[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
NO TIME TO LOSE: SOLUTIONS TO INCREASE
COVID-19 VACCINATIONS IN THE STATES
=======================================================================
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
__________
FEBRUARY 2, 2021
__________
Serial No. 117-1
[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
45-006 PDF WASHINGTON : 2022
-----------------------------------------------------------------------------------
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 NEAL P. DUNN, Florida
KIM SCHRIER, Washington JOHN JOYCE, Pennsylvania
LORI TRAHAN, Massachusetts GARY J. PALMER, Alabama
TOM O'HALLERAN, Arizona CATHY McMORRIS RODGERS, Washington
FRANK PALLONE, Jr., New Jersey (ex (ex officio)
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........................................... 4
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........................................... 12
Witnesses
Ngozi O. Ezike, M.D., Director, Illinois Department of Public
Health......................................................... 14
Prepared statement........................................... 16
Answers to submitted questions............................... 83
Joneigh S. Khaldun, M.D., Chief Medical Executive, State of
Michigan, and Chief Deputy Director for Health, Michigan
Department of Health and Human Services........................ 22
Prepared statement........................................... 24
Answers to submitted questions............................... 90
Clay Marsh, M.D., Vice President and Executive Dean for Health
Sciences, West Virginia University, and COVID-19 Czar, State of
West Virginia.................................................. 30
Prepared statement........................................... 32
Answers to submitted questions............................... 98
Courtney N. Phillips, Ph.D., Secretary, Louisiana Department of
Health......................................................... 35
Prepared statement........................................... 38
Answers to submitted questions............................... 105
Jill Hunsaker Ryan, Executive Director, Colorado Department of
Public Health and Environment.................................. 43
Prepared statement........................................... 45
Answers to submitted questions............................... 111
Submitted Material
Texas State Profile Report: COVID-19, January 21, 2021, submitted
by Mr. Burgess................................................. 82
NO TIME TO LOSE: SOLUTIONS TO INCREASE COVID-19 VACCINATIONS IN THE
STATES
----------
TUESDAY, FEBRUARY 2, 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, Schrier, Trahan, O'Halleran, Pallone
(ex officio), Griffith (subcommittee ranking member), Burgess,
McKinley, Dunn, Joyce, Palmer, and Rodgers (ex officio).
Also present: Representatives Dingell, Soto, Walberg, and
Carter.
Staff present: Kevin Barstow, Chief Oversight Counsel;
Jeffrey C. Carroll, Staff Director; Austin Flack, Policy
Analyst; Waverly Gordon, General Counsel; Tiffany Guarascio,
Deputy Staff Director; Perry Hamilton, Deputy Chief Clerk;
Rebekah Jones, Counsel; Chris Knauer, Oversight Staff Director;
Mackenzie Kuhl, Digital Assistant; Kevin McAloon, Professional
Staff Member; Kaitlyn Peel, Digital Director; Peter Rechter,
Counsel; Tim Robinson, Chief Counsel; Chloe Rodriguez, Deputy
Chief Clerk; Benjamin Tabor, Junior Professional Staff Member;
C.J. Young, Deputy Communications Director; Sarah Burke,
Minority Deputy Staff Director; William Clutterbuck, Minority
Staff Assistant; Theresa Gambo, Minority Financial and Office
Administrator; Brittany Havens, Minority Professional Staff
Member, Oversight and Investigations; Nate Hodson, Minority
Staff Director; Peter Kielty, Minority General Counsel; Bijan
Koohmaraie, Minority Chief Counsel; Clare Paoletta, Minority
Policy Analyst, Health; Brannon Rains, Minority Policy Analyst,
Consumer Protection and Commerce, Energy, Environment; 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 Energy and Commerce Subcommittee hearing
will now come to order.
I am very pleased to convene this first Oversight and
Investigations hearing of the year. I believe it's one of the
first in the U.S. Congress, and I want to welcome all of our
new members. In particular, I want to welcome our new ranking
member, Morgan Griffith, with whom I've worked on many, many
issues, and I think will be a wonderful ranking member.
Before we actually go into business, Morgan, would you like
to say a few words? I'll yield to you.
Mr. Griffith. I'm just thrilled to be the Republican leader
on this subcommittee. It's a subcommittee I've served on since
I first got to the committee, and I love it and I think we're
going to do some great work.
Ms. DeGette. Thank you.
As Mr. Dingell used to say, our charge is broad--rooting
out waste, fraud, and, abuse wherever we may find it--and I'm
sure we'll have many opportunities in the 117th Congress.
Our hearing today is entitled, ``No Time to Lose: Solutions
to Increase COVID-19 Vaccinations in the States.'' The purpose
of the hearing is to examine the distribution and
administration of COVID-19 vaccines in the United States.
Due to the COVID-19 public health emergency, as I have
said, today's hearing is being held remotely, and so all
Members, witnesses, and staff will participate via video
conferencing. As part of the proceedings, we ask everybody to
put their microphone on mute, unless you're speaking, so that--
for the purposes of eliminating inadvertent background noise.
And every time, of course, you need to speak, then we will ask
you to unmute.
If at any time during the hearing I'm unable to chair, the
chairman of the full committee, Chairman Pallone, who I see on
my screen, will serve as chair until I'm able to return.
Documents which are accepted for the record can be sent to
Austin Flack at the email address we've provided to staff. All
documents will be entered into the record at the conclusion of
the hearing.
And 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, the Oversight and Investigations Subcommittee holds
its first hearing of the 117th Congress on an issue that holds
the promise to finally end this pandemic: The rollout of the
COVID-19 Vaccination Program. This committee has conducted
relentless oversight of the COVID-19 pandemic response from the
very start. Last year, we saw endless dysfunction and chaos, as
our country was adrift by the absence of strong, competent
Federal leadership. But, as bad as it was last spring, this
winter has brought an even more dangerous stage.
In recent weeks, cases and hospitalizations have soared all
over the country, and as many as 4,000 Americans per day have
died from this awful virus. And now, as we're seeing, mutations
of the virus are beginning to spread throughout the United
States.
As the title of this hearing makes clear, we have no time
to lose. We must act with a sense of urgency and use every
resource available at the Federal, State, and local levels to
fight the spread of this disease and to end suffering and death
and to return to normalcy.
The Biden administration absolutely has its work cut out
for it. Indeed, it faces the greatest and most immediate
challenge of any Presidential administration in modern memory.
But already we're seeing signs that the ship is beginning to
turn around. The administration recently announced a
comprehensive national strategy for the COVID-19 pandemic,
something this committee has long called for. The plan advances
urgently needed solutions to mount a successful vaccination
program, restore trust with the American people, and mitigate
the spread of the virus, while at the same time providing the
emergency relief that Americans desperately need. We will
continue to engage with the administration on what the Federal
Government needs from Congress to execute this plan and to get
us back on track.
The key task that we're faced right now is the rollout of
the COVID vaccines. The portion of Operation Warp Speed, the
Federal-private partnership to research and develop the
vaccines, test them in clinical trials for safety and efficacy,
and get them authorized for use was an enormous undertaking,
and it was a profound victory for our heroic scientists. But
that was only the first step.
If we don't ensure that Americans also get vaccinated
quickly, the efforts will have been in vain. Those charged with
administering the COVID-19 vaccine program around the country,
including our excellent witnesses today, have a tremendous
opportunity and responsibility to ensure equitable and
expeditious administration of these lifesaving vaccines. And
that's why we're convened today, to hear from State leaders on
the front lines about how we can significantly ramp up
vaccinations.
As we will hear, States are mobilizing to expand who will
be eligible to receive the vaccine next, with a special
emphasis on ensuring equity for those most vulnerable to COVID-
19 and historically marginalized communities. For instance, my
home State of Colorado recently announced plans to hold pop-up
vaccination clinics in 50 high-density, low-income communities
of color, many in my congressional district.
Despite these efforts, we have already been seeing a lot of
frustration and confusion. Since the rollout started in
December, one consistent theme has been the lack of
transparency about how many vaccines are coming and when.
Compounding matters, surveys indicate that, while the majority
of Americans want to get COVID-19, there are some who still
have reservations. Thankfully, the Biden administration has
committed to changes, like transparent data for the States and
the public, that will address some of those issues so that we
can build trust and work to get every available vaccine
administered quickly and equitably.
In fact, the biggest challenge I'm hearing from States
right now is simply a lack of supply. After some initial
challenges in administering the vaccines, State and local
communities are reporting that now the demand for the vaccine
far exceeds the supply, and they stand ready to vaccinate many
more Americans if we can just get them the doses they need.
As I said, we have an excellent panel today, representing
five States that are aggressively working to end this pandemic.
I want to thank each panelist for your efforts, and I'm
grateful for the time you've committed to provide critical
testimony on how we can improve our fight against this
pandemic. I look forward to a candid discussion with the panel
about what's working and what we can do better. And I hope that
you will also elaborate on what more the Federal Government and
Congress can do to improve the partnership in this fight. The
end of this nightmare is in sight. Now is the time to double
down on our efforts and finally turn the corner on this
pandemic.
[The prepared statement of Ms. DeGette follows:]
Prepared Statement of Hon. Diana DeGette
Today, the Oversight and Investigations Subcommittee holds
the first hearing of the 117th Congress, on an issue that holds
the promise to finally end this pandemic: the rollout of the
COVID-19 vaccination program.
This committee has conducted relentless oversight of the
COVID-19 pandemic response from the very start. Last year, we
saw endless dysfunction and chaos as our country was left
adrift by the absence of strong, competent Federal leadership.
As bad as it was last spring, this winter has brought an
even more dangerous surge.
In recent weeks, cases and hospitalizations were soaring
all over the country, and as many as 4,000 Americans were dying
every day from this awful virus.
As the title of this hearing makes clear, we have no time
to lose. We must act with a sense of urgency and use every
resource available--at the Federal, State, and local levels--to
fight the spread of this virus, end the suffering and death,
and return to a sense of normalcy.
The Biden administration has its work cut out for it.
Indeed, it faces the greatest and most immediate challenge of
any presidential administration in modern memory. But we are
already seeing signs of the ship turning around.
The Biden administration recently announced a comprehensive
national strategy for the COVID-19 pandemic, something this
committee has long called for. This plan advances urgently
needed solutions to mount a successful vaccination program,
restore trust with the American people, and mitigate the spread
of the virus, while providing the emergency relief Americans
desperately need.
We will continue to engage with the administration on what
the Federal Government needs from Congress to execute this plan
and get America on track.
The key task we are faced with now is the rollout of COVID-
19 vaccines.
The Federal-private partnership to research and develop
these vaccines, test them in clinical trials for safety and
efficacy, and get them authorized for use was an enormous
undertaking and a profound victory for the country.
But that was only the first step. If we do not ensure that
every American is able to get vaccinated quickly, those efforts
will have been in vain. Those charged with administering the
COVID-19 vaccine program around the country--including our
excellent witnesses today--have a tremendous opportunity and
responsibility to ensure equitable and expeditious
administration of these lifesaving vaccines.
That is why we are convened today: to hear from State
leaders on the front lines about how we can significantly ramp
up vaccinations.
As we will hear today, States are mobilizing to expand who
will be eligible to receive the vaccine next, with a special
emphasis on ensuring equity for those most vulnerable to COVID-
19 and historically marginalized communities.
For instance, my home State of Colorado recently announced
plans to hold popup vaccination clinics in 50 high-density,
low-income communities of color.
Despite these efforts, we have also been seeing a lot of
frustration and confusion. Since the rollout started in
December, one consistent theme has been the lack of
transparency about how many vaccines are coming and when.
Compounding matters, surveys indicate that, while the majority
of Americans want to get the COVID-19 vaccine, some adults
continue to have reservations.
Thankfully, the Biden administration has committed to
changes--such as transparent data for the States and the
public--that will address some of those issues, so that we can
build trust and work to get every available vaccine
administered quickly and equitably.
Indeed, the biggest challenge I'm hearing from most States
now is simply a lack of supply. After some initial challenges
administering the vaccines, States and local communities are
reporting that the demand for the vaccine far exceeds the
supply. And they stand ready to vaccinate many more Americans,
if they are given the doses they need.
We have an excellent panel today, representing five States
aggressively working to end this pandemic.
I thank them for their efforts, and I'm grateful for the
time they've committed to provide critical testimony on how to
improve our fight against this pandemic. I look forward to a
candid discussion with the panel about what is working and what
is not working. I hope they will also elaborate on what more
the Federal Government and Congress can do to improve the
partnership in this fight.
The end of this nightmare is in sight. Now is the time to
double down on our efforts, and finally turn the corner on this
pandemic.
Ms. DeGette. And with that, the Chair is pleased to
recognize the ranking member of the subcommittee, Mr. Griffith,
for 5 minutes for the purposes of an opening statement.
OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE
IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA
Mr. Griffith. Thank you very much, Chair DeGette. And I
look forward to working with you, and thank you for holding
this important hearing.
I want to thank the State public health officials for
taking the time to join us today as your vaccination programs
are well underway. The Federal Government and States are in the
middle of a monumental task to vaccinate everyone that wishes
to be vaccinated. I appreciate you all attending today as we
work together to discuss ways to increase COVID-19
vaccinations.
It was just 1 year ago when this country identified the
first case of a new virus that would rapidly spread throughout
the Nation. In this past year, the Federal Government and
States have come together to fight the pandemic, from providing
testing to therapeutics and, ultimately, a vaccine for
Americans. Pfizer and Moderna continue to manufacture vaccines
at full capacity by releasing between 12 million to 18 million
doses a week to fuel the overwhelming demand from the States.
Ending the pandemic hinges on the efficacy of the national
vaccine distribution efforts. This effort includes not only
sending vaccines to States, but also getting shots into arms.
To date, the Federal Government has shipped more than 49
million doses of COVID-19 vaccines to States. States have
administered almost 28 million of those doses through their
State vaccination plans, with 3.1 million doses administered to
people in nursing homes or long-term care facilities. Last
week, the U.S. averaged 1.2 million doses administered each day
across the U.S. Sixty-two percent of the vaccine supply has
been administered, and that continues to trend upwards each
week.
This progress is the product of Federal and State
collaboration, especially extensive planning and investment
from the initiative Operation Warp Speed. Operation Warp Speed
was launched in May 2020, to accelerate the development,
manufacturing, and distribution of COVID-19 vaccines while
maintaining safety and efficacy standards. This was a massive
undertaking that combined science, government, the military,
and the private sector to provide viable vaccines several years
earlier than typical timelines.
The Federal Government created toolkits and resources to
States for planning COVID-19 immunization programs. For
example, the CDC released a playbook to guide both States and
their local partners on how to plan and operationalize a
vaccination response. Additionally, in the summer of 2020, the
CDC and Operation Warp Speed conducted site visits to develop
model approaches for vaccinations through five pilot programs
in California, Florida, Minnesota, North Dakota, and
Philadelphia. The Federal Government also instructed States on
how to use vaccines to control the coronavirus.
Due to the limited supply of vaccine available, the CDC's
Advisory Committee on Immunization Practices recommended
priority groups for vaccination. This included healthcare
personnel and residents of long-term care facilities to be in
the front of the line, followed by older adults and frontline
essential workers, all groups with a higher susceptibility to
coronavirus. States incorporated these recommendations to
execute a deliberate and measured approach for vaccinations.
The Federal Government worked diligently to distribute millions
of doses across the United States. Now States are working
diligently to administer these doses into arms.
States have varied in their performance when it comes to
administering the vaccine doses that have been allocated and
distributed to their State. For example, Virginia, my home
State, administers 8.49 doses per 100, with 1.2 percent of the
population fully vaccinated. In contrast, in West Virginia,
they administer 13.53 doses per 100, with 3.3 percent of the
population fully vaccinated.
States are under criticism for how their vaccination
campaigns are responding to the demand for shots. States have
noted the lack of resources and infrastructure for
vaccinations, such as a lack of trained personnel to administer
vaccines to eligibility groups. Additionally, miscommunication
to States and providers on the number of doses available has
created a chain of logistical issues. States appear to be
addressing challenges as they learn lessons along the way, but
there is work to be done to vastly improve the rate of doses
administered. Additionally, 8.75 billion from the Consolidated
Appropriations Act enacted at the end of last year with 4.5
billion specifically allocated to the States is on the way to
the States and should be of some help.
As we continue to work on coronavirus stimulus packages, it
is essential to hear State perspectives. As Justice Brandeis
said, the States are the laboratories of democracy. By finding
novel approaches to complex problems, a successful effort by a
State can be a model for other States looking for solutions to
similar problems.
I look forward to the testimony from these witnesses today
and welcome them to the hearing.
[The prepared statement of Mr. Griffith follows:]
Prepared Statement of Hon. H. Morgan Griffith
Thank you, Chair DeGette, for holding this important
hearing.
I also want to thank the State public health officials for
taking the time to join us today as your vaccination programs
are well underway. The Federal Government and States are in the
middle of a monumental task to vaccinate everyone that wishes
to be vaccinated. I appreciate you all attending today as we
work together to discuss ways to increase COVID-19
vaccinations.
Ending the pandemic in this country hinges on the efficacy
of the national vaccine distribution efforts. This effort
includes not only sending vaccines to States, but also getting
shots into arms. To date, the Federal Government has shipped 47
million doses of COVID-19 vaccines to States. States have
administered 26 million of those doses through their State
vaccination plans with 3.1 million doses administered to people
in nursing homes or long-term care facilities.
Last week, the U.S. administered nearly 1.6 million doses
in one day. This progress is the product of Federal and State
collaboration, especially extensive planning and investment
from the initiative Operation Warp Speed.
Operation Warp Speed was launched in May 2020 to accelerate
the development, manufacturing, and distribution of COVID-19
vaccines while maintaining safety and efficacy standards. This
was a massive undertaking that combined science, government,
the military, and the private sector to provide viable vaccines
several years earlier than typical timelines.
The Federal Government collaborated with States to lend
toolkits and resources for planning COVID-19 immunization
programs. For example, the CDC released an interim playbook to
guide both States and their local partners on how to plan and
operationalize a vaccination response. Additionally, in the
summer of 2020, the CDC and Operation Warp Speed conducted site
visits to develop model approaches for vaccinations through
five pilot programs in California, Florida, Minnesota, North
Dakota, and Philadelphia.
The Federal Government also instructed States on how to use
vaccines to control the coronavirus. Due to the limited supply
of vaccine available, the CDC's Advisory Committee on
Immunization Practices (ACIP) recommended priority groups for
vaccination. This included healthcare personnel and residents
of long-term care facilities to be first in line, followed by
older adults and frontline essential workers, all groups with a
higher susceptibility to coronavirus. States incorporated these
recommendations to execute a deliberate and measured approach
for vaccinations.
The Federal Government worked diligently to distribute
millions of doses across the United States. Now, States are
working diligently to administer these doses into arms. States
have varied in their performance when it comes to administering
the vaccine doses that have been allocated and distributed to
their States.
States have faced challenges in this complex, logistical
operation that have contributed to slower than expected
vaccination rates. This is especially true in my home State of
Virginia. For example, in Virginia, the State administers 53
percent of the doses it receives from the Federal Government.
In contrast, our neighbors in West Virginia administer 77
percent of their doses. States that are lagging in vaccinations
fall in the 40 to 50 percent range, while those that are
leading the country administer 60 to 70 percent of the doses
they receive.
States are under criticism for how their vaccination
campaigns are responding to the demand for shots. States have
noted the lack of resources and infrastructure for vaccination,
such as the lack of trained personnel to administer vaccines
eligibility groups. Additionally, miscommunication to States
and providers on the number of doses available has created a
chain of logistical issues. States appear to be addressing
challenges as they learn lessons along the way, but there is
work to be done to improve the process. More resources from the
Consolidated Appropriations Act enacted at the end of last year
is on the way.
As we continue to work on coronavirus stimulus packages, it
is essential to hear State perspectives. With new variants of
the virus emerging and case numbers skyrocketing, we need to
find solutions as quickly as possible.
I look forward to the testimony from these witnesses and
welcome them to the hearing. I yield back.
Mr. Griffith. And, Madam Chair--excuse me--Madam or Chair,
I yield back. Trying to get it right.
Ms. DeGette. And you did.
The Chair now will recognize the chairman of the full
committee, Mr. Pallone, for 5 minutes for purposes of an
opening statement.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you. Thank you, Madam Chairwoman.
And let me also thank Morgan Griffith, our ranking member.
And I see the ranking member of our full committee is here as
well, and I also notice we have a lot of our new Members on
both sides of the aisle. I think the new Members are probably
going to be more active than some of the older Members,
unfortunately. But it's all right. We want you all to get
involved as much as possible.
So, today, this is actually the first hearing of the Energy
and Commerce Committee during the 117th Congress, and obviously
the purpose of it is to examine the urgent need to increase
COVID-19 vaccinations. This committee's top priority is to
combat this pandemic, and in the coming months we'll push an
aggressive agenda that will ensure the Biden administration has
all the tools and resources it needs to crush the virus.
The goal is more pressing than ever. Thousands of Americans
continue to die each day from COVID-19, while new, more
contagious strains are emerging in the United States. I'm
afraid that we're now in a race to keep vaccines ahead of the
new virus variants, and the stakes could not be higher.
The pandemic's toll on the Nation is tragic. To date, more
than 440,000 Americans have lost their lives from COVID-19,
surpassing the total number of U.S. soldiers killed during
World War II. More than 10 million Americans are unemployed,
while one in three households struggle to make ends meet. It's
no wonder Americans' assessment of their mental health is worse
than at any point in the past two decades. And experts, of
course, warned of a dark winter and, unfortunately, they were
right in these dark days, but we're now seeing the rollout of
some of the most powerful tools we have to contain the virus:
That's safe and effective vaccine.
But, unfortunately, the initial rollout during the Trump
administration was marked by confusion and delays. It's no
secret that the demand for a vaccine is outpacing supply,
leading to canceled appointments, endless lines, and mounting
concerns, and limited transparency into the Nation's vaccine
supply as well as conflicting accounts about a reserve held by
the Federal Government have all contributed to uncertainty and
frustration.
But, thankfully, the Biden administration is already taking
action to address these issues, including purchasing additional
doses that will increase our vaccine supply by 50 percent by
the end of summer. And I hope to learn today what more Congress
and the Federal Government can do to provide more certainty and
help accelerate vaccinations across the country but at the same
time ensuring equitable access for the most vulnerable to these
vaccines.
And despite the issues we've encountered with the vaccine
rollout and the painful road still ahead, I'm still optimistic,
as I noticed Diana DeGette was, about that we can finally be on
the path to beating the virus. We have to be optimists.
As I mentioned, there are currently two extraordinarily
effective and safe COVID-19 vaccines authorized by the FDA, and
more could be on the way soon, but States have stretched their
limited resources to implement an unprecedented vaccination
program, reaching 25 million Americans and counting. As you
know, I've been very critical that during the Trump
administration in the last year or so there really was no
national strategy. States were forced to compete with each
other, and that led to the confusion. There needs to be a
national strategy.
But now, the Biden administration says they're going to be
guided by science and they're going to have a national strategy
to beat the pandemic. This is what we've been long calling for.
But this nationwide vaccination campaign--it really is
historic, but it's going to require substantial support from
Congress to succeed.
To that end, Congress must move swiftly to pass the
American Rescue Plan, the comprehensive proposal from the Biden
administration that would fund vaccination efforts and provide
Americans much-needed relief. This is the new COVID bill. Under
that bill, we would invest an additional $20 billion in a
national vaccination program to help ensure greater
accessibility and availability of vaccines across the country.
It includes critical financial support to State and local
governments that have been pleading for more support from the
Federal Government to assist in their efforts to combat this
virus.
So I hope my Republican colleagues will join me without
delay in supporting this new bill that the Biden administration
is putting forward. I don't think there's any time to waste.
And I welcome the State health officials with us. We're going
to look forward to their assessments of the national
vaccination effort. You are vital partners in this
extraordinary campaign. You're being called upon to execute
innovative solutions to unparalleled challenges, and I want to
thank you. We understand that you should not have to do this
without substantial help and a national coordinated effort, and
we want to know what we can do to achieve that.
So thank you again, Madam Chairwoman.
[The prepared statement of Mr. Pallone follows:]
Prepared Statement of Hon. Frank Pallone, Jr.
Today, we convene the Energy and Commerce Committee's first
hearing of the 117th Congress to examine the urgent need to
increase COVID-19 vaccinations across the country. This
committee's top priorities this year are to combat this
pandemic, provide relief to struggling families, and rebuild
our economy. In the coming months, we will push an aggressive
agenda that will ensure the Biden administration has all the
tools and resources it needs to crush this terrible virus.
This goal is more pressing than ever. Thousands of
Americans continue to die each day from COVID-19, while new,
more contagious strains are emerging in the United States. We
are now in a race to keep vaccines ahead of new virus
variants--and the stakes could not be higher.
The pandemic's toll on the Nation is tragic. To date,
nearly 440,000 Americans have lost their lives from COVID-19--
surpassing the total number of U.S. soldiers killed during
World War II. More than 10 million Americans are unemployed,
while one in three households struggles to make ends meet. It's
no wonder Americans' assessment of their mental health is worse
than at any point in the past two decades. Experts warned of a
dark winter, and unfortunately, they were right.
Amid these dark days, we're now seeing the rollout of some
of the most powerful tools we have to contain the virus: safe
and effective vaccines. Unfortunately, the initial rollout has
been marked by confusion and delays. It's no secret that the
demand for vaccine is outpacing supply--leading to cancelled
appointments, endless lines, and mounting concerns.
Limited transparency into the Nation's vaccine supply, as
well as conflicting accounts about a reserve held by the
Federal Government, have all contributed to uncertainty and
frustration.
Thankfully, the Biden administration is already taking
action to address these issues, including purchasing additional
doses that will increase our vaccine supply by 50 percent by
the end of summer. I hope to learn today what more Congress and
the Federal Government can do to provide more certainty and
help accelerate vaccinations across the country, while ensuring
equitable access for those most vulnerable to COVID-19.
Despite the issues we've encountered with the vaccine
rollout and the painful road still ahead, I'm optimistic that
we are finally on a path to beating the virus.
As I mentioned, there are currently two extraordinarily
effective and safe COVID-19 vaccines authorized by the Food and
Drug Administration--and more could soon be on the way.
States have stretched their limited resources to implement
an unprecedented vaccination program, reaching 26 million
Americans and counting.
And we now have a new administration that will be guided by
science and a comprehensive national strategy to beat the
pandemic--something I have long called for.
So there is hope on the horizon, but we have much work to
do to get there. That starts with tackling the biggest
challenges standing in the way of containing the pandemic:
getting vaccines into as many arms as possible, as quickly as
possible.
This nationwide vaccination campaign is truly historic, and
it will require substantial support from Congress to succeed.
To that end, Democrats in Congress are moving swiftly to
pass the American Rescue Plan--a bold, comprehensive proposal
from the Biden administration that would fund vaccination
efforts and provide Americans much-needed relief. Critically,
the plan would invest $20 billion in a national vaccination
program to help ensure greater accessibility and availability
of vaccines across the country.
It includes critical financial support to State and local
governments, which have been pleading for any support from the
Federal Government to assist in their efforts to combat this
virus.
I hope my Republican colleagues will join me, without
delay, in supporting this bill for the American people. There
is simply no time to waste.
I welcome the State health officials with us and look
forward to their on-the-ground assessments of the national
COVID-19 vaccination effort. You are our vital partners in this
extraordinary campaign, and you are being called upon to
execute innovative solutions to unparalleled challenges. Thank
you for dedicating your valuable time to sharing your important
perspectives with the committee today.
The COVID-19 vaccines authorized in the United States are
potent tools in our fight against the virus. But vaccines in
vials don't protect people--vaccines in arms do. We must act
now to overcome the remaining logistical hurdles and strengthen
the Nation's COVID-19 vaccination campaign. There is no time to
lose.
Ms. DeGette. Thank you very much.
The gentleman yields back.
The Chair now is happy to recognize the ranking member of
the full committee, Mrs. Rodgers, for 5 minutes for the
purposes of 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 the Republican leader, Mr. Griffith, as well as
everyone, just I'm really pleased that we're coming together
this morning to address the solutions to increase COVID-19
vaccinations in the United States. Welcome to our new Members.
And to those that are on the front lines, the State health
officials that are with us today, thank you for your continued
vigilance.
The development and the approval of several COVID-19
vaccines in less than a year is one of the greatest
achievements in American history and modern science. I'm also
grateful for the work that has been done in Congress. The fact
that Congress passed, in a matter of days, the CARES Act almost
a year ago, and then just in December an additional $900
billion that was passed by Congress--overwhelming bipartisan
support, again, to meet the needs of Americans.
The Trump administration and the public-private partnership
of Operation Warp Speed set ambitious goals that many doubted
could be achieved. Yet less than a year into this pandemic, we
have vaccinated tens of millions of Americans. Our work is not
over, however, and there are many challenges ahead of us. We
must vaccinate as many Americans as quickly as possible so that
we can save lives, get our economy and schools back open, and
get our lives back.
The distribution of these vaccines should be approached
with the same level of ambition as Operation Warp Speed. We
absolutely must continue to act with a sense of urgency. This
is an extremely complex process involving a system of
transportation, equipment, personnel, and 64 different
jurisdictions, including all States and territories. We must
recognize and appreciate that the distribution and
administration of COVID-19 vaccines is one of the most
ambitious, complex, and important logistical operations ever
undertaken in the United States. Such an enormous operation was
bound to run into difficulties.
But, as we look at solutions, it's important that we not
just look at new ideas, but also take a look at the remarkable
foundation that we're building on, as well as the assets and
resources already in place that can be part of the solution.
The foundation of Operation Warp Speed is amazing. This
effort to have two vaccines with about 97 percent efficacy in
response to a novel pandemic virus before the end of 2020 is
epic and historic. Many skeptics said it couldn't happen.
Actions by Operation Warp Speed and the Department of Defense
also ensured the supply of syringes, needles, and other
essential supplies, to support the vaccination efforts that are
underway. This has been and will continue to be an all-of-
government approach, and we're eager to hear from our witnesses
representing State governments.
As an oversight subcommittee, our job is to find out what's
working, what isn't, and then find solutions to improve our
COVID-19 vaccine distribution and administration efforts. E&C
Republicans are committed to working on solutions to increased
vaccinations, and we're ready to engage in a serious and
credible way. I hope that the new administration, President
Biden and the officials, will stop trying to rewrite history
and stop, you know, saying that this was a dismal failure. Our
goal needs to be continuing to build upon the great foundation.
President Biden's goal pace of 1 million doses administered
a day was already reached. States such as Washington and New
York are attempting to shift blame from their own significant
shortcomings by complaining about the Trump administration and
putting the entire onus for distribution and administration on
the Federal response.
As we will hear from our witnesses today, a localized
response can often best meet the unique challenges of
individual States. West Virginia is very different from
Washington State and has been successful.
Contrary to this administration and certain Governors'
assertion, vaccine distribution plans did exist. In fact, as of
January 31st, more than 49.9 million vaccine doses have been
distributed, 31 million administered.
President Biden says our country is at war with the
coronavirus. I agree. When we fight wars and do it
successfully, we have to do it united, not by using partisan
political tactics like budget reconciliation. Let's work
together on boosting our COVID-19 vaccine distribution efforts
and prepare for future pandemics so this doesn't happen again.
I hope this hearing helps put Congress on a constructive path
with the President to deliver results.
Thank you, Madam Chair. I yield back.
[The prepared statement of Mrs. Rodgers follows:]
Prepared Statement of Hon. Cathy McMorris Rodgers
Thank you, Chair Eshoo and Republican Leader Guthrie, for
holding this important hearing.
Exactly one year ago today, news outlets were reporting
that the global death toll from the coronavirus was 362, with
all but one of those deaths occurring in mainland China.
A year later, and this heartbreaking number has surpassed 2
million, with over 425,000 of these tragic deaths occurring in
the United States.
This pandemic has wreaked havoc on our way of life. The
loss of life has been devasting.
Our previously booming economy has been decimated.
Our mental health crisis has only worsened.
And the long-term impact on our children being kept out of
the classroom is incalculable.
Last Congress, we put our political differences aside to
make extraordinary investments in the fight against COVID-19
through five separate bipartisan relief packages.
These included providing over 30 billion dollars for
States, territories, and Tribes for testing, vaccine
distribution, contact tracing, and public health data
infrastructure improvement.
And over 23 billion dollars to the Biomedical Advanced
Research and Development Authority for the research,
development, and manufacture of novel vaccines, tests, and
treatments.
And 178 billion dollars for healthcare providers on the
front lines of taking care of patients with COVID-19.
This investment and partnership with the private sector has
led to the unprecedented development of innovative vaccines and
treatments coming to market faster than we ever thought
possible.
Operation Warp Speed is one of the most ambitious and
successful undertakings in American history, and with two
lifesaving vaccines now authorized by the FDA, and a third
hopefully soon to follow, there is light at the end of this
dark tunnel.
However, our hard work is not yet complete.
Vaccine distribution is ramping up, but we must ensure
States have the resources and flexibility they need to immunize
successfully as many people who want it, and meet the unique
health needs of their individual populations.
We heard yesterday in the Oversight and Investigations
Subcommittee from West Virginia, which has relied on community
pharmacies to get the vaccines to people.
Unfortunately, Washington State has not been as successful.
Gov. Inslee and others in Olympia spend a great deal of time
pointing fingers at Washington, DC, for the State's slow
distribution instead of figuring out strategies to get people
vaccinated as West Virginia is doing.
Clearly, some States were better prepared and used the
advice of the CDC career scientists to implement locally
targeted strategies more successfully than he has done.
SUPPLY CHAIN
While vaccine distribution is critical to safely and
responsibly reopen our economy and our schools, we also learned
additional challenges during the response to COVID-19.
We learned that our medical supply chain is incredibly
vulnerable and that we rely too heavily on adversarial
countries such as China for critically important products, such
as personal protective equipment.
We need to consider policies that will improve our domestic
manufacturing without impacting cost and consumer access.
Our strategic national stockpile and medical supply
distribution logistics also need to be strengthened.
While we have met this unprecedented crisis with an equally
unprecedented response, our resources are not unlimited.
Congress has a responsibility to oversee the money we have
spent, understand how it is being distributed and used, and
learn what's working and what hasn't.
As Chairman Pallone said during our organizing meeting last
week, this committee has a rich history of bipartisan
cooperation and hard work, perhaps more so than any other
committee in Congress.
Between the pandemic, the economic crisis, and the social
and political unrest, last year was one of the most difficult
in our Nation's history.
Yet, despite these incredible hurdles, Congress was able to
come together on five separate occasions to give the American
people the relief they needed.
This pandemic, and our Government's response, is bigger
than any single administration or political party.
As we discuss these important issues and our path forward
with our distinguished witnesses today, I hope our focus will
be not about pointing fingers for our shortcomings, but an
opportunity to learn what bipartisan steps we can take over the
next several months to win the fight against COVID-19, restore
our way of life, rebuild the greatest economy in history, and
prepare for future pandemics so that a public health emergency
of this magnitude never happens again.
Thank you to our witnesses for joining us today, and I
yield back the balance of my time.
Ms. DeGette. I thank the gentlelady.
The Chair now asks unanimous consent that the Members'
written opening statements be made part of the record, and
without objection, so ordered.
I would now like to introduce our witnesses for today's
hearing: Dr. Ngozi Ezike, who's the director of the Illinois
Department of Public Health; Dr. Joneigh Khaldun, who's the
chief medical executive and chief deputy director for
Michigan's Department of Health and Human Services.
If people can please put their mics on mute.
Dr. Clay Marsh, the West Virginia COVID-19/coronavirus
czar.
Mr. McKinley, I guess you guys have czars down there in
West Virginia.
Dr. Courtney N. Phillips, the secretary of the Louisiana
Department of Health; and Director Jill Hunsaker Ryan, who's
the executive director of the Colorado Department of Public
Health and Environment.
I want to thank all of our witnesses again for appearing in
front of this committee. Every member of this committee
appreciates it, because we know how busy you are.
I know all of you are aware that the committee is holding
an investigative hearing, and as such we hold all of our
hearings under oath. Does anyone here have any objection to
testifying under oath?
Let the record reflect that the witnesses have responded
no.
The Chair then advises you that, under the rules of the
House and the rules of the committee, you are entitled to be
represented by counsel. Does any of our witnesses ask to be
represented by counsel?
Let the record reflect that the witnesses have responded
no.
If you would, please, could you please raise your right
hand so that I may swear you in?
You can unmute and say, ``I do.''
[Witnesses sworn.]
Ms. DeGette. Let the record reflect the witnesses have
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 Chair will now recognize our witnesses for a 5-minute
summary of their written statement. There's a timer on the
screen right here that will count down your time, and it will
turn red when your 5 minutes has come to an end. And so I will
now recognize each of our witnesses.
Dr. Ezike, you are recognized first for 5 minutes, please.
STATEMENTS OF NGOZI O. EZIKE, M.D., DIRECTOR, ILLINOIS
DEPARTMENT OF PUBLIC HEALTH; JONEIGH S. KHALDUN, M.D., CHIEF
MEDICAL EXECUTIVE, STATE OF MICHIGAN, AND CHIEF DEPUTY DIRECTOR
FOR HEALTH, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES;
CLAY MARSH, M.D., VICE PRESIDENT AND EXECUTIVE DEAN FOR HEALTH
SCIENCES, WEST VIRGINIA UNIVERSITY, AND COVID-19 CZAR, STATE OF
WEST VIRGINIA; COURTNEY N. PHILLIPS, Ph.D., SECRETARY,
LOUISIANA DEPARTMENT OF HEALTH; AND JILL HUNSAKER RYAN,
EXECUTIVE DIRECTOR, COLORADO DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
STATEMENT OF NGOZI O. EZIKE, M.D.
Dr. Ezike. Thank you.
Chairwoman DeGette, Ranking Member Griffith, and
distinguished members of the subcommittee, thank you for having
me here today to speak about Illinois' response to the
coronavirus pandemic.
Over the past year in Illinois, we've had more than 1
million cases of COVID-19 and, unfortunately, have lost more
than 19,000 members of our Illinois family. But through
efficient and effective distribution of the vaccine, coupled
with a continued focus on masking, social distancing, and hand
hygiene, we can suppress the spread of the virus and save many
lives.
Within 24 hours of receiving our first allocation of over
40,000 doses, IDPH distributed the entire allocation to local
health departments, with subsequent distribution to hospitals.
We continue to build a statewide provider network to ensure
vaccination occurs with both rapidity and equity.
From the outset, vaccination efforts in Illinois and
throughout the States have been limited by vaccine supply and
sometimes complicated by inconsistent messages regarding
allocations. Operation Warp Speed's promise to Illinois and the
Nation of a steady cadence of vaccine oftentimes fell short,
with reduced or postponed allocations, which left Illinois
receiving fewer than expected doses.
After meticulous planning to vaccinate the target
population for Illinois' Phase 1B, which was shaped by the
Advisory Committee on Immunization Practices' recommendations,
the previous administration did change the priority groups
without forewarning, further complicating our efforts by
confusing the public and nearly doubling the size of the target
population that now heard that they were eligible.
Last month, Governor JB Pritzker activated the Illinois
National Guard to assist local health departments in
administering vaccinations. The Biden administration supported
that move by approving 100 percent of the cost, but we continue
to need assistance.
With our significant engagement, Illinois pharmacies in the
Federal Pharmacy Partnership program have vaccinated many of
our long-term care residents in nearly 1,700 facilities
assigned to them. And, as of January 25th, every resident and
staff person in the Illinois skilled nursing facilities have
been offered that first dose.
While we await additional vaccine supply, a multipronged
approach supported by the Federal Government could help improve
the effectiveness of nonpharmaceutical interventions, actions
apart from getting vaccines and/or taking medicines that will
slow the spread of the illness. Examples include aggressive
expansion of genomic sequencing. That infrastructure is needed
for accurate and timely assessment of the threat and the
identification of new variants.
Another critical piece with heightened application in
economically disadvantaged communities is the continuation of
paid sick leave and direct financial support to encourage
compliance with distancing, quarantine, and isolation orders.
As of yesterday, the 1 millionth dose was administered into
an Illinois resident. But to accelerate immunizations we need
our Federal partners to align our efforts--align their efforts
with ours to help solve practical operational issues.
Of course, we need increased supply of vaccines as well as
resources to quickly administer the vaccine. We need improved
communication channels and fixes to tools provided to States.
The Federal Government should provide States with clear,
consistent projections for vaccine allocation to allow and
enable planning weeks into the future, and continue to update
the Tiberius system so that States are working with clear,
accurate information and can make appropriate plans. We also
need a robust IT solution connecting electronic medical
records, pharmacy logs, and State registration tools so people
can locate vaccines across the jurisdictions.
We're grateful for the influx of funding. And, as you
consider the next round of emergency supplemental funding, I
encourage you to provide additional funds to support the
ongoing vaccination campaign and address emerging funding needs
for State, local, Tribal, and territorial public health
systems.
Thank you for the opportunity to share Illinois'
experience. We will continue to let data, science, and equity
guide our approach. And I'm honored to work with Congress and
the new administration to get to the other side of this
pandemic.
Thank you for your attention.
[The prepared statement of Dr. Ezike follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you very much.
Our next witness is Dr. Joneigh Khaldun, who's the chief
medical executive and chief deputy director of the Michigan
Department of Health and Human Services.
Dr. Khaldun.
STATEMENT OF JONEIGH S. KHALDUN, M.D.
Dr. Khaldun. Thank you.
Chairs Pallone and DeGette, Ranking Members Rodgers and
Griffith, and distinguished members of the committee, thank you
for the opportunity to speak with you today about Michigan's
COVID-19 vaccination efforts. A focus on efficient and
equitable distribution of these vaccines is the way that we are
going to end this pandemic.
I have the honor of serving my State, not only helping to
guide the battle against COVID-19 in my role as chief medical
executive, but also as a practicing emergency physician on the
front lines treating patients in Detroit, one of the hardest-
hit cities by the pandemic early on. I've seen the terrible
impact this pandemic has had on patients, families, and on my
clinical colleagues. In fact, two colleagues that helped train
me in New York City lost their lives to this pandemic last
year. I only wish these vaccines were available sooner so that
they might be alive today.
For me, this vaccination effort is personal, for my
community, for my colleagues, and for my patients. Michigan is
working hard to distribute the vaccine quickly, efficiently,
and equitably to the nearly 10 million residents across the
State. We have a robust network of over 2,000 enrolled
providers and have the capacity to administer up to 80,000
vaccines a day. However, Michigan's biggest challenge with the
vaccine rollout has been the limited supply of vaccine, lack of
predictability regarding vaccine amounts week to week, and the
lack of a national strategy until now.
Despite this, Michigan has made significant strides.
Yesterday, we announced surpassing 1 million doses of vaccine
being administered statewide, and we have jumped more than 20
places in the rankings over the past few weeks as it relates to
our proportion of the population vaccinated.
Michigan has made this progress because we have been
intentional and focused. We have set forth clear goals for our
State and vaccinating partners, with the expectation that 90
percent of received vaccines are administered within 7 days.
We are also laser-focused on equity. We have set the
ambitious but attainable goal of having no disparity in
vaccination rates across racial and ethnic groups. It is
important that vaccination efforts move forward expeditiously
without compromising equity.
It's a tragedy but not a surprise that COVID-19 has
disproportionately impacted communities of color. This
disparity is directly related to structural inequities and
historical racism that has caused communities of color to have
less access to the resources needed to achieve optimal health.
Michigan has been a leader in fighting COVID-19 disparities,
essentially eliminating the disparity between African Americans
and Whites when it comes to COVID-19 cases and deaths. We did
this specifically by engaging trusted community members, using
data to identify testing locations, and developing strategic
messaging in collaboration with communities of color.
We are building on this success in our vaccination efforts,
prioritizing allocation to socially vulnerable groups,
mobilizing a diverse network of vaccinators that can go into
neighborhoods, and launching an aggressive communications and
engagement effort to address hesitancy and misinformation. What
we need at the Federal level is a larger and consistent vaccine
supply, as well as additional funding to specifically address
barriers to access.
Data and reporting having been a challenge throughout this
pandemic, with the vaccine rollout being no exception. States
must manage multiple systems to understand, track, and report
vaccines, and our providers are overburdened by onerous
enrollment, tracking, and reporting systems. This has led to
delays and inaccuracies in data reporting.
Additionally, the CDC website is often inaccurate,
outdated, or does not fully reflect the work of States.
Improvements in data reporting would ease the burden on States
and allow us to focus on implementation of our vaccination
strategies.
Finally, I'd like to thank Congress for passing emergency
supplemental funding for the vaccination response, which will
help Michigan build out its vaccination infrastructure. We have
also requested additional support from FEMA to expand mass
vaccination sites as well as mobile clinics. We look forward to
continuing to partner with the Biden administration on these
efforts.
Overall, I'm pleased with the progress that we've made in
Michigan. We have built out capacity and a strategy that will
prioritize speed without compromising equity. I'm grateful for
our Federal partners, encouraged by the leadership and
engagement demonstrated by President Biden and his team, and
look forward to continuing to work together to end this
pandemic.
Thank you very much.
[The prepared statement of Dr. Khaldun follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
I'm now very pleased to recognize our colleague, Mr.
McKinley, to introduce our next witness.
Mr. McKinley. I have to unmute. There we go.
Thank you, Madam Chair. Did I say that properly? Madam
Chair?
Ms. DeGette. That's perfect. Thank you.
Mr. McKinley. Madam Chair, I'd like to introduce Dr. Clay
Marsh. Dr. Marsh is the current virus czar for the State of
West Virginia. And along with his role, he's also the vice
president and dean for Health Sciences at West Virginia
University, and is considered to be a national leader in
healthcare.
He's published more than 140 papers in peer-reviewed
journals, but I first met his father 40 years ago. Don Marsh
was a longtime editor of the largest newspaper in West
Virginia, one, quite frankly, not particularly friendly to
Republicans. But Don was always fair and objective. So I expect
nothing less than that from Clay as we welcome him to his
presentation today.
Thank you.
Ms. DeGette. I thank the gentleman.
Dr. Marsh, you're recognized for 5 minutes.
STATEMENT OF CLAY MARSH, M.D.
Dr. Marsh. Thank you, and good morning, Chairman Pallone,
Ranking Member Rodgers, Subcommittee Chairwoman DeGette,
Subcommittee Ranking Member Griffith, and other members of the
House Energy and Commerce subcommittee.
It is really a distinct pleasure and privilege to be here
today, and I want to recognize and thank Congressman McKinley,
who is unwavering in his support for West Virginia, and also to
recognize Governor Justice, who's done a remarkable job as a
leader.
What I'd like to do in my time here is to reflect what our
strategies have been and talk a bit about the important
components I believe could be shared, and certainly learn from
other people.
I congratulate the other presenters.
In West Virginia, we recognize that ultimately it is
culture that plays the most important role in outcome. We were
very much impressed by a series of articles that we read at the
beginning of the pandemic, one of which reflected four
mathematical models, agent-based models, that demonstrated that
doing nothing to mitigate the COVID-19 pandemic or doing things
by force were not as effective as doing things collaboratively.
And that's really been a hallmark of what we've tried to do, is
really move toward a level of committed purpose and service to
people in our State.
We recognized early that this pandemic was a ``black swan''
event, a rare event that had catastrophic perturbation of all
of our systems, and therefore we knew we couldn't predict
necessarily the future, but we wanted to become agile and be
capable of changing and trying things and undergoing rapid
learning.
We've created a team-of-teams kind of approach that's been
led by our National Guard, our logistics experts, choosing the
most expert people to lead the part of the response meta that
we could muster in West Virginia. And the great thing about
West Virginia is, although people may represent different
sectors, they all eventually wear the West Virginia hat.
As we started to focus and clarify our priorities, we
agreed with the Advisory Committee on Immunization Practices
but also were informed by data from the United Kingdom and also
from the CDC that demonstrated truly that older patients were
the most vulnerable for death and hospitalization. And the
Governor gave us a directive to save lives, to improve well-
being, and to maintain the capacity and the function of vital
healthcare and industry sectors in West Virginia.
As we looked at our own data, we saw that the average age
of death was 77 years old, 77.5 percent of our citizens who
died were over 70, 92 percent over 60, 97 percent over 50. So
we targeted this age group, along with the vulnerable
populations outlined by the CDC.
And I'm really proud to say, as we started to look at our
own State's needs, we figured out that we had about 250
pharmacies in West Virginia, half of which were privately
owned. So, instead of activating the Federal programs, we went
a different direction and started partnering these pharmacies
with nursing homes, and we were able to immunize all of our
nursing home/assisted living residents before the new year, and
we just finished on our second dose, which has been great
because we know half of our deaths come from this population.
And so, as we start to work to move vaccines quickly, our
goal is to move every vaccine within 5 days to somebody's arm
in West Virginia, answering the risk of our State as predicted
and projected by the Kaiser Family Foundation, the most
vulnerable State moving into this pandemic. We're really proud
to say that we have now immunized 80,000 of 350,000 over-65-
year-old West Virginians, and we're moving forward. And to try
to reduce the confusion about vaccination, we have now started
a preregistration system, and we're hoping to preregister every
person in the State.
I would end by saying that we believe that we all shine
brightest in the service to others, and the only way that we're
going to succeed is together, not only as West Virginians, but
as Americans, and I'm very proud to represent our State today.
And thank you very much for what you're doing.
[The prepared statement of Dr. Marsh follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
I'm now pleased to recognize Dr. Courtney Phillips, the
secretary of the Louisiana Department of Health.
Dr. Phillips.
STATEMENT OF COURTNEY N. PHILLIPS, Ph.D.
Dr. Phillips. Good morning, Chairwoman DeGette, Ranking
Member Griffith, and members of the subcommittee. As mentioned,
I'm Courtney Phillips, and I have the pleasure of serving as
the secretary for the Louisiana Department of Health. First,
thank you all for the invitation to share our journey in the
distribution of COVID-19 vaccines, both our successes as well
as opportunities we have working together for continual
advancement.
With our continued partnership, we are confident we'll be
able to clear these initial hurdles, namely through increased
COVID-19 vaccine allocations, advanced notice of allocation
amounts for planning, and continued flexibility around the
long-term care partnership program.
Although Louisiana has a strong track record of hosting
mass vac events and is ready to employ them once vaccine
availability increases, from the start of our planning we put
our energy towards a low-and-wide strategy for vaccine
distribution. We work with our partners to get local providers
across the State enrolled and comfortable with the logistics of
vaccine receipt and administration. This allowed us to build a
vast network of diverse providers, which was time and labor
intensive, but we do know it was fundamental in achieving
equitable coverage, which has been a top priority in our
planning and rollout from the start.
Per CDC rankings, Louisiana currently ranks 14th for our
first dose administering. While we're proud of the progress
we've made over the past several weeks, we're not satisfied
with where we stand, and we're determined to keep getting
better, determined to be our best selves. Louisianans not only
desire it, but they also deserve it. They're depending on us.
Their lives are dependent upon all of us pulling together in
getting this done.
To date, Louisiana has been allocated a little over 505,000
doses, first doses across our State. More than 93,000 of those
first doses were diverted to the Pharmacy Partnership Long-Term
Care Program, which left about 411,000 for in-State allocation.
Thus far, if you back out this week's allocation, we've
allocated more than 90 percent of our doses within the
community. And we aim to release at least 90 to 95 percent of
doses on a weekly basis when it's received.
This week's allocation is being spread across 406 providers
in every parish in our State. On average, we've increased the
number of provider sites by 65 per week. Our provider sites
include hospitals, outpatient clinics, federally qualified
health centers, rural health clinics, independent and chain
pharmacies, home health agencies, and other healthcare
facilities.
Over the past week, we've tested additional distribution
models, including providing Pfizer vaccines in nonhospital
settings. We're preparing for when increased supply is
available, and that preparation isn't limited to just
distribution models, but it also includes increasing the number
of providers enrolled and ready to receive.
Although supply does not yet support the need for
additional providers, we want to be ready when the time comes.
We initially began this with 701 providers enrolled in week one
and now have over 1,900 providers enrolled across our State.
These providers are spread out all across Louisiana in urban,
rural, and underserved communities. They are ready to receive
and administer vaccine.
That being said, currently only 32 percent of these
providers have been able to receive vaccines because of the
limited supply. And although we have more than 1,900 providers
ready and waiting, we still recognize that we do have some
areas across our State that are healthcare provider deserts.
And to combat this, we're working and gearing up with our local
community partners to deploy mobile vaccine teams, and some of
the recent funding will allows us to do this.
With additional supply, the proper time to strategically
plan, and continued flexibility as to where our vaccine doses
go, Louisiana will be able to significantly increase the number
of residents vaccinated each week. So your continual support in
these areas are needed. And we relayed to you increased supply,
we're ready. I think most States are. Our provider partners and
residents are equipped to handle this increased allocation.
When we talk about the extremely high level of COVID across
our Nation and here in Louisiana--we recently surpassed 400,000
cases--take a moment to step back and think about it. That's
every person in the New Orleans--and then some--area having had
COVID-19.
The narrative across the country has been that vaccines are
going unused and sitting on shelves, so we've worked very hard
in our State to ensure that the limited supply that we've
received from our Federal partners is going into eligible
residents' arms each week, and we've done well. We pushed to a
point where we range from 90 to 95 percent of first-doses
vaccines in the arms of Louisianans within the week that they
receive it. Our providers' weekly dose requirements requests
top 150,000 doses each week. They are ready and asking for
more, and we believe that an increased allotment we can handle
in our State.
Our second area, as mentioned, advance notice. Providing
advance-notice allocation notice would allow the State and our
providers more time to strategically plan. Typically, our week
begins on Tuesday when Louisiana receives an estimated
allocation for the following week. Based on those numbers, the
department works with local providers to determine the need for
the coming week. This list is compiled on Wednesday. Once we
receive firm numbers on Thursdays, we begin the order and load
it into the system. We don't ever lock in before Thursday,
because there's been a couple of instances that those numbers
have changed from Tuesday to Thursday.
Once our order is loaded and submitted, we work with our
providers over Friday and Saturday to make them aware of what's
coming. Monday is shipment, and we begin our process all over
again. But providing States with greater visibility on what's
expected in weeks in advance allows States time to plan and
distribute vaccines more efficiently. This also allows
providers time to adjust for staffing needs based on what
they're going to receive and allow appointments to be scheduled
further in advance.
We were definitely encouraged by the news last week from
our Federal partners that States will be given more notice on
what they can expect to receive, and we do hope that this will
continue. This will be a help.
A third ask that we have is continued flexibility in the
long-term care partnership with both CVS and Walgreens. This
flexibility will allow us to get shots in arms even faster.
Let me begin by expressing our appreciation for these
corporate partners for their responsiveness on issues as they
surface. But continual improvements and proactive
communication, awareness, and the speed of vaccinations are
going to be key.
In recent weeks, we've received approximately 58,000 first
doses, and a large allotment of that goes to a long-term care
partnership. Fortunately, we requested and have received
approval in the recent weeks to keep and utilize those doses
that have gone to the partnership, which has allowed us to
further expand our network within the community in
vaccinations. We're grateful for this flexibility and ask that
it continues.
Ms. DeGette. Doctor, if you could please wind up. Thank
you.
Dr. Phillips. Yes, ma'am. Thank you.
As we continue to move forward, we just want to thank you
all for the financial assistance. Financial burden has been key
in our State. And so the assistance that's been provided in
terms of the FEMA reimbursement, the 100 percent reimbursement
to the National Guard, and the grants have allowed us to be
able to move forward. We need this continued relief as we try
to support the challenges we're up ahead.
Thank you, Chairwoman and committee members, for this time
and any questions, more than happy to once we wrap up. Thank
you.
[The prepared statement of Dr. Phillips follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Doctor.
And last but surely not least is my wonderful executive
director of the Colorado Department of Public Health and
Environment, Dr. Jill Hunsaker Ryan.
Doctor, welcome. Glad to see you here. And you're
recognized for 5 minutes.
STATEMENT OF JILL HUNSAKER RYAN
Ms. Ryan. Thank you, Madam Chair.
And just to clarify, I'm not a physician. So you all may
call me Director Ryan. My background is epidemiology.
But thank you, Chairman DeGette, Ranking Member Morgan
Griffith, and members of the subcommittee. I'm so happy to be
with you here today, and thank you for all of your support so
far.
I'm joining today from Eagle County in Colorado. In
Colorado, we're very proud of our response to the COVID-19
pandemic. We currently have the fifth-lowest rate of
transmission in the Nation and are ranked eighth in terms of
the percentage of vaccine supplies used. Part of our success is
a whole-government approach with the Colorado Department of
Public Health and Environment in unified command with the
Colorado Department of Public Safety, the Governor's office,
and using the Colorado National Guard to support COVID-19
testing and vaccine distribution.
Colorado received the first shipment of vaccine on December
14th, with the Governor signing for it himself. We are moving
as fast as the Federal supply chain allows and are grateful for
every vaccine we receive. When the pandemic began, if you would
have asked me or if you would have told me that we would have
not only one but several vaccines would be in clinical trials
within the year, with distribution starting before 2021, I
would have been very skeptical, but here we are, and this is
simply unprecedented.
Operation Warp Speed deserves our thanks and praise for the
public-private partnership in developing these vaccines, which
will be a game changer in supporting the long-term health and
well-being of our schools, our families, and our communities.
General Perna and his team deserve credit too for efficient
distribution. General Perna has told me that the vaccine is
going from the conveyor belt directly to States.
Colorado's currently receiving about 80,000 doses per week,
and we hear that will increase to 96,000 in mid-February. We do
have the capacity to administer 300,000 doses a week now, with
the goal of 400,000 by the beginning of March.
So our main ask is for more doses and, if possible, greater
predictability in our weekly allotment, which simply helps our
ability to plan. For example, if we knew our number of doses a
month out, with increased supply we could plan even larger
additional clinics and PODs, or points of distribution.
I wanted to take a minute to put in another ask, and that
is simply that the public health system has been so underfunded
for decades. In Colorado, we have a State Department of Public
Health and Environment and then each county is served by a
county local public health agency, 55 in all, and of course
with this response we've all had to scale it massively. My
department has a $600 million-a-year budget. We've been awarded
$1.2 billion in this response that we will push out.
But the problem is, if you can imagine having to scale up a
workforce on the State and local level, trying to hire and
onboard and train and get everybody an email address and
coordinated during a pandemic is so hard. So we need to
ongoingly support our public health system.
Back to vaccines, though, Colorado now has more than 770
providers to help distribute vaccines, and nearly 465,000
people have been vaccinated. Because Coloradans age 70-plus
account for 78 percent of deaths in Colorado, our goal is to
vaccinate 70 percent of them by the end of February.
Hospitals have carried much of the weight in getting this
done. They have dazzling efficiency in reaching a high number
of people quickly. But also, our local public health agencies
have been coordinating the so-called last mile of distribution,
helping determine where vaccine goes in their community, and
setting up mass vaccination clinics or PODs.
Long-term care facilities in Colorado, with the exception
of about 20 rural facilities, are relying on the Pharmacy
Partnership for Long-Term Care Program. We've largely overcome
delays with that program in Colorado by providing staffing
assistance.
And then, finally, an important part of our vaccine
distribution response is to make sure that no one is left
behind. For example, we know people of color have been
disproportionately impacted by COVID-19 in terms of number of
cases, hospitalizations, and deaths. The pandemic has laid bare
the societal disparities that have existed for generations but
which COVID-19 has exploited.
Knowing the challenge, the State has a goal of ensuring
there is a community-based clinic providing vaccines in 50
percent of the top 50 census tracts for high density, low-
income, and minority communities. We'll achieve this goal
through our community-based health centers, local public health
agencies, statewide pop-up clinics in collaboration with
community-based organizations and churches.
Coloradans are eager to get vaccinated, and we are eager to
vaccinate everyone who wants to be vaccinated and end this
crisis.
Thank you for your time today, and I appreciate being able
to come before you to testify.
[The prepared statement of Ms. Ryan follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Ms. DeGette. Thank you so much, Director.
And now it's time for Members to have the opportunity to
ask the panel questions. The Chair will now recognize herself
for 5 minutes.
So I would just like to start with you actually, Director
Ryan. You said in your testimony--and this was echoed in
several of our other panelists' testimony as well--that vaccine
supply and predictability have been a challenge. How are those
challenges impacting the vaccination efforts in Colorado, and
what do you need from the Federal Government to improve the
rate of vaccinations in our State?
Ms. Ryan. Thank you for the question, Madam Chair. We
simply need more supply. As I mentioned, we're getting about
80,000 doses a week. We have the capacity for 300,000 doses now
and are ramping up to 400,000 in the next month. So we need
supply, and then we need better predictability in terms of the
number of weekly doses we will be receiving to help with our
planning efforts.
Ms. DeGette. Yes. And, Dr. Khaldun, you also said in your
testimony, in your written testimony, that Michigan's, quote,
``single biggest challenge with the vaccine rollout has been
the limited supply of vaccine available week to week and the
lack of a national Federal strategy until now.''
I'm wondering, Dr. Khaldun, how you expect the Biden
administration's national COVID-19 strategy to impact
vaccination efforts in your State.
Dr. Khaldun. Yes. So I really appreciate the Biden
administration's strategy. Last week, the State of Michigan
actually updated our strategy that aligns with the Biden
strategy, focused on getting shots in arms, building out a
robust network, maximizing efficiency, personnel, and, of
course, a mass communications effort.
And so what I'm pleased by--and I've had several
conversations with the Biden administration--they will be
supporting us in our strategy. They will be supporting building
out more of the public health workforce and supporting us with
some of our efforts when it comes to equity, whether it be
mobile clinics or supporting personnel that are getting out
into communities.
Ms. DeGette. Dr. Ezike, would you agree that the lack of a
national Federal strategy until now has hamstrung the efforts
in Illinois? And what's the top suggestion for how we can go
forward?
Dr. Ezike. Thank you for that question. I would say indeed
it has. I think at the top of the list we could cite the
confusing messages around the importance of masking. We need a
focused, dedicated message that talks about the importance of
masking. We know that there are other countries outside of ours
that have controlled this virus even before a vaccine was in
place. And so that attention and focus to masking, which I
think I see that this administration absolutely puts at the top
of its priorities, is very important and is one of the first
steps, along with vaccination and promoting vaccination in all
groups.
Also remembering that vaccination, there are lots of
vaccine-hesitant groups. And so, as we are in this period of
still waiting for the supply to increase the demand, we want to
also build that foundation, that community engagement for those
who are vaccine-hesitant. And so we have seen the attention to
that with this administration in the identification of an
equity chair, a COVID equity chair, so that we can work on the
vaccine hesitance as well so that we can bring all of us
through this. We don't want to leave any group behind. And so,
as much as rapidity is important, equity is important. Rapidity
without equity will result in continued disparity.
Ms. DeGette. Thank you. Thank you. I think those are
important points.
Dr. Phillips, you talked about the need for continuing
flexibility and visibility when it comes to the doses allocated
to the Federal long-term care pharmacy program. I wonder if you
can just spend a few moments talking about that program and why
flexibility is so important.
Dr. Phillips. Absolutely. As we know, very early on, week
by week we increased the number of doses that we were
allocating to that program based on the methodology from our
Federal partners. But we do know based on the rate of speed
that they've administered the vaccine that doses have been left
sitting there, waiting. So the speed of distribution is not
keeping up with the speed of allotment that States have
allotted to their partnership.
And so utilizing the most recent clawback availability--so
in recent weeks it's been announced that we're able to pull
back some of that vaccine to match the actual administering
rates. Doing so has allowed us to be able to push more in the
community and not have vaccines sitting anywhere. And so that
flexibility been greatly appreciated.
Ms. DeGette. Thank you so much.
And last but surely not least, because West Virginia's
efforts are a national model, Dr. Marsh, can you just tell us
how Congress and the Federal Government can facilitate better
collaboration between the Federal and State experts and how
that would benefit your vaccination efforts for your State?
Dr. Marsh. Thank you, Madam Chair. Certainly, as the other
experts have testified, that having more vaccine is very
important for us as well. We get about 23,600 doses a week.
Without expanding our infrastructure, we could handle about
125,000 doses a week. And we believe with a small increase in
our infrastructure, it could go over 200,000 doses a week. So
dosing is really important.
But I think also there's a really terrific opportunity for
us to make sure that we're sharing our best practices and
sharing our learnings, and right now I don't think that there
is an integrated portal or pathway to allow each of the leaders
of the States, along with the leaders of the Federal Government
response and perhaps the coronavirus task force experts, to be
able to come together to be able to freely and quickly exchange
information so that we can all undergo this rapid cycled
learning opportunity and also learn the things that don't work,
because it's just as important not to keep doing the things
that don't work as well as trying to adopt the things that do.
Ms. DeGette. Excellent suggestions. Thank you so much. My
time's expired.
And I know now that the chair--or the ranking member of the
full committee, Mrs. Rodgers, is going to go next.
And so you are recognized for 5 minutes.
Mrs. Rodgers. Thank you, Madam Chair.
And thank you all who have joined us as witnesses today. We
thank you for your leadership, your commitment to the health of
all in our communities. This is at a time when we need hope and
healing in our country, and you're on the front lines. So thank
you so much.
My first question is, it's a simple yes or no to all of our
witnesses. I just wanted to ask: At the start of this pandemic,
did any of you anticipate a safe and effective COVID-19 vaccine
to distribute and administer only 10 months later?
Dr. Marsh. No.
Ms. Ryan. No.
Dr. Ezike. No.
Dr. Phillips. No.
Mrs. Rodgers. Thank you.
Next question to everyone: Has a vaccine distribution of
this magnitude and complexity ever been attempted before in the
United States?
Dr. Marsh. No.
Ms. Ryan. No.
Dr. Ezike. No.
Dr. Phillips. No.
Dr. Khaldun. No.
Mrs. Rodgers. Thank you.
I wanted to ask Dr. Marsh also--and I think the last person
was just talking about the importance of best practices and
learning from the other States, which I think is part of the
goal today.
And I just wanted, Dr. Marsh, if you would just speak to
what you believe has been important in West Virginia as we
anticipate this, the challenges with the vaccine distribution,
but a pandemic this large. I just wanted to ask you to speak to
the importance of a localized approach to the response, because
we've heard from so many about a Federal approach.
And I know, in Washington State, you know, I've been
frustrated with a one-size-fits-all approach, not even taking
into consideration as much my region or, you know, we've had
the same responses and restrictions across the State regardless
of the facts on the ground. And my Governor, Governor Inslee,
has continued to say, ``Well, we need more Federal
involvement.''
I just wanted you to speak to the importance of a more
State-by-State approach.
Dr. Marsh. Thank you, Ranking Member Rodgers. Well said.
It's a pleasure to talk about our approach.
And I think that, you know, West Virginia, as a small
State, 1.7 million people, that is very rural, largest city is
50,000, and as we start to look at our own needs in our State,
we see that we have a very distributed location set of where
people are in the State.
So we believe that, in order to best meet the needs of our
citizens, we need to have local involvement at many levels,
that we can share information, same way that we've talked about
here, because, as this is so complex and there are so many
issues that you need to deal with, that you can't really
predict the future, you have to be able to become agile and
respond.
And we're scrappy and resilient, and we have created our
own supply chain for things. We have partnered local pharmacies
with the places we want to vaccinate. We are controlling the
supply chain of our vaccine. We believe pharmacists should be
in charge of the vaccine because of the critical nature and
difficulties in storing and transporting some of this.
But, to me, without absolutely casting any aspersions on
anybody else, we are creating the solutions that work for West
Virginia, and we are all committed to serving our citizens. And
I think that that----
Mrs. Rodgers. Thank you.
I have one more question I want to get to all the
witnesses. And I just wanted each of you to speak briefly
about, what did CDC do to assist you in developing and
exercising your plan before the vaccine was actually delivered
to your State?
Maybe I'll start with Dr. Marsh since I cut him off, and
then I'll go with the others. If you could just speak very
quickly.
Dr. Marsh. Yes. Quickly.
We've had a lot of conversations with CDC, but we created
our own program.
Mrs. Rodgers. OK. Thank you.
Colorado?
Ms. Ryan. Yes. We coordinated with CDC around creating our
original plan in October.
Mrs. Rodgers. Very good.
Illinois?
Dr. Ezike. Yes. We did have multiple CDC, FEMA, HHS
interagency meetings for our region to discuss our plans and
hear of other States in our region to hear their plans as well.
Mrs. Rodgers. Thank you.
And who am I missing here? I'm sorry. Michigan.
Dr. Khaldun. Yes. We also had several meetings with the CDC
and other Federal partners. We also worked very closely with
our local health departments. We have over 45 local health
departments across our very vast State, urban and rural
populations. We worked very closely with them as well on our
plans too.
Mrs. Rodgers. Very good. Thank you all again so much. This
has been a tough, tough year, to say the least.
Ms. DeGette. Thank you so much.
The Chair will now recognize the chairman of the full
committee, Mr. Pallone, for 5 minutes.
Mr. Pallone. Thank you, Madam Chairwoman.
I think I'm going to have to start out by saying that I
definitely disagree with what our Ranking Member Rodgers said
with regard to not having--you know, looking at this State by
State or localizing it versus having more Federal involvement.
I mean, I didn't--I have to take your word for what Governor
Inslee said, but I think I agree with him that we need more
Federal involvement.
I mean, part of the problem that I saw in the last 9 months
under Trump was that States were essentially left alone, and
they were competing with each other for gloves and masks and
supplies and sometimes being gouged with prices.
And I do think, and I've said all along, that we need a
national strategy, which is what Biden is trying to accomplish.
So I understand this one-size-fits-all, but I don't think that
that necessarily works when you have a pandemic of this
magnitude.
Now, that isn't to suggest that this isn't a Federal system
where there is a national strategy and we still try to
implement this, the response, State by State. But the fact that
President Trump so much stressed that States were on their own
and there wasn't a need for a national strategy, I think, was a
huge mistake, and I think it was an ideological approach that
led to the fact that we didn't have an effective response under
the Trump administration. But, you know, whatever. That's my
spiel.
Let me ask this question. Let me go to Dr. Khaldun.
What's happening now, of course, is Biden implemented a
three-prong strategy last week, or started a strategy, where he
said that we're going to give you notice 3 weeks in advance so
you know what's coming. That's the transparency. He increased
the number of vaccines that were coming weekly to the States.
And then he set out a plan to actually vaccinate 300 million
Americans beginning in the summer and certainly by the fall.
So I wanted to hear--I wanted to ask for your response to
that, how that's going, and what you think about it.
And then, secondly, we have a bill. In other words, we have
this bill, the American Rescue Plan, that we're going to try to
do in the next few weeks that provides a lot more money for
vaccines, for testing. And my understanding at the State level
is that the States are still wanting with resources and need
that additional money and need it soon, because many of them--
you know, we didn't provide any State and local aid in general
directly, and many of them are still using their own money and
need Federal help.
So those are the two questions. One's what about what
happened with that three-prong Biden plan, and whether we need
another COVID bill because you're lacking resources.
Dr. Khaldun. Thank you, Chairman, for that question.
So I have been very appreciative, actually, of the Biden
administration, had several conversations with leadership.
We do for the first time have at least--have 3 weeks of
transparency as far as how much vaccine will be getting into
the State. That's very helpful, because now I can tell my
providers that they get a certain amount of vaccine, and they
can go ahead and schedule. So it's been incredibly helpful.
We also are very thrilled that potentially the American
Rescue Plan will go through. We certainly need additional
funding.
Right now, I'm at a point where I have contact tracers that
are getting involved in my vaccination efforts. I have
epidemiologists who work on lead and other things in the health
department who are now being pulled into vaccine efforts. We
absolutely need more funding to build our infrastructure, to
bring in more staff to be able to support our vaccination
efforts.
Mr. Pallone. And then there is about a minute left. If I
could ask the Colorado representative, Ms. Ryan, the same two
questions about the last three-pronged Biden announcement and
the need for another--more resources through another
legislative--through another bill that we're planning.
Ms. Ryan. Thank you for the question.
I will say that the transparency and predictability is
improving, as are the number of doses. We know those are slowly
going to be increasing over the month of February.
Yes, we could absolutely use more Federal help. We are
seeing the same things with our local public health agencies
trying to decide do they put their staff as vaccinators or
contact tracers, still lacking the resources, and pulling all
the staff they have off of all their other duties as they've
done all along.
So I think it speaks to the need for sustainable funding in
addition to emergency funding. And we did just get some funds
from the CDC and a new ELC grant and other funding, and we will
be putting that to good use. But we anticipate, you know, this
response is going to be with us for a long time, COVID is not
going away, and we're going to need sustained dollars.
Mr. Pallone. Thank you.
Thank you, Chairwoman DeGette.
Ms. DeGette. Thank you, Mr. Chairman.
The Chair now recognizes the ranking member of the
subcommittee, Mr. Griffith, for 5 minutes.
Mr. Griffith. Thank you very much, Madam Chair.
Dr. Marsh, if I remember your comments earlier, that you
all did not go with the Federal plan but created your own plan
to suit West Virginia needs. Is that correct?
Dr. Marsh. Yes, that's correct.
Mr. Griffith. All right, I appreciate that, because I think
sometimes it's nice to have a Federal template, but some States
need that ability to do what you all did in West Virginia.
Now, going on to the next question. Since distribution of
COVID-19 vaccines--and I'm with you still, Dr. Marsh--since the
distribution of COVID-19 vaccines started in December, there
has been confusion as to why there is such a discrepancy
between the number of doses distributed as compared to the
number of doses administered by the States. For example, the
CDC website notes that, as of January 31st, over 49.9 million
doses have been distributed, but only 31.1 doses have been
administered.
Can you explain the reason, if you know, for this
discrepancy in doses distributed versus doses administered?
Dr. Marsh. Well, thank you for the question.
Certainly in West Virginia, by working to have local
control of the doses, we've followed every dose and understand
that. Certainly other States have adopted different strategies,
and there are a significant, as I understand it, number of
doses that are not accounted for in the current system. And
whether those are some of the doses that have gone into various
programs, like the Federal pharmacy program or others, I don't
know off the top of my head, but certainly maintaining control
and understanding where the doses are, are a critical component
of success, I believe.
Mr. Griffith. You raised that you all track them. How do
you all track the vaccine, where it's been sent and how it's
being used, and how quickly it's being used?
Dr. Marsh. We receive every dose into one of five hubs that
are located around our State to bisect the State so that the
shortest distance is required to move vaccine between places.
We track each dose that's sent with a GPS tracker, and we then
have an inventory. We know, if the vaccine is not administered
in 7 days, then the vaccine is brought back into the central
hub and reallocated.
Mr. Griffith. Thank you.
I mentioned the CDC website a few minutes ago. In addition,
that website shows a map of the U.S. with COVID-19 vaccine
administration data for each State and territory, including the
total doses administered per hundred thousand. The States and
territories range in their rate of total doses administered
from 38,000--excuse me--3,826 per hundred thousand in the
Federated States of Micronesia to 16,348 per hundred thousand
in Alaska.
Since the Federal Government and its partners in the
private sector have used the same process to ship vaccine doses
to all of the States and territories in the U.S., what do you
believe accounts for the variation among the States in what
some have deemed the last mile in the vaccination
administration efforts?
Dr. Marsh. Are you asking me again?
Mr. Griffith. Yes. Yes, sir. I'm sorry.
Dr. Marsh. Yes. So I think that, as we go forward, you
know, it's--it is easy to point fingers, but, as was said
earlier, this is the most complex program and distribution plan
that we've ever experienced in our country. And certainly
having vaccine is amazing, and we have amazing vaccine, so
that's great.
And I think that, you know, for us, it's really a matter of
all of us working together to get the right priorities, to
follow the doses, and make sure that every American who needs
to have a vaccine in their arm in a priority status gets that
vaccine.
Mr. Griffith. Well, I appreciate that. And that's part of
the reason that Madam Chair DeGette called this meeting.
Clearly there has been confusion about the safety and the
efficacy of the shot and in some States confusion about the
who-what-when-where details of getting the shot.
What methods of communication are you using--and we'll
start with you, Dr. Marsh, and we'll see how much time we have
to get to the others--but what methods--hang on. I don't have
my eyeglasses on, and I lost track.
What methods of communication are you using to provide this
critical information to get the information to constituents?
And, as a part of that, specifically how have you made an
effort to reach seniors and other hard-to-reach populations,
many in my district, not unlike West Virginia, who do not have
reliable access to the internet?
And, also, in December the FCC made an allowance for State
government officials to reach constituents on their mobile
phone for relaying critical information, and have any of your
States used that technology?
So what are you all doing to reach out to folks who may not
be aware that they're on the list to get the shot now?
Dr. Marsh. Very briefly, we have internet. We have
television briefings three times a week. We have a call center.
And we have reached out on different community-based approaches
to reach all the vulnerable people in our communities that
have--that should have access to vaccine.
Mr. Griffith. And I appreciate that. And I will tell you, I
get a mobile notification whenever schools are closed back
home, and the government there is using it for that. I would
think that would be a good technology for this as well.
I don't have time for everybody else to jump in, but if you
all could provide a written response to that last question
about what kind of technology you're reaching out to these
communities that may not be getting the word and who may be a
little bit hesitant, I would greatly appreciate it.
And, with that, I yield back. Thank you for your patience,
Madam Chair.
Ms. DeGette. I thank the gentleman.
The Chair now recognizes the gentlelady from New Hampshire,
Ms. Kuster, for 5 minutes.
You need to unmute, Annie. Unmute.
Ms. Kuster. That's what I'm doing. Sorry. Trying to unmute.
Thank you very much, Madam Chair.
Well, it's taken a Herculean effort to get COVID-19
vaccines developed, authorized, and distributed around the
country. As you've heard today, it will be for naught if we
can't get the vaccines into the arms quickly. And that's why
I'm concerned by the CDC data showing, as of yesterday, only
about 65 percent of vaccines distributed have actually been
administered.
And so I wanted to jump in to legislation that I've
introduced to bolster manufacturing capacity and meet the
challenge, known as the Coronavirus Vaccine and Therapeutic
Development Act, to ensure that enough doses get in the arms of
the American people.
The issue of supply does not account for this large gap in
doses allocated but not administered. And I understand there
may be reporting delays and data challenges. But thousands of
Americans are dying every day, and I believe it's unacceptable
to delay getting the vaccine.
Dr. Phillips, according to CDC data, Louisiana has
administered about 71 percent of the data. Can you confirm, is
Louisiana still holding back vaccine for second doses?
Dr. Phillips. Yes. We do make sure we allot the second
doses wherever the first doses went to ensure that we have
adequate supply for when those individuals present.
I will say that, in terms of the CDC data, it does include
the first and second doses. So when you look at what has been
allocated for a State, it's combining that first and second
dose.
So, although I may have received my first dose and my
second dose may have been shipped to the State, it may not be
my 21- to 28-day timeframe. And so it does give the appearance
that an available dose can be administered as a first dose when
truly that is not the case. So I do think that is one of the
asks that we have, for some clarification on the CDC data for
stratification for those modules.
Ms. Kuster. But how do you feel about the change in
direction that the Biden administration is considering due to
the urgency and due to the various COVID variants that are
coming along with getting the doses into the arms immediately,
knowing that we will have sufficient vaccine for those second
doses?
Dr. Phillips. Yes. Until we know for sure that we're going
to have sufficient vaccine for those second doses, that would
be a worry.
And so, again, this is our first time being able to even
get advanced notice, 3 weeks advanced notice of what our
allotment is going to be. Until that is confirmed and can be
substantiated for some time, that would be a worry in terms of
availability of the supply.
Ms. Kuster. Dr. Ezike, could you respond to the similar
question?
Dr. Ezike. Yes, ma'am.
Ms. Kuster. Would you consider giving those second doses
now as first doses knowing that the remaining second doses
would be manufactured and distributed within the 3-to-4-week
timeframe?
Dr. Ezike. Yes, we are understanding the very difficult and
delicate balance between getting ahead of the variants and
getting ahead of this virus as well as ensuring that we will
have the vaccine 3 to 4 weeks later.
We are--that is the reason that we were able to take
advantage of the ability to take doses--borrow doses from the
long-term care facility and not at all interrupting the
vaccination that would happen in the next 3 to 4 weeks, but
borrowing from there to get more doses in the arms today.
We do know that two doses are required for full efficacy,
as demonstrated in the trials, but even getting that first dose
we know offers some protection, confers some protection, and so
getting as many first doses as well.
So we have been striking this balance between promoting the
first doses as well as the second doses, and we want to use as
many available doses as quickly and effectively as possible.
Ms. Kuster. Dr. Khaldun, maybe you could jump in here. How
will increased transparency and improved data make sure that we
can quickly administer the doses that are available?
Dr. Khaldun. That's very important. Again, I speak to my
local health departments and our healthcare systems frequently.
Knowing ahead of time how much they can expect to receive will
be incredibly helpful. It will actually make it go quicker,
because they can schedule appointments. They can know they
don't have to cancel appointments and they'll be able to plan
for those first and second doses.
So that transparency and knowing ahead of time how many
doses entities will receive is incredibly important.
Ms. Kuster. Thank you.
My time is just about up, but I'll put in a plug for my
bipartisan bill with Congressman Bucshon on this committee, the
Immunization Infrastructure Modernization Act, to provide
Federal support and guidance to the healthcare departments and
providers at the State and local levels and, most importantly,
to improve our healthcare information framework.
Thank you very much. I yield back.
Ms. DeGette. Gentlelady yields back.
The Chair now recognizes the gentleman from Texas, Mr.
Burgess, for 5 minutes.
Mr. Burgess. I thank the chair.
You know, it's interesting to me that, just a little less
than a year ago, we had a committee briefing--we didn't have
hearings on this in a timely way, but we did have a briefing.
All of the experts of public health were at that briefing,
names that you would recognize. And Dr. Fauci was asked, ``How
long before we can get a vaccine?''
And he said, ``Listen, if everything goes perfectly, 18
months. But I must caution you, everything never goes
perfectly.''
Now, I don't believe Dr. Fauci was misleading us a year
ago. I think he was speaking as to the way the world was a year
ago. But this became a priority, and the previous
administration appropriately recognized that priority and began
what we now know as Operation Warp Speed.
And, realistically, this vaccine was available--the
emergency use authorization came right at the middle of
December. So we're just talking 6 weeks ago.
Now, prior to the time, during September and October,
various talking heads on the various television shows would
talk about how the vaccine--it was not possible to deliver the
vaccine in that timeframe. In fact, people were talking against
accepting the vaccine because it's being developed so fast, it
can't possibly be any good, or there may be problems.
And now there has been a massive shift of gears because,
good news, 2 weeks after election day, there was not one, but
two vaccines that were on their way to the FDA. And then, a
month later, the FDA--which truly was lightning speed for them,
provided the emergency use authorizations to bring us to the
discussion today of, how can we do a better job about
distribution?
But I would remind you that a year ago we were told that
that distribution problem would still be 6 months in the
future. So, really, we have to be grateful for where we are
today.
My home State of Texas, the most recent data I received--
and I will submit this, Madam Chair, for the record--but
there's about 2 million doses have been administered in Texas.
Now, I recognize we're a big State, we've got a lot of people,
and we've got a long way to go, but that is a good start.
In fact, I participated with several of my State
counterparts to encourage the creation of a vaccine hub in one
of my counties, Denton County, and this replicated a hub, a
vaccine hub, that was actually started in 2009 with the H1N1
epidemic, and it is now up and functioning. And, in fact,
32,000 doses allocated for Denton County this week, and they
are setting up a drive-thru vaccination site in the parking lot
of Texas Motor Speedway because, after all, that is one of the
biggest locations where you have a big parking lot, one of the
biggest in the country, so they're well set up to do that.
But how grateful we should be to be able to have not just
the vaccine, but now, within such a short period of time, that
level of distribution.
Several of the witnesses testified that they had worked
with CDC. And, again, I need to stress this, because the
approach in the previous administration was, yes, let's work on
the vaccine, but let's also work on the manufacture of said
vaccine even in advance of the emergency use authorization of
the FDA. And the CDC was working with some local health
departments to formulate the plans for administration of the
vaccine when it did become available.
So I think those things were forward leaning and, in fact,
if I recall correctly, quite different from the activity we saw
in 2009 where the manufacture of the vaccine did not begin
until the FDA had, in fact, issued its approval.
So we are several steps ahead of where we could be. That
doesn't mean we're doing good enough. And I appreciate so much
everyone on this panel who is working so hard to make certain
that we do get the amount of vaccine out in the right amount of
time.
Now, let me just ask--and I'd like to ask Doctor--Director
Ryan from Colorado. I worked with your Governor when he was
here at the House of Representatives on the House Rules
Committee. My best to your Governor when you see him again. But
how do you feel that you're doing with the visibility of the
vaccine doses that are going to be coming your way? Are you
hearing about it in a timely fashion?
Ms. Ryan. Thank you for the question.
The transparency is getting better. I think, you know, part
of the issue is that, because it's going from conveyor belt to
States, there is just not a lot of time to tell us the type of
doses or the amount of doses that we're getting. But we know
it's--we do have visibility into the next 2 or 3 weeks now.
Mr. Burgess. And that's great.
And, Madam Chair, just if you'll indulge me for one second.
A little bit of good news, reading in Barron's just the other
day where Sanofi was going to begin to manufacture the Pfizer
product to assist in getting doses out. Sanofi's own exercise
with getting a vaccine was a bit delayed, and so they are
joining the manufacturing side of a competitor's vaccine. And
that's good news too. That's the type of cooperation we're
seeing out there in industry, and I think that's important, and
I believe it will continue.
And I'll yield back.
Ms. DeGette. I thank the gentleman.
The Chair now recognizes the gentlelady from New York, Miss
Rice, for 5 minutes.
Miss Rice. Thank you, Madam Chairwoman.
Much of the confusion surrounding the rollout of COVID-19
vaccine seems to be driven--and I'm hearing this throughout
this hearing--by poor communication. And we know that that, in
the final weeks of the Trump administration, that was
particularly acute.
And obviously what I'm hearing--what all of us are hearing
here today--is how important that communication is between
Federal, State, and local health officials. In fact, GAO has
repeatedly noted that coordination and communication are
critical to the successful implementation of COVID-19 vaccines.
So to you, Director Ryan. In the past your Governor has
been critical of the Trump administration's lack of
communication and maybe miscommunication with Colorado,
particularly in the first months that the vaccines were being
shipped to the States. How would you describe the communication
and coordination that Colorado has had with Federal officials
related to vaccine program planning and implementation in
recent weeks, and have you found it to be more effective, less
effective? How would you rate it?
Ms. Ryan. Thank you for the question.
I have to tell you, you know, General Perna, who has been
the tip of the spear for the vaccine distribution, has been
very supportive from the start. He got on a call with States.
He called me personally and said, ``Here is my number. You tell
me if things aren't going well.''
So, while I, you know, do have a list of complaints from
the last year around communication issues, I have to tell you
that was the first time that I felt like I had someone in
charge that I could go to and that was keeping us updated, and
there was a lot of transparency.
So I can't say--I can't complain too much about the vaccine
rollout and our communication with the general and Operation
Warp Speed. I actually think that's gone pretty well, and, as
they've gotten more visibility, they've given it to us.
Miss Rice. Great.
Dr. Phillips, would you agree? Is there more that can be
done to improve communication between the Federal Government
and the States at this critical time of vaccine distribution?
Dr. Phillips. I think ongoing continued communication is
what we need. I mean, I think you've heard it from everybody in
the hearing today and other States who are not present, is what
we've been asking for, and I think we're continuing to see that
increase, and we're thankful for that.
That allows us to be able to communicate with our local
partners, our local providers, who are asking for the same
information so, when we get it, we're able to share with them.
And if we have to do it with a caveat that this is a draft,
this is the model of it, then we can put those caveats on it.
But the more information we have on the front end, the better
we are in terms of the planning purposes.
Miss Rice. So, you know, we've heard that many cities and
local health departments have been left in the dark by both
Federal and State officials when it comes to distribution of
vaccination plans, relying instead on local hospitals or
providers to confirm if vaccines are available in their
community. I know in New York State, where I'm from, there have
been people who it takes forever for them to get an
appointment, and then, you know, a week or sometimes days
before, their appointments are canceled because of this lack of
communication about how many vaccines were available, when
they're going to arrive, et cetera.
Dr. Ezike, what is your State doing to communicate with
local leaders and public health agencies? And is there room for
greater coordination across all levels of government? And, if
so, what would you recommend?
Dr. Ezike. Yes. Thank you for that question.
Of course, collaboration and communication against all
levels of government, from Federal to State to local health
departments, is key to overcoming this pandemic. You know,
between the State and the local health departments, we
understand that those local health departments are literally
our hands and feet. They, the 97 different local health
departments, are actually the boots on the ground that are
getting this work done as we support them with the funds that
are provided and the additional State resources that we may
have.
So communication--and overcommunication, if there even is
such a thing--is the name of the game, and their success is
directly tied to how much they understand about their future
allocations. We have a rule at the State that anything that we
are doing in their State, whether if we are directly supporting
their efforts or trying to do additional efforts to augment
their existing efforts, that we have to let them know.
If we're coming into your backyard, we're going to let you
know so that you can make sure you direct us in the best way
that it can be done. We want that same kind of partnership and
collaboration, we want to be at the table as decisions are
being made, so that we can help inform things that might not be
top of mind.
I am actually very encouraged with the current
administration, as they have actually taken one of the State
health officers to be a part of the administration, and I think
that will help establish the importance and the communication
between the State health officials as well as with the Feds,
which in turn creates better communication. We have
appropriate, accurate, timely information to share to our boots
on the ground, our local health departments.
Miss Rice. Thank you, Dr. Ezike.
And, Madam Chairwoman, I see that my time is up. I had one
more question, but I will yield back. Thank you.
Ms. DeGette. I thank the gentlelady.
The Chair is now pleased to recognize the gentleman from
West Virginia, Mr. McKinley, for 5 minutes.
Mr. McKinley. There we go. Thank you, Madam Chair.
Look, we've heard a lot of criticism today of the Trump
strategy, but I want to remind people that on September 16th
the States were given a 57-page guidance document--57 pages in
how to set up a program--and they were asked to respond by
October the 16th, just a month later. So for people to say
there are no plans, that just means the States didn't create
one that works.
So, for those of you that can't resist the temptation to
criticize the former administration and even going so far as to
say that the Biden administration was starting from scratch and
there was no national strategy, Dr. Fauci has refuted that very
clearly. So take a deep breath.
Look, Operation Warp Speed created the vaccine. The State,
it's the job of the States to put it in people's arms. But it
seems that States can't even get that right.
Here is a chart, unfortunately, that the majority party had
rules that we had to submit this 24 hours prior to this, but
this chart indicates that there were some States that can't get
it right. Some of you, some States have been complaining they
need more vaccines, but have only given out more than 50
percent.
Look at Illinois. Illinois' vaccination rate is half of
what it is in Alaska at 8.3 people per hundred. But Alaska is
16.8. Or West Virginia is almost 15 per 100, and Illinois, 8;
Colorado, 10; Michigan, 10.
But then they don't--they're not using it. Their use of the
vaccine in Illinois is only 62 percent as compared to North
Dakota, 91 percent.
So apparently they didn't develop a plan that it was
flexible enough to work. So I'm just concerned about that.
Now, unlike New York--and that's a key thing--unlike New
York's Governor, who ignored the vulnerable in their long-term
facility and recommendations of his public health experts, West
Virginia prioritized its long-term care residents and their
staff. West Virginia also finished vaccinating all of their
long-term care facility and staff. Meanwhile, States like
Michigan won't even--won't finish until the end of this month.
So, interestingly enough, no one has given--and no one
really, I think, has given proper attention to Operation Warp
Speed.
Remember, Dr. Fauci testified before the Senate committee
in May of last year that it would take a year to 18 months
before a vaccine could be developed--think about that--a year
to 18 months in May that, through the hard work of the
pharmaceutical companies, researchers, and scientists, a
vaccine was available in December, just 7 months later. So just
7 months after the creation of Warp Speed we had a vaccine.
So I guess what I want you all to take away is complaining
about not getting enough vaccine is like complaining about the
size of your meal when you should be grateful to having food on
the table.
So, Dr. Marsh, I'd like to turn to you, and just in the
remaining time that we have here can you expound just a little
bit more about what was the magic in West Virginia, being not
only at a rate of 15 per hundred vaccination rate, but also at
almost 87, 88 percent used of the vaccine? What can we say to
the other States how they can improve on that?
Dr. Marsh. Well, thank you, Congressman.
Ultimately, West Virginia made a plan that worked for us,
and it was really a matter--and we've talked about this at this
testimony--it's a matter of clear communication, breaking down
parallelisms and sectors. Everybody wore the same hat. We were
operating for a higher purpose. And, as we go forward, we
constantly iterated and are iterating our approach so that we
are moving in a most expeditious and quick way possible.
I just want to reinforce one thing that the Congressman
said as well, and I say this in as an apolitical way as I can.
The fact that we have these vaccines are game changers. This is
the most complex, you know, problematic response probably in
the history of modern-day America and the world. And so staying
together and working together and sharing with each other best
practices is really key for our global and country's success.
Thank you.
Mr. McKinley. Thank you. I yield back.
Ms. DeGette. The gentleman yields back.
The gentleman from New York, Mr. Tonko, is recognized for 5
minutes.
Mr. Tonko. Thank you, Madam Chair. Can you hear me?
Ms. DeGette. We can hear you, sir.
Mr. Tonko. OK. Thank you so much.
Since the start of the vaccine rollout, the challenges and
issues facing State and local health departments have been
endless. Whether it's a lack of transparency in how much
vaccine will be allocated to States each week, shifting
guidance on who to prioritize for vaccinations, questions about
vaccine reserves, or just a simple lack of vaccines, it seems
there has been one constant throughout this process--that being
confusion.
Dr. Phillips, in my district in upstate New York we are
currently seeing more COVID infection cases than we've had at
any time during the pandemic, and the rate of spread is faster
than the rate of vaccinations. At the current rate, it will
take New York State roughly 7 months to vaccinate all eligible
individuals in its phase 1 priority group.
My question to you, is your State facing similar concerns?
And, if so, how can we get more people vaccinated more quickly?
Dr. Phillips. Thank you for that question, sir.
Yes, we do see the rate in terms of the vaccine and the
extended time period and the worries around that. One of the
things that we are doing is looking at the available doses,
first doses that are in the long-term care partnership, and
pulling those back to push into the community so we have an
increased availability in the community, in addition to the
increase announcement that was made last week for vaccine
doses.
But that is going to be a big help to our State, being able
to pull some of that back and utilize it immediately so it's
not sitting there.
Mr. Tonko. Thank you.
Dr. Marsh, one of the main concerns we've heard from States
is the need for greater transparency from the Federal
Government into the vaccine supply chain. Now, I heard your
talk of coordination and communication, but the Biden
administration has taken a crucial first step in promising a 3-
week allocation forecast. But transparency alone will not get
shots in the arms.
So, Dr. Marsh, aside from increased supply and greater
transparency, what would you change to make this process run
more smoothly?
Dr. Marsh. Well, thank you for that question, Congressman.
You know, certainly we are very grateful to the
administration before and this administration for their work to
move vaccines in a more rapid way, to produce more
vaccinations.
A question was asked earlier, which I think is a critical
question for our country, if we could be guaranteed that we
will see more vaccines in the future. Emerging data is
suggesting that a single dose of Pfizer, Moderna, and
apparently Johnson & Johnson may have a significant protective
effect on severe illness and death from COVID-19.
So ultimately we would like to move forward in immunizing
first doses in as many Americans and as many West Virginians as
we can, as FDA and CDC have recommended, that we want to make
sure that that supply is there for the second doses, even if
they're a little bit later than the 21 days for Pfizer and the
28 days for Moderna.
And so I think that a strategy once we see sufficient
supply chain will be to get as many vaccines in the arms--first
vaccines in the arms--as we can, because we are racing with the
variant forms of the virus that look like that they're going to
have a lot more problems for the immediate future coming up.
Mr. Tonko. Thank you, Doctor.
In the capital region of New York, like many places across
the country, the number-one challenge is a consistent, adequate
supply of vaccine. The Biden administration is increasing
weekly supply by 16 percent and has purchased enough vaccine to
ensure 300 million Americans could be vaccinated by the end of
the summer.
Dr. Khaldun, in your testimony you state that Michigan has
the short-term goal of administering 50,000 shots a day but
could be administering up to 80,000 vaccinations per day. So my
question is, will the 16 percent increase in supply be enough
to meet that $80,000--excuse me--80,000-count-a-day projection?
Dr. Khaldun. Yes. Thank you for that question.
So we certainty appreciate the increase in the supply
that's coming into the State. It will absolutely help us to
meet our goals. Actually, our data on our website over the past
couple of days, we've actually had about 50,000 shots in arms
per day, so we are really pleased with that.
What that increase also does, though, is help us to really
target and focus based on equity. We are actually--we have a
pot off the top that we take and target towards areas that have
a higher Social Vulnerability Index so we can really make sure
minority populations and those who are living in poverty have
access to the vaccines, so when we have more, we are more
easily able to allocate based on that.
Mr. Tonko. Thank you.
Madam Chair, I see that my time has run down, and I yield
back.
Ms. DeGette. OK. I thank the gentleman for yielding.
The Chair now recognizes and welcomes Mr. Dunn to the
committee for 5 minutes.
Mr. Dunn. Thank you very much, Madam Chair. It's an honor
to be here. And I appreciate the opportunity to evaluate the
solutions and ideas to improve vaccine distribution at the
State level.
I think we're all acutely aware of the challenges
accompanying distribution of these vaccinations. It's important
to acknowledge that each State faces a set of challenges that
are unique to its characteristics and demographics, and that
requires flexibility and creativity to approach that, not one
size fits all. The needs of Florida are not the same as the
needs of Illinois, for example.
I also want to echo the panel's comments that Operation
Warp Speed produced effective vaccine in record time, and
volumes of those vaccines at a speed logarithmically faster
than ever in history. In fact, the entire universe of virology
research and treatment has experienced a quantum leap forward.
We just this last day or two reached an important milestone
where we have now vaccinated with at least one shot of the
series more people in America than have been tested positive
since the beginning of the pandemic.
And, with that, I'm going to turn to my questions.
Dr. Marsh, I will try to be brief with my questions. I
encourage you to do the same with your answers.
Do you believe that public-private partnerships allow
States to use their own resources more effectively than might
have been possible with a far-reaching Federal mandate?
Dr. Marsh. Thank you, Congressman.
I do believe that these types of relationships could be
very useful. I think that the optimal circumstance is a top-
down meets a bottoms-up approach related to shared governance
in this way.
Mr. Dunn. Thank you. So do you believe, in general, that
there are areas where private industry can meet the needs of a
State better than the Federal Government?
Dr. Marsh. Is that to me again, Congressman?
Mr. Dunn. Yes, sir. Yes, sir.
Dr. Marsh. Yes. Certainly I think that there are
circumstances where private partnerships can meet the needs of
a State in unique ways.
Mr. Dunn. Excellent. So what is your assessment of the
Federal vaccination reporting requirements and infrastructure
currently in place for States to relay information to CDC? Is
it good, bad, or adequate?
Dr. Marsh. I think that, as all of the responses, this is
an evolving issue. I think that it is improving and probably
needs to continue to improve to make it easier on the States to
be able to report more easily.
Mr. Dunn. I was impressed that you got your community
pharmacists on board so quickly with the infrastructure. That
says real planning on your part. Congratulations.
Do you believe that all the shots that have been put in
arms of the people in West Virginia or nationally--opine on
either--do you think that all of those shots have been properly
recorded and submitted to the CDC?
Dr. Marsh. Thank you again for your question.
I don't know the answer to that. Certainly I hope that we
have an accurate reporting system, because documenting and
following each dose of vaccine is critical for our country.
Mr. Dunn. Yes, I don't know the answer either. I just
thought you're so much closer to the delivery than I am, you
would be able to point me there. And I don't fault you for
that. I'm curious to know what it looks like, because I've been
on the other end of that, I'm a physician as well, so I know
how hard sometimes it can be to live up to the burdens of
reporting to the Federal Government.
Is there anything we can do here in Congress to reduce the
burdens on those providing the vaccinations? Any
recommendations you have on that?
Dr. Marsh. I think that, certainly, Congressman, part of
what we need to do is to continue to work with our Federal
Government and States to make sure that we build the
capabilities for appropriate logistics and supply chain
management. This is such a complicated sort of issue, and each
State needs to keep track, in my opinion, of their own vaccines
and their own reporting, but we need to have a coordinating
function that is very much professional as we are going
forward.
Mr. Dunn. Well, I'd like to associate myself with those
comments. Very good, sir.
So your independent pharmacies really leaned in and helped
you a lot. West Virginia has a mostly rural population. I have
a rural part of Florida is my--where I represent, and I think
it actually mirrors West Virginia in a lot of ways in terms of
its rural nature.
Do you think that the system you set up can work well in
other areas, perhaps like my district?
Dr. Marsh. Thank you for the question.
Certainly I think that each State can come up with their
own strategies. But I do believe that the idea about setting
clear expectations and priorities, making sure you have open
communication and working as a single team, and making this a
learning mode, not something where it's top down, but you're
inviting the creativity of your team.
Mr. Dunn. I appreciate that very much.
Do you think that there are some specific successful
strategies for reducing vaccine waste? And I don't know how
much--as we've said, some of this isn't waste. It's just second
doses being held, appropriately or inappropriately. But how do
we reduce waste if, indeed, waste is as bad as we think?
Dr. Marsh. Thank you, Congressman.
I know we're over time, and I would just say I think there
are some strategies we could pursue together to be able to
accomplish that goal.
Mr. Dunn. Thank you very much.
Madam Chair, I yield back.
Ms. DeGette. Thank you.
Dr. Marsh, we'd love to hear your ideas for how to improve,
if you'd like to submit them to our committee.
The Chair now recognizes the gentleman from California, Mr.
Ruiz, for 5 minutes.
Mr. Ruiz. Thank you, Madam Chair.
Health disparities are symptoms of a failed healthcare
system, and this pandemic has highlighted those inequities and
failures.
We see disparities with Latinos, African Americans, Native
Americans, high-risk essential workers having a
disproportionate burden of infections, hospitalizations, and
deaths from COVID-19. And we are seeing disparities in who has
access to care.
We saw it with access to testing. I have been sounding the
alarm on this issue for months, long before a vaccine was
available for use. I warned that, without aggressive
intervention and strategic planning, we would see the same
disparities play out with access to vaccines.
And now we are seeing the inoculation process unfold
exactly as I feared it would, where the highest-risk
individuals do not have proper access to the vaccines, even if
they qualify. A good public health approach prioritizes groups
according to risk of contracting and dying from COVID-19.
Last year, multiple efforts focused on how to determine a
fair and equitable way to prioritize who should have initial
access to COVID-19 vaccines. This planning was crucial. We know
the disease affects some communities at higher rates and with
more severe consequences than others: Black and Latino
communities, high-risk essential workers, such as farm workers,
the elderly, and people with underlying medical conditions.
Yet, despite those efforts to prioritize the highest-risk
groups, there are stark disparities among who has been
vaccinated so far. A Kaiser Family Foundation analysis found
that, among the 17 States reporting race and ethnicity
vaccination data, the share of vaccinations among Black and
Hispanic people is significantly less than these communities'
respective share of COVID-19 cases in their States.
And, despite having disproportionate more infections and
deaths compared to their White counterparts, they are
disproportionately vaccinated less than their White
counterparts.
In Mississippi, Black people account for 15 percent of
vaccinations despite having 45 percent of deaths. In Nebraska,
Hispanics account for only 4 percent of vaccination even though
they represent 25 percent of cases.
Furthermore, prioritizing high-risk groups on paper is not
effective if those individuals are not able to actually access
the vaccine. Underserved, hard-working communities in my
district lack clinics and providers. Many people in my district
don't have access to broadband to schedule a vaccine online.
They don't have hours to spend on the phone trying to get an
appointment. They don't have transportation to the vaccine
site. They don't have access to information in a language they
understand to help them navigate the system.
I saw those issues firsthand yesterday when I went to a
collaborative, nonprofit grower, and public health
collaborative farm worker community vaccination clinic in the
fields to make sure that the people tasked with protecting our
food supply chain were getting vaccines. And I know I'm not
alone. I hear similar stories from communities all across our
Nation.
Dr. Ezike, you and Governor Pritzker have committed to
putting equity at the forefront of Illinois' COVID-19's
response efforts, crafting the State's plan while keeping in
mind, quote, ``the very structural inequalities that allowed
COVID-19 to race through our most vulnerable communities in the
first place.''
Dr. Ezike, how has focusing on equity influenced the
State's decision on vaccine eligibility and ways to reach those
vulnerable communities?
Dr. Ezike. Thank you, sir, for that thoughtful question.
So of course we know that to get past this pandemic and to
eliminate disparities, that equity lens has to be at the
forefront. We know that the CDC has put out information that
Black and Brown communities are three times more likely to die
than their White counterparts. And so that's why we have had an
equity focus, and that has looked in--that has been carried out
by having lots of virtual townhalls, partnering with minority
communities to have innumerable number of virtual townhalls in
Spanish as well as English, working with Telemundo and
Univision, many----
Mr. Ruiz. Dr. Ezike, I have 10 seconds left.
I want to ask Dr. Khaldun, who in their State have been
partnering with Federal Qualified Health Centers, mobile
clinics, local department, school-based health centers, and
other community vaccinators. How will you monitor these efforts
to ensure they actually result in increased vaccinations among
vulnerable communities? And what can the Federal Government do
to encourage the exchange of best practices across State lines?
Dr. Khaldun. Yes. We are really proud of our strategy in
Michigan, that we have set out a goal publicly of having no
disparities when it comes to vaccination rates.
We are working very closely with our partners on the
ground. They do--they are going to be sharing with us how they
are vaccinating in areas that have a higher Social
Vulnerability Index. And we are holding all of our partners
accountable for how they are not only receiving the vaccine,
but what they're doing with it as far as addressing these
disparities.
Mr. Ruiz. Thank you.
Ms. DeGette. I thank the gentleman.
The Chair is now pleased to recognize another new member of
our committee, Congresswoman Schrier, for 5 minutes.
Ms. Schrier. Thank you, Madam Chair.
Well, we've heard repeatedly that the biggest concerns
across the country are the lack of COVID vaccine and also the
confusion caused by the Trump administration's lack of guidance
for States in the early days of their vaccination campaign. And
I am hopeful that the Biden administration's national COVID-19
strategy and the steps it's already taken will get this country
back on course. And, despite all these challenges, public
health leaders, like our witnesses today, have been able to
vaccinate tens of millions of Americans, and I want to thank
you.
Now, Kittitas County in my district has proven to be a
great model for rural communities, much like in West Virginia,
Dr. Marsh. They have administered 98 percent of their vaccine
doses, have not wasted a drop, and they have a solid second
dose set of appointments already booked.
But here is the thing. Kittitas County is successful
because Dr. Larson, their public health official, designed a
nimble distribution system from the ground up, keeping specific
community needs in mind. And I asked Dr. Larson whether he got
any specific guidance from the Federal Government in setting up
this vaccination program, and he said he had not. That 57-page
document didn't have the specifics that he would have
appreciated.
Now, in my pediatrics practice, we, over time, designed a
fine-tuned system for immunization so there would be no wait
times. But this is the largest vaccination program the world's
ever seen, and we shouldn't be asking each city, county, State
to dream up their own plans and manage their own supply chains.
It was a disaster when States were bidding against each other
for PPE at the start of the pandemic, and we still have these
supply chain issues.
Now, I personally have had the opportunity to experience
two community vaccination sites. Both got the CDC manual. One
ran like a finely tuned machine. The other was limping along
terribly. And this is a place where I feel like every community
should have access to best practices, and those can evolve over
time. The Federal Government could facilitate that.
Now, because of our experience and the sheer scale of this
operation, Dr. Larson is now concerned about the supply chain.
He is concerned that we won't have enough of the low dead space
needles that squeeze that sixth dose out of a Pfizer vial and
an eleventh dose out of a Moderna vial. And this is not a
trivial problem.
And so the question is for Director Ryan. Given that the
vaccine supply will hopefully be increasing in the upcoming
months, there's more approved, and the whole world needs the
same supplies, which supplies are you most concerned about?
And, in your opinion, how can Congress help stabilize the
supply chain?
Ms. Ryan. Thank you for the question. And it's a good point
about the specialized needles, because we absolutely are
counting those sixth and eleventh doses in our planning.
You know, I would say we worry about the supply chain in
general, not just vaccines, but all the equipment that goes
along with it. And it's probably, you know, from the beginning
of the pandemic when we were absolutely choked by the lack of
PPE and testing.
And so I think, you know, a great role of the Federal
Government is just ensuring that those supply chains don't
seize up, as everybody around the world needs the same
supplies, that, you know, we are doing additional manufacturing
where we can, because it's one thing to have the doses and
then, to your point, if you don't have all of the other
supplies that go with it, then it just absolutely slows down or
hampers your response.
Ms. Schrier. Thank you.
And, Dr. Marsh, the country has marveled at how well your
State has rolled out its vaccination program. Are you also
concerned about the availability of PPE and needles and, you
know, testing equipment and the like, and what would you
suggest for Federal support?
Dr. Marsh. Well, thank you, Congresswoman. I think that's a
particularly important point to make. Certainly in West
Virginia, we have tried to become more self-sufficient, but we
are actually making our own PPE. We've designed our own N95
equipment masks, our own PCR testing, our own antibody testing.
We're working on doing molecular virology testing for the
mutant viruses.
But I think that, as you point out, as the governments of
South Korea and others learned through their SARS/MRSA
experience, the more self-sufficient we get as a country, the
more we start to make our own stuff so we don't have to rely on
other supply chains, the better off we'll be throughout not
only this pandemic but I believe in the future.
Ms. Schrier. Thank you. I completely agree. Yes, to
vaccinate 300 million Americans by the end of the summer, the
availability of all supplies is going to need to keep up with
the supply vaccine. That means we have to be manufacturing
here. I am just so grateful that this administration's already
taking actions to make sure that our supply chains are solid.
Thank you. I yield back.
Ms. DeGette. The gentlelady yields back.
The Chair now recognizes the gentleman from Pennsylvania,
Mr. Joyce, for 5 minutes.
Mr. Joyce. Good afternoon. Good afternoon. I'd like to
thank Madam Chair DeGette, Ranking Member Griffith, as well as
Chair Pallone and Ranking Member McMorris Rodgers and the
witnesses for appearing here today. Truly, it's an honor to be
serving on Energy and Commerce Committee in the 117th, and I
look forward to continuing this strong bipartisan tradition of
Energy and Commerce.
The COVID-19 outbreak and the global spread has created
public health challenges unlike anything we've ever seen in our
lifetime and, as a physician, unlike anything I had ever seen.
President Trump, and along with Congress, worked together in a
bipartisan manner to pass several relief packages last year to
respond to the pandemic, including billions of dollars in
support of a vaccine. This includes nearly $30 billion that was
passed at the very end of last year in the Consolidated
Appropriations Act.
Last year, the partnership of Operation Warp Speed started
by President Trump produced multiple safe and effective
vaccines in record time, and millions of doses were shipped
across our country. These vaccines are the silver bullet out of
this pandemic, and we must act now to ensure their quick
distribution.
This is why it is so disturbing to me that in my home State
of Pennsylvania we remain behind the national average for doses
administered, in a lowly 37th in doses administered as a
percentage of population. Furthermore, I hear from my
constituents every day who are eligible to receive the vaccine,
but they simply cannot find a dose.
Dr. Marsh, thank you for appearing today. As a doctor
myself, I am concerned about Pennsylvania's vaccine rate of
less than one-half of what you've achieved in West Virginia.
West Virginia's success story should be applauded and needs to
be replicated across our country.
Could you please elaborate--and I know that you've been
asked this previously but ran out of time. Could you please
share what are committee's efforts that need to be made to
ensure that the vaccine deployment occurs, especially like in
rural communities where I represent?
Dr. Marsh. Thank you, Congressman. I will try to be brief.
I do think that there's three parts to your question that are
really, really important.
So, number one, I think that everybody needs to get on the
same page and be committed to a single team's efforts. Just
really briefly, CDC's data from August says that in comparison
to 18-to-29-year-olds who get COVID, that if you're 50 to 65,
your risk of death is 30 times higher, risk of hospitalization
4 times higher. If you're 65 to 75, risk of death 90, 9-0,
times higher, risk of hospitalization 5 times higher; 75 to 85,
risk of death 220 times higher, risk of hospitalization 8 times
higher. Over 85, your risk of death is 630 times higher, risk
of hospitalization 13 times higher.
Once you understand what your purpose is, once everybody
throws together on the team and sacrifices to make sure you can
push doses to the most vulnerable parts of your population,
what saves lives, reduces hospitalizations, then things start
to work well. So I think open communication, you know,
everybody on the same page, clear and where we're going.
And then I think that having the logistics expertise is so
important. We've turned to our National Guard because they're
our experts, but I think federally starting to think about
supply chain and logistics will be very important.
Mr. Joyce. Dr. Marsh, continuing on that all-hands-on-deck
attitude that you've brought forth in West Virginia, are there
additional Good Samaritan safeguards for qualified volunteers
that could help augment the administration of the vaccine?
Dr. Marsh. Absolutely. We're vaccinating our students as
well, who are becoming part of our vaccination team. We've
called it ``vaccinate the vaccinators,'' because we want to
continue to expand our infrastructure so, when additional
vaccine comes available, we'll be able to turn that very
quickly and expand our capacity to vaccinate more West
Virginians.
Mr. Joyce. And I'd like to conclude by asking each of the
panel today, do you feel that additional vaccine and their
administration is the light at the end of the tunnel?
Dr. Marsh, I'll ask you to answer first.
Dr. Marsh. Yes.
Mr. Joyce. Dr. Phillips.
Dr. Phillips. Yes.
Mr. Joyce. Dr. Khaldun.
Dr. Khaldun. Yes.
Mr. Joyce. And, Director Ryan, do you agree that the light
at the end of the tunnel is being implemented by the
administration of the vaccine that was developed during
Operation Warp Speed?
Ms. Ryan. Absolutely.
Mr. Joyce. Thank you all for participating.
Chair--Madam Chair--I yield back.
Ms. DeGette. Thank you.
The Chair now recognizes another new member of the
committee, Congresswoman Trahan, for 5 minutes.
Mrs. Trahan. Thank you, Madam Chair.
And it's wonderful to hear from all of you to make
contagious the successful programs that you've led in your
respective States.
I fully share the sentiment that we all need to be on the
same page, on the same team, when it comes to battling COVID.
And, as we celebrate the miracle of having two highly effective
vaccines, we must be focused on dramatically accelerating
distribution while also addressing the fact that we've fallen
behind on developing treatment and therapies. We've fallen
behind on innovating and creating capacity and testing, which
is integral to our opening of schools and businesses. And we've
fallen behind on investment in genomics research, specifically
sequencing surveillance that identifies new variants, ceding
our leadership to other countries.
I suspect that all of us would agree that, as we accelerate
vaccination, it's essential for us to close the gaps in access,
especially among our communities of color. And I associate
myself with every syllable that Dr. Ruiz spoke in his remarks
about equity.
Additionally, we mustn't allow the well-being of residents
at long-term care facilities to fall behind. As everyone knows,
these folks are especially vulnerable to COVID-19. In the State
of Massachusetts, of the 14,000 COVID-related deaths, nearly
8,000 have been reported in these facilities. And the
disproportionate impact of COVID-19 isn't limited to the
residents of these facilities. A considerable share of our
long-term care services workforce is composed of immigrants,
some of whom have limited English proficiency and lack access
to internet-only vaccine signup systems.
So I'd like to use my time to discuss the challenges you're
facing and the best practices you're using to protect not just
the residents of long-term care facilities but also the staff.
Dr. Marsh, as Ranking Member Griffith mentioned, West
Virginia elected not to participate in the Federal Pharmacy
Partnership, and yet you completed second-dose vaccinations in
long-term care facilities in West Virginia last week. Why did
West Virginia opt out of the Federal program, and how were you
able to vaccinate your long-term care facility residents so
quickly? Are the staff also vaccinated as well? And are there
any lessons that other States and pharmacy partners can take
from your success?
Dr. Marsh. Well, thank you for the question, Congresswoman.
That is a very important one. We know in West Virginia 50
percent of our deaths are from residents of nursing homes. And
so, as we went forward, we wanted to understand what was the
most rapid, expeditious way that we could move vaccine to the
arms of, as you've mentioned, not only the residents but the
staff and the support folks there.
And what we did is we turned--as I said, in our joint
interagency task force, in our open team-of-teams mode--we
turned to the leader of the long-term care association and our
member from the pharmacy board and we asked them what was the
best way to go, and they came back and told us we have 250
pharmacies located all over the State, half of which are
privately owned and that the Federal program would not get us
to where we want to go as quickly.
And so we went with this approach: We met with General
Perna, with Dr. Patel from Operation Warp Speed, we told them
what we planned to do, they said, ``Good. That sounds great for
West Virginia.'' And, ultimately, we did not get rid of the
Federal program, we just didn't activate it.
When it came to immunizing our residents, 85 percent or
more agreed to get immunized, but only about 65 percent of the
staff. And what's really heartwarming is, after we've been
through this round of vaccines, first and second round, we have
a lot of staff now that are coming back and saying, ``We want
to be vaccinated now.'' So that makes me feel really good about
the future for vaccine hesitancy.
Mrs. Trahan. That's helpful. Yes, the recent data from the
Federal Pharmacy Partnership shows that roughly 37 percent of
staff participating in long-term care facilities, a workforce
that is disproportionately comprised of people of color,
decided to get vaccinated.
And so, Dr. Khaldun, what is the State of Michigan doing to
address the equity and hesitancy concerns among healthcare
workers, including staff at nursing homes and other long-term
care facilities?
Dr. Khaldun. Yes, absolutely. So we, of course, prioritize
our most vulnerable residents of our skilled nursing
facilities, our long-term care facilities, and, of course, the
staff. We actually had over 4,400 facilities that were
enrolled, are enrolled in this long-term care program. And so
we similarly were challenged with the speed of the program. We
had to take doses out of the allocation, engage additional
pharmacies as well.
But we've also been challenged by hesitancy. We actually
have a robust paid media effort. We're engaging with members of
the community. We just last week launched our Protect Michigan
Commission, which includes more than 60 people who are
distributed across the State that are really going to be the
messengers that have that information about the safety and
efficacy on the vaccines.
So we are using something similar to what we did with our
Racial Disparities Task Force and how we were able to actually
essentially eliminate the disparity between African Americans
and Whites for COVID-19 cases and deaths.
Mrs. Trahan. Thank you. I appreciate your time. Appreciate
your efforts.
I'm out of time. I yield back.
Ms. DeGette. I thank the gentlelady.
The Chair now recognizes the gentleman from Alabama, Mr.
Palmer, for 5 minutes.
Gary, we can't hear you. It says you're not muted. Try
again.
You have headphones on, I think. We still can't hear you.
I'm going to go--Gary, I'm going to go on to the next person,
then we'll get you in. OK?
Great. Thanks.
I'll now recognize Mr. O'Halleran from Arizona for 5
minutes.
Mr. O'Halleran. Thank you, Madam Chair and Ranking Member,
for having this meeting.
There's an urgency on the ground into getting vaccine doses
out. Over the past several weeks, I've heard consistently from
Arizona public health officials that we need more vaccine.
You know, back in December, I asked Dr. Fauci and the head
of the CDC and the logistics head, ``Are we ready, going to be
ready in the fall? In the winter?'' They said, ``We hope so.''
In September, I asked Dr. Fauci, ``Are we going to be ready
soon?''
``I hope so.''
We are still hoping, because of the lack of a coherent
national plan.
And, you know, I've heard testimony today about
transparency, data systems, the public education campaigns,
none of which are where they need to be at this point in time
for this vaccine program to work at all.
As of yesterday, only 65 percent of shots have been used
nationally. My home State of Arizona lags behind at just 61
percent. Notably, these numbers have improved in recent weeks
and are trending upwards.
I'm trying to understand where the disconnect is here. With
such a large demand for shots, we need to understand why more
than one-third of shots distributed nationally have been
unused. And I believe hesitancy from priority individuals needs
to be discussed. Just today, it was reported that only 37
percent of nursing home staff have received their COVID-19
vaccine, in spite of what was going on in West Virginia.
But I think that we have--solving the second-shot issue, I
don't know where we're going to be with that. Six weeks, eight
weeks, elderly people, nonelderly people, who. Recent
developments regarding the variants of COVID-19, including
those from South Africa and the United Kingdom, have emphasized
the importance of being vaccinated.
When it comes to these more easily transmitted strains,
using every available dose as soon as possible will help ensure
that these variants do not continue to evolve in a way that may
cause vaccines to become less effective. However, this will
prove problematic if delays in getting these second shots
happen. But protection against these variants will be even
worse if individuals do not get their second shot of the
vaccine within the recommended time or soon afterwards. We have
cases of the second shots being delayed up to 6 weeks already.
I hope that this does not continue.
Many rural communities, which have been talked about,
Tribal communities and communities of color, often have been
hit the hardest by COVID. Tribal communities like Navajo, White
Mountain Apache Tribe, and others in my district have had some
of the highest rates within the United States. Likewise, our
healthcare resources in rural and underserved communities have
been stretched thin, to say the least.
To overcome systematic and long-term standing trust issues,
the roots of which we have seen--yet to see again during this
pandemic, we must work with these communities in an educational
process, as well as a professional, medical process.
Dr. Ezike, you have touched a bit on resources needed to
promote confidence in the COVID-19 vaccines. What resources can
the Federal Government provide to help States in overcoming the
hesitancy with COVID-19 vaccines? What would you like to see in
a national public education campaign?
Dr. Ezike. Thank you, sir, for the points raised and that
important question.
So these things, as you said, predate COVID but have been
highlighted by COVID. And so one of the things that is pretty
fundamental is in the area of health promotion and health
education, making sure that even from very young ages we talk
about the importance of vaccines, explain vaccinology, the
science of vaccines, relate even to youngsters how they don't
know about measles, even chicken pox now, polio. No children
are doing double Dutch with braces on their legs, because polio
and so many diseases have been eradicated by vaccines. Many
people don't understand where we've come from to be able to
appreciate the vaccines that they have been able to receive or
not receive in some cases.
So starting with that, again, that's a long--that's a long
haul. That's infrastructure building that may not give us the
full fruits for this vaccine, for this pandemic, but actually
will help us towards the next.
Mr. O'Halleran. Thank you, Doctor. My time is up. I'm
sorry. I just want to point out we're still hoping, and I hope
that we are able to get some of the basics done in a short
time.
Thank you very much, Chairwoman.
Ms. DeGette. I thank the gentleman.
OK. Mr. Palmer, back to you. Let's see if your sound is
working.
Mr. Palmer. Can you hear me now, Madam Chairman?
Ms. DeGette. Yes. You're recognized for 5 minutes.
Mr. Palmer. Thank you.
Dr. Marsh, part of your State's success in vaccine
distribution, as has been pointed out already, is due to the
decision not to participate in the Federal Pharmacy Partnership
Program. How did you guys arrive at that decision?
Dr. Marsh. Well, thank you, Congressman. As I mentioned
earlier, we tasked our leadership from our long-term care
association, along with our pharmacy leadership. As I
mentioned, we had made the initial decision to have all of our
vaccine run through our pharmacists and pharmacies because of
the critical nature of the storage of the Pfizer vaccine as we
started. And so those two individuals went out and gave us the
information that having an arrangement network of local
pharmacies with long-term care facilities that were located
throughout the rural parts of our State was the best strategy,
and that's how we came to that decision.
Mr. Palmer. I want to go back to a point raised by my
colleague, Mr. Ruiz, about the number of minorities that are
not getting the vaccination. And some of my own research into
that area indicates that there is a reluctance on the part of
minorities to get vaccinated, and it's particularly true among
Hispanics and Blacks. I think there was a Pew study from last
fall that showed that only 42 percent of Black Americans were
willing to get vaccinated, and among Whites and Hispanics, it
was 61, 63 percent, somewhere in that range.
And I just wonder what your experience, Dr. Marsh, has been
in West Virginia in terms of being able to get the vaccination
to minorities.
Dr. Marsh. Well, thank you, Congressman. As perhaps people
on this call recognize, West Virginia is primarily Caucasian,
95 percent, but we recognize that we have underserved
communities of color--African American, Hispanic, Latino, even
Native American Indian--and we have created a task force that
meets under the Department of Health and Human Resources
weekly. And we have funded now faith-based community members
and professionals of color to be able to administer testing and
vaccination into the communities of color where there is
perhaps some distrust that exists, from, you know, Tuskegee and
other experiences, so that we are trying to make sure that we
are giving folks the comfort and the trust of the providers to
be able to reduce hesitancy and to enhance the uptick of
testing and vaccination.
Mr. Palmer. Well, I grew up in rural northwest Alabama,
dirt poor, and I remember as a child when they were rolling out
the polio vaccine and they were taking us to get vaccinated,
and I was deathly afraid of needles--something that has
persisted to this day, I'm ashamed to admit.
But I also want to point out a couple of other reports,
another group had done a study, and they said that--and NBC
News reported that, particularly among Blacks, it's a--a high
percentage are unwilling to get the vaccine, while others said
they want to wait and see how the rollout, the first wave goes
before they choose to get vaccinated.
But my concern is, as my colleague pointed out, a
disproportionate number of minorities are really suffering from
this disease. And maybe this is a question for the entire
panel. What is being done to educate people, first of all,
about the dangers that they face? It should be very apparent by
now, and the necessity of going ahead and getting vaccinated.
And this is true not just of minorities, because when you look
at among the White population and you consider that only about
61 or 63 percent are willing to get vaccinated, that's still, I
think, a shockingly high number of people who are unwilling to
be vaccinated.
That's for the entire panel, if anyone wants to take a shot
at that.
Go ahead.
Dr. Khaldun. I can start. Thank you for that important
question. I can say it's important when we talk about hesitancy
that we understand that the history in why communities of color
may be hesitant, it's Tuskegee, but it's also when communities
of color engage with the health system today and what they
experience in the lack of diversity in the healthcare system
and the bias that exists still in the healthcare system.
I think it's important that we recognize that and we not
shame people for being hesitant. And so what does that mean?
That means creating spaces for conversations, using trusted
community members. We have a large cohort of people, faith-
based community leaders, leaders who are community members who
are of color who are writing op-eds and leading conversations
in the community to make sure people have a space to ask their
questions and get those questions answered.
Ms. DeGette. The gentleman's time has expired, and I want
to thank the gentleman and also the witness.
The Chair now recognizes Ms. Schakowsky from Illinois for 5
minutes.
Ms. Schakowsky. Thank you so much, Madam Chairman, and
thank you so much for holding this hearing.
You know, there's been a lot of talk about what could be
done at the Federal level. Well, fortunately, our new
President, Joe Biden, announced right away a whole package of
things that the Federal Government could actually do.
And I just want to say State and local governments are
having a hard time. Yes, some are doing better than others in
terms of the COVID pandemic, but the truth of the matter is
that, in the big COVID relief package, I'm happy to see that
the President of the United States has understood the plight of
State and local governments who have lost their revenue because
of the economy virtually shutting down, who have had trouble
just making the trains go and helping their healthcare workers
and their first responders to have enough money.
All of the costs of the--or most of the costs, anyway--of
the pandemic have fallen on local governments, not-for-profits.
And, fortunately, our President has said that the big package,
the $1.9 trillion, is going to address the needs of State and
local government. And what have we seen from the Republicans?
No, a fraction of that, and to take out all the money to help
State and local governments.
And so I wanted to ask Dr. Ezike--and thank you. I want to
thank you, Doctor, for coming today, for the work that you're
doing to try and help all of the people in the State of
Illinois and to get vaccine where it needs to go.
If we were able to get more State and local help, how do
you think that that would alleviate some of the problems that
we have been seeing?
Dr. Ezike. Thank you so much, Congresswoman, and thank you
for your continued support along this pandemic journey.
So we know that the expansion of the network will increase
the reach. That means that more people will be able to access.
That will give opportunities for, you know, mobile vans to go
to hard-to-reach populations. That will allow people to focus
and have a specific POD for seasonal workers or migrant
workers. So the expansion of efforts, the expansion of the
network just allows the reach to get more corners, every nook
and cranny of our State, and to get it quickly, and also apply
that equity lens so that we're clear and intentional about the
groups that are often left behind--that have been left behind,
to intentionally go after them, both with the appropriate
messaging, the appropriate messenger, and the appropriate
language, to be able to get those people on board as well.
Ms. Schakowsky. Thank you.
You know, I have focused a lot on the elderly since I've
been in Congress, and it is so important that we're able to get
the vaccine to older Americans. And I know that in Illinois now
we're in 1B, that is, that people 65 years old and older. But
we have seen some difficulties, and I've certainly heard calls
at my office of people of that age and way more that are having
a hard time just navigating the system. And I'm just wondering
what kinds of things that you are doing and that the State is
doing to make sure that our older population is having access
to the vaccines.
Dr. Ezike. Thank you, Congresswoman, for that important
issue as well. We know that everyone is not able to use the
internet and to access vaccines doing that way, and so all of
the local health departments are being encouraged to use
resources, to expand the phone lines, so that there can be
people that can call and have that warm hand to help them
through it. People are creating waiting lists of people who are
trying to get the vaccine and then reach out personally and
help schedule that vaccine so they can call back with an actual
time.
So we need more people, not just vaccinators, but
navigators and community organizations, that can help with
identifying people who have to get the vaccine that can't do it
through the traditional methods that have been established and
can be led to the vaccine, and including using the additional
resource that are needed for even transporting people who want
to get vaccinated to the site.
So all of those things are part and parcel for getting our
most vulnerable populations vaccinated as well.
Ms. Schakowsky. And all of those things cost money to do,
and I'm looking forward to some help from the Federal
Government as well.
Thank you, and I yield back.
Ms. DeGette. I thank the gentlelady.
I believe all the members of the subcommittee have now
asked questions, and so we will--we want to thank the members
of the full committee who have joined us for this important
hearing. And, as per committee practice, we will now call on
them to ask questions.
Congresswoman Dingell, I will call on you first. Thank you
for coming.
Mrs. Dingell. Thank you, Chairman DeGette. I have Michigan
in the house--it's important--and Ranking Member Griffith for
convening this important hearing.
And, you know, we all [inaudible] are right now into three
categories. One, which is what I'm going to get more into
detail, is just a shortage of the supply. We had good news
today from the Biden administration [inaudible].
Ms. DeGette. Debbie, we're having some trouble hearing you.
Mrs. Dingell. Can you hear me?
Ms. DeGette. Yes, OK. Let's try that.
Mrs. Dingell. Can you hear me?
Ms. DeGette. You're freezing. I'll come back to you. I'll
come back to you.
Let's go to Mr. Walberg for 5 minutes.
Mr. Walberg. I thank the Chair for waiving us on. This is
an important hearing that we have here today. And I thank each
of the panelists for being here as well, and for the work that
you are charged with doing in States. It's not an easy time. We
understand that, whether we have disagreements or not or
whether this sometimes feels a bit like Groundhog Day as we
talk about things going wrong.
Director Marsh, I appreciate so much your testimony of how
you took control and found creative ways, working with
pharmacies and getting things done.
And, Director Ryan, I appreciate your testimony of how well
the rollout process went in getting the logistics and then the
ability for the State to do what it needs to do.
But I think there are other things that come into play as
well as we look forward to the fact that a million doses per
day has already been achieved as a result [inaudible]. So that
goal is not necessary anymore. We need to expand beyond that.
The fact that we're able to produce the doses before even
approval has taken place. Just think, if that forethought
hadn't been put in place to work with public and private sector
to say, ``We're going to let you produce doses before we give
you the final approval just in case it might work,'' and thank
God it did and we are getting those doses out.
Dr. Khaldun, I have the benefit, I guess, of representing a
district that has its southern border which borders the
northern borders of Indiana and Ohio. So I have the opportunity
to see the difference in the way Michigan has handled it as
compared to those two States. It gives me a little perspective.
Allows my wife to take me out to dinner in Ohio on Friday night
when I couldn't do it in Michigan. It allows me to see what's
taking place in keeping things closed in our State as opposed
to what took place in Indiana and Ohio and the impact on our
economics as a result of that. So those are all good things.
Let me ask you a question. Just a couple of weeks ago, the
CDC ranked Michigan in the bottom 10 among all States in
vaccines administered per 10,000 residents. In early January,
we were ranked in the bottom five. Weeks after, the State
received more than 500,000 doses of the Moderna and Pfizer
vaccine. Only 27 percent of available doses had been
administered, with the State data showing a substantial lag
between doses shipped out and those injected. And, according to
the State's own dashboard, there were more than 500,000 doses
of vaccine sitting on shelves unused while Governor Whitmer
repeatedly said the State was ready to administer as many as
50,000 doses per day.
Now, in all honesty, it's good to hear. The numbers have
improved in the last week or so, but State health officials
have not been able to tell us why Michigan has fared so much
worse than others, including the bordering States.
Dr. Khaldun, can you explain to me why Michigan in
particular lags so far behind other States in getting the
vaccine out? And was this the reason for the resignation of the
Michigan Department of Health and Human Services Director
Gordon?
Dr. Khaldun. So thank you for that question. I'm very proud
of the work that we've done in Michigan. We're actually one of
the top-tier States today when it comes to vaccinating our
population. I'm quite proud of that.
I think there are a couple of reasons why in the beginning
it appeared that Michigan was one of the bottom 10 States. One
of those things was actually data. There was data that actually
was not coming into the CDC, and we found more than 30,000
doses that actually we were not getting credit for. So we
actually found those, submitted those to the CDC. So we were
actually doing better than what it appeared.
We also--and we had more than 4,400 facilities in the
Federal Long Term Care program. There were no doses sitting on
shelves in the State of Michigan that were in the Long Term
Care program. So we, just like other States, were able to take
out of that allocation, put those shots in arms across the
State, while adding additional pharmacies to be able to
vaccinate our individuals in long-term care facilities.
Mr. Walberg. Now, adding to that specifically, as we're
looking at rolling out the doses for teachers, we want to open
our schools and schools that are open. I think of one. I was
talking with a superintendant yesterday who has opened his
school for testing as well as administering of the vaccine, and
yet he's been unable to get his teachers registered to be put
on the list to get the vaccine. Why is that?
Dr. Khaldun. So thank you for that. We're actually pleased
that we were able to move forward with having our childcare
staff and our teachers to be part of this 1B population right
now. We think it's incredibly important for our students to be
back in school. We are actually working very closely with our
local health departments to be able to vaccinate our teachers
across the State. And so those superintendents are working
closely with their local health departments.
Mr. Walberg. My time has expired. I yield back. Thank you.
Ms. DeGette. I thank the gentleman.
I don't--I think we lost Mrs. Dingell. And so--are you
there, Debbie?
OK. We're going to go to Mr. Soto for 5 minutes.
And I will say, for those of you who are new on this
committee, Mr. Soto frequently waives onto this committee, and
he waits till the bitter end, and I so appreciate it, because
your input is very valuable. You're recognized for 5 minutes.
Mr. Soto. Thank you, Madam Chair.
First, I want to thank the Biden administration for
increasing Florida's weekly allocation 16 percent, up from
266,000 to 307,000 for our weekly allotment. That's key. I want
to thank our colleagues who supported the COVID-19 relief so
far. FEMA just awarded $245 million to our State to pay for 100
percent of vaccine costs for the next 90 days, but we need to
keep it up. Florida is 25th per capita in vaccinations--and we
need the help--2 million shots in arms and counting.
I do want to set the record straight. Pfizer was the first
vaccine approved. It was approved on December 11th, 2020. It
was not part of Operation Warp Speed. I'm going to repeat that:
Pfizer was not part of Operation Warp Speed. So it's really
important to keep the record corrected.
The real lesson, I think, is we've had bipartisan support
for NIH funding for years. And that created the health
technology for making these new vaccines, like with Pfizer,
like with Moderna eventually. Really important for us to make
sure that record's clear.
And outreach is critical, particularly rural communities,
many of them rural Anglo communities in my district, as well as
communities of color. We know the history of distrust. It was
mentioned briefly, but it's important to discuss.
The Federal Government last century deliberately infected
Black men with syphilis in the Tuskegee experiment. It
sterilized Puerto Rican women during the '30s and '40s. So we
know that this distrust is there from history, which is all the
more reason why each of us as Members of Congress need to work
with the bipartisan effort with the Biden administration to do
our own outreach.
Local hospitals in Central Florida, such as AdventHealth,
Orlando Health, and BayCare, Osceola Regional, have given me a
list of concerns--hospitals from Central Florida--like
retaining and recruiting expert nurses, concerns of mental
health for healthcare workers, patient Medicare admission
criteria for nursing and ALF patients, and citizens in rural
areas and communities of color. We see retail sites like Publix
that are doing their best, but it's not present in every
community across Florida.
So we've seen uneven allocations like in east Polk County.
Local African-American cities have been left behind. In Osceola
County, a majority Hispanic county has been left behind in
allocations. So I look forward to working with Biden's equity
task force.
I want to first ask Dr. Khaldun. In your testimony, you
state we cannot simply assume our existing healthcare
workforce, many of whom have been working nonstop, will have
enough for this massive undertaking.
Dr. Khaldun, what does your State need for the Federal
Government to help address these workforce issues?
Dr. Khaldun. All right. So one thing I'd say--and thank you
for that question. One thing I'd say is that I'm incredibly
grateful for the support of the Michigan National Guard. They
have been partners throughout this pandemic supporting us with
testing and now with our vaccination efforts across the State.
I think we also need to bring in more community vaccinators. We
need to be using clinical students, and that's what we're
working on as well, just like Dr. Marsh from West Virginia. So
those are the types of things that we are working on to be able
to support our healthcare workforce.
Mr. Soto. And, Dr. Ezike, we know you've mentioned
workforce capacity challenges. How are you addressing those
challenges, and how can Congress help you with these workforce
issues?
Dr. Ezike. Thank you. So we are expanding the pool, as my
esteemed colleagues have mentioned. We've increased the ability
to vaccinate to EMTs, emergency medical technicians. We're
working to expand to--you know, we have pharmacists, of course.
We're looking to put phlebotomists in this as well. Dentists
can be part of this. So we're trying to use as many
vaccinators. And we're looking even at our partners in other
countries that are just doing just-in-time trainings and trying
to bring even nonhealthcare professionals and see if that is a
possibility under direct supervision.
So we do need the ability to expand training programs that
we might be able to have no limitation on the number of
vaccinators and then just be waiting for the vaccine.
Mr. Soto. Thank you.
We saw President Biden bringing up the National Guard,
enlisting FEMA, 100 percent reimbursement, 100 vaccination
sites throughout the Nation.
Dr. Phillips, will this additional workforce help
Louisiana's COVID-19 program? And what other resources will you
all need to make sure your residents are eligible for the
vaccine?
Dr. Phillips. I think, as mentioned, the National Guard has
been a critical partner here in Louisiana from the start to the
end. As we faced COVID, we also faced several hurricanes this
past year, and they were lockstep with us as we went about
those efforts. And the 100 percent funding is going to be
critical as that continues. They are our logistical arm, our
planning force, and our operational specs on the ground. And so
having that has been extremely critical.
The other thing that's helpful is that 100 percent FEMA
funding, which will allow us to tap into those community mobile
strike teams that are able to go into underserved communities
using our Social Vulnerability Index tool. Those are going to
be important to have the funding to be able to support the
needs that we've identified, in addition to volunteers who are
retired clinical workers. They've already mentioned students
and faculty of allied health schools. Looking at our first
responders, including EMT and fire personnel. Making sure we
have access to all available individuals who are medically
trained to be able to provide a vaccine.
And that flexibility. As we learn more, we may have to
adjust to what we need to do. And having the guidance and the
funding to be able to support that flexibility is going to be
critical.
Mr. Soto. Thank you. My time's expired.
Ms. DeGette. I thank the gentleman.
I still don't see Mrs. Dingell.
So, Mr. Carter, we're going to go to you for 5 minutes.
Ms. DeGette. Mr. Carter, we can't hear you.
Mr. Carter. I'm here on the side of the----
Ms. DeGette. OK. You're frozen.
Mr. Carter. I'm sorry.
Ms. DeGette. OK. You want to try?
No. OK. We've lost Mr. Carter.
If the panel doesn't mind, we will allow Mr. Carter and
Mrs. Dingell to submit any questions for the panel that they
might have by written questions, and we would ask you to submit
your answers to those questions.
Is that agreeable to you, Mr. Griffith?
Mr. Griffith. Yes, it is, Madam Chair.
Ms. DeGette. OK. In that case, I believe that all of the
Members have asked questions.
And I really want to thank all of the witnesses for
participating in this hearing today. Your testimony and your
ideas are really helpful and instructive as we try to move
forward to get the entire population of the United States
vaccinated.
I want to remind Members that, pursuant to the committee
rules, they have 10 business days to submit additional
questions for the record to be answered by the witnesses who
have appeared today. And I ask that the witnesses agree to
respond promptly to any such questions, should you receive any.
We only had one document request today in this hearing. It
was the request by Mr. Burgess for the Texas data generated by
the Data Strategy and Execution Workgroup dated January 31,
2021.
And, without objection, that document will be entered into
the record.
[The information appears at the conclusion of the hearing.]
Ms. DeGette. Again, thank you to all of our witnesses and
Members.
Mr. Griffith. Madam Chair, if I might correct my one point,
just so we've got it all down.
Ms. DeGette. Sure.
Mr. Griffith. It is true that Pfizer did not receive any
R&D money as a part of Operation Warp Speed. But, as they
stated in November, for communication purposes and for
logistics and obviously because they got a giant contract, they
did consider themselves a part of Operation Warp Speed,
although they received no money for R&D.
Ms. DeGette. All right. Thank you for your comments, Mr.
Griffith.
And with that, this subcommittee is adjourned.
[Whereupon, at 1:48 p.m., the subcommittee was adjourned.]
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