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tv   Responding to Biological Attack Pandemics Infectious Diseases  CSPAN  June 15, 2018 1:36pm-3:37pm EDT

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>> news this afternoon that president trump's campaign chairman paul manafort is being sent to jail. a federal judge ordered him into custody citing newly filed obstruction of justice charges. he's awaiting trial on federal conspiracy and money laundering charges next month he faces spending the rest of his life in prison. coming up tonight on c-span, more campaign 2018 coverage. primary debate in new york's 11th congressional district. and ates dan dunavan former congressman myal call grimm face off.
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that's tonight at 8:00 eastern. next up a hearing on u.s. preparedness for potential biological attacks, pandemics and infectious disease outbreaks. lawmakers heard from dr. anthony fauci of the institute for analysis of infectious diseases. they also talked about security risks and vaccine development and the management of medical supplies that could be used in a public health emergency. mr.harper: today the subcommittee continues its
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hearing on infectious diseases that endanger the public health. the purpose is to hear from top public health experts on the good work being done at their agencies to protect the public and explore where immaterial improvements need to be made. the biological threats facing the united states in today's global society are ever-evolving and in some cases intensifying. the c.d.c. just reported that the seasonal influenza claimed the lives of 172 children during the most recent flu season. making it the deadliest seasonal flu season for children on record. in recent year the u.s. has also seen an increase in the number of antibiotic resistant bacteria. around the world, viruses are emerge, adapting, and and in some cases re-emerging. currently there's an ebo la outbreak in west africa and a nepa virus outbreak in india that killed at least 17. in recent years we have seen mans in china contract the
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h7n9 influenza strain that's been limited to birds. it's rated by the influenza risk assessment tool as posing the greatest risk to cause a public pandemic. the 2013 ricin mailings addressed to president obama and senator wicker that originated in my home state of mississippi as well as the 2001 anthrax mailings and foreign terrorist threats is a reminder of the risk of intentional biological attacks. today's hearing is especially timely given that the committee is hearing bipartisan legislation sponsored by ms. brooks and ms. eshoo to re-authorize the pandemic and all hazards preparedness act which is set to expire at the end of september. provides pahpa information for industry
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partners and bring about much-needed reforms. one such reform proposed in the legislation is transferring control of the strategic national stockpile from the c.d.c. to h.h.s.'s office of the assistant secretary for preparedness and response to improve management of the stockpile. a year ago, h.l.s.'s office of inspector genre ported systemic issues with security and inventory management of the stockpile risking c.d.c.'s ability to deploy the stockpile during a public health emergency. these issues need to be addressed as does improving the training of state and local stake holders on deployment of medical countermeasures. administrative reforms are also of interest. for example, are there ways to improve the timeliness of the decision making process on threat assessments and appropriate countermeasures. effective threat detection has been a subject of committee oversight. in 2016 the committee questioned the c.d.c. about the
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effectiveness of its laboratory response network or l.r.n. which is responsible for developing assays for public health labs to test for the presence of federal select agents. in a may, 2017, letter to the committee, the c.d.c. reported that the l.r.n. only developed three assays approved by the f.d.a. to detect specific federal select agents. while the l.r.n. has also had those cleared by the f.d.a. under emergency use authorization, after nearly 20 years of this program with about $135 million in funding over the last decade, could the l.r.n. have cleared significantly higher numb of assays through 510-k rigorous f.d.a. process. finally maintaining public confidence in critical preparedness research is essential. in response to safety lapses in
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2014 and an expert fanl's recommendation, the c.d.c. and f.d.a. each formed new offices in 2015 to centralize and elevate oversight of laboratory safety with directors of those offices reporting directly to the agency head. these changes sent a strong message that lab safety was a top priority backed by the clout of direct backing from the agency head. unfortunately both seemed to be back tracking from this good direction. in the f.d.a.'s case,less than a year after this administration approved the reorganization, the sudden change is curious and would seem to be a step in the wrong direction. i would like to thank the distinguished members of our panel for being here today and for your service to our country. i now recognize the ranking member of the subcommittee from colorado, ms. degette, for five minutes.
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ms. degette: thank you, mr. chairman. i know we agree that preparing this country far bioincident is of critical importance. the threat, as you said is real and growing. in april, the c.d.c. reported that in 2017 colorado saw 25 cases of an antibiotic resistant bacteria known descriptively as the nightmare bacteria because 50% of those infected by it die. thankfully those cases were isolated but the same c.d.c. study noted that it's possible for these germs to, quote, spread like wildfire. if that happens, we need to know that we're able to respond. we've looked at this issue in this subcommittee many times over the years as our panel well knows. it's a regular appearance and i want to thank you for coming again. and again and again we found that the federal government has to scram to believe address biosafety incidents. those of us who were here during the fall of 2001 vividly recall the chaos that a few small
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envelopes caused on capitol hill. officers were closed, build wrgs fumigated, some congressional business was suspended and thousands of staffers and other personnel lined up for days to get tested for exposure. far worse, some of the workers in our postal service were infected and died. in 2009 we again had to scramble to produce sufficient doses of swine flu vaccine to protect against this strain of the disease. 2013, hospitals and health care providers were not prepared to deal with the arile of ebola patients in america. in one case a hospital in dallas failed to diagnose ebola in a patient who had traveled to west africa and discharged him. the virus was later transmitted from that patient to two health care workers. in the days and weeks that followed, important questions were raised about how this event was handled and were we
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adequately prepared for the larger event. and then and then of course in 2015 the zeke outbreak underscored the need for the u.s. government to work on disease preparedness every day. and i know the panel here today does just that. i'd like to know, today, though, what lessons we've learned from these incidents and i want to know how the agencies are using what we've learned to better prepare for the next crisis. because there will be one. for example, do we have adequate medical countermeasures in place to respond quickly when an outbreak occurs or a toxin is released? do we have the capacity to quickly deliver these countermeasures to the doctors and nurses who will actually use them? and do the health care workers understand how to deploy the countermeasures? similarly research is key to helping us quickly respond to new and expanding outbreaks.
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how is this research informing our tech nothings? are we prioritizing research into threats of greatest concern? and are we dedicating adequate esources to the threats? i also want to hear more about accord f our agencies -- coordinate their efforts. while each of these agencies today has a specific valuable role to play in ensuring preparedness, nobody can operate effectively alone. in fact, one major finding of the blue ribbon panel's 2015 report of biodefense preparedness, these agencies must ensure they're equipped to work together to respond to pandemics. the blue ribbon report also found that the federal government must dramatically increase the support provided to local injures dicks to help them build and sustain their biodefense capabilities. local providers like hospitals and health care workers will be on the front lines in a public health emergency.
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i want to ensure that we're adequately supporting these providers as well as state and local health departments so they are equipped to detect incidents when they happen and respond appropriately. mr. chairman, i'm really hoping we'll hear today that we've made tangible, measurable progress in this area. i just can't thank our panel today enough for the tireless work that they put in to keeping america safe. we always have a great opportunity to hear from you and we know that you're working hard. we think by having you come up here and take the time, it really helps us represent our constituents and it helps all of us be better prepared for the next emergency that faces us. thank you. nd i yield back.
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>> thank you for your guidance on this issue and also what we tap into you four along the way. the topic of biopreparedness really hits home for me. mr. walden: i think i was the first member of congress to be diagnosed with h1n1 years ago. not a distinction i was glad to get. but one apparently i had. more than that, 30 years ago, a religious group moved to oregon. you may have seen the documentary on netflix called "wild country." if you read judith miller's book "germs," you'll fimed it was the largest bioterror attack in the nation's history. but it took the federal government a years, i think she wrote, to admit that that's really what it was. they grew their own salmonella
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and then sprinkled it over salad bars and singed 751 people, many of whom i know. deliberate biological attacks are just one risk. with more global travel, there's of course increased risk of spread of infectious diseases, as we've seen with flu, our vaccines must be constantly updated to keep up with the latest strains. meanwhile, other path generals can develop antibiotic resistance and our ability to quickly recognize evolving diseases and respond to new outbreaks is reliant on the testing and treatment and capabilities and the men and women who do the work that you all oversee. lack of preparation is not an option. a mock pandemic exercise hosted last month by johns hopkins center for health security with a group of current and former government officials, including our own colleague, susan brooks, i'm told was quite eye-opening. the exercise resulted in a failure to develop a vaccine within 20 months and that led in this exercise, to 150 million deaths globally.
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so obviously we've got to do more to be prepared for these ypes of outbreaks. it's set to expire at the end of september. we intend to move forward with legislation prior to that. our health subcommittee met just last week to consider a bipartisan discussion draft to re-authorize this law and continues to fine-tune it. it's critically important congress re-authorizes this law in time. and make sure we're equipped to handle biothreats and chemical attacks, radio willing emergencies, cybersecurity incidents and mass casualty events. through letters, hearings, investigations, the committee has raised numerous issues regarding biological threats to the u.s. and our nation's ability to respond to ineffect shuss disease outbreaks -- infectious disease outbreaks. we've examined concerns about the c.d.c.'s management and the security of the strategic national stockpile and the capabilities of c.d.c.
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laboratory response network. the trump administration set to transfer to the assistant secretary for preparedness and response and we looked for to hearing more details about how this transfer will work. anothery area of interest to the committee is the area of our bio surveillance capabilities. this could billionster our public health response. i'll be interested in learning more about that as well. one thing we do know, the federal government needs to act faster to identify and determine material threats. the department of homeland security, march, 2018, made a material threat determination for pharmaceutical-based agents such as fentanyl. it took two years for d.h.s. to make this designation. yet car fentanyl, a highly potent form of fentanyl, was used in a terrorist attack more than 15 years ago. so it's only after that designation is made that the public health emergency medical countermeasures enterprise can approve countermeasure development and acquisition. if we knew about it 15 years ago
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and it took two years to get that designation, we can do better. support relies on researchers and scientists working with these diseases and daung roadways -- dangerous pathogens in a safe and secure manner. following lapses at c.d.c. and f.d.a. labs, both created new offices to oversee and prioritize lab safety. these were positive steps. the recent proposals that these agencies to lower the status of their lab safety offices raises concerns with this committee. so i thank you for being here today. and i'd like to yield the balance of my time to dr. burgess and hopefully to mrs. brooks. mr. burgess: thank you, mr. chairman. this issue was one that is important and timely for this subcommittee. and last week the health subcommittee had a hearing on the discussion draft of the pandemic all hazard preparedness act authored by representatives brooks and eshoo. that hearing we heard from witnesses with firsthand
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experience in combating these biological threats to our nation and received input on the draft legislation. certainly our witness panel today is well known to us and they are all experts. i look forward to hearing from our witnesses and i thank you, mr. chairman, and i will yield to misbrooks. -- mrs. brooks. mr. walden: maybe with unanimous consent? mr. harper: 30 seconds. mr. brooks: thaurks mr. chairman, and thank you to our -- mrs. brooks: thank you, mr. chairman. and thank you to our committee. we held a hearing examining how we best combat biological threats and i'm pleased we're once again examining the state of our preparedness and we look to re-authorize. it's not a question of if we face a threat, it's a question of, again, once again, when we face a threat. we've been reminded by the stories that we've heard here today, that these types of incidents have already happened in our country over the last decade and a half. created in 1999, the national
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stockpile is the repository of vaccines, antibiotics and supplies. used in the event of an attack or outbreak. but hh -- h.h.s. and o.i.g. issued a report identifying serious systemic issues within the c.d.c.'s management of the stockpile. i looked for to hearing from our witnesses today, how we're going to ensure that our stockpile is properly managed and we can be prepared as a country for whatever threat we are and may face. i yield back. mr. harper: the chair now recognizes the ranking member of the full committee, the gentleman from new jersey, mr. pallone, for five minutes. mr. pallone: thank you, mr. chairman. ensuring that our nation is equipped to respond to pandemics, natural disasters and the accidental or intentional release of toxins is a key part of protecting public health. past work by this committee has suggested that our nation has not always been as prepared as we need to be. so i'm glad that we're having this hearing today and i hope to hear that we have made tangible progress toward increasing our nation's preparedness. in 2015 the blue ribbon panel on
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biodefense conducted a comprehensive review of the federal government's biopreparedness efforts. the panel found that, and i quote, the nation is dangerously vulnerable to a biological event. it produced an extensive report recommending 30 action items for our public health infrastructure to address. while the blue ribbon panel was the most recent high-level commission to examine our nation's biopreparedness, it was not the first. in fact, for many years experts have warned that our ability to espond to biological and other emerging threats must be improved. these recommendations remain important today because the threats this country faces continue to grow. just this week officials announced that a child in idaho had contracted bubonic playing. last year an outbreak of this plague killed 200 people in madagascar. in march we heard at a hearing that the threat of pandemic flu is among the greatest concerns in the public health world. and antibiotic resivents poses a major threat to public health, killing 23,000 americans every
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year, and making everyday procedures like surgery and chemotherapy increasingly risky. warming temperatures are associated with higher levels of antibiotic resistance in common strains of bacteria. extreme weather events can also lead to public health emergencies. the hurricanes in puerto rico, the virgin islands, texas, and florida last year were a stark reminder of this fact. we must be prepared to address threats from all these sources. the blue ribbon panel produced many recommendations for improving our biopreparedness and i hope our witnesses will show that we have made real progress. for example, i hope to hear that the agencies have established a plan for who will take the lead in resfons a public health threat and how the efforts will be coordinated. along these same lines, i hope we will learn how c.d.c., n.i.h., as per and f.d.a. are working together to identify the greatest threats and to prioritize the research, surveillance and response capabilities to target these threats. we must also focus on how these
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agencies collaborate with state and local health departments, as well as heal care providers such as hospitals -- health care provider such as hospitals -- providers such as hospitals. these are likely to see patients first. in most cases, they'll the ones to dispense countermeasures and to treat those impacted. in 2014, for example, we witnessed the negative consequences that ensued when our health care infrastructure was unprepared to diagnose and treat patients with ebola. the hospital failed to detect the disease and the patient -- in the patient in dallas and that patient later transmitted ebola to two health care workers. this led to a serious question about whether we would be able to handle a larger scale event or incident and we must make sure everyone on the ground has all the resources they need to respond effectively in such a crisis. i also want to hear more about how we are conducting surveillance so when an outbreak happens or a toxin is released, we know as soon as possible. while we cannot anticipate every possible new or mutated
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pathogen, if we can quickly detect when such a pathogen has emerged, we can respond much more effectively. along these same lines, i understand the c.d.c. is gathering a substantial amount of data from laboratories, public health departments and clinicians across the country every day so we must ensure this agency has the resources it needs to effectively use and analyze this data as it comes in. finally, i want to mare more about what we're doing to -- i want to hear more about what we're doing to help us respond to a biosafety incident. countermeasures include preventive measures like vaccines, as well as therapeutics like antibiotics and anti-virals. i understand you work closely with the private sector to develop many of these products. and i hope that we will hear today about how these partnerships have produced useful, safe and effective products that truly address the challenges we face. mr. chairman, i'd like to thank our panelists again for being here, preparing for these threats is certainly not easy.
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but i'm confident that you're up for the task, as long as we do our part and provide you with all the resources that you need. i yield back, mr. chairman. mr. harper: the gentleman yields back the balance of his time. i ask unanimous consent that the members' written opening statements be made part of the record. without objection, they will be so entered into the record. additionaly, i ask unanimous consent that energy and commerce members not on the subcommittee on oversight and investigation be permitted to participate in today's hearing. without objection, so ordered. i would like to introduce our witnesses. . rst we have dr. bright anne schuchat. hen anthony fauci.
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finally, we have rear admiral henton, chief scientist at the u.s. food and drug administration. we welcome all of you. and you are each aware that the committee is holding an investigative hearing and when doing so has had the practice of taking testimony under oath. did you have -- do you have any objection to testifying under oath? let the record reflect that all of the witnesses reflected that they do not. the chair then advises you that under the rules of the house and the rules of the committee, you're entitled to be accompanied by counsel. do you desire to be accompanied by counsel during your testimony today? let the record reflect that each of the witnesses reflected that they do not. in that case, if you would please rise and raise your right hand, i will swear you in. do you swear that the testimony
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you're being to give is the truth, the whole truth and nothing but the truth? thank you, you may be seated. you're now under oath and subject to the penalties set forth in title 18, section 1001 of the united states code. you may now give a five-minute summary of your written statement. i will begin with you, dr. bright. elcome back. mr. bright: distinguished members of the subcommittee, it's a pleasure to speak today on behalf of our assistant secretary for preparedness response. to discuss the state of the nation's health security preparedness. i'm dr. rick bright, the director of the biomedical advance research and development authority, barta -- barda. the mission is to save lives and protect americans from 21st century health security threats. r. da is a component of asp
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staff is dedicated to preparing for and responding to these threats. we're currently coordinating h.h.s.'s response to the ebola outbreak and the d.r.c. and monitoring flu in china. in communities affected by last year's hurricanes, we're there for the long haul. helping local health officials manage recovery and build resilience. it coordinates across the federal government to support state and local partners in emergencies. we enhance medical surge capacity through our national disaster medical system and hospital preparedness program. and we oversee the development and procurement of medical countermeasures. we've made great progress in health preparedness response. barda was created to bridge government and industry, to accelerate the development of life-save medical countermeasures that would not otherwise be available. we use flexible authorities, multi-year advanced funding,
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public-private partnerships, and deep technical expertise to push vaccines, drugs and diagnostics toward f.d.a. approval. in our 12 years, barda has formed over 200 public-private partnerships with industry to accomplish our mission. i want to pause for a second to acknowledge the hard work of our partners who together with the u.s. government work very hard to create a more secure nation with not only products but capabilities to respond when eeded. through project bioshield, barda has supported 27 vaccines, drugs and devices to address national security threats, including smallpox, anthrax, and chemical
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exposure. 14 of these are now in the strategic national stockpile for use in an emergency and seven have now achieved f.d.a. pproval. working together to protect our nation. while this effort has created life-saving products to be procured by the s.n.s., it has also created challenges to quire and sustain sufficient qualities for each threat. critically, each product also represents a company with a response capability that must be sustained to ensure we have these products available when they're needed. project bioshield and the s.n.s. together represent a marketplace for these products that would otherwise never exist and the products would quickly vanish without it. they've all played valuable roles in enhancing our
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preparedness. however, the threats continue to evolve and technology that modify and create new deadly threats have become simpler. we must modernize our capabilities, emphasizing an end to end approach, ranging from early detection through the last mile of administering vaccines and treatments to patients with new technologist and innovation, the time is here to imply transformative approaches to these daunlting health security roblems. as you consider re-authorization, important changes to barda's authorities would sustain and enhance our capabilities. first, advanced propositions for project bioshield will attract more partners to support our mation. without this consistent and
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guaranteed market, the companies are he will talk tonight would work with us. second, an authorization of appropriation for barda's pandemic fluns program will sustain domestic flu vaccine production capabilities, modernize our vaccine technologies and bring new treatments and faster diagnostics into homes across america. i look forward to working with members of this panel, this subcommittee, your congressional colleague, and i'm grateful for the opportunity to present to you today and look forward to your questions. mr. harper: thank you. the chair will now recognize dr. anne chew chat for five minutes -- schuchat for five minutes. ms. schuchat: thank you. describing c.d.c.'s role in preparing, detecting and responding to biological attacks, pandemics and emerging infectious disease outbreaks. today i'll highlight c.d.c.'s role in protecting the nation against health threats.
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i'll describe our role in three areas. preparedness, detection and esponse. first, the work c.d.c. does every day in public health lays the foundation for responding to emergencies. second, the c.d.c.'s world class scientific and medical expertise ensures we're ready to respond to any threat. and third, our longstanding connection to state and local health departments ensures that public health systems function effectively both day to day and during emergency response. let me address how we prepare for emergencies. c.d.c. works every day with state and local health departments. in fact, we have 590 staff assigned to state and local ealth departments. we fund the city's readiness initiative. the public health emergency preparedness grant goes turnover
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state, eight territories and four cities. these funds support staff, enable exercises to test and validate capabilities, and pay for laboratory and communications equipment. the city's ready -- the cities readiness initiative funds the nation's 72 largest cities to develop and test plans to receive and dispense medical countermeasures from the strategic national stockpile. c.d.c. expertise helps assure protection of vulnerable populations against diverse threats. for example, c.d.c. worked with the american academy of pediatrics, the f.d.a. and other stakeholders to address gaps in existing countermeasures for anthrax in children. taking advantage of the agency's scientific and clinical expertise, and longstanding relationships with a.a.p. turning now to detecting threats. c.d.c.'s lab and surveillance systems are able to detect and identify agents causing illness, ranging from infectious agents to chemical or radiation
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exposures. every year labs from all over the world send specimens to c.d.c. because they know we'll be able to identify pathogens that other laboratories cannot. rapid identification of disease permit ps intervention -- permits intervention by a health threat becomes a crisis. c.d.c.'s laboratory response network maintains an integrated, scaleable and flexible system of 125 federal, state and local laboratories. the development of this laboratory network, established in 1999, has provided a larger capacity to test and report more quickly than was previously possible. for example, during the zika virus outbreak response, c.d.c. and our laboratory response laboratories processed over 207,000 specimens. just for zika. now i'll turn to response. when there's a crisis, c.d.c. responds. we're able to rapidly deploy scientific and medical experts anywhere in the world. by the end of the 21-month ebola
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response, 3,700 c.d.c. staff had shifted from their day to day duties to assist with the response. 1,500 of our staff deployed to west africa, making over 2,000 trips. today we're responding to a much smaller ebola outbreak in the democratic republic of congo. during health emergencies, c.d.c. communicates. for example, during the 2009 h1n1 response, c.d.c. held 39 full press conferences and 21 telebriefings. during the zika response, c.d.c. published 51 weekly report articles to make sure the public, health and health care professionals had the latest and best information. being able to prepare, detect and respond to public health threats is a top priority for us at c.d.c. our preparedness and response capabilities are built on broad
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and deep scientific, medical and program expertise. our longstanding partnerships with state and local public health authorities ensures an integrated approach wherever that approach is needed, resulting in better responses and better public health outcomes. which translate to better protection of the people we serve. thank you. mr. harper: thank you. the chair will now recognize dr. fauci for five minutes for your opening statement. mr. fauci: thank you very much, mr. chairman. chairman harper, ranking minoritydy get -- degette, members of the committee. thank you very much for giving me tisease our role in this really dates back many years but was solidified following the attacks on 9/11 with the anthrax
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attacks, which prompted to us develop the strategic plan and a research agenda. for our role in that, as you know, the n.i.h. for s with regard to any emerging infectious diseasesources, for d academic communities, with the ultimate goa of developing vaccines, therapeutics and diagnostics. we have been in a very strong partnership with barda in developing the concepts for interventions, which were then handed over to them for advanced development. this slide just shows a representative example of some key achievements directed specifically at the category a agents that were in our strategic plan. very briefly, for example, a better smallpox vaccine, next generation vaccines for anthrax, anti-toxins for botulism, antibiotics for plague, and
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interestingly, the development f an ebola vaccine, which long antidated the outbreak we experienced in west africa in 2014. having said that, it is important to point out, as we have in the past, and as shown in this interesting article from news day of 2001, the worst bioterrorist may actually be nature itself. it is interesting to point out, mr. chairman, that i have been testifying before this committee for the last 33 years. the first time i did, i drew a map. and it's shown here. the reason i drew the map is i wanted to point out that there would be emerging and re-emerging infectious diseases. and the first time i testified before this committee i put h.i.v. on the map as shown there. today the map is the same structurally, but this is what it looks like. these are the emerging and re-emerging infectious diseases. many of them, many of them are
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curiosities and are not really of great public health impact. but others are really important and we've experienced them recently. such as ebola, zika, and the threat of a pandemic influenza. let's take one of these, ebola. you mentioned in your opening statement, as others have, about the west africa outbreak and the recent outbreak in the democratic republic of the congo. it's important that the c.d.c., the n.i.h. and other agencies of the public health service responded very rapidly there. one thing that was proven that's important is that you can do good research in the context of an outbreak. and we developed with others a vaccine which is called the v.s.v. vaccine which was first tried in a phase one trial right in bethesda at the n.i.h. clinical center and then went over to africa in a phase two trial. this is the vaccine that was used in the ring vaccination program that was actually involved in the west africa
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outbreak. if you then fast forward a couple of years to where we are today, with the outbreak in the democratic republic of the congo, we have actually learned a lot and are applying what we learned to that. the experimental vaccine used in the ring vaccination program has been deployed to the democratic republic of congo and even as we speak today, it is being used in a ring vaccination, with 50 rings and 150 vaccinations per ring. interestingly, and as i mentioned before we came, this is going to get here, in 1995, there was an outbreak in the democratic republic of the congo to just show you the connection between clinical care and research, we brought one of the , cloned to bethesda the cells, made it an ant body and now the democratic republic
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of the congo has asked to us ship that to them for their discretion use as a countermeasure in the epidemic. so it became full circle that our collaboration with them came back with something that perhaps could help them. i want to close in the last couple of seconds with influenza. i wrote this article a few months ago talking about the need for a universal flu vaccine. and in fact we have developed a strategic plan and a research agenda because of the threat not ofpblee getting a better seasonal flu vaccine, but also a threat of a pandemic. we can only do that with a vaccine that essentially is able to protect us against all subtypes of influenza. i'll close on this last slide. this is not working very well. sorry. which is an article that i actually wrote 17 years ago, but it's very relevant today. and what it says is that emerging infections are a perpetual challenge. we've always had them, we have
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them now, and we will always will have them. so if they are perpetual challenge and perpetual risk, we must meet them with perpetual readiness and hopefully we'll be able to do that. thank you. mr. harper: thank you very much. we now have the privilege of hearing from a rear admiral denise hintton. you're recognized for five minutes. ms. hinton: thank you. thank you for the opportunity to atoday to discuss state of biopreparedness. medical and public health preparedness and response is critically torn to the health and security of our nation. and i am pleased to be here today to discuss how f.d.a. is working toward the goal of making sure we have the medical products necessary to protect our nation from a range of public health threats. whether naturally occurring, accidental, or deliberate. the outbreak of ebola virus disease in the democratic republic of congo serves as a
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remind that are biological threats can and often do emerge with little to no warning and can rapidly become global challenges. i can assure you that f.d.a. is dedicated to helping end this outbreak as quickly as possible, as we are actively engaged in supporting international response efforts. f.d.a. plays a critical role in facilitating preparedness for and response to biological threats. our focus -- our role focuses largely on facilitating the development into availability of medical countermeasures or n.c.m.'s, such as vaccines, therapeutics and diagnostic tests to respond to these threats. toward that end we work closely with our h.h.s. partners testifying here with me today as well as other u.s. government partners, product developers and nongovernmental organizations, to facilitate the development and availability of m.c.m.'s. f.d.a. also works closely with
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the department of defense to facilitate the development and availability of m.c.m. tease support the needs of our nation's military personnel. prior to joining f.d.a. and the u.s. public health service commission corps, i proudly served as an officer in the united states air force. so these efforts are near and dear to me and we are fully committed to closely working with our colleagues at the d.o.d. to support the unique needs of the u.s. military personnel. at f.d.a., we have made it a priority to utilize our authorities to proactively work with our private sector and government partners to help facilitate the translation of discoveries in science and technology into safe and effective m.c.m.'s as part of advancing public health and strengthening our nation security. we share commong's -- congress' goal of having safe and effective m.c.m.'s available in the event that they are needed and we have made significant progress toward this important goal. for example, since 2012, f.d.a.
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has approved, licensed or leared more than 120 m.c.m.'s. including supplemental changes to products and modifications to diagnostic devices. for a diverse array of threats including anthrax, botulism, toxins, plagues, smallpox and pandemic influenza. we have also issued more than 60 emergency-use authorizations since 2005 to enable access to products, to respond to threats, including for zika virus, ebola virus, influenza virus, and the middle east respiratory yndrome. developing m.c.m.'s is highly complex and there remain gaps that can challenge edmonton
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programs. -- development programs. without such tools, it is difficult to generate the data necessary to support regulatory decision making. addressing these regulatory science gaps remains a high priority for the f.d.a. and we have established a broad and robust portfolio of cutting-edge research under our m.c.m.'s initiative regulatory science program to develop these tools and to promote innovation in the development of m.c.m.'s. f.d.a. is acutely aware that biothreats can emerge from an accidental release or exposure to threats agents during the course of conducting research. as such, we are working to ensure that our laboratories and workplaces are operated in a safe and secure manner to protect employees, the surrounding communities, and environment. as the f.d.a.'s two scientists, i can assure you that the laboratory safety is a high priority for me and the agents -- and the agency.
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f.d.a. remains deeply committed to working closely with its partners and fully using the authorities congress provided to help facilitate and accelerate the development and availability of safe and effective medical countermeasures. while we have made significant progress, we know that more work remains to be done. we look forward to partnering with congress and stakeholders as we work together to further enhance biopreparedness. thank you for inviting me to testify today. i look forward to answering any questions you may have. mr. harper: thank you investment i ask unanimous consent that the contents of the document binder be introduced into the record and to authorize staff to make any appropriate redakotases. without objection, the documents will be entered into the record with any redakotases that staff determine are plopet -- are appropriate. it's now time for members to have the opportunity to ask you question the a. and i will recognize myself -- ask you questions. and i will recognize myself for five minutes. let me begin by saying that in my 10 years of service in
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congress, i don't know if i've ever been at a committee hearing with a better lineup of witnesses. so thank you all for being here. we look forward to your responses today. thanks question that will go rather quickly for all of you. for each witness, which biological threat is the greatest concern to you and why? we'll start with dr. bright and then go down. mr. bright: that's a difficult question. dr. fauci laid out there are so many threats, constantly emerging. i wish i could take some of them off the table but they keep coming at us. more concerning is the technology advancing so much that they can change the biological threats that we know today into something different that we may not be reaped for. i think our greatest -- prepared for. i think our greatest threat is our response capabilities. being able to respond to nene -- anything that comes our way. mr. harper: is there one that -- biological threat, that is at the top of your list?
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i though they're all important, but is there one that gives you the greatest concern? ms. schuchat: i think influenza. it can effect everyone rapidly and is constantly changing. and with a pandemics, all of the population of the world can be susceptible. so the threat of a pandemic has to be at the top of the list. ecause it can all happen fast. mr. fauci: my number one and maybe number two and number three is influenza also. i agree. for the reasons that dr. schuchat has mentioned. when you have a respiratory virus that can be spread by droplets and aerosol, and then you have a situation, if there's a degree of morbidity associated with that, you can have a catastrophe. i mean, we've experienced in real-world those types of thirnings the one that we always talk about is the 1918 pandemic which killed between 50 million and 100 million people. it is likely that it would be an influenza. but if not influenza, an
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influenza-like respiratory virus. i mean, we had a scare with sars. fortunately public health measures were title of the bill contain it. but influenza first or something like influenza is the one that keeps me up at night. ms. hinton: thank you for the question. i would say the threat that would keep me up at night would be the unknown. if we don't know what that threat may be, we have to be able to anticipate. that would be the unknown would keep me up at night. mr. harper: what issue of biopreparedness is of the highest priority to you and why? mr. bright: the area of biopreparedness and highest priority would be the able -- ability to rapidly detect something that has entered our community or used as a weapon. something we detect -- the sooner we detect something, the sooner we can turn on the machinery and make vaccines and drugs. ms. schuchat: i would say our global health security would be
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at the top of my list. because as you know, a threat anywhere is a threat everywhere. and i think our greatest vulnerabilities are in the weakest countries of the world. we saw in ebola how rapidly west african countries were overwhelmed. and that was an issue for us as well. i think being able to strengthen the ability of every country to be able to prevent, detect and respond to threats is where i'd place my focus. mr. fauci: i would agree with those two. but let me add an additional one that may not necessarily be my first, is in our ability to respond, for example, with a vaccine, the modern day, 21st century technologies of platform technology, where you don't have to wait six to seven months to get a vaccine, where you can really get it out there within a period of a couple of months. which is doable if we put our ind and our resources to it. ms. hinton: our continued efforts in the ebola and then making sure that we contain it
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within the specific regions and not letting it cross the borders. mr. harper: thank you. dr. bright, if i could ask you, obviously the need to rapidly respond to a biological threat is essential. does the public health system have the capability to deliver and administer medical countermeasures rapidly and effectively in a timely manner, as you sit there today? mr. bright: as we sit here today, we are much better and can respond much more quickly than we were in the past 10 years. we've built a national response capability and international capability, incorporate rapetting new sciences and technologies. there's a lot of room for improvement. it still takes too long to respond adequately to protect everyone in our nation. mr. harper: thank you investment i will now recognize the ranking member, ms. degette, for five minutes for her questions. degree degree thank you very much -- ms. degette: thank you very much. building on the questions by the chairman just now, dr. bright, what changes do we need to make to make the system for
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developing countermeasures work more effectively and efficiently? asper has been a good start but where do we need to go? mr. bright: given the 12 years experience with aspr and the enterprise working across the government and working with our public-private partnerships, we've learned a lot. in the past 12 years. not everything is working as effectively or efficiently. degree degree what do we need to do? -- degree -- ms. degette: what do we need to do? mr. bright: we need to ensure there's consistency in funding and availability so the partners that we work with can better align their business models with our government models as withle -- as well. and we need to improve our efficiency for responding to proposals and other contractual mechanisms that we use it work with our industry partners. ms. degette: are efforts under way being made to do those things? mr. bright: yes. efforts are under way. ms. degette: is there something congress can do to help you? mr. bright: congress has been very generous with the
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authorities to date. there are things that we can do to improve our language and our other transactional authorities to be able to work more fluidfully i will and flexibly with our industry partners and we will be happy to submit language. ms. degette: we'd be delited to have that language. dr. fauci, none of these hearings can go without me asking you about what's going on with pandemic flu. you said we're getting closer to developing a universal vaccine. you've said that before because you've been trying to do it for long time. what's your time frame look like now and what are the barriers? dr. fauci: congresswoman degette, the time frame really varies about the level that you're talking about. there's not going to be one home run universal flu vaccine. there will be various terations.
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know about time frame, since we spoke last, we have put into a phase two trial a universal flu vaccine with a company which is a multiple prime followed by a killed vaccine boost. being in a phase two trial means that you're another step closer to getting a product that you'll be able to use. so i would think that -- ms. degette: how long is this trial going on for? dr. fauci: it will probably take -- it's a phase two trial so that he is probably going to take at least a year to determine if this induces the kind of response that would you protect would -- predict would have some broad protection. the fist iteration is not going to be against all -- first itsvation not going to be against all flu. we're hoping the first iteration will cover all of a particular type. h3n2's. of the if that's successful, then maybe all of the h1n1's.
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there are two major groups of influenza. the ultimate one would be the one that covers all of them. i think that's years and years and years away. but the first iteration may be five or so years away. ms. degette: i'll ask you the same question i asked dr. bright, what can congress do to help you? dr. fauci: i think congress has been extraordinary in their positive effect on us, in helping us. for example, in the 2018 omnibus, we were given an additional $40 million to develop a universal flu vaccine and we're getting additional money in the proposal of the house for a 2019 budget. so you've been very supportive and we really appreciate it. ms. degette: we think it's a high priority. i think i can speak for everybody in this room. one more question. you're developing lots of ifferent vaccines, smallpox, flu, anthrax, ebola. how do you prioritize your efforts to target the pathogens and toxins that provide the greatest risk? dr. fauci: that's a very good
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question. we do two things. we target specific path jens based on -- pathogens based on the threat. if you're talking about a bioterror threat it's the intelligence we get. and if you're talking about the possibility of an emerging infection, it's very difficult to guess what's going to come out. 19, it's very t h7 up there as a threat. we clearly made an investment of a considerable amount of money to develop a vaccine for. that but as i mentioned to an answer to one of the other questions, it's to develop platform technologies that's applicable to any disease as opposed to picking out all the diseases and preeveryonetively making a vaccine. in other words, making a kind of a vaccine that you could easily apply to whatever is the outbreak. ms. degette: thank you. thank you, mr. chairman. mr. harper: job. the chair will now recognize -- the gentlewoman yields back the balance of her time.
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the chair will now recognize dr. burgess for naive minutes. mr. burgess: thank you, mr. chairman. and thanks to our panel for being here today. dr. fauchy, i was going to do it but you brought it up and said, sometimes you'll give a time frame and then if it doesn't work out, then people will point that out to you. couple of years ago i think you gave us an 18-month figure on a zika virus vaccine. how close are we today? dr. fauci: thank you for that question. when you're proving that a vaccine works or not, in the classical way you have to get what's called an efficacy signal there. has to be infections in the community to get an efficacy signal. right now, thanks there -- thankfully for the countries involved, the zika infections have plummeted almost to very, very few. however, the phase two trial i spoke to you about some months ago is still ongoing and it's accruing volunteers in the study. so there's an interesting possibility here. let's say there are no -- not
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enough zika cases to be able to get an efficacy signal. we have been in discussions with a lot of help from the f.d.a. about the possibility that if we get a considerable amount, and i say thousands of volunteers, and you bridge it to the animal studies, there's a possibility that they would at least consider that there would be an accelerated approval. you never can guarantee anything. but that's at least on the table . so my short answer to your question is that we are on the road to getting a zika vaccine. i feel pretty confident about that. mr. burgess: from the f.d.a.'s perspective, that expedited approval, is that something we ould look for? dr. fauci: i'll let them speak for themselves, but you never want to anticipate what they'll
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do. mr. burgess: i need something in writing. ask you, a virus was included in that list. c.d.c. has put out a paper on accuse flaccid militis and incidents of that. i recognize that it's low. but it does seem to peak every other august. so as we are coming up on one of those every other augusts, do we know any more about this ill snns -- illness and why it has had the effect that it has? ms. schuchat: the outbreak of severe respiratory disease in children from the virus a few years ago was of concern. it was contemporary with the outbreak of acute flaccid mialitus, very difficult to confirm that one caused the other but there's a good probability that they did.
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the family of interviruses are known to be able to cause neuro pathic problems. when you have a very common set of infections it could be that that was a real rare end of the spectrum among the common once. so i think we do need to be ready for that. unfortunately there are so many different viruses that it's very difficult to pick one that you would necessarily focus on for ountermeasure development. mr. burgess: fairly frightening when that did occur, the concern we heard from parents. dr. schuchat: exactly. it was happening the same time as ebola happened in africa. when the president visited the c.d.c. he was briefed on them. . burgess: let me ask you, when ebola was a much more significant problem, september 2014, the ant body had been
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-- was -- ant i body was in trials and the f.b.i. put a clinical hold on it. there was a reaction that was fairly severe. so we stopped looking at it. when we have that problem going on, i want some reassurance that the regulatory side is not going to interfere with the delivery of what may be a very potent tool. because several people mentioned z-map. it's now a recognized tool in the tool box. is that correct? admiral hinton: that is correct. the f.d.a. is not there to be a roadblock. it's to ensure that the drugs are safe and efficacious. so the reasons behind that may not be privy to us but we do make sure we have safe and
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effective available drugs on the market to retrieve these in emergency situation -- treat these in emergency situations as well. dr. fauci: it was part of a randomized control trial that was run by the n.i.h. it was published in the new england journal ofed me sifpblet the results, because of the -- medicine. the results, because of the cases at the time, were very strongly suggestive of efficacy but not enough to be statistically significant. so the trial is technically still on and right now, in d.r.c., they could use it either on a trial or if they want as compassionate use but it is available. mr. burgess: thank you all very much. thanks for your testimony this morning. mr. harper: the gentleman yields back the balance of his time. who also serves as the chair of our health subcommittee. mr. burgess: mr. chairman. i'm also going to ask unanimous consent to place into the record the report of the independent panel of the united states department of health and human services to the ebola response from 2015. mr. harper: without objection, so ordered. the chair now recognizes the gentlewoman from illinois, ms. schakowsky, for fivings minutes. ms. schakowsky: thank you, mr. chairman. i want to agree with you, mr.
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chairman, that this is an extraordinary panel. dr. fouchy, 33 years before this committee -- fauci, 33 years before this committee. that's a long time. we appreciate you every time we see you. i also want -- i looked this up, dr. schuchat, it looks like you're about 28 years. is it more than that? how many? dr. schuchat: 30 in july. ms. schakowsky: ok, 30 in july. and such experience in all of you. it's just really remarkable. i wanted to -- i thank all of you for being here today. i'm particularly concerned about the improper and overuse of antibiotics that's driving the growth of antibiotic resistance around the worldism noticed, dr. fauci, in your new map with all the, right at the top was antibiotic resistance on the left there. i phelan obligation to raise this issue too -- i feel an
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obligation to raise this issue too for ms. slaughter who was always raising this issue. in the united states, somewhere between 20% and 50% of all antibiotic prescriptions in hospitals are either unnecessary or inappropriate. evidence suggests that ant bots stewardship program -- antibiotics stewardship programs in hospitals can improve prescribing practices and help reduce the occurrence of antibiotics resivents. i'm interested from hearing more from our witnesses on this program. whoever wants to -- these programs. whants to go fist. dr. schuchat. shoipt problem is transformational challenge for us -- dr. schuchat: the problem is transformational challenge for us because it transforms modern medicine. c.d.c. has been investing in efforts to improve stewardship of antibiotics and at this point, by our latest data, had two out of three hospitals had an antibiotics stewardship program, which is a big indeprees before, but we think that there's much more to be
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done. in addition, we have 850 hospitals around the country are reporting on their antibiotic use data to the national health care safety network. so we're tracking data. what we find in the health care system is when you track antibiotic use and feedback to clinicians how they're doing, they can improve. a lot of clinicians are test takers and we like to do really well on those tests so learning that we're not doing as well as our peers in terms of the appropriateness of our prescribing can help improve that. we're also tracking resistance and we've really invested thanks to the congressional support, we've been able to invest in much better, timely, accurate, quality resistance detection around the nation where we got those nightmare bacteria reports that we came out with recently. so i would say that behavior change in clinicians is
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difficult but we're making progress and a stewardship program in every hospital is a good start. but it takes more than the hospital to make that happen. we need the whole plans, the outpatient prescribers as well, to be part of this. ms. schakowsky: you're saying we do have a tracking system now for clinicians, for hospitals? dr. schuchat: right. what we have is, in our national health care safety network, i'm told that 850 hospitals are already reporting to us on their antibiotic use. it includes adva hospitals and 30 military hospitals and they're having that be part of their -- it's voluntary but it's part of their ability to monitor what's going on in their own institution and then look across institutions. ms. schakowsky: who percentage of hospitals does that represent, do you know? dr. schuchat: i don't have that information. but we can get that for you. ms. schakowsky: ok. has the c.d.c. identified any obstacles to successfully implementing stewardship programs? if so, how are you addressing
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those? dr. schuchat: you know, i would say that incorporating the outpatient facilities in the stewardship is important. we also found that rural areas, critical areas were challenged in being able to do all the things that we recommend in terms of antibiotic stewardship. our program convened, a batch of e rural or critical area hospital stewardship leads who had made a way to make a difference, and we're working with them to learn to share their best practices more broadly. large hospitals are on the case now and helping the smaller facilities get up to speed is important. ms. schakowsky: thank you. the remaining seconds, anybody else? dr. fauci: yeah. how we address antibiotic resistance is really a government-wide and it's a program called combating antibiotic resistance bacteria. that was established years ago, a few years ago, that involves
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what dr. schuchat had mentioned regarding the c.d.c. it involves the f.d.a. research component from the n.i.h., to develop new drugs, to understand the mechanisms of resistance, to harness the immune system. but also an organization called carb-x, which barda has a major role in. so maybe you want to mention that briefly. dr. bright: very briefly. so since 2010, barda has invested over $1 billion in addressing the development of new antibiotics to address anti-microbial resistance. we have just in the last year, had the first antibiotic drug licensed in our program. we have several more in phase two and phase through -- three. we also realize that the early stage pipeline was not sufficient to have a stream of new canned gates going into advanced stage development. we did launch a public-private .artnership so we have now funded 34
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different novel technologies to address new mechanisms of action for new antibiotics and vaccines. ms. schakowsky: thank you. my time is up. but i hope that in addition to development, that we're looking at prevention here as well. thank you for your courtesy, mr. chairman. thank you. mr. harper: thank you. the gentlewoman yields back the balance of her time. the chair will now recognize the chair of the house ethics committee and a valuable member of this subcommittee, the gentlewoman from indiana, mrs. brooks, for five minutes. mrs. brooks: thank you, mr. chairman. dr. schuchat, rear admiral hinton, if could you pass that binder over to dr. schuchat. the last pages of that binder has a chart that i would like to enter into the record and ask unanimous consent to enter into the record. it's the budget report for 2016-2020. a large percentage of the c.d.c.'s strategic national stockpile budget appears to not
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go to procuring and updating medical countermeasures for the stockpile but instead goss a category entitled nonprocurement costs. in an effort to inform the discussion today, committee staff did ask c.d.c. to provide a breakdown for what is in this nonprocurement, but we never got it. can you share with us very briefly, and you night mite need to supplement with written response, what makes up the spending for the strategic national stockpile? dr. schuchat: thank you for your question. as you know, the strategic national stockpile has an inventory of about $7 billion. so the annual appropriation is just a piece of that. most of the dollars that are in the nonprocurement go for sustaining and operating. so that would be the rental space, the security for the warehouses, the staff that work, you know, the salaries for the staff. as well as the clinical
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expertise that's helping with the guidance on how to use the product. mrs. brooks: could we get a written breakdown of that what is -- of what that is? dr. schuchat: that should be ons i way to you. mrs. brooks: thank you very much. last year h.h.s.-o.i.g. issued a report offer doing audits and they talked about systemic issues, putting that $7 billion -- was just mentioned into great concern. so, dr. bright, what actions does aspr plan to take in the transfer that is anticipated october 1 to ensure the strategic national stockpile assets will be available in case public health emergencies? dr. bright: as you probably know, we have several working groups working very closely between c.d.c. and aspr to evaluate various components of the stockpile transfer. so we are still -- mrs. brooks: can i interrupt one second. we heard in her opening
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testimony, dr. schuchat, talk about all the many things c.d.c. does relative to public health and these emergencies. and so are you going through all of those things to make sure there is coordination? and is that what the working groups are actually doing? figuring out what part c.d.c. is going to maintain, and what part aspr will have? is that what the working groups are doing? dr. bright: absolutely. there's five different working groups. they're meeting weekly and some have daily communications to understand the various components. understanding how we maintain and sustain the best science and expertise in the currently s.n.s. how we're building and augments the relationship with states and locals to ensure that that is also maintained for robust s.n.s. enterprise. we're also looking at the contracting and the financing and we're looking at the nonprocurement costs as well. we assure you that we are doing everything we can to make sure that those nonprocurement costs are supporting the s.n.s. and its mission. mrs. brooks: i have a question
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with respect to -- i understand there have been instances where barda -- and you mentioned it, had to use project bioshield funds to procure f.d.a.-approved clinical countermeasures or medical countermeasures because for whatever reason c.d.c. declined to procure those countermeasures for the stockpile. how does that uncertainty effect barda's ability to partner with industry and is that being addressed in your working groups? dr. bright: that uncertainty is critical. it's very difficult to make these countermeasures very lengthy, very risky and the companies put aside other very profitable and successful endeavors to work with us in these areas. that marketplace insurance is absolutely essential to them working with us. so we realize as we've been more successful with our partners in making additional countermeasures, it has created an additional burden on the s.n.s. we are working with the s.n.s. at the c.d.c. and our internal staff now to make sure that we are able to address those lapses or those gaps in communication or transparency, to make sure
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hat we have a success. mrs. brooks: thank you. i'd also like to enter into the record a study on biodefense that was sent to dr. cadlick with a very detailed seven recommendations to improve our biodefense posture. mr. harper: without objection. mrs. brooks: among those was the need to improve coordination with state and local partners. and to address problems that have existed in the past. can you tell us how aspr plans to engage with state and local partners once it assumes control of the stockpile? which is of great concern to state and local partners. dr. bright: dry that it is an essential part of an effective -- i agree that it is an essential part of an effective enterprise. the state and local and tribal and territorial partners are the front line. they are the ones who are distributing and administering the vaccines and treatments. so we are dedicated to working with them, making sure they have a voice in the structure, in our system, to understand how they need those medical
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countermeasures and how they need them to be delivered most effectively. it doesn't do us any good to make new drugs and vaccines if they're not suitable for our frontline workers at state and local and tribal andtories to deliver and administer. mrs. brooks: they know how d to deliver and administer them. dr. bright: absolutely. mr. harper: the gentlewoman from florida is recognized. ms. castor: last year florida recorded cases of zika. they were overwhelmingly travel-related cases. but of those known cases, 136 were pregnant women and three babies were born in florida with congenital zika syndrome. thankfully those statistics are down substantially from 2015 and 2016. but the threat to young women of childbearing years and families remains very serious. a study was just published where researchers from the c.d.c. and
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the annenberg public policy center determined that most people have let their guard down now. that they're not taking the precautions that they should when it comes to zika. so, now that you have the results of that study and the threat of ken genital zika syndrome remains serious -- congenital zika syndrome remains serious, what do you plan to do to keep families informed and making sure they're taking all precautions? dr. schuchat: thank you. zika was such a devastating new problem to have for a mmoh bite to be able to cause -- mosquito bite to be able to cause birth defects, i think in may we issued one of our monthly high visibility reports of vital signs on mosquito and tick-borne diseases which have been increasing, trying to get that word out in advance of the mosquito season so people would take these threats seriously. we have another report that's focused on zika that will be coming out in about two months. really highlighting what have we learned from the unfortunately
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thousands of pregnancies that were complicated by zika, folks who reside in the 50 states. to show what the follow-ups have been and what has happened to the babies. as they develop. we need to make mosquito protection much easier for individuals and we need to have better tools for countering mosquitoes in terms of environmentally safe and acceptable tools for them. we have been appreciative of the investments in strengthening our control so there's better surveillance for vector-borne disease and also better understanding of resivents patterns. so we have the right products that can be used. ms. castor: there must be more we can do to communicate to young women and men. it was very strange that this zika became transferable via sex as well. dr. schuchat: yeah. the signs are still up in the airports but people turn them off. so i think continuing to raise
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concerns is a challenge. when people become complacent. so it's sort of our perpetual challenge in prevention. ms. castor: thank you much responding to public health emergencies requires us to have a good understanding of what is happening on the ground. in realtime. and doctors and nurses and others who work directly with patients are likely to be the first to interact with individuals affected in a public health emergency. how does c.d.c. gather data from these clinicians to detect emerging illnesses and other threats? dr. schuchat: we have a variety of surveillance systems to try to identify both known threats and then the unknown or the new, unusual clusters. most important is for there to be a closed connection -- close connection between the clinical community, the doctors and nurses on the front line, and their local and state public health authorities. the first cases of west nile virus disease in new york city were detected, there were some animal losses, but it was that link between clinicians and the local health department. so part of our day to day,
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everyday public health system, is vital for the unknown -- ms. castor: c.d.c. has a laboratory response network that plays a vital role in biopreparedness by ensuring that we are able to quickly diagnose public health threats using -- testing methods known but there are no kits or rapid test available for many dangerous pathogens and tongses. what is going on here and what are the barriers to developing a safe, targeting a wide variety of pathogens and toxins? dr. schuchat: what i would say is the laboratory response network or l.r.n. is a group of 125 hospitals around the -- or laboratories around the country that are within two-hour drive of 85% of all of the population. they are equipped to use validated, standardized s.a.'s to detect a variety of conditions. the c.d.c. has the ability to detect and confirm a longer list
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of the select agents and dangerous pathogens and we prioritize which of the detection methods or a.s.a.'s need to be deployed close to where people live. which ones can be deployed and maintained centraly because it's quite expensive to have the standards high enough to be able to reproduce the results in all of the 125 hospitals. so while there's 45 select agents, we have it for nearly all of them. many of those are managed at the c.d.c. or regional centers of excellence, while the 125 laboratories can test for the things that we think are the most likely. z. luding things like mer ebola, etc. the h1n1 initially. threats to deploy the that the most important to have local ability to detect rapidly.
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dr. bright: if i can add on that too. that's another area of innovation that barda has been focusing on. to drive diagnostics out of centralized lab, to augment that centralized laboratory network, but put the diagnostic in the hands of physicians at physicians' offices. and even go further now. to drive diagnostics into the home. so people will now earlier when they've been infected with something so they can take responsible action to be treated sooner when drugs are more effective and also to take activities to reduce the further spread or transmission of that virus. this area is ripe for innovation to augment our national laboratory support system. ms. castor: thank you very much. mr. harper: the gentlewoman yields back the balance of her time. the chair now recognizes the gentleman from new york, mr. collins, for five minutes. ms. collins: thank you, mr. chairman. i'm going to thank our witnesses and follow up a little bit more on the laboratory response network. i understand that's been around about nine years or thereabouts. i think since 19999. dr. schuchat: yes.
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ms. collins: actual ri i've lost 10 years. i deliberately lost those 10 years, by the way. [laughter] so i know you mentioned 125 labs here in the country. but this is from what i understand, also there's international labs. i mean, we all know the key to a lot of this is early detection. whether it was ebola or some other things, sars, which initially people thought they had the flu, even the an thrack -- anthrax. early detection is the key to jumping on top of this which means the laboratories who are -- that are located outside the country. i know this is a collaborative effort. are you -- let's use the word comfortable, and how is that collaboration between the united states and other countries around the world, as you mentioned, in many cases these could be in africa and other places, for these -- the ability to identify these select agent -- dr. schuchat: the laboratory response network is in other countries as well. but i would say there's other means -- other laboratories that
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we collaborate with around the world to help have that rapid detection and response. and actually that's really what the global health security agenda is about. making sure that there are abilities to find, stop and prevent epps wherever they occur. atural or not. the international collaboration is strengthened by the daily lynx we have in partnership on other threats. as you heard, we're working on ebola in d.r.c. right now. it's the nipa virus detection in india was based on training c.d.c. had given to the laboratory in india years before. so that india could recognize that pathogen themselves, without having to take the time to ship the specimens out of the country. ms. collins: following up on that. what i would call proficiency testing we do for all of our labs, whether it's influenza or h.i.v. or any of the s.t.d.'s. i'm assuming there's a proficiency testing program
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related to our l.r.n.'s, which is always maybe a little more complicated because the 45 elect agents are not nearly -- problematic as influenza. but can you speak to the efficiency program, how often these laboratories are tested? their workers, how their grades are so, that in fact we're comfortable that if there is an outbreak, they're properly identifying it? dr. schuchat: yeah, the proficiency testing and assuring the quality of the laboratory test is vital. that's one of the reasons that one 't have it for every of the select agents in each of the l.r.n. labs, because we want to certify that lab for that test. and make sure that they maintain the agents adequately and everyone who is working on that test is doing it the right way. so we really try to prioritize which asa's will be run regularly in every lab because we do have to make sure that every year in and year out, they're getting the accurate
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results. otherwise it makes no sense to run the test. senator collins: how often is it done, and -- mr. collins: how often is it done and can the c.d.c. conduct the test itself or do you use an outside agency like c.a.p.? dr. schuchat: let me get the details fort committee and i'll follow-up. mr. collins: ok. n my remaining time, egg-based versus cell-based vaccines, can you comment? is the f.d.a. looking at -- we're moving forward, certainly through our influenza season, are you making progress on the cell-based? are you seeing positive potential there? >> absolutely. we have both. we have the egg-based and cell-based vaccines available. and continuing to evaluation and work in that area. both are available. both are promising. mr. collins: there's always
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been some folks, if anyone would like to comment on the egg-based, are we seeing positive steps in the other or -- admiral hinton: we are seeing positive steps in the other direction. egg-based, people have allergens and not having them so having option there is to be able to provide and treat people with is promising and is available. >> there are problems with egg-based and get towards more platform technologies. one of the accidental mismatches that we had in 2016, 2017, particularly in australia, was the vaccine was put into eggs and as it mutated in the eggs as it was glowing, it mutated so the eggs that -- virus that came out of the egg was not the virus that you put into the egg. we had an accidental mismatch.
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the idea of having to grow a virus in a six-month process is something we really need to, as i often say, graduate into the 21st century and do it a little bit better with more advanced technologies. mr. collins: thank you for that. mr. chair, i yield back. mr. harper: the chair will allow dr. bright to finish his response. dr. bright: thank you very much. i like to add just a little bit more to that as well. it's very important to understand the need for diversification, diversified vaccine production. influenza is a tricky virus. eggs has been a reliable vaccine for a number of years. we are looking to find ways to to only diversify and improve eggs-based vaccines. it's important to not discard a reliable technology without having a modernized technology to replace that. we're working with each of the manufacturers now to identify ways to make our flu vaccines
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more effective now while we wait for that universal flu vaccine candidate in the future. mr. harper: the chair will now recognize the gentleman from california, mr. ruiz, for five mins. mr. ruiz: thank you, mr. chairman. emerging infectious diseases are a major threat to the health of american citizens and to people around the world. this includes both new diseases that emerging population that re-emerge. in just the past two months, for example, we have seen outbreaks of ebola in the congo and nepa. dr. schuchat, what are we doing to help those in the developing world? how are we partnering with international players on this? dr. schuchat: yeah. c.d.c. works closely with dozens of ministries of health around the world as well as with international partners like the world health organization and the world food organization to -- the world animal health organization to be able to find, stop, and
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prevent epidemics. mr. ruiz: give me an example how you do that in a very underdeveloped, poor infrastructure nation? dr. schuchat: right. as you know in liberia they suffered from devastating outbreak of ebola in 2014. we have a country office in liberia that's working closely with them focused on four key areas. strengthening laboratory systems, strengthening surveillance, strengthening emergency operation centers and rapid response, and work force development through the disease detective program that we call the field epidemiology field program. that means they can shorten the time recognition of ebola or something else and respond capeably. mr. ruiz: in 2014, 2016, the ebola epidemic killed more than 1,000 people in west africa. in 2014, a doctor that went from west africa to dallas died of ebola. two that contracted survived. what did we learn from that
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experience and what are the changes you made because of it? dr. schuchat: there's three key lessons learned. one, we need every country to have the ability to stop, -- find, stop, prevent epidemics. the second thing is we need the world organizations, the global organizations to be able to surge rapidly when a country's overwhelmed. that's happened effectively in the democratic republic of congo with this ebola outbreak recently. what we learned is infection control is essential, that an issue that is one illness or couple illnesses can amplify into a very large scale problem when we don't have adequate infection control. that's important in the united states. it's important in developing countries for t.b. it's very important for ebola and sars. mr. ruiz: this patient and who other health care workers that
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contracted ebola were obviously in emergency departments -- went to emergency departments, were treated in emergency departments. the first line of defense against any emerging infection or outbreak in the united states is going to be the emergency department and also the first responders. what are you doing in terms of the c.d.c. to coordinate to make sure that they're well equipped? and then i will ask dr. bright that same question. dr. schuchat: we have a family of efforts to educate and keep up to date clinicians that include tens of thousands of clinicians regularly getting updates from us, whether it's through phone calls. mr. ruiz: it's businessy clinicians that works in the emergency departments seeing 20 patients at once to -- dr. schuchat: right. mr. ruiz: how do you integrate that into their daily practice? dr. schuchat: yeah, the system changes are really important. when i saw a doctor at emery last week before i talked to anyone i asked, have you traveled out of the country the last three weeks? it's actually on their phone line before you make an
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appointment. institutions instituting systemwide checks can help make sure that you don't have problems with human error. mr. ruiz: dr. bright? dr. bright: and also, i'd like to say that aspr has worked with our health care coalitions to establish now even a national ebola training center, an education center so we can train the hospital and first responders. we now have 178 ebola assessment hospitals. we have 69 state or jurisdiction designated ebola treatment centers. we have 10 regional ebola and other special pathogen -- mr. ruiz: i am an emergency physician. i have to take examination like crazy just to even -- exams like crazy to keep my board certification and license. i think continuing medical education and training would be very essential. now, the president's budget -- the administration wants to move the strategic national
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stockpile under the aspr. i'd like to ask, dr. schuchat, what are your competitive advantages and why should i think keeping it at the c.d.c.? dr. schuchat: what i could say is there's already been an administrative decision to move the stockpile. so currently c.d.c. is working diligently very closely with aspr to make that transfer as seamless as possible and mitigate any negative consequences that may occur. i think the critical focus we will focus on is -- areas we will focus on is that state and local support are seamless. we work with state and local health departments every day on a variety of things and know them and know where our gaps are and where we need to make progress. we need to make sure that that close relationship continues in a way that doesn't jeopardize the american public. second area is the deep scientific expertise that we have across the agency that has been contributed to maintenance
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of the s.n.s. so when we need clinical guidance for children -- for anthrax countermeasures we can get that best advice incorporated. we need to make sure that that continues. we are well on the way of executing the seamless transition. not transmission. mr. harper: the gentleman yields back. the chair recognizes the vice chair of the subcommittee, the gentleman from virginia, mr. griffith, for five minutes. mr. griffith: thank you, mr. chairman. after a series of safety lapses involving the mishandling of anthrax and smallpox in response to a lab safety expert panel, both the f.d.a. and c.d.c. formed new offices to provide centralized oversight of laboratory safety and science. rear admiral hinton, i have several questions for you regarding the f.d.a.'s office of laboratory science and safety. first, how many labs does the f.d.a. have or oversee? admiral hinton: the f.d.a. has 56 lab facilities.
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mr. griffith: and do you oversee more than that? admiral hinton: no. mr. griffith: and are those -- are you counting everything in a single building or combined? admiral hinton: facilities. within those facilities there might be a total of 2,800 rooms. with those rooms being described as space, an office, closet. admiral hinton: -- mr. griffith: yes, ma'am. how many safety inspections were conducted by the olss over the past year? admiral hinton: no inspections have been conducted within the past year. however, their labs have been inspected by other entities. mr. griffith: ok. ve there been any laboratory acquired infections in the past year? admiral hinton: there have been two noted infections within the last year. the staff that had acquired those infections have been
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observed and the case is closed. mr. griffith: all right. can you give us the reports on those two incidents? admiral hinton: i will work with my staff. mr. griffith: likewise, have there been any potential exposures to threat agents at f.d.a. labs during the past year? admiral hinton: not to my knowledge, no. mr. griffith: all right. september, 2016 letter the f.d.a. sent the committee indicating its intention to hire 13 permanent full-time employees in olss. they said it is staffed by only three permanent full-time employees and three detailees. why doesn't the olss have the 13 permanent employees that were promised in a september letter of 2016? admiral hinton: sir, we have put forth a proposal and soon as we have the dedicated budget for olss we expect for their
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current staff to double. they actually have three permanent staff and three detailed working on this space. mr. griffith: that still only puts you at six as opposed to the 13 that was indicated in 2016. admiral hinton: i agree. we note that. with the approval of the upcoming budget we will be able to double that and have the 13 staff. mr. griffith: the f.d.a. in the september, 2016, letter committed to this committee and in july, 2017, published a notice in the federal register evaluating the olss so the office would directly report to the f.d.a. commissioner instead of the chief scientist. earlier this week, the f.d.a. told committee staff that the f.d.a. has decided to reorganize again and that under the new proposal olss will no longer be a direct report to the commissioner and report to the chief scientist against gwen just as they did when we
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had the lapses back in 2014 and contrary to the expert panel's recommendations, i just would like to know, first, is the chief scientist reporting to you now? admiral hinton: well, actually -- i am the -- but the -- mr. griffith: sorry. is olss reporting to you? admiral hinton: yes, sir. mr. griffith: and then you report on up the line? admiral hinton: yes, i do. mr. griffith: so why did the f.d.a. reverse course in the year and have them report back to the chief scientists? admiral hinton: sir, since that was announced, we had the chance over the past year to observe and to see where it might be best fit for the alignment within the office. within the office of the chief scientist, which reports them to the office of the commissioner and to the commissioner, we work on crosscutting, cross-scientific issues to include those within laboratory science space. so we thought olss would be best in line there under my direct supervision on their
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day-to-day activities. the commissioner will be fully apprised of those activities. mr. griffith: and i certainly mean no disrespect to you, but that was the same setup we had when there were problems being reported and we had the expert panel come i and give us recommendations which f.d.a. agreed to and now y'all are backtracking. i understand different -- some different personnel but seems to me we are creating the same problem we had before. i see my time is up and i have to yield back. thank you, mr. chairman. mr. harper: the gentleman yields back. the chair recognizes the gentlewoman from california, mrs. walters, for five minutes. mrs. walters: thank you, mr. chairman. dr. bright and dr. schuchat, through stockpile procurement or other means, how do we ensure we have sufficient -- for ic capacity in influenza and other infectious disease sns dr. bright: we worked through a number of manufacturers to
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develop diagnostics for influenza, not only laboratory-based but standardize and update the point of care diagnostics for influenza to make sure those are available and in the marketplace for year for pandemic and seasonal influenza detection. dr. schuchat: i would say c.d.c. both asa's and develops recommendations. there were point of care tests for influenza detection and some of them didn't perform as well in the field as we had hoped so we did quite an effort of validation, comparison, shared the data with f.d.a. and new labeling and improvements in the tests followed from that. so we will develop tests against pandemic or avian flu and other high-threat concerns, develop them through to emergency use authorization -k when opriate, 501 possible. it is very labor intensive, very expensive.
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there is a limited number of our tests that we put through to that level but we work closely with f.d.a. on the number of the priority ones. mrs. walters: thank you. dr. fauci, you work by national institute of allergy and infectious diseases to support research for diagnostic testing. multiplex point of care technologies are beneficial because they can be used to simultaneous test for multiple infectious disease pathogens with a single blood or yuren sample. can you -- urine sample. naid is ll us what helping these technologies to detect material threats and infectious diseases? dr. fauci: thank you very much for that question. yes, we are very heavily involved in that, both with our grantees to get concept to develop into something that's translateable as well as contract. multiplex, as you mentioned in
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your statement, is a very important tool of the future. now, for detecting outbreaks. for example, we have multiplex asa's involving a whole series of particular types of viruses. for example, the flavi viruses, many of them which we have particularly in the western hemisphere that we're involved right now in research for the development of a multiplex that would essentially cover all of the associated flavi viruses and we're doing that with with a number of viruses. there is important, i believe, and aggressive ongoing research at the n.i.h. most through through our grantees and contractors. dr. bright: the challenge with the beauty of multiplex is they can do a lot. the challenge is they are large instruments done in centralized laboratories in a hospital or public health laboratory. the innovation that we're diving today that move them to
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the point of care into a physician's office and even to work with those multiplex technologies to push some of those now out into the home. one of our greatest challenges with our diagnostic for any disease is how long it takes for a patient to get to that system and into the system so they can get a sample drawn and can get a result. too much time lapses in that. so we're trying to also use this new technology for multiplex point of care to multiplex point of need into the home to get people earlier notification, to empower patients to get treated sooner. mrs. walters: thank you. rear admiral hinton, how many multiplex point of care tests have the f.d.a. approved for use? admiral hinton: thank you for your question, ma'am. work in this area is progressing well at f.d.a. we cleared more than 25 multiplex tests that could be suitable for point of care testing. mrs. walters: and how many others are currently under assessment by the f.d.a.?
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admiral hinton: i have to get back to you. i don't have the exact number. mrs. walters: can you describe the ranges, capabilities the tests have? how many diseases can a multicomplex test detect? admiral hinton: it can detect many. up to 20. and more at one time. which is incredibly important, especially at the point of care so we can have -- help to easily detect in order to find the best treatment. mrs. walters: thank you. yield back the balance of my time. mr. harper: the gentlewoman yields back. the chair recognizes the gentleman from georgia, mr. carter, for five minutes. mr. carter: thank you, mr. chairman. i want to echo your comments earlier about what an outstanding panel this is. thank you for the important work you do. it's extremely important to our country and we appreciate it very much. dr. bright, i want to start with you. being, of course, from georgia, i am somewhat concerned, even still, about the move of the strategic national stockpile,
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the management of that from the c.d.c. to aspr. i just want to be assured, again from you. i met dr. redfield and think he's doing a great deal. dr. schuchat and i worked together. i can't say enough good things about the c.d.c. and outstanding work they do for our country. i just want to make sure they're still wanting to have the opportunities to stay involved and to be involved in the medical countermeasurement, development, everything that goes along with the c.s.n.s. dr. bright: i echo your comments about the c.d.c. and the great work they're doing. many people don't know, i got my first start in science at the c.d.c. as a fellow. i come from emery university in georgia. i -- emory university in georgia. i appreciate the great scientific leadership at the c.d.c. and the relationship with state and local. we always include that in our assessment, in our programs with the new strategic
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stockpile management. mr. carter: we talked earlier, one of my colleagues mentioned the concern, particularly for the -- that the transfer is not disruptive for the state and local agencies. how can you assure us -- what would you suggest we do to make that the least disruptive as we can? dr. bright: well, the most important thing is to recognize the value of their voice and entire process, not just in the transition of management of the s.n.s. but entire end-to-end process of our response to any emergency or public health emergency threat. so we already have an intentional working group focusing on the state and local and tribal and territory partners and their specific needs and specific interests to make sure those are encapsulated in our management of the s.n.s. mr. carter: thank you. dr. schuchat, would you care to comment on that as well? how can we ensure this is not disruptive to our local and state communities?
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dr. schuchat: i think change by necessity is disruptive. i think it's on our radar. we're working really closely together. you know, the association of state and territorial health officers board was just at c.d.c. yesterday talking to us how we can make sure this goes well as possible. mr. carter: let me ask you. i run the risk of being a little self-serving here. wouldn't it make sense to look at perhaps just having aspr co-locate down to atlanta with the c.d.c.? i recognize you're part of h.h.s. but, you know, we have to get out of this mind set that not everybody's got to be in washington, d.c. we got a big country out here. dr. bright, i'm looking at you. dr. bright: we have a big and beautiful country, sir. and i agree with you and there is no intent to move the strategic national stockpile from atlanta to washington, d.c. there might be one or two individuals who are located in our aspr office to ensure we
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have smooth and efficient ongoing communication with the expert staff that is in atlanta, georgia. mr. carter: ok. that might be a good compromise and we appreciate that very much. the ebola crisis that we had. obviously it was -- we learned a lot of lessons there. i was so proud of the public-private partnership between emory university and the c.d.c. and all four patients recovered. i just wanted to know, will you be using that model in the future in the future for other pandemics and other risks we might run into? we're very proud of the work that was done at emory university. i think it's a great example of what we can do in the future. dr. schuchat. dr. schuchat: i would say that c.d.c. benefits tremendously from being located next to emory and there is a close working relationship. they did such a terrific job in the care of the patients there.
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there is ongoing collaboration and communication and support. i think aspr may have more direct role in the hospitals and the care of such patients and dr. bright might want to comment. dr. bright: i want to make sure we capitalize and not lose that expert and lessons learned from emory university. as you may know, we stood up a national ebola training center that's based in nebraska. it's a collaboration with emory university and university of nebraska. it's one of the finest educational centers on ebola in the world. mr. carter: again, i want to thank you for the work you do. extremely important. especially shout out to the c.d.c. and the work they do. thank you and i yield back, mr. chairman. mr. harper: the gentleman yields back. the chair recognizes the gentlewoman from california, ms. eshoo, for five minutes. ms. eshoo: thank you, mr. chairman, for extending the legislative courtesy to me since i'm not a member of this subcommittee. but i have a great interest in
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this subject matter since we're looking to re-authorize papa. and all of the listening to what's taken place in this hearing and the superb testimony from each one of you. we made great progress since the legislation was first written in 2006 so i'm pleased. in america, we're never satisfied where we are. we always want to improve. so there has been an important pathway of improvement. i thank each one of you. i'm very proud of the two women that are here. rear admiral hinton, it's -- it is really a source of bride to me to hear you respond to the tough questions that have come your way. to dr. schuchat, it's always a
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pleasure to hear you. -- the ht, it's partnership with barda is important and you are taking it to new places. dr. fauci, i don't have questions to ask you. i wish i could cannonize you. you are such a gift to our country. such a gift to our country. you could be in the private sector probably making millions of dollars. you devoted your entire life to the people of our country and you make the national institutes of -- the n.i.h. really stand for the national institutes of hope. you're a leader in that. and i just revere your record, your leadership, and what you've done and what you continue to do. in the -- how is
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restoring barreda's contracting authority -- bard's contracting authority led to the fficiencies and certainty that surrounds the countermeasures of research and development? that's my first question. and my second one is, does your agency interpret your existing authority to allow the stockpile to invest in countermeasures other than those explicitly mentioned in the current statute? maybe start with the second question. do you need any additional authorities? dr. bright: tore more effective, i believe -- to be more effective, i believe we need to modify what we have. ms. eshoo: you don't need additional authorities? dr. bright: no. i believe we need to modify the authorities we have. ms. eshoo: what does that mean, modify the authorities? dr. bright: our other transactional authority, for example, does have limitations on how we can interfaith with
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our industry partners and how they might qualify with that partnership. so we drafted language that allows the greater flexibility to do so. ms. eshoo: have you gotten that to us? dr. bright: if not, we will make sure it's sent quickly. ms. eshoo: do barda's existing authorities promote work on -- it's been brought up not only t this subcommittee but at others, the anti-microbial resistance and antibiotic development or does your agency need additional authorities to engage in that work? dr. bright: we've been working with the authorities we have since 2010 to address anti-microbial resistance. one area of authority that is lacking, we believe it would be beneficial, would be specific authority for the appropriations for pandemic influenza because there's a lot of critical work that needs to happen. ms. eshoo: have you gotten that to us? dr. bright: we do not have that authority yet.
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ms. eshoo: are you going to make that request of us? dr. bright: i believe that request has been submitted. ms. eshoo: there has been some mention earlier how important the advanced -- i think you might have raised it in your opening statement -- on advanced appropriations. i believe that -- because the senate has different rules on this, that we will meet the standards that needs to be met. that's probably the tiediest way for me to say it. but it is critical because if you don't have the advanced appropriations at barda, then the -- our partners in the private sector are not going to be able to continue the work, the important work that they're doing. dr. bright: that's absolutely correct. our business partners work in long-term cycles and forward-looking cycles and the consistency and assurance of that advanced appropriations
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allows them to have that assurance that we will still be there doing our part so they can plan appropriately as well. ms. eshoo: thank you very much to each one of you for what you're doing for our country. you're all heroes of mine. thank you, mr. chairman. i yield back. mr. harper: the gentlewoman yields back. the chair will now recognize ranking member degette for concluding remarks. ms. degette: thank you for yielding for a point of personal privilege. a crisis right now in this country, i know we have a lot of h.h.s. agency representatives here and, of course, aspr under the purview of h.h.s. yesterday, our ranking member frank pallone wrote a letter to secretary about the office of refugee resettlement and these kids that are taking from their parents at the border and then being put under the auspices of this agency. we have real concerns about what's happening to these
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children. we have real concerns about their long-term prospects being taken from their parents. mr. chairman, i just wanted to bring this up because you are going to be getting a request from the minority to have a hearing about this and we would hope that you would seriously consider this because we are quite concerned about the human aspects of this situation. thank you and i yield back. mr. harper: the gentlewoman yields back. the chair will recognize dr. burgess for concluding remarks. mr. burgess: thank you for the recognition. i point out this committee and this subcommittee in particular has a significant history of oversight over the o.r.r. this -- i do feel obligated to point out, this is not the agency that makes the decision about whether or not a family unit is kept together. but they are obligated to take care of whether a child arrives unaccompanied or is separated from their family at the d.h.s.
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facility. but that is the responsibility of this -- in fact, the health subcommittee. we do take that responsibility very seriously. in fact, it was our work, our work in july of 2014 that allowed them to acquire an actual physician to be in those facilities to assess those children as they were brought in and it was our committee that raised the question, shouldn't we at least have some way of contacting the children after they have been placed with a family at least on a voluntary basis? so it was our committee that did that work and that work will continue. i've been in contact with the secretary and the gentleman that runs o.r.r. and i expect to have a robust discussion with them going forward. ms. degette: if the gentleman will yield? thank you very much. i look forward to working with you on this because it's really a critical issue. i'm on that subcommittee too. thank you. mr. harper: i want to thank
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each of you for being here. great insights and expertise. and thank you for participating in today's hearing. i remind members that they have 10 business days to submit questions for the record and i ask that the witnesses agree to respond promptly to any such questions. with that the subcommittee's adjourned. [captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit]
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>> tonight on c-span -- watch the republican primary debate for new york's 11th congressional district. the incumbent is dan donovan that faces michael grimm in a 60-minute debate that was hosted by spectrum news ny-1. make c-span your primary source for campaign 2018. >> this weekend c-span cities tour takes you to new orleans, louisiana, on its tricentennial year. with the help of our cox communications cable partners, we'll explore the literary scene and history of the city. saturday at noon eastern on "book tv," hear about the life and influence of tennessee williams, best known for his lays, "cat on a hot tin roof." then author cody roberts with his book "voodoo and power."
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on "american history tv" -- explore the exhibit "new orleans-the founding era." >> in 2018, we are 300 years old. so the historic new orleans collection decided for our tricentennial exhibition we wanted to look back at the city's earliest years and what it was like when the city first developed. tujacks, n a visit to one of the city's oldest restaurants. >> food here takes a much larger piece than it does anywhere else. we live to eat in new orleans. >> watch c-span cities tour of new orleans, louisiana saturday on "book tv" and "american history tv" on c-span3 working with our cable affiliates as we explore america. >> sunday on "american
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artifacts" on c-span3, tour the library of congress exhibit on the centennial of world war i, which showcases american ideas about the war through artwork, posters, photographs, films, and documents. >> the idea of contributing the war through labor, the idea of growing your own food so as to conserve larger quantity its for the war effort, this is actually by mabel wright who is frank wright's sister. a prominent illustrator in that day. again, another individual kind of rises to the surface during world war i. you see here, also, food conservation, wholesome nutritious foods from corn. i know we make everything out of corn today, but back then we didn't. this is kind of new. again, one thing that's worth noting, in world war ii, we will ration. the government will actually step in and ration food. hoover believed, as head of the food afferings, if you


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