you. [3:23:30] Thank you. [3:23:31] Senator Marshall. [3:23:32] The American people, you know, my family, all of our families are struggling as this pandemic continues to drag on with no end in sight. [3:23:42] The words I hear every day, multiple times each day continue to resonate and echo in my mind as I sit here. [3:23:49] Words like I'm tired, confused, burnout, scared and frustrated. [3:23:56] The list goes on. [3:23:58] Well, what's making the situation worse are the officials leading our nation's COVID response going on national television and contradicting each other. [3:24:06] And of course, some Supreme Court justices are spreading misinformation as well. [3:24:11] Dr. Walensky, this past week you recommended asymptomatic people be able to return to work after five days. [3:24:20] But Dr. Fauci ambiguously corrected you on national television and suggested folks needed a test before return. [3:24:27] How does that make you feel when Dr. Fauci or someone like Justice Sotomayor upstages a previous statement or policies of yours blatantly contradicts and undermines your guidance or offers false claims that cause more confusion for the American people? [3:24:43] Thank you, Senator. [3:24:44] I have the great honor of leading the agency of 12,000 public health servants in this country. [3:24:49] And we work collaboratively with tens of thousands of public health officials around the country to provide guidance. [3:24:55] I also get to work with a COVID-19 task force that is full of a multidisciplinary group of people with diverse expertise from immunology to drug regulation to epidemiology. [3:25:07] This science is moving really quickly. [3:25:09] And I know you will appreciate that it's moving fast and it is changing. [3:25:13] And it is our responsibility to convey that science. [3:25:17] I'll move on. [3:25:19] The FDA has recently set up protocols for monoclonal antibodies and antiviral pharmaceuticals to be prioritized based upon race. [3:25:27] Dr. Woodcock, has the CDC or FDA done a multiple regression analysis on race to see if indeed it's an independent factor for increased morbidity and mortality? [3:25:37] And if it hasn't, don't you think zip code would actually be more predictive? [3:25:40] Wouldn't it make sense to prioritize these antivirals and testing for that matter to senior citizens and those with significant comorbidities, regardless of race, especially if the multiple regression analysis proves my opinion? [3:25:54] Dr. Woodcock? [3:25:57] What FDA did was to recommend if, you know, that people at high risk would be candidates for these products. [3:26:09] Did you do a multi regression analysis on this independent factor? [3:26:15] We did not. [3:26:17] Okay. [3:26:18] We did not. [3:26:19] We don't make those kind of recommendations. [3:26:21] We make recommendations. [3:26:22] But you can do studies, right? [3:26:23] The FDA and CDC can do studies to see if it's truly an independent factor or if not truly that the issue should be about your comorbidities and your age. [3:26:32] So, Dr. Fauci, according to Forbes, you have an annual salary in 2020 was $434,000. [3:26:45] You oversee over $5 billion in federal research grants. [3:26:48] As the highest paid employee in the entire federal government, yes or no, would you be willing to submit to Congress and the public a financial disclosure that includes your past and current investments? [3:27:00] After all, your colleague, Dr. Walensky, and every member of Congress submits a financial disclosure that includes their investments. [3:27:07] I don't understand why you're asking me that question. [3:27:19] My financial disclosure is public knowledge and has been so for the last 37 years or so, 35 years that I've been directed. [3:27:28] The big tech giants are doing an incredible job of keeping it from being public. [3:27:32] We'll continue to look for it. [3:27:34] Where would we find it? [3:27:35] All you have to do is ask for it. [3:27:37] You're so misinformed. [3:27:39] It's extraordinary. [3:27:40] All you have to do is ask for it. [3:27:41] Why am I misinformed? [3:27:42] This is a huge issue. [3:27:43] Wouldn't you agree with me that you see things before members of Congress would see them so that there's an air of appearance that maybe some shenanigans are going on? [3:27:55] You know, I don't think that's – I assume that that's not the case. [3:27:58] Senator, what are you talking about? [3:27:59] I assume it's not the case. [3:28:00] Senator, what are you talking about? [3:28:01] My financial disclosures are public knowledge and have been so. [3:28:06] You are getting amazingly wrong information. [3:28:09] What are you talking about? [3:28:10] I cannot find them. [3:28:11] Our office cannot find them. [3:28:12] Where would they be if they're public knowledge? [3:28:14] Where? [3:28:15] It is totally accessible to you if you want it. [3:28:18] For the public. [3:28:19] Is it accessible to the public? [3:28:20] To the public. [3:28:21] To the public. [3:28:22] Great. [3:28:23] We are reviewing it. [3:28:24] Totally incorrect. [3:28:25] Well, we look forward to reviewing it. [3:28:26] Senator Marshall, Dr. Fauci has answered you. [3:28:29] It is public information and he's happy to give it to you if you would ask. [3:28:33] Senator Moran. [3:28:34] Chairwoman, thank you. [3:28:41] I know this has been talked about. [3:28:45] I've watched a bit of the hearing from my office this morning and into this afternoon. [3:28:50] But would you highlight for me, I suppose this is for Dr. Woodcock, lots of funding. [3:28:59] I think adequate funding. [3:29:00] Certainly knowledge about winter months would bring an increase in cases. [3:29:05] What's the challenge in not being better prepared for access to testing in home and elsewhere? [3:29:14] And how soon will that change? [3:29:18] I don't think that's, I think that's a question for Assistant Secretary McConnell. [3:29:25] But I would tell you, FDA has approved or authorized over 400 tests or collection systems just for COVID. [3:29:34] We've authorized 15 over-the-counter tests. [3:29:38] But it's capacity that we're talking about here, production capacity. [3:29:43] So there's no, what you're telling me, Dr. Woodcock, is there's no problem with the FDA approval of tests. [3:29:50] It's the manufacturing process and the supply chain. [3:29:53] We could do more with more resources. [3:29:58] We have authorized over 2,000 different device products, including the 400 test-related products in two years. [3:30:12] So that's an incredible increase in the workload. [3:30:15] And we really appreciate the funding that Congress has provided. [3:30:19] However, the test manufacturers, many of them give us incomplete results. [3:30:26] We have to go back and forth with them. [3:30:29] The ITAP program that we are doing with NIH for home testing, I think we'll improve that tremendously. [3:30:36] That's a big advance forward. [3:30:39] But there's also the matter of production capacity with this huge surge and so many more people becoming infected. [3:30:47] Is there a separate FDA results process in which the test is read and determined positive or negative? [3:30:58] There's no challenges there in that process? [3:31:01] That's what the ITAP program over at NIH is doing. [3:31:07] They're actually doing the laboratory and clinical testing for the manufacturers and then they send us the data. [3:31:15] And so it's standardized and it's a panel. [3:31:18] And that really accelerates our ability to get these authorized very quickly. [3:31:24] And as I said earlier, we've authorized them within two days of getting the data from the ITAP program. [3:31:31] So that's a tremendous setup that I think is really beneficial where we have standardized testing by scientists and the government. [3:31:41] And that enables the manufacturers to get their products through very fast. [3:31:45] Thank you. [3:31:46] Ms. O'Connell. [3:31:50] Thank you, Senator. [3:31:51] And just to pick up where Dr. Woodcock left off. [3:31:53] Once those tests are authorized, ASPR reaches out to the manufacturers to make sure that we're optimizing the manufacturing capability. [3:32:01] So that part is sort of a seamless process that we have. [3:32:04] But all of the work we're doing in testing in this administration is in service of four priorities. [3:32:09] One, to expand the number of testing sites that are available. [3:32:13] Two, to expand the number of tests that are available. [3:32:16] That's the part that I'm working on to increase capacity. [3:32:19] Three, the kinds of tests that are available. [3:32:21] That's the part Dr. Woodcock just discussed. [3:32:23] And then to help lower the cost of tests. [3:32:26] And is there a problem? [3:32:30] I don't know whether the testing devices are manufactured domestically. [3:32:34] Do we have another challenge of the importation of tests as we did with masks and gowns and gloves? [3:32:41] We continue to look for tests wherever we can find them. [3:32:46] And we have encouraged actually some test manufacturers that are approved in Europe to apply for FDA approval here in the United States. [3:32:55] So I do anticipate we will have some importation of tests at some point. [3:33:00] But we've used the Defense Production Act authorities 12 times to support the domestic manufacture of tests and to priority rate those orders. [3:33:09] So we can increase the supplies and manufacturing capacity here in the U.S. [3:33:13] In the third of a minute that I have left, we've changed, I think, our view on masks recently. [3:33:20] And we're emphasizing N95s. [3:33:22] Is there any intentions to, is there a plan to manufacture additional 95 masks so they're more available? [3:33:33] Is there a way to make them more comfortable? [3:33:36] I'll leave that, that's the crux to my question. [3:33:41] We continue to support the manufacture of N95 masks. [3:33:44] We have 737 million in the Strategic National Stockpile, all sourced from 12 domestic manufacturers. [3:33:51] So we're continuing to support that. [3:33:53] We are also in the process of putting out an agreement for warm-based manufacturing. [3:33:59] So we're able to keep this capacity that we currently have going, even when demand diminishes. [3:34:05] So that's all underway right now. [3:34:07] As far as fit and style and how they work, I'm sure, you know, colleagues at the table are probably, [3:34:13] have various pieces of their programs that might be participating to that effort and consulting with the manufacturers on how that will work. [3:34:21] Thank you. [3:34:22] Move to Senator Tuberville. [3:34:24] Thank you very much. [3:34:25] Just very quickly, you know, I know there's plenty of misinformation on both sides, you know, when it comes to COVID, you know, [3:34:32] but I would say this, you know, the fear-mongering on the left is, and I'm going to give you a couple of questions here about this, [3:34:38] has made the matters much worse. [3:34:40] Dr. Fauci, I just want to ask you this from my constituents back in Alabama. [3:34:44] Ivermectin, 40-year drug. [3:34:48] Now, my constituents read this. [3:34:50] They hear about it and all this. [3:34:51] It's a 40-year drug. [3:34:52] They call it a wonder drug. [3:34:54] It's about a nickel of a tablet. [3:34:56] It's done wonders, supposedly, in India and several other places. [3:35:01] And then you have this new antiviral pill that we're coming out. [3:35:04] And my constituents are saying, this thing's going to cost $500, $600, $700 each. [3:35:09] Could you give me a rundown on the difference in those two, what you think about them? [3:35:16] Get it on record here so we, you know, I can tell my people back home, this is what Dr. Fauci says. [3:35:21] Yeah. [3:35:22] So, Paxlovid, the drug from Pfizer, has shown in a randomized placebo-controlled trial to be highly effective to the point of 89%, almost 90%. [3:35:35] What's it called? [3:35:36] It's Paxlovid. [3:35:37] Okay. [3:35:38] It's made by Pfizer. [3:35:40] And it has been shown in a very well-controlled randomized placebo-controlled trial that if you take that drug compared to the placebo within the first three to five days, within the first three days, you have about an 89% chance of preventing you from going to the hospital or dying. [3:35:58] There were no deaths in the Paxlovid group, and there were several deaths in the placebo group. [3:36:05] That's Paxlovid. [3:36:07] Ivermectin has had non-controlled trials suggesting that it might be effective, mostly anecdotal. [3:36:14] The CDC, excuse me, the NIH guidelines panel have looked at that data and felt there's not sufficient evidence to say that it works or it doesn't. [3:36:24] The WHO recommends strongly against it and suggests that it might actually be harmful. [3:36:32] The NIH active studies are doing a whole bunch of studies with Ivermectin as well as others to try and settle it once and for all to prevent people from taking it if it doesn't work because it could be toxic. [3:36:47] So there's a world of difference between Ivermectin and Paxlovid. [3:36:52] But this is a 40-year drug, and we're talking about one that's just now coming on the market. [3:36:59] So we actually know that much about this Pfizer drug. [3:37:02] I wish they'd come up with a lot of easier names for their drug. [3:37:05] Yeah, they always do that. [3:37:06] They fool me, too, with the names, Coach. [3:37:08] But it is what it is. [3:37:10] The fact is, I think it's kind of a miscomparison to say one is a 40-year drug and one is a drug that was just discovered. [3:37:21] It was just discovered, but it was shown in a very well-controlled clinical trial to be highly effective. [3:37:28] Even though Ivermectin is a good drug for some parasites, it has not been shown in a well-controlled placebo-controlled trial to be effective in COVID. [3:37:39] Okay, thank you. [3:37:40] Dr. Walensky, I don't know if anybody's asked this question. [3:37:43] I just want to get cleared up. [3:37:45] Our Supreme Court Justice last week, looking into the situation with the mandate, [3:37:50] Justice Olimar said there's 100,000 children that are sick as we speak with Omicron, and a lot of them are serious in hospitals. [3:37:59] Is that true, true or false? [3:38:00] I don't have the number of children in the hospitals right now. [3:38:04] It's likely less than 100,000. [3:38:06] Yeah, and Justice Breyer said that, you know, that if we continue to delay this ruling, that we're going to have 750,000 more that are not vaccinated infected a day. [3:38:20] I mean, does that make sense to you? [3:38:22] What I can tell you is our children between the ages of 0 and 4 are one of the only places where our hospitalization rates are currently rising, [3:38:29] and that children who are in the hospital are generally unvaccinated, not uniformly, but generally unvaccinated. [3:38:36] And that's true for not just our 0 to 4 who are obviously ineligible, but also true for our 5 to 11-year-olds as well as our 12 to 17-year-olds. [3:38:45] Thank you. [3:38:46] Well, thank you all for being here today. [3:38:47] Thank you very much. [3:38:48] Thank you, Madam Chair. [3:38:49] Thank you so much. [3:38:50] One final question for Ms. O'Connell and Dr. Walensky, and that's regarding education. [3:38:55] In the past, we have seen school districts that serve a significant number of students of color or those in low-income or rural areas that are facing great challenges in accessing resources they need to serve our students. [3:39:08] How is the federal government working now to make sure that states are equitably distributing tests and necessary resources like masks to all school districts, [3:39:18] particularly those that serve predominantly students from families with low-income, students of color or rural students? [3:39:24] And Ms. O'Connell, I'll start with you. [3:39:26] Thank you, Chair Murray. Equity is woven into all of the work that we are doing in this response. [3:39:32] It is something that we remain focused on, including making sure that schools across all states are able to access the tools and resources they need. [3:39:42] We gave $10 billion, as you know, from the American Rescue Plan for schools to be able to set up their funding programs, testing programs. [3:39:52] We have also made it possible through Operation Expanded Testing, which Dr. Walensky can talk more about, where we have regional hubs where schools can contract directly with labs to run their programs for them. [3:40:06] That was designed for schools that might not otherwise have resources to be able to manage a testing program on their own. [3:40:13] In addition, we are making tests available through the federally qualified health centers and rural health centers. [3:40:19] And we have done that with masks as well earlier in the year. [3:40:24] Thank you. [3:40:25] Dr. Walensky? [3:40:26] Yeah, maybe I will just pick up exactly where Asper O'Connell has put down. [3:40:30] So, you know, our ICAP program, our Increased Community Access to Testing program, does place tests in pharmacies and social vulnerability indices that are high. [3:40:41] That's by design. [3:40:42] Tests in federally qualified health care centers and community centers, just as the Assistant Secretary mentioned. [3:40:48] We also continue to support screening tests at no cost to child care centers, K-12 schools, and congregate settings through exactly the program that the Asper mentioned. [3:40:58] Operation expanded testing. [3:41:00] We prioritize high schools that have, and all schools that have high social vulnerability. [3:41:05] And we have a website now that's active where you can enroll. [3:41:09] Okay, thank you. [3:41:10] Senator Burr, I understand you have two additional questions. [3:41:13] A couple of questions, if I could, Madam Chair. [3:41:16] This is for Dr. Woodcock and Ms. O'Connell. [3:41:19] It's my understanding that prior to Omicron, BARDA informed some therapeutic manufacturers that they would no longer be supporting additional work [3:41:28] on new therapies because there's no longer an unmet need, which may impact whether and how FDA prioritizes reviewing such therapies. [3:41:37] Did BARDA and FDA change course on this policy once the Omicron variant was discovered in November? [3:41:44] BARDA's decision to put that notification out was in light of the fact that the therapeutics development was moved over to Operation Warp Speed, and BARDA was supporting the therapies that were being developed through the [3:42:00] Warp Speed effort. So it was a way of combining the funding that was available to be able to move the therapies through faster. [3:42:07] BARDA never stopped supporting therapy work. But I'll let Dr. Woodcock. [3:42:12] Yeah, there is, we still regard there is an extreme unmet medical need for therapeutics at most stages of the disease, particularly the late stages, where we still don't have interventions. [3:42:27] And so people are dying in the late stage of disease, getting into the ICU, going on the ventilator. So, of course, we have 670 INDs that we have been, clinical protocols that are ongoing, to my knowledge. So the robust development is still ongoing in the therapeutic area. [3:42:50] So how much funding has BARDA allocated to therapeutics this year, and how much is left to spend? [3:43:01] I'll have to go back and check that on the actual development. We've spent a lot of funds this year on the procurement of the therapeutics that have already been developed, but I'd be more than happy to bring that number to you and your staff. [3:43:14] And this is, I'm talking about the development end of it. There's a firm belief out there that BARDA went to the industry and said, we're not supporting this anymore. [3:43:24] They didn't say this got moved over to Operation Warp Speed, which, by the way, doesn't exist anymore. But they said, BARDA said, we're not supporting therapeutics because there's not an unmet need. That's what the industry heard. I'd love for you to clarify that for me. [3:43:42] Last thing, Dr. Woodcock, since we did discuss the point-of-care and at-home testing. I just happened to come up with a chart that FDA put out not long ago. [3:43:55] So let me just, and you're probably familiar with it, one's molecular, one's antigen, and one's serology. And for the molecular and the antigen, if you test yes for point-of-care or at-home, that kicks you to the right. [3:44:11] The next box is high manufacturing capacity. If your answer is no there, it kicks you down to an FDA intends to decline box. There's no option. So if you're not a high manufacturing test, then FDA is going to decline to review. [3:44:36] Boy, I got to tell you, I think this is a huge mistake. Now, if you tell me that you've got a couple hundred tests that fall into the high manufacturing capacity right now at the FDA, where you've got the luxury of being able to kick out new innovative companies that haven't solved their manufacturing yet, by all means, tell me that's the case, that there are a couple hundred. [3:45:03] Right now, Ms. O'Connell is struggling to buy 500 million tests. We're 47, maybe 50 million there. That leaves another 450 million to purchase. And we're going to distributors trying to buy their inventory, not to manufacturers trying to buy their capacity. [3:45:24] Something's not right here, guys, on testing. And I will tell you, the current administration's chief of staff got it right in 2020, March, and he said, testing's broken, testing's broken, testing's broken. [3:45:39] I just say to all of you right now, testing's broken. And Ms. O'Connell, I think the responsibility falls to the ASPR. I wrote the law. If, in the case of CDC, they were the delay to begin with, but to acquire testing, that falls in your lane. [3:45:57] And I, for the life of me, can't figure out after 82 billion dollars, except for somebody sitting down and saying, well, we just don't need those tests. We don't need to buy them. How you could let Abbott close two lines because there wasn't any business? [3:46:16] These are some of the most premier manufacturers in the world that we've let get out of the mass manufacturing of home test business. If I'm wrong, tell me I am. I respect all four of you in a huge way. But I also express my disapproval very quickly. And that's what I'm doing today. Anything you want to add to that, Ms. O'Connell? [3:46:43] Please, thank you, Ranking Member Burr. Let me just clarify, of course, that the initial contracts you're speaking of towards the 500 million were the available inventory that these distributors had. These are the distributor contracts. The manufacturer contracts are currently being worked. You will see that capacity come on quickly. We just haven't been able to land the contracts, to draft the contracts as quickly as the distributors, but they are coming. [3:47:07] My suggestion in the future is that when you guys huddle inside the COVID team, try to get the administration to refrain from making these proclamations until we've got the product, until we know who we're negotiating with. [3:47:24] But we're now three weeks since the president said we're going to buy 500 million tests. We have 50 million currently contracted. I don't know how long it's going to take to get the rest of the contracts. [3:47:37] This is not dissimilar to when we went out and said we're going to booster everybody in America, yet we rolled it out with just people over 60 to start with, and then we started moving down. [3:47:47] And now we're begging people to get boosted, which is where we should have been on day one, because we had the product available. [3:47:55] But listen, you guys have a tough job, and I don't know of anything else Congress can do than try to create the statutory framework that you can work in to do your job, which exists, or provide the funding to allow you to acquire. [3:48:12] Those are the only two things we can do other than bitching gripe when it doesn't happen as quickly as we'd like. [3:48:18] But, Tony, I really respect you, and I'm sorry you and your family are going through what you're going through. [3:48:23] But please understand, we go through that every time we go home with millions of people in North Carolina, millions that believe the bad information that's out there, [3:48:35] millions of people that have a loved one in the hospital but there's no monoclonal form to take, [3:48:41] millions of people who are unvaccinated, probably wish today they had gotten vaccinated, probably wish they had gotten boosted, [3:48:48] but they're now in the ICU and their wife or husband or daughter is calling us and saying, what do I do? [3:48:55] So we're here to support. [3:48:58] What you need, tell us. [3:49:03] But don't think that we're just going to sit here and print money without a full accountability of where it has gone. [3:49:13] And I hope the Secretary is listening to that conversation today. [3:49:18] Senator Blunt and I said, give us a full audited accounting of the $82 billion and we'll entertain additional funding for testing. [3:49:26] That was 10 days ago. [3:49:28] I'm not sure when we're going to get it or if we're going to get it, but it's conditional. [3:49:33] And this is the most powerful person on the other side of the appropriations, and I think she knows I'm serious on this one. [3:49:39] There's got to be accountability on the money and the way it's spent. [3:49:46] Thank you for being here. [3:49:47] Thank you, Madam Chairman. [3:49:48] Thank you. [3:49:49] I want to thank, truly thank all of our witnesses today, Dr. Walensky, Dr. Fauci, Dr. Woodcock, Assistant Secretary O'Connell. [3:49:56] We all know this is a very difficult, challenging, changing time, and you've all been through it for a long time. [3:50:03] I think you do understand the frustration. [3:50:07] I'm sure you all have it as well as where we are. [3:50:10] We all want to find solutions and we stand at your back to be able to provide those. [3:50:14] But thank you so much for answering all our questions. [3:50:17] This is really an important conversation about the threat of the new COVID variant or whatever the next one is and about the path forward for our pandemic response. [3:50:25] And we really do appreciate all the work you and all the people in your agencies do. [3:50:29] So for any senators who wish to ask additional questions, questions for the record will be due in 10 business days, January 26th at 5 p.m. [3:50:37] And with that, the committee does stand adjourned. [3:50:39] Thank you. [3:51:48] Pardon me? [3:51:49] We'll leave them the sole person. [3:51:50] Thank you. [3:51:51] Thank you. [3:51:52] Thank you. [3:51:53] Thank you. [3:51:54] Thank you. [3:51:55] Thank you. [3:51:56] Thank you. [3:51:57] Thank you. [3:51:58] Thank you. [3:51:59] Thank you. [3:52:00] Thank you. [3:52:01] Thank you. [3:52:02] Thank you. [3:52:03] Thank you.