[Senate Hearing 117-085]
[From the U.S. Government Publishing Office]
S. Hrg. 117-085
VACCINES FOR VETS: OUR BEST SHOT AT ENDING
THE COVID-19 PANDEMIC
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
FEBRUARY 24, 2021
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
45-822 PDF WASHINGTON : 2021
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SENATE COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran, Kansas, Ranking
Bernard Sanders, (I) Vermont Member
Sherrod Brown, Ohio John Boozman, Arkansas
Richard Blumenthal, Connecticut Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii Mike Rounds, South Dakota
Joe Manchin III, West Virginia Thom Tillis, North Carolina
Kyrsten Sinema, Arizona Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire Marsha Blackburn, Tennessee
Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Democratic Staff Director
Jon Towers, Republican Staff Director
C O N T E N T S
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February 24, 2021
SENATORS
Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............ 1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas...... 2
Manchin III, Hon. Joe, U.S. Senator from West Virginia........... 9
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 11
Murray, Hon. Patty, U.S. Senator from Washington................. 13
Boozman, Hon. John, U.S. Senator from Arkansas................... 15
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 17
Tuberville, Hon. Tommy., U.S. Senator from Alabama............... 19
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 20
Sinema, Hon. Kyrsten, U.S. Senator from Arizona.................. 22
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire...... 24
WITNESSES
Richard A. Stone, MD, Acting Under Secretary for Health, Veterans
Health Administration, Department of Veterans Affairs,
Accompanied By: Jane Kim, MD, MPH, Chief Consultant for
Preventive Medicine, Ralph T. Gigliotti, FACHE, Network
Director, VISN 19: VA Rocky Mountain Network, William P.
Patterson, MD, Network Director, VISN 15: VA Heartland Network. 4
APPENDIX
Richard A. Stone, MD, Acting Under Secretary for Health, Veterans
Health Administration, Department of Veterans Affairs, prepared
statement...................................................... 32
Statements for the Record
Moderna, Inc..................................................... 36
Pfizer........................................................... 44
Dr. Richard Nettles, M.D. Vice President of U.S. Medical Affairs,
Janssen Infectious Diseases and Vaccines. Johnson and Johnson.. 48
Questions for the Record
Response to Questions for the Record submitted by:
Hon. Jerry Moran............................................... 54
Hon. Sherrod Brown............................................. 59
Hon. Kyrsten Sinema............................................ 61
VACCINES FOR VETS: OUR BEST SHOT AT ENDING THE COVID-19 PANDEMIC
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WEDNESDAY, FEBRUARY 24, 2021
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 4:12 p.m., in
room G50, Dirksen Senate Office Building, Hon. Jon Tester,
Chairman of the Committee, presiding.
Present: Tester, Murray, Brown, Blumenthal, Hirono,
Manchin, Sinema, Hassan, Moran, Boozman, Rounds, Tillis,
Blackburn, and Tuberville.
OPENING STATEMENT OF CHAIRMAN TESTER
Chairman Tester. I call the hearing to order. Dr. Stone, I
want to thank you for being here with your team once again. We
appreciate what you do, and thank you for being here.
Today, with two vaccines authorized for emergency use and
being distributed across the country, we will take stock of how
VA is doing in terms of reaching its work force and the
millions of veterans that the VA serves. It is my focus to
bolster the vaccine supply chain and ensure there is a system
to distribute the vaccine quickly and efficiently to all
veterans, regardless of where they may live, and I know this is
a goal shared by Senator Moran also.
From what I understand, the Department is excelling in
getting shots into arms in a safe and timely manner once doses
are received from the Department of Health and Human Services.
I want to commend you in your efforts to administer more than
two million doses to veterans and employees so far, outpacing
the private sector.
Yesterday, Senator Moran and I had a productive
conversation with Dr. Kessler and General Perna, the Biden
administration officials responsible for development,
manufacture, and distribution of coronavirus vaccines. We told
them that the VA has proven its ability to quickly deliver
vaccines where they are most needed, and that the Department
already has the capacity to deliver above and beyond its
current allotment. Moving forward, we will continue to press
them for a larger allotment for the VA, and we will expect you
to do the same.
To date, the Department has only received about 2.3 million
doses. That means we still need about 17 million more doses to
get veterans and staff fully vaccinated.
Beyond concerns with the overall supply chain, which are
being addressed, I remain mostly focused on how we can better
reach veterans in rural, remote, and underserved areas. The VA
has piloted a vaccine fly in program for rural areas of
Montana, like Havre and Kalispell, and to communities in
Alaska, which I think is an innovative way to reach rural vets.
However, we know that barriers remain to getting our rural
veterans vaccinated in Montana and across the country. That is
why we wanted Ralph Gigliotti from VISN 19 and Dr. Patterson
from VISN 15 with us here today, and thank you folks for coming
to this hearing.
I look forward to hearing more about how you, Dr. Stone,
are allocating vaccines to different VISNs, and then how you,
Ralph and Dr. Patterson, are allocating them to the different
medical facilities within your VISN. Whether a veteran lives
next door to a VA medical center or hundreds of miles away from
the nearest one, all veterans must have equitable access to
getting this vaccine.
I know that reaching areas, particularly highly rural and
frontier areas, brings both logistical challenges and
potentially higher refusal rates than elsewhere, but we have to
get this right. And we have to do a better job of communicating
with veterans, setting their expectations, and giving them a
better idea of when, how, and where to get a vaccine when it is
their turn. Addressing these issues of both supply and demand
are truly our best shot at ending this pandemic and getting our
economy back on track.
I want to thank you all for being here today, and I look
forward to the conversation ahead.
Senator Moran, you have the floor.
OPENING STATEMENT OF SENATOR MORAN
Senator Moran. Chairman Tester, thank you very much, and
thank you for the conversation we had with the general and the
doctor yesterday. Good afternoon to everyone here today. I am
pleased, Mr. Chairman, that we are conducting this hearing on
this important topic. A shot in the arm is perhaps the most
important thing we can do to improve our country's well-being,
both economically and health-wise, and we certainly want to
make certain that veterans are vaccinated as quickly and as
time-efficiently as possible.
I give special welcome this afternoon to VISN director, Dr.
William Patterson. Thank you for your leadership. Thank you for
the relationship that we have and your good works with my
staff. I am very grateful for that.
Throughout these past 11 months, our Nation has faced
nearly an overwhelming challenge of responding to coronavirus.
We have all been impacted by the loss of lives, strain on our
health care system, upheaval in education structures, and
economic disruptions. Through the hard work and determination
of our country's scientific and medical communities, we now
have two promising and available vaccines for COVID-19. With
millions of Americans getting their doses each week, we are
getting closer and closer to beating the virus.
In addition to our individual actions to help keep our
neighbors and ourselves safe and healthy, those of us on this
Committee have a special responsibility to America's veterans.
Through cooperation with and oversight of the VA, it is our job
to make certain that American veterans are best served and best
taken care of through these extraordinary times.
The VA's dedicated work force has answered the call, and we
honor and thank those who report to work every day to care for
our heroes on the front lines of this pandemic. Remember
especially those that have died in the course of their work,
many of them veterans themselves, serving their brothers and
sisters in uniform.
I think we can all agree that the VA has stepped up during
this pandemic, making themselves available to veterans far and
wide, and executing numerous fourth-mission assignments. I want
to highlight that earlier this month employees at the Kansas
City VA, faced with cancellations at a mass vaccination event,
conducted rapid outreach to eligible veterans to get shots in
arms, and kept working until nearly midnight to make certain no
doses went to waste. I commend and congratulate those who were
responsible for that and those who made certain that the shots
occurred.
As we move closer toward the home stretch--hopefully to a
home stretch--with each passing week, I seen immunization
numbers continue to rise and ICU admissions numbers fall. It is
critical that we not lose sight of our core mission: taking
care of our veterans.
I want to make certain that the VA is doing its best work
in taking care of veterans and seeing that this vaccination
rollout is working in the most efficient and expeditious manner
possible. My staff has been having weekly calls with the
Department, but despite that we continue to learn things
through news articles and veterans that we did not otherwise
know. This leads to a time-consuming process of requesting a
call, facing scheduling delays to connect with proper people at
the VA, and finding out weeks later things we should have
known, could have known, much earlier had we been informed
directly.
One example of this is the use of algorithms to determine
the vaccine eligibility prioritization. We are hearing now that
veterans who should be at high risk, based on disability or
injuries, are not being prioritized properly in the program,
and I look forward to hearing from Dr. Stone and others in
regard to this topic.
At the same time, we are learning that the VA is
continuing, perhaps even expanding, vaccination efforts for
elements of the Federal work force from other departments and
for caregivers. A concern is that the VA could be overextending
itself without enough oversight to ensure smooth processes or
make certain its primary patient population is getting
vaccinated. I look forward to the assurance that that is not a
problem.
The VA's unique mission needs to be managed in accordance
with the population it serves, and existing system and
infrastructure in place to execute it. Congress, in recent
years, has legislated significant reforms to put veterans at
the center of their care decisions, and we must make certain
that even in times of great strain veterans do not fall through
any gaps.
Particularly, I want to make certain that veterans in rural
and highly rural areas, similar to what Senator Tester,
Chairman Tester, said, that those veterans in that part of the
country are not overlooked. My staff and I have received
multiple assurances from VHA officials that rural vaccination
efforts would have access to a fair share of allotment and at a
pace equal to their urban counterparts.
I visited the Colmery O'Neil Hospital in Topeka on Monday,
on my return to Washington, DC, and I was pleased to see the
efforts that are underway to make sure that rural veterans are
not left behind, that CBOCs are being utilized, and I raised
the topic, although I do not think the answer was the one I
would hope to hear, that even our Community Care providers are
capable of providing vaccinations to veterans through the VA.
I am concerned that the Department lacks a standard
communication strategy for outreach to veterans, and that the
decisions are largely VISN dependent. VISNs are also delegated
authority to draft their own vaccination plans, which could
lead to inequities across VHA, and while I am generally for
local control and decisions being made locally, I want to make
sure that veterans across the country receive what they are
entitled to and what they are eligible for.
I have some concerns about the VA's plan to direct veterans
to pharmacies in the community for vaccines and from what
allotments those doses would be coming. So while I think it
could very well be a good idea, I want to know what it is
detracting from and utilization of those local pharmacies could
be very helpful in vaccinating rural veterans.
I want to make sure it is the best course of action to
optimize vaccine rollout in the ways that reach veterans
quickly, efficiently, and in a way that bolsters public health
rather than placing unintended strains on vaccine supplies in
communities or risking surplus at a VA site. This process is
something we ought to get right, and the details matter.
Mr. Chairman, I look forward to a robust conversation today
as we look to find ways to improve upon the process in place
and make certain that those who serve in uniform are best
served by the department created to care for them. And with
that, Mr. Chairman, I yield back.
Chairman Tester. Ranking Member Moran, thank you for your
Statement. Dr. Stone, I understand you are going to be the
point person here to testify and the others will be here for
questions. You have 5 minutes. Please know that your entire
written testimony will be a part of the record. You may
proceed.
STATEMENT OF RICHARD A. STONE ACCOMPANIED BY JANE KIM, RALPH T.
GIGLIOTTI AND WILLIAM P. PATTERSON
Dr. Stone. Thank you, Chairman Tester, Ranking Member
Moran, and distinguished members of the Committee. Thank you
for the opportunity to testify today about the Department's
response to the COVID-19 vaccine rollout. You have already
recognized a number of the team members to my left, but Dr.
Jane Kim is our Chief Consultant for Preventative Medicine, and
I am accompanied also by Dr. William Patterson, Director of
VISN 15, and Mr. Ralph Gigliotti, Director of VISN 19.
I would like to acknowledge the somber milestone achieved
this week of 500,000 deaths of our fellow Americans due to
COVID-19. Of that number, just over 10,000 are veterans, and
131 are VA employees. We collectively mourn all of those lost
and continue our pledge to save every possible life that comes
into the VA for care.
Throughout this pandemic, VHA employees have stood on the
front lines, courageously delivering care to America's
veterans, and for the American population broadly. That heroic
effort has now turned to distributing and administering as many
vaccine doses as possible. It has been an emotional time for
many in health care, as teams who fought this disease on the
front lines have begun to have hope that relief is coming.
We are absolutely committed to get as many veterans
vaccinated as quickly as we can. The logistics and the delivery
of these vaccines is very complex and requires new and unique
processes. We are reaching out to veterans when they are
eligible, and we encourage veterans to use our Web-based ``Keep
Me Informed'' tool to get updates about VA vaccinations.
Yesterday, as of February 23d, VA had administered well
over 2.1 million doses of the vaccines. These include over 1.1
million first doses to veterans and 484,000 doses, first and
second doses, to VA employees, which have inoculated well over
90 percent of our clinical staff. VA is currently providing
vaccine at more than 215 sites nationally, and we are using
virtually all the doses that we receive as soon as they arrive
each week. And we have the capacity to deliver between 300,000
and 600,000 doses weekly.
More than 6 million veterans depend on us for their health
care, and CDC plans to provide us with first and second doses
for each of those 6 million, as well as our 400,000 employees.
And we are focusing our efforts on enrolled, eligible veterans
who are listed in the highest-risk categories. Veterans who are
not yet receiving care through the VA health care system are
encouraged to enroll now.
We remain committed to health care equity across multiple
dimensions, and that also applies to our vaccination efforts.
We are working hard to reach our most rural veterans and those
communities hit hardest by the pandemic. For rural veterans, we
have developed distribution guidance to facilitate safe
transportation of vaccines to rural areas. Our planning has
ensured equitable access and distribution of vaccines to racial
and ethnic minorities disproportionately affected by the COVID-
19 pandemic. We are very pleased that we are seeing relatively
comparable outcomes across race once veterans are enrolled in
our care.
In preparation for the vaccine rollout, our teams wanted to
ensure that wherever possible every veteran felt confident
about receiving their shot. We recognize that the most trusted
voice in making health care decisions is a patient's health
care provider. Therefore, our outreach plan features VA staff
and providers proactively calling the veteran. They serve to
provide information, answering questions, and scheduling
appointments for vaccination. This has helped to overcome
barriers such as vaccine hesitancy. In fact, enrolled veterans
over age 75, the group currently prioritized for vaccination,
25 percent of white, 28 percent of Hispanic, and 30 percent of
black veterans have been vaccinated.
I am incredibly proud of our teams who are doing outreach,
responding to questions and dedicating themselves to this
effort. While we have not seen racial or ethnic disparities in
vaccinations so far, we will continue to actively manage equity
in our system.
I would like to specifically address our support to those
caregivers of veterans participating in the Program of
Comprehensive Assistance for Family Caregivers. VA offers
testing and vaccinations to eligible family caregivers, and so
far more than 2,000 caregivers and 12,700 veterans involved in
this program have received at least their first dose of
vaccine.
Before I close, I would like to thank this Committee for
your support in passing the CARES Act, and I am pleased to
report that we are on track to fully execute the remaining
CARES Act funding in the coming months. Those funds have
facilitated the agility VHA has demonstrated over this
pandemic.
The Biden administration's American Rescue Plan will
sustain our response and ensure that we can respond to the
inevitable wave of delayed and deferred care. Your support
remains essential to our continuing effort to provide excellent
care for veterans and their families, and I am grateful to this
Committee and its leadership for your partnership.
My team and I look forward to answering your questions.
Chairman Tester. Thank you, Dr. Stone. I appreciate the
testimony. We will start with the questions now.
I understand, and correct me if I am wrong, Dr. Stone, the
VA is receiving about 125,000 doses per week, and the VA is
getting those administered within a week, for the most part,
all of them. Dr. Stone, you said that the VA has capacity to
administer 300,000 to 600,000 per week, and I know this is
contingent upon national supply. But what is your ideal weekly
allocation of doses?
Dr. Stone. Between 300,000 and 600,000 a week. I am quite
pleased, sir, that we just received a call before we came over
here that we will, next week, receive almost 600,000 doses.
Chairman Tester. That is good news, Moran. Look what
happens. That is good. That is really good.
So then the question is, now you have got some vaccines to
work with, at least in the short term, and hopefully that will
continue in the long term. How do you decide how those vaccines
are distributed to the VISNs?
Dr. Stone. I am going to defer to Dr. Kim for the answer to
that.
Chairman Tester. Okay.
Dr. Kim. Hi. I will be happy to speak to that. So my name
is Jane Kim. I am a general internist and preventive medicine
physician, and since September 2020, I have been leading the
COVID national vaccine planning team for VA.
So in terms of vaccine allocation, our strategy really
flows out of the Health and Human Services strategy, which uses
a pro rata approach to determine vaccine allocations for the
country. So for each State jurisdiction or Federal entity, the
allocation of vaccines is determined by population, using a pro
rata approach.
We, in VA, follow a similar methodology using pro rata, but
primarily base it on the CDC priority phase that we are
currently in. So we are currently in Phase 1b, which is mainly
75 and older veterans. So for each VISN we take the number of
veterans in that VISN who are 75 and older, and the denominator
is the number of veterans in our system who are veterans 75 and
older. And that is all of our veteran users of our health care
system.
Chairman Tester. Can you have those--you have got those
metrics lined out so you are comfortable that you have the
metrics for veterans in each VISN that are 75 years and older?
Dr. Kim. Yes.
Chairman Tester. Okay.
Dr. Kim. Before we started this we did a population
enumeration and got those numbers nailed down.
Chairman Tester. Okay. So that is fine. Thank you. And
then, Ralph Gigliotti, at the VISN level, how do you decide
vaccines that go to each VA medical center within your VISN, or
each State? Is it done the same way?
Mr. Gigliotti. Sorry. Yes, Mr. Chairman. It is done the
same way. We base it on the 75-plus age with patients, patients
that may be on hemodialysis, organ transplant, chemotherapy,
that type of thing.
Chairman Tester. Okay. So I know you have got your boss
sitting here, just to your right a couple of paces down, or
maybe right next to you, as far as that goes. The question is,
do you feel like VISN 19 is getting the adequate number of
doses?
Mr. Gigliotti. We are using the formula that is being used.
We look forward to when the volume increases and we have
detailed plans at all eight of our health care systems to roll
out more vaccine.
Chairman Tester. How much lead time are you able to give
the veterans to know when they can be vaccinated?
Mr. Gigliotti. So we do scheduling in advance. We trust the
weekly supply that we have been getting. We get excellent
communication from Dr. Kim, from Dr. Stone, so we know in the
upcoming weeks what we are projected for, and we go ahead and
schedule out for that.
Chairman Tester. So the 600,000 doses aside, that you got
today, because that is good news, are you able to give the
veteran 2 weeks' notice? One week notice? Two days' notice?
Mr. Gigliotti. So yes to all of that. We are able to
schedule in advance, 2 weeks to 4 weeks is the norm. However,
there are some situations where we are able to call veterans in
on a day or two's notice, because when we reach out to the
veteran we ask what type of lead time do you need to come in
for a vaccine. And so if we have an extra supply for a
particular week we are able to bring somebody in on a day or
two notice also.
Chairman Tester. Thank you. I have got some more questions
but there will probably be another round. Senator Moran.
Senator Moran. Mr. Chairman, thank you, and thanks again to
Dr. Stone and his colleagues for joining us today. I am perhaps
exploring some of the things that Senator Tester just did, but
I want to see if I can be specific or get a specific answer.
Dr. Stone, in your written testimony you provided the
insight that the VA's allocation process to VISNs is similar to
how HHS allocates the vaccines to the States, and that is,
again, this population issue that Senator Tester just raised.
Are the VISNs bound to this pro rata allocation formula when
reallocating to the network of facilities they have within the
VISN? So does the veteran population coming to the VISN, is
that then translated into, in my case, Wichita and Topeka as
the same number, based upon veteran population?
Dr. Stone. We have given discretion to the regional leaders
to distribute to their health care centers, based on
refrigeration capacity and labor capacity, to deliver vaccine.
And, therefore, that discretion has included the kind of thing
you described in your opening Statement, sir, that sometimes we
find that we have got some extra doses and we may reach below a
risk population to even a younger veteran.
We know that the major risk of death and serious illness is
based on age, and of all the variables, age seems to be the
thing that stands out. And, therefore, we have followed the CDC
guidance, but there is the flexibility, at the local medical
center level, to reach to a lower group of risk should have
vaccine available, because the transport of these vaccines is
very difficult, especially the Pfizer vaccine.
Now, in your State, the nearly 20,000 doses that have come
into your State, have been mainly in Moderna, and I am sure Dr.
Patterson can correct me if I am wrong on that.
Senator Moran. Dr. Patterson, let me ask this question to
see, again, if I can get this answer. So does Wichita and
Topeka get allocated based upon changes in conditions of VISN
decision, or is it specific to we have this many doses, based
upon population, and based upon the number of veterans that
utilize Wichita and the number of veterans that utilize Topeka,
Topeka Leavenworth, that is how we allocate them?
Dr. Patterson. It is a little bit in that way, Senator. Of
course, we prioritize according to the guidelines we get from
VA Central Office in terms of scheduling veterans to come in.
But we do not have enough vaccine each week to do that entire
broad population at one time. So what we have done is we
allocated a minimum amount to each medical center.
So for instance, Topeka and Eastern Kansas, Kansas City,
Marion, Poplar Bluff, will all get a minimum of 600 doses each
week. That is the minimum. Now, if they have the ability to do
more, or if they have scheduled an event, if we have an amount
above that, which we generally do, then we supplement that. So
they are prioritizing based upon the age group, over 75, and
then if they get all those done, well, first the CLC patients,
then the over 75. If they need to go between 65 and 75, they do
that.
But as you referenced in your earlier comments about the
event in Kansas City, we had 200 people not show up one night
for vaccines. So we have standby lists ready to go, and we
start calling those veterans. And I was out there that night,
at 8 that night, and stayed until about 10, and it was amazing
to watch the parking lot of people just pulling in, flipping
off their lights, and running into the building, even carrying
their kids in pajamas sometimes, to be sure that they could get
a vaccine.
Senator Moran. Again, thank you for that response, that
response to supply.
The conversation that we just had, Dr. Stone and Dr.
Patterson, lends itself to my next question. My staff has been
informed that the VA's risk stratification framework includes
vaccinating veterans based upon occupation, starting in Phase
1b with frontline and essential workers. So another way to
allocate will be based upon what a veteran's occupation is--are
they an essential worker. Can you clarify whether it is VACO's
guidance for VISNs and facilities to vaccinate based upon
occupation?
Dr. Stone. I can. Certainly in 1b, frontline essential
workers are identified by the CDC, so that is where that came
from. As we have identified it, I think Ralph Gigliotti
probably has the best story when it comes to that, of how they
approached frontline essential workers. Mr. Gigliotti, do you
want to go ahead?
Mr. Gigliotti. Sure. What we did was identify the various
caregivers across all eight of our health care systems, and
then using the employee stratification, offer it to employees
in order to ensure those that came in contact with veterans
were eligible, able to receive the vaccine. And it has gone
really well, and we have right now 76 percent of our employees
have received a first dose, and many of them have also received
a second dose.
Senator Moran. I think I am talking about the veteran's
occupation, not the staff member's occupation, right?
Dr. Stone. Right. What I was referring to, and I apologize
for catching Mr. Gigliotti on this one, was that they had
identified and called veterans who were part of the local
police department and had reached out to them and said, ``Look,
all the police officers in this community who are veterans, we
have got vaccine for you, as part of the 1b allocation,'' thus
unloading the community to it provides. And please clarify.
Mr. Gigliotti. Yes. That was with the Havre fight that we
did in Montana, and that was with first responders from the
Rocky Boy Native American Nation.
Senator Moran. My time has expired, but I would ask this
followup question. You can answer it later. Is there a way to
verify a veteran's occupation to make sure that they are in the
occupation that they say they are?
Chairman Tester. Good enough. Thank you, Senator.
Senator Moran. Apparently, you do not have time to answer.
Chairman Tester. I am interested to know that too,
actually.
We will go to Senator Brown, virtually, if he is there.
Going once. Going twice.
Okay. Manchin is up.
SENATOR JOE MANCHIN
Senator Manchin. Okay. Thank you so much, Mr. Chairman, for
being so kind.
Dr. Stone, I am pleased that we have so many, 20, vaccine
candidates reaching the final stages. I come from the State,
the beautiful, beautiful State of West Virginia. Very, very
patriotic and an awful lot of veterans. And I imagine when the
vaccines are approved, some of them will need specific storage
temperatures again. And I would hope you all would take into
consideration, in some of the smaller rural areas, we do not
have the ability to handle that. So when you are designing what
vaccines are going to go to what area, will you make sure that
basically it is matched up with the capabilities of handling
the vaccine so it does not spoil, it is not wasted? Is that
part of your----
Dr. Stone. It is, Senator, and as you know, because of the
rural nature of much of your State, we have shipped over 37,000
doses to your State. It has all been Moderna, which has been
easier to handle at a -20 degrees. None of it has been Pfizer.
It is just too difficult to move that around.
Senator Manchin. Absolutely.
Dr. Stone. And it has given us the ability to actually
immunize about 38 percent of the over-75-year-old veterans in
your State.
Senator Manchin. We are going to need a lot more, as you
know. All the States do. We understand that. But in the rural
States such as ours, as long as you make sure that you are
identifying the type of facility it is going to take in order
to handle that new vaccine when they come, whether it being J&J
or other ones, I understand, are coming on quite rapidly.
Dr. Stone. They are, and I will defer to Dr. Kim. It is not
clear to us what the guidance is going to be from the FDA and
the CDC on the utilization of the new vaccine that will come.
That is the single-dose vaccine. And so I will defer to Dr.
Kim.
Dr. Kim. Yes, Senator, I am sure you know from previous
people who have testified here that the FDA is meeting this
Friday to discuss the Johnson & Johnson vaccine and possibly
authorize it if data looks favorable this weekend. And we, you
know, in the scientific community, really like that vaccine
because it is one dose, refrigerated, and can last apparently
up to 6 months in a refrigerator, which makes it a great option
for places that only have a refrigerator, such as maybe some
rural facilities, maybe in your State. So it is a nice
versatile option from a storage standpoint, as well as it is
only one dose, which some veterans may really like.
Senator Manchin. Let me ask you this. In the weather
conditions we have been having and some of the extreme weather
around the country, have we lost, or has any of it spoiled, not
being able to get to market or get to the end user?
Dr. Stone. We have had minimum wastage, and, look, every
dose is a tragedy. We had, up in VISN 1 in the Northeast, a
contractor who was cleaning up after a broken pipe with a
flooded area, inadvertently unplug one of our negative-70-
degree freezers and we lost a palette of the Pfizer vaccine, so
we lost about 1,000 doses. And so that has been the largest
loss that we have had.
Frankly, the VISN leadership have done the same sort of
thing that Dr. Patterson did, at 8 and 9 at night where we are
calling veterans and we have got cancellation lists. That is
true across the Nation.
Senator Manchin. A lot of the people live in rural area.
They do not have internet service. A lot of them are not on
internet service. I know when you are contacting, trying to set
your appointments up, what other, other than just a phone
itself, how are you all able to communicate?
Dr. Stone. I am going to defer to Dr. Patterson and Mr.
Gigliotti about how they are doing their scheduling.
Dr. Patterson. We do schedule as much as possible, but we
also have some walk-in availability in a lot of places. But one
of our big partners has been the veteran service organizations,
so the Legion, the VFW. They have a lot of good connections in
the community, and particularly in small communities where they
are very strong. We set up events there and they help us get
the word out. We may use social media and robocalls and the
local clinics, but that community connection really goes a long
way.
Senator Manchin. I also was pleased to see the VA had been
allowed to participate in the Defense Production Act committee
and help determine the most effective ways to meet our Nation's
needs. However, even with the great new developments we are
seeing with vaccines, we need to be prepared to continue to
deal with the COVID-19 on the long term, as we are seeing it,
and if you are all prepared for that. So how has the VA's
participation in the committee's decision on deploying the DPA
helped you respond to the COVID-19 pandemic?
Dr. Stone. Sir, I think it is too early to say what our
participation with the DPA has been. At this point, we are
still working and we have briefed our new Secretary on our
desire to be at the table in the Defense Production Act. But
how the Defense Production Act is utilized as well as our role
and our voice as the largest provider of health care services
in the Nation is one that I think still remains to be seen.
Senator Manchin. Are you able to get all the equipment you
need? Are you getting PPEs for your employees and everything?
Dr. Stone. Yes, sir.
Senator Manchin. And do you have your portable--in West
Virginia we have a lot of the portable trailers that go around,
trying to help people who live pretty far away from a facility
or a clinic.
Dr. Stone. Yes, sir. In comparison to where we were 6
months ago, our supplies of PPE as well as our emergency stocks
and our rolling stock is in much better shape than it was early
in the pandemic, even a year ago.
Senator Manchin. Are you able to spin shots out of your
portable, out of your portables?
Dr. Stone. We can, and we are.
Senator Manchin. Yes.
Dr. Stone. And we are using it mainly for transportation.
We are finding, for efficiency sake, large open areas is a
better place to go, and whether that is a parking lot----
Senator Manchin. They will come. They will come, sir.
Dr. Stone [continuing]. they will come. And so we are using
that, but we are using the portable materials to transport and
to assure the safety of the vaccine and the mixing of the
vaccine when that is appropriate.
Senator Manchin. Thank you very much.
Chairman Tester. Senator?
Senator Manchin. Mr. Chairman, I am indebted to you, being
so kind.
Chairman Tester. You can stick around for the second round
too. Senator Tillis.
SENATOR THOM TILLIS
Senator Tillis. Thank you, Mr. Chairman, and thanks to
Senator Boozman for letting me go. I want to welcome you all
here for the great work that you do. Dr. Kim, I want to--I feel
like I have VISN 6 represented, to the extent that you are
still doing work down at the Durham VA, so thank you for that
work down there, one of several great facilities we have in
North Carolina.
Dr. Stone, I think in testimony before the House
Appropriations Committee you talked about a mass vaccination
down at the Salisbury facility as being successful. I would
guess a lot of that depends on supplies as to whether or not
you can replicate that. But do you see those mass vaccination
programs as supply increases, maybe after we get another
vaccine in the mix? Do you see that as being a key part of
trying to step up the tempo on vaccinating veterans?
Dr. Stone. I do. I think the mass vaccination events---in
fact, on President's Day weekend, that 3 days, every single day
we dispensed over 70,000 doses into veterans' arms. I think
that Dr. Kim can go over what has actually been done at Durham
and mass vaccination events, but we see that as the future, as
we increase our supply of vaccines.
Senator Tillis. Dr. Kim, I would like you to add to that,
but I would also--I have been watching the final analysis of
the Johnson & Johnson vaccine. We know logistically that makes
everybody's life easier. We also know that it changes the way
you may distribute them. So can you tell me a little bit on the
mass vaccination strategy, but tell me to what extent are you
already planning for the eventual availability of the one-shot,
non-cold-storage vaccine that should enter the rotation? I know
its efficacy is probably, for, I think, the more difficult
cases about 10 percent lower, but certainly a highly effective
vaccine.
So tell me a little bit about how that plays in it and also
maybe start with the mass vaccination strategy.
Dr. Kim. Sure. I just will say that the mass vaccinations
certainly are a really effective strategy to get shots in arms.
You get a lot of vaccinators together and run a clinic all day,
and you can do thousands. So I did one at Durham a few weeks
ago and it was incredible. We had some frontline essential
workers come through, a lot of older veterans. So I know those
types of strategies are being used all across the country,
including in North Carolina, and we will continue to do that.
We are scaled up now to do that every weekend.
I will say, for the Johnson & Johnson product, I am very
curious to see how that product will be discussed at FDA's
Advisory Committee on Friday. You are right about the efficacy
looking to be lower than the two products currently available,
Pfizer and Moderna. You know, but I think we do see, in the
data, at least the paper that came out today, that we will
brief the committee, the advisory committee, that the Johnson &
Johnson product does appear to protect against severe illness
and death from COVID-19, which certainly is really the goal. We
might want to get moderately ill or just mildly ill, but we
certainly do not want to be in the hospital or to die from
COVID. So we will see how that kind of plays out in terms of
the discussion on the data.
In terms of how we would use this vaccine, we have talked
about that a lot. You know, it is a great product because it is
refrigerated, one dose, so it certainly could lend itself very
well to mass vaccination. You would only need to go once,
versus going back another time. But, you know, I think we will
see how the efficacy plays into that discussion as well.
Senator Tillis. I will ask my final two questions and try
to keep within time. The first question, you were talking about
you have instances where you may have surplus supply, and you
may have veterans--you have spoken about the distribution to
police officers. But is there some sort of an appeal process or
waiting list for people with chronic underlying conditions that
are below the age cut right now and an outreach to them to
potentially get them ahead?
Dr. Kim. Yes, Senator. In CDC's Phase 1c, which includes
adults who are 65 to 74 years old, alongside of them are the
younger adults who are 64 and younger who have a high-risk
medical condition. And, you know, as we look at the phases of
vaccination in VA, there are facilities, including Durham, who
are at Phase 1c, and who are reaching out to some veterans in
that age group who have a high-risk medical condition. So we
are right there in terms of getting to that age group and that
high-risk group.
Senator Tillis. Okay. The final question has to do with
moving forward with respect to the COVID relief package we are
talking about, or funding that you already have in reserve. As
your priorities either covered by the last phase of the COVID
relief package or do you feel like that the funding priorities
that are in the proposed COVID relief package are matched up
with what you think your needs are?
Dr. Stone. I think that the CARES Act covered us well for
what we saw as the needs to confront this battle against the
virus. What we did not get covered, what we did not even
consider, was exactly what happened after the great influenza
of 100 years ago. There is a tremendous amount of health care
that comes in a population that has not come in for its health
care for the last year. And as much as we have encouraged
urgent care, there is a huge tail of deferred and delayed care
that we are beginning to recognize and talk to your staffs
about, as we look at what the needs of this system are for the
future.
In addition, the economic instability, where a veteran
loses their health insurance, and then comes to us as the
safety net, is resulting in our actuaries projecting very
significant surge of care as we go into the remainder of this
year and into the next few years.
Senator Tillis. Thank you. Thank you all, and to the VISN
directors, thank you. I am sure you are probably only behind
VISN 6 in your performance. Thank you very much. You do a great
job.
Chairman Tester. Thank you, Senator Tillis. Senator Murray.
SENATOR PATTY MURRAY
Senator Murray. Thank you very much, Mr. Chairman. Dr.
Stone, Dr. Kim, welcome, and I appreciate you being here with
us today.
I want to start on the topic of how we promote vaccine
confidence and fight disinformation and misinformation that can
lead to vaccine hesitancy. We are seeing misinformation about
vaccines spread really easily and widely across the internet,
including through social media and messaging apps, coming from
all kinds of sources and targeted to all kinds of people. And a
lot of discussion around misinformation has been around
communities of color. But we know that disinformation is a
serious concern among all demographics. That can lead to our
veterans, caregivers, family members refusing a vaccine, even
when they are offered one.
So I wanted to ask you, how is the VA and its Federal
partners tackling this disinformation targeting all groups of
veterans?
Dr. Stone. Senator, thank you. In my opening Statement I
discussed the fact that we are very proud of the fact that we
are not seeing, in communities of color, a vaccine hesitancy
resulting in disparities. What we are seeing, however, in rural
America, is much more hesitancy to take this, and therefore we
have had a very active campaign to communicate, especially with
our primary care providers, recognizing the fact that the most
trusted person is your doctor or your care team, in really
dispelling the problems of vaccine hesitancy.
I am going to defer to Dr. Kim, who has been close to this
effort.
Dr. Kim. Sure. Thank you. Senator, we have thought a lot
about this issue, ever since the fall when we knew these COVID
vaccines would become available, and thought about how to get
information out to our veterans that was science-based. We did
focus groups with our veterans, especially those of color, to
find out what they needed to know to help them make a decision
if they were hesitant. And they told us they wanted the
science. They wanted to know if a vaccine was safe and if it
was effective. And they, as Dr. Stone said, wanted to talk to
someone they trusted on their health care team.
So we combined all of that and have been working with CDC,
who has a Vaccinate With Confidence campaign, to get science-
based information on the vaccines in the hands of our
clinicians so they could have conversations with their veteran.
You know, there really is no substitute for the hard work of
calling somebody and having a conversation with them, and it is
100 percent worth it when you can talk to one person and they
figure out that they do want to get vaccinated. They tell their
family. They tell other veterans. They tell their coworkers.
And so there is no substitute for that hard work, and we
prepared our staff in VA for those conversations, and I have
heard many stories from around VA about how clinicians are
getting on the phone, talking with their veteran, helping them
make those decisions.
Senator Murray. Well, thank you for that. And as we know,
COVID-19 has had a disparate impact on communities of color. We
know there has been a history of racism and medical
mistreatment of people of color in this country, and those
inequities have made the COVID crisis even more damaging for
communities of color, and made it critical we do not let
systemic racism block people of color from getting vaccinated.
I was really glad to hear that the VA has been working with
communities of color to answer questions about--any questions
they have about vaccines, but even when those questions are
answered there are still barriers to access, and often these
facilities are not located in the same community, which may
force veterans to take time off from work, or find child care,
or find transportation to reach a VA facility where the vaccine
is offered.
So what is the VA doing to build trust within these
communities and address those barriers to access?
Dr. Stone. Senator, I am going to defer to our regional
leaders, Dr. Patterson, because you have done a very aggressive
outreach to these populations. And, Dr. Patterson, if you could
also discuss just about the relative access of your veteran
population, and then, Mr. Gigliotti, if you could follow that.
Dr. Patterson. Right. Thank you for the question, Senator.
If you look at VISN 15, and we cover the States of Kansas,
Missouri, southern Illinois, some of southern Indiana, a little
bit of northeast Arkansas and northwest Kentucky, within that
area overall 95 percent of our veterans live within 60 minutes
of a VA facility, whether it be a clinic or a hospital.
Now that tells you one story for an entire six-State area.
However, if you look at individual areas within there, most of
our medical centers follow that same pattern. Some of them, for
instance Wichita, only has 73 percent who live within the CBOCs
in the rural areas that are within 60 minutes, and some are all
rural and have a lot more contact.
However, when you also talk about the way that our
hospitals reach out to every ethnic group in order to get
vaccinated, when we look at the large cities--St. Louis, Kansas
City, even Wichita--our medical centers are located in the
black communities. And so while Kansas City talks about a
vaccine desert because there are no hospitals within a mile to
five miles of the black communities, ours is in the middle of
it.
And so we are not seeing the equity problem with
vaccination because physically we are close enough to the
community for people to get there and get vaccinated.
With our clinics, particularly in our metropolitan areas--
--
Senator Murray. Okay. I am over time. So, Mr. Chairman, in
respect to you, I have a few other questions that I would like
to submit, and I want to make sure we continue to watch this
very carefully.
Chairman Tester. Absolutely. Thank you, Senator Murray.
Senator Boozman.
SENATOR JOHN BOOZMAN
Senator Boozman. Thank you, Mr. Chairman, for having the
hearing, very much. First of all, I want to thank you all for
being here, and I want to give a big shout-out to the folks at
the VA in Arkansas that are doing such a tremendous job, and
truly our frontline workers and heroes and we are certainly
impressed with the dedication that they are using to serve
their communities and their State.
So, Dr. Patterson, thank you. A lot of people from
northeast Arkansas use your services. I have been over to check
it out and again, I really enjoyed the fact that you all are
doing a great job.
Dr. Stone, I have had the pleasure of working with you now
very, very closely for the last few years and I appreciate all
that you do. I would like to talk to you a little bit about
funding. The CARES Act provided $19 billion. The most recent
data shows that roughly $9 billion of that has been obligated.
Congress recently provided VA with its full request for medical
care in Fiscal Year 2021. In December, when Fiscal Year 2021
appropriate bills, and most recent COVID-19 relief package
passed, VA indicated it did not need any additional funds to
assist with response to the pandemic.
The current budget reconciliation package being considered
in the House allocates $17 billion for VA to respond to the
pandemic. I guess the question is, what has changed between
December and today that leads the VA to require an additional
$17 billion?
Dr. Stone. Senator, first of all, thank you for your kind
comments and I appreciate and I have enjoyed----
Senator Boozman. We do appreciate you very much.
Dr. Stone. Well, thank you, sir. I think there are two ways
to think of this. First is the fight against the virus itself,
and it was the foresight of this Committee, and frankly, all
the oversight committees that got us the funding that allowed
us to express the agility that we have had throughout this.
But there is another piece of this, and the other piece, as
we turn to the final mile of this pandemic, that we are
beginning to recognize this tremendous toll on the American
population and the American veteran. It is mainly deferred and
delayed care that begins to generate what we have asked the
Biden administration to consider, and that is that we have a
very substantial need that will peak in late 2021 and 2022, as
we go through. Now, you could say, well, make this part of the
budget, but this is not a sustaining problem. This is a bow
wave that is going to come and go. And, therefore, when I was
in DoD doing wartime funding, we viewed this as what we called
contingency operation funding, which I view the American Rescue
Plan and the CARES Act as a contingency operation. Then, as
part of the budget, you have got your base funding that is
going to be ongoing. And I know since we have talked budget a
fair amount over these last few years this is something you and
I have discussed before.
Senator Boozman. Right. So we are prefunding probably
additional funds needed in 2021. Would that be fair? And 2022?
Dr. Stone. I think a number of these funds will be needed
in 2021, and especially----
Senator Boozman. It is fair to say you have not--I guess I
should ask, have we spent the dollars that we have allocated so
far? Are we in good shape?
Dr. Stone. We are still in good shape. We have obligated a
little over $7.2 billion. But we will obligate the remaining
$10 billion before the end of this fiscal year.
Senator Boozman. Okay. I am sorry. I did not mean to
interrupt. So 2021 and 2022, your concern is we are going to
need additional funding, that is kind of a one-time thing.
Dr. Stone. Yes, sir.
Senator Boozman. Okay. Very good. One thing that has come
up, I have heard from veterans in Arkansas who are eligible to
get the vaccine and then their spouses were not, and maybe that
veteran was pretty fragile and things, and then you still have
the concern of the spouse coming in and out. Has there been any
way of looking at eligibility for married couples?
Dr. Stone. Not successfully. I will tell you----
Senator Boozman. Is that just the dollars-and-cents factor,
or----
Dr. Stone. No. It has to do with the law that was written
in the late 1990's.
Senator Boozman. Okay. So you would need additional
legislation.
Dr. Stone. We need additional legislative relief in order
to get there. Yes, sir.
Senator Boozman. Well, maybe that is something that the
Chairman and I can work on.
Chairman Tester. I agree.
Senator Boozman. Thank you very much.
Senator Moran. What about the Ranking Member?
Senator Boozman. And the Ranking Member also.
Chairman Tester. Absolutely.
Senator Boozman. We do not want to leave him out.
Chairman Tester. Thank you, Senator Boozman. Senator
Hirono?
SENATOR MAZIE HIRONO
Senator Hirono. Thank you, Mr. Chairman. I am told that,
Dr. Stone, you have not been asked this question yet. What is
your targeted number of veterans to be vaccinated?
Dr. Stone. We would like every veteran in America to be
vaccinated, but right now, with the austere supply we have, we
are targeting the 6 million active users of the system,
Senator, and those 6 million active users are those that have
depended upon us, and it is absolute that we must take care of
those 6 million first before we look at any expanded
population.
Senator Hirono. When do you think you will be able to
vaccinate those 6 million active users of the system?
Dr. Stone. It entirely depends on the available vaccine.
Our goal was within a 120-day period to be able to vaccinate.
It remains to be seen whether we will have a sustained supply.
It is not terribly difficult to figure out that if you getting
125,000 doses a week, how many weeks it is going to take you to
get to 6 million. If we receive a half a million this coming
week and that is a sustained amount, we can move very quickly
and meet our goal of vaccinating this high-risk population.
Senator Hirono. So, Dr. Stone, you have a capacity to
vaccinate a lot more people than the number of doses that you
get. What is your capacity right now?
Dr. Stone. Capacity right now is in excess of 300,000 a
week. I mentioned that over the holiday weekend we were able to
do over 70,000 a day. I think that is sustainable. And so,
therefore, somewhere between 350,000 and 600,000 a week is
certainly within the realm of possibility.
This is one of the most effective vaccination programs
ever, remembering that nobody has tried to do this since the
Sabin and Salk vaccines of the 1960's in the polio epidemic in
the children of America.
Senator Hirono. Yes. So did you say that you get 125,000
doses per week, that is currently what you are getting now?
Dr. Stone. We were just called on the way over here to say
that we would be getting about 500,000 doses this coming week.
We have seen a gradual increase, and we are very hopeful with
the new vaccine that is coming on the market that we will
continue to see increases, and the problems that we are having
with the amount of vaccine will resolve itself over these next
number of weeks.
Senator Hirono. So you are getting 500,000, and your
current capacity is 300,000. Are you opening up other PODs
outside of the VA system to provide these vaccines?
Dr. Stone. We will expand our VA direct delivery system to
accommodate this. We are very efficient at it. We also have,
through our Community Care, offered through our urgent care
system, vaccination if those are urgent cares were able to get
vaccine. And so we will continue to increase our capacity as we
receive additional supplies.
Senator Hirono. So you can do this all within the VA
system, is what you are saying.
Dr. Stone. Yes.
Senator Hirono. So you did indicate that you are
vaccinating first the people who are in your system. So there
must be a lot of veterans who have never utilized veteran
services. But at some point you need to contact them, right?
Dr. Stone. We are reaching out to veterans and asking
veterans. We have had over 8 million contacts the last few
weeks, where we have reached out to veterans and encouraged
them to enroll in VA health care. Both Mr. Gigliotti and Dr.
Patterson can discuss their efforts in enrolling veterans on
the spot who come in for vaccination.
Senator Hirono. I am running out of time, so I originally
asked what is your target number and you did not give me the
number. You said 6 million currently in the system. But how
many veterans are out there?
Dr. Stone. There are 18,500,000.
Senator Hirono. And your goal should be to get every single
one of them vaccinated, assuming that they are not going to
object to getting a vaccine. So I know that you are doing
everything you can to reach out to all of the veterans who are
not within the system right now. Have you seen that during this
COVID that there are veterans who have not utilized veteran
services who are contacting you on their own because they want
to be vaccinated?
Dr. Stone. Yes.
Senator Hirono. Good. You have been asked a number of
questions about vaccine hesitancy, and I think you said that
you have not seen that--I may have heard this incorrectly--you
have not seen this in communities of color, vaccine hesitancy.
Did I hear that correctly?
Dr. Stone. You did. We are actually very proud of the jobs
that the team has done to reach out to communities of color, to
improve their trust and confidence in both the vaccination
program and the VA.
Senator Hirono. So there is just one more quick thing, if
you do not mind, Mr. Chairman. I do appreciate that the VA is
providing vaccines to veterans in Guam and American Samoa. I
understand the rate of vaccination among these veterans is
really low, with only a handful of veterans in these places
being vaccinated so far. I hope that you are making concerted
efforts to reach out to the veterans in Guam and American
Samoa. They often have difficulty getting access to veteran
services. That is my understanding. So there are logistical
challenges to them getting the vaccines, that I hope you are
addressing these challenges, Dr. Stone.
Dr. Stone. Senator, I will tell you, this has been a very
frustrating area. We have been working through the Departments
of Health at each of these areas. We have agreed to bring in
additional personnel to support those Departments of Health. We
need the Departments of Health, primarily because of the
refrigeration capacity, and we are looking forward to the newer
vaccines as they come that do not require as complex handling,
to expand our ability to reach each of these islands and areas.
Senator Hirono. Thank you. Thank you for doing your very
best. Thanks, Mr. Chairman.
Chairman Tester. Thank you, Senator Hirono. I want to
recognize one of the two new members to the Senate Veterans'
Affairs Committee, next, Senator Tuberville. And we have all
been waiting anxiously for your questions.
SENATOR TOMMY TUBERVILLE
Senator Tuberville. Thank you very much, Mr. Chairman.
Thank you for what you do. I am a military brat. Dad died on
active duty. Huge. I spent a lot of time in the VA over the
years with my dad. But as a representative of the State of
Alabama we have 380,000 veterans. We are a military State. And
I just recently went through most of our VAs through the State,
and I am very proud of what they are doing. Obviously, we have
got a lot of work to do in some areas. but we have got a lot of
veterans, and with these wars that we have had we have got a
lot more coming. And all veterans need a vaccine. They all need
it. We all know that, and we are talking in circles in here, in
some areas.
There are a lot of new veterans in our State that have
PTSD, underlying conditions. And I know that we want to get it
to the older veterans, and rightly so, because they are more
vulnerable. But nobody is any more vulnerable than our kids,
our young men and women with PTSD, and we have got a lot of
them. We are losing 22 veterans a day to suicide, and that has
really increased since this virus, because stacking one problem
on top of another creates more problems.
And I really do not have a question. I just wanted to ask
you, really, is there any priority to any of these young men
and women that have recently come back, you know, with PTSD,
with underlying conditions, with lost legs, lost arms, that
have huge problems on top of problems, and scared to death that
they are going to get this virus but they cannot get the
vaccine. Is there any priority that we can look at that?
Dr. Stone. There is, sir, and it is part of that 1c group
that Dr. Kim was talking about, as we have looked at it. Now we
have not seen an increased amount of virus sensitivity based on
PTSD, but we have seen a lot of problems, and those problems
primarily relate to the intense isolation that has occurred
because of this pandemic and the fact that people have been
locked in their homes.
Therefore, we have converted about 75 percent of our
behavioral health engagement to video-type visits that have
reached into the veteran's home, and we have replaced face-to-
face visits with video visits that a veteran can interact with
our psychiatrists and psychologists to make sure they remain
stable.
Our calls to our Veteran Crisis Line have gone up very
significantly. Part of that is the 988 system that is being
fielded around the Nation. But the rest of it is because of the
really strain on this population that you so articulately laid
out. This is an extraordinarily at-risk population that needs
our engagement.
Senator Tuberville. Thank you very much. Another thing that
I noticed--and not just going through the VAs but also the
hospitals all over Alabama--we are struggling, at times, even
getting first responders to take the vaccine. They are a little
leery about taking it. Marketing is a huge problem sometimes,
in something new like this. I wish, you know, with the
trillions of dollars, billions of dollars that we are spending
on this, sometimes you need to market, you know, through public
service of take the vaccine. We have got to get rid of this
thing. I mean, and people do not take this if they are leery of
it.
Sometimes you even use football coaches. In our State we
have got a pretty famous one in that State that probably could
do a PSA to say, ``Take your vaccine. First responders,
veterans, anybody that has an opportunity to take it.'' I think
sometimes we forget to use the things that we have at our
disposal to get people to understand that, you know, things do
work, and we are not trying to trick anybody. We are just
trying to make it work.
But again, thank you for your service. Thank you for what
you are doing. We truly--and I know our veterans appreciate it
too. We truly thank you. Thank you very much.
Thank you, Mr. Chairman.
Dr. Stone. Senator, thank you. Let me just respond that
anybody that a veteran trusts, that can talk about this
vaccine, has value to making sure that we increase the amount
of vaccination. Your State has some of the lowest acceptance
rates of vaccine in the country, and part of that dates back to
World War II era, where there were some egregious things done
in various experiments. So that message needs to be overcome,
and we would welcome participation in that, to get that message
out.
Chairman Tester. Thank you, Senator Tuberville, and I am
sure the football coach you are referring to is the old Auburn
Tiger himself, Coach Tuberville.
Senator Blumenthal?
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thanks, Mr. Chairman. I apologize if I
cover ground you have already done, but I first want to say how
proud I am to know that Connecticut, really, I think it is at
the forefront of these efforts to vaccinate veterans. In
Connecticut, 47 percent of our veterans have received a first
dose, and 23 percent a second dose, which is far ahead of the
national average. I am also pleased to say that 77 percent of
our veteran employees have been vaccinated, and so they are
protected.
I think that this kind of record is due to real leadership.
Obviously, you are trying to inspire that kind of leadership at
the national level. But we need more aggressive leadership at
the local level to counter the kind of misinformation and
hesitancy that is found among certain populations, and, as
well, to provide vaccinations to caregivers and spouses, family
members, who live with our veterans, because I think one of the
reasons why veterans may not come for a vaccine is that their
spouse or caregiver is not going to get it as well, and either
because they depend on that person for transportation and
advice or for some other reason, they may be hesitant.
I know you have answered the question about what can be
done to provide the vaccine to those caregivers, the non-
veterans who provide for our veterans, and that you would need
additional statutory authority to do so. Is that correct?
Dr. Stone. For the most part, yes. It is a bit of a nuanced
answer and I apologize for that. For those families that are
engaged in our subsidized or reimbursed family caregiver
program, that caregiver program we do have authority to give
vaccine, and have vaccinated more than 2,000 family caregivers.
What we do not have authority for is the rest of the population
that are not on subsidies, and in those subsidies--and it is a
nuanced, complex answer and it is not very satisfactory, sir.
We need some additional authorities to get to the rest of that
population.
We have 200,000 elderly, frail veterans that we are helping
in the home. About 20,000 we can vaccinate their caregiver, and
180,000 we cannot. And that is the kind of discussion that we
need to have of how we get those additional authorities in
order to protect that veteran and their caregiver.
Senator Blumenthal. Well, I offer my support and help.
Whatever we can do to expand that authority, if necessary, I
think there would be strong support for it.
And as to the younger veterans, are they more hesitant? Are
they less likely to take the vaccine? Do you notice any
difference in age groupings as to that hesitancy?
Dr. Stone. I am going to defer to Dr. Kim on this.
Dr. Kim. Yes, I will maybe speak to the focus group that we
did with veterans, that included veterans of younger and older
age, and I think what we saw, you know, I think reflects maybe
what we see in non-VA surveys from last year, is that hesitancy
is at all age groups, unfortunately. I think it falls along
racial and ethnic lines, actually, where blacks and African
Americans and Hispanics had more hesitancy compared to whites,
and that was played out by age. And I know it was a focus
group, but I think it just really parallels what we see in
larger national surveys.
So I think our efforts to communicate really reach across
ages, to make sure that we get the messaging across about the
science, that we can trust these vaccines, that they are safe
and effective.
Senator Blumenthal. And then, finally, if you had to pick,
out of a community, one person, one type of person to overcome
that hesitancy, to recruit people to take the vaccine, would it
be a faith leader? Would it be a coach? Who would you choose?
Dr. Stone. It would be your provider, your nurse
practitioner or your PA or your physician.
Senator Blumenthal. So someone with medical credentials----
Dr. Stone. Yes.
Senator Blumenthal [continuing]. to talk about medicine.
Makes a lot of sense, right?
Dr. Stone. And, sir, that is exactly why we think we have
done so well with this, is we have had this proactive outreach
to our communities, especially our communities of color, and we
think that is why we have erased the disparities in the
population, that other parts of the American health care system
are seeing. And we are trusted, because of what Dr. Patterson
said. We are trusted because we are in those communities.
Senator Blumenthal. And again, the people who are most
persuasive and compelling on an issue of science or medicine
are the people who have the credentials of medical doctors or
nurses or scientists, who can attest to the efficacy and safety
of the vaccine.
Dr. Stone. Yes, sir.
Senator Blumenthal. Thank you. Thanks, Mr. Chairman.
Chairman Tester. Thank you, Senator Blumenthal. Senator
Sinema.
SENATOR KYRSTEN SINEMA
Senator Sinema. Thank you, Mr. Chairman, and thank you to
Ranking Member Moran for holding this hearing, and thank you to
all of our witnesses for being here.
Dr. Stone, I appreciate that in addition to providing
vaccine support for its work force, the VA has stepped in to
support vaccine distribution for the Department of Homeland
Security. This is an especially important program for Arizona's
Customs and Border Protection employees.
In Arizona, the VA should further identify ways to offer
vaccines for CBP employees through VA community clinics and
mobile vet centers, given the often long distances between
where they work and the nearest VA medical center. You know, it
is 3 hours from Yuma, on the border, to our medical centers in
Phoenix or San Diego, and it is 3.5 from Yuma to Tucson. So I
would appreciate you and your office keeping me updated as you
work with DHS to expand this program, and share any challenges
you experience.
We have heard from a number of Arizona veterans with
questions and concerns about the availability of the vaccine
and scheduling appointments across the Arizona VA medical
centers. I appreciate the responsiveness of the Arizona VA
medical centers as my team works at the local level to address
these concerns. So I will focus my questions on how these
issues are being addressed nationally.
Currently, the VA has 9.3 million enrolled veterans, 6
million with an active status. We have received calls from
veterans who enrolled with the VA, have an inactive status, and
are scheduled and then canceled, presumably because of their
inactive status. Should veterans with an inactive status have
access to vaccination appointments, and if so, what clarifying
guidance must be sent to the medical centers to make sure that
they do?
Dr. Stone. When we are no longer in an austere environment
where we know that we are only going to get 6 million doses, I
think will be able to expand to the rest of the enrolled but
not active users.
Senator Sinema. So there will be a point where the VA will
be able to offer vaccines to inactive status veterans.
Dr. Stone. That would be my absolute desire. You know, my
view is that none of us are going to get our lives to turn back
right-side up again until we get the American population
vaccinated. So I share your desire to get vaccine into as many
people as we can. And as soon as CDC and HHS can assure us that
we will move beyond the 6 million doses, we will expand, and we
are actively recruiting veterans to move to enrolled status so
we can begin to interact with them.
Mr. Gigliotti, I think, can discuss some of the efforts in
his VISN, as can Dr. Patterson in his VISN, to really seek out
those veterans and to bring them in.
Senator Sinema. Well, thank you. My next question is, how
is the VA tracking instances of canceled vaccination
appointments to ensure that veterans are not losing access, and
how are they identifying and fixing potential problems as they
arise?
Dr. Stone. Mr. Gigliotti or Dr. Patterson, do you want to
take that?
Dr. Patterson. Senator, what we do is reschedule them. So
if they call in and cancel and cannot make the appointment we
usually ask them why, just to be sure that, for instance, they
are not ill and maybe they need to come to the clinic anyway.
But we just put them back on the list and reschedule them.
Senator Sinema. Okay. Do folks fall through the cracks when
that occurs, or is that not something you have experienced?
Dr. Patterson. You know, it is really interesting when I
visit the medical centers and see the vaccination clinics, the
incredible enthusiasm that the staff has. It is really
rewarding to go and watch how eager they are to vaccinate
people. So they have a list and they keep up with it. I cannot
guarantee that nobody falls through the cracks, but clearly
they want to get them vaccinated.
Senator Sinema. Thank you. Moving on, the Northern Arizona
VA Health Care System is piloting the use of a mobile vet
center to bring vaccines to community clinics in an effort to
expand distribution to more rural areas. This is very important
for vaccinating Arizona veterans. What is the VA doing
nationally to ensure that as efforts such as this expand access
to rural and highly rural areas, how is the VA working to
ensure that these are successful, that they are resourced
appropriately across the VA network, so that rural and highly
rural veterans can also access the vaccine?
Dr. Stone. So Mr. Gigliotti, in his VISN, piloted an
airborne delivery of vaccine. We have now expanded that to VISN
20 in both Alaska and Oregon. We also are using mobile assets,
as you referenced, and we are discussing these type of unique
solutions on a daily basis, in what we call our health
operations update, where each of the VISNs highlights what they
are doing to get vaccine out.
We have been having ongoing discussions with our emergency
operations team to make sure we have maximum numbers of
vehicles available and have been working with the White House
team to assure that we are taking what I view as the most
difficult area of inequity, which is the remote areas of this
Nation where there are health care deserts, trying to get
vaccine into areas.
We are very proud that last week we flew an airplane into
southern Alaska to an island where there were 50 veterans, and
vaccinated virtually the entire veteran population. It is that
kind of creativity and effort that I describe as part of the
herculean effort that we are undergoing. Nobody has done this
before, but one of the things we have recognized is these huge
distances and remote areas, especially as you have described,
in your State.
Chairman Tester. Thank you, Senator Sinema.
Senator Sinema. Thank you.
Chairman Tester. Next up we have the second newest member,
or one of the two newest members, I should say, from the great
State of New Hampshire, Senator Hassan.
SENATOR MARGARET WOOD HASSAN
Senator Hassan. Well, thank you very much, Senator Tester
and Ranking Member Moran, for holding this hearing on what is a
critical issue of vaccine distribution to veterans. And I just
want to say I am really excited to be a member of this
Committee and I am really looking forward to the work that we
can do together to serve our veterans. And I want to thank the
witnesses today for your work to serve our Nation's veterans
too.
Dr. Kim, I wanted to start with a question for you. First,
thanks for working to get these vaccines out to veterans as
quickly as possible. New Hampshire, as you probably know, does
not have a full-service VA hospital, and as a result, Granite
State veterans get some of their care across the border at the
VA Medical Center in White River Junction, Vermont, or in
Bedford, Massachusetts. That can create some challenges when
the States are not fully aligned in terms of vaccine
availability and protocols.
So how does the VA determine the vaccine allocation for
these kinds of facilities that serve veterans across State
lines, and what steps is the VA taking to disseminate the
information to veterans who may be crossing State lines to get
their care?
Dr. Kim. Sure. So I think, Senator, that the answer to that
question is that we know for the veterans who receive care in a
certain medical center who they are. We know their age, their
demographics, et cetera. So whether they live in New Hampshire
or whether they live in Massachusetts, if they are served by
that medical center or clinic we know whether they are in a
priority phase for vaccination.
So we will reach out to them, regardless of where they
live. I have patients who I see in North Carolina but they live
in Virginia. To me that does not matter. They are served by me
so I will reach out to them when it is their turn. And I think
the same would apply to your veterans, as well, in your State.
I wonder if, you know, the question is whether--you know, I
know each State has their own phase where they are. Certainly
each State has flexibility to do that. For the VA, you know, we
do follow CDC, but there is flexibility, say, for your area of
the country, for that particular VA to move into Phase 1a, 1b,
or 1c, depending on how much supply they have. But it really
depends on the veterans they serve in that facility as to, you
know, when they are reaching out to them.
Senator Hassan. Thank you. Another question for you, Dr.
Kim. Many facilities are offering an online appointment
registration system for veterans to sign up for the vaccine,
and if this has been asked already forgive me. But the online
portals are obviously a great tools. Some veterans may struggle
with the technology, though, or they do not have the
connectivity to access the system. And many veterans in my
State live in rural areas, which, one, has less access to
broadband. Also a lot of veterans in my State are older and
have less exposure to online tools.
So what alternatives is the VA offering veterans who may
have limited internet access or technological know-how to
register for appointments online?
Dr. Kim. Sure. I will just say--and I will let Mr.
Gigliotti and Dr. Patterson comment--we are using all
modalities, especially those we know that are veterans in each
medical center respond to.
Senator Hassan. Thank you.
Mr. Gigliotti. Senator, in that scenario, the partnership
with American Legion, Disabled American Veterans, and other
service organizations is critical to get the word out. One
thing we have also had great success with are electronic town
halls. They have really ramped up in the last year, due to the
pandemic. The minimum attendance that we have had is 1,500, and
in some cases up to 8,000. So veterans getting the word to
other veterans has also really helped in that scenario.
Dr. Patterson. Yes, Senator. The veteran service
organizations are a great partner in this way. We reach out to
them, ask them to contact their members, and they will also
contact other people in the community, even if they are not a
member of the VFW or the Legion. And we are using some of their
facilities, because it is a great drawing point.
Senator Hassan. Thank you. I will just echo what Senator
Sinema was just speaking about, in terms of making sure we are
getting to our rural veterans in remote areas. And it was great
to hear the pilot programs you have up in Pittsburg, New
Hampshire, which is on the Canadian border. It is one of our
largest towns but it has 900 people total, and it is a
beautiful spot but it takes 3 hours for people in wintry
weather to get to Manchester. So I really appreciate those
efforts and would like to work with you all on expanding them.
Dr. Stone, I wanted to drill down a little bit on the data
you have about veterans who are declining the vaccine. We have
begun to see data on the rates of certain segments of the
population declining to get the vaccine, including actively
serving military members and first responders, something that
you have heard about from other members of the Committee too.
In your testimony you described listening sessions with
minority veterans and other concrete steps that you are taking
to help reduce vaccine hesitancy among the veteran population.
Now that vaccines are being administered, are you gathering
data on how many veterans have declined to receive the vaccine
and whether their reasons match the concerns you were hearing
about during your planning?
Dr. Stone. I do not think our data is as clear as it should
be, and it appears that about 15 percent of the population is
declining. And then as time goes on much of that is just a
hesitancy, that once their friend begins to get it, or a fellow
veteran, or a family member does, they will then go ahead and
get the vaccine. So the numbers are declining of hesitancy, but
it requires very active listening sessions and engagement of
that population in order to resolve it.
I will tell you, I have worked the vaccine clinic that we
have been operating in Washington, DC. Many of the people
coming in, especially in the communities of color, want
pictures taken so they can send it to their family members,
say, ``Look, I got the vaccine.'' It has been a very emotional
engagement, even as a provider with 40 years of experience.
These are very emotional engagements for many of these
families. But it is those kinds of things that we have been
talking about that I think has made us successful in erasing a
lot of the hesitancy.
Now there is a portion of the population that will never
get the vaccine, and we have seen that with vaccine, really,
refusal across many areas of the country, over multiple types
of vaccines. This is really unique, new types of vaccines that
we are dealing with, and it is just going to take a lot of
education and a lot of work and a lot of trust for us to get to
where you and I would like to be one this.
Senator Hassan. Thank you very much. Thank you, Mr. Chair,
for your indulgence.
Chairman Tester. Thank you, Senator Hassan. A couple more
questions, really quick. First of all, just to followup to
Senator Hassan's question, I think gathering that information
as to why the veterans are hesitant is critically important.
You are spot-on on rural veterans. I think the Ranking Member
would concur that there is a lot of hesitancy in rural America
and we have got to figure out how to break that down.
Mr. Gigliotti, you are using fly ins to reach rural
veterans, and you talked about expanding that to VISN 20, at
least Dr. Stone did. I think it is really good. I think the fly
ins can be incredibly effective, and they have been incredibly
effective. The question is, are there other approaches you plan
to use, because the fly ins are a bit limited.
Mr. Gigliotti. Thank you, Mr. Chairman. We are using the
fly ins, as you said. Today is our third one. Lewistown is
having that. We are using dual-use vehicles and the medical
mobile units, where we have them across our VISN, and those are
part of the deployment strategy to reach the rural veterans,
particularly in the rest of Montana, Wyoming, and we are
looking at eastern Utah for that. So those are critical.
Dr. Patterson made the point, in his VISN, which is
accurate for mine, that 90 percent of our VISN population of
veterans lives within 60 miles of a facility that can give out
the vaccine, and a large chunk of that percentage is within 0
to 30 minutes, and then 30 minutes to 60. So it is really going
to be important for us, when the volume increases in the
vaccine, to get the word out, to be able to come to those
clinics themselves, and for those very rural areas using those
two vehicles, the flights as well as the dual-use vehicles.
Chairman Tester. Yes, and it all works together. You guys
know that. I mean, the availability of the vaccine is No. 1, so
you guys can plan for it and tell the folks where to go, to
those CBOCs, or whether there is a mobile van going out and how
to get to them. So I appreciate that.
Dr. Stone, what percentage of the work force has refused
the vaccine?
Dr. Stone. I can tell you that 73 percent of the entire
work force has received the vaccine, over 90 percent of our
clinical personnel. Refusals of the vaccine have primarily
occurred amongst some of our non-licensed personnel in our
CLCs, and we are working hard to do educational programs for
that in order to get those numbers up.
Chairman Tester. As a last resort, do you have the
authority to make the vaccines mandatory as a condition of
employment, regardless of whether these are medical
professionals or they are non-licensed personnel?
Dr. Stone. Senator, I have that authority but I am not
going to use it, and I am not going to use it under the
Emergency Use Authorization. When there is full licensure of
the vaccine we will revisit that decision, but as an Emergency
Use Authorization, and the fact that our employees are
dramatically taking the vaccine. This is much different than
the commercial marketplace. Our employees are taking the
vaccine, and I am very pleased. That has been reflected in the
fact that prior to the vaccine we were running consistently
6,000 employees that could not come to work because of either
exposure or actual infection with COVID. That number this
morning has dropped to under 1,100. So literally 5,000 more
people are coming to work now than had.
Chairman Tester. Senator Moran.
Senator Moran. Senator Tester, thank you for the second
round. I will try to be brief, as you were. I want to ask a few
questions related to the $17 billion request for the VA making
its way through Congress. In my view, unfortunately, it is
coming through Congress in an expedited manner, that we will
not have, as this Committee, the opportunity to debate and
amend, or even understand that legislation.
I want to visit with you about how the request is related
to the $10.5 billion that is remaining in the CARES funding
currently. Is it true--I think you said this, maybe in your
opening Statement--is it true that the remaining $10.5 billion
in CARES funding will met COVID-specific needs, such as PPE,
testing equipment and supplies, increased health care costs,
through the remainder of the fiscal year?
Dr. Stone. It is my anticipation that it will meet the
requirements primarily of health care. About $3.5 billion is
needed for Community Care, and we have a request that is
working its way through to repurpose $3.5 billion in Community
Care. The majority of the rest will go into direct patient
care, within our direct care system, for the care of patients
with COVID.
Senator Moran. So $10.5 billion, about $3 billion of it
needs to be repurposed to meet Community Care opportunities,
requests, and the other $7.5 billion is to provide care within
the VA?
Dr. Stone. The financial people are probably cringing at
this point because I am sure there is a piece that I have
missed. There are some pieces that are going into the homeless
programs. We have taken the caps off of HUD-VASH vouchers to
make sure that we are taking away insecurity in homes. But that
is primarily what it is addressing.
Senator Moran. And then the $17 billion that is in what I
would call Phase 5, the legislation that the House is currently
considering, those are targeted at needs that may occur in
Fiscal Year 2022 and beyond, and in part, at least based upon
pent-up demand for health care?
Dr. Stone. I would not quite put it that way. I think it
will be late 2021 that that occurs. I think probably the last
quarter of 2021 we are going to see a bow wave.
Let me give you an example of this. We are down by 12,000
surgeries a month in our direct care system. They are not going
out to the community. That is pent-up demand and it is surgery
being done later. Think about putting off a knee replacement
for a year. That is a tougher surgery. And so what our
actuaries are telling us is that deferred and delayed care is
going to create a bow wave that none of us anticipated a year
ago, when we were looking at what was in the CARES Act.
In addition, reliance on our system that is coming because
people are losing insurance because of job loss is resulting in
more veterans enrolled. We will enroll well over 300,000
additional veterans this year. And so that sort of bow wave is
what we are trying to take care of in this late 2021 and 2022
timeframe. It is our hope, then, that that will stabilize once
we have taken care of that, and we can come back here with a
much more optimistic picture.
Senator Moran. Dr. Stone, you would not expect me not to
ask this question. The reason that I want to make sure I
understand--you also said it is not occurring in the community,
under Community Care, it is not occurring in the VA, the
surgeries that you described. The fact that it is not occurring
in Community Care is not a result of anything that the VA is
doing to restrict that from occurring in the community. It is
just that the patients are deciding to defer. Is that true?
Dr. Stone. The best example of this is the fact that we
have got a big problem in VBA, where we have got people that do
not want to come in for their comp and pen exam. So we have got
a lot of built-up comp and pen exams. Over 50,000 of those are
veterans that just will not come in for a face-to-face visit.
Well, if you will not come in for your comp and pen exam, you
are not coming in for your knee replacement either.
And so it is not because we are failing to refer to the
community or have not built an adequate community environment
for people to go to. This is exactly what happened after the
great influenza of 100 years ago, that there was this bow wave
of care that was necessary because it was delayed or deferred.
Senator Moran. Dr. Patterson, anything unique about our
VISN in regard to this topic?
Dr. Patterson. No, Senator. There is not.
Senator Moran. Okay. Thank you. Just to conclude, Mr.
Chairman, first of all, Dr. Patterson, is there anything that
you would--I do not know how many times you have testified
before Congress, but welcome to this occurrence. Is there any
request that you would have of me on behalf of the veterans in
our VISN, that you would like for me to know?
Dr. Patterson. Well, Senator, I know you visit every county
every year, and I really appreciate it when you come visit our
vaccine clinics, because it is great press for us. It hits the
local news, and I think it just encourages veterans to come in
and get vaccinated.
We have a rally cry in our network called ``Reclaim the
Summer,'' and you might have heard that when you were in Topeka
earlier this week. But that is what we want to do. We want
everyone vaccinated so we can have a summer again, play
baseball.
Senator Moran. I like that. In the absence of the Chiefs'
victory maybe we will have a Royals victory.
I would add to only confirm what Senator Blumenthal said,
and that is the importance of spouses and caregivers. And
yesterday Senator Tester and I, in our conversations with the
general and the doctor, General Perna and Dr. Kessler, raised
this issue with them, and they indicated a willingness to see
if there was something they needed to do to make this possible.
I did not understand your response to Senator Blumenthal.
Is there something that prohibits the VA from vaccinating
spouses, spouses who are not veterans?
Dr. Stone. Yes.
Senator Moran. Okay. And that could be corrected within
this system that we have developed for distribution of
vaccines, or takes something within the VA, within the
Congress?
Dr. Stone. Not within the authority of the Secretary to do
non-veterans for providing any sort of health care, unless they
are on the stipend program.
Senator Moran. Maybe there is a way to get to it in the
fourth mission. I will look for ways to be of help in
accomplishing that.
Dr. Stone. Sir, we are talking to a number of States about
exactly that, and working with a number of States to try and
get at it in that manner, and thus unload the rest of the State
from the vaccine that is necessary and protect veterans at the
same time, sir.
Senator Moran. That is good news. Mr. Chairman, thank you.
Chairman Tester. I will tell you this, Ranking Member
Moran. Our staffs are going to get together and we are going to
figure out what kind of language it needs to give them the
temporary authority in this particular case of a pandemic, and
then we are going to give all the credit to Boozman. That is
just the way it works around here.
I just want to thank you guys for your testimony. I am
going to give you an example of exactly what you are talking
about on pent-up demand. My brother, who is a few years older
than I am, that has COPD, has not seen a doctor in a year. He
just got his second shot. He is proceeding to set up doctor
appointment after doctor appointment after doctor appointment
right now. There is a lot of pent-up demand out there, and
there will be. You guys being able to deal with that is going
to be a challenge.
The other thing we have not talked about here today, that
we all know is a big deal, is mental health, and the fact that
the isolation caused by this pandemic has only contributed, not
only in the VA but across society, to increased mental health
problems. I just met with a bunch of school personnel today
that are talking about kids having increased mental health
problems.
I will just put a plug in for the John Scott Hannon bill,
that the Ranking Member and myself got done last Congress. I
think that can help, and, of course, telehealth can. But that
is another expensive proposition that we have to deal with.
Thank God you are there, Dr. Stone, and you have good people
like the panel up here today, that can deal with that.
Look, I cannot give you guys enough credit. The Ranking
Member and myself were on the call yesterday with Dr. Kessler
and General Perna, and, quite frankly, we just need to get more
vaccines in your hands to get distributed. I think what
happened today is a really good sign, and hopefully that will
keep up. And they assured us that, by the way, it would come
up, that it would ramp up more and more. And, in fact, in 3
weeks it sounds like you guys may be really in full swing.
So thank you for what you are doing. We are going to
continue to push the administration in a bipartisan way to use
all the authorities they have to get more doses allocated for
the VA. It is important that we take care of our veterans. It
is a cost of war.
I would ask that any post-hearing questions be sent to the
clerk no later than a week from today, and we will keep the
record open for a week as well.
This hearing is adjourned. Thank you all.
[Whereupon, at 5:49 p.m., the Committee was adjourned.]
APPENDIX
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