[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
A SHOT AT NORMALCY: BUILDING COVID-19
VACCINE CONFIDENCE
=======================================================================
VIRTUAL HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
MAY 26, 2021
__________
Serial No. 117-35
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
48-986 PDF WASHINGTON : 2022
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COMMITTEE ON ENERGY AND COMMERCE
FRANK PALLONE, Jr., New Jersey
Chairman
BOBBY L. RUSH, Illinois CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California Ranking Member
DIANA DeGETTE, Colorado FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland ADAM KINZINGER, Illinois
JERRY McNERNEY, California H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont GUS M. BILIRAKIS, Florida
PAUL TONKO, New York BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York BILLY LONG, Missouri
KURT SCHRADER, Oregon LARRY BUCSHON, Indiana
TONY CARDENAS, California MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice NEAL P. DUNN, Florida
Chair JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware DAN CRENSHAW, Texas
DARREN SOTO, Florida JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
------
Professional Staff
JEFFREY C. CARROLL, Staff Director
TIFFANY GUARASCIO, Deputy Staff Director
NATE HODSON, Minority Staff Director
Subcommittee on Oversight and Investigations
DIANA DeGETTE, Colorado
Chair
ANN M. KUSTER, New Hampshire H. MORGAN GRIFFITH, Virginia
KATHLEEN M. RICE, New York Ranking Member
JAN SCHAKOWSKY, Illinois MICHAEL C. BURGESS, Texas
PAUL TONKO, New York DAVID B. McKINLEY, West Virginia
RAUL RUIZ, California BILLY LONG, Missouri
SCOTT H. PETERS, California, Vice NEAL P. DUNN, Florida
Chair JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington GARY J. PALMER, Alabama
LORI TRAHAN, Massachusetts CATHY McMORRIS RODGERS, Washington
TOM O'HALLERAN, Arizona (ex officio)
FRANK PALLONE, Jr., New Jersey (ex
officio)
C O N T E N T S
----------
Page
Hon. Diana DeGette, a Representative in Congress from the State
of Colorado, opening statement................................. 2
Prepared statement........................................... 3
Hon. H. Morgan Griffith, a Representative in Congress from the
Commonwealth of Virginia, opening statement.................... 5
Prepared statement........................................... 6
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 7
Prepared statement........................................... 9
Hon. Cathy McMorris Rodgers, a Representative in Congress from
the State of Washington, opening statement..................... 10
Prepared statement........................................... 10
Witnesses
Nick Offerman, Actor and Woodworker.............................. 13
Prepared statement........................................... 15
Answers to submitted questions............................... 81
Saad B. Omer, Ph.D., Director, Yale Institute for Global Health,
Yale University................................................ 17
Prepared statement \1\
Answers to submitted questions............................... 82
J. Nadine Gracia, M.D., Executive Vice President and Chief
Operatinig Officer, Trust for America's Health................. 18
Prepared statement........................................... 21
Answers to submitted questions............................... 85
Amy Pisani, Executive Director, Vaccinate Your Family............ 29
Prepared statement........................................... 32
Answers to submitted questions............................... 89
Karen Shelton, M.D., Director, Mount Rogers Health District,
Virginia Department of Health.................................. 37
Prepared statement........................................... 39
Answers to submitted questions............................... 96
----------
\1\ Dr. Omer's statement has been retained in committee files and is
available at https://docs.house.gov/meetings/IF/IF02/20210526/112684/
HHRG-117-IF02-Wstate-OmerS-20210526-U1.pdf.
A SHOT AT NORMALCY: BUILDING COVID-19 VACCINE CONFIDENCE
----------
WEDNESDAY, MAY 26, 2021
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 11:00 a.m. via
Cisco Webex online video conferencing, Hon. Diana DeGette
(chair of the subcommittee) presiding.
Members present: Representatives DeGette, Kuster, Rice,
Schakowsky, Tonko, Ruiz, Peters, Schrier, Trahan, Pallone (ex
officio), Griffith (subcommittee ranking member), Burgess,
McKinley, Long, Joyce, Palmer, and Rodgers (ex officio).
Also present: Representatives Bilirakis and Carter.
Staff present: Kevin Barstow, Chief Oversight Counsel;
Jesseca Boyer, Professional Staff Member; Jeffrey C. Carroll,
Staff Director; Austin Flack, Policy Analyst; Waverly Gordon,
General Counsel; Tiffany Guarascio, Deputy Staff Director;
Perry Hamilton, Clerk; Rebekah Jones, Counsel; Chris Knauer,
Oversight Staff Director; Mackenzie Kuhl, Digital Assistant;
Kaitlyn Peel, Digital Director; Peter Rechter, Counsel; Tim
Robinson, Chief Counsel; Chloe Rodriguez, Clerk; Caroline Wood,
Staff Assistant; C.J. Young, Deputy Communications Director;
Sarah Burke, Minority Deputy Staff Director; Diane Cutler,
Minority Detailee, Oversight and Investigations; Theresa Gambo,
Minority Financial and Office Administrator; Marissa Gervasi,
Minority Counsel, Oversight and Investigations; Brittany
Havens, Minority Professional Staff Member, Oversight and
Investigations; Nate Hodson, Minority Staff Director; Peter
Kielty, Minority General Counsel; Emily King, Minority Member
Services Director; Bijan Koohmaraie, Minority Chief Counsel;
Clare Paoletta, Minority Policy Analyst, Health; Olivia
Shields, Minority Communications Director; Alan Slobodin,
Minority Chief Investigative Counsel, Oversight and
Investigations; Michael Taggart, Minority Policy Director; and
Everett Winnick, Minority Director of Information Technology.
Ms. DeGette. The Subcommittee on Oversight and
Investigations hearing will now come to order.
Today the hearing--the committee is holding a hearing
entitled, ``A Shot at Normalcy: Building COVID-19 Vaccine
Confidence.''
Today's hearing will explore strategies for increasing
confidence in and uptake of COVID-19 vaccines.
Due to the health emergency, as I noted, today's hearing is
being held remotely. All witnesses, Members, and staff will be
participating via video conferencing.
And, as is usual for our proceeding, microphones will be
set on mute for the purposes of eliminating inadvertent
background noise. Members and witnesses, don't forget you will
need to unmute each time you wish to speak.
Now, if at any time I am unable to continue as chair, which
has happened because of technology, the vice chair of the
subcommittee, Mr. Peters, will serve as chair until I am able
to return.
Documents for the record can be sent to Austin Flack at the
email address that all of the staff has. And all of the
documents will be entered into the record at the conclusion of
the hearing.
The Chair now recognizes herself for an opening statement.
OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Today we continue our oversight of the Nation's COVID-19
response efforts.
Throughout the pandemic, this subcommittee has conducted
robust oversight over a range of critical issues, including
vaccine development and distribution [audio malfunction] enter
a new phase of the pandemic, today's hearing addresses one of
the most consequential COVID-19 issues that this subcommittee
has examined: the pressing need to increase COVID-19 vaccine
confidence and uptake in the United States. And it is simple,
why. If not enough people get vaccinated, the massive
investments that we have made to develop the vaccines and the
extraordinary efforts that we have made to make them widely
available will never reach their full potential.
Now, fortunately, we are making significant progress. In
just 5 months, more than 160 million Americans have received at
least 1 COVID-19 vaccine. And over 85 percent of seniors have
received at least 1 dose. In the 2 weeks since the FDA
authorized Pfizer's vaccine for children ages 12 to 15, more
than 2 million children in this age group received their first
dose.
Thanks to the millions of Americans who have chosen to get
a safe and effective COVID-19 vaccine, we do have a shot at
returning to normalcy. So, if you want to take off your masks,
if you want to get together with friends and family safely, if
you want to go on vacation, then join the millions of Americans
who have done it, and get vaccinated.
Here is the bad news, though: We are not out of the woods
yet. Although it is easier to get a vaccine, millions of
Americans remain unvaccinated, and immunization rates in many
places remain alarmingly low. In some States, less than 30
percent of the population has received even--I am sorry, less
than 40 percent of the population has received even a single
dose. And since peaking in mid-April, we have seen a decline in
the number of daily doses administered across the country.
This is worrying. And, frankly, it is going to take a
collective push to get to the Biden administration's goal of 70
percent of American adults having at least 1 shot by the Fourth
of July. That is why this subcommittee is working tirelessly to
support vaccination efforts nationwide, including today's
hearing, which explores why some people so far haven't gotten
vaccinated.
So that is the big question: Why haven't some people gotten
vaccinated?
Polling indicates that many unvaccinated Americans have
safety concerns or unanswered questions about how the vaccines
work. Compounding these problems, rampant misinformation and
outright lies are spreading on social media platforms, in many
cases igniting viral hoaxes and fueling vaccine hesitancy.
But low vaccine confidence isn't the only reason for the
slow uptake. Some unvaccinated Americans, especially in rural
areas and communities of color, still confront access
challenges, like the inability to take off of work or to get a
vaccine from a trusted source.
Additionally, far too many Americans--in particular, young
adults--they just don't have the urgency or motivation to get
vaccinated. They don't understand that, while they are likely
to have a mild case, they could get a serious case or even
die--and worse, infect others who are at risk.
Clearly, this is not a one-size-fits-all solution. It often
takes the right message, from the right source, delivered at
the right time. We are going to need a variety of strategies
and incentives to overcome the range of reasons keeping
unvaccinated Americans on the fence.
I believe that our witnesses today can shed light on these
challenges, and I want to thank every single one of them for
being with us. I look forward to discussing, at the end, what
is working and what needs to be done.
And so I just want to say a few things, in conclusion.
If you are worried about the vaccine's safety, you should
know millions of doses have been administered throughout the
country and around the world. The data is in. The vaccines are
safe.
If you are unsure about the vaccine's efficacy, you should
know extensive, real-world data is available, and it shows the
vaccines are extremely effective. They prevent hospitalization
and severe illness, and they save lives.
And if you question the benefit of getting vaccinated, you
should know that fully vaccinated Americans can resume their
prevaccine lives and go around without wearing a mask or
physical distancing. So you can get back to your normal life. I
was at a press conference yesterday at the State legislature,
and everybody had a vaccine, and nobody had a mask, and it was
wonderful.
The facts are not in dispute. The only question is, how can
we help unvaccinated Americans get their shots? I know, if we
work together in a bipartisan fashion, we can do just that, and
that is why I am so pleased again to have our witnesses.
[The prepared statement of Ms. DeGette follows:]
Prepared Statement of Hon. Diana DeGette
Today, we continue our oversight of the Nation's COVID-19
response efforts.
Throughout the pandemic, this subcommittee has conducted
robust oversight over a range of critical issues, including
vaccine development and distribution challenges.
As we enter a new phase of the pandemic, today's hearing
addresses one of the most consequential COVID-19 issues this
subcommittee has examined: the pressing need to increase COVID-
19 vaccine confidence and uptake in the United States.
Because if not enough people actually get vaccinated, the
massive investments made to develop these vaccines, and the
extraordinary efforts to make them widely available, will never
reach their full potential.
Fortunately, we are making significant progress. In just
five months, more than 160 million Americans have received at
least one dose of a COVID-19 vaccine. Over 85 percent of
American seniors have received at least one dose.
And, in the two weeks since FDA authorized Pfizer's vaccine
for children ages 12 to 15 years old, more than 2 million
children in this age group received their first dose.
Thanks to the millions of Americans who have chosen to get
a safe and effective COVID-19 vaccine, we now have a shot at
returning to normalcy. So if you want to take off your masks,
get together with friends and family safely, or go on vacation,
then join these millions of Americans--and go get vaccinated.
But here is the bad news: We are not out of the woods yet.
Although it is easier than ever to get a vaccine, millions
of Americans remain unvaccinated--and immunization rates in
many places remain alarmingly low.
In some States, fewer than 40 percent of the population has
received even a single dose. And, since peaking in mid-April,
we have seen a decline in the number of daily doses
administered across the country.
This is worrying, and it will take a collective push to
reach the Biden administration's goal of 70 percent of American
adults having at least one shot by the Fourth of July.
That's why this subcommittee has been working tirelessly to
support vaccination efforts nationwide--including by holding
today's hearing exploring why some Americans have, so far, not
gotten vaccinated.
So why are some people still not getting vaccinated?
Polling indicates that many unvaccinated Americans have
safety concerns or unanswered questions about how the vaccines
work.
Compounding these problems, rampant misinformation and
outright lies are spreading on social media platforms--in many
cases, igniting viral hoaxes and fueling vaccine hesitancy.
But low vaccine confidence is not the only reason for the
slowing uptake.
Some unvaccinated Americans--especially in rural areas and
communities of color--still confront access challenges, such as
the inability to take off work or obtain a vaccine from a
trusted source.
Additionally, far too many Americans--particularly younger
adults--do not have the sense of urgency or motivation to go
get vaccinated.
Clearly, there is not a one-size-fits-all solution. It
often takes the right message from the right source, delivered
at the right time. We will need a variety of strategies and
incentives to overcome the range of reasons keeping
unvaccinated Americans on the fence.
Thankfully, our witnesses here today can shed light on
these challenges. I look forward to discussing what is working
and what more needs to be done to increase vaccine confidence
and uptake.
At the end of the day, I hope that any American watching
this hearing who is unsure whether to get vaccinated takes away
these key facts:
If you are worried about the vaccines' safety, you should
know that hundreds of millions of doses have now been
administered throughout the country. The data is in. The
vaccines are safe.
If you are unsure about the vaccines' effectiveness, you
should know that extensive, realworld data is available and
shows the vaccines are extraordinarily effective. They prevent
hospitalization and severe illness, and they save lives.
And, if you question the benefit of getting vaccinated, you
should know that fully vaccinated Americans can resume their
pre-pandemic lives without wearing a mask or physically
distancing. So, if you get vaccinated, you can start getting
back to normal life.
These facts are not in dispute. The only question is how we
can help unvaccinated Americans get their shots. I am confident
that if we work together, in a bipartisan fashion, we can build
trust and increase uptake-and make our shot at normalcy a
reality.
Ms. DeGette. And I am also pleased to now yield 5 minutes
to the ranking member, Mr. Griffith, for an opening statement.
We have got some background noise somewhere. Everybody
needs to make sure they are muted.
OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE
IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA
Mr. Griffith. Thank you, Madam Chair. I appreciate that. If
I may take a brief moment of personal privilege, and just say
that all of us in Virginia are mourning the passing of former
Senator John Warner, who served Virginia ably and was a very
nice man. And so we are mourning his passing overnight.
That being said, I do appreciate you holding this hearing
on building COVID-19 vaccine confidence.
I also want to thank the witnesses for taking the time to
join us today, especially Dr. Karen Shelton, who is from the
9th District of Virginia and doing some great work to serve all
of the people in southwestern Virginia.
We have come a long way since the first confirmed case of
COVID, as SARS-CoV-2, which causes COVID, and that was
diagnosed in January of 2020. Today we have three safe and
effective vaccines with enough supply for every American aged
12 and up who wants one. So far, over 61 percent of the U.S.
population have received at least 1 dose. While we are well on
our way to returning to normalcy, we still have to work to
reach the higher rates of vaccinations necessary to eliminate
the virus. The virus is a significant threat to our public
health.
At the beginning of the national vaccination campaign,
demand exceeded supply. Now the U.S. faces the opposite
problem: the vaccine supply is plentiful and exceeds the number
of people in line to be vaccinated. The current unvaccinated
population varies in its demographics, intentions, and concerns
about the COVID-19 vaccines.
There are about 13 percent of individuals who say they will
definitely not receive the COVID-19 vaccine, yet there is a
slightly larger share of individuals, 15 percent, who are
waiting to see how the COVID-19 vaccine is working on other
people before they receive their shot. These individuals could
be persuaded to get COVID-19 vaccines by receiving answers to
their questions and concerns. The leading concerns that
contribute to vaccine hesitancy are that COVID-19 vaccines are
not safe as they are said to be and that individuals will
experience side effects following vaccination.
Individuals are also concerned about what is actually
misinformation about infertility and other possible long-term
effects from getting the COVID-19 vaccines. Trusted messengers
need to meet these Americans where they are, by listening to
their concerns and asking permission to share accurate
information to help them reach the right decision for each
individual, while reinforcing their safety, dignity, choice,
and autonomy.
My home district is a region of rural communities. The
Centers for Disease Control and Prevention released a study
last week that people in rural areas are receiving the COVID-19
vaccines at a lower rate than those in urban areas. My district
is actually doing fairly well, but this study demonstrates a
need to identify the barriers in many rural communities and to
find solutions to remove them.
Additionally, I have heard from my district on reasons why
there are lower rates of vaccination. Two common factors
contributing to the lower rates are a lack of information on
the technology of the COVID-19 vaccines as well as a lack of
access to receive the vaccine. The good part about these
barriers is that they can be removed. We can provide accurate
information on the decades of development for the mRNA
technology in two of the vaccines, and that there were no cuts
in safety requirements, just cuts in red tape.
We find innovative ways--we can find innovative ways to
bring vaccines to the people through mobile vaccination
clinics. Public health practitioners should continue
collaborating with healthcare providers, pharmacies, employers,
faith leaders, and other community partners to identify and
address barriers to COVID-19 vaccination in rural areas and
other communities.
Another key group of individuals who benefit from receiving
the vaccine are children. Yes, COVID-19 is usually milder in
children as compared to adults, but some children can get very
sick and suffer complications from COVID-19. It is crucial to
target messaging and provide accurate information and resources
to this population so parents can make the best decisions for
their children.
According to the CDC, more than a half-million children
between ages 12 and 15 received a Pfizer vaccine just 1 week
after it was approved for this age group. This is a great
accomplishment, and I hope we can continue to work with
advocacy groups to provide parents with the necessary
information to make this decision so they are confident in
getting their children vaccinated. I look forward to hearing
from our witnesses today on what messages and strategies work
best to remove barriers to a much higher level of COVID-19
vaccination throughout the United States so that we can all
return to normalcy.
Thank you, Madam Chair, and I yield back.
[The prepared statement of Mr. Griffith follows:]
Prepared Statement of Hon. H. Morgan Griffith
Thank you, Chair DeGette, for holding this hearing on
building COVID-19 vaccine confidence. I also want to thank the
witnesses for taking the time to join us today, especially Dr.
Karen Shelton, who is from my district, and doing some great
work to serve southwestern Virginia.
We have come a long way since the first confirmed cases of
SARS-CoV-2, the virus that caused COVID-19, were diagnosed in
the U.S. in January 2020. Today, we have three safe and
effective vaccines with enough supply for every American age
twelve and up who wants one. So far, over 61 percent of the
U.S. population has received at least one dose.\1\ While we are
well on our way to returning to normalcy, we still have work to
do to reach the higher rates of vaccinations necessary to
eliminate the virus' significant threat to our public health.
---------------------------------------------------------------------------
\1\ https://covid.cdc.gov/covid-data-tracker/#vaccinations.
---------------------------------------------------------------------------
At the beginning of the national vaccination campaign,
demand exceeded supply. Now, the U.S. faces the opposite
problem--the vaccine supply is plentiful and exceeds the number
of people in line to be vaccinated.
The current unvaccinated population varies in its
demographics, intentions, and concerns about the COVID-19
vaccines. There are about 13 percent of individuals who say
they will ``definitely not'' receive the COVID-19 vaccine.\2\
Yet, there is a slightly larger share of individuals, 15
percent, who are waiting to see how the COVID-19 vaccine is
working on other people before they receive their shot.\3\
These individuals could be persuaded to get COVID-19 vaccines
by receiving answers to their questions and concerns.
---------------------------------------------------------------------------
\2\ https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-
19-vaccine-monitor-dashboard/messages/messages/information.
\3\ https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-
19-vaccine-monitor-dashboard/messages/messages/information.
---------------------------------------------------------------------------
The leading concerns that contribute to vaccine hesitancy
are that the COVID-19 vaccines are not as safe as they are said
to be, and that individuals will experience side effects
following vaccination. Individuals are also concerned about
what is actually misinformation about infertility and other
possible long-term effects from getting the COVID-19 vaccines.
Trusted messengers need to meet these Americans where they are,
by listening to their concerns and asking permission to share
accurate information to help them reach the right decision for
each individual while reinforcing their safety, dignity,
choice, and autonomy.
My home district is a region of rural communities. The
Centers for Disease Control and Prevention (CDC) released a
study last week that people in rural areas are receiving the
COVID-19 vaccines at a lower rate than those in urban areas.\4\
My district is actually doing pretty well, but this study
demonstrates a need to identify barriers many rural communities
are facing and find solutions to remove them.
---------------------------------------------------------------------------
\4\ https://www.cdc.gov/mmwr/volumes/70/wr/mm7020e3.htm?s--
cid=mm7020e3--x.
---------------------------------------------------------------------------
Additionally, I have heard from my district on reasons why
there are lower rates of vaccination. Two common factors
contributing to the lower rates are a lack of information on
the technology of the COVID-19 vaccines as well as a lack of
access to receive the vaccine. The good part about these
barriers is that they can be removed. We can provide accurate
information on the decades of development for the mRNA
technology in two of the vaccines and that there were no cuts
in safety requirements, just cuts in red tape. We can find
innovative ways to bring vaccines to the people through mobile
vaccination clinics. Public health practitioners should
continue collaborating with health care providers, pharmacies,
employers, faith leaders, and other community partners to
identify and address barriers to COVID-19 vaccination in rural
areas or other communities.
Another key group of individuals who benefit from receiving
the vaccine are children. Yes, COVID-19 is usually milder in
children as compared to adults, but some children can get very
sick and suffer complications from COVID-19. It is crucial to
target messaging and provide accurate information and resources
to this population so parents can make the best decision for
their children. According to the CDC, more than half a million
children between ages 12 to 15 received a Pfizer vaccine just
one week after it was approved for this age group. This is a
great accomplishment, and I hope we can continue to work with
advocacy groups to provide parents with the necessary
information to make this decision so that they are confident in
getting their children vaccinated.
I look forward to hearing from our witnesses today on what
messages and strategies work best to remove barriers to a much
higher level of COVID-19 vaccination throughout the U.S. so
that we can all return to normalcy.
Thank you, Madam Chair, I yield back.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the chair of the full committee, Mr. Pallone, for an
opening statement for 5 minutes.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Chairwoman DeGette, and thanks for
this continued effort of the Oversight and Investigations
Subcommittee to do critical oversight of the COVID-19
vaccination campaign in our country.
Through the collective efforts of the American people over
the past year, we have overcome the initial challenges of
developing, producing, and distributing safe and effective
vaccine. But now we face the more difficult task of reaching
those Americans who have yet to embrace this important tool.
The fact is, vaccine doubts and fears are not new
challenges. In fact, this committee has a history of addressing
these issues in a bipartisan manner. In 2019, for example, we
held a hearing on the measles outbreak and renewed our efforts
to provide resources to support vaccine confidence and uptake
throughout the Nation. And we followed that with bipartisan
legislation led by Representative Schrier. It finally passed
late last year. And that bill authorized a campaign to educate
and inform Americans on the benefits of vaccine. Earlier this
year we significantly expanded upon those activities in the
American Rescue Plan, which invested $160 billion in COVID-19
response efforts, and that included $20 million in dedicated
resources for vaccine distribution clinics, mobile units, and
an awareness campaign.
So, while these issues of awareness and confidence are not
new, the gravity of the challenges facing us today is
unprecedented because of the pandemic. Millions are stricken
ill, more than a half a million lives tragically lost, and the
enormous toll on the mental and financial well-being of
Americans.
But in the face of all this, we have risen to the occasion.
We have worked together at a Federal, State, and local level
through public and private partnerships and across political
lines to develop several safe and effective vaccines. And we
have solved supply issues and continue our work to ensure
equitable distribution. And the result of this collective
effort, if you are 12 years or older and you want a COVID
vaccine, there is one waiting for you now.
So I just wanted to mention not only decisive action by
Congress and the Biden administration's leadership, now we have
more than 116 million Americans who have received at least 1
dose of the vaccine, and more than 130 million of those are
fully vaccinated.
So the number of new daily cases and deaths have fallen
significantly since the start of the year. This is, obviously,
cause for celebration. But we can't stop until more Americans
are protected from COVID-19, and that is what we are going to
hear about today. What are the next steps?
What we know so far is there is no single factor causing
eligible unvaccinated Americans to sit on the sidelines. Some
people are skeptical of the vaccine's safety or worry about
long-term effects. Some have been misled by bogus and
misleading information. Still others have a distrust of the
medical system or the government's role in developing vaccines.
And many Americans, particularly in rural communities and in
communities of color, are open or even eager to be vaccinated,
yet continue to face barriers to access. So this--there is not
one reason, Madam Chair, why some Americans remain
unvaccinated, and there is no single solution.
But the encouraging news is that our efforts have been
successful so far. Poll after poll shows increasing confidence
in the COVID-19 vaccines. And that progress, though, did start
to plateau relatively recently. So that is why we have to
redouble our efforts to understand who could be reached and how
best to reach them. We have to do a lot of hard work, really,
to just go out and meet people where they are.
As we enter this vaccine campaign and its new aspects of
it, I am pleased to be working alongside our Republican
colleagues to encourage Americans to roll up their sleeves. I
think that if we really want to be--go back to normalcy, we
need every eligible American to make the right choice, get a
shot, protect themselves, their community, and the Nation.
So, again, I am just looking forward to the witnesses. I
want to say to everyone--they may already know--that Chairwoman
DeGette has been outspoken in continuing this oversight of the
vaccine campaign, and today is a manifestation of that.
And I appreciate your prioritizing this in your
subcommittee. It is very important.
And thanks to Morgan Griffith, as well.
I yield back.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
Today we continue our critical oversight of the COVID-19
vaccination campaign in the United States--our best shot at
containing the virus and beating this pandemic.
Through the collective efforts of the American people over
the past year, we have overcome the initial challenges of
developing, producing, and distributing safe and effective
COVID-19 vaccines. But we now face the difficult task of
reaching those Americans who have yet to embrace this life-
saving tool.
Vaccine doubts and fears are not new challenges. In fact,
this committee has a history of addressing these issues in a
bipartisan manner.
In 2019, for instance, we held a hearing on the measles
outbreaks and renewed our efforts to provide resources to
support vaccine confidence and uptake throughout the Nation. We
followed that with bipartisan legislation led by Representative
Schrier, finally passed late last year. The legislation
authorized a campaign to educate and inform Americans on the
benefits of vaccines and increase our understanding of how best
to reach unvaccinated individuals.
Earlier this year, we significantly expanded upon those
activities in the American Rescue Plan, which invested $160
billion in COVID-19 response efforts. This included $20 billion
in dedicated resources for vaccine distribution and
administration, vaccination clinics, mobile vaccination units,
and a vaccine awareness campaign.
While issues surrounding vaccine confidence are not new,
the gravity of the challenges facing us today is unprecedented
as we continue to combat this pandemic. Millions stricken ill.
More than half a million lives tragically lost. And enormous
tolls taken on the mental and financial well-being of too many
Americans.
In the face of all this pain and hardship, this Nation has
again risen to the occasion. We have worked together at the
Federal, State, and local levels; through public and private
partnerships; and across political lines to develop several
safe and effective vaccines. We have also solved supply issues
and continue our work to ensure equitable distribution
throughout the country.
As a result of this collective effort, if you are 12 years
or older and you want a COVID-19 vaccine, there is one waiting
for you.
And, thanks to decisive action by Congress, combined with
the Biden administration's bold leadership and determined
commitment to science, more than 160 million Americans have
received at least one dose of a vaccine, and more than 130
million of those are fully vaccinated.
Because of this, the number of new daily cases and deaths
have fallen significantly since the start of the year.
This is cause for celebration. Our efforts, however, must
not stop until more Americans are protected from COVID-19. And,
as we will hear today, more work is needed.
Today, there is no single factor causing eligible,
unvaccinated Americans to sit on the sidelines. Some people are
skeptical of the vaccines' safety or worry about long-term side
effects. Some have been misled by bogus and misleading
information that pollutes social media. Still others have an
understandable distrust of the medical system or the
government's role in developing the vaccine. Many more
Americans--particularly in our rural communities and in
communities of color--are open, or even eager, to be
vaccinated, yet continue to face barriers to access.
Just as there is no one reason why some Americans remain
unvaccinated, there is no single solution to building vaccine
confidence to get more people vaccinated.
The encouraging news is that our efforts have been
successful so far: Poll after poll has shown increasing
confidence in COVID-19 vaccines since the first one was
authorized more than five months ago. But that progress has
begun to plateau while millions of unvaccinated Americans still
remain vulnerable to the virus.
That's why we must redouble our efforts to understand who
can be reached and how best to reach them. We must do the hard
work of meeting people where they are.
The importance of this work cannot be overstated. As we
enter a critical juncture of our vaccination campaign, I am
pleased to be working alongside our Republican colleagues to
encourage Americans to roll up their sleeves.
If we are to have a true shot at normalcy, we need every
eligible American to make the right choice: Get a shot and
protect themselves, their community, and the Nation.
Thank you to our witnesses for being here today, I yield
back.
Ms. DeGette. Thank you so much, Mr. Chairman, and the Chair
is now pleased to recognize the ranking member of the full
committee, Mrs. McMorris Rodgers, for 5 minutes for an opening
statement.
OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mrs. Rodgers. Thank you, Madam Chair and Republican Leader
Griffith. Thanks to the innovative work of the private sector,
the Trump administration, Operation Warp Speed, and the
continued work of the Biden administration, America has led the
way with safe and effective vaccines. It is a historic and
remarkable example of American innovation that is giving people
the courage to dream again.
As we work to get a vaccine to every person who wants one,
building trust and confidence is foundational. Our goal today
is to equip people with the information they need to make the
best decisions for themselves, their children, and their
families. That is the American way: to lead with trust, not
fear.
So I want to thank our distinguished panel for being here
to share their expertise and answer questions people may have
about the COVID-19 vaccines.
I would now like to yield the remainder of my time to Dr.
John Joyce, who is leading, with other doctors in Congress, to
encourage people to talk to their doctors about the safety of
COVID-19 vaccines.
[The prepared statement of Mrs. Rodgers follows:]
Prepared Statement of Hon. Cathy McMorris Rodgers
Thank you, Chair DeGette and Republican Leader Griffith.
Thanks to the innovative work of the private sector, the
Trump administration, and Operation Warp Speed...
... America has led the way with safe and effective
vaccines.
It's a historic and remarkable example of American
innovation that is giving people the courage to dream again.
As we work to get a vaccine to every person who wants
one....
... building trust and confidence is foundational.
Our goal today is to equip people with the information they
need to make the best decisions for themselves, their children,
and their families.
That is the American way--to lead with trust, not fear.
So I want to thank our distinguished panel for being here
to share their expertise....
... and answer questions people may have about the COVID-19
vaccines.
I would now like to yield the remainder of my time to Dr.
John Joyce, who is leading with other doctors in Congress to
encourage people to talk to their doctors about the safety and
efficacy of COVID-19 vaccines.
Mr. Joyce. I would like to thank------
Ms. DeGette. The gentleman is recognized.
Mr. Joyce. I would like to thank Ranking Member McMorris
Rodgers for yielding me time, and for Chair DeGette and Ranking
Member Griffith for holding this hearing on such an important
topic.
Safe and effective vaccines are critical tools as our
Nation seeks to eradicate the COVID-19 pandemic and restore our
normal way of life as Americans. Thanks to the success of
Operation Warp Speed under President Donald Trump's leadership,
multiple safe vaccines were developed and produced in record
time.
As a physician, I believe that every American who wants a
vaccine should be able to get one, and this choice must remain
between an individual and their doctor and pharmacist.
Alongside other doctors in Congress, I have encouraged every
American to talk to their own doctor or healthcare provider or
pharmacist. Discuss the vaccine. I chose to get the vaccine as
soon as it was available to me. Doctors, nurses, and
pharmacists nationwide recommend that the COVID-19 vaccine is
received by their patients, and over 90 percent of doctors in
the U.S. have already chosen to become vaccinated.
There are many reasons that some people, even those who
want to be vaccinated, still have not been vaccinated. This is
a concern to all of us. These include those who do not have the
time; those who do not have the ability to sign up to get a
vaccine; and those who are concerned about taking time off from
work, especially if they have side effects; those who still
have questions about concerns of the safety and effectiveness
of vaccines. These are all individuals who have yet to be
vaccinated.
We have also heard about access challenges, including for
those who live in rural areas of the country. For instance,
there are people who do not have internet, a computer, or a
smartphone. They don't know how to sign up for an appointment
without those resources. We have also heard instances of people
who live far away from the closest place offering COVID-19
vaccines. These are some of the hurdles that need to be
overcome so that those who live in rural areas are not
disproportionately impacted in their ability to get a COVID-19
vaccine, simply because of where they live.
Widespread vaccination is the key to restoring our freedom
and getting our communities back to normal. I look forward to
working with the members of this committee in achieving these
goals.
Thank you, and I yield back, Madam Chair.
Ms. DeGette. I thank the gentleman. Does the gentlelady
yield back, as well?
Mrs. Rodgers. Yes, Madam Chair, I yield back the remainder
of our time.
Ms. DeGette. Thank you. OK, thank you.
The Chair will ask unanimous consent that all Members'
written opening statements be made part of the record.
And without objection, so ordered.
I am now going to introduce our witnesses for today's
hearing. But before I do, I just want to note so often--just
yesterday, for example, I was in a panel discussion where
people were lamenting the lack of bipartisanship in Congress.
This is the Oversight Subcommittee of Energy and Commerce, and
I just want to say how anybody watching this should recognize
that, in a strong bipartisan way, the leadership of this
committee, which has oversight over healthcare policy in the
U.S. Congress, is bipartisan in their strong urging of all
Americans to get the vaccine. And I want to thank my colleagues
for their strong commitment, and Dr. Joyce, and all the other
doctors on the committee, for being so outspoken.
With that, I want to introduce our witnesses.
Our first witness is Nick Offerman, and my sheet here says
``Actor and Woodworker.'' And I would like to say welcome. I am
a big fan, and I know the other members of this committee are,
as well.
Dr. Saad Omer, who is the director of Yale Institute for
Global Health at Yale University.
Dr. J. Nadine Gracia, executive vice president and chief
operating officer of the Trust for America's Health.
Amy Pisani, executive director of Vaccinate Your Family.
And now I am going to recognize Mr. Griffith to introduce
our last witness.
Mr. Griffith. Thank you, Madam Chair.
Ms. DeGette. Mr. Griffith, you are muted.
Mr. Griffith. Thank you, Madam Chair, I appreciate it.
It is my pleasure to welcome Dr. Karen Shelton. A native of
Bristol, Virginia, she received her bachelor of science in
biology from Wake Forest and her doctor of medicine from the
University of Virginia. She practiced for 19 years in OB/GYN,
as an OB/GYN, before joining the public sector. Today she
serves the Virginia Department of Health as director of the
Mount Rogers Health District and acting director of Lenowisco
and Cumberland Plateau Districts.
And Dr. Shelton, we are glad to have you here today, and so
proud of the work you are doing for southwestern Virginia.
Thank you.
Ms. DeGette. I thank the gentleman.
To the witnesses, I know you are all aware that the
committee is holding an investigative hearing. And when we do
so, we have the practice of taking testimony under oath.
Does any witness have an objection to taking--to testifying
under oath today?
Let the record reflect the witnesses have responded no.
The Chair will then advise you that, under the rules of the
House and under the rules of this committee, you are entitled
to be accompanied by counsel. Does any witness request to be
accompanied by counsel today?
Let the record reflect the witnesses have responded no.
And if you would, then, would you [audio malfunction] sworn
in?
[Witnesses sworn.]
Ms. DeGette. Let the record reflect the witnesses responded
affirmatively.
And you are now under oath and subject to the penalties set
forth in title 18, section 1001 of the U.S. Code.
The now--the Chair will now recognize our witnesses for 5-
minute summaries of their written statements.
As you can see, there is a timer on the screen that counts
down your time, and it turns red when your 5 minutes has come
to an end.
And so now I would like to start with our first witness.
Mr. Offerman, you are recognized for 5 minutes.
STATEMENTS OF NICK OFFERMAN, ACTOR AND WOODWORKER; SAAD B.
OMER, Ph.D., DIRECTOR, YALE INSTITUTE FOR GLOBAL HEALTH, YALE
UNIVERSITY; J. NADINE GRACIA, M.D., EXECUTIVE VICE PRESIDENT
AND CHIEF OPERATING OFFICER, TRUST FOR AMERICA'S HEALTH; AMY
PISANI, EXECUTIVE DIRECTOR, VACCINATE YOUR FAMILY; AND KAREN
SHELTON, M.D., DIRECTOR, MOUNT ROGERS HEALTH DISTRICT, VIRGINIA
DEPARTMENT OF HEALTH
STATEMENT OF NICK OFFERMAN
Mr. Offerman. Thank you, Subcommittee Chairwoman DeGette,
Ranking Member Griffith, and members of the subcommittee. Thank
you so much for this opportunity to discuss this issue of
vaccines.
As an actor, author, and woodworker, I will not be offering
medical advice today. I will leave that to the scientists and
medical experts on the panel, also known as the smart people.
Instead, I would like to lead with my ignorance in these
matters to represent the rest of the citizens who are not
epidemiologists and doctors, but feet-on-the-ground, hands-in-
the-dirt people across our country whose lives and livelihoods
have taken a pounding from this pandemic.
Ignorance is an area in which I can claim some authority.
And it is from that perch I would like to communicate that I am
not only an actor and author and woodworker, but I am also a
small business owner and a proud Midwesterner. It is from those
personal perspectives I would like to communicate why it is so
important we all get vaccinated.
Now, I understand that some Americans with experiences and
backgrounds similar to my own are hesitant to get the vaccine.
So I wanted to jump on this opportunity to get a positive
message out to them. There is nothing more positive than the
vaccine itself. I even hear people refer to it as a miracle.
Now, this makes sense, given the magnitude of death and
destruction that the virus has caused and the speed with which
the vaccine prevents that death and destruction once it is
administered.
But I don't think that ``miracle'' is quite accurate. A
miracle is something inexplicable that appears from nowhere,
sent by unseen forces. The vaccine is not a miracle. The
vaccine is a gift from the world's greatest scientists and
thinkers and activists. It is the product of human ingenuity,
the absolute pinnacle of achievement created out of whole cloth
by a bunch of dang geniuses who have saved us from endless
death and destruction by solving a complex problem of
microbiology in record time.
Now, as we have heard, unfortunately, the very expedience
with which the vaccine has arrived is also a source of
confusion, causing people to fear that it was rushed. Well, you
are damn right, folks. It was rushed. It is a pandemic. But you
can rest assured the hustle was not applied to the safety of
the vaccine. The science didn't arrive overnight. The science
is based on 40 years of work. The hustle was just applied to
getting that science to you and me by bypassing the usual
bureaucratic hurdles, the red tape.
So when the pandemic hit, all of my own acting work was
canceled. But after a few months we were able to start up
again, carefully shooting TV and film. And the reason for this
is because, on each show, about 200-odd crew members looked
each other in the eye, and we all agreed to behave like we
loved each other. We were ignorant to the medical science, so
we agreed to trust the world's smartest doctors and follow
every strict protocol so that we could go back to making our
livings and taking care of our families. Three different shows
I completed because we listened to the doctors and we thought
about each other.
I also run a small custom furniture outfit in Los Angeles
called Offerman Woodshop that was crippled by the pandemic. The
vaccine is going to save our business. We at Offerman Woodshop
also help run a nonprofit called Would Works that trains
individuals experiencing homelessness to be wood workers. Now,
because of the heightened medical vulnerability of the unhoused
population we serve, that program has been officially closed
since March of 2020, losing us a year of revenue and leaving
our artisans out in the cold. But now, due to the ubiquity of
vaccines in L.A. County, we are poised to relaunch all of our
programs this summer.
Finally, I am close with my family of 38 people in the
village of Minooka, Illinois. Unfortunately, because of
disinformation from social media platforms with no oversight, a
few of them have refused masks from the get-go, and they now
refuse the vaccine. We also have a couple of immunocompromised
nephews, which means we all have to avoid the antivaxxers, whom
we love, for the safety of the rest of the family. It breaks my
heart, and we can't wait when we--so we can all be reunited.
On January 5th of this year, Los Angeles County had 8,098
people hospitalized with COVID-19. A few days ago that number
was 319. That is more than 96 percent lower in just 4\1/2\
months. That is the gift of this vaccine.
I urge anyone who has not yet been vaccinated to catch my
enthusiasm and hear the smart people who are about to speak.
Medicine doesn't care who you voted for. We amazing humans have
created a vaccine that serves the common good. The vaccine
doesn't take sides, unless you count alive versus dead.
I am so sincerely grateful to the committee for hearing me
today. Thank you very kindly.
[The prepared statement of Mr. Offerman follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much. I don't think any of us
could have said it better. But now it is time for the smart
people to talk, and I am first going to recognize Dr. Omer for
5 minutes.
Doctor?
STATEMENT OF SAAD B. OMER, Ph.D.
Dr. Omer. Hi, my name is Saad Omer, I am the director of
Yale Institute for Global Health, and it is my privilege to be
here. Thank you.
With the U.S. vaccine supply outpacing the number of doses
being administered, there is no shortage of diagnosis for what
ails the--or what are the barriers to increasing this coverage
even further.
However, 20 years of research on vaccine acceptance and
data from this pandemic show that the reality is a bit nuanced.
And a lot of these things were appropriately covered by the
various Members who spoke before me. Here are a few
observations based on this research.
First of all, we must recognize that vaccine acceptance
behavior is a spectrum. On the one end, we--of this spectrum--
are individuals who actively demand vaccines, and on the other
hand are people who would refuse vaccines in all situations.
Even if you put Mom and apple pie in a shot, some people would
refuse it.
Then, you know, in this pandemic, active vaccines--seekers
were so vociferous that it created the impression that, as soon
as the supply improves and major delivery bottlenecks are
resolved, there will be persistent increases in immunization
rates until herd immunity is reached. However, for several
weeks there is more vaccine available in the U.S. than there
are seekers.
Fortunately, we must recognize that strict refusers are a
relatively small group, estimated to be approximately 10 to 13
percent of eligible adults. This is larger than other vaccines.
But nevertheless, it is not 20, 30, 40 percent of the
population.
There is much larger--there is a much larger group of so-
called fence sitters, who have questions about the vaccine but
can be persuaded with the right interventions.
And then there are those who do not have a lot of concern
about immunization but are not particularly enthusiastic about
it, either. They don't wake up every morning and think about
vaccines, unlike some of us, whose job is to think about
vaccines when we wake up every morning. So--but they are still
susceptible to--amenable to nudges, and that is good news.
So, given the range of enthusiasm about vaccines, there is
an interplay between vaccine demand and vaccine access. Those
who actively demand vaccines go the extra mile of--for getting
it, sometimes traveling long distances to be vaccinated.
However, now that most of the vaccine enthusiasts have been
immunized, practical issues such as how easy it is to get an
appointment have become relatively prominent reasons for
nonvaccination.
So we know from data that ethnic and racial minority groups
in the U.S. have been disproportionately harmed by the
pandemic. African Americans, for example, had a COVID-19
mortality rate twice that of White Americans. And many nascent
efforts to bring vaccines directly to communities, including
programs that work with local, civic, and religious leaders,
are playing a role in addressing barriers for getting
vaccinated. These programs need to be sustained and scaled up.
Getting communities engaged with the vaccine will be easier
with a scalable template. And I have proposed an approach that
involves pairing a community validator--for example, a church
leader--with an expert--for example, a physician--with roots in
the same community, and replicating this model across the
country.
Another group that the data have identified are
conservative men, who have emerged as another group
particularly hesitant to vaccines against COVID-19. Trying to
persuade this group through messages that don't speak to their
values could be counter-productive. And we have done some
research on how to speak to people who emphasize liberty, and
there are ways to doing so.
Overall, vaccines have traditionally enjoyed bipartisan
support, and our data show that support is important in
instilling and increasing confidence in COVID-19 vaccines, as
well.
One of the things that I would highlight that--irrespective
of the reason for nonvaccination, healthcare providers are the
most trusted source of vaccine information, even among those
who are highly hesitant. A strong endorsement by a healthcare
provider is a consistent predictor of vaccine acceptance. And
so how do we make--enable our healthcare providers to do so?
And one idea is to have a national continued medical
education program that trains them in these up-to-date,
evidence-based communication methods that have been developed
and evaluated through Federal funding over the last 5, 10
years, generally around vaccines, and then scale it up at the
national level. Yale is developing such a program, and others
are welcome to do so, as well.
While physician and healthcare providers are best suited to
persuade vaccine-hesitant individuals, having an effective
vaccine conversation requires time. And currently, doctors can
charge for administering a vaccine, but they--if the
vaccination doesn't happen, there is no reimbursement. So,
since they cannot predict the future, it would be useful to
make this counseling itself reimbursable.
So I will stop here and would be happy to answer questions
as my turn comes.\1\
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\1\ The prepared statement of Dr. Omer has been retained in
committee files and is available at https://docs.house.gov/meetings/IF/
IF02/20210526/112684/HHRG-117-IF02-Wstate-OmerS-20210526-U1.pdf.
---------------------------------------------------------------------------
Ms. DeGette. Thank you so much, Doctor. I am now pleased to
recognize Dr. Gracia for 5 minutes.
Dr. Gracia. Thank you----
Ms. DeGette. Doctor?
STATEMENT OF J. NADINE GRACIA, M.D.
Dr. Gracia. Thank you, good morning. My name is Nadine
Gracia, and I am the executive vice president and chief
operating officer at Trust for America's Health, which is also
known as TFAH.
TFAH is a nonprofit, nonpartisan public health policy,
research, and advocacy organization which has focused attention
on the importance of a strong and effective public health
system as well as on making health equity foundational to
policymaking at all levels.
I am honored and very pleased to be before you today to
discuss the issue of vaccine confidence during this critically
important time in our Nation.
By way of background, I previously served as the Deputy
Assistant Secretary for Minority Health and the Director of the
Office of Minority Health at the U.S. Department of Health and
Human Services.
The COVID-19 pandemic is an unprecedented and devastating
pandemic for the U.S. and the world. While we have certainly
seen disparities in public health emergencies in the past, the
COVID-19 pandemic has greatly exposed our Nation's systemic
inequities. Prior to the pandemic, communities of color already
faced inequitable opportunities for health and well-being. And
we urge policymakers not to lose sight of the need for
continued outreach, education, and access for communities that
are both at higher risk from COVID-19, and may have greater
barriers to vaccination.
In October of last year, TFAH, in partnership with the
National Medical Association and UnidosUS, cohosted a national
convening on building trust in and access to a COVID-19 vaccine
in communities of color and Tribal nations. As an outcome of
the convening, we published a brief in December with
recommendations for policy action. Our recommendations
addressed six key areas:
First, ensuring the scientific fidelity of the vaccine
development process.
Second, meaningfully engaging and providing resources to
trusted community organizations and networks in vaccination
efforts.
Third, providing communities the information they need to
understand the vaccine, make informed decisions, and deliver
messages from trusted messengers and pathways.
Fourth, ensuring that it is as easy as possible for people
to be vaccinated. And vaccines must be delivered in community
settings that are trusted, safe, and accessible.
Fifth, ensuring complete coverage of the cost associated
with the vaccine.
And sixth, funding and requiring disaggregated data
collection and reporting.
Now, while these recommendations are most immediately
applicable to the COVID-19 vaccine, many will remain essential
beyond this pandemic and will be important in earning vaccine
trust in these communities into the future.
While the focus of this hearing is on vaccine confidence,
the data also show that access remains an issue for many
populations. A recent Kaiser Family Foundation survey
highlighted that Latinos are most eager to get the vaccine but
continue to face barriers in access. In another example,
vaccination sites may be inaccessible for people who are
homebound, including many older adults and people with
disabilities.
TFAH released an issue brief in March on ensuring that this
population and their caregivers are prioritized for
vaccination. The report highlights innovative programs such as
one in the chair's home State of Colorado, where the Health
Department partnered with a service that provides primary care
at home to administer thousands of doses of the vaccine to
people who are homebound. Leveraging community partnerships and
trusted services that engage with the population can provide
important lessons for building community resilience before the
next emergency.
Some of the COVID-19 vaccination funding provided in the
last Congress and through the American Rescue Plan Act has been
targeted to increasing vaccine confidence and access in
communities of color in rural and underserved communities. And
it appears that this focus is paying off. Last week the White
House announced that, after months of receiving a
disproportionately smaller share of vaccinations, 51 percent of
those vaccinated in the U.S. were people of color in the prior
2 weeks. We urge Congress and policymakers to carry forward
these lessons for funding and preparedness programs to ensure
equity is central to the responses.
In closing, we urge Congress to build upon the lessons of
the pandemic. We must modernize public health infrastructure
and workforce. We must invest in community organizations that
work with underserved populations and maintain these
partnerships long after the pandemic. And we must provide long-
term investments, both in the systems that develop and deliver
the vaccines and those that build bridges to the communities
that are most affected. Now certainly is the time.
Thank you.
[The prepared statement of Dr. Gracia follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
Ms. Pisani, now I am very pleased to recognize you for 5
minutes for your opening statement.
STATEMENT OF AMY PISANI
Ms. Pisani. Thank you, Chairwoman DeGette and Ranking
Member Griffith and members of the subcommittee, including
Congressman Burgess, who has hosted several Vaccinate Your
Family briefings over the years on vaccines and disinformation,
as well. My name again is Amy Pisani, and I have had the
pleasure to serve as the executive director of Vaccinate Your
Family for the past 25 years.
Vaccinate Your Family was founded by former First Lady
Rosalynn Carter and former First Lady of Arkansas Betty
Bumpers, who was the wife of Senator Dale Bumpers. That was 30
years ago this summer. And they founded our organization on the
heels of a massive measles outbreak that took the lives of many
children and hospitalized over 10,000 people. Our founders
traveled to every State in the Nation, building statewide
immunization coalitions which continue to thrive. And one thing
was clear to them back then and remains true today: Vaccination
efforts need Federal support and guidance for certain, but they
are best implemented at the local level, where community
members can work together to make the greatest impact on their
neighbors.
I want to take this moment to thank the Members of Congress
and both administrations for the work that you have done to
protect and promote public health and to really protect us and
keep us from economic ruin while we awaited those lifesaving
vaccines that Mr. Offerman so clearly, generously spoke about.
As you know, everyone is now eligible at 12 years and
older, and families are being tasked with making a monumental
decision. So--whether to vaccinate their family members of all
ages, and where to go to access those vaccines, which is not
always a simple procedure in this country.
Now, I know that having access to science-based information
is really essential to building confidence, and that is what we
are going to be talking about a lot today. I actually
experienced hesitancy while I was pregnant with my first child
20 years ago, in the year 2000. Just after a few years in my
role as executive director, I attended the House Committee on
Oversight and Government Reform hearings where Andrew
Wakefield, who has since been stripped of his medical license,
was given the opportunity to share his now-retracted Lancet
study that proclaimed that MMR vaccines caused autism. And that
became a spotlight of the Nation.
As a pregnant person who was really learning the science of
vaccines still, I became susceptible to the gravitas of
Wakefield, and I became bewildered by the data he was
presenting to members of the committee. But fortunately, I was
able to reach out to Vaccinate Your Family's board members,
including Dr. Walter Orenstein and Dr. Paul Offit, renowned
vaccine experts, and they answered each one of my questions
with patience and compassion. And they helped me to move from
hesitancy to confidence by the time my child's vaccines were
due.
So my confidence was built on information provided by
experts that I trusted, and from that experience I became even
more committed to ensuring that our organization builds
educational and social media efforts that bring the science to
the public so that they, too, can make informed decisions on
vaccines for their own families.
Now, we have learned the two key tenets to building
confidence are transparency and respect. Since the beginning of
the pandemic, our organization has focused not on encouraging
people to just blindly accept an eventual vaccine but to learn
about the safety systems in place that ensure the ongoing
safety of our vaccines.
We called for companies developing vaccines to hit all the
usual milestones in the development, keeping in mind that some
steps could be conducted simultaneously, and that would speed
up the process without compromising their safety or efficacy,
as many of the Members have discussed this morning.
We also called on the FDA to adhere to the normal review
process, ensuring that each vaccine would be vetted in the
public eye, as it would be for any other product.
And to build trust in COVID-19 and routine vaccines, we are
collaborating with who we consider--who we think are trusted
stakeholders in their communities, one of which is the Good
Health WINs program, Women's Immunization Networks. And we are
doing so with the National Council of Negro Women to reach
their 12 million members with vaccine resources for their
family, friends, and neighbors.
We have also begun working with Dia de la Mujer Latina, to
not just translate materials into Spanish but to create
culturally relevant resources that engage and motivate Spanish-
speaking people.
We are also continuing to work with immunization coalitions
to develop new programs to raise vaccination rates in both
rural and conservative areas, enlisting new partners, such as
agricultural extension workers and evangelical leaders.
So, Congress, you can help us on the path to good
confidence to--to confidence by supporting great public health
policies.
First, let's improve access. Plain and simple, poor
children and those in rural areas are up to a third less likely
to receive some vaccine. And among adults, we spend $27 billion
preventing--on vaccine-preventable diseases that could have
been prevented through vaccines.
Public health officials need good, timely data to evaluate
their efforts, and you can help us by supporting four bills,
which--many of which are sponsored by E&C Committee members,
actually: the Strengthening Vaccines for Children Act; the
Black Maternal Health Momnibus Act; the Helping Adults Protect
Immunity, or HAPI, Act, and that helps eliminate cost-sharing
for vaccines for Medicaid beneficiaries; and the Immunization
Infrastructure Modernization Act.
Finally, it is important to remember that people need other
lifesaving vaccines. And I do urge the public to come visit
VaccinateYourFamily.org, learn about our Don't Skip Vaccines
and our Good Health WINs collaborations, and for educational
materials on all diseases.
And for Congress, we have a special report that we write
for you every year called the State of the ImmUnion, which is
on our website.
Thank you so much for the opportunity to testify. I look
forward to answering questions.
[The prepared statement of Ms. Pisani follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much. And I urge all the Members
to read your report, because it is an excellent snapshot of
where we are. And now the Chair is very pleased to recognize
Dr. Shelton.
You are recognized for 5 minutes for an opening statement.
STATEMENT OF KAREN SHELTON, M.D.
Dr. Shelton. Good morning, Chairwoman DeGette, Congressman
Griffith, and members of the committee. My name is Dr. Karen
Shelton, and since 2016 I have been the director of the Mount
Rogers Health District with the Virginia Department of Health.
I am also acting director for a Lenowisco and Cumberland
Plateau Health Districts. I am honored to be with you today to
discuss the importance of vaccines and vaccine education, as
well as the role that local health departments like mine play
in improving vaccines, access, and acceptance.
We are very proud of our work in the far southwest region
of Virginia, in Mr. Griffith's district. I serve a geographic
area with 16 localities that is larger than Connecticut. End to
end, it takes me about 4 hours to drive across our
jurisdiction, with many communities that lack access to
broadband internet or even cell service. Situated in the heart
of Appalachia, practicing public health in southwest Virginia
might look different from public health in other parts of the
country. But what all local health departments have in common
is the shared goal of protecting and promoting the health of
our communities.
The response to COVID-19 pandemic has been the epitome of
what public health does for our community. We know our
communities well, including the assets and barriers to care,
distinct local culture, the industries and living situations
that might pose challenges, as well as the community-level
partners and organizations that must be included to be
successful. We live in our community and serve our neighbors.
In the fall of 2020, prior to the authorization of COVID-19
vaccines, our region experienced a surge of cases,
hospitalizations, and deaths. Our area already was experiencing
disproportionately poor health outcomes and is at increased
risk from COVID-19 due to chronic disease and elderly
population and limited healthcare access. In the winter,
district daily caseloads spiked, and we could no longer conduct
full case investigation or contact tracing. We advised schools
to go fully virtual, and our local hospital capacity teetered
on the brink of being overrun.
At the peak of our disease burden, vaccines became
available, and the ability to vaccinate our healthcare workers
and first responders, followed by our most vulnerable elderly
population, brought inexpressible joy. When vaccines began to
roll out late December 2020, the Far Southwest Health
District--had the advantage of a long history of partnerships,
providing vaccines in our communities, and being service-
oriented health departments with large staff, allowed us to
begin giving vaccines rapidly.
With these partnerships, we led the State in percentages of
population vaccinated from the onset of the vaccine campaign
through March. We vaccinated our high-risk essential workers
and prioritized teachers, because they had been teaching in
person since the fall. We watched as our case rates fell and
healthcare capacity was restored.
We realized early on that the vaccination rollout heavily
favored the tech savvy, those with internet, cell service,
smartphones, and computers. As vaccine supply increased and
demand decreased, we transitioned to our mobile units in May to
reach the areas of the community that were more remote and had
less broadband access.
We are working with county administrators, emergency
coordinators, schools, faith communities, and local businesses
to increase vaccine uptake. We are scheduling outreach and
mobile clinics at farmers markets, festivals large and small,
high traffic areas such as convenience stores, and places
people are already gathering: restaurants, breweries, wineries,
churches, hiking trails, sporting events, food banks, parks,
music events. We are partnering to give tickets as incentives
for vaccines and creating messaging with trusted local voices.
Some of our challenges have been in data acquisition.
Currently, vaccines given out of State do not show up in our
counts. And as we border North Carolina, Tennessee, Kentucky,
and West Virginia, this makes it challenging to discern our
true vaccine numbers. Virginia is working to access this data.
Another challenge is technology needs. Our existing network
is so poor that we cannot reliably participate in Zoom or
Google Meet.
We know there is some vaccine hesitancy in our community.
However, many labeled as hesitant have simply not had access to
vaccine or opportunity to have their questions answered. We
feel it is important not to label our population, in order to
avoid creating resistance where it may not truly exist. We know
there are multiple reasons why people choose not to be
vaccinated: medical, religious, political. We feel our role is
to provide education and opportunity for vaccination by meeting
people where they are in their own community and being
champions for the vaccine.
We are grateful to Congress, emergency funding, and
attention to the needs of public health response of COVID-19.
This response would benefit from single-dose vaccine packaging,
streamlined national vaccine data, coordinated messaging that
speaks to many different populations, and continued resources
for local public health outreach.
We know that some of the most important components of a
successful vaccination campaign are access, education,
opportunity, and respect. We appreciate the support of the
Federal Government to create access to vaccine, and we will
continue to work respectfully with our communities for
education and opportunity. We will continue to seek to learn
from others' successful vaccination strategies.
Thank you again for inviting me to testify today, and I
look forward to your questions.
[The prepared statement of Dr. Shelton follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, and thanks to all of our
witnesses for their testimony.
It is now time for Members to ask questions, and the Chair
will recognize herself for 5 minutes.
We know that COVID-19 vaccines are safe, effective, and our
shot at a return to normalcy. And, as the panel has been
discussing today, the main issue is, are Americans choosing not
to get vaccinated, or do they simply not have the opportunity,
and how can we help them?
Dr. Omer, you testified that there is a large group of
``fence sitters'' who have questions about the vaccine, that--
but can be provided with the right interventions. Can you very
briefly tell us what some of those interventions that the data
shows us might work are?
Dr. Omer. Yes--no, so this is a group that--which doesn't
actively think about vaccine but can be persuaded, or--either
their beliefs are----
Ms. DeGette. Yes, can you tell us some of those methods
that can work?
Dr. Omer. Yes. So one of them, one of the approaches, is to
provide basic information about the immunization process
itself. So that is number one.
The second thing is making--bringing the vaccines closest
to them, but also informing them that it is there.
The third is these community outreach efforts--sorry, can
you hear me?
Ms. DeGette. Yes.
Dr. Omer. Yes, so I will----
Ms. DeGette. We can hear you.
Dr. Omer. I will continue, yes. So----
Ms. DeGette. Yes, please.
Dr. Omer [continuing]. Then community outreach efforts that
are--so the administration has announced, in terms of investing
in community health workers and individuals going door to door,
there are existing programs there, as well, that are
coordinated by community-based organizations. Empowering them
with evidence-based messaging, but also the ability to schedule
there and then.
So these are some of these approaches----
Ms. DeGette. Right.
Dr. Omer [continuing]. That can bridge the gap between
demand and supply.
Ms. DeGette. Thank you very much.
And Dr. Shelton, you talked about some of the unique needs
of rural individuals. I am wondering if you could tell us some
of the strategies that you think work with rural Americans.
Dr. Shelton. Thank you. Yes, we have been working--like I
said, one of our greatest problems is access, and--to the
vaccine, as far as going out to populations where they have not
been able to take advantage of registration and sign-ups
online. So going out into the communities where there is not--
where they don't have the broadband access or cell service or
computer service. So we have been taking our mobile units out
into the community to try to reach them.
We would benefit from greater education opportunities with
these. We do have some community health workers beginning to
come online. But again, training them, and getting them up and
rolling to be able to actually answer those questions on the
spot with people who were there to give vaccines would be very
helpful in our ongoing strategy there.
Again, taking opportunities also where there is----
Ms. DeGette. Great, thanks. OK, thank you.
Ms. Pisani, you have been working on these vaccine issues
for years, as you said. And one of the greatest pockets of
vaccine hesitancy is, obviously, with children, which you have
been working on. My home State of Colorado has one of the
largest groups of these parents.
Very briefly, what would you say to the parent of a child
who is eligible for a shot, who isn't sure about the benefits?
Ms. Pisani. Congresswoman DeGette, were you calling on me?
It broke up for a second.
Ms. DeGette. Yes, I was calling on you. What would you say
to the parent of a child who is reluctant to get a shot for
that child about what the benefit would be?
Ms. Pisani. Yes, and I think that that is a big decision
that families need to make. And everyone should be asking about
any medical product. And that is something that Vaccinate Your
Family, we feel really strongly we want to be the sort of no-
judgment zone.
So really, what you need to think about are, first of all,
we know that millions and millions of children have now been
vaccinated safely. But also, really thinking about what are the
risk-benefit ratios, I don't think that some parents are really
recognizing that. Even though we haven't had a huge number of
children who have died from COVID, we know that they can have
multisystem inflammatory disorder. We don't know what the long-
term consequences will be of COVID. We know that people who got
polio decades ago are back in their wheelchairs today. We know
that, if you get chickenpox, you can get shingles later in
life, which I got last year and, let me tell you, it is no
picnic.
So we don't know what the future will be. And it is--you
know, that is why I vaccinate my own kids. I want to make sure
that they don't end up suffering something in the future.
Ms. DeGette. Thank you so much.
OK, I am going to finish with you, Mr. Offerman, because I
think one of the reasons you have chosen to be a spokesperson
urging people to get the vaccine is because you are well known
for playing the TV character Ron Swanson, who has a [audio
malfunction] government programs, even though he worked for the
government. And so I want to ask you, what is your message to
Americans out there who are wondering if they should get the
vaccine, or if they should have their family members get the
vaccine?
Mr. Offerman. Sorry, can you repeat the--just the last part
of your question?
Ms. DeGette. Sure.
Mr. Offerman. Wondering if they should get a vaccine, or--
--
Ms. DeGette. What is your best--or tell their family
members why they should get a vaccine.
Mr. Offerman. Well, to me, it really just comes down to, as
Ms. Pisani just pointed out, the risk-benefit ratio, the--what
is likely to occur at the hands of COVID-19 is much more
catastrophic than what has now been proven to be a harmless
vaccine.
And so it is not a sensibility of deciding for oneself and
saying, ``Oh, my immune system will take care of me.'' Instead,
act as a member of a community, or as a good neighbor or a good
citizen and say, ``Ah, the experts have made it clear that, for
the health of all, we absolutely have to achieve this herd
immunity. So let's all get our shots.''
Ms. DeGette. Thank you so much.
And now, Mr. Griffith, I am very pleased to recognize you
for 5 minutes.
Mr. Griffith. Thank you, Madam Chair. I took my headset off
because, apparently, I was the cause of the previous--my
headset was causing the previous buzz. Hopefully this is
better----
Ms. DeGette. We are not judging, though. Don't worry.
Mr. Griffith. All right, I appreciate it. And I do
appreciate this hearing being held today.
In recent months we have seen a variety of efforts by the
State, local, and Federal Government to educate and inform the
public about vaccines. We have also seen efforts by the private
sector, such as public service announcements from our cable
providers and other TV and radio providers, and website tools
that seek to bring awareness. It is important that we continue
to find creative ways to communicate this information, as there
are still many pockets of unvaccinated individuals.
And Dr. Shelton, I was wondering if I could speak with you
about that. You mentioned the proximity of the States and--that
are near us, and the committee has heard me talk about that
many times, how you could actually be in five States in a
single day down in our corner of southwest Virginia.
That being said, you are getting the information from the
States, but I read an article--or you are hoping to get that
information from the States. You haven't yet. I also read an
article last week that the Federal Government was starting to
share that information with localities. And I was just
wondering if the VA was sharing that information, because both
Mountain Home there in Johnson City and the VA center in Salem
have vaccinated a lot of 9th District constituents. And I am
just wondering if that is showing up in your records of people
in our district that have been vaccinated.
Dr. Shelton. No, sir, not yet. We don't have the Federal
doses calculated--in one instance, but we did talk with one of
the local penitentiaries about the number of vaccines given. It
actually raised our percentage points 3 points in that county,
just--but that was--access to--at this time.
Mr. Griffith. And that was the--was that the Grayson
facility or the Lee facility? Was it Federal or State?
Dr. Shelton. Federal facility.
Mr. Griffith. A Federal facility, OK.
Dr. Shelton. In Lee.
Mr. Griffith. Yes, ma'am. And you have talked somewhat
about it, but--I know you are learning about the pockets of
unvaccinated people, and I am glad to hear you have mobile
units out there. Do we need to do more to get the mobile units
out, and maybe not just units that do the vaccinations but, as
you have indicated, educate the public about the history of the
vaccines and the safeness of them?
Are there other things that we should be doing or
encouraging Virginia to do in that regard?
Dr. Shelton. Well, we have a messaging campaign, and we are
looking to kind of adapt this messaging and work toward our
localities in things that speak to them. As Dr. Omer said,
message about liberty and freedom along a lot of our
constituents who may not be wanting to get vaccinated, but also
to answer their questions. A lot of people have concerns.
Concerns about--is huge in our area, and there are other--some
of these more distinct cultural, rural areas, messaging would
be very helpful.
Also, we do have health education that we are beginning to
send out in advance--to answer these questions one on one. And
so we are--and how to really--and to be the boots on the
ground, and to answer those questions--and more people out
doing this would be helpful.
Mr. Griffith. And I appreciate that, and I also appreciated
in your comments that you talked about not labeling people or
pressuring them, because the people in our area are very proud
people. And you want to turn folks off, come in and say, ``We
are from Richmond'' or ``We are from Northern Virginia, and we
are going to tell you how to do it.'' That doesn't work in our
area, as you know, and I appreciated you making those comments.
Do you want to amplify that at all?
Dr. Shelton. Well, the health department in southwest
Virginia provides a lot of--for our community, and we are a
trusted source of information to them. So we do respect all the
viewpoints that we do hear, and we try to work with people in
their own community and to address their concerns,
specifically--again [audio malfunction] people without a lot
of--they ought to have all their questions answered.
Mr. Griffith. Yes, I appreciate that, and I think it is
very helpful that you are a native of the area and have long
served both patients and the community, and I think that helps
you get that message out. If there is anything that we can do
to help get that message out, not only in our part of southwest
Virginia but in east Tennessee or rural parts of North
Carolina, West Virginia, all of which border our territory,
and--we are more than happy to do it.
And as you can see, as as the chairwoman pointed out, this
is not a Democrat or Republican issue. This is about all of us
working together. And we have had some counties that have been
hit pretty hard, even over the border in West Virginia. I had a
county over there, not in my district, but one that was really
hit pretty hard. So we are trying to do it, and we appreciate
what you are trying to do and what all the witnesses are doing
here today. Thank you.
I yield back----
Ms. DeGette. I thank the gentleman. The Chair now
recognizes the chair of the full committee, Mr. Pallone, for 5
minutes.
I don't see Mr. Pallone.
Mr. Pallone?
We may have lost him briefly. And so, Ms. Kuster, are you
ready to go? Why don't I recognize you for 5 minutes?
Ms. Kuster. Thank you, and I apologize, I am just trying to
pull up my remarks. Thank you so much, Chairwoman DeGette----
Ms. DeGette. Take your time.
Ms. Kuster. Can you hear me? Chairwoman DeGette, can you
hear me?
Ms. DeGette. Yes, yes.
Ms. Kuster. Great. Thank you for holding this important
hearing today, and thanks so much for our witnesses, for your
testimony and preparation.
The progress we have seen these past few months in beating
back COVID-19 has been nothing short of remarkable. In just
over 1 year, we have undertaken an incredible effort to
manufacture multiple highly effective and safe vaccines. And we
have undertaken, literally, a warlike vaccination campaign to
get shots into the arms of the American people.
On January 20th, when President Biden took the oath of
office, only 1 percent of adults were fully vaccinated. But
today over 50 percent of American adults are fully vaccinated.
And not to brag on New Hampshire, but over 70 percent of adults
in my State have at least 1 dose.
While these statistics are encouraging, more must be done
as we begin to see the signs of vaccine hesitancy among certain
populations. A key component to our continued vaccination
efforts is ensuring that we have hard data collected to ensure
that we can improve access in rural communities, including my
district. And that is why earlier this year I introduced the
Immunization Infrastructure Modernization Act, bipartisan
legislation that would improve and expand information sharing
between State and Federal governments, as well as public and
private healthcare providers, to ensure that vaccines are being
administered effectively, efficiently, and fairly across all
States and territories.
Immunization information systems, IIS, are secure,
multifaceted systems that allow for the sharing of crucial
information and the maintenance of records. My bipartisan
legislation aims to bolster these systems and support real-time
immunization record data exchange and reporting.
Dr. Gracia, you identified in your testimony deficiencies
in our immunization information systems, many of which could be
improved by advancing my bipartisan legislation with
Congressman Bucshon. Can you discuss why it is so important for
immunization information systems to be consistent in the type
of data collected and reported?
Dr. Gracia. Yes, thank you for that question and for your
leadership with regards to addressing the importance of a
strong and robust immunization infrastructure. That is, indeed,
really, a core part of what we need with regards to our public
health system and our public health infrastructure.
What we have seen, for example, has been--over the years
that, actually, the immunization information systems have not
kept up to pace with regards to the need for funding to ensure
that we have really robust, comprehensive immunization systems
that can do the type of surveillance, whether it is in the
detection of outbreaks, being able to tailor interventions--
because you identify that there are certain populations in
communities that, either for hesitancy or for access, have not
been immunized--and then being able to ensure that there is
interoperability of these systems, as well as ensuring that the
programs themselves--and that the immunization program itself
has the ability to do the type of vaccine education and
outreach.
And so, as we think about, certainly, within the context of
the COVID-19 pandemic, how critical that is for the local
communities, as well as States, to be able to tailor
interventions to be able to get resources to those communities
that are undervaccinated, it is also important in the longer
term, as we think about shoring up our immunization
infrastructure to be able to detect and assess and address the
next emergency.
Ms. Kuster. Great. And Mr. Offerman, thank you for joining
us and using your platform to encourage Americans to get the
COVID vaccine. You speak to the effects the pandemic has had on
your work in the entertainment industry and how, by listening
to doctors and trusting each other, you and your colleagues
were able to safely get back to work last year.
Since this was a successful strategy, how do you think this
can help our national vaccination effort, particularly in rural
areas like the one you grew up in?
Mr. Offerman. Well, you know, I think it is just a matter
of extending the leadership that the--our other witnesses are
talking to, and getting this clear messaging to all of our
citizens who are confused by the information they are getting.
That comes from a variety of reasons: misinformation,
conspiracy theories, mistrust, et cetera. And I think we just
need to turn up the volume on the clear information that it is
safe, everyone should do it.
It is your duty, as a family member. You know, if you love
yourself, your family, your community, it is beholden on all of
us to step up and be a good neighbor and a good family member
and just shout that to the hills.
Ms. Kuster. Great. Well, thank you for helping us shout
that to the hills. And with that, I yield back.
Ms. DeGette. I thank the gentlelady. The Chair now
recognizes the ranking member of the full committee, Mrs.
McMorris Rodgers, for 5 minutes.
Mrs. Rodgers. Thank you, Chair DeGette and Morgan Griffith.
As ranking member, I really appreciate the approach of today's
oversight hearing, and thank you to all our witnesses. I, too,
just have some followup questions.
Dr. Omer, I wanted to ask the simple question: Do you have
confidence in the three COVID-19 vaccines that are available
today in the United States and the ways in which they were
developed, reviewed, and authorized?
Dr. Omer. Absolutely. And as an independent academic, I
would have said so if I did have any lack of confidence in
them.
Mrs. Rodgers. Thank you.
Ms. Pisani, I wanted to ask, do you believe it is important
for people to get the best and most accurate information?
And you stated that, that you believe it is important. How
do you believe that they can, and allow them to make the best
decisions for that--themselves?
Because right now, some of the most common questions we
have from people are that they are concerned about getting--you
know, they want to make sure that they have the best and most
accurate information when it comes to getting the COVID-19
vaccine, and just any insights you have, as far as addressing
those concerns.
Ms. Pisani. Well, I mean, I think there's a combination of
issues, obviously. And maybe we'll talk a little bit more about
social media disinformation, and that is a really important
issue that we have to deal with.
But we do know that people do trust their providers. And so
they are the most important source of information right now, no
matter where you live.
But, you know, hearing from some folks in rural and urban,
the challenges are so different, depending on where you live.
And I literally traveled the Nation with Mrs. Carter and Mrs.
Bumpers. And if you're in Wyoming, and you are an hour and a
half away from your medical care, that type of message that you
need to get is a little bit different than a person who could
just go down the road and go to any clinic and get vaccinated.
So that trusted messenger issue, I mean, we are getting a
little tired of hearing it, but it is so essential. Like, if
you trust your evangelical leader, that is the person who needs
to encourage your vaccinations. If you trust your local
football coach, if you are from Penn State, those are the folks
that you want to encourage to talk about vaccines. So I think
it is different, no matter--depending on where you live.
Mrs. Rodgers. Thank you.
Dr. Omer, I wanted to ask you to address the issue of
people being concerned about side effects, because the fear of
the fever, the fatigue, especially following the second
vaccine, is one of the leading reasons why people are choosing
not to get the COVID-19 vaccine. Would you just address what
you think is the best way to approach someone who is concerned
about the side effects and the potential of losing a day of
work or two?
Dr. Omer. Yes. I think that is a really good question. So
there are two things that should be emphasized for the
individual.
First of all, that this is the transient side effect. We
get fatigue, pain, sometimes fever. They are expected. They
were seen in the trials, and they are not connected to the
serious adverse events, et cetera. So if you are getting that,
it is just that, it is inconvenience. It is hard, in its own
right, to be down with fever or fatigue, but it is not a sign
of something more--sort of ominous, it's not an ominous sign
for a more severe and long-term side effect. That is number
one.
The reason why it is happening is that, when your body is
trying to mount a strong immune response, for some people--not
for everyone, I did not get these side effects. That did not
mean that I did not mount an adequate immune response. But for
some people, that means that that inflammation, that immune
response, leads to these transient side effects. And so those
are the things we need to communicate.
Mrs. Rodgers. Thank you.
And my final question, Dr. Shelton, in your written
testimony you note that in the rural areas it is especially
important to build the cross-sector partnerships in order to
meet the needs of the community. And I just wanted to ask if
you could share any examples of those partnerships and why you
believe it is critical in the rural communities, in particular.
Dr. Shelton. Yes, we have built these relationships over
time. It is very important, the relationships we have with our
hospitals, as well as our pharmacies and healthcare providers
with the rollout of the vaccine. But we also have long-term
partnerships with our county administrators, emergency
coordinators, and schools. When it came time to go out and give
the vaccine to the students, for those who were 16-plus and
then 12-plus, we, you know--begin to provide vaccines within
the schools.
Also, working in our larger--emergency coordinators, just
having the whole community pitch in and help with these efforts
went a long way toward increasing--and the number of people we
were able to vaccinate.
Mrs. Rodgers. Super. Thanks for your work.
Madam Chair, I yield back the remainder of my time. Thank
you.
Ms. DeGette. I thank the gentlelady. The Chair now is
pleased to recognize the chairman of the full committee, Mr.
Pallone, for 5 minutes.
Mr. Pallone. Thank you, Chairwoman DeGette. My questions, a
lot of them are the same ones that Ranking Member Rodgers
asked, so I guess we think alike, Cathy. But let me try to ask
those that maybe you didn't cover. I wanted to ask Dr. Omer
about these, you know, misconceptions.
You know, we hear fears from Americans about vaccine
safety, that they were developed too quickly, or the process--
review process wasn't rigorous enough, and there is also this
thing about the side effects with--that vaccines can cause
fertility problems.
Just, you know, set the record straight for us. Why should
we not be worried about this type of misinformation that is
swirling, particularly online?
Dr. Omer. Yes. So this is a misconception that is out there
that we--the corners were cut. The corners weren't--you know,
nobody took a shortcut. It is just that we built a highway. And
that is why the--streamlining the process, cutting the--some of
the bureaucratic process but also increasing efficiency by how
we recruited in trials.
If I may take the liberty of giving you one example. So if
you need 30,000 people in a trial, which were an average size,
30 to 40,000 people, you can have 30 sites with 1,000 people,
or you can have 60 sites with 500 people, or 120 sites for
recruitment for 250 people. So that is why--that is one example
of how efficiently we expanded the number of sites, because
resources were available, et cetera, so that we did these
trials quickly, rather than doing it--you know, waiting for
each site to enroll, let's say, 1,000 people, or 3,000, if you
were going with 10 sites. So that is important.
The processes that were used to ensure safety and efficacy
are time tested. This was--these were the processes, the data
collection, the evaluation. And just to remind everyone that
all--with all of these trials, by regulation they have to have
an independent data and safety monitoring board. So, even
beyond the outside committee independent review that FDA
performed while these trials were going on, there was weekly,
ongoing safety review and effectiveness review after the data
became available was happening.
And then now, the--there is an unprecedented effort to
ensure that there is robust vaccine safety surveillance. And
that is why you hear about certain signals. You know, if you
look for--you do robust surveillance, you hear about these
signals. And FDA and the CDC has done--taken a rational--
conservative, in a sense--to protect the safety--to protect the
general public against any uncertainty, as well. That path, by
leveraging those data and having a short timeframe from signal
emergence to signal evaluation, and then a recommendation. So
this has enabled us to trust the process, and to trust the
outcome of this development and deployment process.
Mr. Pallone. Well, thank you. Another [audio malfunction].
Ms. DeGette. OK, Mr. Chairman, can you start your question
again?
Mr. Pallone. Yes. [Audio malfunction] come down today to
meet with the vice president on broadband. So I had to get on
the road.
But this is about whether people who previously had COVID-
19 should still get vaccinated.
Dr. Omer. So I don't know if----
Mr. Pallone [continuing]. Understanding around that.
Dr. Omer. Sorry, I----
Ms. DeGette. Go ahead, Doctor.
Dr. Omer. Yes, so--OK, I was unclear if the question was
for me, but I would answer it.
Mr. Pallone. Yes, it is OK. Well, I guess it--actually if
Dr. Gracia wants to answer it, about whether people who
previously had COVID-19 [audio malfunction].
Dr. Gracia. Yes, the recommendation is that people who have
had COVID-19 should still get the COVID-19 vaccine. You know,
there is natural immunity and antibodies that are developed
through infection with COVID-19. However, that is not as robust
as what we know from--with regards to vaccination. And so--and
we don't know how long that natural immunity can last. And so
the recommendation is, indeed, for those who have COVID-19 to
also get the COVID-19 vaccination.
Mr. Pallone. All right, thank you so much.
Thank you, Chairwoman DeGette, I appreciate it. I yield
back.
Ms. DeGette. Thank you. Thank you, Mr. Chairman.
The Chair is now pleased to recognize Dr. Burgess for 5
minutes.
Mr. Burgess. I thank the chair, and I thank all of our
witnesses for being here today. This is such an important panel
that we have put together.
And I--you know, the--one of the things that leads to
hesitancy, of course, is not being consistent in the
information that is delivered. And I think Mr. Offerman,
actually, said it at the beginning of his testimony. He is--
``Here I am, just a regular guy, and we have to defer to all
the scientists.''
But let me just tell you, Mr. Offerman, this is a novel
disease. And the scientists were sometimes embarrassed, because
what they had said at the beginning wasn't what they ended up
saying several weeks or months later. And I can think of no
area where that has been less pronounced--or where it would be
more pronounced--as where did this virus originate. And the
stories that we were told early on are now not comporting with
the stories that we are hearing now.
And Chairwoman DeGette, I think it would be incumbent upon
this committee, being the primarily investigative committee of
the subcommittee of the Committee on Energy and Commerce, to
ask those questions, and ask them thoroughly. I realize----
Ms. DeGette. Will the gentleman yield?
Mr. Burgess. Yes, I would be happy----
Ms. DeGette. Will the gentleman yield?
So I agree. I think it is very important that we find a--
that we investigate where--particularly, if the virus escaped
from some lab, because that, of course, has implications for
international health.
Mr. Burgess. Yes----
Ms. DeGette. And I have already spoken to the ranking
member. Whatever we can do--I don't think China is going to
produce any documents to this committee.
Mr. Burgess. No----
Ms. DeGette. But we are going to do whatever investigation
is appropriate. And Mr. Griffith and I are on the same page.
Mr. Burgess. So reclaiming my time, because it is----
Ms. DeGette. I will give you a little extra time, too.
Mr. Burgess. All right.
Ms. DeGette. I will give you a little extra.
Mr. Burgess. I have got more than I can get through,
anyway, and I, obviously, will be submitting questions for the
record, as is my habit.
But that is--if we can reestablish some credibility, even
after the fact, I think that is going to be so critically
important, because not only do we have a once-in-a-lifetime
pandemic, we had it on top of a once-in-a-lifetime political
year, and it left people, in many cases, confused. And now the
challenge for all of us is to--how do we get to people and help
them understand what is--what I believe would be in their best
interest.
Chairman Pallone, I guess we have lost you to the ether
somewhere, but I have asked for your help in interceding with
the Speaker. All of us, or most of us, took the vaccine in
December. The Speaker told us we were--it was necessary for the
continuity of government, and so--fully vaccinated, to be sure.
And yet we behave as if we are still frightened of the
disease. And that does not send--in my opinion, that does not
send the right message. So, in conjunction with other doctors
in the Doctors Caucus, we have asked the Speaker for
clarification. We have to vote in these odd ways. We are doing
this hearing in a virtual format. This should be in our main
hearing room.
This should be--if we are, indeed, all vaccinated, and we--
or those of us who are vaccinated believe that we can no longer
transmit the illness or contract the illness, we should behave
that way. And if there is someone who says, well, for whatever
reason, I don't feel comfortable being in that setting, sure,
let's have special arrangements. But we shouldn't be doing
hearings remotely. We shouldn't be doing voting on this
intractable schedule that just seems to never end. It doesn't
allow us the opportunity to amend bills and have the
appropriate legislative input. So I just make that plea. It is
time. It is time for us to get back to normal.
Now, I do have to ask Mr. Offerman a question, because this
is absolutely critical, and I need to know the answer to it.
With your vast experience as a wood worker, do you find that
English walnut has no sense of humor?
Mr. Offerman. Thank you for your question. I want to hit
one point you just mentioned, and that is I believe, once you
are vaccinated, you can still transmit the virus. It doesn't
eradicate that possibility. The vaccination is simply a
protection. But the reason that we are--I believe we are still
trying to be safe, is because you can still catch it and pass
it to others.
Mr. Burgess. Yes, well, the--reclaiming my time again, the
CDC guidelines that came out a week ago Thursday seemed to
have--seemed in a different place than that. And I recognize
that there is new information coming all the time, and we
have--many of us have been--have issued pronouncements that
turned out then to be inoperative later on. That is part of
dealing with an novel virus that is of this severity.
But it does appear that those who have been vaccinated
are--if the virus is recoverable from their nasopharynx, it is
no longer infective. And we need to know the answer to that, to
be sure. But you just look at the broad graphs of the
prevalence of disease in the United States of America, and,
clearly, something is different now than it was in January. And
do we need to be behaving the same way we were in January?
And if we believe that the vaccine is what has brought us
to that point, why don't we model that behavior?
Thank you, Madam Chair. I will yield back, and I have got a
ton of questions I will submit for the record.
Ms. DeGette. I thank the gentleman. The Chair now
recognizes Miss Rice for 5 minutes.
Miss Rice. Thank you, Madam Chair.
And Dr. Burgess, I couldn't agree with you more. I would
love to get--for all of us to get back to our prepandemic life.
And I would encourage you to speak to your colleagues on your
side of the aisle as to why they are preventing us from doing
that, and because they are not getting vaccinated.
Mr. Offerman, if I could ask you, if you had every
unvaccinated Member of Congress before you, what would you say
to them? How would you convince them? What would you say to
convince them to get the vaccine?
Mr. Offerman. Well, thank you for your question.
And just to answer Dr. Burgess quickly, English walnut is
indeed humorous.
If I had the unvaccinated Members of Congress before me, I
would simply try to appeal to their common sense and say,
``Look, as our conversation just now pointed out, we are
humans, which means we are always learning more information.
Sometimes we think we have got it figured out, but then things
continue to evolve. Even if we have a solution, the variants
show up. We will always have to be vigilant. There will be
more, you know, there will be more, ostensibly, SARS viruses
coming in our future.''
And so I would just say, ``Look, all we--with the
information that we have, the decent thing to do to--is to
pitch in for the common good, regardless of any other
misinformation, and get the shot.''
And if you guys--you know, if you need a cookie, or a
lottery ticket, or I will take you down the street for a glass
of single malt, if that is what it will take, then I will be
happy to pick up that bar tab.
Miss Rice. You might have some Members take you up on that,
Mr. Offerman.
The daily average vaccine administration in the U.S.
reached a peak of 3.4 million doses in April of 2021.
Unfortunately, that average has declined to approximately 1.8
million daily doses in recent weeks. So this is the issue that
we are talking about.
Mr. Offerman, you mentioned you had some family members
back home in Illinois who are told--look, we are not going to
be able to get--I have someone in my own family who is --
knows--you know, has family members who knows the science of
this, that were experts in infectious disease. Do you know--and
I am not asking you to out any of your relatives by name, but
is the reason--is it mis- and disinformation?
Because there is so much of that on social media. We can't
control where people are getting their information from, but we
know that there are, you know, a handful of people, Robert
Kennedy Jr. being one of whom, who posts mis- and
disinformation regarding this vaccine every day on social
media.
So have you been able to figure out the source of the
hesitancy in people in your family, and how do you address
that, specifically?
Mr. Offerman. Well, I mean, yes, the--one of the family
members in question actually used to work as a phlebotomist.
And so they feel they have, you know, a sense of authority. And
their information streams are, you know, both news channels, or
``news channels,'' and social media platforms that turn this
issue somehow into a political football and say, you know, ``Is
this administration telling you the truth? Should we listen
more to this administration?''
And this--you know, I understand that that is, you know,
the state of affairs in modern-day America. But this--what we
say to this family member is, ``Your children, two--arguably,
the cutest children in the family--haven't gotten to see their
grandparents for over a year because of the danger of''--you
know, it is a perfect storm. We have a couple of
immunocompromised kids, as well. So we have to be incredibly
vigilant. ``Can't you just do this for the good of the
family?''
And, you know, because of their incredible will and their
wonderful Midwestern stubbornness, they so far refused. So we
just try not to pull our hair out, and keep taking a deep
breath and say, ``Hopefully, we can all get together soon.''
Miss Rice. Mr. Offerman, I just want to thank you so much,
because, you know, you say that you are not one of the smart
people here and not one of the scientists, but you--your
ability to reach millions of people is unmet by anyone on this
Zoom. And so I really appreciate you being--and willing to talk
about this, and to do it in a way that, you know, can reach
regular people. You are talking specifically to people who
don't have medical backgrounds, and many of whom admire the
work that you do. So thank you so much.
And thank you to all of the other smart witnesses who
testified here today, and I yield back.
Thank you, Madam Chair.
Ms. DeGette. I thank the gentlelady. The Chair now
recognizes Mr. McKinley for 5 minutes.
Mr. McKinley. And I thank you, Madam Chairman, and thank
you for getting this panel together, because this is going to
be an interesting discussion.
But before I raise further questions, I would like to go to
Dr. Omer because, based on his written testimony, there were
some--he revealed he had quite a knowledge of the process of
the vaccination.
So I am asking you if--without Operation Warp Speed, would
we have a vaccine today in just 8 months?
Dr. Omer. I think it is correct to say that the efforts
that happened over the last year have really helped develop and
sort of evaluate these vaccines.
But I also point out----
Mr. McKinley. If I could, if--let me just--that is what I
wanted to point--I think back on the other, as to why we are
not getting--I think we are sending mixed signals. We elected
officials, public statements, public--I think we are sending
confusing and mixed signals out to the public. No wonder they
are--look back on just last year, just--not even 7 months ago,
8 months ago, we had the then-Senator Harris saying that she
would not take a vaccine if it were approved by the Trump
administration. Now, think about that.
And then we have--for decades all of us were taught, once
we get a vaccine, we are protected against a disease. But
then--and then, on May 13th is a--a couple of weeks ago, the
CDC announced that vaccinated people no longer need to wear
masks. That sets the tone. But now, follow through with that.
The next statement, just a few days later, a week later,
the President was at the Ford Rouge plant in Michigan, wearing
a mask after he had been vaccinated, after the CDC had already
come out. Dr. Fauci was wearing a double mask, and he was asked
about that, the issue, again, challenged on that.
So, Dr. Omer, again, do you think the actions of our
political officials and--their statements and their actions,
are they impacting us on the vaccine hesitancy?
Dr. Omer. So, unfortunately, I wouldn't be able to track
back, you know, sort of--since I wasn't following exact
specific day or time where everyone was--anyone was wearing a
mask, but I can do--I can speak broadly, because we tested this
in our messaging trials, as well, that bipartisan support and
endorsement of vaccines are extremely important. And so I agree
with a clear, bipartisan message on this issue is helpful.
Mr. McKinley. OK. So let me say--build off a little bit
what Dr. Burgess was saying, because I think we are all
frustrated about this, because Speaker Pelosi has said she is
not going to let us go back into session until all the Members
are vaccinated. But unlike the Senate--they are back, and they
are not wearing masks. They are back on the floor. They are
working in committees. But we are still--like this hearing
today--still being done virtually.
Now, this is contradictory towards what the Attending
Physician has said and what the CDC's guidelines are saying.
So, Dr. Omer, do you think that Nancy Pelosi is following the
science in continuing to keep the House shut down and extending
proxy voting?
What is the end game?
Dr. Omer. So Congressman, unfortunately, I am not in the
position of evaluating specific House policies because I
haven't looked at it.
But I will say that, when these trials were done, they did
not include end points for transmission. So when the data came
out, it was very appropriate to say that, to prevent
transmission to others, we should wear masks even if you are
vaccinated. Since then, the state of evidence has evolved. And
for several weeks, or actually, you know, a couple of months,
we had--we started seeing studies that say that even
transmission is drastically reduced.
But there is a nuance to this. The nuance is that if you
know--if you can verify that everyone is vaccinated, then it is
perfectly safe. And CDC has said that, for people to interact
like, you know, pretty much normal, with the exception if you
are in a healthcare facility, et cetera.
Mr. McKinley. Then, if I could, just in----
Dr. Omer. We could----
Mr. McKinley [continuing]. Go back, if I could--reclaiming
my time, but are we ever going to get--it is not realistic to
get 435 Members of the House to get vaccinated before we go
back into session again. Are we going to continue this
nonsense?
I think it--let me hear from you.
Dr. Omer. So I would--again, without commenting on specific
policies, because I am not sort of that knowledgeable about the
details, but I would say that, even if you cannot verify, a lot
of activities can happen indoors. CDC has said that, with
masking and--but then it depends on what the compliance is for
masking, et cetera, if you don't know who is vaccinated and who
is not.
So that--there is a nuance there. I do think that we have
evidence of high protection and decreased transmission.
Mr. McKinley. Thank you.
Madam Chairman, I yield back the balance of my time.
Ms. DeGette. Thank you.
The Chair now recognizes Congresswoman Schakowsky, the
birthday girl, for 5 minutes.
Ms. Schakowsky. I thank the chair and all our witnesses. It
is so great to celebrate with you today.
In March the Center for Countering Digital Hate and Anti-
Vax Watch found that 65 percent of antivaccine social media
content stemmed from just 12 individuals called the
Disinformation Dozen. Despite being brought to the attention of
the social media companies, a review one month later found that
at least nine of those individuals still maintained active
accounts on Facebook and Instagram and Twitter.
More alarming, a sample review of Facebook posts over the
last week showed that online--that only 19 posts had fact-
checking labels applied to them. The posts that are left say
things like ``asymptomatic people can't spread the virus'' and
that the ``COVID-19 vaccine is a genetic mutation.'' One post
alone reached approximately 62,500 people.
Ms. Pisani, although vaccine myths continue to be
accessible on social media, we understand that your
organization had a challenging time getting factual vaccine
information posted on social media. Can you briefly tell us
about your experience, and how long did it take to be resolved?
Ms. Pisani. That is a really great question. It happened--
it has happened to us on several occasions. And so at Vaccinate
Your Family we started Facebook--I believe it was almost the
year it began. We jumped right into social media. We felt like
it was a really important place to be.
And what happened was, years ago, we ended up being drowned
out by these larger organizations that have a lot of money. And
they were sharing disinformation. And it was a--just a few
people, but with the most amount of money. While the rest of us
were starting to realize that we had to provide information in
order to be allowed to post, we hadn't realized it yet. And so
they had beat the algorithms. We didn't know about them yet, so
we hadn't fixed our problem.
Most recently, during the COVID year, we were no longer
able to get comments on our Facebook page for almost 7 months.
We never were able to speak to a single person at Facebook.
That is a really big deal, because we are the largest social
media group on vaccines in the nation, and we have people from
around the world. So when we can't--when our posts don't get
boosted because we don't have a lot of movement on our pages,
that makes a really big difference.
So the companies can fix our algorithms. They--there is a
lot that they can do. They can stop feeding people
disinformation based on their search terms, on the information
that they are already reading. They could whitelist groups like
Vaccinate Your Family, Voices for Vaccines, the Academy of
Pediatrics, and other groups that share fact-based information.
There is so much that could be done to fix the problem.
Ms. Schakowsky. Well, thank you for that. That is very
disturbing, and I want to work with you to see if we can make
that better, so that factual information doesn't have barriers
to getting out.
Dr. Gracia, unfortunately, as you mentioned in your
testimony, misinformation campaigns have targeted people of
color and low-income communities, often without accessibility
to antivaccine--to--without accountability. The antivaccine
movement has been able to exploit justifiable, historic
distrust, and the media companies have helped to further their
antivaccine goals.
Can you talk to us a little bit about that? I am almost out
of time, but I would love to hear that.
Dr. Gracia. Yes, thank you for that question. It is
important, because when we talk about why certain communities
may not be getting vaccinated, this issue of misinformation is
so critically important, and it is important as it relates to
communities of color.
There are efforts underway. One of the efforts that we
have, for example, at Trust for America's Health, is through
our Public Health Communications Collaborative, in which--it is
a collaborative between Trust for America's Health and a
partnership with the CDC Foundation and the de Beaumont
Foundation, where we actually do tracking on misinformation and
provide guidance, in particular, for public health officials at
the local and State levels to be able to address
misinformation.
And then there are also other efforts. For example, the
campaigns Between Us, About Us, where you have, for example, a
campaign specifically for the Latino community that was
recently launched through UnidosUS and the Kaiser Family
Foundation, creating PSAs and other tools featuring Latino
healthcare providers and other Latino health workers that can
be used in the community to be able to combat some of that
misinformation that is happening.
And there is, likewise, a campaign specifically featuring
Black healthcare providers that the Black Coalition Against
COVID and others are engaged in. And that way they have the
tools and the resources to be able to address some of the many
myths about the COVID-19 vaccine.
Ms. Schakowsky. Thank you so much. And trusted messengers,
I think, are so important. So thank you for your important
work.
I yield back, and I appreciate----
Ms. DeGette. I thank the gentlelady. And the Chair now
recognizes Mr. Palmer for 5 minutes.
Mr. Palmer. Thank you, Madam Chair, and happy birthday,
Jan. And following up on your last question, I think that there
is a role for faith-based organizations in increasing the
confidence in the vaccines and maybe even serving as a familiar
distribution site.
And what I would like to ask Dr. Gracia is, has anyone
looked into reaching out and partnering with the faith-based
organizations for vaccine distribution or for public service
announcements as a communication vehicle to raise the
confidence among people, particularly in minority communities,
which we know have an aversion to certain vaccinations?
Dr. Gracia. Yes, absolutely. The faith community, faith
leaders are such important partners as it relates to being
trusted messengers and trusted institutions, as far as places
of worship in communities. And in certain communities of color,
it is actually one of the entities we highlighted in our policy
brief as a core and trusted messenger. There are, indeed, many
messengers.
The administration has certainly been engaging with the
faith community but also seeing, you know, local health
departments, State health departments that have worked with
faith leaders, where it is either to be able to get messages
out to communities or to serve as potential vaccination
centers, utilizing, for example, a church parking lot, doing
virtual town halls to be able to deliver messages that they
trust from their faith leaders.
Mr. Palmer. Dr. Shelton, along the same lines, there are
certain--there are unique issues that rural communities face
when it comes to vaccine distribution. And I think that working
through the faith community in rural areas could be helpful.
But can you comment on how State and local governments could
increase access to and confidence in the vaccines in rural
communities?
Dr. Shelton. Yes, thank you. Certainly--has been a great
asset to our vaccine distribution--we had----
Mr. Palmer. Madam Chairman, I can't hear her answer. I--
suspend my time for a moment.
Ms. DeGette. Yes, yes, we are having difficulty hearing
you.
Dr. Shelton. OK, can you hear me now?
Ms. DeGette. Yes. Perfect, thank you.
Mr. Palmer. OK.
Dr. Shelton. OK, yes, certainly, our faith communities have
been a huge asset--sites that we had----
Mr. Palmer. Madam Chairman, suspend again, if I may.
Ms. DeGette. Yes, yes. This is the other issue this
committee needs to work on, is our broadband access in rural
areas.
Mr. Palmer. Yes.
Ms. DeGette. So let's try it again.
Mr. Palmer. If she can't--if we can't understand her, can
she just answer the question in writing, submitted to the
committee?
We will try it one more time, but if we can't hear her, we
will just ask for her to submit it in writing.
Dr. Shelton. OK. Can you hear me now?
Mr. Palmer. Oh, yes.
Ms. DeGette. Yes.
Dr. Shelton. OK. Certainly, our faith-based communities
have been a very important part of--many of our large--that we
have had over the last several months have been in faith--we do
this for our--also for local outreach to our neighborhoods,
actually some of our--communities, including our Black and
Hispanic communities. So that's a very important thing.
As far as our State and local governments, I think working
with our faith communities--there.
Mr. Palmer. OK. I couldn't understand all of it. So, if you
don't mind, submit it in writing.
I would also like you to respond to--I have had some people
speak to me about people having excess to vaccine and not
knowing what to do with it, and concerned about it expiring.
So, if there are some things going on in your State and
local governments in that regard, I would like to know about
that.
And I would also like to point out that we are all focused
on injectable vaccines, and there is research being done right
now--there are clinical trials being done on another internasal
vaccine that not only has shown promise in mucosal immunity,
but it will protect against infection, but it also protects
against transmission. And I--Doctor, I just hope that we will
continue to focus on the development of new vaccines that there
might not be as much opposition to.
And the last thing I would like to say, Madam Chairman, I
don't know how many of you have had a chance to look at Mr.
Offerman's website for his wood working, but the canoe that he
made out of cedar is absolutely, stunningly beautiful. And I
don't know if he built it, or someone in his shop built it.
They built a dresser out of walnut, apparently, a solid piece
of walnut. It is amazing. I don't know if any of us could
afford a canoe or a dresser like that. But they are really
beautiful pieces.
And I want to commend you for your outreach to the
homeless. I think one of the great tragedies of the welfare
state and homelessness is the loss of incredible talent and
ingenuity and imagination among those people. And the fact that
you are bringing them in, giving them a chance to demonstrate
their artistic ability is amazing. And I want to congratulate
you on that.
And I yield back.
Ms. DeGette. The gentleman yields back. The Chair now
recognizes the chairman of the Environment and Climate Change
Subcommittee, Mr. Tonko, for 5 minutes.
Mr. Tonko. Thank you, Chairwoman DeGette. Can you hear me?
Ms. DeGette. Yes, we can hear you.
Mr. Tonko. OK, thank you. And I thank you and Ranking
Member Griffith for hosting this wonderful meeting.
We have heard today that there is no one-size-fits-all
solution to--for increasing COVID-19 vaccination rates. While
we have made tremendous strides in just a few short months to
increase vaccine supply, we know that availability does not
equal access. And the reality is that many Americans remain
unvaccinated due to access barriers to getting vaccinated.
Dr. Gracia, you emphasized in your testimony, and I quote,
``lack of culturally and linguistically appropriate information
and services, less access to technology required to sign up,
less access to transportation, and a lack of paid sick leave
may be hindering vaccine access for some populations.'' So how
are these barriers preventing unvaccinated Americans from
accessing COVID-19 vaccines, especially those who make up the
movable middle?
What populations are most likely to face these challenges?
Dr. Gracia. Certainly. Thank you for that question. So if
we think about, for example, low-income communities, many
communities of color, with regards to being disproportionately,
actually, those that work in some of the frontline jobs, some
of the jobs that were deemed as essential jobs in the COVID-19
pandemic, that actually--many workers of color did not have
access to paid sick leave.
And so the challenge of, for example, being able to take
time off or being worried about--and losing income, or losing
their job, being able to get the vaccine, and worrying about
the side--potential side effects and having to take time off
can be a barrier. And so addressing those types of issues, such
as sick leave, as well as access to child care that families
may need in order to get the vaccination, are addressing some
of the issues of equitable access.
As it relates to providing information that is culturally
and linguistically appropriate, that is ensuring that, for the
diversity of communities that we are serving, that information
is available, that it is respectful and responsive to the needs
of the communities that are being served. And so that is where
partnership with trusted community organizations is so
critically important.
It is one--certainly, if it is a community that has limited
English proficiency, ensuring that communications materials are
translated into the languages that the community speaks, to
ensure that they have access to information to make those
informed decisions. But it is also understanding what might be
some of the concerns and how to message that most
appropriately.
So it is, as many have said, it is the message and the
messenger, and that is where it gets to understanding the
cultural appropriateness of the messages that are being shared,
and not doing so in a judgmental way that is a concern of why
people aren't being vaccinated, but really getting to the
causes of understanding why there may be limits in vaccination.
You also look at other barriers. For example, access with
regards to the sites. Are the sites open and accessible during
hours that they can actually go to, if they have to work one or
more jobs?
And so these are the types of things that we are seeing,
certainly now with these investments, and the--or these
strategies with regard to pop-up clinics and mobile clinics,
and extending clinic hours or the vaccination site hours. These
are critically important ways to ensure that access is not a
barrier to actual vaccination.
Mr. Tonko. Thank you.
And Mr. Offerman, as an owner and operator of a small
business, you have the opportunity to work with the nonprofit
Would Works to provide training opportunities to people
experiencing homelessness or living in poverty, individuals
likely to face access barriers. Like many others, we understand
that operations of both the woodshop and Would Works were
affected by COVID-19. Has vaccine uptake allowed normal
operations to resume for you?
Mr. Offerman. At the woodshop we are just about, you know,
back up on our feet. Everybody's vaccinated. And so we still
are employing masks, just erring on the side of safety. I don't
see why we wouldn't do that.
And at Would Works we have just announced today,
coincidentally, we are opening the program back up. That is a
much more vulnerable population, so we are taking extra
precautions. But it's a wonderful organization. We are very
happy to support it. So many of the people who are without
homes just need an opportunity. They all want to go to work.
They just need a chance. So I love--I wish we would--Would
Works nationwide.
Mr. Tonko. Well, thank you. And alleviating access concerns
among unvaccinated Americans is, clearly, just as important as
addressing other reasons why some people have yet to get the
COVID-19 vaccine. So I am encouraged by the strategies being
deployed across the country and certainly hope we can amplify
these efforts.
And with that, Madam Chair, I yield back. And again, thank
you.
Ms. DeGette. Thank you. And I am now pleased to yield to
Dr. Joyce 5 minutes.
Mr. Joyce. Thank you for yielding, Madam Chair, and to this
panel for testifying on this important subject today.
Dr. Omer, some clinicians had concerns that the U.S. Food
and Drug Administration's recommended pause on the Johnson &
Johnson vaccine might increase vaccine hesitancy and reduce
public confidence in the overall approval process for the other
vaccines, as well. Dr. Omer, do you feel that the FDA's actions
instill a higher degree of confidence in the safety of the
COVID-19 vaccines that have received the emergency use
authorizations from the FDA?
Dr. Omer. Yes. I think that was the right thing to do. As
they were evaluating they had a temporary pause, communicated
the reason for that pause. They--you know, whenever you have an
emerging event, there are several difficult options. But they
chose the best--the most appropriate, in my perspective--of
those difficult options. So, yes, in the long run, it will
instill confidence in our vaccine safety and regulatory system.
Mr. Joyce. Dr. Omer, can you comment on how common the
severe blood clotting, combined with low levels of platelets,
that resulted in the FDA's recommending a pause of the J&J
vaccine--would you say this is a rare, a very rare event? Could
you comment additionally, please?
Dr. Omer. So, depending on the group, it is a rare to very
rare event. And looking at the risk versus benefit, it heavily
favors benefit.
But then it was appropriate to evaluate that, take a pause,
evaluate that risk-benefit ratio, and then resume that--the
vaccination drive with this vaccine.
Mr. Joyce. Dr. Omer, how does the rate of severe events for
the J&J COVID-19 vaccine compare to other vaccines that we more
commonly see people get, the chicken pox vaccine, the MMR that
has been discussed previously in today's hearing, which have
been proven to be safe and effective?
So what is the rate of severe events comparing J&J's COVID-
19 vaccine with other, more commonly administered vaccines?
Dr. Omer. Well, it depends on the event. But overall, it is
at par or favorable compared to other commonly used vaccines.
So, you know, I would be happy to provide specific details
between--based on the risk group and age group, et cetera. But
I think it is reasonable to say that, qualitatively speaking,
or sort of broadly speaking, that this vaccine is--has similar
safety profile or, in certain cases, certain groups, better
safety profile than some of the--our other commonly used
vaccines, as well.
Mr. Joyce. Yes, I would like to see that additional data,
if you could, please.
And then finally, Dr. Omer, on another subject, how common
is it for someone to have an allergic reaction after receiving
one of the COVID-19 vaccines?
And is the risk the same among the--all three vaccines that
have received the emergency use authorizations from the FDA?
Dr. Omer. So there are different databases that were used.
It is also considered within the rare side effect range. And it
is one of the ways this is mitigated, because right now we are
in a situation where it is mitigated by having people wait an
extra 30 minutes if--extra 15 minutes, a total of 30 minutes,
who have, you know, a predisposing situation, have a history of
allergy, et cetera. So it is more, in the context of mRNA
vaccines, if you look at the the absolute numbers. But even for
mRNA vaccines, it is in the territory of rare events.
So it ranges from, you know--so there are a few ranges
around that. But, you know, it is in the rare category for--
even for mRNA vaccines.
Mr. Joyce. And Dr. Omer, could you please comment for us,
Dr. Omer, on the safety, from your perch, for the use of these
new vaccines in adolescents and children?
Dr. Omer. That is a really good question. So, based on the
current data and the data that the Advisory Committee on
Immunization Practices has evaluated, in the groups for which
it is currently recommended, 12 and up, the benefits
substantially outweigh risks. We continue to monitor events.
There was a--there is a signal that various public health
agencies, as you know, you may have seen in the news that they
are evaluating proactively, just to remind everyone it is a
self-limiting event in certain teams. And so--and I have
confidence that we will get clarity on this event, as well, in
the coming weeks, fairly soon.
Mr. Joyce. And I thank you for that answer. My colleague,
Dr. Schrier, the pediatrician on this panel today, I am sure
will also have questions regarding immunization and children.
Thank you, Madam Chair, and I yield the remainder of my
time.
Ms. DeGette. I thank the gentleman. The Chair now is
pleased to recognize the vice chair of the subcommittee, Mr.
Peters, for 5 minutes.
Mr. Peters. Thank you, Madam Chair. I just want to start by
saying I certainly share the frustration of Dr. Burgess that we
are not all together in person, unmasked, which I believe we
could be, if we were all vaccinated. And I know that--I think
the--every Democrat is vaccinated. I am sad to say that every
Republican is not. So if there is anything we can do to
encourage that, I would certainly jump in.
And, as the daily--number of daily vaccinations has
declined since April, State and local governments are thinking
about that issue, too, with respect to incentive programs to
motivate unvaccinated Americans to get shots. In New Jersey
there is a shot-and-a-beer program. In Ohio there is a vaccine
lottery that offers you a million bucks. I don't know if that
indicates that there is higher self-regard among Ohioans than
New Jerseyites--I say that as a former New Jerseyite. Major
League Baseball teams are offering free tickets to those who
get vaccinated at the ballpark.
And the question I have, I guess, for Dr. Omer is whether
these programs work. I mean, even before the pandemic hit, you
have been researching ways to incentivize vaccine uptake. So do
these vaccine incentive programs work?
And what types of incentive programs would be most
effective?
Dr. Omer. So there are two things. We know, as a concept,
incentives have a role in increasing vaccine coverage. So there
has been evidence for several years. We have done some
experiments, others have done some experiments, but incentives
are useful.
In this pandemic, although the uncertainty is that the--
what kind of incentives are better suited. So with our 50-State
laboratory, people like us, like myself, are watching and
learning from it. And I think it is--but then, you know, within
certain limits, it is worth trying different models. So that is
the short answer.
Mr. Peters. And Dr. Gracia, what is your view on the
effectiveness of these types of vaccine incentives, and
particularly--do you have any evidence that they can increase
vaccine uptake in communities of color or Tribal nations?
Dr. Gracia. Thank you. I think, similarly to Dr. Omer's
response, you know, we too, just at our organization, follow
the evidence with regards to these policy recommendations.
And with regards to incentives, you know, there can be a
place for incentives, and there is just a great deal of
innovation that is happening both in the public and private
sector regarding that. So I think studying that to see how that
is impacting the uptake for various communities, I think, will
be important for us, not only now in the pandemic but certainly
moving forward.
Mr. Peters. OK, thank you.
Dr. Shelton, your testimony indicates that you are
partnering with stakeholders to give away tickets to
incentivize vaccinations. How has the community responded to
this incentive?
And more broadly, what kinds of incentives or innovative
approaches for encouraging uptake have you seen work in rural
communities that can be replicated or expanded on?
Dr. Shelton. Well, thus far in our mobile units and
outreach, the numbers have been very low as we go out. So we
are looking to see what incentives might be helpful. And I
would love to have some of these incentives to offer to our
community as ways to see whether or not these experiments truly
do work.
We are just at the beginning of these incentive programs.
So, again, we don't have a lot of knowledge yet about what is
working, but we look forward to trying these incentives, and
seeing what will work, and reporting back on any successes that
we do have.
Mr. Peters. And Dr. Omer, any recommendations for employers
who may want to incentivize COVID-19 vaccinations for their
employees? Any recommendations you have for us?
Dr. Omer. Yes. First of all, promote it as a social norm.
And we know that--we have evidence that promoting even an
emerging social norm is helpful.
Ensure that there is safety of everyone involved. So we
know that, even though these vaccines are highly effective,
people who are immunocompromised, there are certain concerning
data about them, et cetera. So have those, you know,
precautions available for these people.
And sort of look at things like time off for--you know,
during vaccination. It is easy to vaccinate, and there will
come a time where onsite vaccination will have--pretty soon,
for at least some large entities, onsite vaccination may have a
role in there.
So I think companies and employers of various sizes have a
huge role. Even small businesses. But Mr. Offerman very
eloquently spoke on the--on small businesses.
Mr. Peters. Right. Well, it looks like there is a lot of
information to come in on this. And I would certainly invite
any of the witnesses who see results from these incentives to
reply to the committee and offer us information on that. We
would love to get that information.
And Madam Chair, I appreciate you holding this hearing. It
is OK to do hearings, virtually. I think it may be in some ways
pretty useful, but I really am anxious to get back to work with
everybody in person without masks in the committee room. And if
there is any way we can incentivize the rest of our colleagues
to get vaccinated, maybe we have learned something from this
testimony, as well.
Thank you, I yield back.
Ms. DeGette. Thank you, and I agree.
The Chair is now pleased to recognize Mr. Long for 5
minutes.
Mr. Long. Thank you, Madam Chair, and I appreciate it, and
thank all the witnesses for being here today. And I might
suggest that, as a first move to get away from these Zoom and
committee hearings and things, we might consider doing them
over at the White House. Because if you will Google ``Pelosi,''
``White House,'' ``no social distancing,'' you will see that it
is very safe to mingle, mix and mingle there, with people who
have been and have not been vaccinated. So just a suggestion
for a first move, so we can get back to more normal times.
Dr. Gracia, according to a recent report issued by the
Centers for Disease Control, residents in rural communities
like I represent a lot of here in southwest Missouri are at
increased risk for severe COVID-19-associated morbidity and
mortality. Last September, COVID-19 incidents of cases per
100,000 residents in rural communities surpassed those in urban
counties. Further, the report found that COVID-19 vaccination
coverage was lower in rural communities, at a little under 40
percent, than in urban communities, a little over 45 percent.
The implications of these findings are the disparities in
COVID-19 vaccination access and coverage between urban and
rural communities can hinder progress toward ending the
pandemic. What are the unique challenges found in rural
communities of getting available vaccine doses into patients'
arms?
Dr. Gracia. Thank you for that question, and critically
important to address, certainly, these disparities that we are
seeing in rural communities. And similarly, we can point to
some of the longstanding, as you noted, health disparities that
exist in rural communities.
We know, certainly, access to healthcare has been one of
the areas that--having access to a healthcare provider and
routine, regular care, as far as preventive services, those are
issues that can be challenging in rural communities, and that
pre-dated the pandemic. But recognizing, certainly, that also,
beyond the access to healthcare, are really what we think about
the broader social determinants of health.
So, in addition to access to healthcare, is ensuring you
actually have transportation to be able to get to those
services. Do you have, you know, income, the income to be able
to maintain, you know, and have access to healthy, affordable
foods and be able to engage in the types of physical activity,
et cetera, that is needed for a healthy lifestyle?
I think that we need to really address some of these
longstanding issues as it relates to rural health disparities,
certainly, as we move forward beyond the pandemic with regards
to access to healthcare, whether it is through telehealth and
the closure of rural hospitals. We have seen several rural
hospitals that have closed during the context of the pandemic,
and making access to care more difficult.
But with regards to vaccination, I think some of the
promising things that are now happening is the investments,
certainly, because of the legislation that has been passed, to
do more investments to getting mobile healthcare units out, to
be able to fund and support rural health clinics, to be able to
do vaccinations in rural communities, and also to be able to
educate and do outreach to rural communities through community
health workers and other types of health outreach to increase
vaccination.
Mr. Long. OK, thank you. And I, for one, would like to see
everyone vaccinated. I appreciate that. And it is discouraging
that the rural areas are not able to get the same access.
My next question for Ms. Pisani: The Pfizer vaccine, which
is the one that I took back in December, is now available to
children 12 to 15. And the Moderna announced this week--or
Moderna announced this week that their vaccine is safe and
effective for children ages 12 through 17, and they plan to
submit their findings to the FDA in early June.
What are the most frequently asked questions that you get
from parents that have children in this age range about the
COVID vaccine?
Ms. Pisani. We get pretty much the same questions we get
with all vaccines, and they want to know what are the long-term
side effects of getting a vaccine, which, of course, the
answer, again, is what is the long-term side effect of getting
the virus. You have to remember to answer it that way.
Parents are hearing the same rumors that are just literally
going through wildfire on social media. I have never seen
anything like it in my life. You will hear a rumor one day
about, you know, questions about infertility here, and then it
will go all the way across the globe. And so my friends and my
family who have, you know, kids my age and younger--my kids'
age and younger--they are asking the same questions: Will they
be safe, you know, why do they need them, if they--if the virus
isn't as dangerous to the children? And of course, that is all
just misinformation that we need to correct.
Mr. Long. OK. As the father of a pediatrician, I appreciate
that very much. And it is--I have said it before on here, but I
will say it again, it is very disturbing to me to have someone
of such notoriety as Robert Kennedy, Jr., of all people,
leading the anti-vaxxer charge.
With that, Madam Chair, I yield back.
Ms. DeGette. I thank the gentleman. The Chair now
recognizes an actual pediatrician, Dr. Schrier, for 5 minutes.
Ms. Schrier. Well, thank you, Chairwoman DeGette, and thank
you to our excellent witnesses today.
Vaccine hesitancy is such an important topic. And, as a
pediatrician, I spent 20 years reassuring anxious parents about
routine childhood vaccinations. And most parents, like you
said, that are considered vaccine hesitant have heard something
from a friend, online, that gives them pause, and they just
want to be sure that they are making the right decision for
their child. And we know that conversations with a trusted
primary care provider makes all the difference in the world.
However, we are seeing a higher degree of reluctance when
it comes to the COVID vaccine for all the reasons you pointed
out. So at this point, most parents who definitely want the
COVID vaccine for their kids over 12 have already done it or
scheduled it. My 12-year-old got his 10 days ago. More hesitant
families will visit their primary care provider to seek answers
from their trusted doctor.
So I want to start with Dr. Gracia. One of the main
questions that I get from parents is about why they should
vaccinate their child, when they have heard that the risk to
children from COVID-19 is low, and they are making this risk-
benefit calculation. So, as a pediatrician yourself, can you
briefly describe how you would answer that question to that
hesitant parent?
Dr. Gracia. Yes, thank you for that question, and thank
you--it was a pleasure, certainly, also, to partner with you on
the vaccines briefing that we did last year, just ongoing,
highlighting the importance of vaccinations, and why this is so
critical, not only in emergencies but beyond, in calm times, if
you will.
I think, you know, formerly, when I formerly practiced as a
pediatrician, I think an important thing is, really, to hear
and understand a parent's concerns about the vaccination and be
able to articulate, certainly, the safety and effectiveness of
the vaccine and to note that, yes, while, you know, children
have a much lower risk with regards to severe illness and
hospitalizations from COVID-19, that is still important to
provide that protection and to also think about it from the
standpoint of there may be others in the family, for example,
if someone is immunocompromised or they interact with others,
that it also can provide that protection with regards to
decreasing the risk of transmission.
But I think it is especially important, too, to think about
the ability for children then to engage in the activities that
they were engaging in prepandemic and recognizing some of the
social and emotional needs of children to really be able to re-
engage in the things that they did prepandemic, and that
vaccination is an important strategy for us to get there.
Ms. Schrier. I agree. And the risk of COVID is not zero.
Several hundred kids have died. We don't know about long COVID.
There are many risks, like you said, and getting back to
normalcy is so important.
Now, specifically, can you address the concern that some
parents now have about finding a handful of cases of mild
myocarditis out of many million vaccinated teens, and perhaps
how they should think about that risk compared to, say, the
risk of getting myocarditis from any viral infection, or
certainly at a much higher risk of getting it from COVID
itself?
Dr. Gracia. Right. And I think that it's important, really,
one, to hear--again, hear those questions, to listen to their
concerns as parents and to tell them what is known now and, as
you noted, that, yes, myocarditis can be caused by other
viruses, by other bacteria, for example, as well, and--but to
assure them, for example, one, you know, the American Academy
of Pediatrics continues to recommend that children 12 and above
should be vaccinated and that what is being studied, actually
showing that, of the cases that--right now there--that there is
not conclusive evidence that there is an association with the
vaccine and also that the cases and the numbers of cases that
are being seen is what would also be seen at baseline.
And so, you know, really, it is stressing, too, that,
especially for organizations such as the American Academy of
Pediatrics, the pediatricians who are themselves vaccine
experts, and really take this very seriously, and reading the
data, I continue to recommend it, as does the CDC.
And then getting back to Dr. Omer about--that these----
Ms. Schrier. And then----
Dr. Gracia [continuing]. The systems, yes.
Ms. Schrier. Right. We are looking for a blip above
baseline, and we haven't hit that.
Last quick question. I just wanted touch on the new
guidance that the COVID vaccine can be coadministered with
other childhood immunizations that have been--that have dropped
by about 30 percent during the pandemic. And so can you tell me
again, Dr. Gracia, your thoughts about coadministration?
What do you say to a parent who is nervous about getting
COVID with, like, HPD and Tdap, and our ability to then track
potential rare adverse effects if they are given together.
Dr. Gracia. So, again, I would emphasize, you know, when--I
was going to say practice--so I would emphasize again the
importance that--how our safety systems are working to be able
to detect if there are any concerns with regards to, you know,
something like a coadministration, to know that--you know, that
these academies, whether it is the American Academy of
Pediatrics and others, certainly are reviewing this, and
feeling that there is--safety with regards to being able to do
that coadministration, which can also then be a support for
parents, especially in the need to be able to come back to the
office, to be able to do other administration of vaccinations--
--
Ms. Schrier. Thank you.
Dr. Gracia [continuing]. And building on the existing
infrastructure that----
Ms. Schrier. Thank you.
Dr. Gracia [continuing]. Offices----
Ms. Schrier. I am out of time. It is so great to see you
again. And then just--that path back to normalcy, to school, to
summer camps, everything, is vaccinating our kids. Thank you so
much.
Ms. DeGette. I thank the gentlelady. And then I apologize
to Mr. Long for somehow implying his daughter wasn't a
pediatrician. What I meant was he is not a pediatrician,
although he assures me he once played a doctor on the radio. So
there you go.
Mrs. Trahan, I am now pleased to recognize you for 5
minutes.
Mrs. Trahan. Thank you, Chairwoman DeGette. Like so many of
my colleagues, I am so pleased that earlier this month FDA
expanded the authorization of the Pfizer COVID-19 vaccine for
adolescents 12 to 15 years old. And CDC quickly recommended its
use among this age group.
And I am also encouraged by yesterday's news that,
according to Moderna studies, its COVID-19 vaccine appears to
be safe and effective for children as young as 12, as well.
However, just as misinformation is spread across social
media about the COVID-19 vaccine for adults, I too am concerned
that families are facing a barrage of myths and disinformation
about their use among children. So I am glad to have such a
robust panel of experts here today to help us get the facts
straight.
Ms. Pisani, according to your testimony, the Vaccinate Your
Family campaign has grown over the years into ``one of the
nation's largest social media programs aimed at educating the
public on vaccines and their safety and to counter vaccine
disinformation.'' Unfortunately, we know that this
disinformation is rampant online, with parents and children
exposed to a range of myths about the safety of the COVID-19
vaccines.
What lessons can we learn from Vaccinate Your Family's
efforts to combat vaccine disinformation?
Ms. Pisani. Thank you for asking that question. So we
have--obviously, we have been around for 30 years, so we didn't
start in social media. We began working directly with parents,
and children were our focus for 25 years.
So--but one thing we can learn is that--never repeat the
negative, first of all. And also that there's efforts being
made. And I have to say Google is doing an amazing job. They
are giving out grants around the world to try to help stop
disinformation. And Instagram is doing a great job. I don't
know why Facebook is not following up with that.
But we have to really think about the groups that are
targeting people, and they have taken to targeting communities
of color to sow doubt. And, you know, after all the work that
has been done to help the disparities, and all the work we need
to do, we have to really think about what is, you know, the
line of freedom of speech. We all hold it sacred, but when
there is a group of individuals or companies that are making a
cottage industry about spreading disinformation and selling
alternative products instead of vaccines, I think something
needs to be done. That is endangering the United States and,
frankly, the global citizens.
Mrs. Trahan. Yes, I couldn't agree more. We have taken that
up on another subcommittee--this one. But, you know,
authorizing a vaccine for adolescents 12 years and older is one
hurdle, but getting shots in arms of those adolescents is
another challenge altogether.
You know, Dr. Shelton, you mention in your testimony that
your agency has been vaccinating middle and high school
students in school clinics. Has this proven to be successful?
You know, what other activities have you led or have
planned to expand vaccination efforts to these younger teens
and preteens?
Dr. Shelton. Yes, we have been very grateful for the
partnership with our schools to be able to go in and offer
vaccines in the middle and high school levels. To be sure, the
uptake has been small. It is a difficult time of year. There
are a lot of end-of-year testings and sports events going on,
and people are afraid to--of side effects and that they may
miss work.
So I think a lot of the messaging that we need to use with
focusing in our schools is we know that our schools transmit
disease, are kind of like the petri dish of the community, so
to speak. In the winter time we routinely combat flu and
norovirus in our schools.
And so we know that one of the incentives for parents to
talk with--for pediatricians and healthcare providers to
discuss with their parents is, if you want your students to
have all of the great benefits of being--in-person school, and
all the social, mental, and physical well-being that they
receive from the school, in addition to just the learning,
vaccines really are our path to be able to have our schools go
in person for longer amounts of time.
We had with--recently, in April, an increase in our cases
throughout the district, because we had five different
outbreaks in schools, despite having gone in school since the
fall. This is the first time. And so, being able to go in and
take those vaccines to the schools, we have seen some successes
there. But definitely, the importance of what people can
achieve by in-person school and the importance of having those
vaccines is very much what needs to be messaged.
Mrs. Trahan. Yes, no question.
Finally, Dr. Omer, with my remaining time, your testimony
cites a survey experiment in which you found that ``a
bipartisan endorsement of COVID-19 vaccines would help increase
confidence in the vaccines.'' That is precisely the goal of
this hearing today, to work together to debunk vaccine
misinformation and send a clear message of support for the
COVID 19 vaccines.
Dr. Omer, if we were--if we are not able to dispel vaccine
myths, boost confidence, and increase uptake, what potential
consequences do we face?
Dr. Omer. So I think we are at risk of entering a vicious
cycle, because if we have--so one way of responding to an
outbreak is to get ahead of it. And if we don't get ahead of it
by having high vaccination rates, we increase the probability
of variants emerging, and then it becomes a cycle of where we
need, for example, boosters and other approaches and some
nonpharmaceutical interventions, although not--certainly, not
at the level as we saw last year, but other measures that
hamper normalcy but are applied to prevent adverse outcomes in
the public health, in the sense of public health.
So we absolutely need to invest in our--redouble our
efforts to vaccinate as high a proportion of our population as
possible.
Mrs. Trahan. Thank you, Dr. Omer.
I yield back, Madam Chair.
Ms. DeGette. I thank the gentlelady. The Chair now is
pleased to recognize Dr. Ruiz for 5 minutes.
Mr. Ruiz. Thank you for holding this very important
hearing, Chairwoman.
When vaccine distribution was ramping up, there was concern
that Black and Hispanic individuals would have a greater amount
of vaccine hesitancy than White individuals. And that narrative
continues. But it just has not been my personal experience, as
a physician, public health expert working in the community,
inoculating some of the hardest-hit, hardest-to-reach
constituents of mine, the Hispanic farm workers, which in my
district face one of the highest rates of infections and
deaths. And I have been going out there, administering the
vaccine and educating communities about its importance.
[Audio malfunction] for Blacks and Hispanics, they just
don't want the vaccine because of mistrust, et cetera. That
narrative is dangerous. It abdicates the responsibility of the
healthcare system and us to make sure they have access. And it
just blames those that have been left behind for generations.
And the data is showing that my experience was actually a more
accurate picture of what was occurring.
As it is, the problem is not hesitancy, it is access. As
with many aspects of our healthcare system, it is not about
whether someone wants to get the vaccine, it is whether there
are barriers preventing them from doing so. Despite months of
headlines driving a narrative that Black Americans and other
people of color would be the primary communities hesitant to
get the COVID-19 vaccine due to discrimination and a history of
medical experimentation in these communities, Kaiser Family
Foundation polling shows Black Americans are just as likely to
want to get the COVID-19 vaccine as White Americans. And, in
fact, among unvaccinated people, Hispanic adults report being
twice as likely as White adults to want to get the vaccine.
So I am concerned that, despite being motivated to get the
COVID-19 vaccine, access barriers are preventing people of
color from getting vaccinated. And we know that Hispanics, for
example, have the lowest vaccination rate, even though they
have the highest infection rate and death rate than other
communities. As a result, the vaccination rates in these
communities are disproportionally--way disproportionately--
lower than their White counterparts in the United States.
Dr. Gracia, in referencing the vaccination rate disparities
among Hispanic adults compared to White adults, you cautioned
that ``if we only look at the population as a whole, we may be
missing significant barriers to access and information.''
So you have touched on some of those barriers already
today. Could you further detail what barriers may specifically
be preventing Black and Hispanic adults from getting the COVID-
19, and what are some good, successful efforts that allow us to
overcome those barriers?
Dr. Gracia. Thank you, Congressman Ruiz. Yes, these are--it
is important, as you noted, with regards to the narrative that
is being shared, and understanding that inequitable access can
also drive these disparities in vaccination rates.
One of the things that we can see is that, when we
prioritize and center equity with regards to the vaccine
distribution and allocation and administration and ensuring
that the sites and locations are accessible, whether it is from
the standpoint of the hours--you know, that you have evening
hours and weekend hours that are available, that the sites are
trusted, community sites, where communities of color already
seek their health services.
And we have seen an impact of that, for example, with
regards to the community health centers that receive Federal
funding, that of the 10 million doses that they have given,
over 60 percent of the vaccine administration has been to
people of color. And knowing that----
Mr. Ruiz. Yes. You know, the initial phase of this vaccine
really got the low-hanging fruit, and they did a first-come,
first-served basis. That puts--advantages those who have high-
speed internet, those that have the educational capacity to
navigate a complex system, those that have the flexibility from
leaving work and standing in line or waiting on the phone for
hours at a time. And it disadvantages rural, underserved
communities who don't have those factors to benefit them.
So we need to shift now from that model to a grassroot,
community-based model, working with community health promoters,
taking the vaccines to the people where they are at, with
trusted individuals from the community.
And we also have to think how we can change our healthcare
delivery system, because the status quo has resulted in these
barriers and failures that have not focused on equity but has
promoted health disparities. And because of that, we need to
use this new form of outreach into our healthcare delivery
model, so we can address health disparities in general, so we
don't find ourselves in this situation in the next pandemic.
And I ran out of time. And I appreciate you all being here.
Ms. DeGette. Thank you so much. This completes the
questioning from members of the subcommittee, but we are always
happy to welcome members of the full committee to ask questions
in these hearings. And we have two today. And so my first
nonsubcommittee member, but a wonderful member of the full
committee that I will recognize for 5 minutes, is Mr.
Bilirakis, for 5 minutes.
Mr. Bilirakis. Thank you very much, Madam Chair. I
appreciate it very much. And I want to preface my comments by
saying that I did get the vaccine, both doses. I had COVID in
early January, but I chose to get the vaccine after the 90
days. And I have had a very positive experience.
However, this is for the panel, whoever would like to ask
this question--answer this question. Dr. Jay Carpenter, an
internist in my district, has encountered young patients who
have been vaccinated, young patients in their early twenties,
who have suffered from myocarditis--so, again, let me pronounce
it again: myocarditis--and the inflammation of the heart.
So has anyone experienced that, any of the experts? Have
they seen this from, again, young adults in their twenties?
So who would like to reply to that?
Maybe we can get the--you know, if it is applicable, the
whole panel can apply--reply, quickly.
Has anyone seen this?
Ms. Pisani. I would say that it is such a rare--it is such
a rare reaction that there is still research taking place. And
here in the U.S. we have amazing systems that oversee our
safety, and so we have a vaccine-adverse-event reporting
system, where everyone is encouraged, if they have any type of
adverse event from a vaccine, they are to report it there. We
have the Vaccine Safety Datalink. We have got the Clinical
Immunization Safety Assessment System. I mean, there is just--
and there's new systems that were put in place just for COVID,
V-safe and the FDA's BEST system is working.
So there is a lot of different systems that are out there.
And I do feel very confident that we will soon know if there is
any type of need for any type of pause. And it makes me feel
comfortable that there was a pause on J&J when it was
requested.
Mr. Bilirakis. OK, anyone else? Anyone else want to
comment? Have they experienced this, or heard about this?
I mean, it is very serious, and I would like to actually
have Dr. Carpenter maybe contact you, and maybe elaborate more.
Is--was that OK? Would--do you welcome that?
[No response.]
Mr. Bilirakis. OK, I----
Dr. Gracia. Congressman, what I would just add to is, with
regards to what we noted earlier, that what has been detected
is not above the baseline of what we would detect with regards
to cases of myocarditis.
So as Ms. Pisani noted, we are continuing to review that
and determine if there is actually any association, but there
is----
Mr. Bilirakis. Thank you----
Dr. Gracia [continuing]. At this time.
Mr. Bilirakis. No, I appreciate that very much. And I
understand. My chief of staff has been in direct contact with
this particular physician, an internist, and apparently he has
experienced this, his patients have experienced this more than
once. So it is definitely worth looking into.
Dr. Shelton. I would say we have not seen that locally, in
our area, but certainly, as has been mentioned, the V-safe
programs and other monitoring systems, we will continue to look
toward those for any--and report any side effects.
Mr. Bilirakis. Thank you very much.
Dr. Omer, again, on this topic, given how much information
is available, it can be difficult to know which sources of
information you can trust. That is for sure, particularly with
the internet. How can one ensure that information they find
about COVID-19 vaccines is accurate and comes from critical--
credible sources?
Dr. Omer. That is a really good question. So the general
public can go to several reliable sources and--such as, for the
CDC, so the technical documentation from the CDC has been
consistently reliable on this issue and others, as well.
The second thing is professional associations. So we have
20 years of research that shows that in this country there is a
high level of trust in professional associations. For example,
when it comes to pregnancy vaccination, American Congress--
American College of Obstetricians and Gynecologists. For
pediatric vaccinations, American Academy of Pediatrics. They
are highly--not just trusted but trustworthy entities, because
they go through a very careful, deliberate process to evaluate
the risk and benefit. So these are some of those sources that
folks can go to.
And the third thing is that--I have mentioned this national
continued medical education program for physicians and
providers, other providers. Just--that is one of the reasons
why we are doing this, so that, you know, primary care
providers, frontline providers feel empowered to talk about
vaccine efficacy and safety, and in a way that is evidence-
based.
Mr. Bilirakis. OK, let me make a statement. I know, Madam
Chair, my time is finished, but I recommend that our Members
communicate directly with their constituents. I have had a town
hall meeting, it was very successful, with experts, CDC and
NIH, and they directly answered their questions.
I can't go any further, so I will submit the rest of my
questions for the record. Thank you.
Ms. DeGette. I thank the gentleman. And Mr. Carter, you are
recognized for 5 minutes as our cleanup batter.
Mr. Carter. Thank you, Madam Chair. I appreciate the
opportunity to waive on, and I thank all of the witnesses. This
is very important, very important for me.
I have a large minority population in my district, and it
is very important. And I am very concerned, as a pharmacist and
member of the Doctors Caucus, a healthcare professional. I went
through the clinical trials myself, with the vaccine, to try to
set a good example. And I am very concerned about that.
I want to start with you, Dr. Shelton, because I want to
know--you have mentioned in your testimony about the many
communities that lack access to broadband internet or even to
cell service. And we all know that that is a problem. We all
know that they can't get to know--or they don't know how to
sign up for an appointment or get their COVID-19 vaccine. How
can we address that?
How can we address these challenges that--to make sure that
these people that don't have access to Internet or cell
service, or other kind of technologies, that it is not a
barrier to them getting COVID-19 vaccines?
Dr. Shelton. Well, certainly, providing broadband access is
a long-term goal for many, and for our State, as well.
Currently, though, it--this lack of access does hamper their
ability to even ask their own questions, to find their own good
information, and correct and true information.
So we have addressed this by, you know, a lot of people
just call the health department or call the pharmacy or the
healthcare provider. We have encouraged people to help their
families, friends, neighbors who may not have access to try to
access and sign them up, especially our elderly population, not
as computer savvy, by taking the vaccines out into the
community and using our local radio stations or other media
stations to allow people to know that there's, you know,
vaccines coming, vaccines available.
But this doesn't help as much to answer the questions one
on one. So we value those opportunities to speak with them, and
encouraging them. This new move that we have now, where we can
redistribute the vaccine in smaller increments to many more
local providers, will go a long way with helping people to
access their local physicians and having their local healthcare
providers give them that one-on-one information.
Unfortunately, a lot of people who are not interested in
the vaccine may not go to their healthcare provider regularly,
anyway, or even have one. So we do have to continue to look at
how we could best message in these areas.
Mr. Carter. Thank you for mentioning the role of
pharmacies, because 95 percent of all Americans live within 5
miles of a pharmacist. They are the most accessible healthcare
professionals in America. So thank you for mentioning that,
because that is very important, and certainly a big part of
what we are trying to do here.
Dr. Omer, I wanted to ask you, according to the Kaiser
Family Foundation, about 6 in 10 African-American adults and
two-thirds of Hispanic and White adults now say they have
either gotten the vaccine, or at least one shot of the vaccine,
or they will get it as soon as they can.
At the same time, African Americans and Hispanic adults
remain somewhat more likely than White adults to wait and see,
if you will, before getting vaccinated. What are--Dr. Omer, in
your experiences, what are the main concerns, the top concerns
or questions that you have heard from minority populations
about COVID-19 vaccine?
Dr. Omer. That is a really good question. So the concern,
the specific concerns, overlap significantly with the rest of
the population. But they do, you know, sit on a bed of not-so-
pleasant series of interactions with the health system overall,
not having sort of a healthcare home in certain situations, and
some of the other structural barriers that were described
earlier.
So the concerns overlap. For example, the concerns,
questions about the process, the questions about--that arise
from certain rumors, people talking about risk and benefit in
certain subpopulation, et cetera. But that is--but they sit on
this baseline of understandable mistrust in a lot of these
situations.
Mr. Carter. Well, thank you. And that is something--and I
tell you, that, to me, is difficult to get your arms around and
difficult for us to address that situation.
You know, we in the Doctors Caucus, we have done everything
we can and certainly done a lot to try to build up the
confidence of people in the vaccine and let them know that it
is safe and effective. And, you know, yes, it was done quickly,
but that is because we cut red tape. We didn't cut corners. And
they need to be assured of that.
And I think that--and I am real proud to be a member of the
Doctors Caucus and proud of what we have done in the way of
trying to encourage everyone and bringing about, you know, the
fact that it is safe and effective, and building up that
confidence.
One more question, Dr. Gracia, just really quickly, you
mentioned in your testimony about the real barriers and
perceived barriers. What are--what is the difference there,
what are you talking about?
Dr. Gracia. So, you know, real barriers, for example, if
you simply don't have access, right, to a vaccination site, or
if you, for example, don't have the internet technology to be
able to sign up for vaccine appointments, versus what might be
a perceived barrier, for example, believing that there is costs
associated with the vaccine or that you might not--or not
knowing what the eligibility terms are with regards to the
vaccine. It is really helping to clarify what are the barriers
that an individual experiences and helping them to address
getting access to the vaccine.
Mr. Carter. Great.
Well, this has been a great panel, Madam Chair, and thank
you again for allowing me to waive on. And I will yield back.
Ms. DeGette. I thank the gentleman, and I thank all of the
Members for an excellent hearing. Everybody's questions were
very helpful. And I mostly want to thank our witnesses again,
an extraordinarily informative and interesting hearing.
We, this subcommittee, we intend to continue our oversight
over the vaccine distribution process. And we stand at the
ready for all of you, our witnesses, to help in any way we can.
So, as you get data for our researchers and our physicians, if
you can let us know. And, Mr. Offerman, if you can, please let
us know what we can do to help you in your outreach efforts, as
well.
And with that, I remind the Members that, pursuant to
committee rules, they have 10 business days to submit
additional questions for the record. And I would ask the
witnesses, if you do get these questions, to please respond
promptly to any of them that you may have.
Thank you again to all of you for appearing today.
And with that, the subcommittee is adjourned.
[Whereupon, at 1:38 p.m., the subcommittee was adjourned.]
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